Sikkim Pips

1. HEALTH CARE DELIVERY
SYSTEM
NHM,SIKKIM

2. DEMOGRAPHIC PROFILE
CENSUS 2001, 2011
INDICATORS
SIKKIM INDIA
2001 2011 2011
Population (lakhs)
5,40,493 6,10,577 12,101.93
Decadal growth rate
(%) 33.06 12.36 17.64
Sex Ratio (Adult) 875 890 940
Child Sex Ratio
963 957 918
Literacy Rate (%):
68.81 82.20 74.04

3. HEALTH FACILITIES IN SIKKIM..
STATE LEVEL STNM
Hospital
2 CRH
Manipal
DISTRICT HOSPITALS 4
COMMUNITY HEALTH
CENTRES
2
PRIMARY HEALTH
CENTRES
24
SUB CENTRES 147
URBAN PHC 1
URBAN HEALTH POSTS 6
TOTAL FACILITIES 186

4. SERVICE DELIVERY…
At all the Govt.Health facilities there is provision for:
Free drugs
Free Diet
Free Diagnostic services

5. NATIONAL HEALTH MISSION
Programme Implementation
Activities and Status

6. NATIONAL HEALTH MISSION ….
The two sub missions of National Health Mission are :-
National Rural Health Mission launched on 12th
April’2005
National Urban Health Mission Launched on 15th
May’2013
NRHM and NUHM, both flexible and dynamic are
intended towards ensuring universal access to health care
through strengthening of health system, institutions and
capabilities

7. THE VISION OF NATIONAL
HEALTH MISSION….
…Is attainment of universal
access to Equitable,
Affordable and Quality health
care services, responsive to
peoples’ need with effective
intersectoral convergent
action

8. VARIOUS PROGRAMME UNDER
NATIONAL HEALTH MISSION
• Reproductive Maternal Neonatal Child & Adolescent
Health
• National Leprosy Eradication Programme
• Revised National Tuberculosis Control Programme
• National Mental Health Programme
• National Programme for Control of Cancer,
Diabetes, Cardiovascular and Stroke
• National Programme for the Healthcare of the Elderly
• National Oral Health Programme

9. • National Vector Borne Disease Control Programme
• National Programme For Control of Blindness
• Integrated Disease Surveillance Programme
• National Iodine Deficiency Disorder Control
Programme
• National Tobacco Control Program
• Quality Assurance Programme
• National Deafness Control Programme
• National Urban Health Mission

10. PLAN OF ACTION/COMPONENTS
• Accredited Social Health Activists (ASHA)
• Strengthening sub-centers
• Strengthening Primary Health Centers
• Strengthening CHCs for first referral care
• District health plan under NRHM
• Strengthening disease control program
• Public-private partnership for public health
goals, including regulation of private sector
• New health financing mechanisms
• Reorienting health/medical education to
support rural health issues

11. GOALS TO BE ACHIEVED UNDER
NHM..
1. Reduce MMR to 1/1000 live births
2. Reduce IMR to 25/1000 live births
3. Reduce TFR to 2.1
4. Prevention and reduction of anaemia in
women aged 15–49 years
5. Prevent and reduce mortality & morbidity
from communicable and non- communicable
diseases, injuries and emerging diseases
6. Reduce household out-of-pocket expenditure
on total health care

12. GOALS TO BE ACHIEVED UNDER
NHM CONTD..
7. Reduce annual incidence and mortality from
Tuberculosis by half
8. Reduce prevalence of Leprosy to <1/10000
population and incidence(New cases) to Zero
in all districts
9. Annual Malaria incidence to be <1/1000
people
10.Less then 1 percent micro filarial prevalence
in all Districts
11.Kala-Azar Elimination by 2015, <1 case per

13. ACHIEVEMENTS SO FAR…
HEALTH INDICATORS
STATUS..

14. MATERNAL AND CHILD HEALTH
CARE….
Indicators DLHS -2
(2003-04)
DLHS-3
(2007-
08)
DLHS-4
(2012-
13)
HMIS
(2016-17)
Percentage of Pregnant
women who had three or
more ANC visits.
67.9 69.9 84.8 90.1
Percentage of
Institutional delivery
53.4 49.8 82.7 98.4
Percentage of Delivery
at home
40.9 49.0 16.0 1.6
Percentage of Full
immunization
53.1 77.8 85.2 95

15. PROGRESS IN HEALTH INDICATORS

16. CRUDE BIRTH RATES(CBR) AS PER
SAMPLE REGISTRATION SURVEY
(SRS)
SRS
1994
SRS
2003
SRS
2008
SRS
2011
SRS
2012
SRS
2013
SRS
2014
SRS
2015
SIKKIM 24.6 21.9 18.4 17.6 17.2 17.1 17.1 17
INDIA 30.5 24.8 22.8 21.8 21.6 21.4 21.0 20.8

17. CRUDE BIRTH RATES(CBR)…

18. CRUDE DEATH RATES(CDR) AS PER
(SRS)
SRS
199
4
SRS
2003
SRS
2008
SRS
2011
SRS
2012
SRS
2013
SRS
2014
SRS
2015
SIKKIM 6.9 5.0 5.2 5.6 5.4 5.2 5.1 5
INDIA 10.1 8.0 7.5 7.1 7.0 7.0 6.7 6.5

19. INFANT MORTALITY RATE ( IMR)
INFANT MORTALITY RATES(IMR)…
Year (SRS) SIKKIM INDIA
1994 51 74
2005 30 58
2006 33 57
2007 34 55
2008 33 53
2009 34 50
2010 30 47
2011 26 44
2012 24 42
2013 22 40
2014 19 39
2015 18 37

20. INFANT MORTALITY RATES (IMR) AS PER
(SRS)

21. MATERNAL DEATH BY ABSOLUTE
NUMBERS ( STATE REPORT)
Year Maternal Deaths
2011-12 25
2012-13 26
2013-14 11
2014-15 15
2015-16 08
2016-17 16

22. MATERNAL DEATHS BY ABSOLUTE
NUMBER

23. TOTAL FERTILITY RATE (TFR)
Total
Fertility Rate
NFHS II
(1998-99)
NFHS III
(2005-06)
NFHS-4
2015-16
SIKKIM
2.75
2.02 1.2
INDIA 3.40 2.70 2.2

24. ACHIEVEMENTS…
Expected
Outcome
Baseline and
Achievement
Strategies
Reduction
of Infant
Mortality
Rate
(IMR)
•IMR was 30 in 2005
(SRS)
and now has declined
to 18 in 2015 (SRS)
Implementation of RMNCH+A
program in right earnest
ASHA Schemes-
•Home Based Newborn Care
(HBNC)

25. ACHIEVEMENTS…
Expected
Outcome
Baseline and
Achievement
Strategies
Reduction
of Total
fertility
Rate(TFR
)
TFR was 2.2 in 2005 (SRS)
which has decline to 1.7 in
2010 (SRS).
NFHS IV (2015-16) shows
TFR -1.2
ASHA Schemes- HDC, Ensuring
Spacing at Birth, Pregnancy Test Kit
Promotional Intervention:
• Revised Compensation scheme
• Family planning Indemnity scheme
Promoting contraception through
increased Advocacy
Counselors at high delivery facilities
IEC Activities

26. ACHIEVEMENT…
Expected
Outcome
Baseline and
Achievement
Strategies
Prevention and
reduction of
anaemia in
women aged 15–
49 years
15-49 yrs- 59.3% were
anemic NFHS -3 (2005-
06)
15-49yrs-34.9% were
anemic NFHS IV
(2015-16)
IFA supplementation
to PW
WIFS
IEC

27. ACHIEVEMENT…
Expected
Outcome
Baseline and
Achievement
Strategies
Reduction of
Leprosy
prevalence
rate to
<1/10000
population
Since 2002-03 PR
of leprosy is
<1/10000
population
Improved early case
detection
Improved case management
Stigma Reduction
Capacity building e.g MOs
Health workers etc.
Improved Monitory &
Supervision

28. Expected
Outcome
Baseline and
Achievement
Strategies
Tuberculosis
DOTS services
Target=203/l
akh
Target =<5
Target = 85%
Annual Incidence
205 per lakh in 2014
196 per lakh in 2015
185 per lakh in 2016
Death rate
3% -2014
2% -2015
3%-2016
Cure rate
78% in 2014
79% in 2015
78% in 2016
New TB cases
1312 -2014
1218 -2015
1166 -2016
Augmentation of organizational
support at centre and state level
Use sputum testing as primary
method of diagnosis
 Standardized treatment regimen
 Ensuring regular, uninterrupted
supply of drugs
 Emphasis on training, IEC,
operational research & NGO
involvement

29. ACHIEVEMENT…
Expected
Outcome
Baseline and
Achievement
Strategies
Reduction of
mortality due to
malaria, dengue,
kala azar, filiaria
 Till now no deaths has
been reported.
There was an outbreak
of Dengue in 2013. the
total of 679 cases of
dengue was reported.
Identification of high risk area
Capacity building e.g MOs
Health workers etc.
 epidemic preparedness
Improved Monitoring &
Supervision
Cataract
Operation
Target 800 cases
2013-14- 416 (52%)
2014-15- 519 (65%)
2015-16 -460 (57.5%)
2016-17 -608 (76%)

30. Programme Achievement
National Programme for
Prevention and Control of
Cancer, Diabetes,
Cardiovascular Diseases and
Stroke (NPCDCS)
Establishment of
1. District NCD Cell in East & South
2. Cardiac Care Unit in East & South
3. Chemotherapy Unit in STNM hospital
4. Training
5. IEC
6. Population Based Screening of NCD
launched 2016 (East and South)
National Programme for
Health Care of the Elderly
(NPHCE)
Establishment of
1.10 bedded ward in East & South
2.provides supportive appliances
3.provides home based care
4.Training
5.IEC

31. ACHIEVEMENT…
Expected Outcome Baseline and Achievement
Implementation of Free Diagnostic services No 45 dated 03/03/17 HC,HS and FW
(District Hospitals and all peripheral
Health facilities)
Implementation of Free Drugs services
Implementation of Free Dialysis services Yes

32. HEALTH INFRASTRUCTURE
STRENGTHENING….
S.No Facility Completed
1 Conversion of PHC to CHC 2
2 Conversion of Sc to PHC 2
3 Sc building construction 12
4 MO quarter 9
5 Nurses quarters 8
6 DEIC 1
7 Strengthening of facility at all
PHCs and CHCs
26

33. STRENGTHENING OF HEALTH
INFRASTRUCTURE UNDER NHM….
S.No Facility On going
Constructi
on
1 Doctors Quarters in District hospitals at
Mangan , Singtam and Gyalzing
3 (Six unit
each)
2 Urban PHC under construction at Ranipool 1
3 Construction of Tshangu PHC 1
4 Reconstruction of Rongli PHC 1
5 Construction of MO quarter
Dentam,Rongli,Sang and Jorethang
4
6 Construction of ANM quarter
Buriakhop and Karzi
2

34. COMMUNITY ACTION FOR HEALTH
Accredited Social Health
Activist (ASHA)
666
Rogi Kalyan Samiti
(RKS)
31
Village Health Sanitation
and Nutrition Committee
(VHSNC)
641
Urban Health Sanitation
and Nutrition Committee
(UHSNC)/ MAS
15

35. OUTREACH SERVICES
OUT REACH SERVICES NUMBER
Village Health Nutrition Day
(VHND)
7992/year
Urban Health Nutrition Day
(UHND)
144/year
Outreach to Slum and
Vulnerable group under NUHM
72/year
Immunization out reach 8978/year
Mobile Medical Unit (MMU) 4 MMU
Home Based New Born
Care( HBNC)
666 ASHAs visit
under HBNC

36. HUMAN RESOURCE
Sl. No Designation Total
1 Specialist 5
2 Medical Officer 46+1+4=51
3 Dental Surgeon 8
4 MO AYUSH 9+5=14
5 GNM 57+3+3+17=80
6 BSC nurses 10
7 ANM 86+5+6=96
8 Pharmacist 17+3=20
9 Lab.Technician 15+4+4=23
10 X-ray Technician 8+4=12

37. HUMAN RESOURCE ….
Sl.
No Designation Total
10 Paramedic Ayush 5
11 OT Technician 3
12 ECG Technician 2
13 Incinerator Operator 5
14 Dental Technician 6
15 Others 119
TOTAL 459

38. FUND
APPROVED
ROP 2016-
17
OPENING
BALANCE
01.04.17
FUND RECEIVED
2016-17
TOTAL
FUND
2016-17
EXPENDITU
RE
2016-17
BALANC
E
CENTRE STATE
5130 1386.81 2247.32 300 3934.13 2228.21 1705.92
Statement of grant received from GoI & its expenditure as on 31.3.2017
(In lakhs)

39. ALL INDIA LEVEL PERFORMANCE ON 16 HEALTH
INDICATORS OF RCH (2015-16)

40. THANK YOU
Dr. M.L.Lepch
ADHS –cum –NO
NHM