The document provides information on the organization and management of health services in Uttar Pradesh at the state, district, and sub-district levels. At the state level, the principal secretary oversees health policy and budgeting under the minister. Directors provide technical assistance. Key programs include UPHSDP, SIFPSA, and UPSACS. At the district level, the CMO implements health programs with support from the SMO and medical officers. Subcenters, PHCs, and CHCs provide primary healthcare services to populations of around 6,000-30,000 people on average across large areas. Staffing and infrastructure availability remains below requirements at many facilities.

1. STATE MAP OF UTTAR PRADESH
. Districts :70
Subdistricts:320
Towns:704
Villages:107452.

2. ORGANIZATION AND
MANAGEMENT AT STATE LEVEL
MINISTER
Principal
Secretary
Med Health & FW
Secretary
Medical Health
Director General
Medical Health
Director
Medical care
Director
Public Health
Director
Administration
Director
paramedical
Secretary Family
welfare & MD NRHM
Director General
National Program
Evaluation And
Monitoring
Secretary and
Project Director
UPHSDP
Secretary and
project Director
UPSACS
Secretary and
Exec. Director
SIFPSA

3. PRINCIPAL SECRETARY:
 Senior member of Indian Administrative
Services
DUTIES AND RESPONSIBILITIES:
 Assists minister in policy making
 Modifies policies from time to time
 Budgeting and control of expenditure
RESPONSIBILITIES OF PRINCIPAL
SECRETARY

4. RESPONSIBILITIES OF THE
DIRECTOR
 Directorate is headed by Director General,
Medical and health services.
 Provides technical assistance to Secretary
and Minister.
 Supervises,controls policies framed by state
govt.
 Co-ordinates and controls implementation of
health programmes and projects.

5. UTTAR PRADESH HEALTH SYSTEM
DEVELOPMENT PROJECT(UPHSDP)
 World Bank project
 To provide effective,responsive and comprehensive
health care in U.P.
 Through institutional and human resource
development in addition to investment in health
policy and public private partnership.

6. STATE INNOVATION IN FAMILY PLANNING
PROJECT SERVICES AGENCY(SIFPSA)
 Catalyst for Goverment of India in
reorienting, revitalising state’s family planning
services.
 Joint endeavour of Govt. and USAID
 Assists admnistration in reducing population
growth to a level consistent with social and
economic objectives.

7. UTTAR PRADESH STATE AIDS CONTROL
SOCIETY (UPSACS)
 Overall goal is to halt and reverse the
incidence of AIDS in Uttar pradesh by
integrating programs for prevention, care
and treatment.

8. NACO(National AIDS Control organization)
UPSACS(UP State AIDS Control Society)
HIV/AIDS PREVENTION AND CONTROL
COMMITTTEE
District program manager
District AIDS Prevention and Control
unit(DAPCU)
Coordinator/
Supervisor
Assistant
cum
Accountant
Support
staff
ORGANIZATIONAL STRUCTURE FOR AIDS
CONTROL PROGRAMME IN UTTARPRADESH

9. ORGANIZATION AND MANAGEMENT OF
HEALTH AT DISTRICT LEVEL
 District Health System is Headed by CMO
(Chief Medical officer).
 CMO is Assisted by Deputy CMO for
implementing various programs.
 District hospital is headed by Senior medical
officer (SMO).

10. CMO
(Chief Medical Officer)
Dy. CMO
(Urban Setup)
Medical
Officer(PHC)
Medical
suprintendent(CHC)
Dy. CMO
(Rural Setup)
Medical
Supritendent
Medical Officer
SMO
(Senior Medical Officer)
ORGANIZATION AND MANAGEMENT AT
DISTRICT LEVEL

11. RESPONSIBILITIES OF CMO
 In-charge of Health & family welfare
programs in District.
 Planning & implementation of National health
programs at the District level.
 Supportive supervision.
 Coordinating with relevant departments.
 Managing finances.
 Monitoring & reviewing progress.

12. RESPONSIBILITIES OF SMO
 Overall in charge and responsible for
supervising activities of Health and Family
welfare programmes in dispensaries etc
 He is further assisted by Health supervisor.

13. LADY MEDICAL OFFICERS
 Innovative scheme of hiring
women medical officers to
serve at block PHCs and at
CHCs.
 CMOs can contract
practising medical graduates
who are paid on a visit basis.
 Where no allopathic doctor
available, even women
practitioners of the
Indigenous System of
Medicine hired.
 The women medical officers
provide services from 8 a.m.
to 2 p.m.

14. CONTINUED..
 56 Women medical officers have been
contracted under this scheme throughout UP.
 More than 40,461 visits have been made by
women medical officers.
 This innovative scheme is an example of a
unique public and private sector partnership,
and won wide acclaim.

15. SOCIO-ECONOMIC PROFILE

16. TOTAL POPULATION
 Most Populous state in India.
 Population of 199,581,477.
 16.49% of the total Indian population.

17. RURAL POPULATION
0
10000000
20000000
30000000
40000000
50000000
60000000
70000000
80000000
U.P. India
population
Chart Title

18. URBAN POPULATION
0
50000000
10000000
15000000
20000000
25000000
30000000
35000000
U.P. India
Chart Title

19. DECADAL GROWTH OF U.P.
0
5
10
15
20
25
30
1991-2001 2001-2011
Chart Title

20. ECONOMY OF U.P.
 Second lowest per capita income.
 Per capita income of Rs 23,132.
 1 crore of population below poverty line.

21. POPULATION DENSITY
 Population density is of U.P. - 828/sq. km.
 Population density is of India- 382/sq. km.

22. LITERACY RATE:
 Overall literacy rate of U.P. is 69.72%
 Literacy rate of India is 74.04%
 Female literacy rate is 59.3%
 Male literacy rate is 70.23%

23. SEX RATIO
905
906
907
908
909
910
911
912
913
914
915
U.p. India
Column2
Column1

24. SCHEDULE CASTE POPULATION
 Schedule cast population in Uttar Pradesh
was around 35.15 million in the year 2010.
 Constitutes about 17% of the total population
of Uttar Pradesh.

25. SCHEDULE TRIBE POPULATION
 Schedule tribe population of Uttar Pradesh is
just around 0.11 million.
 0.5% of the total population of Uttar Pradesh.

26. CRUDE BITH RATE &CRUDE DEATH ARTE
 Crude birth rate has
reduced to 28.7
 Crude Death Rate is
Highest
28.7
8.2
22.5
7.3
27.2
6.6
0
5
10
15
20
25
30
35
CBR CDR
UP
India
Rajasthan

27. TOTAL FERTILITY RATE
 TFR has reduced from
4.82 to 3.8 but is still
higher than the
national average of 2.7
and nowhere close to
the target of 2.1 for the
year 2012
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
UP India Rajasthan
TFR
TFR

28. MATERNAL MORTALITY RATE
 MMR at 440 (SRS 04-
06) has improved from
517 in SRS 01-03, but
still way above the
national average of
254.
0
50
100
150
200
250
300
350
400
450
500
UP India Rajasthan
MMR
MMR

29. HEALTH INDICATORS
 Neonatal mortality: The probability of dying in the first month of
life
 Post neonatal mortality: The probability of dying after the first
month of life but before the first birthday
 Infant mortality : The probability of dying before the first birthday
 Child mortality : The probability of dying between the first and
fifth birthdays

30. NEONATAL MORTALITY RATE
 Neonatal mortality rate has decreased by 12
deaths per 1,000 live births (from 51 to 39)
 National Average :- 34
 This accounts for 70% of the IMR

31. INFANT MORTALITY RATE
• HIGHEST IN THE
COUNTRY
0
10
20
30
40
50
60
70
UP India Rajasthan
IMR
IMR

32. CHILD MORTALITY RATE
 HIGHEST IN THE COUNTRY
 The child mortality rate (at age 1-4 years) has decreased by
14 deaths per 1,000.
 Currently it is, 96 as compared to 65 deaths of national average

33. EARLY CHILDHOOD MORTALITY RATES FOR THE FIVE-YEAR
PERIOD PRECEDING THE SURVEY, NFHS-1, NFHS-2, AND NFHS-3
49
43
39
79
68
57
33
29
18
0
10
20
30
40
50
60
70
80
90
NFHS1 NFHS2 NFHS3
Chart Title
NMR
IMR
CMR

34. PUBLIC HEALTH INSTITUTIONS

35. SUB-CENTERS (SC’S)
 Sub centers are physically in bad
shape, maintenance of old buildings is poor.
 Some of the sub centers, not having been
able to meet the accreditation standards are
not eligible for JSY scheme and hence are
performing poorly
 As on march 2010, the number of SC’s
functional was 2,052 as compared to total
number of SC’s all over India is 1, 47,069.

36. PRIMARY HEALTH CENTERS
 The number of PHC’s functional as on
March’2010, was 3692 and the total number
of PHC’s functional all over India was 23,673.
 There has been an increase of 32 PHCs
since 2005

37. COMMUNITY HEALTH CENTRE’S (CHC’S
 The CHC has adequate space, wards and
manpower for its functioning
 As on March 2010, there are 515 CHC’s
functioning in UP as compared to 4535
CHCs all over India.
 There has been progress in the number of
CHCs from 386 in 2005

38. COMPARISON CHART
0
5000
10000
15000
20000
25000
30000
Required In position Shortfall
CHC
PHC
SC

39. HEALTH CENTRES IN UTTAR-PRADESH

40. DISTRICT HOSPITAL
 There are special district hospitals only for
women (Janana Hospital)
 Number of DH :-134

41. FIRST REFERAL UNITS
 FRUs in UP is like a misnomer :- that are
operationalised without fulfilling the criteria of
services to be provided like caesarian
section, new born care, blood transfusion
services which is quite similar to FRU we visited
in Rajasthan.
 As on March’2010, 121 FRUs have been
operationalised so far against the target of 257
by 2010. Out of 121 functional FRUs in the
state, 65 are in CHCs and 56 are in District
Women’s hospital

42. POPULATION SERVED
23986
8931
50077
474824
15122
7671
49062
284446
PER DOCTOR
PER CHC
PER PHC
PER SC
UP INDIA

43. AVERAGE RURAL POPULATION BY SC’S, PHC’S
AND CHC’S
255647
163725
UP
INDIA
CHC
CHC
35660
31364
UP
INDIA
PHC
PHC
6416
5049
UP
INDIA
SC
SC

44. AVERAGE AREA COVERED BY SC’S, PHC’S AND
CHC’S
CHC PHC SC
INDIA 687.81 131.72 21.2
UP 455.09 63.48 11.42
0
100
200
300
400
500
600
700
800

45. AVERAGE RADIAL DISTANCE COVERED BY
SC’S, PHC’S AND CHC’S
14.79
6.47
2.6
12.03
4.49
1.91
CHC
PHC
SC
Chart Title
UP INDIA

46. AVERAGE NO. OF VILLAGES COVERED BY
SC’S, PHC’S AND CHC’S
14.79
6.47
2.6
12.03
4.49
1.91
CHC
PHC
SC
UP INDIA

47. INTERNATIONAL AGENCIES FUNDING IN UP
 WHO :- MCH, RCH
 UNICEF :- Supporting NRHM
 NIPI :- Within the overall framework of
NRHM, NIPI focuses on newborn and child
health.
 WORLD BANK :- Aids UPHSDP

48. GROUP II
FIELD VISIT AT A GLANCE

49. CHC
BASSI
PHC
BASCO
(20 km
PHC
TUNGA
(18 km)
SC SC SC
SC
MADHOGARH
(2 km)
SC SC
PHC
ROJWADI
(25 km)
PHC
BADWA
(30 km)

50. PLACES COVERED
Aug 04’ 2011 : COMMUNITY HEALTH CENTRE, BASSI (DIST. JAIPUR)

51. CHC : BASSI
 Population Covered : 25000.
 No. of Beds : 30 (10 Male + 20 Female)
 No. of OPD Patients/day : 600
 No. of IPD patients/day : 25
 Total No. of deliveries under JSY :2000/Yr.
 No. of PHC’s Covered : 4
 24x7 Emergency Services available.
 Listed as FRU.

52. S.No. Personnel IPHS Norms Current
Availability
1. General Surgeon 1 1
2. Physician 1 1
3. Gynae/Obs. 1 1
4. Pediatrician 1 1
5. Anesthetist 1 Nil
6. Public Health Program
Manager
1 Nil
7. Eye Surgeon 1 Nil
8. General Duty Officer 4 4
9. Nursing Staff 7+2 7+2
CLINICAL MAN POWER

53. MAJOR SERVICES AVAILABLE
 Lab services : CBC, Blood
Sugar, BT, CT, AFB, Sputum, Urine.
 Diagnostic services : ECG, X-Ray, Sono-Graphy
(PPP).
 Equipments : 4 Incubators, Autoclave, Hot air
Oven, Rotor and shakers.
 Cold Chain : Deep
Freezer, ILR’s, Refrigerators, Ice Box.
 All vaccination and immunization services are
given by trained staff under the guidance of
doctors.

54. INCUBATORS

56. MAJOR SERVICES CONTINUED…
 Free medicine and Treatment provided to BPL
card holders.
 Deliveries done under JSY Scheme.
 Provides high rate of institutional deliveries.
 AIDS Awareness program is executed via ICTC.

58. INTEGRATED COUNSELING AND TESTING
CENTRE (ICTC)
 12- 15 patients per day
 Patients referred from Doctors, NGOs and
voluntarily also.
 Awareness programs includes awareness
camps in villages and mainly focused on the
migrant people.
 Proper follow-ups are also maintained.

60. MAJOR ISSUES TO BE CONSIDERED
 No proper emergency room for the casualties.
 Blood Bank available but non-functional.
 Increment in the No. of beds in the female ward esp.
pre and post delivery wards.
 No Intercom facilities.
 No Availability of the residential facilities for staff.
 More facilities required for the surgical and post
surgical departments.

61. AUGUST 05’ 2011 :
1) PRIMARY HEALTH CENTRE, TUNGA, BASSI (DISTRICT: JAIPUR)
2) SUB CENTRE, MADHOGARH, BASSI (DISTRICT: JAIPUR)

62. PHC : TUNGA
 Population Covered : 7000.
 No. of Beds : 14( sanction 6 beds)
 No. of OPD Patients/day : 90(50 females, 40
males)
 No. of IPD patients/day : 5
 Total No. of deliveries under JSY : 700/Yr.
 No. of Sub-Centers Covered : 6
 Emergency Services available.

63. FACILITIES AVAILABLE
 All the facilities are available (OPD
services, MCH services, Family planning
consultation, Nutritional services, proper
store, laboratories, labor room)
 ILR’s are available for storage of vaccines
 DOTS Therapy Available
 Conducts school health Programs including
dental, height and weight check up and nutrition
advice
 Have monthly meetings with Panchayat regarding
basic sanitation and hygeine measures.

64. INTERVIEW WITH ASHA
 She attends 8-10 families/ day and covers 205 families.
 Key works include:- Immunization, VHSC (attend
meetings with panchayat), Awareness regarding
Nutrition and Health supplements.
 Distribution of health supplements.
 Accompanies the women for ante-natal
checkups, vaccination and during labor.
 Awareness about Road to health charts and nutritional
status of neonates and infants.
 ASHA gets paid as per performance.

65. MAJOR ISSUES AT PHC
 No AYUSH practitioner.
 No Ambulance service.
 No utility room for dirty linen and used items.
 No proper waste disposal system.
 Excessive workload on ANM, Need for more
staff.

66. SUB CENTRE
 1 ANM (Auxiliary nurse and Midwife) is
providing services like handling deliveries, basic
medications and First-aid.
 LHV visits once in a week.
 Farthest village is 4 km away.

67. KEY FACILITIES
 Immunization
 Family planning counseling
 Nutrition counseling
 Distribution of Nutritional supplements
 Promotion of sanitation
 Health surveys in villages
 Regularly in communication with ASHA to help
her.

68. DISTRICT HOSPITAL - DAUSA

69. DISTRICT HOSPITAL- DAUSA
 DH hospital : Dausa is grade III hospital.
(According to IPHS norms, district hospitals have
150- 200 beds are graded III).
 Headed by PMO
 Population Covered : 20 LACS
 No. of Beds : 150
 No. of OPD Patients/day : 700
 No. of IPD patients/day :125
 Total No. of deliveries under JSY :400/Month.
 24x7 Emergency Services available.

70. PHYSICAL INFRASTRUCTURE
 Entrance Hall
 Waiting Hall
 OPD Room
 Indoor Patient Wards
 Emergency Room
 Observation Ward
 Operation Theatre
 Labor Room
 Nursery
 Laboratory Room
 X-ray Room
 ECG Room
 Blood Bank
 Administration
Room
 Store/Pharmacy
 Toilets

72. DEPARTMENTS
 OPD
 IPD
 Emergency
 General Medicine
 Surgery
 Gynecology/Obstratic
s
 Pediatrics
 Orthopedics
 Ophthalmology
 ENT
 Skin VD : Post Vacant
 Psychiatry
 Dentistry
 AYUSH

73. SUPPORT SERVICES :
 Operation Theatre
 SNCU
 Medico Legal
 Blood Bank
 Post Mortem :
Sampling
 Pharmaceutical
Services
 Mortuary
 ICTC
 STD Clinic
 Laundry
 Nursing Services
 Biostatistics Room

74. DIAGNOSTIC SERVICES
 Clinical Pathology : All tests except Stool
examination.
 Pathology : Only sampling services available.
 Biochemistry : Only LFT, RFT, Blood Sugar.
 Microbiology : Sampling apparatus present but
not working.
 Histopathology : Sampling present.
 Serology : Sampling present.

76. YASHODHA : SCHEME
 Appointed in the labor department to provide a
comfort level and Information to the incoming
patients.
 One Yashodha/5 deliveries.
 Paid on work basis Rs. 100/delivery.
 Qualifications : VIII passed, Trained in
counseling.
 Key works : Identification of danger signs in
Mother and Babies, Awareness about Breast
feeding.

77. CONCLUSION
 DAUSA hospital is easily accessible and spacious
too.
 Hoardings for public awareness are displayed well.
 Citizen Charter was available
 Priyadarshni ( Facility for new born care) present.
 YASHODHA scheme available.
 Telemedicine services was available.
 Health Management Information System was
present.
 Hygiene in the hospital is in poor state.

79. Poor Sanitation and Hygienic
Conditions

80. RECOMMENDATION
 There is great need for public private partnership
as the district hospital is overburdened.
 Integration with Other Local Health-Related
Services.
 Rehabilitation department like Physiotherapy and
Occupational therapy should be present.
 Hygiene and Sanitation is Important for
“Complete Health” and it should be delivered.