AP PIP final - RRC-NE

CHAPTERISUMMARY1. Executive SummaryBy addressing all the components like maternal health, child health, familyplanning, adolescent health including urban health, vulnerable group, gender equity,logistics management, program management and financial management, the overallaim is to provide equitable quality services to all the rural population.The state of Arunachal Pradesh during RCH-II envisages achieving MaternalMortality Rate (MMR) from the present level of 306 to less than 100, Infant MortalityRate (IMR) of less than 30 by 2010 from the present level of 61 and a Total FertilityRate (TFR) of 2.1 at the end of 2010 from current level of 3(NFHS 3).The Program Goals and Objective of the State is to reduce IMR to 30/1000 LBby 2012, MMR to 100/1 lakh by 2012, TFR to 2.1 by 2012, Malaria MortalityReduction Rate 50% by 2010, Cataract operation increase to 46 lakhs by 2012,Leprosy prevalent rate -

CHAPTERIIProcess of Plan PreparationThe National Rural Health Mission (NRHM) was launched in the State ofArunachal Pradesh in the financial year 2005-06 with the objective of providingintegrated quality health care services to the people, with special emphasis on therural poor. The cornerstone of the Mission is to bring about synergy in the inputs andinterventions of various vertical national health and family welfare programs in orderto ensure holistic approach in plans, policies, strategies and implementation of thehealth department in the State. It is envisaged under NRHM to bring all verticalprograms of the Department of Health & Family Welfare under a single and unifiedumbrella.Components of NRHMThe components of NRHM are as follows:A RCH IIB NRHM AdditionalitiesCDERoutine ImmunizationNational Disease Control Programs- RNTCP- NVBDCP- NLEP- IDSP- IDD- NPCBInter-sectoral ConvergenceState level workshop called for Participatory Planning for Health for preparingDistrict/Block Health Action Plan for RCH II, NHRM & RI was convened in the monthof September 2008 at Naharlagun which was attended by concerned officers of theHealth Department from the districts and state, representatives of the Women andChild Departments, and the PHED. The workshop deliberated on vital points likefacility survey, household survey and plans to address the major areas of health withtechnical inputs from RRC -NE. These were the issues to be addressed in the Blockand District Health Action Plan. Further, Workshop for 6 days on District HealthManagement was also organized at Naharlagun with the help of NHSRC, Delhi &GoI. Further, 3 days workshop on modification/correction of BHAP / DHAP was heldwef 18 th February with technical inputs from state planning team/ RRC-NE.The issues like integration of organizational structures, decentralization anddistrict management of health programs, community participation and ownership,merger of societies into one Health Society, preparation of District/Block HealthAction Plans covering health, FW, nutrition, water, sanitation and involvement ofPRIs were also discussed in the workshop. Meetings at the district level with stakeholders for BHAP/DHAPs, involvement of the district machinery on sustainable basiswas imperative; in the preparation of the DHAPs, interaction with the officers /officials and community was necessary when bottom-up approach is adopted.2

Incorporating all the data received through DHAPs from 16 districts, the statePIP has been framed. Depending upon the absorptive capacity of the districts, andJRM V findings, a implementation plan is made for 09-10.NRHM StrategiesDe-centralized village, district & State level planning.One of the core strategies of the NRHM is to empower local governments tomanage, control and be accountable for public health services at various levels. TheVillage Health and Sanitation Committee (VHSC), the standing committee of theGram Panchayat will provide oversight of all NRHM activities at the village level andwill also be responsible for developing the Village Health Plan with the support of theANM, ASHA, AWW and self-help groups. Since PRI and ICDS field functionaries arenot fully functional and not having much capacity for carry forward the healthactivities in the villages, the state could not do much and realized to find out newstrong strategy for it.At the Block Level, Panchayat Samitis will coordinate the work of the GP intheir jurisdiction and will serve as link to the DHM. The DHM will be led by the ZilaParishad and will control, guide and manage all public health institutions in thedistricts. Few districts had orientation training for the members of the PRIs so as toget their due participation in effective implementation of NRHM and it is going on inother districts. In one district, there is no elected PRI but in absence of them, thelocal leaders have been included in this category.De-centralized planning is the key to success of the NRHM program. TheNRHM programme planning strongly advocates for “Bottom up Approach”, wherethe needs and aspiration of the masses is taken care of and on priority basis the planis designed at the district level, which is again apprised at state level and at stateagain after prioritizing the district plans the state plan is prepared. So, in the courseof preparation of DAP, majority of the districts had house hold survey, followed bySC level meeting (where ANM is posted) and also PHC level meeting in presence ofofficers from other line department. Based on the discussion of the series of PHClevel meeting, the District Health Action Plan (DHAP) is prepared. The inputs givenduring the capacity building workshop of I & II was also used while assessingthe need need of the community and why a particular activity could not beproperly implemented. FGD was also conducted with ASHAs, PRIs andpreganant mothers in few seleted areas with the help fo health officials. DHAPof all districts are assessed and asked to make necessary changes. For assessingthe DHAPs, 3 days workshop was organized at state level. Finally, after assessingthe DHAPs of all the districts, the State Health Action Plan (SPIP) is prepared.Overall, the involvement of PRI has been very encouraging and able tobreak the sackle of lack of knowledge about NRHM etc been improved during theyear. However, it is hoped that during the coming years, their participation would beimmense for more active involvement in NRHM implementation.3

CHAPTERIIIBACKGROUND AND CURRENT STATUS3.1 Demographic features:The state is situated in the northeastern part of India, bounded byinternational boundaries with China in the north, Myanmar in the southeast andBhutan in the west. The state is situated at latitude of 90.36 0 E to 97.3 0 E andlongitude of 26.42 0 N to 29.30 0 N covering a total land area of 83,743 sq. km. Thepopulation of Arunachal Pradesh is 10, 91,117 (Census 2001).Density of populationis 13 persons per square kilometer. Sex ratio of the state is 901 females per 1000males as per census 2001. The total literacy rate of the state is 54.74% with a maleliteracy rate of 64.07% and female literacy rate of 44.24%. The per capita income(97-98) of the state is Rs. 13424. [Source: Provisional Census of India 2001].The state has a total population of 10,91,117 (Census 2001) with maleconstituting 573951 and 517166 females. The percentage of population belowpoverty line in 1999-2000 is 33.47 (SRS Bulletin, April 2001) with a percentagedecadal growth of 26.21 and Average Annual Exponential Growth Rate of 2.33. Therural population constitutes 79.59% and the urban only 20.41 %. The decadal growthrate of urban population is a staggering 101.29 %.3.2 Administrative divisionsThe administrative set up of Arunachal Pradesh and its changing districtboundaries correspond broadly to natural boundaries of river basin. Even theboundaries of Sub-Divisions, Community Development Blocks and AdministrativeCircles within the districts have also been directly affected by the terrain features,though there is no cadastral survey conducted till date for clear cut demarcation ofadministrative boundaries.There are 16 Districts, 37 sub-divisions, 155 circles, 17 towns, 84 blocks and3862 villages constituting an elaborate administrative structure for diffusingdevelopmental activities in the state.3.3 CURRENT STATUS AND GOAL3.3.1 MATERNAL HEALTHPROCESS/ INTERMEDIATE INDICATOR1. % of all births in government and privateinstitutions (Overall)2. % of deliveries by skilled birthattendants (doctors, nurses, ANMs)(Overall)3. % of pregnant women getting registeredin first trimesterCURRENTSTATUS31.2(NFHS – III)33.4(NFHS – III)24.5(NFHS – II)GOAL09-10 10-1145 6044 6032 364. % of pregnant women receiving 3 or 36.4 50 604

more antenatal checks5. % of pregnant women receiving 2 dosesof Tetanus Toxoid injections6. % of pregnant women receiving 100tablets of IFA7. Number of facilities operationalized toprovide 24 hours delivery (and BasicEmergency Obstetric Care) according toGOI norms(NFHS – III)45.6(NFHS – II)56.3(NFHS – II)CHCs 30 1PHCs 10(DHS, AP-2008)8. Percentage of women visited byANM/AWW in post natal period within 2months (Home deliveries)9. Number of facilities operationalized in asustained manner as per GOI norms forproviding Comprehensive Emergencyobstetric care (including provision ofCaesarean section and bloodstorage/banking facilities):GH/DHs (blood bank in 7 are beingfunctionalized)23.3(NFHS-III)3(DHS, AP-2008)CHCs (Blood storage being operationalized) 1(DHS, AP-2008)3.3.2. CHILD / NEONATAL HEALTH55 5865 6710 1030 406 41 0PROCESS/ INTERMEDIATE INDICATORCURRENTSTATUSGOAL08-09 09-101. Percentage of exclusively breastfed at 6months of age60(NFHS – III)2. Percentage of 13 – 24 months of age28.4fully immunized children :(NFHS-III)3. Percentage of children given ORS in33.5diarrhea(NFHS-III)4. Percentage of children received treatment 43.6for ARI(NFHS-III)5. Prevalence of anemia in children 66.3(NFHS-III)80 9045 7050 5365 8045 305

3.3.3 FAMILY PLANNINGPROCESS/ INTERMEDIATE INDICATOR1. Unmet need for family planning amongeligible couples :2. Unmet need for spacing methods amongeligible couples :3. Contraceptive prevalence rate amongeligible couples :4. Percentage of permanent femalesterilization5. Percentage of permanent malesterilizationCURRENTSTATUS19.3(NFHS – III)8.6(NFHS – III)35.2(NFHS – II)14.5(RHS 2002)0.1(NFHS-III)GOAL08-09 09-1012 95 450 5525 300.3 0.43.3.4. Adolescent Reproductive and Sexual HealthData for adolescent group is not available for the state.3.4. Public health infrastructureAt present, Public Health facilities are the back bone of health delivery andfamily welfare services in the State. Catering to the health and family welfare needsof the people are 2 General Hospitals at Naharlagun and Pasighat, 12 DistrictHospitals at Tawang, Bomdila, Seppa, Ziro, Daporijo, Along, Yingkiong, Roing, Anini,Tezu, Changlang and Khonsa, 44 Community Health Centers (CHCs), 85 PrimaryHealth Centers (PHCs), 381 Sub-Centers (SCs), 45 Homeopathy Dispensaries and9 Ayurvedic uni ts.No. Facility Required /SanctionedIn Position(on 31/02/08)1 Sub-centres - 3811.1 Sub-centres functional b 273 (162 with ANM)2 Primary Health Centres - 852.1 PHCs offering 24 hour services (exceptmanpower)3 Community Health Centres 313.1 CHCs functioning as FRUs d 14 District Hospitals 144.2 DHs/GH functioning as FRUs( 2 withoutAnesthetist)55106

3.5 Private and NGO health services/infrastructureNames of NGOsVHAIKARUNA TRUSTFuture GenerationArunachal (FGA)Alok Prayas JACNani Sala FoundationBlock/Villages of NGOsoperationsLumla (Tawang)Thrizino (W.Kameng)Deed Neelam (L.Subansiri)Nacho (Upper Subansiri)Gensi (West Siang)Khimyong (Changlang)Wakka (Tirap)Mengio (Papumpare)Walong (Anjaw)Bameng (East Kameng)Sangram (Kurung Kumey)Jeying (Upper Siang)Etalin (Dibang Valley)Anpum (Lower Dibang Valley)Sille (East Siang)Wakro (Lohit)MNGO for P/PareVHAAP MNGO for East Kameng, W/Kameng.Daying EringFoundationBoria Tari MemorialSocietyUH Pasighat3.6. DP (donor assisted) programmes in the stateUH Naharlagun / ItanagarThere is no DP operating in the FW / NRHM at present.3.7. Institution arrangement and organizational development:issues and gaps• Institutional involved in RCHThe Mission Director (NRHM) coordinated all arrangements under thetechnical inputs / support from the Nodal Officer (NRHM) cum SPM and the DRCHOin the districts were instrumental in ensuring coordination, planning andimplementation of RCH activities.Inter departmental cooperation was received from the Department of SocialWelfare, Women and Child Development through AWW in implementing RCHactivities primarily at the grass root level. The PRIs were involved in many activitiesunder NRHM as detailed in NRHM PIP. Two mother NGOs for 3 districts along withfew field NGOs were assigned roles during the year. NGOs running PPP underNRHM were a part of the team.7

Different works department of the state Government were involved in thepreparation of estimates and execution of civil works in the state as there is noseparate construction cell in the directorate.Above all, the different branches in the health department had full cooperation& coordination during the year for implementation of RCH / NRHM activities.• Current organization structureMission DirectorState Finance ManagerState Programme Manager/Nodal Officer (NRHM)IEC Officer/NodalOfficer (JSY)Consultant(Finance)Consultant(HMIS)Consultant(Training)Cold ChainOfficerDy. MEIOState AccountsManagerState DataManagerTechnical Assistant(Cold Chain)DEEAccountantDataAssistantComputerAssistant8

Organogram of District Programme Management Support Unit (DPMSU)DMO-cum-CEO (Governing Body)DRCHO/DFWO-cum-CEO (Executive Body)District Programme ManagerAccountantStatistical InvestigatorComputer AssistantData AssistantPrograms.State Health &FW Department in relation toNRHM Vs VerticalMinistry of Health & Family WelfareSecretary (Health & Family Welfare)DIRECTOR OF HEALTH SERVICESMD (NRHM)SPMUDPMUJT. DHS(FW)JT. DHS(NLEP)JT.DHS(NAMP)JT DHS(EST)JT. DHS(P&D)Program Officer(NBCP)Program Officer(DENTAL)DDHS(TB)DDHS(PH)DDHS(S&T)DDHS(GA)StateEpidemiologistAsst.FoodControllerAdmin.OfficerAccountsOfficerAsst. DrugController9

• Accountability of staffMission Director: The Mission Director is accountable to the Government ofArunachal Pradesh for overall implementation of NRHM activities.Nodal Officer (NRHM): NO(NRHM) is the main technical person accountableto the Mission Director for advise and guide in all matters of planning andimplementation of NRHM activities. The state has no SPM as on date and theresponsibility of SPM rest with state Nodal officer (NRHM).State Finance Manager: He is accountable to the Mission director for timelyand proper audit of annual accounts under the NRHM, timely release of fund toimplementing agencies, effective internal control system, timely submission offinancial reports and returns. He is responsible for overall monitoring and supervisionof finance and accounts.Consultant (Finance) and State Accounts Manager: They are accountableto the State Finance Manager for proper maintenance of books of accounts as perFinance & accounts Manual at the Mission Directorate, timely and proper collectionand preparation of financial reports & returns, timely release of funds to theimplementing agencies.Consultant (HMIS) and State Data Manager: They are directly responsibleto the State Nodal officer for proper maintenance of demographic/health data bank,timely reporting of demographic and health data.Consultant (Training): She is directly accountable to the State Nodal Officerfor timely and proper preparation of training plan and calendar, proper coordinationof training activities, timely release of training fund to districts and implementingagencies and reporting to various agencies involved in monitoring and supervision.• HRD including placement of staff, tenure, job descriptions, delegation ofpower, performance appraisal system- Some of the contractual staff, especially ANMs, could not be optimallyplaced as per plan. It was found that several ANMs were posted at District Hospitalsand CHCs. This was on account of non-availability of SC building / residentialquarters in the sub-centres, low pay rates and high cost of living in the rural areasand non-sanctioning of enough SNs by the state for DH / GH in the state. However,Steps will be initiated to rationalize the manpower and work load facility wise.- In order to streamline the staff recruitment, posting, ToR, Terms & conditionetc for staffs under NRHM, it has been decentralized upto DHS level. Thedecentralization involves the following:- The existing contractual technical staff posted and serving as on date underNRHM at the district shall be the exclusive staff of DHS of the respective districts.The existing staffs shall not be transferable to other districts and are transferablewithin the districts as per requirement.10

- The relevant documents of already serving concerned staffs shall be madeavailable to the respective District Health Societies of the districts for maintenance ofstaffs.- The recruitment of the contractual technical staffs except specialists andMedical Officers under NRHM for the districts will be done by the respective DistrictHealth Societies after getting approval and sanction from MD (NRHM).- The recruitment process in the districts shall be as per recruitments rulesand terms of conditions and TORs issued by the State Health Society.- On completion of recruitment process, the names of contractual staffsrecruited with place of posting shall be intimated to the MD (NRHM).- The recruitment rule for NRHM staffs is in placed.Performance appraisal system:-- The appraisal for all categories of contractual staffs under NRHM has beenAppraised on yearly basis as on date at state and district society level.- The appraisal is done for each staff by a standing performance appraisalboard at state and district health society level on the basis of standardperformance appraisal indicators.- However, the appraisal of all categories of NRHM staffs is being modified toaddress all the possible areas of activities along with a modified performanceappraisal board members.• TrainingPresently only one training centre exits in the state i, e Health and TrainingResearch Centre, Pasighat, which provides basic training courses for ANMs only.There is no training centre to cater for in-service training and other nursing andmedical course. This is one of the major bottlenecks in the successfulimplementation of Training Program. During the year, no regular training asproposed under RCH II could be implemented. However, continuation of RCHtraining could be conducted in all the Districts. The GoI would be required toprovide assistance for the same in the form of establishment of SHFTC.Performance of training for the year 2008-09 (upto Dec’08)SI. No. Name of the training Total Training Load1 LSAS of MO 22 EmOC of MO 23 MTP using MVA of MO 20 (going on)4 IUD insertion of ANM 40 (going on)5 RI for GNM 206 RI for ANM 457 IMNCI for ANM 458 IMNCI for GNM 459 PDC 1310 IUCD Master Trainer 211

• Logistics- Procurement, warehousing , distribution and timely useThe state follows the NRHM procurement guidelines and or stateprocurement norms. However, there is no standard protocol on the subject.State and district store is required exclusively for storing NRHMarticles. As on date, the articles are stored in makeshift / temporary storerooms and at times, items become un-useable due to want of ideal storeroom.The distribution of NRHM items is carried out either by hiringtransportation from State headquarter or district headquarter. The state needtransport system for timely and safe distribution of NRHM items. Proper stockmaintenance, issue, receipt etc is being maintained but it needs improvement.• HMISThe HMIS / M&E have been one of the poor areas where the state hasfailed. However, with the existing manpower and new good plan, it isexpected that the area of concern will improve considerably.• Lack of proper communication facilities.• Irregular reporting• Poor monitoring due to lack of fund• Frequent Power failure• Lack of awareness regarding importance of reporting• No monitoring plan at the sub district levelsIn order to overcome the identified gaps, following measures shall beensured.• Telephone with Internet facility• Capacity building training, Review meetings• Proper monitoring plans• Provision of power backup• Hiring of Vehicle for monitoring.3.8. Programme Finances• Analysis of budget availability :Budget availability for RCH-II from different sources during 2008-09 is depicted inthe following table:12

(A) Budget availability during 2008-09:(Rs. In Lakhs)Projects State Plan/Non Plan Central Plan(Govt. ofIndia)Other sourcesRCH –II & PPPNil/400.00 1318.38 NilNRHM Nil 1679.39 NilRoutineImmunisationNil219.85 NilProjectNilIPPI Nil Nil NilIEC/BCC Nil Nil NilMNGO Scheme Nil Nil NilHealth Mela Nil Nil NilGrand Total 400.00 3217.62 Nil• Analysis of expenditure during 2005-06 to 2007-08 and 2008-09 and keyissues for shortfallsFinancial Performances during the financial year 2005-06, 2006-07 and 2007-08(Performance in % age)Activities 2005-06 2006-07 2007-08RCH Flexible Pool 66.36 60.64 69.96Mission Flexible Pool 58.43 38.70 42.51Routine Immunisation 78.99 86.35 74.96IPPI 69.98 94.66 90..96The utilization rate in respect of Mission Flexible Pool fund during the year 2008-09was low due to the following factors:1. Bulk of the funds sanctioned and released under NRHM Mission FlexiblePool was tied up in civil works pertaining to upgradation of districthospitals, construction of Sub Centre buildings and PHC quarters, theexecution of which was hampered due to unprecedented rainfalls in theState last year resulting in communication disruptions in several districtsfor as long as 6-7 months.2. There was low rate of utilization in respect of RKS funds at the sub-districtlevel due to ignorance about the relevant guidelines pertaining to utilizationof fund.13

ProjectsFinancial Performances during the financial year 2008-09 (Upto 3 rd Qtr.)OpeningBalance(Rs. in Lakhs)Fund Received Total Fund Expenditureincurred% ofExpenditureto TotalFundRCH FlexiblePool -331.20 1402.00 1070.80 906.55 84.66NRHMAdditionalities 2567.08 714.00 3281.08 1318.15 42.11RoutineImmunisation 2.41 82.05 84.46 54.48 64.50IPPI 4.75 87.50 92.25 5.87 0.06Grand Total 2243.04 2285.55 4528.59 2212.03 48.85An analysis of the above tables reveals that utilization of fund has significantlyimproved from 2007-08 to 2008-09. No state share or funding for NRHM has beenreceived so far.No Issues of fund overlap have been detected.• Fund routing mechanisms in RCH-II: timelinesThe State Health Society transferred the fund to the District Health Societythrough the electronic mode but from there after the funds are transferred tothe PHC/CHC level in the form of demand draft or cheque.14

CHAPTERIVSITUATIONAL ANALYSIS4. RCH4.1 Maternal HealthThe mothers who had atleast 3 ANCs for their last birth in the state is 36.4%.Those mothers who consumed 90 days or more when they were pregnant with theirlast child is 11.6%. There is a wide gap between the mothers who had attended theANC and may be provided 100 IFA but very minimal numbers of mother actuallyconsumed the IFA. Similarly, birth assisted by SBA is 33.4%. However, only 30.8 %have actually delivered in the institution. The reason could be due to lack BCC / IPCto be provided by health personnel and also may be due several health facilities notmanned by ANMs.The mothers who received post natal care within 2 days of delivery is 23.3%.There is ample evidence that health personnel are not proactive in providing thePNC. This is compounded by lack of requisite manpower in the facilities especially inSCs and PHCs. Another reason could be that the health personnel pooled in PHCsare not going to the mothers for PNC due to lack of motivation in the healthpersonnel itself. There is an area for BCC to pick up in the state broadly for thewhole community and particularly to the health personnel.4.2 Child healthChildren 12-23 months who are fully immunized is 28.4% and who had BCGis 57.7%. This shows that there is a wide gap between introduction to immunizationand sustenance of the service. The possible reasons could be lack of awareness onthe part of the community and also availability of services. Accessibility is an area ofconcern for the state of Arunachal Pradesh. Likewise, children who had received 3doses of OPV is 55.8% but as compared to vaccines given later are less. Thisclearly indicates vast area of improvement in terms of continuous BCC / orientationabout the importance of full immunization.Children who have received 3 doses of DPT Vaccine is 39.3%. There is avariation between OPV and DPT whereas these 2 vaccines are given together. Thereasons that are prevalent in area are mothers are worried of fever after thevaccination, maternal psyche not tolerating injection / cry of the beloved child etc.Measles coverage is also very low at 38.3%. All this decline may be attributed toineffective BCC, irregular Immunization days etc. Children 12-35 months old whoreceived vitamin A doses in last 6 months stands at 17.4% only. Very often, it is dueto non availability of Vit A supply and also due non promotion regarding the need ofadministering vitamin A by the health personnel.Children who received ORS is 33.5%. Children with diarrhea taken to a healthfacility during the last 2 weeks are 37.9%. The evident reason for very low level ofhospital treatment is due to lack of facility nearby / accessibility is poor and similarlyconsumption of ORS is low due to ignorance / the taste of the preparation. Anotherreason prevalent in some districts could be that if ORS is taken, it aggravates15

diarrhea. Regarding ARI taken to a health facility is 43.6% only. Varied methods ofBCC etc are urgently required for improving the utilization of the services.Children under 3 years breastfed within 1 hour of birth are 55% andexclusively breastfed upto 5 months is 60%. Introduction of weaning food for 6-9months children is 77.6%. Traditionally, breast feeding is practiced in the state butlittle more effort has to be put in BCC in general and particularly to the mothers bythe attending health workers.Children under 3 years who are stunted is 34.2% , who are wasted is 16.5%and who are underweight is 36.9%. Acitivities related to improved intake of qualityfood and timely feeding of required food has to be informed to the communitythrough BCC etc. There is an area of improving the knowledge and skill of the healthpersonnel to promote the same.Children aged 6-35 months who are anemic is 66.3%. The reason could beinitiation of weaning food in time and also quality food.4.3 Family PlanningCurrent use of any method is 43.2% and any modern method is 37.3% whichinclude male sterilization (0.1%), IUD (3.6%), Pill (8.3%) and Condom (2.9%). Thepromotion of all these methods has been slow and tardy leading to very low level ofacceptance. Serious BCC has to to designed to address these issues. A vigorousBCC needs to be formulated to involve male in limiting the family size. Convergencewith other agencies dealing with similar agenda would have to be involved likeAPSACS.Total unmet need for family planning is 19.3% contributed by spacing (8.6%)and limiting (10.7%). Due lack of health personnel in many facilities across the stateand may be unmotivated health workers etc are few reasons seen at ground level.However, even acceptance level is low due to ignorance and lack of motivation.4.4 Adolescent Reproductive and Sexual Health (ARSH)Data shows that women aged 15-19 years who were already mothers orpregnant is 15.4%. Early marriage is a social problem some pockets of the state.Necessary BCC activities to sensitize the community are on through healthdepartment and other agencies. The trend is that the marriage age duringadolescent period is coming down.4.5 District / sub district variations.4.5.1 Maternal HealthConsidering the literacy rate amongst the population and bettercommunication facilities and health infrastructure, it is evident that West Siangdistrict is having better coverage in terms of 3 or more ANC. This is also true for thedistricts of Lohit and Tirap. Even in receiving 2 doses of TT injections, the samedistricts have performed better. The chronically poor performance in the districts ofEast Kameng and Tawang may be due to lack of infrastructure and manpowercompounded by inaccessibility and far flung location of the population. The averagenumber of deliveries attended by health personnel is very poor probably due to nonavailabilityof these personnel at their place of postings for want of quarters.16

4.5.1.1 DISTRICT INDICATORS ON MATERNAL HEALTH (Source: DLHS-RCH,2002)ParticularsDibangValleyEastKamengLohit Tawang Tirap UpperSubansiriWestSiangThree more Antenatal 40.4 17.1 53.7 21.5 51.3 21.6 57.6check-upWho had received TT 35.9 29.1 53.5 40.7 54.7 28.2 50.9injectionReceived 100 or more IFA 11.5 6 28.9 26.2 15 3.4 9.8tabletsReceived full Antenatal 7.6 4.4 19.7 13.3 13.6 2.7 6.6check-up (ANC)Delivery In govt. health 34.1 34.6 36.7 17.9 34.1 22.8 37.5facilityDelivery in private health 4.4 3.3 4.6 1.9 5.6 2.6 3.2facilityAttended by Doctor /ANM/ 5.7 7 16.1 2.9 11.7 6.5 6.5Nurse/ TBASafe Delivery 42 42.3 50.7 22.2 46.7 30.2 44.5Note: Data not available for rest of the districts4.5.2 Child HealthIn terms of starting of breastfeeding within 2 hours of delivery, since thetradition to breast-feed the child in all the tribes of the state, the averageperformance in the entire district is at an equitable level except for Tirap districtwhere the level is very low at 22.9%. This could be due to certain practices that existin their society. The percentage of exclusive breast-feeding is as high as 83%.Certain amounts of awareness generation / communication steps need to be takenup to improve early initiation of breast feeding and extending exclusive breastfeeding up to 6 months.The percentage of children who had BCG vaccination is above 50% in all thedistricts except for East Kameng district where the coverage of vaccination is verypoor. This could be due to poor infrastructure, lack of skilled manpower, untimelysupply of vaccines as the district is composed of high mountainous, inaccessible,remote and very dismal communication facility. One reason is due to lack ofelectricity supply in the whole of the district.It is evident from the above data that lots of children do drop out of theimmunization schedule till all the vaccines are taken. The reasons assigned for thisdropout are lack of awareness, untimely provision of vaccines at the site etc. The fullimmunization coverage in all the districts are very poor except Tawang district whichcould be due to religion that has been incorporated with the way of life and alsoteachings on these health problems being discussed in the religious meeting. TheBCC component to induce awareness among all the tribes of the state would beideal in order to achieve reasonable and acceptable level of coverage.17

4.5.2.1 DISTRICT INDICATORS ON CHILD HEALTH (Source: DLHS-RCH, 2002)ParticularsWomen who startedbreastfeeding within 2hours of the birth to theirchildWomen who gave exclusivebreast milk for at least 4months to their childPercentageof childrenwhoreceivedDibangValleyEastKamengLohit Tawang Tirap UpperSubansiriWestSiang50.7 64.5 51.1 52.1 22.9 51.9 64.486.9 89.6 77.3 86.4 83 87.2 85.9BCG 55.9 40.8 59 76.5 64.8 52.6 74.6DPT (Three 27.2 20 47.7 53.5 57.8 22.3 45.8injections)OPV (Three 22.9 18 33.5 56.1 42.3 17.5 34.7doses)Measles 38.2 15.1 47.4 63.4 57.6 26.6 54.4Full9.5 2.4 19.8 51.2 36.4 4.8 29.7ImmunizationsNote: Data not available for rest of the districts4.5.3 Family PlanningThe TFR of this state is well below national average at 2.52. Whileconsidering the factors that really contribute to the TFR in the state, a mention isnecessary to be made about the knowledge about any modern spacing methodwhich is well above 70% in all the districts. But the current use of any modernmethod is only around 30% (average). The district of East Kameng fares very poor at15.7%; may be due to lack of infrastructure, inefficient logistic system, lack ofmanpower compounded by pitiable / no communication facility.The use of condoms in all the districts is very poor and also the unmet needfor spacing coverage is low. The knowledge about NSV is almost nil in some districtswhich apparently leads to really dismal achievement level which is not more than1%. This area need focused attention so as to involve male group in achieving RCHobjectives.Regarding IUD acceptors, the performance level is very low averaging about6%. The locally circulating rumors of health problems that may lead to, afteraccepting IUD is rampant whereby a more individualized effort is necessary throughBCC.4.5.3.1 DISTRICT INDICATORS ON FAMILY PLANNING (Source: DLHS-RCH, 2002)Particulars DibangValleyEastKamengLohit Tawang Tirap UpperSubansiriWestSiangMean children ever 4.31 4.06 3.99 4.03 3.62 4.96 4.71Crude Birth Rate 31.54 19.64 25.8 19.89 23.28 27.13 22.49Total Fertility Rate 3.05 2.45 2.8 2.48 2.66 2.94 2.39Birth order 3 and 45.8 46.6 46 44.5 43.5 57.2 45.718

aboveKnowledge about 84.1 75.3 86.8 81.7 97.1 80 91.1any modernmethodKnowledge about 80.5 71.9 71.8 81.1 78.8 73.5 62.5any modernspacing methodKnowledge about 16.1 20.2 4.2 3.8 12.9 14.4 19all modern methodsHusbands knowing 0 10.9 13.3 2.8 7.1 8.2 15.6NSVCurrent use of any 30 16.1 39.7 31.9 23.8 22.4 50.9methodCurrent use of any 29.1 15.7 37.6 31.9 22 22 50.8modern methodFemale sterilization 12.8 5.2 19 3 13.1 10.1 36.4Male sterilization 0 0.8 0.4 0.5 0.2 0.1 0IUD 2.3 0.5 4.1 12.1 1.7 2.4 3.6Pill 12.6 8.6 11.5 15.8 5.1 8.5 9.6Condom 1.4 0.7 2.3 0.6 1.9 1 0.9Current use of any 1 0.4 2.1 0 1.8 0.4 0.1other traditionalmethodUnmet need for 32.8 27.6 29.6 32.5 33.3 23.5 14.6limitingUnmet need for 2.1 4.8 4. 3.5 10.4 6.6 3.4spacingTotal 34.9 32.4 33.6 36 43.7 30.1 184.6 Health Infrastructure/ FacilitiesAt present, Public Health facilities are the back bone of health delivery andfamily welfare services in the State as private hospitals are not available. Catering tothe health and family welfare needs of the people are 2 General Hospitals atNaharlagun and Pasighat, 12 District Hospitals at Tawang, Bomdila, Seppa, Ziro,Daporijo, Along, Yingkiong, Roing, Anini, Tezu, Changlang and Khonsa, 44Community Health Centers (CHCs), 85 Primary Health Centers (PHCs), 381 Sub-Centers (SCs), 45 Homeopathy Dispensaries and 9 Ayurvedic units .There are 162 SCs functional with ANM in position and 111 SCs arefunctional with either other paramedics. However, there are 342 SCs with SCbuilding and out of which 40 SCs are with attached ANM quarter.There are 55 PHCs providing 24 hours service but the standard is not uptoIPHS. Even though PHCs are functional, all the PHCs are not as per IPHS in termsof physical infrastructure requirement for which further improvement is required. Only28 PHCs are having proper labour room and the rest providing delivery service inrelocated / make shift labour room. Further, accommodation for staffs are limitedwhich often translate into staffs not staying at the PHC. IMEP is not addressed at thislevel so far except for routine immunization.19

Upgradation of CHCs was taken up since 2 years and still furtherimprovement is required. 21 CHCs are provided with labour room and furtherimprovement on the critical componets would be taken up from RKS fund. Due tolack of specialist, 18 OT already provided is deteriorating and now, it needs repairand renovation. IMEP is not addressed at this level so far except for routineimmunization. Blood storage facility is available in 3 CHC (1 is functional at CHCRuksin which is an FRU) and the rest are to be made functional. Special mention ismade for CHC, Koloriang in Kurung Kumey where there is no DH and no FRU.There is an urgent need for further upgradation of this facility to functionalise as FRU(Only one in the district).DH / GH are being upgraded and minimum requirement to be an FRU areavailable except that there is requirement of residential quarters.4.7 Human Resource Development including TrainingThe state has no training centre. Training programs however are beingconducted at the two General Hospitals which are identified as the training centre inthe state.and also has vertical programs organizing various training activities. Since,all the training programs face complex tasks. Establishment of a well equippedtraining centre is a mandatory.Problem Identification:With ever increasing number of manpower employed, development of aseparate HRM to organize, conduct and monitor the personnel and training activitiesin the state has become very important. The identified training centre renderstraining programs to health personnel who are registered for the training. This coversaround 50% of the trainees. The remaining trainees fail to receive the training at thetraining centre and so has to be imparted training in the district hospitals. Allocationof per diem of Rs.125/day for paramedics and Rs.200/day for MOs is very less asper Actual.Discrepancy:Training centre should be able to impart training and provide minimalaccommodation to the trainees. It should also provide training to all the identifiedtrainees in the state. But currently only about 50% of the trainees receive the trainingin the training centre and the rest receive in District Hospital. Training program needsto be enhanced through OR program from the existing level4.8 Inequity/ GenderIn Arunachal Pradesh, there is not much of gender discrimination / biasnessat present. Vulnerable communities in Arunachal Pradesh include those groups whoare underserved due to problems of geographical access, and those who suffersocial and economic disadvantages such as Scheduled Castes/Scheduled Tribes(SCs / STs) and the urban poor. Scheduled Castes and Scheduled Tribes do not liveonly in homogeneous communities, but are found within heterogeneous communitiesboth in rural and urban areas. Arunachal Pradesh is one out of those six20

predominantly tribal populated States/ UTs where more than 60% of the populationis tribal. However, in the State of Arunachal Pradesh, the SC population is less than3%. The RCH indicators for slum population are worse than the urban average.Marginalization results in poorer social indicators for these groups, includingmaternal and child health indicators. This can be as much a result of service providerbehavior as of health seeking behavior and capabilities. It is proposed in the laterpart to address the vulnerable group.4.9 LogisticThe present system of logistic in the state of Arunachal Pradesh needs furtherreview and streamlining for Procurement, storage and distribution. The currentlogistics in the state has lead to material loss and inefficient management at all levels.There is a need for establishment of warehouse or proper storehouse at stateand zonal levels along with a proper storage manual / guidelines. There are severalneeds but storehouse for the districts are required urgently. There is a need to involveRRC-NE for further strengthening the logistic system in the state.4.10 HMIS/ M&E (existing capacity including availability of staff at state anddistrict levels, access to computers, internet, etc.)A State HMIS Cell is already created, where every Data related to Program isbeing maintained. Reports and returns received from the districts are compiled andanalyzed. Existing capacity including availability of staff at state and district levels,access to computers, internet, etc. are as follows:Manpower StatusState HMIS/M&E Cell1. State Program Officer/Deputy Director (M&E) 12. Consultant (HMIS) 13. Data manager 14. Data Assistant 1District HMIS/M&E Cell1. District Program Manager 82. District Data Assistant 163. Computer Assistant 16Equipment at state and district levelsState HMIS/M&E Cell1. Computers 02 Nos2. Internet Connection 013. Fax Yes4. Telephone Yes21

District HMIS/M&E Cell1. Computers 16 Nos2. Internet Connection 063. Fax 104. Telephone 164.11. BCC4.11.1 Status of IEC Bureau in Arunachal Pradesha. State IEC Bureau - 1b. District IEC wing - 16c. District Family Welfare Bureau - 24.11.2 IEC MANPOWER IN THE STATEi. Deputy Director, IEC (State level) - 1ii. Mass Education and Information Officer (District Level) - 1III Dy. Mass Education and Information Officer (District Level) - 4IVDistrict Extension Educator (District Level) - 64.11.3 STATUS OF MAHILA SWASTHA SANGH (MSS) IN ARUNACHALPRADESH DURING THE YEAR 2008-09Sl.No. Name of the districts No. of MSSfunctioning1 Tawang 182 West kameng 503 East kameng 224 Papum pare 275 Lower Subansiri 206 Kurung Kumey 177 Upper Subansiri 108 West Siang 509 East Siang 3010 Upper Siang 1511 Lower Dibang Valley 4512 Dibang Valley 2513 Lohit 3414 Changlang 1815 Tirap 4016 Anjaw 27TOTAL448 Nos.22

4.12 Convergence/ CoordinationA convergence committee has been constituted at the state level under thechairman ship of the Chief Secretary which includes secretaries/ Directors fromrelated department and representatives from NGO, PRI etc are the members. Thiscommittees will overseas the activities which are to be convered at all level.However, activity of the committee needs to be up-scaled.The executive committee of the state health society constitutes differentprogram officer within the department to look into this activity. The DCs and the otheradministrative officers are the chairman of DHS & RKSs and are regularly involved inNRHM Programs.However, the committee is weak and needs improvement in the proposedyear. Better plan for convergence at intra-departmental and inter-departmental levelhas been proposed.The National Population Policy 2000 and the National Health Policy, 2001,include decentralization and convergence of service delivery at village levels andrecognize the PRI as the agency responsible to ensure this. In the context of healthand family welfare, perhaps the most significant impact is the ability of women to getelected to local bodies. In some areas, women PRI members take an active role inpolio eradication, health camps, mobilize women for services and monitorattendance of staff.Several factors influence the progress of decentralized planning andimplementation, not the least being political will, and peoples’ readiness to engagewith decentralization.The National Rural Health Mission (NRHM) is seen as a vehicle to ensure thatpreventive and promotive interventions reach the vulnerable and marginalizedthrough expanding outreach and linking with local governance institutions. PRIs areseen as critical to the planning, implementation, and monitoring of the NRHM. At theDistrict level a District Health Mission will coordinate NRHM functions.ASHA, (Accredited Social Health Activist), the mechanism to strengthenvillage level service deliveryare in place. The Village Health Committee (VHC) willform the link between the Gram Panchayat and the community, and will ensure thatthe health plan is in harmony with the overall local plan.Capacity building of PRI is required in thematic areas and leadership skills,negotiating, monitoring, ability to withstand patronage and political interference.Capacity building processes need to be tailored to literacy levels, sex andcircumstances of PRI members. Joint orientation and sensitization meetingsbetween PRI and health and medical professionals could help to bridge the gap ineducation and social strata. Developing Citizen Charter of Rights and Codes ofconduct also lay down guidelines for boundaries of operation and accountabilitywhich is already addressed under RKS. NGOs could be involved in PRIstrengthening in a variety of ways, including: consciousness raising, provision oftechnical advice, support in participatory planning, capacity building and facilitatingmonitoring processes, such as community and social audits to improveaccountability.SWWCDThe slow pace of progress in infant mortality and child malnutrition is an areaof serious concern and maximum infant deaths occur in the neonatal period.Proximate determinants of infant and child survival include a mix of preventive and23

curative interventions which can be successfully implemented through a mix ofactions at the village levelCommunity level action for increasing mobilization, action and behaviorchange processes, supported by well organized primary and secondary healthsystems, are required to enable women cross a range of barriers, including genderinequity and poor access to quality health services.The SWWCD covers the Integrated Child Development Services (ICDS), toprovide supplementary nutrition for pregnant and lactating mothers and childrenunder six, and non-formal preschool education; programmes to ensure social andeconomic empowerment of women through collectivization, welfare and supportservices etc. At the village level, it is represented by a village level honorary worker,the Anganwadi Worker (AWW) and her assistant, an Angnawadi helper. At the blockLevel, the Child Development project Officer is the functionary in charge of DWCDschemes.The AWW under the purview of the SWWCD performs the duties of frontlinegrass roots workers along with the ASHA. The AWW is also involved in severalprograms like RI, Blindness Control, Leprosy, Pulse Polio Immunization, and theRCH programme. Coordination is immensely needed in areas such as healthservices, nutrition, immunization, and referral. Both are having overlapping goals,and thus complementary programming is essential.The National Rural Health Mission (NRHM) is seen as a vehicle to ensure thatpreventive and promotive interventions reach the vulnerable and marginalizedthrough expanding outreach and linking with local governance institutions.The child health strategy concentrates on the: essential newborn care,breastfeeding, immunization, and care of the sick newborn and child throughoutpatient/home based care and inpatient care. This approach is called theIntegrated Management of the Neonatal and Child hood Illness (IMNCI).SWWCD InterventionsChild Health-Monthly Weighing of children undersix-Maintaining Growth chart-Child cards for children below six (formedical history)-Nutrition supplementation-Referral of children with 2SD and3SD malnutrition to the PHC-Non-formal pre school education-Health and nutrition education-Elicit community support andparticipation in running theprogramme-Assist PHC staff in immunization ofchildren- House visits to ensureDHFW InterventionsChild Health- Identify malnutrition among children (0-5)and manage or refer to PHC-Provide ORS to children with diarhoea-IFA to infants and young children-Vitamin A solution-Immunization-Weigh and examine newborn as son aspossible after birth.-Health Education24

appropriate feeding practices andattendance at AWC.Maternal health-Nutrition supplement to a sub-sect ofall pregnant and lactating women(BPL)-Enables all pregnant and lactatingmothers to collect at the AWC forANM visitOther women’s health issues:Maternal Health-Register and provide care to all pregnantwomen throughout pregnancy-Urine and Hb test, BP and three abdominalexaminations-Refer complications and facilitate referral-Conduct three postnatal visits-Health educationOther women’s health issues:-Family planning motivation-Distribution of contraceptives-Referral for IUD or terminal methods-Follow up of users for side effects-RTI/STI education, recognition, andreferral-Minor ailments treatment/referralThey will be responsible for ensuring that all children 0-6 and children forimmunization and other health services are brought to the AWC on a fixed day, whenANM and MO visit to provide immunization, and other health care services. Servicesto be provided on the Health & Nutrition Day include: ANC, Newborn check up,Postnatal care, Immunization of mothers and children, IFA and Vitamin Aadministration, treatment for minor ailments, and health education.They will mobilize women and children, with support from community toaccess services through a fixed Village Health & Nutrition Day held every month atthe AWC. They will counsel women for institutional deliveries and facilitate referral. Itwill be emphasized that AWW and/or ASHA to be present at all home deliveries (assecond attendant) to provide care and advice for the newborn.They could motivate newly married women and recently delivered women touse family planning. The AWC would serve as the depot for pills and condoms andalso facilitate referral for other methods.They would participate in routine immunization and special campaigns likepulse polio and also provide Vitamin AIn order to ensure effective functioning of the two areas of convergencediscussed above, joint planning of between the two at various levels is necessary.Other cross cutting areas:Success of convergence in health, nutrition, and empowerment requiresconvergence of approaches in: planning modalities, monitoring and informationsystems, capacity building and training inputs. Additionally the Health Departmentmust ensure that convergence efforts are backed by a strong service deliverysystem, responsive to community needs.25

SchoolThere may not be direct scheme / activities linked to the health indicators butas a major Department having capacities and establishment across the state, it willbe ensured that there resources are being utilized for improving health indicators.This includes using of students in health programs, school health programs in theschools in sensitizing the students etc to health needs. Teachers may also beutilized for propagation of health information to the students in turn who willdisseminate the messages to the parents and community.PHEDUnder NRHM it is to help and to promote sustainable and equitable access to water,particularly safe drinking water and sanitation facilities in urban and rural areas. Italso promotes effective management in order to reverse unsustainable exploitationof water resources.The Community seeks to promote knowledge sharing and inter-agency collaborationas the means to achieve this end. By tapping into the collective knowledge of diversepractitioners across the sector, the Community helps members increase theeffectiveness of water and environmental sanitation operations and developmentinitiatives. There are issues which is covered• Access, quality and effectiveness of water and sanitation service delivery• Responsible management of water as a natural resource• Unsustainable use of water• Water pollution and contamination• Inadequate delivery mechanisms and infrastructure• Inefficient institutional and governance structures• Financial resource constraints• Socio-economic and cultural barriers to water accessThe facility survey also indicates that majority of the households are notprovided with potable and safe drinking water. Similarly, sanitation facilities are alsovery scarce. Under the convergent efforts of the line departments, it is hoped thatthese issues also would be sddressed during the program period.VH&ND is another area where convergence has started. The committee willoversee under the aegis of SHM & DHM. This committee will not only address thehealth need but also covering all the aspects of sanitation.AdministrationInvolvement of General Administration in RCH and NRHM activities isindispensable to the success of the programme, beginning from the State level downto the village level. Active participation of the district administration in required inmobilizing manpower and arranging transport facilities during IPPI campaigns andother health camps. At the decision making level, Chief Secretary is the chairman ofSHS governing body and the Secretary(H) is the chairman of executive body of SHS.26

They are regularly in touch with the DCs in the districts, while at the district levelDeputy Commissioners are the chairman of governing body of District Health Societyand holding regular meetings and monitoring the progress of the programs withmajor emphasis on RCH activities. Administrative officers at all levels are thechairman of Rogi Kalyan Samity. By virtue of their position in various institutions ofNRHM, their involvement in decision and policy making has become vital. At theimplementation stage, their participation is invariably required for ensuring interdepartmentalcoordination and convergence of activities related to health programs.4.13. Finance (Show expenditure / fund utilization figures by source anddifferent heads and identify reasons for poor utilization)a) RCH Flexible Pool Fund for the Financial Year 2008-09(Till Dec 2008)SL.NORCH-II ActivityApprovedBudget(Rs. In Lakhs)Expenditure(Rs. InLahks)% age ofUtilisation1 Maternal Health 64.40 96.18 149.352 Child Health 12.50 5.00 40.003 Family Planning Services 13.00 5.21 40.084 Adolescent health 14.40 0.00 05 Urban Health 25.61 28.55 111.486 Tribal Health 0.00 0.00 07 Vulnerable Groups 0.00 0.00 08 Innovations/ PPP/ NGO 493.00 348.56 70.709 Infrastructure and HR 261.00 92.61 35.4810 Institutional strengthening 26.07 8.89 34.1011 Training 77.69 39.47 50.8012 BCC/IEC 35.16 31.73 90.2413 Procurement 0.00 12.79 014 Programme Management 84.00 153.43 182.65Total Base Flexi pool 1106.83 822.42 74.30JSY 170.00 57.37 33.75Sterilizationcompensation 41.50 26.76 64.48NSV campsTotal RCH Flexipool 1318.33 906.55 68.77NRHM ACTIVITIES DURING THE YEAR 2008-0927

Sl ActivityNo1 Workshop for StateDistrict &Block level MissionteamPer Unit Cost(In Rs.)2 State levelworkshop @ Rs. 2.5lakh per workshop.Rs. 2.5 lakh perworkshop for hiring ofprivate facilties.32 District levelworkshop @ Rs.50,000 perworkshop.ApprovedApproved @Rs. 2.5Lakhs perworkshop,inclusive ofallexpenditurePhysicalProgressState-2,RemarksApproved District-10 Rest reportawaited2 Orientation of PRIon NRHM activities3 Untied Grant toVHSCOrientation of 800PRI on NRHMactivities in 14District levelworkshop @ Rs.1463 per PRIUntied grant to 2177VHSC @ Rs. 10,000per VHSC557 Villages Health &Nutrition Day @ Rs.1000 per villageApproved @Rs. 400/- perparticipant.Approved.The Stateshould striveto have allVHSCs formin the currentyear.Approved.VHSC mayused theuntied fundfor thispurpose.2 orientationtraining iscompleted incollaborationwith Departmentto PRI530 VHSC Till 31 st Dec.2008expenditureto the tuneof Rs. 53.03Lakhsreported.204 reported Expenditurefor VillageHealth &NutritionDay is notreported till31 stDec.20084 Selection &training ofCommunity HealthWorkers (ASHAs)Selection, Trainingand otherrequirement ofCommunity 390Health workers(ASHAs) @ Rs.10,000 per ASHAApproved.All 3862ASHAshould betrained,provideddrug kits andmentored.Amount @Rs. 10,000/-Selection : 3387TrainingProvided:Module I: 2495Module II toModule IV : 729Training onmodule 2-4& 5 is goingon in thedistricts.Expected tobecompletedwithin thisyear.28

5 Selection ,remunerationtraining of ANMS6 Selection,remunerationtraining of StaffNurses at PHC/CHC7 Selectionremunerationtraining of MOs atPHCsSelectionremuneration andtraining of 40 ANMs@ Rs. 6000 per ANMSelectionremuneration trainingof 117 staff nurse atPHC/CHC level @Rs. 7500 per staffnurseSelectionremuneration trainingof 82 MOs at PHCs@ Rs. 20,000 perMOper ASHAprovidedaccordingly.Details ofactivities tobe carriedout may beprovided.Module V : 729Drug Kitsprovided: 1161Approved 40 recruited Achieved100%Approved 56 recruited Therecruitmentof remaining61 SNs isdecentralized to Distt.and will berecruitedshortly.Approved @Rs. 15,000/-per MO. TheState hadalreadyrecruited 72MOs @ Rs.15,000/- permonth salaryduring 2007-08 and thereis nojusitifcationfor providedforincreaseingsalary by Rs.5,000/-. The10 AYUSHMOsrecruited lastyear(included inthe 72approved forcurrent year)may also becontinuedand 5 new35 (Allo)47 (Ayus)Achieved100%29

8 Selection,remunerationtraining ofspecialists at CHCSelectionremuneration trainingof 3 specialist atCHC level @ Rs.25,000/- perSpecilaist.proposed arealso includedin theapproval.Approved for10 months.1Rest will berecruited inthis year.9 Construction &Maintenance ofphysicalinfrastructure ofSHCs10 Construction &Maintenance ofphysicalinfrastructure ofPHCs11 Procurement anddistribution ofquality equipmentsand drugs in thehealth systemConstruction andmaintenance ofphysicalinfrastructure of 25SHCs @ Rs. 9 lakhper SHCConstruction andmaintenance ofphysicalinfrastructure of 1PHCRented Store House(HQ) @ Rs. 5000 permonth16 vehicles for hiringfor distribution ofdrugs equipment Rs.500 pm for 8 monthsApproved 9Approved 8ApprovedYes,implemented.Rented storehouse inpositionThe activityhas beenundertakenout of theState sharefund of2007-08Theexpenditurehas beenmet from theunspentbalance oflast year’sfund.Approved Nil Being fundnot releasedby GoI12.For Sub Centre @ Rs.18135/- per SC for 50SCsUntied grants/ RKS andAnnual MaintenanceGrants to SCs, PHCsand CHCsUntied fund for273 functionalSub Centres &Rs. 10,000 perSCAnnualMaintenanceNotApproved.Drugs beingsuppliedunder RCH -IIApprovedApproved273 SC18 SC30

13Support for MobileMedical Units14 State Level resourceCentreGrant to 273functional SCs@ Rs. 10,000per SCUntied fund for85 PHCs @ Rs.25,000 per PHCAnnualMaintenanceGrant to 85 PHC@ Rs. 50,000per PHCRKS Fund forPHC/CHCRKS fund for 31CHCs @ Rs.1,00,000 perCHCUntied fund for31 CHCs @Rs.50,000 per CHCAnnualMaintenanceGrant to 31CHCs @ Rs.100,000 perCHCMMU Drugs for16 MMUs @ Rs.1,00,000/- perMMUMaintenance/Repair for 16MMUs @ Rs.2,00,00/- perMMUPol for 16 MMUs@Rs. 2,00,000/-per MMUMan powerrequirement willbe made fromthe concernedDHApprovedApprovedApprovedApprovedApprovedApproved.ApprovedApproved.Notapproved.Only hiringof buildingand13 approx. PHC12 approx. PHC14 DH, 85 PHC,273 SC6 approx. CHCExpenditureawaitedMMUs placed toall the 16districts andactivities aregoing onDuring thecurrentfinancialyear 2008-09, theSHS hadnotreceivedany fundunder theMissionFlexiblePool Fund.Theexpenditurearereportedout of thelast yearunspentbalanceMMUsplaced toall the 16districtsandactivitiesare goingon.31

furnishing it15 Improving physicalinfrastructure ofSC/PHC/CHC/DH16 Ambulances for allPHCs/CHCs/DHsPhysicalinfrastructure for5 PHC(C/o 3additional qtrs.Per PHC forSNs) @ Rs.7,00,000/- perPHCPhysicalinfrastructure for5 DH @ Rs.7,00,000/- perDH10 Ambulancesfor PHCs @ Rs.6,00,000/-2 Ambulancesfor DH @ Rs.15,00,000/- perambulancesproposed.NE-RRC’ssupport maybe obtainedand theStateFacilitatoroptimallyutilized.Approved.Estimate forthe qtrs. Maybe providedseparately.Approved @Rs. 7.00Lakhs perqtr, 1 eachfor theDH/GH atPasighat,Seppa, Ziro,YingkiongandDaporijo.CPWD/StatePWDshedule ofrates & IPHSnorms maybe followed.ApprovedApproved.Theseambulancesare not to beused for VIPduty.Not taken upThe activity hasbeen taken upfully. Tenderingfor the purposeis completedand supplyorder issued.As fund forthe purposehas not yetbeenreleased byGoI.Inanticipationof releasefrom theGoI.32

17 Telephone forSHCs/PHCs/CHCs/DHs18 Strengthening NursingSchool19 Additionalitiesrequested by NationalDisease ControlProgramme20 Revised NationalTuberculosis Controlprogramme50 Telephone for PHCs/CHCs /DHs51Approved 50implementedNotapproved.The proposalneedsfurtherrefinement inorder toensure thatINC normsare metwhile startinga GNMSchool.Notapproved.Theprogrammebudget maybe accessedfor therequirementproposed.4.15 Template-1Sl.No.BackgroundCharacteristics1 Geographic Area (inSq. Kms)2 Number of blocks 833 Size of Villages (2001Census)1-500501-2000Number8374338623442 (Census-2001)392 (Census-2001)33

2001-50005000+4 Number of towns5 Total Population(2001)26 (Census-2001)3 (Census-2001)171097968 (Census-2001)Urban227881 (Census-2001)Rural870087 (Census-2001)6 Sex Ratio (F/M*1000)901• Population Sex RatioPopulation Sex Ratio 893789101112131415161718 MMR19Child Sex Ratio 964Decadal growth rate 26.21Density- per sq. km 13Literacy Rate (6+ Pop) 54.74Male 64.07Female 44.24%SC population 0.507%ST population 67.77 (2001Census)No. of schools 538No. of AnganwadiCentresLength of road per100 sq. km.% of villages havingaccess to safedrinking water facility% of householdshaving sanitationfacility (Specify Type –sewer, septic tank)% of population belowpoverty lineHealth StatusMorbidity Male FemaleChildIMRHealth Resources-Facilities (Specify level38621535670.466.433.47 (SRS BulletinApril 2001)30661Will be givenseparately34

2021222324of Facility likeSubcentre)Personnel(SanctionedVacancy)Finances(Requirementand Releases)1.Birth rate and deathrate2. Fertility rate.3. Disease maximumDisability.4.High Risk GroupsB.To link with thenutritionaldeterminants-1. % ofInfants with low birthweight. 2.Weight forAge no. above 90%,3. No between 60%-80%, 4.No. below 60% weightfor ageNo of Primary schoolteachersNo of children enrolled(Age wise) (Allrelevant data neededto Start School HealthProgramme)3.03 (NFHS III)DNA12803.2 Programme Objectives for Arunachal Pradesh3.2.1 Public Health FacilitiesTemplates 2NumberGovernmentHealth FacilityBuildingsRentedDistrict Hospital 12 DH+2GH 0Medical College Hospital 0 0AYUSH Colleges and0 0HospitalsSub District 0 0Rural Hospitals 0 0UFWC 4 0CHC including Identified31 0FRUsBPHC 0 035

85 (28 with Labour 0Sector PHCRoom)Subcentre 342 (40 with Quarter) 0Ayurvedic Dispensary 9 0Homeopathic Dispensary 45 03.2.2 Human resourcesTemplates 3Staff Sanctioned In-Position VacantDistrict Medical Officer16 16DRCHO 16 16Medical Superintendent-CHC 0 0Medical Officers includingspecialists ( sub district facilities) /NA 214(1 Gynee.Contratual)from AYUSH also560 519(37contractualAllo,Medical Officers/from AYUSH also26 AYUSH)Lady Medical Officers only if there is 0 0any separate cadre in the state)Lab technicians 64 86(22 contractual)X-ray techniciansStaff Nurse 170 331 (110 contractual)LHV 2 2ANMs 390 548( 158 contractual)Male MPWsDistrict TB Officer 13 13Senior Treatment Supervisor (STS) 13 13Senior TB Laboratory Supervisor 13 13Staff provided under the VectorBorne Disease Control Programmelike District Malaria Officer, AssistantMalaria Officer and, Malaria2 2InspectorMention any other categoryDistrict Programme ManagerAccountantData Assistant8172136

3.2.3 Functionalities & critical staff in positionTemplates 4Critical Staff Names SanctionedDistrict HospitalObs – 9Availability ofAnaes- 9staff needed forPaed- 6serviceGuaranteesCHC Ob&Gyspecialists (eitherqualified ortrained),PediatricianAnesthesist(either qualifiedor trained) atidentified FRUsPHC Availabilityof a medicalofficer at PHCSub CentreAvailability of anANM at subcentre (residentat sub-centre)3.2.5 LogisticsIndicate blockswhere more than20 percent postsare vacantIndicate PHCs,with more than 10percent posts arevacantLogistics ElementsAvailability of a dedicated Districtwarehouse for health departmentStock outs of any vital supplies inlast yearIndenting Systems (from peripheralfacilities to districts)Existence of a functional system forassessing Quality of VaccineInPosition9961101RelocatedfromamongMOs withPGdegree.50 50381 161Templates 5DescriptionNil.Recurrent stock outoccurs but no exact isavailableDistrict demand as anwhen stock out.The cold chain systemis in force right fromairport at ghty to theSC level.VacancyMoresanctionedpost reqd.Morerequirementfor otherfacilities asstate Govtis notsanctioningthe posts.37

TrainingTemplates 6Details about the training institution/sName of the Institution:Physical Infrastructures Availability of lecture halls, place fortraining faculty, residential accommodation for trainees ( menand women) , dining hall, furnitures, safe drinking water andelectricity etcProvide details of Faculty (Sanctioned and In-position) withdesignation and specializationAvailability of Teaching Aids, computers etc. Assessment ofavailability of common audio visual aids at the facilityAvailability of annual training plans for the last year andachievements of the plan?Availability of training calendar for the current year with clearcut time line for the training activities. Training activities underNRHM: i) Orientation / sterilization workshops on NRHM -District level officers of related departments, sub district levelofficers, elected PRIs, field NGOs, faculty of ANMTCs/DTCs,block panchayat and Gram panchayat ii) Training forstrengthening of health system -ASHA training -Skill basedtrainings The districts are required to indicate the trainingsconducted for all categories of health personnels with referenceto the training load. The cumulative number of trainedmanpower and the number of trained during the current yearalong with percentage of achievement may be specified.3.2.7 BCC InfrastructureTemplate-7Human Resources for BCC i.e. DistrictMedia officers, Dy Media officers andblock level staff Any trainings the staffhas undergone in media planning ormaterial development in past five yearsAny functional Mass media audiovisualaids such as 16 mm projectors,Video cameras, VCD/DVD players-Did the district prepare a BCC plan inthe past year? -If yes, what BCCactivities were planned andundertaken? -In the absence of plan,find out what BCC activities wereundertaken?Are there other institutions available inthe private sector for conductingcommunication activities using modernKey issuesNilNilNilyesYesThere are 12(twelve) IEC/BCC officerspositioned in the whole state. Most of thedistricts are without IEC manpower. None ofthese 12 officers had undergone any trainingin media planning or material development.Proposals for new recruitment are 5 Nos. ofDistrict Extension Education (DEE)No BCC Plan proposed by the District.However, districts have undertaken fewactivities as per their local situation. Activitiesare Outdoor & Rural publicity Campaign suchas – through IPC, Health Awareness Camp,wall writings, Pictorial Hoardings, FolkDramas & Plays, Postures/Leaflet/pamphletand involvement ofMSS members.1) HOPIN FILMS BANK TINALI,ITANAGAR, ARUNACHAL PRADESH2) FRONTIER FILMS, ABOTANI COLONY38

media or folk media???Private Health facilitiesTemplate-9Name of theblock withICDSProgrammePrivate Services FacilitiesMulti-Specialty Nursing HomesSolo Qualified PractitionersITANAGAR-(A.P)3) Aaj Ki AwajTemplates 8Number and location incase of sub districtfacilities.Practitioners from AYUSH 5Approved MTP centres in Private1NGOsectorRMPs (Less than formal qualifiedpractitioner)Number of nursing homes withfacilities for comprehensiveemergency obstetric care4 (Ramakrishna MissionHospital, Niba Clinic,BTM Hospital, HeemaHospital)Accredited centres for sterilizationserviceAccredited centres for IUD services 13.2.9 ICDS ProgramNumber ofAWCsCDPOsandACDPOsTemplates 9Supervisors AWWs AW helpersS F S IP S IP S IP S IP1 State 2359 2359 16 16 2359 2359 2359 2359Total3.2.10 Elected representativesTemplate-10Name of theblockpanchayatvillagesTotalmembersTotal ZPTemplates 10TotalBDC/MandalmembersTotalPanchayatPradhansMale Female Male Female Male Female1 84 1640 91 4539

3.2.11 NGOs, CBOs etcTemplate-11Names of NGOsVHAITemplates 11Key Activities inHealth/Nutrition/community organisationHealthBlock/Villages of NGOsoperationsLumla (Tawang)Thrizino (W.Kameng)Deed Neelam (L.Subansiri)Nacho (Upper Subansiri)Gensi (West Siang)KARUNA TRUST Health Khimyang (Changlang)Wakka (Tirap)Mengio (Papumpare)Walong (Anjaw)Bameng (East Kameng)Sangram (Kurung Kumey)Jeying (Upper Siang)Etalin (Dibang Valley)Anpum (Lower Dibang Valley)Future Generation HealthSelle (East Siang)Arunachal (FGA)Alok Prayas JAC Health Wakro (Lohit)Nani Sala Foundation Health MNGO for P/PareVHAAP Health MNGO for East Kameng, W/Kameng.Daying EringFoundationBoria Tari MemorialSocietyHealthHealthUH PasighatUH Naharlagun / Itanagar3.2.12 Maternal HealthTemplates 12Source NFHS -3Sl. No Particulars Overall Urban RuralMaternity Care (for births in the last 3 years)1 Mothers who had atleast 3 ANC visits fortheir last birth(%)2 Mothers who consumed IFA for 90 days ormore when they were pregnant with theirlast child (%)3Birtth assisted by adoctor/nurse/LHV/ANM/other health36.4 56.6 28.311.6 24.3 6.633.4 65.4 20.840

45personnel (%)1Institutional births (%)1Mothers who received postnatal carefrom a doctor/nurse/LHV/ANM/otherhealth personnel within 2 days ofdelivery for their last birth (%)1This component is addressed in RCH II PIP.3.2.13 Family PlanningTemplates 1330.8 61.4 18.823.3 43.4 15.2Source NFHS -3Sl. No. Particulars Overall Urba RuralnCurrent use1 Any method (%) 43.2 47.3 41.6a. Any modern method (%) 37.3 39.4 36.4b. Female sterilization (%) 22.5 19.4 23.72c. Male sterilization (%) 0.1 0.0 0.1d. IUD (%) 3.6 6.5 2.5e. Pill (%) 8.3 8.7 8.2F. Condom (%) 2.9 5.1 2.1Unmet need for family planning3Total unmet need (%) 19.3 19.7 19.2a. For spacing (%) 8.6 11.0 7.6b. For limiting (%) 10.7 8.7 11.5This component is addressed in RCH II PIP.3.2.14 Child HealthTemplates 14Child Health Source NFHS -3Sl.No.Particulars Overall Urban RuralChild immunization and vitamin A supplementation11 Children 12-23 months fullyimmunized (BCG, measles, and 328.4 51.2 21.1doses each of polio/DPT) (%)2 Children 12-23 months who havereceived BCG (%)57.7 65.1 55.33 Children 12-23 months who havereceived 3 doses of polio vaccine (%)55.8 62.8 53.54 Children 12-23 months who havereceived 3 doses of DPT vaccine (%)39.3 60.5 32.541

5Children 12-23 months who havereceived measles vaccine (%)6 Children age 12-35 months whoreceived a vitamin A dose in last 6months (%)38.3 53.5 33.317.4 21.3 16.0Treatment of childhood diseases (children under 3 years)17 Children with diarrhoea in the last 2weeks who received ORS (%)33.5 37.5 30.88 Children with diarrhoea in the last 2weeks taken to a health facility (%)37.9 40.0 36.59 Children with acute respiratoryinfection or fever in the last 2 weekstaken to a healthfacility (%)43.6 53.5 38.2Child Feeding Practices and Nutritional Status of Children110 Children under 3 years breastfedwithin one hour of birth (%)11 Children age 0-5 months exclusivelybreastfed (%)12 Children age 6-9 months receivingsolid or semi-solid food and breastmilk (%)13 Children under 3 years who arestunted (%)14 Children under 3 years who arewasted (%)15 Children under 3 years who areunderweight (%)3.2.15. National Disease program55.0 53.7 55.560.0 55.6 62.077.6 * 80.634.2 31.7 35.216.5 6.3 20.536.9 23.8 42.1Templates 1515.1 National Vector Borne Disease Control Programme (Malaria)DescriptionNumber SourceAPI for Malaria (per 1000 population)State VHDC37SocietySlide positive rateState VHDC13.98SocietyPlasmodium Falciparum Rate (PFR) 3.64 State VHDCSocietyAnnual Blood examination Rate (per 100population)25.57 State VHDCSocietyFever Treatment depots andDDCs574534State VHDCSociety42

15.2. Revised National Tuberculosis Control ProgrammeSL. DescriptionNo.1 Percentage of TB suspects examined outof the total outpatients.2 Annualized New Smear Positive (NSP)case detection rate per 100000population.3 Annualized Total Case detection rate per1,00,000 populationNumber/ SourcePercentage2% State TBControlSociety63% State TBControlSociety188% State TBControlSociety4 Treatment success rate 88% State TBControlSociety15.3. National Blindness Control ProgrammeSL.Description Number SourceNo.1 Cataract surgery rate (CSR) 579 (Upto Nov’08) Staterecord2 % of Reflective error age group 10-14years1054(Upto Nov’08) Staterecord3 Surgical camp organized last year 11(Upto Nov’08) Staterecord4 Personnel trained 11(Upto Nov’08) Staterecord5 Service delivery points having qualityassurance guidelinesGH,DH,CHC,PHC Staterecord6 % of teachers trained 35(Upto Nov’08) Staterecord7 Number of NGOs receiving assistanceand beneficiary assessment.NilStaterecord15.4. National Leprosy Eradication ProgrammeDescriptionNumber SourcePR – Leprosy cases per 10,000 population 56 0.44/10,000populationANCDR – New Leprosy cases per 1,00,000 population 36 2.80/100,000populationProportion among the new cases detected32 88.8MBFemale 03 8.33Child 02 5.55ST 11 30.543

SC 06 16.6Proportion of Patients completed treatment (RFT) 32 47.0515.4 National Integrated Diseases Surveillance ProgrammeDescriptionNumber SourcePercentage of facilities sending their reports in time 16 districts ArunachalSurveillanceSocietyUp gradation of Labs Nil StateStateLeprosyControlSocietyTraining of staff in disease surveillance pending StateStateLeprosyControlSociety15. 5 National Iodine Deficiency Disorders Control Programme (NIDDCP)DescriptionNo. of persons suffering from IDDNumber of persons consuming Iodized saltNumber SourceNIDDCP Cell6 %

For implementation of RCH-II, the assistance from various relateddepartments shall be mandatory to achieve desired result in plan period andspecifically coordination and convergence of ICDS services at village level must beensured.At the block level the PHC management committee which includes PRI, ICDS,education, PWD, PHE, and Rural Development is being constituted to havecoordinated effort to implement the RCH-II activities.At the district level the district health and family welfare society (DHS) hasalready been functioning under the Chairmanship of Deputy Commissioner andHead of the Departments of Districts as members. For better coordination,representatives from various related departments of the districts are included in thedistrict level management body. The public representatives are made partners inplanning and implementation of RCH activities.RTI/ STI activities, blood safety measures shall be integrated under RCH-IIand converse with the on going activities under State Aids Control Society / NACO.A state level committee already exists and similar committee will beconstituted in the districts.3.2.17 New interventions under NRHMTemplates 17ActivityGoal for Achievement %DistrictNumber of ASHAs selected 3862 3387Number of ASHAs undergone First Orientation2695training for seven daysNo of Fully trained Accredited Social Health729Activist (ASHA)for every 1000 population/largeisolated habitationsNumber of clients benefited under JSY 10043 7782No of Village Health and Sanitation Committeeconstituted and untied grants provided to them.No of 2 ANM Sub Health Centresstrengthened/established to provide serviceguarantees as per IPHS,No of PHCs strengthened/established with 3Staff Nurses to provide service guarantees asper IPHS.No of CHCs strengthened/established with 7Specialists and 9 Staff Nurses to provide serviceguarantees as per IPHS.No of Sub Divisional Hospitals strengthened toprovide quality health services.No of District Hospitals strengthened to providequality health servicesNo of Rogi Kalyan Samitis/Hospital DevelopmentCommittees established in all CHCs/SubDivisional Hospitals/ District Hospitals.3862 264250 (approx)0001212 DH2GH29CHC45

No of Untied grants provided to each VillageHealth and Sanitation Committee, Sub Centre,PHC, CHC to promote local health action.Annual maintenance grant provided to every SubCentre, PHC, CHC and one time support toRKSs at Sub Divisional/ District Hospitals.Systems of community monitoring put in place.Procurement and logistics streamlined to ensureavailability of drugs and medicines at SubCentres/PHCs/ CHCsNo PHCs/CHCs/Sub Divisional Hospitals/ fullyequipped to develop intra health sectorconvergence, coordination and serviceguarantees for family welfare, vector bornedisease programmes, TB, HIV/AIDS, leprosy etc.District Health Plan reflects the convergencewith wider determinants of health like drinkingwater, sanitation, women’s empowerment, childdevelopment, adolescents, school education,female literacy, etc.Facility and household surveys carried out or notAnnual State and District specific Public Reporton Health published Institution-wise assessmentof performance against assured serviceguarantees carried out.Institution-wise assessment of performanceagainst assured service guarantees carried out.79 PHC031 CHC85 PHC273 SC14 DHYes16-Facility SurveyCompleted11-House holdSurvey Completed(West Kameng,East Kameng,Papumpare, WestSiang, East Siang)Not doneNot done yetMobile Medical Units providedYesNo. of Ayush dispensaries re-located to PHCs 10No. of PHCs where AYUSH physicians10appointedOutcome of Objective Setting - Template 18IndicatorPresentStatus2008-09 2009-10(NFHS-III)1.Complete ANC coverage 59% 50 60Maternal 2.% of institutional31%Health deliveries47 503. % of safe deliveriesYr 546

FamilyPlanningChildHealthOtherhealth4. ContraceptivePrevalence-Limiting-Spacing35.2 50 555. Unmet need-Limiting-Spacing 8.6 % 5 46. Full Immunization rate 28.4 % 45 707. % feeding colostrums8.% exclusively60 % 80 90breastfeeding9. Incidence of grade III/IVanemia66.3% 45 3010. PF Rate-Malaria 4.17%11. Case detection rate-TB 91 %12. Complete cure rate-TB 93 %Outcome of B/ L Consultations - Template 19ProblemsAccess to Lack of infrastructure, lack ofservice manpower, manpower not willing toQuality ofservicestay in SC / difficult areas.Lack of interest seen in many of theworkforce, sincerity, lack recurrentknowledge / skill upgradation.Demand/ Demand is seenCommunityInvolvementSolutionsMore infrastructure beprovided and manpower,strong HRD required.More training needed andmotivation to theproviders especially in fordifficult areas.More BCC / IPC required.47

CHAPTERVPROGRESS & LESSONS LEARNT FROM RCH-IIIMPLEMENTATION DURING 2005-095. 1. Summary of ProgressState Health Mission (SHM)The State Health Mission was constituted under the chairmanship of HCMalong with State Health Society wherein governing body under SHS is headed by CSand the Executive body is headed by Secretary (Health). The State NRHMSecretariat is headed by Mission Director under State Programme ManagementUnit.Similarly, all the Districts have District Health Mission under the Chairmanshipof chairman, Zila Parisad. The District Health Society headed by DeputyCommissioner.All the District Health Society are constituted, notified and registered underSociety Registration Act.The last State health Mission meeting was held in the month of February2008.Rogi Kalyan Samiti (RKS)Rogi Kalyan Samiti/Hospital Management Committee has been constituted,notified and registered in 12 out of 14 District Hospitals, 29 out of 31 CHCs and 79out of 85 PHCs as on date.Account books have been opened in 14 District Hospital, 29 CHCs and 77PHCs.Out of 378 Sub centres, so far 245 untied fund Joint Account Books havebeen opened.Village Health Sanitation Committee (VHSC)Out of the expected 3862 VHSC, so far 2642 VHSC has been constituted andnotified and the process of constituting more VHSC is going on.The details are as below:STATETOTALSTAWANG 189BOMDILA 125EAST KAMENGPAPUMPARE 230UPPER SIANG 92KURUNG KUMEY 191LOWER SUBANSIRI 98WEST SIANG 399EAST SIANG 132DIBANG VALLEY 140LOWER DIBANG VALLEY 98LOHIT 17748

Facility Survey/ House Hold SurveyANJAW 129CHANGLANG 96KHONSA 132UPPER SUBANSIRI 414Total:- 2642Facility Survey for 12 DH, 29 CHC, 41 PHC, and 299 SC has been completedalong with 11 /16 House hold Survey completed. The summary of survey reports areas below:House hold Survey in the Districts was conducted during the year 2006 – 07.The State has received survey reports of only 6 Districts. There are 3862 numbers ofVillages in the state, of which 436 villages have been covered in this analysis. Thisanalysis is based on 58903 households included in the survey. As per the survey,12.2% houses are Pucca, 16.41% House are semi pacca and 71.31% houses areKachha. It can be seen that out of the households surveyed, 12.13 % villages havetoilet facilities inside the village. A very negligible percentage of 0.72% villages haveCommunity toilets. Therefore, it can be analyzed that proper Sanitation facilities is anarea of concern. Proper drinking water facility is another area of concern. It can beseen and observed that only 39.11% out of the surveyed households have properdrinking water facility. As far as disease and illness of the population is concerned,the prevalence of malaria is observed to be the highest with a percentage of 71.13%.Jaundice 15.89% and TB 6.43%. Deaths of children aged less than five yearsreported during last one year Male 52.44%, Female 47.55% is also observed to behigh. Maternal deaths reported due to cause related pregnancy/ child birth duringlast one year before the survey is also much higher giving a total of 90 mothers witha percentage of 0.016%. The table given below can give a proper picture of thereport. However, no updation of the HHS and FS could be done.VILLAGE HEALTH INFORMATION SCHEDULEBlock O. Identification ScheduleState/ UTArunachalAPradeshBDistrictC Taluk/ Block 436D Village 657E Panchayat 144F Household Address 0G Referance Month 0H Referance Year 20060Block 1. HouseholdDetails 0Sl. No. 01.1 Name of the Headof the Household1.2 Sex of the Head ofPercentage%49

the Household:Male 11924 86.03%Females 1935 13.96%1.3 Number of Members306335in the Household1.3.a. Males 160694 52.45%1.3.b. Females 145641 47.541.4 Type of HouseholdPucca 7192.2 12.20%Semi-pucca 9670.2 16.41%Kachha 42041.6 71.37%1.5 Ownership of HouseOwn 59636.7 89.79%Rented 6775.35 10.20%1.6 Number of separate334632rooms in the house1.7 Is there a separate18460.2room for kitchen/(Yes)No1.8 Whether toilet7149.1 12.13%facility availableinside the village?(Yes)No1.9 Is there a425.003 0.72%community toiletfacility in thevillage? (Yes)No1.1 What is the main0source of lightningin the household?(Specify)Electricity 32859.1Kerosin lamp 17010.5Others 18649.41.11 Is there a regular23040.2source of drinkingwater in thehousehold? (Yes)No1.12 Whether thedrinking source ofwater change fromseason to season?52850

(Yes)No1.13 What type of fuel is0used for cooking?(Specify)Firewood 41901.9 71.13%Kerosin Stove 2567 4.35%Gas 15754.1 26.74%1.14 Main occupation of0the house holdBusiness 5152 8.74%Services 13092.2 22.22%Farmer 40190.8 68.23%1.15 Number of earningmembers in the46700 15.24%household1.16 Monthly income ofthe household1.17 Whether food isavailable throughoutthe year? (Yes)No1.18 If no, the difficultmonths for foodavailability1.19 What is the mode oftransport availablein the household (ifany)?1.20.aDoes the householdown a TV? (Yes)No1.20.bDoes the householdown a Radio? (Yes)No1.21 Does the householdown any agricultureland? (Yes)No1.22 Area of theagriculture land, ifany1.23 Area of theagriculture landirrigated, if any19880 33.75%householdsays yes0295118609.1 31.59%20105.5 34.13%16539.720075.56548.11.24 Does the household 926551

Block 2. Health &Family Welfare2.1 Number of childrenaged less than oneyear (Infants)2.2 Number of childrenaged 0 to 5 years2.3 Number of childrenaged 6 to 14 yearsown any livestock?(Yes/ No) (Specify)Poultry 1913Piggery 1582Goathery 111Cattle 1119Others 2782.4 Number of births inthe family during thelast one year2.5 Any marriage in thefamily during thelast one year?(Yes)No2.6 Age of the person atmarriage (if answerto column 2.4 is“Yes”)2.7 Number of currentlypregnant womenMale 9609 57.55%Female 7081 42.42%Male 27617 53.81%Female 23701 46.18%Male 36415 52.49%Female 32956 47.50%Male 4374 53.62%Female 3783 46.37%1479054952.8 Deaths 982.8.aAny deaths reportedin the family duringlast one year2.8.b2.8.c2.8.dAny deaths ofchildren aged lessthan five yearsreported during lastone yearAny deaths ofchildren aged lessthan five yearsreported during lastone yearAny maternal deathreported due tocause relatedpregnancy/ childbirth during last oneMale 708 52.44%Female 642 47.55%Male 172 50.58%Female 168 49.41%Male 141 55.29%Female 114 44.7%90 0.016%52

year2.8.eWhether any trained0medical attentionwas given topregnant women?(Yes/ No) (If answerto column 2.4.d. isyes)2.9 Diseases and0Illness2.9.a.Any one suffered0from any of thefollowing diseasesduring last threemonthsAsthma 760 6.53%Tuberculosis (TB) 748 6.43%Malaria 8274 71.13%Jaundice 1849 15.89%2.9.b.If suffered from TB,446has he/ shereceived anytreatment? (Yes/No)2.1 Food Habits 02.10.a.Food habits of the2112family -Veg.Non Veg. 1439432.10.b.Anyone in the family84314.2chew paan masalaor tobacco?(Yes)No2.10.c.Anyone in the family79474.2smoke? (Yes)No2.10.d.Anyone in the family103786drink alcohol? (Yes)No2.11 Health Services 02.11.a.When members of0the household getsick, where do theygenerally go fortreatment?2.11.b.Whether healthservice providedpublic or private?053

2.11.c.2.11.d.Expenditure950150incurred on seekinghealth care duringlast one monthItems on which0money spent forseeking health careduring last onemonth.Doctors fee 36Drugs 920Special food 4Transport 75Others 2CHC upgradation to Indian Public Health Standard (IPHS).Under Block pooling, Basar CHC was upgraded.Janani Suraksha Yojana(JSY):JSY has been implemented in the state since 2005-06.The rural poor womenare availing the facilities provided under this scheme.JSY Beneficiaries2006-07 2007- 2008-09 (till 3 rd Qtr.)081433 7689 7782During the year no cash assistance were given to Home deliveries.Efforts aremade to popularize the scheme through IEC materials and it is hope that institutionaldeliveries will definitely improved during the year.Drug-Kits:Drug Kits under NRHM has been supplied to the districts during 2006-07 andmore Drug Kits are being procured. RCH drug Kits for Maternal and Child Healthunder RCH II have been finalized and it will be supplied in kinds by GoI.Health Melas organized:During this year, so far 8 Health Melas have been organized at at Namsai(Lohit), Longding (Tirap), Thrizino PHC(West Kameng), Bameng PHC(EastKameng), Tawang and Jairampur (Changlang), Mengio (Papum Pare) and Anjaw.Ambulance:Under NRHM, 4 ambulances were supplied to the districts (Mukto PHC inTawang, Dirang CHC in West Kameng, Darak PHC in West Siang, and Diyun PHCin Changlang).10 more ambulances were supplied by NGO to PHCs through PPPfunding under RCH-II which was implemented by VHAI / Karuna Trust. During the54

Year, procurement process completed and order placed for procuring 20 new basicAmbulances and 2 Critical Care Ambulances.Training completed:Training of District Program Manager(DPM) Induction (8 DPM), Accountants (17),MIS(18 Data asst & 8 DPM), RI (174), Skill Birth Attendant ToT (Gyn)-1, SBA- ANM(59) & SBA GNM(59), Intrauterine Device(66ANM), Medical Termination ofPregnancy(MTP) Training (24 MO), Integrated Management of Neonatal andChildhood Illnesses(IMNCI) ToT (10 MOs), IMNCI orientation (36 MOs), IMNCITraining, (79 MOs), Emergency Obstetrics Care(EmOC) master Trainer- 1 (SuratMedical College), Advocacy training for PRI (1000) were conducted during 2006-08.IUD ToT (2) IMNCI Staff Nurse (120), MTP MOs (20), Life SavingAneasthesia MOs (2) , EMoC MO (2), RI GNM(20) , RI ANM(45),PDC MO (13),were conducted during 2008-09 (upto Dec’08)Training of Medical Officers in SBA, IMNCI and RTI/STI and of ASHA wasconducted during the year. The other training Activities proposed during the yearcould not be taken up due to non availability of Fund. However, most of theremaining Activities proposed will be taken up in this year.Accredited Social Health Activist (ASHA)Already 2495/3862 ASHAs completed training in different districts forintroduction 1 st module, 729 ASHAs completed in all the modules. Drug kits alreadyprovided to 11161ASHAs along ASHA diary. ASHAs will be provided drug kits alongwith Apron and ASHA bag during the year. The training is continuing at present. Formaking the ASHA training successful, the help from the reputed NGOs has beensought for. The managing of the ASHA training has been outsourced to the NGOSand the Resource Persons are from among the trained persons from HealthDepartment, PHED. SWWCD, NGOs and GA. The quality of the training ismonitored by the senior level state / district NRHM officials.The selected ASHAs are working as catalyst for community mobilization, which onlycan result the true success of NRHM. She will be promoter of good health practicesand will provide a minimum package of curative care as appropriate and feasible forthat level and making timely referrals.Sl.NoName oftheDistrictTotal No. of ASHANo. of ASHA Trained inPrototype Module and DrugKit.Proposed Selected M-I M-II M-IIIM-IVDrugKitNGOentrustedwith thetraining.1 Tawang 189 186 189 1892 WestKameng2152001843 EastKameng28816125 18VoluntaryHealthAssociationof India55

4 UpperSubansiri3984244105 LowerSubansiri2162552446 KurungKumey4712221877 Papum274Pare296222 222 222 222 1218 East Siang 132 132 132 132 132 132 1329 West399Siang399375 375 375 375 37510 Upper76Siang9584 8411 DibangValley1111053012 LowerDibang 12768Valley13013 Lohit 225 205 7214 Anjaw 281 214 188 18815 Tirap15654 54(VHAI)VHAAPNani SalaFoundation(NSF)15516 Changlang 304 208 31 0 VHAAPTotal 3862 3387 2495 729 729 729 1161District Health Action Plan (DHAP) / State PIPAll 16 districts have submitted the DHAP for the year 2009-2010.Sub Centre functionalizationThe most difficult task of all is making the SCs functional. It is beingtried again and again that the ANMs are posted and are actually in position at the SClevel. Relocation / posting of ANMs have been initiated and so far there has beenincrease in the number of functional SCs to 162 as against 103 during the last year.10 new SC building were constructed during 2006-07 and 40 SCs is beingupgraded during 2007-08 out of approved 50 SCs. However, the requirement iscontinually high but implementation has been proposed in few select SCs as persurvey report.PHCThere are 55 PHCs providing required services at present (16 are run byNGOs under PPP) by either by infrastructural upgradation or manpower relocation.During 2007-08, 5 PHCs were been upgraded. Provision of quarters (n=20) providedto 12 PHCs during 2007-08.56

Following are the list of PHCs who are providing primary health careservices.Sl Institution DistrictRun by NGOs1 Lumla Tawang2 Thrizino West Kameng3 Bameng East Kameng4 Mengio Papum Pare5 Deed Neelam Lower Subansiri6 Sangram Kurung Kumey7 Nacho Upper Subansiri8 Gensi West Siang9 Sille East Siang10 Jeying Upper Siang11 Dambuk Lower Dibang Valley12 Etalin Dibang Valley13 Wakro Lohit14 Walong Anjaw15 Khimyong Changlang16 Wakka TirapGovt. run17 Jang Tawang18 Bhalukpong West Kameng19 Sinchung West Kameng20 Nafra West Kameng21 Seijosa East Kameng22 P/Kessang East Kameng23 Balijan Papum Pare24 Leporiang Papum Pare25 Basar Nallah Papum Pare26 Yazali Lower Subansiri27 Yachuli Lower Subansiri28 Raga Lower Subansiri29 Taliha Upper Subansiri30 Maro Upper Subansiri31 Liromoba West Siang32 Kaying West Siang33 Tirbin West Siang34 Supple East Siang35 Yembung East Siang36 Borguli East Siang37 Bilat East Siang38 Koyu East Siang39 Nari East Siang40 Telam East Siang41 Geku Upper Siang42 Anpum LDV43 Hunli LDV57

Functionalizing DH44 Lathao Lohit45 Piyong Lohit46 Mahadevpur Lohit47 Innao Changlang48 Diyun Changlang49 Karsang Changlang50 Nampong Changlang51 Laju Tirap52 Kanubari Tirap53 Parsi Parlo K/Kumey54 Loilang Lohit55 Dollungmukh L/SubansiriThere are 10 GH/DH in the state out of 14 GH/DH are functioning as FRU.Two MO each in EmOC & LSAS have been trained and are placed in the aboveDistrict Hospitals. Further one MO are currently under going training on Anaesthesiaat Assam Medical College, Dibrugarh under multi skilling and one Mo undergoing inEmOC at Gauhati Medical College.The plan is to relocate them to the identified DH(District Hospital Khonsa) after completion. The activities under DH upgradation aregoing on in all the District Hospitals focusing mainly on maternal and Child Healthcomponent.58

Name ofworkConstructionof Sub-Centre(attachedwith ANMQuarter)Name ofDistrictsTawangWestKamengSl.No.Location/IdentifiedHealthcentre/HospitalSTATUS OF CIVIL WORKSRate Year ofSanctionSanctionedamountExpenditure tilldateStatus(Physicalprogress in%)1 Rho village900,000.00 100%900,000.00900,000.002007-082 Lhou village900,000.00 100%900,000.00 900,000.003 Seru village 900,000.00 2008-09 900,000.00 900,000.00 30%1 Jamiri SC 900,000.00 2007-08 900,000.00 900,000.00 100%RemarksEastKameng1 Jayeng Bagang SC 900,000.00 2008-09 900,000.00 900,000.00 100%Papumpare1 Ompuli SC 900,000.00 NA 900,000.00 900,000.00 100%2 Rillo SCNA900,000.00 100%900,000.00900,000.003 Mabiaso SCNA900,000.00 100%900,000.00900,000.004 Toru SC900,000.002006-07900,000.00600,000.00 100%KurungKumey1 O-point SC2 Sango SC3 Meer SC900,000.002007-08900,000.00900,000.00 900,000.002008-09900,000.00900,000.00900,000.00 100%900,000.00 100%NA 50%LowerSubansiri1 Pania SC900,000.002007-08900,000.00900,000.00 100%59

2 Kamporijo SC3 Ambam SC900,000.00 900,000.002007-08900,000.00900,000.00900,000.00 100%900,000.00 100%UpperSubansiri1 Bui SC2 Panimuri SC900,000.00900,000.00NA2008-09900,000.00900,000.00900,000.00 100%400,339.00 100%East Siang1 Namsing SC2 Parong SC3 Riga SC4 Pareng SC900,000.00900,000.002007-08900,000.00900,000.00900,000.00 900,000.002008-09900,000.00900,000.00899,182.00 100%899,927.00 100%899,956.00 100%NA 50%West Siang1 Bam SC2 Yigi SC3 Jirdin SC4 Pagi SC900,000.00900,000.00900,000.00900,000.00NANANANA900,000.00900,000.00900,000.00900,000.00NA 100%NA 80%NA 95%NA NAUpper Siang 1 Katan SC900,000.00NA900,000.00900,000.00 100%LowerDibangValley1 Rukmo SC2007-08900,000.00 100%900,000.00900,000.002 Abali SC 2007-08 900,000.00 100%60

900,000.00 900,000.00DibangValley1 Arjoo SC 900,000.00NA2900,000.00NANA900,000.00900,000.00900,000.00 100%900,000.00 NALohit1 Sitapani Miri SC 900,000.002007-08900,000.002 Nongkhong SC 900,000.00 900,000.003 Tillai SC 900,000.002008-09900,000.004 Danglat SC 900,000.00 900,000.00900,000.00900,000.00900,000.00900,000.00100%100%Anjaw 1 Halaikrong SC 900,000.002007-08900,000.00900,000.00 100%Changlang1 Kengkhu SC 900,000.00900,000.002 Modoi SC 900,000.002008-09900,000.003 Balupathar SC 900,000.00 900,000.00NANANA35%Tirap1 Pumao SC 900,000.002 Makat SC 900,000.00NA2007-08900,000.00900,000.00NA NANA 50%TOTAL (RS) 16 40 36,000,000.00Upradation of West 1 Bana PHC 1,400,000.00 2008-09 1,400,000.00 NA 50%61

PHCTOTAL (RS)KamengPapumpare 2 Mengio PHC 1,400,000.00 NA 1,400,000.00 NA 100%Kurung1,400,000.00 2007-08 1,400,000.00100%Kumey 3 Pasi- Parlo PHC1,399,812.00Upper Siang 4 Jeying PHC 1,400,000.00 NA 1,400,000.00 NA 100%Changlang 5 Khimiyong PHC 1,400,000.00 NA 1,400,000.00 1,400,000.00 100%5 57,000,000.00Constructionof PHCQuarterEastKameng1Bameng PHC (2units) 600,000.002008-091,200,000.00 NA 70%2 Bana PHC 600,000.00 600,000.00 NA 50%Papumpare 3 Taraso PHC (2 units) 600,000.00 NA 1,200,000.00 NA 70%KurungKumey 4 Chambang PHC 600,000.00 2008-09 600,000.00 NA NALowerSubansiri 5 Dollungmukh PHC 600,000.00 2008-09 600,000.00 NA 100%East Siang 6 Riga PHC 600,000.00 2007-08 600,000.00 NA 10%West Siang7 Daring PHC 600,000.00 NA 600,000.00 NA 60%8 Pobdi PHC 600,000.00 NA 600,000.00 NA 70%Changlang 9 Diyun PHC (2 units) 600,000.00 NA 1,200,000.00 NA 100%62

Public Private Partnership (PPP) for PHCsThe PPP project has been the most successful initiative undertaken by the stateunder NRHM Program. The MoU was signed between the state and 4 NGOsnamely; Voluntary Health Association of India, Karuna Trust, JAC Prayas and FutureGenerations Arunachal. The management of 1 PHC each, namely; Wakro PHC andSille PHC respectively. PPP Project was approved by GoI in September 2005 andOperationalised in January 2006 by Involving NGOs of National repute in HealthService delivery in Arunachal Pradesh.To functionalise remote 16 PHCs ofArunachal Pradesh and to deliver quality Primary Health Care Services, the proposalwas met.Management of 9 PHCs have been given to Karuna Trust, namely; BamengPHC, Mengio PHC, Sangram PHC, Jeying PHC, Anpum PHC, Etalin PHC, WalongPHC, Khimyong PHC and Wakka PHC.Voluntary Health Association of India has been handed over 5 PHCs namely,Lumla PHC, Thrizino PHC, Nacho PHC, Deed Neelam PHC and Gensi PHC.JAC Prayas and Future Generations Arunachal have been handed over theAchievements• Immunization, Institutional Delivery, ANC Coverage, Family planningmethods etc. ANC coverage has increased.• Institutional Delivery has increased.• All the PHCs managed under PPP are now run on 24 x 7 basis.• Minor operations have also been carried out in the OT, Laboratoryservices are also being performed with facilities for pathological &biochemical investigations, like tests for malaria,TB etc.• The project has also contributed in family planning services to peoplefor use of any kind of contraception.• Many outreach activities and Health Melas have been conducted.• RKS/PHC management committees have been constituted andfunctioning well.• All the SCs under PPP PHCs are functional are now functional.• Awarded best state for PPP by GoI in 2007.• VHSC and VHND are functional in all the villages falling under PPPPHC area.Mobile Medical Unit(MMU)The Mobile Medical Unit Scheme is being implemented in the state. The MMUconsists of 3 vehicles housing medical personnel, Laboratory Equipments andDiagnostics Equipments. The MMU I, II & III are given to all the 16 districts.63

MMU Activity Report of Arunachal Pradesh (April to December’ 2008)Sl.No Name of the District Month Patients Place.treated1 West Siang April’08 105 Nikte2 East Siang June’08 624 Riew, Pankang, Parong,Beiung3 Lower Dibang Valley April’08 340 Bishmaknagar,Balani,Katmadu,Denio, Doleshwar,RukmoMay’08 303 Malek & GergomBasti,Abali,Chidu,RukmoJune’08 381 Bishmaknagar, Roing TeaEstate,Balek, BalaniJuly’08 321 Holokbari,10Km, Baksek/TaparSept’08 434 Paglam, Bango, Keba-Tanali,Kaling-I & II4 Changlang April’08 DNA BordumsaMay’08 DNA BordumsaJune’08 DNA Manmao.Khimiyang,NamtokJuly’08 DNA Yatdam,Namphai,Innao5 Anjaw April’08 81 AmliangJune 39 Bomna School & MetengliangJuly 48 PayeAugust 44 Quibang SCSept’08 35 Bomna & Metengliang6 Tirap Sept’08 DNA Wakka PHCOct’08 199 Lamsa SCNov’08 305 Pongchou PHCDec’08 279 PumaoSCState Convergence Committee:Constituted and notified on 31-10-2006 and during ASHA review meeting, theconvergence activities were reviewed. Even though committee is constituted, theactivity has been minimal.NPCC Approval under NRHM 2008-09Sl.No.ComponentsAmountproposed inSPIPAmountApprovedby NPCC1 RCH 1428.34 1318.332 Mission Flexipool 1509.271 1679.393 Immunization 221.05 219.8564

4 RNTCP 211.27 180.945 NLEP 230.87 82.736 IDSP 341.00 50.217 NIDDCP 103.82 40.008 NPCB 229.35 299.909 NVBDCP 1284.60 1284.6010 Infrastructure679.64 679.64Maintenance (TreasuryTransfer)Total 6239.21 5835.59RCH outcome and service utilizationThe Maternal Health, Child Health, Family Planning and ARSH are addressedin the situational analysis. However, the performance during the year is as below:Performance IndicatorsAchievement05-06 06-07 07-08 08-09(Apr’08 toDec’08Maternal HealthANC Registered 18753 20835 17978 15106ANC 3 check-ups 7607 8757 4816 3872TT2+Booster 11626 13389 8826 7414IFA 4794 5797 19451 15106Institutional Deliveries 8594 8342 8003 7356JSY beneficiries 1433 7689 7782RTI/STI 2583 392 2999 3181MTP 1481 1475 888 646Child HealthImmunization(Infant 0-1 year)BCG 20574 21428 16446 13828DPT(3 rd dose) 15230 20778 13193 10775OPV (3 rd dose) 15501 20987 13389 11014Measles. 24406 19373 14006 12707Childhood diseasesDiarrhea and dehydration 11017 8620 12776 16035Measles 215 311 1793 2326Pertussis 0 176 76 92Family PlanningMale Sterilization 5 12 34 26Female sterilization 1988 1934 2277 2847IUDs 2927 3110 2523 1350Oral Pills 18688 21273 16347 12245Condom 62384 74039 48164 19460Number of ASHA Selected 1615 1228 310 234Village Health & Nutrition Day (VHND)held28 318 20465

5.2. Lessons learnt:-1. The HRD policy has been changed and decentralized down to DistrictHealth Society level for technical staff. The decentralization would facilitaterecruitment and posting of manpower as per the local need. ToR of all categories ofstaff and recruitment norms along with appraisal norms have been forwarded to theDistrict Health Societies.However, due to non-availability of doctors at the district and subdistrictlevels, the recruitment of MOs and Specialists will be undertaken centrally atthe Mission Directorate.2. The PPP for running PHCs by NGOs has been a success intervention. Themonthly reports shows that the performance has been very good and quality healthcare services are delivered. Therefore, the PPP model may be continued and maybe replicated to some more PHCs or even to CHCs.GoI may consider continuationand if acceptable similar model may be replicated to CHCs even though it takesaway major chunk of RCH funding. External evaluation by RRC- NE has beencompleted and the report is evaluated.3. It has been experienced during the last year that intimation regardingconduct of multi skilling training for MOs is often received by the State belatedly. It istherefore suggested that such trainings may be intimated at least 20 days earlier sothat necessary arrangements can be done well in advance.4. It has further been experienced that training programmes are conducted bythe Ministry of Health & Family Welfare, Govt. of India at different places at theCentral level which are often not in congruence with the training plan enshrined inthe State PIP. It amounts to execution of training plan framed by the Ministry and notthe one proposed by the State in its PIP. This may be clarified.5. Based on the experience of the last two years of NRHM period, it isstrongly felt that adequate training needs to be imparted to the current SPMSU &DPMSU staff to enhance their technical skills. This is more relevant in the case ofthe District Programme Managers (DPM) who have not been at par with theexpected level of performance due to recruitment of under-qualified candidates. Dueto non-availability of full fledged MBAs, even BBAs were selected by the SCOVA,which speaks for the imperative need to train them in skill development.6. The implementation of JSY scheme during the last year was severelyhampered due to lack of fund for the purpose. While other states were providedspecific fund for JSY, Arunachal Pradesh was asked to meet the expenses fromRCH-II flexible pool fund which was not sufficient even for recurring programmemanagement expenses and other approved technical activities.7. The State’s population being highly dispersed far and wide in inaccessibleareas with linguistic and ethnic diversity of the people having different socioeconomicbackgrounds, it was focused on developing district wise and communityand tribe specific activities which can be adaptable by the tribal people.8. Due to shortage of IEC personnel in the districts, IEC activities could not beimplemented as desired in the peripheral level. Therefore, additional manpower inthe districts will be required to implement the IEC activities and to translate theobjectives into reality.9. Lack of awareness regarding different health care services were thecontinuing problems among the people in the state. Therefore, IEC activities havebeen implemented through various print and electronic media to bring awarenessgeneration among the people in the state. Print advertisement containing essential66

RCH/FW messages have been published in the local newspaper and magazine forwider publicity in the state. Outdoor publicity campaign has been implemented in allthe districts as per the requirement of the people based on local needs. Fund werereleased to district health society for group meeting, IPC campaign, FGD, healthcamp, health mela, folk song, plays and dramas, exhibition, film shows, advocacyprogramme and school programme to disseminate RCH and its services to thepeople especially emphasized on maternal health, child health, family planning andadolescent health. Radio jingles were broadcast in eleven local dialects through fiveAIR stations including FM Radio Oo..la..la at Itanagar. Two health camps weresuccessfully conducted in the district. Descriptive Health Chart Board on JSY wereprocured and distributed to all the districts as a part of innovative IEC/BCC campaignin the state.10. Fund was utilized as per the State Programme Implementation Plan(SPIP) and more strategies will be focused as per need during this financial year foreffective implementation of IEC/BCC in the state.11. A State HMIS Cell is already created, where every Data related toProgram is being maintained. Reports and returns received from the districts arecompiled and analyzed. Now almost all the districts are well acquainted with thesystem. With the existing capacity, including availability of staff, the system is in thetrend of improvement. Now, almost all the health facilities of the state are wellprovided with the new MIES reporting formats. As online reporting cannot beensured from the sub district level, manual reporting is in place. However, regularand quality reporting from the sub centre level has always been an accept ion due tolack of proper communication facilities.12. The web based HMIS portal launched by the GoI has been initiated by thestate at the state headquarter level and shall continue. During the year, Nodal Officer(NRHM) and Consultant (HMIS) have been oriented on the HMIS Web portal. Twodays orientation has also been given to the DPMSU with technical support fromNHSRC. The system of Feedback is not yet in place which is a major drawback inthe system. However, the state shall introduce.5.3 Programme ManagementProgramme Management Cost:During the financial year 2007-08, the programme cost inevitably overran to nearly11-12% of the total allocation which overshot the prescribed ceiling of 6%. Due tomeager amount of allocation to the State of Arunachal Pradesh vis-à-vis other biggerstates, the 6% prescription for management cost is not sufficient to meet therecurring expenses under programme management. The Ministry may considerexemption for the state from this prescription and increases the cap to 12% of thetotal allocation.Reasons for the underutilization of fund during the financial year 2008-09:• The State Health Society received bulk of its allocated fund pertaining to the year2007-08 amounting to Rs. 18 Crores during the financial year 2008-09, on 9 th &11 th April.• Due to unprecedented rainfall during monsoon last year, most of the districtsremained cut off by road communication for as many as 7 months at a stretch,67

thereby hampering the execution of approved civil works in which bulk of theNRHM funds were tied up.• Utilisation of RKS funds at the sub-district level was low due to ignorance aboutthe guidelines regarding utilization of fund.• There was some delay in the execution of the MMU scheme due to belatedsupply of the vehicles by the suppliers and implementation of MMU services hasbeen hampered due to lack of driver and other technical manpower.• Dispite all constraints related to late receipt of fund, the fund utilization is about80%.68

CHAPTERVIRCH II PROGRAMME OBJECTIVE AND STRATIGIESPart A: RCH ProgrammeRCH II Programme objectives and strategies6.2.1. Maternal HealthObjective: Providing adequate client friendly Maternal Health ServicesStrategy 1: To make adequate infrastructure, manpower and resources tofunctionalize additional 3 DHs as FRU.6.2.1.1. Operationalise facilities (details of infrastructure & human resources,training, IEC/BCC, equipment, drugs and supplies in sections 9, 11, 12 and 13)6.2.1.1.1 Operationalise DHs as FRUsThere are 14 District Hospitals and 44 CHCs (31 functional) in the state andout of which, 2 GHs are fully functional as FRUs and 8 DHs and one CHC arepartially functional as FRU. However, blood bank is in position in 2 DH/GH and bloodstorage in one FRU. The blood bank infrastructure in 8 DHs has already beeninspected by GoI and the state is waiting for certification. Although, 2 DH (Tawangand Bomdila) are providing comprehensive obstetrics services, there is noanaesthetist but it is managed by MO trained in Anaesthesia for 6 months. However,properly trained manpower (LSAS / PG degree) MO is required.The status of existing FRUs is as below:District Manpower availability Blood bankObstetrician Anaesthetist PaediatricianTawang yes NA By MO InspectedBomdila Yes NA By MO DoNaharlagun Yes Yes Yes YesZiro Yes Yes Yes InspectedDaporijo Yes Yes Yes, Med Spl InspectedAalo Yes Yes Yes, Med Spl InspectedYingkiong Yes Yes Yes, Med Spl InspectedPasighat Yes Yes Yes YesRoing Yes Yes(LSAS) Yes InspectedTezu Yes Yes(LSAS) By MO InspectedRuksin CHC Yes Yes By MO Blood storage69

6.2.1.1.1.1 Organise dissemination workshops for FRU guidelinesAlready done.6.2.1.1.1.2 Prepare plan for operationalisation across districts (including staffing,infrastructure, training, equipment, drugs & supplies, etc.)Upgradation of these facilities have been completed in 4 DH as on datethrough DH upgradation under NRHM and all the facilities have good labourroom and operation theatre. However, due to absence of adequate requiredmanpower, only 10 DH / GH and 1 CHC are functioning as FRU. For thisyear, the state proposes to operationalize 3 additional DH, one at Seppa,Changlang and Khonsa. The plan for manpower placement is:1. Seppa DH: EmOC trained MO is already in place and the plan is to trainone MO in LSAS during the year.2. Changlang DH: One MO in EmOC and one MO in LSAS will be trainedduring the year 2009-10.3. Khonsa DH: Already one MO each are undergoing training at GMC,Guwahati and AMC Dibrugarh respectively in EmOC and LSAS. Oncompletion, they will functionalise this DH during the year.4. In addition to the above, one MO each for DH – Tawang and Bomdila willbe trained during the year.Seventeen (17) additional SNs will be placed in the identified DHs during theyear for which fund is proposed under NRHM additionalities..Training component is addressed in Training plan. Drug requirement underRCH has already been placed to GoI for supply in kinds.The newborn carecorner will be installed in all the FRUs (14). Details are available under ChildHealth component.6.2.1.1.1.3 Monitor progress against plan; follow up with training, procurement, etcThe progress of the plan will be monitored by SPMSU, DPMSU and themonitoring team existing in the state and districts.6.2.1.1.1.4 Monitor quality of service delivery and utilisation including through fieldvisits.The quality issue will be monitored by quality assurance committee at stateand districts level on quarterly basis.Strategy 2: To make adequate infrastructure, manpower and resources tofunctionalize additional 10 PHC as 24x7.6.2.1.1.2 Operationalise PHCs to provide 24-hour services6.2.1.1.2.1 Prepare plan for operationalisation across districts (including staffing,infrastructure, training, equipment, drugs & supplies, etc.)There are 85 PHCs in the state out of which 55 are providing requiredservices. Even though 55 are functional, only 28 PHCs are having labour room, butrequires additional repairment. Ony 10 PHCs are having manpower requirement andservices as per 24x7 PHCs..70

It is proposed to functionalise 10 more PHCs to 24x7 during this year byproviding / improving staff, labour room, newborn care corner and also required skillupgradation training.A) Staff: - Requirement of MOs is projected under NRHM additionalitiesand they will be posted in identified PHCs only.- 8 new additional staff nurses will be recruited from RCH II as 52 SNsare already in place which will continue @ Rs 7500/ per month.- Additonal 10 Lab. Tech. will be recruited to provide laboratory servicesin the proposed 10 additonal 24x7 PHCs. Out of the existing 20 nos. ofLab. Technician, 10 are in PHCs and rest are in CHC / DH and willcontinue. The monthly renumeration will be Rs. 6000/- per month.B) Infrastructure: - As majority of the PHCs are having labour roombut not as per the standard and therefore, it is proposed to repair/renovate/extend identified 20 Labour rooms @ Rs. 200000/- perfacility.Provision of 20 generators are proposed for 20 nos. 24x7 PHCs @ Rs2 lakhs per set and the shed plus the required maintenance and PoLwill be borne from RKS fund.C) Equipment: - All the identified PHCs are having good/working labourtable and suction machine. The additional requirements are:-- Delivery kit – 8 nos.@ Rs.9, 900/-D) Drugs & Supplies: - GoI may provide drug kit in kinds as per therequirement lists already provided.6.2.1.1.2.2 Monitor progress against plan; follow up with training, procurement,etc.The progess will be monitored regularly by SPMSU, DPMSU and themonitoring committee already in place.6.2.1.1.2.3 Monitor quality of service delivery and utilisation including through fieldvisits.The quality assurance committee at the district level and state for maternaland child health including sterilization will monitor the service delivery at all level.The visit will be done every month on routine basis.6.2.1.1.3 Operationalise MTP services at health facilities6.2.1.1.3.1 Prepare plan for operationalisation across districts (including training,equipment, drugs & supplies, etc.)- MTP services are provided effectively in 14 DHs and 1 CHC. In addition tothis, 10 PHCs (24x7) and 20 CHCs haveMTP trained MOs. Therefore, it isproposed to further strengthen this 30 health facilities for which MVA will be71

provided to 30 Health facilities (PHCs and CHCs) @10 nos. @Rs.1500/- perset where MTP trained doctors are posted.- MTP set numbering 30 will be procured @1 set per facility @Rs.3000/- per setand placed to the identified PHCs and CHCs.- In addition, it is proposed to train 10 more MOs (24x7 PHCs) during the year.The training proposal is addressed in training plan.6.2.1.1.3.2 Monitor progress against plan; follow up with training, procurement, etcThe progress will be monitored by state and district program management unitand the monitoring team in place.6.2.1.1.3.3 Monitor quality of service delivery and utilisation including through fieldvisits.The quality of the training is monitored by quality assurance committee and also bythe team lead by program officer (Training) at the state level.6.2.1.1.4 Operationalise RTI/STI services at health facilities6.2.1.1.4.1 Prepare plan for operationalisation across districts (including training,equipment, drugs & supplies, etc.)The RTI/STI facilities are provided in 14 DHs, 30 CHCs and 55 PHCs but notas per norms. The services at DH level is taken care of by APSACs and it isproposed to impove the PHCs and CHCs numbering 20 PHCs and 30 CHCs.Training is addressed under training component and equipment required is 50Binocular Microscope only @Rs. 40,000/-. The drug kit will be provided to all theidentified facilities in kinds by GoI.6.2.1.1.4.2 Monitor progress against plan; follow up with training, procurement, etcThe progress will be monitored by state and district program management unitand the monitoring team in place6.2.1.1.4.3 Monitor quality of service delivery and utilisation including through fieldvisits.The quality of the training is monitored by quality assurance committee andalso by the team lead by program officer (Training) at the state level.Strategy 3: To functionalize 50 Sub Centres to provide ANC and PNC services.6.2.1.1.5 Operationalise sub-centres6.2.1.1.5.1 Prepare plan for operationalising services at sub-centres (for a range ofRCH services including antenatal care and post natal care)There are 381 nos. of Sub-Centres out of which 162 are functional with ANMand 111 with other paramedics. The state has 381 sub centre building but only 40SC buildings are with ANM quarter and the rest doesnot have any accommodationfacility. 122 extensions will be provided in the existing functional Sub-Centres wherethere is no Quarter for ANM. The proposal is made under NRHM additionalities.Also it is proposed to functionalise 50 more Sub-Centres by providing requiredANM by relocation and by extension of new SC buildings.The exisiting 118 ANMs will continue under RCH II. All the ANMs will providedaily ANC to the pregnant mothers and also PNC to the post partum mothers.72

Further, ASHAs / AWW will identify pregnant women and motivate them for earlyregistration and to undergo at least 3 ANCs.Post partum visits will be ensured and will be provided by ANMs. ASHA willbe mobilized for identifying / mobilizing the post partum women.The functional SCs will provide services mainly related to maternal health,child health and family planning and other activities.6.2.1.1.5.2 Monitor quality of service delivery and utilisation including through fieldvisitsThe quality of the service delivery and provisions at SC level will be monitoredby quality assurance committee and also by the SPMSU, DPMSU, RKS and VHSCof the SC area.Strategy 4: To ensure the provision of referral transport to sick mothers.6.2.1.2 Referral Transport6.2.1.2.1 Prepare and disseminate guidelines for referral transport for pregnantwomen and sick newborns / childrenAdequate transport facilities are not available even in the private sector. Thismakes the beneficiaries to avoid or delay in accessing health facilities thereby riskingmortality. Guidelines / protocol for referral transport for transporting pregnantwomen, sick new-born and children will be provided by the state to the district andfacilities for adoption. The BPL / SC/ST beneficiaries would be transported free ofcost from their residence to the nearest health facility or to the health institutions ifreferred from that institution and back. The cost involved for such transport will bewithin the estimated rate of Rs 700/ per transportation.Provision of mobility support for expectant mothers, sick new born andchildren @ Rs.700 per case are to be ensured in the state taking in to considerationthe difficult terrain of the state. The above provision may be used for PoL or paid tothe beneficiaries on production of cash memos. If the government vehicles areavailable in the institutions, those vehicles will be utilized for the purpose and fuel willbe met from Rs 700/- per case from referral transport. An estimated 1800beneficiaries (900 sick mother + 900 sick children) will be provided referral transportfacility.6.2.1.2.2 Implementation by districtsImplementation of the activity will be at facility level and the state PMSU,DPMSU, BPMSU and RKS will monitor the progress of the implementation of referraltransport as proposed.Strategy 5: To make adequate provision of health care services in the outreach areas.6.2.1.3 Integrated outreach RCH services6.2.1.3.1. RCH camp in unserved/underserved areas.6.2.1.3.1.1 Implementation by districts of RCH camps in Un-served/under-servedareas.73

Outreach RCH camps are essential component as per as the state isconcerned considering the difficult geographical lay-out, difficult terrains, scatteredinstitutions and low health seeking BehaviorRCH camps will be organized in all the 16 districts. One such camp will beconducted in each district every quarter. The services like Immunization services,FW activities, IEC activities etc will be provided during these camps. The mobilemedical unit (MMU) will also be a part of the RCH Camps with all provisions underMMU wherever functional. Consumables would be provided for this activity.Budget for one RCH camp is as below:Service componentsUnit cost(Rs)1. Medicines 15,0002. Transportation (hiring) 50003. Public announcement / notice etc 10002. Honourarium for staff1 MO:1 Staff Nurse:1 ANM:1 Attendant:20012575504. Documentation 3005. Refreshment 10006. contingencies 250Total 23,000Total fund required for conducting 64 RCH camps shall amount toRs.1472000/-.6.2.1.3.1.2. Monitoring quality of services and utilizationThe outreach camp implementation in all the under served, unserved areas,at the PHC / CHC level and will be closely monitored by the DPMSU and districtmonitoring team.The quality of the camp and utilization of service provided in the camps will bemonitored by state/district monitoring team.Strategy 6: To ensure holding of VHND for providing basic health services at thevillage level.6.2.1.3.2. Monthly Village Health and Nutrition Days at Anganwadi Centers/schools6.2.1.3.2.1. Implimentation by Districts of monthly Village Health & Nutrition DayMonthly Village Health and Nutrition Days at Anganwadi Centers/schools /community building would be organized in all the villages where trained ASHAs arepresent.(n=2495).Due to non functional status of SCs and the need for ANM to attend theVHND it is proposed that the ANM will attend atleast one VHND / month in the SCarea.Village Health & Nutrition Day (VHND) will be organized at the AWCs on aTuesdays once a month. It will be ensured that there will be involvement of village74

Health & Sanitation Committee comprising of ASHA/AWW/ANM/PRI in the VHND.VHND will be observed as per the guideline issued from the GoI. There are certainvillages in the state which are not having AWCs. In such places, VHND will beorganized in the SC/ community hall / a facility identified in the village for thispurpose. ANC registration will be a priority in VHND. Maternal anemia and childhoodanemia will be addressed by providing IFA. Deworming will be a part of the VHND.The contingency expenditure for organizing VHND will be met from VHSCuntied fund and as decided by the VHSC.The VHND activity will comprise of awareness activity on total health,immunization session, providing OCP, condom, anti malaria activity etc and onattendance by ANM, the VHND will provide ANC, PNC IUD insertion etc,6.2.1.3.2.2. Monitor quality of services and utilizationThe quality of the VHND will be monitored by quality assurance committeeand also by the team at VHSC, RKS, block PMSU, DPMSU and SPMSU level.Strategy 7: To provide incentives to mothers for ensuring institutional delivery.6.2.1.4. Janani Suraksha Yojana (JSY)6.2.1.4.1. Dissemination of guidelines to districts and sub distictsJSY guidelines have already been disseminated to all the institutions forstrict implementation.6.2.1.4.2. Implementation of JSY by districtsImplementation of JSY in the state is to be made more effective. There wassome delay in getting the funds and releasing them to the districts in time. So,beneficiaries could not be paid as per the guidelines. Each district has projectedtheir JSY requirements in the DHAP. As per the DHAPs sufficient funds will bedisbursed to the districts in time. Care is taken in providing referral transport underthe scheme. The beneficiaries will be provided transport facility from their residenceto the service delivery facility and back for which provision for transportation will be inall the institutions.Adequate need - based IEC/BCC activities will be instituted right from theDistrict Hospital to the SC level through various means of communication/ tools asappropriate to the people as per needs. Outdoor & rural publicity campaign will beundertaken for the target groups to popularize JSY scheme.1. Target of Institutional deliveries during 2009-10 =11200 beneficiariesJSY benefits to Mother =1400JSY benefits to ASHA = 600Total JSY fund proposed = 11200 benf. X Rs. 2000.00= Rs. 2.24 Crores.(2800 beneficiaries per quarter) @ Rs. 2000/-= 56, 00,000/-2. Target of Home delivery during 2009-10 - 4000 beneficiaries(1000 beneficiaries per quarter)@ Rs. 500/-= 5, 00,000/-75

Targets have been set based on the performance during 2007-08-09 &expected capacity to absorb the case load. The beneficiary under JSY has beencalculated at about 35% of the target set. Additional funds will be requested once thestate is able to achieve record & report performance above 35%. Considering thecase load, the calculations have been made to increase the institutional delivery to35% during the year.The payment to the beneficiaries will be ensured at the time of delivery to themother in the institution. Referral package will be made as per guidelines. MOICs ofHealth centres will be the Nodal person for Grievance redressal. Also thebeneficiaries outside the PHC/CHC etc. will be instituted for ensuring better healthcare facilities and transparency and for facilitating grievance redressal. Two daysstay after delivery in the hospital will be implemented in all the health centres toensure safety of the mother and new born child.Proper documentation and updated records on JSY will be maintained andtimely submission of JSY reports will be adhered while implementing the schemeduring the year.6.2.1.4.3. Monitor quality and utilization of servicesQuality and utilization of services will be monitored by the monitoringcommittees at quarterly basis.6.2.1.5. Other strategies/activitiesSensitization & community awareness generation are other areaswhich are considered for better implementation of JSY. This in turn will generatedemand from the community for services and incentives. This component isaddressed in BCC component. As the Medical Officers (MOs) are not fully awareabout the need of using JSY card, Immunization card against each fund release toJSY beneficiary so the Doctors will be trained in detail on JSY scheme. Adequateneed-based IEC activity will be initiated at all level so as to popularize JSY amongthe masses. Three zonal level training on JSY will be imparted to all the MedicalOfficers (MOs) to orient them on JSY. After imparting training to Medical Officers(MOs), on the basis of average delivery load for each institution, the JSY fund will bereleased to all the peripheral level. Close monitoring in the form of verification of JSYbeneficiaries will be undertaken to know quality of implementation. Sufficientnumbers of JSY cards, Immunization cards will be made available upto the Sub-Centre level. Dissemination on JSY messages will be undertaken through IPCcampaign, Focus Group Discussion, Electronic and print media and through variousoutdoor and rural publicity campaigns in the state.76

6.2.2 CHILD HEALTHObjective: To bring down the IMR from 61 (NFHS-III) to

training school is in operation. The IMNCI activities will be incorporated in theteaching curriculum of the existing ANM School at Pasighat and GNM school atItanagar run by RKM.Other activities are regular ANC (addressed in MH), IFA supplementation andadvice on supplementary food to pregnant women and improved child feedingpractices like exclusive breast feeding, timely weaning and immunization will beimplemented.Strategy 2: To ensure the availability of adequate equipments and trained manpowerfor providing newborn care services.6.2.2.2. Facility Based Newborn Care /FBNC (details of training drugs andsupplies, under saection 11 & 13)6.2.2.2.1 Prepare and disseminate guidelines for FBNCGuidelines along with the NBCC kits will be made available to selected 14 DH/ GH and 20 PHCs (24x7)6.2.2.2.2 Prepare detailed operational plan for FBNC across districts (includingtraining, BCC/IEC, drugs and supplies etc)Newborn Care Corner will be installed in 14 DH / GH and 20 PHCs (24x7). Allthe 14 DHs have either Obstetrician or Paediatrician to operationalize the newborncare corner. Therefore, training will be imparted to the MOs and SNs of the 20selected 24x7 PHCs.6.2.2.2.3 Implementation of FBNC activities in districtsThe MOi/c of the PHCs and the Paediatrician / Obstetrician will be the nodalofficer for implementing the NBCC in the districts.6.2.2.2.4 Monitor progress against plan; follow up with training, procurement etc.The monitoring committee and the quality assurance committee will monitorthe progress and quality of the NBCC services.Strategy 3: To enhance the skill of identified mothers regarding home based neonatalcare through ASHA, MSS members and AWW.6.2.2.3 Home Based New Born Care/HBNC(details of training drugs andsupplies,under section 11 & 13)6.2.2.3.1 Prepare and disseminate guidelines for HBNCAs a part of ASHA training course, importance of exclusive breast feeding,usage of ORS etc will be imparted.6.2.2.3.2 Prepare detailed operational plan for HBNC across districts (includingtraining, BCC/IEC, drugs and supplies etc)- At the village level, ORS will be made available with all the trained ASHA. TheASHAs will motivate and provide counseling to the use of ORS during78

diarrhoeal episode at the household level during their house visits. Also theimportance of use of ORS will be highlighted during the VHNDs.- Exclusive breast feeding upto 5 months is 60% (NFHS III). Further, in order toincrease the percentage of exclusive breast feeding, it will be ensured that theASHAs during their home visits will counsel the mothers about the advantageof exclusive breast feeding. The MSS and AWW will also be involved in thisactivity. During VHNDs, the importance of exclusive breast feeding will behighlighted. Further, ANM will also counsel the mothers about exclusivebreast feeding during her routine house visits and also at the health facility.- In RCH camp / health camp, focus will be given for providing importance ofexclusive breast feeding, for which a specific stall with all IEC materials willbe installed.- The BCC / IEC plan is provided under BCC/ IEC component.6.2.2.3.3 Implementation of HBNC activities in districts6.2.2.3.4 Monitor progress against plan; follow up with training, procurement etc.Monitoring of the activities will be undertaken by SPMSU, DPMSU and themonitoring committee of ditrict level.Strategy 4: To generate health awareness amongst the students of identified schoolsthrough organizing health camps.6.2.2.4. School Health Programme6.2.2.4.1. Prepare and disseminate guideline for school health programmeThe school health service is a personal health service, which is an economicaland powerful means of reaching student community health this should be almost thelevel of knowledge except in curative care of what any community health workerwould provide. The children can be encouraged to disseminate such information inthe community and in families. Every child has a right to preventive promotive andcurative health care services and in addition vulnerable families require support forchild care.Health education in the form a part of the routine life of the school contribution tothe development of a right attitude among children towards health and to theinculcation of good health habits in them. Early detection of health related problemsthat are commonly occurring amongst primary school children and building of healthawareness in the community through primary school children.It is proposed to undertake school health program in pilot basis for which 3schools per CHC area will be identified to promote school health program. Therefore,total schools that will implement school health program is 63 (31 CHCsx3 schools)6.2.2.4.2. Prepare detailed operational plan for school health programmes.1. State official/ district level to visit a government school in the area to make acomprehensive assessment of healthy life.79

2. Design a school health card which can be use for every student and aconsolidation form so that it can have an assessment of the schools health ata glance.3. A school responds to report of an outbreak of diseases in the village wherethe school is situated and ensure service delivery to all the school.4. A bi-annual health checks with follow up and remedial action on illnessesidentified and at least one annual checkup on dental and eye/ear.6.2.2.4.3. Implementation of school health programme in the state1 Counseling, inter-personal communication and FGD so that find their problemin a better way.2 Help children to learn health needs at particular age by organizing quizcompetition/debate, role play/dramatization, drawing competition & visualizinga video shows/short films which all base on health issues.3 Organizing of health camp by providing a health check-up and free distributionof medicines and vaccine.The MO i/c of the respective CHC area will be acting as a nodal person inimplementing school health programme. Dy. MEIO/DEE will also be involved in theschool health programme. Regular reports and returns will be managed by Dy.MEIO/DEE in consultation with DRCHO/DMO.Budgetary requirement: - 126 health camps @ Rs. 5000/- per campIEC material @ Rs. 3000/- per camp6.2.2.4.4 Monitoring progress and quality of services.The importance in monitoring is to be able to know at the school progress thatchildren are making in relation to each other towards the goals of reduction in healthcare like water borne disease, universal access to safe drinking water and sanitation,malaria, dental, eye, Aids, TB, Leprosy, STI/RTI, Immunization and Adolescent.6.2.2.5 Infant and Young Child Feeding/IYCF (details of training, drugsand supplies, under sections 11 and 13)6.2.2.5.1 Prepare and disseminate guidelines for IYCF.Guidelines whenever received from GoI will be prepared and will be disseminated toall the districts.6.2.2.5.2 Prepare detailed operational plan for IYCF across districts (includingtraining, BCC/IEC, drugs and supplies, etc.).Detailed operational plan for IYCF will be prepared and implemented in all thedistricts of the state. BCC & IEC activities and training can be under taken beforethat. Monitoring of the progress against plan; and follow-up training will beimplemented.6.2.2.5.3 Implementation of IYCF activities in districts.6.2.2.5.4 Monitor progress against plan; follow up with training, procurement, etc.Strategy 5: To ensure availability of adequate equipments and manpower in the FRUsto provide care to the sick children.80

6.2.2.6 Care of Sick Children at FRUs6.2.2.6.1 Prepare and disseminate guidelines.Guidelines for effective implementation of NBCC for reducing the mortality &morbidity of infants will be prepared and disseminated to all the FRUs in the state.6.2.2.6.2 Prepare detailed operational plan for care of sick children and severemalnutrition at FRUs, across districts (including training, BCC/IEC, drugsand supplies, etc.).All 14 FRUs will be equipped with newborn care corner by providing NBCCkit. All these 14 FRUs have either obstetrician or Paediatricians to operate the NBCCand therefore, no training is proposed.The referral transport system suggested under the maternal healthcomponent can be utilized for emergency transportation of sick children to thenearest higher service delivery point.Since NBCC is not fully functional, SNCU facility will be made available in thelater period.6.2.2.6.3 Implementation of activities in districts.NBCC will be implemented in 14 FRUs and 20 PHCs.6.2.2.6.4 Monitor progress against plan; follow up with training, procurement, etc.Monitoring will be done by monitoring committee, SPMSU, DPMSU and RKS.Strategy 6: To ensure availablability of ORS, ARI services and IFA syrup with zinc atall level (SC, PHC CHC & DH) and with ASHA.6.2.2.7 Management of Diarrhoea, ARI and Micronutrient malnutritionManagement of Diarrhoea, ARI and Micronutrient malnutrition will be taken upmore efficiently. Adequate supply ORS packets will be ensured for the purpose fromNRHM Drug and state drug supplies. The community will be sensitized in utilizingthese facilities and understanding the problems that may arise due to acute diarrheain children through VHNDs and regular visit of ANM, ASHA and AWW. Sensitizationof each & every household in using homely available rice water with pinch of salt asan emergency measure in preventing dehydration will be taken up.Acute respiratory tract infection is a major cause of illness leading tomortality among children. Cold climate of Arunachal Pradesh has increased thenumber of ARI cases reaching the hospitals for treatment. Considering this need,measures are planned for effective management of ARI cases in health institutions.Micronutrients like IFA (S) 100 Nos per child, Zinc along with ORS andVitamin A (as per number of beneficiaries) would be made provided to the children toreduce morbidity / mortality from GoI supply and additional NRHM drugs.81

6.2.2.8 Other strategies/activities (please specify – PPP/Innovations/NGO to be mentioned under section 8)Under PPP in 16 PHCs in the state, all the Child health components are beingprovided. This is reflected in section 8 in details.6.2.3 FAMILY PLANNING(Details of training, IEC/BCC, equipment, drugs andsupplies in sections 11, 12 and 13)Objective: To reduce Total Fertility Rate (TFR) from 3 (NFHS III) to 2.7.Strategy 1: To promote terminal / limiting methods through adequate IEC / BCCactivities and to ensure sterilization services in health facilities and also throughsterilization camps.6.2.3.1 Terminal/Limiting Methods6.2.3.1.1 Dissemination of manuals on sterilisation standards & quality assurance ofsterilisation services.Manuals for sterilization standards & quality assurance of sterilization servicesare already made available in all service delivery institutions. By this sterilizationstandards can be maintained and quality can be ensured. Operational plan forprovision of sterilization services across districts including provision of qualityassurance committee are in place.6.2.3.1.2 Prepare operational plan for provision of sterilisation services acrossdistricts (including training, BCC/IEC, equipment, drugs and supplies, etc.).The training plan for providing sterilization services in the health facilities areplanned in the training plan.The trainings will include minilap operation training at GH/ DH (GH, Pasighat, Naharlagun, DH Aalo and DH Daporijo) for providing theservices at PHC level for 20 MOs. The detail plan and budget is in training plan.Laparoscopic ligation operation training for O&G specialists who are currentlyposted in the DH will be taken up this year outside the state for 6 numbers ofspecialists. The details are in training plan.On completion, it is expected that all the DH / GH will provide laparoscopicsterilization service in the facility (Fixed) and sterilization camp as planned.IEC / BCC plan is addressed in IEC plan.Basic equipments required are available in all the district hospitals and thedrug requirement will be met from FRU / PHC drug kits. Other requirement will bemet locally from hospital supplies provided by state government and therequirements during camps are budgeted separately.6.2.3.1.3 Implementation of sterilisation services by districtsSterilization (Laparoscope/minilap) services are provided in the FRUs and willbe implemented further in all the functional facilities of the districts on fixed daysweekly. The days will be notified and exhibited in the health facility as per the82

convenience of the facility. Necessary awareness generation will be created throughIEC activities for utilizing the services.To popularize NSV service, it will be conducted on fixed days at healthfacilities in districts and the days will be exhibited in the institutions.6.2.3.1.3.1 Provide female sterilisation services on fixed days at health facilities indistrictsIn all the FRUs, the minilap services are available and in 5 GH / DH,laparoscopic sterilization services are provided as on date. After completing theproposed trsaining, it is proposed that 20 PHCs will provide minilap service on fixedday (may be monthly on the basis of case load).The laparoscopic sterilization service would be available in all the FRUs andservices provided on a fixed day on weekly basis.6.2.3.1.3.2 Provide NSV services on fixed days at health facilities in districtsAll the FRUs will provide NSV services on the same day as sterilization dayfor females.6.2.3.1.3.3 Organise female sterilisation camps in districts.Female sterilization camps / NSV camps / health melas will be organized in14 districts (not planned for Dibang Valley & Kurung Kumey) twice a year (n=14x2).Adequate publicity will be provided for these camps and quality of service will beensured. The details of Female Sterilization camp are as below:Budget for one Female Sterilization camp:S.NoHeadCamp Management forFemale Sterilization1 Transport for service provider8,000team (as per actual / entitlement )2 POL / Transport for acceptors 5,0003 Contingency 2,0004 IEC (Newspapers, Hand Bills,NilCable TV, Banners etc)Total 15,000Total fund required for 28 Female Sterilization Camp is Rs 420000/-.Target for Female Sterilization for the year 2009-10 =2500. Therefore thecompensation money required is Rs.25, 00,000/-6.2.3.1.4 Accreditation of private providers to provide sterilization servicesTaking into consideration the shortage of specialists in the state, accreditationof private providers from one hospital will be taken up to provide sterilization servicesapart from the existing specialist.83

6.2.3.1.4.1 Organise NSV camps in districts.The camp is not separately planned as there is no case load. However, theNSV service will be a part of sterilization camp in the districts.6.2.3.1.5 Accreditation of private providers to provide sterilisation servicesThere is no csope for such accreditation.6.2.3.1.6 Monitor progress, quality and audit of services through Quality AssuranceCommitteesThe quality assurance committee already in place will monitor the progressand assure quality of the services provided.Strategy 2: To generate awareness regarding spacing methods adequate IEC / BCCactivities and to ensure availability of services and manpower in health facilities.6.2.3.2 Spacing Methods6.2.3.2.1 Prepare operational plan for provision of spacing methods across districts(including training, BCC/IEC, drugs and supplies, etc.).For achieving the objective, an operational plan for provision of spacingmethods across districts is prepared. Care is taken for including training, BCC/IEC,and ensuring supply of drugs and other consumables for effective implementation ofthe plan. Only 3.6% (NFHS-III) of couples are protected by IUD. This is to beincreased to 7% in 07-08 and to 15 % by 09-10 by providing IUD services at allhealth facilities and providing IUD in all districts through RCH Camp / mobile campetc. IUD training is proposed under training portion for ANM / SN during the year.6.2.3.2.2 Implementation of IUD services by districts.Training of manpower (MO & ANM/GNM) is underway andfurther training isproposed under training plan.A total of 120 (ANM/SN) from 3 districts (East / West / Upper Siang) were tobe trained during 2008-09 of which 40 nos have been trained. The remaining 80trainees will be trained during 2009-10. In addition, all OG specialists from 11 DH willbe given orientation on IUD insertion for 1 day at state level, 51 MOs (31 CHCs and20 PHCs) and 50 ANMs / SNs will be trained in IUD insertion. The services will beprovided through camps etc also.6.2.3.2.2.1 Provide IUD services at all health facilities in districts.IUD will be made available and accessible up to the PHC level. Monitoring willbe intensified in all the poorly performing districts by the state and district qualityassurance committee.6.2.3.2.2.2 Organise IUD camps in districts.No separate camp is proposed. The services will be provided during RCHcamp, health mela and MMU sessions.6.2.3.3 Accreditation of private providers to provide IUD insertion services.84

The RKM Hospital, Itanagar will be accredited for the IUD service.6.2.3.4 Social Marketing of contraceptivesNot proposed.6.2.3.4.1 Set up CBD Outlets6.2.3.5 Organise Contraceptive Update seminars for health providersContraceptive update seminar for health providers, monitor progress, qualityand utilization of services are other interventions proposed for bringing down theunmet needs of the spacing methods will be organized at state headquarter oncethis year and one each in all the districts. The state contraceptive update will inviteall the O&G specialist of the districts (16) and it will be for 1 day only.6.2.3.6 Monitor progress, quality and utilisation of services.There will be supervision and monitoring of the services quarterly by themonitoring committee at the state and district level.6.2.3.3 Other strategies/activities (please specify – PPP/Innovations/NGO to be mentioned under section 8)Similarly, under PPP in 16 PHCs in the state, all the Family planningcomponents are being provided. This is reflected in section 8 in details.6.2.4 ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH / ARSH(Details of training, IEC/BCC in sections 11 and 12)Objective: To increase awareness among the target group regarding reproductiveand sexual health.Strategy 1: To ensure proper and timely coordination with APSACS for implementingARSH program.6.2.4. Adolescent Reproductive and Sexual Health/ ARSHARSH services will be implemented for all adolescents, married andunmarried girls and boys as per the need of target groups on sexual behaviorparticularly unprotected sex, teenage pregnancy, child birth, unwanted pregnancy,unsafe abortion, risk of contacting RTI/STI, malnutrition and substance abuse suchas alcohol, illicit drugs, tobacco etc which will all be imparted in an adolescentfriendly manner through FGD, counseling, advocacy, IPC, plays, dramas, skits etc inthe schools.ARSH services will be addressed as per the needs of all Adolescentsensitivity. Adolescent are of different ages married and unmarried adolescent, thosein school and those out of school, vulnerable groups like street children and thoseexperimenting with drugs. These needs are correspondingly heterogeneous andhence will provide different types of services according to the awareness level of theadolescent groups.Implementation of Adolescent Health Programmes has been preparedkeeping in mind the awareness level of Adolescent groups in state. Activities havebeen planned and prepared as per ARSH guidelines to ensure adolescent friendlyservices in the state.Also programmes like Capacity building and Orientation programmes will beincorporated to service providers at state level in order for them to be able to providethe adolescent services effectively.85

ARSH programme has been incorporated along with the school healthprogrammes. The effective tools are FGD, group meetings, counseling, songs, plays& dramas, extempore speech, workshop, seminar, exhibition etc. by makingparticipation of various adolescent groups in the programme.6.2.4.1. Adolescent friendly services6.2.4.1.1. Disseminate ARSH guidelines:GoI guidelines have been received and necessary reprinting would be done(2000 copies) and disseminated to the districts.6.2.4.1.2 Prepare operational plan for ARSH services under the state guidance.In consultation with APSACS, the following activities will be carried out:• Training manuals will be reprinted and necessary translation done.• Printing of posters, leaflets, pamphlets, calendars and hoardings withvarious ARSH messages to be distributed in schools and unreachedplaces.• Capacity building/ Orientation for Service providers at state level.• Meetings/ Orientation for District Management at state level• Community Mobilization programmes at unreached places.• Drug supplies, IEC materials to be distributed.• Maintenance and up-gradation of Health facilities.• Inter-departmental Collabrations.6.2.4.1.3. Implement ARSH services in the districts.The ARSH services will be implemented in the 14 DH / GH during the year inconsultation with APSACS. The main objective will be to provide correct informationabout their health care as per the target groups on sexual behaviour particularlyunprotected sex, teenage pregnancy & child birth, unwanted pregnancy & unsafeabortion, risk of contacting RTI/STI, malnutrition & substance abuse such as alcohol,illicit drugs and tobacco etc. by using effective tools as per the awareness level.6.2.4.1.3.1 Setting up of Adolescent clinic at health facilities:All the District / General Hospitals (14) are having counselors from APSACS.As per discussion with APSACS officials, all this 14 DH /GH will be identified asAdolescent clinic. The total fund required for Adolescent friendly clinics in DH Rs.50,000/-.Necessay training will be imparted by APSACS to the counselors and theMOs.6.2.4.1.3.2 Monitoring progress, quality and utilization of services.The monitoring committee at state and district level along with the officials ofAPSACS will monitor the progress and will ensure quality is maintained as requiredunder the guidelines. Further, the utilization pattern will be analysed by thecommittee.6.2.4.1 Other strategies/activities (please specify – PPP/Innovations/NGO to be mentioned under section 8)86

6.2.5 URBAN RCHThe proposal envisages upgrading and continuation of the existing healthservice delivery system in the identified urban areas of Arunachal Pradesh underUrban Health Program.GoalThe principal objective of this project is to improve the health status of theurban poor by providing quality and sustainable integrated primary health serviceswith special emphasis on maternal and child health care.Objectivei. To provide integrated and sustainable system for primary health caredelivery with a focus on urban poor living in slums and other healthvulnerable groups in Itanagar-Naharlagun, and Pasighat.ii. To enhance capacities among NGOs/ stakeholders to plan andimplement urban health program effectively.iii. To strengthen linkages between communities and primary healthfacilities and referral system from primary to secondary facilities.iv. To improve health status of the urban poor by increasing reproductivechild health services coverage.CoverageA. Itanagar-NaharlagunThe capital complex as is popularly known bears cosmopolitan characteristicsin terms of settlement pattern and the domicility of its inhabitants. The city has thehighest urban population in the state and has the largest concentration of slumdwellers amounting to whooping decadal growth rate of 100.17 %. The population ofthe city has increased by leaps and bounds on account of a steady trend of migrationfrom the rural areas. Being a commercial hub of the state and contiguous withAssam, there is a sizeable chunk of floating population like construction workers,petty traders and daily laborers. Slum dwellers and floating population constitutesabout 25-30 % of the population.There are few concentration of slums along the river Pachin. Settlement takesplace during winter when the river bed becomes dry but in summer, the settlementareas are washed away due to monsoon. A few cluster of slums are found aroundthe national highway and are vulnerable to demolition and evictionMigration trends in the city reflect inter-state temporary migration (primarilyfrom poorer districts of the state), Bihar, Assam etc including few pockets of Nepalilabourers.Existing Public Sector Health facilitiesThere are 2 Dispensaries and 8 HSC. These centres provide irregularantenatal care and immunization services. Only two centres provide immunizationservice on weekly basis for DPT / OPV, DT, TT and Measles vaccine. BCG is notadministered in all these centres, for which the baby has to be taken to FRU(General Hospital, Naharlagun). These centres are not able to provide theirmandated services to full because of the limited staff (either due to vacancies / ANMor other staff moved to other health centres)87

Only one 2 nd tier Hospital (GH, Naharlagun) is running to full capacity with aconsiderable number of RCH related cases being returned due to shortage ofmanpower and spaceB. PasighatPasighat, the headquarters of East Siang District has the second highesturban population in the state and concentration of slum dwellers amounting to adecadal growth rate of 50.09% on account of a steady trend of migration from therural areas, floating population particularly from the adjoining districts of the upperAssam and Bihar constituting about 30% of the total population. They areconcentrated in areas like Banskota Colony, Leprosy Colony, GTC Colony, Mirku,Mirbuk , Mirsam, Muri line, 21 mile, Dapi, pakok, Tigra, Roing, PI Line, Solungground colony, 2 mile area etc.Existing Public Sector Health FacilitiesThere is one Dispensary and 3 HSC in the city. The pattern of public healthdelivery system in the city does not follow any particular guidelines. Therefore, it isoften very difficult to ascertain whether a health centre is designated asUHP/UHFC/HSC. These centres provide irregular ANC and immunization services.These centres are not able to provide their mandated services to full because oflimited staff and infrastructure.This General hospital Pasighat is running to maximum capacity with aconsiderable number of RCH related cases returned due to shortage of space. Thisis the only functional 2 tier facility in the whole district.Service Delivery ModelThe past schemes and provision for the health infrastructure in the urbanareas were focusing mainly on providing family welfare services. These facilitieshave been partially effective in delivering free vaccination services, antenatal care/post natal care, and family planning services. Therefore, the Government ofArunachal Pradesh proposes this service delivery model for achieving acceptablelevel of maternal and child health delivery services.First TierOf the present first tier health centres in the twin cities of Itanagar-Naharlagunconsisting of health facilities not included in the rural health facilities, 2 of the centerswill be restructured to 2 urban health centres. Both the centres will be managed bythe Department of Health and Family Welfare. The first tier will be following acommunity health promotion strategy in the form of building linkages and communityownership of the programme through link volunteers and community basedorganizations at the slum levelOut of the present first tier health facilities, 2 centres will be restructured tourban health centres (UHC) and will require up gradation.The services available at first tier will primarily be of an outpatient dept. andoutreach in the slums. The package includes maternal care, child health,immunization, family planning services and care for basic illnesses along withlaboratory testing facilities, BCC etc.Second TierThe city presently has one General Hospital, Naharlagun managed by publicsector that serves as referral centre for the residents of the city (excluding charitable88

organization run Ramakrishna Mission Hospital, Itanagar). This hospital is presentlyoverloaded with patients both in OPD and IPD and will be improved.The city of Pasighat has one General Hospital, with facilities for terminalfamily planning methods, MTP services, new born care and comprehensiveobstetrics care. This hospital (FRU) will be improved.Packages of ServicesA. Urban Health Centre (UHC)The proposed service that would be provided in the first tier health facility isas follows:1. Delivery services.2. Antenatal care, postnatal care, referrals for institutional deliveries.3. Immunizations4. Family planning, IUD insertion and referral for terminal methods5. Laboratory services.6. Treatment of minor illnesses including RTI / STI.7. Depot holder for ORS / contraceptives.8. Health education and outreach service.9. Services under NAMP, DOTS etc.10. Targeted IEC, BCC and training.Apart from the above proposed services, the UHC staff will perform additionalrole in conducting scheduled outreach camps in coordination with link volunteer,assess field situation to develop plans with NGO & link volunteer, determine theprocess to be adopted for sustainability of the health centre (e.g. user fees) andconduct activities linked to National Programs.Each UHC will operate for 8 hours per day from 8 AM to 4 PM on 5 days aweek. Outreach service will be conducted on every Saturday. Medicines,equipments, other consumables etc will be provided for the existing 2 UHCs.Human ResourcesUrban Health CentreThe following existing filled up posts per UHCs would continue.LMO - 1ANM - 3PHN/SN - 1Data Assistant - 1Laboratory Assistant - 1Night Chowkidar - 1Male attendant - 1Female Attendant - 2Sweeper - 1Infrastructure improvement:On the basis of experience, it is proposed to provide a functional labour roomto both the UHC @ 5 lakhs (Total 10 lakhs)Community Level Activities1. The identification process is completed and 30 LV will continue atNaharlagun and 19 link volunteers for Pasighat. The responsibility ofmobilization and identification of the Link Volunteers would be entrusted tothe partner NGOs.89

2. The link volunteer will receive an amount of Rs. 500/- per month.3. The link volunteer will be provided all the trainings provided to the ASHAsand locally arranged recurrent workshop / orientation etc on NRHM.Outreach ActivitiesAs per records available, there have been activities in relation to outreachservice. Therefore, in order to further improve coverage, to provide quality serviceand to establish good relationship with the target community, a fresh outreach plan isproposed:Guidelines for Outreach Camps1. Outreach camps would be conducted fortnightly in all the slum areas.2. On the basis of ‘fixed day approach’, the camp would be conducted onevery Saturday.3. Every UHC shall constitute 2-3 teams to conduct 2-3 different campsevery week.4. On account of mobility support, a vehicle each can be hired on campdays which will include delivery of vaccines.5. The designate partner NGO shall support the UHC staff throughcommunity mobilization, focused IEC and BCC activities.6. Along with 6 monthly report / review, monthly reports will be reviewedIEC/BCC Activities and Capacity Building/ Training will be covered under RCHII as a whole. Coordination and Convergence and Monitoring and Evaluation Planwill be same as in NRHM. The HR Plan will be addressed under NRHM umbrella.Budget requirement for this year:Sl Designation /Items Quantity Rate Total1 ManpowerLMO 2 15000 360000PHN/SN 2 7500 180000ANM 6 6000 432000Data Assistant 2 7500 180000Laboratory Assistant 2 6000 144000Night Chowkidar 2 3500 84000Male attendant 4 3500 168000Female Attendant 2 3500 84000Sweeper 2 2500 60000Contingencyexpenses2 2000/month/UHC 480002 Outreach session 48 800/ session 384003 NGO Co-ordinator 2 6500 1560004 Link Volunter 49 500 2940006 InfrastructureLabour room 2 500000 1000000Grand total 3228400Therefore, total amount required for Urban RCH is Rs.32,28,400/-90

6.2.6 TRIBAL RCHThe state of Arunachal Pradesh is a tribal state. All the activities proposed inthe PIP are for providing quality health care services to the tribal population.Therefore, no separate proposal is made.6.2.7 Vulnerable GroupsSpecific health activities targeting vulnerable communities such as SCs, STs,and BPL populations living in urban and rural areas (not covered by Urban and TribalRCH)BackgroundVulnerable communities in Arunachal Pradesh include those groups who areunderserved due to problems of geographical access, and those who suffer socialand economic disadvantages and the urban poor. The RCH indicators for slumpopulation are worse than the urban average. Marginalization results in poorer socialindicators for these groups, including maternal and child health indicators. This canbe as much a result of service provider behavior as of health seeking behavior andcapabilities.Rationale of vulnerable communities1. Poor connectivity to health centers because of distance, topography, and lackof public transport.2 Lack of suitable transport facility for quick referral of emergency cases3 Location disadvantage of Sub-Centres, PHCs, CHCs4 Social and cultural barriers especially for women5 Several areas in the state are accessible only through air sorties.6 Scarcity of funds for non-salary expenditures7 Lack of appropriate HRD Policy to encourage / motivate the service providersto work in remote tribal areas8 Poor work environments and dissatisfaction amongst the workforce;9 Understaffing of several remote or even semi-remote facilities;10 Weak monitoring and supervision systemsThe Vulnerable Communities Health Plan for the RCH-II program adds valueby acting as a “conscience” within the Department of Family Welfare to ensure thatRCH-II is progressively more focused on reaching those least served.Goals:To improve health status of vulnerable population by ensuring accessibilityand availability of quality primary health care and family welfare services to them.Objective: The overall objective of the Vulnerable Plan is to:(i) improve accessibility, availability and acceptability of health services includingRCH services by strengthening infrastructure including training and skilldevelopment of service providers, improving supply of equipment, medicinesetc in an integrated and participatory manner and(ii) To bring them at par in this respect with rest of the population, and thusimproving the aggregate indicators towards achieving the expected results setunder RCH Phase II by the end of 2010.91

StrategyThe State will do justified resource allocations towards the vulnerable groups.The behavioral change communication strategy developed for RCH will take intoaccount the specific needs of the vulnerable groups. There would be convergence ofhealth activities with those of other departments such as ICDS and Water andSanitation. Private Sector and NGOs will also give priority to vulnerable communitiesand supplement/complement the efforts of Government Departments.The majority of indicators for success will be based on quality andconvergence of services to the vulnerable. In the first few years, performanceindicators will be mostly process indicators that show that the state is addressingcomprehensively the problem of improving services to the vulnerable. In the lateryears of the Program, output and outcome indicators will be used to show thebenefits received by vulnerable communities.Elected representatives of PRI at various levels will be involved inimplementation and monitoring. The States will also involve health service providers,NGOs, RKS and women self help groups.Health Plan for Vulnerable GroupsIn smaller towns, the requisite focused interventions for urban poor includingslum dwellers are incorporated in the Urban Health program of RCH II PIP. Thecurrent plan would include 2 slum areas in each of the District headquarters of 14Districts under Routine Immunization (2x14/ month). There are 11 identified airfedareas where normally facilities are not available. The areas are Desali, Thingbu,Singa, Aivelly circle, Taksing, Tali, Chambang, Parsi Parlo, Damin, Monigong andSarli. Frequency of service delivery will be monthly once through outreach sessions.Helicopter services are proposed to cover these areas for RI once in 2 months inwhich MCH activities will be an important component (11x6).Health Plan for other vulnerable communities and the poor living in urban andrural areas (not covered by Urban Project) are prepared as a part of District HealthPlan but may indicate in detail. But it may not be addressed properly as expected.Another area is to address the migrant labourers in the state.Service delivery model:It is proposed to strengthen the existing service delivery model bysupplementing with (i) grassroots level support for service provision and engagement& training of ASHA who could maintain link between health facility and thecommunity. NGOs and Private Sector through Public-Private Partnership also beinvolved in the provision of Primary Health Care Services as is done under PPPrunning 16 PHCs and also as part of the referral system.In order to increase utilization of health services by the vulnerable group /tribal / difficult to reach area population, some of the innovative approaches thatneed to be addressed are involving the community in the planning process, as wellas in the management and implementation of various programs; using CommunityBased Workers both men and women from the community as social mobilizer,educator and provider of non clinical services; involvement of local elected bodies92

Type of services:The Program envisages provision of a community based ASHA from thecommunity to work as social mobiliser, educator and provider of non-clinical servicesincluding depot holder for contraceptives. She will work with AWW under theguidance and supervision of the ANM/PRI. The payment of incentive would be linkedto some minimum performance criterion. The VHSC and the RKS at the communitylevel is the centre of all program implementation. Activities are proposed to addressthe need for all level of facilities.Human Resource Development:The State Governments will consider suitable incentives to the health serviceproviders to ensure availability of required manpower in the vulnerable / hard toreach areas. It is proposed that the ANMs / HA posted to the above identified airfedareas would be given an incentive of Rs 1000/- per month per person. It is identifiedthat 33 Nos of ANMs and 22 Nos of HA (EPI) would be paid as above to encourageand to instill a feeling of being cared for.The above as was in 2007-08 could not be implemented due to fundconstraint. The same proposal will be implemented during the year & will be ensuredthat the incentives are paid through RKS/ District Health Society.Integration with Other DepartmentsInter-sectoral linkages of various agencies involved in the state need to beencouraged. Efforts would be made to integrate with other departments likeEducation, Rural Development and Social Welfare Department for the delivery ofservices, especially where Public health care facilities are inadequate. Projects withintegration with other departments would be encouraged.CoverageThe schedule for coverage is laid down in the PIPs for Urban slums underUrban Health. Which include Itanagar – Naharlagun and Pasighat. Similarly in ruralareas, the District Plans incorporates provision to provide focused attention to 2urban slums / vulnerable groups in remaining urban areas not included in the UrbanRCH during RCH II. The 11 identified air-fed areas would be included under theunreached / difficult to reach areas.Another area of coverage would to identify the migrant labourers in the state.Identifying them is difficult, but especially in terms of Immunization, MH etc, they willbe covered during outreach sessions.93

Monitoring and Evaluation (M&E)The States will monitor availability of quality services to vulnerable populationincluding those who are underserved due to problems of geographical access, andthose who suffer social and economic disadvantages and the urban poor up todistrict level. The districts will monitor performance at CHCs / PHCs and Sub-Centrelevels.The monitoring will not be restricted to physical and financial achievementsbut will also include the following:Process Indicators- Percentage of districts having identified vulnerable groups and having thesegroups included in their PIPs.- Percentage of districts having conducted facility survey and mapping up ofavailable infrastructure and manpower etcOutput Indicators- Percentage of Ante-Natal/Post Natal coverage from vulnerable groups ascompared to the rest of the population- Percentage of deliveries conducted by skilled providers (doctors, nurses,ANMs) among the vulnerable groups as compared to rest of the population.- Percentage of institutional deliveries among the vulnerable groups- Percentages of children among vulnerable groups fully immunized-age groupwise- Number of cases provided transport facilities in cases of emergenciesincluding obstetric emergencies.6.2.7.2.1 INNOVATIONS/PPP/NGO6.2.7.2.1.1 Public Private Partnership (PPP) for PHCsThe PPP project has been the most successful initiative undertaken by thestate under NRHM Program. The MoU was signed between the state and 4 NGOsnamely; Voluntary Health Association of India, Karuna Trust, JAC Prayas and FutureGenerations Arunachal.Management of 9 PHCs have been given to Karuna Trust, namely; BamengPHC, Mengio PHC, Sangram PHC, Jeying PHC, Anpum PHC, Etalin PHC, WalongPHC, Khimyong PHC and Wakka PHC.Voluntary Health Association of India has been handed over 5 PHCs namely,Lumla PHC, Thrizino PHC, Nacho PHC, Deed Neelam PHC and Gensi PHC.JAC Prayas and Future Generations Arunachal have been handed over themanagement of 1 PHC each, namely; Wakro PHC and Sille PHC respectively.The PPP project is being evaluated by RRC –NE and the final report will bepublished shortly.94

a. The ProjectThe PPP Project was approved by GoI in September 2005 andOperationalised in January 2006 by Involving NGOs of National repute in HealthService delivery in Arunachal Pradesh.To functionalise remote 16 PHCs ofArunachal Pradesh and to deliver quality Primary Health Care Services, the proposalwas medb. Achievements• Immunization, Institutional Delivery, ANC Coverage, Family planningmethods etc. ANC coverage has increased.• Institutional Delivery has increased.• All the PHCs managed under PPP are now run on 24 x 7 basis.• Minor operations have also been carried out in the OT, Laboratoryservices are also being performed with facilities for pathological &biochemical investigations, like tests for malaria,TB etc.• The project has also contributed in family planning services to peoplefor use of any kind of contraception.• Many outreach activities and Health Melas have been conducted.• RKS/PHC management committees have been constituted andfunctioning well.• All the SCs under PPP PHCs are functional are now functional.• Awarded best state for PPP by GoI in 2007.• VHSC and VHND are functional in all the villages falling under PPPPHC area.c. Issuesa. Fundingb. Manpower Drain: Turn Over of staff due to lack of job security underNGO.c. Supply of medicinesd. Power supplye. User chargesf. Public participationg. Synergies with other programsh. Field visits / Outreach sessions.i. Reporting – M&E, status, manpower etcj. Difficult geographical terrain, communication bottlenecks, remotevillages.k. Attractive package difficult/ limited due to resource constraints for staffsd. Duration / extension of the project. ExpansionIt is proposed to extent the PPP Project upto the Mission period i.e 2012. NPCCapproval (Financial grant in aid) has already been made till March 2009.On approval,revised MoU will be signed with the NGO and for new proposal.e. Financial involvementAll the 16 PHCs run by NGO under PPP are providing excellent PrimaryHealth Care services to the rural population.An amount of Rs. 220275.00 (Rupees95

two lakhs twenty thousand two hundred seventy five) only per PHC per month isreleased. An annual grant in aid, amounting to Rs. 42292800.00 (Rupees four croretwenty two lakhs ninety two thousand eight hundred) only is involved in managementof 16 PHCs. The grant in aid is made by the GoI under the RCH Programme.Public Private Partnership (PPP) For Community Health Centrea. The ProjectThe project proposes inclusion of 2 (Two) CHCs under the already existingPublic Private Partnership on a pilot basis for improving the health care deliverysystem of the remort areas mainly border areas or Arunachal Pradesh. The existingSub Centres, under the jurisdiction of the CHCs would be similarly handed over tothe Agency for management. The services provided by and through the Sub Centreswill be as per the standard/normal guidelines and in conformity with the activities ofthe CHC.The existing health delivery system in the state relies on the Governmenthealth infrastructure. In the light of the increasing expectations of the people, andwith the main objective of improving and reforming the health delivery system, thestate government has envisaged the proposed model of Public Private Partnership.The strategic objective of the project is to provide to the people residing in theCommunity Health Centre area with quality clinical and preventive health services,and at the same time effectively implementing the National Rural Health Mission.The objective is to be achieved by using the services of reputed NGOs andVoluntary Organisations in 2 CHCs of the state who would bring with them theexpertise in running health institutions. The Project will also increase the people’sand the community’s participation in the community and public health management.b. Service Delivery:The Agency shall be responsible to provide the following services:The Community Health Centres (CHCs) which constitute the secondary levelof health care shall provide referral as well as specialist health care to the ruralPopulation. In order to provide Quality Care, these CHCs are to provide optimalexpert care to the community and achieve and maintain an acceptable standard ofquality of care. These standards would help monitor and improve the functioning ofthe CHCs.• 24 hours Emergency/Casualty Services.• OPD service for six days per week as per the timings specified by theState Government.• 5 to 10 Bed inpatient facility.• 24 hrs labour Room and emergency Obstetrics facility.• EmOC & Minor Operation Theatre Facility• 24 hrs Ambulance Facility• Make available essential medicines as per the details at Schedule B to theMOU. The Agency would be encouraged to keep in stock such additionalmedicines as are found necessary after assessing the field situation.96

• Participation in and implementation of National Programs of Health &Family Welfare including the National Rural Health Mission. Outreach/IECactivities by conducting medical camps• All “Assured Services” as envisaged in the CHC shall be available, whichincludes routine and emergency care in Surgery, Medicine, Obstetrics andGynaecology and Paediatrics in addition to all the National Healthprogrammes.• Routine and emergency cases.• All the support services to fulfil the above objectives will be strengthenedat the CHC level.c. MANPOWER REQUIREMENTTo provide the services, the minimum staff deployed would be as under.MinimumPersonnelrequirementGeneral Surgeon 1Physician 1Obstetrician/Gynaecologist 1Paediatrics 1Anaesthetist 1Public Health Programme Manager.Eye surgeon 1TotalSupport Manpower*Nurse-midwife 9Dresser (certified by Red Cross/St.JohnsAmbulance) 1Pharmacist/compounder 1Lab. Technician 1Radiographer 1**Ophthalmic Assistant 0-1Ward boys/ nursing orderly 2Sweepers 3ChowkidarOPD attendantStatistical Assistant/Data entry operatorOT attendantRegistration clerkTotal Essential5***97

d. Modalities of ImplementationThe State Government shall hand over the building and physical infrastructureof the CHC(s) to the Agency along with the existing equipment, furniture, etc. and aninventory of the same would be made jointly by the State Government and theAgency. The conditions of the building/equipment handed over will be duly recorded.The Agency will maintain the said building/equipment with due care as would bereasonably expected.The Agency shall provide all the Health/Medical/Family Welfare Services,curative and preventive/promotive, as are normally expected from any CommunityHealth Centre, to the local population residing in the geographical area under thejurisdiction of the said CHC(s). The Agency will engage its ownMedical/Paramedical/other staff for providing these services.e. Hospital Management CommitteeA Hospital management committee to be constituted at the CHC level comprisingrepresentatives of the Agency, District Medical Officer, District RCH Officer, DeputyCommissioner or his nominee (not below the level of Circle Officer) and not morethan three representatives from the Anchal Samitis in the Area. When the number ofAnchal Samitis is more than three, the names of the three nominees and their termin the PHC Management Committee will be decided by the Anchal Samiti Membersthemselves and communicated through the Deputy Commissioner. At least one ofthe Anchal Samiti nominees would be a lady. The local MLA of the area would be apermanent Special Invitee to the PHC Management Committee. Such other officers,as required and necessary (for example, Child Development Project Officer,Assistant/ Junior Engineer from Works Department) can also be special invitees tothe said CommitteeThe RKS under NRHM will also be constituted in the CHCs and willfollow the NRHM norms.f. Accountability:It is mandatory for every CHC to have “Rogi Kalyan Samiti” to ensureccountability. Every CHC shall have the Charter of Patients’ Rights displayedprominently at the entrance. A grievance mechanism under the overall supervision ofRogi Kalyan Samitis would also be set up.g. Review and monitoring structureThe Committee would meet at least once, every two months and will beresponsible for guiding/monitoring the project. It will address local issues andproblems as are normally expected from such a Committee. The CHC managementcommittee can also function as the Rogi Kalyan Samiti.At the State level, a Steering Committee chaired by the Commissioner &Secretary (Health) along with suitable representation from all stake holders includingthe Agencies, Central Government and other State Government Departments will beformed. This State level steering committee will meet at least once, every three98

months. It will review the work done at the CHCs, suggest suitable improvementsand midcourse corrections, and resolve the difficulties faced by the Agency inrunning of the CHC.h. EvaluationThe Government would evaluate the success of the pilot project in providingimproved health services to the people. The Agency will also be encouraged toundertake internal evaluation.i. Project FundingThe Fund required for the purpose shall be met from the RCH II budget. TheAgency will receive funds from the Government, towards meeting the cost ofPersonnel, Drugs (Medicines), Reagents, Surgical Material, Health CareConsumables, Administrative Charges, Civil Works, Furniture, Equipment (includingSurgical EquipmentThe funds required, per annum, for operating and managing the CHC wouldbe as follows.Sl.No. Items Maximum Fund per annum1 Medicines and other HealthcareConsumables.Medicines - Rs.3,00,000/-Materials & Supplies - Rs. 30,000/- Rs.3,94,229/-Laboratory Reagents, - Rs. 10,000/-Kits./Surgical Items - Rs. 54229/-2. Maintenance, Furniture, EquipmentCivil Works(Maintenance)- Rs.100,000/-Office furniture - Rs. 50,000/- Rs. 5,50,000/-Hospital furniture - Rs. 1,00,000/-Surgical Equipments - Rs. 3,00,000/-3. Other Administrative ChargesWater & Electricity - Rs. 10,000/-Traveling Allowances - Rs. 20,000/-Ambulance Services - Rs. 70,000/- Rs. 1,00,000/-4. Personnel Cost MinimumrequirementMonthlyRemunerationTotal peryearGeneral Surgeon 1 25000.00 300000.00Physician 1 25000.00 300000.00Obstetrician/Gynaecologist 1 25000.00 300000.00Paediatrics 1 25000.00 300000.00Anaesthetist 1 25000.00 300000.00Public Health Programme Manager. 1 25000.00 300000.00Eye surgeon 1 25000.00 300000.00Total 175000.00 2100000.00Support Manpower99

*Nurse-midwife 9 9000 972000.00Dresser (certified by Red Cross/St.JohnsAmbulance) 1 6000 72000.00Pharmacist/compounder 1 9000 108000.00Lab. Technician 1 8000 96000.00Radiographer 1 8000 96000.00**Ophthalmic Assistant 0-1 5000 60000.00Ward boys/ nursing orderly 2 5000 120000.00Sweepers 3 3000 108000.00Chowkidar3500 42000.00OPD attendant 5000 60000.00Statistical Assistant/Data entry operator 5***7000 84000.00OT attendant 5000 60000.00Registration clerk 5000 60000.00Total Essential 78500 1938000Total maximum fund per annum = 1 + 2 + 3 + 4= Rs. Rs.3,94,229+ Rs. 5,50,000.00 + Rs. 1,00,000.00 + Rs. 1938000.00= Rs. 2982229.00(Rupees Twenty Nine Lakhs eighty two Thousand two hundred twenty nine Only perCHC per annum.)Therefore, the total cost for managing 2 CHCs under the Project would be= Rs. 2982229.00 x 2 CHcs= Rs. 5964458.00(Rupees Fifty nine Lakhs sixty four Thousand four hundred fifty eight Only for 2(Two) CHCs per annum.)Maximum funding figures indicate the maximum amount that the Governmentwill provide under the respective head.j. Performance Monitoring and Standards of ServiceThe performance of the Agency will be monitored largely on the basis ofoutput based indicators. These indicators and performance standards can besuitably expanded and/or modified after mutual consultation and in the interest ofbetter service delivery to the general public. The indicators and standards specifiedfor the health delivery expected from the Agency are the minimum standards. TheAgency would be encouraged to serve as a role model and to provide services at amuch higher standard.External evaluation has been done for existing 16 PHCs under PPP and it isproposed that such evaluation will be carried out after 2-3 years.6.2.7.2.1.2 MNGOTwo MNGOs are functioning in the state of Arunachal Pradesh which coveredonly 3(three) districts in the state. The Voluntary Health Association of ArunachalPradesh (VHAAP) allotted against East Kameng and West Kameng districts of100

Arunachal Pradesh and NANI SALA Foundation (NSF) allotted against Papumparedistrict. There fore, MNGOs activities in state in terms of service delivery in the furflung and remote areas are limited and hence required more MNGOs to accesshealth services in all the districts. However, both MNGOs in the state allotted againstdifferent districts are functioning smoothly and implementing the scheme as per GOIguidelines and doing commendable services in the rural areas. People are beingbenefited through various activities undertaken by these MNGOs in the state. Thereare 6(six) more NGOs found eligible in the desk review which is under process in thestate.The field NGOs under the existing MNGOs scheme is involved in servicedelivery, in addition to advocacy and awareness generation campaign in the districts.The key service delivery undertaking by these MNGOs are:-• Maternal and Child Health• Family planning• Adolescent Reproductive Health• Prevention and Management of RTI/STIBesides service delivery, IEC/BCC activities are being implemented throughvarious tools methods involving community members mainly emphasized in therural areas to highlight essential RCH/FW messages in community based andlocal specific strategy to create awareness, to impart knowledge and sustainingbehavioral changes in all the peripheral areas with an objective to improve healthseeking behavior and to increase community participation in the state.Monitoring Progress and Quality of Services.The importance in monitoring is to be conducted to assess the improvementsin service delivery and results in a given area of intervention. A system of periodicreporting and ongoing monitoring is in place for assessing the MNGO’s performance.Review its performances from time to time through the field visits in the allotteddistricts undertaken by the designated MNGOs in the state.Budget requirement:a. For the newly proposed MNGOs (n=6) for which baseline survey andpreparatory work, an amount of Rs 1 lakh per MNGO will be provided.Therefore total requirement is Rs 6 Lakhs.b. For the existing MNGOs (n=2) for 3 districts, an amount of Rs 15 Lakhs perdistrict and requires a total of Rs 45 Lakhs for the year.6.2.7.2.1.2 PNDT and Sex RatioThere is State and District level PC & PNDT committee at the State anddistrict level..6.2.7.2.1.2.1 Operationalise PNDT CellThe PC&PNDT cell is in operation in the state level as well as at the districtlevel. The cell is in place.6.2.7.2.1.2.2 Orientation of programme managers and service providers on PC &PNDT Act101

The orientation workshop in standardization on Male and female sterilizationwill be conducted at the state level and 16 batches one for each district. A team offour members including Gyneacologist and Medical Officers will be participating inthe workshop. The duration of workshop is one day. Fund required is Rs 3 lakhs willbe required.There will be sensitization workshop 1 (one) at State level for the women incollaboration with Arunachal Pradesh Women Welfare Society and State WomenCommission of Arunachal Pradesh for 1 day at Itanagar and the fund required is Rs1 Lakh.The State level PC & PNDT Committee review meeting will be held in the 2 ndquarter of 2009. Similarly, the District level PC & PNDT meeting will be held during3 rd quarter 2009. Budget requirement is Rs 1 lakhs for state and Rs 8 lakhs (@ Rs50000/) per district during the year.6.2.7.2.1.2.3 Monitoring of Sex Ratio at BirthIn the State 16 (sixteen) ultra sonography clinics have been registered and 2(two) are under process for registration. There is no record of violating PC & PNDTact in the state so far.6.3 INFRASTRUCTURE AND HUMAN RESOURCES6.3.1 IMEP6.3.1 Operationalise Infection Management & Environment Plan at healthfacilities (details of training, equipment, drugs and supplies, undersections 11 and 13)6.3.4.1 Organise dissemination workshops for IMEP guidelinesThe IMEP guidelines have already been disseminated to the districts.6.3.4.2 Prepare plan for operationalisation across districts (including staffing,infrastructure, training, equipment, drugs & supplies, etc.)In the state, in 2 GH, IMEP (Incinerator) facilities are present. Other than this,there is no such facility to take care of the waste products as required under NPCB.All the DHs will be functional by the year end and it is required that all this facilitieshave incinerators. The waste load in all the hospitals are increasing day by day andthe situational analysis shows that the waste products are not properly disposed offthereby inviting environmental hazards.As on date, 11 DH/GH/CHCs are functional as FRUs and it is proposed that in5 DH/CHC, the incinerator facility may be provided on priority at an estimated cost ofRs 25 Lakhs each for 5-10 kg/hour size capacity.Training of the manpower who would handle the incinerators will be trainedalong with MOs, Nurses etc by the company itself at facility level. Further, trainingwill be provided to all the hospital staff by the trained MOs Nurses and handlers.Drug and supplies for the proposed hospitals will be met from RKS fund.6.3.4.3 Monitor progress against plan; follow up with training, procurement, etcMonitoring will be done by the monitoring committee and also from time totime by the pollution Control Board.102

6.4 INSTITUTIONAL STRENGTHENING6.4.1 Organization Review/ work force management/ HRDComprehensive HRD policy in Arunachal Pradesh has been very weak. It hasbeen experienced that distribution of nursing staff and doctors in highly skewed dueto various extraneous factors including political pressure for transfer and posting.Due to limited fund provision for program management as per the 6%stipulation, incentive scheme and salary increments have not been possible till nowwhich is a de-motivating factor.For future planning, already documents related to manpower status underHealth Department have been furnished to RRC-NE for TA.Delegation of power to MD (NRHM) per case & to Secretary (Health & FW)will continue. The tenure of programme Officer/Staff will be ensured to continue inthe same office till end of the programme period. This is required to maintaincontinuity of the program and for effective implementation.Alternatively, it is proposed that Govt. of India may provide necessarydocuments relating to established HR practices of other states especially in regardsof formation and operationalisation of District cadre for reference. If it is viable for thestate of Arunachal Pradesh then it will be adopted for HR practices of the state.In view of the need to integrate all the vertical programs and mainstreaming ofAYUSH under NRHM, it is proposed to develop a reporting system in which all theState Programme Officers of vertical programs will report to the Mission Director(NRHM). Similarly, all the accounts managers/ accounts officers/accountants will bebrought under the broad umbrella of Financial Management Group (FMG) under theleadership of SFM in order to ensure integration of all accounts under NRHM.Relocation of staff especially ANMs will be taken up strongly this year so as tofunctionalized maximum number of SCs in the state. The relocation procedure hasbeen very difficult over the years but with more efforts & support from policy makers,the activity will hopefully be done.Decentralization:In view of the Human resource problem in the state, the executive committeeof the State Health Society has decided to decentralize the human resourcedevelopment/ planning upto the District Health Society level. This will not onlyimprove the skewed manpower positioning/placement in the district but also willdelegate more autonomy, more responsibility in planning/ implementation & also willdefinitely improve the ownership of the programme at all level in the districts.The existing manpower in the districts will be reveiwed districtwise forpossible relocation of the manpower in their own hometown/district prior toimplmentating the district cadre proposal.The District Health Society as per their requirement & manpower sanctionedat the state level will be allotted to the health facilities for immediate recruitment &posting from local candidates as per guidelines. The recruitment under NRHM will beon contractual basis and non-transferable. Citizen Charter will be display in all thehealth facilities & any grievance will be addressed through grievance redressalmechanism that exists under RKS.Further, the salary of the contractual manpower under NRHM will be paid byDistrict Health Society on the basis of their performance & presence in their dutystation. Format for appraisal of performance (ToR) already exists in the state.103

6.4.1.1 Procurement managementProcurement Policy & ProceduresThe RCH-II Procurement policy and the General Financial Rules of the Govt.of Arunachal Pradesh is the main policy instrument, governing procurement policy.The guidelines on procurement procedure for Health sector goods of servicesand selection of hiring of consultant circulated by the Ministry of Health & FamilyWelfare, Govt. of India is the followed for procurement policy and procedure.The guidelines will be disseminated to the District Health Societies and RogiKalyan Samiti.Procurement organization and staffing.The State Programme Management Unit and District ProgrammeManagement Units are the organization for the procurement at the State and Districtlevels respectively.The establishment of procurement unit with additional staffs at State &districts are felt need but considering the considering the pressing budget constrainunder Programme Management component the existing organization arrangementwill continue for the procurement.Procurement Audit/ Review:There is no separate organization or agency for audit and review of theprocurement.The procurement procedures are reviewed by the auditing agency during theaudit of the account.Procurement MIS & Record keeping:-The list of constract issued at various levels of organization are maintained atrespective levels of organization are maintained at respective levels of organizations.The stock register of the stores are maintained at the respective levels.Inventory Control & Storage:-There are no proper store houses at State quarter, General Hospitals, DistrictHospitals, CHCs, PHCs for proper storage of stores.A central store house will be constructed at State headquarter.The existing store house at district headquarter, health institutions will berepaired institutions will be repaired or extended with minimum facilities like lighting,Ventilation and racking.Quality Control for drugs:-The drugs are procured as per the State Govt. procurement policy for drugs.The drugs are procured from the products of the pharmaceuticals havingGMP certification and approved by the state Govt.104

The drug scruples are drawn from the procured drugs and sent to the KolkataDrug testing laboratory for quality test, but it takes long time to get the result.6.4.1.2 Logistics management/ improvement6.4.1.2.1 Logistics consultant(s) recruited and in positionNo consultant available in the state. However, as required, consultant at RRC-NE helps in the activity.6.4.1.2.2 Review of logistics management system doneReview of logistic management has not been taken up in the state so far.6.4.1.2.3 Training of staff in logistics managementLogistic management training not proposed.6.4.1.2.4 Strengthening of warehousing facilities (construction/ repair/ renovation,furniture, computers, software, etc.)Store house for storing NRHM items is not properly addressed so far. The stateheadquarter and aalso the districts do not have proper store house. Therefore, it isproposed that 17 store house (16 Districts + 1 state) will be constructed during theyear at an estimated cost of Rs 8 Lakhs.6.4.2 HMIS / M&ERegular monitoring, timely review of the RCH/NRHM activities shall becarried out. The quality of MIES in State HQ and in districts is in improving trend.Reporting and recording of NRHM/RCH formats are irregular, incomplete andinconsistent. Formats are not filled up completely. The information is not properlyreviewed at the PHC level. No feedback is provided upon that information fromthe Block PHC to the SC. State to the Districts feedback system shall beintroduced from the beginning of the financial year.Now almost all the Districts are reporting in the revised HMIS formatdeveloped by GoI. For overall management of the Health Information System, aHMIS Cell has already been created under the Mission Directorate in the state. AMonitoring and Evaluation Cell shall also be created during this financial year2009-10. A State Program Officer for Monitoring and Evaluation is already inplace. The HMIS/M&E Cell shall be responsible for overall monitoring andevaluation of the programme in the state and the districts.At district level, the District Health Society with the District ProgramManagement Support Unit in place is responsible for the all data disseminationfrom the sub-district level to the district level for management of HMIS.As such, there will be a Monitoring Team constituted each at state anddistrict level to monitor the implementation of the NRHM/RCH activities. TheHospital Management Committee/ Rogi Kalyan Samity at all PHCs and CHCs isalready in place.6.4.2.1. Strengthening of M&E CellA State HMIS Cell has been created, where every Data related to Health is beingmaintained. Reports and returns received from the districts are compiled and105

maintained. In fact, the reports that are being received from the districts are notcomplete for any month. Hence, a clear analysis can’t be drawn. For properstrengthening of HMIS in the state, integration of activities across other programsshall be ensured with utilization of IT infrastructure. Developing an electronic systemof monitoring & reporting is in partial fulfillment in the state. The Web based HMISPortal launched by the GoI shall be used for data reporting. The state shall ensuresame at the District HQ level with availability of internet facility.6.4.2.1.1. M&E consultant(s) recruited and in positionPresently, the state has 1 (One) Consultant - HMIS in position recruited underRCH-II and will continue till the end of the programme. The Consultant – HMISmaintains all the health statistics. The SPMU/DPMU is assisting in the HMIS/M&Eactivities. Moreover, as per the GoI notification, Nodal Officer for M&E at State andDistrict levels have been identified and notified. They are responsible formaintenance of all the health statistics at the District level.Manpower StatusState HMIS/M&E Cell:One State Monitoring Officer from the state level alongwith the followingofficial on contract basis are available:1. State Program Officer/Deputy Director (M&E) 12. Consultant (HMIS) 13. Data manager 14. Data Assistant 1District HMIS/M&E Cell1. District Program Manager 82. District Data Assistant 163. Computer Assistant 166.4.2.1.2. Provision of equipment at state and district levelsDue to non availability of inter communication facilities, there have alwaysbeen delay in the flow of information from the districts to the state, state to theCentre and vise versa. In order to overcome the problem and the situation, it isproposed to have provision of equipments for HMIS activities at the state and Districtlevel. Present status of the equipments available at State and District HMIS/M&ECell are as follows.Status of Equipment at state and district levelsState HMIS/M&E Cell1. Computers 03 Nos2. Internet Connection 013. Fax Nil4. Telephone Nil106

District HMIS/M&E Cell1. Computers 16 Nos2. 3. Fax 104. Telephone 16Costing for the procurement of equipments at State level:Following proposals were made in the SPIP 2008-09, but could not befulfilled. As such the activity shall be carried forward during this financial year 2009-10. The budget requirement shall be met from the last approval.State Levela). 1 Fax Rs. 20000.00b). 1 telephone with Internet connection Rs. 5000.00c). 1 inverter Rs. 34000.00Total Rs. 59000.00District levela). 6 Fax @ Rs. 15000.00 Rs. 90000.00b). 16 Internet Connections @ Rs. 5000.00 Rs. 80000.00c). 16 Inverters @ Rs. 34000.00 Rs. 544000.00Total Rs. 714000.00The budget for the purpose shall be met from the approval of SPIP 2008-09.6.4.2.2. . Operationalising the new MIES format107

REPORTS AND RETURNSNationalLevelState HQ(SPMSU)District Head Quarter(DPMSU)District HospitalCHCHealth personSHCPHCANMThe above illustration is a design of hierarchal reporting system/data flow,followed in the state. The prescribed Revised Monthly, Quarterly & Annual reportingformats under NRHM for SCs, PHCs, CHCs, DHs are being provided and shallcontinue as and when required. The reports and returns from all the health facilitiesare sent to the District HQ in manual form. A consolidated report is then generated atthe district level and sent to the state. The Web based HMIS Portal launched by theGoI shall be used for data reporting. The state shall ensure same at the District HQlevel with availability of internet facility. The reports shall be uploaded in time on theHMIS Web Portal. The Districts with no availability of internet shall continue to reportmanually to the state which the state shall upload the report on line. As there is nointernet facility at the lower levels, timely manual reporting shall be ensured.The new monthly, quarterly & annul MIES formats have been supplied to allthe health facilities in sufficient quantity. Hence, it is operational at all levels. Thestate has also started reporting online. Facility wise reporting in the new MIESformats is already in place and will continue to report in the same format. Due tonon availability of internet facility at the district level, manual reporting to the state108

is in place now. Online reporting from the district to the state shall be ensuredduring this financial year.Timeline for submission of reportsi. From SC/PHC/CHC/DH/FRU to the District HQ - 3 rd of the following month inprescribed Reporting format.ii. From District to State HQ - 5 th of the following month in District MonthlyConsolidated Reporting format6.4.2.2.1 Review of existing registersAll the health facilities have been provided with sufficient numbers of ANC,PNC, Delivery, Disease, Death, JSY, Immunization, stock indent, etc. registers forproper maintenance of data to generate quality information. This year too, review ofall existing service delivery registers of health institutions will be done to have propermaintenance of Data. There will be provisions for procurement of the same andmaking it available in sufficient quantity at the Sub district facility levels. Regularupdating and data compilation will be ensured. This shall be done during the 1 stquarter of the financial year 2009-10.Sl. Health Facility Registers Nos. Rate AmountNo.1 ANC 1600 80/- (Approx.) 128000.002 PNC 1600 80/- (Approx) 128000.003 JSY 1600 80/- (Approx) 128000.004 Delivery 1600 80/- (Approx) 128000.005 Death 1600 80/- (Approx) 128000.006 Stock Indent 1600 80/- (Approx) 128000.007 Stock Delivery 1600 80/- (Approx) 128000.008 Immunization 1600 80/- (Approx) 128000.009 Eligible Couple 1600 80/- (Approx) 128000.0010 Childhood Disease 1600 80/- (Approx) 128000.00Total 1280000.00Sl. State/ District HQ Nos. Rate AmountNo. Registers (1 Monthly Status 17(40”x 25”) 5000/- (approx) 85000/-2 Monthly performance 17(40”x 25”) 5000/- (approx) 85000/-3 Immunization 17(40”x 25”) 5000/- (approx) 85000/-4 Childhood Disease 17(40”x 25”) 5000/- (approx) 85000/-Total 340000/-6.4.2.2.2 Printing of new formsThe new MIES formats have already been made available to all the healthfacilities. However, Printing of new forms and formats will be ensured to facilitate allthe health facilities of the state for proper and timely reporting. Printing of the existingformats like MIES, Status. will be done during the 1 st Quarter.109

Sl. No. MIES Formats Nos. Rate Amount1 Monthly Consolidated DH 1000 Rs. 4.00 40002 Monthly Consolidated CHC 1500 Rs. 4.00 60003 Monthly Consolidated PHC 5000 Rs. 4.00 200004 Monthly Consolidated SC 10000 Rs. 4.00 400005 MIES Quarterly Report 10000 Rs. 4.00 400006 MIES Annual 2000 Rs. 4.00 8000Total 1180006.4.2.2.3. Training of staffTraining component on MIS Monitoring Evolution will include DHIS 2, webbased online Data entry, quality checking of data, compilation and analysis of data,feed back to field and timely reporting to higher authority. MIS training for, DPM,Accountants, Data Assistant, Statistical Investigator, Data Manager will be organizedon total HMIS Quarterly once this year with technical support from GoI.The reporting system in the state is flowing from SC level to the district levelto State level but still there are lots of areas for improvement.Some of the major problems identified are: District level and SC level reporting authorities are not well acquainted withthe reporting system in the present HMIS reporting format. Lack of awareness about importance and quality of data among grass rootlevel reporting personnel, i.e., the ANMs, MO i/c, etc. Inconsistent, Incomplete, Inaccurate and under reporting are the majorproblems identified in the present system. Lack of analysis and monitoring mechanism of periodic reports at District andSub District level. There is scope for improvement of quality of data in the reports.These problems shall be sorted out by organizing orientation program on HMISand reporting system for different level of users. A decentralized training plan duringthe year 2009-10 is proposed to overcome the situation.A training programme for 2 days is proposed to be organized at State HQ toorient the District level officers, initially District Programme Manager (DPM), DistrictData Assistants, Accountants, Statistical Investigator and Computer Assistants of alldistricts. The training shall be on the new reporting system and M&E. the trainingshall include orientation on the DHIS 2, Web based HMIS portal. The training isproposed to be conducted in 2 batches with participants from 8 districts in eachbatch. They shall be the trainers for the training programme to train the Sub districtlevel officers & staff involved in reporting.Similarly 2 days training will be conducted at district HQ in each district to orientthe Block level officers and staff. The training shall be scheduled during the 2 nd and4 th quarters. From each Health Facility a person responsible for reports will be invitedto the 2 Days training programme to be conducted at the District HQ. The orientation110

programme will mainly focus on the reporting system, reporting formats and dataanalysis under NRHM. The expenditure is budgeted in the Training head.Decentralized HMIS/M&E Training PlanAt State HQ2 days training on Reporting System and M&E for District Level Officers(TOT for Block Level Officers & Staff)• Category of Participants from District = 8 DPMs, 16 DA, 16 Com.Assist.• Total Participants from 16 Districts = 40• Category of Participants from State HQ = 1 Data Manager, 5 DA/Com. Assist.• No of Participants in 1 batch = 23• No of Batch = 2At District HQ2 days training on Reporting System and M&E for Block Level Officers(TOT for MPHC/SHC/SD/SC level users)• Total no of Districts = 16• No of Batch = 16• No of Participants from each Health Facility = 1• Total No of Health Facility = 12 DH, 2 GH, 31 CHCs, 85 PHCs• Total No of Participants = 1741 day training on Reporting System and M&E at Block Level• Total no of SC = 381• No of Batch = 174• Total No of Participants = 177(For SC level users)Review Meeting:Review Meetings at every level will be carried out to ensure quality andregular reporting. Details are as follows: Block PHC Level Review Meeting on every 2 nd to 4 th day of the every quarter.111

District Level Review Meeting on 6 th to 7 th day of the each quarter. Half Yearly State Level Review Meeting.All the PHC, CHCs and DHs will organize a review meeting on 2 nd to 4 th Day of thequarter and send the minutes of the review meeting to the Mission Director (NRHM),Arunachal Pradesh. MO i/c of the PHC will be the chairperson of the review meeting.The meeting shall review the following along with other matters: Review of implementation of all Programmes. Review and analysis of reports submitted by the ANMs from the SCs. Examine the registers maintained by the ANMs to assure quality of servicesand data. Feedback and suggestion of improvement. Analysis of goal and achievement of each programme. Analysis of field surveys, FGD etc. if anyAt the Districts will organize a District level review meeting on 6 th to 7 th day of theQuarter. Districts will compile the status of the review meeting of all the DHs, CHCs,PHC and SCs and send a quarterly report to the Mission Director, NRHM, along withthe minutes of District level review meeting. The District medical Officer of theconcern District will be the chairperson and District Programme Manager will be theconvener of the review meeting. The meeting must included the review of thefollowing along with other matters: Review of implementation of all Programmes. Review and analysis of reports submitted by health facilities. Analyze the performance and quality of service & data. Feedback and suggestion of improvement. Analysis of goal and achievement of each programme. Analysis immunization performance based on RIMS software. Review of the minutes of the Block PHC level review meeting. Analysis of field surveys, FGD etc. if anyHalf yearly State Level review meeting is proposed to be organized at State HQ toreview performance of all the Programmes. Review of reports submitted by theDistricts will be the main objective of the meeting. Reports submitted by monitoringteam will also be reviewed in the meeting.112

Budget Estimate for Review meetingSl Review Meeting123Quarterly reviewmeeting at HealthFacilities(174 meetings perquarter)District-levelquarterly reviewmeeting(16 meetings perquarter)State-level halfyearly ReviewMeeting(1 meeting perquarter)No ofReviewMeetingsRate696 Shall be metfrom the RKS fund.Amount64 Rs.1500.00 Rs.96000.002 Rs.1,50,000.00Rs.3,00,000.Total 588 Rs.396000.0000113

6.4.2.3. Other M&E activities (please specify)MONITORING & EVALUATIONSchematic diagram for monitoring and evaluationState Health Society (SHS)State Programme ManagementSupport Unit (SPMSU)MCHSTATE MONITORING TEAMHMIS/M&EFPIEC/BCCImmunizationFinanceDistrict Health Society (SHS)District Programme ManagementSupport Unit (DPMSU)DISTRICT MONITORING TEAMHospital ManagementCommittee/RKSVillage Health CommitteeMonitoring from State Level:A monitoring plan shall be introduced in the state which shall come into effectfrom the first quarter of this financial year. It is planned that the state Monitoring teamof the State officials shall monitor every district twice a year with mobility supportfrom mobility support head. The budget for the purpose shall be met from NRHMAdditionality. The State Monitoring and Evaluation Team (SMET) shall compriseofficials from the State HMIS/M&E Cell.A team of at least 3 members shall monitor all 16 Districts twice during theyear. Monitoring of all Health Facilities at least up to the PHC level will be ensured.114

This will include monitoring of activities like maternal health, Child Health, JSY,Immunization, IEC/BCC activities, PPP, VHND, outreach activities, etc. It will bepurely done on the basis of a prepared calendar. The team will carry prescribedchecklist for monitoring and submit the detail report to the Mission Director, NRHM,Arunachal Pradesh and the Director Health Services. A feedback and suggestion onthe observations shall be sent to all the Districts for improvement.Monitoring at District Level:A District Monitoring Team will be constituted to monitor various programmesunder NRHM in each district. The District Monitoring and Evaluation Team (DMET)will consist of the following officials from the District Health Society;1. District Medical Officer2. District RCH Officer3. District Program Manager4. Data Assistant/ District Nodal M&E Officer5. AccountantThe team will carry prescribed checklist for monitoring and submit the detailreport to the District Health Society with a copy to the Mission Director and DirectorHealth Services & FW. Feedback of the monitoring report will be sent the concernHealth Facility with suggestion for improvement.Since, there have been no monitoring plans so far, it had been difficult toreview the progress of the program in an actual sense. During this financial year2009-10, it is planned to set up a Monitoring & Evaluation Cell at the State level. TheCell shall be responsible for taking up all monitoring activities in the State. The M&ECell shall focus on the monitoring of all the health facilities. The cell shall alsoevaluate the progress of the program annually. Efforts shall be initiated to introducea routine self evaluation of the programme at least once a year. It is also planned tohave an annual evaluated publication in respect of the program, incorporating allother National Disease Control Programs. This would be a step forward indocumentation of the achievements made so far. A monitoring plan shall beintroduced in the state which shall come into effect from the first quarter of thisfinancial year. It is planned that the state officials shall visit every district twice a yearwith mobility support from mobility support head. The budget for the purpose shall bemet from NRHM Additionality.In order to do so, it is proposed that a vehicle @ Rs. 25000/- per month behired exclusively for monitoring activities in the state.ESTIMATED COST FOR MONITORINGThe total budget proposed for the purpose amounts to Rs.1120000.00. Of thetotal budget, an amount of Rs. 480000.00 will be utilized for monitoring 16 Districtsby the State MET. The total budget to be released to the Districts will be Rs.640000.00. The budget for the purpose will amount to Rs. 10000.00 per District perquarter for monitoring all the Health Facilities of the respective Districts.The budget will be met under NRHM Additionalty. The details are as follows:115

Sl.No.Districts tobemonitoredMonitoringbyCOMMUNITY MONITORINGMonth formonitoringRateTotal1. 16 Districts State MET Half yearly 10000.00 320000.002. 16 Districts District MET Quarterly once 5000.00 320000.003. Total 640000.00The State intends to initiate Community Monitoring on a Pilot Project basisfrom this financial year onwards. Mapping shall be done by information on monitoringand planning. Good coordination, training and information delivery mechanisms shallbe essential for the purpose. As such Districts with, PRI members, NGOs, membersfrom VHSC, etc. who are active and in place within the community that have a role orinfluence on planning, management, assessment, monitoring and reporting shall beprioritized. Community Mapping, survey shall be ensured to enhance thecommunity’s ability to carry out monitoring which requires capacity in the form ofresources and skills – both social and technical. It shall be done by Gatheringinformation about the community, which will help to design Community BasedMonitoring that is in its interests.Two (2) districts namely East Siang and Lower Dibang Valley are proposedDistricts to be taken up as the Project area.It is planned that the project be a process where concerned citizens, agencies,academia, community groups and local institutions collaborate to monitor, track, andrespond to issues of common community concern.Capacity buildingTo carry out the same, capacity building of the people involved in the sameshall be required. Capacity building is required; by which individuals, organizations,institutions and societies develop their abilities individually and collectively to performfunctions, solve problems and achieve objectives. Understanding the groups andpeople involved in Community Based Monitoring will generate knowledge about howto engage them, use their skills and meet their needs. Participation Assessment shallbe focused as it will help find the best approaches for building capacity.116

Role of State in Capacity building:• Develop consensus among state and local communities about the aspects ofHealth issues in particular and the Program in general.• Provide training and technical assistance to communities on how to use data onrisk, protection, and outcomes in planning and programs.• Create coordination, comprehensive systems to address the issues, assistcommunities in collecting the data, and organize them so that communities use it.• Collect and organize data in public archives and make these data available to thecommunities.• Develop a community consensus about what behaviors—and influences on thosebehaviors—require monitoring.• Develop a coordinated strategy among relevant local agencies to collect, share,organize, and make use of available data; to the extent that the use of such databecomes a standard practice in the community, a greater number of effectivepreventive practices will be shaped over time.• Encourage and to describe the efforts that community leaders are making torespond to the findings.• Use data to guide prevention and treatment practices in the community. Whenevidence of progress in reducing a problem in the programs and policies previouslyimplemented to achieve the outcome will receive increased support.Advantages:• Provides the opportunity for decision-makers to describe their informationneeds and the chance to maximize collaboration between partners.• As communities become skilled, they can use data to guide them inmaking plans and policies in important ways.• By focusing attention on measurable outcomes, community-monitoringsystems can help bring about genuine and critical improvements in thelives of children and adolescents in every community.• The combination of skill sets, shared values, respect and trust within acommunity of people that allow for cooperation for mutual benefit.• Information needs are identified, monitoring becomes demand-driven,which informs the development of more effective tools and solutions forlocal issues.• The decision-makers then feed this knowledge and skill into appropriatelocal choices that are adaptive.The Process of Community Monitoring shall involve fund requirement. It isproposed that an amount of Rs. 100000.00/- (Rupees one lakh) only per districtmaking a total of Rs. 200000.00/- (Rupees Two Lakhs) only shall be earmarked forCommunity Monitoring.117

Sl.No District Fund requirement.a) East Siang Rs.100000.00b) Lower Dibang valley Rs.100000.006.4.3. BCCIEC/BCC strategy in the state has been planned on the basis of findings of theKAP study team conducted in the district by questionnaires, interviews, groupmeetings and FGD with different target groups in the districts. Implementation ofIEC/BCC activities in the state has been prepared and planned on the basis of feltneed based realistic BCC strategy and advocated for developing local specificIEC/BCC campaign using indigenous socio-economic background of the tribalpeople. The BCC strategy of the state also talks about “multichannel” activities usingvarious mass-media, folk media and also IPC as well as group communication. Asthe stat has unique geographical terrains, highly dispersed and inaccessible areasso the use of most localized form of communication would be the best way ofinforming and motivation community s as to achieve desired objectives. e.g.folksongs, plays and dramas in the local festivals.The state IEC Bureau will release fund to the districts as per the DistrictAction Plan (DAP) for implementation of IEC/BCC activities in all the districts.Monitoring of field activities in the districts will be carry out by the state level. To planand development of various means of communications/tools like to select the type ofAudio-Visual materials, print materials and its quality, to assist preparation of localspecific communication materials suitable for concerned districts and distribution ofIEC materials will be undertaken by State IEC Bureau. Tribe will be the basis ofaudience segmentation in the implementation of IEC/BCC activities in the statebecause Tribe is an entity having distinct dialects, cultures, food habits and life style.BCC/IEC strategy has been developed on the basis of specific local need of theaudience segment. Another basis of segmentation will be areas specific i.e. Urbanand Rural. Separate means of communication or tools will be utilized as per theawareness level of the people.Upgradation of State and District IEC/BCC Bureau is outmost important in theState. Due to inadequate manpower, infrastructure facilities, vehicles for monitoringwork, non- availability of adequate IEC materials and budget crunch are the majorfactors responsible for low achievement of IEC activities as desired in the peripherallevel. Most of the district IEC/BCC wings ar being run by staff drawn from otherunrelated fields. Therefore, all the vacant posts on the Bureau need to be fill upurgently and responsibility of all the IEC activities should be handed over to theIEC/BCC Bureau so that the state could translate the objectives into reality.118

6.4.3.1. STRENGTHENING OF IEC/BCC BUREAUS (STATE AND DISTRICTLEVEL)The state/district must have adequate IEC equipments to carry out IEC/BCCactivities. Due to lack of these equipments, state IEC bureau could not carry out theactivities as desired in the state.It is proposed to have at least 1 no. of Laptop, 1 No. of Computer withaccessories, 1 No. of Handycam Camera, 1 no. of Digital Camera, 1 No. each ofComputer table, 1 no. of Scanner and 1 no. of Almirah to strengthen the state IECbureau in the state HQ.6.4.3.1.1. Contractual Staffs recruited and in positionA) REGULAR MANPOWERDeputy Director, IEC (State level) - 1Mass Education and Information Officer (District Level) - 1Dy. Mass Education and Information Officer (District Level) - 4District Extension Educator (District Level) - 6B) No contractual Manpower6.4.3.1.2. Other activities (Professional training on Capacity building forDMO/DRCHO & IEC Officers of the state)The success of NRHM depends on the ability to communicate effectively witheach functionary/stakeholder with in the health system. It is understood now that theavailability of the resources and the necessary infrastructure alone will not ensurethe health of community and raise the standard of living and quality of life. Thedevelopment communication plays very significant role in improving health status ofthe community. Therefore it is necessary for all those persons who are engaged incommunity health to know the concepts of health communication targeted atcommunity mobilization and their participation in preventive & promotive health alongwith population control measures.Capacity building for DMO/DRCHO and IEC officers is felt due to inadequateunderstanding of key programmes by core personnel, capacity to carry outinterventions varies from state to state and lack of understanding to introduceinnovations in the communication process among the health programme & mediamanagers. The intra communication would be useful for successful implementationof NRHM interventions. More over-1. It would ensure greater clarity with in the system on key initiatives.2. It would establish proper articulation of objectives and details by keystakeholders with in the programme.3. It would improve the final impact of the programme by establishing a two waycommunication process.4. It would help identifying definite roles & responsibilities for key functionarieswith in the communication process.It is therefore propose to conduct 5 (five) days training course of one batchwith 48 (forty eight) participants at Itanagar/Naharlagun which will be conducted inthe first quarter during the year 2009 -10.119

KEY ELMENTSGrassroot levelBlock/District levelState level Village Health Day Flexi-funds ASHA routine (JSY-Immunization-other)Regular Meetings BPMU/DMPU meetings (Planning, Supervision, reporting) RKS Meetings, MO Meetings Workshop, Training sessions Visits to S-Cs, PHC/CHC for ratings IEC, IPC Health Melas MNGOs Others resources)KEY CHANNELS/INTERFACES SPMU/SHS meetings Monthly inputs one-mode & Quarterlycollection of data, reports, ratings etc. News Letter-cum-Bulletin dissemination Health Mela Participation by other sector partners IEC Training, Capacity Building workshopsOther channels/InterfacesGrassroot levelBlock/District levelState levelANM/PRI/ASHA/AWW/VHSCJSY/immunization needs of households.Flexi funds utilization by PRI PHC Bi monthly meetings ofFacilitators, ASHA / ANM / AWSupervisors/LHVs Sub-Centre / ANM: School healthmeeting, PRI meetings, Sectoral meeting(PRI / ASHA / AWW / ANM) Community-level PRI / ASHA / AWW /VHSC-House visits / Communitymeetings / village health days / VHSCmeetings / Film Show / wall painting /mobile clinics,SHM / SPMU (Half yearly meetings)Monthly CMOs meetings;Collectors meetings; Health Melas/Expos DHM/DPMU(DHS) District-level RKS meeting by Monthly,Quarterly meeting with DMOs: Health Melas / Expos;training / workshops (BHM/BPMU) Block level MOs meeting Quarterly; RKSMeeting: training/workshops.DPMU/BPMUMNGOs, Donors’ Association,Teachers, School, Primary cooperatives,RMPs, Resource groups, religiousorganizationsSPMUHospital, School network, Transportnetwork, Co-operatives, AIR-DD, PROs,Private Hospital, Rotary/Lion,Associations120

PERIODIC INPUTSStateBlockCHC/PHCSub Centre Booklet on flexi-fund Utilization – for all Sub Centre, PRIs[Once initially. To beupdated as required] Adaptation of Model Communication Kit (once in 2 years) and later replication(Annually) Replication for IPC Kits for ASHA/ANM/MPW in each Language for replication byStates (Annually) Replication of film on best practices (Annually) Development of display set for exhibition up to block level (Comprising foldablekiosks, laminated boards, Poster, Message stickers, other display material) once in 3years. And its replication (Annually) State level bulletin/info-sheet for all Sub-Centre (Half yearly) Poster on topical issues/programme-Distribution to sub-centres level (Once in 2 month) Awards, Ratings, Best performing DPMUs, CHCs/PHCs. IEC Review-Quarterly. Health Melas at block level [annually] Inspection, Visits, Fedbacks, Ratings of PHCs(Doctors, RK Samits, Performance of PHC) Poster and Display board for this at PHCs[Twice a year activity-April-June & Dec-Feb.Ratings once a year] District level RKS meeting by Quarterly Quarterly meeting with BMOs Training/Workshops (as appropriate) IEC review-Quarterly. MOs meeting quarterly. RKS meeting bi monthly. Training/Workshop (once a year) Visits/inspection of PHCs (twice a year-JSY, Immunization, Patient Friendlyapproach) Visit/Inspection of Sub-Centres (twice ayear-JSY, Immunization) Health Mela/Expos (once a Year) Mobile clinics/ambulances. IEC review Quarterly.[Supervising by Block Health facilitator?] School Health Meeting, PRI meetings,Sectoral meetings(PRI/ASHA/AWW/ANM) House Visit/Community meeting/Village Health Days/VHSCMeeting/Film shows/Wallpainting/mobile clinics.121

Periodicity – wise activitiesSl. Monthly Bi-Monthly Quarterly Half Yearly Annual Sporadic AD-HOCNO.1 Visit by ASHA GrassRootPHC Level GrassRootDPMU State SPMSU State HealthMelaState/DistrictMini Exhibitionat Marketplace,communitycenterDistrictandstate2 Village HealthDay3 Report ofASHA, ANMother to BlockHealthFacilitators4Mobile ClinicTrip sheet5 Making atvillageGrassRootGrassRootGrassRootGrassRKS MeetBPMU MeetVisit toSC,PHC,CHC, byblock andSPMU andHealthfacilitatorGrassRootGrassRootBlock&DistrictDMOsMeetDistrictNews Lettercum StatebulletinPosters ReviewingIEC forStateBlockLevelASHA/ANMmeetsBlock ReviewingIEC forDistrictsPRI, ANMmeet on flexi122StateDistrict andStateBlock/DistricRating ofSC/PHC/CHCWorkshop forASHA/ANMOtherWorkshopforBPMUstaffWorkshopDistrictandStateDistrict/StateDistrictandStateStateCommunitymobilizationAIDS DayIssue specific,season,SpecificCampaign asdivided fromtime to timeFunctioninauguration,ratingrecognitionetc.Issue specific,seasonGrassroot/Districtlevel/State

level Root fund utilizationJSY/ImmunizationachievementstforDPMUandMNGO6 WorkshopforSPMSUstaffSettingannualwork planStateState&Districtspecificcampaign asdecided from,time to time123

6.4.3.2. Development of state BCC strategySensitization programme through Group meetings for social activistand PRI members on Health determinants as per felt need and awarenesslevel of the Area, Block & Villages targeting unreached and rural population inthe districts. 128 nos. of group meeting will be organized in the state (2 eachin every Qtr i.e. 16 districts X 4 Qtr = 128 nos.). 8 nos. of group meeting inevery district during the year.6. 4.3.3. IMPLEMENTATION OF IEC/BCC strategy Maternal Health6.4.3.3.1. BCC/IEC activities/campaign for maternal healthIPC campaign through MOs, ANMs/GNMs, Health educators andASHAs involving PRI members and members of Women Welfare Society(WWS) will be organized on early registration of pregnancy and institutionaldelivery targeting the rural population in the district. 192 nos. of IPC campaignwill be organize in the state. 12 (Twelve) nos. of IPC campaign in everydistrict will be organized during the year. (NO FUND)6.4.3.3.1.1. BCC/IEC activities for maternal health intervention(except JSY)Focus group discussion (FGD) through MOs and ANMsinvolving MSS and Angan Wadi Workers (AWWs) will be organize in the ruralpopulation un-served areas targeting woman to assess the status of earlyregistration and institutional delivery in the district. 384 nos. of FGD will beorganize in the state (6 each in every Qtr i.e. 16 districts X 4 Qtr. = 384). 12nos. of FGD in every district during the year. ()6.4.3.3.1.2. BCC/IEC ACTIVITIES FOR JSYRural publicity campaign to sensitize the community throughawareness health camps through MOs, ANMs and ASHAs will be engage inthis health awareness camps by involving educated youths and PRImembers in the rural and urban areas targeting eligible couples, parents,married and unmarried woman. 48 nos. of health camps will organize in thestate (1 each in every Qtr. i.e. 16 districts X 3 Qtr. = 48 nos.). 420 nos.descriptive health chart board containing JSY messages will be printed atthe state HQ. and will be distributed to all the district for furtherdistribution in the DH, CHC, PHC and SC as a part of innovativeIEC/BCC campaign in the state @26 nos. each to all the district and 2nos. each in 2 General Hospital during the year. 4000 col. Cm of printadvertisement on RCH/FW messages will be published in the localnewspaper and magazine as a part of publicity campaign targeting theurban population and educated group.6.4.3.3.2. BCC/IEC activities/campaign for Child HealthAs a part of awareness health campaign health mela will be organizein the rural and urban areas involving public leaders from the community withan aim to sensitize all age group on health related issue. 48 nos. of healthmelas will be organize in conjunction with maternal health camps in the state(1 each in every Qtr. i.e. 16 district X 3 Qtr. = 48 nos.). It is also observed thatradio jingles is one of the most effective IEC/BCC camping in the state.Therefore 88 nos. of radio jingles in 11 local dialects involving local artists will

e produce and broadcast at 5 AIR stations including FM Radio Ooo…la...la… in the state during the year.6.4.3.3.3. BCC /IEC activities/campaign for Family PlanningAwareness campaign through folk songs plays and dramas will beorganized during the local festivals/events involving local cultural groups onRCH/FW messages/themes. Rural population including young and old will betargeted to sensitize on family planning. 32 nos. of folk songs, plays anddramas will be organized in the state (1 each in every district during the year).Exhibitions /Film shows will also be organize during the local festivals/eventsinvolving village head and local youth through MOs, ANMs and projectionist.32 nos. of exhibitions/film shows will be organized in the state (1 each inevery district during the year).6.4.3.3.4. IEC/BCC activities/campaign for ARSHHigh / Higher secondary school programme through MOs,ANMs/GNMsinvolving teachers and students will be organized in the rural and urban areasby categorizing different classes in the identified schools. In this programmestudents will participate through debate, extempore speech, drawing, songs,plays and dramas. 64 nos. of school programmes will be organized in thestate. 4 nos. each in every district during the year.6.4.3.4. Any other activities.Maintenance of MSS CentresThere are 448 nos. of Mahila Swastha Sangh (MSS) functioning in theState. For maintenance of the existing MSS, an amount of Rs. 1200/- perMSS will be required per year.6.5. TrainingTraining including for private sector / NGOsThe Identification of trainees has been done as per actual needs facilitywise.6.5.1. Strengthening of training institutions6.5.1.1. Carry out repairs/ renovation of the training institutionsThe state at present has no training centre.6.5.1.2. Provide equipment and training aids to the training institutionsIn absence of a training centre the training activities cited under RCHphase-II and NRHM are conducted mostly in two general hospitalsestablished in Naharlagun and Pasighat in the state. Some of the in statetrainings are also organized by hiring seminar halls.No training equipments are available in the state headquarters.However, training equipments are a prime requisite.125

6.5.1.3. Contractual staff recruited and in positionOne Consultant training is recruited and in position on contract and willbe continuing till end of the programme. However, with the establishmentof the State Training centre it will be upgraded to HR Consultant andstate service.6.5.1.4 Others activities6.5.1.4.1. One telephone connection with Broadband may be provided.6.5.1.4.2. Establishment of SHFWTCRationaleTraining is a vital component in development of its manpower in anorganization to achieve its objectives. The mandate for in service training isto improve performance of Health and Family Welfare Programmes. A majorpre-requisite for providing quality health care service is upgrading the skillsand knowledge of all health personnel as well as key personnel of relatedsectors in the districts acquire the knowledge and skills to provide the healthcare services effectively and efficiently of integrated services.Presently only one training centre, namely the Nursing Training School,Pasighat exists in the state. This nursing school conducts the basic trainingcourses for Auxiliary Nurse Midwifery only. The department of Health andFamily Welfare is also experiencing difficulties in conducting the trainingactivities under the ongoing Reproductive and Child Health Program.Since there is no any training centre to cater for in-service training of allcategories of health care providers, the national training strategy underNRHM which is to be incorporated by the state is not successful. And so,most of the training courses are missed, also sending of staffs outside thestate e.g. Child in Need Institute, Kolkata is very expensive and timeconsuming.It is also to be mentioned here that the Department currently have land areafor construction of the proposed training centre. If the proposed trainingcentre is not constructed now than the available land area may beutilized by the State Govt. for some other purposes.Justification -Training centre in the stateIn order to provide better quality health services in the stateestablishment of one training centre in the state is very essential forimplementation of in-service training strategy laid down by government ofIndia. The training centre is to be upgraded to a training Institute in future.At present two General Hospitals namely, GH-Naharlagun and GH-Pasighatare identified the two training centers in the state however, all the trainingactivities cannot be completely carried out. The two General Hospitals are126

presently satisfying the clinical aspect of the trainings but implementation ofclassroom training still suffers.Most of the classroom trainings are audio visual in nature it requires a trainingroom with necessary training equipments. Management and organization ofall vertical training activities to be planned and implemented from one centrepoint for easy maintaining of record keeping and documentation and also toavoid duplication of training. Certificates may be Authenticated and issuedfrom one such established Institution to avoid further confusion.The training Centre should consist of at least three classrooms. It should bewell furnished with all the required training equipments and Materials. Itshould also comprise of two guest rooms. All the Classrooms should be wellfurnished with training equipments such as laptops, digital camera, TV,widescreen and Projector, Desk top Computer with broadband connection,scanner and printer. The centre should also have a phone facility.The program Managers/Officers will be identified in the training faculty.It will act as the centre for all training information and the depot for all thetraining Materials, Guidelines and Modules published by Govt. of India.ComponentIt is proposed to establish one state level Health and Family WelfareTraining Centre, located at Naharlagun, Arunachal Pradesh under FamilyWelfare Department, headed by the Mission Director (NRHM). This trainingcentre will cater not only to the needs of the Health and Family WelfareDepartment but will also serve as the venue for training, meetings,seminars, workshops etc for all other related govt. and non govt.organization.The training faculty will be drawn from the existing TOT trained personnel /specialist from state health service as and when required as per the trainingplan.Objectives:The overall objective of the training centre will be to train all healthpersonnel in key child survival, safe motherhood, and populationstabilization program and to impart continuous in-service training, ultimatelyresulting in improvement of the quality of the services.It also aims to organize lectures, seminar, conference, symposia, workshopetc for high and middle level manager.Inputs RequiredTo establish the state level Health and family Welfare training Centre,following inputs will be required:a. Construction of the building for the Training Centre.b. Provision of teaching aids.127

• Over head Projector -2 nos.• LCD projector-1 Nos.• White Board- 2 Nos.• PA System- 1 Nos.• Colour television – 2 Nos.• Laptop with accessories – 1 Nos.• PC with broadband connection– 2 Nos.• Telephone – 1 Nos.• Generater - 1 Nos.c. Provision of furniture and stationary.d. Provision of books for librarySome of the activities will be implemented in the coming years.CommitmentTraining is a regular and ongoing activity of health and family welfare servicedelivery. It is also an important and integral component of any central orstate government schemes and program. Therefore, the utility of theproposed health and family welfare training centres will continue to exist andwill be sustainable on long term basis.Budget estimate:The total fund required for the construction of the State Level Health andFamily Welfare Training Centre along with the components required to makeit functional is Rs. 3000000 (Rupees Thirty Lakhs only) this year andremaining requirement of Rs 1.9 Cr will be proposed in the next year. Detailsof the building estimate is at Annexure – 8.(provided seperately)6.5.2 Development of training packages.128

Details of Training Expenditure 2009-10Budget HeadNumber of Participant in acourseNo. of BatchDuration (in days) for eachparticipantDA to Group B, C, D andequivalent participantsTA (to and Fro)DA to Group A participantsofficers & equivalentHonorarium to District & SubDistrict guest facultyHonorarium to guest faculty forcourses atState/Regional/National levelWorking LunchInstitutional Overheah & for useof institutional facilitiesincidental expenditure,photocopying, job aids, flipcharts, LCD etc.Total Fund requiredSBA ToT 1 1 3 15128 1215 10000 4676.7 2000 33019.7ANM/LHV 12 6 21 50400 48000 75600 34110 53400 261510EmOC MO 1 1 112 45490 45360 112000 33787 22400 259037LSAS MO 4 1 126 40000 204120 126000 70878 102400 543398MTP using MVA MO 10 1 15 60000 60750 15000 24862 30000 190612RTI/STI MO 58 10 3 70470 30000 32470 116003 248943IMNCI MO 56 1 10 224000 226800 66000 94320 112000 723120SN 15 1 10 30000 6000 60000 18900 30000 144900ANM/LHV 43 4 10 86000 172000 24000 55200 86000 423200FBNC MO 20 4 3 80000 8100 12000 18615 12000 130715SN 20 4 3 12000 12000 7200 4860 1200 37260Minilap MO 20 2 12 12000 120000 8100 24000 31815 48000 243915IUD ToT 14 1 1 56000 5670 1000 9820 2800 75290MO 51 10 5 204000 20655 50000 48848 51000 374503ANM/LHV 130 13 5 130000 520000 65000 126750 130000 971750

Contraceptive UpdateSpecialist,MedicalOfficers andProgrammeOfficers 65 1 1 26325 1000 6048 13000 46373LaparoscopicSterlization Specialist 6 3 12 84000 29160 16974 130134Ultrasound Specialist 16 4 30 224000 194400 480000 898400M.Sc Nursing 2 400000 400000CME MO 400 8 2 324000 50000 56100 430100SN 350 7 2 140000 50000 28515 2185156784695130

6.5.2.1 Development/translation and duplication of training materials.Since, all the training Modules and Guidelines under the training activities aredesigned by Government of India. These training Materials will be duplicatedand multiplied at the state headquarter as per the requirement of the state. Onmultiplication of these Materials they will be made available to all the identifieddistricts training centers wherein training activities will be conducted.6.5.2.2 Specialized training equipment (for skill trainings) provided.Since, specialized skill trainings are conducted outside the state; there is nospecific requirement for specialized training equipments.6.5.2.3. Other Specify6.5.3 Maternal Health Training6.5.3.1 Skilled Attendance at Birth / SBA6.5.3.1.1. Setting up of SBA Training CentresThe state has no separate SBA Training centre. At present the two GeneralHospitals established at Naharlagun (Papum Pare district) and Pasighat (EastSiang district). General Hospital Pasighat will be identified for conducting SBAtraining.6.5.3.1.2. TOT for SBAThe state has one Master Trainer in SBA posted at CHC Ruksin in EastSiang District. One additional Master trainer in SBA would be required for trainingmore number of batches. Calculated Fund requirement is Rs. 33019/-.6.5.3.1.3. Training of Medical Officers in SBATraining of MO in SBA will be planned on availability of SBA Modules fromGoI.6.5.3.1.4. Training of Staff Nurses in SBATraining in SBA for Staff Nurses is not planed this year.6.5.3.1.5. Training of ANM/ LHV in SBA.The Training in Skill Birth Attendance is long duration training emphasizingmainly on hands on training. The duration of training is 3-6 weeks depending of theskill of the trainee. However, in the state the training will be planned for 6 weeks incomplete and will be imparted by a Master trainer. General Hospital Pasighat isidentified the training centre.Training load is twelve (12) numbers of ANM from the CHCs and PHCs fromWest Siang and Upper Siang districts will be trained. The number of batches will besix (6) with a size of 2 per batch. The calculated Fund requirement is Rs. 261510/- @Rs. 21792.5 per trainee. Training shall be completed by the third quarter of the year.The SBA training will require the following items namely:A) SBA KITB) Parthographs

6.5.3.2. EmOC Training6.5.3.2.1. Setting up of EmOC Training CentresThe state has no separate EmOC Training centre. However, General HospitalNaharlagun is identified for the conducting in state EmOC training.6.5.3.2.2 TOT for EmOCThe State has one Master Trainer in EmOC.6.5.3.2.3. Training of Medical Officers in EmOCThe Training in EmOC comprises of two parts. First, 4 weeks training inEmOC for Medical Officers is conducted outside the state at a Medical Collegeidentified by FOGSI (GoI). Second, 12 weeks is conducted at General HospitalNaharlagun by a Master Trainer. Total Training duration is 16 weeks.The training load in EmoC is One (1) numbers of Medical Officer. Theestimated Fund requirement is Rs. 259037/-. Training will be completed by thesecond Quarter of the year.6.5.3.3. Life saving Anaesthesia skills training.The state has no Medical College for undertaking LSAS Training.6.5.3.3.1. Setting up of Life saving Anaesthesia skills Training Centres6.5.3.3.2. TOT for Anaesthesia skills training.The TOT in LSAS is not planned for the year.6.5.3.3.3. Training of Medical Officer in life saving Anaesthesia skills.The duration of training in Life Saving Aneasthetic skill is 18 weeks. The instate training will be conducted at General Hospital Naharlagun after training at theidentified Medical College and in consultation with RRC-NE. The training loadis four (4) numbers of Medical Officers.The calculated Fund requirement is Rs. 543398/- @ Rs. 135849.50/- pertrainee. Training will be completed in the 3 rd quarter of the year.6.5.3.4. MTP Training6.5.3.4.1. TOT on MTP using MVATOT in MTP is not planned for the year.6.5.3.4.2. Training of Medical Officers in MTP using MVAThe training in MTP shall be imparted to 10 numbers of Medical Officers in thestate. Training will be imparted by a Gyneacologist. Both General HospitalNaharlagun and Pasighat will be identified the training Centre.The duration of132

training is 15 days. The Fund requirement is Rs. 2,68,000/- @ Rs. 26,800 pertrainee. Training will be completed by the 2 nd and 3 rd of the year.6.5.3.4.3. Training of MOs in MTP using other methods (Pl. specify)Training not planned6.5.3.5. RTI/STI TrainingTraining not planned6.5.3.5.1. TOT for RTI/STI trainingMaster Trainer already available in the Districts, trained by APSACS.6.5.3.5.2. Training of Laboratory Technicians in RTI/STITraining not planned.6.5.3.5.3. Training of Medical Officers in RTI/STI58 MOs (30 CHC +28 PHC) will be trained in RTI/STI in 10 batches at theDistrict level during 2 nd and 3 rd quarters. The train ing is planned in consultation lwithAPSACS. The estimated fund required amounts to Rs. 248943.00 @ Rs. 4292.12per trainee.6.5.3.5.4. Training of Staff Nurses in RTI/STITraining not planned.6.5.3.5.5. Training of ANMs/LHVs in RTI/STITraining not planned.6.5.3.6. Orientation of Dai/TBAs on safe deliveryTraining not planned.6.5.3.7. Other Maternal Health Training (Pl. specify)IMEP Training6.5.4.1. TOT on IMEPTraining not planned.6.5.4.2. IMEP training for state and district programme managersTraining not planned.6.5.4.3. IMEP training for medical officersTraining not planned.6.5.5. Child Health Training6.5.5.1. IMNCI training (pre-service and in- service)6.5.5.1.1. TOT on IMNCI (pre-service and in- service)Training not planned.6.5.5.1.2. IMNCI training for Medical OfficersThe training in IMNCI is divided into 8 days of Audio visual and two days ofsupervision which also includes one community visit. This year training will beimparted to 56 numbers of Medical Officers of west Siang. The Fund requirement isRs. 723120/- @ Rs. 12,291/- per trainee. Training will be completed by the fourthquarter.6.5.5.1.3. IMNCI training for Staff nurses.The State has a pool of 10 Master trainers who will be further utilized intrainings of GNM/ANM/Aww in the state. Both Audio visual and two days ofsupervision training with one community visit will be imparted. Training load isfifteen (15) numbers of GNM in one (1) batch. Training will be imparted by a133

Master Trainers. The identified training centres are General Hospital Pasighatand Naharlagun.The calculated Fund requirement is Rs. 144900/- @ Rs. 2587.5/- per trainee.Training will be completed by the fourth quarter of the year.6.5.5.1.4. IMNCI Training for ANMs/LHVs.Training in IMNCI for 43 ANMs is planned for this year in 4 batches.Thecalculated Fund requirement is Rs. 423200/- @ Rs. 9841/- per trainee. Training willbe completed by the fourth quarter of the year.6.5.5.1.5. IMNCI Training for Anganwadi WorkersTraining not planned6.5.5.2. Facility Based Newborn Care / FBNCTraining not planned6.5.5.2.1. TOT on FBNCTraining not planned.6.5.5.2.2. Training on FBNC for Medical Officers20 numbers of MOs in 4 batches will be trained in operationalising New BornCare Corner in the GH/DH wherever Pediatrecians are available. The duration of thetraining will be for 3 days per batch @ Rs. 6535.75/- per trainee. Total amountrequired Rs. 130715/-. The training shall be initiated in the 2 nd quarter.6.5.5.2.3. Training on FBNC for SNs20 numbers of SNs in 4 batches will be trained in operationalising New BornCare Corner in the GH/DH wherever Pediatrecians are available. The duration of thetraining will be for 3 days per batch @ Rs. 1863/- per trainee. Total amount requiredRs. 37260/-. The training shall be initiated in the 2 nd and 3 rd quarter.6.5.5.3. Home Based Newborn Care / HBNCTraining not planned6.5.5.3.1. TOT on HBNCTraining not planned6.5.5.3.2. Training on HBNC for ASHATraining not planned6.5.5.4. Care of sick children and severe malnutritionTraining not planned6.5.5.4.1. TOT on Care of sick children and severe malnutritionTraining not planned6.5.5.4.2. Training on Care of sick children and severe malnutrition forMedical OfficersTraining not planned6.5.5.5. Other child health training (please specify)Training not planned134

6.5.6. Family Planning Training6.5.6.1. Laparoscopic Sterilisation Training6.5.6.1.1. TOT on laparoscopic sterilisationThe training will be conducted outside the state, so there is no requirement ofToT.6.5.6.1.2. Laparoscopic sterilisation training for Specialist/ Medical officersThere are 11 functioning FRUs in the state where 5 facilities are having Lap.Sterilization trained specialists. The remaning 6 specialists will be trained in Lap.Sterlization technique outside the state during 2 nd , 3 rd & 4 th quarters of the year. Thetraining cost per candidate is Rs. 21689/-. Total requirement is Rs. 130134/-.6.5.6.2. Minilap Training6.5.6.2.1. TOT on MinilapThe O&G Specialists in place will be the Trainers for Minilap training.6.5.6.2.2. Minilap training for medical officersThe training in Minilap will be conducted for 12 working days for MedicalOfficers in CHC/FRU&DH. Training load is 20 Medical Officers with a batchsize of 2 per batch. Training will be imparted by a Gyneacologist. The Fundrequirement is Rs.243915/- @ Rs. 12,195.75/- per trainee. Training will becompleted by the fourth quarter of the year.6.5.6.3. Non-Scalpel Vasectomy (NSV) TrainingTraining not planned6.5.6.3.1. TOT on NSVTraining not planned6.5.6.3.2. NSV training for MOsTraining not planned6.5.6.4. IUD insertion6.5.6.4.1. TOT for IUD insertionOne day orientation on IUD of Gynecologist will be imparted to oneGyneacologist from each district in the state. Duration of training will be one day inwhich the state Master Trainer will be orienting the various techniques regardinginsertion and removal of the new intra uterine device.Fund requirement is Rs.75290/- @ Rs. 5378/-per trainee. Training will becompleted by the fourth quarter of the year.6.5.6.4.2. Training of Medical Officers in IUD insertion.The training in IUD for Medical Officers will be imparted to all the 51Medical Officres from all the 31 CHCs and 20 PHCs in the state. Training will beimparted by a master trainer.The training duration is of five days. Number of batches will be 13 witha batch size of 5 trainees per batch.The Fund requirement is Rs.374503/- @ Rs. 7343/-per trainee.Training will be completed by the fourth quarter of the year.135

6.5.6.4.3. Training of staff nurses in IUD insertionTraining not planned.6.5.6.4.4. Training for ANM/LHVs in IUD insertionThe training of ANM shall be imparted to 130 numbers of ANM in thestate (80 from previous year+50 new). The duration of training is 5 days. Trainingwill be imparted by a Master Trainer in a batch size of 10 per batch. The Fundrequirement is Rs. 971750/- @ Rs. 7475/- per trainee. Training will be completedby the fourth quarter of the year.6.5.6.5. Contraceptive Update.The Contraceptive Updates at the state level will be conducted once this yearwhere all the Specialist, Programme Officers / Medical Superintendent will attend.Further, update at the Disrict level will be oreganized for MOs/Nurses ones in everydistrict. Training will be completed by the third quarter of the year. The Fundrequirement is Rs. 46373/-.6.5.6.6. Others Family Planning Training.6.5.7. Adolescent Reproductive and Sexual Health/ARSH Training6.5.7.1. TOT for ARSH trainingTraining not planned.6.5.7.2. Orientation training of state and district programme managersTraining not planned.6.5.7.3. ARSH training for medical officersTraining not planned.6.5.7.4. ARSH training for ANMs/LHVsTraining not planned.6.5.7.5. ARSH training for AWWsTraining not planned.6.5.8. Programme Management Training6.5.8.1. Training of SPMSU staff65.8.2 Training of DPMSU /BPMSU staff6.5.9. Other training (pl. specify)6.5.9.1 Professional Development CourseThe PDC training is a 10 weeks course with a batch size of seven (7) traineesper batch. Training is imparted at NIHFW Kolkatta. Training load for the year is 14.Programme is supported by GoI.6.5.9.2 Ultrasound TrainingTraining in Ultrasound will be imparted to 16 number of specialist fromeach 16 districts in the state. Duration of training in ultrasound will of 3 weeks. Abatch of four specialists in a batch size of four will be trained during the year. TheFund requirement is Rs.898400/- @ Rs. 13821/- per team. Training will becompleted by the fourth quarter of the year.6.5.9.2 MSc (Nur) course)136

The state is planning to establish GNM School this year and it is expected thatin near future, there will be a Nursing College in Arunachal Pradesh. In order toprepare the existing BSc Nursing qualified in service nurse, it is proposed to send 2candidate having BSc Nursing degree for MSc Nursing course outside the state. GoImay facilitate the state for the proposal. The estimated cost per student for this yearis Rs, 2 lakhs (Total required is Rs 4 Lakhs only).6.5.9.2 Continuing Medical Education to all MOs and Staff NurseA two days workshop at the state level will be organized for providing continuingMedical Education to all the MOs and Staff Nurses.The workshop will be held at thestate level.1. Total No. of MOs in the state: 400 (8 batches)Estimated Fund: Rs. 430100/- @ Rs. 1075.252. Total No. of Staff Nurses in the state: 300 (7 batches)Estimated Fund : Rs. 218515/- @ Rs. 624.33/-HMIS TrainingTraining component on MIS Monitoring Evolution will include DHIS 2; webbased online Data entry, quality checking of data, compilation and analysis of data,feed back to field and timely reporting to higher authority. MIS training for, DPM,Accountants, Data Assistant, Statistical Investigator, Data Manager will be organizedon total HMIS Quarterly once this year with technical support from GoI.The reporting system in the state is flowing from SC level to the district levelto State level but still there are lots of areas for improvement.Some of the major problems, which are identified, are: District level and SC level reporting authorities are not well acquainted withthe reporting system in the present HMIS reporting format. Lack of awareness about importance and quality of data among grass rootlevel reporting personnel, i.e., the ANMs, MO i/c, etc. Inconsistent, Incomplete, Inaccurate and under reporting are the majorproblems identified in the present system. Lack of analysis and monitoring mechanism of periodic reports at District andSub District level. There is scope for improvement of quality of data in the reports.These problems shall be sorted out by organizing orientation program on HMISand reporting system for different level of users. A decentralized training plan duringthe year 2009-10 is proposed to overcome the situation.A training programme for 2 days is proposed to be organized at State HQ toorient the District level officers, initially District Programme Manager (DPM), DistrictData Assistants, Accountants, Statistical Investigator and Computer Assistants of alldistricts. The training shall be on the new reporting system and M&E. the trainingshall include orientation on the DHIS 2, Web based HMIS portal. The training isproposed to be conducted in 2 batches with participants from 8 districts in eachbatch. They shall be the trainers for the training programme to train the Sub districtlevel officers & staff involved in reporting.137

Similarly 2 days training will be conducted at district HQ in each district to orientthe Block level officers and staffs. The training shall be scheduled during the 2 nd and4 th quarters. From each Health Facility a person responsible for reports will be invitedto the 2 Days training programme to be conducted at the District HQ. The orientationprogramme will mainly focus on the reporting system, reporting formats and dataanalysis under NRHM.138

Decentralized HMIS/M&E Training PlanAt State HQ2 days training on Reporting System and M&E for District Level Officers(TOT for Block Level Officers & Staff)• Category of Participants from District = 8 DPMs, 16 DA, 16 Com.Assist.• Total Participants from 16 Districts = 40• Category of Participants from State HQ = 1 Data Manager, 5 DA/Com. Assist.• No of Participants in 1 batch = 23• No of Batch = 2At District HQ2 days training on Reporting System and M&E for Block Level Officers(TOT for MPHC/SHC/SD/SC level users)• Total no of Districts = 16• No of Batch = 16• No of Participants from each Health Facility = 1• Total No of Health Facility = 12 DH, 2 GH, 31 CHCs, 85 PHCs• Total No of Participants = 1741 day training on Reporting System and M&E at Block Level• Total no of SC = 592• No of Batch = 174• Total No of Participants = 177(For SC level users)139

Estimate for 2 days Training of Reporting System and M&E for District Level userEstimate for 1 batchSl Particulars Rate Qty Unit Days Amount1 TA from District HQ to 800.00 20 Nos 2NaharlagunRs.32000.002 DA 400.00 23 Nos 2 Rs.18400.003 Honorarium for 1000.00 4 Nos 2Resource PersonsRs. 8000.004 Training Material 500.00 23 Nos 1(Study material, Pen,Rs. 11500.00Note Book, Folder)5 Lunch 350.00 30 Nos 2 Rs.21000.006 Contingency 15 % of the total amount Rs. 13635.00Sub Total Rs. 1045535.00No of Batch 2Total Estimated Cost (Rs)Rs.209070.00Estimate for 2 days Training on Reporting System and M&E at District LevelEstimate for 130 batches for 16 DistrictsSl Particulars Rate Qty Unit Days AmountTA/ DA to particpants:1 TA to Dist HQ (to & Fro) 200.00 174 Nos 2 Rs.69600.002 DA 200.00 174 Nos 2 Rs.69200.003 Honorarium for 500.00 3 Nos 2Resource PersonsRs. 3000.004 Training Material (Study 300.00 174 Nos 1material, Pen, NoteRs. 52200.00Book, Folder+CD)5 Contingency 15 % of the total amount Rs. 35100.006 Lunch 200.00 190 Nos 2 Rs. 40000.00TotalRs.269100.00Estimate for 1 day Training of Reporting System and M&E at Block level1 day training on Reporting System174 (Batch)and M&E at Health Facilities = 12 DH,2 GH, 31 CHCs, 85 PHCsTotal No of Participants = 378(For SC level users)Training Expense per Health facility Rs. 2000.00Total Amount Rs. 348000.00140

Training on DHIS 2, web based online Data entry, quality checking of data,compilation and analysis of data, feed back etc.Budget EstimateSl Name of the TrainingTotal Participants(Physical Target)Estimated Amount(Financial Target)12 days training for District Leveluser at State HQ(TOT for Sub District levelusers)1 day training for District Leveluser at State HQ(TOT for Sub District levelusers)46 (1 st Qtr) Rs.209070.0046 (2 nd , 3 rd & 4 th Qtr) @Rs. 139380/- pertrainingRs. 418140.00232 days training on ReportingSystem and M&E for BlockLeveluser(TOT for DH/CHC/PHC/SClevel users)1 day training on ReportingSystem and M&E at HealthFacilities = 12 DH, 2 GH, 31CHCs, 85 PHCsTotal No of Participants = 378(For SC level users)174 (2 nd & 4 th Qtr) @Rs. Rs.269100/- pertraining for 16 DistrictsRs.538200.00378 (3 rd qrt. @ Rs.2000/- per Centre) Rs. 348000.00Total Rs. 1513410.00Training BPMSU staffTraining of 84 Nos. BPMSU will be imparted during the first quarterafter selection. The details of the training is as followsNos. of Participants – 84Duration of Training - 2 days per batchNo of batches – 3Materials - @ Rs. 250/- per participants = Rs.21,000/-Stationery @ Rs. 90/- per participants =Rs. 7,560/-Seminar Hall Charges @ Rs. 1,800/- per day for 6 days =Rs.10,800/-Lunch @ Rs. 150/- per participant = Rs. 12,600/- per day per batch for 6 days= Rs. 75,600/-Tea & snacks & Water @ Rs. 70/- per participants for 6 days = Rs. 35,280/-Total financial involvement is Rs. 1,50,240/-333141

6.6 Equity /genderA perspective that aims at the enlargement of human capabilities as one of itscore concerns cannot remain oblivious to the glaring disparities between males andfemales in many spheres of life. The transformative and emancipative potentialitiesof any discourse of social change will remain severely limited and lopsided unlessthe centrality of the gender question is explicitly recognized and incorporated into theideas, policies and agencies. Gender equality, it is being increasingly recognized, isa necessary condition for sound and sustainable human development.The four critical elements of the human development concept-productivity,equality, sustainability and empower men-demand that gender issues should beaddressed as development issue and as human rights concerns. ‘Development, ifnot engendered, is endangered’.Since gender disparities in health and schooling outcomes are largely causedby parental discrimination against the girl child, public policies that increase theparental incentive to invest in girls are likely to work well in narrowing the gendergap. Many empirical studies from around the world, suggest that gender disparitiesin the health, schooling, and nutritional outcomes of children tend to narrow withmother’s schooling, as mothers (relative to father) tend to invest more in their femalechildren.In Arunachal Pradesh, there is not much of gender discrimination / biasnessat present. Vulnerable communities in Arunachal Pradesh include those groups whoare underserved due to problems of geographical access, and those who suffersocial and economic disadvantages such as Scheduled Castes/Scheduled Tribes(SCs / STs) and the urban poor. Scheduled Castes and Scheduled Tribes do not liveonly in homogeneous communities, but are found within heterogeneous communitiesboth in rural and urban areas. Arunachal Pradesh is one out of those sixpredominantly tribal populated States/ UTs where more than 60% of the populationis tribal. However, in the State of Arunachal Pradesh, the SC population is less than3%. The RCH indicators for slum population are worse than the urban average.Marginalization results in poorer social indicators for these groups, includingmaternal and child health indicators. This can be as much a result of service providerbehavior as of health seeking behavior and capabilities. It is proposed in the laterpart to address the vulnerable group.Gender Related Development IndexThe Gender-related Development Index (GDI) is basically the HDI, adjusteddownwards for gender inequality. It is based on the same three indicators - lifeexpectancy at birth, adult literacy combined with gross enrollment ratio and real GDPper capita in terms of purchasing power parity dollars-used in the construction of theHDI, but concentrates on the inequality between sexes as well as the averageachievement of all people taken together. Although many important dimensions ofgender inequality such as intra-family distribution of resources, security and dignityof individuals are not captured by the GDI, yet has been widely used as a measureof relative deprivations among males and females.142

Comparative Rankings of HDI and GDI for Districts of Arunachal PradeshDistricts GDI HDIValue Rank Value RankTawang .435 10 .453 10West Kameng .489 5 .506 5East Kameng .388 13 .403 13Papum Pare .577 1 .595 1Lower Subansiri .481 6 .493 7Upper Subansiri .435 11 .443 11West Siang .541 3 .551 3East Siang .568 2 .577 2Upper Siang .477 8 .488 8Dibang Valley .510 4 ..523 4Lohit .479 7 .495 6Changlang .467 9 .479 9Tirap .421 12 .440 12ArunachalPradesh.489 .501The GDI for Arunachal Pradesh has been estimated to be 0.489, which islower than that of India as a whole in 200. So far as the ranking of districts in termsof GDI in concerned, it follows that same pattern as the HDI. Papum Pare has thehighest and East Kameng the lowest rank in GDI. Districts having relating high GDIinclude East Siang and Dibang Valley, while Tawang, Upper Subansiri and Tiraphave relatively low ranks. The gap between HDI and GDI is highest in Tirap closelyfollowed by Papum Pare and Tawang districts. The gap is relatively low in UpperSubansiri, East Siang and West Siang. The only district which has a higher rank inGDI than that of HDI in Lohit and Lower Subansiri has a higher rank in HDI than thatin GDI.Female Life ExpectancyFemale life expectancy at birth in Arunachal Pradesh has been estimated tobe 54.51, which is marginally higher than the male life expectancy in the state,53.66. At the district level, in four out of the thirteen districts, male life expectancywas estimated to be higher than that of the females. While Papum Pare, the mosturbanized district, has the highest female life expectancy a birth, East Kameng hasthe lowest life expectancy. It is important to note that female life expectancy in thestate is not only lower than the current national average of 64.84, but also lower thanthe country’s average in 1981-85.Sex RatioA lower sex ratio typically represents a lower social status of women, whichcreates conditions for discriminations at various levels. Sex ratio in the state afterdeclining from 862 in 1981 to 859 in 1991 increased to 901 in 2001. Among thedistricts West Kameng has the lowest and East Kameng and Lower Subansiri havethe highest sex ratio. Dibang Valley with lowest sex-ratio of 788 in 1991 has shown143

improvement with 840 in 2001. Out of thirteen districts, five districts have shown sexratio below the State sex ratio of 901 and eight districts above the same.Child Sex RatioThe child sex ratio (CSR), which is less likely to be affected by migration, hasregistered a sharp decline from 982 in 1991 to 961 in 2001. Another disturbingfeature of this decline is that it was in rural areas where this decline has been themost severe. Although we do not have data from 2001 census to find out the childsex ratio among the ST population, it is important to note that in 1991, CSR amongthe ST population was 976, which was lower than that1991, CSR among the STpopulation was 976, which was lower than that for all social groups. At adisaggregated level, of the thirteen districts, only three- Papum pare, LowerSubansiri and Upper Subansiri-have experienced an increase in CSR, others haveshown a decline during the last decade.144

Infant and Child MortalityInfant and child mortality rates are among the most widely used indicators ofhealth status. Although female infant mortality rate was estimated to be 76 for thestate as a whole, considerable inter-district variation in IMR has also been notice.Among the districts, it was found that East Kameng has the highest infant mortalityrate for females, while East Siang has the lowest.Universally, the inherent biological vulnerability of the male infant in a genderneutralenvironment makes the male IMR higher than the female IMR. The maledisadvantage disappears in the subsequent four years and the gender gap inmortality becomes marginal. However, of all the districts, female IMR in as many asin five districts, a result which is rather unexpected in a pre-dominantly tribal society.The female under-five mortality rate was estimated to be 137 for the state asa whole. Among the districts it varied between 94 in East Siang to 202 in EastKameng.Owing to lack of trend data on IMR and under five mortality rates forArunachal Pradesh we do not have any clue to the patterns of change in thesevariables.Nutritional StatusOne of the crucial aspects of the food consumption pattern in the state is highaverage consumption of leafy vegetables, roots and tubers as well as fish and meat,not only in comparison with the national averages, but also the neighboring states. Asubstantial proportion of these items are collected from forests and jhum fields. Akey-aspect of women’s nutritional status is their participation in forest-relatedactivities and access to forest resources. Women’s access to forests and otherCommon Pool Resources is intrinsically linked to their micro-level strategies for riskdispersion, mutual support and solidarity in a high risk ecological-economic context.Female Literacy RatesFemale literacy rate for Arunachal Pradesh, according to census 2001, wasonly 44.24 per cent, much lower than the national average of 54.03 per cent.However the state has made rapid progress in raising the female literacy-from only14.02 percent in 1981 to 44.24 per cent in 2001. In rural areas female literacy rate isas low as 37.56 per cent, and the rural-urban gap in female literacy continues to bevery high. Among the ST population female literacy has gone up from 7.31 per centin 1981 to 24.94 per cent in 1991.Although the state has made significant progress in the past, its performancein comparative terms has not been very impressive. Considering inter-districtvariations exist in female literacy rates from 61.72 per cent in Papum Pare to 29 percent in Tirap and 28.86 per cent in West Kameng. Among the rest, districts havingrelatively high female literacy levels include, West Siang and East Siang. Substantialgap exists between urban and rural female literacy level in many of the districts aswell. The gap is the highest in Tirap followed by Tawang, Lower Subansiri,Changlang and Dibang Valley respectively. The rural-urban gap in female literacy islowest in East Siang district. Given the inaccessibility and inadequacy in provision ofsocial infrastructure, there is a huge gap in the opportunities before the rural womenand their urban counterparts. As expected, while Papum pare had the highestliteracy level for females, it was lowest in Tirap.145

Educational AttainmentThe relative educational deprivation of females gets manifested, not just inliteracy rates, but also in terms of other educational indicators as well. Among theliterate females, a substantial proportion has studied only up to below primary level.In 1991, of the total female literates in Arunachal Pradesh 36.4 per cent had studiedup to below primary levels, while in rural areas 40.9 per cent of literate females hadstudied up to that level. In some district like East Kameng 48 per cent of femaleliterates had not studied beyond primary levels. On the other hand, 601 per cent ofliterate males had studied up to graduation and beyond in the state, but only 3.6 percent of women could reach that stage in 1991.National Family Health Survey data for 1998-99 shows that median year ofschooling among males in Arunachal Pradesh was 4.4 %, while that for females wasonly 2.1 per cent.Among the women in the age group 15-44 many of whom are in theworkforce, 71.02 per cent were illiterate, 21.17 per cent had studies up to belowmatric level, 6.07 per cent had completed matriculation and only 1.74 per cent hadstudied up to graduation and above. According to 1991 census in four out of theeleven districts, namely Tawang, East Kameng, undivided Lower Subansiri andTirap, level of illiteracy among the females of this age group was higher than 80 percent in 1991.Thus, notwithstanding the substantial improvement in literacy levels for malesand females, it is important to note than gender gap in the level of educationreceived, pose a critical challenges for eliminating gender bias in education in thestate.The Girl Child: More Hurdles than Opportunities?According to the NFHS-II, the percentage of children not attending schools inthe age group of 6-14 was 18.3 per cent in the state. While among the boys 14.1 percent were out of school, among the girls there percentage was 22.7 per cent. In theage group 6-10, the gender gap in school attendance was found to be even wider.So far as the reasons for not attending schooling schools are concerned, differencein the relative importance of different factors in case of boys and girls, give an insightinto the additional constraints faced by the girl child. Among the boys who neverattended schools, distance of the school was the most important reason, followed by‘not having interest in studies’. But among the girls the most important reasons wererequirement for household work (30.8%), school too far away (16.6%), and cost ofeducation (10.5%). In case of boys only 0.7 per cent considered education to beunnecessary, the percentage was 5.6 in case of girls. In comparison to boys, a highpercentage of girls who have dropped out from schools, the main reasons werehousehold work, not having interest in studies, and cost of education. Marriage wascitied to be the main reasons for discontinuing education in case of 13 per cent ofout-of-school girls.Women in Decision-MakingIt is difficult to explain the status and position of women in Arunachal Pradeshin generalized terms. Given the substantial influence of traditional mores, communityinstitution and regionally differentiated socio-cultural practices, there are variations in146

the condition and position of women in different indigenous communities. Traditionalsocial differentiations as well as newly emerging economic differentiations withinthese communities have also an impact on the position enjoyed by women ofdifferent strata. Along with that, the migrations from different parts of the country,education, mass entertainment, media exposure and external cultural influenceshave been influencing the making of gender relations in the changing social milieu.According to NFHS-II, among the female respondents, overall, 93.6 percent of women were involve in decision making on what to cook, 70.0 per cent indecisions regarding their own health care, 76.5 per cent in purchasing jewelry, and74.8 per cent in staying with their parents or siblings in the state. The survey alsoreveals that 46.8 per cent of women do not need any permission to visit markets and53.7 per cent do not need any permission to visit friends or relatives. Around 78.6per cent have some access to money. There is no consistent pattern in rural-urbandivide: while more rural women participate in decision making regarding cooking andpersonal health care, a comparatively higher proportion of women participate indecision making regarding purchasing jewelry or staying with parents or sibling inurban areas. Urban women also have greater access o money. It is interesting tonote that educated women and those having a high standard of living have lessfreedom of mobility, although they have comparatively higher access to money thanilliterate and poor women.Gender and GovernanceArunachal Pradesh has crossed the journey to parliamentary democracy in ashort span of less than fifty years and the democratic political process, institutionsand practices have been gradually accepted by the tribal communities.The traditional village-chef and the village councils continue to remain the keypolitical institutions at the grassroots level. These institutions, in spite of theconsiderable diversity in their power, area of operation and modes of decisionmaking,have been largely described as democratic and participatory. But womenwere rarely allowed to take any part in these traditional institutions. The percentageof women village-chiefs was only 1.13 per cent in the state. In eight of thirteendistricts there was not a signal women appointed as the village chief.The share of women village chief was highest in Dibang Valley- only 2.20 percent. However, the transition to the three-tier panchayat Raj System hasconsiderably altered women’s shares at the village, intermediate and districtpanchayat levels were 39.60, 34.99 and 33.82 per cent respectively in the recentlyconcluded panchayat elections. The introduction of reservation for women in thedecentralized institutions of governance may play a catalytic role in graduallyeliminating the gender bias in sharing of political power in the state.In the absence of reliable date, it is difficult to estimate women’s share in topmanagerial and technical posts in the state. However, given the low levels ofindustrialization and the thin presence of the private corporate sector in the state, theshare of women in top-level decision-making can be assessed in the top levelbureaucracy. In the top-level of civil administration in the state, the share of womenwas found to be 6.66 per cent only.147

Gender sensitive service deliveryAll the districts will ensure home visit and required service delivery to thewomen headed households tracing from the Household survey report. ANM, ASHAand AWW will serve these populations in a priority basis.6.7. Financial ManagementStructure of the Finance BranchThe SFM will be the Chief Finance Officer of the integrated financialmanagement system of all the vertical programmes (National Diseases ControlProgrammes) under the umbrella of NRHM and will report to the Mission Director.He will lead the State Financial Group (FMG) and will be assisted by the Consultant(Finance).The functions of the State Financial Management Group will be as follows:i. Timely disbursement of funds to the district health societies.ii. Collection of Statement of Expenditure from the district health societies.iii. Compilation of statements of expenditure of the districts along with theexpenditure at the state level.iv. Preparation and submission of Utilization Certificates.v. Budget analysis of the state and districts.vi. Maintenance of books of accounts as per the Finance Manual of GoI.vii. Timely conduct of concurrent audit and statutory audit of SCOVA.viii. Training of finance and accounts personnel of districts.ix. Integration of books of accounts of National Diseases ControlProgrammes.x. Financial monitoring of the districts and blocks.Maintenance of Books of AccountsThe books of accounts at the state and district level are maintained as per thedouble entry book keeping principles, on cash basis of accounting. All the books ofaccounts are maintained on accounting software Tally at both the level of state anddistrict. The transactions are recorded with the supporting documentation for thetransactions. The supporting documents could be crossed referenced so as to linkthem to each item of expenditure with budget heads, project components, andexpenditure categories.Strengthening Financial Management System.(1) Constitution of State FMGThe Financial Management System under NRHM has been strengthened byconstituting a Financial Management Group (FMG) at the state level by integratingthe finance and accounts staff of all National Diseases Control Programmes underthe leadership of State Finance Manager (NRHM).The constitution of DistrictFinancial Management Groups will be undertaken during the financial year 2009-10after appointment of District Accounts Manager. It is proposed to redesignate the148

incumbent District Accountants as District Accounts Managers during the financialyear 2009-10 on the strength on their gaining at least two years experience in NRHMfinance & accounts and their training in TALLY software.(2) Equipment and capacity building.All the districts have also been provided with one trained accountant each. Apartfrom the above, all of the districts have been provided with a computer exclusivelyfor finance and accounts personnel during the financial year 2006-07 and 2007-08 intwo phases along with accounting software “TALLY” during the year 2007-08.Capacity building workshop for Finance and Accounts Personnel was providedduring the month of August, 2007 for 7 days special focus on Accounting SoftwareTALLY. The capacity building/ skill upgradation training will be imparted during thefinancial year 2009-10 too.(3) Constitution of Internal Audit TeamDuring the financial year 2008-09, an internal audit team was constitutedunder the leadership of the State Finance Manager (NRHM) comprising the followingfinance & accounts officials of all the vertical programmes under NRHM:1. State Finance Manager (NRHM) : Team Leader2. Finance Consultant (NRHM) : Member3. State Accountant (STCS) : Member4. Finance Consultant (IDSP) : Member5. Accountant (NVBDCP) : Member6. Accountant (NLEP) : MemberThe team will visit the districts to monitor financial performance and toundertake regular checks of the books of accounts of the society. After theappointment of Director (Finance & Accounts), the leadership and its responsibilitiesof the Team will be vested in him.Internal Accounting Control MechanismThe internal accounting control mechanism will be further strengthened in thelight of the instructions issued by Govt. of India following some observations placedon record by the statutory auditors. All the districts have been instructed to makepayments by crossed/account payee cheques & demand drafts only. In order toensure effective financial control, the system of joint signature by Mission Directorand SFM at the state level and DMO and DRCHO/DFWO at the district level will beadopted during the financial year 2009-10. All expenditure sanctions will be put upand accorded only after the concurrence of the SFM. The SFM will be responsiblefor ensuring prudence in the financial management of all the vertical programmesunder NRHM. The generic guidelines issued by Govt. of India for FinancialManagement Group (FMG) have already been adopted with effect from the financialyear 2007-08. Not more than Rs 5,000/- will be kept with the cashier in the form ofcash for petty expenses at any particular time. The delegation of administrative andfinancial powers as per Govt. of India generic guidelines have been notified and arebeing implemented with effect from the financial year 2008-09.149

Financial and Accounting PolicyThe system for financial sanctions will be followed as spelt out above. For thepurpose of accounting, State Health Society and District Health Societies will betreated as separate entities different from the Department of Health & FamilyWelfare. All transactions will be measured in terms of rupee only. The financial yearof SCOVA, for the purpose of accounting, will begin on 1 st April of the current yearand end on 31 st March of the subsequent year. The accounts of the State HealthSociety and all District Health Societies will be maintained on cash basis, based onhistorical concept of cost. No depreciation will be charged on the assets. All genuineassets created in the course of implementing the programmes will be capitalized attheir original values. Fixed assets will be stated at the cost of acquisition andsubsequent improvements thereto including taxes, duties, freight and other incidentalexpenses relating thereto will be capitalised. For the purpose of fixed assets onlythose assets procured for use in the premises of Mission Directorate/State SCOVASecretariat and District SCOVA offices including vehicles will be accounted for. Allthe fund releases to districts and other implementing agencies are treated asadvances and are booked as expenditure only after the receipt of SOEs. In the caseof release by Districts to CHCs, PHCs, SCs, NGOs and other implementing agenciesupto a maximum Rs. 5,000/- this will be treated as expenditure for the purpose ofSOE subject to settlement with vouchers at the time of audit.Integrated Financial GuidelinesIn order to ensure uniform and integrated financial management practicesamong all the vertical programmes under NRHM, following measures have beentaken to streamline the financial management, accounting, auditing, fund flow andbanking arrangements:(ii)(i) A Financial Management Group (FMG) comprising the followingfinance & accounts officials has been constituted in the StateProgramme Management Unit (SPMU) to handle the integratedfinance, accounts and audit of all vertical programmes underNRHM:(a) Consultant (Finance)(b) State Finance Manager (NRHM)(c) State Accounts Manager (NRHM)(d) State Accountant(e) Accounts Officer/Accounts Manager/Accountant(RNTCP)(f) Accounts Officer/Accounts Manager/Accountant(NVBDCP)(g) Accounts Officer/Accounts Manager/Accountant (NBCP)(h) Accounts Officer/Accounts Manager/Accountant (IDSP)(j) Accounts Officer/Accounts Manager/Accountant (NLEP)(k) Accounts Officer/Accounts Manager/Accountant (IDSP)The FMG will be responsible for centralized processing of fundreleases, accounting of expenditure, monitoring of UtilisationCertificates and audit arrangements, besides being responsible for150

(iii)(iv)(v)(vi)(vii)collection, compilation and submission of SOEs, FMRs, UCs and AuditReports from District Health Societies to the A.P. State Health Societyand further to Govt. of India, Ministry of Health & Family Welfare.The FMG will be responsible for managing all bank accounts underwhich funds are received under NRHM.All the finance & accounts staff/officials representing verticalprogrammes will continue to handle their respective programmeaccounts and report to their respective Programme Officers/Managers.However, in their capacity as a member of the FMG, they will havereporting relationship with the State Finance Manager (NRHM) inrespect of programme finance, accounts, audit, reports and returns.All the finance/accounts staff co-opted into the FMG will act asinterface between their respective programme and SPMU and ensureintegration of inputs and interventions in respect of finance, accountsand audit under NRHM.A Group Account in the name of A.P. State Health Society has beenopened with the State Bank of India, Naharlagun, Nationalised Bankhaving Real Time Gross Settlement (RTGS) facility for electronictransfer of fund to handle funds for (a) RCH (b) Additionalities underNRHM and (c) Immunisation. For the purpose of all other verticalprogrammes, respective sub-accounts under the Group Account havebeen opened.All the existing bank accounts will be closed during the financial year2008-09 and the balance amount will be transferred to the respectiveaccounts in the Group Account of the State Health Society.(viii) The exercise of administrative and delegation of financial powers havebeen circulated to all the District Health Societies as well as to all thevertical Programmes during the financial year 2007-08.(ix)(x)Expenditure sanctions will be issued by the respective ProgrammeOfficers/Managers within their powers. On approval, a copy of thesanction letter will be endorsed to the State Finance Manager (NRHM)for further necessary action.Withdrawal of funds will be effected by joint signatory in themanner as spelt out below:RCH, Additionalitiesunder NRHM &ImmunisationMission Director(NRHM) &State Finance Manager(NRHM)AllProgrammes(NDCPs)verticalConcerned StateProgramme officer&State Finance Manager(NRHM)(xi)Release of funds/payments will be made by the FMG, on receipt ofsanction letter, by means of cheque/demand draft/electronic fundtransfer through e-banking with due reference to the approved PIP andbudget.151

(xii)The FMG will maintain separate and identifiable ledger accounts for thefollowing:(A) RCH(B) Additionalities under NRHM(C) Immunisation(D) RNTCP(E) NVBDCP(F) IDSP(G) NIDDCP(H) NPCB(I) NLEPAll the individual vertical programmes will further maintain detailedaccounts as per their respective guidelines.(xiii) All fund transfers to District Health Societies for all programmes underNRHM will be centrally done by the FMG of SPMU as per the approvedNRHM PIP and Annual District Plans as approved by the GoverningBody/Executive Body of A.P. State Health Society.(xiv) The FMG will be responsible for providing and sharing with therespective Programme Officers/Managers all financial statements,accounts and information in respect of their programmes(xv) The SFM will be the nodal officer of FMG under the overall supervisionand control of Mission Director (NRHM). He/she will be responsible forintegrating and monitoring the accounts of all vertical programmesunder the broad umbrella of NRHM.Financial Reports and Returns.Monthly expenditure reports along with fund position statement will befurnished by the districts to the Mission Directorate latest by 15th of the subsequentmonth, and the Mission Directorate will submit quarterly FMR to Govt. of India within30 days from the end of the quarter. Utilisation Certificates will be prepared sanctionand activity-wise on first-in-first-out basis. Monthly Bank Reconciliation Statement(BRS) will be prepared by the districts and submitted to Mission Directorate alongwith monthly expenditure report.Audit of SCOVA AccountsThe mechanism of monthly Concurrent Audit has been adopted in the A. P.State Health Society and District Health Societies since the year 2007-08. However,due to some unavoidable factors, the periodicity of concurrent audit has beenreduced to quarterly during the financial year 2008-09. The quarterly concurrentaudit will continue in the financial year 2009-10 and the scope of the audit willinclude all the vertical programmes under NRHM. Statutory audit will be conductedby a CAG-empanelled CA firm listed by the Ministry of Health & FW, Govt. of India. Aconsolidated audit report will be prepared for RCH-II, Immunisation, NRHMAdditionalities and all other vertical programmes. Since there is only one CA firm inthe entire state of Arunachal Pradesh, the concurrent auditors will be appointed fromthe neighbouring state of Assam on the basis of technical and financial bidding.152

Books of Accounts.The following books of accounts will be invariably maintained by theDistricts and State SCOVAs:Training1. Draft received register2. Draft/Cheque issued register.3. Advance tracking register.4. Cash Book [ In Accounting Software TALLY5. Activity-wise financial Ledger.6. Stock ledger/register7. Journal Register for adjustment.In order to upgrade the skills of accounts personnel, the followingtrainings will be conducted during the financial year 2009-10:1. 1-day workshop on financial management issues for district & stateprogramme officers of vertical programmes under NRHM.2. 3-day skill upgradation training on finance, accounts, audit andTALLY software for accounts personnel of District and StateSCOVAs including vertical programmes.3-day induction training for all Block Accountants.6.8 Convergence/ CoordinationCONVERGENCE IN ARUNACHAL PRADESH:One key to success of NRHM is intersectoral convergence. The need forconvergence is not only with other health determinant departments but also withinthe department. Apart from PPP and VHND, no well thought activities could beimplemented last year due to different bottlenecks. This year, the state envisage toimplement few planned activities through vertical programmes and will prepare aplan for next year to be implemented with the assistance of other health determinantdepartments. This years plan is as follows:Objective:To built and peruse a combined effort to suffice the health needs of beneficiaries ofmultiple health determinant sectors.Strategy 1 :Functionalize the state level convergence committee under the chairmanship ofChief Secretary.Activity: 1.A meeting will be organized with all NRHM line departments chaired by ChiefSecretary, Arunachal Pradesh. The main objective of the meeting will be to orient allthe departments on convergence issues of NRHM. At state level, a Joint Director(DHS) will be designated as Nodal Officer (Convergence) to carry forward theactivities of convergence not only with other health determinant departments but alsowithin the department. Through the State level convergence committee, Nodal officerwill initiate policy review for convergence and develop implementation procedures.SPMU will facilitate the Technical Assistance and Support. Meeting will be held twicethis year.153

Activity: 2.Similarly, the district and Community Development Block level convergencecommittee will be formed under the chairmanship of DC and BDO. At district level, adistrict level officer will be designated as Nodal Officer (Convergence) and at blocklevel the MO in charge CHC/PHC will be designated as Nodal Officer(Convergence).District level convergence committee will ensure the implementation of the directivesof the State Level Convergence Committee.Strategy 2 :Close coordination of all vertical programmes of Health Department.Activity: 1.Develop policy framework and Programme wise procedural guidelines / manual byNO (convergence).Activity: 2.Approval of procedural guidelines / manual by state level convergence committeeand dissemination of these to all vertical programmes.Activity:3.Ensuring implementation of Programme wise convergence activities in state / district/ block level (NB: a tentative Programme wise convergence activities articulatedbelow)Activity:4.Ensuring implementation of all national disease control programmes through all RKSin different level.Activity:5.Sensitize PRI s to actively involve in health development activities (through VHND)Activity:6.Monitoring Programme wise convergence activities in state / district / block levelStrategy 3 :Develop effective coordination between health and other line departments like WCD,PHED, PWD, Urban & Rural Development, Education, Panchayat, Youth Affairs, etcat all levels.Activity: 1.Develop policy framework and Programme wise procedural guidelines / manual byNO (convergence) for next year through consultative sittings with the healthydeterminant departments.Activity:2.Approval of procedural guidelines / manual by state level convergence committeeand dissemination of these to all vertical programmes before current financial year.Activity:3.Ensuring implementation of Programme wise convergence activities in state / district/ block level in next financial yearActivity:4.Sensitize PRI s to actively involve in health development activities (through VHND)Activity:5.Initiate Joint Planning, monitoring, evaluation by ANM, AWW, ASHA FNGO/NGO,VHSC and PRI representatives in VHSC meeting for health determinant activitiesthat may be reflected in Village Health Action Plan of next year. It will be initiated by154

ASHA supervisor/facilitator under the guidance of ASHA mentor group / coordinationgroup of district level.Activity:6.Preparation of joint monitoring plan in consultation with all line departments andMonitoring Programme wise convergence activities in state / district / block level innext financial year.Strategy 4 :Continuing partnership with NGOs.4. 1. Partnership with NGOs running 16 PHCs under PPP.4. 2. Partnership with MNGOs.Activity: 1.NGOs would be encouraged to run their PHCs as a 24x7 PHC, ensure 12 registersin SCs under them and hold VHNDs in AWC/SC/community hall as per convenience.As a pro-poor strategy, the NGOs will be involved for reaching out to themarginalized communities for the following functions: Social Mobilization &Communication: Specific activities would include Village Contact Drives, Trackingthe dropout women and children, health education to the women SHG members,distribution of contraceptives etc.Activity: 2.Provide financial, technical and managerial support to NGOs for running 16 PHC.Activity: 3.Monitor, evaluate and assess potential / promising practices by SPMU for scaling up.Activity: 4.Evaluation of PPP by third party technical group assured through RRC-NE,Guwahati.Tentative Programme wise convergence activities within vertical programmes:convergence activities1. Maternal Health1.1 Community mobilization and organization of VHNDs atAWC/SC/community hall once a month to deliver ANC services.1.2 Referral of complicated cases for safe institutional delivery. Anadvance Referral money will be available with ANM under the directsupervision of the concerned MO. Community representative throughPRI/VHSCs/ women SHG/MSS will be identified by ASHA coordinationgroup (district / block) for organizing a suitable arrangement of referraltransport.1.3 Assisting the pregnant women for her laboratory investigations (Ifpossible, Collection of blood and urines samples of pregnant womenand send it to PHC for examination and report back)ResponsibilityASHAcoordinationgroup ofconcerneddistricts, DRCHO,DPM, CDPO.ASHAcoordinationgroup of alldistricts, VHSCV,DRCHO, DPM.ASHA, ANM,AWW155

1.4 Regular home visits and follow ups by ASHA/ AWW/ANM forensuring observed consumption of IFA tablets by moderately andseverely anemic pregnant mothers.1.5 De-worming of all pregnant and adolescents girls twice in a Yearthrough VHND1.6 Health awareness campaign / BCC / ACSM by ASHA/AWW/ANM/MSS1.7 Ensuring JSY benefit to the mother1.8 Ensuring PNC visit by ANM through the linkage of ASHA/AWW2. Child Health2.1 Ensure registration of all births and deaths of mothers with theVillage Registrar of Births & deaths.2.2 Community mobilization and Organization of VHNDs at each andevery AWC once a month to deliver child health and nutritionservices like:- Growth monitoring of child under six during VHNDs-Maintaining Growth chart-Nutrition supplementation to child- Identify & referral of unmanaged malnutrition cases to the PHC-Non-formal pre school education-Health and nutrition education to mother, adolescent girls-Assist PHC staff in immunization of children- House visits for dropout child of immunization and to ensureappropriate feeding practices and attendance at AWC.2.3 Supervision & Monitoring on all VHNDs by PRI representatives.Elicit community support and participation in running the programme3.Immunization3.1 Conduct Home Visits to trace out the Un-immunized children andDrop outs3.2 Provision of Immunization during regular VHNDs organized at everyAWCs4 Family Planning3.1 Regular updating of EC register and quarterly population survey ofher coverage area.3.2 Ensure distribution of OCPs, emergency pills, condoms and IUDinsertion to eligible couple.5. Adolescents Health5.1 To provide weekly dose of observed IFA and bi-annual dose ofdeworming to adolescents girls in schoolDRCHO, VHSCVHSCASHAcoordinationgroup of alldistricts, VHSCV,DRCHO, DPM.ANM, ASHA,AWWASHA, AWWASHAcoordinationgroup ofconcerneddistricts, DRCHO,DPM, CDPO.AWW, ASHA,ANMAWW, ASHA,ANMPRI/VHSCASHA , AWW andANMASHA , AWW andANMASHA, ANM,AWWASHAs , AWCsand ANMsASHA, AWW,ANM, Teachers156

5.2 Sensitization of AWWs, ASHAs, female PRI representatives andschool teachers, on following issues:• Adolescents growth and development• Group counseling of adolescents on Sexual and reproductivehealth concerns of boys and girls including Menstrual hygiene• Nutrition and anemia in adolescents• Contraception for adolescents• RTIs/STIs and HIV/AIDS in adolescents• Birth preparedness and parenting• Child bearing• Safe abortion6. National Disease Control Programme6.1 IDSP4.1.1 Symptomatic identification of diseases covered under IDSP andrefer to the nearest health facility4.1.2 Follow up of all referral cases6.2 RNTCP6.2.1 Awareness development at community level regarding signsand symptoms of reportable cases for early detection,isolation and seeking treatment through mass media,, IPS, &counseling6.2.2 Developing and dissemination of IEC material, includingleaflets and posters to the community6.2.3 IPC through convergent approach6.2.4 Identification of persons with symptoms of TB and refer tonearest DOTS centre (Gram Sabha will work withANM/Health workers in identifying affected persons).6.2.5 Enabling access for consultation, sputum, X Rays, andfurther treatment. Panchayat will ensure that the person hasaccess to requisite clinical and diagnostic examination (Thiswill be done through facilitation of ASHA and medical staff)6.2.6 Ensuring drug delivery to patient compliance anduninterrupted supply. (Block Panchayat will be responsible forensuring supply of doctors, drugs, laboratory consumables,and X-rays. Village panchayat to liaise with Gram Sabha toensure compliance with treatment. This will be done by theVHSC and ASHA/ANM)ASHA, AWW,ANMASHA, AWW,ANMANMs,ASHAs,members-do--do-6.2.7 ASHA will be training as DOT provider by RNTCP RNTCP6.3 NPCB6.3.1 Awareness development at community level regarding signs andsymptoms of reportable diseases of eye for early detection and seekingtreatment.AWWs,PRI157

6.3.2 Sensitizing the community by BCC activities like IPC throughconvergent approach for attending screening camps to beorganized by NPCB.6.3.3 Identification of persons with blindness6.3.4 Maintain a village register for Blindness6.3.5 Enabling access for consultation, diagnosis, specialist facilities,treatment and referral in govt. facility which is nearest for thepatient. Panchayat will ensure that the person has access /referral to requisite clinical and diagnostic examination6.3.6 PRI will be involved in village Blind Registry, Identification,motivation and transport of affected persons for cataract surgery,organizing screening camps, and school eye screeningprogrammes.6.4 Leprosy6.4.1 Ensuring accessible and uninterrupted MDT services available toall patients through flexible and patient friendly drug deliverysystem6.4.2 Identify cases in need of reconstructive surgery andrehabilitation6.4.3 Referral to Government/ NGO facilities for rehabilitation.ASHA, AWW,ANM, SchoolTeacher, NPCBASHA, AWW,ANM, PRImemberASHAASHA, AWW,ANM, PRImemberPRIASHA, AWWsand PRIs tothe village andBlock PanchayatsIn collaborationwith the districtPanchayat-do-6.5 National Vector Borne Disease Control Programme- Identification of villages based on case load and sprayingNVBDCP- Identification of persons in need of diagnosis and management ASHA, AWW,ANM- Enabling access to consultation, blood smears drugs, and further ASHA, AWW,treatmentANM- Panchayats in- ensure spraying, where appropriate,cooperation withthe Gram Sabha.- case finding, blood smear, reporting result, diagnosis and ensuringtreatment and follow up- Ensuring health worker functions in vector borne diseases,monitoring, and surveillance.- ensuring supply of insecticides, roster of workers, and monitoringavailability of doctors, drugs, and laboratory consumbles- awareness raising related to vector borne diseases, distribution ofinsecticide treated bednets, distribution of anti-malaria drugs at villagehealth workers,PRIincollaboration withGram SabhaBlock PanchayatsPRI158

level, through Drug Distribution Centers and Fever Treatment Depots,Promotion of larvivorous fish, and mass drug administration forfilariasis.- Environmental sanitation and safe drinking water supply by detectinglocation with problems7. Water borne diseases7.1 drinking water Sample testing by ASHA trained / assisted byPHEDPHEDASHA, PHEDCONVERGENCE WITH APSACS:Convergence with the APSACS is as follows:1. Collaboration for the treatment and control of STDs.2. A closer collaboration in family health awareness campaign.3. APSACS at present is running its own program in collaboration withNGOs on awareness generation as well as target interventions. There isneed for involving other NGOs through the district health mission. They werebeing done by APSACS in the district and should be in the knowledge ofdistrict health mission.4. The ICTC centres are presently being run in the District Hospital. TheICTC centers may be started at the CHC level.5. PPTCT center: There is need to make the HIV positive pregnantwomen aware of the fact that it is now possible to prevent HIV transmissionform mother to child and the drugs for the purpose are also free. This can bedone through the family health awareness camps as well as through ASHAs,ANMs and Anganwadi workers etc.6. Awareness about the relationship between HIV and TB: As TB is amajor opportunistic infection for in HIV infected person and vis-à-vis it isnecessary to use the NRHM machinery to make the rural population awareof it.7. School AIDS education programs: The school AIDS program under aNACO scheme is being run by the state AIDS control society in collaborationwith the department of school education. It is important that the Panchayatiraj institutions and the district health mission are also kept in close touch withthe activities under the program.8. Free medicine distribution for OIs: At present treatment and medicinesfor OIs are available only at General Hospital, Naharlagun. It is suggestedthat they should be available at all the GH / DHs and also at the CHC levelalso in those blocks where VCTCs come across HIV positive cases becausefor the poor HIV positive people it is not possible to travel to district headquarters or to the medical colleges for treatment of OIs.9. IEC campaign for awareness of HIV: So far most of the programs hadbeen held in towns whereas there is a need for a massive awarenesscampaign both for making those people who have under gone risk behaviors159

emoving stigma and discrimination against HIV positive people, similarprograms should be organized in the rural areas also.10. Targeted intervention: In a number of districts, various NGOs arerunning programmes as targeted interventions. It is necessary that thedistrict health mission also keeps a track of the activities under theinterventions programmes.Area ofConvergenceRTI/STIICTCRole and Functions ofFW / RCH-II-PrimaryResponsibilityintegrateRTI/STImanagement at all levelsin public sector system-Broadly RCH IIstrategies should befollowed-At PHC level,first line drugs to beoffered,-District, CHC and FRUto offer comprehensiveetiological and lab basedtreatment. At districtlevel, linkages with STDreferral labs to bestrengthened.-Infrastructure (space) tobe provided in facilitieswhere ICTC are located.-Support to ensurereferral from otherdepartments-Overall supervision byhead of facility, incollaboration withOb/Gyn, STD, Paed,and other depts.-Frontline providers /ASHA / Health workersto motivate communityat risk for ICTCRole and Functionsof APSACS-Support to NGOs tocontinue. Servicedelivery whetherdirectly through NGOsor referral to public orprivate sector.-Ensure that all STIservice data areprovided to theConvergencecommittee level.Primaryresponsibility—- increase VCTC sitesexpansionin phasedmanner-APSACS support forstaff and supplies,-Include Youth FriendlyInformation Centers atCHC and PHC-VCTC to serve othercounseling needs.-Cadre/of counselorsto staff the sites.Convergencemechanisms/aspects-At State level,aConvergencecommittee isformed tomonitoraccess ofRTI/STIservicesgeneralpopulation.ReportforHIV/AIDSConvergenceCommittee.to-Training ofproviders(public, privateand NGO) andlab techswithin purviewof FW / RCH-II.-Convergencecommittee toreviewfunctioning ofVCTC throughperiodic statereports.-Training ofproviders ofFW / RCH-II atall levels toincludeelements ofrisk protection,160

PPTCT-Overall supervision byhead of facility-Located in Ob/Gyndepartment, managedby HOD-Ensurenondiscriminatory practices-Ensure universalprecautions-At the community level,ANM/ASHA follow up ofVCTC clients testingpositive for ANC, andmotivate for PPTCTBCC -All messages for FW /RCH-II to includeHIV/AIDS preventionand care and support asappropriateCondomPromotionTraining-Ensure that NGOprograms also usemessage content asdefined-Enhance condom usefor dual protectionPrimary Responsibilityfor training of all serviceinterventions (exceptVCTC/PPTCT) to bewithin FW/ RCH-II.PrimaryResponsibility toensure functioningPPTCT-Expand PPTCT sitesin a phased manner-APSACS to supportcounselor and lab.Tech. and supplies forPPTCT.-Messages forHIV/AIDS highlightappropriate serviceprovision throughpublic and privatehealth system-Ensure that NGOshighlight serviceaccess in addition toprevention messages.-Condom promotionkey to prevention-Support training interms of content andtechnical support.-Primaryresponsibilityformotivation fortestingthroughFW /RCH-II.-NGO trainingfacilitated byAPSACS.-ConvergenceCommittee toobtain data onfunctioning ofPPTCT andreviewperformance-Training forall providers toincludeattitudinal aswell technicalskills, anduniversalprecautions.-BCCstrategy/division forAPSACS andFW/RCH-IIunder jointmanagement.Condomprocurement /supply fromGoI anddistribution forFW andAPSACSunder singleentity.-APSACS tocoordinatewith groupsworking onRCH IImodules to161

-Support training contentand technical support forVCTC and PPTCTtrainingReporting FW/RCH-II MIS tocapture service data -RTI/STI, VCTC, andPPTCT-MIS to includeHIV/AIDS indicatorstraining VCTCcounselors in a rangeof issues includingHIV/AIDS, whichincludesafemotherhood, familyplanning and childcare.PPTCT staff trainingalso to be conductedby APSACS.-Ensure that VCTC,PPTCT, and sentinelsurveillance data isreflected in districtMIS.ensureHIV/AIDScontent for allworkers.-Joint WorkingGroup to beinstituted toreview andensure thatHIV/AIDSmessages andcontent fortraining aretailored toeach level ofprovider-Ensure thattrainingmodules areshared withNGO partnersof FW/ RCH-IIand APSACS.-Developprotocols andguidelines forkey services.-Ensuredisseminationof protocolsand guidelinesto NGOs andprivate sector.-APSACS tocoordinatewith FW /RCH II toensure thatHIV/AIDSindicators areincluded inMIS for RCHII.-Joint WorkingGroup toreview RCH IIMIS andensure thatreporting of162

RTI/STI,VCTC, andPPTC is alsoincluded.BloodSafetyMaintain quality of bloodtaken from blood banksto blood storage centersat secondary levels offacilities.-PrimaryResponsibility toassure safety of bloodat banks at districtlevel and above-Surveys(NFHS III andDLHS) toincludeinformation onHIV/AIDS aswell.-JointWorkingGroup toreview the“Serviceutilization bythecommunity”.Convervence with APSACS- Identification of persons with symptoms- Identification of facilities for examination, diagnosis, and counseling- Enabling referral- Ensuring appropriate treatment and management- Gram Sabha will be responsible for awareness campaigns along withhealth worker.- Block Panchayat will identify sites where appropriate treatment andcounseling facilities are available.- Block Panchayats will ensure attendance of doctors, and other staffand identify bottlenecks to services at PHC/CHC.- Where required Panchayat will enable counseling for members of theaffected families.- - In some state, PRI representatives have been sensitized to basic ofHIV/AIDS and the need to ensure non-discriminatory practices in theircommunitiesDHFW will ensure convergence of RTI/STI control ( to reduceHIV/AIDS transmission ) at all levels, in collaboration with the NationalAIDS Control Programme (NACP)- - PRI could be involved in reducing stigma and discrimination at thecommunity level.6.9 District and Block Plan:All the districts have prepared DHAP and 50% of the blocks have BHAP. Theresource allocation is annexed.163

6.10. Role of State, District and Block.As annexed in the workplan.6.11. Synergy with NRHM:All the activities proposed under NRHM additionalities has been done inaccordance with theidentified requirements under RCH II.164

CHAPTERVIIProgramme Management ArrangementProgram ManagementThe following programme management staff will be appointed/ continued during thefinancial year 2009-10 at the State, District and Block levels:ProgrammeMgt. UnitStateProgrammeManagementUnit (SPMU)DistrictProgrammeManagementUnit (DPMU)BlockProgrammeManagementSupport Unit(BPMSU)Sl.No.DesignationNo. ofstaff inposition/proposedExistingmonthlysalary (Rs.)1. State Programme Manager 1 22,000/-2. Consultant (Fin) 1 21,000/-3. Consultant (MIS) 1 16,000/-4. Consultant (Training) 1 16,000/-5. State Accounts Manager 1 12,000/-6. State Data Manager 1 12,000/-7. State Accountant 1 9,000/-8 Data Assistant 1 7500/-1. District Program Manager 16 16,000/-2. Accountant (District 16 9,000/-Accounts Manager)3. Statistical Investigator 2 75,00/-4. Data Assistant 16 75,00/-1 Accountant-cum-Data 84 6500/-AssistantBudgetHead/ProgrammeRCH-IIFlexiblePoolThe above proposal is based on the existing norms as suggested by GoI. It is furtherproposed that the above SPMSU and DPMSU staff will continue during the year. Total fundrequirement is Rs 146.32 lakhs.SPMSUThe SPMSU will continue to be lead by the State Nodal Officer (NRHM) who is fromregular state health service. Under SNO (NRHM), the SPM on recruitment will work. TheSPM will be recruited this year through RRC-NE as already proposed above. The delay inrecruitment has been due to non-availability of required qualified manpower in the state.DPMSUIn 8 districts, DPMs are in position and the remaining 8 DPMs will be recruited during theyear through RRC-NE. The existing DPMs may also be re interviewed at RRC-NE to assessthe skill and knowledge which the DPM has gathered during the last 3 years. The existingmanpower at DPMSU level will continue as above.165

Salary enhancementIt is proposed to restructure and enhance the pay rates of SCOVA staff in the light ofthe implementation of 6 th Pay Commission recommendations in Arunachal Pradesh andrising cost of living in the State. Current workload and the requisite qualifications of differentposts have also been taken into consideration while restructuring the pay rates. Due tobudget constraints under Programme Management, it would not be possible to effectuatepay increase at par with that of the regular Govt. staff who have been benefited bysubstantial increases as depicted and annexed at annexure 6Constitution of Block Programme Management Support Unit (BPMSU)The setting up of BPMSU is budgeted under NRHM Additionalities.Recruitment of BPMSU StaffThe A. P. State Health Society will constitute 84 Block Programme ManagementSupport Units (BPMSU) during the financial year 2009-10 for as many Blocks of the State inorder to ensure proper maintenance of accounts and prompt reporting from the sub districtlevel to district level. The BPMSU will be the accounting centres for all the implementingagencies including SCs, PHCs and CHCs under the respective Blocks.Proposed Qualification & Designation of Block PersonnelEach Block will be provided an Accountant-cum-Data Assistant on contract basiswho will be responsible to collecting, recording, maintaining and reporting physical andfinancial reports in respect of the implementing units under the Block. The requiredqualification for the post of Accountant-cum-Data Assistant will be B.Com pass along withworking knowledge of computer.RemunerationThe consolidated pay will be Rs. 6,500/- (Rupees Six thousand five hundred) Onlyper month. Local candidates of a particular Block with the requisite qualifications will bepreferred for the post.Induction Training of BPMSU StaffIn order to orient the newly recruited Accountants-cum-Data Assistants, a 3-dayinduction training will be imparted on accounting and reporting system.Justification:In order to run the program activities smoothly and effectively, it is felt that asound system of logistic support should be in position. Therefore, considering theabove fact the program management activities has been designed as follows:ActivityAmount (Rs.)Procurement of Generator 15,00,000/-PoL (HQ + Distt.) 16,60,000/-Mobility Support (HQ + Distt.) 15,60,000/-Repair & maintenance of vehicle 17,80,000/-(HQ + Distt.)166

Stationery 6,00,000/-Telephone expenses 60,000/-Electricity & water supply 20,000/-Contingency 8,50,000/-Current audit 18,00,000/-Annual audit 25,00,000-Grand total (2009-10) 1,23,30,000/-As depicted above, a generator set will be procured at HQ. as there isfrequent interruption of power supply which adversely hamper the day-to-day workschedule. Pol, mobility support and repair & maintenance of vehicles will be providedfor 21 Nos. (5 HQ. + 16 distt.) of vehicles of all the program officials of HQ. &districts for monitoring the program activities. Apart from the above, stationery andsundry expenses has been kept in consideration for meeting the expenses. A bulk offund is kept as contingency expenses, as during the course of time someunavoidable expenses used to come out, such as visiting of GOI officials, audit team,minor repair and maintenance of office building etc.Regarding audit, as suggested and instructed by GoI, that auditor for the year2008-09 will be appointed from open market through tendering by following highlystandard criteria of selection method. It is assumed that a big firm will appointed, forwhich the fee will also be high. Apart from the fee, all the expenses relating t TA/DA,accommodation etc will be borne by the SCOVA.167

CHAPTERVIIIBUDGETBudget:Annexed Summary Budget at Annexure 3cAnnexed Summary Detail Budget (RCH II FLEXIPOOL) at Annexure 3e168

CHAPTERIXMONITORING AND EVALUATIONMONITORING AND EVALUATION• Key Indicators For Measuring ProgressMONITORING INDICATORS1. The state intends to monitor the following 13 process indicators:A. % of ANM positions filledB. % of block having full time program manager for RCH with financial andadministrative powers delegatedC. % of district/ block program managers aware of their responsibilitiesD. % of district/ block program managers whose performance was reviewedduring the past six monthsE. % of districts not having at least one month stocks of essential stuffs likei. measles vaccineii. oral contraceptive pills andiii. gloves etc.F. % of districts reporting quarterly financial performance in timeG. % of district plans with specific activities to reach vulnerable communitiesH. % of districts that were able to implement the basic M&E triangulationinvolving communities to monitor Citizen’s charter, IPHS, NRHM guidelinesetcI. % of outreach sessions where guidelines for ad syringe use and safe disposalare followedJ. % of FRUs following agreed infection control and health care waste disposalproceduresK. % of 24 hrs PHCs conducting minimum of 10 deliveries/monthL. % of upgraded FRUs offering 24 hr. emergency obstetric care servicesm. % of health facilities offering RTI/STI facilities as per agreed protocols169

2. The state also intends to monitor the following output indicators from mid &end-line surveysA. Number of eligible pregnant women receiving complete ANCpackageB. % deliveries with skilled attendance including institutional deliveries.C. % of C-section deliveriesD. % of eligible pregnant women covered under JSYE. Number of women receiving post partum care within two weeks ofdelivery.F. Number of maternal deaths by weeks after birthsG. Number of 24 hrs PHCs conducting minimum of 10deliveries/monthH. Contraceptive prevalence rateI. % eligible couples using any spacing method for more than 6monthsJ. % of women delivered during past one year who received 100 IFAtabletsK. % deliveries conducted by skilled providers (doctors, nurses orANMs)L. % of upgraded FRUs offering 24 hr. emergency obstetric careservicesM. % of 12-23 months children fully immunizedN. % of mothers and newborn children visited within 2 weeks ofdelivery by a trained community level health provider/AWW or healthstaff (ANM/nurse/doctor)O. % of children suffering from diarrhea during past 2 weeks receivedoral rehydration solutionP. Polio free status achievedThe follwing are the intermediate indicators to be monitored during the year;1. No. of PHCs upgraded to provide 24X7 services2. No. of functional Sub-Centres3. Programme Management1. SPMU in place with 100 % staff2. % DPMU staff in place4. Training1. No. of personnel trained in IMNCI (MO/ANM/AWW/ASHA/H&N workers etc.)2. No. of personnel trained in SBA (MO, ANMs, SN)3. No. of personnel trained in IUD insertion4. No. of MOs trained in Life-saving anaesthesia skills5. No. of MOs trained in MTP170

5. Maternal Health1. Proportion of ANC registrations in first trimester of pregnancy2. % of planned RCH outreach sessions held in the quarter6. Child Health1. % of planned Immunization sessions held in the quarter7. Family Planning1. % of planned Sterilisation camps held in the quarter8. Adolescent Health1. Proportion of ANC registrations in first trimester of pregnancy for women

• Steps To Implement New MIES FormatREPORTS AND RETURNSNationalLevelState HQ(SPMSU)District Head Quarter(DPMSU)District HospitalCHCHealth personSHCPHCANMThe above illustration is a design of hierarchal reporting system/data flow,followed in the state of Arunachal Pradesh. The prescribed Revised Monthly,Quarterly & Annual reporting formats under NRHM for SCs, PHCs, CHCs, DHs areprovided and shall continue as and when required. As there is no availability ofInternet at the sub District levels, the reports and returns from all the health facilitiesare sent to the District HQ in manual form. A consolidated report is then generated atthe district level and sent to the state. Now almost all the Districts are reporting in thenew MIES Format. The state has started reporting online in the HMIS Web portal.The state shall ensure same at the District HQ level with availability of internetfacility. The reports shall be uploaded in time on the HMIS Web Portal. The Districtswith no availability of internet shall continue to report manually to the state which thestate shall upload the report on line.Timeline for submission of reports172

From SC/PHC/CHC/DH/FRU to the District HQ- 3 rd of the following month in prescribed Reporting format.From District to State HQ- 5 th of the following month in District Monthly Consolidated ReportingformatReview Meeting:In order to Implement New MIES Format at all the levels and to ensure quality andregular reporting, Review Meetings at every level will be carried out as follows: Block PHC Level Review Meeting on every 2 nd to 4 th day of the every quarter. District Level Review Meeting on 6 th to 7 th day of the each quarter. Half Yearly State Level Review Meeting.All the PHC, CHCs and DHs will organize a review meeting on 2 nd to 4 th Day of thequarter and send the minutes of the review meeting to the Mission Director (NRHM),Arunachal Pradesh. MO i/c of the PHC will be the chairperson of the review meeting.The meeting shall review the following along with other matters: Review of implementation of all Programmes. Review and analysis of reports submitted by the ANMs from the SCs. Examine the registers maintained by the ANMs to assure quality of servicesand data. Feedback and suggestion of improvement. Analysis of goal and achievement of each programme. Analysis of field surveys, FGD etc. if anyAt the Districts will organize a District level review meeting on 6 th to 7 th day of theQuarter. Districts will compile the status of the review meeting of all the DHs, CHCs,PHC and SCs and send a quarterly report to the Mission Director, NRHM, along withthe minutes of District level review meeting. The District medical Officer of theconcern District will be the chairperson and District Programme Manager will be theconvener of the review meeting. The meeting must included the review of thefollowing along with other matters: Review of implementation of all Programmes. Review and analysis of reports submitted by health facilities. Analyze the performance and quality of service & data. Feedback and suggestion of improvement. Analysis of goal and achievement of each programme. Analysis immunization performance based on RIMS software. Review of the minutes of the Block PHC level review meeting. Analysis of field surveys, FGD etc. if any173

Half yearly State Level review meeting is proposed to be organized at State HQ toreview performance of all the Districts. Review of reports submitted by the Districtswill be the main objective of the meeting. Reports submitted by monitoring team willalso be reviewed in the meeting.Budget Estimate for Review meetingSl Review Meeting123Quarterly reviewmeeting at HealthFacilities(174 meetings perquarter)District-levelquarterly reviewmeeting(16 meetings perquarter)State-level QuarterlyReview Meeting(1 meeting perquarter)No ofReviewMeetingsRateAmount696 Rs.500.00 Rs.348000.0064 Rs.1500.00 Rs.96000.004 Rs.1,50,000.00 Rs.3,00,000.00Total 588 Rs.744000.00174

CHAPTERXSustainabilitySustainabilitySustainability is key issue, which needs to be addressed so as to see to it that thatthe activities being introduced under the on going programme is continued even after theproject period. This can only happen when some in-built mechanism is kept in theprogramme, which would take care of sustainability. So, to address the key issue ofsustainability, various committees are formed at various level starting from national, state,district, block and village.As a 1 st step towards addressing the key issue of sustainability, the concept of usercharge has been introduced. The user charge means that who so ever receives servicesfrom the health institutions needs to pay very minimal amount as a part of total expenditureof treatment. The people living below the poverty level are exempted from paying anyamount. The charging of user fee not only helps in making a programme sustainable in longrun but also it generates a sense of belongingness to that programme, which is veryimportant. Since, family welfare is a state subject and the state is responsible for extendinghealth services to its citizen, but due to poor pecuniary condition of the state, it is alwaysgood that common masses join hands with the government in running the programme. Withthe user charge the cost of the maintenance of the facilities created can be done. Once thecost recovery through user charges is achieved, a pricing mechanism for the type of servicessought by different segment of client can be introduced. In the entire process of making asystem sustainable the state has to play a key role as to the expanding bearings on theirbudget. The states considering their poor financial health will make an honest attempt torecover part of the recurring costs.The states will make attempt to fund some of the component like salary and certainrecurring costs through a matching agreement in the initial years and later through a higherstate budgetary allocation over a period of time can scale-up the components funded andover a period to fully take on maximum funding like salaries and recurring cost of theprogram components.Continuous awareness generation activities and improved quality care in the healthfacilities is expected to generate community demand to ensure regular and un-disruptedsupply of drugs, equipment and better quality care and as per the institutional restructuringproposal; the ANMs would be posted to their own place of stay, for which help from thecommunity would be sought for to reduce the burden of accommodation of ANMs for longterm sustainability. During the programme implementation, enough measures will be takenso that the community members understand that they the key partner of programmeimplementation and what all is being done is done for them keeping the needs andaspiration of the community at centre.Necessary efforts will be put to generate resource from other funding agencies alsofor sustenance. The bank interest from all fund available would also be mobilized.175

Part B: NRHM AdditionalitiesNRHM Additionalities (44 points)1. Workshops for State, District and Block level Mission TeamsDuring this year, the state wants to organize 2 State level workshops and 10 Districtlevel workshopsThe state has organized 2 State level workshops and 10 District level workshopsduring the financial year 2008-09. The state level workshops were organized in collaborationwith other departments; as such the approved amount for the purpose has not been utilizedcent percent. Therefore, the state intends to organize 2 State level workshops during thisfinancial year 2009-10 with the remaining unspent balance @ Rs. 2.5 lacs per Workshop.Similarly, at the district level, 10 Districts have reported workshops. The rest 22District level workshops shall be carried forward to 2009-10. This shall be organized @ Rs.50000/- per workshop and amounting to Rs. 11 lacs. The workshop shall include all thedissemination topics. Participants from respective blocks shall be invited.The details of the dissemination topics to be covered during the workshops shall beon NRHM general activities, convergence, Grievances cell, citizens charter, RKS and fundutilization, VHSC, VHND, JSY, Adolescent health, Nutrition, Routine Immunization etc.2. Orientation of PRI on NRHM activities.Seven hundred PRI members will be trained in 12 districts. Fund requirement is Rs400x700 PRI =Rs 28000/-During the year 2008-09, the state in collaboration with the department of PRI, hasorganized 2 orientation trainings of PRI on NRHM activities. As such the approved amountfor the same is unspent. It is planned to carry forward the rest 12 out of approved 14Orientation workshops of PRI on NRHM activities during the year with the remaining unspentbalance. Budget for the purpose shall amount to Rs. 28000/- for 700 PRI @ Rs. 400/- .3 Untied grants to Village Health and Sanitation CommitteesTotal projection for the year 09-10 is 2642 VHSC for which total amount Rs.2,64,20,000/-.Out of the approved 2177 VHSC @ Rs. 10000/- per VHSC, only 530 VHSCs havebeen given untied grants during 2008-09. The rest 1647 VHSC shall be carried forward andprovided untied grants amounting to Rs. 164.7 lacs.However, the state will ensure expenditure of the fund already with theVHSCs in the state and SoE for VHSC fund will be submitted to GoI during 1 stquarter 2009. Therefore, fund requested for release is Rs 2, 64, 20,000/-.Village Health & Nutrition DayApart from the existing 2177 VHSCs, more 353 VHSCs will conduct monthly VHNDin their respective village {n=(353+2177) x12=30000 VHNDs}.4. Selection and training of Community Health Workers (ASHAs, AWWs) etc.The details of last year’s performance regarding ASHA are stated below.176

Sl.NoName oftheDistrictTotal No. of ASHANo. of ASHA Trained inPrototype Module and DrugKit.Proposed Selected M-I M-II M-IIIM-IVDrugKitNGOentrustedwith thetraining.1 Tawang 189 186 189 1892 WestKameng2152001843 EastKameng28816125 184 UpperSubansiri3984244105 LowerSubansiri2162552446 KurungKumey4712221877 Papum274Pare296222 222 222 222 1218 East Siang 132 132 132 132 132 132 1329 West399Siang399375 375 375 375 37510 Upper76Siang9584 8411 DibangVHAAP11130Valley10512 L/ Dibang127Valley1306813 Lohit 225 205 7214 Anjaw 281 214 188 18815 Tirap15654 5415516 Changlang 304 208 31 0 VHAAPTotal 3862 3387 2495 729 729 729 1161VoluntaryHealthAssociationof India(VHAI)Nani SalaFoundation(NSF)The pending training and other activity of ASHAs will be carried forward in this year2009-10 as per the GoI norms, total Rs. 386.20 lacs will be required this year for total 3862ASHAs including Drug Kit replenishment, positioning of ASHA facilitators and ASHAResource Centre. Last year’s balance of ASHA programme is 269.07 lakhs as on 1-1-2009..177

Objective:Strengthening of ASHA Support MechanismStrategy:Positioning the ASHA resource centreActivities:1. Positioning of ASHA Resource Centre:For providing support to the ASHA network an ASHA Resource Centre as perbudgetary guidelines of GOI, shall be set up. The ASHA resource centre isenvisaged to strengthen the ASHA process. The ASHA Resource Centre wouldcomprise of a Manger (MBA), one Statistical Assistant (Graduate in Statistics)and One Office Asstt. It will be outsourced to NGO under a state level NodalOfficer officiating in SPMU. The ASHA resource centre will provide information,documentation and other technical support for ASHA programme setup,monitoring, supervising and evaluating ASHA work. At the same time theresource centre will assess the onsite support needs for ASHA and will supportthe needs through coordination with regional & national centres, other technicalorganisation and government health system departments and personnel.Apart from ASHA programme they will have to undertake activities related to all thecommunity process and mobilisation like implementation of JSY, RKS, Untied funds,VHSC, Village Health and Nutrition Days, House hold survey, community monitoring,community participation, social planning, and village health planning usingparticipatory rural appraisals (PRA) techniques. These professionals ideally will befrom social work or social science with experience with community work atgrassroots and involving civil societies.Strategy:To facilitate regular meeting of ASHA and related officials including regular handlingof grievances of ASHAs.Activities:1. Monthly meeting with ASHA facilitators and Block ASHA Coordinator(MOi/c of PHC/CHC as an ex-officio):Above a set of 10 ASHAs, one ASHA facilitator will be there by which Arunachalwill have 387 ASHA facilitators in the whole state. So, on an average, there willbe 5 ASHA facilitators in a block for 86 blocks.It is proposed to have monthly meeting of ASHA facilitators at the block level,where each of the facilitator will share the cluster level performances of ASHAsand field level constraints will also be discussed so as to decide the future courseof action for more effective performances of ASHAs.178

Activity Unit cost Budget requirementMonthly meeting of Rs. 200x 387x12 Rs. 928800ASHA facilitators atBlock levelFooding @ Rs. 50x 20x6 Rs. 6000Total Rs. 9348002. Bi-Monthly meeting with ASHAs and Block ASHA Coordinator (MO i/c ofPHC/CHC as an ex-officio):All the ASHA under each block will have meeting with their respective ASHAfacilitators, ASHA block coordinators and ANMs bi-monthly once on a fixed day.The day will be called as “ASHA Day”. Each of the ASHA will share their fieldlevel performances and also issues and concerns. Accordingly necessarysuggestions & supports will be given. In the ASHA Day, the back log incentives ofthe ASHAs will be met by MO i/c of the respective PHC / CHC. This will alsoaddress the vital question of submission of timely UC by block to district & districtto state.Activity Unit cost Budget requirementBi-Monthly meeting of Rs. 200x 3862x6 Rs. 4634400ASHAs at Block levelFooding Rs. 50x 3862x6 Rs. 1158600Total Rs. 57930003. Monthly meeting of facilitators at district level:It is proposed to have monthly meeting of ASHA facilitators at the district level,where each of the facilitator will share the block / cluster level performances ofASHAs and field level constraints will also be discussed so as to decide thefuture course of action for more effective performances.Activity Unit cost Budget requirementMonthly meeting of Rs. 300x 387x12 Rs. 1393200ASHA facilitators atdistrict levelFooding Rs. 100x 387x12 Rs. 464400Total 18576004. State level meeting of District Community Mobilizers:District Community Mobilizers will meet bi-monthly, preferably in a fixed date atstate level, where each district community Mobilizers will make a formalpresentation on the activities performed in the district regarding communityprocesses. The person will also highlight what are the given activities could notbe performed and the reasons for non completion. Based on the presentationsmade by each of the District community mobilizers the degree of support to beextended to the respective district would be decided.179

Activity Unit cost Budget requirementBi-Monthly meeting of Rs. 500x16x6 Rs. 48000district communitymobilizers at state levelFooding @ Rs. 100x 20x6 Rs. 12000Total Rs. 600005. Performance incentive for the ASHA facilitators:It is planned that ASHA facilitators will be paid on the basis of their performance. It isexpected that each ASHA facilitators will go to field for 15 -20 days and for that eachof them will be paid @ Rs 150 / day x no of days visited. They will also be paid afixed monthly honorarium of Rs. 1000/- ( One thousand).Activity Unit cost Budget requirementHonourarium @ Rs 1000 x 387 Rs. 387000Per day allowance @ Rs. 150x 20x12 x 387 Rs. 13932000Total Rs 143190006. Monthly Honourarium for 16 Dist Community Mobilizers & 1 state CommunityMobilizer:Activity Unit cost Budget requirementMonthly Honourarium of @ Rs 8000 x 16x 12 Rs. 1536000district CommunityMobilizersHonourarium of StateCommunity Mobilizer@ Rs. 10,000 x 1 x 12 Rs. 120000Total Rs. 16560007. Monitoring plan: Considering the Fund constraint, it is decided for effectivemonitoring under ASHA resource center the existing monitoring mechanism ofSPMSU and DPMSU will be used by the State & district Community mobilizers.Thevother programmatic review meeting plat form will also be used to assess theeffectiveness of the ASHA programme in the state.Strategy:To provide mentoring support to ASHAs by ASHA mentoring Groups at State andregional levels.180

ASHA need to stay in touch, to share, to strengthen her role and need to developsupport mechanism. There is an urgent need now to provide social infrastructure,build a supporting environment and develop the right practices. Support fromprofessional as well as from other civil societies can be successful in demonstratinga quality model programme.One ASHA mentoring group is formed at State level with members from NGOs,Academic institutes and other state programme mangers. One NGO named asVoluntary Health Association of India (VHAI) has already attended the regionalmentoring meeting at Guwahati as arranged by RRC and NHSRC together duringNovember’ 2008. The members of the mentoring group are expected to make fieldvisit bi-monthly in the mutually agreed districts and furnish the report to the MD(NRHM). For carrying out such activity, it is proposed that the members should bepaid TA on actual and Rs. 1000/- as DA per day.Activity Unit cost Budget requirementTA for Field visit by Rs. 3000x 2 daysx 6 Rs. 324000AMG membertimesx 9 memb ersDA Rs 1000 x 2 daysx 6 x 9 Rs. 108000State Level Meeting Rs. 1000 x 9 x 4 Rs. 36000quarterly (TA + Food +DA + Misc)Total 468000Training / Orientation of State Community Mobiliser , District Community Mobiliser,ASHA Facilitators:Since these persons would be newly given engament under ASHA programme , so,it is proposed to impert training / orientation for three days to these members so thatthey get to know in detail regarding the ASHA programme and also what is expectedout of them. The no of trainees : 1 ASHA State Community Mobiliser + 16 DistrictCommunity Mobiliser + 387 ASHA facilitators = 404. In each batch there will be 40trainies for 10 batches.The budget is shown below:Activity Unit cost Budget requirementTA for participants @ Rs. 1000/- 404x1000=404000DA for participants @ Rs. 200 /- for 3 days 200x3x404= 242400Training Matterials @Rs. 100/- 100x 404 = 40400Over Head (Venue hiring,generator etc)@ Rs. 25000 x 10 batch 25000 x 10= 250000Rs. 936800ASHA drug kit replenishment:The drug kit for ASHAs will be replanished twice in this year. For that budgetrequirement is @ Rs. 1300x 2x3862= Rs. 10041200/-181

1. Training of Trainers on Book – 5 for State:Training of 5 state Level trainers for Module V will be done in 2009-10. The Statelevel Training for State Trainers will be completed by first quarter of 09 . It will beconducted by RRC, Guwahati. Only TA / DA will be provide by State.2. Training of district level trainres on ASHA module -5 th :Training of 10 trainers from 16 districts will be brought to the state for providingtraining on Module V . It will be done in first quarter of 2009-10.Total no ofmembersproposedfor trainingNo. ofBatch160 4 (40each)Duration DA fortrainees@ Rs.100/perdayTotal noofmembersx 100 x 4daysHonorariumto resourceperson @ Rs100/- per dayMaximum of5 trainers x100 x 4 daysx no ofbatchesFood @Rs 100/-permemberplus 5trainersper dayNo oftrainers+ no oftrainee x100 x 4daysTrainingmaterials@ Rs.70/- pertraineesTA as perstategovernmentrule (approx)Rs. 500 x 1timeTotalBudget4 days 64000 8000 66000 11200 82500 2317003. Training of ASHAs on book 5:Already selected and trained 3862 ASHA will be having training in book 5 for 4 daysin 2009-2010 as it could not be completed in 2008-2009. This training will beprovided by the identified 160 district trainers of 16 districts trained on book 5.No. of ASHAsforTraining3862(97 batches of40 ASHAseach)Rs100/-for to &frotravel:once ina year.Rs100x 1x No.ofASHADA for 6days @100/perdays perASHATrainingMaterial@70/- perASHAHonorariumto 5 trainers@ Rs 100/-per trainersper day No.of 97 batchesFood &Lodging @ Rs100/- perASHA per dayas per RCHGuidelinesunderContingency(386200x4days)TotalBudget(Rs)386200 2317200 270340 48500 1544800 4567040ii) Reorientation Training of 3862 ASHA for 12 times for 1 days each(12 days training in a year for all 3862 ASHAs): The ASHA facilitators, DistrictTrainers, Mo i/c , community mobilisers will trained the local ASHAs.182

No. of ASHAsforReorientationTrainingNo. ofBatchRs 100/-for to &fro travel:12 timesin theyear.Rs 100x12 x No.of ASHADA for 12days @100/perdays perASHATrainingMaterial@160/- perASHATotalBudget(Rs)3862 97 4634400 4634400 617920 9886720Total activity based budget requirement for implementing proposed activities underASHA resource center:Activity Unit cost Budget requirementMonthly meeting of Rs. 200x 387x12 Rs. 928800ASHA facilitators atBlock levelFooding @ Rs. 50x 20x6 Rs. 6000Bi-Monthly meeting of Rs. 200x 3862x6 Rs. 4634400ASHAs at Block levelFooding Rs. 50x 3862x6 Rs. 1158600Monthly meeting of Rs. 300x 387x12 Rs. 1393200ASHA facilitators atdistrict levelFooding Rs. 100x 387x12 Rs. 464400Bi-Monthly meeting of Rs. 500x16x6 Rs. 48000district communitymobilizers at state levelFooding @ Rs. 100x 20x6 Rs. 12000Honourarium @ Rs 1000 x 387 Rs. 387000Per day allowanceMonthly Honourarium ofdistrict CommunityMobilizersHonourarium of StateCommunity Mobilizer@ Rs. 150x 20x12 x Rs. 13932000387@ Rs 8000 x 16x 12 Rs. 1536000@ Rs. 10,000 x 1 x 12 Rs. 120000TA for Field visit by Rs. 3000x 2 daysx 6 Rs. 324000AMG membertimesx 9 memb ersDA Rs 1000 x 2 daysx 6 x 9 Rs. 108000State Level Meeting Rs. 1000 x 9 x 4 Rs. 36000183

quarterly (TA + Food +DA + Misc)Training of newlyrecruited ASHAfacilitators & CommunityMobilisersASHA drug kitreplenishment:Training of 5 th Modulefor district trainersTraining of 5 th Modulefor ASHAsTraining of 12 days(Budgeted for 6 dayshere, rest t6 das fromBi-monthly ASHAmeeting)- Rs. 936800Rs. 1300/- per kit fortwo timesRs. 10041200/-Rs. 231700Rs. 4567040Rs. 4943360Rs. 458085005. Performance related incentives for ASHAs.Performance related incentive would be linked up with other vertical programs and tothe schemes of line departments determining the health e.g. Sputum collection & transportunder RNTCP, Blood slide collection under NVBDCP, total sanitation campaign under PHEDetc. Village health committee and Rogi Kalyan samiti may decide on release of performancerelated incentive to ASHAs as decided by the committee. Under Convergence, it will beensured that incentives are provided to ASHAs as may be applicable by the differentDisease Control Programmes and related departments.6. Selection, remuneration and training of ANMs.A total number of 40 ANMs are working under NRHM Additionalities and shallcontinue @ Rs. 6000/- per month. No new ANM proposed.Relocation process has been going on as proposed last year. As mentioned in theRCH section, the State Govt. has already decentralized the HRD policy for streamliningposting/relocation of contractual staff.However, slight increase in the remuneration may be made, in order to motivate theANMs for the benefit of the programme.(Proposal is made separately for Rs. 8,000/- per month subject to approval from GoI)7. Selection, training and remuneration of Staff Nurses at PHC/CHC /DH level.PHC: Requirement NilCHC: Out of the approved 117 SNs during 2008-09, 56 have been recruited and willcontinue. The rest, 61 SNs shall be appointed on contract and total of 117 SNs may becontinued. No new Sns is proposed for 2009-10. The recruitment is decentralized to therespective DHS.DH: It is proposed to recruit 17 more SNs for 3 District Hospitals of Tirap, Changlangand East Kameng 2009-10.184

The existing monthly remuneration is Rs. 7,500/- per month. The total fundrequirement is Rs 1005000/-.(Proposal is made separately for Rs. 10,000/- per month subject to approval fromGoI).8. Selection, training and remuneration of Medical Officers at PHCs/CHCsa. As on date, out of 85 PHCs, 55 are functional in terms of basic services but notreaching 24x7 in terms of manpower.Out of approved (n=82), the 54 MOs recruited last year are in position and the rest28 MOs shall be carried forward for recruiting during this financial year 2009-10.The monthly salary would be Rs. 15,000/- Per month per MOs. Therefore, for 82MOs @ Rs 15000/- per MO per month, the total fund requirement is Rs 1230000/-.(Proposal is made separately for Rs. 22,000/- per month subject to approval fromGoI).b. 40 nos. of Dental Surgeon are in place under State Govt. Additional 15 DentalSurgeon may be approved for recruitment for 50% CHCs only. The monthly salary would beRs. 15000/- per month per surgeon.9. Selection, training and remuneration of Specialists at DH level.The state has already requited 1 Specialist under NRHM out of the approved 3specialists. The existing Specialist will continue.Relocation of existing Specialist and MOs with post graduate degree or EmOC /LSAS is being undertaken to address the requirement for 3 DHs to be made functionalduring the year.Specialist will be drawn from EmOC/LSAS trained MBBS doctors and be posted inthe identified DH.The remuneration would be for 1 specialist of Rs. 20,000/- month.(Proposal is made separately for Rs. 28,000/- per month subject to approval fromGoI)10. Construction and maintenance of physical infrastructure of SCs.Out of the approved construction of 25 SCs during 2008-09, none could be initiatedand all will be carried forward in 09-10. Budget required is Rs. 22500,000 @ Rs. 9 lakhs perSC.11. Construction and maintenance of physical infrastructure of PHCs.A. Provision for Untied Fund:-The proposal is to functionalize 1 PHCs (Kaying PHC) at West Siang Districts duringthe year 2009-10. The fund was appved @ 12 lakhs which is unspened. So, it will be carriedout during 09-10.12. Procurement and distribution of quality equipments and drugs in the healthsystem.LOGISTIC STRENGTHENING:SITUATION ANALYSIS:Procurement of RCH - II supplies were proposed last year.185

Procurement Policy & ProceduresThe RCH-II Procurement policy and the general financial rules (GFR) of the Govt. ofArunachal Pradesh supported by World Bank guideline are the main policyinstrument for governing procurement policy. The guidelines on procurementprocedure for Health sector goods of services and selection of hiring of consultantcirculated by the Ministry of Health & Family Welfare, Govt. of India will be followedfor procurement policy and procedure. The guidelines will be disseminated to theDistrict Health Societies and Rogi Kalyan Samitis.Procurement organization and staffing.The State Programme Management Unit and District Programme Management Unitsare the organization for the procurement at the State and District levels respectively.The establishment of procurement unit with additional staffs at State & districts arefelt need but considering the pressing budget constrain under ProgrammeManagement component the existing organizational arrangement will continue forthe procurement.Procurement Audit/ Review:There is no separate organization or agency for audit and review of the procurement.The procurement procedures are reviewed by the auditing agency during the audit ofthe account.Procurement MIS & Record keeping:-The lists of construct issued at various levels of organization are maintained atrespective levels of organizations at respective levels of organizations. The stockregisters of the stores are maintained at the respective levels.Inventory Control & Storage:-There are no proper store houses at State head quarter, General Hospitals, DistrictHospitals, CHCs, PHCs for proper storage of stores. A central store house will beconstructed at State headquarter. The existing store house at district headquarters,health institutions will be repaired or extended with minimum facilities like lighting,Ventilation and racking. Interim strategy will be to higher the store/ware houses inrent in different level.Quality Control for drugs:-The drugs are procured as per the State Govt. procurement policy for drugs. Thedrugs are procured from the products of the pharmaceuticals having GMPcertification and approved by the state Govt. The drug supplies are drawn from theprocured drugs and sent to the Kolkata Drug testing laboratory for quality test, but ittakes long time to get the result. Entire batch of the drug, whose samples have beensent for quality testing, should be kept in quarantine and released only aftersatisfactory test report is received. The overall time taken in sample testing should186

e minimized. The equipment specifications developed by MoHFW (available onMoHFW website)should be referred by SHS for procurement of medical equipment.LOGISTIC SYSTEM DEVELOPMENTThe present functioning of logistic system needs strengthening of Procurement,storage and distribution of logistics under NRHM. Govt. of Arunachal has no goodinfrastructure at State and district level for procurement. There is no existingWarehouse system, no proper infrastructures, staff to manage RCH-II logistic. Statehas to develop it for unified Logistic Management structure at state, region anddistrict level.Procurement:Requirement of procurement of drug, equipment, IEC materials etc. will be estimatedas per need assessment of facilities district wise. To avoid wastage of Kit systemdrugs, supplies to sub-centres shall be assessed in PHCs and unutilized drugs shallbe distributed to needing facilities like CHCs and DH.Institutional /organizational strengthening is required now through DistrictProgramme Management unit and State Programme Management unit towardsbringing up a logistic management wing. State Programme Manager shall assessthis situation twice in a year.Mainly from Govt. of India supplies are coming under RCH-II programme. Howeverprocurement system of Central procurement following Good Manufacturing Practicesshall be followed in case of state supplies. All these procurement will be done fromTNMSC. If not available, then as per GoI guide line / existing rate contract of StateGovt.Storage:At state level, central store house will be rented at Rs. 5000/- per month, totalrequrment for the year 2009-10 is Rs. 60,000/- . Again 3 regional storehouses in 3different regions proposed this year to be taken by relocating rooms within theexisting facility. From next year, the construction will be started for those. Kittingprocess will be outsourced to NGO or private firm at state level.(Per district 1 store house & 1 more store house at state level will be constructed @Rs. 9 Lakhs. So, total 153 Lakhs will b required for it.)Distribution:Distribution process in Arunachal is quite poor resulting untimely delivery of materialsat peripheral health institutions / up to user point where supplies should reach.Presently, ambulances and other vehicles from districts taking care of receive anddelivery of vaccines from State Cold storage to District level Storage and from districtto Vaccine storage Centres of respective districts.For this purpose one vehicle at state level will be hired @ Rs. 5000 per month for 4months as and when required (minimum twice in a year to all the districts).187

Distribution of supplies from Central state store to DH, then to CHC and then to PHCand from PHC to sub-centre level will be carried out by it. District Management Unitshall monitor regular and adequate supplies including vaccines up to the sessionsites everywhere utilizing programme fund. Regional Level Distribution Organizationshall be contracted with fixed terms of references as decided by State ProgrammeManagement unit for ensuring nil stock out in each facility level. However distributionof supplies to session sites in outreach areas/ health camps shall be assisted byMMU and NGO having capacity to handle the task.(Last year’s approval was @ Rs 500/- only which is not possible in the state.)Logistic management information system: Utilization of drugs, equipment shall beassessed monthly in PHCs district wise with feedback to regional warehouses andcentral state store house through extended/modified new MIS developed by the MIScell at state level. These data generation and monitoring will be done by therespective DPMU with assistance from Block level Data cum account manager. Allthese were houses will maintain computerised records for further quality controlissues. New logistic management information system will be an integral part ofMIS from sub-centre level to DH. It shall be reviewed at SC, PHC, CHC, DH, districtand state level for taking action regularly. State Management Unit shall providefeedback to districts based on monthly assessment of MIS to improve logistics offamily welfare. In future, at state, regional & District level, biometric finger printingmay be introduced on pilot basis to identify / avoid double issue of the drugs.The distribution of logistics shall be regularly monitored from State and DistrictManagement Unit and monthly report of Stock, supplies shall be ensured at stateUnit district wise.Storage system in all health facilities shall be improved maintaining monthlyinventory of all supplies and District storage (generally maintained in Districthospitals) shall be strengthen with training of manpower and infrastructurestrengthening in PHC/CHC/DH level for storage under all RKS.Procurement of Dental Chair: As 15 Dental Surgeons are to be recruited this 09-10, the state requires 15 dental chairs. The cost fequired for that is 30 lakhs (@ 2lakhs / dental chair).13. Untied Grant to SCs, PHCs and CHCsa. Sub CentreUntied fund @ Rs 10000/ SC and maintenance fund @ Rs. 10000/SC will beprovided to the 273 functional SCs during the year. Total (27.30x2=) 54.6Lakhs proposed for that. Balance for untied fund is Rs. 23.89 Lakhs, but itis commited expenditure.b. PHCUntied fund to 85 PHCs @ Rs 25000/ PHC will be provided. Toralrequired=Rs. 2125000/-.AMG to 85 PHCs @ Rs 50000/ PHC will also be provided. Total Rs.4250000/- required.188

RKS fund @ Rs. 1 lakh/ PHCs will also be provided. Total required 85 lakhs.c. CHC for 31Untied fund @ Rs 50000/ CHC for 31 CHC is proposed. Total required=15.50 lakhs.AMG to 31 CHCs @ Rs. 1 lakhs/ CHC will also be provided. Total required 31lakhs.RKS fund @ Rs 1 lakh for 31 CHCs will also be provided. Total required = 31lakhs.It is proposed to implement the activities as mentioned in the RKS guidelinesand will be monitored more vigorously.d. RKS Fund for DH : For 14 DH/GHs @ 5lakhs = 70 lakhs required.14. Supports for Mobile Medical UnitThe MMU are almost completed. 1 st (Transporting manpower for Mobile Medicalcamp) and 2 nd (consisting of laboratory equipments) for vehicles are already in place but theprocurement of 3 rd vehicles are not yet completed. 3 MMU III (consisting of Diagnosticequipments) has already been supplied and on priority, these 3 vehicles are provided toP/Pare, Tawang and Changlang districts along with the 2 MMU I & II. It is expected thatduring March’2008, supply will be completed. Manpower required for MMUs will be met fromexisting manpower of District Hospital/ under District Health Society.The MMU is being operationalized this year and maintenance fund will be required.The detail breakup of requirement is as below:- MMU drugs will be provided @ Rs 1 lakh per district for 16 districts.- Maintenance/repair fund of Rs 2 Lakhs per district will be provided to 16districts.- POL @ Rs 2 lakhs for all 16 districts will be provided.- Contractual appointment of drivers for MMU (48 nos.) @ Rs. 3500/- perperson per month may be approved.So, total requirement @ 5 lakhs for 16 districts= 80 lakhs.15. Program Management CostRecruitment of BPMSU StaffThe A. P. State Health Society will constitute 84 Block Programme ManagementSupport Units (BPMSU) during the financial year 2009-10 for as many Blocks of the State inorder to ensure proper maintenance of accounts and prompt reporting from the sub districtlevel to district level. The BPMSU will be the accounting centres for all the implementingagencies including SCs, PHCs and CHCs under the respective Blocks.The Program management cost for SPMSU and DPMSU has been addressed inRCH – II.Proposed Qualification & Designation of Block PersonnelEach Block will be provided an Accountant-cum-Data Assistant on contract basiswho will be responsible to collecting, recording, maintaining and reporting physical andfinancial reports in respect of the implementing units under the Block. The requiredqualification for the post of Accountant-cum-Data Assistant will be B.Com pass along withworking knowledge of computer.189

RemunerationThe consolidated pay will be Rs. 6,500/- (Rupees Six thousand five hundred) Onlyper month. Local candidates of a particular Block with the requisite qualifications will bepreferred for the post.16. Improving physical infrastructure at SC / PHC / CHC /DHRequirement of residential quarters for the facilities mentioned below is required andis proposed as per the requirement.1. PHC:Construction of PHC quarter (3 quarters for staff nurses per PHC)5PHCX 7,00,000/- = Rs. 35,00,000.2. DH:Physical Infrastructure for 5 quarters for 5 DHs @ Rs. 7 Lakhs = 35 Lakhs.(DH of pasighat, seppa, ziro, yingong, daporizo).None of the above onstruction could not be carried out last year and will be done in FY 09-10.3. CHC:Prpoosal for Upgradation of koloriang CHC enclosed and not budgeted due to fundconstraint Annexure- 9 (provided seperately)17. Ambulance for PHC / CHC / DHAt present 61 (31 PHCs, 30 CHCs) & 2 GH have ambulances. So, (85-31=) 54 moreambulances required for rest of the PHCs. On priority, 20 ambulances required this FY 09-10. So, fund required is Rs (20x 6 lakhs=) 120 lakhs.For DH / GH, better equipped ambulances will be provided with facility for caringcardiac and neurological cases since number of patients are increasing day after day. It isfelt that no equipped ambulances are available in any of the DH /GH. Recurrent VIPmovement also signals its requirement. Therefore, it is proposed to provide 2 such units tobe placed at 2 GH (Pasighat & Naharlagun) which are fully functional. The total estimatedcost for 2 such ambulances are Rs. 38 Lakhs @ Rs 19 Lakhs per unit.These ambulances will have the following euipiments:-DescriptionPATIENTS HANDLING SYTEMSAutomatic Loading StretcherHead Immobilization SystemFolding StretcherScoop StretcherVacuum Splint KitAnti shock trousers (Imported)KED Extrication deviceVacuum MattressEMERGENCY EQIPMENTSAutomatic Suction Pump Model Accuvac Basic # WM10709 fromQty.1 No.1 No.1 No.1 No.1 No.1 No.1 No.1 No.1 No.190

Weinmann, GermanyMouth to Mouth Respirator Model Lifeway # 10560 fromWeinmann, Germany (Set of 5 Nos.)Resuscitation Bag for Adults & Children Model Combibag #WM11026 from Weinmann, Germany includes ventilator, suctionand oxygen inhalation devices.Resuscitation Kit (Imported) Model ULM Case-I # WM52222from Weinmann, Germany includes ventililator, suction and oxygeninhlation devices.Syringe Infusion PumpDefibrillator/ Monitor/Pacer Model Lifepack-20 from M/sMedtronic Physio Control, USA.Facility for Automatic External Defibrillation/ Manual Defibrillation/Monitoring through same set of electrides, Biphasic EscalatingEnergy upto 360 Joules EnergyOptions IncludedSPO 21 No.1 No.1 No.1 No.1 No.1 No.There fore total 22 Ambulances asked for during 09-10 is Rs. 120 + 38 Lakhs = Rs. 158Lakhs18. Telephones for SHCs/PHCs/CHCs/District Hospitals.The health facilities which are functional as on date and already having telephoneconnection with internet and fax facilities would be provided monthly rent to 100 connections@ Rs 500/month. Total requirement is 100x 500x 12 = Rs.6,00,00019. Preparation of District and State level public reports on health annually byNRHM Directorate.Proposed Rs. 1,50,000 /- for state report & (Rs 50,000x 16 dist=) Rs. 800,000/- dordistrict reports for 16 districts will be required.20. MAINSTREAMING OF AYUSHThe AYUSH is already streamed into the health system and co-location /relocation of AYUSH facilities with manpower is only aimed under NRHM and rest ofactivities under AYUSH will be proposed from AYUSH through AYUSH Department toGoI.In Arunachal Pradesh, Govt. of Arunachal Pradesh introduced the Indian systems ofmedicine and homoeopathy at various places like District HQ, Hospitals, PHCs and theplaces where no other health care facilities was not provided to render ISM and Homoeofacilities to the people of the State. Later on, during the course of time seeing the people’sresponse and gaining popularity of these traditional systems in the state, the Govt. openedthe dispensaries.Even though, the concept of bringing all systems of treatment under one umbrella asconceived now under NRHM; in Arunachal Pradesh this concept has been already prevailingi.e. several Ayurvedic and Homoeopathy units are functional under one roof only at DistrictAllopathic Hospitals, PHCs and CHCs.The Average out patient attendants at each Ayush health care unit is reported 20 to30 per day as per the District Health reports.191

A part of that there are more than 500 known species of medicinal plants areavailable in Arunachal Pradesh which can be put to use for manufacturing the allopathy,ayurveda and homoepathy, unani, siddha drugs.Existing manpower and infrastructure:Sl.No. Facilities Homeopathy AyurvedaUnder StateGovt.UnderNRHMUnder StateGovt.UnderNRHM1 2 GH 2 0 1 12. 12 DH 12 2 1 3CHC 7 5 1 5PHC 6 8 0 2SC/11DispensariesTotal:- 38 15 3 111. Eleven AYUSH Medical Officers posted in 11 District Hospitals. 8 of them are inCHCs, 10 in PHCs and 8 in GH / Dispensaries under specialty clinic.2. 10 Bedded specialty wing in DHs in 10 DHs, the activity of which is going on andGoI has released the fund.3. GoI has released funds for 51 facilities with AYUSH manpower @ Rs 25000/ onlyfor essential drugs.Proposal for sanction of Manpower and infrastructureThere are 23 CHCs, 75 PHCs without AYUSH Doctors. The total requirement ofAYUSH Doctor is 98 Nos. Under State Deptt.of Health & FW there are 39 Homoeopathydoctors and 3 Ayurvedic doctors are working on regular basis. During 2006-07, 42 Ayushdoctors are appointed on contractual basis under NRHM.In continuation of mainstreaming of AYUSH under NRHM, it is proposed that 5AYUSH Doctors will be appointed on contract at a consolidated monthly salary of Rs 20000/-per month. (Proposed and budgeted under Sl.No. 8)Proposal for co-location/relocation of AYUSH facilities:All the AYUSH set up are already a part of existing PHC / CHC / DH / GH. TheAYUSH set up are not a separate entity in the state. However, specialty clinic in 3 areas willbe co-located to the nearby PHC / CHC. Otherwise, facilities are provided under the broadumbrella of PHC / CHC /DH/GH only.Identification & renovation of AYUSH OPDs in existing Health Centres andprocurement of AYUSH medicines, referral books & equipments are being undertaken by theAYUSH department.21. Strengthening Nursing School:As per, the requirement of providing quality health services to the populationof Arunachal Pradesh and as no Nursing School in Arunachal Pradesh underpublic sector, a proposal for establishing of Nursing School in Arunachal Pradeshis put being submitted. The Nursing school is envisaged to be implemented with192

effect and the broad detail of proposal as below. The manpower/ teaching facultywill be adjusted from the existing tutor for ANM training centre and additionalteaching faculty would be added during the year added through either creation ofnew post under the state govt. or relocation of qualified manpower from within thesystem with requisite qualification as per the INC norms:-1. Immediate requirement - Rs, 18,29,806/-2. Infrastructure - Rs. 17, 16, 00,000/-Total: - Rs. 17,34,29,806/-So, Immediate requirement as starting cost is Rs.18,29,806/-,Detail proposal is annexed at Annexure – 7.193

ACTION PLAN FOR NCD of ARUNACHAL PRADESHIntroduction:NCDs are recognized as an emerging health problem in the state of ArunachalPradesh also. The most of the NCD are managed poorly by curative approach onlyin this state. Success is very limited as seen in this approach in the state as it wasnot treated as . So, the state is willing to propose another approach that is anattempt to address NCDs through the comprehensive strategic integrated diseaseprevention & control plan with special focus on NCD in Primary Health Care. It will tryto reduce the key risk factors & early detection & management of important NCDslike Diabetes, CVD, Stroke, Substance Abuse / Alcohol related diseases andCancer. Also it will try to develop an appropriate referral system to cost effectivemanagement of all the NCDs in primary health care. However, during the FY 09-10,the activities will be piloted in Papum Pare & East Siang only due to limitation ofavailable manpower & budget constraint. Fund will be managed through State /District Health Society.Objective 1 : Functionalization of NCD CellStrategiesStrategy1: Development of NCD cell / unitActivity : Notification of State& District NCD cells.STATE LEVEL:1. Establishment of NCD Cell:ActivitiesIdentification of a Cell in the Directorate.A separate dedicated cell will be established at the state Hq. located in theDirectorate by relocating room.Nodal Officer of the rank of Jt DHS preferably a Public Health Specialist.A separate Jt DHS will be identified / appointed as Nodal Officer (NCD).Supporting staff–On contract / identified - Medical Officer with PH background,Accountant, Data Assistant*.Functions- Administrative- Technical support- Managerial supportThe cell will Supervise & monitor and evaluate the NCD program.The Medical Officer will be responsible for training/capacity building with HRD.He will also provide Medical, sensitization of stakeholder in the program.Identification and appointment of District Nodal Officer in consultation withCMO.OrganogramNodal Officer (NCD)Medical OfficerAccountant Data Assistant194

2. Appointment of staff: On contract for 1 year which will be extendable subjectto excellent performance report at the end of the year. The TOR will be asbelow:Medical Officer – MBBS with PH Diploma/Degree with 2 years experience inPublic Health.Accountant / Account Manager will have to possess M Com / B Com with workingknowledge inTally software and computer.Data Assistant will have to possess MCA / BCA/Any graduate with 1 yr Diplomain CAThe process of recruitment will be through walk-in-interview sufficientlyadvertised in thenational / local papers.A consolidated pay of the above will be as per GoI norms.3. Transfer of funds to DHS: Through NRHM funding mechanism to a newlyopened group account under NRHM.4. Identification of Institution:- Medical College / RH&FWTC / District Hospitals / General Hospitals.5. Establishment of Dedicated Units:GH / DH at Districts.Medical College / private hospitals6. Establishment of a Technical Committee: A committee comprising of thefollowing members will be as belowCommitteeChairmanMembers- NO (NCD)- All specialist (Med College/ GH/ DH/ Nursing Homes)- SIO (NIC), Dietician, Members from IMA, IPHA, DFI,ICS- Rep Defense services, Railways Postal services.Member Secretary cum Convenor – Medical Officer(NCD)TOR: Policy / Decision making on NCD.Review of the ProgramSitting once in a quarter.DISTRICT LEVEL:1. Establishment of NCD Cell.A NCD cell will be established in all the district to be headed by a designatedDNO (May be MS of the DH/GH)2. Appointment of staff:One Medical Officer will be appointed on contract / identified.One DHPO / District MEIO2 supporting staff (Accountant, Data Assistant)Function of the NCD Cell:-Coordination of the activities under NPDCS-Report to SNO on monthly basis.195

-Identification of NGOs / SHG in the districts.-Identification of private practitioner3. Constitution of District Advisory CommitteeIt will be in line with State Committee including District administration and PRImembers4. Transfer of funds to DHS:Funding will be from group account at state level.5. Site identification:Identification of Sites for community based interventions in all the blocks inconsultation with state Nodal Office and block administrators. BCC campaign at theidentified community centre under the supervision the DHPO / District MEIO.6. Renovation and infrastructure improvement at district NCD cell.Objective2:Reduction of morbidity & mortality of common NCDs (CVD, Diabetes, Stroke,Alcohol related diseases ).Stretagy 1: Development of Village level data baseActivity 1 : VHSC will conduct house hold survey in 2 pilot districts. Technicalassistance will be provided from RRC through SPMU & DPMU.Strategy 2: IEC & BCC campaignActivity 1: Positive life style campaign, Health Exhibition, Radio gingles, Signaturecampaign for Smoke free public places / office / schools / colleges.Activity 2: Advocacy workshop at district (Nahar lagun & Pasighat) & state levelStrategy: 3. Capacity BuildingActivity: 1. Training of ASHA, AWW, VHSC, PRI.2. Training of Lab Tech, Health Assistants, ANMs, MOs.Strategy 4: Adopt healthy life style to reduce common preventable &measurable risk factors ofthe common NCDs (Risk reduction)Activity : 1. School Health Programme2. Community based awareness programme3. Work Place based awareness programme.Stg 5 : Early Detection / diagnosis :Activity: 1. Surveillance of NCDs & risk factors of NCDs through ICMR / IDSP.(State IDSP wing may help for developing population profile of risk factors &diseases by age & gender.).2. Organising opportunistic screening / camp for identification of individualsat risk in service delivery centers like PHCs, CHCs, DHs for early detection &treatment of common NCDs (Diabetes, hypertension). It will invite the steps tostrengthen these facilities for estimation of Blood Sugar, Urine Sugar and ensuringavailability of functional minimum equipments like weight machine, measuring tap,sphygmomanometer, stethoscope etc. For screening camps, may tie up with othersuitable national programme.3. Develop Referral ServiceStg 6 : Targeted interventions like Rehabilitation / Management of commonNCDs (Diabetes,CVDs, stroke, Alcohol related diseases, other NCDs )Act 1 : 1. Comprehensive management of NCDs in existing Health ServiceDelivery Centers (more focus on facilities of urbanized areas like GH & UrbanHealth Center of Naharlagun & Pasighat )196

2. Community based intervention for Primordial Prevention & Reductionof Risk Factors3. Community based rehabilitation servicesStg 7Stg 8: Integration with other National Programmes (cancer, mental health etc): Monitoring & EvaluationWork Plan:Activity Qtr 1 Qtr 2 Qtr 3 Qtr 4A. State Level1.1 Identification of a Cell in the Directorate. x1.2 Appointment of Nodal Officer (NCD) x1.3 Supporting staff X x2. Appointment of staff: X x3. Transfer of funds to DHS: X X x4. Identification of Institution X x5. Establishment of Dedicated Units X x6. Establishment of a Technical Committee xB. DISTRICT LEVEL:1. Establishment of NCD Cell x2. Appointment of staff X x3, Function of the NCD Cell: X X x3.1 Constitution of District Advisory Committee x4.Transfer of funds to DHS: X x5. Site identification: X x6. Renovation and infrastructure improvement. X X x197

Budget for NCD :Sl.No.Activities Rate / details No. ofUnitsSub TotalA1Staff for State Level01 1 NO – NCD (Ex-Officio in therank of Jt DHS preferably)- 1 -02 1 MO @ Rs. 15000/- 1 15000x 12=18000003 1 Data Assistant @ Rs 6000/- 1 6000x12=7200004 1 Accountant @ Rs. 6000/- 1 6000x12=72000Total fixed cost for State:(it will also work for Papum Pare District &State initially during Piloting)Rs. 324000/-A2Staff for District Level05 1 District NO (NCD)(May be MS of the DH/GH)- 1 -06 1 MO @ Rs. 15000/- 1 15000x 12=18000007 1 DHPO / 1 District MEIO(Ex-officio)- 1 -08 1 Data Assistant @ Rs 6000/- 1 6000x12=7200009 1 Accountant @ Rs. 6000/- 1 6000x12=72000Total fixed cost for East Siang District: Rs. 324000/-Total fixed cost for State & District: Rs. 6,48000/-Training (for 2 districts)MO 30,000 2 60,000Health Assistant / ANM 40,000 4 80,000Lab Tech 20,000 2 40,000Advocacy WorkshopState Level 50,000 1 50,000District Level 30,000 2 60,000Monitoring From SPMSU - -198

Health Promotion Activity(School, Work Place etc.)1,00,000 Allschool1,00,000Community Based intervention 50,000 4 2,00,000Training of ASHA, AWW, VHSC,PRIHouse Hold Survey(Office expense for tour / studyetc.)Renovation and infrastructureimprovement at district NCD cell.Office over-head Expense(state & District)15,000 4 60,0001,00,000 2 2,00,0001,00,000 2 2,00,0002,00,000 - 2,00,000Total 12,50,000Grand Total: Rs. 18,98,000/-Quality Improvement Project inPublic Health Sector ofArunachal PradeshIn Arunachal Pradesh, the public health sector is facing so many challenges. Statenow wishes to initiate a quality improvement project leading to certification of ISO9001:2008. For that, state has identified the District Hospital of East Siang, situatedat Pasighat. It has 120 bed strength. The budget proposed for it for the first year isRs. 8,02,600. The technical support for it will be provided from RRC-NE & NHSRC.DISTRICT ORAL HEALTH PROGRAMARUNACHAL PRADESHTo begin with, Oral Health Program will be conducted in 2 districts in a yearnamely Lower Subansiri and West Kameng.I. Strengthening of District Hospitals:1. Remuneration of Contractual Staff:Since Dental staffs are already existent in the above districts, nocontractual staffs will be appointed for the time being.2. Upgradation, Equipment and Consumables:This will be done in the above mentioned 2 district hospitals only forthis year.199

Items (per district)Type ofExpenditure (in lakh)ExpenditureRenovation of existing space One time 7.00Dental chair with adequate One time 1.50accessoriesAutoclave One time .40Ultrasonic Scaler & Polishing Kit One time .30Dental X-Ray Unit with developer One time .70Light cure gun (1) One time .303.50Extraction forceps (3 sets) One time .10Restorative (filling) instrument (3 One time .10sets)Root canal instrument set (3 sets) One time .10Consumable dental material, As requiredInstruments, repair,, contingencies1.50Total12.00 lakhsRecurring Expenditure/year at district hospital = 1.50 lakhsII. Training of Oral Manpower:No. of PHC/CHC at Lower Subansiri - 5 nos.No. of PHC/CHC at West Kameng - 5 nos.Training of health workers at PHC/CHC (Rs 5000 per training XRs 250005 training sessions/ year) for 1 day* Training & continuing Dental Education of dental surgeons ofthe district* As we don’t have a Dental College in our state at present, we cannotconduct PPP this year, however in the succeeding year if needed, the statemay contact regional dental college ghy in consultation with RRC- NE/Ghy forimplementation of Oral Health Program through PPP.III. School Oral Health Promotion and Community outreach program:No. of schools in which awareness couldbe promoted and screening performed6 schools per district X Rs 1000 = Rs6000• Organizing camps for awareness Rs 5000 per camp& screening of oro dental diseases• Hiring dental surgeon for support Rs 1000 per campin campsDental surgeon, Nurse and AssistantConsumables for providing dental Rs 4000 per camptreatment for basic dental problem likeextraction, restoration & hand scalingRs 10000No. of camps to be organized = 5 nos. 5 camps X Rs 10000 = Rs 50000per districtTotal Rs 56000200

Monitoring and Evaluation:The state and district monitoring committee of NRHM will monitor andevaluate the quality of work carried out in the two districts.Fund Routing Mechanism:Fund may be released to State Health Society and further the State HealthSociety will release to District Health Socirty of the identified districts.Total BudgetComponentBudget (in lakhs)Strengthening of district hospitals 2 districts X 12.00 = 24.00Training of health workers Rs 25000 X 2 districts = .50School Oral health promotion &Rs 56000 X 2 districts = 1.12Community Outreach programTotal 25.62201

Part B: Work Plan NRHM Additionalities 2009-10Strategy / Activity1. workshops for State, Districtand Block level MissionTeams:-1.1 State level Workshop1.2 District level Workshop2. Orientation of PRI on NRHMactivities3. Untied grants to Village Healthand Sanitation Committees.4. Selection and training ofCommunity Health Workers(ASHAs).:-5. Performance related incentivesfor ASHAs.6. Selection, remuneration andtraining of ANMs.7. Selection, training andremuneration of Staff Nurses atPHC/CHC level.-8. Selection, training andremuneration of Medical Officersat PHCs.9 Selection, training andremuneration of Specialists atCHC level.10 Construction and maintenanceof physical infrastructure of SHCs11. Construction and maintenanceof physical infrastructure of PHCs.12. Construction and maintenanceof physical infrastructure of CHCs.13 Procurement and distribution ofquality equipments and drugs inthe health system.14 Untied grants to SCs, PHCs,and CHCs15. Support to Mobile MedicalUnits/ Health Camps.16. Grants in aid to NGOs atdistrict, state and national levels.Timeline2008-09 2009-10Q1 Q2 Q3 Q42010-11ResponsibilityState/DistrictState /districtState /districtDistrictDistrictState /districtState /districtState /districtState /districtState /districtState /districtState /districtState /districtState /districtState /districtSourceof funds(Pls.specify)NRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHMNRHM202

Strategy / ActivityTimeline2008-09 2009-10Q1 Q2 Q3 Q42010-11ResponsibilityState/DistrictSourceof funds(Pls.specify)17. Monitoring and EvaluationState / NRHMCosts.district18. Management Costs/State / NRHMContingencies.district18.1. Selection & Recruitment ofBPMSU18.1.2. Procurement of computersfor BPMSUState / NRHM19. State Health Resource Centredistrict20. Improving physicalState / NRHMinfrastructure of SC/ PHC /CHC/District Hospitalsdistrict21. Ambulances for allState / NRHMPHCs/CHCs/District Hospitals.district22. Telephones forDistrict NRHMSHCs/PHCs/CHCs/DistrictHospitals.23. Rogi Kalyan Samitis / HospitalDistrict NRHMManagement CommitteesState / NRHM24. Ceiling on civil worksdistrict25. Preparation of District HealthState / NRHMAction Plansdistrict26. Preparation of State levelState NRHMreports on NRHM.27. MAINSTREAMING OFState NRHMAYUSH28. Strengthening NursingState NRHMSchool29. NCD State NRHM30. QIP State NRHM31. Oral Health Programme State NRHM32. Additionalities requested byState NRHMNational Disease ControlProgramme203

PART B. NRHM ADDITIONALTIES BUDGET 2009-10Budget headUnit ofmeasurePhysical Target Rate Amount RemarksBaseline(CurrentStatus)Targetfortheyear(Rs./unit)(Rs.Lakhs)1. workshops for State, District and Block level Mission Teams:-Nos. 2 2.5 Carriedforwardfrom1.1 State level Workshop2008-091.2 District level Workshop Nos. 22 0.52. Orientation of PRI on NRHM activities Nos. 100 700 0.0043. Untied grants to village Health andNos 530 1647 0.1Sanitation Committees.3.1 Village Health & Nutrition Day Nos. 30000 VHSCuntiedfund willbeutilised4. Selection, training and otherrequirementof CommunityHealth Workers (ASHAs).:-5. Performance related incentives forASHAs.6. Selection, remuneration and training ofANMs.7. Selection, training and remuneration ofStaff Nurses at PHC/CHC level.8. Selection, training and remuneration ofMedical Officers at PHCs9 Selection, training and remuneration ofSpecialists at CHC level.10 Construction and maintenance ofphysical infrastructure ofSHCs*11. Construction and maintenance ofphysical infrastructure of PHCs.Nos.Nos. 0Nos. 40 0.06 28.8Nos. 134 0.075 120.6Nos. 69 0.15 124.2Nos. 1 0.2 2.4458.085 Ref.writeupNos. 122 2 244 Addressin Part Aof RCHNos.12 Carriedforwardfrom12008-09Nos. - - 012. Construction and maintenance ofphysical infrastructure of CHCs.13. Procurement and distribution of quality equipments and drugs in the healthsystem.13.1. Procurement of equipment204

Budget headUnit ofmeasurePhysical Target Rate Amount RemarksBaseline(CurrentStatus)Targetfortheyear(Rs./unit)(Rs.Lakhs)13.1.1. Procurement of Dentel chair Nos. Nil 15 2 3013.1.2. Rented Store House (HQ) Nos. 1 0.05 0.613.13. Vehicle for distribution N os. 1 0.05 0.213.14. C/o Store house at HQ & Distt. Nos. 17 9 15313.2 Procurement of Drugs13.2.1. Sub Centre13.2.2. PHC13.2.3. CHC14 Untied grants to SCs, PHCs, and CHCs14.1. Untied fund for Sub Centre Nos. 273 0.1 27.314.2 AMG to SC Nos. 273 0.1 27.314.3 Untied fund for PHCs Nos 85 0.25 21.2514.4 AMG to PHC 85 0.5 42.514.5. RKS Fund for PHC Nos. 85 1 8514.6 Untied fund for CHCs Nos 31 0.5 15.514.7. AMG to CHCs Nos. 31 1 3114.8. RKS fund for CHCs Nos. 31 1 3114.9. RKS fund for DHS Nos. 14 5 70.015. Support to Mobile Medical Units 015.1. MMU drugs Nos. 16 1 1615.2. Maintenance/ repair Nos. 16 2 3215.3. POL Nos. 16 2 3215.4. Contractual appointment of drivers for Nos.0.035 20.16MMU (48 nos.) @ Rs. 3500/- per person permonth may be approved.4816. Grants in aid to NGOs at district, state0and national levels.17. Monitoring and Evaluation Costs. 018. Management Costs/ Contingencies. 018.1. Selection & remuneration ofNos nil 84 0.065BPMSU**65.5218.2. Procurement of computers for Nos nil 84 0.55BPMSU46.219. State level Resource Centre20. Improving physical infrastructure of SC/PHC/CHC/District Hospitals020.1. Physical Infrastructure of PHC (C/o 3 Nos. 535additional qtrs. Per PHC for SNs720.2. Physical Infrastructure of DH Nos. 5 7 3521. Ambulances for all PHCs/CHCs/District Hospitals. 0205

Budget headUnit ofmeasurePhysical Target Rate Amount RemarksBaseline(CurrentStatus)Targetfortheyear(Rs./unit)(Rs.Lakhs)21.1. Ambulance for PHCs Nos. 20 6 12021.2. Ambulance for DH Nos. 2 19 3822. Telephones for SHCs/PHCs/CHCs/District Hospitals. 022. 1.Telephones for PHCs/CHCs/District Nos. 100 0.005 6Hospitals.22.2. Telephones for SHCs Nos. 023. Rogi Kalyan Samitis / HospitalAddressed in Sl. No. 14 0Management Committees24. Ceiling on civil works Nos. 025. Preparation of District Health ActionNos. 16 0.5 8Plans26. Preparation of State level reports onNos. 1 1.5 1.5NRHM.27. Mainstreaming of AYUSH 0 Ref.writeup28. Strengthening Nursing SchoolRef.18 writeup29. NCD 18.9830. QIP 8.02631. Oral Health Programme 25.6232. Additionalities requested by National Disease Control Programme32.1. Revised National Tuberclosis ControlProgrammeGrand Total 2018.58Note:-* Extention of 122 SC @ Rs 2 lac. Per SC** SPMSU & DPMSU expenses has been address in RCH-II programme management206

Part C: UIPROUTINE IMMUNIZATION1. Situation Analysis of the State Immunization ProgrammeBackgroundImprovement in Child survival and maternal health are important goals underNational Rural Health Mission. Significant reduction in infant and child mortality rates hasbeen achieved with the implementation of interventions like Universal ImmunizationProgram, Oral Re-hydration Therapy Program and other maternal and child health Schemesduring 1985-90 and subsequently under the CSSM Program. Interventions like antenatal,Institutional delivery and postnatal care, prophylaxis and treatment of nutritional anemia andreferrals of women with complications are the major focus area for maternal health. Amongthe child health interventions the focus is now to improve newborn care, prevention andtreatment of diarrhea and control of deaths due to pneumonia etc.Under the Strengthening of Routine immunization program, focused attention isbeing given to full immunization coverage of all children with antigens that is available underRI.In Arunachal Pradesh, as a distinct program, the EPI was implemented to providevaccination to all the pregnant women and children. In 1985-86, it was further expanded toachieve 100% vaccination for pregnant women and 85% of all the children and it waslaunched in 2 districts only. Then the CSSM was launched in 1992-93 but due to reasonsunknown, the program was not very successful as expected.The rationale of the proposal is to strengthen outreach services by providing inputs toincrease coverage and improve quality of Immunization, child health interventions andmaternal health services by addressing gaps in service delivery and creating demandthrough IEC and social mobilization both in urban and rural areas of the state.Socio-demographic situationArunachal Pradesh is situated in the northeastern part of India, bounded byinternational boundaries with China in the north, Myanmar in the southeast and Bhutan inthe west. The state is situated at latitude of 90.36 0 E to 97.3 0 E and longitude of 26.42 0 N to29.30 0 N covering a total land area of 83,743 sq. km. It has a total population of 1097968(Census 2001) with an average population density per square kilometer of 13 persons. Thesex ratio of the state is 901 females per 1000 males as per census 2001. Due to its peculiartopography and difficult terrain, there is widely dispersed settlement pattern of the populationwherein rural population constitutes 79.59% and the urban only 20.41 %. The percentage of207

population below poverty line in 1999-2000 is 33.47 (SRS Bulletin, April 2001) with apercentage decadal growth of 26.21 and Average Annual Exponential Growth Rate of 2.33.The total literacy rate in the state is 54.74% with a male literacy rate of 64.07% and femaleliteracy rate of 44.24%. The per capita income (97-98) of the state is Rs. 13424. [Source:Provisional Census of India 2001]. The MMR for the state is not available. The IMR is 61(NFHS III), 37 (SRS 07) and the TFR is 3 (NFHS III)State Profile:Population 1097968 2001 CensusRural 79.59% 2001 CensusUrban 20.41% 2001 CensusSex Ratio 901 Female per 1000 Male 2001 CensusPopulation BPL 33.47% SRS April 2001Decadal Growth Rate 26.21 % SRS BulletinLiteracy Rate 54.74 2001 CensusNo. of General Hospital 2No. of District Hospital 12No. of CHC (Functional) 35No. of CHC (Functional with Cold Chain) 31No. of PHC (Functional) 82No. of PHC (Functional with Cold Chain) 571. Current Scenario of Implementation of Immunization Programme.The objective of the immunization programme is in line with the objectives framedunder NRHM with additional inputs from GOI, it is envisaged to attain a level of immunizationcoverage in line with the National goals.1. a. Implementation Status:Despite the tireless effort being made to improve the immunization coverage level inthe state, there are certain obstacles which make it difficult to achieve the target as per plan.The climatic condition and topography of the state play crucial role in hindrance to thecarrying out of activities. Lack of dedicated and well trained personnel, shortage of personneletc. also contribute equal share in low outcome of the activities. The immunization programcovers all townships of the state by regular routine EPI program and special VaccinationProgram like Immunization Month staring from November 2008 to cover mainly the unreachchildren.208

Sl.No.1.a.1. Manpower Status dedicated in immunization programme:ParticularSanctionedPostInPositionAdditionalRequirementState EPI Officer 1 1Deputy Director, ImmunizationDistrict Immunization Officer 16 16Medical Officers (Regular)Medical Officers (Contractual)State Cold Chain Officer 1 1Technical Assistant 1 1District Cold Chain Officer 16Refrigerator Mechanics (Regular) 12 4Refrigerator Mechanics (Contractual) 1 1Computer Assistant 17 17Health Assistant 132Health Assistant (Contractual) 20ANM (Contractual) 118ANM (Regular) 173Health InspectorPharmacistInsufficient number of trained staff in particular and overall staff as a whole causesdelay in implementation of programme as planned. However, in order to accelerate theimmunization activities and to increase coverage level, Routine Immunization Month hasbeen introduced from November 2008 in which there will be rigorous immunization activitiescovering all the villages of the state.1. a.2. COLD CHAIN SYSTEM:Managing and maintaining Cold Chain System in Arunachal Pradesh is one of themost difficult task for the Health Department due to uneven physical and geographicaldistribution of this hilly state. Erratic power supply, dismal transportation and communicationfacilities in Arunachal Pradesh are the main hindrance to the establishment of a stable coldchain system in the state in all fronts. The uneven topography of the State practically limitsthe reach of Cold Chain staff for timely maintenance of cold chain system and EPI personnelto reach the remote and difficult areas.The transportation of vaccines up to PHC level and storing them there is also onearea where the state is facing problem. As most of the PHCs are situated in remote and hillyareas and road connectivity to some of PHCs being almost nil, it is very difficult to maintainthe vaccines in effective cold chain system. During monsoon season most of the roadconnections are blocked frequently which hinders the smooth flow of vaccines to PHC/CHCwhich again blocks the carrying out of immunization activities.209

Another factors leading to difficulties in maintaining cold chain system is lack of AMC.Government of India is learnt to have Annual Maintenance Contract (AMC) with the suppliersin respect of Cold Chain Equipments with some organization but there is no relevantinformation available with the State Government regarding the Annual Maintenance Contract(AMC) for cold chain equipments. Supply of cold chain equipments have been made directlyto districts, but no such information of AMC is available either with the district authority or thestate.In state like Arunachal Pradesh where the power supply is erratic, solar powerrefrigeration system has been the backbone of Immunization System. There is the extensionof cold chain network using 30 solar power refrigerators for irregular or unreliable and noelectricity area in the state. These were installed during 1999-2000 and out of these only 18are functional and the remaining are non-functional either want of battery, plates, chargecontroller or other spare parts. As most of the Refrigerator Mechanics are not trained onrepair and maintenance of solar powered refrigeration system, they are unable to repair thesame. 20 more Solar Refrigerators had been proposed in the SPIP of 2007-08, the locationand planned site of which had already been furnished to GoI but the state is yet to receivethe same.Non-availability of spare parts also leads to difficulty in the maintenance of cold chainequipments and reduction of breakdown period and rates. It is very difficult to arrange spareparts in the state due to which spare parts are to be arranged from outside the state.Sometimes the fund provided by GoI is not sufficient to meet the spare part requirements.Thus, GoI may provide either sufficient fund or spare parts. The spare parts proposed during2008-09 in the PIP are yet to be allocated to the State.One CFC WIC is installed in the state Headquarter (Central Cold Chain room,Naharlagun). As the number of beneficiaries increase year after year, at times it is notenough for storage and distribution of vaccines for all the districts in the state. Due to ageingof the same, the cooling is sometime not effective. On many occasions, there have beenbreakdown of cooling unit. During last two years, the compressors of cooling units havebeen changed three times. The demand of the vaccine volume, storage and preparation ofice packs have increased almost three folds for routine immunization activities, NIDs overthe year.Present status and position of cold chain equipments is exactly not known due tonon-availability of Cold Chain Technicians in some districts. Reports from the districts alsodo not reflect exact status and position of cold chain equipments. Staffs other than ColdChain Technicians are not familiar with the names and model of equipments. Thus, it isdifficult to get correct information pertaining to cold chain equipments from those districtswhere there are no Cold Chain Technicians. In order to assess the exact position and status210

of cold chain equipments throughout the state, one time crash inspection by the StateHeadquarter personnel to every district is required. However, the breakdown rate of coldchain equipments in the state is negligible. Whenever there is breakdown of cold chainequipments in those districts where there are no Cold Chain Technicians, Technicians aredeputed from the State Headquarter for repair and maintenance work.Total number of Cold chain equipment (ILR/DF) in use under EPI program in thestate as reported is 325 units. Since most of the equipments in use are CFC basedequipments, sensing the non-availability of CFC gases, it is planned to phase out these CFCequipments and replaced by non-CFC equipments. But, as not much NON-CFC equipmentsare available for replacement at the state, these CFC equipments are still in use in manyPHCs and CHCs.There are only 13 Refrigerator Mechanics (One contractual) in the state out of which3 are stationed at the state headquarter and still 6 (six) districts have no RefrigeratorMechanics. So far all the technicians have been trained on repair and maintenance of NON-CFC equipments at SHTO, Pune.In the state, there are 57 PHCs and 35 CHCs having Cold Chain System. RemainingPHCs and CHCs are functioning without Cold Chain System. There are 92 cold chainhandlers for all functional PHCs and CHCs in the state. The training has been completed for52 Handlers on Cold Chain Management and Vaccine Handling during 2008-09 out of 85proposed. Training of remaining Vaccine Handlers including that of District Hospital andGeneral Hospital numbering 66 is to be done during 2009-10.Every district in the state is hilly due to which the heavy and bulky vaccine vanssupplied by GoI are not suitable. There are 16 (sixteen) vaccine vans supplied by GOI butonly 6 (six) of them are in running condition but not used for transportation of vaccinebecause of their unsuitability for zigzag and narrow tracks and unreliability of the vehicleitself. Remaining 10 (ten) are not running for want of maintenance and authorized dealers inthe state.The state has been directed to procure the spare parts for cold chain equipmentslocally but the fund allotted for cold chain maintenance under RI is not enough for procuringspare parts as the spare parts required for ILRs/DFs are not available in the state and are tobe procured from Assam or other parts of India. Most of the time, the repair work is delayeddue to unavailability of spare parts. There are few ILRs/DFs in remote PHCs/CHCs lying unrepairedfor want of compressors and other accessories leading to increased break downtime.211

elow.The present status and position of Cold Chain Equipments in the State is furnishedCold Chain Equipments (CFC)Equipments Available Working RemarkILR (Small) 31 24 To be replaced by CFC freeILR (Lagre) 1ILR-cum-Deep Freezer 20 13 To be replaced by CFC freeDeep Freezer (Small) 22 16 To be replaced by CFC freeDeep Freezer (Large) 37 27 To be replaced by CFC freeTotal 111 80Non- CFC Equipments:Equipment Available WorkingILR (Small) 138 98ILR (Large) 9 3Deep Freezer (Small) 54 48Deep Freezer (Large) 13 9214 158Solar 30 18Others Equipments:Equipments Available WorkingVoltage Stabilizers 251 195Cold Box (Small) 209 198Cold Box (Large) 135 134Vaccine Carrier 2398 2173Non-CFC Toolkits* 17 15CFC ToolkitsVide issue voucher No. INT/UIP/97-98/ 2579, dated 19 th Dec. 1997, five numbers ofNON-CFC Toolkits had been received from Govt. MSD. Kolkata on 30 th Dec. 1997. Out ofthese five numbers, two are not working now.Status of Generators:In the state, as of now, 17 Generator sets are available in the districts and all are inworking condition. One 7.5 KVA generator is attached to WIC in Central Cold Chain Room atState HQ, Naharlagun.Health Facilities with Cold Chain System:FacilitiesTotal in With Cold Without Coldthe State Chain System Chain SystemGeneral Hospital 2 2 NilDistrict Hospital 12 12 NilCHCs 31 32 12PHCs 85 57 59212

1. a.3. Vaccines and Logistics:The vaccines are supplied by GOI through Zonal Depot in Kolkata and are deliveredat Guwahati airport which more than 500 Kms away from the State Cold Chain Room atNaharlagun. At times, it is very irregular but overall, the vaccines are supplied most of thetime in sufficient quantity. Due to untimed supply, unavailability of transportaion support forcollection from Guwahati, there is always problem for timely collection.The vaccines and logistics need to be supplied by GoI to the state cold chain centreat Naharlagun.Status of Vaccines in the State till 31. 12. 2008:VaccinesOpeningBalance ason01.04.2008Receivedduringthe year till31.12.2008ClosingBalanceas on31.12.2008Quantityconsumedduring the year till31.12.2008OPV 31000 294000 190500 134500BCG** 154000 250000 128500 275500Measles 6500 35000 3000 38500DPT 72500 55000 38000 89500DT 7500 5000 5500 7000TT 53000 75000 75500 52500**238500 doses of BCG Vaccines were received from Deputy Director (TB) on 01.01. 2007 out of which 152500 doses got expired on February 2008 and April 2008 the detailsof which is given below. Therefore, actual consumption of BCG Vaccines in 2008-09 is275500-152500=123000 doses.Details of BCG Vaccines that expired in April 2008Batch No.Manufacturing Date ofDateExpiryNo. of Vials No. of Doses.334 March 2006 Feb. 2008 2550 vials 25500 doses343 March 2006 Feb. 2008 2100 vials 21000 doses393 May 2008 April 2008 8650 vials 86500 doses398 May 2006 April 2008 1150 vials 11500 doses400 May 2006 April 2008 800 vials 8000 dosesTotal 15250 vials 152500 dosesLogistics:The overall logistic support has been satisfactory except some occasion when it wasnot available. The supply may be made in such a way that there is no gap with logistics. Thedelivery may be made on a particular routine so that the state can plan accordingly.213

Auto Disable and Disposable Syringes:SyringesOpeningBalance as on01.04.2008Receivedduringthe year till31.12.2008ClosingBalanceas on31.12.2008Quantityconsumedduring the yeartill 31.12.20080.1 ml 8400 18000 4600 218000.5 ml 63200 61000 26600 976005 ml DS 2400 6000 1600 68001.a4. Trainings:The training component on immunization was mixed up with regular RCH trainingprogram. Therefore, specific subject relating to immunizations were not properly addressed.Training on use of AD syringe was conducted 2005-06. Training of Medical Officers on RIwas planned in 2007-08 and 2008-09 in each district. Fund was released to each districtaccording to number of Medical Officers. Training of Paramedics RI was planned during2008-09 and fund had been released to district as per the number of paramedics in eachdistrict. The training of Cold Chain and Vaccine Handler was conducted at StateHeadquarter, Naharlagun during 2008-09. The detail status of training on RI in the State till31 st December 2008 is shown below.Training status under RI till 31.12.20082007-08 2008-09 TotalRI Staffs Planned Trained Planned Trained plannedMedical Officers 239 210 93 48 332 258Paramedics 958 512 958 512Cold Chain andVaccine HandlersTotaltrained85 52 85 52Training of Medical Officers and Paramedics on RI is in progress in the districts andis expected to be completed by March 2009.1.b. District wise coverage level of all antigens for 2007-08 and 2008-09 till Dec. ‘08The full immunization coverage of the state is 28% (NFHS 3) and 44% (CES 07).There are several reasons to the very low performance level:1b.1 Baseline informationSl. No. Category of BeneficiariesTarget2008-09 2009-101 Total Population 1321289 13567002 Pregnant Women 36468 374453 Infants (0 - 1 yrs ) 30654 314754 Children ( 1 -2 yrs ) 30390 312045 Children ( 0- 5 yrs ) 184980 1899386 Children ( 0 - 3 Years ) 105703 1085367 Children at 5 yrs 31975 32832214

8 Children 10 at yrs 32239 331039 Children at 16 yrs 28011 28762Sl. No. CategoryTarget2008-09 2009-101 Session planned in Urban Areas 384 3842 Session planned in Rural Areas 22800 341763 Total sessions planned 23184 345604 No. of session with hired vaccinators5 No. of hired vaccinators215

1.b.2. District-wise Vaccination Coverage Reports:Name of State/UTs: Arunachal Pradesh Year:2008-09 (Till December 2008) Table 1.bYearly Target(2007-08)Yearly Target(2008-09) BCG OPV-1 OPV-3 DPT-1 DPT-3Name of Infant Pregnant Pregnant 2007- 2008- 2007- 2008- 2007-2007- 2008- 2007-District s Women Infants Women 08 09 # 08 09 # 08 2008-09 # 08 09 # 08 2008-09 #Tawang 927 1066 1038 1235 556 460 677 527 674 454 677 527 674 454West Kameng 1640 1887 2158 2567 545 607 798 608 576 436 798 609 576 437East Kameng 1397 1607 1449 1724 227 300 296 487 229 218 296 484 229 196Papum Pare 3184 3663 4447 5291 3540 2042 3062 1986 2334 1346 3038 2230 2309 1154LowerSubansiri 1208 1389 1454 1730 722 601 658 599 583 450 665 599 555 450Kurung Kumey 1121 1290 1198 1426 335 735 272 1092 318 543 263 1098 309 538UpperSubansiri 1452 1670 1368 1627 810 921 1216 1089 1406 483 1216 1025 1406 543West Siang 2393 2752 2892 3440 1312 1288 1567 1359 1405 1325 1567 1359 1261 1325East Siang 1912 2199 2362 2810 1228 1164 1227 1239 906 862 1232 1245 911 827Upper Siang 786 904 883 1051 349 106 412 203 223 151 391 187 278 123L/Dibang Valley 1165 1340 1549 1843 720 591 712 602 482 414 710 610 476 414Dibang Valley 157 181 208 248 69 72 66 74 76 79 65 70 76 68Lohit 3092 3556 3692 3843 2333 1747 2116 1790 1680 1517 2116 1790 1680 1517Anjaw 455 524 526 626 235 146 270 159 177 119 272 151 184 112Changlang 2357 2711 3591 4272 1996 2042 2144 2104 1829 1633 2144 1892 1829 1633Tirap 3159 3634 2616 3113 1561 1006 1391 1116 1233 984 1391 1116 1233 984Total 26405 30373 31431 36846 16538 13828 16884 15034 14131 11014 16841 14992 13986 10775

Table 1.b. continues....JE-routineHep BBirth Hep B-1 Hep B-3 Measles TT2+Booster(Whereverapplicable) Vita A- 1st DoseSl.No Name of District (Wherever applicable)2008-2007-08 09 # 2007-082008-09 # 2007-082008-09 # 2007-08 2008-09 #1 Tawang703 429 155 118172 4192 West Kameng 541 500 377 389 5 4563 East Kameng 128 283 181 43 198 4784 Papum Pare 3668 1334 905 503 1963 12225 Lower Subansiri 927 493 366 277 368 4496 Kurung Kumey 308 1349 112 97 206 13697 Upper Subansiri 605 751 719 399 448 3468 West Siang 1245 1628 802 698 838 16139 East Siang Not applicable 963 879 707 481 Not applicable 63 125310 Upper Siang 177 84 225 104 0 3611 L/ Dibang Valley 492 486 268 399 233 35012 Dibang Valley 112 71 52 61 20 11113 Lohit 1594 1628 1685 1664 487 134614 Anjaw 219 98 1587 176 97 11815 Changlang 1134 1516 686 1606 510 148016 Tirap 1250 1527 183 586 128 1239Total 14066 13056 9010 7601 5736 12285# Coverage for 2008-09 till Dec'081.c. Reporting and incidents of VPD and outbreaks for 2007-08 and 2008-09 till Dec. ‘08The reporting system at all level in the state on RI activities has been lacking and need urgent intervention. There is aresponse system established in the state to cope with outbreaks on VPDs and AEFIs. There is a peculiar reporting mechanism inthe state that outbreaks are often reported from the community and the media. The current form of intervention in all cases of217

outbreak is epidemiological intervention by the state epidemiologist and constitution of rapid action team to manage out-breaksfrom among the doctors in the hospitals in few occasions.District-wise VPD reports in 2008-09 (in numbers)Sl. Name of Diptheria PertusisNeonatalTetanusTeatanus(other) Measles Polio -P1 Polio -P3 AESNo District Case Death Case Death Case Death Case Death Case Death Case Death Case Death Case Death1 Tawang 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 02 West Kameng 0 0 0 0 0 0 0 0 42 0 0 0 0 0 0 03 East Kameng 0 0 0 0 0 0 0 0 60 0 0 0 0 0 0 04 Papum Pare 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 05 Lower Subansiri 0 0 2 0 0 0 0 0 152 0 0 0 0 0 0 06 Kurung Kumey 0 0 0 0 0 0 0 0 258 0 0 0 0 0 0 07 Upper Subansiri 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 08 West Siang 0 0 56 0 0 0 0 0 688 0 0 0 0 0 0 09 East Siang 0 0 3 0 0 0 0 0 13 0 0 0 0 0 0 010 Upper Siang 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 011 L/ Dibang Valley 0 0 0 0 0 0 0 0 40 0 0 0 0 0 0 012 Dibang Valley 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 013 Lohit 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 014 Anjaw 0 0 28 0 0 0 0 0 5 0 0 0 0 0 0 015 Changlang 0 0 0 0 0 0 0 0 823 0 0 0 0 0 0 016 Tirap 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0Total 0 0 89 0 0 0 0 0 2161 0 0 0 0 0 0 0218

Total reported VPD outbreaks in State/UTNo. of outbreaks No. of outbreaks No. of Cases in No. of Deaths inreported investigated outbreaks outbreaksMeasures2007-2007-2007-takenVPDs 08 2008-09 # 08 2008-09 # 2007-08 2008-09 # 08 2008-09 #Diptheria 1. Immediate acute casePertusis 77 89management done in allMeasles 1895 2161affected areas.AES2. Special Measles Imm.Round conducted after theoutbreak.3. Blood sample sent foranalysis# Report for 2008-09 till Dec'08219

1.d. Trends of IMR of the States for last 5 years.The trend of IMR in the state has gone down from 146 (1951) to 61(NFHS-3)for the state of Arunachal Pradesh. The trend of IMR for the last five years in theState is as below:Sl. No. Year IMR of the State1 2003-04 63 (NFHS-II)2 2004-05 63 (NFHS-II)3 2005-06 61 (NFHS-III)4 2006-07 61 (NFHS-III)5 2007-08 37 (SRS-07)1.e. Status Report and Plans for AEFI:So far, fifteen districts except East Kameng District have constituted AEFICommittee with the District Medical Officer/Medical Superintendent as chairman tostrengthen the AEFI system in the District Level. The committee so constituted willinvestigate all reported cases of Adverse Event following Immunization. Formation ofAEFI Committee for all districts will be completed by 2009.2. Supervision and Monitoring:The RI activities in the state are under the direct supervision of Joint Directorof Health Services (FW) supported by State Immunization Officer / Deputy Director(MCH), Cold Chain Officer, Technical Assistant, Senior Refrigerator Mechanic andComputer Assistant especially for planning and implementation of RI Programme. Inthe districts, the supervision and monitoring of RI activities are headed by DIOs(District RCH Officers) with the assistance from DPM, District Account Manager(RCH-II) and other RI related staffs. At the implementation end i.e. at PHC/CHC/SClevel, the program is planned and implemented by the Medical Officers In-charge andother paramedics.2.1. Status of Routine Immunization Cell in the State:In the state level the Immunization Cell consists of State ImmunizationOfficer, Cold Chain Officer, Technical Assistant (Cold Chain), RefrigeratorMechanics, Data Assistant RI and Computer Assistant. Planning for implementationis made by the State Immunization Cell on the basis of requirements and proposalsfrom the districts. Progress and performance reports from the districts are compiledand crosschecked timely and submitted to GoI. The State Immunization Officer timelysupervises and monitors the RI activities in the State. The Cold Chain Officer alongthe Refrigerator Mechanics timely monitors the cold chain system in the districts. Inthis current financial year 2008-09, cold chain systems of two districts have beenmonitored in which 15 cold chain stores have been visited. In those districts wherethere are no Refrigerator Mechanics repair and maintenance of cold chain system

are looked after by the Mechanic adjacent district. It becomes a very tedious job inthe part of a Mechanic to look after two districts due to which the response andbreakdown time is high.2.2. Review Meeting.In the State the Review Meeting on RI is held twice a year. In this currentfinancial year review meeting on RI was held during the month of September duringwhich it was decided to introduce Routine Immunization Month. Since then RoutineImmunization has been scaled up and is on progress.2.3. Data Analysis and action taken at all levels:The district data furnished are analysed at the state level and from time totime, feedback is provided to the districts for mid course correction. Similarly, eventhough not effectively practiced, the facility data received at district level are analysedfor corrective action at district level.3. Status of RIMS:In the RIMS Arunachal Pradesh is registered in the name of Changlongwhich does not exist in the State whereas the state headquarter of ArunachalPradesh is Naharlagun. Thus for the RIMS Arunachal Pradesh may be registeredeither in the name State or State Headquarter. The matter has been highlighted toGOI for earlt action. However, RIMS has been uploaded up to March 2007 and forrest of the months could not be uploaded due to software failure.So far RIMS software training has been conducted only for five districts v.i.z.Changlang, Tirap, Papum Pare, East Siang and Lower Subansiri out of 16 (sixteen)districts. These districts also do not upload due to non-availability of RIMS softwareand internet facilities in the districts. Further, Computer Assistants are in positionnow in all districts and GoI may provide software for RIMS and conduct training onceagain on RIMS to all the districts in the state without which, the RIMS intervention willnot pick up.4. Co-ordination with Partners:In Arunachal Pradesh 16 PHCs are run by NGOs under Public PrivatePartnership (PPP) Project. In all these PHCs immunization activities are undertakenby NGOs. In other health facilities other than those undertaken by NGOs,immunization activities are carried out with the involvement other partners. TheSWWCD has been coordinating in immunization programs in all the districts.221

However, there is enough scope for increasing the coordination effort andinvolvement at all level. During Out Reach Immunization Sessions AnganwadiWorkers are involved for mobilization of children to session site and they are paidhonorarium of Rs 100/- per session. PRIs are involved in creating awareness amongthe parents to get their children immunized. However, the coordination amongvarious partners as on date has been very minimal except in IPPI program.5. Strategies for Improving Routine Immunization:Current Status and GoalThe objective of the immunization programme is in line with the objectivesframed under NRHM with additional inputs from GOI, it is envisaged to attain a levelof immunization coverage in line with the National goals.OUTCOMES STATE INDIACurrent status Goal Current Goal08-09 09-10status06-07 09-10MMR 306 (NFHS 3) 285 200 306 200 50ACTIVITIES PROPOSED AND FUND REQUIREMENT UNDER ROUTINEIMMUNIZATION5.1. Mobility Support for Supervision of RI activities in the State.Supervision of RI activities in the districts by State team lead by SEPIOat once per month per district and that of PHC/CHC/SC are to be supervisedby the DIOs by visiting all the PHC / CHC once a month. Therefore, GoI mayprovided fund required @ Rs 50,000/- per district for 16 districts.Supervision of RI activities from State Headquarter @ Rs 1,50,000/-may be provided by GoI as mobility support for State Headquarter teamconsidering the peculiar topography of the State.222

5.2. Cold Chain Maintenance:The inadequacy of cold chain maintenance fund leads to failure intimely and proper maintenance of cold chain equipments and increasedbreakdown rate of cold chain equipments.Due to insufficient fund the required spare parts cannot be arranged,as no spare part can be arranged from within the state. Seeing the cost indexand rising inflation, the fund provided by GoI for Cold Chain Maintenance isinadequate.In the State, there is 1 State Cold Chain Depot, 16 District Cold ChainStores, 2 General Hospitals, 12 District Hospitals, 35 CHCs and 57 PHCs,functioning with Cold Chain System.Fund for Cold Chain maintenance is essentially required for all abovefacilities and thus the same may be considered by GoI @ Rs 3,00,000/- forState Headquarter per year, Rs 10,000/- for each District Headquarter peryear and Rs 5,000/- each for General Hospitals, District Hospitals, CHCs andPHCs per year. Therefore, the total fund requirement is Rs 9, 90,000/-5.3. To provide immunization to all children in Urban Areas by increasingaccess through government and society run facilities.Apart from the proposed outreached sessions under urban healthprogram (Itanagar-Naharlagun and Pasighat), additional 2 Immunizationcamps per District Headquarter per month (32 Immunization camps per monthand 384 camps per year) will be organized in all the 16 District Headquartersin slum or underserved areas. Manpower would be provided from the DistrictHospital through a mobile unit which is already in place.The mobility support would be provided at the rate of Rs 1,400/- percamp along with other logistics at GoI norms and total fund requirement is Rs5,37,600/-.5.4. To improve coverage by increasing the Immunization Sessions.5.4.1. Alternate Vaccine Delivery:In all 388 sub-centres areas, Out Reach Sessions (ORS) would be organizedtwo times per month per sub-centre (776 ORS per month or 9312 ORS per year).223

In the peripheral areas of PHCs/CHCs, it is often seen that children aremissed out. In order to increase the immunization coverage level and to catch themissed children, ORS will be held in peripheral areas of all 85 PHCs and 31 CHCs atthe rate 2 ORS per month per PHC/CHC (232 ORS per month or 2784 ORS peryear).Therefore, there will be total of 12096 (9312+2784) ORS in a year and forORS, an amount of Rs 300/- would be provided for alternate vaccine delivery (AVD)per session. The districts place detail work plan at the SC and PHC/CHC level forconducting ORS and it would be ensured that the activities are implemented as perthe plan.Therefore, GoI is required to have special consideration to provide support byfunding the required of Rs 36,28,800/-.5.4.2. Mobility Support for all Out Reach Session.A PHC level team / district level immunization team is in placecomprising of MOs, ANM, LHV, HA, AWW, ASHA for providing outreachsessions in all SC area every month wherever there is no manpower.In all, 12096 (9312+2784) out reach immunization sessions, Rs 1,500/-per session will be provided to immunization team as mobility support (POLand TA/DA as admissible) for organizing out reach immunization sessions,considering the peculiar geographical terrain and topography of the state.This is absolutely necessary due to lack of staff at the sub-centre levelor non-functional status of majority of the SCs in the state.Therefore, GoI may consider the funding with special consideration fora total fund requirement of Rs 1,81,44,000/-.5.5. Mobilization of children by AWW / ASHA to the Immunization siteIn all the 12096 ORS sites, village-wise mobilization of children wouldbe done through AWW /ASHA/Link worker etc. and the support involvedwould be provided @ Rs 150/- per AWW / ASHA per session for all sessionsand the total amount required for mobilization of children throughASHAs/AWW for all sessions will be Rs 18,14,400/- per year.224

5.6. Support for Computer Assistants under Routine Immunization.In the State, as of now, there are 17 Computer Assistants in position underRoutine Immunization Program. They will be paid revised consolidated amount of Rs10,000/- per month and total amount required in a year for all the CAs will be Rs20,40,000/-.5.7. Printing and Dissemination of Immunization Cards, Tally Sheets etc.5.7.1. Printing and Dissemination of Immunization Card etc.The total estimated beneficiaries in the State for 2009-10 is 31476.However, it is proposed to print 50000 Nos. of Immunization Card, TallySheets and Reporting formats as required under Routine Immunization at thestate level at the rate of Rs. 5/- per beneficiary (as per GOI norms) and thetotal amount required will be Rs. 2,50,000/-5.7.2. Hanging Tracking Bags for Immunization.Instead of Tickler Boxes, it is also proposed to use Hanging TrackingBags under Routine Immunization similar to Chattisgarh model. Therefore,2000 Nos. of Hanging bags will be required @ Rs 150/- per bag which the GoIis requested to consider by funding an amount of Rs. 3,00,000/-5.8. Review Meeting:5.8.1. Review Meeting at State Level.A 3 days quarterly State Level Review Meeting on progress andachievement of Routine Immunization will be held at the State Headquarteronce in a quarter involving 3 participants (DIO, Accountant and ComputerAssistant) from each district of 16 Districts in the State. Total expectedparticipants from the district per meeting are 48.The necessary support will be provided as per GoI norms @ Rs 1250/-per participant per day and the total amount required in a year will be Rs7,20,200/-5.8.2. Review Meeting at District Level.One day quarterly Review Meeting on RI will be held at each DistrictHeadquarter of 16 Districts for one day involving a total of 16 DIOs, 85 MO i/cof PHC, 31 MO i/c of CHC, CDPOs of 86 Blocks and about 200 other225

stakeholders like PRIs, NGOs. The financial support as per GoI norms @ Rs100/- per participant per day for meeting will be required.Therefore GoI may like to support an amount of Rs 1,67,200/- per yearfor one day quarterly Review Meeting at District level.5.8.3. Review Meeting at Block Level.Apart from Review Meeting at District Level, a one day quarterlyReview Meeting, exclusively on RI, will be held at Block Level in which all MOi/c of (85 PHCs and 31 CHCs) and all 3387 ASHAs will be involved. Thefinancial involvement, as per the GoI norms @ Rs 50/- per ASHA ashonorarium and Rs 25/- per person at the disposal of MO I/C for refreshmentwill be required.Therefore, GoI may like to provide financial support of Rs 10,50,900/-per year for Review Meeting at Block level.5.9. Orientation Training under Routine Immunization:5.9.1. Orientation training to Paramedics on RI:Unless the paramedics are trained on Routine Immunization, expectedoutcome of immunization program cannot be expected. Hence training ofparamedics (HA/ANM) on RI is an important component under RoutineImmunization Program.During the financial year 2009-10, focus will be to impart training onRoutine Immunization to 958 paramedics. The training will be held at eachdistrict headquarter in 32 batches, each batch comprising of 25-30participants. At least 2 faculties per batch will be required.Fund requirement for one trainee for 3 days, based on revised RCHnorm for training and considering an average DA as per State Govt. Rate @Rs 250/- per day per trainee, average TA @ Rs. 1,500/- per trainee andsharing the amount incurred for 2 faculties and venue hiring charge amongthe trainees in a batch, will be Rs. 4,630/- per trainee.Therefore, the total fund requirement of Rs 44,35,540/- for training ofParamedics may be provided by GoI.226

5.9.2. Orientation Training of Medical Officers5.9.2.1. Training of Trainers outside the StateBefore starting training of Medical Officers on RI at State level, at least5 Medical Officers will be selected and deputed outside the State (Say NewDelhi) to obtain master trainer training on Routine Immunization and these fiveMedical Officers will become Master Trainers for the State.The fund requirement will be Rs 20,000/- per Officer and the total fundrequirement will be Rs 1,00,000/- which may kindly be supported by GoI.5.9.2.2. Training of Trainers at State Level.32 Medical Officers will be trained at State level for 3 days by mastertrainers and these 32 Medical Officers will be responsible for impartingtraining to all the Medical Officers in the districts. As there is no traininginstitute for Health Department, one training venue will have to be hired at GoInorms of Rs 10,000/- per venue.Fund requirement for one trainee in 3 days as per revised RCH normfor training, considering the DA as per State Govt. Rate @ Rs 505/- per dayper trainee and an average TA @ Rs. 2,000/- per trainee and sharing theamount incurred for 2 faculties and venue hiring charge among the trainees ina batch, will be R 5,960/- per trainee. Therefore, total fund requirement forTraining of Trainer at State level will be Rs 1,90,720/- which the GoI maysupport in terms of funding.5.9.2.3. Training of Medical Officers at District levelIn current year 2000-10, focus will be to impart a 3 days orientationtraining on Routine Immunization to 332 Medical Officers of allPHC/CHC/District Hospital whoever is engaged under Routine ImmunizationProgram. Out of 332 Medical Officers, 5+32=37 Medical Officers will alreadybecome Master Trainers. Therefore, training will be imparted to 295 MedicalOfficers at District Headquarters in 10 batches, comprising of 25-30 MedicalOfficers per batch.For imparting training, at least 2 trainers will be required for each batchand 10 Training venues will have to be hired at Revised RCH norms fortraining @ Rs 10,000/- per venue.The fund requirement for one trainee in 3 days based on revised RCHnorms, considering the DA @ Rs 505/- (average as per State Government227

ate) per day per trainee and an average TA @ Rs 1,500/- per participant(average) and sharing the fund incurred for 2 faculties and venue hiringcharge among the trainees in a batch, will be Rs 5,510/- per trainee and thetotal fund requirement is Rs 16,25,450/-.5.9.3. One Day Refresher Training for RI Computer Assistants.One day Refresher Training will be organized at State Headquarter for17 Computer Assistants to impart training on RIMS, HMIS and Immunizationformats under NRHM. The trainer will be hired from outside the State soas to impart quality training.As per revised RCH norm for training and considering the DA @ Rs250/- per day per trainee as per State Govt. norms, an average TA @ Rs.2,000/- per trainee and sharing the amount incurred for 2 faculties and venuehiring charge among the trainees in a batch, the fund required for training willbe Rs 3,710/- per trainee.Therefore, the total fund requirement of Rs 63,070/- is proposed fromGoI.5.9.4. Orientation Training of Cold Chain and Vaccine Handlers.Apart from RI training to paramedics, 2 days training on Cold ChainManagement and Vaccine Handling will be imparted to paramedics(preferably the Health Assistant), dealing in cold chain, vaccines and logisticmanagement, one from each PHC, CHC, District Hospital, General Hospitaland District Cold Chain Store wherever cold chain system is in place.Out of 119 health centres with cold chain system, a 2 days training onVaccine Handling and Cold Chain Management was planned for 85 healthcentres during July 2008. However, training was imparted to 52 paramedicsonly, as the disruption of road communication caused less turnout.During the financial year 2009-10, a 2 days training will be imparted toremaining 67 paramedics in 2 batches and the training will be conducted atstate Headquarter, Naharlagun.Based on the revised RCH norm, considering an average DA @ Rs250/- per day per participant, average TA @ Rs 2000/- per trainee andsharing the amount incurred for 2 faculties and venue hiring charge among228

the trainees in a batch, the total requirement for one trainee in 2 days will beRs 4,370/- per trainee.The financial requirement may be supported by GoI under specialconsideration and the total fund requirement will be Rs 2,92,790/-.5.9.5. One Day Training of Block Level Data Handlers.In Arunachal Pradesh, separate block level data handlers as of now donot exist. The data in all PHC/CHC are handled and managed by theparamedics at PHC/CHC level. Therefore, this type of training will beincorporated with the training of paramedics.Therefore, no specific fund for training of block level data handlers isrequired.5.10. Microplanning.For effective implementation of Routine Immunization as per plan,preparation of proper microplan is absolutely essential. In all 388 Sub-Centres, 87 PHCs and 31 CHCs in 16 districts, microplans will be preparedusing the grass root information with the participation of ANM, ASHA andAWW.5.10.1. Microplanning at sub-centre level.In all 388 sub-centres, support will be ensured for preparation ofmicroplan @ Rs 100/- per sub-centre. Total fund requirement for microplan atsub-centre level is Rs 38,800/-5.10.2. Microplanning at PHC/CHC levelFinancial support will be provided to 116 PHC/CHC @ Rs. 1,000/- perPHC/CHC for preparation of microplans at PHC/CHC level and the total fundrequired for the same will be Rs 1,16,000/-.5.10.3. Microplanning at District Headquarter.Support will be provided to 16 Districts @ Rs 2,000/- per DistrictHeadquarter for preparation of microplans at District Headquarter and thetotal fund required for the same will be Rs 32,000/-.229

5.11. Vaccine Lifting POL:5.11.1. Vaccine lifting from Guwahati Airport to State Headquarter,Naharlagun.Vaccines required for the State are airlifted up to the nearest Airport,Guwahati and from there these are to be collected by the State by road whichis a long way drive of more than 500 Kms.The matter has been addressed to GoI several times for dropping thevaccines up to the State Headquarter, but no action is seen to be initiated byGoI.As the State does not have insulated Vaccine Van, vaccines are to betransported in hoodless truck and sometime the truck remains in off roadcondition.Every time it happens that the intimation of dispatch of vaccines comessuddenly from MSD Kolkata by telephone. In such cases, if the truck is in offroad condition, we are compelled to outsource the vehicle for collection ofvaccines. Several occasions it has been experienced that vehicle foroutsourcing is not available even. In such cases vehicle has to be outsourcedat much higher rate, as no fixed rate for hiring exists in the State.Therefore, GoI may either arrange to drop the Vaccines and otherlogistics up to the State Headquarter or proposal for additional support of Rs.2,00,000/- for collection of vaccines from Guwahati Airport for minimum of 10collections per year as mobility support (Vehicle hiring, POL support or TA/DAfor staff) as well as to meet up financial requirement for outsourcing ofvehicles may be approved.5.11.2. Vaccine lifting from State Store to District Store/PHC/CHC.Lifting of vaccines from the state cold chain room to 16 districtswhenever required would be ensured once every quarter and from districtstore to all the CHCs/PHCs once every month.An amount of Rs 1,00,000/- per district per year for all 16 districts asPOL/DA support as required will be provided as per GoI norms. Supportiveprovision in terms of fund may be provided by GoI. The total fund requirementis Rs 16,00,000/-.230

5.12. Consumables for Computers including for internet access.In all 16 districts and State Headquarter stationary items consumablefor computers including internet access charge are to be provided.In view of raising inflation and cost index of materials in the State, therate given in GoI norm @ Rs 400/- per district per month, is too insufficient atleast for one cartridge and two rims of paper per month.Therefore, special consideration may be made by GoI in terms offunding @ Rs 3,000/- per Month for State Headquarter and Rs 1,500/- permonth per district for 16 districts. Therefore, the total fund required for theyear will be Rs 3,24,000/-.5.13. Injection Safety.5.13.1. Plastic Bags (Red/Black).Injection safety is an important component under RoutineImmunization. For safe handling and safe disposal of waste products duringout reach and normal immunization session plastic bags are required.Therefore, availability plastic bags will be ensured at all 12096 session sites.Therefore, GoI may support the requirement by providing fund @ Rs. 2/- per(red) bag Rs 2/- per (black) bag per session (Rs 4/- per session) and totalamount required is Rs. 48,384/-5.13.2. Beach/Hypochlorite Solution.Provision for Bleach/Hypochlorite solution will be ensured at all 116PHCs and 44 CHCs, 12 District Hospitals and 2 General Hospitals at GoInorm of Rs. 500/- per PHC/CHC per year which the GoI may provide supportby funding.5.13.3. Twin Bucket.Twin bucket ensured to all 85 PHCs and 31 CHCs 12 District Hospitalsand 2 General Hospitals at GoI norm of Rs 400/- per PHC/CHC per yearwhich the GoI may provide monetary support of Rs 52,000/-.5.14. Biomedical Waste Pit:Waste disposal mechanism would be put in place in all the PHCs,CHCs and wherever cold chain systems are in place. In the State there are 2General Hospitals, 12 District Hospitals, 35 CHCs and 57 PHCs functioning231

with Cold Chain System and another 30 PHCs functional without cold chainsystem, making the total to 133.In 2007-08 proposal for waste disposal pit was approved for 34numbers and for 40 numbers in 2008-09.In this financial year focus will be for another 59 number of waste pitsat the rate of Rs 20,000/- per centre. Therefore the fund requirement is Rs11,80,000/-.5.15. State Specific.5.15.1. Helicopter SortiesThere are 8 places identified as air-fed areas where normally facilitiesare not available. These areas are Tali, Parsi-Parlo, Damin and Pip-Sorang inKurung Kumey District, Monigong in West Siang District, Singa in UpperSiang district, Aivelly in Dibang Valley and Vijaynagar in Changlang District.In these places immunization activities are not provided regularly and ittakes 4 to 7 days to reach those sites due to lack of road connectivity. Further,it is not advisable considering the maintenance of cold chain system.In order to cover those areas, it is planned to held immunizationsession from this year 2009-10 onward by tying up with the Pawan Hanshelicopter services. The frequency of service delivery to those places will beonce in a month with least 3 immunizing staffs per session.In all these air-fed areas, there will be 8 immunization sessions permonth and 96 Immunization Sessions per year.Therefore, GoI is requested to provide financial support at the rate ofRs 3000/- per staff per session for mobility support (Helicopter fare) and Rs150/- per Kg as material carrying charge for minimum of 80 Kg per session.Thus, the total amount required per session is Rs 21,000/-.The rates given are the rates followed by Deptt. Supply and Transportof State Government and the same are applied during IPPI program also. Thetotal amount required for 96 sessions in a year will be Rs. 20,16,000/-5.15.2. POL Maintenance Fund for Generator under RI.One 7.5 KVA (Kirloskar) Generator is installed along with the WIC inthe Central Cold Chain Room at State Headquarter. Due to inconsistent and232

non-reliability of the power supply, the generator has to be operatedfrequently so as to support the cold chain system.Another 17 generators of 4 KVA ratings are reported to be available in16 districts under RI Program.Necessary POL maintenance fund may be supported by GoI @ Rs30,000/- per year for State Headquarter and Rs 10,000/- per district per year.5.15.3. Requirement of New Generator for WIC at Central Cold ChainRoom.In the State, the power supply is inconsistent and unreliable. In order tosupport the cold chain system in the central cold chain room at StateHeadquarter, one Generator (Kirloskar) of 7.5 KVA is installed along withWalk-in-Cooler. Also, along with WIC, there are 5 Deep Freezers (Large)installed in the Central Cold Chain room at State Headquarter for the purposeof ice packs. The generator, as it was installed during 1995 along with theWIC, it has become old and the output capacity is not sufficient to support thepower requirement of all cold chain equipments installed in central cold chainroom.Therefore, one new generator (Kirloskar) of 32 KVA capacity isabsolutely required in the central cold chain room of State Headquarter inorder to backup the cold chain system during power failure. GoI may kindlyprovide the required generator or may consider Rs 10,00,000/- for theproposal.5.15.5. Salary for Health Assistant and Refrigerator Mechanic.In 2006-07, 20 Health Assistants and 1 Refrigerator Mechanic wererecruited under the Routine Immunization Program on contractual with priorapproval from GoI. Since then, the salaries for of these contractual staffs havebeen met from the Routine Immunization fund at a consolidated amount of Rs5500/- per month for Health Assistant and Rs 8000/- per month forRefrigerator Mechanic respectively.It is proposed to continue the salaries for these Health Assistants andRefrigerator Mechanic under Routine Immunization in 2009-10 @ Rs 8,000/-per month and @ Rs 12,000/- per month for Refrigerator Mechanic.Total fund required for salary of Health Assistant for financial year2009-10 is Rs 19,20,000/-.233

Total fund required for salary of Refrigerator Mechanic for the financialyear 2009-10 is Rs. 1,44,000/-Therefore, GoI may like to approve Rs 20, 64,000/- for the salaries ofabove contractual staff under Routine Immunization Program.5.15.6. Batteries and Solar Plates for Solar Powered Refrigerators.The provision of solar refrigerators in the state of Arunachal Pradeshhas been a great boost to operationalise cold chain system in different healthfacilities. Out of 30 units of Solar Powered Refrigerators supplied by GoIduring 1999-2000, only 18 units are functional and 12 units are not functionaleither due to damage of solar plates or batteries.Therefore GoI may either like to provide 36 Nos. of solar batteries and60 nos. of solar plates or provide fund @ Rs 12,000/- per unit of batteries andRs 15,000/- per solar plates. This is absolutely essential on account of nonavailabilityof power supply in places in the State wherever solar refrigeratorsare installed.5.15.7. Routine Immunization Month.As per NFHS-III, the full immunization coverage is 28% and as perCES-07 full immunization coverage is 45%, which is a very poor status. Onthe basis of the analysis of the report, it has been surfaced that backlog formeasles has become very high in the State.In order to increase the full immunization coverage level, the backlogsand dropout has to be reduced. Therefore, in order to increase the fullimmunization coverage level and to catch up the backlogs, the RoutineImmunization Month has been introduced in the State during 2008-09 alongwith the normal immunization session in the health centres and out reachimmunization sessions. Routine Immunization Month is a massive specialprogram observed continuously for four months, starting in October andending in January to coincide with NID. The plan is to visit every village toimmunize every child either eligible or missed out.5.15.8. Special requirement of Vaccines and AD Syringes.5.15.8.1. Vaccines.Most of the time the vaccines requirement for the State have beensufficient, except for Measles, which might have been due to calculation errorduring previous year or before that. During the Routine Immunization Months234

it is highly felt that all the vaccines are available in the stock so that there is nogap in the supply. However, the annual requirement of vaccines will remainsame.As far as the beneficiaries of BCG and Measles are concerned, therequirements of these two vaccines for 2009-10 are 31475 doses only.However, the specific need of the State is that one session will need aminimum of one vial of each of these vaccines considering the vaccinevulnerability and cold chain point of view.Till date, the allocation of BCG vaccine by GoI for the State has beensufficient, but that of the Measles has been recurrently insufficient.5.15.8.2. AD Syringes.Till date the supply of 0.5 ml Auto Disable Syringes have beensufficient. However, the supply of 0.1 ml AD Syringes and 5 ml Disposable(Re-constitutional ) Syringes have been very low as compared to the supply ofBCG. Therefore, GoI may increase the supply of 0.1 ml AD Syringes and 5 mlRe-constitutional Syringes as per the State requirement.6. Additional support required in kinds from GoI to improve RoutineImmunization.6.1. Walk-in-Cooler.In the State one CFC Walk-in-Cooler (Huurre HRC-100) is in positionand it was installed in 1995.Several times the breakdown of compressors of cooling unit occurredand replaced. CFC gas R-12 is not easily available as the production of thesegases has been banned in view of environmental effect world wide.There are leakages occurring in the wall of the existing WIC due toageing and same is in use by using M-Seal. As the number if beneficiarieshave increased many folds, the chamber is not enough to house vaccinerequirements.Therefore a new NON-CFC WIC with higher volume may beconsidered for the State by GoI. No civil work is required for the proposedNON-CFC WIC.235

Sl. No.6.2. Walk-in-Freezer.Till date the State is using 3 Deep Freezer for preparation of Ice Packsin the State Headquarter. As the requirements have increased many fold, theDeep Freezers are not sufficient for preparation of ice packs especially duringNIDs (IPPI), there is a recurrent shortage of ice packs.Therefore it is felt that one WIF (NON-CFC) is urgently required in thestate and GoI may consider the proposal and immediately install the same inthe State.The required civil works have been proposed under NRHM.6.3. Cold Chain Equipments.Vide GoI release letter No. 36 nos. of ILR (Small), 10 Nos. of (ILR(Large), 78 Nos. of Deep Freezer (Small) and 15 Nos. of Deep Freezer(Large), making the total 139 Nos. of equipments, have been allocated for theState of Arunachal Pradesh.The consignee addresses for delivery of equipments had already beenfurnished to GoI but the State is yet to receive the same from GoI. GoI maysupply the equipments at the earliest.There is a cold chain expansion plan for 30 PHCs and 3 CHCs whichare functional without cold chain system. Therefore, along with theequipments already allocated by GoI, another 33 ILRs (Small) and 33 DeepFreezers (Small) will be required, the consignee address of which will befurnished separately.Plan is also to set up two new Zonal Stores, one at Bhalukpong inWest Kameng District and another one at Namsai in Lohit District. Therefore,4 ILRs (Large) and 4 Deep Freezers (Large) along other necessaryaccessories are required. The required civil works have been proposed underNRHM PIP.ItemsStock(Functional)**Replacementfor CFC236ExpansionRequirementin 2009-10Alreadyallocated butyet to besupplied1 WIC 1 1 12 WIF 1 13 ILR-140 (Small) 122 24 33 57 364 ILR-300 (Large) 16 13 8 21 105 DF-140 (Small) 64 25 33 83 786 DF-300 (Large) 36 27 8 22 15

Cold Boxes7 Large)134 392 392Cold Boxes8 (Small)198 652 6529 Vaccine Carrier 2173 3400 340010 Vaccine Van 17 176.4. Solar Powered RefrigeratorsIn view of the non-reliability of supply of electricity in the State, solaroperated refrigerators have been the most reliable support to the cold chainsystem. In the State PIP 2006-07 and 2007-08, proposal were made for 20solar powered refrigerators with consignee addresses but till date, the matterremains unattended.Therefore, GoI is requested to allocate 20 units of solar operatedrefrigerators along with other necessary accessories for the State.6.5. Annual Requirement of Vaccines, AD Syringes and Logistic Support.6.5a. BeneficiariesCategory 2009-10 2010-11Total Population 1356700 1393059Pregnant Women 37445 38448Live Birth 33918 34826Infants (0 - 1 yrs ) 31475 32319Children ( 1 -2 yrs ) 31204 32040Children ( 0- 5 yrs ) 189938 195028Children ( 0 - 3 Years ) 108536 111445Children at 5 yrs 32832 33712Children 10 at yrs 33103 33991Children at 16 yrs 28762 29533Nos. of menstrual cycles of women per year 1499154 1539330Nos. of Condom required per cycle 14991535 15393303Nos. of pregnant women suffering from anemia 18722 19224Nos. of increased risk of pregnant who will need3744 3845referralTT 1 26211 26914No. of dosesTT2 26211 26914TT Booster 11233 11535Nos. of Deliveries 33700 34604Institutional Deliveries 10447 10727Home Delivery 6740 6921Nos. of sick new borne 3370 3460237

Nos. of sick new borne treated at PHC 30330 31143Nos Required Referral 3370 3460Nos of MTP to be done 507 520RTI/STI 330 339Eligible Couple 230639 2368206.5b. Annual Vaccine Requirements.The requirements of BCG and Measles Vaccines are as per theState Specific based on the vulnerability of vaccines to heat as well as tocatch up the backlogs of the Measles. All the vaccine requirements include25% Wastages and 25% Buffer Stock.Sl.No.Antigens 2009-10 2010-111 TT 205133 2106312 BCG 197280 2018563 OPV 236063 2423934 DPT (0-1 Year) 188850 1939145 DPT (5 Years) 49248 505686 Measles 98640 1009287 Hep B8 JE (Routine)6.5c. Annual AD Syringes Requirements:All the requirements are based on the State Specific including 25%Wastages and 25% buffer stock.AD SyringeAs per StateQuantity RequiredSpecific0.1 ml 197280 2018560.5 ml 699551 7114335 ml 39456 403726.5d. Requirement of Other LogisticsSl. No.QuantityItemsRequired1Voltage Stabilizers (Low voltage input, 100Volt)2002 Voltage Stabilizers (Normal voltage input) 2003 Cold Box (Large) 3924 Cold Box (Small) 6525 Vaccine Carrier 3400238

SN126.6. Vaccine VansNon-functional big Vaccine Vans are being condemned. The vaccinesare often transported in cold box with such care that T-series vaccines do notcome in contact with ice packs. Further, the topography of state is such thatthe temperature remains low that suits the vaccines.Therefore GoI may supply the following Vaccine Vans / vehicles at theearliest for the state as the existing Vans are not suitable for narrow andzigzag tracks due to their heavy and bulky bodies. Most of them are nonfunctionaland off road in want of maintenance and no fund for maintenance.Vehicle Description Quantity RemarkVaccineVansLightVehicleSmall, but fourwheel drive 16Four wheeldrive with rearcarriage1Big vans are not suitable for hillyregion with narrow and zigzagtracksFor transportation of Cold Chainitems and also for movement ofrepairing team from headquarter tothose districts without mechanics.6.7. Requirement of Hub Cutter.Hub Cutters should be supplied by GOI in sufficient quantity. Therequirement is based on the number outreach sessions planned. Followingare the requirement of Hub Cutters for the year 2009-10HealthfacilitiesNo. offacilitiesSessions/facility/monthQnty. reqd/month/facilityQnty. reqd in ayearDistrictHospital/GeneralHospital 14 0CHC 35 3 3 1260PHC 87 3 3 3132Sub-Centres 383 4 4 18384Total 227766.8. Requirement of Solar plates and batteries for Solar RefrigerationSystem.Out of 30 units of Solar Powered Refrigeration Systems, 18 units arefunctional and remaining 12 units are non-functional either in want ofreplacement of solar plates or batteries as the solar plates / batteries becomedamaged due to ageing.239

Therefore, GoI is requested to allocate following spare parts for thesolar refrigerator for effective implementation of Immunization program inelectricity lack areas.Sl. Name of Spare PartsQnty. requiredNo.1 Solar Plates 60 Nos.2 Solar Batteries 36 Nos.3 Charge Controller 30 Nos.6.9. Annual requirement of cold chain equipments spare parts.In the state, non-availability of spare parts in the local market leads todelay in repair and maintenance of NON-CFC equipments and also CFCequipments. However, on priority, Non-CFC equipments will be repaired.Therefore, GoI may provide the following spare parts on priority.Sl.No.Code Part Name Qnty.Spare parts for NON-CFC VESTFROST ILRs/DFsCOMPRESSOR FR 10G COMPLETE FOR MF-3040801110 Nos.2 0802 COMPRESSOR FR 8.5G COMPLETE FOR MK-304 10 Nos.3 0803 COMPRESSOR FR 6G COMPLETE FOR MF-144 20 Nos.4 0804COMPRESSOR TL 5G HST COMPLETE FOR MK-14430 Nos.5 0805STARTING DEVICE FOR FR 10G & FR 6GCOMPRESSORS100 Nos.6 0806 STARTING DEVICE FOR FR 8.5G COMPRESSOR 20 Nos.7 0807STARTING DEVICE FOR TL 5G HSTCOMPRESSOR100 Nos.8 0808 THERMOSTATE (FREEZER) 100 Nos.9 0809 THERMOSTATE (ILR) 100 Nos.10 THERMOMETER (DIAL) 300 Nos.11 0821 FILTER DRIER 20 G = 50 Nos.& 10 G = 200 Nos 250 Nos.12 0825FAN COMPLETE FOR COMPRESSORS MF304/MK 304 AND FOR MF-144100 Nos.13 0826 STARTING CONDENSOR ILR-304 15 Nos.14 0827 STARTING CONDENSOR FOR ILR-144 100 Nos.15 STARTING CONDENSOR FOR FREEZER-304 15 Nos.16 STARTING CONDENSOR FOR FREEZER-144 100 Nos.6.10. Requirement of Charging Units for NON-CFC Toolkits (Small):Vide MoHFW allocation No. Y.11013/1/2008-CC&V, dated New Delhi,the 30 th June 2008, one unit of NON-CFC Toolkit (Large) and 11 units ofNON-CFC Toolkit (Small) were received from Govt. MSD, Kolkata, on 4 th Nov,2008.240

It has been found that the 11 units received during 2008-09 arecompletely different from that received during 1997-98. The new Toolkitsreceived in 2008-09 do not have Charging and Recycling Units, withoutwhich, these Toolkits are of no practical use and are not yet issued to theRMs.Therefore GoI may either arrange to allocate and supply 11 numbers ofCharging Units and 11 numbers of Recycling Units for the State immediatelyor may provide fund @ Rs. 25000/- per unit.YearTherefore, consolidated audited report of expenditure since 2005-06 to 2007-2005-062006-072007-087. Component wise expenditure of funds received and achievements.7.1. Expenditure report from 2005-06 to 2007-08Till 2007-08, there were no bifurcations of funds for RI Program eitherby GoI or by the state. It was during 2007-08; the fund received from GoI hadbeen bifurcated activity-wise and released to the district. However, theexpenditure report from the districts had not been received as per activity wisefunding. There were no formats designed for reflecting achievements alongwith the expenditure report either. It was only during April 2008 the reportingformats for component wise expenditure and achievements had beenreceived from GoI. However, the efforts were being made in the State levelduring 2007-08 for receiving expenditure report along with the achievementsfrom the districts, but reports received were either incomplete or incorrect.08 is as furnished.OpeningBalanceon 1 stday offinancialyearFundreceivedfrom GoIReportedExpenditure duringthe yearClosingbalance at theend of thefinancial yearRemark15,546 40,26,626 31,80,469 8,61,703 AuditedExpenditure8,61,703 94,89,948 89,38,923 14,12,728 AuditedExpenditure14,12,728 81,99,373 72,05,277 24,06,824 AuditedExpenditure241

7.2. Expenditure report of RI in 2008-09During 2008-09, the fund received from GoI was Rs 82, 05,000/- andaudited unspent balance of 2007-08 as on 01.04.2008 was Rs 24, 06,824/-.Thus the total fund available with the State Routine Immunization Head wasRs 1, 06, 11,824/- only.However, after the fund allocation according to theactivities approved in the state PIP, the total fund required for RI activities inthe districts was Rs 1,06,34,971/- only, which exceeded the fund available inthe State by Rs 23,147/- only. Subsequently, the same had been released tothe districts according to activities planned in the districts along with thereporting format. However, the reports received from the districts areinconsistent and incomplete when compared with the quarterly FMR. Somedistricts are yet to the expenditure report. As per the reports received from thedistricts, the component wise expenditure report for 2008-09 in the State is asbelow.Component wise expenditure report in 2008-09Sl.No. Activity HeadBifurcatedfund Expenditure Target AchievementDistrictsMobility Support forDistrict1 Supervisin of RI Activities 395000 210092 350 times2Alternate Vaccine Deliveryfor ORS 1140000 9925135700sessions2215sessions5700 17993 Mobility Support for ORS 5700000 1809411 sessions sessionsMobility Support for Imm.Session in Urban (Slam)4 area 105000 62,624 84 sessions 28 sessionsMobilization of Children5throughlink workers 570000 2944501963sessions6 Bio-medical Waste Pit 645000 264773 43 pits 18 pits7 Vaccine Lifting 240000 617038Emergency advance toDibang valley District 35800Total fund status for RIActivities 8830800 36955669Training of MedicalOfficers 215510 13443510 Training of Paramedics 1588661 984082Total Status in Districts 10634971 4701335100Doctors958Paramedics57 Doctors540Paramedics242

State HQMobility support for1 supervision 393282 Cold Chain Maintenance 278863 Review Meetings 1976344Cold Chain HandlersTraining 1972845Printing of ImmunizationCard 3000006Printing of TrainingModule 2525007Vaccine Lifting fromGuwahati 15596Total Status in StateHeadquarter 0 1030228Total in the State 10634971 5731563The above is as per the expenditure reports received from 11 districtsout of 16 districts till 31. 12. 2008 and expenditure at the State Headquarter.Still 7 districts are yet to submit the reports on expenditure.8. RI Work Plan 2009-10Sl.No Activities Qtr-I Qtr-II1 SupervisionsMobility Support for Supervision of RI activities1.1in District by DIOsMobility Support for Supervision of RI activitiesin District by State Level Officer1.22 Cold Chain Maintenance2.1 State Headquarter2.2 District HeadquarterPHC/CHC/District Hospital/General2.3 HospitalImmunization Session in Urban3 slum areas (Focus on urban slum area)4 Increasing Immunization Sessions4.1 Alternate Vaccine DeliveryMobility Support for Out Reach4.2 SessionsMobilization of Children through5 ASHA/Mobilizers6 Support for Computer Assistants7 Printing and DisseminationPrinting and Dissemination ofImmunization Cards etc.7.17.2 Hanging Tracking Bags8 Review MeetingsQtr-IIIQtr-IV243

8.1 Review Meeting at State Level8.2 Review Meeting at District Level8.3 Review Meeting at Block Level9 Training on Routine ImmunizationTraining of Paramedics on Routine9.1ImmunizationTraining of Medical Officers on RoutineImmunization9.29.2.1 Training of Trainer outside the State9.2.2 Training of Trainer in the State9.2.3 Training of Medical Officers at District LevelOne Day Refresher Training to Computer9.4 AssistantTraining on Vaccine Handling and Cold9.5 Chain Managements10 Microplanning10.1 Microplanning at Sub-Center level10.2 Microplanning at PHC/CHC10.3 Microplanning at District Headquarter11 Vaccine Lifting11.1 From Guwahatri Airport to State HeadquarteFrom State Store to District Stores and11.2 subsquently to PHC/CHC12 Stationaries Support for Computers12.1 State Headquarter12.2 District13 Injection safety13.1 Plastic Bags (Red/Black)13.2 Bleaching/Hypochloric Solution13.3 Twin Bucket14 Bio-medical Waste PitTotal under Normal requirement15 State Specific15.1 Helicopter Sorties.15.2 POL maintenance for Generators15.2.1 State Headquarter15.2.2 District32 KVA generator for Central Cold Chain15.3 Room15.4 Salaries for contractual staff15.4.1 Salary for Health Assistants15.4.2 Refrigerator Mechanic15.5 Requirement of solar plates and batteries15.5.1 Solar plates15.5.2 Solar batteries16 Solar Powered Refrigerator17 Charging Unit for NON-CFC Toolkits18 Recycling unit for NON-CFC Toolkits19 Routine Immunization Month244

8. Budget.The budget portion is the direct reflection of the financial requirementsproposed in the strategies for improving Routine Immunization.2009-10FundSl.NoService Deliveryrequirements(in Rs) Target1 Supervisions1.11.21.1 Mobility Support for Supervisionof RI activities in District by DIOs 800000 1920 visits per year1.2. Mobility Support for Supervisionof RI activities in District by StateLevel Officer 1500002 Cold Chain Maintenance2.1 State Headquarter 300000At least 1 visit perdistrict per month1 Central Cold Chain Store, StateHQ2.2 District Headquarter 160000 16 District Cold Chain Stores2.33PHC/CHC/District Hospital/GeneralHospital 53000057 PHC, 35 CHC, 12 DistrictHospitals and 2 General HospitalsImmunization Session in Urbanslum areas (Focus on urban slumarea) 537600 384 Immunization Camps per year4 Increasing Immunization Sessions4.1 Alternate Vaccine Delivery 3628800 13152 Out Reach Sessions4.2Mobility Support for Out ReachSessions 18144000 13152 Out Reach Sessions5Mobilization of Children throughASHA/Mobilizers 1814400 13152 Out Reach Sessions6 Support for Computer Assistants 2040000 17 Computer Assistants7 Printing and Dissemination7.1Printing and Dissemination ofImmunization Cards etc. 2500007.2 Hanging Tracking Bags 3000008 Review Meetings8.1 9.1. Review Meeting at State Level 7200004 Meetings per year for 3 dayswith 48 participants from 16Districts8.2 9.2. Review Meeting at District Level 167200 4 Meetings per year for 1 day8.3 9.3. Review Meeting at Block Level 1050900 4 Meetings per year for 1 day9 Training on Routine Immunization9.1Training of Paramedics on RoutineImmunization 4435540Training of Medical Officers onRoutine Immunization9.2.2 Training of Trainer in the State 190720Training of Medical Officers at District9.2.3 Level 16254501 training per year, 958Paramedics9.29.2.1 Training of Trainer outside the State 100000 1 training outside the State1 time at at State Level for 32Officers9.39.4One Day Refresher Training toComputer Assistant 630701 training per year, 295 MedicalOfficers1 training per year, 17 ComputerAssistantsTraining on Vaccine Handling andCold Chain Managements 292790 1 training at State HQ245

10 Microplanning10.1 Microplanning at Sub-Center level 38800 1 Time at all Level10.2 Microplanning at PHC/CHC 11600010.3 Microplanning at District Headquarter 3200011 Vaccine Lifting11.111.212From Guwahatri Airport to StateHeadquarte 200000 At least 10 collection per yearFrom State Store to District Storesand subsquently to PHC/CHC 1600000Stationaries Support forComputers1920 lifting from District Store toPHC/CHCs and 64 liftings fromState Store to District Store12.1 State Headquarter 3600012.2 District 28800013 Injection safety13.1. Plastic Bags (Red/Black) 48384 13152 Sessions per year13.2. Bleaching/Hypochloric Solution 5300013.3. Twin Bucket 5200014 Bio-medical Waste Pit 1180000Total under Normal requirement 4094465415 State Specific15.1 Helicopter Sorties. 2016000 96 Sessions per year15.2 POL maintenance for Generators15.2.1 State Headquarter 3000015.2.2 District 16000015.332 KVA generator for Central ColdChain Room 1000000 1 unit15.4 Salaries for contractual staff15.4.1 Salary for Health Assistants 1920000 20 Health Assistants15.4.2 Refrigerator Mechanic 14400015.5Requirement of solar plates andbatteries15.5.1 Solar plates 900000 90 batteries and 60 plates15.5.2 Solar batteries 43200016 Solar Powered Refrigerator 0 To be provided by GoI17 Charging Unit for NON-CFC Toolkits 0 To be provided by GoI18 Recycling unit for NON-CFC Toolkits 0 To be provided by GoITotal fund requirement under StateSpecific 6602000Total fund under Routine Immunization 47546654246

S.No.PART D: STRENGTHENING NATIONAL DISEASECONTROL PROGRAMS.Revised National Tuberclosis Control ProgrammeAnnual Plan for Programme Performance & Budget for the year1 st April 2009 to 31 st March 2010State: ARUNACHAL PRADESHObjectives:1. To achieve and maintain a cure rate of at least 85% among newlydetected infectious (new sputum smear positive) cases, and2. To achieve and maintain detection of at least 70% of such cases in thepopulationThis action plan and budget have been approved by the STCS.Signature of the STO .Name Dr. B. Tada, DDHS (TB)Section-A – General Information about the State1 State Population (in lakh) please give projected population for next 12 Lakhyear2 Number of districts in the State 163 Urban population 3 Lakh4 Tribal/ Hilly population All are hillypopulation5 Any other known groups of special population for specificinterventionsNil(e.g. nomadic, migrant, industrial workers, urban slums, etc.)(These population statistics may be obtained from Census data /StateStatistical Dept/ District plans)No. of districts without DTC: -3 (three) namely:- Upper Dibang Valley,Anjaw & Kurung KumeyNo. of districts that submitted annual action plans, which have beenconsolidated in this state plan: 13Organization of services in the state:Name of the District1 DTC Bomdila,W/KamengProjectedPopulation(in Lakhs)Please indicatenumber of TUs ofeach typeGovtNGOPlease indicate no. ofDMCs of each type in thedistrictPublicSector*0.82 1 3NGOPrivateSector^247

2 DTC Tawang,Tawang dist.0.39 1 2 13 DTC Seppa,E/Kameng0.63 1 14 DTC Ziro, L /Subansiri 1.07 125 Kurung Kumey 16 DTC Naharlagun,P/Pare1.33 1 2 17 DTC Daporijo U/Subansiri0.61 1 18 DTC Along, W/Siang1.13 1 49 DTC Pasighat,E/Siang0.96 1 310 DTC Yingkiong,U/Siang0.37 1 211 DTC Tezu, Lohit21.58 112 Anjaw 113 DTC Roing, D/1Valley0.64 114 L/Dibang1Valley15 DTC Deomali, Tirap 1.10 1 316 DTC Changlang,Changlang1.37 1 3Total 12.00 13 32 2*Public Sector includes Medical Colleges, Govt. health department, otherGovt. department and PSUs i.e. as defined in PMR report^ Similarly, Private Sector includes Private Medical College, PrivatePractitioners, Private Clinics/Nursing Homes and Corporate sectorRNTCP performance indicators:Important: Please give the performance for the last 4 quarters i.e. July 2007to June 2008Name of theDistrict (alsoindicate if it isnotified hilly ortribal districtTotalnumber ofpatientsput ontreatment*Annualisedtotal casedetectionrate(per lakhpop.)No ofnewsmearpositivecasesput ontreatment*Annualised Newsmearpositivecasedetectionrate (perlakh pop)Cure rateof NSPdetectedin the last4correspondingquartersPlan for the nextyearAnnualized NSPcasedetectionrateCurerateDTC Bomdila, 135 165/Lakh 60 73/Lakh 98% 75 < 85%DTC Tawang, 79 208/Lakh 21 55/Lakh 90% 75 < 85%DTC Seppa, 251 398/Lakh 60 95/Lakh 69% 75 < 85%248

DTC633 472/Lakh 142 106/Lakh 87% 75 < 85%NaharlagunDTC Ziro, 146 136/Lakh 51 48/Lakh 74% 75 < 85%DTC Daporijo 86 141/Lakh 32 52/Lakh 85% 75 < 85%DTC Along 166 146/Lakh 63 55/Lakh 87% 75 < 85%DTC Pasighat 241 251/Lakh 99 103/Lakh 85% 75 < 85%DTC Yingkiong 63 175/Lakh 29 81/Lakh 83% 75 < 85%DTC Tezu 243 154/Lakh 104 66/Lakh 91% 75 < 85%DTC Roing 91 144/Lakh 43 68/Lakh 99% 75 < 85%DTC Deomali 216 196/Lakh 66 61/Lakh 84% 75 < 85%DTC148 107/Lakh 61 55/Lakh 85% 75 < 85%ChanglangTotal 2498 207/lakh 831 70/lakh 86% 75 < 85%* Patients put on treatment under DOTS regimens only are to be included.Section B – List Priority areas at the State level for achieving theobjectives planned:S.No. Priority areas Activity planned under each priority area1 Traininga. Training of MPW, Pharmacist, nursing staff etc.b. Training and Re-training of MOSc. Re-training of LT, Community Volunteer etc.d. Training & re-training of MOs at State levele. Training of Microbiologist & LT of IRL at nationallevel.f. TB/HIV training for DTO / MO-TC, STS / STLS, &LT.2 IEC a. Placement of Hoarding / Wall paintingb. Community meeting / Sensitization meetingc. Media publication3 Printing a. Printing of Modules, TB & Lab Registerb. Printing of treatment card, Patients Identity card,Reporting format, Stock Register etc.4 Contractual Service a. Appointment of Microbiologist for IRLb. Appointment of LT for IRLPriority Districts for Supervision and Monitoring by State during the nextyearSNoDistrictReason for inclusion in priority list1 East Kameng2 Lower SubansiriFor Low Performance249

3 Changlang4 All other low performingdistrict- Do-Section C – Consolidated Plan for Performance and Expenditure undereach head, including estimates submitted by all districts, and therequirements at the State Level1. Civil WorksActivityNo.requiredas perthenormsin thestateNo.alreadyupgraded/present inthe stateNo.plannedto beupgradedduringnextfinancialyearPl providejustificationif anincrease isplanned inexcess ofnorms (useseparatesheet ifrequired)EstimatedExpenditureon theactivityQuarter inwhich theplannedactivityexpectedto becompleted(a) (b) (c) (d) (e) (f)STDC/IRL1 1 10,00,000.00SDS 1 Justification 10,000.00DTCs 16 13enclosedseparate 58,500.00sheetTUs 16 13 1 51,900.00DMCs 34 34 1 64,000.00TOTAL 11,84,400.002. Laboratory MaterialsActivityAmountpermissibleas per thenorms inthe stateAmountactuallyspent in thelast 4quartersProcurementplannedduring thecurrentfinancialyear (inRupees)EstimatedExpenditurefor the nextfinancialyear forwhich plan isbeingsubmittedJustification/Remarks for(d)250

(Rs.)(a) (b) (c) (d) (e)Purchaseof LabMaterialsbyDistricts1.5 Lac /million /district7,80,916.00 4,50,000.00 10,00,000.00 Lab materialfor the stateLabmaterialsfor EQAactivity atSTDC.15 lacs /millionpopulation2,00,000.00 Lab materialforproposedIRLTOTAL 12,00,000.003. HonorariumActivityAmountpermissibleas per thenorms inthe stateAmountactuallyspent in thelast 4quartersExpenditure(in Rs)planned forcurrentfinancialyearEstimatedExpenditurefor the nextfinancial yearfor which planis beingsubmittedJustification/Remarks for(d)(Rs.)Honorariumfor DOTprovider(both tribal& nontrebledist.)(a) (b) (c) (d) (e)1. Rs.250/- DOTProviders2. Rs.250/-TreatmentCompletedPatients.4,32,840.00 4,50,000.00 9,00,000.00 For DOTProvider &treatmentcompletepatients.Honorariumfor DOTprovider ofCat-IVpatientsTOTAL 9,00,000.00251

No. presentlyinvolved in RNTCPAdditional enrolment proposedfor the next fin. yearCommunityvolunteers in all1800 500the districts** These community volunteers are other than salaried employees ofCentral/State government and are involved in provision of DOT e.g.Anganwadi workers, trained dais, village health guides, ASHA, othervolunteers, etc.4. IEC/Publicity:Permissible budget for State and all Districts as per Norms: Rs. 14,75,000.00Estimated IEC budget for all Districts, as per action plans (please encloseconsolidation summary): Rs. 19,96,000.00Estimated IEC activities and Budget at the State level (excluding districts) forthe next financial year proposed as per action plan detailed below: Rs.10,94,000.00TargetGroup/ObjectivePatientsandGeneralpublic /forawarenessgeneration andsocialmobilizationActivities Planned at State LevelNo. ofactivitiesheldin lastJuly4 Apr--quarte JunSeprsActivity(All activities tobe planned asper local needs,catering to thetarget groupsspecified)Outdoors:- wall paintings- Hoardings- Tin plates- Banners- othersOutreachactivities:- Patientproviderinteractionmeetings- Communitymeetings- Mike publicity- OthersNo of activitiesproposed in thenext financial year,quarter wise3231132311Oct-Dec32311Jan-Mar32311Totalactivitiesproposed duringnext fin.year1281244Estimated Costperactivityunit (Rs.)500550050010001000Totalexpenditure for theactivityduring thenext fin.Year18,000.0044,000.006,000.004,000.004,000.00Puppet shows/street plays/etc.School activities 1 1 1 1 1 1000 4,000252

Opinionleaders/NGOsforadvocacyHealthCareproviders –publicandprivateAnyOtherActivitiesproposedPrint publicity- Posters- Pamphlets- Others(Pocket Calendar/ Wall Calendar/Car Sticker etc)Media activitieson Cable/localchannelsRadioAny other activity: (Advertise onmagazines)Sensitization11111000040,000.0040,000.0010,000Rs. 54.00Rs. 5.00Rs. 10.006 6 6 6 24 Rs.1,000.001,60,000.002,00,000.001,00,000.0024,000.001 1 1 1 4 2,000.00 8,000.00meetingsAdvertisement 4 4 4 4 16 6,000.00 96,000.00Power pointPresentations /one to oneinteractionInformationBooklets/brochuresWorld TB DayactivitiesAny other publicevent- CMEs- Interactionmeetings- one to oneinteractionmeetings- InformationBooklets- ExhibitionstallCommunicationFacilitators (eachfor 5-6 districts)11311311131131 11 1 1,50,000.00441230000copies215,000.005,000.00500.005/ per20,000.00Total Budget1,50,000.0060,000.0020,000.006,000.001,50,000.0040,000.0010,94,000.00253

5. Equipment Maintenance:ItemNo.actuallypresentin thestateAmountactuallyspent in thelast 4quartersAmountProposed forMaintenanceduringcurrentfinancial yr.EstimatedExpenditurefor the nextfinancialyear forwhich planis beingsubmitted(Rs.)Justification/Remarks for(d)(a) (b) (c) (d) (e)Computer14(Maintenanceincludes AMC,software andhardwareupgrades,PrinterCartridges andInternetexpenses)4,01,995.00 2,50,000.00 4,20,000.00Photocopier14(includes AMC,toner etc.)Fax 14OHP 14BinocularMicroscopes48 72,000.00STDC/ IRLEquipmentAny Other (pl.specify)TOTAL 4,92,000.00254

6. Training:ActivityNo.inthestateNo.alreadytrainedinRNTCPNo. Planned to betrained in RNTCPduring each quarterof next FY (c)Expenditure(in Rs)Planned forcurrentfinancialyearEstimatedExpenditurefor the nextFinancialyear(Rs.)Justification/remarks(a) (b) Q1 Q2 Q3 Q4 (d) (e) (f)Training ofDTOs (atNationallevel)13 12Training ofMO-TCsTraining ofMOs (Govt+ Non-Govt)Training ofLTs ofDMCs- Govt+ Non GovtTraining ofMPWsTraining ofMPHS,pharmacists,nursingstaff, BEOetcTraining ofCommVolunteersTraining ofPvtPractitionersOther447 250 4 4 4 50,000.00 6, 00,000.00184 100 25 50,000.00 30,000.00700 50 125 125 125 125 50,000.00 4, 00,000.00ExpenditureincludedTA/DAExpenditureincludedTA/DA255

trainings #Re- trainingof MOs 270 60 60 60 60 5, 00,000.00Training atDist. &State levelRe- Trainingof LTs ofDMCs34 34Re- Trainingof MPWsRe- Trainingof MPHS,pharmacists,nursingstaff, BEORe- Trainingof CVsRe-trainingof PvtPractitionersTB/HIVTraining ofMO-TCsand MOs447 44 30 30 30 301,00,000.002, 00,000.00TB/HIVTraining ofSTLS, LTs ,MPWs,MPHS,NursingStaff,CommunityVolunteersetcTB/HIVTraining ofSTS800 93 100 100 100 100 45,000.00 3, 00,000.0013 131 50,000.00Training atDist & Statelevel256

Provision forUpdateTraining atVariousLevels #ReviewMeetings atState LevelAny OtherTrainingActivity1 1 1 180,000.00 1,60,000.00# Please specifyTOTAL: RS 22,40,000.007. Vehicle Maintenance:Type ofVehicleNumberpermissibleas per thenorms inthe stateNumberactuallypresentAmountspent onPOL andMaintenancein theprevious 4quartersExpenditure(in Rs)planned forcurrentfinancialyearEstimatedExpenditure forthe nextfinancial yearfor which planis beingsubmitted(Rs.)Justification/remarks(a) (b) (c) (d) (e) (f)FourWheelersTwoWheelers17 14 18,17,104.00 12,00,000.00 18,25,000.0016 13 3, 30,283.00 2, 00,000.00 3, 90,000.00TOTAL 22,15,000.008. Vehicle Hiring*:Hiring ofFourWheelerNumberpermissibleas per thenorms inthe stateNumberactuallyrequiringhiredvehiclesAmountspent inthe prev.4 qtrsExpenditure(in Rs)planned forcurrentfinancialyearEstimatedExpenditurefor the nextfinancialyear forwhich planis beingsubmitted(Rs.)Justification/remarks257

(a) (b) (c) (d) (e) (f)ForSTC /STDCForDTOFor MO-TC16 13 15,051.00 3,00,000.00 9,28,200.00TOTAL 9,28,200.00* Vehicle Hiring permissible only where RNTCP vehicles have not beenprovided9. NGO/ PP Support:ActivityNo. ofcurrentlyinvolvedinRNTCPin thestateAdditionalenrolmentplannedfor thisyearAmountspent intheprevious4quartersExpenditure(in Rs)planned forcurrentfinancialyearEstimatedExpenditurefor the nextfinancialyear(Rs.)Justification/remarks(a) (b) (c) (d) (e) (f)NGOsinvolvementscheme 1NGOsinvolvementscheme 2NGOsinvolvementscheme 3NGOsinvolvementscheme 4NGOsinvolvementscheme 5258

NGOsinvolvementunsignedPrivatepractitionersscheme 1Privatepractitionersscheme 2Privatepractitionersscheme 3APrivatepractitionersscheme 3BPrvt Pract.scheme 4APvt Pract.Scheme 4BTOTAL10. NGO/ PP Support: (New schemes w.e.f. 01-10-2008)ActivityNo. ofcurrentlyinvolvedinRNTCPAdditionalenrolmentplannedfor thisyearAmountspent intheprevious4quartersExpenditure(in Rs)planned forcurrentfinancialyearEstimatedExpenditurefor the nextfinancialyear forwhich plan isbeingsubmittedJustification/remarks(Rs.)(a) (b) (c) (d) (e) (f)ACSMScheme: TBadvocacy,communication,20 8, 40,000.00259

and socialmobilizationSC Scheme:SputumCollectionCentre/s2515,00,000.00TransportScheme:Sputum Pick-Up andTransportService12 2, 88,000.00DMC Scheme:DesignatedMicroscopyCum TreatmentCentre (A & B)2 11,00,000.004, 50,000.00LT Scheme:StrengtheningRNTCPdiagnosticservicesCulture andDST Scheme:ProvidingQualityAssuredCulture andDrugSusceptibilityTestingServicesAdherencescheme:PromotingtreatmentadherenceSlum Scheme:Improving TBcontrol inUrban Slums2 80,000.006 6, 50,000.00260

TuberculosisUnit ModelTB-HIVScheme:Delivering TB-HIVinterventions tohigh HIV Riskgroups (HRGs)TOTAL 24,58,000.0010. Miscellaneous:Activity*e.g. TA/DA,Stationary,etcAmountpermissibleas perthenormsin thestateAmountspent in theprevious 4quartersExpenditure(in Rs)planned forcurrentfinancialyearEstimatedExpenditurefor the nextfinancial year(Rs.)Justification/remarks(a) (b) (c) (d) (e)TA/ DAOfficeStationaryTelephone /fax bill32,30,639.00 15,00,000.00 40,00,000.00Justificationsheetenclosed.Other Officeexpn. OfDTCS &STCSTOTAL 40,00,000.00* Please mention the main activities proposed to be met out through this head261

11. Contractual Services:Category ofStaffNo.permissible asper thenormsin thestateNo.actuallypresent inthestateNo.planned tobeadditionallyhiredduringthisyearAmountspent in theprevious 4quartersExpenditure (in Rs)planned forcurrent fin.yearEstimatedExpenditure for thenextfinancialyear(Rs.)(a) (b) (c) (d) (e)TB/HIV Coord.Urban TBCoord.MO-STCS 1 1 2,33,100.00 1,19,700.00 2,49,150.00State Acctt 1 1 1,98,000.00 1,03,500.00 2,11,500.00State IEC Offr 1 1 1,94,250.00 99,750.00 2,07,750.00Pharmacist 1 0 1 1,02,000.00Secretarial 1 1 42,000.00 42,000.00 88,200.00AsstMO-DTC 16 13STS 16 13 1 12,20,112.00 7,41,000.00 16,17,000.00STLS 16 13 1 12,18,000.00 7,44,000.00 16,21,500.00TBHV 0DEO 17 14 11,07,600.00 5,82,900.00 11,91,300.00Accountant 16 13 3,41,734.00 1,78,200.00 3,63,000.00part timeContractual LT 8 7 2 5,46,000.00 3,44,250.00 8,93,850.00Driver 17 12 6,57,142.00 3,56,400.00 7,37,167.00Microscobilogis 1 0 1 3,60,000.00tIEC Facilitator 3 0 3 3,20,000.00TOTAL 78,60,417.00Justification/remarks12. Printing:ActivityAmountpermissibleasperAmountspent in theprevious 4quartersExpenditure(in Rs)planned forcurrentfinancialEstimatedExpenditurefor the nextfinancialyear forwhich planJustification/remarks262

thenorms inthestateyearis beingsubmitted(Rs.)(a) (b) (c) (d) (e)Printing- Statelevel:*(Modules,Exercise book,pamphlets, TBRegister, LabRegister etc.)1.5Lakhs/MillionPop12,84,800.00 6,00,000.00 15,00,000.00Printingwill betaken atStatelevel,such asTreatment Card,PatientID Cardform,Referform etc.Printing- Dist.Level:*Treatment cards,Patients ID cards,Lab. Forms,referral treatmentforms, Qtrlyreporting formatsetcTOTAL 15,00,000.00* Please specify items to be printed in this column13. Research and Studies (excluding OR in Medical Colleges):Any Operational Research projects planned (Yes/No)______________________________________(If yes, enclose annexure providing details of the Topic of the Study,Investigators and Other details)Whether submitted for approval/ already approved? (Yes/No)_______________________________Estimated Total Budget____________________________________________263

14. Medical CollegesActivityAmountpermissibleas pernormsEstimatedExpenditure forthe nextfinancialyear(Rs.)Justification/remarks(a) (b) (c)Contractual Staff: MO-Medical College(Total approved instate ___ ) STLS in MedicalColleges (Total no instate ___ ) LT for MedicalCollege (Total no instate ___ ) TBHV for MedicalCollege (Total no instate___)Research and Studies: Thesis of PGStudents OperationsResearch*Travel Expenses forattending STF/ZTF/NTFmeetingsIEC: Meetings and CMEplannedEquipment Maintenance atNodal Centres* Expenditure on OR can only be incurred after due approvals of STF/STCS/ZTF/CTD (as applicable)264

15. Procurement of Vehicles:EquipmentNo.actuallypresentin thestateNo. plannedforprocurementthis year(only ifpermissibleas pernorms)EstimatedExpenditurefor the nextfinancialyear forwhich plan isbeingsubmitted(Rs.)Justification/remarks(a) (b) (c) (d)4-wheeler**142-wheeler 13** Only if authorized in writing by the Central TB Division16. Procurement of Equipment:EquipmentNo.actuallypresentin thestateNo.plannedfor thisyear(only aspernorms)EstimatedExpenditurefor the nextfinancial yearfor which planis beingsubmitted(Rs.)Justification/remarks(a) (b) (c) (d)Computer 15Photocopier 15Fax Machine 15OHP 12LCD 1265

Section D: Summary of proposed budget for the state – ArunachalPradeshBudget estimate for thecoming FY 2009 - 2010Category of Expenditure(To be based on the plannedactivities and expenditure inSection C)1. Civil works Rs. 11,84,400.002. Laboratory materials Rs. 12,00,000.003. Honorarium Rs. 9,00,000.004. IEC/ Publicity Rs. 30,90,000.005. Equipment maintenance Rs. 4,92,000.006. Training Rs. 22,40,000.007. Vehicle maintenance Rs. 22,15,000.008. Vehicle hiring Rs. 9,28,200.009. NGO/PP support Rs. 24,58,000.0010. Miscellaneous Rs. 40,00,000.0011. Contractual services Rs. 78,60,417.0012. Printing Rs. 15,00,000.0013. Research and studies Rs. 0.0014. Medical Colleges Rs. 0.0015. Procurement –vehicles Rs. 0.0016. Procurement – equipment Rs. .00Grant Total as per Tribal Action Plan Rs. 2,80,68,017.00** Only if authorized in writing by the Central TB DivisionConsolidated District IEC Action Plan for 2009-10Outdoors:- wall paintings- Hoardings- Tin plates- Banners- othersOutreach activities:- Patient providerinteraction meetings- Community meetings- Mike publicityAmount peractivityRs. 500.00Rs. 5,500.00Rs. 500.00Rs. 500.000.00@ Rs. 1000.00@ Rs. 1000.00@ Rs. 1000.000.00Total No.90601001001505226Total CostRs. 45,000.00Rs. 3,30,000.00Rs. 50,000.00Rs. 50,000.000.00Rs. 1,50,000.00Rs. 52,000.00Rs. 26,000.000.00- OthersPuppet shows/ streetplays /etc.School activities Rs. 1000.00 150 Rs. 1,50,000.00266

Print publicity- Posters- Pamphlets- Others(Pocket Calendar / WallCalendar/ Car Stickeretc)Media activities onCable/local channelsRadioAny other activity :Rs. 5000.00 39 1,95,000.00(Advertise onmagazines)Sensitization meetings Rs. 1,000.00 52 Rs. 52,000.00Media activities Rs. 1,000.00 52 Rs. 52,000.00Power pointPresentations / one toone interactionInformation Booklets/brochuresWorld TB Day activities Rs. 40,000.00 13 Rs. 5,20,000.00Any other public event /- CMEs- Interaction meetings- one to oneinteraction meetings- Information Booklets- Any other (Exhibitionstool)CommunicationFacilitators (each for 5-6districts)Rs. 15,000.00Rs. 1,000.000.0044Rs. 60,000.00Rs. 4,000.000.00Rs. 10,000.00 26 Rs. 2,60,000.00Grant total Rs.Rs.19,96,000.00Justification for Annual Action Plan 2009-101. Civil WorksPropose IRL and propose 2 (two) nos. of TU, namely TU at Bamengunder DTC Seppa and TU at Namsai under DTC Tezu2. Laboratory MaterialThere is increase in the cost of Lab Material and also rate of thearticles of Lab. Material is much higher in this state then other localitiesin the countries. Since, there are high cost of transportation involved.3. Miscellaneous267

Miscellaneous expenditure involves the TA/DA of the officers andstaffs, telephone bills, fax bill, office stationeries, contingencyexpenditure like transportation of drugs GMSD Guwahati to SDS andfrom SDS to districts etc. on account of high transportation cost andcontingency expenditure in this state, the miscellaneous expenditure ismuch higher.4. PrintingPrinting charge for modules of MOs, STS, STLS, LTs, pamphlets,booklets, TB Register, Lab, Register, Treatment card, Refer form etc atstate level etc. at state level.5. Contractual Services.1. 2 nos. of new STS and STLS for proposed TUs are to beappointed.2. 1 no of Microbiologist for IRL to be appointed.3. 2 nos. of LTS for the proposed IRL to be appointed.4. 1 no of Pharmacist for SDS to be appointed.5. 3 nos. of IEC Facilitators to be appointed for the state.268

RNTCP ADDITIONAL SECTION UNDER NRHM FOR THE YEAR 2009-101. CIVIL WORKOne time cost for up-gradation of IRLs to perform solid cultureand drugs sensitivity testing for diagnosis of MDR-TBa. Back up Generator for un interrupted electricitysupply 15 KVA Rs. 10,39,500.00b. Cold room for IRL Rs. 15,51,000.00c. Incubation room for IRL Rs. 25,00,000.00d. Up-gradation for indoor facility for designatedDOTS plus site. Rs. 10,00,000.002. MISCELLANEOUSTravel cost for MDR-TB Patients and one attendant for visit forDOTS plus site.Rs. 5,00,000.003. IEC ACTIVITESOUTDOOR Amount per activities Total No.Total Cost .Wall Painting Rs. 1,000.00 100 Rs.1,00,000.00Hoarding big size with Iron frame Rs. 6,500.00 51 Rs.3,31,500.00Community meeting Rs. 1,500.00 50 Rs.75,000.00Grand Total Rs. 70,97,000.00269

National Programme Control of Blindness.PIP OF NPCB 2009-10Physical Target & other activities under NPCB for the year 2009-101. CATARACT OPERATION GOI TARGET2000Special drive of Cataract operation camp will also be organizedin all the districts for attaining the target over & above fixed facilitysurgeries.2. School Eye Screening Target set up by GOIa) No. of Students to be screened 15,000b) Children to be detected withrefractive errors 1000c) Free Spectacles to be provided 300Free spectacles will be provided to all the children detected withrefractive errors.3. Infrastructure Development Targeta) Strengthening of District Hospital 2 No.b) Sub-District Hospital 1 Nos.c) Vision Centre 10 Nos.d) Eye-OT cum Eye-Wings 3 Nos.e) Mobile Ophthalmic Unit 1 No.with tele-Ophthalmologyf) Eye bank 1 No.g) Contractual Ophthalmic manpower 20 Nos. PMOA &3 Nos. OS.4. Participation of NGORKM Hospital, a NGO Hospital has been nominated to provide afund from GOI for development of eye-care facilities service. For thispurpose Rs. 12.50 lakhs has been sanctioned in 2008-09 as a firstinstallment and a provision of Rs. 17.50 lakhs is provided in the PIP forthe year 2009-10 for the second installment.270

5. TrainingIn-service refresher training will be given to the followingcategories1) Eye-Surgeon,2) I/C M.O., PHC3) Ophthalmic Asstt.4) Staff Nurse5) O.T. Technician6. Commodity AssistanceSophisticated eye-equipments are provided to the DistrictHospitals of the state alongwith consumable items like 10/0 sutures &IOL .7. IECPublic awareness about prevention & timely treatment of eyediseases are done through news-paper advertisements, installation ofhoarding, wall-writing, posters, pamphlets, Radio Jingles over AIR etc.8. Human Resource DevelopmentProposal for new Contractual appointment of OphthalmicAssistants (20 Nos.) against 20 Nos. of vision centre alreadydeveloped & Eye-Surgeon(3 Nos.) against two new District Hospital &one sub District Hospital have been made and some sanction of salaryfor this has already been made by the GOI.This man-power is to be continued during 2009-10. Post ofcontractual grief counselor will be proposed for the four eye donationcentres already created.9. Associate Activities1) Members of Gaon Panchayet will be approached for their cooperationtowards eye-care activities to the village-level.2) Help of Anganwadi works will be taken for bringing villagers sufferingfrom eye-ailments, necessary steps will be taken.3) ASHA’s are being trained for NPCB activities by DBCS & will beutilized for identifying motivating & bringing cataract patients to cataractsurgical facilities.10. Monitoring Indicators under NPCBa) No. of Cataract operationb) School Eye Screening performancec) No. of Eye collection.271

FINANCIAL IMPLICATION OF PIP-2009-10Rs, in lakhHead1. Salary & Honorariuma) Salary----------------------b) Honorarium -------------PhysicalAccounts officer - 1NoData Entry Operator - 1 NoAdministrativeAssistant-1NoFinancial1.560.780.662. Stationery -----------------Cost of Statinery articles- 0.753. Office expenses------ ----------------------------------- 0.60----4. Miscellaneous - - - - - 0.75expenses5. POL Expensess 1No Vehicle-AR-01’C’-3280(cost of diesel,Mobil B.oiletc) 1.006.Maint of officeEquipments & Vehicle2NosComputer,1NoFax,1No Xerox,2NosTelephone & 1No Vehicle. 1.507. Traveling expenses - - - - - - - - - - - 1.008. Training - - - - - - - - - - - 2.709. Contigenciesa) Telephone Postage & - - - - - - - - - - - 0.80Faxb) Refreshment - - - - - - - - - - - 0.05c) Bank charges - - - - - - - - - - - 0.02d)Consumable - - - - - - - - - - - 0.10e) Others - - - - - - - - - - - 0.50272

HEAD PHYSICAL FINANCIAL10. School Eye Screening of School 4.80ScreeeningChildren in all theDistricts(16 Districts)@Rs,30,000/-11. Eye Bank - - Establishment of 1No Eye 10.00-Bank12. Strengthening of17.50Eye-care facilities inNGO Sector (Ongoing)13. I. E. C. 8.0014. Dark – room forVision CentreConstruction of new 20Nos Dark room in 20 Nosvision centres @ 1.5 lakhseach.15. Fund for DBCS Installment of funds for16Nos Eye Socities @5.0lakhs for each DBCS.16. Eye ward and EyeO.T.17. Eye Donationcounselors18. OphthalmicAssistants on Contractbasis (on going)19. OphthalmicSurgeon on Contract(on going)30.0080.00New construction of Eye –ward and Eye O.T.-= 2Nos@ Rs,75.00 lakhs each 150.004 No @ 10.000 P.M. 4.8020 Nos contractual basisOphthalmic Assistant@Rs,8000/-PM19.203 Nos Contractual basisEye Surgeons @25,000/- 9.0020.CommodityFor purchase ofAssistancesSophisticated Eye 60.00equipments for Districts21. Fund for Special 16 D. B. C. S.@ 16.00driveRs,1,00,000/- Each.Total 422.07273

ARUNACHAL PRADESHNATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMMEState Action Plan – 2009-10A. Status of Health facilitiesS.Health facilityNoNo1 District Hospital 142 Block PHC 853 Add PHC/ Mini PHC 284 Sub centre 3825 Villages 38636 FTD 6157 ASHA 31758 Rapid response team formed (yes/no) Yes9 Population 1304123B. Human ResourceS.NoHealth facility Sanctioned In Place Trained1 *DMO (Full Time) 16 16 162 District Malaria Officer 03 03 033 AMO 9 9 94 MO 560 560 3805 Lab Technician 19 19 196 Lab Technician 11 11 11(contractual)*7 Health Supervisors (M) 308 308 3088 Health Supervisors (F) - - -9 MPW (M) - - -10 MPW (M) 200 200 173(contractual)#11 MPW (F) - - -12 Malaria Technical 15 15 15Supervisor(contractual)*13 ASHA 3862 3175 2962* DMO= District Medical Officer* GFATM/World Bank# Applicable to state that have been sanctioned.274

GFATM States (Arunachal Pradesh):-State PMUSanctioned In PositionConsultant M&E 1 no. 1 no.Project Director/ Programme Officer 1 no. 1 no.Finance Consultant 1 no. 1 no.IEC Consultant 1 no. 1 no.Data entry operator 1 no. 1 no.Secretarial Assistant/Accountant 1 no. 1 no.275

C. District wise Epidemiological Situation:Districts Population Year BSC BSP PV PF ABER API SPR SFR AFI DEATHDue toMalariaTirap 100227 2003 27650 1771 1614 71 27.59 17.67 6.41 0.26 0.71Tirap 100227 2004 20577 1361 1248 41 20.53 13.58 6.61 0.20 0.41Tirap 100227 2005 20294 1558 1437 38 20.25 15.54 7.68 0.19 0.38Tirap 100227 2006 25331 2230 2014 216 25.27 22.25 8.80 0.85 2.16 57Tirap 100227 2007 25323 2477 2029 309 25.27 24.71 9.78 1.22 3.08Changlang 124994 2003 37363 5517 3672 1794 29.89 44.14 14.77 4.80 14.35Changlang 124994 2004 29746 4687 3004 1619 23.80 37.50 15.76 5.44 12.95Changlang 124994 2005 25340 2600 1588 986 20.27 20.80 10.26 3.89 7.89Changlang 124994 2006 33360 4144 1924 2215 26.69 33.15 12.42 6.64 17.72 3Changlang 124994 2007 27930 2197 1040 1121 22.35 17.58 7.87 4.01 8.97Lohit 143478 2003 44185 5928 4398 594 30.80 41.32 13.42 1.34 4.14Lohit 143478 2004 31599 3974 3004 938 22.02 27.70 12.58 2.97 6.54Lohit 143478 2005 40610 4327 2452 1811 28.30 30.16 10.66 4.46 12.62 2Lohit 143478 2006 44298 5242 3235 2007 30.87 36.54 11.83 4.53 13.99 14Lohit 120936 2007 39641 4874 3022 1747 32.78 40.30 12.30 4.41 14.45 4L/D/Valley 51305 2003 33150 4391 3794 594 64.61 85.59 13.25 1.79 11.58L/D/Valley 51305 2004 22880 2465 2299 166 44.60 48.05 10.77 0.73 3.24L/D/Valley 51506 2005 23928 1938 1805 130 46.46 37.63 8.10 0.54 2.52 9L/D/Valley 51752 2006 34893 4201 3883 318 67.42 81.18 12.04 0.91 6.14 4L/D/Valley 50117 2007 33374 4773 4445 328 66.59 95.24 14.30 0.98 6.54 7East Siang 87430 2003 53521 9556 8565 795 61.22 109.30 17.85 1.49 9.09East Siang 87430 2004 46560 7193 5908 1087 53.25 82.27 15.45 2.33 12.43

East Siang 87430 2005 60538 8213 6183 1879 69.24 93.94 13.57 3.10 21.49East Siang 87430 2006 51604 8538 5714 2824 59.02 97.66 16.55 5.47 32.30 14East Siang 87430 2007 46734 7002 4549 2174 53.45 80.09 14.98 4.65 24.87 8West iang 103575 2003 31078 3852 3821 31 30.01 37.19 12.39 0.10 0.30West Siang 74595 2004 26229 7969 7965 4 35.16 106.83 30.38 0.02 0.05West Siang 103575 2005 24890 4409 4055 119 24.03 42.57 17.71 0.48 1.15West Siang 103575 2006 21080 3572 3557 15 20.35 34.49 16.94 0.07 0.14West Siang 103575 2007 16405 3898 3829 69 15.84 37.63 23.76 0.42 0.67Papum2003Pare 12175023036 1863 1206 644 18.92 15.30 8.09 2.80 5.29Papum2004Pare 12175019166 1108 922 181 15.74 9.10 5.78 0.94 1.49Papum2005Pare 12175032564 4685 3665 927 26.75 38.48 14.39 2.85 7.61Papum502006Pare 12175041286 6314 3913 2401 33.91 51.86 15.29 5.82 19.72Papum172007Pare 12175032611 3418 2514 901 26.79 28.07 10.48 2.76 7.40U/Subansiri 54995 2003 8042 264 259 4 14.62 4.80 3.28 0.05 0.07U/Subansiri 54995 2004 5728 159 158 1 10.42 2.89 2.78 0.02 0.02U/Subansiri 54995 2005 12220 920 845 75 22.22 16.73 7.53 0.61 1.36U/Subansiri 54995 2006 7955 1215 1074 142 14.46 22.09 15.27 1.79 2.58 5U/Subansiri 54995 2007 3763 721 602 113 6.84 13.11 19.16 3.00 2.05L/Subansiri 97614 2003 2056 117 109 6 2.11 1.20 5.69 0.29 0.06L/Subansiri 97614 2004 2335 159 144 12 2.39 1.63 6.81 0.51 0.12L/Subansiri 97614 2005 3151 129 125 3 3.23 1.32 4.09 0.10 0.03L/Subansiri 97614 2006 2362 142 136 5 2.42 1.45 6.01 0.21 0.05L/Subansiri 54082 2007 2513 142 142 0 4.65 2.63 5.65 0.00 0.00East 57065 2003 5186 932 886 36 9.09 16.33 17.97 0.69 0.63277

KamengEast2004Kameng 57065617 105 97 6 1.08 1.84 17.02 0.97 0.11East2005Kameng 570655776 1739 980 449 10.12 30.47 30.11 7.77 7.87East442006Kameng 570658739 3057 1855 1202 15.31 53.57 34.98 13.75 21.06East2007Kameng 570656309 1786 756 638 11.06 31.30 28.31 10.11 11.18W/ Kameng 74595 2003 2818 125 116 9 3.78 1.68 4.44 0.32 0.12W/ Kameng 74595 2004 1534 60 56 4 2.06 0.80 3.91 0.26 0.05W/ Kameng 74595 2005 3482 198 140 57 4.67 2.65 5.69 1.64 0.76W/ Kameng 74595 2006 5154 454 262 192 6.91 6.09 8.81 3.73 2.57 5W/ Kameng 74595 2007 4040 241 117 117 5.42 3.23 5.97 2.90 1.57Upper2003Siang 331466902 500 500 0 20.82 15.08 7.24 0.00 0.00Upper2004Siang 331466302 609 0 0 19.01 18.37 9.66 0.00 0.00Upper2005Siang 331466190 499 499 0 18.67 15.05 8.06 0.00 0.00Upper2006Siang 331461400 124 124 0 4.22 3.74 8.86 0.00 0.00Upper2007Siang 331464232 453 453 0 12.77 13.67 10.70 0.00 0.00U/D/Valley 7426 2007 961 41 9 7 12.94 5.52 4.27 0.73 0.94K/Kumey 43532 2007 93 29 23 4 0.21 0.67 31.18 4.30 0.09Anjaw 22542 2007 752 19 7 11 3.34 0.84 2.53 1.46 0.49278

Sl.NoC2. High Risk Areas:NameDistrictofHigh riskPHCs(No)High riskSubcentre(no)High riskVillage(no)High riskPopulation (no)TribalPopulation(no)1 Tirap 6 21 167 91298 824472 Changlang 5 16 149 90941 809313 Lohit 4 11 60 95226 852264 Upper Dibang1 2 12 6230 5150Valley5 Lower Dibang5 9 119 54698 41083Valley6 East Siang 19 27 144 78698 751147 West Siang 6 14 134 95114 893348 Upper2 19 128 49632 48439Subansiri9 Lower2 6 57 45439 38400Subansiri10 Kurung Kumey 4 3 46 46406 4517311 Papum Pare 9 27 152 47242 4076312 East kameng 3 13 145 46767 4381513 West Kameng 2 9 113 43815 3808314 Upper Siang 4 13 92 29670 2765015 Anjaw - 6 16 15640 13576S.NoTotal 71 187 1534 =836816 =755184C3. The areas as per following API rangesAPI District (No) PHCs(No)Subcentre(No)Villages(No)Population @Village(No)%population of State1 95.24 L/D/Valley 6 17 119 428 4.632 80.09 East Siang 16 22 144 607 10.013 40.13 Lohit 9 27 193 257 8.134 37.63 West Siang 11 33 198 260 6.315 31.30 East Kameng 2 25 210 184 7.146 28.07 Papum Pare 6 35 197 456 8.127 24.71 Tirap 6 31 167 600 13.028 17.58 Changlang 10 24 189 372 12.759 13.67 Upper Siang 5 13 92 360 4.2510 13.11 Upper Subansiri 11 29 118 138 7.0711 5.52 U/Dibang Valley 1 7 94 79 0.6

12 3.23 West Kameng 6 24 92 351 2.4813 2.63 Lower Subansiri 6 28 43 103 3.3114 0.84 Anjaw 1 12 46 194 2.0015 0.67 Kurung Kumey 6 34 129 338 3.96D. GIS mapping (Based on epidemiological data for the year 2007 foridentified 61 high endemic districts) List attached.• Status of village wise data entry of the districts of Papum Pare andKurung Kumey in GIS format for identified high endemic districts.E. Outbreak: Yes/ no if yes;• No of outbreaks :- Nil• Area affected :- Nil• Period of outbreak :- Nil• No of deaths reported during outbreak :- Nil• Reasons for outbreak :- Nil• Containment measures taken :- NilF. Specific activities:Total:- 102 361 2031a. RD Kits (selected Pf endemic districts only)Sl.No.DistrictName1 TirapPlanning for distribution of Rapid Diagnostic Kits 2009-10 which wasallocated in 2008-09 (Quantity as per allocation in Annexure)RDTs tobedistributed in2009-10PHCs ininaccessible areas(No)Subcentreininaccessibleareas(No)Villagesininaccessibleareas(No)Population atVillagesininaccessible areas(No)SlideCollectionininaccessible areas(No)4 12 148 56298 75962 Changlan3 16 168 60941 8379g3 Lohit 4 19 196 75226 132894 U/Dibang1 2 13 2230 NilValley2 lakhs5 L/Dibang5 19 189 31083 6674Valley6 East14 29 178 58698 14020Siang7 West3 24 184 65114 4921Siang8 Upper2 19 163 39632 NilSubansiri9 Lower 2 9 157 30439 502280

Subansiri10 Kurung4 13 146 30406 NilKumey11 Papum7 27 152 45242 6522Pare12 East3 13 195 36767 630kameng13 West2 13 113 13815 Nilkameng14 Upper2 13 98 25670 NilSiang15 Anjaw 2 6 36 13640 Nil58 234 2185 585201 62533Requirement of Rapid Diagnostic Kits based on epidemiological data of 2007 for2010-11S.No.DetailsSubcentre(no)Village(no)TotalPopulationTribalPopulationSlideCollection1 Areas with high Pf % 234 2185 585201 585201 1500002 Of the above prioritizedto be equipped withRDT during the year3 No of RDTs Required for2010-11all all all2 lakhs• Planning for RDTs is to be done based on the ABER & expected noof Malaria Cases. Of the Malaria cases 50% are expected to be Pf;of the Pf cases 50% are expected to be in remote inaccessibleareas – where RDTs are to be used.• Villages planned to be equipped with RDTs should have trainedASHAb) Areas for supply of ACTA. Planning for distribution of ACT 2009-10S.No.Details1 Districtsidentified forroll out of ACT2 Clusters ofPHCs aroundPf resistancefociNos.12districtsTotalPopulationPf casesreported inpreviousyearACTBlisters(foradult)ASTabs(forchild)SPTabs(forchild)989725 7539 4000 4000 4000PF resistance study not done and identified281

c) BednetsAll planning should be based on enumeration of bednets inhouseholds by Bednet SurveyANameofDistrictEligibleS/C(Nos)EligibleVill(Nos)EligiblePop.Planning for distribution of BednetsTotaNo.lof TotaldistHou BednHouseribuseho etsholdstedld requirNo.tillwith eddatebed Nos.Nosnets.TribalPop.1 Tirap 21 148 9129882447 22845 25002 Changl 24 168 9094 80931 20232 3300ang13 Lohit 27 196 9522 85226 23806 280064 U/Diba 7 13 6230 5150 1557 330ngValley5 L/Diba 17 189 5469 41083 13674 2300ng8Valley6 East 22 178 7869 75114 19674 2500Siang87 West 33 184 9511 89334 23778 2400Siang8 UpperSubansiri9 LowerSubansiri10 KurungKumey11 PapumPare12 Eastkameng13 Westkameng429 163 4963228 157 4543934 146 4640635 152 5224225 195 5176724 113 43815AB48439 12408 200038400 11359 180045173 11601 230040763 13060 470043815 12941 250038083 10953 1300C=Ax24569040464476123114273483934847556248162271823202261202588221906D800010000850010007000800075006000500070001450080004000TotalintactbednetstablebelowNos.Totalplanned tobedistributedin the yearas perallocation inAnnexure(Nos)ITNs LLITotalplannedtobetreatedEF G E+F11524 22845 2284 3435 6912652 20232 2023 3282 8413254 23806 2380 3706 60872 1557 1557 24298453 13674 136749528 19674 1967414632 23778 237787584 12408 124087214 11359 113597068 11601 116017152 13060 130609362 12941 129418204 10953 1095322127292023841088248349822884581065619157282

14 UpperSiang13 98 3067015 Anjaw 12 36 1564036 218 84781 5 1627650 7667 154013576 3910 18675518420946532456153347820=41893050005324 7667 7667 12991500 2306 3910 3910 6216100 12512 20946 2094 279000 9 5 65 360NB: 2 nets per household; Avg size of household to be taken as 5IRS:-Planning for IRS: Please specify criteria for selection of areas for(Specify whether the unit of planning is village / sub centre.Mention the cut off used for API, Pf% deaths for selection ofareas; whether MAP criteria has been applied)Population projected for IRS 2009-10 based on map criteria. Theunit selected for spray Sub-Centres.S.No1234District/PHCSelectedforIRSTirapChanglangLohitU/Diban(Base the planning for IRS on epidemiological data)SprayTraisSuningqb Totas Equucen Villa l Trib batc ipmatre ge Pop al hes entdsel sele ulati Pop of reqsect cted on ulati spra uirereed (no) sele on y dq(no ctedsqu (no)ui)adsre(no)d(no)PHCs(No)SelectedforIRS6 21 1648 24 2938 25 2271 6 27109049124994132287230072447809316522621501030pumps10 30 “10 30 “1 3 “NameofinsecticideDDT50%Insecticiderequired(MTs)DDT16MT16MT17MT(U/DVallMalathion500Litres500litres500litresSP283

567891011121314gValleyL/DibangValleyEastSiangWestSiangUpperSubansiriLowerSubansiriKurungKumeyPapumPareEastkamengWestkamengUpperSian5 12 559 22 1726 40 3726 23 2916 31 825 33 1589 43 2004 31 2076 34 1224 14 92509178743010357554995540824353269617570657459534375370835569865114393342843935400451733976333815236506 18 “10 30 “10 30 “10 30 “7 21 “10 30 “10 30 “9 27 “7 21 “5 15 “ey tobeprovidedbyL/D/Valley)10MT17MT17MT8MT7MT8MT17MT7MT5MT5MT500litres500Litres500Litres284

1516S.NogAnjawNaharlagun1 13 371 5 18Total:- 85 382District/ PHCSelected forIRSPHCs(No)SelectedforIRSSubcentreselected(no)25172254284411029796Villageselected(no)1 Tirap 6 21 1642Changlang8 24 2933 Lohit 8 25 2274U/DibangValley135768441637799TotalPopulationselected1090491249941322872 6 “2 6 “119TribalPopulation724478093165226Spraysquadsrequired(no)10357PumpsTrainingsbatchesofspraysquads(no)(AnjawtobeprovidedbyLohit)(NaharlaguntobeprovidedbyP/Pare)150MTEquipmentrequired(no)30pumps10 30 “10 30 “1 6 27 2300 2150 1 3 “3MTNameofinsecticideDDT50%DDT16MT16MT17MT(U/DValley tobeprovidedInsecticiderequired(MTs)Malathion500Litres500litres500litresSP285

567891011121314L/DibangValleyEastSiangWestSiangUpperSubansiriLowerSubansiriKurungKumeyPapumPareEastkamengWestkamengUpperSiang5 12 559 22 1726 40 3726 23 2916 31 825 33 1589 43 2004 31 2076 34 1224 14 9215 Anjaw 1 13 3716Naharlagun5091787430103575549955408243532696175706574595343752254237083556986511439334284393540045173397633381523650135766 18 “10 30 “10 30 “byL/D/Valley)10MT17MT17MT10 30 “ 8 MT7 21 “ 7 MT10 30 “ 8 MT10 30 “17MT9 27 “ 7 MT7 21 “ 5 MT5 15 “ 5 MT2 6 “1 5 18 8441 8441 2 6 “Total:- 85 382 25171029796637799119357Pumps(Anjaw tobeprovidedbyLohit)(Naharlagun tobeprovidedbyP/Pare)150MT500litres500Litres500Litres3MT286

N.B. Details of Micro planning for Spray squads to be done as per tablesin Appendix 1 and summated above• Associated activities for IRS:- Specify what IEC activity will be carried out for sensitization &mobilization of community for Spray also in also in advance informationregarding spray dates operations: Yes- Supervision Plan: within the PHC and from district level (Sub centre/village wise) Supervision Plan with village level date of spray andSC/PHC district level supervision. (Yes)- Selection of sites for dumping insecticides completed? Site selected- Whether safeguards for storage & handling of insecticides ensured?Yes- Certification on functional status of equipment by DMO by day/ mth/ yr.It shall completed by Jan’2009- Spare parts of spray equipments like lance available -Yes- Provision of protective gear for spray workers present- Yes- No of functional stirrup pumps? – 242 No required - 100- No required to be repaired 70 nos.- Certification by panchayat for coverage of IRS – to be planned inJan’09.G. InnovationsSl.InnovationsNo.1 Patient referral Eg.Like use of NRHM/RKS flexi funds fortransport of severecases2 Transportation ofslidesEg. Use of Publictransport system3. NGO/CBOinvolvement4. Communitymobilization287Describe detailsTransportation for referred cases.a) Per patient from road side Rs. 350/-b) from interior villages per patient Rs.500/-For each slide transportation and collection ofreport within 48 th hours, Rs.5/- each slides.Outsourcing of training for ASHAs practicedEducation Department will be involved forEssay competition/Debate in schoolsYouth Organization used for IEC campaign.

H. Others: Specify any other planning to be untakenI. Commodity RequirementRequirement for Balance NetPrevious year’scurrent year Available requirementItem utilization (no)(no)(no) (2-3)1 2 3 4Insecticide For IRS 150 MT 160 MT Nil 160 MT(Kg)Insecticide For ITMN 7277 8000 Nil 8000(Lts)ITNs 1,00,000 3,00,000 Nil 3,00,000Chloroquine (No.) 21,17,000 10,00,000 2,00,000 10,00,000Primaquine 2.5 (No.) 8,00,000 8,00,000 Nil 8,00,000Primaquine 7.5 (No.) 93,000 8,00,000 Nil 8,00,000ACT ( Artesunate 2300 8000 Nil 8000+SP) Blister (No.)Artesunate tabs22500 51000 Nil 51,000(No.)S+P CombinationNil 10000 Nil 10,000(No.)Quinine Injection 46030 55000 Nil 55,000(No.)Quinine SulphateNil 2,00,000 Nil 2,00,000(No.)Arteether Inj (No.) 2236 25000 Nil 25,000RDK (No.) 181000 2,00,000 3000 2,00,000Micro Slides (No.) Nil 3,00,000 Nil 3,00,000Pumps (No.) Nil 200 Nil 200MicroscopeNil 85 Nil 85(binocular) for everyPHCBlood Lancets Nil 3,00,000 Nil 3,00,000288

S.NoJ. Training: mention number of batches to be trainedTrainingsCostperBatchPrevious year(no)Current yearQ1 (no) Q2 (no) Q3 (no) Q4 (no)Total(no)TotalCost (Rs)1 Medicalspecialistsat DistrictHospital2 MedicalOfficers1.2 4 2 1 1 1 5 6.003 LaboratoryTechnicians 0.76 3 1 1 1 - 3 2.28(induction)4 LaboratoryTechnicians(reorientatio0.76 7 2 2 - - 4 3.04n)5 HealthSupervisors 0.20 16 16 4 - - 16 3.20(M)6 HealthSupervisors 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00(F)7 HealthWorkers (M)0.20 16 12 4 - - 16 3.208 HealthWorkers (F)0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.009 ASHA 0.15 64 30 34 - - 64 9.6010 CommunityVolunteersother than0.30 10 10 - - - 10 3.00ASHA11 Ento. Asstt. 0.30 5 5 - - - 5 1.512 LT/MTS 0.76 1 1 - - - 1 0.76Total 124 32.58289

S.NoBCC/ IEC: mention number of eachActivitiesUnitCost(Rs)Previousyear (no)Current yearQ1 (no) Q2 (no) Q3 (no) Q4 (no)Total(no)TotalCost (Rs)A.PrintMedia1 Posters 19 100000 50000 50000 50000 50000 200000 38.002 Hoardings/Glow sign 8320 100 100 100 100 300 24.96board3 Newspaperadvertisem 10000 30 10 15 5 5 35 3.50ent4. VariousPamphlets12 150000 100000 100000 50000 50000 300000 36.005. Sticker 13 60000 50000 50000 50000 50000 200000 26.006. WallHanging65 25000 15000 10000 10000 5000 40000 26.007. Variousguidelines150 8000 5000 5000 5000 - 15000 22.508 Calendar 180 3000 - - - 3500 3500 6.30B. ElectronicMedia4 TVcampaigns5 RadiocampaignsC. Community level6 Healthcamps7 Villagelevelawarenesscamps forIRS8 Others(specify)a.advocacywoskshop&intersectoralmeetings150000 2 2 - - - 2 3.0020000 6 5 5 2 - 12 2.402000 430 1280 - - - 1280 25.60Variousrates- 31.54290

K. PPP involvementS.No.Schemes1 Scheme Ia. Provision ofEDPT for thepopulation of PHCsin high risk areas.Previous year(no)-Planned inCurrent year (no)40 nos. @ Rs. 0.11eachCost4.40b. In Urban sector2 Scheme IIMicroscopy andtreatment centres-3 nos. @ Rs. 3.07lakhs each9.21- 7 nos. @ Rs. 0.312.17each3 Scheme III - - -4 Scheme IVITBN (Communityowned anddistributed)a. In High riskvillages/PHC wise)b. Urban Sector5 Promotion of use ofLarvivorous fishScheme VIIRS (2 rounds)6High risk Sub -Centres----40 nos. @ Rs. 0.19each3 Nos. @ Rs. 4.43lakhs each7.6013.2959 nos. 10.9359 Nos. @ Rs. 0.25each14.75Total 62.35K. Larvivorous Fish291

L. Do a SWOT analysis of the districts as below:-S.No.DistrictHatcheriesSeasonalwaterbodiesPerennialwaterbodiesWaterbodiesreleasedwith fishpreviousyear (no)PlannedinCurrentyear (no)Cost1 Pasighat - Plenty Plenty 7 20 3.702 Tezu - Plenty Plenty - 5 0.933 Roing - Plenty Plenty 4 10 1.854 Ziro - Plenty Plenty - 7 1.305 Changlang - Plenty Plenty - 5 0.936. Papum Pare - Plenty Plenty 5 12 2.22Total 59 10.93Strengths :Training of trainers (TOT) includesMOs and LTs are conducted.All MTS and LTs are trained70% of ASHAs are trained.MPWs/Spray team training is goingonWeakness :Actions to be Taken :Reorientation training is furtherrequiredMore messages to be circulated inthe rural populations to disseminateproper knowledge and control ofmalaria through IEC activities tochange their misconceptionsSpray teams are not getting fullcooperation from villagers in IRS.Opportunities :Laboratories to be established ineach PHCsMore Man Power is required.Good quality Binocular Microscope292

for each PHCs is required.Threats :EDPT could not be done in theinterior villages due to shortage ofmanpower.Now this will be done through PPPinvolvementM. Proforma for Urban Malaria SchemeStatus of hatcheries/ up-scaling of Larvivorous fish in the States:-Arunachal PradeshS.NoName ofstates/UTs.1 ArunachalPradesh Capitaltown,(Naharlagun &Itanagar)No. ofhatcheries atDistrictlevelNo. ofhatcheries atBlock/PHC/Village levelNo. ofwaterbodiesseeded4 nos. 4 nos. NilMONTH-WISE EPIDEMIOLOGICAL REPORT FOR THE YEAR 2008Month Wise Epidemiological Report for the Year 2008Arunachal PradeshMonths Population BSC/BSE BSP Pf Pv SPR SFR RT DeathsJan7632 734 151 583 9.62 20.57 710Feb 8734 852 173 679 9.75 20.31 852Mar 10643 1103 210 893 10.36 19.04 1103Apr 13547 1216 254 962 8.98 20.89 1216May105641218385 1987 409 1578 10.81 20.58 1987Jun 27702 2802 755 2047 10.11 26.95 2802 10Jul 32065 4268 997 3271 13.31 23.36 4268 3Aug 31136 4817 1194 3623 15.47 24.79 4817 6Sept 29484 4536 1258 3278 15.38 27.73 4536Oct 25504 3222 526 2696 12.63 16.33 3222293

NovDecTotal 204832 25537 5927 19610 12.47 23.21 25513 19NilGuidelines for preparation of micro action plan for IRSAppendix 1Table 1 Training ProgrammeTraining of Supervisors and Spray SquadsTotal Number TrainingSessions(No)DatesMPWs and otherSupervisorsSpray squads 119VenueTable 1 Spray ProgrammePHC Spray ProgrammeSub-centre village Date of spray Squad No. Dumping sitefor insecticide382 2517 01/04/08 to30/08/08119 YesTable 1 Village wise beat for spray squadsVillage wise Beat of Spray SquadsSquad village Population Date of SprayNo.I Round II Round119 2517 1029796 01/04/08to15/06/0816/06/08to30/08/08294

Expenditure (Financial Performance) – Budget Proposal2008-09(Expenditure)2009-10(Proposed)RemarksMalaria (Rs. In Lakhs)DBS :1. Salary for contractual MPW(Male)84.00 256.32 For 356 nos.2. Operational Expenses (Please specify)a. Equipments & Materials 56.35 70.95Including good qualitybinocular microscope of 85nos. for every PHC and200 nos. of HC PumpsPrimaquine tab, lab articlesetcb. Operational Expenses 36.04 46.003. Spray Wages 43.20 45.004. TA/DA for state & Distcontractual staff63.70 65.005. ASHA incentives 7.10 7.506. ASHA facilitators incentives 0.00 4.007. Training7.a MPW 3.20 4.70For induction as well as reorientation7.b ASHA 10.09 15.00 -do-7.c. Spray Workers 3.60 3.60 Re-orientation training7.d. FTD - -IEC/BCCTraining :-1. Medical Officer 3.60 4.80For 4 nos. batch (induction& reorientation)2. Laboratory Technician 10.64 5.32 For 7 nos. batch3. Health Supervisor 3.20 3.20For 16 nos. i.e. one each inevery district4. Health Workers 3.20 3.20 -do-295

5. ASHA 9.60 9.60Reorientation training2008-09 2009-10Remarks(Expenditure) (Proposed)6. Spray Team 3.00 3.00 Reorientation training7. Entomological Asstt. 1.50 1.50 Reorientation training8. LTs/MTS 0.35 0.00IEC ActivitiesI. Advocacy Workshopa. State Level 0.80 0.80 For 4 nos. workshopb. District Level 2.56 5.12For 4 nos. each in everydistrict.c. PHC Level 7.52 7.52For 2 nos. each in everyPHCd. Town areas 0.52 1.56d. Sub Centre Level 8.71 8.71 For every Sub-Centree. Village Level 6.60 3.67II. Intersectoral Meetinga. State Level 0.48 0.96b. District Level 0.96 1.92c. PHC Level 1.59 1.28III. Health Camps 1.20 2.00IV. Awareness Camp 12.75 18.00For every High RiskvillagesV. News Paper Advert. 3.26 3.50VI. Print MediaPoster, Hoardings,Pamphlets, Sticker, Leaflet,guidelines, TV campaign,Radio etc at State as well asDistrict level.Human Resource (Statelevel) :- Project Coordinator M &E Consultant Finance Consultant IEC Consultant SecretariatAsstt./Accountant Computer OperatorHuman Resource (DistrictLevel)243.05 250.00--3.001.251.200.72GFATM5.046.004.204.201.801.08To enhance thedissemination as how toprevent and control malariain the rural populationthrough NGOs, ASHAs,Health Workers etcConsidering pay revisionand 5% annual incrementin the pay296

MTS LT Accountants11.707.921.8016.3811.092.88Fund required for ProposedAdditional Manpower• MTS 15 Nos. - 16.38• LTs 30 Nos. - 30.24Considering pay revisionand 5% annual incrementin the payTraining2008-09(Expenditure)2009-10(Proposed)Medical Officer 1.20 2.40ASHA/Communityvolunteers- -MTS - 0.76LTs - 0.76RemarksFor 2 nos. batch trainingFor 1 no. of batch (re-orientation)For 1 no. of batch (re-orientation)Planning & Administration 27.75 33.50 For State as well as districtMonitoring & Evaluation : Hiring of Vehicle MTS bike/POLmoney Review MeetingAdditional FundRequirement for ProposedMTS• Motor Bikes 15 Nos.@ Rs. Rs.50,000/- each• POL money for 15nos. Bike @Rs. 2500/-each permonthIEC (Camps for treatment ofbed nets)Operational Expenses fortreatment of bed nets16.728.131.95--19.5011.401.957.504.508.97 10.008.30 12.00Public Private Partnership - 62.35Sub Total : 732.98 1119.64(State as well as District)For Govt. supplied andcommunity owned bed nets297

JEIEC Material - 15.00Training - 3.302 nos. of death case reported in08-09 in Changlang Dist.Sub Total : - 18.30Grand Total 732.98 1137.94298

NATIONAL LEPROSY ELIMINATION PROGRAMMEARUNACHAL PRADESHFOR THE YEAR 2009 – 2010.A. Achievement:• Arunachal Pradesh has 16 (Sixteen) Districts, and haveDistrict Health Society (NLEP) under the control of A.P. StateHealth Society (NLEP), Naharlagun.At present in Arunachal Pradesh there is no high endemicDistrict and presently prevalence rate is 0.44/10,000 Population.All the vertical staff have been integrated with the GHC underNRHM staff since 2005-06.Arunachal Pradesh is at the final stage of elimination ofLeprosy. Therefore, we are giving more importance towards theIEC Activities as well as training of the untrained new entryMedical Officer’s, Health Workers, Lab. Technician’s and ASHAincluding PRI members.• Achievement (Physical) in the Year 2008 – 2009 :(i) New Leprosy Cases Detected (April-Dec’ 2008) = 36(ii) Leprosy Cases released from treatment = 32(iii) No. of Cases under treatment as on 31 st Dec’08 = 56(iv) Present Prevalence Rate = 0.44/10,000Pop.(v) Annual New case detection rate = 2.80/ 100,000 Pop.• Achievement (Financial) in the Year 2008 – 2009 :(i) Fund received from GOI (2008-2009) = 40.53(ii) Fund Utilized during the year upto Dec’ 08 = 38.02(iii) Fund Balance as on 31. 12. 08 = 2.51B. The new initiative Planned :(i) IEC Activities(ii) Early Case Detection and Treatment.(iii) Provide MDT in all Health Centres and providing RCS to thepatient as well as financial aids.(iv) DPMR.(v) Referral.(vi) Patient Welfare.(vii) Training.(viii) NGO’s involve.299

C. Man Power Position :C. State Leprosy Society :SlNo.DesignationRegularStaffContractualStaff1. Jt. DHS (Lep.)/ DDHS (Lep.) 01 -2. AUO (Lep.) 01 -3. Sr. Para Medical Supervisor 01 -4. Statt. Asstt 01 -5. Sr. Para Medical Worker 01 -6. Sr. Health Educator 01 -7. UDC 01 -8. LDC 01 -9. Driver 01 0110. Data Entry Operator - 01D. District H/ Qtr. :SlNo.DesignationRegularStaffContractualStaff1. District Medical Officer 16 -2. SMO 04 -3. Non - Medical Supervisor 10 -4. Para Medical Worker 40 -5. Statt. Asstt. 01 -6. Lab. Technician 02 -7. Smear Technician 01 -8. UDC 04 -9. LDC 04 -10. Gr. IV 09 -11. Computer Operator 01 -12. Driver 03 11(E) Training Plan :(i) 04 (Four days) training for new entrants Medical Officers, including NGO.Total 70 nos. of M.O’s training will be given into 2 Batches during Sept’09& December’09.1 st Batch ( September’ 09 ).TA/ POL. Money 35 M.O. X @ 3000 = 1,05,000/-DA 35 M.O. X @ 405 X 4 days = 56,700/-Honorarium to Faculties Members 3 nos. X @ 500 X 4 days= 6,000/-TA/ POL Money to Faculties 3 nos. X @ 2000 = 6,000/-Banner 2 nos. X @ 2000 = 4,000/-Lunch 50 persons X @ 150 X 4 days = 30,000/-Tea & Snacks 50 X @ 10 X 4 days = 2,000/-Training Materials 45 persons X @ 100 = 4,500/-Total : = 2,14,200/-300

(Rupees Two lakhs fourteen thousand & two hundred) only.2 nd Batch (December ‘ 09 ).TA/ POL. Money 35 M.O. X @ 3000 = 1,05,000/-DA 35 M.O. X @ 405 X 4 days = 56,700/-Honorarium to Faculties Members 3 nos. X @ 500 X 4 days= 6,000/-TA/ POL Money to Faculties 3 nos. X @ 2000 = 6,000/-Banner 2 nos. X @ 2000 = 4,000/-Lunch 50 persons X @ 150 X 4 days = 30,000/-Tea & Snacks 50 X @ 10 X 4 days = 2,000/-Training Materials 45 persons X @ 100 = 4,500/-Total : = 2,14,200/-(Rupees Two lakhs fourteen thousand & two hundred) only.(ii) 04 (Four) days training for new entrants HS & HW (M & F) training will begiven into 03 batches during August’ 09, October’ 09 & December’ 2009.1 st Batch during August’ 2009.TA 30 Persons X @ 500 = 15,000/-DA 30 X @ 150 X 4 days = 18,000/-Honorarium to Faculty Members 3 nos. X @ 500 X 4 days = 6,000/-Training Materials 50 Persons X @ 50 = 2,500/-Banner 2 nos. X @ 2000 = 4,000/-Lunch 40 persons X @ 150 X 4 days = 24,000/-Tea & Snacks 40 X @ 10 X 4 days = 1,600/-Total : = 71,100/- X 3Batches= 2,13,300/-(Rupees Two lakhs thirteen thousand & three hundred) only.(iii) Re-orientation Training of PHC M.O. & M.O. under Special Campaign(a) For 02 (Two) days Re-orientation Training of PHC M.O’s, in eachDistrict 17 M.O’s, 35 M.O. from Capital Complex & NGO’s will begiven in 07 (Seven) batches during June’ 2009 to December’ 2009.Nos. of M.O. =17 M.O. from each District X 16 Districts = 272Nos.Capital Complex & NGO = 35 Nos.Total :- = 307 Nos.1 st Batch During June’ 2009.DA for 35 M.O X @ 405 X 2 = 28,350/-TA/POL Money 35 M.O X @ 1000 = 35,000/-Honorarium to faculty member 4 nos. X @ 500 X 2 days = 4,000/-TA/ POL. Money to faculties 4 X @ 2000 = 8,000/-Training Material 40 X @ 100 = 4,000/-Lunch 50 X @ 150 X 2 days =15,000/-Tea & Snacks 50 X @ 10 X 2 days = 1,000/-Total = 95,350/- X 7 BatchesG/ Total = 6,67,450/-(Rupees Six lakhs sixty seven thousand four hundred& fifty) only.301

(iv) Training to Lab. Technicians for Smear Examination for 04 (four)Days.District Hospital 16 Nos. X 2 Lab. Tech = 18 PersonsTraining conducted during (September’ 2009).DA for 18 persons X @ 150 X 4 days = 10,800/-TA for 18 persons X @ 500 = 9,000/-DA for Faculties 4 Persons X @ 500 X 4 days = 8,000/-Lunch 25 persons X @ 150 X 4 days = 15,000/-Tea & Snacks 25 X @ 10 X 4 days = 1,000/-Training Materials 30 X @ 50 = 1,500/-Total : = 45,300/-( Rupees Forty five thousand & three hundred ) only.(v) Other Categories as per DPMR :Lack of information on referral centre & Reconstructive Surgery. There isno facilities for RCS in Arunachal Pradesh. Hence, General HospitalNaharlagun may be identified as Referral centre for RCS purposes. AnAmount of Rs. 70,00,000/- (Rupees Seventy lakhs) may allotted forprocurement of Surgical Instruments/ Materials etc.Surgical Instruments/ Materials @ 70,00,000/- = 70,00,000/-(Rupees Seventy lakhs) only.( Rupees Eighty three lakhs fifty four thousand four hundred & fifty )only.(vi) Training of ASHA for Half Day.Total ASHA: 3,863 Nos.TA : 3,863 X @ 300 = 11,98,900/-DA : 3,863 X @ 750 = 2,89,725/-Training : 3,863 X @ 70 = 2,70,410/-Lunch & Refreshment : 3,863 X @ 160 = 6,18,080/-Total = 23,77,115/-(Rupees Twenty three lakhs seventy seven thousand one hundred & fifteen)only.Grand Total: (i+ii+iii+iv+v+vi) = 1,07,31,565/-(Rupees One crore seven lakhs thirty one thousand five hundred & sixty five)only.(F) IEC PLAN :(i) Mass Media - T.V., Radio & Press.= Development of Video-Grapyfor creating awareness in local dialect.@ 2000/- minute X 7 days =1,50,000/-= Radio Jingles @ 60,000/- year = 60,000/-302

= Press (Local News Paper) @ 5000 X 16 Nos. X 3 times = 2,40,000/-Total : = 4,50,000/-(Rupees Four lakhs fifty thousand) only.(ii) Out Door Media :Sl Activities Unit Cost per unit Total CostNo.Local Market1. Hoarding 64 @ 16,500 10,56,000/-2. Wall Painting 2,640 @ 400 10,56,000/-3. Bus Panel 32 @ 2,500 80,000/-4. Rallies 16 @ 10,000 1,60,000/-5. Quiz 16 @ 5,000 80,000/-Total : 24,32,000/-(iii) Rural Media :Sl Activities Unit Cost per unit Total CostNo.Local Market1. Folk Shows 320 @ 5,000/- 16,00,000/-2. Health Mela 36 @ 5000/- 1,80,000/-3. Poster (Multi colour) 35,000 @ 14.50/- 5,07,500/-4. Sticker (Multi colour) 35,000 @ 10/- 3,50,000/-5. Folder 3 fold55,000 @ 10/- 5,50,000/-(Multi colour)Total : 31,87,500/-(iv) Advocacy Meeting :SlActivities Unit Cost per unit Total CostNo.Local Market1. IPC Work Shop16 @ 6,000/- 96,000/-(HW & MO’s)2. Meeting with16 @40,000/-Zilla Parishad2,500/-3. Orientation Camp for NGO & 32 @ 2,000/- 64,000/-Mahila Mandals4. IPC Meeting for Influences/ 1360 @ 700/- 9,52,000/-Options Leaders5. Observe Anti-Leprosy Day 17 @1,70,000/-10,000/-6. Observe Independence Day 32 @ 3,20,000/-& Republic Day.10,000/-Total : 16,42,000/-Grand Total : (i+ii+iii+iv) Rs. 77,11,500/-(Rupees Seventy seven lakhs eleven thousand & five hundred)only.303

(G) DPMR PLAN :Splints & Crutches @ 4000 X 16 Distt = 64000/-MCR Foot Wear @ 200 X 60 Persons X 16 Distt. = 1,92,000/-Patient Welfare @ 6000 X 16 Distt. = 96,000/-Welfare allowances for RCSPatients from BPL Families @ 5000 X per Patient = 1,00,000/-Total : = 4,52,000/-(Rupees Four lakhs fifty two thousand) only.(H) Procurement Plan :(i) Supportive Drugs/ @ 15,000 X 16 = 2,40,000/-(ii) Lab. Reagents @ 5,000 X 16 = 80,000/-(iii) Printing of Registers, Forms etc. @ 10,000 X 16 = 1 ,60,000/-(iv) Printing of Registers, Forms etc. (State H/ Q) = 50,000/-Total : = 5,30,000/-(Rupees Five lakhs thirty thousand) only.(I) Contractual Services :Contractual Driver@ 4,500/- P.M. X 12 persons X 12 = 6,48,000/-DEO, H/ Qtr. @ 8,000/- P.M. X 1 X 12 = 96,000/-Honorarium @ 400 P.M. X 15 X 12 = 72,000/-Total : = 8,16,000/-(Rupees Eight lakhs & sixteen thousand) only.(J) NGO Services :• NGO A.P.R.W.C.S, Itanagar was submitted their Action Plan for Rs.56,46,460/- (Rupees Fifty six lakhs forty six thousand four hundred &sixty) only during the year 2008-09 to the GOI and GOI provided Rs.5,00,000/- (Rupees Five lakhs) only accordingly they have been askedto submit the performance report, Utilization Certificate and AuditedReport for the same amount. Hence, Rs. 51,46,460 (Rupees Fifty onelakhs forty six thousand four hundred & sixty) only may be allottedduring the year 2009-2010.(K) Incentive for ASHA :Estimated MB Cases 56 nos. X @ 500 = 28,000/-PB Cases 35 nos. X @ 300 = 10,500/-Total : = 38,500/-(Rupees Thirty eight thousand & five hundred) only.(L) NLEP Monitoring and Review :• A Traveling cost for Contractual staff Driver@ 500 P.M. X 12 nos X 12 mnths = 72,000/-• A Traveling cost for Regular Driver304

@ 500 P.M. X 17 nos X 12 mnths = 1,02,000/-• Review Meeting at State and District Level@ 50,000 X 4 = 2,00,000/-• MDT Supply & Management Cost(Transportation from State H/ Qtr to District) @ 4000 X 16 = 64,000/-Total : = 4,38,000/-(Rupees Four lakhs thirty eight thousand) only.(M) Vehicle Operation and Hiring :State Level :POL money for 2 nos. Vehicle X @ 1,00,000 = 2,00,000/-Maint. 2 nos. vehicle X @ 50,000 = 1,00,000/-District Level :POL/ Maint for 14 nos. Vehicle X @ 50,000 = 7,00,000/-• Requirement for hiring at State Level 1 no.X @ 25,000 P.M. = 3,00,000/-Requirement for hiring at District Level16 nos. X @ 25,000 P.M. = 48,00,000/-Total : = 61,00,000/-(Rupees Sixty one lakhs) only.(N) Office Expenses and Consumables :• (i) Office Expenditure :SLS @ 2,30,000/ year for Telephone, electricity,Maint XEROX, FAX Computer etc. = 2, 30,000/-DLS @ 20,000/- year X 16 Districts for Telephone,electricity, Maint XEROX, FAX Computer etc. = 3,20,000/-Total : = 5,50,000/-Total : (F+G+H+I+J+K+L+M) = 1,40,70,960/-(Rupees One crore forty lakhs seventy thousand nine hundred & sixty) only.Grand Total : (E+F+G+H+I+J+K+L+M+N+) = Rs. 3,25,14,025/-(Rupees Three crores twenty five lakhs fourteen thousand & twenty five)only.305

ACTION PLAN UNDERNATIONAL LEPROSY ELIMINATION PROGRAMMEIN ARUNACHAL PRADESH FOR THE YEAR 2009 – 2010.SlActivitiesAmount ProposalNo.1. Training Plan Rs. 1,07,31,565/-2. I.E.C Plan Rs. 77,11,500/-3. DPMR Plan Rs. 4,52,000/-4. Procurement plan Rs. 5,30,000/-5. Contractual Services Rs. 8,16,000/-6. NGO Services Rs. 51,46,460/-7. Incentive for ASHA Rs. 38,500/-8. NLEP Monitoring and Review PlanRs. 4,38,000/-of State/ District Plan9. Vehicle Operation and Hiring Rs. 61,00,000/-10. Office Expenses and Consumable Rs. 5,50,000/-Grand Total : Rs. 3,25,14,025/-(Rupees Three crores twenty five lakhs fourteen thousand & twenty five) only.306

INTEGRATED DISEASE SURVEILLANCE PROJECT1. INTRODUCTIONSTATE PIP FOR THE YEAR 2009-10The PIP for 2009-10 has been prepared as per the National PIPand the State PIP submitted by the Government of Arunachal Pradeshto the Government of India and based on the activities left out during2007-09.The proposal contains the component wise financial requirementfor implementation of IDSP in the state for the year 2009-10 as per theNational PIP.2. DISEASES TO BE INCLUDED IN IDSP:In addition to the 13 diseases already included in the National PIP, thefollowing four diseases have been included as a state priority.2.1. Viral HepatitisThere is a very high prevalence of Viral Hepatitis cases as hasbeen reported from most part of the state and as such ViralHepatitis has been prioritized as a state specific disease in ourstate.2.2. Substance AbuseThe use of drugs particularly opium was always recorded inparticularly four districts of Arunachal Pradesh, Anjaw, Lohit,Changlang & Tirap. In fact the use of opium was traditional tothese districts. However, there has been a rise in the use ofother narcotic substances which are not local and the youngchildren have started to exploit it. Many de-addiction campswere organized in the state but the cases in some districts isincreasing. As such it is emphasized that the problem has tobe addressed urgently to which may otherwise expand to aproportion which will be hard to control as has been faced bysome north east states.2.3 Vitamin A deficiencyVitamin-A deficiency is very common among the children inthis hilly tribal state along with nutritional deficiency and it isproposed to give special attention to administration of Vitamin-A to the children in this state.307

2.4. Worm InfestationWorm infestation is most common in the villages of the state.Their hygiene is poor and the water quality is doubtful. Thisgives rise to nutritional deficiencies and as such it is proposedto undertake surveillance on worm infestation in the state.3. SURVEILLANCE MECHANISM IN THE STATE:Under IDSP it is proposed to establish a surveillance system whereindata inflow will be from PHC/CHC to the DSU directly. There are veryfew Private hospitals/ clinics having considerable patient registrationand these institutions will be involved in surveillance under IDSPthrough a MOU.There are some sentinel sites which are used for HIV surveillance andtheir services will be utilized for surveillance of air and water quality.Periodic special surveillance will be undertaken by L3 laboratory for thefollowing diseases: Diabetes MellitusAnemiaHypertensionVit.A DeficiencyIodine Deficiency DisordersSmoking & Tobacco4. IMPLEMENTATION PLAN:The State PIP for the year 2009-10 emphasizes on the following Planof Implementation, time line and budget requirement.4.1 CIVIL WORK for UPGRADATION OF STATE AND DISTRICTSURVEILLANCE UNITS and LABORATORIES:The State Surveillance Unit and the District Surveillance Unit alongwith Surveillance Committees was already notified as per theguidelines. Similar arrangement is necessary for augmentation of theDistrict hospitals to prepare itself for the task required under IDSP.Some of the activities were undertaken during 2007-08, others will becompleted by the end of the financial year. Rest activities are proposedto be taken up during 2009-10 as per the proposal hereunder for civilworks for the L3 Lab, District Labs and Peripheral (CHC) units andlabs.308

ANNEXURE-1PROPOSED COST ESTIMATE FOR CIVIL WORKS OF DSU/ DISTRICT ANDPERIPHERALLABORATORY, ARUNACHAL PRADESH DURING 2009-10SlItem1 Minor Civil worksCivil works for Surveillance Unitsa& Computer roomState(1 no)District(remaining, 3)CHC (32nos) @20000TOTAL640,000 640,000b Civil works for laboratory 180,000 420,000 640,000 1,240,000Total 1,880,0004.2 FURNITURES AND FIXTURESFurniture for DSU was provided during 2007-08. It is proposed toprocure the furnitures for the District Laboratories and surveillance unitand Laboratories for CHCs as per requirements during 2009-10.The requirement of fund for furniture/fixtures is proposed at Annexure-2.SlAnnexure-2PROPOSED COST ESTIMATE FOR FURNITURES AND FIXTURES FORSURVEILLANCE UNITS/LABORATORIES DURING 2009-10ItemState(1 no)District(16 nos)CHC (32nos)TOTAL2 FurnishingFurniture & fixtures fora Surveillance Units & Computer320,000 320,000roomFurnitures & Fixtures forb Laboratory60,000 960,000 320,000 1,340,000Total 1,660,0004.3 OFFICE EQUIPMENTS for AUGMENTATION OF SSU/DSU:Most of the office equipments required to equip the DSUs to undertakethe activities envisaged under IDSP and as per guidelines wascomplete during 2007-08.During 2009-10 it is proposed to install AC in the DSUs and connectthe CHCs wherever telephone connectivity is available.309

Until the computer network is established, the reporting will be donemanually in conventional ways, but using the formats prescribed underIDSP.The budget requirement for office equipments is given in Annexure-3.SlItemAnnexure- 3Requirement of Office Equipments (2009-10)(Amount in Rupees)UnitPriceOfficeequipment forPSU (CHC)Units Total Units Total5 Air conditioner 24,000 0 16 384,0006 Telephone 5,000 32 160,000Officeequipment forDSUTotal costof officeequipment384,000160,000Total 160,000 384,000 544,0004.4 STRENGTHENING OF MANPOWER:The IDSP is so designed that it will require a dedicated team of expertsfor undertaking the scheduled activities of surveillance, data transferand maintenance of records and accounts. Accordingly the manpowerrequired in the State and District Surveillance Units to do their specifiedjobs has already been appointed. The financial budget required for thesalary of the contractual staffs for 2008-09 has been calculated below.The salary of the staffs engaged under IDSP and proposed to be paidby SSU is given as under:Sl Title Monthly Salary Paying agent12345Consultant(Finance)Data ManagerData Entry OperatorAccountantAdministrativeAssistant10,000/-10,000/-6000/-7000/-5000/-SSUHCLSSU/DSUSSU/DSUSSU/DSUThe budget requirement for salary of contractual staffs appointed underIDSP for the year 2009-10 is given in Annexure-4.310

Annexure-4TOTAL BUDGET REQUIRED FOR SALARY OF CONTRACTUAL STAFFS(2009-10)(Amount in Rupees)SlTitleMonthlyfeesSSU DSU TotalTotal for 1monthTotal for(2008-09)1 Consultant (Finance) 10,000 1 0 1 10,000 120,0002 Data Manager 10,000 1 16 17 03 Accountant 7,000 0 16 16 112,000 1,344,0004 Data Entry Operator 6,000 2 16 18 108,000 1,296,0005 AdministrativeAssistant5,000 1 16 17 85,000 1,020,000Total 315,000 3,780,0004.5. PRINTING OF MANUALS AND FORMATS:It is proposed that as soon as the training is over, the reporting will startunder IDSP as envisaged. Until the IT network is in place, the reportingwill be undertaken manually through conventional means as per theIDSP formats and protocol.Manuals and guidelines, registers and forms were printed in limitednumbers during 2007-08. However, now it is required to print thesemanuals/formats for which separate budget for printing is proposed asfollows:311

Annexure-5Budget requirement for PRINTING of formats and manualsduring 2009-10SlPrinting materialsNo. of Quantity Estimatedpages required cost1 Form L1 1 5000 95002 Form L2 1 1000 22003 Form L3 2 500 18004 Form S 1 20000 380005 Form P 2 10000 21000Form W 1 200 5606 Guidelines for filling IDSP form 10 500 95007 Register for syndromic surveillance 50 200 190008 Register for presumptive surveillance 50 200 190009 HW manual 26 500 2470010 MO manual 57 200 2166011 Operation manual 165 200 6270012 User manual( 4 colour) 225 200 14400013 Training manual 259 200 129500503,120.004.6 TRAINING NEEDS IN IDSPSince the most important component of IDSP is reporting, it is requiredto train every individual involved in IDSP right from the ANM to HW toMO. Particularly in Sub-centres and Peripheral institutions which ismostly understaffed it will be necessary to train every staffs in theperiphery whose services will be utilized for reporting.Though it was proposed to complete these trainings during 2007-08and after the completion of Masters Training i.e. TOT to be trained byexpert faculty from GoI, but, it did not happen due to non release offund for training by GoI in 2008-09.It will be required to train about 2700 personnel which includes traineesfrom all level. The proposed number of trainees in different categoriesand levels is given in the following table. The training will be finishedwithin this year, 2009-10.312

Table-1NUMBER OF TRAINEES IN THE STATEIN DIFFERENT CATEGORY AND LEVELS(REMAINING)CategLevelTraineesoryState Surveillance State Surveillance Officer (SSO), State ProgrammeITeammanagers, State Microbiologists / members of StateDistrict Surv. District Surveillance officer, 2 District programmeTeamManagers, District Microbiologist / RRT membersMedical Officers of the PHCs, CHCs and UrbanII Medical OfficersHealth sector. MOs of the SPM departments of localClinical Medical Medical Officers of the Hospitals, SubdistrictIIIofficers Hospitals, Medical College Hospitals, SPPsMPWs (Male / Female), Health Supervisors, ANM,IV Sub Block staffNGO volunteers, traditional healersVState and DistrictLab. TechniciansState and District level microbiologists / LT. Also ofthe urban health sector.NumbersTotalNo. ofbatches10 10 16x16 96 316 perdistrict14 perdistrict110 perdistrict5 perdistrict237 11257 131783 8962 3VISub District Level5 perPHC / CHC / Urban dispensary LTsLab. Techniciandistrict149 7VIIData entry2 perDEOs at CHC, District and state leveloperatorsdistrict34 2VIII Data managers Statisticians at District and State level2 perdistrict38 2Total 2666The budget requirement for the training has been calculated as per the actualneed since the difficulty in the state has an inherent effect being increasedcost and the training cannot be conducted within the budget specified in thenational PIP. The financial requirement for providing these trainings is given inAnnexure-6.Annexure6Sl1Total noofTraineesRequiredno. ofbatchesTraineesTraineesper BatchCost perbatchHealth workers/ Para medicalworker/ANM/ GNM 20 18,000 1783 89Laboratory Technicians/Assistants (Peripheral) 20 21,000 149 7Total fundrequired160200014700023 Data Managers 20 62,000 38 2 1240004 District Lab Technicians 20 62,000 62 3 1860005 Medical officers 20 42,000 494 25 10500006State/District Surveillanceteam/ District trainers /RapidResponse team7 DEO 20 62,000 34 2 124000Total2560 3,233,000313

4.7 IEC ACTIVITIESIEC activities will be the major means of social mobilization used tocreate awareness about disease surveillance, its objectives, potentialto improve health services.The budget requirement for IEC activities has been calculated for oneyear as per the guidelines of GOI, for the year 2009-10 in the followingannexure.Annexure-7Budget requirement for IEC Activities in 2009-10SlItemDistrict Units (16 nos)State Unit (1 no)Amount Total Amount TotalGrandTotal1 Press advertisement 20,000 320,000 150,000 150,000 470,0002Organisation ofsensitization workshop30,000 480,000 100,000 100,000 580,0003 Review Meeting of DSU 10,000 160,000 50,000 50,000 210,0004IEC materials(Printmedia)20,000 320,000 150,000 150,000 470,0005 TV spot telecasting 0 400,000 400,000 400,0006 Radio broadcasting 0 150,000 150,000 150,0007Other includingindigenous methods20,000 320,000 0 320,000Total 1,600,000 1,000,00026000004.8. OPERATION COSTThe State & District units will be allotted specific fund under Operationalcost to maintain the SSU/DSU. Requirement of operational cost forundertaking various activities under IDSP is given in Annexure-7.Annexure-7Requirement of operational cost in 2009-10Cost DSU (16 nos) CHCs (31 nos)Itemsper Cost perCost per Total Total costTotal costSSU DSUitem costPOL, Travel cost, maint.&hiring of vehicle100000 40000 640,000 5000 160,000 800,000Office expense on telephone,fax, electricity60000 20000 320,000 4000 128,000 448,000Office Stationery &consumables60000 20000 320,000 2000 64,000 384,000DA to officers/staffs engagedunder IDSP80000 30000 480,000 3000 96,000 576,000Miscellaneous includingcontingencies50000 20000 320,000 1000 32,000 352,000Total 350000 130000 2,080,000 15000 480,000 2,560,000314

4.9 LABORATORY SUPPORT FOR IDSPComprehensive support will be provided to the laboratories at all levels,Peripheral Laboratory, District Laboratory and the state level PublicHealth Laboratory in form of Infrastructure support, LaboratoryEquipments and Laboratory supplies.The laboratories will maintain standard Bio safety and waste disposalmeasures. These units will report to the District Public HealthLaboratory (DPHL) on weekly basis on IDSP format.There are two types of requirement, one is equipments which are nonrecurring and the other is materials and supplies which will be requiredin a recurring basis.(a)LABORATORY EQUIPMENTSThere will be requirement of major Laboratory equipments forperipheral, district and state laboratory which is given in followingAnnexures.Some of the laboratory equipments not being supplied by CSU will beprocured during the year 2009-10.(i)LABORATORY NEED AT PERIPHERAL LABORATORY:The CHCs in the state will be provided with equipments that will benecessary to carry out laboratory activity for diseased under IDSP. Thesupply will be as per guidelines for the 32 CHCs as given in thefollowing annexure, district wise.Annexure-8BUDGET REQUIREMENT FOR PERIPHERAL LABORATORIESName of District Total noof CHCName of CHC perdistrictTotal cost @40,000 per CHC1 TIRAP 2 Longding, Deomali 80,0002 CHANGLANG 2 Miao, Bordumsa 80,0003 LOHIT 2 Namsai, Chowkham 80,0004 ANJAW 1 Hayuliang 40,0005 LOWER DIBANG 2 Dambuk, Parbuk 80,000VALLEY6 EAST SIANG 3 Ruksin, Boleng, Mebo 120,0007 UPPER SIANG 2 Mariang, Tuting 80,0008 WEST SIANG 5 Basar, Likabali,200,000Rumgong, Yomcha,Mechukha9 UPPER1 Nacho 40,000SUBANSIRI10 Lower SUBANSIRI 1 Old Ziro 40,000315

11 KURUNG KUMEY 4 Koloriang, Palin, Nyapin, 160,000Sangram12 PAPUM PARE 3 Sagalee, Doimukh,120,000Kimin13 EAST KAMENG 1 Chayangtajo 40,00014 WEST KAMENG 3 Kalaktang,, Dirang,120,000RupaTotal 32 1,280,000(ii) NEEDS AT DISTRICT LABORATORIESThere are 16 districts in the state and but some of the districts arevery new and lacks infrastructure. Care would be taken to addressthese issues and these laboratories will be upgraded so that theycan undertake the activities under IDSP properly.The budget requirement for laboratory equipments for the DistrictHospitals is given in the following annexure.Annexure-9BUDGET REQUIREMENT FOR LAB EQUIPMENTS OF DIST.LABORATORIESTOTAL DISTRICTSUnit costfor eachDist. labTotal costofequipmentsTirap,Changlang, Anjaw, Lohit, Dibang 850,000 13,600,000valley, Lower Dibang valley, East Siang,Upper Siang, West Siang, Upper Subansiri,Lower Subansiri, Kurung Kumey,Papumpare, East Kameng, West Kameng,Tawang.Total 16 850,000 13,600,000(iii)NEED AT STATE LABORATORYCurrently there is no State Public Health Laboratory in the state.However, the State Level Laboratory at General Hospital Naharlagunhas the requisite personnel and it will be setup to function as a StatePublic Health laboratory which will undertake the following functions:1 Provide quality control of District laboratories2 Impart training of Laboratory Personnel at the district levels3 Participate in the epidemic investigation in response tosurveillance challenges316

4 Link up with state and district surveillance units so thatinformation transfer is optimized.5 Function as the Primary laboratory for NCD risk factorsurveillance.The list of items to be procured is as per the guidelines of the GOI.The budget requirement for procurement of Laboratory equipments forState laboratory(L3) as per guidelines is given in the followingannexure.Annexure-10BUDGET REQUIREMENT FOR STATE LABORATORYState Laboratory Unit cost foreach StateTotal cost ofequipmentslaboratory(General Hospital,Naharlagun)850,000 850000Annexure-11850,000 850,000SUMMARY OF FINANCIAL REQUIREMENT FORLABORATORY EQUIPMENTS IN THE STATE during 2009-10STATEEquipment for CHCsNo. ofLabTotal cost@ 40,000Equipments for DHNo. ofLabTotal cost@ 850,000Equipments for StatelabNo. ofLabTotal cost@ 850,000Total Cost onEquipmentsArunachalPradesh32 1,280,000 16 13,600,000 1 850,000 15,730,000(b)LABORATORY REAGENTS & SUPPLIES:It is required to procure materials and supplies for all level oflaboratories, peripheral, district and state laboratory. The itemsincluded will be required in a recurring basis. The budget requirementfor their procurement during 2009-10 is given in the Annexure-12:Annexure-12BUDGET REQUIREMENT FOR MATERIALS AND SUPPLIES317

STATEMaterials & Suppliesfor CHCsNo. ofLabTotal cost@ 10,000Materials & Suppliesfor DHNo. ofLabTotal cost@ 100,000Materials & Suppliesfor State labNo. ofLabTotal cost@ 200,000Total Cost onMaterials &SuppliesArunachalPradesh32 320,000 16 1,600,000 1 200,000 2,120,0005.0 INFORMATION TECHNOLOGY IN IDSPIT based electronic transfer of data is proposed to be used for thecomputing and communication needs of the program. It is proposed toconnect the state headquarter with the district and block level units ofIDSP with telephones which can be used for transfer of information ondisease outbreaks quickly.The IT component will be provided by NIC and no expenditure isforeseen this year since the NIC has not even surveyed the state forinstallation of the IT component and it is presumed that the expenditureon IT component will be during 2009-10 only.Until the IT network is in place, the reporting will be done inconventional ways with the help of communication materials supplied.On establishment of IT network the reporting along with surveillancewill be switched over to electronic mode.4.10 SummaryThe State PIP for the year 2009-10 for implementation of IDSP hasbeen prepared as per the guidelines of Govt. of India and as per the State PIPalready submitted to GOI with stress on the needs of the state government toachieve the goals set under IDSP. Special emphasis has been laid oninfrastructure development and training, lack of which compromises thequality of services.Disease Surveillance in the state had been very poor and thedepartment intends to utilize the resources being provided under IDSP to plugthese gaps and provide necessary inputs in terms of disease surveillance andconsequently, timely intervention to arrest the outbreaks or epidemics.It is intended to rigorously train as many functionaries whoseinvolvement will manifest the results. Proper training will result in qualityservice and emphasis will be given to train and reorient thefunctionaries for proper surveillance and reporting.The summary total budget requirement for 2009-10 is given in thefollowing table:318

Annexure- ASUMMARY OF TOTAL COST ESTIMATE HEAD WISEFOR THE PROJECT PERIOD 2009-10Sl ITEM TOTAL (2009-10)A Sl INVESTMENT ITEM COST TOTAL (2009-10)1 Minor Civil works 1,880,000.0012 Furnishing Minor Civil works 1,660,000.00 1,880,000.003 Laboratory equipments 15,730,000.0024 IEC activitiesFurnishing2,600,000.001,660,000.005 Training 3,233,000.003 Laboratory equipments 15,730,000.006 Printing 503,120.0047 Office IEC Equipments activities 544,000.00 2,600,000.008 Fees 3,780,000.0059 Operational Training costs 2,560,000.00 3,233,000.0010 Laboratory reagents 2,120,000.006 Printing 503,000.00Grand Total 34,610,120.007 Office Equipments 544,000.00319

Subtotal 26,150,000.00BRECURRING COST1 Fees 3,780,000.002 Operational costs 2,560,000.003 Laboratory reagents 2,120,000.00Subtotal 8,460,000.00Grand Total 34,610,000.00The following chapter presents the detailed budgetary requirement toimplement IDSP in the state for the year 2009-10. Process has already beenstarted for the same and necessary instructions passed to the districts.NATIONAL IODIIINE DEFICIENCY DISORDERS CONTROL PROGRAMME((NI IDDCP))1. PREFACEIodine Deficiency Disorders are one of the most severe form of micronutrientdeficiency which superimposes it’s harmful effects on theproductivity and vitality of our society.Some obvious clinical manifestation of Iodine Deficiency, such asGoitre, has been recognised for thousands of years, but only in therecent past a realistic picture has emerged both of the board spectrumof disability, morbidity and mortality and the vast global dimensions ofmillions affected by the iodine malnutrition.IDD affects people throughout the world. It causes brain disorders,cretinism, miscarriages and goiter. It is the world's single mostimportant and preventable cause of mental retardation. And it is almostunknown. Equally unknown is the success in eradicating it. Calling it"one of our best kept secrets" the World Health Organization hasrededicated itself to eliminating Iodine Deficiency Disorder, or IDD,through an intense programme of salt iodisation.320

At the World Health Assembly in Geneva, Dr. Gro Harlem Brundtland,the Director- General of the WHO, in 1999 outlined a series ofmeasures designed to eradicate IDD within the next decade. She toldthe Assembly "Iodine Deficiency Disorders constitute the singlegreatest cause of preventable brain damage in the foetus and infant,and retarded psychomotor development in young children. Whenelimination of IDD is achieved it will be a major and total public healthtriumph, ranking with small pox and poliomyelitis."Appreciating the ground reality, Govt. of Arunachal Pradesh submitsthis State Plan of Action for the year 2009-10 with the objective tocontrol IDD in the state and bring about total awareness among thepeople about the ill effects of Iodine deficiency and the ways by which itcan be controlled through a concerted Information, Education &communication mechanism and proper monitoring and evaluation.321

2. STATE PROFILE:Arunachal PradeshTable-2.1:State Statistics1 Total area 83,743 sq. km.2 Population 10, 91,117 (Census 2001)3 Male 5799414 Female 5780275 Tribal Population 67.22 %6 Rural Population 79.59%7 Urban Population 20.41 %.8 Population Density 139 Sex ratio (Total) 901 females per 1000 males.10 Sex ration (Tribal) 1003 females per 1000 males.11 population below poverty line in 33.47 (SRS Bulletin, April 2001)1999-200012 Decadal Growth Rate 26.21 %13 Annual Exponential Growth Rate 2.33.14 decadal growth rate of urban 101.29 %.population15 Total literacy rate in the state is 54.74%16 Male literacy rate 64.07%17 Female literacy rate 44.24%.18 per capita income (97-98) Rs.13,424 [Source: ProvisionalCensus of India 2001]Administrative Set up: ARUNACHAL PRADESH (Source: Census 2001)Table-2.2322

SL.NO.DISTRICTHEADQUARTERPOPULATIONSUBDVNBLOCKTOWNCIRCLEVILLAGE1 TAWANG TAWANG 34705 2 3 1 9 1892 WEST KAMENG BOMDILA 74595 3 4 1 10 2153 EAST KAMENG SEPPA 57065 2 4 1 11 2884 PAPUMPARE YUPIA1217502 2 2 9 2745LOWERSUBANSIRIZIRO 55332 1 3 1 6 2166KURUNGKUMEYKOLORIANG 42282 1 6 0 12 4717UPPERSUBANSIRIDAPORIJO 54995 1 8 1 13 3988 WEST SIANG ALONG1035756 11 2 20 3999 EAST SIANG PASIGHAT 87430 3 4 1 10 13210 UPPER SIANG YINGKIONG 33146 3 4 0 10 76LOWER DIBANG11ROING 50391 2 3 1 6 127VALLEY12 DIBANG VALLEY ANINI 7152 1 1 0 5 1111250513 LOHIT TEZU2 3 2 8 225014 ANJAW HAYULIANG 18428 1 2 0 7 281CHANGLAN 1249915 CHANGLANG4 5 2 13 304G41002216 TIRAP KHONSA3 6 2 8 1567386TOTAL 37 85 17 16932.3. Current Health Situation in Arunachal Pradesh:1. General Hospital : 2 Nos under Govt.1 No. in NGO sector2. District Hospital : 14 Nos.3. Community Health Centre : 32 Nos.4. Primary Health Centre : 83 Nos.5. Sub-Centre : 422 Nos.6. Homeopathy Dispensary : 37 Nos7. Ayurvedic Dispensary : 2 Nos.8. Dental Units : 39 Nos.9. Hansens Disease Sanatorium : 4 Nos.10. Dispensaries : 12 nos.11. Drug De-addiction centre :323

12. Nursing Schools : 1 in Government1 in private sector.13. Autonomous/private hospitals : 414. Microscopy Centres : 3215. Sentinel surveillance sites : 123. NIDDCP in ARUNACHAL PRADESH5.1. PREVALENCE IN ARUNACHAL PRADESHNIDDCP inARUNACHAL PRADESHStarted in the state in 19871969 (ICMR)( %) , 1 9 6 9 ( I C M R ) ,3 8 . 21980 (ICMR)( %) , 1 9 8 0 ( I C M R ) ,2 6 . 8( %)1991(StateGovt.)( %) , 1 9 9 1 ( St a t eG o v t . ) , 1 1 . 42001(Stategovt.)( %) , 2 0 0 1 ( S t a t eg o v t . ) , 80 5 1 0 1 5 2 0 2 5 3 0 3 5 4 0 4 5The prevalence of Goitre in the state has reduced considerably toless than 6% from 38% during 1969(ICMR survey).5.2. BAN NOTIFICATIONBasing on the ICMR report the Government of Arunachal Pradesh,then Union Territory of India under the signature of Secretary (Supplyand Transport), Shillong issued a notification on 26th Oct, 1976 underClause (IV) of section 7 of PFA, 1954 prohibiting the sale of noniodised salt for edible purposes with effect from 1st Dec,1976.Government of India has very recently imposed a total ban onconsumption of non-iodised salt for edible purpose.5.3. FORMATION OF STATE IDD CELLNIDDCP erstwhile NGCP in Arunachal Pradesh was launched in theyear 1986 in persuasion to the proposal of the ministry of health &Family Welfare, Govt. of India with creation of the following posts toestablish the IDD Cell in the state headquarter with 100% Centralassistance.324

1. Technical Officer : One Post.2. Technical Assistant (IDD) : One post3. Statistical Assistant : One Post.4. LDC cum Typist : One Post.5. Laboratory Technician : One Post.6. Laboratory Assistant : One Post.The team is led by State Programme Officer (IDD).The State IDD laboratory is engaged in quantitative andqualitative analysis of iodine in edible salt. Measure of biochemicalavailability of Iodine in human body through Urinary Iodine Excretionmethod will be started after laboratory is upgraded.5.4. ORGANISATION CHART:325

DIRECTOR OF HEALTH SERVICESDISTRICTLEVELACTIVITIESSTATE PROGRAMME OFFICERSTUDENTSTECHNICAL OFFICERSTATISTICALASSISTANTAwarenessTECHNICAL ASSISTANTLAB.TECHNICIANPUBLICGovt. OfficesLAB.ASSISTANTPublic, Citizen Group5.5 ACTIVITIES UNDERTAKEN5.5.1. BASELINE SURVEY:Endemic Goitre survey is conducted every year in some districts ofArunachal Pradesh in a phase manner to determine the followingindices:a) To determine the prevalence of Goitre and IDD.b) To study the efficacy of consumption of Iodised salt and effect ofcompulsory iodisation of all edible salts.c) To intensify health awareness activities with proper IECmaterials and motivate people’s participation in the programme.d) To determine the content of Iodine in edible salts in the state.These surveys are primarily carried out in schools for childrenbetween the age group of 6 to 15. The incidences of Nodular Goitre326

among these children are almost non existent now which reflects theefficacy of iodised salt in controlling IDD.5.5.2. IEC ACTIVITIES UNDERTAKEN :IEC is one of the major components of the programme. Consciouseffort is being made to reach out to the people and informing themabout IDD and its prevention. The Department undertakes the followingactivities every year as part of the IEC campaign:1. PRESS RELEASE BY HON’BLE CHIEF MINISTER ANDHON’BLE HEALTH MINISTER.2. PANEL DISCUSSION ON DOORDARSAN.3. RADIO TALK IN ALL INDIA RADIO4. SCHOOL HEALTH AWARENESS PROGRAMME5. PUBLIC DISPLAY & SEMINARS6. ESSAY COMPETITION7. PAINTING COMPETITION.8. LECTURES IN COLLEGES AND SCHOOLS.DMO in their respective districts also carry out various activities aspart of IEC campaign. Fund of Rs.50,000.00 is provided to all the 16DMOs to conduct such IEC campaign during Global IDD PreventionDay, being observed on 21 st October every year.5.5.3. IODINE PROPHYLEXIS IN ARUNACHAL PRADESH:Prevention of endemic goiter among the people in Arunachal Pradesh byIodized salt prophylaxis is an important objective laid down by Govt. ofIndia.The entire edible salt in A.P. is iodized. In order to determine the Iodinecontent in salt, salt samples are being analysed throughout the stateusing SPOT TEST KITS supplied by UNICEF. The Spot test kits aredistributed in the districts and the health functionaries conduct salt test atthe shopkeeper and consumer level. The use of Spot Test Kits has beenseen to be an excellent media for increasing interest and awarenessamong the students and general public. The reports received from thedistricts are compiled in the state health directorate.The supply and distribution of Iodized salt in the state is monitored by theDirector of Civil Supplies, Naharlagun. However, the open market isflooded with various brands of Iodized salts manufactured by differentmanufacturers.Another level of monitoring the quality of Iodised salt is throughestimation of Iodine present in salt by conducting iodometric titration inthe laboratory. For the purpose one State IDD Monitoring Laboratory issetup in the state headquarter with one Lab. Technician and one LabAsst. who undertakes titration of salt samples. These personnel havebeen trained at NICD and AIIPH & Hygiene for the purpose.327

The Laboratory staffs undertake volumetric estimation of the iodinepresent in salt samples collected from various parts of state.5.5.4 LABORATORY ACTIVITY:A State IDD monitoring laboratory is set up in the state headquarterwhich is engaged in analyzing salt samples collected from various partsof the state quantitatively estimate the amount of iodine present in salts.The staffs are engaged in collection of salt samples from the salt traders.The state IDD Monitoring laboratory is also strengthened to be able toestimate the iodine deficiency in the population through Urinary IodineExcretion method. The laboratory staffs have been trained for thepurpose at NICD, New Delhi and All India Institute of Hygiene & PublicHealth, Kolkata.6. STATE PLAN OF ACTION6.1 OBJECTIVES:The State Plan of Action has been prepared for the period 2009-10 bywhen it is proposed that a complete functional monitoring system is inplace and the extent of Iodine deficiency in the state is known.The State Plan of Action is prepared with the following objective:6.1.1. The State Plan of Action proposes a comprehensive strategyfor Universal Salt Iodisation Programme in the state.6.1.2. To establish a decentralized system of monitoring for the qualityof Iodised salt consumed so that timely and effective publichealth action can be initiated in response to health challenges.6.1.3. To improve the awareness level of the people so that thedemand for good quality iodised salt increases.6.1.4. To facilitate sharing of relevant information with the healthadministration, community and other stakeholders and evaluatestrategies.6.1.5 To find out the incidence of Iodine deficiency.6.1.6 To establish a proper and effective monitoring system in thestate.With the objectives set, the department proposes this Plan of Action toinitiate measures to control iodine deficiency in the population.6.2. COMPONENTS :To achieve the above objectives, the following components have beenincluded in the Plan of Action for three years:6.2.1 SURVEY328

6.2.2 IEC6.2.3 LABORATORY ACTIVITY6.2.4 MONITORING6.2.1 SURVEY:6.2.1.1 ACCESS TO IODISED SALT:The department of health in collaboration with the department ofCivil Supplies plan to make available Iodised salt through out thestate. For the purpose the Department will encourage Salt tradersto install Re-iodisation Plants in the state with assistance fromDepartment of Industries and Department of Civil Supplies.Convergence with ASHA / Health DayA survey will be conducted in the state to know the percentage ofpeople in the state who use Iodised salt. The specific objectives ofthe survey is to identify proportions of households effectively usingiodised salt.The proposed activity is as follows:Sl Activity Cost perdistrictYear wise Proposed No. of districtsto be covered2009-10 Cost Toral1 Survey 50,000/- 16 50000/- 8,00,000/-6.2.1.2. ESTIMATION OF IODINE DEFICIENCY IN THE POPULATION:Scientific determination of the extent of iodine deficiency in thepopulation is of paramount importance to initiate correct interventionfor achieving the desired level of human resource development inthe state.As such it is proposed to conduct survey of the school childrenbetween the age group of 6 to 15 to know the percentage ofchildren having Goitre and indicative IDD.The proposed activity is as follows:Sl Activity Cost perdistrict2 Survey of theschool childrenfor Goitre & IDDYear wise Proposed No. ofdistricts to be covereddistrict Total50,000/- 16 800000The budget requirement for the above activity is proposed atAnnexure-II329

6.2.1.3. MEASURE OF URINARY IODINE EXCRETION & TSH:The State Plan envisages qualitative estimation of iodine deficiency inthe population and evaluate daily iodine intake of state population.The children between the age group of 5 to 15 will be screened forlevel of iodine in the body through Urinary Iodine excretion method.The urine samples will be collected from the districts and analyzed inthe state IDD laboratory. The median value of urinary iodine of schoolchildren will give a clear idea of the iodine deficiency in thepopulation.Simultaneously, another study will be conducted for estimating thelevel of Thyroid Stimulating Hormone (TSH) present in the cord bloodsamples of the new born. For the purpose, cord blood samples ofnew born will be collected from select hospitals and analyzed.Iodine deficiency is a risk factor for the growth & development of thepeople living in iodine deficient environment throughout the world andArunachal Pradesh is no exception. Being in the sub-Himalayanregion, the state is vulnerable to the malnutrition and needs the effortto determine the magnitude of the problem and to study the result ofIodine supplementation by Iodised salt.The proposed activity is as follows:SlActivityProjectdurationMethodologyProjectarea3 UrinaryIodineexcretion ofchildrenbetween agegroup 5-151 yearCollection of urinesamples fromschool children andanalyzing them atState IDDMonitoringlaboratoryRandomsurvey ofschoolchildrenfrom alldistricts4 Measure ofThyroidStimulatingHormone(TSH)1 yearsCord Bloodsamples will becollected from newborn babies andthey will be testedfor level of TSH inblood.All districtsofArunachalPradeshThe requirement for the project is given in Annexure-III.6.2.2 IEC ACTIVITIES:IEC activities will be the major means of social mobilization and will beused to create awareness about IDD Control programme, its objectivesand role that the community can play in improving the preventing iodinedeficiency.330

While the availability of iodised salt is being ensured in the statethrough various legislations, it is imperative to educate the peopleabout the efficacy of iodised salt in controlling Iodine deficiency and themeasures required to quality of salt at the consumer level.Adequate IEC activities would be undertaken throughout the state andmore focused in the districts to highlight the benefits of Iodised salt.Suitable IEC components will be developed and media interventionsought to educate the mass about the iodine deficiency and the ways itcan be prevented. There will be an overall emphasis on monitoringsystem performance, evolution and on building capacity at all levels.The following activities are proposed:Sl Activity Year wise number of activityproposed2009-10 Total no5 State level Sensitization 1Meeting at Itanagar6 Sensitization meeting at16District Level7 School Health Awareness16 16Programme8 Press advertisement 2 29 Radio Broadcasting 1 110 Printing IEC materials11 State level ReviewMeeting12 District level ReviewMeeting13 Block level sensitizationmeeting1 116 1680 80The requirement for the project is given in Annexure-IV.6.2.3. MONITORING AND EVALUATIONIt is proposed to strengthen the monitoring and evaluation procedure inthe state so that a mechanism is evolved by which a system of monthlyreporting is established in all the districts.Monitoring Mechanisms.a. Sharing of information about the prevalence of Goitre/IDD and thepercentage of people consuming Iodised salt.b. Developing effective partnership with health and non health sectorsin monitoring.Monitoring Activity:a. Collection of data331

. Compilation of datac. Analysis and interpretation of datad. Feedbacksf. Use standard formats developed by State IDD Cell.g. Ensure regularity of the reportsh. Ensure actions taken as per the reports.Use of Information TechnologyTo facilitate proper communication, data manning, feedback and fordissemination of reports and improving timeliness of responses at thestate and district level, it is proposed to provide the followingcommunication equipments like personal computer, fax machine andOverhead projectors in all the districts. At the state level, LCD Projectoris proposed to be procured under IEC component.Sl Item Requirement for Requirement TotalState Hq. for districts1 Personal1 16 17Computer2. Fax machine 1 16 173. Over head1 16 17projector4. LCD Projector 1 1Financial requirement for the above items is given in Annexure-V.6.2.4. STRENGTHENING OF MANPOWER:The Plan of Action under NIDDCP is so designed that it will require adedicated team of people for undertaking the scheduled activities ofsurvey, laboratory activity, monitoring and evaluation. Since there areno staffs under NIDDCP, it is proposed to appoint the following staffson contractual basis on fixed pay for the project period i.e. for threeyears 2006-07 to 2008-09.The proposed manpower to be appointed on contractual basis is asfollows:Sl Title StateHeadquarterDistrictTotal1 Data Entry Operator 1 12 Research Assistant 1 1332

The budget requirement for salary of contractual staffs proposed forthree years from 2009-10 is given in Annexure-VI.6.2.5. TRAININGFor the programme to be successful, effective training of all categoriesof staff is vital. The Training strategy would aim at strengthening thecapacities of both medical and paramedical staffs. Professional trainingis a pre-requisite for any research activity. Though the officers aresensitized on the programme it will be required to train the technicalpersons entrusted with the job. The Research Assistants to beappointed on contractual basis and the laboratory technicians will beadequately trained for collection of samples and their laboratoryanalysis. The emphasis of the training will therefore be on developmentof both skills and capacities.The staffs involved in survey and for research activity will be trained atState IDD laboratory along with Regional laboratory at All India Instituteof Public Health & Hygiene, Kolkata where they will be trained onprotocols for Iodine deficiency monitoring as well as Quality assurance.333

SUMMARY PLAN OF ACTION, Arunachal PradeshNarrative summary Performance indicator Means of verification Important assumptionGoalSustainable IDD Elimination Adequate UIE among 5-15 yr-old school children;State level survey in2008-10Political will prevailsamong all key partnersObjectiveUSI achieved Iodine levels areadequate in >90% of saltused in householdsOutputs1. State PLAN OF ACTIONadoptedActivities1.1. Define the roles andresponsibilities of actingpartners, timeline, financialneeds, reporting requirementsand funding sources1.2. Discuss draft PIP with highlevelleaders in government,science, and consumergroups and establish aState Plan of Action formspart of IDD Controlprogramme and budgetdecisionsDraft Plan of Actionapproved by the keyacting partners: MOH,and State Governmentwith ConsumerrepresentativesConsultations held with allgroups mentionedSalt supply data frommonitoring to show thattotal edible salt supply isiodizedFunds disbursed toimplement Plan of Actionis utilizedState Plan of Action to beapproved by GOI andfunds released for it'sexecutionAcceptance expressed bygroups consultedSalt used inhouseholds isrepresentative of totaledible salt supplyAll partners play theirpart in executing theState Plan of ActionGovt. of India approvesthe State Plan of Actionand supports theproject334

coalition1.3. Conduct a high-level policyadvocacyevent to obtainbroad PIP acceptanceHigh degree ofparticipation by all partnergroups in the eventPolitical decision-makersagree to prioritize IDDeliminationOutputs2. State level CoalitionestablishedActivities2.1. Assure nomination of a highlevelpolitician as Chair andestablish adequate technicalsupport2.2. Invite balanced andadequate level membershipsfrom all acting and supportivepartners2.3. Define oversight functionsbased on expressed demandfor information, and planneduse of monitoring data fordecisions2.4. Ensure public reporting ofthe state progress toward IDDState level Coalitionmembers known andacceptedChair has beennominated and hasaccess to adequatetechnical supportMembers acceptinvitation for membershipin the CoalitionMonitoring reportingrequirements have beendefined by the state levelCoalition and transmittedto partnersThe State Coalitionissues a annual progressState level Coalitionmeeting scheduleannouncedChair sets meetingagenda of State levelCoalition on secretariatrecommendationsMembers participate inState level Coalitionmeetings and functionsState Coalition obtainscomprehensivemonitoring informationand uses it forprogramme decisionsAnnual report obtainedand used by the media toAll partners accept theirrole in overseeing theIDD eliminationprogrammePartners understand andaccept IDD eliminationthrough USI as a multisectoralresponsibility335

elimination report inform the publicOutputs3. USI legislation and/orregulation enactedActivities3.1. Formulate legislation (underPFA) to mandate theiodization of household salt,animal salt & food industry3.2. Define ways and proceduresto enforce the draft legislation3.3. Ensure acceptance of draftsub-laws by all parties involvedor affectedOutputs4. Supplies of iodized edible saltensuredActivities4.1. Obtain readiness by salttraders to import and sell onlyiodized salt for human andanimal consumptionLaws formulated onmandatory iodization ofedible saltLegislation drafted oneach salt type(household, animal, foodindustries)Appropriate enforcementprocedures formulatedOrganize review of draftproposals by broadersocietyAppropriate systemsdeveloped for qualityassurance, quality controland promotion of iodizedsalt for human and animalconsumptionEdible salt supplysource(s) have beenconsultedLaws enacted andpublishedPublicity of the legislationthrough media.Draft legislation andenforcement proceduresreviewed and acceptedby all involved or affectedQuality assurance andquality control methodsand procedures acceptedby all parties involved oraffectedSupply source(s) haveconfirmed that sufficientamount of good qualityiodized salt is availableIn placeIn placeCustomers of salt importfirms and consumersaccept that only iodizedsalt is supplied for humanand animal consumptionNo objection against nonavailabilityof non-iodizedsalt among consumers336

4.2. Establish a system foreffective quality assurance ofall the edible salt supplies4.3. Support food inspection indeveloping an appropriatemodule for quality control4.4. Support salt industry inappropriate ethical promotionthrough their sales channelsOutputs5a. Advocacy and re-advocacyamong leaderships takes placeActivities5a.1. Conduct advocacy on USIand IDD elimination as part ofmilestone eventsOutputs5b. Critical gatekeeper groupsare being informed andeducatedSystem defined thatassures adequateiodization of all the ediblesalt imported.Quality control module ofall edible salt suppliesproposedIodized salt promotionplan developed by saltenterprisesMilestone events arebeing used for advocacyand re-advocacy amongpolitical leaders on theimperatives of IDDelimination and USI assingle, sufficient strategyPlans developed for highleveladvocacy as part ofsociety consultation, lawenactment and goalattainment eventsInformation/educationmaterials submitted tocritical gatekeeperQuality assurance systemis accepted by salttraders.Inspection moduleaccepted by salt tradersPlan to be submitted toGOIAdvocacy and readvocacyforms part ofPlan of Action adoption ,broad societyconsultation , USI lawenactment andceremony to mark goalattainmentState Coalition memberscoordinate thecontributions to be madein advocacy amongconstituenciesEducation on USI/IDDinserted in ongoingcurriculums of criticalPolitical & communityleaders participate and/ortake note of milestoneevents.No political objectionsraised among leadershipsagainst USI as the single,sufficient strategy for IDDeliminationEducation leads tohabitual practicessupportive of USI337

educational systemsgatekeeper groupsActivities5b.1. Conduct information andeducation for educational,media and public healthprofessionals5b.2. Conduct information onIDD and USI fordissemination through retailnetworks for household,animal and food industry saltOutcomes/Results5c. Broad public acceptance forUSI is being stimulatedActivities5c.1. Conduct educationalactivities through mass media5c.2. Develop information andeducation for leading medical,educational, food industry,media and public healthprofessionalsCritical gatekeepergroups receiveinformational andeducational materialsRetail networks receiveinformational andeducational materialsIndormation/educationmaterials submitted tokey informationdissemination systemsMass media expertscollaborate in developingeducational messagesCommunication expertscollaborate withrespective partners inmaterial developmentCritical gatekeepergroups use informationaland educational materialsRetail networks useinformational andeducational materialsMass media, gatekeepergroups and edible saltretailers conductcoordinated consumereducationMass media disseminateeducational messagesInformational materialsdeveloped for criticalgatekeeper groupsNo objection raised orcreated amonggatekeeper groupsagainst USI as single,sufficient strategy for IDDeliminationRegular provision ofinformation leads toacceptance of USI amongbroad publicNo objection amongmass media, gatekeepergroups and retailnetworks338

5c.3. Develop information onIDD and USI fordissemination through retailnetworks for household,animal and food industry saltSalt import firmscollaborate with experts inmaterial development forproduct promotionInformational materialsdeveloped for retailnetworks of salt importfirmsOutputs6a. Supply of edible salt is beingmonitoredActivities6a.1. Develop system for regularreporting of edible saltsupplies to retail shops6a.2. Set up system for annualreporting on results of qualitycontrol inspections by healthfunctionariesOutputs (Products)6b. Population iodine nutritionstatus is being monitoredSalt Traders Associationhave developed theircapacity for reportingsupply of edible saltQuarterly reportingsystem on edible saltsupplies has beendevisedDeptt. of health hasdeveloped annualreporting system on QCof edible salt supplies inretail marketsSystem in place tomeasure and report onthe use of iodized ediblesalt and its impact onpopulation iodine nutritionstatusSalt Traders Associationissue periodic reports onsupply of edible saltSalt Traders Associationreports quarterly on theamount and quality of theedible salt supplies in thestateDeptt. of health reportsannually on QC results ofedible salt supplies inretail marketsRegular monitoringreports are received andreviewed in StateCoalition, and used fordecisions on how toproceedState supply data indicatethat progress toward USIis continuousNo objection by SaltTraders Associationagainst public reportingReview and decisioncapacity by GOI339

Activities6b.1. Develop and strengthencapacity on salt iodine andurine iodine assessment andreporting6b.2. Design regular datacollection and reporting onedible salt use and iodinenutrition status in population6b.3. Conduct State level surveyto affirm optimal populationiodine nutrition andsustainable attainment of thegoalDistrictwise capacity andsupport needs for salt andurine assessmentsconsidered andestablishedSalt and urine samplecollection, measurementand reporting systemdesigned, tasks assignedand costs budgetedTiming and draft design ofa verification survey to beagreed upon by theGovernmentAssessment andmanagement capacity forsalt and urine iodinemeasurement establishedin each districtSampling of salt andurine for iodinedeterminations andreporting is ongoingPlan for survey execution,connection with Govt. ofIndia, and funding havebeen madeFunctional salt and urinesampling, measurementand reporting systems inplace to document theuse of iodized edible saltin the population anddemonstrate its impact oniodine status340

7. BUDGETINGThe Annual budget for the State Plan of Action for implementation ofNIDDCP in the state for 2009-10 has been proposed as per the staterequirement and would be allocated by the Govt. of India.7.1 STATE LEVELState IDD Cell in the state headquarters will implement the approvedPlan of Action. Under the umbrella of the Arunachal Pradesh RuralHealth Mission, and through Integrated Disease Surveillance Project, aseparate bank account in the name of “State IDD Cell, ArunachalPradesh” would be opened in the State Bank of India. The books ofaccounts at the state level would be maintained using double entrybook keeping principles.7.2 DISTRICT LEVELThe District Surveillance Units of the districts will receive funds bycheque/demand draft from the State IDD Cell for undertaking theactivities at the state level. The account will be maintained in aseparate bank account which would be operated under the umbrella ofthe District Surveillance Society.7.3 BOOKS OF ACCOUNT AND PROCEDURE:The account of NIDDCP would be maintained in accordance withprocedures and policies prescribed by the GOI and conforming toGeneral Financial Rules (GFR) as issued from time to time.Standard books of accounts on a double entry basis (cash and bankbooks, journals, fixed assets register, ledgers, work registers,contractor registers etc.) will be maintained.8. SUMMARYThe National IDD Control Programme in the state is functioning as perthe guidelines of Govt. of India since last 20 years.This State Plan of Action has been proposed for three years in whichperiod it is planned to undertake two research work to determine theextent of iodine deficiency prevalent in the population.The major components which are part of the normal programmeimplementation are:1. Survey2. IEC activity3. Monitoring quality of iodised salt.341

4. To determine the level of iodine present in iodisedsalt.Special emphasis has been laid on IEC since the impact of Iodinedeficiency almost always goes unnoticed and very few people areaware of the different consequences of Iodine deficiency.Laboratory activity is vital to track the quality of various brands/makesof iodised salts available in the state.It is intended to strengthen the reporting system. Many districts do notreport and even f they do, not always timely. It is proposed to provideone PC to all the districts so that they can send the report in time,efficiently.The spot test kit supplied by UNICEF since last decade had been anexcellent medium for awareness generation both at the communitylevel and for the students. This year also, UNICEF will be requested tosupply atleast 5000 Spot test Kits which will be distributed to thedistricts.Total budget requirement proposed for 2009-10 is Rs. /-Annexure in the following pages gives the budget requirement totransform this Plan of Action into result.342

SlANNEXURE-IBUDGET REQUIREMENT FOR SURVEYTO ACCESS THE PERCENTAGE OF HOUSEHOLD CONSUMING IODISEDSALTActivityCost perdistrictTotal no. ofdistrictsTotal Budget requirement for2009-10(In Rupees)1 Survey to estimate thepercentage of householdhaving access to Iodisedsalt 50,000/- 16 8,00,000/-Total 8,00,000/-ANNEXURE-IIBUDGET REQUIREMENT FOR SURVEYTO ESTIMATE THE PREVALENCE OF GOITRE & IDD IN SCHOOLCHILDRENSlActivity1 Survey to estimate theprevalence of Goitre & IDD inthe school children of the agegroup 5 to 15.Cost per districtsurveyTotal no. ofdistricts50,000/- 16Total Budget requirementfor 2009-10(In Rupees)8,00,000/-Total 8,00,000/-343

ANNEXURE-IIIBUDGET REQUIREMENT FORDETERMINATION OF IODINE DEFICIENCY IN THE POPULATIONSl ITEMS Cost for 2009-10 JustificationIn Rupees1 Equipments 5,50,000/- Laboratoryequipments to beprocured for theinvestigation.2 Office expanses 1,30,000/- Fax machine, LCDProjector, Laptop3 TA/DA 70,000/-4 Miscellaneous 50,000/-5 Total 8,00,000/-ANNEXURE-IVBUDGET REQUIREMENT FOR IEC ACTIVITIESIN THE STATE DURING THE PROJECT PERIOD, 2009-10Sl5678910ActivityState levelSensitizationMeeting atItanagarSensitizationmeeting atDistrict LevelSchool HealthAwarenessProgrammePressadvertisementRadioBroadcastingPrinting IECmaterialsCostestimateNumberofactivityper yearTotalnoGrandTotal1,80,000/- 1 1 1,80,000/-50,000/- 16 16 8,00,000/-10,000/-20schoolsper dist32 6,40,000/-50,000/- 2 2 1,00,000/-10,000/- 5 5 50,000/-1,00,000/-1 perdistrict16 16,00,000/-344

11Block levelSensitizationmeeting10,000/-5 blocksper dist80 8,00,000/-Total 41,70,000/-ANNEXURE-VBUDGET REQUIREMENT FORPROCUREMENT OF OFFICE EQUIPMENTS FOR THE PROJECTPERIOD, 2006-2009Sl ITEMS CostNo of activity & cost for2006-07Total Total Justificationrequired1 PersonalComputer withUPS & Printer50,000/- 16 8,00,000/- Required forMonitoring &reportingFax machine 10,000/- 16 1,60,000/-2 Over-headProjector12,000/- 16 1,92,000/- Required forIEC.3 LCD Projector 70,000/- 1 70,000/-Total 12,22,000/-ANNEXURE-VIBUDGET REQUIREMENT FORSALARY OF STAFFS PROPOSED TO BE APPOINTED ONCONTRACTUAL BASIS FOR THE PROJECT PERIOD, 2006-2009Sl ITEMS Cost Total requirement of fund1 Salary ofResearchAssistant.2 DataEntryOperator8,000/-permonth6,000/-permonthTotalrequired2009-10 Total Justification1 96,000/- 96,000/- Thepersonnelwill beappointed1 72,000/- 72,000/- on Contractbasis toundertakethelaboratoryactivity.Total 1,68,000/- 1,68,000/-345

ANNEXURE-VIITOTAL BUDGET REQUIREMENT FOR THE PROJECT PERIOD, 2009-10FOR PLAN OF ACTION ON NIDDCPSUMMARY OF TOTAL BUDGET REQUIREMENTSl Activity State IDD Cell Districts (16) Total1 Survey to estimate the household havingaccess to Iodised salt 8,00,000/- 8,00,000/-2 Survey to estimate prevalence of IDD 8,00,000/- 8,00,000/-3 Laboratory requirement8,00,000/- 8,00,000/-4 IEC activities3,30,000/- 38,40,000/- 41,70,000/-5 Office equipments/ Maintenance of StateIDD Cell 70000/- 11,52,000/- 12,22,000/-6 Salary of contractual staffs168000/- 1,68,000/-Total 13,68,000/- 6592000/- 79,60,000/-CONCLUSION:The NIDDCP is the state is functioning with its limited resources. Overthe years Goitre and survey has been done in almost all districts. Whatis encouraging is that Goitre has almost disappeared in the state withonly a few sporadic reports. The incidence of Goitre was very highduring 1960s with a prevalence rate of 38%, as per ICMR survey.Subsequent survey by ICMR in 1970s showed a reduction in theprevalence rate to about 28%. State IDD cell has since 1990 startedconducting survey of selected districts and the prevalence rate hassince been reduced to less than 6%. The dramatic reduction in theprevalence rate of Goitre is definitely due to consumption of Iodisedsalt in the state. Use of non-Iodised salt was banned in the state since1974 and it’s impact has been transformed into results.However, there is a need to study the actual prevalence of iodinedeficiency in the population for which Goitre survey is not enough. Alsothe availability of Iodised salt in the households as per the UniversalSalt Iodization programme needs to be ascertained.As such, along with regular salt monitoring and simple goiter survey, ithas been proposed in this Plan of Action to undertake two researchworks in the state:5. To ascertain the percentage of household havingaccess to Iodised salt.346

6. To determine to percentage of population with Iodinedeficiency through Urinary Iodine Excretion measurewith confirmation through a measure of TSH.The State Plan of Action has reflected the need of the state as regardsto research work along with routine duties as per the National IDDControl programme.347

Part E:INTER-SECTORAL CONVERGENCECONVERGENCE IN ARUNACHAL PRADESH:One key to success of NRHM is intersectoral convergence. The need forconvergence is not only with other health determinant departments but also withinthe department. Apart from PPP and VHND, no well thought activities could beimplemented last year due to different bottlenecks. This year, the state envisage toimplement few planned activities through vertical programmes and will prepare a planfor next year to be implemented with the assistance of other health determinantdepartments. This years plan is as follows:Objective:To built and peruse a combined effort to suffice the health needs of beneficiaries ofmultiple health determinant sectors.Strategy 1 :Functionalize the state level convergence committee under the chairmanship of ChiefSecretary.Activity: 1.A meeting will be organized with all NRHM line departments chaired by ChiefSecretary, Arunachal Pradesh. The main objective of the meeting will be to orient allthe departments on convergence issues of NRHM. At state level, a Joint Director(DHS) will be designated as Nodal Officer (Convergence) to carry forward theactivities of convergence not only with other health determinant departments but alsowithin the department. Through the State level convergence committee, Nodal officerwill initiate policy review for convergence and develop implementation procedures.SPMU will facilitate the Technical Assistance and Support. Meeting will be held twicethis year.Activity: 2.Similarly, the district and Community Development Block level convergencecommittee will be formed under the chairmanship of DC and BDO. At district level, adistrict level officer will be designated as Nodal Officer (Convergence) and at blocklevel the MO in charge CHC/PHC will be designated as Nodal Officer (Convergence).District level convergence committee will ensure the implementation of the directivesof the State Level Convergence Committee.Strategy 2 :Close coordination of all vertical programmes of Health Department.Activity: 1.Develop policy framework and Programme wise procedural guidelines / manual byNO (convergence).Activity: 2.Approval of procedural guidelines / manual by state level convergence committeeand dissemination of these to all vertical programmes.Activity:3.Ensuring implementation of Programme wise convergence activities in state / district/ block level (NB: a tentative Programme wise convergence activities articulatedbelow)Activity:4.Ensuring implementation of all national disease control programmes through all RKSin different level.Activity:5.Sensitize PRI s to actively involve in health development activities (through VHND)Activity:6.Monitoring Programme wise convergence activities in state / district / block levelStrategy 3 :348

Develop effective coordination between health and other line departments like WCD,PHED, PWD, Urban & Rural Development, Education, Panchayat, Youth Affairs, etcat all levels.Activity: 1.Develop policy framework and Programme wise procedural guidelines / manual byNO (convergence) for next year through consultative sittings with the healthydeterminant departments.Activity:2.Approval of procedural guidelines / manual by state level convergence committeeand dissemination of these to all vertical programmes before current financial year.Activity:3.Ensuring implementation of Programme wise convergence activities in state / district/ block level in next financial yearActivity:4.Sensitize PRI s to actively involve in health development activities (through VHND)Activity:5.Initiate Joint Planning, monitoring, evaluation by ANM, AWW, ASHA FNGO/NGO,VHSC and PRI representatives in VHSC meeting for health determinant activitiesthat may be reflected in Village Health Action Plan of next year. It will be initiated byASHA supervisor/facilitator under the guidance of ASHA mentor group / coordinationgroup of district level.Activity:6.Preparation of joint monitoring plan in consultation with all line departments andMonitoring Programme wise convergence activities in state / district / block level innext financial year.Strategy 4 :Continuing partnership with NGOs.4. 1. Partnership with NGOs running 16 PHCs under PPP.4. 2. Partnership with MNGOs.Activity: 1.NGOs would be encouraged to run their PHCs as a 24x7 PHC, ensure 12 registers inSCs under them and hold VHNDs in AWC/SC/community hall as per convenience.As a pro-poor strategy, the NGOs will be involved for reaching out to themarginalized communities for the following functions: Social Mobilization &Communication: Specific activities would include Village Contact Drives, Tracking thedropout women and children, health education to the women SHG members,distribution of contraceptives etc.Activity: 2.Provide financial, technical and managerial support to NGOs for running 16 PHC.Activity: 3.Monitor, evaluate and assess potential / promising practices by SPMU for scaling up.Activity: 4.Evaluation of PPP by third party technical group assured through RRC-NE,Guwahati.349

Tentative Programme wise convergence activities within vertical programmes:2. Maternal Healthconvergence activities1.2 Community mobilization and organization of VHNDs atAWC/SC/community hall once a month to deliver ANC services.1.2 Referral of complicated cases for safe institutional delivery. An advanceReferral money will be available with ANM under the direct supervision of theconcerned MO. Community representative through PRI/VHSCs/ womenSHG/MSS will be identified by ASHA coordination group (district / block) fororganizing a suitable arrangement of referral transport.1.3 Assisting the pregnant women for her laboratory investigations (Ifpossible, Collection of blood and urines samples of pregnant women and sendit to PHC for examination and report back)1.4 Regular home visits and follow ups by ASHA/ AWW/ANM for ensuringobserved consumption of IFA tablets by moderately and severely anemicpregnant mothers.1.9 De-worming of all pregnant and adolescents girls twice in a Year throughVHND1.10 Health awareness campaign / BCC / ACSM by ASHA/AWW/ANM/MSS1.11 Ensuring JSY benefit to the motherResponsibilityASHA coordinationgroup of concerneddistricts, DRCHO,DPM, CDPO.ASHA coordinationgroup of alldistricts, VHSCV,DRCHO, DPM.ASHA, ANM, AWWDRCHO, VHSCVHSCASHA coordinationgroup of alldistricts, VHSCV,DRCHO, DPM.1.12 Ensuring PNC visit by ANM through the linkage of ASHA/AWW ANM, ASHA, AWW3. Child Health2.1 Ensure registration of all births and deaths of mothers with the VillageRegistrar of Births & deaths.2.4 Community mobilization and Organization of VHNDs at each and everyAWC once a month to deliver child health and nutrition services like:- Growth monitoring of child under six during VHNDs-Maintaining Growth chart-Nutrition supplementation to child- Identify & referral of unmanaged malnutrition cases to the PHC-Non-formal pre school education-Health and nutrition education to mother, adolescent girls-Assist PHC staff in immunization of children- House visits for dropout child of immunization and to ensure appropriatefeeding practices and attendance at AWC.2.5 Supervision & Monitoring on all VHNDs by PRI representatives. Elicitcommunity support and participation in running the programme3.Immunization4.2 Conduct Home Visits to trace out the Un-immunized children and DropoutsASHA, AWWASHA coordinationgroup of concerneddistricts, DRCHO,DPM, CDPO.AWW, ASHA, ANMAWW, ASHA, ANMPRI/VHSCASHA , AWW andANM350

4.3 Provision of Immunization during regular VHNDs organized at everyAWCsASHA , AWW andANM5 Family Planning3.3 Regular updating of EC register and quarterly population survey of hercoverage area.3.4 Ensure distribution of OCPs, emergency pills, condoms and IUD insertionto eligible couple.5. Adolescents Health5.3 To provide weekly dose of observed IFA and bi-annual dose of dewormingto adolescents girls in school5.4 Sensitization of AWWs, ASHAs, female PRI representatives and schoolteachers, on following issues:• Adolescents growth and development• Group counseling of adolescents on Sexual and reproductivehealth concerns of boys and girls including Menstrual hygiene• Nutrition and anemia in adolescents• Contraception for adolescents• RTIs/STIs and HIV/AIDS in adolescents• Birth preparedness and parenting• Child bearing• Safe abortion7. National Disease Control ProgrammeASHA, ANM, AWWASHAs , AWCs andANMsASHA, AWW,ANM, Teachers7.1 IDSP5.1.1 Symptomatic identification of diseases covered under IDSP and referto the nearest health facility5.1.2 Follow up of all referral casesASHA, AWW, ANMASHA, AWW, ANM7.2 RNTCP7.2.1 Awareness development at community level regarding signs andsymptoms of reportable cases for early detection, isolation and seekingtreatment through mass media,, IPS, & counseling7.2.2 Developing and dissemination of IEC material, including leaflets andposters to the community7.2.3 IPC through convergent approach7.2.4 Identification of persons with symptoms of TB and refer to nearestDOTS centre (Gram Sabha will work with ANM/Health workers in identifyingaffected persons).7.2.5 Enabling access for consultation, sputum, X Rays, and furthertreatment. Panchayat will ensure that the person has access to requisiteclinical and diagnostic examination (This will be done through facilitation ofASHA and medical staff)7.2.6 Ensuring drug delivery to patient compliance and uninterrupted supply.(Block Panchayat will be responsible for ensuring supply of doctors, drugs,laboratory consumables, and X-rays. Village panchayat to liaise with GramSabha to ensure compliance with treatment. This will be done by the VHSCand ASHA/ANM)ANMs,ASHAs,members-do--do-AWWs,PRI351

6.2.7 ASHA will be training as DOT provider by RNTCP RNTCP7.3 NPCB6.3.1 Awareness development at community level regarding signs andsymptoms of reportable diseases of eye for early detection and seekingtreatment.6.4.2 Sensitizing the community by BCC activities like IPC throughconvergent approach for attending screening camps to be organizedby NPCB.6.4.3 Identification of persons with blindness6.4.4 Maintain a village register for Blindness6.4.5 Enabling access for consultation, diagnosis, specialist facilities,treatment and referral in govt. facility which is nearest for the patient.Panchayat will ensure that the person has access / referral to requisiteclinical and diagnostic examination6.4.6 PRI will be involved in village Blind Registry, Identification, motivationand transport of affected persons for cataract surgery, organizingscreening camps, and school eye screening programmes.6.5 Leprosy6.4.2 Ensuring accessible and uninterrupted MDT services available to allpatients through flexible and patient friendly drug delivery system6.4.2 Identify cases in need of reconstructive surgery and rehabilitation6.4.3 Referral to Government/ NGO facilities for rehabilitation.ASHA, AWW,ANM, SchoolTeacher, NPCBASHA, AWW,ANM, PRI memberASHAASHA, AWW,ANM, PRI memberPRIASHA, AWWs andPRIs tothe village andBlock PanchayatsIn collaborationwith the districtPanchayat-do-6.5 National Vector Borne Disease Control Programme- Identification of villages based on case load and sprayingNVBDCP- Identification of persons in need of diagnosis and management ASHA, AWW, ANM- Enabling access to consultation, blood smears drugs, and further treatment- ensure spraying, where appropriate,- case finding, blood smear, reporting result, diagnosis and ensuringtreatment and follow up- Ensuring health worker functions in vector borne diseases, monitoring, andsurveillance.- ensuring supply of insecticides, roster of workers, and monitoringavailability of doctors, drugs, and laboratory consumbles- awareness raising related to vector borne diseases, distribution ofinsecticide treated bednets, distribution of anti-malaria drugs at village level,ASHA, AWW, ANM- Panchayats incooperation withthe Gram Sabha.health workers,PRI in collaborationwith Gram SabhaBlock PanchayatsPRI352

through Drug Distribution Centers and Fever Treatment Depots, Promotion oflarvivorous fish, and mass drug administration for filariasis.- Environmental sanitation and safe drinking water supply by detectinglocation with problemsPHED7. Water borne diseases7.1 drinking water Sample testing by ASHA trained / assisted by PHEDASHA, PHED8. CONVERGENCE WITH APSACS:Convergence with the APSACS is as follows:11. Collaboration for the treatment and control of STDs.12. A closer collaboration in family health awareness campaign.13. APSACS at present is running its own program in collaboration withNGOs on awareness generation as well as target interventions. There isneed for involving other NGOs through the district health mission. They werebeing done by APSACS in the district and should be in the knowledge ofdistrict health mission.14. The ICTC centres are presently being run in the District Hospital. TheICTC centers may be started at the CHC level.15. PPTCT center: There is need to make the HIV positive pregnantwomen aware of the fact that it is now possible to prevent HIV transmissionform mother to child and the drugs for the purpose are also free. This can bedone through the family health awareness camps as well as through ASHAs,ANMs and Anganwadi workers etc.16. Awareness about the relationship between HIV and TB: As TB is amajor opportunistic infection for in HIV infected person and vis-à-vis it isnecessary to use the NRHM machinery to make the rural population awareof it.17. School AIDS education programs: The school AIDS program under aNACO scheme is being run by the state AIDS control society in collaborationwith the department of school education. It is important that the Panchayatiraj institutions and the district health mission are also kept in close touchwith the activities under the program.18. Free medicine distribution for OIs: At present treatment and medicinesfor OIs are available only at General Hospital, Naharlagun. It is suggestedthat they should be available at all the GH / DHs and also at the CHC levelalso in those blocks where VCTCs come across HIV positive cases becausefor the poor HIV positive people it is not possible to travel to district headquarters or to the medical colleges for treatment of OIs.19. IEC campaign for awareness of HIV: So far most of the programs hadbeen held in towns whereas there is a need for a massive awarenesscampaign both for making those people who have under gone risk behaviorsremoving stigma and discrimination against HIV positive people, similarprograms should be organized in the rural areas also.20. Targeted intervention: In a number of districts, various NGOs arerunning programmes as targeted interventions. It is necessary that the353

district health mission also keeps a track of the activities under theinterventions programmes.Area ofConvergenceRTI/STIICTCRole and Functions ofFW / RCH-II-Primary ResponsibilityintegrateRTI/STImanagement at all levelsin public sector system-Broadly RCH II strategiesshould be followed-At PHClevel, first line drugs to beoffered,-District, CHC and FRU tooffer comprehensiveetiological and lab basedtreatment. At district level,linkages with STD referrallabs to be strengthened.-Infrastructure (space) tobe provided in facilitieswhere ICTC are located.-Support to ensure referralfrom other departments-Overall supervision byhead of facility, incollaboration with Ob/Gyn,STD, Paed, and otherdepts.-Frontline providers /ASHA / Health workers tomotivate community at riskfor ICTCRole and Functions ofAPSACS-Support to NGOs tocontinue. Servicedelivery whether directlythrough NGOs or referralto public or privatesector.-Ensure that all STIservice data are providedto the Convergencecommittee level.Primaryresponsibility—- increase VCTC sitesexpansionin phasedmanner-APSACS support forstaff and supplies,-Include Youth FriendlyInformation Centers atCHC and PHC-VCTC to serve othercounseling needs.-Cadre/of counselors tostaff the sites.Convergencemechanisms/aspects-At State level,a Convergencecommittee isformed tomonitor accessof RTI/STIservicesgeneralpopulation.ReportHIV/AIDSConvergenceCommittee.forto-Training ofproviders(public, privateand NGO) andlab techs withinpurview of FW /RCH-II.-Convergencecommittee toreviewfunctioning ofVCTC throughperiodic statereports.-Training ofproviders of FW/ RCH-II at alllevels to includeelements of riskprotection,motivation fortesting- throughFW / RCH-II.PPTCT -Overall supervision byhead of facility-Located in Ob/Gyndepartment, managed byHOD-Ensure non discriminatoryPrimary Responsibilityto ensure functioningPPTCT-Expand PPTCT sites ina phased manner-NGO trainingfacilitated byAPSACS.-ConvergenceCommittee toobtain data onfunctioning ofPPTCT andreview354

practices-Ensure universalprecautions-At the community level,ANM/ASHA follow up ofVCTC clients testingpositive for ANC, andmotivate for PPTCTBCC -All messages for FW /RCH-II to includeHIV/AIDS prevention andcare and support asappropriateCondomPromotion-Ensure that NGOprograms also usemessage content asdefined-Enhance condom use fordual protectionTraining Primary Responsibilityfor training of all serviceinterventions (exceptVCTC/PPTCT) to be withinFW/ RCH-II.-Support training contentand technical support forVCTC and PPTCT training-APSACS to supportcounselor and lab. Tech.and supplies for PPTCT.-Messages for HIV/AIDShighlight appropriateservice provision throughpublic and private healthsystem-Ensure that NGOshighlight service accessin addition to preventionmessages.-Condom promotion keyto prevention-Support training in termsof content and technicalsupport.-Primary responsibilityfor training VCTCcounselors in a range ofissues includingHIV/AIDS, which includesafe motherhood, familyplanning and childcare.PPTCT staff training alsoto be conducted byAPSACS.performance-Training for allproviders toincludeattitudinal aswell technicalskills, anduniversalprecautions.-BCCstrategy/divisionfor APSACSand FW/RCH-IIunder jointmanagement.Condomprocurement /supply from GoIand distributionfor FW andAPSACS undersingle entity.-APSACS tocoordinate withgroups workingon RCH IImodules toensureHIV/AIDScontent for allworkers.-Joint WorkingGroup to beinstituted toreview andensure thatHIV/AIDSmessages andcontent fortraining aretailored to eachlevel of provider-Ensure thattrainingmodules areshared withNGO partnersof FW/ RCH-IIand APSACS.-Develop355

ReportingFW/RCH-II MIS to captureservice data - RTI/STI,VCTC, and PPTCT-MIS to include HIV/AIDSindicators-Ensure that VCTC,PPTCT, and sentinelsurveillance data isreflected in district MIS.protocols andguidelines forkey services.-Ensuredisseminationof protocols andguidelines toNGOs andprivate sector.-APSACS tocoordinate withFW / RCH II toensure thatHIV/AIDSindicators areincluded in MISfor RCH II.-Joint WorkingGroup to reviewRCH II MIS andensure thatreporting ofRTI/STI, VCTC,and PPTC isalso included.Blood SafetyMaintain quality of bloodtaken from blood banks toblood storage centers atsecondary levels offacilities.-Primary Responsibilityto assure safety of bloodat banks at district leveland above-Surveys(NFHS III andDLHS) toincludeinformation onHIV/AIDS aswell.-Joint WorkingGroup to reviewthe “Serviceutilization by thecommunity”.Convervence with APSACS- Identification of persons with symptoms- Identification of facilities for examination, diagnosis, and counseling- Enabling referral- Ensuring appropriate treatment and management- Gram Sabha will be responsible for awareness campaigns along withhealth worker.- Block Panchayat will identify sites where appropriate treatment andcounseling facilities are available.- Block Panchayats will ensure attendance of doctors, and other staff andidentify bottlenecks to services at PHC/CHC.- Where required Panchayat will enable counseling for members of theaffected families.356

- - In some state, PRI representatives have been sensitized to basic ofHIV/AIDS and the need to ensure non-discriminatory practices in theircommunitiesDHFW will ensure convergence of RTI/STI control ( to reduce HIV/AIDStransmission ) at all levels, in collaboration with the National AIDS ControlProgramme (NACP)- - PRI could be involved in reducing stigma and discrimination at thecommunity level.Work Plan of Intersectoral ConvergenceStrategy / Activity1. Functionalize the state level convergencecommittee under the chairmanship of ChiefSecretary.1.1. State Level Meeting1.2. District Level Meeting2. Close coordination of all verticalprogrammes of Health Department.2.1. Develop policy framework and Programmewise procedural guidelines / manual2.2. Approval of procedural guidelines / manual2.3.Implementation of Programme wiseconvergence activities in state / district / blocklevel2.4. Implementation of all national disease controlprogrammes through all RKS in different level.2.5. Sensitize PRI s to actively involve in healthdevelopment activities (through VHND)2.6. Monitoring Programme wise convergenceactivities in state / district / block level3. Develop effective coordination betweenhealth and other line departments like WCD,PHED, PWD, Urban & Rural Development,Education, Panchayat, Youth Affairs, etc at alllevels.3.1. Develop policy framework and Programmewise procedural guidelines / manual3.2. Approval of procedural guidelines / manual3.3. Ensuring implementation of Programme wiseconvergence activities3.4. Sensitize PRI s to actively involve in healthdevelopment activities3.5. Initiate Joint Planning, monitoring, evaluation3.6. Preparation of joint monitoring plan4. Continuing partnership with NGOs forTimeline2008-09 200Q1 Q2 Q3 Q49-102010-11ResponsibilityState/District357

Strategy / ActivityTimeline2008-09 200Q1 Q2 Q3 Q4 9-102010-11ResponsibilityState/Districtrunning 16 PHCs under PPP.4.1. MNGO4.2. Provide financial, technical and managerialsupport to NGOs for running 16 PHC.4.3. Monitor, evaluate and assess potential /promising practices4.4. Evaluation of PPPBudget Intersectoral ConvergenceStrategy / Activity1. Functionalize the state level convergencecommittee under the chairmanship of ChiefSecretary.1.1. State Level Meeting2008-09(in lakhs)Q1 Q2 Q3 Q41.1.1 Intra Departmental 0.05 0.051.1.2 Inter Departmental 0.25 0.251.2. District Level Meeting1.2.1 Intra Departmental@ 2000 x 16 districts1.2.2 Inter Departmental@5000 x 16 districts2. Close coordination of all verticalprogrammes of Health Department.2.1. Develop policy framework and Programmewise procedural guidelines / manual0.32 0.320.8 0.8- - - -2.2. Approval of procedural guidelines / manual - - - -2.3.Implementation of Programme wiseconvergence activities in state / district / blocklevel2.4. Implementation of all national disease controlprogrammes through all RKS in different level.2.5. Sensitize PRI s to actively involve in healthdevelopment activities (through VHND)- - - -- - - -Remarks- - - - BudgetedunderNRHMAdditionalities/training2.6. Monitoring Programme wise convergence 0.2 0.2358

Strategy / Activity2008-09(in lakhs)Q1 Q2 Q3 Q4activities in state / district / block level3. Develop effective coordination betweenhealth and other line departments like WCD,PHED, PWD, Urban & Rural Development,Education, Panchayat, Youth Affairs, etc at alllevels.3.1. Develop policy framework and Programme - - - -wise procedural guidelines / manual3.2. Approval of procedural guidelines / manual - - -3.3. Ensuring implementation of Programme wiseconvergence activities3.4. Sensitize PRI s to actively involve in healthdevelopment activities- - - -Remarks- - - - BudgetedunderNRHMAdditionalities/training3.5. Initiate Joint Planning, monitoring, evaluation - - - - Budgetedunder DAPplanning3.6. Preparation of joint monitoring plan - - - - Budgetedunder DAPplanning4. Continuing partnership with NGOs forrunning 16 PHCs under PPP.4.1. MNGO - - - - Budgeted4.2. Provide financial, technical and managerialsupport to NGOs for running 16 PHC.4.3. Monitor, evaluate and assess potential /promising practices4.4. Evaluation of PPPTotalunder RCH- - -- - Budgetedunder RCH- - - - Budgetedin point 2.6above- - - - Budgeted0.3 1.32 0.3 1.32underNRHMAdditionalities359

Therefore, the total budget for all the activitiesunder NRHM is as below:Sl.No.ComponentsBudget(in lakh)A. RCH-II 1608.99B. NRHM Additionalities 2018.58C. Routine Immunization 475.46D. VERTICAL PROGRAMME1. Revised National TB Control Programme 70.971. National Programme For Control Of Blindness 422.072. National Vector Borne Disease Control1137.94Programme3. National Leprosy Eradication Programme 325.144. Integrated Diseases Surveillance Programme 346.105. Iodine Deficiency Disorder 79.6E. Intersectoral Convergence 3.24GRAND TOTAL:- 6488.09360