State Health Mission

NRHM Additionalities

1. Workshops for State, District and Block level Mission Teams

Workshops will be conducted for all the activities under NRHM. This will be a part of updating knowledge and skill at all level. The details are as below:

1. Workshop on NRHM general activities, convergence
2. Grievance cell, citizens charter, RKS and fund utilization, VHSC, VHND
3. JSY
4. STI /RTI
5. PC&PNDT Act
6. Role of ASHA
7. IEC / BCC
8. IMNCI
9. FRU
10. 24x7 PHC, IPHS
11. Block & Village Health Plan
12. MMU
13. MIS
14. Financial management
15. Adolescent health
16. popularizing FP methods and EC pill
17. Nutrition
18. Routine Immunization
19. IDSP
20. Malaria
21. IDD
22. NSV
23. TB
24. Sanitation
25. Waste disposal management.

2. Orientation of PRI on NRHM activities.

The District Health Mission, led by the Zila Pramukh enables to coordinates, plan and supervise all NRHM intervention in the district. At the village level, the gram Panchayat/ Village Health team is responsible for planning, monitoring, coordination of health and related function and supervision of ASHA. The Panchayat Samiti (block level) supports the Gram Panchayat and serves as the link between DHM and the gram Panchayat. To facilitate coordination between the PRI and the service delivery system, linkages are envisaged at the following levels:

Level1. Community level and Sub centre, primary health centre- Gram Panchayat.

Level 2. PHC, Community Health Centre – Panchayat Samiti.

Level 3. Over all responsibility of NRHM and District Hospital – Zila Parisad.

3. Untied grants to Village Health and Sanitation Committees

The existing Village Health Committee at the Gram Panchayat level oversees all NRHM activities. However, at the state the constitution of the committee is broad based and is called as Village Health and Sanitation Committee. It is headed by ASM at the Gram Panchayat level and by Panchayat representative at the village level.

The roles of VHSC are as follows:

1. Ensuring discussions on Health issues in Gram Sabha.

2. Attendance and participation of women and marginalized groups and Gram sabha.

3. Formulation/synthesis of village health plan.

4. Facilitate birth and death registration, conduct maternal, new born and under five deaths audits; report of outbreak of epidemics.

5. ASHA being accountable to VHSC and Gram Panchayat, payments will be made to her after the approval of Gram Panchayat.

6. Gram Panchayat will be responsible for safety and protection of women workers in that area.

7. To ensure vigilance against indulgence of the provider in unethical and harmful treatment practices; counter stigma against people with particular illnesses, minorities and equitable asses to health services are the responsibilities of VHSC.

Untied grants to every village with a VHSC will be ensure upto Rs. 10000/- for 3862 VHSC provided the committee is constituted, notified and bank account in the name of VHSC is opened. This untied grant would be used for household surveys, health camps, sanitation drives, revolving fund etc.

4. Selection and training of Community Health Workers (ASHAs, AWWs) etc.

The implementation of ASHA is done by Gram Panchayat Committee in consultation with the District Health Society and training conducted as per the guidelines.

5. Performance related incentives for ASHAs, AWWs.

Performance related incentive would be linked up with other vertical programmes and to the schemes of line departments determining the health. Village health committee and Rogi Kalyan samity may decide on release of performance related incentive to ASHAs.

6. Selection, remuneration and training of ANMs.

A total number of 118 ANMs have been recruited so far, under RCH-II and 20 from NRHM additionality. The majority of them are already in SCs. They will be continued this year also and further requirement will be met from the existing ANMs in the state by relocating them to SCs.

7. Selection, training and remuneration of Staff Nurses at PHC/CHC level.

So far 52 (31-RCH + 21 – NRHM) Staff Nurses have been recruited on contract basis. In order to functionalize 2 DH and already functioning 1 DH + 2 GH, 35 SNs will be recruited during the year (7 each in DH / GH) as the gap has been identified during facility survey. This will enhance the relocation of the existing ANMs in these hospitals due to absence of SN.

8. Selection, training and remuneration of Medical Officers at PHCs

As per the envisaged plan under NRHM, it is proposed that 20 Medical Officers (Allopathy), 32 AYUSH MOs would be recruited on contract to be posted in the non functional PHCs. As on date, out of 85 PHCs, 50 are functional in terms of 24X7. It is envisaged that at least 10 PHCs would be made functional during the year. The monthly salary would be Rs 15,000/- Per month for AYUSH MO and MBBS MO.

9. Selection, training and remuneration of Specialists at CHC level.

As proposed in the RCH II PIP,2 DHs will be made functional during the year in terms of providing specialists (trained MOs in Anesthesia, Obstetrics and Paediatrics). Since the training plan is taking time to take off, it is proposed that one each of specialists in in Anesthesia, Obstetrics and Paediatrics will be recruited during the year (n=6). The remuneration would be of Rs. 25,000/ month. The approved activity last year could not be completed as only one Obstetrician only joined the duty. Remaining specialist requirements along with this year’s proposal would be recruited and continued during the year.

10. Construction and maintenance of physical infrastructure of SHCs.

There are 381 SCs in the state. However, out of which 273 are functional and for which, an annual maintenance grant of RS. 10,000 will be available to every SC. This amount will be used for provision for improvement of water supply, toilets, SC building etc as per the GoI guidelines.

For maintenance of 273 SCs @ 10000/ SC as untied fund, the total amount required would be Rs. 0.273 Crores.

For construction of new SC building for Functionalization, 50 SCs at the rate of Rs. 9 Lakhs per SC will be constructed during the year. Rest SCs will be taken up in a phased manner in the ensuing years.

11. Construction and maintenance of physical infrastructure of PHCs.

During the year, 10 PHCs will be made fully functional as 24x7, the infrastructure inputs would be in place.

20 PHC new building will be constructed during the year @ Rs 12 lakhs. This requirement is such that even if the PHC is functional, many PHC buildings are of very bad quality / on the verge of being collapse.

Apart from this, an annual maintenance grants of Rs 50000/- will be made available to each PHC (n=85). Provision for water, toilets, their use and their maintenance, etc, has to be maintained from RKS fund.

Untied fund of Rs 25000/- would be provided to all 85 PHCs during the year.

12. Construction and maintenance of physical infrastructure of CHCs.

Construction of infrastructure for all the identified CHCs would be carried out during the year. The will be an additional requirements required during the year. The putting in of new inputs in the form of OT, blood storage facilities, labour room etc is envisaged for all these CHCs. As per the survey report, the need s are many but the requirement are set on priority. The status of CHC upgradation is as below;

Rogi Kalyan Samiti will undertake maintenance of CHCs from an Annual maintenance grant of Rs. 1 lakh to every CHC to ensure quality services through functional physical infrastructure.

13. Pocurement and distribution of quality equipments and drugs in the health system.

The Drug Kits has already been supplied to the districts for 2006-07. However, with an enhanced funding, it is proposed to include all the existing health facilities. Therefore, additional fund requirements for the year ending March 2008 has been submitted to GoI.

14. Untied grand to SCs, PHCs and CHCs

It will be provided to 273 SCs at the rate of Rs 10,000/- per annum

To 85 PHCs, untied fund of Rs 25000/- will be provided during the year.

Untied fund for CHCs will be provided to 31 CHCs at the rate of Rs 50000/- per annum.

15. Supports for Mobile Medical Unit.

The state will require MMU during the year at the rate approved by GoI. However, during 2006-07, 16 units were approved and released to the state. No maintenance fund for the MMU will be required for this year as the MMU is being operationalized this year. Maintenance fund will be required from 2008-09. The MMU has already been ordered to the companies.

16. Improving physical infrastructure at SC / PHC / CHC /DH.

All the areas for improvement of SC / PHC / CHC have been articulated. The DH upgradation is under way from the fund received from GoI @ Rs 1 crore. Further fund requirements will be put in as additional need as and when the activity is completed.

Requirement of residential quarters for the facilities mentioned below are proposed as per the requirement.

1. PHC: It is proposed to construct 105 quarters for PHC staff (3 additional quarters – one for Mo, 3 for SNs) for 35 PHCs.

2. DH : Due to scarcity of quarters, it has become very difficult to perform round the clock service from far away location and lack of building for hiring. It is proposed to provide 70 quarters (Specialist, MO & SN) at the rate of 5 quarters per DH for 14 districts.

17. Ambulance for PHC / CHC / DH.

The perennial problem of non availability of transport system for referral etc is very evident in all the districts.The ambulances approved last year (4) has already been ordered and have been placed at Tawang(Mukto), Darak, Diyun PHC and Dirang CHC.

18. Rogi Kalyan Samitis / Hospital Management Committees.

To establish a management structure called Rogi Kalyan Samity (RKS) /Hospital Management Committee to ensure a degree of permanency and sustainability of the GH,DH, PHC and upgrade CHCs to Indian Public Health Standards.

Activities:

1. Formation of RKS and opening of bank accounts
2. Preparation of guidelines for RKS
3. Untied grants to CHCs. Every CHC Rupees 50,000 as untied grants for local health action. The resources could be used for any local health activity for which there is a demand.

RKS are proposed to be established in all GH, DH, Community Health Centres, and Primary Health Centres in the state. The initiative would bring in the community ownership in running of rural hospitals and health centres, which will in turn make them accountable and responsible.

A support of Rs.5.0 lakhs per District hospital fund as corpus fund for 14 DH / GH in the state during the year.

Rs.1.00 lakh per CHC (n=31) and Rs.1 lakh per PHC per annum (85) would be given to these societies.

19. Ceiling on civil works

BLOCK POOLING

Proposed interventions

The proposal is for construction of residential quarters in all the identified health facilities. The quarter would be required to pool Medical Officers, GNM, Laboratory Technicians and Grade IV staff who are otherwise posted to the adjoining CHCs, PHCs and SCs. These staff would visit the adjoining facilities as frequent as possible to provide quality services to the nearby health facilities. The facilities covered are as follows:

1. Basar CHC: This covers 2 CHCs, 3 PHCs and about 15 SCs.

2. Namsai CHC: This is covering 2 CHC, 5 PHCs and 20 SCs

3. Deomali CHC:This will cover 1CHC, 3 PHCs and 15 SCs.

The pooled health staff would visit as per a work out plan to all the health facilities that it covers. Therefore, it is proposed that the following residential quarters may be provided to the identified health facility on priority.

Technical parameters & blueprint

It is proposed to construct RCC type quarters under this proposal as per the technical designs/layouts developed by the State PWD for quarters. The State PWD rate / CPWD for all types of quarter will be followed. Therefore, Type III quarter will cost Rs. 600000/- (Six lakhs) per unit.

20. MAINSTREAMING OF AYUSH.

The state has proposed to incorporate the Medical Officer proposal and co-location / relocation of AYUSH facilities only and the rest of activities for AYUSH will be covered from AYUSH fund through AYUSH Department, GoI.

In Arunachal Pradesh, initially during 1980 Govt. of Arunachal Pradesh introduced the Indian systems of medicine and homoeopathy at various places like District HQ, Hospitals, PHCs and the places where no other health care facilities was not provided to render ISM and Homoeo facilities to the people of the State. Later on, during the course of time seeing the people’s response and gaining popularity of these traditional systems in the state, the Govt. opened the dispensaries. Even though, the concept of bringing all systems of treatment under one umbrella as conceived now under NRHM; in Arunachal Pradesh this concept has been already prevailing i.e. several Ayurvedic and Homoeopathy units are functional under one roof only at District Allopathic Hospitals, PHCs and CHCs.

The Average out patient attendants at each Ayush health care unit is reported 45 to 60 per day as per the District Health reports.

A part of that there are more than 500 known species of medicinal plants are available in Arunachal Pradesh which can be put to use for manufacturing the allopathy, ayurveda and homoepathy, unani, siddha drugs.

Existing manpower and infrastructure:

1.Eleven AYUSH Medical Officers posted in 11 District Hospitals. 8 of them are in CHCs, 10 in PHCs and 8 in GH / Dispensaries under specialty clinic.

2.10 Bedded specialty wing in DHs in 10 DHs, the activity of which is going on and GoI has released the fund.

3.GoI has released funds for 51 facilities with AYUSH manpower @ Rs 25000/ only for essential drugs.

Proposal for sanction of Manpower and infrastructure

There are 23 CHCs, 75 PHCs without AYUSH Doctors. The total requirement of AYUSH Doctor is 98 Nos. Under State Deptt.of Health & FW there are 39 Homoeopathy doctors and 3 Ayurvedic doctors are working on regular basis. During 2006-07, 10 Ayush doctors are appointed on contractual basis under NRHM.

In continuation of mainstreaming of AYUSH under NRHM, it is proposed that 32 AYUSH Doctors will be appointed on contract at a consolidated monthly salary of Rs 15000/- per month.

Proposal for co-location/relocation of AYUSH facilities:

All the AYUSH set up are already a part of existing PHC / CHC / DH / GH. The AYUSH set up are not a separate entity in the state. However, specialty clinic in 3 areas will be co-located to the nearby PHC / CHC. Otherwise, facilities are provided under the broad umbrella of PHC / CHC /DH/GH only.

Routine Immunization

1. STRATEGIES FOR IMPROVING ROUTINE IMMUNIZATION

Current Status and Goal

The objective of the immunization programme is in line with the objectives framed under NRHM with additional inputs from GOI, it is envisaged to attain a level of immunization coverage in line with the National goals.

Expected Outcome

Summary of Activities

a). To improve coverage by increasing the access through Govt. facilities.

In lower belt / soft area numbering 224 SC of the total SCs, ors would be organized (896 ors / month) The districts would prepare detail work plan at the sc level for conducting ors and would be ensured that the activities are implemented as per the plan.

A PHC level team / district level immunization team will be constituted comprising of MOs, ANM, LHV, HA, AWW, ASHA for providing outreach sessions in 224 SC area every month wherever there is no manpower. Additional mobility support is absolutely necessary due to lack of staff at the sc level or non-functional status of majority of the SCs in the state. AWW / ASHA will be engaged for mobilization of children during immunization sessions at a rate stipulated by GOI.

b). To increase immunization coverage in inaccessible areas

In 154 inaccessible sc areas, ors (4 times / month / SC) would be conducted which will need special consideration in terms of funding for vaccine lifting and mobility support (TA, DA) This is absolutely necessary due to lack of staff at the SC level or non-functional status of majority of the SCs in the state.

C). To provide routine immunization to all children in urban areas by increasing access through government and society run facilities.

Apart from the proposed outreached sessions under urban health program (Itanagar-Naharlagun and Pasighat), an additional immunization camps will be organized in all the district headquarters at the rate of 2 Immunization camps per district headquarter (2 Slum areas) per month in 15 district headquarters (360 Immunization camps per year). The mobility support would be provided along with logistics at GOI norms. Manpower would be provided from the District Hospital after establishing a proper mobile unit. Apart from involving 2 society run Hospitals to conduct immunization sessions on a fixed day, an additional NGOs would be involved to organize vaccination camps along with the above proposals in the urban areas.

d). Mobilization of children by AWW / ASHA to the Immunization site.

In all the session sites village-wise, mobilization of children would be done through AWW / ASHA / Link worker etc and the support involved would be provided at Rs 50 /- for AWW / ASHA per session for all sessions.

e). Strengthening the Cold Chain Systems.

Proper maintenance of cold chain equipments and storage will be ensured at all level and the old equipments will be phased out. Provision for 20 solar operated refrigerators in non-electrified PHCs during the year. Fund for cold chain maintenance would be provided to 1 WIC (State cold chain room), 16 districts, 25 CHCs and 81 PHCs where cold chain systems are in place to ensure timely procurement of spares as per GoI norms. The supply of AD syringes, Hub cutter and plastic bags along with vaccines would be made available to all the facilities providing immunization services.

POSITION OF COLD CHAIN EQUIPMENTS IN THE STATE

f). Orientation training of ANM, Technician and doctors on immunization

G). Strengthening program management and supervision.

It will be strengthened to improve services, identify bottlenecks, timely corrective intervention for optimal utilization of resources. The state level Officer would be provided mobility supports for supervisory visit to districts 2 times each district per year in the form of TA / DA, POL.

Mobility support would be provided for supervisory visit to the field area in the district (1 visit to all the area within the district per month) by the DRCHO as per GOI allocation norms.

Computerization of MIS system with introduction of RIM at the state and district headquarters will be ensured. For which, 4 Computers with accessories and a computer operator each to state and all the districts will be provided on contract at the rate of Rs. 6500/- per month.

h). Program evaluation.

A quarterly review of the immunization program will be organized for one day among State and District level immunization officials at the state headquarters for assessing service delivery, supplies, equipments, logistics, manpower resource and district performances (16 districts X3 person @ Rs 1250 per person including stationery expenses).

Similarly, the DRCHO will hold at least one review meeting per 2 months with the program personnel. All the activities under this PIP would be evaluated at all level. The program outcome indicators and performance level would be reviewed at the end of every year so as to ascertain the level of achievements.

i). Waste management

Waste disposal mechanism would be put in place in all the PHCs, CHCs and wherever cold chain systems are in place (n=40) during the year at the rate of Rs 20000/- per centre. Remaining health centres would be taken in a phased manner.

j). Provision for Diesel Generator

In view of no power supply in many far flung areas, in the identified health centre, provision for Diesel generator would be provided to 15 Health Centres (Rs 1 lakh/ set) and POL provision would be made from the RCH fund at the rate of Rs 2000/- per centre.

k). Additional Manpower

In view of the acute shortage of Refrigerator Mechanic (RM), 4 nos. of RM will be appointed on contract for 4 districts presently without RM. This is necessary in order to minimize the sick time of the cold chain equipments. It is very often seen that RM has to travel several hundred kilometers to repair sick cold chain equipments either from state headquarters or neighboring districts. An additional Refrigerator Mechanic has been appointed on contract basis to oversee the cold chain repair and maintenance from state headquarters at a consolidated pay of Rs 8000/- per month. This is absolutely necessary considering the experience gained over the years on cold chain maintenance and would continue.

l). Mobility (POL) support for vaccine lifting

An additional need are mobility support for lifting of vaccines from nearest airport Guwahati (10 lifting per year) to the state cold chain system (POL support may be provided at the rate of Rs 5000/- per collection), lifting of vaccines from state cold chain room to 16 districts whenever required would be made available (6 times per year) and for lifting of vaccines from district cold chain room to all the CHCs and PHCs. An amount of Rs. 5000/- per month per district would be provided as POL / DA support.

m). Provision for Immunization Card/ Register

It is proposed to procure the necessary Immunization Card (100,000 nos) at the state level yearly at the rate of Rs. 3/- per card (as per GOI norms) and provision of Rs 200000/- for provision of Immunization registers.

n). IPPI (Intensified Pulse Polio Immunization)

The IPPI program would be implemented in the state as and when GoI directions are received. The fund requirement for such IPPI program is Rs.1 Crore.

o). Helicopter Sorties.

There are 11 exclusively airfed and hard to reach areas which requires helicopter sorties. The areas will be covered 4 times per year. Therefore total sorties required is 44 and the rate for each sortie (3 hours / sortie – average) is Rs 120000/ -. Therefore for 44 sorties the total requirement will be Rs 5280000/- per year. The above requirement is absolutely required.

Other Activities

a. With the introduction of Immunization weeks during the last two years the immunization coverage level has gone up many fold. The State plan to organize more immunization week during the year on alternate months.

The fixed Immunization Days in the state is on Tuesday & Saturday and outreach session are carried out as per the microplan of the particular areas. The state strives to generalize availability of microplan in all the health facilities.

b. State Level steering committee is in place for special immunization drive like IPPI etc.

National Disease Control Programme

The National Disease Control Programme are being implemented in state under NRHM with a view to achieve the MDG goals to halt the spread of major diseases and reverse the trend by 2015 so as to reduce the mortality and morbidity and increase life expectancy and quality of life. The NDCP encompasses: Revised National TB Control Programme (RNTCP), National Vector Borne Disease Control Programme (NVBDCP), and National Programme for control of Blindness (NPCB), The National Leprosy Eradication Programme (NLEP), Integrated Disease Surveillance Programme (IDSP), and Iodine Deficiency Disorder Control Programme (IDDCP).

1. The National Vector Borne Disease Control Programme (NVBDCP)

NVBDCP include major vector borne diseases of public Health importance, such as Malaria, Filariasis, Japanese Encephalitis, Dengue, and Kala azar. As per the National Health Policy 2002 the goal is to reduce morbidity and mortality by 50% by 2010. In Rajasthan only Malaria and Dengue are prevalent the strategy for control of vector borne diseases includes:

Enhanced Surveillance with support of community based volunteers (ASHA) and grass root level workers.

Early diagnosis and proper case management through strengthening Primary and Secondary Health institutions.

Integrated vector management using bio-friendly methods and limiting use of insecticides.

Epidemic preparedness and rapid response.

Institutional strengthening and Capacity building of Health personnel.

Behavior change communication

Intersectoral Collaboration

Computerized Management information system.

2. The National Leprosy Eradication Programme.

Leprosy is a disease of public health concern in India. It is a disease of medico-social concern .Current prevalence is 1.8/10000. Rajasthan has achieved prevalence elimination level (prevalence below 1/10000) in 2000. Current prevalence Rate is 0.24/10000. Under the NRHM the strategies drawn under the National Leprosy Eradication Project to be continued. The fie component include Decentralization and institutional development , strengthening and integration of service delivery, disability care and prevention , IEC and training. Services will be continued to be provided at CHC, PHC, Additional PHC, and hospitals with support from the district nucleus. The sub-centers will be involved in delivery of second and subsequent doses of MDT. NGO will continue to be involved in reconstructive surgery, disability care and prevention and IEC. Village and district Health plans will enable identification and ensure referral of cases requiring disability treatment to the appropriate facility. CMHOs and medical officers will continue to be trained on Leprosy Programme management.

3. Integrated Disease Surveillance Programme (IDSP)

Objective of IDSP is to establish a state based system of surveillance through Information and communication technology (ICT) for communicable and non-communicable diseases so that a timely and effective public health action can be initiated in response to the health challenges. IDSP will also improve the efficiency of the existing surveillance activities of the different disease control Programs. Surveillance system will be strengthened through Capacity building of medical officers and health workers and technicians, strengthening of laboratory network and reporting system through ICT. This would p[provide a string foundation to the disease control Programmes under NRHM. ASHA being the link between community and public health system will strengthen the community based surveillance system.

4. Revised National Tuberculosis Control Programme (RNTCP)

The RNTCP is the vehicle through which through which the WHO recommended DOTS (Directly Observed Therapy Short course) is implemented in India. All the districts of Rajasthan are being covered. As part of the Programme Designated Microscopy centers (DMCs) have been established at PHC, CHC and district hospitals. RNTPC supports the salary of laboratory technicians, laboratory supplies and consumables. All medical officers are trained under RNTCP for diagnosis management and referral. All SCs, PHCs, CHCs and district hospitals function as DOTS centres. Community level DOTS providers are also trained in delivery of drugs. Para medical staff is trained in monitoring consumption of ant TB drugs. The RNTCP also involves the civil society organizations in its outreach of communication efforts. Under NRHM the ASHA will be the facilitator for early access to the diagnosis, referral and follow-up as a community DOTS provider.

5. National Blindness Control Programme (NPCB)

The National Blindness Control Programme aims at reducing prevalence of blindness from the current level of 1.5% to 0.34% by the 2010. Rajasthan state has set a target of about 3 lac cataract operations every year to achieve the goal. Under NPCB apart from providing surgical treatment through IOL (Intraocular lens) implant for cataract, which is major cause of blindness, the other causes of blindness such as childhood blindness, glaucoma and retinal disorders are also dealt. School health check up is also one of the major components of the Programme. ASHA would play an important role in creating awareness of the Programme and motivate people to seek treatment. NRHM would also seek to create synergy between the NPCB and Vitamin A supplementation Programme.

Intersectoral Convergence

Convergence at the village level appears integral to the functions of both programmes but also to all the related departments.. Such convergence is critical to the success of the National Rural Health mission. The National Rural Health Mission (NRHM) is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. The key to the success is through inter-sectoral convergence, community ownership through Village Health Committees at the level of the village.

An Accredited Social Health Activist (ASHA) is expected to work with communities for social mobilization and improve access to services. ASHA’s role will be to facilitate care seeking and serve as a depot holder for a package of basic medicines. The AWW, schoolteacher, members of local community based organizations and the Village Health Committee are expected to support the ASHA in her work.

The location of the AWC and AWW (mostly local women) and the functions of nutrition and health make them a natural ally for the health sector. Key participants in the ICDS scheme are children below six years, pregnant and lactating women, specifically marginalized women. Thus the programme design of ICDS is such that it can make significant contributions to malnutrition and mortality- the success in ensuring healthy childhoods and outcomes for pregnant mothers.

The child health strategy concentrates on the: essential newborn care, breastfeeding, immunization, and care of the sick newborn and child through outpatient/home based care and inpatient care. This approach is called the Integrated Management of the Neonatal and Child hood Illness (IMNCI).

ASHA, (Accredited Social Health Activist), the mechanism to strengthen village level service delivery, will be a local resident and selected by the Gram Panchayat or the Village Health Committee. She will be supported in her work by the AWW, school teacher, community based organizations, such as SHGs, and the VHC. Her role would be to facilitate care seeking and serve as a depot holder for a package of basic medicines. She will be reimbursed by the panchayat on a performance based remuneration plan. The Village Health Committee (VHC) will form the link between the Gram Panchayat and the community, and will ensure that the health plan is in harmony with the overall local plan.

Capacity building of PRI is required in thematic areas and leadership skills, negotiating, monitoring, ability to withstand patronage and political interference. Capacity building processes need to be tailored to literacy levels, sex and circumstances of PRI members. Joint orientation and sensitization meetings between PRI and health and medical professionals could help to bridge the gap in education and social strata. Developing Citizen Charter of Rights and Codes of conduct also lay down guidelines for boundaries of operation and accountability which is already addressed under RKS. NGOs could be involved in PRI strengthening in a variety of ways, including: consciousness raising, provision of technical advice, support in participatory planning, capacity building and facilitating monitoring processes, such as community and social audits to improve accountability. The sensitization / training is covered under RCH II and also in NRHM Additionalities. There is no separate budget proposed.

School authorities and the students will be involved in health activities. This includes using of students in health programs, school health programs in the schools in sensitizing the students etc to health needs. Teachers may also be utilized for propagation of health information to the students in turn who will disseminate the messages to the parents and community.

The facility survey also indicates that majority of the households are not provided with potable and safe drinking water. Similarly, sanitation facilities are also very scarce. Under the convergent efforts of the line departments, it is hoped that these issues also would be addressed during the program period.

VH&ND is another area where convergence has started. The committee will oversee under the aegis of SHM & DHM. This committee will not only address the health need but also covering all the aspects of sanitation. For all these activities, it is proposed that convergent activities will require resources and time. Therefore, the proposal is as below:

1. Convergence meetings:  At state level 2 times per year with all the departments. And at the district level, 2 such meetings will be organized per district.
2. Workshop on innovations:  One workshop per district and 2 workshops at state level will be organized.