MedCosmos PSM

SOCIO-ECONOMIC CLASSIFICATION ( INDIA )

2008-09-04T18:04:00.000-07:00

SOCIO-ECONOMIC CLASSIFICATION ( INDIA )

The Socio-economic status (SES) is an important determinant of health and nutritional status as well as of mortality and morbidity. Socio-economic status also influences the accessibility, affordability, acceptability and actual utilization of various available health facilities. There have been several attempts to develop different scales to measure the socioeconomic status. The earliest attempts to find out the social class of an individual were from the standpoint of psychologists.

In Indian studies, the classification of British Registrar General based on occupation was tried earlier. Later on Prasad's classification of 1961based on per capita monthly income and later modified in 1968 and 1970 has been extensively used. Now a days Kuppuswami scale is widely used to measure the socio-economic status of an individual in urban community based on three variables namely education, occupation and income.
The modification of Kuppuswami scale meant to determine the socioeconomic status of family based on education and occupation of head of the family and per capita income per month has also been widely used. Recently, Mishra et al have suggested an economic revision of Kuppuswami's scale in order to account for the devaluation of rupee.

In the Rural areas, Pareekh classification based on nine characteristics namely
1.Caste
2.Occupation of family head
3.Educatiion of family head
4.Level of social participation of family head
5.Landholding
6.Housing
7.Farm power
8.Material possessions
9.Type of family.

The present instrument is proposed to measure the socio-economic status of the family and is neither based on the individual nor on the head of the family. Unlike the commonly used Kuppuswami Scale and later its modification, the modified version of Kuppuswami Scale and Pareekh Scale, the instrument developed by us is applicable both for urban as well as rural families. Moreover, the instrument has been developed for all sections of the Society.

Here I am giving Latest Data regarding to both Classifications commonly used.....

PRASAD'S CLASSIFICATION

Social Class	PRASAD'S CLASSIFICATION 1961	MODIFIED PRASAD'S CLASSIFICATION 1997
1	100 and above	1900 and above
2	50-99	950-1899
3	30-49	570-949
4	15-29	285-569
5	below 15	below 284

KUPPUSWAMI'S CLASSIFICATION
It is Based on Education, Occupation and Income Of Family Head.

A. EDUCATION

Professional Degree , PG and Abobe	7
Graduate	6
Intermediate or Past High School Diploma	5
High School Certificate	4
Middle School Completion	3
Primary School or Literate	2
Illiterate	1

B.OCCUPATION

Profession	10
Semi Profession	6
Clerk, Shop Owner, Farm Owner	5
Skilled Worker	4
Semi Skilled Worker	3
Unskilled	2
Unemployed	1

C.PER CAPITA INCOME ( Rs. Per Month )

1500 or above	12
750-1499	10
565-749	6
375-564	4
225-374	3
75-224	2
Below 75	1

The Total Score is Graded as follows :

Upper	26-29
Upper Middle	16-25
Lower Middle	11-15
Upper Lower	5-10
Lower	< 5

__________________

11th Five Year Plan in INDIA

2008-09-04T18:02:00.000-07:00

In India we know that our government plan in terms of FIVE YEARS GOAL..This year they have launched 111th Five Year Plan..( 2007-2012 )

In the context of the formulation of Eleventh Five Year Plan (2007-2012), the following sectorwise WORKING GROUPS/STEERING COMMITTEES/TASK FORCE have been set up by Planning Commission, to make recommendations on various policy matters.

1.Agriculture
2.Backward Classes
3.Communication & Information
4.Development Policy
5.Education
6.Environment & Forests
7.Financial Resources
8.Health & Family Welfare
9.Housing & Urban Development
10.Industry & Minerals
11.Labour, Employment and Manpower
12.Multi Level Planning
13.Power & Energy, Energy Policy and Rural Energy
14.Programme Evaluation Organisation
15.Rural Development
16.Social Justice & Women Empowerment
17.Science & Technology
18.State Plans
19.Tourism
20.Transport
21.Village & Small Enterprises
22.Voluntary Action Cell
23.Water Resources
24.Women and Child Development
25.International Economics

Get More details and documents of all of these from below..

http://planningcommission.nic.in/plans/planrel/11thf.htm

Brief Intro to 11th plan..
Report
Towards Faster and More Inclusive Growth: An approach to the Eleventh Five Year Plan 2007-2012

Download Booklet from here..

http://planningcommission.nic.in/plans/planrel/app11_16jan.pdf

Hardy-Weinberg Law for Population Genetics

2008-09-04T17:48:00.000-07:00

As stated in the introduction to population genetics, the Hardy-Weinberg Law states that under the following conditions both phenotypic and allelic frequencies remain constant from generation to generation in sexually reproducing populations, a condition known as Hardy-Weinberg equilibrium.
1.large population size
2.no mutation
3.no immigration or emigration
4.random mating
5.random reproductive success

If we mate two individuals that are heterozygous (e.g., Bb) for a trait, we find that
25% of their offspring are homozygous for the dominant allele (BB)
50% are heterozygous like their parents (Bb) and
25% are homozygous for the recessive allele (bb) and thus, unlike their parents, express the recessive phenotype.

This is what Mendel found when he crossed monohybrids. It occurs because Meiosis separates the two alleles of each heterozygous parent so that 50% of the gametes will carry one allele and 50% the other.

When the gametes are brought together at random, each B (or b)-carrying egg will have a 1 in 2 probability of being fertilized by a sperm carrying B (or b).

Results of random union of the two gametes produced by two individuals, each heterozygous for a given trait. As a result of meiosis, half the gametes produced by each parent with carry allele B; the other half allele b.

Results of random union of the gametes produced by an entire population with a gene pool containing 80% B and 20% b.

-	0.5 B	0.5 b	-------------------------------------------------------------	-	0.8 B	0.2 b
0.5 B	0.25 BB	0.25 Bb	-------------------------------------------------------------	0.8 B	0.64 BB	0.16 Bb
0.5 b	0.25 Bb	0.25 bb	-------------------------------------------------------------	0.2 b	0.16 Bb	0.04 bb

But the frequency of two alleles in an entire population of organisms is unlikely to be exactly the same. Let us take as a hypothetical case, a population of hamsters in which
80% of all the gametes in the population carry a dominant allele for black coat (B) and
20% carry the recessive allele for gray coat (b).
Random union of these gametes (right table) will produce a generation:
64% homozygous for BB (0.8 x 0.8 = 0.64)
32% Bb heterozygotes (0.8 x 0.2 x 2 = 0.32)
4% homozygous (bb) for gray coat (0.2 x 0.2 = 0.04)
So 96% of this generation will have black coats; only 4% gray coats.
Will gray coated hamsters eventually disappear?

No. Let's see why not.
All the gametes formed by BB hamsters will contain allele B as will one-half the gametes formed by heterozygous (Bb) hamsters.
So, 80% (0.64 + .5*0.32) of the pool of gametes formed by this generation with contain B.
All the gametes of the gray (bb) hamsters (4%) will contain b but
one-half of the gametes of the heterozygous hamsters will as well.
So 20% (0.04 + .5*0.32) of the gametes will contain b.
So we have duplicated the initial situation exactly. The proportion of allele b in the population has remained the same. The heterozygous hamsters ensure that each generation will contain 4% gray hamsters.

Now let us look at an algebraic analysis of the same problem using the expansion of the binomial (p+q)2.
(p+q)2 = p2 + 2pq + q2
The total number of genes in a population is its gene pool.
Let p represent the frequency of one gene in the pool and q the frequency of its single allele.
So, p + q = 1
p2 = the fraction of the population homozygous for p
q2 = the fraction homozygous for q
2pq = the fraction of heterozygotes
In our example, p = 0.8, q = 0.2, and thus
(0.8 + 0.2)2 = (0.8)2 + 2(0.8)(0.2) + (0.2)2 = 0.64 + 0.32 + 0.04

The algebraic method enables us to work backward as well as forward. In fact, because we chose to make B fully dominant, the only way that the frequency of B and b in the gene pool could be known is by determining the frequency of the recessive phenotype (gray) and computing from it the value of q.

q2 = 0.04, so q = 0.2, the frequency of the b allele in the gene pool. Since p + q = 1, p = 0.8 and allele B makes up 80% of the gene pool. Because B is completely dominant over b, we cannot distinguish the Bb hamsters from the BB ones by their phenotype. But substituting in the middle term (2pq) of the expansion gives the percentage of heterozygous hamsters. 2pq = (2)(0.8)(0.2) = 0.32

So, recessive genes do not tend to be lost from a population no matter how small their representation

Ooooooooops....Found Somewhat Difficult...!! But they ask this sometimes in CM ( PSM ) as Spotting or in Example...Have to Understand once..

Health Legislation In India

2008-09-04T17:38:00.000-07:00

This is a compilation of over 200 health related Acts & Rules (Central) that are there in INDIA...Get them read as per your need and curiosity.....

HEALTH FACILITES & SERVICES
-Indian red cross socity act 1920
-All-idia institute of medical science act 1956
-Post graduate institute of medical education and research chandigarh act 1966
-Bureau of indian standards act 1986
-Bureau of indian standards rules 1987
-National institute of pharmaceutical education and research act 1998
-Bombay nursing homes registration act 1949
-Delhi nursing homes registration act 1953
-Madhya pradesh upcharyagriba tatha rujopachar sambandhi sthapas adhiniyam 1973
-Orissa clinical establishment act 1991
-Orissa clinical establishment rules 1994
-Manipur nursing home and clinics registration act 1992
-Sikkim clinical establishment act 1992
-Nagaland health care establishment act 1997
-West bengal clinical establishment rules 2003

DISEASE CONTROL & MEDICAL CARE
-Epidemic Diseases act 1897
-Indian aircraft act 1934
-Indian aircraft(public health)rules 1954
-Indian port health rules 1955
-Medical termination of pregnancy act 1971
-Medical termination of pregnancy rules 1975
-Medical termination of pregnancy regulation 1975
-Transplantation of human organs act 1994
-Transplantation of human organs rules 1995
-transplantation of human organs amendment rules 2002
-Pre natal diagnostic techniques Regulation & prevention of misuse act 1994
-Pre natal diagnostic techniques Regulation & prevention of misuse Rules 1996
-Pre natal diagnostic techniques Regulation & prevention of misuse amendment act 2002
-Pre natal diagnostic techniques Regulation & prevention of misuse amendment rules 2003

ETHICS & PATIENTS RIGHTS
-Counsumer protection act 1986
-Counsuer protection rules 1987
-Consumer protection amendment act 2002
-Ethical guidelines for biomedical research on human subjects,2000
-Right to information act 2005
-Right to information regulation of fee and cost rules 2005
-Right to informatio regulation of fee and cost amendement rules 2005
-Central information commission appeal procedure rules 2005

HUMAN RESOURCES
-Allopathy
-Indian medical council act 1956
-Indian medical council rules 1957
-Indian medical council election of licentiates rules 1965
-Establishment of new medical college & higher course regulations 1993
-Medical council of india amendment 1998
-Medical council of india regulations 2000
-Indian medical council ammendment 2001
-Eligibility for admission in an undegraduate medical cource in a foregin medical instituation regulations 2002
-Indian medical council professional conduct & etiquette & ethics regulations 2002
-Screening test regulations 2002
-Indian systems of medicine & homeopathy
-Indian medicine central council act 1970
-Homeopathy central council act 1973
-Central council of indian medicine regulaions 1976
-Homeopathy practitioners professional conduct & etiqiette & code of ethics regulations 1982
-Practitioners of india medicine standards of professional conducat & etique & code of ethics regulation 1982
-Homeopathy diploma course DHMS 1983
-Homeopathy minimum standards of education 1983
-Homeopathy degree cource BHMS regulation 1983
-Indian medicine central council minimum standards of education in indian medicine amendement regulation 1989
-Homeopathy central council amendement act 2002
-Indian medicine central council PG ayurveda education regulation 2005
-Dentistry
-Dentist act 1948
-Dental council of india employees conditions of service regulations 1955
-Dental council of india regulations 1956
-Dental council of india dental hygienists revised course 1972
-Dental mechanics regulation revised cources 1972
-BDS cource regulations 1983
-MDS course regulation 1983
-Dental council of indian regulations pension & GPF & Gratuity 1984
-Dentists amendement act 1993
-Establishment of dental colleges 1993
-Dental council of india establishment of new colleges regulations 2006
-Pharmacy
-Pharmacy act 1948
-Pharmacy council of india regulatios
-Nursing
-Indian nursing council act 1947
-Indian nursing council regulations
-Rehabilitation
-Rehabilitation council of india act 1992
-Rehabilitation council of india regulations 1997
-Rehabilitation council of india conditions of service 1998

RADIATION PROTECTION
-Atomic energy act 1962
-Radiation protection rules 1971
-Radiation surveillance procedures for medical application of radiation 1980
-Atomic energy working of the mines minerals and handling of prescribed substance rules 1984
-Atomic energy safe disposal of radioactive wastes rules 1987
-Radiation survelliance procedures for medical application of radiation 1989
-Safety code for medical diagnostic X ray equipment and installations
-Statoutory requirement for safe operation of X ray machines by medical instituations in india
-Registration of diagnostic X ray and CT scan installations

HAZARDOUS SUBSTANCES
-Narcotic drugs and psychotropic substances act 1985
-Narcotic drugs and psychotropic substances rules 1985
-Prevention of illicit traffic in narcotic drugs and psychotropic substance act 1988
-Hazardous wastes management and handling rules 1989
-Rules for the hazardous micro organism genetically engineered organisms of cells 1989
-Manufacture & storage & import of hazardous chemical amendement rules 2000
-Hazardous wastes management andd handeling rules 2002
-Schedule 1-List of processes generating hazardous wastes
-schedule 3-List of waste applicable only for imports and exports
-Schedule 2-List of waste substance with concentration limits
-Schedule 4-List of non ferrous metal wastes for recycling & processing
-Schedule 5-Used oil specification for re-refining
-Schedule 6-Hazadous wastes prohibated for import to and export from india
-Schedule 7-Authorities - duties and corresponding rules

OCCUPATIONAL HEALTH & ACCIDENT PREVENTION
-Fatal accident act 1855
-Workmen compensation act 1923
-Factories act 1948 amendment 1987
-Plantations labour act 1951
-Mines act 1952
-Mines and minerals regulation and development act 1957
-Motor transport workers act 1961
-Personal injuries emergency provisions act 1962
-Personal injuries compensation insurance act 1966
-Mine creche rules 1966
-Contract labour regulation and abilition central rules 1971
-Child labour prohibition and regulation act 1986
-Dock workers safety & health & welfare rules 1990
-Public liability insurance act 1991
-Public liability insurance rules 1991
- National commission for safai karamcharis act 1992
-Building and other construction workers reggulation of employment and conditions of service act 1996
-Building & other construction workers CESS act 1996

ELDERLY,DISABLED,REHABILITATION & MENTAL HEALTH
-Mental health act 1987
-Central mental health authority rules
-State mental health rules 1990
-Persons with disabilities act 1995
-Persons with disabilites rules 1996
-National trust for welfare of persons with autism & cerebral & palsy & mental retardation and multiple disabilities act 1999
-National trust for welfare of persons with autism & cerebral & palsy & mental retardation and multiple disabilities rules 2000

FAMILY,WOMEN & CHILDREN
-Indian divorce act 1869
-Guardians and wards act 1890
-Parsi marriage and divorce act 1939
-Dissoluction of muslim marriages act 1939
-Special marriage act 1954
-Hindu marriage act 1955
-Hindu succession act 1965
-Hindu minority and guardianship act 1956
-Hindu adoption and maintenance act 1956
-Supression of traffic in women & girls act 1956
-Children act 1960
-Orphanages and other charitable home act 1960
-Dowry prohibitation act 1961
-Muslim women protection of rights on divorce act 1986
-National commission for women act 1990
-Juvenile justice act 2000

SMOKING,ALCOHOLISM & DRUG ABUSE
-Cigrattes regulation of production supply and distribution act 1975
-Cigarettes and other tobacco products act 2003
-Cigarettes and other tobacco products rules 2004
-Prohibitation of sale on cigarettes and other tobacco products around educational institutions rules 2004

SOCIAL SECURITY & HEALTH INSURANCE
-Payment of wages act 1936
-Minimum wages act 1948
-Employees's state insurance act 1948
-Employee's state insurance central rules 1950
-Life insurance corporation act 1956
-Life insurance emergency provisions act 1956
-Maternity benefit act 1961
-Maternity benefit mines and circus rules 1963
-Insurance regulatory and development authority act 1999
-IRDA advisory committee meetings regulations 2000
-IRDA Insurance advertismenat & discloser regulation 2000
-IRDA obligations of insueres to rural or social sectors regulations 2000
-IRDA Lcensing of insurance agents regulations 2000
-IRDA registration of indian insurance companies regulations 2000
-IRDA insurance surveyors and loss assessors Regulation
-IRDA General insurance & reinsurance regulation 2000
-IRDA assets & liabilities & solvency margin of insurers regulation 2000
-IRDA actuarial report and Abstract regulations 2000
-IRDA appointed actuary regulations 2000
-IRDA third party administrators health services regulation 2001
-IRDA Investment ammendement regulations 2001
-IRDA licensing of corporate agents regulation 2002
-IRDA licensing of insurance agents amendement regulations 2002
-IRDA manner of receipt of premium regulation 2002
-IRDA Protection of policyholders interests regulation 2002
-IRDA protection of policyholders regulations amendment 2002

ENVIRONMENTAL PROTECTION
-Insecticides act 1968
-insecticides rules 1971
-insecticides amendment rules 1993
-insecticides amendment act 2000
-water prevention and control of pollution act 1974
-Water prevention and control of pollution rules 1975
-Central board for the prevention and control of water pollution rules 1975
-Water prevention and control of pollution CESS act 1977
-Water prevention and control of pollution CESS rules 1978
-Water prevention and control of pollution CESS amendment act 2003
-Air prevention and control of pollution act 1981
-Air prevention and control of pollution rules 1982
-Air prevention and control of pollution rules for union territories 1983
-Bhopal gas leak disaster act 1985
-Bhopal gas leak disaster amendment act 1992
-Environment protection act 1986
-Environment protection rules 1986
-National environment tribunal act 1995
-Environmental protection third amendment rules 2002
-Biomedical waste rules 1998
-Recycled plastic manufacture and usage rules 1999
-Municipal solid wastes rules 2000
-Noise pollution Rules 2000
-Ozone depleting substances rules 2000
-Biological diversity act 2002
-Biological diversity rules 2003
-Disaster management act 2005
-Constitution of national disaster management authority 2005
-Application for obtaining authorisation for collection &reception &treatment & transport & storage & disposal of hazardous waste 1
-Application for registration of facilites possessing environmentally second management practise for recycling non ferrous metal wastes or used lubricating oil 11
-Form for filling recyclers non ferrous metal wastes or used oil 12
-Form for filling returns of auction or sale of non ferroi]us metal wastes or used oil 13
-List of processes generating hazarodous wastes 1
-List of waste substances with concentration limits 2
-List of waste applicable only for imports and exports 3
-List of non ferrous metal wastes for recycling & reprocessing 4
-Used oil soecification for re-refining 5
-Hazardous wastes prohibated for import to and export from india 6
-Environment impact assessment notification 1994
- Notification mining processes and operations 2003
-Notification river valley projects 2003
-Notification location of new projects 2003
-Notification objections and suggestion
-Notification pollution controll 2003

NUTRITION & FOOD SAFETY
-Prevention of food adultration act 1954
-Prevention of food adultration rules 1955
-Prevention of food adultration 1st amendment rules 2002
-Prevention of food adultration 2nd amendment infant milk food rules 2002
-Prevention of food adultration 5th amendment 2002
-Prevention of food adultration 6th amendment mineral water rules 2002
-Prevention of food adultration 7th amendment sample to be sent rules 2002
-Prevention of food adultration 9th amendment vegetarian food rules 2001
-Infant milk substitutes feeding bottles and infant food act 1992
-Infant milk substitutes feeding bottles and infant food rules 1993
-Infant milk substitutes feeding bottles and infant food amendment act 2003
-Atomic energy control of irradiation of food rules 1996
-Edible oils packaging regulation order 1998
-Vegetable oil products regulation order 1998
-Public distribution system control order 2001
-Food saftey and standards act 2006

HEALTH INFORMATION & STATISTICS
-Births & deaths & marriages registration act 1886
-Registration births and deaths act 1969
-Collection of statistics act 1953
-Collection of statistics rules 1959
-Census act 1948
-Census amendment act 1993

INTELLECTUAL PROPERTY RIGHTS
-Patents act 1970
-Patent rules 1972
-Patents amendment act 2005
-Arbitration and conciliation act 1996
-Trade marks act 1999

CUSTODY,CIVIL & HUMAN RIGHTS
-Indian penal code 1860
-Socities registration act 1860
-Prisoners act 1900
-Unlawful activites & preventation act 1967
-Code of criminal procedures 1973
-Protection of human rights act 1993

OTHERS
-Indian contract act 1872
-Indian evidence act 1872
-Indian forest act 1927
-Essential commodities act 1955
-Standards & weights measures act 1976

Follow the link and list of all will be there...( in PDFs )

http://gujhealth.gov.in/Health%20legistation/M_index.htm

CNAA-Community Needs Assessment Approach

2008-09-04T17:33:00.000-07:00

The International Conference on Population and Development, Cairo, Egypt held on 5 - 13 September, 1994 recommended that the aim of family planning programme must be to enable couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so and to ensure informed choices and make available a full range of safe and effective methods. The success of population education and family planning programme in a variety of settings demonstrates that informed individuals everywhere can and will act responsibly in the light of their own needs and those of their families and communities. The principle of informed free choice is essential to the long-term success of family planning programmes.

2. Under the Target Oriented approach, the National level targets in respect of different family planning methods were used to be fixed in consultation with the States/Union Territories, keeping in view the long- term demographic goals and past performance levels of the States/Union Territories. These targets, however, became an end in itself and not the means to bring about the expected decline in the birth rates. The target based system followed up to 31st March, 1996, suffered from negligence of the quality of services provided to the people under family welfare programme. The needs of the individual client were not properly met. Thus the numerical method-specific targets provided such type of demographic planning which is against the democratic ethos of the country. Thus, a need arose to introduce decentralised participatory approach with emphasis on clients’ satisfaction and quality of services under Target Free Approach doing away the target-oriented approach.

3. The approach of determining targets was given up after extensive consultation with the States and after making pilot studies in one District of each of the 18 States in 1995-96. In the 4th conference of the Central Council of Health & Family Welfare, the Council placed on record its appreciation of the efforts made by all the State Govts. to implement the Family Welfare programmes on the basis of Target Free Approach with effect from 1996-97. In its 5th conference held in January 1997, the Council urged all States & Uts and Voluntary Organisations to secure the full involvement of the community in the implementation of family welfare programme under Target Free Approach.

4. On the basis of the experience gained during the experimental approach and in pursuance of the decision taken in Conference of State Secretaries (Family Welfare) held on 2nd February, 1996, the Target Free Approach for the family welfare programme was extended all over the country from 1st April 1996, which necessitates the decentralised participatory planning renamed as Community Needs Assessment Approach (CNAA) in 1997-98. Decentalised planning implicates close association of the community and its leading lights and opinion leaders such as village Pradhans, Mahila Swasthya Sanghs, Primary School Teachers, etc. in formulation of the PHC based family welfare and health care plan. Under this approach, plans regarding family welfare services were to be formulated in consultation with the community at the grass root level and expected to lead to improvement in quality of services and client satisfaction matching with ground situation requirements. In this connection, a manual of CNAA on Family Welfare Programme had already been circulated to all the States and Uts to provide guidance in decentralized planning at the level of SC/PHC containing various forms/formats and the guidelines for filling up the same for preparing these.

5. A total of 9 forms were prescribed in the CNAA manual in which the reports were to be made by the ANM for the sub-center, by in-charge medical officer for the PHC/FRU/sub-district Hospital/district hospital to the District Family Welfare Officer and by the District FW Officer to the State Govt. and to the Govt. of India (Department of FW).

These 9 forms are of two types – forms 1 to 5 are Action Plan forms which have to be prepared once in every year prior to the beginning of the financial year by the ANM, In-charge MO PHC/FRU/Sub-district hospital/district hospital, District Medical Officer and the State Action Plan by the State FW Officers. Form No.6 to 9 of the CNAA manual are the monthly reporting forms to be submitted by 15th-25th of the following month by ANM/MPW(Male) for sub-center/Urban Health Post/revamping center to the PHC, by Medical Officer in-charge FRU/CHC/sub divisional Hospital/PPC District Hospital to the District FW Officer and the consolidated monthly report by the District FW Officer to the state FW Department and the Department of FW(Ministry of Health & FW, New Delhi).

5. Forms 4 and 5 relate to district and State Level annual Action Plan which were required to be submitted to the Department of FW, Ministry of Health & FW, Govt. of India, New Delhi through NICNET by 28th of March every year in respect of the following Financial Year. The form 5 which is the Action Plan for the State is the aggregate compilation of the Action Plan submitted by all the districts in the State on Form 4. Besides the above two forms, a consolidated monthly report (form No.9) from district were also to be submitted to Department of Family Welfare, Govt. of India, New Delhi through NICNET by 25th of the following month. During 2003-2004 and 2004-05 (up to Feb. 2005) State Annual Action Plans (Form 5) have been received from 31 and 28 States/Uts respectively. During these two years 342 and 318 District annual Action Plan (Form 4) out of a total of about 595 districts in the country have been received. The monthly report from the district/states is received in the form No. 9 by this Ministry.

6. From the various quarters and the forums apprehensions emerged that the guidelines stipulated in CNAA manual were perhaps not being followed in preparing/formulation of the Annual Plan at various levels in States/Uts. As a result, the implementation of CNAA in its letter and spirit might be suffering. In view of these apprehensions and also to strengthen the MIES as a tool which could fully meet the requirements of phase-II programme of RCH, an expert group was set up under the Chairmanship of Prof. Mari Bhatt with the terms and reference to review the existing reporting arrangements and formats, MIES manual and software; ii) to strengthen monitoring and supervision at the field level iii) to recommend convergence of a unified MIES for the programme.

7. Proposed mechanism as per recommendations of Prof. Mari Bhatt committee:

The role of male health workers in CNAA should be enlarged and properly spelt out.
-Formulation of MIES Cell and States as well as center
-Pilot testing of revised CNAA in one EAG state and one non-EAG state.
-Building/Strengthening institutional mechanisms both for internal and external validation of information to be furnished.
-Internal validation through the supervisory staff of DHO and PHCs
-External validation through PRCs, RETs, local medical colleges and Training centres.
-Strengthening MIES infrastructure at the Centre and in States/Districts
CNAA Cell in M&E Division at Central level headed by a Director with adequate staff and infrastructure to be established.
-Similar Cells are to be constituted at State and District level.
-Requirement of districts and states for Computer hardware and Development of software--provide with HW &SW training of Programme Managers,Statistical Officers on use of MIES for planning and programme management.
-For having check on quality services INDIA CLEN a body under AIIMS is to develop a system jointly with the help of national level medical colleges, PRC, RETs and other state level institutions to monitor the quality of services.

Updates.....

CNAMA- Community Need Assessment and Monitoring Approach..Now CNAA is renamen as ANAMA to give more emphasis on monitoring in National Family Welfare Programmes in INDIA..

To give summary,

We started as TOA- Target Oriented Approach, than
TFA-Target Free Approach, then
CNAA- Community Need Assessment Approach, then
CNAMA-Community Need Assessment and Monitoring Approach.

I think you understood whole progress....

NSV- Non Scalpel Vasectomy

2008-09-04T17:28:00.000-07:00

No-Scalpel Vasectomy is one of the most effective contraceptive methods available for males. It is more effective than the oral pill or the injectable contraceptive. It is an improvement on the conventional vasectomy with practically no side effects or complications. This new method is now being offered to men who have completed their families, as a special project, on a voluntary basis under the Family Welfare programme.

The No-Scalpel Vasectomy project is being implemented in the country ( INDIA ) to help men adopt male sterilisation and thus promote male participation in the Family Welfare programme. Ensuring the availability of this new technique up to the peripheral level will help increase the acceptance of male sterilisation in the country. The project is being funded by the UNFPA. The total contribution by UNFPA for the project is Rs. 9.15 crores. The contribution of the Government of India will be in kind such as providing centres for training and making available the necessary infrastructure at the training sites.

Non Scalpel Vasectomy or No Scalpel Vasectomy is a simplified approach to vasectomy. The difference between this new method and the conventional method is only in approach to the vas deferens. However, this deference is vital as it has resulted in lowered complication rate- as seen from the results of over 10 million vasectomies performed all over the world. After proper counseling of the client, the following steps are undertaken to perform NSV.

1.The client is operated under local anesthesia.

2. The vas deferens is fixed in the midline raphe of the scrotum by a specially designed ring forceps. The amount of tissue contained in this ring is a minimal amount of skin, the vas deferens and a very small quantity of surrounding tissues.

3. A sharp pointed instrument, much like a specially sharpened mosquito artery sharps, is used to puncture the skin directly overlying the vas contained in the ring forceps.

4. The puncture hole is enlarged to about twice the diameter of the vas deferens; which is now seen lying in the small wound. Proper performance of this step and the next step is the heart of the no scalpel vasectomy technique. If done properly all tissues right down to the vas would have been separated and the bare vas will be sighted.

5. Next step involves a delicate but firm grasping of the vas deferens with the puncturing instrument and deliberately rotating the instrument in a clockwise direction so that the vas deferens is delivered out of the puncture hole.
6. Subsequent handling of the vas such as ligature of ends of vas and excision of a small segment of vas is identical to the conventional technique. The tied ends are pushed back into scrotum.

7. The opposite vas is manipulated so as to underlie the puncture wound and this is again trapped in the ring forceps. Through the existing wound the tissues surrounding the opposite vas are punctured, dilated and the bare vas delivered as before.

8. At the end of the procedure a tiny puncture hole results which does not require any closure.

9. The net result is a no incision, no stitch vasectomy with minimal dissection using only 3 instruments (vas fixation forceps, vas dissection forceps and a scissors) as compared to around 14 instruments in conventional vasectomy. The complications such as haematoma and sepsis have been reduced from 2% to 0.3% and from 2% to nil respectively in a large series.

All about Vision 2020

2008-09-04T17:24:00.000-07:00

Why VISION 2020 - The Right to Sight Initiatives?

The global burden of blindness is 50 million in year 2000. This will grow to 75 million by the year 2020 unless special efforts are taken to arrest & reverse this trend.

Towards this purpose, a global initiative called 'Vision 2020 Right to sight" was launched as a collaborative movement by WHO (representing governments) and IAPB (representing International Non profit NGO organizations) in 1999. India is committed to reduce the burden of avoidable blindness by the year 2020 by adopting strategies advocated for Vision 2020. To align and collate efforts of different sectors and organizations towards the National Plan of Action there emerges a stronger need for a representative forum in parallel to the global body to achieve the goals of vision 2020 in India. There are an estimated 12 million blind people in the country. Over 90% of the blind live in Rural Areas. Because of the increase in life expectancy and the projected increase in country population this number is likely to rise to more than 18 million by the year 2020 if current trends continue. Blindness is mainly a problem of developing countries like ours, but a problem, which could be avoided in up to 80% of cases.

The VISION 2020 Movement believes that eye health is a social, economic and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of vision loss and the blindness of the poor and marginalized people. The Right to Sight means that powerful interests have to be challenged and that political and economic priorities have to be drastically changed.

Here is many files giving all information in detail about this WHO Initiative..

INTRODUCTION TO VISION 2020
http://www.v2020.org/core/core_picker/download.asp?documenttable=libraryfiles&id=372

WHO REPORT ON VISION 2020
http://www.iapb.org/03ab&c_BoT_Feb06_WHOreport.ppt

BLINDNESS PREVENTION STATISTICS
http://www.v2020.org/core/core_picker/download.asp?documenttable=libraryfiles&id=790

BLINDNESS,POVERTY AND DEVELOPMENT
http://www.v2020.org/core/core_picker/download.asp?documenttable=libraryfiles&id=477

HELPING PEOPLE TO SEE BETTER

http://www.v2020.org/core/core_picker/download.asp?documenttable=libraryfiles&id=302

STATE OF THE WORLD SIGHT

http://www.v2020.org/core/core_picker/download.asp?documenttable=libraryfiles&id=51

Important Days in Medical

2008-09-04T17:19:00.000-07:00

JAN 12 : National Youth Day
JAN 29 : UNICEF Day
JAN 30 : Anti Leprosy Day

FEB 8 : International Women's Day
FEB 24 : World T.B.Day

APR 7 : World Health Day
APR 11 : Safe Motherhood Day
APR 22 : World Habitat Day

MAY 1 : World Labour Day
MAY 28 : International Women's Health Day
MAY 31: World Anti-Tobacco Day

JUN 5 : World Environment Day
JUN1-7 : Cleanliness Week
June Month is observed as Anti Malaria month

JUL 1 : Doctors Day
JUL 1-7 : Malaria Week
JUL 11 : World Population Day

AUG 1-8 : Breast Feeding Week
AUG 6 : Hiroshima (Nuclear Hazard) Day
25 Aug-10 Sep: Eye Care Fortnight

SEP 1-7 : Nutrition Week
SEP 8 : World Literacy Day
SEP 15 : Occupational Health Day & World Peace Day
SEP 24 : World Heart day

OCT 1 : World Antiterror Day & National Voluntary Blood Donation Day
OCT 2 : Anti Drug Addiction Day
OCT 4-10 : Mental Health Week
OCT 16 : World Food Day

NOV 14 : Universal Children's Day & Diabetes Day
NOV 14-20 : Newborn Care Week

DEC 1 : Anti AIDS Day
DEC 3 : World Handicap Day
DEC 10 : Human Right Day
DEC 15 : World Energy Saving Day

INDIA's Health System Profile

2008-09-04T17:07:00.000-07:00

Organization of the health system

The healthcare services’ organization in the country extends from the national level to village level. From the total organization structure, we can slice the structure of healthcare system at national, state, district, community, PHC and sub-centre levels.

National level – The organization at the national level consists of the Union Ministry of Health and Family Welfare. The Ministry has three departments, viz. – Health, Family Welfare, and Indian System of Medicine and Homeopathy, headed by two Secretaries, one for Health and Family Welfare and the other for ISM and H. The department of Health is supported by a technical wing, the Directorate General of Health Services, headed by Director General of Health Services (DGHS).

State level - The organization at State level is under the State Department of Health and Family Welfare in each State headed by Minister and with a Secretariat under the charge of Secretary/Commissioner (Health and Family Welfare) belonging to the cadre of Indian Administrative Service (IAS). By and large, the organizational Structure adopted by the State is in conformity with the pattern of the Central Government. The State Directorate of Health Services, as the technical wing, is an attached office of the State Department of Health and Family Welfare and is headed by a Director of Health Services. However, the organizational structure of the State Directorate of Health Services is not uniform throughout the country. For example, in some states, the Programme Officers below the rank of Director of Health Services are called Additional Director of Health Services, while in other states they are called Joint/Deputy Director, Health Services. But regardless of the job title, each programme officer below the Director of Health Services deals with one or more subject(s). Every State Directorate has supportive categories comprising of both technical and administrative staff.

The area of medical education which was integrated with the Directorate of Health Services at the State, has once again shown a tendency of maintaining a separate identity as Directorate of Medical Education and Research. This Directorate is under the charge of Director of Medical Education, who is answerable directly to the Health Secretary/Commissioner of the State. Some states have created the posts of Director (Ayurveda) and Director (Homeopathy). These officers enjoy a larger autonomy in day-to-day work, although sometimes they still fall under the Directorate of Health Services of the State.

Regional level – In the state of Bihar, Madhya Pradesh, Uttar Pradesh, Andhra Pradesh, Karnataka and others, zonal or regional or divisional set-ups have been created between the State Directorate of Health Services and District Health Administration. Each regional/zonal set-up covers three to five districts and acts under authority delegated by the State Directorate of Health Services. The status of officers/in-charge of such regional/zonal organizations differs, but they are known as Additional/Joint/Deputy Directors of Health Services in different States.

District level - In the recent past, states have reorganized their health services structures in order to bring all healthcare programmes in a district under unified control. The district level structure of health services is a middle level management organisation and it is a link between the State as well as regional structure on one side and the peripheral level structures such as PHC as well as sub-centre on the other side. It receives information from the State level and transmits the same to the periphery by suitable modifications to meet the local needs. In doing so, it adopts the functions of a manager and brings out various issues of general, organizational and administrative types in relation to the management of health services. The district officer with the overall control is designated as the Chief Medical and Health Officer (CM & HO) or as the District Medical and Health Officer (DM & HO). These officers are popularly known as DMOs or CMOs, and are overall in-charge of the health and family welfare programmes in the district. They are responsible for implementing the programmes according to policies laid down and finalized at higher levels, i.e. State and Centre. These DMOs/CMOs are assisted by Dy. CMOs and programme officers. The number of such officers, their specialization, and status in the cadre of State Civil Medical Services differ from the State to State. Due to this, the span of control and hierarchy of reporting of these programme officers vary from state to state.

Sub-divisional/Taluka level – At the Taluka level, healthcare services are rendered through the office of Assistant District Health and Family Welfare Officer (ADHO). Some specialties are made available at the taluka hospital. The ADHO is assisted by Medical Officers of Health, Lady Medical Officers and Medical Officers of general hospital. These hospitals are being gradually converted into Community Health Centres (CHCs).

Community level – For a successful primary healthcare programme, effective referral support is to be provided. For this purpose one Community Health Centre (CHC) has been established for every 80,000 to 1, 20,000 population, and this centre provides the basic specialty services in general medicine, pediatrics, surgery, obstetrics and gynecology. The CHCs are established by upgrading the sub-district/taluka hospitals or some of the block level Primary Health Centres (PHCs) or by creating a new centre wherever absolutely needed.

PHC level – At present there is one Primary Health Centre covering about 30,000 (20,000 in hilly, desert and difficult terrains) or more population. Many rural dispensaries have been upgraded to create these PHCs. Each PHC has one medical officer, two health assistants – one male and one female, and the health workers and supporting staff. For strengthening preventive and promotive aspects of healthcare, a post of Community Health Officer (CHO) was proposed to be provided at each new PHC, but most states did not take it up.

Sub-centre level – The most peripheral health institutional facility is the sub-centre manned by one male and one female multi-purpose health worker. At present, in most places there is one sub-centre for about 5,000 populations (3,000 in hilly and desert areas and in difficult terrain).

Health information system

Census – The census in India is a decennial activity, which pools tremendous resources, and huge data pertaining to many facets of population is generated. The census in India started on regular basis from the year 1891 and last one was conducted in the year 2001. The data represents the situation as on 1st March (except 1971 census when it was 1st April). It normally provides age and sex structure and spatial distribution of population. In addition, it also provides information on some socio-economic factors. Occasionally some additional information is also obtained like mortality, disability, etc. Among all sources of information, census information reaches maximum accuracy.

Civil Registration System - It is a continuous permanent systematic activity of enlisting vital events countrywide. Considering its utmost importance, this activity is given legal status through a special Act, “Birth and Death Registration Act 1969.” Authorities like local registrar, Registrar General under the act in different areas like rural, urban have been designated from various sectors. Normally, the local registrar is from local self-government or from health department. General apathy leads to gross under-registration from time to time and differs from place to place. There is often a considerable time lag between collection of data and its compilation and publication. The data collected from urban area are comparatively of better quality than from rural area.

Sample Registration System – In 1964-65, Government of India introduced Sample Registration System for improving reliability of data pertaining to vital events and also to have urban and rural break-up. Population covered was 61,12,000 in 1998. Although initiated on pilot basis, it covered 2,235 urban sampling units and 4,436 rural sampling units selected. A Government servant, usually a teacher, is selected and trained to function as enumerator. A baseline survey of sample unit is conducted to obtain information about usual resident population of the same sampling areas. The enumeration of birth and deaths is continuously carried out pertaining to resident population by him for his area. Every six months, an official supervisor makes a visit and independently checks all the households in the area of enumerator. Thus, it functions as a continuous process and which is superimposed by periodic retrospective surveys. Unmatched or partially matched events after verification are added and final estimates are worked out. Sometimes, additional information is also collected through sub samples. Presently, this is supposed to be most accurate data source providing information about birth rate, death rate, age specific death rates, Infant Mortality Rate, age and sex composition, and seasonal and spatial variations in these statistics. It has been decided now to collect data pertaining to causes of deaths on regular basis. Sample Registration System provides information by states and for the country.

National Sample Surveys – National Sample Survey Organisation regularly conducts nation-wide surveys collecting information regarding social, economical, demographic, industrial and agricultural conditions. The organisation has many wings. One wing shoulders responsibilities like designing the sample survey, improving quality of data, etc. Another wing consists of well trained full time personnel who actually conduct surveys. The organisation also obtains support from State statistical organizations. Normally, the surveys collect multi sectoral information. The surveys are conducted in the form of rounds stretched over a specific period, generally one year. The first round was carried in the year 1951 and 55th round in the year 1999-2000. The organisation has published extensive information through 456 reports. Sometimes, special information directly pertaining to health is also collected.

Ministry of Statistics and Program Implementation

Service statistics - Information generated from Sub Centre level and above is also fed into the health information system on specifically designed reporting formats submitted monthly. The health and family welfare information is compiled at district level and submitted to State level from where it goes to central level (GoI).

Ministry of Health and Family Welfare brings out two publications yearly (there is backlog currently) – Family Welfare Yearbook and Health Information Yearbook. These yearbooks compile all information available from various sources and present by districts, states and country. However, most of the information pertains to services provided by public sector.

In addition, all India surveys are also conducted such as National Family Health Survey (1,2 and 3 have been done ), RCH survey, etc.

India has national disease surveillance. The surveillance exists only for polio and HIV/AIDS and it has been effective in getting information. However, there is a need for a strong disease surveillance network in the whole country for better information on diseases and better health initiatives.

JSY- Janani Suraksha Yojana..

2008-09-04T16:51:00.000-07:00

This is nice booklet on JSY-Janani Suraksha Yojana, in PDF formet.

http://nposonline.net/pdf/policies/Janani_Suraksha_Yojana.pdf

JANANI SURAKSHA YOJANA (JSY)

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Yojana, launched on 12th April 2005, by the Hon’ble Prime Minister, is being implemented in all states and UTs with special focus on low performing states.

2. JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care. The success of the scheme would be determined by the increase in institutional delivery among the poor families

3. The Yojana has identified ASHA, the accredited social health activist as an effective link between the Government and the poor pregnant women in l0 low performing states, namely the 8 EAG states and Assam and J&K and the remaining NE States. In other eligible states and UTs, wherever, AWW and TBAs or ASHA like activist has been engaged in this purpose, she can be associated with this Yojana for providing the services.

3.1 Role of ASHA or other link health worker associated with JSY would be to:

F Identify pregnant woman as a beneficiary of the scheme and report or facilitate registration for ANC,

F Assist the pregnant woman to obtain necessary certifications wherever necessary,

F Provide and / or help the women in receiving at least three ANC checkups including TT injections, IFA tablets,

F Identify a functional Government health centre or an accredited private health institution for referral and delivery,

F Counsel for institutional delivery,

F Escort the beneficiary women to the pre-determined health center and stay with her till the woman is discharged,

F Arrange to immunize the newborn till the age of 14 weeks,

F Inform about the birth or death of the child or mother to the ANM/MO,

F Post natal visit within 7 days of delivery to track mother’s health after delivery and facilitate in obtaining care, wherever necessary,

F Counsel for initiation of breastfeeding to the newborn within one-hour of delivery and its continuance till 3-6 months and promote family planning.

Note: Work of the ASHA or any link worker associated with Yojana would be assessed based on the number of pregnant women she has been able to motivate to deliver in a health institution and the number of women she has escorted to the health institutions.

4. Important Features of JSY:

4.1 The scheme focuses on the poor pregnant woman with special dispensation for states having low institutional delivery rates namely the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. While these states have been named as Low Performing States (LPS), the remaining states have been named as High performing States (HPS).

4.2 Tracking Each Pregnancy: Each beneficiary registered under this Yojana should have a JSY card along with a MCH card. ASHA/AWW/ any other identified link worker under the overall supervision of the ANM and the MO, PHC should mandatorily prepare a micro-birth plan. Please see Annexure – I. This will effectively help in monitoring Antenatal Check-up, and the post delivery care.

4.3 Eligibility for Cash Assistance:

LPS States
All pregnant women delivering in Government health centres like Sub-centre, PHC/CHC/ FRU / general wards of District and state Hospitals or accredited private institutions

HPS States
BPL pregnant women, aged 19 years and above

LPS & HPS
All SC and ST women delivering in a government health centre like Sub-centre, PHC/CHC/ FRU / general ward of District and state Hospitals or accredited private institutions

Note: BPL Certification – This is required in all HPS states. However, where BPL cards have not yet been issued or have not been updated, States/UTs would formulate a simple criterion for certification of poor and needy status of the expectant mother’s family by empowering the gram pradhan or ward member.

4.4 Scale of Cash Assistance for Institutional Delivery:

Category
Rural Area
Total
Urban Area
Total

Mother’s Package
ASHA’s Package
Rs.
Mother’s Package
ASHA’s Package
Rs.

LPS
1400
600
2000
1000
200
1200

HPS
700

700
600

600

Note 1: Importantly, such woman in both LPS and HPS states, choosing to deliver in an accredited private health institution will have to produce a proper BPL or a SC/ST certificate in order to access JSY benefits. In addition she should carry a referral slip from the ASHA/ANM/MO and the MCH - Janani Suraksha Yojana (JSY) card.

Note 2: ANM / ASHA / MO should make it clear to the beneficiary that Government is not responsible for the cost of her delivery. She has to bear cost, while choosing to go to an accredited private institution for delivery. She only gets her entitled cash.

4.5 While mother will receive her entitled cash, the scheme does not provide for ASHA package for such pregnant women choosing to deliver in an accredited private institution.

4.6 Limitations of Cash Assistance for Institutional Delivery:

In LPS States
All births, delivered in a health centre – Government or Accredited Private health institutions. Refer to para (b).

In HPS States
Upto 2 live births.

4.7 Disbursement of Cash Assistance: As the cash assistance to the mother is mainly to meet the cost of delivery, it should be disbursed effectively at the institution itself.

4.7.1 For pregnant women going to a public health institution for delivery, entire cash entitlement should be disbursed to her in one go, at the health institution. Considering that some women would access accrediting private institution for antenatal care, they would require some financial support to get atleast 3 ANCs including the TT injections. In such cases, atleast three-fourth (3/4) of the cash assistance under JSY should be paid to the beneficiary in one go, importantly, at the time of delivery.

4.7.2 To Beneficiary:

a. The mother and the ASHA (wherever applicable) should get their entitled money at the heath centre immediately on arrival and registration for delivery.

b. Generally the ANM/ ASHA should carry out the entire disbursement process. However, till ASHA joins, AWW or any identified link worker, under the guidance of the ANM may also do the disbursement.

4.7.3 At accredited private institution: Disbursement of cash to the mother should be done through the ANM/ASHA/ Link worker channel and the money available under JSY should be paid to the beneficiary only and not to any other person or relative. Also refer to para (e).

ü Should ensure that:

· Such accredited private institution would also be responsible for any postnatal complication arising out of the cases handled by them.

· They should not deny their services to any referred targeted expectant mother.

Note: Every month, accredited private health centers would prepare a statement of JSY - delivery / ANC/ obstetric complication cases handled by them and send it to the Medical officer, along with the referral slips for sample verification by the concerned ANM / ASHA.

4.7.4 In the District / Women’s Hospital / State Hospital etc :

· State / District should allocate sufficient amount of money (based on the load of deliveries in these institutions) for each of these institution. This money should be kept in a separate account under the supervision of the Rogi Kalyan Samity.

· The residency of the beneficiary would determine entitlement of cash benefit in such institutions, to be verified based on the referral slip from the ANM, carried by the beneficiary.

Format of Referral Slip: State should prepare a format of the referral slip, which should mainly indicate, identification details of the beneficiary, JSY registration number in the register of the ANM, reason for referral (including medical complications), name of ASHA, amount already disbursed, amount due, including referral transport money (if applicable), amount due to ASHA and to be paid, signature of MO/ANM.

· It is therefore, essential that all targeted expectant mother should carry a referral slip from the ANM/MO where she generally resides. This will, infact, help all such pregnant woman who go to her mother’s place for delivery.

· Disbursement of money to expectant mother going to her mother’s place for delivery should be done at the place she delivers. The entitlement of cash should be determined by her referral slip carried by her and her usual place of residence.

· A voucher scheme may be introduced in such a way that along with admission slip for delivery, a voucher amounting to mother’s package plus the transport assistance money is given to the expectant mother and that she should be able to encash the same at the Hospital’s cash counter, at the time of discharge.

4.8 Flow of Fund:

i. State/ District authorities would advance Rs. 5000/- and Rs. Rs.10,000/- to each ANM in HPS /LPS States respectively as a recoupable impressed money from the JSY fund.

ii. This money could be kept in the joint account of ANM and Gram Pradhan, as in case of untied fund placed with sub-centers so that the ANM could ‘roll’ the entire amount by advancing Rs.1500 to Rs. 2,500/- to ASHA / AWW per delivery and later she could recoup it from the PHC or CHC, where JSY fund is parked by the authorities.

Expenditure Monitoring: ASHA / AWW should provide an expenditure statement of money advanced to her in previous month to the ANM in the monthly meeting held by ANM.

iii. There should be a clear authority for ANM to withdraw cash from this account for advancing it to the ASHA or AWW / any other health link worker, needed for ready use towards disbursement to the pregnant and also for arranging the referral transport for escorting the pregnant women to the institution.

Note: Where an elected body of the Panchayati Raj Institution (PRIs) exists, the State Governments/Health society may keep the money in a joint account of the Gram Pradhan and the ANM (like that of the untied fund). The process of recoupment of fund should be so simple to be able to disburse the cash to the pregnant women in time.

4.9 ASHA Package: This package, as of now, is available in all LPS, NE States and in the tribal districts of all states and UTs. In rural areas it includes the following three components:

· Cash assistance for Referral transport to go to the nearest health centre for delivery. The state will determine the amount of assistance (should not less than Rs.250/- per delivery) depending on the topography and the infrastructure available in their state. It would, however, be the duty of the ASHA and the ANM to organize or facilitate in organizing referral the transport, in conjunction with gram pradhan, Gram Sabha etc.

Note: This assistance is over and above the Mother’s package.

· Cash incentive to ASHA: This should not be less than Rs.200/- per delivery in lieu of her work relating to facilitating institutional delivery. Generally, ASHA should get this money after her postnatal visit to the beneficiary and that the child has been immunized for BCG.

· Transactional cost (Balance out of Rs.600/-) is to be paid to ASHA in lieu of her stay with the pregnant woman in the health centre for delivery to meet her cost of boarding and lodging etc.. Therefore, this payment should be made at the hospital/ heath institution itself.

Note 1: In Urban areas, ASHA package consists of only the incentive for ASHA, for providing the services, as at para 3.1

Note 2: In case ASHA fails to organize transport for the pregnant woman to go to the health institution, transport assistance money available within the ASHA’s package should be paid to the pregnant woman at the institution, immediately on arrival and registration for delivery.

Note 3: In case ASHA is yet to join, transport assistance money may be kept with the institution and a voucher scheme may be introduced for disbursement.

4.10 Payment to ASHA: ASHA should get her-

ü First payment for the transactional cost at the health centre on reaching the institution along with the expectant mother.

ü The second payment should be paid after she has made postnatal visit and the child has been immunized for BCG.

All payments to ASHA would be done by the ANM only. In this case too, a voucher scheme be introduced in such a manner that for every pregnant woman she registers under JSY, ANM would give two vouchers to ASHA, which she would be able to encash on certification by ANM.

Important: It must be ensured that ASHA gets her second payment within 7 days of the delivery, as that would be essential to keep her sustained in the system.

4.11 Special Dispensation for LPS states:

ü Age restriction removed

ü Restricting benefits of JSY up to 2 births removed. In other words, the benefits of the scheme are extended to all pregnant women in LPS states irrespective of birth orders.

ü No need for any marriage or BPL certification provided woman delivers in Government or accredited private health institution.

Important: The state / UTs would be responsible for instituting an appropriate monitoring mechanism and ensure that a proper accounting procedure is put in place for all transactions.

4.12 Subsidizing cost of Caesarean Section or management of Obstetric complications: Generally PHCs/ FRUs / CHCs etc. would provide emergency obstetric services free of cost. Where Government specialists are not available in the Govt’s health institution to manage complications or for Caesarean Section, assistance up to Rs. 1500/- per delivery could be utilized by the health institution for hiring services of specialists from the private sector. If a specialist is not available or that the list of empanelled specialist is very few, specialist doctors working in the other Government set-ups may even be empanelled, provided his/her services are spare and he/she is willing. In such a situation, the cash subsidy can be utilized to pay honorarium or for meeting transport cost to bring the specialist to the health centre. It may however be remembered that a panel of such doctors from private or Government institutions need to be prepared beforehand in all such health institutions where such facility would be provided and the pregnant women are informed of this facility, at time of micro-birth planning.

Important: State Governments would ensure that this assistance is not misutilized and would exercise adequate control and monitor expenditure under this component.

4.13 Assistance for Home Delivery: In LPS and HPS States, BPL pregnant women, aged 19 years and above, preferring to deliver at home is entitled to cash assistance of Rs. 500/- per delivery. Such cash assistance would be available only upto 2 live births and the disbursement would be done at the time of delivery or around 7 days before the delivery by ANM/ASHA/ any other link worker. The rationale is that beneficiary would be able to use the cash assistance for her care during delivery or to meet incidental expenses of delivery. It should be the responsibility of ANM/ASHA, MO PHC to ensure disbursement. It is very important that the cash is disbursed in time. Importantly, such woman choosing to deliver at home should have a BPL certificate to access JSY benefits.

5. Compensation Money: If the mother or her husband, of their own will, undergoes sterilization, immediately after the delivery of the child, compensation money available under the existing Family welfare scheme should also be disbursed to the mother at the hospital itself.

6. JSY Benefits in Accredited Private Health Institution: In order to increase choice of delivery care institutions, at least two willing private institutions per block should be accredited to provide delivery services. State and the district authorities should draw up a list of criterion / protocols for such accreditation. (Please see a model criterion at Annexure-2) Such beneficiaries delivering in these institutions would get the cash benefits admissible under the JSY.

7. Equip Sub-centers for Normal delivery: For women living in tribal and hilly districts, it becomes difficult to access PHC/CHCs for maternal care or delivery. A well-equipped sub-center is a better option for normal delivery. Deliveries conducted in sub-centers, which are accredited by the state / district authorities will be considered as institutional delivery and therefore, women delivering in these centers would be eligible for all cash assistance under JSY.

Important: All States and UTs to undertake a process of accreditation of all such sub-centre located in Govt. buildings and having proper facility of light, electricity, water, and other medical requirements of basic obstetric services including drugs, equipments and services of trained mid-wife for the purpose of conducting normal deliveries in these institutions.

8. Provision of Administrative Expenses: Upto 4 % and 1% of the fund released could be utilized towards administrative expenses like monitoring, IEC and office expenses for implementation of JSY by the district and state authorities respectively.

9. Essential Strategy: While the scheme would create demand for institutional delivery, it would be necessary to have adequate number of 24X7 delivery services centre, doctors, mid-wives, drugs etc. at appropriate places. Mainly, this will entail

· Linking each habitation (village or a ward in an urban area) to a functional health centre- public or accredited private institution where 24X7 delivery service would be available,

· Associate an ASHA or a health link worker to each of these functional health centre,

· It should be ensured that ASHA keeps track of all expectant mothers and newborn. All expectant mother and newborn should avail ANC and immunization services, if not in health centres, atleast on the monthly health and nutrition day, to be organised in the Anganwadi or sub-centre:

o Each pregnant women is registered and a micro-birth plan is prepared (please see Annexure-1)

o Each pregnant woman is tracked for ANC,

o For each of the expectant mother, a place of delivery is pre-determined at the time of registration and the expectant mother is informed,

o A referral centre is identified and expectant mother is informed,

o ASHA and ANM to ensure that adequate fund is available for disbursement to expectant mother,

o ASHA takes adequate steps to organize transport for taking the women to the pre-determined health institution for delivery.

o ASHA assures availability of cash for disbursement at the health centre and she escorts pregnant women to the pre-determined health centre.

10. Possible IEC strategy:

· To associate NGO and Self Help Groups for popularizing the scheme among women’s group and also for monitoring of the implementation.

· To provide wide publicity to the scheme by:

ü Promoting JSY as a component of total package of services under RCH along with programmes like Pulse polio programme, Monthly Village Health Day, Health Melas etc,

ü Printing and distributing JSY guidelines, pamphlets, notices in local languages at SC/PHCs/CHCs/ District Hospitals/ DM’s and Divisional Commissioner’s office and even in at the accredited Pvt. Nursing Homes, in abundance,

ü Supporting printing of state’s stationery, specially for State’s Health Secretary, DMs / SDMs/ Block/ PHC/ CHC/ District Hospital, advocating on Institutional Delivery and cash benefits of JSY,

ü Facilitate organizing workshops and meetings in villages / blocks - by women’s group, local leaders (PRIs), Opinion Maker, at functional health institutions on promoting maternal health in general, Institutional Delivery and JSY,

ü Undertaking wall painting in all sub-centers, PHCs and CHCs, District & State Hospitals and the accredited private institutions,

ü Supporting women self help Groups and NGOs for promoting the scheme,

ü Facilitating woman Panchayat member to take review of Janani Suraksha Yojana (JSY)

11. Establish a grievance redressal cell in each district, under the District Project Management Unit, mainly to facilitate meeting people’s genuine grievances on -

ü Eligibility for the scheme,

ü Quantum of cash assistance,

ü Delays in disbursement of the cash assistance,

An officer, supported by an assistant, if necessary, may be made responsible to supervise the grievance cell. However, proper information about the grievance cell, giving the officer’s name, postal address and his telephone number should be displayed prominently at all health centers and institutions. If necessary, fund available under administrative expenses could be utilized for this purpose.

12. Display of names of JSY beneficiaries: The list of JSY beneficiaries along with the date of disbursement of cash to her should mandatorily be displayed on the display board at the sub-center, PHC/CHC/District Hospitals (from where beneficiaries have got the benefit), being updated regularly on month-to-month basis. Wherever necessary, display boards may be procured.

13. Guidelines For urban areas: The state shall prepare detailed guidelines by stating a simple procedure of implementing the Janani Suraksha Yojana (JSY) in the urban areas through the Municipalities/local bodies ((where an elected body exits) and quickly obtain approval of the state Government/SHS. The guidelines should bring out clearly, the chain of fund flow as well as disbursement of the benefits to the ultimate beneficiaries. The quantum of grants to be placed at the disposal of the Municipalities shall be in proportion to the BPL families in the Municipal area. The district annual plan will also include the plan of the municipalities in the districts wherever applicable. The Chief medical Officer of such an authority should be the implementing authority. It must be ensured that basic objectives and the scale of disbursements are not altered. A copy such plan along with necessary Government’s order should be sent to the GOI.

14. Monitoring:

14.1 Monthly Meeting at Sub-centre Level: For assessing the effectiveness of the implementation of JSY, monthly meeting of all ASHAs / related health link workers working under an ANM should be held by the ANM, possibly on a fixed day (may be on the third Friday) of every month, at the sub-center or at any of Anganwadi Centres falling under the ANM’s area of jurisdiction. If Friday is a holiday, meeting could be held on following working day.

14.2 Prepare Monthly Work Schedule: In the monthly meeting, the ANM, besides reviewing the current month’s work vis-à-vis envisaged activities, should prepare a Monthly Work Schedule for each ASHA / village level health worker of following aspects of the coming month:

· Feed back on previous month’s schedule -

(a) Number of pregnant women missing ANCs,

(b) No. of cases, ASHA/link worker did not accompany the pregnant women for Delivery,

(c) Out of the identified beneficiary, number of Home deliveries,

(d) No. of post natal visits missed by ASHA,

(e) Cases referred to Referral Unit (FRU) and review their current health status,

(f) No. of children missing immunization.

· Fixing Next Month’s Work Schedule (NMWS): To include -

(i) Names of the identified pregnant women to be registered and to be taken to the health center/Anganwadi for ANC,

(ii) Names of the pregnant women to be taken to the health center for delivery (wherever applicable),

(iii) Names of the pregnant women with possible complications to be taken to the health center for check-up and/or delivery,

(iv) Names of women to be visited (within 7 days ) after their delivery,

(v) List of infants / newborn children for routine immunization,

(vi) To ensure availability of imprest cash,

(vii) Check whether referral transport has been organized.

Note 1: While no target needs to be fixed, but for the purpose of monitoring, some monthly goal of institutional delivery for the village may be kept.

Note 2: A format of monthly work schedule to be filled by the ANM /ASHA incorporating the physical and financial aspect may be printed.

15. Reporting: For the purpose of reviewing the progress of implementation and also for allocating fund to the state, under the RCH-flexi Pool, all States would provide

· Annual District-wise report as per Annexure IV, reaching MoHFW in the month of April of the following financial year

· Quarterly Report as per Annexure V, reaching MoHFW in the month following the end of the Quarter.

However, depending on the requirement of the Ministry, special reports may also be sought.

Most Important:

16. Any deviation from the above process will not be accepted by the Central Government and that such expenditure will not be treated as legitimate utilization of the fund given under JSY. It may be noted that all payments before or after seven days of delivery will be treated as illegitimate subject to audit objection.

Annexure-I

MICRO-BIRTH PLAN FOR JSY BENEFICIARIES

STEP
Activity
To be undertaken by
Proposed Time Line

1
Identification and Registration of beneficiary
ANM/ASHA/AWW or any link worker

Atleast 20-24 weeks before the expected date of delivery.

2
Filling up of Maternal and Child card ( In duplicate – one each for mother and ASHA/Link worker)

(This will form part of the JSY’S Registration Card).

ANM/ASHA/AWW or an equivalent link worker

Immediately on registration

3

4 I-s’:

Inform dates of 3 ANC & TT Injection (s)

Identify the health center for all referral

Identify the Place of Delivery

Inform expected date of delivery

ANM/ASHA/AWW or an equivalent link worker

Provide the 1st ANC immediately on Registration.

ASHA to follow up the ANCs at the Anganwadi Centres/Sub-center (SC) and ensure that the beneficiary attends the SC/Anganwadi centre /PHC for ANC on the indicated dates

Motivation: ANM should call the beneficiary to the Anganwadi/SC to participate in the Monthly meeting and explain enhanced cash and Transport assistance benefits for Institutional delivery.

Immediately on registration

4
Collecting BPL or necessary proofs /certificates

Wherever necessary from Panchayat / local bodies / Municipalities

ANM/ASHA/AWW or an link worker

Within 2-4 weeks from Registration

5
Submission of the completed JSY card in the Health center for verification by the authorized/Medical officer.

II. Take necessary steps toward arranging transport or making available cash to the beneficiary to come to the Health Centre

III. Ensure availability of fund to ANM/Health worker/ASHA etc.
MO, PHC

ANM/ASHA/AWW/link worker

ANM/ MO, PHC

Atleast 2-4 weeks before the expected date of delivery

6.
Payment of cash benefit / incentive to the mother and ASHA
ANM/ MO, PHC

At the institution.

For complicated cases or those requiring cesarean section etc:

Ac –1
Pre-determine a Referral health center and intimate the pregnant women
By ANM/ASHA/link worker

Ac –2
Familiarize the woman with the referral centre, if necessary carry a letter of referral from MO PHC
ANM/ASHA/link worker

Ac –3
Pre-organize the transport facility in consultation with family members/community leader
ANM/ASHA/Community

Ac –4
Arrange for the medical experts if the same is not available in the referred heath center
MO, PHC

CRITERIA FOR ACCREDITATION OF 24 HOURS COMPREHENSIVE EMERGENCY OBSTETRIC CARE

Annexure-II

Casualty services
A pregnant woman in labour or distress on entering the hospital at any time during the day or night is directly taken to the obstetric casualty and immediately examined by a professional with midwifery skills and decision taken within fifteen minutes.
- If there are signs or bleeding, convulsions or shock, she should be immediately attended by the Obstetrician on duty and necessary treatment to be initiated.

- Send the mother to the labour room, ward or operation theatre, depending on the signs and symptoms.

· No pregnant woman in labour or distress should be turned away from the hospital for any reason at any time of the day or night.

· Casualty should be located close to the labour room and theatre.

· Casualty to receive advance intimation about the arrival of the mother and keep the specialist team ready with blood, if needed.

· Casualty should have the following round the clock:

- An obstetrician

- Life saving drugs and IV fluids

- Facility for examining the patient (including pv)

- Emergency protocols

- Telephone connection in the casualty, labour room and blood bank

- Patient transport system within the institution

Emergency Obstetric Procedures

Procedures
- Vaccum extraction

- Forceps delivery

- LSCS

- Emergency Hysterectomy

- Manual removal of placenta

- Dilation and Curettage

- Laparotomy

- Blood transfusion

Facilities
- Separate theatre for above obstetric procedures.

- The Government shall provide at least 4 obstetricians, 4 paediatricians, 2 general surgeons and 2 anaesthetists to each CEmONC centre.

Emergency Newborn Care

· Every delivery to be attended by a staff nurse trained in newborn resuscitation.

· Paediatricians to be available in the institution round the clock for emergency interventions

· Emergency Protocol should be available

Laboratory Services

24 hours laboratory services including
- Blood grouping, typing and cross matching

- All routine examinations such as haemoglobin, blood glucose, urine sugar, albumin.

Post Natal Care

All normally delivered mothers should be observed in the labour room for at least two hours after delivery. Before transferring the mothers to the postnatal ward, pulse, BP, firmness of the uterus and amount of vaginal bleeding should be checked.

In the postnatal ward vital signs and height of the uterus should be monitored once in two hours for the first six hours and once in six hours till 24 hours. Twice a day monitoring until discharge should follow this.

Those mothers who had instrumental vaginal delivery should be observed in the labour ward for six hours after delivery before transferring the mother to the postnatal ward pulse, BP, firmness of the uterus, urine output and amount of vaginal bleeding should be checked. Postnatal care in the ward is similar to the care provided for normal vaginal delivery.

Post Operative Care

Staff
- For the first two hours after surgery, staff nurse remains at the bedside to monitor patient continuously.

- Hourly checkups of vital signs (temperature, pulse, BP, and urine output), for the next six hours.

- Forth hourly check up of vital signs by staff nurse for next two days and thereafter twice daily till discharge.

- Check up by doctor at least once during the first two hours and every sixth hourly for three days and then twice daily till discharge.

Records and Registers

Parturition Register
Case Records
Reporting Formats
Referral register

Ambulance Services

For referral
Ø Ambulance with driver and fuel available 24 hours.

Ø Linkages with other ambulance providers.

Ø Casualty to have telephone attender who will organise the transportation.

Adherence to standard emergency treatment protocol

Standard emergency treatment protocol should in the casualty, in labour ward and in theatre.
The obstetrician and staff nurse posted in the labour ward and theatre should be thorough with emergency protocol.

Quality of provider- Patient interaction
Patient treated with respect and dignity.
Privacy and confidentiality assured.
Informal payment from patients strictly banned.
Informed consent obtained from the family for major procedure.
Procedures clearly explained to family members.
A female attendant to be permitted in labour room while ensuring asepsis.

*****

Annexure III

JANANI SURAKSHA YOJANA (JSY)

FREQUENTLY ASKED QUESTIONS AND ANSWER

Q.1 Has the National Maternity Benefit Scheme (NMBS) been replaced by the Janani Suraksha Yojana (JSY) from FY 2005-06?

Ans. Yes. A new 100% centrally sponsored scheme - Janani Suraksha Yojana (JSY) has been launched w.e.f 12.04.05. However, the cash benefits of the National Maternity Benefit Scheme (NMBS) have been incorporated in the Yojana.

Q.2 Why Janani Suraksha Yojana?

Ans. The NMBS was not addressing all the concerns of safe motherhood in a focused manner. Need is felt for a comprehensive package for obstetric care services to save the lives of the mother and the newborn. The main objectives of JSY are to reduce maternal and neo-natal mortality by promoting institutional delivery for making available medical care during pregnancy, delivery and post delivery period.

Q.3 Is there any change with regards to eligibility criterion for availing benefits of Janani Suraksha Yojana?

Ans. The scheme has expanded the eligibility criterion. As in October 2006, eligibility for cash assistance for institutional delivery is as follows:

LPS States
All pregnant women delivering in Government health centers like Sub-centre, PHC/CHC/ FRU / general wards of District and state Hospitals or accredited private institutions

HPS States
BPL pregnant women, aged 19 years and above

LPS & HPS
All SC and ST women delivering in a government health centre like Sub-centre, PHC/CHC/ FRU / general ward of District and state Hospitals or accredited private institutions

Q.4 What is basis of LPS and HPS states?

Ans. States with lower levels of institutional delivery rates have been classified as LPS states. These are - the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam and Jammu and Kashmir. The remaining states are named as HPS states.

Q.5 Why there are the special dispensations for pregnant women from LPS states?

(i) Age certificate is not an instrument that is available easily. Many LPS states have yet to get the process of birth registration organised in rural areas. In view of this, for all BPL pregnant women belonging to LPS states, any kind of age certification would not be insisted upon for availing the benefits of JSY.

(ii) Removal of restrictions on the number of child births: Restricting the benefits upto 2 births would in fact encourage women of higher fertility in the LPS states to deliver at home in an unsafe condition. Such women are exposed to higher risks of mortality and morbidity too because of neglect on their part to access health care and facilities. Therefore, the restriction on the number of childbirths for accessing benefits of JSY has been removed. In other words, the benefits of the scheme are extended to all BPL pregnant women in LPS states irrespective of birth orders.

(iii) Institutional delivery being the primary strategy for promoting safe motherhood, it is necessary that all women are encouraged to avail institutional care. With a view to encourage women from poor families to access public health institution for delivery, in LPS states, the benefits of JSY would be extended to all women (BPL and APL) availing institutional delivery care in Govt. health centres like SC, PHC, CHC, FRUs and general wards of the District and State Hospitals.

Q.6 Is it mandatory to implement JSY?

Ans. Yes.

Q.7 Is there any cash benefit for pregnant women from BPL families preferring to deliver at home?

Ans. In LPS and HPS States, BPL pregnant women, aged 19 years and above preferring to deliver at home is entitled to cash assistance of Rs. 500/- per delivery. Such cash assistance would be available only upto 2 live births and the disbursement would be done at the time of delivery. The rationale is that beneficiary would be able to use the cash assistance for her care during delivery or to meet incidental expenses of delivery.

Q.8 If the focus of the scheme is to promote institutional delivery, why should there be a provision for home delivery?

Ans. It is true that we have to discourage home delivery. However, in view of the Hon’ble Supreme Court’s direction, it is mandatory to provide for home delivery. In case of home delivery, cash benefits of JSY are as provided under NMBS. It would be the responsibility of the ANM, ASHA to counsel the pregnant woman to deliver in a health institution.

Q.9 If the Government’s policy is to control population, why would Government be relaxing two child restrictions under the Yojana?

Ans. It is true that couples in the reproductive age group, should have all the options to decide their family size and that the Government should endeavor to adhere to its stated population policy. JSY is a scheme for saving the lives of mothers from the causes related to delivery, which is also a stated policy of the Government. Women who are in the higher orders of birth, are more at risk of mortality, as they tend to neglect their delivery care and it is by bringing them to institution, and not by keeping them out of the domain of institutional delivery care that these high fertility women could be counseled for family planning.

Q.10 When would the cash benefit under JSY be disbursed?

Ans. The cash benefit should be disbursed to the beneficiary preferably at the institution. If ASHA is unable to organize transport (wherever applicable) disbursement of transport assistance should be done in the health centre as soon pregnant women arrive and registers for delivery. It should be the responsibility of ANM, MO, PHC/ASHA to take all proactive actions to ensure timely disbursement.

Q.11 What is the rationale for disbursing the cash at the time of delivery?

Ans. It is desired that the cash benefit available under this scheme is used by the beneficiary for pregnancy related care especially at the time of delivery and also for post delivery care. If cash is given earlier, it is possible that it may be expended for other purposes.

Q.12 If after having received the cash benefit, the child dies, would the benefit under JSY be extended for the next birth?

Ans. Yes. Proper record should be maintained.

Q.13 If a still child is born in a health institution, can the benefit of JSY be disbursed to the mother?

Ans. Yes. Proper record should be maintained.

Q.14 What is the scale of transport assistance out of ASHA package?

Ans. Generally, an amount of Rs. 250/- may be earmarked for this. It is, however, upto the State Government to determine the scale of transport assistance. It may be ensured that the incentive to ASHA which is part of ASHA package should not be less then 200/- per delivery facilitated by her, in addition to the transactional cost of around Rs.150/- per delivery for escorting and staying with the mother in the health centre. It may be mentioned that ASHA would get cash benefit only if she accompanies the pregnant woman to the health centre.

Q.15 Where would the transport assistance money be kept ?

Ans. Keeping in view, the need to make available the cash required to transport women in the critical condition of delivery to a health centre, transport assistance amount should be kept with the ASHA with clear knowledge of the beneficiary. The mode of transport should be pre-decided by the ANM/medical officers/family member. A proper protocol for arranging the transport should be put in place with assistance of the community, ASHA and the ANM.

Q.16 Can the parameters of the JSY be modified by the states/UTs?

Ans. No. However, if any state or UT has any cogent reason for modifying, it is welcome, in consultation with the GOI. But kindly note that unilateral change by any state or UT is not advisable as it may lead to audit objections.

Q.17 A poor woman needs treatment for C-Section or other obstetric complications. Is there any provision for such situations under JSY?

Ans. Yes. Generally FRUs / CHCs etc. would provide emergency obst. services free of cost. Where Government specialists are not available in the Govt’s health institution, assistance up to Rs. 1500/- per case could be utilized by the health institution for hiring services of experts to carry out the surgery in a Government medical facility. Remember, this assistance is to the Govt. health institution and not to the beneficiary.

Q.18 Generally, in remote areas, even a private medical expert is not available. What to do then?

Ans. In such a situation, expert doctors working in the other Government health institutions may even be empanelled provided his/her services are spare. The cash assistance for C-section or any other obstetric complications, limited to Rs.1500 per case, can be utilized to pay honorarium or for meeting transport cost to bring the expert to health centre. It may however be remembered that a panel of such doctors need to be prepared beforehand by all such health institutions where such facility would be provided and the pregnant women are informed of this facility, at time of micro-birth planning.

LINKAGE WITH ASHA

Q.19 What is the role of ASHA under JSY?

Ans. ASHA is to act as a facilitator and is an important component of the JSY strategy. Her main roles would be as follows:

F Identify pregnant woman as a beneficiary of the scheme and report or facilitate registration for ANC,

F Assist the pregnant woman to obtain necessary certifications wherever necessary,

F Provide and / or help the women in receiving at least three ANC including TT injections, IFA tablets,

F Identify a functional Government health centre or an accredited private health institution for referral and delivery,

F Counsel for institutional delivery,

F Escort the beneficiary women to the pre-determined health canter and stay with her till the woman is discharged,

F Arrange to immunize the newborn till the age of 10 weeks,

F Inform ANM/MO about the birth or death of the child or mother,

F Post natal visit within 7 days of delivery and track mother’s health,

F Counsel for initiation of breastfeeding to the newborn within one-hour of delivery and its continuance till 3-6 months and promote family planning.

The compensation package for ASHA is available to her if she escorts/stays with the pregnant women in the health centres.

Q.20 What is a micro-birth plan?

Ans. The scheme is not of distributing cash benefit, but of providing quality maternity services to the pregnant women too. Micro-birth plan is a tool for efficient coordination of all the activities. It mainly entails –

· Essential activities,

· Who would perform the activities, and

· The desired timeline.

Q. 21 Is it mandatory?

Ans. Yes. It is mandatory to draw a Micro-birth plan for each JSY beneficiary besides filling up a Maternal and Child Health Card (MCH Card).

Q.22 Who would draw the micro-birth plan?

Ans. The micro-birth plan would be drawn by the ANM. ASHA or any other link work would assist and it is essential that they know the component of the birth plan.

Q. 23 What are the essential components of a micro-birth plan?

Ans. Inform the mother and the family about 4 Is, namely -

· Inform dates of 3 ANC & TT Injection (s) and ensure these are provided,

· Identify the health centre for all referral,

· Identify the Place of Delivery,

· Inform expected date of delivery.

In addition,

ü Collecting BPL or necessary proofs /certificates

ü Timely submission of the completed JSY card in the Health centre for verification by the authorized/Medical officer,

ü Arranging transport for the beneficiary to go to the Health Centre for delivery or complications, well in advance,

ü Ensuring availability of fund with the ANM/link Health worker/ASHA etc.

Q.24 How would ASHA’s work be adjudged under this scheme?

Ans. Work of the ASHA should be assessed based on the number of pregnant women she has been able to motivate to deliver in a health institution.

Q.25 Where ASHA has not been recruited; can the ASHA package be disbursed to Anganwadi Worker or to any link worker/Trained Birth Attendant (TBA)?

Ans. If the Anganwadi worker or the TBA performs all the activities of the ASHA, the ASHA package can be disbursed to them, only till the time ASHA is available in the village.

Q.26 When a beneficiary does not utilize the services of ASHA even if she is in place, can ASHA package be disbursed?

Ans. No.

Q.27 Will ASHA receive any compensation package if she does not escort the pregnant women to the health centre during delivery?

Ans. If ASHA does not do the antenatal protocol nor she escorts the pregnant women, she will not receive the compensation package.

However, if ASHA has done the ANC protocol (Please ensure from AWW/ANM through a due process set out by the medical officer, PHC) and arranges an escort after due recording of the reasons for not being able to escort the pregnant women (in a register maintained by ANM for micro-planning of the delivery of the registered beneficiaries), the package available to ASHA may be disbursed to her. The officials concerned should exercise due caution and carry out proper checks before disbursement of such cash benefits.

In such a situation when ASHA or any other health worker –AWW/ANM does not escort the pregnant women to a health centre, the eligible pregnant women would get additional benefit of the admissible cash benefit earmarked for transport assistance out of the ASHA’s package.

Q.28 Is the reporting of the implementation status giving details of fund utilized and number of beneficiaries benefited under the JSY to the Ministry of Health & Family Welfare, mandatory?

Ans. Six-monthly district wise report need to be sent mandatorily to the central government. This will form the basis of release of further grants.

Q.29 Is there a role for the Gram Panchayat under the JSY?

Ans. Where Panchayati Raj Institutions (PRIs) exist and an elected body is in place, the State Governments/District society may keep the money in the joint accounts of the ANM and the Gram Pradhan. The Panchayat and the local bodies need to be effectively involved in BPL certification process in a manner that genuine poor pregnant women are able to benefit from the scheme.

Q.30 Is it mandatory to keep an imprest with ANM ?

Ans. Yes. A recoupable imprest of Rs.5000/- should be kept with ANM. The purpose is to make quick disbursement to the beneficiary. Out of this, the ANM should keep atleast Rs. 1500/- (recoupable) with the ASHA/Anganwadi Worker so that when the pregnant women need to be taken to the health institution for delivery, ASHA is able to organize transport quickly. This would quicken the process of disbursement that is key to the success of JSY.

FINANCIAL MATTERS:

Q.31 Is there a separate budget/allocation for JSY?

Ans. Unlike under NMBS, grants for JSY will be released to the State Health Society (SHS) as part of RCH flexi pool, based on the recommendation of the NBCC and the State’s PIP. It would be upon the SHS to allocate and disburse the JSY fund to the District Health Society (DHS).

Q.32 Is there any component under the JSY grant to meet certain essential expenditures, as a part of the administrative expenses? If yes, what are the activities permissible under the administrative expenses?

Ans. Yes, Upto 4 % and 1% of the fund released could be utilized towards administrative expenses like monitoring, IEC and office expenses for implementation of JSY by the district and state authorities respectively.

BPL CERTIFICATION:

Q.33 If poor pregnant women do not have BPL Card but otherwise considered very poor and needy by the community, how to certify and disburse cash benefit under JSY?

Ans. The Panchayat and the local bodies need to be effectively involved in the certification of poor and needy expectant mother, in a manner that genuine poor pregnant women are able to benefit from the scheme. However, if the BPL certification is not available through a legally constituted process, the beneficiary could still access the benefit on certification by Gram Panchayat/pradhan provided the delivery takes place in a Government institution. The benefit available under JSY will be admissible in a private hospital only against a regular BPL card whose number etc. has to be quoted in the birth certificate to be issued by the private institution.

Q. 34 Will there be any requirement of BPL card in LPS states?

Ans. No, provided women access government or accredited health institution for delivery. However, for getting cash component for home delivery, BPL card would be essential.

Q.35 What about SC and SC women?

Ans. Such women would also not require a BPL certification if they access government or accredited health institution for delivery.

Q36 Can cash benefit of the mother be handed over to the institution, in lieu of the services provided?

Ans. No. Cash benefit to mother has to be given to the mother. It is upto the mother to decide, asto how it is to be utilized. Any deviation in this regard would be construed as violation and may lead to audit objections.

Q37. When would the ASHA package be disbursed?

Ans. ASHA package is to disbursed in two installment. Transactional cost to be paid to ASHA in lieu of her stay with the pregnant woman in the health centre for delivery should be paid at the hospital/ heath institution itself. And, cash incentive to ASHA, being not less than Rs.200/- per delivery in lieu of facilitating institutional delivery should be paid after her post natal visit to the newly delivered mother and the newborn has been immunized for BCG.

Chiranjeevi Yojana

2008-09-04T16:50:00.002-07:00

Government of Gujarat announced a “Chiranjeevi Yojana” in April 2005. The objective of this scheme is to encourage private medical practitioners to provide maternity health services in remote areas which record the highest infant and maternal mortality and thereby improve the institutional delivery rate in Gujarat. The scheme was finally launched as a one year pilot project in December 2005 in five districts viz., Banaskantha, Dahod, Kutch, Panchmahal, and Sabarkantha. The private empanelled providers are reimbursed on capitation payment basis according to which they are reimbursed at a fixed rate for deliveries carried out by them. The payments are made for a batch of 100 deliveries. This is expected to take care of case-mix differences (i.e., normal or complicated deliveries) and help the providers to keep the costs below the reimbursed amounts. The scheme proposes to use a voucher system to target the people living below poverty line. The objective of this paper is to document the experience in implementing this scheme and discuss the issues in up-scaling it further.

On 30-10-2006 Asian Innovation Award at Singapore from Wall Street Journal and the Financial Express for Chiranjeevi Yojana...

Download booklet from here..

http://www.4shared.com/file/32955275/ac740c13/Chiranjeevi_Study.html

http://mohfw.nic.in/NRHM/Presentations/Chiranjeevi_Gujarat.pps

Sanitation of Fairs and Festivals

2008-09-04T16:50:00.001-07:00

Sanitation of Fairs and Festivals

The maintenance of sanitation of fairs (melas) and religious festivals in India is very important and is a complicated task. During bathing festival people congregate by thousands along the banks of sacred rivers, which afford sufficient opportunity for pollution of Water and spread of diseases.

Secondly, pilgrims reach the place half starved, not used to any discipline and are also not in a mood to co-operate with the health authorities. This results in low resistance and increased spread of infection. Congregation of people in the melas is responsible for spread of diseases by the contamination of food and water.

How to carry out these measures

Since different fairs vary greatly in size and character, it is not possible to formulate fixed rules which apply to all places under all conditions. So sanitary measures called for must depend upon the local condition.

1.Some persons or a body should be held responsible for the organization and control of fairs or melas.

2.The number of people (approximately) likely to be present in the melas is taken into account.

3.A plan of works should be prepared.

4.The area of the mela should be divided into isolated plots and each such plot placed in charge of one or more sanitary officers who should see that latrines are kept clean, that the lodging houses are free from sickness and kept in proper order.

5.The number of carts, sweepers, scavengers and inspectors necessary should be calculated beforehand on the basis of the number of people attending the mela.

6.All lodging houses should be registered, and a fixed number of lodgers should be accommodated.

7.Rules should be drawn up for the number of persons accommodated, cleanliness of the premises, protection of water supply, for both the staff and pilgrims. This should be enforced

Majority of people attending the pilgrim centres travel by train. It is necessary that proper medical arrangements should be made by the railway authorities and there should be arrangement for medical inspection in important stations, so that patients suffering from infectious diseases may be removed without delay. The Public Health Authorities of adjoining states and Railway Health Authorities should meet before the fair and draw up a scheme for concerted action.

Advantages of getting the pilgrims vaccinated and inoculated should be borne in mind. A preliminary work should be done by drawing up a regular plan of work previously by constituting a responsible mela committee. Long before the opening of the mela, the pilgrims should be advised by posters and news paper advertisements.

The objects of mela sanitation are to maintain good sanitation of the mela ground to protect the health of the people coming to the mela. This is also possible by making satisfactory sanitary arrangements in the mela and also protecting the health of the people who came for the trade. It is better if the people are inoculated one week before they come to the mela ground. The expected number of pilgrims may be obtained from the previous years' records.

Requirements for Mela Sanitation

A. BEFORE THE MELA STARTS:

1. Size -If it is a permanent place of pilgrimage like Tarakeswar or Hardwar, where there are permanent inhabitants, extra space for the additional people has to be found out. Mela site should be leveled and cleansed. The area should be planned for roads, shops and temporary sheds for the accommodation of the people. The whole area should be lighted during night. There should be good should be lighted during night. There should be good approach road.

2. Accommodation -Temporary sheds to be constructed
3. Water supply -Piped water from the reservoirs with taps or tube wells.
4. Food supply -Shops with whole-some food should be started.
5. Temporary latrines -One seat for 1000 people and trenching for the disposal.
6. Health office -A.D.H.S., D.H.O. should be staying in the mela area.
7. Temporary hospital -For infectious diseases in particular.
8. Police station -Law and order to be maintained by the Police.
9. Publicity office -to inform people about the arrangements made so that they may avail them
10. Appointment of sweepers -1 for 1000 people coming.

B. DURING THE MELA:

1. Supply of protected water -regular disinfection of water source.
2. Maintaining cleanliness of the mela ground by scavengers.
3. Disposal of refuse and human excreta.
4. Immunization of the people -Protection of the shop-keepers.
5. First aid centres in the different zones of the mela ground.
6. Isolation and treatment of the sick in the hospital.
7. Law and order -Watch over the anti-social elements.
8. Encourage people to leave the mela area as soon as possible.

C. AFTER THE MELA IS OVER:

1. Cleaning the area –particularly in a permanent place of pilgrimage by disposal of refuse of all types.
2. Transfer of the sick: if any to the nearest hospital for complete treatment.

The following points should particularly be attended before the mela starts :

1. Accommodation:
After selection of the site the whole area should be cleared of jungles and vegetations and divided into plots. Each plot should be kept under the supervision of a Sanitary Inspector with a conservancy squad who will be responsible for all sanitary measures for that area. There must be a provision of police patrol to enforce all sanitary measures in general. The place should be carefully marked out and provision should be made for the accommodation of police. Hospital, water-supply, residential blocks and latrines.
All shallow depressions and pools should be filled up or fenced in, so that people cannot use them.

2. Medical and Sanitary Arrangements
Every fair shall be under the charge of the Medical Officer of Health. Each block should be placed under the charge of a Sanitary Inspector who will inspect daily the area under him and report the occurrence of any suspicious case of illness. Arrangements must also be made for receiving daily report from sweepers in charge of latrines. Any infectious case should at once be removed to the temporary hospital thus isolating the patients. The first aid treatment centres should be opened in different sections of mela with out-doors treatment centre and medical inspection room. Anti-cholera and smallpox vaccination should be given to the pilgrims and shop-keepers.

3. Water supply:
Deep tube-well should be sunk. This should be considered as ideal for the absence of filtered water-supply. Existing tanks and wells, if any, should be treated with bleaching powder daily and new wells must be dug. All well water should be disinfected with bleaching powder before opening of mela. If there are existing tanks, a few should be reserved for supply of drinking water.
The problem of water-supply should be made easier. By arranging big galvanized iron tanks (400 gallons) with taps at selected places irregularly filled with purified water in different sections of the mela by pipes. Water-supply in regard to Mela Sanitation is very important. Since pilgrims are commonly affected by water-borne diseases like cholera and dysentery.

4. Conservancy:
Trench latrine, measuring 40" x 12" x 18" deep should be dug -one seat for every 1000 persons, with partitions made of bamboo. After evacuation of stool it is to be covered by the user with the excavated earth. A trench can have 12 seats in a row with bamboo partitions. Mobile screens to be placed in front of and behind the trench. Disinfectants like bleaching powder should be given on the sides. One sweeper for every 1000 persons should be appointed.

5. Food Supply
Arrangement should be made for supply of pure and wholesome food at, a reasonable price. Sanitary Inspectors should examine the milk, fish and other foods and see that these are kept clean. All prepared foods should be kept covered.

6. Publicity and Propaganda:

This should be done in the mela grounds by loud speakers, shows on picture, posters etc., advising the pilgrims to follow hygienic principles. Pilgrims should also be advised by posters, news appears and advertisements about necessity of taking of precautionary and preventive measures long before the opening of mela.

7. Lighting arrangements during night are also necessary.

National Population Policy-2000 ( INDIA )

2008-09-04T16:44:00.000-07:00

On 11 May, 2000 India is projected to have 1 billion (100 crore) people, i.e.
16 percent of the world's population on 2.4 percent of the globe's land area.
If current trends continue, India may overtake China in 2045, to become
the most populous country in the world. While global population has
increased threefold during this century, from 2 billion to 6 billion, the
population of India has increased nearly five times from 238 million (23
crores) to 1 billion in the same period. India's current annual increase in
population of 15.5 million is large enough to neutralize efforts to conserve
the resource endowment and environment.

Get booklet From Here..

http://gujhealth.gov.in/family-wel/National%20Population%20Policy.pdf

National Blood Policy (India)

2008-09-04T16:41:00.000-07:00

National Blood Policy (India)

A well organised Blood Transfusion Service (BTS) is a vital component of any health care delivery system. An integrated strategy for Blood Safety is equired for elimination of transfusion transmitted infections and for provision of safe and adequate blood transfusion services to the people. The main component of an integrated strategy include collection of blood only from voluntary, non-remunerated blood donors, screening for all transfusion transmitted infections and reduction of unnecessary transfusion.

Get Booklet from here in PDF..

http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN009847.pdf

Latest GROWTH CHARTS

2008-09-04T16:38:00.000-07:00

Latest GROWTH CHARTS..!!

Latest Growth Charts are available which include not only height and weight but also Head circumference...

Get from here..

http://www.iapindia.org/IAP_Growth_Charts.pdf

Nutrition Rehabilitation Centre

2008-09-04T16:36:00.000-07:00

What is NRC..??

It is Nutrition Rehabilitation Centre..Actually it is not working in our hospital but i was asked a question about it..

It is Nutrition Rehabilitation Centre..Actually it is not working in our hospital but i was asked a question about it..

If it is working in your hospital, then add more info here..I have written what I know..

Functions of The Nutritional Rehabilitation Center
--feeds sick children
--teaches mothers about diet, nutrition
--teaches them how to grow vegetables.
--The center provides mobile clinics for children under five and antenatal patients.

Baby-Friendly Hospital Initiative (BFHI)

2008-09-04T16:31:00.001-07:00

This is some details about BFHI..!

The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for lactation. The BFHI assists hospitals in giving breastfeeding mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies and gives special recognition to hospitals that have done so.

In many other countries around the world, hospitals have already received Baby-Friendly Hospital designations from their national authority. More than 19,000 international maternity facilities have received the Baby-Friendly Award

Medical practitioners never tire of listing the virtues of exclusive breastfeeding. But fact remains that a considerable percentage of mothers are bound by tradition and do not practice exclusive breastfeeding. While some ultra-modern urbanized moms feel breastfeeding may spoil their figures, there is yet a larger number that often deprive their infant of this ‘manna from heaven’ due to baseless myths, traditions and, at times, even the lack of knowledge on correct breastfeeding procedure.

Keeping this in perspective, a group of trainers comprising 26 young men and women have been on a mission of creating awareness about breastfeeding in three blocks of Lalitpur district for the last four months. Through a UNICEF-supported Baby Friendly Community Health Initiative (BFHI) project, they reach out to pregnant women and lactating mothers.

This is enough perhaps..

Medical Officer's MANUAL

2008-09-04T16:30:00.000-07:00

Medical Officer's MANUAL..!!

This is given very briefly in PARK...But teacher can ask details in VIVA..

Download booklet from

http://gujhealth.gov.in/publications/pdf/MO_manual.pdf

Infant Milk Substitute Act

2008-09-04T16:29:00.000-07:00

In Addition to IYCF, they might ask you this one also..Just go through It if possible..

The Ministry of Food Processing Industries, Government of India, on 15th January 2005, has proposed to repeal the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 (IMS Act, 1992) and proposed a new bill “Food Safety and Standards Bill 2005”. Strangely, though the IMS Act serves an altogether different purpose which has nothing to do with the proposed new Act. Under section 108 Schedule 1 of the Bill, the IMS Act has been included in the list of Acts to be repealed instead of the list of Acts which need only be modified. Government of India has asked for comments and suggestions.

The repeal of this highly relevant legislation could put the lives of millions of infants and young children at risk. The repeal is also completely unnecessary, since there is absolutely no conflict between the two Acts, and the proposed new Act operates in an altogether different field.

Briefly, the IMS Act seeks to promote breast-feeding by curbing unethical marketing and promotional practices which denigrate mother’s milk or interfere with breast-feeding. Insofar as food standards and safety issues are concerned, the IMS Act leaves those to be regulated by the Prevention of Food Adulteration Act (PFA).

The proposed “Food Safety and Standards Bill 2005” is concerned primarily with those aspects already covered by the PFA, and has nothing whatsoever to do with protection or promotion of breast-feeding, nor with curbing unhealthy marketing practices of infant milk substitutes, feeding bottles and infant foods.

Why the IMS Act must not be repealed
The IMS ACT is a not a routine food law, nor does it have anything in common with the other Acts in the repeal list. It is a special Act to protect, promote and support breast feeding; it does not deal with purity or adulteration of baby foods, but leaves those matters to the general laws enacted to deal with them. Like the PFA, it focuses on marketing practices and other practices which interfere with breast-feeding, and thereby jeopardize the well being of baby and mother. The protection of breast-feeding is vital for saving the lives of millions of children in India every year.

http://164.100.24.167/bills-ls-rs/8-2002.pdf

All about NRHM

2008-09-04T16:28:00.000-07:00

All about NRHM..!

This is a booklet giving Intro to INDIA's New VISION to Rural Public Health..NRHM- National Rural Health Mission..Launched in 2005..In 18 states of India..

http://mohfw.nic.in/NRHM/Documents/Mission_Document.pdf

http://darpg.nic.in/arpg-website/Con...2007-Final.PPT

GATHER Approach

2008-09-04T16:27:00.001-07:00

What Is GATHER Approach..?

G = Greet the person
A = Ask how can I help you?
T = Tell them any relevant information
H = Help them to make decisions
E = Explain any misunderstanding
R = Return for follow up or Referral

It is used In counselling of adolescent and for Family Planning..Download booklet from here..Right click on link and click Save as...

http://www.infoforhealth.org/pr/j48/j48.pdf

Contraception for adolescents

2008-09-04T16:23:00.002-07:00

This is just some guideline..not exact theory answer..

Contraception for adolescents presents problems for physicians because the pediatricians and child psychologist with the greatest knowledge of adolescents are not the ones who prescribe contraception.

Customary medical procedures may be inadequate for dealing with adolescents. Older women consulting for contraception usually themselves decide what method to choose, and their resistence to contraception and ambivalence to pregnancy can be explored.

For adolescents, contraception may be a constraint rather than a choice.

It may be imposed despite their conflicting desire for pregnancy and motherhood. Adolescents are usually accompanied by another person, who may make establishment of rapport difficult. If communication is not possible, it can be suggested that the examination be postponed. Attentive patience may eventually permit the examination to progress.

The attitudes, preconceived notions, and emotions of the physician may prevent establishment of rapport with the adolescent patient. When contraception is imperative, there are usually no great risks in prescribing oral contraceptives even if the examination is refused.

If the examination is done, the parts of the genital anatomy should be named and perhaps shown in a mirror to reassure the client that she is "normal", an important concern at this age. The examination should be used as an occasion to provide adolescents with the information they need to prevent gynecological and breast disorders, sexually transmitted diseases, cervical cancer, and other problems, and to seek prompt treatment if necessary.

The immature reproductive systems and immune defenses of adolescent patients limit contraceptive choices for them, but lack of contraception brings its own serious risks of unwanted pregnancy, abortion, ectopic pregnancy, and even eventual sterility.

Oral contraceptives (OCs) are completely effective, provide protection against some pelvic infections, and are safe when contraindications have been ruled out. OCs can be used before sexual activity commences, without risk to later fertility, and no interruption of the sexual act. OCs are generally well tolerated, but the daily discipline they require may be beyond the capabilities of some adolescents. The formulation should be changed if needed.

Local methods provide some protection against sexually transmitted diseases but they are expensive and perhaps difficult for adolescents to obtain. Condoms can be useful if the male agrees to use them.

Natural methods are unsuitable in very young girls with unstable cycles.

IUDs are almost always contraindicated for adolescents because of the heightened risk of infection. ..

Contraceptive methods should only be proposed for adolescents, never imposed. The physician should be readily available to answer questions. In the final analysis, a medical consultation is probably not the ideal approach to providing contraceptive information for adolescents, specialized centers or families might be better.

PCPNDT Act

2008-09-04T16:23:00.001-07:00

PCPNDT Act -Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act

“It is unfortunate that for one reason or the other, the practice
of female infanticide still prevails despite the fact that the gentle
touch of a daughter and her voice has soothing effect on the
parents.”

Four years since the Supreme Court has made the abovementioned observation, the situation remains grim and this is reflected in the overall sex ratio in various states where female infanticide still prevails. However, the traditional system of killing the girl child after her birth has now given way to the more modern techniques of sex selection and female foeticide.

PNDT Act passed by the Indian Parliament came into force in 1994 for regulation and prevention of misuse of the diagnostic techniques.
Subsequently, following a Supreme court order on its proper implementation certain amendments were made to the Act. The declining sex ratio in India particularly in the 0-6 year age group is a matter of grave concern. It was expected that proper implementation of the PCPNDT Act would check the pre-natal sex determination and elimination of the female foetus within the womb at least to some extent. However, although there has been ample time for implementing the Act, there is no sign that the decline in child sex ratio has been halted. Most states have set up the infrastructure prescribed in the Act, but this infrastructure is still to be effective.

A study of the census reports of 1991 and 2001 shows that the situation has worsened in most parts of India. The census 2001 further reveals that the situation is far worse in respect of Girl child population in the age group of 0-6, particularly in the affluent areas of Punjab (793 girls to 1000 boys), Haryana (820), Chandigarh (845), Himachal Pradesh (897) and Delhi (865).

Amendment was needed as Some TechnoDocs and others who wanted to have just male child have misused the term PRENATAL..!!

For more details download

http://ncw.nic.in/PNDT%20conference.pdf

ROME Programme

2008-09-04T16:22:00.001-07:00

ROME Programme

Reorientation of Medical Education Programme

The Reorientation of medical Education (ROME) Program adopted by World Health Organization lays stress on making the medical education program relevant to the professional competencies. If the medical education program of today is aimed at producing competent medical graduates for tomorrow, an account of the future roles of medical graduates who are independent to think, independent to judge and independent to make decision and practice Medicine, Surgery, Obstetrics and Gynaecology has been considered, during the four and half years of MBBS program.

The scheme for re-orientation of medical education (ROME) was introduced with the objectives of
(i) introducting community bias in the training of undergraduate medical students with emphasis on preventive and promotive services,

(ii) reorientation of the role of medical colleges, so that they became an integral part of the health- care system and did not continue to function in isolation,

(iii) reorientation of all faculty members so that hospital-based and disease-oriented training was progressively complemented by community- based and health-oriented training for providing comprehensive primary health care, and

(iv) the development of effective referral linkages between PHCs, District Hospitals and Medical Colleges. The scheme has been implemented in its first phase, in about 106 medical colleges.

In spite of a one-time grant-in-aid of about Rs. 16 lakhs to each of the participating institutions, the objectives of the scheme could not be achieved to the desired extent.
This was largely due to
(i) lack of commitment to the programme at all levels,
(ii) slow progress in the utilisation of Central funds, and
(iii) absence of efforts in the restructuring of teaching and training programmes at the college levels.

ENTOMOLOGY SLIDES

2008-09-04T16:15:00.000-07:00

ENTOMOLOGY SLIDES

download from here

PSM_Slides

Why water should not be boiled before making ORS..?

2008-09-04T16:13:00.000-07:00

According to the criteria proposed by the WHO Diarrhoeal Diseases Control Programme, a suitable chemical agent to be added to the standard ORS ingredients at the time of packing to ensure decontamination of the reconstituted solution would need to be:

effective against the organisms concerned,

non-toxic to man,

effective in the pH of ORS solution,

non-reactive with the ORS ingredients,

non-reactive with ORS packaging material,

acceptable from the point of view of taste, smell, and colour of the ORS solution,

non-disruptive of the absorption process in oral rehydration, inexpensive .

As none of the chemical agents currently used for the sterilization of water (e.g. chlorine and chlorine compounds) do not meet these criteria, the WHO Diarrhoeal Diseases Control Programme would not recommend their use. In this connection, it should be noted that as a strong oxidizing agent chlorine or its disinfectant compounds (e.g. sodium or calcium hypochlorite) would react with glucose because of its reducing properties . The WHO Diarrhoeal Diseases Control Programme arrives at the conclusion that boiling is an effective method of decontamination of water to be used for the preparation of ORS solutions, but has the following disadvantages:

the difficulty of obtaining fuel and its cost,the time required for boiling and cooling (and consequently the delay in commencing therapy),the risk that, after boiling and cooling, the water or ORS solution prepared with it may become contaminated during measuring, mixing, handling, or storage,the risk that the water may be used for preparing the ORS solution before it has been sufficiently cooled,the (perhaps minor) risk that the users will mistakenly boil the ORS solution after preparation.
On the basis of available information, the following recommendations have been made regarding the preparation of ORS solutions:

best

What is the difference between sex and gender?

2008-09-04T16:07:00.000-07:00

What is the difference between sex and gender?

Sex = male and female

Gender = masculine and feminine

Sex refers to biological differences; chromosomes, hormonal profiles, internal and external sex organs.

Gender describes the characteristics that a society or culture delineates as masculine or feminine.

So while your sex as male or female is a biological fact that is the same in any culture, what that sex means in terms of your gender role as a 'man' or a 'woman' in society can be quite different cross culturally. These 'gender roles' have an impact on the health of the individual.

In sociological terms 'gender role' refers to the characteristics and behaviours that different cultures attribute to the sexes. What it means to be a 'real man' in any culture requires male sex plus what our various cultures define as masculine characteristics and behaviours, likewise a 'real woman' needs female sex and feminine characteristics. To summarise:

'man' = male sex+ masculine social role(a 'real man', 'masculine' or 'manly')

'woman' = female sex + feminine social role(a 'real woman', 'feminine' or 'womanly')

IMMUNIZATION GUIDE FOR HEALTH WORKER

2008-09-04T16:05:00.000-07:00

IMMUNIZATION GUIDE FOR HEALTH WORKER

Here is the Latest Guide...

http://www.whoindia.org/LinkFiles/Routine_Immunization_Facilitator_Guide_IH_for_HWs_2006.pdf

Just Right Click on the Link and click " Save As"..

MAMTA Day

2008-09-04T16:04:00.001-07:00

What is MAMTA Day.?
Malnutrition Assessment and Monitoring to Act Day
To reduce the malnutrition among children and convergence with other department state government has replaced ‘Immunization day' as "Health and Nutrition Day" with growth monitoring. Immunization, ANC and mother education. This day was named as ‘MAMTA DAY'.

The Gujarat government is using the "Mamta Divas" strategy to create mother and child friendly environment at anganwadi centers for effective delivery of services .

Compensation for family planning hiked

2008-09-04T15:59:00.001-07:00

Concerned over a decline of 4.3 per cent in sterilisation performance in the country, the Union Health and Family Welfare Ministry has further increased the compensation package for the loss of wages to people who adopt family planning methods. The compensation has been nearly doubled for men undergoing vasectomy to boost male participation in family planning.

This is the second revision within a year as the compensation package was revised on October 31 last. But despite this, sterilisation saw a further fall of 4.3 per cent during 2006-07 as compared to the previous year.

According to the new package, the compensation for vasectomy has been increased to Rs. 1,500 from Rs. 800 and tubectomy to Rs. 1,000 from Rs. 800 in public facilities and to Rs. 1,500 for both these interventions in accredited private health facilities to all categories of people in high focus States and those below the poverty line, the Scheduled Castes and the Scheduled Tribes in the non-high focus States.

In 2006, the Ministry enhanced the compensation package from Rs. 400 to Rs.800 for people of all categories in the high-focus States and from Rs. 300 to Rs.800 for tubectomy and Rs.200 to Rs.800 for vasectomy in non-high focus states for BPL acceptors only.

In the 18 high focus States where the facility is provided in the public institutions, the acceptor (individual) receives Rs. 1,100, motivator Rs. 200 and the remaining is to be kept aside for other expenses accrued. Those going in for tubectomy will get Rs. 600 and the motivator Rs. 150.

In the non-high focus 17 States and Union Territories, an individual gets Rs. 1,100 for vasectomy while the BPL, the SC and the ST categories opting for tubectomy will be paid Rs. 600.

The motivator in the first case receives Rs. 200 and Rs. 150 in the second category. Amounts of Rs. 50 and Rs. 100 have been kept aside for drugs in the two categories while the surgeon gets Rs. 100 and Rs. 75.

Similarly, the compensation for tubectomy for those above poverty line people in non-high focus States has gone up from Rs. 300 to Rs. 650 where the acceptor will now get Rs. 250 in the non-high focus States.

NRHM- Hope or Disappointment..??

2008-09-04T15:54:00.000-07:00

The recently declared National Rural Health Mission has aroused significant interest, being both welcomed and closely scrutinized, since there is a long overdue and outstanding need to strengthen weak and dysfunctional public health systems in rural India. In this setting, Jan Swasthya Abhiyan (People’s Health Movement – India), a large national coalition of 18 national networks and several hundred organisations working in different states and concerned with the health sector, has been involved in analysing various aspects of the Mission. The concern has been that it should develop in a manner that actually strengthens public health systems in an integrated manner, and that it should empower communities to be involved in the planning and utilization of these systems in a Rights-based framework. In this article, one will draw upon and reflect on a few of the major concerns about NRHM that have emerged during the insightful discussions in JSA, although the responsibility for opinions expressed and liability for any omissions finally rests with the author.

Some general concerns
The first concern is that there is no systematic analysis of previous policies, and no major lessons seem to have been learnt from the past.

A second concern relates to the influence of the globalisation-privatisation framework on the Mission.

ASHA – barriers to success, measures required to overcome them

•Selection criteria – at present, an educational level upto eighth class (middle education) is expected for a woman to qualify as ASHA. An analysis of the 1991 census data shows that in the rural areas of the NRHM states in Northern India, over 91% women did not have middle level education – and more recent data shows that this situation has not changed significantly in the subsequent period.

•Lack of adequate regular compensation – In the final programme design, ASHA is supposed to work primarily as a volunteer. She would be compensated on performance of certain specific tasks related to National programmes. However, for her major routine activities such as immunisation, weighing of newborns, facilitating ANC, treating patients, visiting households, giving education to mothers, mobilising the community etc., as per the financial norms, the maximum compensation from the Village Untied Fund that may be given is mentioned as Rs. 1000 annually, or about Rs. 83 per month

•Limited provisions for First Contact Care – One of the strongest felt needs expressed by communities is the need for basic curative care being made available within their village. Many NGOs have demonstrated that well trained Health workers can give a wide range of First Contact Care effectively. However, the ability of ASHA to give basic care in simple illnesses is dependent on adequate relevant training, provision of a proper kit and regular replenishment of the range of necessary medicines. The drug list for ASHA as has been presently proposed is extremely limited, and the budgetary norm for drugs is Rs. 50 per month

•Activist or appendage? By her very name – ‘Accredited Social Health Activist’ the ASHA is supposed to be an ‘Activist’ mobilizing people and facilitating their access to health services as a right. However, given the fact that the ANM will be involved in sanctioning her compensation, and she would be reporting to the health system for implementation of various programme related activities, would she be realistically able to function as an ‘activist’ and lead people to put pressure on non-performing health services?

•Focus on RCH, possible adverse influence of Family Planning programme - While the ASHA’s role in providing primary medical care at the village level appears weak, a look at the indicators to be used for monitoring her performance shows that out of the eight outcome indicators for ASHA, seven are related to RCH.

• Principal amount of adequate remuneration for ASHA should be assured and delinked from specific activities, with a small performance linked component if necessary. The remuneration for regular health activities and village level processes could be routed through the Panchayat or Village health committee if required. Monitoring of ASHA should involve social monitoring by the Gram Sabha and Village health committee, and technical monitoring by the Public health system

Public-private partnerships
The NRHM documents specify ‘Public private partnership’ as one of the Mission components. However, given the fundamentally divergent objectives of the Public health system (to provide services to the general population based on public financing) and of the Private medical sector (to run as profitable institutions, providing care to those who can pay), a ‘partnership’ of such differing institutions needs to be very clearly specified, to prevent its abuse. The variable quality of care, frequent lack of minimum standards, prevalence of irrational practices and often unaffordable price of care in the Private medical sector has been documented by various studies. In this context, the foundation of the relationship between the Public health system and the private medical sector must be effective public regulation of the quality, rationality and costs of care in the private sector. There is no reason why Indian Public Health Standards cannot be applied to the private sector as well. The long-standing and glaring non-regulation of this proliferating sector and the need for strong, effective measures in this direction are only weakly addressed in the Mission document which does not mention any specific legislative or operational mechanisms and blandly talks of the ‘need to refine regulation’

Conclusion – need to critically support and influence the Mission; People’s Rural Health Watch
In India, given the dismal situation of rural health services in most states, any genuine measure to strengthen the rural public health system is welcome; hence the National Rural Health Mission has aroused many hopes and expectations. The long-overdue renewed attention to public health, and most of the overall goals of the Mission are definitely positive. However, as this article has tried to outline, in many respects the Mission falls significantly short of expectations, and the details of the actual measures do not seem equal to its objectives. There is a decision to strengthen national health services, but this is presently significantly linked to internationally funded programmes; there is a desire to improve public health but this is mixed up with some notions of privatisation; there is a recognition of the present deep health crisis, but the response is somewhat fragmented and seems to lack an integrated, health systems approach.

Finally, History, it is said, repeats itself – the first time as tragedy, and the second time as farce. The story of ensuring health care for the rural people of India may be traced back to the Bhore Committee, which adopted the goal of Universal access to Health care for all on the eve of Indian independence. That this goal could not be achieved is obvious; and then history repeated itself for the first time a quarter of a century ago when ‘Health for All’ was adopted as a goal for Health development. This repetition of history ended in tragedy, with the subversion of the comprehensive Primary Health Care approach, which was replaced by a set of technological ‘quick-fixes’ that only scraped the surface of the problem while leaving the systemic issues unchanged. And now, History is repeating itself for the second time; again the declared goal of the Mission is “to improve the availability of and access to quality health care by people, especially for those residing in rural areas…”

BIRTH AND DEATH REGISTRATION : OVERVIEW

2008-09-04T15:51:00.000-07:00

INTRODUCTION :
Although the registration of birth and death is a statutory activity in India, its implementation is unsatisfactory. As per the estimates of Registrar General India prevalence of birth registration in the country is 51%. This means that about half of the 25 millions babies born in India every year go unregistered. In several large cities registration of birth is as low as 35 %. Therefore concern regarding the number of unregistered birth & death in India has rown.

IMPORTANCE OF BIRTH REGISTRATION :
Birth registration is the first step in establishing the identity of the child and birth certificate is the first legal document available to a child. Birth certificate is important for admission in school, for vaccination, for adoption, for age or nationality, for marriage or divorce, for passport, to own land, to open bank account, to receive social security and to vote. Proper birth registration system helps the Govt. to know the number of its citizen, helps in
planning their needs & development and to plan the immunization program.

IMPORTANCE OF DEATH REGISTRATION :
Death certificate is necessary for the fallowing purposes –
1. To get insurance, property and bank claims for individual.
2. For disease control, accident prevention.
3. For use in research – demographic and medical.
4. For use in public administration.
5. For use in vital statistics.

INFRASTRUCTURE FOR BIRTH & DEATH REGISTRATION IN INDIA :
The registration of birth & death (RBD) Act, 1969 provides for statutory authority at the center and in each state. The act has enabled the central govt. to promote uniformity and compatibility in registration and compilation of vital statistics. It allows the state govt. to develop an efficient system of registration. RBD act, provides for the appointment of functionaries for birth & death registration at national, state, district and local level.

At the central level, Registrar General is the central authority for registration of birth & death in the country. The Registrar General is appointed by Central Govt., who coordinates and unifies the civic registration activities in states & UT and provides general directives and guidelines for working of the act.
Chief Registrar of birth & death heads the civil registration in state & UT. He is responsible for organization & operational aspects of implementation of RBD act. in state & UT.

At the district level, the state govt. appoints a District Registrar of birth & death. In urban areas, municipal authority i.e. Commissioner or Head of health dept. serve as Registrar of birth & death. Sub-registrars are appointed by the Registrar with the approval of Chief Registrar of state and will function under supervision of the Registrar. In large cities function of a Registrar is more of manager of the system. For each corporation/municipality, etc., there is one Registrar of birth & death. In the rural area panchayat secretary (Gram Sevak) is registrar of birth & death.

PROCEDURE FOR BIRTH & DEATH REPORTING & REGISTRATION :
Many institution are not aware of the fact that they are responsible for reporting and therefore do not report directly to the registration centers. Registration of birth and death is compulsory. They are to be reported for registration in the prescribed form within 21 days.
Birth & death occurring in hospitals, Nursing Homes and other medical/non-medical institutions like jail, boarding house, hostel, train, road, plane have to be reported by the incharge of the institution. Birth & death occurring in the house are to be reported by the head of the household. A birth & death certificate is issued free of charge for the events reported within time i.e. within 21 days of the event. Birth can be registered without the name of the child, which can be entered later up to 15 years. Birth & death are registered only at the place of occurrence. RBD act provide for a system of notifier of the event of birth & death.

Multipurpose workers, anganwadi workers and other workers can be designated as notifier where the families are not interested in informing birth & death event. RBD act provide for penal provisions selectively against defaulting institutions and also the registration functionaries for non-compliance of the Act.

PROCEDURE FOR LATE/DELAYED REGISTRATION :
For information of birth & death received after 21 days of occurrence but within a period of 30 days, the event is registered on payment delayed fee of Rs 02=00 (two) only.
For information of birth & death received after 30 days of occurrence but within one year, the event is registered on payment of delayed fee of Rs. 05=00 (five) and on production of written permission of Head of Health Department of Municipality/Corporation for urban area and Block Development Officer for rural area.
For information of birth & death received after one year of occurrence, the event is registered on payment of delayed fee of Rs. 10=00 (ten) and on production of orders of Executive Magistrate.

PUBLISITY MEASURES FOR BOOSTING REGISTRATION & REPORTING :
Information Education and Communication package in awareness activities should stress not only on the importance of registration but also on, how and where to register birth and death. This can be done by linking birth and death registration campaign with immunization and other related campaign; by Incorporating birth & death registration module in training & orientation of Dai, Anganwadi & health workers, school teachers, SHG and NGOs and by Involving youth, adolescents and women groups in the awareness campaign Visibility of the registrar’s office is of utmost importance and should have signboard & timings of the registration. It is also necessary to have details about the provisions of the Act prominently displayed. There are several areas where public, Registrars have doubt about the correct procedures, and therefore brochure containing frequently asked questions might be made available to public.

Children’s Day (November 14) function may be used effectively for publicity on birth registration. Martyr’s day (January 30) may be used for publicity on death registration.
Possibility of making this an annual feature may be considered. Collaboration and support of Drug manufacturers, Baby food manufacturers, Life insurance companies, Toy manufacturers, Greeting card industry, Chocolate and Confectionary industry may be taken for organization of the function as above.

At state and Corporation level various departments like Health & Family Welfare, Women & Child, Information & Publicity, Transport, Urban Development, Estate and local govt. departments should be involved/integrated in the publicity measures. Special drives at least once a year may be conducted to register birth & death whose birth & death have not been reported, a system of amnesty to allow the births to be reported without late fee or affidavit. At city level the measures like Hoardings & Wall Paintings, Distribution of Pamphlets, Massages on public transport vehicles, Electronic signboards, Cinema slides, Cable, TV, Stickers, Newspaper advertisements & articles and other innovative ideas should be undertaken to create awareness about the registration and reporting of birth & death events.