This document discusses the National Rural Health Mission (NRHM) in India. It was launched in 2005 with the key objectives of improving access to affordable, effective and reliable healthcare in rural areas. Some of its main goals included reducing infant and maternal mortality, increasing access to public health services, and addressing disparities across states. It focuses on improving infrastructure, human resources, and service delivery at primary healthcare centers. The document provides statistics on health indicators like IMR, MMR and progress made in achieving targets set by NRHM in different states of India.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
This presentation shall help you get insights of Basic documents like Birth Certificate and Death Certificate. For any assistance do contact Galaxy4u Legal Consulting Pune
Necessity of Implementation of Registration of Birth and Death Act, 1969 by R...Naveen Bhartiya
Necessity of Implementation of Registration of Birth and Death Act, 1969 by Ramakanta Satapathy
National Consultation on ‘Expanding Access and Using the Law to Ensure Sexual and Reproductive Health Rights’ was held in December’ 2015. The consultation brought together experts, activists, lawyers, health workers and students from all corners in the country, in building the understanding on the issues and the emerging challenges.
Human Rights Law Network
http://hrln.org
The presentation aim to explain Pradhan Mantri Jan-Arogya Yojana (Ayushman Bharat) to everyone. In terms of how what where, so that public can get benefit of it.
Population policy in general refers to policies intended to decrease the birth rate or growth rate.
Statement of goals, objectives and targets are inherent in the population policy.
History
National Population Policy 2000
Objectives
National Socio-Demographic Goals
Conclusion
This presentation shall help you get insights of Basic documents like Birth Certificate and Death Certificate. For any assistance do contact Galaxy4u Legal Consulting Pune
Necessity of Implementation of Registration of Birth and Death Act, 1969 by R...Naveen Bhartiya
Necessity of Implementation of Registration of Birth and Death Act, 1969 by Ramakanta Satapathy
National Consultation on ‘Expanding Access and Using the Law to Ensure Sexual and Reproductive Health Rights’ was held in December’ 2015. The consultation brought together experts, activists, lawyers, health workers and students from all corners in the country, in building the understanding on the issues and the emerging challenges.
Human Rights Law Network
http://hrln.org
The presentation aim to explain Pradhan Mantri Jan-Arogya Yojana (Ayushman Bharat) to everyone. In terms of how what where, so that public can get benefit of it.
Population policy in general refers to policies intended to decrease the birth rate or growth rate.
Statement of goals, objectives and targets are inherent in the population policy.
History
National Population Policy 2000
Objectives
National Socio-Demographic Goals
Conclusion
This ppt gives you the details about the NRHM scheme. The SWOT analysis has been done which helps you to know the strength and weakness part of the NRHM program.
BY: Dr.Pavithra R (M.H.A)
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
This presents the trends, issues, and challenges in the Philippine Health Care Delivery System. The data were mostly taken from the Philippine Department of Health (DOH) website and DOH Region VI Office.
Relationship between Health Care System Setup and Adherence To Tuberculosis T...QUESTJOURNAL
ABSTRACT : Despite the concerted effort to detect and treat TB, there are still poor treatment outcomes in a significant number of the patients. These poor treatment outcomes have been significantly linked to poor adherence to TB treatment. Therefore, a cross sectional descriptive study was conducted in Kisumu East District to establish the relationship between health care system factors and TB treatment adherence among patients aged above 18 years attending TB clinics in Kisumu East District, in Western Kenya. A total sample of 250 respondents was surveyed. An interviewer administered structured questionnaire was used to collect data from the respondents on the social, demographic aspects of the patients and structural aspects of TB care. The data was analyzed using descriptive statistics for socio-demographic variables and bivariate analysis to determine the health care system factors that significantly predicted treatment adherence. P values, Odds Ratios with 95% confidence interval (CI) were used to demonstrate significance of association between the health system related predictors and adherence. Significance was assumed at P value ≤0.05. Behaviour of the health care workers (OR: 3.6; 95% CI1.1-12.1; P=0.031) and waiting time (OR: 7; 95%CI: 3-18; P<0.001) were the significant determinants of adherence related to health care set up. Health care system setup has a number of immediate modifiable predictors of adherence like waiting time and staff behaviour. It is important to establish the key predictors of adherence that are linked to health care system for quality TB treatment and care services in every TB care setting.
Understanding Maternal Mortality using the medical and social contexts. In explaining the social contexts, the presentation will present a case of the Zuellig Family Foundation on Maternal Death Reviews.
Paper presentation on Rural Health Practitioners at GPH, Sri-Lanka 2014Dr. Suchitra Lisam
The presentation is about the study carried out in Assam in 2013 to assess the role of Rural Health Practitioners (RHPs) towards augmenting health care service delivery at health centers.
Epidemiology of malaria in irrigated parts of Tana River County, KenyaILRI
Poster by John Muriuki, Philip Kitala, Gerald Muchemi and Bernard Bett presented at the 9th biennial scientific conference and exhibition of the Faculty of Veterinary Medicine, University of Nairobi, 3-5 September 2014.
Primary health care reform in 1 care for 1 malaysiaEyesWideOpen2008
The government denies that 1Care has been confirmed and accepted, yet it promotes its 1Care reforms internationally!
This is from the International Journal of Public Health Research Special Issue 2011, pp (50-56)
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
HealthCare System in Thailand:Past -
Present and Where is the Future ?
Dr. Pradit Sintavanarong
Minister of Ministry of Public Health, Thailand
ริชมอนด์ 11-10-56
AMR challenges in human from animal foods- Facts and Myths.pptxBhoj Raj Singh
This presentation talks about ÄMR: A public health threat, a “silent pandemic”.
Infections caused by Antimicrobial-drug-resistant (AMR) pathogens caused >1.27 million deaths worldwide in 2019 (low level or no surveillance) and increasing year after year which may be > million in coming decades. Covid-19 caused ~6.8 million deaths in >3 years but now the pandemic is ending but the AMR pandemic has no timeline for its ending. Many deaths are also attributed to AMR pathogens.
More antibiotic use (irrespective of the sector) = More AMR.
This presentation also talks about ways and means to mitigate the AMR pandemic. 1. Stopping the blame game. All are equally responsible for the emergence of AMR, the share of developed and educated communities is much more than poor and un-educated communities.
2. Working together: On-Line Real-Time AST Data Sharing Platform for different diagnostic and research laboratories doing AST routinely.
3. Implementing not only antibiotic veterinary and medical stewardship but antimicrobial production and distribution stewardship too.
4. Educating for Environmental health not only human, plant, and animal health.
5. AMR's solution is not in searching for alternatives to antibiotics but in establishing environmental harmony.
6. More emphasis on AMR epidemiology than on AMR microbiology and pharmacology.
7. Development of understanding that bacteria and other microbes are more essential for life on earth than the human race. Microbes can live without humans, but humans can’t without microbes.
Global-Health is of prime importance than economic growth/ greediness.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Launched in 12th April, 2005
Key objective is “architectural correction” of health
sector
Seeks to improve access of rural people to affordable,
effective, accountable and RELIABLE health care
Address the issue of gross intra-state and inter-district
disparities in demographic indicators
Integration of key determinants of health like
sanitation, safe water, hygiene, nutrition
Focus on 18 high focus states including 8 EAG states
3. Reduction in IMR and MMR.
Universal access to public health services such as women’s
health, child health, water, sanitation and
hygiene, immunization and nutrition.
Prevention and control of communicable and non-
communicable diseases, including locally endemic diseases.
Access to integrated comprehensive primary health care.
Population stabilization, gender and demographic balance.
Revitalize local health traditions and mainstream AYUSH.
Promotion of healthy life styles.
4. IMR reduced to 30 per 1000 live births by 2012.
Maternal Mortality reduced to 100/100,000 live births by 2012.
TFR reduced to 2.1 by 2012.
Reduction in mortality due to malaria, dengue, Kalazar,JE; Filaria
elimination 2015.
85% cure rate under TB DOTs.
46 lakh cataract operations by 2012.
Leprosy prevalence rate- reduction from 1.8 per 10000 in 2005 to
<1/10000 thereafter.
Upgrading CHCs to IPHS.
Increase utilization of FRUs from 20% to 75%;
5. Availability of trained community level worker at village level, with a drug
kit for generic ailments.
Health Day at Aanganwadi level on a fixed day/month for provision of
immunization, ante/post natal check ups and services related to mother and
child care, including nutrition.
Availability of generic drugs for common ailments at sub centre/hospital
level.
Good hospital care through assured availability of doctors, drugs and
quality services at PHC/CHC level.
Improved access to universal immunization.
Improved facilities for institutional deliveries.
Availability of assured health care at reduced financial risk through pilots
of Community Health Insurance.
Provision of household toilets.
Improve outreach services through mobile medical unit at district level.
6. Trust communities and forge partnerships.
Innovation and autonomy.
Role for community organizations /PRIs.
Habitation level health workers in referral chains.
Service delivery and outcome focus.
Service guarantees-a rights based approach.
Recognition of need for management skills.
Public health through convergent action.
Giving authority to those with the motivation…
7.
8. NRHM – 5 MAIN APPROACHES
COMMUNITIZE
IMPROVED
MANAGEMENT
THROUGH
CAPACITY
BUILDING
FLEXIBLE
FINANCING
MONITOR, PRO
GRESS AGAINST
STANDARDS
INNOVATION IN
HUMAN
RESOURCE
MANAGEMENT
9.
10. Decline in MMR estimates in 2007-09 over 2004-06:
– For India: 212 from 254 (a fall of about 17%)
• States realizing MDG target of 109 have gone up to 3
with TamilNadu & Maharashtra (new entrants)
joining Kerala
• Andhra Pradesh, West Bengal, Gujarat and Haryana
are in closer proximity to achieving the MDG target
.
12. Every 6th death in the country pertains to an infant.
IMR in India has registered a 3 points decline to 50
from 53 in 2008
Maximum IMR in Madhya Pradesh (67) and
minimum IMR in Kerala (12)
Kerala (12) & Tamil Nadu (28) have achieved the
MDG target (28 by 2015)
Delhi (33), Maharashtra (31) and West Bengal (33)
are in close proximity
14. TFR for the country remained stationery at 2.6
during 2008 to 2009
Bihar reported the highest TFR (3.9) while Kerala
and Tamil Nadu, the lowest (1.7)
Replacement level TFR, viz 2.1, has been attained by
Andhra Pradesh (1.9), Delhi (1.9), Himachal Pradesh
(1.9), Karnataka (2.0), Kerala (1.7), Maharashtra
(1.9), Punjab (1.9), Tamil Nadu (1.7) & West Bengal
(1.9).
17. Kala-azar fatality rate reduction in 2010 was 21.74%
from 2007 in India.
Till Oct’11 Kala-azar fatality rate reduction was
33.33% compare to 2010 in India.
Kala-azar fatality rate reduction in 2010 was 44.9%
from 2007 in West Bengal.
In 2011 till October no death due to kala-azar in West
Bengal.
23. Dengue case fatality rate reduction was 68.55% from
2007 (1.24%) to 2010 (.39%).
But rate of dengue case fatality rate has been
increased by 69.23% in Nov’11 from 2010.
In west Bengal Dengue case fatality rate reduction
was 97.15%.
There is no death due to dengue in West Bengal till
Nov’2011.
26. Malaria case fatality rate had been increased by 20%
from 2005 (.05%) to 2010 (.06%) in India.
But in 2011 till October (.03%) malaria case fatality
rate had been decreased by 50% compared to 2010 in
India.
Malaria case fatality rate had been decreased 63.63%
from 2007 (.11%) to 2010 (.04%) in West Bengal.
Till Oct’11 malaria case fatality rate reduction rate
was 50% compared to 2010.
29. Japanese Encephalitis case fatality reduction by 40%
from 2007 to2011 in India.
Japanese Encephalitis case fatality reduction by
55.2% from 2007 to2011 in West Bengal.
30. Kala-azar mortality reduction by 21.93% in
2006-08.
Malaria mortality reduction by 45.23% in
2006-08.
Microfilaria reduction rate from 2006-2008
was 26.74%.
Dengue mortality reduction rate in 2006-2008
was 56.52%.
31. Goal: Cataract operations-increasing to 46 lakhs until 2012.
5700000
5750000
5800000
5850000
5900000
5950000
6000000
6050000
2008-09 2009-10 2010-11
cataract surgery 5810336 5906016 6023173
AxisTitle
cataract surgery
32. The year 2010-11 started with 0.87 lakh
leprosy cases on hand as on 1st April
2010, with PR 0.72/10,000.
Till then 32 States/ UTs had attained the level
of leprosy elimination. A total of 510 districts
(80.6%) out of total 633 districts also achieved
elimination by March 2010.
39. Physical infrastructure up-gradation, human resource
augmentation, equipment provision taken up in
nearly all community health Centres.
DLHS-III found 90.1% CHCs with normal delivery
service.
Since the IPHS provides for a higher Standard, it will
take some time before augmentation is as per IPHS.
40. INFRASTRUCTUR
E/HUMAN
RESOURCE
2005 2010 Comment
No. of Health
Sub-centres(SC)
146026 147069 .7% increase
Health SCs in
Govt. Buildings
63901 84957 32.95% increase
ANMs at Health
SC
139798 200010 43.07% increase
PHCs in Govt.
Buildings
23236 23673 1.88% increase
No. of CHCs 3346 4535 35.53% increase
Specialist at
CHCs
3550 6781 91% increase
GDMOs other
doctors at CHCs
NA 9432
Nurse midwife at
PHC/CHC
28930 93935 3.25 times more
Paramedical staff 12284 21740 1.75 times more
41. 461 Districts Equipped with Medical Mobile unit under
NRHM
1787 Mobile Medical Units Operational in the State/UT
Under NRHM
4764 ERS Vehicles Operational in the State/UT Under
NRHM
8826 Ambulances functioning in the State/UTs (At
PHC/CHC/SDH/DH)
42.
43.
44.
45. No separate data on utilizationss levels in FRUs.
The CRM reported much higher utilization of in-
patients facilities due to increased institutional
deliveries.
Total 2891 First Referral Unit is operationing (31st
March 2011).
883 FRUs in 10 high focus non NE states.
120 FRUs in 8 high focus NE states.
1842 FRUs in Non high focus states-large.
46 FRUs in Non high focus states –small & UTs.
46. Total 128 FRUs operationing till 31st March 2011.
In Last 5 years of NRHM no more District Hospital had
been upgraded to FRUs.
27 more sub divisional hospitals have been up graded to
FRUs.
In 2005 in WB there was no CHCs was functioning as
FRUs, but as per 2010 SEVEN CHCs are functioning as
FRUs.
47.
48. 8.25 lakh ASHAs selected.(2010) with 690221 having drug
kits.
46,690 ANMs appointed on contract.
8624 MBBS doctors appointed on contract.
2460 specialists appointed on contract.
7692 AYUSH doctors appointed on contract.
14490 paramedic staff appointed on contract.
49.
50. 42003 ASHA selected & 32123 ASHA with drugs kit.
51 paramedical staff appointed.
Specialists appointed 1253.
No data on appointment on staff nurse.
19 AYUSH doctors & paramedical staffs.
51. NRHM has brought the thrust on human resources at
centre stage.
Performance based payment system.
Failure of The World Bank funded Health Systems
projects on account of lack of attention to human
resource.
52. Boat Clinics in Assam to partnerships with tea-gardens.
Partnerships for diagnostics in Bihar & West Bengal.
Emergency transport system in Haryana, AP, Gujarat,
Rajasthan.
Rural medical assistants in Chhattisgarh.
Rural Health Practitioners in Assam.
Orissa recruited AYUSH doctors to provide services at PHC
where no MBBS doctor.
53.
54. By end 2010, the total number of ASHAs had risen to
825,000.
Except for Himachal Pradesh all other 17 high focus state opt
for the ASHA programme.
In January 2009, responding favourably to a very positive
political and administrative feedback from the states, a
decision was taken to extend the programme within even the
non high focus states to cover the entire state. Except in
Tamilnadu, which kept the programme limited to tribal areas,
all other states opted for this expansion.
55. At the national level, the guidelines lay out three roles
for ASHA:
facilitator of health services
service provider
activist.
56. At the time of the study only Assam had set up the full support structure as
per national guidelines.
Orissa had a structure in state and district and block level, but not yet at the
sub-block level.
Orissa had the most functional review process in place, with a clear
schedule of meetings and some mechanisms of recording and measuring
progress.
Rajasthan had all structures in place, but these require more content, depth
and skills to be effective.
At the time of the evaluation Bihar had no support structures in
place, although plans were underway to establish these.
Jharkhand only state and district structures were in place.
In contrast Andhra, Kerala and West Bengal had no full time support
structures in place at any level and were managed by ad hoc appointments
of nodal officers who oversaw this work in addition to many other tasks
57. Andhra had a more motivated District Public Health and
Nutrition officer, though despite this, it was perhaps the most
weakly monitored and supported ASHA of the eight states
studied.
Kerala had a regular schedule of meetings and the ANM
(called JPHN) was much more available for playing this role-
as her work had either shifted up to the PHC or been shifted
down to the ASHA- making her a supervisor of an ASHA with
little work outputs of her own.
In West Bengal, panchayat and field functionaries formed a
viable administrative support team, though this is of little use
in providing clinical support.
All states except Kerala have involved NGOs in the
programme.
58. In Assam and Orissa stable leadership at state level
and a dedicated technical agency have served the
programme well.
In West Bengal, Kerala, and Andhra Pradesh while
there is commitment to the ASHA programme this is
not reflected in the management or support or
realised in terms of outcomes.
In Rajasthan Bihar and Jharkhand, frequent
leadership changes have hampered programme
progress.
59. In most states, minimum levels of training have been achieved, but the pace of
training fell far short of what was required.
In West Bengal, 90% had received 23 days of training.
In Orissa about 86% received more than 16 days training of which nearly 54% had
received more than the targeted 23 days of training.
In Assam 77% received more than 16 days, of which 26% had received more than
23 days.
In Kerala, 52% had received over 16 days- all had completed module 4.
The poorest performance was Bihar, where about 97% of ASHA had received less
than 16 days, and 87% had received less than ten days of training over a four year
period! In effect for 87% of the ASHAs in Bihar only Module 1 had been covered.
In Jharkhand 46% had received between 11 and15 days of training and 50%
received less than ten days.
In Rajasthan 31% of ASHA had received less than 16 days of training, with the
remaining 69% getting more than 16 days.
60. Except in Orissa and Assam, states adapted the modules for
local context and need.
Jharkhand and West Bengal substantially strengthened the
message content. Jharkhand even revised the modules entirely,
made it more pictorial and richer in key information.
Rajasthan, Uttar Pradesh and Angul in Orissa supplemented
these modules with child and newborn health modules of their
own and Kerala included messages on non communicable
disease.
Andhra Pradesh did not use these modules at all.
61. Across the states, most ASHAs are receiving Rs. 500 to Rs.
1000 per month with the highest being in Orissa followed by
Assam.
In West Bengal ASHA’s receive a fixed sum of Rs. 800 per
month. West Bengal has a fixed amount system which is well
implemented.
Rajasthan, a fixed sum of Rs. 950 of which at least Rs. 500 is
delivered in an assured manner. Rajasthan has a fixed plus
performance based payment system but with weak
implementation
In Angul (Orissa) newborn visits are also incentivised and
accounts for the ASHA receiving the highest amounts.
62. Assam, Orissa and Kerala have robust mechanisms of
accounting and timely payment, but net receipts in Kerala
are lower since payment is linked to RCH activities.
Andhra, Bihar and Jharkhand have performance based
payments which are poorly implemented - clearly co-relating
with the lack of a management-support structure in these three
states.
In Andhra Pradesh and Kerala, the problem is compounded by
JSY being a poor yield opportunity as only BPL women get
the JSY package and anyway fertility rates are much lower.
Mode of payment in Orissa, was the bank transfer, in
Assam and Rajasthan a mix of all three- bank transfer,
cheque and cash; in Jharkhand and AP it was a mix of
cash and cheque and it was cash predominantly in West
Bengal, Kerala, Bihar.
63.
64. The highest expenditure of all eight states is in Assam amounting to Rs. 12,546.
Orissa reports the second highest expenditures with about Rs. 10,689 per ASHA
Kerala expanded its programme late, but still reports an expenditure of Rs. 10,689
per ASHA.
Rajasthan’s estimate of Rs. 7529 over three years may be a serious under-estimate-
as the state government spends almost Rs. 500 per month per ASHA on fixed
honorarium.
West Bengal’s Rs. 8300 represents the slower pace of training and the lack of
investment in support structures.
Jharkhand has expenditure at Rs. 7348 per ASHA.
Bihar’s expenditures of Rs. 3373 per ASHA is the lowest amongst the 8 states
examined and it correlates with the weakest programme- where training is still to
take off beyond the first round, and where there is no support structure in place.
65. All states have spent much less than allocated, reasons
are….
Inability or unwillingness to invest in management
and support structures at state, district and block
levels.
Poor pace of training and no doubt impacts the
quality of training.
Quality of political and administrative support the
programme.
66. VHSC have been formed in Rajasthan, Jharkhand, Assam, Andhra Pradesh
and Orissa (referred to as Gaon Kalyan Samiti).
In West Bengal, Kerala and Bihar the existing health and sanitation
committees of the Gram Panchayats have been designated as the VHSC
with differing nomenclature and modifications in membership.
Except in Kerala, Assam and Orissa, and to a limited extent in West Bengal
there is little systematic training of the VHSC members.
The ASHA is a member of this committee and is expected to attend the
meetings, mobilise community and raise issues relating to health in the
village. Where established it is generally supportive of the ASHA and
usually the ASHA has an important role in this.
But in West Bengal such a relationship is established only in 48% of cases
and in Jharkhand this is about 66%.
The process has taken place in only about one fifth of the villages of West
Bengal and half the villages of Andhra Pradesh.
67. ASHA’s activities
Optimising outcomes for time spent
Areas for skill building
Reaching the unreached
Advocacy for health outcomes
Advocacy for activism
Role of ASHA Mentoring Groups
Support to ASHAs
Drug Kits
Incentives
Monitoring the ASHA programme
Support, training and on the job monitoring
Role, clarity and synergy
Involvement of NGOs
VHSC
Building convergence and co-operation
68. Till 2005 central funding to states was on normative
basis.
During financial year 2005-06 basic PROGRAMME
IMPLEMENTATION PLANS (PIPs) prepared.
Financial management group operationalised
To oversee the release of funds.
Monitoring of utilisation certificates & audit reports.
69.
70.
71. Latest version of Tally ERP.9 for NRHM
accounting.
Implemented concurrent audit system through
C.A firms.
Open tender system.
Ensuring timely submission of all FMRs on
quarterly basis.
Implementation of e-Banking.
72.
73.
74.
75. 2005-06 2006-07 2007-08 2008-09
% incraese in central transfers under
NRHM
26.24% 19.50% 26.05% 19.12%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
AxisTitle
% incraese in central transfers under NRHM
76. 2005-06 2006-07 2007-08 2008-09
% increase under state expenditure 23.41% 19.12% 13.37% 19.94%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
AxisTitle
% increase under state expenditure
77. 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
public expenditure on health as
percentage of GDP
1.16% 1.23% 1.22% 1.23% 1.37% 1.45%
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
1.40%
1.60%
AxisTitle
public expenditure on health as percentage of GDP
80. 2005-2006 2006-2007 2007-2008 2008-2009
PUBLIC EXPENDITURE IN TOTAL
HEALTH EXPENDITURE
22.72% 23.82% 25.09% 26.70%
20.00%
21.00%
22.00%
23.00%
24.00%
25.00%
26.00%
27.00%
AxisTitle PUBLIC EXPENDITURE IN TOTAL HEALTH EXPENDITURE
81. 619 Integrated District Health Action Plans in 2009-10.
Achievements of District Health Action Plans:
◦ Institutional structures.
◦ Provision of untied resources for local action.
◦ Identified areas for focused attention through facility and
household surveys.
◦ Convergence with wide determinants.
BASIS FOR DECENTRALIZED PLANNING…………
82. Initial journey of NRHM-
underfunded, underperforming, public health system.
Positive programmatic approach-
◦ Provision of resources
◦ Expansion of public health infrastucture
◦ Additional human resources
◦ Creation of community structures
◦ Decentralized
◦ Non-verticalized framework
83. State to send resource envelope to Districts-October 2009
District plans based on village/gram panchayats/ block
panchayat samiti plans-December2009
First Draft PIP before State Health Mission- First week
Jan 2010
Pre-appraisal meetings in Jan up to 15th 2010
Final NPCC meetings between Feb and 15th March 2010
84. Clear action plan for backward districts as part of the
PIP.
Clear action plan for streamlining of procurement and
logistics.
Clear action plan for operationalising HMIS up to
facility level.
Capacity development of all institutions crafted under
NRHM.
Higher utilisation of financial resourses under NRHM
Clear plan for human resources for health
Clear action plan on training and skill developement
85. Neo-natal Mortality
Population stabilisation
Malaria
MDR-TB
Making facilities family friendly-water, electricity, clean
toilets, lights ,security
Vibrant VHSCs and RKSs
NABH/ISO certification of government facilities
86. Total 147069 SCs.
• 84957 in SCs in Govt. Buildings.
• 140942 SCs with one ANMs.
• 6127 without ANMs.
• 59068 SCs with 2nd ANMs.
18348 APHCs, PHCs, CHCs & other Sub District
facilities functional as 24X7 basis
Total 23673 PHCs
Total 4535 CHCs
90. Total 10356 SCs.
• 4684 in SCs in Govt. Buildings.
• 10205 SCs with one ANMs.
• 151 without ANMs.
• 7715 SCs with 2nd ANMs.
622 APHCs, PHCs, CHCs & other Sub District facilities functional as
24X7 basis
Total 909 PHCs
Total 348 CHCs
348 CHCs functional as 24X7 basis compared to ZERO at the start of
NRHM.
Of the 93 CHCs just 8 CHCs completed physical up-gradation according to
IPHS.
92. 4.51 lakh village health and sanitation committees constituted.
1.87 cr village health and nutrition days organised.
8,25,000 ASHAs selected.
4.43 lakh joint account operationalised.
16687 PHCs have Rogi Kalyan Samiti out of total 23673 PHCs.
Nearly all CHC, Sub Divisional and District hospitals have the Rogi
Kalyan Samiti facility.
District Health Mission under the Chairman Zila parishad/ District Tribal
Council and District Health Society under the District magistrate have been
constituted nearly all the states/UTs.
State health Mission under the Chief Minister and the state Health Society
under the Chief Secretary have been constituted and meet regularly in
nearly all the states.
Mission Steering Group under the Minister Health and Family Welfare at
the national level has been meeting regularly to take all decisions regarding
NRHM.
93. SRS
DLHS-III
IAP study (Rajasthan, UP,MP)
Kaveri Gill’s study (AP, UP, Rajasthan, Bihar)
PRC study (31districts)
Citizen’s report
Community Monitoring reports
External Evaluation of JSY in 7 states.
Performance audit of NRHM by CAG
94. 90.7% of villages have beneficiary under Janani
Surakhsa Yojana (JSY).
72.6% of villages have sub-centres within 3 kms.
90.6% sub-centres with ANM.
57.8% of ANM living in quarter where available.
53.1% PHCs functioning on 24 hrs basis.
19.2% PHCs having AYUSH medical officer.
52% CHCs designated as FRU.
90.1% CHCs having 24hrs normal delivery service.
9.2% FRUs having blood storage facility.
95. 45.6% of ANM living in quarter where
available.
25.9% PHCs functioning on 24 hrs basis.
17.9% CHCs designated as FRU.
10% FRUs having blood storage facility.
96. Positive contribution of ASHA but more training is
necessary.
Facility improvement on an unprecedented scale.
Slow pace of utilization of untied fund.
Management structure needs further strengthening.
HR challenges.
Pleads for higher financial allocation.
97. Decentralized management to be faster.
JSY putting pressure on public system.
System preparedness in adequate.
Question ability of PRI to hold system accountable.
More effforts at building capacity.
Invest in ability and confidence.
99. Popularity of the scheme.
Increase in institutional deliveries.
Quality issue at facilities.
Low 48 hrs stay.
Large case loads.
Changing health seeking behaviuor.
Timeliness of payments.
Role of ASHA.
102. Institutional deliveries increased from 47% (DLHS-
III, 2007-08) to 72.9% (CES, 2009).
Number of Pvt. institutions accredited under JSY
12645 in India, 6691in High Focus- Non NE (10) , 53
in High Focus- NE (8), 5841 in Non High Focus-
Large (10) , 60 in Non High Focus- Small & UT(7).
66 Pvt. institute in WB accredited under JSY.
107. 263 Sick New Born Care unit (SNCU) established
under NRHM till 31ST March 2011.
1120 New Born Stabilisation Unit.
6403 New Born Care Corner (NBCC) .
In West Bengal
6 Sick New Born Care unit (SNCU) established
under NRHM till 31ST March 2011.
100 New Born Stabilisation Unit.
105 New Born Care Corner (NBCC) .
108. No. of districts implementing IMNCI
–current(10) and planned(remaining eight).
–No. of districts where training is saturated-One district
(Purulia)
Plan for HBNC, including incentives to ASHAs Visit of New
born (during PNC ) incorporated in revised ASHA
comprehensive incentive package.
6th& 7thmodule training initiated in 2 districts.
109. The new initiative of JSSK would provide completely
free and cashless services to pregnant women
including normal deliveries and caesarean operations
and sick new born (up to 30 days after birth) in
Government health institutions in both rural and
urban areas. The new JSSK initiative is estimated to
benefit more than one crore pregnant women &
newborns who access public health institutions every
year in both urban & rural areas.
110. Free and Cashless Delivery.
Free C-Section.
Free treatment of sick-new-born up to 30 days.
Exemption from User Charges.
Free Drugs and Consumables.
Free Diagnostics.
Free Diet during stay in the health institutions – 3days in case
of normal delivery and 7 days in case of caesarean section.
Free Provision of Blood.
Free Transport from Home to Health Institutions.
Free Transport between facilities in case of referral as also
Drop Back from Institutions to home after 48hrs stay.
111. Financial management
Programme management
Data management
Development of standards
IPHS
ISO 9001
NABH
Capacity development for public health
Accountability system
112.
113. Universal HIV screening included as an integrated component of ANC
check up.
VHNDs may be utilized for rapid blood test.
Counselors at ICTCs also counsel the non-HIV pregnant women on
nutrition, STI & birth spacing.
Link workers & out reach workers to under take line listing of all pregnant
women and prepare birth plan for non HIV women as well.
ASHAs to be trained on the module “ Shaping our lives” by NACO.
ASHAs to provide ANC & STI counselling, referral, pre and post natal
care for mother and new born,
All 24*7 health facilities to be strengthened by ICTC service & PPTCT
service.
Appropriate incentives to the service providers conducting deliveries in
24*7 facilities.
114. FP counselors may be trained on STI, PPTCT, ANC and
nutrition.
Infrastructure up-gradation .
All HIV patients to be screened for TB and vice versa.
SACS to take care of condom promotion in the high
prevalence states.
PD SACS & MD NRHM should meet quarterly.
115. Macro Health Indicators-30 marks
IMR-15 MARKS
CBR-5 MARKS
CDR-5 MARKS
TFR-5 MARKS
Physical capacity and delivery outcomes of rural services
centre-40 marks
24*7 PHCs as a % of total no of PHCs-5 marks
FRUs as % all CHCs, SDHs and DHs-5 marks
Institutional deliveries-10 marks
OPD/IPD-4 marks
ABER-2 marks
% of new smear positive patients registered-2 marks
Sterilization performance-2 marks
Physical infrastructure development-10 marks
116. Outcomes in enhancements of human resources in
the health systems-20 marks
ASHA programme-8 marks
ANM, Nurses-4 marks
Doctors,Specialists, AYUSH doctors-3 marks
% utilisation of untied funds under the NRHM Mission flexible
pool-5 marks
Outcomes in the area of Goverence-10 marks
Institutional framework and decentralisation-4 marks
Financial performance and state contribution-3 marks
Innovation-3 marks
117. Home based care component in the training programme of
ASHA training.
Basic provision for neo-natal at all facilities.
Strengthening VHSC.
Public Health specialist at all level; every state must have a
public health cadre.
Indian Public Health Service.
Universalization of basic protocols of care at all levels.
NRHM needs further deepen decentralized management and
accountability by engaging NGOs for community monitoring.
118. Every facility to develop its detailed institutional plan.
Establishment of medical & nursing institutions in
deficient states.
Urban Health Mission.
National Health Bill.
Supervisory structures and job descriptions of every
workers should well be established.
Speed up the Village Health Registers.
RSBY
Malaria, TB & IDSP further intergraded into the NRHM.
Speed up the accreditation process.
119. 1. Kishore J. National Health Programs Of India
2. WHO. Meeting people’s health needs in rural areas- The progress so far the way
ahead
3. Maternal & Child Mortality and Total Fertility Rates Sample Registration System
(SRS). Office of Registrar General, India 7th July 2011
4. National Vector Borne Disease Control programme
5. National Programme For Control Of Blindness
6. National Leprosy Elimination Programme
7. RNTCP-2011 report
8. National Rural Health Mission. Meeting people’s health needs in partnership
with states, The journey so far (2005-2010).MOHFW.Govt. of India
9. National Rural Health Mission State Wise Progress
10. Programme Implementation Plan 2011-12. West Bengal State Health and Family
Welfare samiti.
11. ASHA –Which way forward…? Excecutive Summary-Evaluation of ASHA
Programme. NHSRC
12. National Health Account
13. Guidelines for Janani-Shishu Suraksha Karyakram. MOHFW. Govt. of India
14. NRHM & NACP convergence. MOHFW. Govt. of India