The document provides information on the organization and management of health services in Uttar Pradesh at the state, district, and sub-district levels. It summarizes that at the state level, the Principal Secretary oversees health policy and budgets, while various Directors provide technical assistance. At the district level, the CMO manages programs, and the SMO oversees individual health centers. The document also outlines the responsibilities and norms of community health centers, primary health centers, and sub-centers in the state.

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

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

3. RESPONSIBILITIES OF PRINCIPAL
SECRETARY
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

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

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

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

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

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

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

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
35
 Crude birth rate has 30 28.7
27.2
reduced to 28.7 25 22.5
20
 Crude Death Rate is 15 UP
Highest 10 8.2
India
7.3 6.6 Rajasthan
5
0
CBR CDR

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

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

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
70
IMR
COUNTRY 60
50
40
IMR
30
20
10
0
UP India Rajasthan

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
Chart Title
90
80 79
70
68
60
57
50 49 NMR
43 IMR
40 39
CMR
33
30 29
20
18
10
0
NFHS1 NFHS2 NFHS3

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
30000
25000
20000
CHC
15000
PHC
SC
10000
5000
0
Required In position Shortfall

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
UP INDIA
284446
PER SC
474824
49062
PER PHC
50077
7671
PER CHC
8931
15122
PER DOCTOR
23986

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

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

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

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

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. FIELD VISIT AT A GLANCE
GROUP II

49. CHC
BASSI
PHC PHC PHC PHC
BASCO TUNGA ROJWADI BADWA
(20 km (18 km) (25 km) (30 km)
SC
SC SC SC MADHOGARH SC SC
(2 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. CLINICAL MAN POWER
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 1 Nil
Manager
7. Eye Surgeon 1 Nil
8. General Duty Officer 4 4
9. Nursing Staff 7+2 7+2

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

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

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

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.