ARUNACHAL PRADESH

15TH -22ND DECEMBER 2010

� Dr Himanshu Bhushan, Assistant Commissioner, MH Division,

MOHFW

� Dr. G. Lakshmaiah, CMO, NVBDCP, GOI

� Dr. Dipankar Bhattacharya, Civil Society Member

� Dr. Jayanat Pratap Singh, Consultant, NRHM

�Ms. Asmita, Consultant, NRHM

� Dr. Shilpi Sharma, Consultant, Planning Commission

� Dr..Vaibhao Ambhore, Consultant, NRHM

State Participants

�Mr. Talem Tapok, MD(NRHM), Govt of Arunachal Pradesh

� Dr. Padung, State Program Officer, NRHM, Govt of Arunachal

Pradesh

� TAWANG

�CHANGLANG

Socio-Demographic Information

Total Area 83, 743 sq. km

No. of Districts 16

No. of Circles 110

No. of Villages 4507

Major Tribes 26

Total population (2001)10.98 lacs

13.84 lacs (Projected)

Decadal growth rate 26.21%

Average Exponential growth rate 2.63% PA

Population Density/ sq km 13 / sq km.

Literacy rate (Total) 54.74%

Sex ratio 901

Particulars Overall Rural Urban

Institutional births (%)47.7 42.5 67.7

Birth assisted by a doctor/nurse/LHV/ANM/other

health personnel (%) during home delivery 1.2 1.3 0.8

Mothers who had atleast 3 ANC visits for their last

birth(%)

48.2 43.9 64.7

Married women aged 15-49 who are anaemic (%)

Maternal Health (DLHS-3)

Married women aged 15-49 who are anaemic (%) 48.9 (NFHS-3)

Mothers who consumed 100 IFA Tablets(%) 42.9 45.2 34.3

Mothers who received postnatal care from a

doctor/nurse/LHV/ANM/other health personnel

within 2 days of delivery for their last birth (%)38.3 35.3 49.7

JSY Beneficiaries 11600 /74%

Total Fertility Rate 3.0 (NFHS-3)

Particulars Overall Rural Urban

Children aged 12-23 months fully immunized (BCG,

measles, and 3 doses each of polio/DPT) (%) 40.3 34.5 55.8

Children aged 12-35 months who received a vitamin A

dose in last 6 months (%) 45.1 41.9 54.9

Children with diarrhoea in the last 2 weeks who

received ORS (%) 64.1 58.7 87.3

Children with diarrhoea in the last 2 weeks taken to a Children with diarrhoea in the last 2 weeks taken to a

health facility (%) 57.9 59.0 52.8

Children with acute respiratory infection or fever in the

last 2 weeks taken to a health facility (%)

76.9 78.4 73.4

Children aged 0-5 months exclusively breastfed (%) 51.5 52.6 47.9

Children aged 6-35 months who are anaemic (%)66.3 (NFHS-3)

Infant Mortality Rate 61 (NFHS-3)

32 (SRS 2008)

Particulars Overall Rural Urban

Current use

Any method (%) 52.0 50.9 57.4

a. Any modern method

(%)49.0

48.2 52.8

b. Female sterilization (%) 30.6 30.5 30.9

c. Male sterilization (%) 0.5 0.5 0.2c. Male sterilization (%) 0.5 0.5 0.2

d. IUD (%) 3.7 3.4 4.9

e. Pill (%) 10.9 10.6 12.3

F. Condom (%) 3.1 2.9 3.6

Unmet need for family planning

Total unmet need (%) 14.3 13.6 18.0

a. For spacing (%) 3.9 3.7 4.9

b. For limiting (%) 10.4 9.9 13.1

Item Required In Position Shortfall

MultipurposeWorker(Female)/ANM At Sub Centers & PHCs

708 256 452

Health Worker (Male)/MPW(M) 592 156 436

Health Assistants(Female)/LHV at 116 0 116

Health Assistants(Male) 116 0 116

Doctor at PHCs 116 87 29Doctor at PHCs 116 87 29

Surgeons at CHCs 44 5 39

Obstetricians & Gynaecologists at CHCs 44 1 43

Physicians at CHCs 44 3 41

Paediatricians at CHCs 44 0 44

Total specialists at CHCs 176 9 167

Radiographers 44 7 37

Pharmacist at CHCs & CHCs 160 66 94

Laboratory Technicians at PHCs & CHCs 160 52 108

Nurse Midwife 424 312 112

Performance Performance Indicators Physical Achievement

05-06 06-07 07-08 08-09 09-2010

Maternal Health

ANC 3 check-ups 7607 8757 4816 5098 8136

Institutional Deliveries 8638 8423 8897 10154 9409

JSY beneficiaries 1433 7689 9018 9939

Immunization (Infant 0-1 yr)

BCG 20574 21428 16446 16063 17696

DPT (3rd dose) 15230 20778 13193 13193 14099DPT (3rd dose) 15230 20778 13193 13193 14099

OPV (3rd dose) 15501 20987 13389 17119 14088

Measles 24406 19373 14006 13840 13594

Family Planning

Female sterilization 1988 1934 2277 3443 1383

Village Health & Nutrition Day

(VHND) held

28 318 308 1473

State Health Society Meeting 1 1 1 1

District Health Society Meeting 16 15 1 7

MMU Camp 36 27

Year

RCH NRHM Addl. RI

Funds Exp % used Funds Exp

%use

d Funds Exp % used

05-06 735 373.6 50.8 287.3 167.9 58.4 40.42 31.8 78.6

06-07 825.0 348.1 42.3 2139.0 564.2 26.4 103.52 68.35 66.006-07 825.0 348.1 42.3 2139.0 564.2 26.4 103.52 68.35 66.0

07-08 903.1 1128.7 124.9 4723.8 1897.9 40.2 117.16 72.05 61.5

08-09 1177.2 1350.8 114.7 3942.4 2109.9 53.5 127.16 126.62 99.6

09-10 1492.4 1357.2 90.9 3326.5 1640.3 49.3 49.54 119.91 242.0

•Improved and clean infrastructure

•Citizen charter, doctors roaster, JSY Beneficiary & IEC displayed

•Good immunization coverage and follow up

•Good training of ASHA •Good training of ASHA

•VHND’s have started taking place

•No delays in fund transfer

•Up-to date reporting

•Highly proactive and motivated staff; require proper mentoring

•District hospital(Tawang) has operationalized“homeopathy wing” out of RKS

•District Hospital (Changlang) has a good “Panchkarmaunit” but it is not yet functional; due to non-availability of attendant.

•Good PPP Model seen at PHC Khimiyang; Changlang. •Good PPP Model seen at PHC Khimiyang; Changlang.

•Good utilization of RKS in improving service delivery

•Nischay Kit available at all Sub centers and with ASHAs

•Good coordination between DMO, RCHO and other staff

� Lack of Assured referral due to difficult terrain

� JSY payments through cash

� Poor convergence between ASHA, ANM and AWW

� Irregular RKS meeting , Lack of interest in health by the PRIs

� No standard formats for RKS, AMG, Untied, Registers etc.No standard formats for RKS, AMG, Untied, Registers etc.

� Poor cash book maintenance, except DH

� Issue of UC & SOE of VHSC’s

� Shortage of staff including specialists

� ANMs are not deployed at sub-centre but at DH. So, many sub centers lacking ANMs

� Lack of Standard Treatment Protocols

� Weak mentoring of supervisors and monitors

• Poor training status, None of the ANM is SBA /IMNCI Trained

• VHNDs limited to organizing cleanliness and immunization

• Standard guidelines for managing

• Finance and Logistics not present

• No internet connectivity below district Level

• Weak Supply Chain Management of drugs

• Sub –Optimal Utilization of equipments • Sub –Optimal Utilization of equipments

• Lack of comprehensive and sustainable plan for procurement of equipments

• Weak Outreach Coverage

• No blood bank

• No technical Protocols to Facilities

• VHSC account not opened in more than 50%

villages

• For name based tracking of pregnant

women and children only formats received.women and children only formats received.

• No nutritional and FP counseling

• AWC not adequately functional, lack of

proper & adequate ration supply

• MDR not implemented

• IEC weak beyond facility level

� Allotment of funds on the basis of population needs reconsideration because of low density and wider coverage area

� Establishing Regional Monitoring Units for close supervision and quality implementation of the activities.

� Creation of Infrastructure & office set up for DPMU & NRHM Staff

� Reorientation of DPM, Data Manager , Finance Manager & Other Program Managers on Monitoring with a checklist

� Clear targets and accountability to be given to programme officers and DPMUs.

� Special drive for recruiting specialists with high salary/incentive

� ANMs working at district hospital should be posted back to the Sub Centers� ANMs working at district hospital should be posted back to the Sub Centers

� Higher salaries/ Hard to reach area incentives along with performance incentives can be given to people working in difficult terrain.

� Local Medical Graduates / ANMs are available and needs to be offered appointments

� Offer of PG seats may be linked with 2-3 years bond for serving in difficult terrain

� Family planning services , ANC , PNC and Nutritional activities needs a special focus

� Provision of diet below district hospitals for facilitating 48 hour stay

� NRC can be created along with strengthening of micro-nutrient supplementation Plan

� Innovations like Palki scheme, birth waiting home, incentives etc can be thought for linking service delivery with assured transport.

� Comprehensive IEC/BCC plan to be prepared involving all programs for optimal and best utilization of IEC funds available under different programs

� IEC need to be focused particularly in blocks and villages

� PRI’s, public leaders, opinion farmers to be oriented at regular interval on � PRI’s, public leaders, opinion farmers to be oriented at regular interval on RCH and NRHM key issues.

� Targeting married couple required for FP services

� Presence of doctors at the health facility with assured services delivery should be ensured at DH during emergency hours.

� Key skill based trainings like SBA, IMNCI, NSSK, Minilap needs augmentation

� More training centers need to be created along with pool of master trainers

� If needed, some critical training can be conducted outside the state.

� Need to give induction training to fresh recruits

� More ANM/SN Training Institutes needed , PPP model can be explored

� Creation of ASHA/ANM home at district level to facilitate their stay during training and as a companion during Institutional delivery

� Assured referral transport with innovations like Palakhi Scheme, Birth Waiting Homes can be established

� MCH Centre plan for all districts with more focus on creation of level I facility, catering to the needs of scattered population level I facility, catering to the needs of scattered population

� Concurrent audit and its finding should be communicated to district level at regular periodicity.

� Disease surveillance and reporting needs improvement

� Reorientation of Paramedical workers and doctors for special focus on timely detection & treatment of Malaria cases particularly in endemic zones

� Anti malaria drugs and RD kits to be made available on priority.

� Homeopathy facilities including availability of manpower and drugs at the PHCs to be strengthened. Such alternative will help the shortage of homeopathy doctor.