Developed & Designed

By
 Mr.Durgesh Kumar (DPM)
 Mr. Upendra Kr. Jha (DPC)
 Mr. Binay Bhushan (BHM)

Dr. Omprakash Panjiyar Mr.Daya Nidhan Pandey, IAS

Civil Surgeon cum Member Secretary District Magistrate cum Chairman
District Health Society, Sitamarhi District Health Society, Sitamarhi

DHS Sitamarhi
 Foreword

Recognizing the importance of Health in the process of economic and social

development and improving the quality of life of our citizens, the Government of
India has resolved to launch the National Rural Health Mission to carry out necessary
architectural correction in the basic health care delivery system.

This District Health Action Plan (DHAP) is one of the key instruments to achieve
NRHM goals. This plan is based on health needs of the district.

After a thorough situational analysis of district health scenario this document has been
prepared. In the plan, it is addressing health care needs of rural poor especially women
and children, the teams have analyzed the coverage of poor women and children with
preventive and promotive interventions, barriers in access to health care and spread of
human resources catering health needs in the district. The focus has also been given
on current availability of health care infrastructure in pubic/NGO/private sector,
availability of wide range of providers. This DHAP has been evolved through a
participatory and consultative process, wherein community and other stakeholders
have participated and ascertained their specific health needs in villages, problems in
accessing health services, especially poor women and children at local level.

The goals of the Mission are to improve the availability of and access to quality health
care by people, especially for those residing in rural areas, the poor, women and
children.

I need to congratulate the department of Health and Family Welfare and State Health
Society of Bihar for their dynamic leadership of the health sector reform programme
and we look forward to a rigorous and analytic documentation of their experiences so
that we can learn from them and replicate successful strategies. I also appreciate their
decision to invite consultants (NHSRC/ PHRN) to facilitate our DHS regarding
preparation the DHAP. The proposed location of HSCs, PHCs and its service area
reorganized with the consent of ANM, AWW, male health worker and participation of
community has finalized in the block level meeting.

I am sure that this excellent report will galvanize the leaders and administrators of the
primary health care system in the district, enabling them to go into details of
implementation based on lessons drawn from this study.

Mr.Daya Nidhan Pandey, IAS

DM cum Chairman
District Health Society, Sitamarhi

1
 Foreword

Recognizing the importance of Health in the process of economic and social development
and improving the quality of life of our citizens, the Government of India has resolved to
launch the National Rural Health Mission to carry out necessary architectural correction in
the basic health care delivery system.

In a plan which is centrally made and driven, there is little room for such adaptation. District
level planning is a necessary component of any effort at decentralization.

Districts vary widely in needs and even more widely in possibilities for intervention. Thus, in
one district there may be a problem of poor infrastructure whereas in another district
shortages of man power other resources. In one district there may be a problem of drug
resistance in Malaria Control Programme, where as in another district the need may be to
integrate malaria control with filarial control. Thus strategies have to be district specific not
only because health needs vary, but because perceptions at people and capacities to conduct
programmes also vary.

This District Health Action Plan (DHAP) is one of the key instruments to achieve NRHM
goals. This plan is based on health needs of the district.

After a thorough situation analysis of district health scenario this document has been
prepared. In the plan, it is addressing health care needs of rural poor especially women and
children, the teams have analyzed the coverage of poor women and children with preventive
and promotive interventions, barriers in access to health care and spread of human resources
catering health needs in the district. The focus has also been given on current availability of
health care infrastructure in public/NGO/private sector, availability of wide range of
providers. This DHAP has been evolved through a participatory and consultative process,
wherein community and other stakeholders have participated and ascertained their specific
health needs in villages, problems in accessing health services, especially poor women and
children at local level.

The goals of the Mission are to improve the availability of and access to quality health care
by people, especially for those residing in rural areas, the poor, women and children.

I hope this District Health Action Plan will help in achieving the goals of National Rural
Health Mission (NRHM). It will enable health care personnel to serve people smoothly.
DHAP seeks to achieve pooling of financial and human resources allotted through various
central and state programmes by bringing in a convergent and comprehensive action plan at
the district level. DHAP and its subsequent implementation would inspire and give new
momentum to the health services in the District of Sitamarhi.

Mr. RamaShankar Daftuar

DDC cum Vice Chairman
District Health Society, Sitamarhi

2
 About the Profile

Even in the 21st century providing health services in villages, especially poor women
and children in rural areas, is the bigger challenge. After formation of National Rural
Health Mission, we are doing well in this direction. Launching Muskan- Ek Abhiyan
we are try to achieve 100% immunization and Anti Natal Care. Janani Evam Bal
Suraksha Yojana is another successful program that is ensuring safe institutional
delivery of even poor and illiterate rural women. Like wise several other programs
like RNTCP, Pulse Polio, Blindness control and Leprosy eradication are running and
reaching up to last man of society. But satisfaction prevents progress. Still, we have to
work a lot to touch miles stones. In this regard sometime, I personally felt that
planning of any national plan made at center lacks local requirements and needs. That
is why, despite of hard work, we do not obtain the optimum results. The decision of
preparing District Health Action Plan at District Health Society level is good.

Under the National Rural Health Mission the District Health Action Plan of Khagaria
district has been prepared. From this, the situational analysis the study proceeds to
make recommendations towards a policy on workforce management, with emphasis
on organizational, motivational and capability building aspects. It recommends on
how existing resources of manpower and materials can be optimally utilized and
critical gaps identified and addressed. It looks at how the facilities at different levels
can be structured and reorganized.

The information related to data and others used in this action plan is authentic and
correct according to my knowledge as this has been provided by the concerned
medical officers of every block. I am grateful to the DHS consultants, ACMO,
MOICs, MOs, Block Health Managers, Grade'A' Nurse, ANMs and AWWs from their
excellent effort we may be able to make this District Health Action Plan of Khagaria
District.

I hope that this District Health Action Plan will fulfill the intended purpose.

Dr. Omprakash Panjiyar

Civil Surgeon cum Member Secretary
District Health Society Sitamarhi

3
 About the Profile

The goals of the Mission are to improve the availability of and access to quality health
care by people, especially for those residing in rural areas, the poor, women and
children.

Keeping in mind the goals of National Rural Health Mission (NRHM), this District
Health Action Plan of Sitamarhi district has been prepared. From this, situational
analysis the study proceeds to make recommendations towards a policy on workforce
management, with emphasis on organizational, motivational and capability building
aspects. It recommends on how existing resources of manpower and materials can be
optimally utilized and critical gaps identified and addressed. It looks at how the
facilities at different levels can be structured and reorganized.

The information related to data and others used in this action plan is authentic and
correct according to my knowledge as this has been provided by the concerned
medical officers of every block. I am grateful to the state level consultants, DPM,
DAM, M & E Officer, DPC, DCM, MOICs, Block Health Managers, BCM, ANMs
for their excellent effort.

We hope that this District Health Action Plan will fulfill the intended purpose.

ACMO cum Nodal officer

District Health Action Plan, Sitamarhi

4
 About the Profile

National Rural Health Mission was introduced to undertake architectural corrections in the public Health
System of India. District health action plan is an integral aspect of National Rural Health Mission. District
Health Action Plans are critical for achieving decentralization, interdepartmental convergence, capacity
building of health system and most importantly facilitating people‟s participation in the health system‟s
programmes. District Health Action Planning provides opportunity and space to creatively design and
utilize various NRHM initiatives such as flexi –financing, Rogi Kalyan Samiti, Village Health and
Sanitation Committee to achieve our goals in the socio-cultural context of Sitamarhi.

National Rural Health Mission (NRHM) is a comprehensive health programme launched by Government
of India to bring about architectural corrections in the health care delivery systems of India. The NRHM
seeks to address existing gaps in the national public health system by introducing innovation, community
orientation and decentralisation. The mission aims to provide quality health care services to all sections of
society, especially for those residing in rural areas, women and children, by increasing the resources
available for the public health system, optimising and synergising human resources, reducing regional
imbalances in the health infrastructure, decentralisation and district level management of the health
programmes and community participation as well as ownership of the health initiatives. The mission in its
approach links various determinants such as nutrition, water and sanitation to improve health outcomes of
rural India.

The NRHM regards district level health planning as a significant step towards achieving a decentralised,
pro-poor and efficient public health system. District level health planning and management facilitate
improvement of health systems by 1) addressing the local needs and specificities 2) enabling
decentralisation and public participation and 3) facilitating interdepartmental convergence at the district
level. Rather than funds being allocated to the States for implementation of the programmes developed at
the central government level, NRHM advises states to prepare their perspective and annual plans based on
the district health plans developed by each district.

The concept of DHAP recognises the wide variety and diversity of health needs and interventions across
the districts. Thus it internalizes structural and social diversities such as degree of urbanisation, endemic
diseases, cropping patterns, seasonal migration trends, and the presence of private health sector in the
planning and management of public health systems. One area requiring major reforms is the coordination
between various departments and vertical programmes affecting determinants of health. DHAP seeks to
achieve pooling of financial and human resources allotted through various central and state programmes by
bringing in a convergent and comprehensive action plan at the district level.

It is our pleasure to present the Sitamarhi District Health Action Plan for the year 2012-13. The District
Health Action Plan (including the Block Health Action Plan) seeks to set goals and objective for the
District Health system and delineate implementing processes in the present context of gaps and
opportunities for the Sitamarhi district health team.

I am very glad to share that all the BHMs/MOICs/ANMs of the district along with key district level
Programme Officers (DIO)/DTO/DLO/DMO) for putting his sheer hardwork with dedication to complete
the Action Plan on time. Participated in the planning process. The plan is a result of collective knowledge
and insights of each of the District Health System Functionary. We are sure that the plan will set a definite
direction and give us an impetus to embark on our mission.

Binay Bhushan Upendra Kr. Jha Durgesh Kumar

Block Health Manager District Planning Coordinator District Programme Manager
Sitamarhi Sitamarhi Sitamarhi

5
 Table of contents
Sl.
Subject Page No.
No.

1. Excutive Summary 7 – 10

2. Introduction of DHAP Under NRHM 11 – 18

3. About District 19 – 58

4. DHAP Process 59 – 62

Situation Analysis (Infrastructure, Equipment & Human Resource)

i. HSC
5. ii. APHC 64 – 150
iii. PHC
iv. Sadar Hospital
Work Plan & Activities for Service improvement
i. District Level Programme Analysis & Work Plan
ii. Nutritional Rehabilitation Centre
iii. Maternal Health
iv. New Borne & Child Health
v. Family Planning
6. vi. ASHA 151 – 311
vii. Routine Immunization
viii. Revised National Tuberculosis Control Programme
ix. National Leprosy Eradication Programme
x. Malaria, Filaria & Kala-Azar Programme
xi. Blindness Controll Programme
xii. IDSP

7. Budget of Part A, B, C, D, E, F, G, H, I & other activity 312 – 330

6
 EXECUTIVE SUMMARY
The National Rural Health Mission is a societal Mission & launched to strengthen public
health systems to provide universal and equitable access to quality health care services and to
improve the health status of people. The success of NRHM will depend on policy of
reaching the last household in rural areas. There are still many difficult, most difficult and
inaccessible areas where more effort has to be made to reach quality services to the
people.With the growing concerns for health of the community, National Rural Health
Mission (NRHM) is seen as a vehicle to ensure that preventive and promotive interventions
reach the vulnerable and marginalized through expanding outreach and linking with local
governance institutions. NRHM envisages achievement of ascertained goals by promotion of
intersectoral linkages, which is anticipated as imperative for its effective implementation.
These linkages can be within the public health system such as RCH, Family Planning,
Routine Immunization and National Disease Control programmes or with other departments
like Women and Child Development, Education, PRI and Water and Sanitation. These
linkages could also be with the NGOs, the private health sector and the corporate sector with
the overall objective of improvement of services and fragmentation of efforts. For making
NRHM fully accountable and to facilitate the responsiveness of NRHM, need for formulation
of District Health Action Plan (2007-12) has been recognized. DHAP intends to provide a
guideline to develop a liable public health delivery system through intensive monitoring and
performance standard.

The process for formulation of DHAP required participatory approach at various levels. To
make the plan more practicable and to ensure that grass root issues are voiced and heard, the
initial stages of process of plan development included consultations at village and block level.
As NRHM emphasizes community participation and need based service delivery with an
improved outreach to disadvantaged communities, village and block level consultations
provided vital information to guide the district health action plan. The consultations
endeavored to reach a consensus on constraints at community level and feasible
solutions/interventions strategies regarding a particular subject matter. Based on discussions
on both demand and supply side concerns in the blocks the priorities were set and agreed.
Further to share the findings of village and block level process with a larger stakeholder
group and to finalize a strategic action plan district level workshop was conducted.

Following the consultations at village and block level, consultations at district level involving
a large range of stakeholders from different levels, aimed at delineating strategies to achieve
identified district plan objectives. For effective implementation of suggested approaches it
has been endeavored to carve out specific activities for each strategy and assign the activities
a tentative time frame so as to indicate when a particular activity can happen.

Prior to consultative meetings, an attempt has been made to identify the performance gaps
within the framework of existing health system by conducting situational analysis. It has been
found that the situation of public health infrastructure in the district is not appalling however
major gaps are found in human resource situation with high number of vacant staff positions
for male MPWs, ANMs, specialists and lab technicians. The situation of convergence of
health department with ICDS is notable. At the community level close collaboration exists
between the ANMs and the AWWs. The activities of the two departments are integrated,

7
providing complementary job functions to ensure better accessibility and availability of
health services. Involvement of PRI in issues of health through village health and sanitation
committees is limited. Though the committees are constituted in most of the villages their
functionality is unconvincing.

With the vision to improve the reproductive and child health condition within the district,
increase in female literacy has been anticipated as the foremost strategy. The challenge of
providing quality services to the poorest and remotest areas can be achieved by developing
pro-people partnerships with the nongovernment sector and promoting convergence with
other concerned departments and agencies such as ICDS, panchayat and education. To ensure
universal access to quality services, upgradation of facilities and strengthening of technical
capacity of existing human resources, especially with regard to emergency obstetric care
needs to be focused. Improved fund flow, timely procurement of goods and services, cadre
management, planning and monitoring through infusion of managerial skills is envisaged as
necessary in order to reach the objectives of the mission. Intensified IEC activities by local
health workers, panchayat leaders, community societies/local NGOs will provide much
needed support for behaviour change of community regarding maternal care during
pregnancy, ANC, institutional deliveries, breastfeeding practices as well as family planning.
Need for using health facilities for deliveries and other issues related to RCH, family
planning, female education and gender equity would be the central point of counseling during
interactions between health workers and pregnant women.

To promote access to improved health care at household level through ASHAs, induction
trainings of ASHAs are still needed to be finished. With a view to bring about
decentralization, encourage community participation, and improve health service delivery,
establishment of RKSs have been suggested at all CHCs and PHCs. However, specific
guidelines for functioning mechanism as well as trainings of members will ensure
streamlined activities under RKS. Upgradation and strengthening of health infrastructure
needs urgent recruitment of required number of gynecologists, anesthetists, pediatricians,
staff nurses, ANMs, MPWs and lab technicians either on permanent or contractual basis, as
well as assurance of adequate procurement and logistic supply. For upgrading standard of
services, multi-skilling of doctors/ paramedics is envisaged by imparting refresher training
courses. Increased outreach of services is also envisioned to be achieved by initiating medical
mobile units, which will operate within the most vulnerable areas. To make MMUs
functional there is need for deployment of staff, availability of conveyance, equipments and
drugs. Further, since Ayurveda, Unani and Homeopathy system of medicine have had a long
presence in the State, specially in the remote and rural areas it is suggested to use their
potential for improving accessibility to health services by mainstreaming of AYUSH within
the framework of primary health delivery.

With the objective of achieving the targets of child immunization there is a felt need for
strengthening. The service delivery mechanism by increasing manpower as well streamlined
adequate supply of vaccines. Besides, regular in-service trainings can help build the capacity
of health workers on various managerial aspects as well as improve the efficiency of delivery.
In order to deal with the critical cultural issues, that might be hampering the performance of
child immunization indicators, convergence with PRI through gram panchayat, other
influential members of the community and local NGOs/CBOs is considered significant.
Involvement of panchayat to ascertain better coverage of immunization is envisioned through

8
establishment and activation of VHSCs, which motivate community for higher acceptance of
vaccination by organizing various innovative activities and by inter-personal communication.

As far as vector borne diseases are concerned, the risk of malaria is high in the district. To
tackle the performance of indicators of malaria, institutional strengthening is suggested by
upgradation of existing laboratories and increasing the number of laboratories for malaria
microscopy. Need of filling up vacant posts for staff workers and lab technicians are highly
recognized. Outreach of services delivery is expected to be achieved by co-opting with
private institutions with the vision to increase slide collection rate. Intersectoral coordination
between health department, ICDS, PRI, education dept, NGOs and water and sanitation
department is primarily emphasized for IEC on issues related to general health and
environmental hygiene.

For improvement in RNTCP indicators intensified case detection activities are proposed. To
ensure high responsiveness from the community regarding acceptance of services,
sensitization of community through PRI and collaboration with private practitioners is
presumed. In addition to this availability of advanced diagnostic techniques with quality
assurance are expected to build faith among the community members towards institutional
health care services. For easy accessibility to treatment facility, increasing the number of
DOTS providers is also proposed. In addition to this, the much needed behavioural change of
staff members can be achieved by imparting trainings for orientation and better counseling
skills.

Outreach of NBCP services can be attempted by increasing the number of outreach camps in
un-reached and remote areas. For improving eye care delivery services there should be
adequate supply of diagnostic equipments as well as drugs. Gaps in service delivery are felt
due to non-posting of eye specialists at health facilities even in Sadar Hospital, Sitamarhi.
Thus filling up vacancies for eyesurgeons and imparting refresher training courses on new
techniques and interventions will help in accomplishment of required targets. In this regard,
convergence with schools is envisaged for organization of school eye-screening camps.

With the view of reduction of leprosy regular surveys are proposed for case detection along
with constant monitoring and reporting mechanism. Service delivery can be strengthened by
recruitment of motivated and dedicated staff for field activities. To tackle the identified cases,
it is important to convince community members for rebuttal of prevailing misconceptions
associated with the disease. Initiatives on IEC and BCC can be attempted by collaboration of
activities with panchayat, which is supposed to be the most efficient medium for sensitization
of community.

However in order to expedite the process and to make it more effective, convergence at
various levels require detailing of effective operational approaches, laying out clear roles and
outcomes, and clear mechanism for joint planning and monitoring. This will not only ensure
streamlining of strategies but also ensure accountability of the public health system of
different departments, be it health department, ICDS, PRI, education or water and sanitation.
Continuous monitoring will keep a check on effective collaboration of services related to
immunization and institutional delivery, AYUSH infrastructure, supply of drugs, upgradation
of CHCs to IPHS, utilization of untied fund, and outreach services through operationalization
of mobile medical unit

9
INTRODUCTION OF DHAP UNDER NRHM

In the process of economic and social development for improving the quality of life, importance of
health has long been recognized. In order to galvanize the various components of health system,
Government of India has endeavoured to launch the National Rural Health Mission (NRHM). NRHM
was launched in April 2005, to provide effective health care to rural population throughout the
country with special focus on 18 states which have weak public health indicators and/or weak
infrastructure.

The mission aims to expedite achievements of policy goals by facilitating enhanced access and
utilization of quality health services, with an emphasis on addressing equity and gender dimension.

Specific objectives of the mission are:

 Reduction in child and maternal mortality

 Universal access to services for food and nutrition, sanitation and hygiene, safe drinking water
 Emphasis on services addressing women and child health; and universal immunization
 Prevention and control of communicable and non-communicable diseases, including locally
endemic diseases
 Access to integrated comprehensive primary health care
 Revitalization local health traditions and mainstreaming of AYUSH

One of the main approaches of NRHM is to communities, which will entail transfer of funds,
functions and functionaries to Panchayati Raj Institutions (PRIs) and also greater engagement of Rogi
Kalyan Samitis (RKS), hospital development committees or user groups. Improved management
through capacity development is also suggested. Innovations in human resource management are one
of the major challenges in making health services effectively available to the rural/tribal population.
Thus, NRHM proposes ensured availability of locally resident health workers, multi-skilling of health
workers and doctors and integration with private sector so as to optimally use human resources.
Besides, the mission aims for making untied funds available at different levels of health care delivery
system. Core strategies of mission include decentralized public health management. This is supposed
to be realized by implementation of District Health Action Plans (DHAPs) formulated through a
participatory and bottom up planning process. DHAP enable village, block, district and state level to
identify the gaps and constraints to improve services in regard to access, demand and quality of health
care. In view with attainment of the objectives of NRHM, DHAP has been envisioned to be the
principle instrument for sitamarhi dhs

NRHM covers the entire country, with special focus on 18 states where the challenge of strengthening
poor public health systems and thereby improve key health indicators is the greatest. These are Uttar
Pradesh, Uttaranchal, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Orissa, Rajasthan, Himachal
Pradesh, Jammu and Kashmir, Assam, Arunachal Pradesh, Manipur, Meghalaya, Nagaland, Mizoram,
Sikkim and Tripura. The mission envisions targeting especially rural/ tribal people, poor women and
children for providing equitable, affordable, accountable and effective primary health care.planning,
implementation and monitoring, formulated through a participatory and bottom to up planning
process. NRHM-DHAP is anticipated as the cornerstone of all strategies and activities in the district.
DHAP integrates the various interrelated components of health to ensure quality of care and access to
service with specific reference to various interrelated paradigm as mentioned below:

• Resources: health manpower, logistics and supplies, community resources and financial
resources, voluntary sector health resources.

10
• Access to services: public and private services as well as informal health care services; levels of
integration of services within public health system.

• Utilization of services: outcomes, continuity of care, factors responsible for possible low
utilization of public health system.

• Quality of care: technical competence, interpersonal communication, and client satisfaction,

client participation in management, accountability and redressal mechanisms.
• Community: needs, perceptions and economic capacities, PRI involvement in health, existing
community organizations and modes of involvement in health.
• Socio-epidemiological situation: local morbidity profile, major communicable diseases and
Transmission patterns, health needs of special social groups (e.g. Adivasis, migrants, very remote
Hamlets)

For effective programme implementation NRHM adopts a synergistic approach as a key strategy for
community based planning by relating health and diseases to other determinants of good health such
as safe drinking water, hygiene and sanitation. Implicit in this approach is the need for situation
analysis, stakeholder involvement in action planning, community mobilization, inter-sectoral
convergence, partnership with Non Government Organizations (NGOs) and private sector, and
increased local monitoring. The planning process demands stocktaking, followed by planning of
actions by involving program functionaries and community representatives at district level.

This manual is intended to be a user-friendly tool to assist range of stakeholders, to be engaged in the
district health planning, in developing the DHAP. The intended target group for this document
includes:

 Members of State and District Health Missions

 District and Block level program managers of line departments i.e., Health and Family Welfare,
Women and Child Development including Integrated Child Development Scheme (ICDS) and
Water/sanitation departments.
 State Program Management Unit and District Program Management Unit Staff
 Members of PRIs and MNGOs/ FNGOs and civil society groups (in case these groups are
involved in the DHAP formulation)

Besides above referred groups, this document will also be found useful by public health managers,
academicians, faculty from training institutes and people engaged in programme implementation and
monitoring and evaluation.

Objectives of the DHAP

The aim of the present study is to prepare DHAP based on the broad objective of the NRHM .
Specific objectives of the process are:

 To identify critical health issues and concerns with special focus on vulnerable /disadvantage
groups and isolated areas and attain consensus on feasible solutions.
 To examine existing health care delivery mechanisms to identify performance gaps and develop
strategies to bridge them
 To actively engage a wide range of stakeholders from the community, including the Panchayat, in
the planning process
 To identify priorities at the grassroots level and set out roles and responsibilities at the Panchayat
and block levels for designing need-based DHAPs
 To espouse inter-sectoral convergence approach at the village, block and district levels to make the
planning process and implementation process more holistic

11
The District Health Action Plan of Sitamarhi has been prepared under the guidance of the Chief
Medical Officer, Additional Chief Medical Officer, All District Programme officer of Sitamarhi and
District Programme Management Unit (DPMU) DHS with a joint effort of the Block Programme
Management Unit (BPMU), Rogi Kalyan Samiti, District Health Educator, the BMOs and various
M.O-PHCs as well as other concerned departments under a participatory process. The field staff of the
department has also played a significant role. Public Health Resource Network has provided technical
assistance in estimation and drafting of various components of this plan.

Preparation of DHAP

The Plan has been prepared as a joint effort under the guidance of Civil Surgeon, all incharge
programme officers as well as the MOICs, Block Health Managers, ANMs, as a result of a
participatory processes as detailed below. After completion the DHAP, a meeting is organized by
Civil Surgeon with all MOIC of the block and all programme officer. Then discussed and displayed
prepared DHAP. At last it has been approved by the chairman of the District Health Society. If any
comment has came from participants it has added then finalized. The field staffs of the department too
have played a significant role. District officials have provided technical assistance in estimation and
drafting of various components of this plan.
After a thorough situational analysis of district health scenario this document has been prepared. In
the plan, it is addressing health care needs of rural poor especially women and children, the teams
have analyzed the coverage of poor women and children with preventive and promotive interventions,
barriers in access to health care and spread of human resources catering health needs in the district.
The focus has also been given on current availability of health care infrastructure in
pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved
through a participatory and consultative process, wherein community and other stakeholders have
participated and ascertained their specific health needs in villages, problems in accessing health
services, especially poor women and children at local level.

District Health Action Plan Planning Process

- State level Fast track training on DHAP.

- Collection of Data through various sources
- Understanding Situation
-Assessing Gap
-Orientation of Key Medical staff, Health Managers
on DHAP at district level

-Block level Meetings

-Block level meetings organized at each level
by key medical staff and BMO

-District level meetings

-District level meeting to compile information
-Facilitating planning process for DHAP

Approval
12 from the District
Magistrate
Methodology

Planning process started with the orientation of the different programme officers,
MOICs, Block Health Manager and our health workers. Different group meetings
were organized and at the same time issues were discussed and suggestions were
taken. Simple methodology adopted for the planning process was to interact
informally with the government officials, health workers, medical officers,
community, PRIs and other key stake holders.

Data Collection

Primary Data: All the Medical Officers were interacted and their concern was taken
in to consideration. Daily work process was observed properly and inputs were taken
in account. District officials including CMO, ACMO, DIO, DMO, DLO, RCHO and
others were interviewed and their ideas were kept for planning process.

Secondary Data:Following books, modules and reports were taken in account for this
Planning Process:
 RCH-II Project Implementation Plan
 NRHM operational guideline
 DLHS Report
 Report Given by DTC
 Report taken from different programme societies e.g. Blindness control, District
Leprosy Society, District TB Center , District Malaria Office
 Census-1991,2001,2011.
 National Habitation Survey-2003
 Bihar State official website

Tools:
Main tools used for the data collection were:
 Informal In-depth interview
 Group presentation with different district level officials
 Informal group discussions with different level of workers and community
representative
 Review of secondary data

Data Analysis:

Primary Data: Data analysis was done manually. All the interviews were recorded
and there points were noted down. After that common points were selected out of that.

Secondary Data: All the manuals books and reports were converted in to analysis
tables and these tables are given in to introduction and background part of this plan.

13
 SWOT ANALYSIS OF THE DISTRICT
 STRENGTHS

1. Involvement of C.S cum CMO: - C.S cum CMO take interest, guide in every activity
of Health programme and get personally involved.

2. Support from District Administration:- District Magistrate and Deputy Development

Commissioner take interest in all health programmes and actively participate in activities.
They provide administrative support as and when needed. They make involvement of
other sectors in
health by virtue of their administrative control.

3. Support from PRI (Panchayati Raj Institute) Members:- Elected PRI members of
District and Blocks are very co-operative. They take interest in every health programmes
and support as and when required.

4. Well established DPMU and BPMU:- Since Four year, all the posts of DPMU &
BPMU are filled up. Facility for office and automation is very good. All the members of
DPMU & BPMU work harmoniously and are hardworking.

5. Effective Communication: - Communication is easy with the help of internet facility

at block level and land line & Mobile phone facility which is incorporated in most of
PHCs of the district.

6 .Facility of vehicles: - Under the Muskan Ek Abhiyan programme every Block

have the vehicles for monitoring.

7. Support from media: - Local newspapers and channel are very co-operative for
passing messages as and when required. They also personally take interest to project good
and worse things which is very helpful for administration to take corrective measures.

 WEAKNESS

1. Lack of Consideration in urban area: - Urban area has got very poor health
infrastructure to provide health services due to lack of manpower.

2. Non availability of specialists at Block level: - As per IPHS norms, there are
vacancies of specialists in most of the PHCs . Many a times only Medical Officer is
posted, they are busy with routine OPD and medico legal work only, so PHC do not fulfill
the criteria of ideal referral centers and that cause force people to avail costly private
services.

3. Non availability of ANMs at PHCs to HSCs level - As per IPHS norms, there are
vacancies of ANMs in most of the HSCs. Out of 534 Sanctioned post of contractual

14
ANMs only 115 ANMs are Selected so HSCs do not fulfill the criteria of ideal Health
Sub Centre and that cause force people to travel up to PHCs to avail basic health services.

4. Apathy to work for grass root level workers: - Since long time due to lack of
monitoring at various level grass root level workers are totally reluctant for work. Even
after repeated training desired result has not been achieved. Most of the MO, Paramedical
& other Health workers do not stay at HQ. Medical Officers, who are supposed to
monitor the daily activity of workers do not take any interest to do so. For that reason
workers also do not deliver their duties regularly and qualitatively. Due to lack of
monitoring & supervision some aim, object & program is suffering allot.

5. Lack of proper transport facility and motarable roads in rural area:- There are
lack of means of transport and motarable roads in rural areas. Rural roads are ruled by
„Jogad‟, a hybrid mix of Motor cycle and rickshaw, which is often inconvenient mean of
transport. The fact that it is difficult to find any vehicle apart from peak hours is still the
case in numerous villages.

6. Illiteracy and taboos:-The literacy rate in rural area has still not reached considerable
mark. Especially certain communities have constant trend of high illiteracy. This causes
prevalence of various taboos that keep few communities from availing benefits of health
services like immunization or ANC, institutional delivery…etc

 OPPORTUNITIES

1. Health indicator in Sitamarhi district is not satisfactory . Services like Institutional

delivery, Complete Immunization , Family Planning, Complete ANC, School Health
activity , Kala-azar eradication may required to be improved. So there are opportunities to
take the indicator to commendable rate of above 75+% by deploying more efforts and
will.

2. Introduction of PPP Scheme: Through introduction of PPP Scheme we can overcome

shortfall of specialist at Block level.

3. Involvement of PRIs: - PRI members at district, Block and village level are very co-
operative to support the programmes. Active involvement of PRI members can help much
for acceptance of health care deliveries and generation of demand in community.

4. improvement of infrastructure: -. With copious funds available under NRHM, there

is good opportunity to make each health facility neat and clean, Well Equipped and Well
Nurtured.

 THREATS

1. Flow of information if not properly channeled to the grass root stakeholder

2. Natural calamities like every year flood adversely affected the progress of Health
Programme.

15
PROFILE OF SITAMARHI DISTRICT

16
Sl. Parameter/ Data
No Variable
1. Total area 2293 Sq. Km

2. Latitude 26*49`N

3. Longitude 85*05`E

4. Altitude 85 Meter
In North – Nepal (International Border), South – Muzaffarpur District, East – Darbhanga & Sitamarhi
5. Boundary / Border line
District, West – East Champaran & Sheohar District.
1991 2001 2011
Description
Total Rural Urban Total Rural Urban Total Rural Urban

Population (%) 100% 94.06% 5.94% 100% 94.29% 5.71% 100% 94.42% 5.58%

Actual Population 20,13,796 18,94,203 1,19,593 26,82,720 25,29,407 1,53,313 34,19,622 32,28,904 1,90,718

Male 10,69,132 10,69,132 64,897 14,17,611 13,35,214 82,397 18,00,441 16,98,885 1,01,556

Female 9,44,664 89,968 54,696 12,65,109 11,94,193 70,916 16,19,181 15,30,019 89,162

Population Growth 23.72% 32.58% 27.47%

SC Population(%) 12.1%

ST Population(%) 0.02%
Proportion to Bihar
3.23% 3.29%
Population
6. Sex Ratio (Per 1000) 884 886 846 892 894 861 899 901 878

Child Sex Ratio (0-6) 921 918 965 924 925 915 932 934 881
Total Child Population
556,582 643,851 614,408 29,443
(0-6 Age)
Male Population (0-6
289,273 ` 333,315 317,660 15,655
Age)
Female Population (0-6
267,309 310,536 296,748 13,788
Age)
Child Proportion (0-6
20.2 20.75% 18.83% 19.03% 15.44%
Age)
Boys Proportion (0-6
19.8 20.41% 18.51% 18.70% 15.42%
Age)
Girls Proportion (0-6
20.64 21.13% 19.18% 19.40% 15.46%
Age)

% of Population with
86.8%
Low Standard of
Living
% of Population with
7. Medium Standard of 6.7%
Living

% of Population with
6.5%
High Standard of
Living
8. Density/km2 878 1,170 1,491

Literates 817,711 1,485,896 1,365,865 120,031

Male Literates 556,936 917,879 848,694 69,185

Female Literates 260,775 568,017 517,171 50,846

9.
Average Literacy 28.49 26.53 58.67 38.46 36.71 66.23 53.53 52.24% 74.43%

Male Literacy 39.86 37.86 69.67 49.36 47.73 74.72 62.56 61.45% 80.54%

Female Literacy 15.49 13.63 45.22 26.13 24.28 56.24 43.4 41.93% 67.46%
10 32234 45662 58379
Eligible Couple

17
Sl. Parameter/ Data
No Variable
No. of Sub-Divisions 03
No. of Blocks/PHCs 17
No. of` Nagar Parishad 01
No. of Nagar Panchayat 05
No. of Gram Panchayat 273
No. of Revenue Village 835(Inhabited – 802 , Uninhabited – 33 )
No. of A P H Cs 36
No. of HSCs 273
No. of Sub-Divisional 1
Hospitals
No. of Referral Hospitals 1
No. of Doctors 133
No. of ANMs 272 – Regular & 98 – Contractual in Position.
No. of Grade A Nurse 37
No. of paramedicals
Total ICDS Projects 18
No. of Anganwari 2700
Centres/Workers
No. of ASHA 2223/2965
No. of MAMTA 85
No. of M.L.A. 08
No. of M.P. 01
Educational & Research Primary Schools-1479
Institutes
Project Girls High School-17
I.T.I-01
Sanskrit School-20
Important Rivers Bagmati , Lakhandei , Lalbakea , Adhwara group
Average Rainfall 1100 MM to 1300 MM
Highest Temperature 32* C to 41* C
Soil Balui , Domat.
Paddy , Wheat , Sugar Cane , Marua , Arhar , Mustard ,
Main Crop
Mung etc.
Ram Janaki Temple at Sitamarhi (Janaki Sthan), Janaki
Temple at Punaura, Haleshwar Sthan, Panth-Pakar,
Main Tourist Palace
Bodhayan-Sar, Baghi Math, Pupri, Goraul Sharif,
Shukeshwar Sthan, Sabhagachhi Sasaula
Transportation/Communicatio NH-77 & NH-104 , Railway Braud Gauge.
n

18
 Introduction

The district is popularly known as the “Land of Goddess Sita”. This is the place where Sita
was born, the main character of the epic Ramayana. The district is situated along the border
of Nepal.In 1875, a Sitamarhi subdistrict was created within the Muzaffarpur district.
Sitmarhi detached from Muzaffarpur and became a separate district as of December 11, 1972.
1994 saw the split of Sheohar district from Sitamarhi. It is situated in the northern part of
Bihar. The district headquarters are located in Dumra, five kilometers south of Sitamarhi. The
district headquarter was shifted here after the town of Sitamarhi was devastated in one of the
worst ever earthquake in January 1934.Sitamarhi is a sacred place in Hindu mythology. Its
history goes back to Treta Yug. Sita, the wife of Lord Rama sprang to life out of an
earthenware pot, when Raja Janak was ploughing the field somewhere near Sitamarhi to
impress upon Lord Indra for rain. It is said that Raja Janak excavated a tank at the place
where Sita emerged and after her marriage set up the stone figures of Rama, Sita and
Lakshman to mark the site. This tank is known as Janaki-kund and is south of the Janaki
Mandir.

The Sitamarhi district is bounded by Nepal on the north, Muzaffarpur on the south, by the
districts Darbhanga and Sitamarhi on the east and on the west by the districts East
Champaran and Sheohar. In course of time, the land lapsed into a jungle until about 500 years
ago, when a Hindu ascetic, named Birbal Das came to know the site by divine inspiration
where Sita was born. He came down from Ayodhya and cleared the jungle. He found the
images set up by Raja Janak, built temple over there and commenced the worship of Janaki or
Sita. The Janaki Mandir is apparently modern and is about 100 years old only. The town
however contains no relics of archaeological interest.

In course of time, the land lapsed into a jungle until about 500 years ago, when a Hindu
ascetic, named Birbal Das came to know the site by divine inspiration. He came down from
Ayodhya and cleared the jungle. He found the images set up by Raja Janak, built a temple
over there and commenced the worship of Janaki or Sita. The Janaki Mandir is apparently
modern and is about 100 years old only. The town however contains no relics of
archaeological interest.
It has witnessed communal violence led by local politicians in the past but on the whole both
the leading communities here a good rapport. This district is often bereaved by natural
calamities. One of the most devastating is excess flooding due to mis-management of the
banks by both civilians and government officials.

The district is currently a part of the Red Corridor.

Important places to visit are Ram Janaki Temple at Sitamarhi (Janaki Sthan), Janaki Temple
at Punaura, Haleshwar Sthan, Panth-Pakar, Bodhayan-Sar, Baghi Math, Pupri, Goraul Sharif,
Shukeshwar Sthan, Sabhagachhi Sasaula

19
Geography
The initial provisional data suggest a density of 1,491 in 2011 compared to 1,170 of 2001.
Sitamarhi district occupies an area of 2,294 square kilometres (886 sq mi), comparatively
equivalent to Australia's Groote Eylandt.
Rivers: Bagmati, Lakhandei, Adhwara Group.
Economy
In 2006 the Ministry of Panchayati Raj named Sitamarhi one of the country's 250 most
backward districts (out of a total of 640). It is one of the 36 districts in Bihar currently
receiving funds from the Backward Regions Grant Fund Programme (BRGF).
Divisions
Subdivisions
 Sitamarhi
 Sadar
 Belsand
 Pupri
Blocks
The district is divided into 17 blocks (Taluks)
 Bairgania
 Bajpatti
 Bathanaha
 Belsand
 Bokhra‡
 Chorout‡
 Dumra
 Majorganj
 Nanpur
 Parihar
 Parsauni‡
 Pupri
 Riga
 Runni Saidpur
 Sonbarsa
 Suppi‡
 Sursand
(‡ = Recently created)
Villages
 Gorhaul sharifBath Asli
 Akhta
 Koily
 Dumari
 Sahiyara
 Mahuain Pathrahi (Bajpatti)

20
 Kharka
 Ajamgarh
 Andahara
 Bhasepur
 Gosaipur
 Tilaktajpur
 Sarhachia
 Kodhiyar
 Rasalpur
 Bela
 Dheng
 Maniyari
 Madhopur
 Bela Bahadurpur
 Amanpur
 Rudauli
 Matiyar
 Baduri
 Hanuman, Nagar
 Punaura
 Ratwara
 Basdev Pur Boha
 Madhopur Chaturi
 Bhalani Madan
 Soura
 Lalpur
 Kauriya
 Kodariya
 Manik Chauk
 Runi Saidpur
 Hardiya
 Durgauli
 Koeli
 Sirsi
 Nanpur
 Bhadiyan
 Humayunpur(Dipu)
 Jogiyara
 kamtaul
 Paktola
 Mehsaul
 Madhuban
 Chakmahila
 Dumra
 Mohanpur
 Bhavdepur
 Bhairokothi
 Bhupbhairo
 Bariyarpur
 Jainagar

21
 Dostia
 Chhaurahiya
 Janipur
 Madhesra
 Bishnupur Kam deo
 Barma(Choraut)
 Barari Behta
 malmalla
 mirjadpur
 Pakri
 Rewasi
 Sahwajpur
 Kharsan
 Kushmari
 (Balua panchayat)runni saidpur)
 Chainpura
 Hariharpur
 Narayanpur
 Balha
 Rasalpur
 madhubani
 Ram Nagar
 Ram nagra
Transport
Connectivity: National Highway 77 connects the area to the Muzaffarpur district and Patna to
the South. State highways link it to the Madhubani (to the east) and Sheohar (to the west)
districts. Railroad lines connect Sitamarhi to Darbhanga, Sitamarhi to Runnisaidpur and
Sitamarhi to Bairgania(Broad-Gauge) and Muzaffarpur, Raxaul and Narkatiaganj Converting
meter gauge to broad gauge work in progress. Nearest airport is Janakpur (45Km),
Tribhuwan(Kathmandu),Patna(145Km),Gaya(235Km) & Varanasi(395Km).
Demographics
According to the 2011 census Sitamarhi district has a population of 34,19,622 of which male
& female were 18,00,441 & 16,19,181respectively roughly equal to the nation of Panama or
the US state of Connecticut. This gives it a ranking of 96th in India (out of a total of 640).
The district has a population density of 1,491 inhabitants per square kilometre (3,860 /sq mi) .
Its population growth rate over the decade 2001-2011 was 27.47 %. In the previous census of
India 2001, Sitamarhi District recorded increase of 32.58 percent to its population compared
to 1991. Sitamarhi has a sex ratio of 899 females for every 1000 males compared to 2001
census figure of 892.The average national sex ratio in India is 940 as per latest reports of
census 2011 Directorate. Average literacy rate of Sitamarhi in 2011 were 53.53 % compared
to 38.46 of 2001 census. If things are looked out at genderwise, male & female literacy were
62.56 & 43.40 respectively.For 2001 census same figures stood at 49.36 & 26.13 in Sitamarhi
District. Total literate in Sitamarhi District were 14,85,896 of which male & female were
9,17,879 & 5,68,017 respectively. In 2001 Sitamarhi District had 8,17,711 in its total region.
Culture
Languages:- It is located in at the confluence of Mithila, Vajji(Licchvians) and Bhojpur
region of Bihar. Most of the people are either Maithils or Vajji. But their culture is deeply

22
affected by Bhojpur too. Language spoken is Hindi, English, Bajjika (Vajjika), Bhojpuri,
Maithili,Urdu and.Nepali But the local people used to talk in Bajjika which resembles with
Maithili, bhojpuri and Hindi which is a consequence of its location being surrounded by these
regions.
Festivals:- The major festival of this area is Chhath puja in which people offer their
prayer to Lord Sun.Almost all the people wherever they are, their major desire is to celebrate
Chhath puja at their home with their family members and villagers.Holi and Diwali are other
two festivals celebrated with so much of gaiety. Other festivals such as Dusshera, Makar
sakranti,Id, Christmas and others are also celebrated with full enjoyment. Among all festival
celebrated here what remains common is enjoyment , co-operation and brotherhood. The
culture festival such as Sama which is played by girls of the area for their brothers good wish
is one of the most famous one. It is really enjoyable to see this festival in the chilling cold of
the winter season.
Marriage:- The major cultural event is marriage in this area which takes a large amount
of preparations and arrangement with many cultural rituals.
Cuisine:-"Khichdi", the both of rice and lentils, seasoned with spices, and served with
several accompanying items like curd, chutney, pickles, papads, ghee (clarified butter) and
chokha (boiled mashed potatoes, seasoned with finely cut onions, green chilies) constitutes
the lunch for most on Saturdays and is a staple food here. Afternoon meals mostly consists of
Rice, Lentil and vegetables while the dinner will consist of Rotis (flatbread) and Vegetables.
Fairs:- Maha Shivratri Mela, Vivah-Panchami Mela & Ramnavami Mela (huge market of
cattles, horses and elephants are the main feature of these fairs)
Crops:-The major food crops are rice, wheat and maize. Apart from it this area is major
producers of sugarcane, tobacoo and other cash crops. People here are very laborious. Lentils,
sun flower and mustard is also grown in this area. Crop and agriculture has given rise to
many agro based industries in this area.
Fruits:-This area is famous for litchi sahi and china. The litchi crop is available from May
to June only.There are large number of mango and litchi orchards in this area. Export of these
licthi bring a large amount of foreign currency to the country. At the same time it is boosting
the economic scenario of the whole area.
Education
 Thakur Jugal Kishore Singh College
 Kendriya vidyalya jawahar nagar
 Srk Goenka College
 Lakshmi High School
 Delhi Public School
 S.H.B.S. Boarding School
 D.A.V. Public School
 Mathura High School
 J.B. High School Majorganj
 High School Runi Saidpur
 High School Bela Shanti Kutir
 High School Pupari
 Middle School Bela Shanti Kutir
 Middle School Basdev Pur Boha
 Middle School Bhadiyan

23
 Middle School Sahiyara
 shri Lakhan Narayan Memorial High School Choraut
 Mahanth sri Ayodhya Ramanuj High School, Rewasi
 MP HIGH SCHOOL DUMRA SITAMARHI**
 high school balua ()panchayat)
 amshobha mandal (Samajsevi)
Sports
Heman Trophy (cricket) is organised every year at the Goenka College Ground, which adds
some zeal to the life of the youths. Cricket is played in every nook and corner of the district.

Health profile of Sitamarhi District

Sitamarhi has shown consistent improvement in some of the key health indicators across the years. Still the overall situation
of the district leaves much to be desired. According to a survey by International Institute of Population Sciences conducted
in 2006, the key RCH and other health indicators of the district are as follows:
Table 2 :rhi Health Profile
Key population Infant Mortality rate 52
indicators Maternal mortality rate 430
Crude birth rate 31.9
Death rate 5.0
DLHS 3 DLHS 2
District Level Household & Facility Survey Bihar DLHS 3
(07-08) (02-04)
Key RCH Girls marrying below 18 yrs. 44.4 61.3 46.2
Indicators Birth order 3+ 56.3 62.0
(in percentages) Current use of any FP method 25.3 25.3 32.4
Total unmet need 41.2 39.5 37.2
Pregnant women who registered in the first trimester 22.0
Pregnant women with 3 + ANC 22.9 11.4 26.4
Pregnant women receive at least 1 TT injections 66.2 20.7 58.4
Delivery assisted by a skilled attendant at home 4.7 4.6 5.9
Institutional births 16.4 8.0 27.7
Children with full immunization 39.1 32.1 41.4
Children with Diarrhea treated within last two weeks 79.0 92.5 73.7
who received treatment
Children with Acute Respiratory infections in the last 76.5 73.4
two weeks who were given treatment
Children who had check up within 24 hours after 19.1
delivery
Children who had check up within 10 days of delivery 20.0

1. Health Facilities in Sitamarhi District

Sitamarhi district has one Sadar Hospital (DH) located in Sitamarhi City. Sub Divisional Hospital is under Construction in
Pupri. The district has a total of 17 Primary Health Centres (PHCs), 54 Additional Primary Health Centres (APHCs) and 341
Health Sub centres (HSCs). The district has One Referral Hospitals located at Mejarganj. The two operational blood bank is
at one in Sadar Hospital & second in Pupri in Sitamarhi district. The planning team for the DHAP undertook a
comprehensive mapping and situational analysis of these health facilities in terms of infrastructure, human resources and
service delivery.

24
Human Resources for Health in Sitamarhi

2(A) Medical Officers

Sitamarhi currently has 144 regular doctors sanctioned out of which 104 are present. Similarly 56 contractual positions are
sanctioned for doctors against which only 35 MBBS & 41 AYUSH, are posted. 15 Specialist doctors are also posted.

2(B) Staff Nurses

The total number of positions sanctioned under this category is 17, in position 12 Grade A nurses (Regular) and contractual
staff nurse is 108 out of which 59 is in positioned.

2(C) ANM

The total number of positions sanctioned under the regular ANM is 341, in position 202.
And ANM(R) sanctioned post is 341 out of which 115 are in position.

2(D) LHV

Total number of positions sanctioned post is 29 out of which 5 are in position.

2(E) Health Educator

Total number of positions sanctioned post is 28 out of which 20 are in position.

DHAP PROCESS IN DISTRICT SITAMARHI

The District Health Action Plan of Sitamarhi has been prepared under the guidance of the Chief
Medical Officer, Additional Chief Medical Officer, All District Programme officer of Sitamarhi and
District Programme Management Unit (DPMU) DHS with a joint effort of the Block Programme
Management Unit (BPMU), Rogi Kalyan Samiti, District Health Educator, the BMOs and various
M.O-PHCs as well as other concerned departments under a participatory process. The field staff of the
department has also played a significant role. Public Health Resource Network has provided technical
assistance in estimation and drafting of various components of this plan.

Process of Plan Development

Preliminary Phase

The preliminary stage of the planning comprised of review of available literature and reports.
Following this the research strategies, techniques and design of assessment tools were finalized. As a
preparatory exercise for the formulation of DHAP secondary Health data were complied to perform a
situational analysis.
Main Phase – Horizontal Integration of Vertical Programmes

The Government of the State of Bihar is engaged in the process of re – assessing the public healthcare
system to arrive at policy options for developing and harnessing the available human resources to
make impact on the health status of the people. As parts of this effort present study attempts to
address the following three questions:

1. How adequate are the existing human and material resources at various levels of care (namely
from sub – center level to district hospital level) in the state; and how optimally have they
been deployed?
2. What factors contribute to or hinder the performance of the personnel in position at various
levels of care?
3. What structural features of the health care system as it has evolved affect its utilization and
the effectiveness?

25
With this in view the study proceeds to make recommendation towards workforce management with
emphasis on organizational, motivational and capacity building aspects. It recommends on how
existing resources of manpower and materials can be optimally utilized and critical gaps identified
and addressed. It also commends at how the facilities at different levels can be structured and
organized.

he study used a number of primary data components which includes collecting data from field through
situation analysis format of facilities that was applied on all HSCs and PHCs of Sitamarhi district. In
addition, a number of field visits and focal group discussions, interviews with senior officials, Facility
Survey were also conducted. All the draft recommendations on workforce management and
rationalization of services were then discussed with employees and their associations, the officers of
the state, district and block level, the medical profession and professional bodies and civil society.
Based on these discussions the study group clarified and revised its recommendation and final report
was finalized.
Government of India has launched National Rural Health Mission, which aims to integrate all the
rural health services and to develop a sector based approach with effective intersectoral as well as
intrasectoral coordination. To translate this into reality, concrete planning in terms of improving the
service situation is envisaged as well as developing adequate capacities to provide those services. This
includes health infrastructure, facilities, equipments and adequately skilled and placed manpower.
District has been identified as the basic coordination unit for planning and administration, where it has
been conceived that an effective coordination is envisaged to be possible.
is Integrated Health Action Plan document of Sitamarhi district has been prepared on the said context.

Preparation of DHAP

The Plan has been prepared as a joint effort under the guidance of Civil Surgeon, all incharge
programme officers as well as the MOICs, Block Health Managers, ANMs, as a result of a
participatory processes as detailed below. After completion the DHAP, a meeting is organized by
Civil Surgeon with all MOIC of the block and all programme officer. Then discussed and displayed
prepared DHAP. At last it has been approved by the chairman of the District Health Society. If any
comment has came from participants it has added then finalized. The field staffs of the department too
have played a significant role. District officials have provided technical assistance in estimation and
drafting of various components of this plan.
After a thorough situational analysis of district health scenario this document has been prepared. In
the plan, it is addressing health care needs of rural poor especially women and children, the teams
have analyzed the coverage of poor women and children with preventive and promotive interventions,
barriers in access to health care and spread of human resources catering health needs in the district.
The focus has also been given on current availability of health care infrastructure in
pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved
through a participatory and consultative process, wherein community and other stakeholders have
participated and ascertained their specific health needs in villages, problems in accessing health
services, especially poor women and children at local level.

26
District Health Action Plan Planning Process

- State level Fast track training on DHAP.

- Collection of Data through various sources
- Understanding Situation
-Assessing Gap
-Orientation of Key Medical staff, Health Managers
on DHAP at district level

-Block level Meetings

-Block level meetings organized at each level
by key medical staff and BMO

-District level meetings

-District level meeting to compile information
-Facilitating planning process for DHAP

Approval from the District

Magistrate

27
 District Profile

District Health Administrative Setup

Sitamarhi
SHS
State

District
Zila Parisad Magistrate DHS,
Civil Surgeon

ACMO
District
Programme District Program MO
Manager Officers
DCM PHC-MOIC 1. NLEP 1. Medical Specialist
2. RNTCP 2. Surgical Specialist
Panchayat Samiti
3. Malaria 3. Gynecologist
APHC-MO 4. Filaria 4. Anesthetist
Rogi kalyan 5. Kala Azar
Samiti 6. Immunization
BHM HSC-
7. Blindness
ANM
Gram Panchayat BCM 8. IDSP
M
Community
ASHA
VHSC
AWW
LRG(Local Resource
Group- Dular)

28
Situational Analysis:

29
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54
SITUATION ANALYSIS OF HSC, APHC, PHC, RH, & DH
The three tiers of the Indian public health system, namely village level Sub centre, Additional
Primary Health Centre and Primary Health Centres were closely studied for the district of
Sitamarhi on the basis of three crucial parameters:

1) Infrastructure
2) Human resources and
3) Services offered at each health facility of the district.

The Indian Public Health System (IPHS) norms define that a Village Health Sub centre should be
present at the level of 5000 population in the plain regions and at 2500-3000 population in the
hilly and tribal regions. As most of the Sitamarhi is situated in the plain terrain, the norm of Sub
centre per 5000 population is expected to be followed. A sub centre is supposed to have its own
building with a small OPD area and an examination room.. Sub centres are served by an ANM,
Lady Health Volunteer and Male Multipurpose Health Worker and supported by the Medical
Officer at the APHC. Sub centres primarily provide community based outreach services such as
immunisation, antenatal care services (ANC), prenatal and post natal care and management of
mal nutrition, common childhood diseases and family planning. It provides drugs for minor
ailments such as ARI, diarrhoea, fever, worm infection etc. The Sub centre building is expected
to have provisions for a labour room, a clinic room, an examination room, waiting area and toilet.
It is expected to be furnished with essential equipment and drugs for conducting normal
deliveries and providing immunisation and contraceptive services. In addition equipment for first
aid and emergency care, water quality testing and blood smear collection is also expected to be
available.

The Primary Health Centre (PHC) is required to be present at the level of 30,000 populations in
the plain terrain and at the level of 20,000 populations in the hilly region. A PHC is a six bedded
hospital with an operation room, labour room and an area for outpatient services. The PHC
provides a wide range of preventive, primitive and clinical services. The essential services
provided by the PHC include attending to outpatients, reproductive and child health services
including ANC check-ups, laboratory testing during pregnancy, conducting normal deliveries,
nutrition and health counselling, identification and management of high risk pregnancies and
providing essential newborn care such as neonatal resuscitation and management of neonatal
hypothermia and jaundice. It provides routine immunisation services and tends to other common
childhood diseases. It also provides 24 hour emergency services, referral and inpatient services.
The PHC is headed by an MOIC and served by two doctors. According to the IPHS norms every
24 *7 PHC is supposed to have three full time nurses accompanied by 1 lady health worker and 1
male multipurpose worker. NRHM stipulates that PHCs should have a block health manager,
accountant, storekeeper and a pharmacist/dresser to support the core staff.

According to the IPHS norms, a Community Health Centre (CHC) is based at one lakh twenty
thousand population in the plain areas and at eighty thousand populations for the hilly and tribal
regions. The Community Health Centre is a 30 bedded health facility providing specialised care
in medicine, obstetrics & gynaecology, surgery, anaesthesia and paediatrics. IPHS envisage CHC
as an institution providing expert and emergency medical care to the community.

In Bihar, CHCs are absent and PHCs serve at the population of one lakh while APHCs are
formed to serve at the population level of 30,000. The absence of CHC and the specialised health
care it offers has put a heavy toll on PHCs as well as district and sub district hospitals. Moreover
various emergency and expert services provided by CHC cannot be performed by PHC due to

55
non availability of specialised services and human resources. This situation has led to negative
outcomes for the overall health situation of the state.

On different level, there are various institutions in the health system from where health facilities
are being provided to the people. The IPH standard specifies the properties, requirements and
service specifications of all institutions. In the network of health system of a district, there are
following hierarchy of institutions at different level-:

DistrictHospital
District Level

Sub-Divisional
Sub- Division Level Hospital

FRU Referral
Hospital/CHC

Block Level BPHC

APHC
Halka Level

Village Level HSC

In the present situational analysis of Sitamarhi district, we will try to find out answer of the
following questions-
 Is there sufficient no. of HSC, APHC, BPHC, CHC, Sub-divisional hospital & District
Hospital sanctioned as per IPH standard?
 What are the gaps between no. of required and sanctioned institutions?
 Whether all institutions have resources, manpower and infrastructure as per IPH norms
or not?
 Whether all institutions are providing the health services as per IPH norms or not?
 Is there sufficient fund allotment for institutions and programs?
 What are the activities that will improve the quality of services and will make it more
reliable?District

DThe situation analysis on the basis of no. of institutions, infrastructure, manpower,

services and budget is given below

56
Health Sub Center: Health Sub Center is the first line service deliverable institutions from
where different types of services are provided to women and children. The objectives of IPHS for
Sub-Centre's are:
 To provide basic Primary health care to the community.
 To achieve and maintain an acceptable standard of quality of care.
 To make the services more responsive and sensitive to the needs of the community.

No. of Institutions (Health Sub Center)

As per IPH standard at every 5000 population one HSC has to be established.
District Maximum HSC required No. of Sub center Gaps in No.
Population as per IPH Norms @ already sanctioned/ of HSC
(2011) 5000 people established
34,19,622 684 341 343

To obtain 100% IPH standard -: Need to sanction 343 new HSC to achieve 100% IPH
standard.
Table presents the additional requirements of Sub centres as per population norms mandated by
IPHS as well as according to the database available with District Health Society Sitamarhi. As
per IPHS norms, Sitamarhi district requires a total of 684 Sub centres of which 213 are
functioning in the district. 128 more have currently become functional and 343 more required as
per IPHS. At the Sub centre level infrastructure poses major constraints. The analysis reveals that
of the existing 213 HSCs, only 166 are situated in any building premises. Out of these 166, 71
are in a Government building and 95 are in rented buildings. Out of the 47 remaining Subcenters,
buildings are under construction for 41 of them. 47 HSCs still do not have any building. The 41
HSCs operating in Govt buildings are currently being renovated. It is also important to note that
no Sub centre in the district has received untied funds.

In the present situational analysis of the blocks of district Sitamarhi the vital statistics or the
indicators that measure aspects of health/ life such as number of births, deaths, fertility etc. have
been referred from census 2001,2011, report of DHS office, Sitamarhi and various websites as
well as other sources. These indicators help in pointing to the health scenario in Sitamarhi from a
quantitative point of view, while they cannot by themselves provide a complete picture of the
status of health in the district. However, it is useful to have outcome data to map the effectiveness
of public investment in health. Further, when data pertaining to vital rates are analyzed in
conjunction with demographic measures, such as sex ratio and mean age of marriage, they throw
valuable light on gender dimension. Table below indicates the Health indicators of Sitamarhi
district with respect to Bihar and India as a whole.

GAPS IN INFRASTRUCTURE: BPHC

Population
80000-120000

Population
APHC 20000-30000

Population
HSC
5000
First contact point with community

57
Introduction:
Health Sub Centre is very important part of entire Health System. It is first available
Health facility nearby for the people in rural areas. We are trying to analyze the situations at
present in accordance with Indian Public Health Standards (IPHS).
Infrastructure for HSCs:

IPHS Norms:

1.Location of the centre: The location of the centre should be chosen that:
a. It is not too close to an existing sub centre/ PHC
b. As far as possible no person has to travel more than 3 Km to reach the Sub centre
c. The Sub Centre Village has some communication network (Road
communication/Public Transport/Post Office/Telephone)
d. Accommodation for the ANM/Male Health Worker will be available on rent in the
village if necessary.

58
For selection of village under the Sub Centre, approval of Panchayats as may be considered
appropriate is to be obtained.
i. The minimum covered area of a Sub Centre along with residential Quarter for ANM
will vary from 73.50 to 100.20 sq mts. depending on climatic conditions(hot and dry
climate, hot and humid climate, warm and humid climate), land availability and with
or without a labor room. A typical layout plan for Sub-Centre with ANM residence as
per the RCH Phase-II National Programme implementation Plan with area/Space
Specifications is given below

Typical Layout of Sub- Centre with ANM Residence

Waiting Area : 3300mm x 2700mm

Labour Room : 4050mm x 3300mm
Clinic room : 3300mm x3300mm
Examination room : 1950mm x 3000mm
Toilet : 1950mm x 1200mm

Residential accommodation : this should be made available to the Health workers with
each one having 2 rooms, kitchen, bathroom and WC. Residential facility for one ANM is
as follows which is contiguous with the main sub centre area.
Room -1 (3300mm x 2700mm)
Room-2(3300mm x 2700mm)
Kitchen-1(1800mm x 2015mm)
W.C.(1200mm x 900mm)
Bath Room (1500mm x 1200mm)
One ANM must stay in the Sub-Centre quarter and houses may be taken on rent for the
other/ANM/Male Health worker in the sub centre village. This idea is to ensure that at
least one worker is available in the Sub-Centre village after the normal working hours.
For specifications the “Guide to health facility design” issued under Reproductive and
Child Health Program (RCH-I and II) of Government of India, Ministry of Health and
Family Welfare may be referred.

59
 Item IPHS Norms Maximum Present Status Gaps Task for 2012-13 Budget for
requirement (2012-13)
Amount (in
Rs.)
The minimum covered area of 684 Sitamarhi have 213 341 100 100X2000000
a Sub Center along with (Max. HSC as established Health =20,00,00,000
residential Quarter for ANM per IPHS) Sub Centers and
will vary from 73.50 to 100.20 128 more Health
Physical Infrastructre

sq meters. sub centers are

proposed to be
establish new
building. Again, out
of 213 established
HSCs, only 68 have
their own buildings
and rest 145 run in
rented houses. All
these 68 HSCs need
new buildings.
Examination Table-1 1X 341 = 341 All HSc required 341 All 341X 12000=
Writing table- 2 2X 341 = 682 Furnitures sanctioned/established 4092000
Armless chairs 3 3X 341 = HSc 682X 8000 =
Medicine Chest 1 1023 5456000
Labour table 1 1X 341 = 341 1023X2000=
Wooden screen 1 1X 341 =341 2046000
Foot step 1 1X341 = 341 341X 5000=
Coat rack 1 1X 341 =341 1705000
Bed side table 1 1X 341 = 341 341X 8000=
Stool 2 1X 341 =341 2728000
Almirahs 1 2X 341 = 682 341X 1000=
Lamp 3 1X 341 = 341 341000
Side Wooden racks 2 3X 341 = 341X 200 =
Fans 3 1023 68200
Tube light 3 2X 341 = 682 341X 1000 =
Basin stand 1 3X 341 = 341000
Furniture

1023 341X 500 =

3X 341 = 170500
1023 341X 300 =
1X 341 = 102300
1023 341X12000=
4092000
1023 X 200=
204600
341 X 1500=
511500
1023X 1500=
1534500
1023X 250=
255750
341x
1500=511500
Total-
24159850

60
 Basin Kidney 825ml 2X341=682 All HSc required 341 341
Tray instrument 1X341=341 equiepments Total -
Jar Dressing 1X341=341 5,0000000
Hemoglobin meter 1X341=341 (Approx.)
ForcepsTissue160mm 1X341=341 (To provide all
Forceps sterilizer 1X341=341 listed
Scissors surgical 1X341=341 Equipments to
Reagent strips forurine 1X341=341 all
Scale, Infant metric 2X341=682 working 341
Equiepment

Sterilization kit 8X341=2728 HSC)

Vaccine Carrier 20X341=6820
Ice pack box 12X341=4092
Forceps 12X341=4092
Suture needle straight 12X341=4092
Suture needle curved 20X341=6820
Syringe 1X341=341
Disposable gloves 20X341=6820
Clinical Thermometer 1x 341= 341
Torch 1x 341= 341
weighing (baby) 1X341= 341
weighing (Women) 1X341= 341
Stethoscope 1X341= 341
Kit A All HSc required 341 341 Total -
ORS 150X341= Drugs 5,0000000
IFA Tab. (large) 15000X341= (Approx.)
IFA Tab. (small) 13000X341= (To provide all
Vit. A Solution(100 ml) 6X341= listed
CotrimoxazoleTab(child) 1000X341= Medicine to all
Kit B working 341
Tab.Methylergometrine 480X341= HSC
Maleate (0.125mg) 500X341=
Drugs

Paractamol (500mg) 10X341=

Inj.Methylergometrine 300X341=
Maleate 180X341=
Tab.Mebendazole(100 mg) 5X341=
Tab.Dicyclomine HCl. (10 125X341=
mg) 120X341=
Ointment Povidone Iodine5% 10X341=
Cetrimide Powder
Cotton Bandage
Absorbant Cotton (100 gm
each)
Manpower
Manpower IPHS Maximum Present Gaps Task for Budget for (2012-13)
manpower Manpower 2012-13
required
Health worker 2 2x341=682 162(Regular) 179+ 179+ 682X15000X12=110160000/00
(female) 115(ANM 226 226
R)
Health worker 1 1x341=341 Nil 341 341 341X6000X12=24552000/00
(male) (funded and
appointment by the
state government)
Support Services
Minimum facilities like estimatIon of 341 341 341 341 40,00,000(Approx)
haemoglobin by using a Approved
Haemoglobin Colour Scale, urine test for the
Laboratory

presence of protein by using Uristix, and

urine test for the presence of sugar by using
Diastix should be available. Haemoglobin
Colour Scale Uristix Diastix
Wherever facility exists, 341 341 341 341 341x20000=
Electricity

Uninterrupted power supply has 68,20,000

to be ensured for which inverter facility
/solar power facility is to be
provided.Solar power set
Potable water for patients and staff and water 341 341 341 341
for other uses should being adequate quantity.
Towards this end, adequate water supply
should be ensured and safe water may be
provided by use of technology like filtration,
Water

chlorination, etc. as per the

suitability of the center.

61
 Where ever feasible, telephone facility / cell 341 341 341 341 341x1500+341x100x12=
phon
Tele
phone facility is to be 9,20,700
e Provided. Mobile phone
Services and Others
Sub Heads Gaps Issues Strategy Activities Budget

Out of 213 1. Non payment of 1. Ensuring 1. Budget to construct 341 HSC is given Rent for HSC
only 68 HSC rent payment of rent till above. Construction of building is time 273X1000X12=
have 2. Land own buildings are taking process. So, timely payment of rent 32,76,000
its own availability not constructed. is needed
building, for new building 2. Involvement of 2. DM should instruct the CO to
remaining are DM to arrange arrange land for HSC.
running in land.
rented
building
Infrastructure

Infrastructure

Purchasing No, excuse. There is no other way except Detail budget

Lack of Equipments, purchasing all required resources. has been given
Equipments, HSC are working Drugs, Furniture, above
Drugs, but without and Power etc. as
Furniture , resources per IPH standard.
Power
Untide fund are available but problem in
Formats/ Arrangements of handleling. Untide fund is operated jointly 341X10,000=
Registers Always it is found fund for these by ANM & PRI people but they have no 34,10,000
and that HSC is miscellaneous proper knowledge to handle it. Only one
Stationeries lacking expenses PRI e.i Mukhiya (Pradhan) should be
(Untied fund stationeries authorized for joint account and then proper
orientation should be given them.
No Skilled staff to Arrange all Purchase Drug, equipments, furniture as per Detail budget
institutional perform required IPHS. Arrangement of Ambulance at APHC has been given
delivery at Institutional resources to & PHC level to quickly send patients in above
HSC level delivery is perform bigger hospital in case of complications.
available but institutional
lacking delivery.
resources.
1. In compare to 1. Make 1. Need to aware village women through Detail budget
delivery there are community Orientation program. Regular supply of has been given
Poor ANC poor percentages aware about the TT & IFA. above
of pregnant merit of ANC 2. Ensure availability of drug and
women 2. Make system Equipments necessary for check up
registration. more reliable.
2. Minimum three
antenatal check-
ups
Poor Post 1.A minimum of 2 Ensuring Strict rule to compel ANM to visit at home. No need of
Natal postpartum home minimum 2 Orientation & Training program of ANM extra Budget.
Care visits Postpartum visits over early breast feeding, on diet & rest, Orientation &
2. Initiation of at home. hygiene, contraception, essential new Training
Services of HSCs

early breast- Ensuring borncare program can

feeding within counseling on be organized
half-hour of early breast from Untied
birth feeding, on diet & fund.
3. Counseling on rest, hygiene,
diet & rest, contraception,
hygiene, essential newborn
contraception, care
essential new born
care,
Infant and young
child feeding.
Family Counseling and Start MTP First purchase the essential equipments and Detail budget
Planning appropriate Services at drugs listed above. Training/refreshing of equipments
and referral for safe HSC level. course of and drugs has
Contraception abortion suitable ANM. been given
services (MTP) for above
those in need.
RNTCP Eradication of Easy availability Referral of suspected symptomatic cases to Budget will be
TB of drugs & referral the PHC/Microscopy center given under
of Provision of DOTS at sub centre and proper RNTCP head
patients. documentation and follow-up
AIDS, Eradication & Making people IEC activities to enhance awareness and For IEC
Blindness, Control aware about preventive measures about AIDS, 341X5000=
Leprosy, these disease Blindness, Leprosy, Malaria, Kala 17,05,000
Malaria, azar, Japanese Encephalitis, Filariasis,

62
 Kala azar, Dengue etc and control of
Japanese Epidemics
Encephalitis,
Filariasis,
Dengue
etc and
control of
Epidemics
Child 1. No 100% child Working at various 1. Preparation of micro plan at PHC Vaccine is
Immunization immunization levels to obtain level. Special Plan for hard to reach supplied from
2. Drop out cases 100 % area. state. So, no
3. Shortage of Child 2. Proper monitoring. need to
vaccine. immunization. 3. Filling up immunization card to follow prepare the
up. budget at
4. Vaccine is supplied from state that is district level
irregular. So, ensure availability of all
vaccine to increase reliability.
5. To control drop out cases if possible new
vaccine like Easy 5 and MMR
should supply.
Budget Summary (Health Sub Centre)
Head Sub head Budget Remarks
Infrastructure Physical Infrastructure 20,00,00,000
Furniture 2,41,59,850
Equiepments 5,00,00,000
Drugs 5,00,00,000
Laboratory 40,00,000
Electricity 68,20,000
Telephone 9,20,700
Manpower Health worker(Female) 11,01,60,000
Health worker(Male) 2,45,52,000
Services of HSc Infrstructure(Rent) 33,00,000 For 275 HSC
Untied Fund 34,10,000
Annual Maintenance 17,50,000 25000*70=17,50,000
Grant(70)
IEC 17,05,000
Total 48,07,53,550

63
Additional Primary Health Center are the cornerstone of rural health services- a first port of
call to a qualified doctor of the public sector in rural areas for the sick and those who directly
report or referred from Sub-center for curative, preventive and promotive health care. A
typical Primary Health Center covers a population of 20,000 in hilly, tribal, or difficult areas
and 30,000 populations in plain areas with 4-6 indoor/observation beds. It acts as a referral
unit for 6 sub-center and refer out cases to PHC (30 bedded hospital) and higher order public
hospitals located at sub-district and district level.
In Bihar Additional PHCs operate at the population of 30,000. The APHC is the cornerstone
of the public health system since it serves as a first contact point for preventive, curative and
promotive health services. It is the first port of the public health system with a full time
doctor and provision for inpatient services. There are 36 functional APHCs in Sitamarhi. 22
new APHCs are newly sanctioned. In general the APHCs in Sitamarhi suffer from:
1) Lack of facilities including availability of building
2) Constant power and water shortages
3) Unavailability of doctors
4) Doctors not residing at the facility
5) Insufficient quantities of drugs and equipment
6) Lack of capacity to use untied funds.
The objectives of IPHS for APHCs are:
I. To provide comprehensive primary health care to the community through the Additional
Primary Health Center.
ii. To achieve and maintain an acceptable standard of quality of care.
iii. To make the services more responsive and sensitive to the needs of the community.

No. of Institutions (Additional Primary Health center)

As per IPH standard at every 30,000 population one APHC has to be established.

District Population Maximum APHC No. of APHCs already Gaps in No. of APHC
(2011) required as per IPH sanctioned/
Norms @ 30,000 people established

34,19,622 114 56 68

To obtain 100% IPH standard -: Need to sanction 68 new APHC to achieve 100% IPH standard.
Task for 2012-13 -:Make functional(24X7) to 56 APHC

64
Item IPHS Norms Maximum Present Status Gap Task Budget for
requireme s for (2012-13)
nt 2012-13
It should be well planned with the entire necessary 114 Sitamarhi have 34 56 20 20X1,00,00,000=
(Max. established Rs20,00,00,000
infrastructure. It should be well lit and ventilated with APHCs and 22
APHCs
as much use of natural light and ventilation as possible. as
more APHCs are
Physical Infrastructre

proposed to be
The plinth area would vary from 375 to 450 sq. meters per establish new
depending on whether an OT facility is opted for. IPHS) building. Again,
out of 34
established
APHCs, only 8
have their own
buildings and rest
26 run in rented
houses. All these
08 APHCs need
new buildings.
Examination table 3 Sundry Articles including 114 All APHc 56 All 10,00,000(Apprx
Writing tables with table Linen: required sanctio ) per APHC
sheets 5 Buckets 4 Furnitures ned/est Total -
Plastic chairs 6 Mugs 4 ablishe 10,00,000 X 56=
Armless chairs 8 LPG stove 1 d 5,60,00,000
Full steel almirah 4 LPG cylinder 2 APHc (To provide all
Labour table 1 Sauce pan with lid 2 listed furniture
OT table 1 Water receptacle 2 to all
Arm board for adult and child Rubber/plastic shutting 2 APHC)
4 meters
Wheel chair 1 Drum with tap for storing
Stretcher on trolley 1 water 2
Instrument trolley 2 I V stand 4
Furniture

Wooden screen 1 Mattress for beds 6

Foot step 5 Foam Mattress for OT
Coat rack 2 table 1
Bed side table 6 Foam Mattress for labour
Bed stead iron 6 table 1
Baby cot 1 Macintosh for labour and
Stool 6 OT table 4 metres
Medicine chest 1 Kelly‟s pad for labour and
Lamp 3 OT table 2 sets
Shadowless lamp light Bed sheets 6
(for OT and Labour room) Pillows with covers 8
Side Wooden racks 4 Blankets 6
Fans 6 Baby blankets 2
Tube light 8 Towels 6
Basin 2, Basin stand 2 Curtains with rods 20 Metres

65
 • Normal Delivery Kit • Phototherapy unit Maximu All APHc 56 56 10,00,000(Apprx
• Equipment for assisted • Self inflating bag and mask- m required ) per APHC
vacuum delivery neonatal size APHC is equiepments Total -
• Equipment for assisted • Laryngoscope and Endotracheal 114 10,00,000 X56=
forceps delivery intubation tubes (neonatal) So 5,60,00,000
• Standard Surgical Set • Mucus extractor with suction tube requirem (To provide all
• Equipment for New Born and a foot operated suction machine ent listed
Care and Neonatal • Feeding tubes for baby 28 is equipments to all
Resuscitation • Sponge holding forceps - 2 according APHC)
• IUD insertion kit • Valsellum uterine forceps - 2 ly
• Equipment / reagents for • Tenaculum uterine forceps – 2
essential laboratory • MVA syringe and cannulae of
investigations sizes 4-8
Equiepment

• Refrigerator • Kidney tray for emptying contents

• ILR/Deep Freezer of MVA syringe
• Ice box • Trainer for tissues
• Computer with accessories • Torch without batteries – 2
including internet facility • Battery dry cells 1.5 volt (large
• Baby warmer/incubator. size) – 4
• Binocular microscope • Bowl for antiseptic solution for
• Equipments for Eye care soaking cotton swabs
and vision testing • Tray containing chlorine solution
• Equipments under various for keeping soiled instruments
National Programmes • Residual chlorine in drinking
• Radiant warmer for new water testing kits
borne baby • H2S Strip test bottles
• Baby scale
• Table lamp with 200 watt
bulb for new borne baby
Oxytocin - Inj-Amp 1 ml Ranitidine Hydochloride Tablet 114 All APHc 56 56 Total -
(5i.u./ml) 150mg required Drugs 10,00,00,000
5% Dextrose 500 ml bottle Metoclopramide Tablet- 10mg (Approx.)
B Complex Tab Diethylcarbamazine Tablet- 50mg (To provide all
Gentamicin - Ear/Eye Drop 5 Paracetamol Dicyclomine Tablet listed
ml (500mg+20mg) Medicine to all
Promethazine - Inj-Amp. 2ml Fluconazole Tablet 50mg APHC)
amps (25 mg/ml) DiethylcarbamazineTablet
Pentazocine Lactate Inj. Inj- 100mg
Amp.- 1 ml (30 mg/ml) Xylometazoline Drops - 0.1%
Diazepam - Inj-Amp. 2ml (Nasal) 10ml vial.
amps (5mg/ml) A.R.V.
Cough Expectorant 100 ml Theophyline IP Combn. 25.3mg/ml
pack Aminophyline Inj. IP 25mg/ml
Ampicillin 250mg Capsule Adrenaline Bitrate Inj. IP 1mg/ml
Ampicillin 500mg Capsule Methyl Ergometrine Maleate
Drugs

Cetrizine Tablet - 10mg 125mg/Tablet, Injection

Doxycycline Capsule-100mg Amoxycilline Trilhydrate IP
Etophylline & Theophylline 250mg/Capsule
Inj.2ml Amoxycilline Trilhydrate IP
Fluconazole Tablet – 200mg 250mg/Dispersible Tab.
Dicyclomine Tablets - 20mg Phenoxymethyl Penicillin
Dexamethasone Inj.- 4mg/ml- 130mg/ml
10ml Vial Vit K3 (Menadione Inj.)
Atropine Inj. 0.6mg/ml - 1ml USP100mg/ml
Ampoule Lignocaine Solution Nalidixic Acid Tabs. 100mg/Tab
2% Solution 2%- 30ml Vial Phenytoin Sodium Inj. IP 50mg/2ml
Diazepam Tablet- 5mg Chlorpromazine Inj.- 4mg/ml- 10ml
Chlorpheniramine Maleate Vial
Tablet 4mg Atropine In
Cephalexin ) Capsule- 250mg
Metronidazole Tablet- 200mg
Support Services
1. Routine urine, stool and blood tests 114 56 56 56 Budget for
2. Bleeding time, clotting time, Laboratory
3. Diagnosis of RTI/ STDs with wet mounting, Grams stain, etc. Equipments=2,0
4. Sputum testing for tuberculosis (if designated as a microscopy center 0,000X56APHCs
Laboratory

under RNTCP) = 1,12,00,000

5. Blood smear examination for malarial parasite.
6. Rapid tests for pregnancy / malaria
7. RPR test for Syphilis/YAWS surveillance
8. Rapid diagnostic tests for Typhoid (Typhi Dot)
9. Rapid test kit for fecal contamination of water
10. Estimation of chlorine level of water using orthotoludine reagent

66
Electricity Wherever facility exists, uninterrupted power supply has to be ensured 114 56 56 56 Generator
for which Generator and inverter facility is to be provided. service can be
out sourced.
56 X 1,00,000 X
12=6,72,00,000
Potable water for patients and staff and water for other uses should being 114 56 56 56
Water

adequate quantity. Towards this end, adequate water supply should be

ensured and safe water may be provided by use of technology like
filtration, chlorination, etc. as per the suitability of the center.
Where ever feasible, telephone facility / cell phone facility is to be 114 56 56 56 Total 56 X1500
Telepho

Provided. Mobile phone +56X12X100 =

ne

84,000+67200=1
,51,200
The APHC should have an ambulance for transport of patients. This may Ambulance
be outsourced. service may be
Transport

outsourced
Total-56X 15000
X 12=
1,00,80,000
Laundry and Dietary facilities for indoor patients: these facilities Laundry and
can be outsourced. Dietary facilities
can be
and Dietary
facilities
Laundry

outsourced
10,000 per
APHC per month
Total -56 X
1,00,000 X12 =
6,72,00,000

Services and Others

Sub Heads Gaps Issues Strategy Activities Budget

Out of 56 1. Non 1. Ensuring 1. Budget to construct Rent forAPHC

only 8 payment of payment of 56APHC is given above. 48X1000X12=
APHC have rent rent till own Construction of building is 5,76,000
its own 2. Land buildings are time taking process. So,
building, availability not timely payment of rent is
remaining for new constructed. needed
are running in building 2. Involvement 2. DM should instruct the CO
rented of DM to to
building arrange land. arrange land for HSC.
Infrastructure

Infrastructure

Lack of HSC are Purchasing No, excuse. There is no other Detail budget
Equipments, working Equipments, way except purchasing all has been given
Drugs, but without Drugs, required resources. above
Furniture resources Furniture, and
Power Power etc. as
per IPH
standard.
Formats/ Always it Arrangements Untide fund are available 56X25,000=
Registers is found of fund for but.no initiation is taken by 14,00,000
and that HSC these APHC MO.
Stationeries is miscellaneous
(Untied fund lacking expenses
stationeries
No No Arrange all Purchase Drug, equipments, Detail budget
Institutional services of required furniture as per IPHS. Hire has been given
delivery at delivery. resources to required manpower to support above
Services of HSCs

HSC level perform this service. Arrangement of

institutional Ambulance at APHC & PHC
delivery. level to quickly send patients
in bigger hospital in case of
complications.
Medical care Non OPD Services 6 hours in the morning and 2 Nothing new
Functional hours in the evening for
24 hours Minimum OPD Attendance these services
emergency should be 40 patients per Detail budget

67
 services doctor per day. has been given
Appropriate management of above.
Referral injuries and accident, First
services In- Aid, Stabilization of the
patient services condition of the patient before
(6 beds) referral, Dog bite/snake
bite/scorpion bite cases, and
other emergency conditions
Ambulance Service to
support referral
Provision of diet, light,
laundry etc to start indoor
service.
Maternal Non Antenatal care Start immunization properly. Nothing new
and functional Intra-natal care start JBSY at APHC level for
Child Health Postnatal Care Establish lab for minimum these services
Care New Born care investigations like Detail budget
Care of the hemoglobin, urine albumin, has been given
child and sugar, RPR test for above
syphilis
Nutrition and health
counseling
Promotion of institutional
deliveries
Conducting of normal
deliveries
Assisted vaginal deliveries
including forceps /vacuum
delivery whenever required
Manual removal of placenta
Appropriate and prompt
referral for cases needing
specialist care.
Management of Pregnancy
Induced hypertension
including referral
Pre-referral management
A minimum of 2 Postpartum
home visits, first within 48
hours of delivery, 2nd within
7 days through Sub-center
staff.
Initiation of early
breastfeeding within half-
hour ofbirth
Education on nutrition,
hygiene, contraception,
essential new born care
Family No FP 1. Start FP Education, Motivation and No need of
Planning operation operation counseling to adopt extra Budget.
Contraception at 2.Distribution appropriate Family Planning Orientation &
& MTP APHC of methods. Training
level. contraceptives Provision of contraceptives program can
such as such as condoms, oral pills, be
condoms, oral emergency organized
pills, Contraceptives, IUD from
emergency insertions. Untied fund.
Contraceptives. Permanent methods like
3. IUD Tubal ligation and
insertions vasectomy/ NSV.
Follow up services to the
eligible couples adopting
permanent methods
Counseling and appropriate
referral for safe abortion
services (MTP) for Those in
need.

68
 Counseling and appropriate
referral for couples having
infertility.
RNTCP No DOT Treatment and All APHCs to function as Budget will be
center at Distribution of DOTS Centers to given under
APHC drug. deliver treatment as per RNTCP head
RNTCP treatment guidelines
through DOTS providers and
treatment of common
complications of TB and side
effects of drugs, record and
report on RNTCP activities as
per Guidelines.
Integrated No IDSP Need to start APHC will collect and Budget for
Disease IDSP analyze data from sub-center Computer
Surveillance and will report Information to operator and
Project PHC surveillance unit. Stationary.
(IDSP) Appropriate preparedness and 56X
first level action in out-break 7500X12=
situations. 50,40,000
Laboratory services for
diagnosis of Malaria,
Tuberculosis, Typhoid and
tests for detection of faucal
Contamination of water
(Rapid test kit) and
chlorination level.
National No NPCB Need to start Diagnosis and treatment of Budget will be
Program program NPCB common eye diseases. given under
for Control Program Refraction Services. District
of Detection of cataract cases Blindness
Blindness and referral for cataract program head
(NPCB) surgery.
National Starting AIDS IEC activities to enhance Budget will be
AIDS control awareness and preventive given under
Control program at measures about STIs and District AIDS
Program APHC level HIV/AIDS, Prevention of program head
Parents to
Child Transmission
Organizing School Health
Education Programme
Screening of persons
practicing high-risk behaviour
with one rapid test to be
conducted at the APHC level
and development of referral
linkages with the nearest
VCTC at the District Hospital
level for confirmation of HIV
status of those found positive
at one test stage in the high
Prevalence states.
Risk screening of antenatal
mothers with one rapid test
for HIV and to establish
referral linkages with CHC or
District Hospital for PPTCT
Services.
Linkage with Microscopy
Center for HIVTB
coordination.
Condom Promotion &
distribution of condoms to the
high risk groups.
Help and guide patients with
HIV/AIDS receiving ART
with focus on Adherence.

69
 Leprosy, Eradication Making people IEC activities to enhance
Malaria, & Control aware about awareness and preventive
Kala- azar, these disease measures about
Japanese and providing AIDS,Blindness, Leprosy,
Encephalitis, treatments Malaria, Kala azar, Japanese
Filariasis, Encephalitis, Filariasis,
Dengue etc Dengue etc and control of
and control of Epidemics
Epidemics Starting treatment of patients
if reported.
Referral facilities for better
treatment.

Budget Summary (APHCs)

ead Sub head Budget Remarks

Physical Infrastructure 20,00,00,000

Furniture 5,60,00,000
Equiepments 5,60,00,000
Infrastructure

Drugs 10,00,00,000
Laboratory 1,12,00,000
Electricity 6,72,00,000
Telephone 1,51,200
Transport 1,00,80,000
Laundry & Dietry 6,72,00,000
For all 16,86,72,000 MO-30000x4x56x12=8,06,40,000,,ANM(A)-20000x4x56x12=5,37,60,000,
Manpo

Pharmacist-15000x1x56x12=100,80,000,,Accountant(RKS)-
wer

15000x56x12=100,80,000
Dresser-10000x3x56x12=2,01,60,000,Sweeper-6000x1x56x12=40,32,000
Infrstructure(Rent) 11,52,000 48APHC*Rs 2000/M
Services of APHC

Untied Fund 14,00,000

Annual Maintenance 1000000 10*100000
Grant
Seed Money 52,00,000
IDSP 50,40,000
Total 9218719200

70
Primary Health Centers exist to provide health care to every citizen of India within the allocated resources
and available facilities. The Charter seeks to provide a framework which enables citizens to know.
 what services are available?
 the quality of services they are entitled to.
 the means through which complaints regarding denial or poor qualities of services will be
addressed.
Objectives
 to make available medical treatment and the related facilities for citizens.
 to provide appropriate advice, treatment and support that would help to cure the ailment to the
extent medically possible.
 to ensure that treatment is best on well considered judgment, is timely and comprehensive and
with the consent of the citizen being treated.
 to ensure you just awareness of the nature of the ailment, progress of treatment, duration of
treatment and impact on their health and lives, and
 to redress any grievances in this regard.
No. of Institutions (Primary Health center)
As per IPH standard at every 1,00,000 population one PHC has to be established.
District Population Maximum PHC required No. of PHCs already Gaps in No. of PHC
(2011) as per IPH Norms @ sanctioned/
30,000 people established

34,19,622 34 17 17
To obtain 100% IPHS standard -: Need to sanction 8 new PHC to achieve 100% IPHS standard.
Task for 2012-13 -:
 Out of 17 sanctioned PHC all 13 PHC are established and functioning with 24x7Services . So, in
financial year 2012-13, i.e. 4 PHCs will make functional 24x7 Services

71
Ite IPHS Norms Maximum Present Ga Task Budget for
m Requireme Status ps for (2012-13)
nt 2012-13
The PHC should have 30 indoor beds with one Operation 34 (Max. Sitamarhi 17 10 10x1,50,00,00
theatre, labour room, X-ray facility and laboratory facility. PHCs as per have17 0=
Infrastructre

It should be well lit and ventilated with as much use of IPHS) established 15,00,00,000
Physical

natural light and ventilation as possible. The plinth area PHCs & no
would vary from 375 to 450 sq. meters depending on PHCs have
whether an OT facility is opted for. sufficient
Infrastructure
for 30 beds..
Examination table 6 Sundry Articles including 34 All PHC 17 17 10,00000(App
Writing tables with table Linen: required r
sheets 5 Buckets 4 Furnitures x) per PHC
Plastic chairs 50 Mugs 4 Total -
Armless chairs 8 LPG stove 1 10,00,000 X
Full steel almirah 10 LPG cylinder 2 17 =
Labour table 6 Sauce pan with lid 2 1,70,00,000
OT table 5 Water receptacle 2 (To provide
Arm board for adult and Rubber/plastic shutting 2 all
child 4 meters listed furniture
Wheel chair 1 Drum with tap for storing to all
Stretcher on trolley 1 water 2 PHC)
Instrument trolley 2 I V stand 4
Wooden screen 1 Mattress for beds 6
Furniture

Foot step 5 Foam Mattress for OT

Coat rack 2 table 1
Bed side table 6 Foam Mattress for labour
Bed stead iron 6 table 1
Baby cot 1 Macintosh for labour and
Stool 6 OT table 4 metres
Medicine chest 1 Kelly‟s pad for labour and
Lamp 3 OT table 2 sets
Shadowless lamp light Bed sheets 6
(for OT and Labour room) Pillows with covers 8
Side Wooden racks 4 Blankets 6
Fans 6 Baby blankets 2
Tube light 8 Towels 6
Basin 2 Curtains with rods 20
Basin stand 2 Metres

72
 • Normal Delivery Kit • Self inflating bag and Maximum All PHCs 17 17 20,00,000
• Equipment for assisted mask-neonatal size PHC is 34 required (Approx) per
vacuum delivery • Laryngoscope and So Equiepments. PHC
• Equipment for assisted Endotracheal intubation requirement Total -
forceps delivery tubes (neonatal) is 3,40,00,000
• Standard Surgical Set • Mucus extractor with accordingly
• Equipment for New Born suction tube and a foot
Care and Neonatal operated suction machine
Resuscitation • Feeding tubes for baby
• IUD insertion kit 28
• Equipment / reagents for • Sponge holding forceps
essential laboratory -2
investigations • Valsellum uterine
• Refrigerator forceps - 2
• ILR/Deep Freezer • Tenaculum uterine
• Ice box forceps – 2
Equiepment

• Computer with accessories • MVA syringe and

including internet facility cannulae of sizes 4-8
• Baby warmer/incubator. • Kidney tray for
• Binocular microscope emptying contents of
• Equipments for Eye care MVA syringe
and vision testing • Trainer for tissues
• Equipments under various • Torch without batteries
National Programmes –2
• Radiant warmer for new • Battery dry cells 1.5 volt
borne baby (large size) – 4
• Baby scale • Bowl for antiseptic
• Table lamp with 200 watt solution for soaking
bulb for new borne baby cotton swabs
• Phototherapy unit • Tray containing chlorine
solution for keeping
soiled instruments
• Residual chlorine in
drinking water testing kits
• H2S Strip test bottles

73
 Paracetamol Tab- 500mg per Diethylcarbamazine- 34 All PHCs 17 17 Total -
Tab. Tablet- 50mg required 17,00,00,000
Paracetamol Syrup- Paracetamol Drugs
125mg/5ml-60ml Dicyclomine- Tablet
Atropine - Inj. 0.6 mg per (500mg+20mg)
1ml amps Fluconazole- Tablet 50mg
Ciprofloxacin – Tab Diethylcarbamazine-
500mg/Tab Tablet- 100mg
Co Trimoxazole Tab 160 + Xylometazoline- Drops -
800 mg Tab 0.1% (Nasal) 10ml vial.
Gentamycin – Inj M.D. vial A.R.V.
(40 mg/ml)- 30ml vial Theophyline IP
Oxytocin - Inj-Amp 1 ml Combn.25.3mg/ml
(5i.u./ml) Aminophyline Inj. IP
5% Dextrose 500 ml bottle 25mg/ml
B Complex Tab Adrenaline Bitrate Inj. IP
Gentamicin - Ear/Eye Drop 1mg/ml
5 ml Methyl Ergometrine
Promethazine - Inj-Amp. Maleate 125mg/Tablet,
2ml amps (25 mg/ml) Injection
Pentazocine Lactate Inj. Inj- Amoxycilline Trilhydrate
Amp.- 1 ml (30 mg/ml) IP 250mg/Capsule
Diazepam - Inj-Amp. 2ml Amoxycilline Trilhydrate
amps (5mg/ml) IP 250mg/Dispersible
Cough Expectorant 100 ml Tab.
pack Phenoxymethyl Penicillin
Drugs

Ampicillin 250mg Capsule 130mg/ml

Ampicillin 500mg Capsule Vit K3 (Menadione
Cetrizine Tablet - 10mg Inj.)USP 100mg/ml
Doxycycline Capsule-100mg Nalidixic Acid
Etophylline & Theophylline Tabs.100mg/Tab
Inj.- 2ml Phenytoin Sodium Inj.
Fluconazole Tablet – 200mg IP50mg/2ml
Dicyclomine Tablets - 20mg Chlorpromazine
Dexamethasone Inj.- Hydrochloride 25mg/ml
4mg/ml- 10ml Vial Cephalexin /Ceptrofloxin
Atropine Inj. 0.6mg/ml - 1ml 250mg/Tablet
Ampoule Sodium Chloride Inj. IP
Lignocaine Solution 2% I.V. Solution 0.9w/v
Solution 2%- 30ml Vial Gama Benzine hexa
Diazepam Tablet- 5mg Chloride As decided by
Chlorpheniramine Maleate- CS
Tablet- 4mg Plasma Volume Expander
Cephalexin )- Capsule- As decided by CS
250mg Inj. Magnesium Inj. 50%
Metronidazole- Tablet- preparation
200mg Hydralazine Misoprostol
Ranitidine Hydochloride- 200mg/Tablet
Tablet 150mg
Metoclopramide- Tablet-
10mg

Support Services
Laboratory 1. Routine urine, stool and blood tests 34 17 17 1 Budget for
2. Bleeding time, clotting time, 7 Laboratory
3. Diagnosis of RTI/ STDs with wet mounting, Grams Equipments=5,00,000X1
stain, etc. 7PHCs= 85,00,000
4. Sputum testing for tuberculosis (if designated as a
microscopy center under RNTCP)
5. Blood smear examination for malarial parasite.
6. Rapid tests for pregnancy / malaria
7. RPR test for Syphilis/YAWS surveillance
8. Rapid diagnostic tests for Typhoid (Typhi Dot)
9. Rapid test kit for fecal contamination of water
10. Estimation of chlorine level of water using
orthotoludine reagent
Electricity Wherever facility exists, uninterrupted power supply 34 17 17 1 Generator serviceis
has to be ensured for which Generator and inverter 7 out sourced.
facility is to be provided.

74
 Water Potable water for patients and staff and water for other 34 17 17 1
uses should being adequate quantity. Towards this 7
end, adequate water supply should be ensured and safe
water may be provided by use of technology like
filtration, chlorination, etc. as per the suitability of the
center.
Telephone Where ever feasible, telephone facility / cell phone 34 17 17 1 Total 2X17 X1500
facility is to be Provided. Mobile phone 7 +17X12X500 =1,53,000
Transport The APHC should have an ambulance for transport of Ambulance service is
patients. This may be outsourced. Outsourced Total-17X
15000 X 12 = 30,60,000
Laundry and Dietary facilities for indoor patients: Laundry and Dietary
these facilities facilities can be
and Dietary
facilities
Laundry

can be outsourced. outsourced

10,000 per APHC per
Month Total -17 X
1,00,000 X12
=2,04,00,000

Manpower IPHS Maximum Present Gaps Task Budget 12-13

manpower Manpower For 12-
required 13
General Surgeon 1 17X1=17 0 17 17 40000*17*12=81,60,000
Obstetrician/ 1 17X1=17 0 17 17 40000*17*12=81,60,000
Gynecologist
Pediatrics 1 17X1=17 0 17 17 40000*17*12=81,60,000
Anesthetist 1 17X1=17 5 12 12 40000*12*12=57,60,000
Physician 1 17X3=51 17 0 51 30000*51*12=1,83,60,000
Eye surgeon 1 17X1=17 0 17 17 40000*17*12=81,60,000
Dental Surgeon 1 17X1=17 5 12 17 30000*17*12=61,20,000
Health Manager 1 17X1=17 10 7 7 25000*17*12=51,00,000
Accountant 1 17X3=51 11 6 6 15000*17*12=30,60,000
Nurse-midwife 1 17X3=51 12 39 39 20000*51*12=1,22,40,000
Dresser 1 17X3=51 4 47 47 10000*34*12=40,80,000
Pharmacist/ 1 17X2=34 6 28 28 12000*34*12=48,96,000
compounder
Lab. Technician 1 17X1=17 12 5 5 12000*17*12=24,48,000
Radiographer 1 17X1=17 0 17 17 15000*17*12=30,60,000
Ophthalmic 1 17X1=17 3 14 14 15000*17*12=30,60,000
Assistant
Ward boys/ 1 17X3=51 0 51 51 8000*51*12=48,96,000
nursing
Orderly
Sweepers 1 17X3=51 4 47 47 6000*51*12=36,72,000
Chowkidar 1 17X3=51 0 Home Guard hired
OPD attendant 1 17X3=51 0 51 51 10000*51*12=61,20,000
Statistical 1 17X1=17 0 17 17 10000*17*12=20,40,000
Assistant/
Data entry
operator
OT attendant 1 17X3=51 0 51 51 10000*51*12=61,20,000
Registration clerk 1 17X3=51 0 51 51 10000*51*12=61,20,000
Total ` 12,97,92,000

75
Sub Gaps Issue Strategy Activities Budget
Heads s

Out of 17 sanctioned PHC Avail Upgradation of all Renovation of PHCs

Bairagania : Bairagania PHC is able PHC into 30 purchase of Detail
situated in the Border of Nepal. facili bedded facilities, furnitures priorities budget
X-ray & Pathology services is ties strengthening of the equipments. has been
required. PHC Bajpatti It has its are infrastructure and given
own building. PHC Belsand, not operationalization Appointment of
Dumra, Mejarganj, Nanpur, comf of construction block Accountants
Parihar, Pupri, Riga, Runni ortab works. for all running PHCs.
Saidpur, Sonbarsa, Sursand have le the
own building, Bathanaha PHC servi Strengthening of For the proper work
running in HSC building, Nanpur ces block management it is necessary to
PHC running in rented building supp unit monitor the PHCs
and Bokhara, Parsauni, Chorout & ort to facilities.
Suppi Newly established. be Monitoring Formation of RKS
deliv where it is not form.
ered
at
PHC
s.
Lack of some Equipments, Drugs, PHC Purchasing No, excuse. There is Detail
Furniture, Power PHC Pupri & are Equipments, no other way except budget
Infrastructure

Infrastructure

Runni Saidpur 12 beded and work Drugs, Furniture, purchasing all has been
Bairagania, Bajpatti, Bathanaha, ing and Power etc. as required resources. given
Belsand, Dumra, Mejarganj, but per IPH standard
Nanpur, Parihar, Riga, Sonbarsa, witho
Sursand, Bokhara, Chorout, ut
Parsauni and Suppi is functional resou
in APHC Sasaula building are rces
available 6 beds but as per needs
it requires 30 bedded Hospital
hence for provision of 24 Extra
bed which cost Rs. 10000 x 24
beds =240000 Rupees will be
required.
Alwa Arrangements of Untide fund are
Formats/ Registers and ys it fund for these available but.no 17X25,00
Stationeries (Untied fund) is miscellaneous initiation is taken by 0=
foun expenses PHC MO. 4,25,000
d
That
PHC
is
lacki
ng
Stati
oneri
es
Huma Most of the PHCs have Lack of A Fillin Staff recruitment Selection and Detail
n Grade Nurse, Lack of Specialist g up Capacity building recruitment of staff. budget
Resour doctors, Lack of ANM, Lack of the Appointment of has been
ce pharmacist, Lack of Trained Male short block health manager given
workers, age and accountant. above
staff Training need
untra assessment PHC‟s
ined level staff. Training
staff. of other staff as per
need.

76
 Deliv Arrange all Purchase Drug, Detail
Institutional delivery at PHC level ery required equipments, furniture budget
servi resources and as per IPHS. has been
ces manpower to Hire required given
but improve the quality manpower to support
with of institutional this service..
poor delivery.
resou
rces
Medical care Not Care of routine and 6 hours in the Nothing
upto emergency cases in morning and 2 hours new for
mark surgery in the evening these
Care of routine and Minimum OPD services
emergency cases in Attendance should Detail
medicine be 40 patients per budget
New-born Care doctor per day. has been
24 hours Appropriate given
emergency management of .
services injuries and accident,
Referral services First Aid,
In-patient services Stabilization of the
(30 beds) condition of the
patient before
referral, Dog
bite/snake
bite/scorpion bite
cases, and other
Services of PHCs

emergency
conditions
Ambulance Service
to support referral
Provision of diet,
light, laundry etc to
start indoor service.
Maternal and Non 24-hour delivery improve quality of Nothing
Child Health Care funct services including JBSY at PHC level new for
ional normal and Establish lab for these
assisted minimum services
deliveries investigations like Detail
Essential and hemoglobin, urine budget
Emergency albumin, and sugar, has been
Obstetric Care RPR test for syphilis given
Antenatal care Nutrition and health
Intra-natal care counseling
Postnatal Care Promotion of
New Born care institutional
Care of the child deliveries
Conducting of
normal deliveries
Assisted vaginal
deliveries including
forceps / vacuum
Delivery when ever
required
Manual removal of
placenta
Appropriate and
prompt referral for
cases needing
specialist care.

77
 Management of
Pregnancy Induced
hypertension
including
referral/Pre-referral
management
A minimum of 2
Postpartum home
visits, first within 48
hours of delivery, 2nd
within 7 days
through Sub-center
staff.
Initiation of early
breast-feeding within
half-hour of birth
Education on
nutrition, hygiene,
contraception,
essential new
borncare
Family Planning Contraception FP 1. Full range of Education,Motivatio No need
& MTP opera family n and counseling to of
tion Planning services adopt appropriate extra
at Including Family Planning Budget.
PHC Laparoscopic methods. Orientatio
level. Services Provision of n&
2. Safe Abortion contraceptivessuch Training
Services as condoms, oral program
3. Distribution pills, emergency can be
of contraceptives Contraceptives, IUD organized
such as condoms, insertions. from
oral pills, Untied
emergency Permanent methods fund.
Contraceptives. like Tubal ligation
3. IUD insertions and vasectomy /
NSV.

Follow up services to
the eligible couples
adopting permanent
methods

Counseling and
appropriate referral
for safe abortion
services (MTP) for
Those in need.

Counseling and
appropriate referral
for couples having
infertility.
RNTCP Treatment and All PHC function as Budget
DOT Distribution of DOTS Center to will be
cente drug. deliver treatment as given
r at per RNTCP under
PHC treatment guidelines RNTCP
through DOTS head
providers and

78
 treatment of common
complications of TB
and side effects of
drugs, record and
report on RNTCP
activities as per
Guidelines.
Integrated Disease No Need to start IDSP PHC will collect and Budget
Surveillance IDSP analyze data from has
Project (IDSP) sub-center and will been
report Information to given
PHC surveillance above.
unit. Appropriate
preparedness and
first level action in
out-break situations.
Laboratory services
for diagnosis of
Malaria,
Tuberculosis,
Typhoid and tests for
detection of faucal
Contamination of
water (Rapid test kit)
and chlorination
level.
National Program No Need to start Diagnosis and Budget
for Control of NPC NPCB Program treatment of common will be
Blindness (NPCB) B eye diseases. given
progr Refraction Services. under
am Detection of cataract Blindness
cases and referral for program
cataract surgery.
National AIDS Starting AIDS IEC activities to Budget
Control Program control program at enhance awareness will be
APHC level and preventive given
measures about STIs under
and HIV/AIDS, District
Prevention of Parents AIDS
to Child program
Transmission head
Organizing School
Health Education
Programme
Screening of persons
practicing high-risk
behaviour with one
rapid test to be
conducted at the
APHC level and
development of
referral linkages with
the nearest VCTC at
the District Hospital
level for
confirmation of HIV
status of those found
positive at one test
stage in the high
Prevalence states.

79
 Risk screening of
antenatal mothers
with one rapid test
for HIV and to
establish referral
linkages with CHC
or District Hospital
for PPTCT Services.
Linkage with
Microscopy Center
for HIVTB
coordination.
Condom Promotion
& distribution of
condoms to the high
risk groups.
Help and guide
patients with
HIV/AIDS receiving
ART with focus on
Adherence.
Leprosy, Malaria, Kala- Eradi Making people IEC activities to
azar,Japanese catio aware about these enhance awareness
Encephalitis, Filariasis, Dengue n& disease and and preventive
etc and control of Epidemics Contr providing measures about
ol treatments AIDS,Blindness,
Leprosy, Malaria,
Kala azar, Japanese
Encephalitis,
Filariasis, Dengue
etc and control of
Epidemics
Starting treatment of
patients if reported.
Referral facilities for
better treatment.

Head Sub head Budget Remarks

Infrastructure Physical Infrastructure 15,00,00,000
Furniture 1,70,00,000
Equiepments 3,40,00,000
Drugs 17,00,00,000
Laboratory 85,00,000
Telephone 1,53,000
Transport 30,60,000
Manpower 12,97,92,000
Laundry & Dietry 2,04,00,000
Services of PHC Untied Fund 4,25,000
Annual Maintenance 34,00,000 Rs2,00,000*17PHC
Grant
IEC 17,00,000
Total 63,96,05,000

80
:

District Health System is the fundamental basis for implementing various health policies and delivery of
healthcare, management of health services for define geographic areas. Referral Hospital is an essential
component of the district health system and functions as a secondary level of health care which provides
curative, preventive and promotive healthcare services to the people in the area. The overall objective of
IPHS is to provide health care that is quality oriented and sensitive to the needs of the people of the district. The
specific objectives of IPHS for RHs are:
i. To provide comprehensive secondary health care (specialist and referral services) to the community through the
Referral Hospital.
ii. To achieve and maintain an acceptable standard of quality of care. To make the services more responsive and
sensitive to the needs of the people of the district and the hospitals/centers from which the cases are referred to the
district hospitals
No. of Institutions (Referral Hospital)
As per IPH standard one Referral Hospital at every district.
District Population Maximum RH required No. of RH already Gaps in No. of RH
(2011) as per IPH Norms sanctioned/
established
34,19,622 2 2 0

To obtain 100% IPH standard -: Need to strength proposed for referral hospital to achieve 100% IPH
standard.
Task for 2012-13 -:
 Need to provide required manpower, resources, drugs and equipments to minimize the gaps.
Availability of furniture, equipments, drugs and supplies in different service providing Units/Wards in
FRUS
IPHS Norms

requirement

Budget for
Maximum

(2012-13)
Task for
2012-13
Present
Status
Gaps
Item

An area of 65-85 m2 per bed has been 2 2 2 2

2x1,50,00,000=

considered to be reasonable. The area

Infrastructre
Physical

will include the service areas such as

3,00,00,000

waiting space, entrance hall, registration

counter, etc. In case of specific
requirement of a hospital, flexibility in
altering the area is kept.
Waste disposal should be carried out as
Disposal

per the GOI guidelines, which is under

Waste

preparation

81
 Doctor's chair Instrument Tray 2 2 2 2
Doctor's Table Assorted
Duty Table for Kidney Tray
Nurses Assorted
Table for Basin Assorted
Sterilization use Basin Stand
Long Benches Assorted
Stool Wooden Delivery Table
Stools Revolving Blood Donar Table
Steel Cup-board O2 Cylinder
Wooden Cup Trolley
Board Saline Stand
Racks -Steel – Waste Bucket
Wooden Dispensing Table
Patients Waiting Wooden
Chairs Bed Pan
Attendants Cots Urinal Male and
Office Chairs Female
Office Table Name Board for
Foot Stools cubicals
Filing Cabinets Kitchen Utensils
(for records) Containers for
M.R.D. kitchen
Requirements Plate, Tumblers
(record room use) Waste Disposal -
Pediatric cots Bin / drums
with railings Waste Disposal -
Cradle Trolley (SS)
Furniture

Fowler's cot Linen Almirah

Ortho Facture Stores Almirah
Table Arm Board Adult
Hospital Cots Arm Board Child
Hospital Cots SS Bucket with Lid
Pediatric Bucket Plastic
Wooden Blocks Ambu bags
Back rest O2 Cylinder with
Dressing Trolley spanner ward
Medicine type
Almirah Diet trolley -
Bin racks stainless steel
ICCU Cots Needle cutter and
Bed Side Screen melter
Medicine Trolley Thermometer
Case Sheet clinical
Holders with clip Thermometer
Bed Side Lockers Rectal
Examination Torch light
Couch Cheatles forceps
Instrument assortted
Trolley Stomach wash
Instrument equipment
Trolley Mayos Infra Red lamp82
Surgical Bin Wax bath
Assorted Emergency
,000

Wheel Chair Resuscitation Kit-

ure
ted
x)

e
 • Imaging • Baby scale 2 2 2 2
Equipment • Table lamp with
• X-ray room 200 watt bulb
accessories for new borne baby
• Cardiac • Photo therapy unit
equipments • Self inflating bag
• Labor ward and maskneonatal
equipments size
• Equipment for • Laryngoscope and
New Born Care Endotracheal
and Neonatal intubations tubes
Resuscitation (neonatal)
ENT equipment • Mucus extractor
Eye equipment with suction tube
Dental Equipment and a foot operated
Laboratory suction machine
equipments • Feeding tubes for
OT equipment baby 28
Surgical • Sponge holding
equipment forceps - 2
Physiotherapy • Valsellum uterine
equipments forceps - 2
Endoscopes • Tenaculum
equipments uterine forceps – 2
Anesthesia • MVA syringe and
Equiepment

equipments cannulae of
• IUD insertion sizes 4-8
kit • Kidney tray for
• Equipment / emptying contents
reagents for of MVA syringe
essential • Trainer for tissues
laboratory • Torch without
• Refrigerator batteries – 2
• ILR/Deep • Battery dry cells
Freezer 1.5 volt (large
• Ice box size) – 4
• Computer with • Bowl for
accessories antiseptic solution
including internet for
facility soaking cotton
• Baby swabs
warmer/incubator. • Tray containing
• Binocular chlorine
microscope solution for
• Equipments for keeping soiled
Eye care and instruments
vision testing • Residual chlorine
• Equipments in drinking
under various water testing kits
National • H2S Strip test
equipmen

Programmes bottles
(Approx)
2000000

all listed
provide

• Radiant warmer 83
for new borne
(To

Baby
 Dicyclomine Inj- Carbamazepine 2 2 2 2
Atropine - Inj. Cephalexin
Norfloxacin- Tab Metronidazole
Ciprofloxacin - Metronidazole
Tab Cefotaxime
Ciprofloxacin - Atenolol
Tab Furosemide
Co Trimoxazole Ranitidine
Tab Hydochloride
Amoxicillin- Cap Metoclopramide
Gentamycin - Inj Isosorbide Dinitrate
Albendazole Diethylcarbamazine
Alprazolam - Tab Ciprofloxacin
Ranitidine - Inj Metronidazole
Oxytocin - Inj- Cefotaxime
Amp Enalapril
Methyl Enalapril
Ergometrine Chloramphenicol
Glibenclamide Alprazolam
5% Dextrose Tramadol
5% Dextrose + Dexamethasone
0.9% Cefotaxime
B Complex Amlodipine
Silver Erythromycin
Sulphadiazine Stearate
oint - Cetrizine
Promethazine - Omeprazole
Inj-Amp. Prednisolone
Pentazocine Diethylcarbamazine
Lactate Inj. Ampicillin Sodium
Diazepam - Inj- Atenolol
Amp. Hydroxy
Drugs

Cough progesterone
Expectorant acetate
Ampicillin Xylometazoline
Ciprofloxacin Prednisolone
Thiopentone Betamethasone
Cetrizine Chloram Phenicol
Doxycycline Bupivacaine
Ampicillin & Hydrochloride
Cloxacilin Succinyl Choline
Etophylline & Intermediate acting
Theophylline insulin
Dopamine Lente/NPH Insulin
Hydrochloride Insulin injection
Adrenaline (Soluble) - Inj.
Sodium 40IU/ml
Bicarborate premix insulin
Tinidazole (30/70 Human)
Fluconazole A.S.V.S.
Clotrimazole ARV
Cream 84
Dicyclomine
Tablets
Dexamethasone
Support Services
1. Routine urine, stool and blood tests 2 2 2 2
2. Bleeding time, clotting time,
3. Diagnosis of RTI/ STDs with wet
mounting, Grams stain, etc.
4. Sputum testing for tuberculosis (if

Equipments=5,00,000X2=10,00,000
designated as a microscopy center
under RNTCP)
Laboratory

5. Blood smear examination for

malarial parasite.
6. Rapid tests for pregnancy / malaria

Budget for Laboratory

7. RPR test for Syphilis/YAWS
surveillance
8. Rapid diagnostic tests for Typhoid
(Typhi Dot)
9. Rapid test kit for fecal contamination
of water
10. Estimation of chlorine level of
water using orthotoludine reagent
Wherever facility exists, uninterrupted 2 2 1 2
Electricit

Generato

serviceis

sourced.
power supply has to be ensured for
y

which Generator and inverter facility is

out
to be provided.

r
Potable water for patients and staff and 2 2 1 2
water for other uses should being
adequate quantity. Towards this end,
Water

adequate water supply should be

ensured and safe water may be
provided by use of technology like
filtration, chlorination, etc. as per the
suitability of the center.
Where ever feasible, telephone facility / 2 2 1 2
Telephon

+2X12X

=15,000
2X1500

cell phone facility is to be Provided.

e

Total

Mobile phone
500

The APHC should have an ambulance 2 2 2 2

service is
Ambulan

Total-2X
Transpor

3,60,000
15000 X
outsourc

for transport of patients. This may be

outsourced.
12
ed
ce

=
t

Laundry and Dietary facilities for 2 2 2 2

facilities
Laundry

outsourc
facilities
Laundry
Dietary

Dietary

indoor patients: these facilities

10,000
perRH
and

can be

month

can be outsourced.
and

per
ed

85
Manpower IPHS Maximum Present Gaps Task Budget 12-13
manpower Manpower For
required 12-
13
Medical Suprintendent 1 1X2=2 2 2X50000X12=12,00,000
Medical Specialist 3 3X2=6 6 6X40000X12=28,80,000
Surgery Specialist 3 3X2=6 6 6X40000X12=28,80,000
O & G Specialist 6 6X2=12 0 12 12X40000X12=57,60,000
Psychiatrist 1 1X2=2 0 2 2X40000X12=9,60,000
Dermatologist/Venerologist 1 1X2=2 0 2 2X40000X12=9,60,000
Pediatrician 3 3X2=6 6 6X40000X12=28,80,000
Anesthetist 6 6X2=12 12 12X40000X12=57,60,000
ENT surgeon 2 2X2=4 4 4X40000X12=19,20,000
Opthalmologist 2 2X2=4 4 4X40000X12=19,20,000
Orthopedician 2 2X2=4 4 4X40000X12=19,20,000
Radiologist 1 1X2=2 2 2X40000X12=9,60,000
Casualty Doctors / 20 20X2=40 40 40X30000X12=72,00,000
General Duty Doctors
Dental Surgeon 1 1X2=2 2 2X30000X12=7,20,000
Health Manager 1 1X2=2 2 2X20000X12=4,80,000
Accountant 1 1X2=2 2 2X15000X12=3,60,000
AYUSH Physician 4 4X2=8 8 8X15000X12=14,40,000
Pathologist 2 2X2=4 4 4X40000X12=19,20,000
Staff Nurse 20 20X2=40 40 40X20000X12=96,00,000
Hospital worker (OP/ward 20 20X2=40 40 40X10000X12=48,00,000
+OT+blood bank)
Ophthalmic Assistant 2 2X2=4 4 4X20000X12=9,60,000
ECG Technician 1 1X2=2 2 2X20000X12=4,80,000
Laboratory Technician ( 4 4X2=8 1 8 8X12000X12=11,52,000
Lab +Blood Bank
Maternity assistant (ANM) 4 4X2=8 8 8X12000X12=11,52,000
Radiographer 2 2X1=2 1 2 2X20000X12=4,80,000
Pharmacist 6 6X2=12 12 12X12000X12=17,28,000
Physiotherapist 2 2X2=4 4 4X12000X12=5,76,000
Statistical Assistant/ 1 1X2=2 2 2X10000X12=2,40,000
Data entry operator
Total 5,68,08,000

Head Sub head Budget Remarks

Infrastructure Physical Infrastructure 3,00,00,000
Untied Fund 100000 2*Rs 50000
Annual Maintenence Grant 600000 2*Rs 300000
Furniture 20,00,000
Equiepments 20,00,000
Drugs 2,00,00,000
Laboratory 10,00,000
Telephone 15,000
Transport 3,60,000
Manpower 5,68,08,000
Laundry & Dietry 2,40,000
Total 11,31,23,000

86
District Health System is the fundamental basis for implementing various health policies and delivery of
healthcare, management of health services for define geographic areas. District hospitals is an essential
component of the district health system and functions as a secondary level of health care which provides
curative, preventive and promotive healthcare services to the people in the district. The overall objective of
IPHS is to provide health care that is quality oriented and sensitive to the needs of the people of the district. The
specific objectives of IPHS for DHs are:
 To provide comprehensive secondary health care (specialist and referral services) to the community through
the District Hospital.
 To achieve and maintain an acceptable standard of quality of care. To make the services more responsive
and sensitive to the needs of the people of the district and the hospitals/centers from which the cases are
referred to the district hospitals
No. of Institutions
As per IPH standard one District Hospital at every district.
District Population Maximum DH required No. of DH already Gaps in No. of DH
(2011) as per IPH Norms sanctioned/
established

34,19,622 1 1 0

To obtain 100% IPH standard -: Need to strength sanction district hospital to achieve 100% IPH standard.
Task for 2010-11 -:
Need to provide required manpower, resources, drugs and equipments to minimize the gaps.
Availability of furniture, equipments, drugs and supplies in different service providing Units/Wards in DH
IPHS Norms

requirement

Budget for
Maximum

(2012-13)
Task for
2012-13
Present
Status

Gaps
Item

An area of 65-85 m2 per bed has 1 Sitamarhi 410b Renovatio 1x10,0

Waste Physical Infrastructre

been considered to be reasonable. have1 eds n 0,00,00

The area will include the service established &Upgradat 0=
areas such as waiting space, DH have ion of DH 10,00,0
entrance hall, registration counter, no for 300 0,000
etc. In case of specific requirement sufficient beds
of a hospital, flexibility in altering Infrastructu
the area is kept. re for 500
beds..
Disposa

Waste disposal should be carried

out as per the GOI guidelines,
which is under preparation
l

87
 Doctor's chair Instrument 1 Inadequate 1 1 10,000
Doctor's Table Tray Assorted 00(App
Duty Table for Kidney Tray r
Nurses Assorted x) per
Table for Basin DH
Sterilization use Assorted Total -
Long Benches Basin Stand 10,00,0
Stool Wooden Assorted 00
Stools Revolving Delivery
Steel Cup-board Table
Wooden Cup Blood Donar
Board Table
Racks -Steel – O2 Cylinder
Wooden Trolley
Patients Waiting Saline Stand
Chairs Waste Bucket
Attendants Cots Dispensing
Office Chairs Table Wooden
Office Table Bed Pan
Foot Stools Urinal Male
Filing Cabinets and Female
(for records) Name Board
M.R.D. for cubicals
Requirements Kitchen
(record room use) Utensils
Pediatric cots Containers for
with railings kitchen
Cradle Plate,
Fowler's cot Tumblers
Ortho Facture Waste
Table Disposal - Bin
Hospital Cots / drums
Hospital Cots Waste
Pediatric Disposal -
Wooden Blocks Trolley (SS)
Furniture

Back rest Linen Almirah

Dressing Trolley Stores
Medicine Almirah
Almirah Arm Board
Bin racks Adult
ICCU Cots Arm Board
Bed Side Screen Child
Medicine Trolley SS Bucket
Case Sheet with Lid
Holders with clip Bucket Plastic
Bed Side Lockers Ambu bags
Examination O2 Cylinder
Couch with spanner
Instrument ward
Trolley type
Instrument Diet trolley -
Trolley Mayos stainless steel 88
Surgical Bin Needle cutter
Assorted and melter
Wheel Chair Thermometer
 • Imaging • Baby scale 1 20,00,000 1 1 20,00,0
Equipment • Table lamp (Approx) 00
• X-ray room with 200 watt per (Appro
accessories bulb DH x)
• Cardiac for new borne
equipments baby
• Labor ward • Photo
equipments therapy unit
• Equipment for • Self inflating
New Born Care bag and
and Neonatal maskneonatal
Resuscitation size
ENT equipment •
Eye equipment Laryngoscope
Dental and
Equipment Endotracheal
Laboratory intubations
equipments tubes
OT equipment (neonatal)
Surgical • Mucus
equipment extractor with
Physiotherapy suction tube
equipments and a foot
Endoscopes operated
equipments suction
Anesthesia machine
equipments • Feeding
• IUD insertion tubes for baby
kit 28
• Equipment / • Sponge
reagents for holding
essential forceps - 2
laboratory • Valsellum
• Refrigerator uterine
• ILR/Deep forceps - 2
Equiepment

Freezer • Tenaculum
• Ice box uterine
• Computer with forceps – 2
accessories • MVA
including internet syringe and
facility cannulae of
• Baby sizes 4-8
warmer/incubator • Kidney tray
. for emptying
• Binocular contents of
microscope MVA syringe
• Equipments for • Trainer for
Eye care and tissues
vision testing • Torch
• Equipments without
under various batteries – 2
National • Battery dry 89
Programmes cells 1.5 volt
• Radiant warmer (large
for new borne size) – 4
 Dicyclomine Inj- Carbamazepi 1 DH 1 1 Total -
Atropine - Inj. ne required 1,00,00
Norfloxacin- Tab Cephalexin Drugs ,000
Ciprofloxacin - Metronidazol
Tab e
Ciprofloxacin - Metronidazol
Tab e
Co Trimoxazole Cefotaxime
Tab Atenolol
Amoxicillin- Cap Furosemide
Gentamycin - Inj Ranitidine
Albendazole Hydochloride
Alprazolam - Tab Metoclopram
Ranitidine - Inj ide
Oxytocin - Inj- Isosorbide
Amp Dinitrate
Methyl Diethylcarba
Ergometrine mazine
Glibenclamide Ciprofloxacin
5% Dextrose Metronidazol
5% Dextrose + e
0.9% Cefotaxime
B Complex Enalapril
Silver Enalapril
Sulphadiazine oint Chloramphen
- icol
Promethazine - Alprazolam
Inj-Amp. Tramadol
Pentazocine Dexamethaso
Lactate Inj. ne
Diazepam - Inj- Cefotaxime
Amp. Amlodipine
Cough Erythromycin
Expectorant Stearate
Ampicillin Cetrizine
Drugs

Ciprofloxacin Omeprazole
Thiopentone Prednisolone
Cetrizine Diethylcarba
Doxycycline mazine
Ampicillin & Ampicillin
Cloxacilin Sodium
Etophylline & Atenolol
Theophylline Hydroxy
Dopamine progesterone
Hydrochloride acetate
Adrenaline Xylometazoli
Sodium ne
Bicarborate Prednisolone
Tinidazole Betamethaso
Fluconazole ne
Clotrimazole Chloram
Cream Phenicol 90
Dicyclomine Bupivacaine
Tablets Hydrochlorid
Dexamethasone e
Support Services
1. Routine urine, stool and blood tests 1 1 0 1 Budget for
2. Bleeding time, clotting time, Laboratory
3. Diagnosis of RTI/ STDs with wet Equipments=
mounting, Grams stain, etc. 10,00,000
4. Sputum testing for tuberculosis (if
designated as a microscopy center
under RNTCP)
Laboratory

5. Blood smear examination for

malarial parasite.
6. Rapid tests for pregnancy / malaria
7. RPR test for Syphilis/YAWS
surveillance
8. Rapid diagnostic tests for Typhoid
(Typhi Dot)
9. Rapid test kit for fecal
contamination of water
10. Estimation of chlorine level of
water using orthotoludine reagent
Wherever facility exists, 1 1 0 1 Generator
Electrici

uninterrupted power supply has to be serviceis

ty

ensured for which Generator and out sourced.

inverter facility is to be provided.
Potable water for patients and staff 1 1 1 1
and water for other uses should being
adequate quantity. Towards this end,
Water

adequate water supply should be

ensured and safe water may be
provided by use of technology like
filtration, chlorination, etc. as per the
suitability of the center.
Where ever feasible, telephone 1 1 1 1 12,000
Telep
hone

facility / cell phone facility is to be

Provided. Mobile phone
The DH should have an ambulance Ambulance
for transport of patients. This may be service is
outsourced. outsourced
Transport

Total-2X
15000 X 12
= 3,60,000
Laundry and Dietary facilities for Laundry and
indoor patients: these facilities Dietary
can be outsourced. facilities can
and Dietary
facilities
Laundry

be outsourced
1,00,000 per
month
Total -1 X
1,00,000 X12
= 12,00,000

91
Manpower IPHS Maximum Present Gaps Task Budget 12-13
manpower Manpower For
required 12-
13
Medical Suprintendent 1 1 1 0 1X50000X12=12,00,000
Medical Specialist 3 3 3X40000X12=14,40,000
Surgery Specialist 3 3 3X40000X12=14,40,000
O & G Specialist 6 6 0 6X40000X12=28,80,000
Psychiatrist 1 1 0 1X40000X12=4,80,000
Dermatologist/Venerologist 1 1 0 1X40000X12=4,80,000
Pediatrician 3 3 3X40000X12=14,40,000
Anesthetist 6 6 6X40000X12=28,80,000
ENT surgeon 2 2 2X40000X12=9,60,000
Opthalmologist 2 2 2X40000X12=9,60,000
Orthopedician 2 2 2X40000X12=9,60,000
Radiologist 1 1 1X40000X12=4,80,000
Casualty Doctors / 20 20 20X30000X12=36,00,000
General Duty Doctors
Dental Surgeon 1 1 1X30000X12=3,60,000
Hospital Manager 1 1 1X30000X12=3,60,000
Accountant 1 1 1X15000X12=1,80,000
AYUSH Physician 4 4 4X15000X12=7,20,000
Pathologist 2 2 2X40000X12=9,60,000
Staff Nurse 20 20 20X20000X12=48,00,000
Hospital worker (OP/ward 20 20 20X10000X12=24,00,000
+OT+blood bank)
Ophthalmic Assistant 2 2 2X20000X12=4,80,000
ECG Technician 1 1 1X20000X12=2,40,000
Laboratory Technician ( 4 4 4X12000X12=5,76,000
Lab +Blood Bank
Maternity assistant (ANM) 4 4 4X12000X12=5,76,000
Radiographer 2 2 2X20000X12=4,80,000
Pharmacist 6 6 6X12000X12=8,64,000
Physiotherapist 2 2 2X12000X12=2,88,000
Statistical Assistant/ 1 1 1X10000X12=1,20,000
Data entry operator
Total 3,24,84,000

Head Sub head Budget Remarks

Infrastructure Physical Infrastructure 5,00,00,000
Annual Maintenance Grant 10,00,000
Furniture 10,00,000
Equiepments 20,00,000
Drugs 1,00,00,000
Laboratory 10,00,000
Telephone 12,000
Transport 3,60,000
Manpower 3,24,84,000
Laundry & Dietry 12,00,000
Total 9,90,56,000

92
Unless the above mentioned action plan not considered,consider the plan given below for District
Hospital
lnj vLirky lhrke<h Action Plan 2012-2013

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93
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Jh gkfen erhu iz;ks0izkoS0
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3 efgyk jhlsIlu lgk;d 3 8,000=00x3x12 ef
4 prqFkZ oxhZ; deZpkjh iq#"k 17 6,000=00x17x12 ef
5 prqFkZ oxhZ; deZpkjh efgyk 6 6,000=00x6x12 ef

lnj vLirky lhrke<h ( ACTION PLAN

2012 -13 )
LFkku dk uke Hkou
ftldk Lo#i fjis;j Tools
fn;k tkuk ([kpZ ([kpZ deZpkjh dqy (
vko;;d gSA laHkkfor½ laHkkfor½ ([kpZ laHkkfor½ [kpZ laHkkfor½
vkWijs'ku
fFk,Vj
1 ¼orZeku½ 1,00,000=00 1,00,000=00
● O.T lgk;d 03
@ 15,000x03x12 =5,40,000=00
1,00,000=00
│

●prqFkZ oxhZ; deZpkjh 03 ─

2 izlo okMZ @10,000x03x12 =3,60,000=00 10,00,000=00
● O.T lgk;d 03
@ 15,000x03x12efgyk
=5,40,000=00 ● prqFkZ oxhZ;
deZpkjh 03 ─ @10,000x03x12
3 gìh foHkkx 1,50,000=00 1,50,000=00 efgyk =3,60,000=00 12,00,000=00
● O.T lgk;d 03
@ 15,000x03x12 =5,40,000=00
● prqFkZ oxhZ; deZpkjh 03 ─
4 vkW[k foHkkx 1,50,000=00 2,50,000=00 @10,000x03x12 =3,60,000=00 13,00000=00
vkblksys'ku
│

5 okMZ 4,00,000=0 4,00,000=0

6 HkaMkj x`g 5,00,000=00 5,00,000=00
│ │

│ │ │ │

7 nok HkaMkj 5,00,000=00 5,00,000=00

8 IykLVj #e 1,00,000=00 1,00,000=00 2,00,000=00
9 Msªflax #e 1,00,000=00 1,00,000=00 2,00,000=00
2,00,000=00
( dqlhZ $
okVj
ikqjhQk;j $ 8,80,000=00
okVj fpyj $
osfVax 'ksM Vsyhfotu ● lgk;d 3
10 ¼ejht ijhtu½ 5,00,000=00 lfgr ½ @ 5000=00x3x12 = 1,80,000=00
11 ,Ecqysal 'ksM 2,00,000=00 2,00,000=00
│

94
 thi / dkj /
eksVjlkbfdy /
LVSaM deZpkjh

│
/ fpfdRkd ds
12 fy, 2,00,000=00 2,00,000=00
thi / dkj /
eksVjlkbfdy /
lkbfdy LVSaM

│
¼ejht ,oa
ijhtuksads
13 fy,½ 2,00,000=00 2,00,000=00
Hkstuky;
¼ejht ,oa

│
ijhtuksa ds
14 fy,½ 2,00,000=00 2,00,000=00
dSUVhu
Hkou¼vLFkk;h½

│
15 fuekZ.k 2,00,000=00 2,00,000=00
Qqyokjh dk
LFkk;h
?ksjkcanh
¼bZaV dh
│

│
jsfyax +
xzhfyax +
16 xkSfc;u½ 3,00,000=00 3,00,000=00
MkWDVj M~;qVh
#e iq#"k
│

│
17 efgyk 3,00,000=00 3,00,000=00
deZpkjh
M~;qVh #e
│

18 iq#"k efgyk 2,00,000=00 │ 2,00,000=00

efgyk fpfdRld
19 vkokl 3,00,000=00 3,00,000=00
mik/kh{kd
20 vkokl 3,00,000=00 3,00,000=00
vLirky
21 izca/kd vkokl 3,00,000=00 3,00,000=00
2,00,000=00
22 deZpkjh vkokl x 10 vkokl 2,00,000=00 x 10 vkokl
iksLVekVZe
23 gkml 5,00,000=00 5,00,000=00
okMksZ ds
ckjkenksa dks
?ksjokuk
fxzfyax djkuk
lftZdy
24 dkyktkj okMZ 4,00,000=00 4,00,000=00
dsUnzh;d`r
dEI;qVjhd`r
fuca/ku ¼24
25 ?kaVk½ 2,00,000=00 1,50,000=00 3,50,000=00
lqj{k xkMZ
'ksM fuekZ.k
(3 'ksM ─
10x15 eq[;
}kj ,oa nks
vU; izos'k
26 IokabV ij½ 1,50,000=00 1,50,000=00
vLirky ihjlj
fLFr Hkouksa
dh jaxkb
iksrkbZ ,oa
27 ejEerh 5,00,000=00 5,00,000=00

95
 iksLVekVZe
gkml dh
ejEerh ,oa
foljk l[kus
gsrq ,d dejk
dk fuekZ.k]
28 feÍh HkjkbZA 3,00,000=00 3,00,000=00

Setting Objectives and Suggested Plan of Action

Introduction
District health action plan has been entrusted as a principal instrument for planning, implementation
and monitoring of fully accountable and accessible health care mechanism. It has been envisioned
through effective integration of health concerns via decentralized management incorporating
determinants of health like sanitation and hygiene, safe drinking water, women and child health and
other social concerns. DHAP envisages accomplishing requisite amendments in the health systems by
crafting time bound goals. In the course of discussions with various stakeholder groups it has been
anticipated that unmet demand for liable service provision can be achieved by adopting Intersect oral
convergent approach through partnership among public as well as private sectors.
Targeted Objectives and Suggested Strategies
During consultation at district level involving a range of stakeholders from different levels, an attempt
has been made to carve out certain strategies to achieve the specific objectives that are represented by
different indicators. The following segment of the chapter corresponds to the identified district plan

96
objectives demonstrating current status of the indicators along with the expected target sets that are
projected for period of next financial year.
Strengthening of District Health Management
Objectives / District Health Society to make functional and empower to plan, implement and Monitor the progress of
Milestones the health status and services in the district.
1. Capacity building of the members of the District Health Mission and District Health Society regarding
the program, their role, various schemes and mechanisms for monitoring and regular reviews
Strategies 2. Establishing Monitoring mechanisms
3. Provide ASHA as link workers to mobilize the community to strengthen health seeking behavior and to
promote proper utilization of health services.
1. Orientation Workshop of the members of the District health Mission and society on strategic
management, financial management & GoI Guidelines.
2. Issue based orientation in the monthly Review and planning meetings as per needs.
3. Improving the Review and planning meetings through a holistic review of all the programmes under
Activities NRHM and proper planning.
4. Formation of a monitoring Committee from all departments.
5. Development of a Checklist for the Monitoring Committee.
6. Arrangements for travel of the Monitoring Committee
7. Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up
of the recommendations.
1. Technical and financial assistance needs to be imparted for orientation and integration of societies.
Support 2. A GO should be taken out that at the district level each department should monitor the meetings closely
required and ensure follow-up of the recommendations.
3. Instructions & directions from GoI for proper functioning of the societies and monitoring committee.
4. Funds to maintain society office & staff.
2012-13
1.Orientation Workshops of the members of the District Health society
1. Issues based workshops will be organized.
Timeline 2. Formation of the monitoring Committee and will start the monitoring visits.
3.Reorientation Workshops
4.Workshops as per need
5.Strengthening of the Monitoring Committee
District Programme Management Unit
In NRHM a large number of activities have been introduced with very definite outcomes. The
cornerstone for smooth and successful implementation of NRHM depends on the management
capacity of District Programme officials. The officials in the districts looking after various
programmes are overworked and there is immense pressure on the personnel. There is also lack of
capacities for planning, implementing and monitoring. The decisions are too centralized and there is
little delegation of powers.
In order to strengthen the DPMU, five skilled personnel i.e. Programme Manager, Accounts
Manager ,Dist. Nodal M & E Officer ,District Planning Coordinator and District Community
Mobilizer have being provided in each district. These personnel are there for providing the basic
Status support for programme implementation and monitoring at district level.The District Programme
Manager is responsible for all programmes and projects in district and the District Accounts
Manager (DAM) is responsible for the finance and accounting function of District RCH Society
including grants received from the state society and donors, disbursement of funds to the
implementing agencies, preparation of submission of monthly/quarterly/annual SoE, ensuring
adherence to laid down accounting standards, ensure timely submission of Ucs, periodic internal
audit and conduct of external audit and implementation of computerized FMS. The Dist. Nodal M &
E Officer has to work in close consultation with district officials, facilitate working of District RCH
Society, maintain records, create and maintain district resource database for the health sector,
inventory management, procurement and logistics, planning and monitoring & evaluation, HMIS,
data collection and reporting at district level.
Objective Strengthened District Programme Management Unit
Strategies 1. Support to the civil surgeon for proper implementation of NRHM.
2. Capacity building of the personnel

97
 3. Development of total clarity at the district and the block levels amongst all the district officials
and Consultants about all activities
4. Provision of infrastructure for the personnel
5. Training of district officials and MOs for management
6. Use of management principles for implementation of District NRHM
7. Streamlining Financial management
8. Strengthening the Civil Surgeon‟s office
9. Strengthening the Block Management Units
10. Convergence of various sectors
1. Support to the Civil surgeon for proper implementation of NRHM through proper involvement
of DPMU and more consultants for support to civil surgeon for data analysis, trends, timely reports
and preparation of documents for the day-to-day implementation of the district plans so that the
Civil Surgeon and the other district officers:
• Finalizing the TOR and the selection process
• Selection of consultants, one each for Maternal Health, Civil Works, Child health, Behavior
change. If properly qualified and experienced persons are not available then District Facilitators to
be hired which may be retired persons.
2. Capacity building of the personnel
• Joint Orientation of the District officers and the consultants
• Induction training of the DPM and consultants
• Training on Management of NRHM for all the officials
• Review meetings of the District Management Unit to be used for orientation of the consultants
3. Development of total clarity in the Orientation workshops and review meetings at the district
and the block levels amongst all the district officials and Consultants about the following set of
activities:
• Disease Control
• Disease Surveillance
• Maternal & Child Health
• Accounts and Finance Management
• Human Resources & Training
• Procurement, Stores & Logistics
Activities • Administration & Planning
• Access to Technical Support
• Monitoring & HMIS
• Referral, Transport and Communication Systems
• Infrastructure Development and Maintenance Division
• Gender, IEC & Community Mobilization including the cultural background of the Meos
• Block Resource Group
• Block Level Health Mission
• Coordination with Community Organizations, PRIs
• Quality of Care systems
4. Provision of infrastructure for officers, DPM, DAM, DNM&E Officer, DPC,
DCM and the consultants of the District Project Management Unit.
• Provision of office space with furniture and computer facilities, photocopy machine, printer,
Mobile phones, digital camera, fax, Laptop etc;
5. Use of Management principles for implementation of District NRHM
• Development of a detailed Operational manual for implementation of the NRHM activities in the
first month of approval of the District Action Plan including the responsibilities, review
mechanisms, monitoring, reporting and the time frame. This will be developed in participatory
consultative workshops at the district level and block levels.
• Financial management training of the officials and the Accounts persons
• Provision of Rs. 500000 as Untied funds at the district level under the jurisdiction of the Civil
Surgeon
• Compendium of Government orders for the DC, Civil surgeon, district officers, hospitals, CHCs,
PHCs and the Subcentres need to be taken out every 6 months. Initially all the relevant documents

98
 and guidelines will be compiled for the last two years.
6. Strengthening the Block Management Unit: The Block Management units need to be
established and strengthened through the provision of :
• Block Health Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants
(BDA) for each block. These will be hired on contract.
Support 1. State should ensure delegation of powers and effective decentralization.
from state 2. State to provide support in training for the officials and consultants.
3. State level review of the DPMU on a regular basis.
4. Development of clear-cut guidelines for the roles of the DPMs, DAM, DNM&E Officer, DPC &
DCM .
5. Developing the capacities of the Civil Surgeons and other district officials to utilize the capacities
of the DPM, DAM, DNM&E Officer, DPC & DCM fully.
Each of the state officers Incharge of each of the programmes should develop total clarity by
attending the Orientation workshops and review meetings at the district and the block levels for all
activities.
Time 2012-13
Frame • Selection of District level consultants, their capacity building and infrastructure
• Development of an operational Manual 2012-13
• Selection of Block management units and provision of adequate infrastructure and office
automation
• Capacity building up of District and Block level Management Units
• Training of personnel
Reorientation of personnel

REPRODUCTIVE & CHILD HEALTH

CHILD HEALTH

High levels of child malnutrition and low levels of female literacy, particularly in rural
areas increase risk of child mortality and morbidity. Failure of family to properly plan
their family in matters related to delaying and spacing of births leads to significantly
high mortality among children. Failure of programme to effectively promote
breastfeeding immediately after birth and exclusive breastfeeding is yet another factor
affecting IMR. A high level of child malnutrition, particularly in rural areas and in
children belonging to disadvantaged groups adds to the problem. The Anganwadi
centre and Sub Centre often lacks drugs, ORS packets, weighing scales, etc. The plan
for child health takes these factors into consideration.
Goal

99
Reduce Infant Mortality Rate (IMR) (target – from 551(AHS-2010-11) to 50 by 2013)
Reduce under five mortality rate from 70(AHS 2010-11) to 60
Objectives:-
 To promote early and exclusive breast feeding to infant
 To reduce mortality and morbidity due to diarrhea through use of Zinc and ORS
 To reduce mortality and morbidity due to ARI
 To reduce the prevalence of anemia among children
 To ensure full immunization of the children
Strategies:-
Promotion of early and exclusive breastfeeding
 Promote early and exclusive breastfeeding to the child
 Appropriate infant and young child feeding
 Strengthen essential home based newborn care (HBNC)
 Universal coverage of routine immunization of Children
 Universal coverage of Vitamin A, IFA supplementation
 Training on IMNCI and FIMNCI
A.2.6. Management of Childhood Diarrhea Through the Use of Zinc and ORS
District-Sitamarhi

1. Introduction
India has a national policy for management of diarrhoea among children that
recommends the use of Zinc tablets along with ORS in the treatment of diarrhoea as
per the MOHFW, GoI directive dated 2nd Nov. 2006. A high-level meeting held under
the chairmanship of Dr. M.K. Bhan, Secretary, Department of Biotechnology
recommends for every case of diarrhoea, a dose of 20 mg/day for 14 days for
children above age 6 months and 10mg/day for children aged 2-6 months.
The high-level committee recommendations emphasize that:
a) Zinc tablets should be available in all parts of the country including Anganwadi
centers.
b) An effective communication strategy be put in place
c) Health care providers including Anganwadi Workers and ASHAs are oriented and
trained in the use of zinc along with ORS.

2. Situation Analysis:-
The district Sitamarhi is the 11th most populous districtof Bihar having one polio high
risk block namely Dumra.There are 11blocks(Belsand, Runni, Saidpur, Parsauni,
Sursand, Baiginia, Bathnaha, Bazpatti, Dumra,Parihaar, Sonbarsha) which were
severely affected due to flood in the current year (2011-12). The diarrhea prevalence
is also very high which is 12.5% as compared to the state average of 12.1%.

100
Indicator Sitamarhi Bihar Source
District State
Children suffered from Diarrhea 12.5 12.1 DLHS-3
in the last two weeks prior to
survey (%)
Children with Diarrhea in the 79 73.7 DLHS-3
last two weeks who were given
treatment (%)
Children with Diarrhea in the 21.6 22 DLHS-3
last two weeks who were
received ORS (%)
Women aware of ORS (%) 10.8 23.8 DLHS -3
IMR 67 55 Annual Health
Survey,10-11
Under 5 Child Death 106 77 Annual Health
Survey,10-11

4. Progress update during the current year (2011-12) :

The district implemented the childhood diarrhea management program in 2011-12.
Micronutrient Initiative (MI) provided technical and operational support to the district
through the placement of Divisional Coordinator and provided training on childhood
diarrhea management to all MOs, CDPOs, BHMs, BCMs, LHVs, Staff Nurses,
Pharmacists, ANMs, ASHAs and Anganwadi Workers. MI also supplied 2,25,160
combo kits (each kit consists of two packets of ORS and 14 tablets of Zinc DT),
recording and reporting formats, compliance cards, IPC tool for counseling. Further,
MI trained all Data Entry Operators in the block PHCs and

District on record keeping and reporting. MI also imparted two days training to all
BCMs on supportive supervision and provided printed supportive supervision
checklists.

The district introduced reporting on Zinc –ORS from August, 2011immediately after
completion of training. The supply of combo kits was distributed to all AWWs,
ASHAs, HSCs, PHCs and Sadar Hospital. The report for the month of August,
September & October reveals that5419number of cases reported in which 4990
treated with both Zinc &ORS which is 92%. The BCMs have started supportive
supervision visits from December 2011 as per their plan.

5. Plan of Action for 2012-13:-

5.1 Specific Objectives (2012-13):

I) At least 4,09,328(50% of the total expected diarrheal cases in a year) childhood
diarrheal episodes treated with ORS & Zinc through public health system (Sadar
Hospital, PHCs, APHCs,HSCs, ASHAs and Anganwadi Workers)
II) At least 4,09,328 numbers of Zinc syrup bottles and 8,18,657 packets of ORS are
procured and distributed to AWWs, ASHAs, HSCs, APHCs, PHCs &Sadar Hospital.
Population 0-5 years Expected Target for 2012- No. of No. of
as per 2011 Children yearly 13 (At least 50% bottles of ORS
census (14.35% of Childhood cases will be Zinc Syrup packets to

101
 the total diarrheal reported and to be be
population as cases treated through procured for procured
per the (@1.71 per public health 2012-13 (@ for 12-13
CBR(28.7), child/annu care system (At 1 bottle per (@ 2
Annual al as per present 28.6% episode) packets
Health NCMH, cases reported in per
Survey, 10- 2005, GoI) govt. health episode)
11 facilities as per
forSitamarhi) DLHS-3, India)
34,19,622 4,78,747 8,18,657 4,09,328 4,09,328 8,18,657

5.2Implementation Strategies (2012-13):

 Procurement of Zinc Syrup & ORS packets at the district level.
 Distribution of ZincSyrup& ORS packets to AWWs, ASHAs, HSCs, APHCs,
PHCs & District Hospital.
 Ensure no stock out of Zinc& ORS at all levels at all times
 Continue the involvement of BCMs in Supportive Supervision.
 Refresher training of all ANMs,AWWs, ASHAsonchildhood Diarrhea
management and recording and reporting.
 Print & distribute training module for the refresher training of ANMs, AWWs,
and ASHAs.
 Refresher training of Data Entry Operators on recording & reporting.
 Refresher training of BCM on Supportive supervision.
 Print & distribute registers (ANM, ASHA, AWW) reporting forms (PHC, APHC,
HSC, ASHA, AWW), Supportive supervision checklist for BCMs.
 Print & distribute inter personal communication (IPC) tool kit & Compliance
cards for counseling by ANM, ASHA, AWW.
 Create awareness in the community about the importance of Zinc& ORS
through various BCC& Social Mobilization activities.
 Celebrate important events like ORS- Zinc day / Week.
 Quarterly review at district level under the chairmanship of DM/CS with key
Health and ICDS officials andquarterly review at block level under the
chairmanship of MOIC with the presence of Health and ICDS officials.
 Monthly review meeting with BCMs on the supportive supervision visit findings
at the district level& monitoring visits by DCM to BCMs during supportive
supervision visits.
 Strong coordination with the development partners.

5.2 Supports by other Development Partners (2012-13):-

Micronutrient initiative will continue to provide the following support in 2012-13 to
district Sitamarhi:
 Continue to provide techno-managerial support through the placement of
Divisional Coordinator.
 Provide technical support in refresher training of ANMs, AWWs, ASHAs,
BCMs& Data Entry Operators.

102
  Provide prototype soft copy of training module, Inter Personal Communication
(IPC) tool kit, Compliance Cards, Registers, Reporting forms, Poster, Wall
Painting & Display Board.
 Support in organizing district and block level review meetings.
 Continue to provide mobility support to the BCMs for the supportive
supervision visits.

5.4 Following activities proposed under NRHM budget (2012-13):

 Procurement of Zinc Syrup (4,09,328) and ORS packets (8,18,657) for
4,09,328 diarrheal episodes
 Print and distribute posters and display boards at Sadar Hospital, PHCs,
APHCs, HSCs, AWCs
 Mobility support for hiring vehicle for the distribution of Zinc and ORS from
the district to block PHCs
 Undertake wall paintings in villages
 Print & distribute training module, Registers, Reporting forms, Supportive
Supervision Checklist, Compliance Cards, Inter Personal Communication
(IPC) tool kit.
 Mobility support for DCM to carry out monthly monitoring visits.
 Monthly Review meeting of BCMs at the district level.
 Celebrate ORS –Zinc day and week at the district and block levels


MATERNAL HEALTH
Logical Framework
Sl. Goal Sl. Impact indicators
1 To improve 1.1 Reduction in MMR
maternal health
Sl. Objectives Sl. Outcome Sl. Strategy Sl. Output
indicators indicators
1 To increase 1.1 % of 1.1.1 To make functional 1.1.1.1 % of PHC
institutional safe institutional PHC (24hr x7days) having
delivery by50% delivery for institutional functional
to 70% by year reported deliveries in all OT and
2012-13 PHC. Labour room
with
equipment
1.1.1.2 % of PHC
having
Obestetric
First Aid
medicine
24hrx 7 days

103
 1.1.1.3 % of Grade A
nurse
available
24hrx7days
1.1.1.4 % of PHC
having
functional
Neo-natal
care units
1.1.2 To make functional 1.1.2.1 No of FRUs
FRU for having
institutional functional
deliveries blood storage
units linkage
with blood
banks and
24hr ready
referral
transport
1.1.2.2 No of FRUs
having EmOc
and BmOc
facilities
1.1.2.3 No of FRUs
having
specialist
doctors/
multiskilled
Medical
Officers
1.1.2.4 No of FRU
having
functional
Neo-natal
care units
1.1.3 To provide Referral 1.1.3.1 No of
transport services pregnant
at FRU /PHC women
availed the
referral
facilities
(pick up and
drop)
1.1.4 To strengthen 1.1.4.1 % of
Janani Suraksha pregnant
Yojana / JSY women
reecieved
JBSY
payments
immediately

104
 after delivery
and how
many PHCs
having JBSY
facilities
2 To increase safe 2.1 Proportion of 2.1.1 To ensure support 2.1.1.1 % of home
delivery by birth attendant of SBA at home deliveries
trained ANM by skilled health deliveries attended by
100% personnel SBA
3 To increase 3.1 % ANC 3.1.1 To strengthen 3.1.1.1 % of HSCs
ANC coverage reported through HSC for providing having
with quality HMIS formats / outreach maternal ANMs
18.9% to 50% Form -7 care 3.1.1.2 % of HSCs
by year 2010 conducted
fixed ANC
and clinics
( planned &
held)
3.1.2 To organize 3.1.2.1 % of RCH
integrated RCH camps
camps specially planned and
for hard to reach held
areas, isolated
population and
Maha Dalit Tolas
3.1.3 To improve 3.1.3.1 No of
adolescent pregnant
reproductive and adolescent
sexual health counseled by
ANM/
AWW/ASHA
3.1.4 To accelerate 3.1.4.1 % of OPD
APHC for OPD clinics
and Fixed AN organized at
clinics APHC level.
4 To provide safe 4.1 % MTP cases 4.1.1 To provide MTP 4.1.1.1 No of
abortion reported through services at health facilities
services at all HMIS formats / facilities having MTP
facilities Form -7 services
(public and
private )
5 To increase 5.1 % of Mahila 5.1.1 To strengthen 5.1.1.1 % of mothly
community mandal Monthly Village Village
participation in meetings Health and Health &
maternal care conducted. Nutrition Days Nutrition
Days planned
and held
MATERNAL HEALTH
Sl. Strategy Sl Gaps Sl Activities

105
 To make Infrastructure
A1 functional 1.1 Out of 17 PHC 1.1.1 Need based (
PHC (24hr 14 PHC running Service
x7days) for in own building delivery)Estimation
institutional and one in of cost for
deliveries running APHC upgradation of
Building, one in PHCs.
running HSC
Building & one
in rented
Building.
1.2 At present no 1.2.1 Preparation of
PHCs are priority list of
working with interventions to
delivery deliver services.
planning and
80-100 OPD per
day in each
PHC. This huge
workload is not
being addressed
with only six
beds inadequate
facility.
1.3 The 1.3.1 Sending the
comparative recommendation
analysis of for the certification
facility survey with existing
(08-09) and services and
DLHS3 facility facility detail.
survey (06-07),
the service
availability
tremendously
increased but
the quality of
services is still
the area of
improvement.
1.4 Lack of 1.4.1 Prioritizing the
equipments as equipment list
per IPHS norms according to
and also under service delivery
utilized and IPHS norms.
equipments. 1.4.2 Purchase of
equipments
1.5 Lack of 1.5.1 Purchase of
appropriate Furniture
furniture

106
 1.5.2 Lack of 1.5.2.1 Construction of
facilities/ basic PHCs
amenities in the
PHC buildings
To make 1.6 As per IPHS
functional norms each
PHC (24hr PHC requires
x7days) for the following
institutional clinical
deliveries staffs:(List
attached)
1.6.1 The actual Selection and
position is not recruitment of
sufficient as per ANMs, Nurse
IPHS norms Grade A, Doctors
List of Human on contractual basis
resource is and give priority in
attached selection those who
are living in same
PHC.
Salary of
Contarctual Grade
A nurses
Selection and
recruitment of
grade A nurses for
conducting
delivery
Selection and
recruitment of
dresser
Selection and
recruitment of
Pharmasist.
Three month
induction training
of Grade A nurse
under supervision
of District level
resource team.
1.7.1 Training need
Assessment of
1.7
PHC level staffs
Mobility support to
BHMs
1.8.1 Appointment of 5
1.8 Accountants
Trainings of BHMs
on Health statistics

107
 Training on
Program, Finance
management and
HMIS
Drug Supply
1.9 Irregular supply 1.9.1 Ensuring the
of drugs because availability of
of unavailability FIFO list of drugs
supply of drugs with store keeper.
agency.
1.10 Only 38 1.10.1 2.Implementing
essential drugs computerized
are rate invoice system in
contracted at all PHCs
state level .
Purchase of Drug
invoice software
Lack of fund for 1.10.2 3.Fixing the
the responsibility on
transportation of proper and timely
drugs from indenting of
district to medicines
blocks. ( keeping three
months buffer
stock)
1.11 There is no 1.11.1 4. Orientation
clarity on the meetings/ training
guideline for on guidelines of
need based drug RKS for operation.
procurement
and
transportation.
1.12 Drugs are not 1.12.1 5. Enlisting of
properly stored equipments for safe
storage of drugs.
1.12.2 6. Purchase of
enlisted
equipments.
1.12.3 7.training of store
keepers on
invoicing of drugs
To make 1.13 17 PHCs are 1.13.1 Ensure 24 hrs new
functional lacking 24 hrs born care services
PHC (24hr new born care in PHC.
x7days) for services.
institutional 1.14 A few PHCs 1.14.1 Ensure 24 hrs
deliveries provides 24 hrs BEmoC services at
BEmoC PHC
services.

108
 Training of one
Doctor from each
PHC on BEmoC.
Equipments for
BEmoC
1.15 PHC does not 1.15.1 Deputation of
have laboratory regular Lab tech at
facilities on PPP PHC level for
based srvices. providing free of
Phc have T.B cost lab services to
lab Technician. all pregnant women
and BPL families.
1.16 1.16.1 Recruitment of lab
technicians as
required for regular
support of lab
activity
Training of TB lab
technician on other
pathological tests.
Purchase reagent
(recurring) for
strengthening lab.
Purchase of
equipments/
instruments if
needed. Fund could
be rooted through
RKS and if it is not
utilized it could be
diverted to other
women and child
friendly activities.
1.14 Referral Services
1.14.1 No pick up 1.14.1.1 Provision for pick
facility for BPL up & drop pregnant
patients. mothers and BPL
families free of
cost using existing
Ambulance
services at PHC
level.
Provide EDD list
of pregnant
women to
Ambulance driver
and Number of
ambulance driver
and 102 /PHC tel
No to all Pregnant
109
 women

Prepare list of
Vehicle those are
utilized in
Monitoring work in
PHC that can be
use in pick up and
dropping facility.
1.15 Quality of food, 1.15.1 Assigning mothers
cleanliness committees of local
(toilets, Labour BRC for food
room, OT, supply to the
wards etc) patients in govt‟s
electricity approved rate.
facilities are not Review of
satisfactory in Cleanliness activity
any of the PHC. in all PHC by
Quality assurance
committee and
payment of agency
should be link with
it.
1.15.2 Hiring of workers
for cleanliness of
OT and Labour
room in PHC
Purchase
equipments and
uniform for
cleanliness in all
PHC
Training of
Workers on using
machine/
equipments and
importance of
cleanliness.
Develop
mechanism for
monitoring of
cleanliness work
1.16 Non availability 1.16.1 Printing of formats
of HMIS and purchase of
formats/registers stationeries

110
 and stationeries 1.16.2 Biannual facility
survey of PHCs
through BHM as
per IPHS format
1.16.3 Regular monitoring
of PHC facilities
through PHC level
supervisors in
IPHS format.
1.17 Operation of 1.17.1 Ensuring regular
RKS: monthly meeting of
RKS.
1.17.2 Appointment of
Block Health
Managers,
Accountants in all
institutions.
1.18 Lack in uniform 1.18.1 Training to the
process of RKS RKS signatories for
operation. account operation.
1.18.2 Trainings of BHM
and accountants on
their
responsibilities.
1.19 Lack of 1.19.1 Meeting with
community community (School
participation in children or other)
the functioning representatives on
of RKS. erecting boundary,
beautification etc,
1.19.2 Meeting with local
public
representatives/
Social workers and
mobilizing them
for donations to
RKS.
1.20 In serving 1.20.1 Meeting in RKS
emergency with Local Police
cases, there are Station in charge to
maximum handle emergency
chances of situation.
misbehave from
the part of
attendants, so
staffs reluctant
to handle
emergency
cases.

111
To make 1.37 No guidance to 1.38.1 Pictorial wall
functional the patients on painting on every
PHC (24hr the services section of the
x7days) for available at building denoting
institutional PHCs. the facilities and
deliveries attached trained
volunteers to guide
patients.
1.38 Non friendly 1.39.1 Name plates of
attitude of staffs Doctors
towards the poor
patients in
general and
women are
disadvantaged
group in
particular.
Displaying Name
Photograph and
DOB of all staff of
PHC and put
cleanliness staff
name on top of the
list.
Lack of
There are 2 LHV
1.41 counseling 1.41.1
in the district we
services
can utilize their
experience in
counseling work of
women and
adolescent girls
after training.
1.42 There is no hot 1.42.1 Installation of solar
water facility for heater system and
PW and there is light with the help
no adequate of BDO/Panchayat
lighting facility at PHC or purchase
at adjoining area equipments from
of PHC market.
1.43 Lack of 1.43.1 Convergence
convergence meeting by RKS &
DHS
1.44 Lack of timely 1.44.1 Orientation of the
reporting and staffs on indicators
delay in data of reporting
collection formats
1.44.2 Purchase of
Lack of space Laptops for DPM,
1.45 for waiting, DAM, DNM&EO
environmental and BHMs with

112
 cleanliness internet facility.
around PHC,
provision for 1.45.1 Gardening
hospitality etc

1.45.2 Sitting arrangement

for patients
Construction of
patients waiting
shade
1.45.3 Installation of LCD
projector for
manage wait over
time of OPD
patients.
1.45.4 Installation of safe
drinking water
equipments/water
cooler,
Welcome PW at 1.45.5 Apron with name
2.3 Institution and plates with every
PHC and FRU doctors
1.45.6 Presence of staffs
with uniform and
name plates.
1.45.7 “MAMTA” should
also be appointed
at PHC level as
well.
2.3.1 Provision of food
for the delivered
mothers and
mothers under gone
in tubectomy in all
the health facilities.
2.3.2 Mobilize
community
Resources for
providing Free
Reporting of food for PW at
maternal death Institution.
Maternal death 2.3.3 Quality indicators
2.4 reporting is (clean
usually not environment, wards
reported by with clean linen,
worker clean toilets , clean
labour rooms,
running waters
supply, hot water

113
 and safe water for
inpatients, new
born corners,
treatment
protocols, aseptic
precautions,
immediate
disbursement of
JBSY funds
2.4.1 Training of ASHA
& ANM on
reporting of
Maternal deaths
and conduct
Verbal Autopsy
2.4.2 Incentives for
maternal death
reporting by ASHA
@ Rs 50/-per
maternal death
2.4.3 Reporting line
should be in five
columns – name of
mother, place of
death, date of
death, cause of
death and no. of
birth.
2.4.4 Institution and
urban center also to
Biomedical report Maternal
waste death to the district
management is CS/ACMO.
2.5
not properly 2.4.5 Maternal Death
taken care off at should be reported
all institution by ASHA, AWW,
ANM Staff Nurse
& Doctors to the
district data center
.
2.4.6 Investigation of
maternal death by
district team. and
third party
review(District
magistrate)
2.4.7 Training of ASHA
and investigation
team objective and
process of

114
 investigation and
review of maternal
death
2.5.1 Procurement of
equipment
2.5.2 As per example
Introduce color
coded buckets for
Tracking of facilities as per
pregnant women rule.
from first 4.1.1 Review of early
4.1
Trimester is not registration with 3
done form the AN checkup ,two
register. TT.100/200 IFA
Tab. in ASHA
Diwas.
4 To 4.2 Too much 4.2.1 Ensure 100
strengthen documentation %Pregnancy Test
Janani process. Photo Kit is to ASHA and
Suraksha required for regular supply.
Yojana / mother and
JSY baby.
4.2.2 Direct transfer of
funds from district
to PHC through
core banking /
directly from DHS
4.2.3 Finger print
technology for JSY
beneficiaries at
facility level where
computer with
internet facility is
available. This will
help in financial
monitoring.
4.2.4 The photo system
should be replaced
by some other
alternatives like-
bank account
opening of
pregnant women in
first trimister and
directaly transfer
the money to their
account after
delivery.

115
 Incentive for
institutional
delivery. If
postoffice saving
account is opened
for all the ASHAs
then payment
process will be
easier for them.
5.1 Home Delivery 5.1.1 Home Delivery
is still should be
prevailing conducted by SBA
through trained Staff Nurse
untrained or ANM.
traditional Dai‟s
5 To ensure 5.1.2 Provision of Dai
support of Delivery kit(DDK)
SBA at to TBA where
home institution access is
deliveries poor. And it should
be supervised by
ANM for home
deliveries.
5.1.3 Delivery kit
Reporting of (equipment,
home delivery is medicine)for ANM
5.2 not done so the should be supplied
PNC is not 5.1.4 Supply of delivery
provided Kits as per number
of deliveries
conducted in home.
5.2.1 Incentive based
system for
reporting of home
delivery by ASHA
and it should be
linked with ANM
5.3 Non payment 5.3.1 The JSY money to
of Home the mother who has
delivery through delivered baby at
JSY Home paid by
ANM.
10.1 Out reach camps 10.1.1 Identifying
are not orgnised Socially Backward,
in plan manner. Slums & Maha
It is totally Dalit Tolas.
based on
demand of
orgnisation and
eventually it is

116
 not reported to
respective HSCs
and PHCs.

10 To organise 10.1.2 Hiring trained

integrated alternate
RCH camps vaccinator/ retired
specially for ANMs and Medical
hard to officer .hiring
reach areas, vehicle for fixed
isolated day out reach
population camps with drugs.
and Maha 10.1.3 Fixed day OPD
Dalit Tolas clinics at APHC
level and adjoining
HSC of respective
APHCs. with
dedicated MO and
support staff.
10.1.4 To make calendar
for camps with date
and identified
No training
areas.and link
programme for
NGOs those who
11.1 adolescent
are willing to
particularly
orgnise Camps
health and sex.
10.1.5 Community based
reporting system
through SMS.
involve PRI
members and
training on
reporting and
Camp approach
11.1.1 Multipurpose
counsellor can be
used for adolescent
care. For this
services of LHV
can be used.and
callender of
activity could be
devloped.

117
11 To improve 11.2 Preventions of 11.2.1 Linkage with
adolescent anemia in adolescent anemia
reproductive adolacencent control programme
and sexual girls in Schools with
health Unicef. And
training to one
teacher from the
school
11.3 Marriage before 11.3.1 Public
legal age. Sensitization
particularly women
11.4 Preventions of 11.4.1 Adolescent
teen age pregnancy should
pregnancy and be addressed with
abortion. priority care(
eclampsia, 3 ANC,
anemia, 100 IFA,
100% institution
delivery, low birth
Wight baby, Breast
feeding.PNC with
in 48 hours.
11.6 Limited 11.6.1 Family counseling
interventions for for adolescent
empowering pregnancy tracking
adolescent girls on above
mentioned through
ASHA and AWW.
11.6.2 State to develop
and issue
guidelines for
implementation of
Kishori
MandalsFormation
of Kishori Mandals
by registration of
all girls(11-18 yrs)
11.6.3 Prepare a monthly
MTP services plan of activities
12.1 are not available for one day per
in Public sectors week
To improve 11.6.4 Counseling
adolescent nutrition, health
reproductive and social issues
and sexual every week at
health AWCs by AWW
11.6.5 Weekly
distribution of IFA
Tablets to out-of-
school girls at

118
 AWCs

11.6.6 Deworming
adolecent every 6
months
11.6.8 Initiate family
schools for learning
child care , safe
motherhood life
skills and Family
life education
12.1.1 Selection of
facilities for
provision of safe
abortion services
12 To provide 12.1.2 Location of facility
MTP availability of
services at trained service
health provider, space,
facilities equipments.
12.1.3 To Provide
appropriate
equipments at all
facilities and MVA
syringes.
12.1.4 Putting the trained
doctors at
appropriate
Nutrition and
facilities to
Counselling
commence the
Component is
services
not visible in
12.1.5 Training of
13.1 VHND and
Medical officers
there is no
and Para medical
monitoring of
staffs on Safe
VHND activity
abortion services
by Community.
training including
awareness about
legal aspects of
MVA/ EVA and
Medical abortion
by IPAS .
12.1.6 Formation of
district level
committee (DLC)
to accredit private
sites as per GOI
guide line .

119
 12.1.7 Develop reporting
system of MTP
services in private
and public secter.
12.1.8 Through training
program make the
govt doctors skilled
to perform MTP in
the approved sites.
12.1.9 To Involve
community to
aware about
location of services
, process and legal
aspects of MTP
services through -
AWW, ASHA &
ANM, LRG and
mass media.(IEC)
To provide 12.1.10 The services of
MTP Pregnancy testing
services at should be
health strengthened and it
facilities should be linked
with MTP services.
12.1.11 NGO‟s and local
Practitioner should
be involved for
counseling and
information of
facility
12.1.12 Assurance of
privacy and link
with family welfare
services counseling
at all facility.
12.1.13 Linkage with MTP
services with
NGOs (PPP) those
who are working in
Safe abortion
services. and create
one nodal center at
district and PHC
level.
12.1.14 Training of ASHA
on medical
abortion.

120
 13.1.1 AWC should be
developed as a Hub
of activities
(VHND)
13 To 13.1.2 Develop an activity
strenghten plan calendar for
Monthly VHND as
Village seasonality.
Health and 13.1.3 Counseling of
Nutrition mothers on ANC,
Days preparation for
Child care
,STI/RTI, and
AYUSH,
adolescent Health
13.1.4 Organize VHND in
Four Table concept
regularly where
One place is for
registration, one is
for weighing, one
is for immunization
and fourth is for
counseling
13.1.4 Meeting of VHSC
and preparation for
area specific
Infrastructure
epidemiological
planning and
community based
monitoring.
13.1.5 Skill development
training is required
to ANM , ASHA
& AWW and Dular
(LRG)
13.1.6 Develop
monitoring plan
map of each
village and
displaced at AWC
with identification
of priority houses
with PW, lactating
women
,Malnourished
children , New
born, DOTs and
other services

121
 13.1.7 SMS reporting
system of
conducting VHND
and ANM collect
Data from field
level and compile it
in weekly/Monthly
formats.
B APHC 1.3 Out of 56 1.3.1 Registration of
APHCs only 8 RKS
are having own
building
To form 1.4 Existing 28 1.4.1 Rennovation of
/strenghten buildings are APHCs buildings
APHC in not properly from RKS Fund
Phase maintained
manner
Human
Resource
2 2.1 in the district no 2.1.1 Operationalising
any APHC one APHC in each
functioning as PHC by conducting
per IPHS norms daily OPD by
Doctor and support
staff.
2.2 2.2.1 Notification from
district for
oprationaliing
APHC
Drug Supply
3 3.1 No drug kit as 3.1.1 Purchasing 23
such for the listed OPD Drugs
APHCs as per of PHC for APHC
IPHS norms.,
5.1 No regular 5.1.1 Trained service
clinic at all provider on
PHCs & syndrome
APHCs. management of
RTI/STI (As per
GOI guide line) up
to APHC level.
5 RTI/STI 5.1.2 Logistics of setting
services at of clinics and free
health drugs availability
facilities 5.1.3 Integrated
Counselling
services in four
public sector
facilities by trained
personnel .

122
 5.1.4 IEC/BCC for
awareness
available RTI/STI
services at all
health facilities.

Chid Health
Logical Framework
Sl. Goal Sl. Impact indicators
1 1.1 Reduction in IMR
To improve 1.2 Child performance in the school - enrolment, attendence and dropout
Child health &
achieve child
survival
Sl. Objectives Sl. Outcome indicators Sl. Strategy Sl. Output
indicators
1 To increase 1.1 % increase of ORS 1.1.1 Home Based Newborn Case
ORS distribution . Care/HBNC increasement
distribution
80.4% to 100%
2 To increase % increase of treatment
treatment of of diarrohoea within two
diarrohoea weeks
60.4% to 100%
3 To increase % increase of treatment
treatment of of ARI/Fever in the last
ARI/Fever in two weeks
the last two
weeks 66.5% to
100%
4 To increase of % increase of infant care Strengthening of Facility Based No of PHC
infant care with with in 24hr of delivery . Newborn Care/FBNC and trained initiated
in 24hr of workers on using equipments. FBNC with
delivery from trained
9.6% to 50% MAMTA on
facility based
new born
care..
5 To increase % % increase of 1.1.2 Infant and Young Child No of training
of breastfeeding within 1 Feeding/IYCF orgnised in
breastfeeding hr of birth . PHC on IYCF
from 8.3% to
100% within 1
hr of birth
6 To increase % increase of
intiation of complimentry feeding
complimentry among 6month of
feeding among children.
6 month of
children from
86.1% to 100%
7 To increase % increase of exclusive
exclusive breastfeeding among 0-6
breastfeeding month of children .
among 0-6
month of
children from
24.4% to 100%
8 To increase % increase of full
immunization immunization coverage .
coverage from
56.3% to 100%

123
9 To increase vit To increase Vit A 1.1.3 Management of diarrhea, ARI and Two round of
A coverage of reported adequte Micronutrient Malnutrition Child survival
received atleast coverage among (9m to through Child srvival months Month
one dose 5ys ) organised in
(9month to 35 one financial
months ) from year
30% to 100%

10 To decrese % of decrese 1.1.4 Care of Sick Children and Severe No of VHND

Malnutrition Malnutrition age group Malnutrition and strenthen orgnised vs
of (0 to 5 yrs) VHND at all AWCs Planned.
2.1 2.1.1 School Health Programme School health
Camp are
being
organized

Sl. Strategy Gaps Activities Unit

Cost
Home Based Assessment of Training load and NA
Newborn Training Gaps(AWW- prepare calendar of training
Care/HBNC ,ASHA,ANM1,MPW- Incorporate ASHA in IMNCI NA
No ASHA is trained on training team
IMNCI ASHA kit regular supply and
incorporate use of ASHA Kit in
training curriculum.

Inadequate monitoring of Division of area among all NA

this activity at field level trained supervisors for revision of
IMNCI activity in their area.
BHM will be responsible for NA
review of health supervisor sand
LS(ICDS)on given format.Unicef
staff will support in devloping
review mechanism in PHC.
Incorpate IMNCI reports in HIMS NA
formate
Encouraging mother regarding NA
child care.in VHND
Frequent checkups of babies by NA
Paediatrician.
Distribute telephone number to
AWW and ANM of respective
doctors those who are supervising
them in the field.
Wednusday could be fixed a day NA
for IMNCI related work at HSC
level
Community based Monitoring
support system devlop with SHG
in one PHCTraining of Group
membersseed money to SHG for
reffral services and other need
based services.
Facility Based Lack of Baby warmer All PHCs should be equipped
Newborn machines with baby warmer machines.
Care/FBNC ANMs and Doctors are Training of Doctors and ANMs to
not trained to operate operate baby warmer machine.
these machines
There is no provision of Organize training programme for
stay of mothers of newborn care for the nurses in the
neonates at PHC. district hospitals
Neonatal Care Unit not District level Supporting
up to mark. supervisory team should be
devlope with the responsibility of
nunfuctioning of neonatal care

124
 unit.
Training of team on monitoring of
NCU
Non availability of Training of Mamta and staff
“MAMTA” at PHC level. nurse on logistics of New born
Care units.by district level
supervisory Team.
Infant and Non awareness of breast Colostrum feeding and breast
Young Child feeding and proper diet feeding inclusively for six
Feeding/IYCF of young children. months.
Baby friendly hospital
Training of one doctor from each
Nursing hospital at District Level
Two days training of one staff
nurse from each private hospital
on counselling skill.
Accreditation of nursing home
and facility according to norms of
baby friendly hospital initiatives
Poor knowledge Development and Printing of
regarding new born care BCC materials
and child feeding Preparing adolescent and
practices pregnant mother on IYCF by IPC
through AWW, LRP and ASHA
Linking JBSY with colostrums
feeding
Myths and Counselling and orientation of
misconceptions about local priests, opinion leaders,
early initiation of breast fathers, mother in laws by ICDS/
feeding, exclusive breast Health functionaries in mothers
feeding and meetings and VHSCs meetings
complementary feeding Folk performance to promote
exclusive breast feeding
Uniform message on radio from
state head quarter
Lack of awareness on Organize social events through
importance of appropriate VHSCs
and timely IYCF Strengthening of Mahila Mandal
meetings- fortnightly with
involvement of adolescent girl
Organize healthy baby shows,
healthy mother / pregnant woman.
Appreciation and reorganization
of positive practices in
community. For this purpose
hiring a documentation specialist.
Celebration of “Annaprashan(
Muhjutthi) Day” at AWC
Demonstration of recipes.
Exposure visits to existing NRCs
to observe different models in the
country
Care of Sick There is not a single unit Establish rehabilitation center in
Children and in the district where district hospital, FRU and one
Severe severly malnourished PHC and promote locally
Malnutrition children could be treated. available food formula
Management of There is high privlance of Procurement of ,ORS , Vitamin
diarrhea, ARI PEM and anemia among A supplementation(9m to 5 years
and childrn because of Child children) with De-worming
Micronutrient nutrition is least priporty pediatric IFA syrup.
Malnutrition among service providers. Include covrage of Vitamin A and
IFA,children in New HIMS
format.
Insure two round of Vitamin A
and deworming for the age group
of (9m to 5 yrs) & (2 yrs to 5

125
 yers) respectivly in the month of
April And Oct as per GOI guide
line.
Involvement of ICDS, school
teachers and PRI for monitoring
and evolution
School Health No Pre School Health Half yearly health checkup camp
Programme checkup & complete for children in schools should be
Immunization card. organized. Implementation
through selection NGO.
No training of school Training of school teacher by the
teacher for basic health medical personnel with support of
care and personnel administrative person.
hygiene.
No regular health Quarterly meetings of VEC
checkup camp at school. representatives by attending
existing meetings of VECs
representatives at block level by
the concerned MOICs and BHMs.
No Training & Screening Linking existing 7 opthalmic
of school‟s teacher for paramedics with this program and
eye sight test. developing school wise calender.
No other specific School health anemia control
program has been programme should be
formulated in the district. strengthened with biannually de
worming .
Organizing
competitions/Debates/Painting
competitions/Essay/demonstration
and model preparation of
nutritional food and health.
Half yearly Health checkups and
health card of all school going
children.
Films shows on health, sanitation
and nutrition issues
Social science Lab activities.
Rally and Prabhat Phery in
epidemic areas. (Kala-azar &
Malaria)
Referral system for the school
children for higher medical care.

Family Planning
Logical Framework
Sl. Goal Sl. Impact indicators
1 Population 1.1 To decrease TFR upto replacement level
stablisation To increase sex ratio
Sl. Objectives Sl. Outcome Sl. Strategy Sl. Output indicators
indicators
2 To increase 2.1 % increase in 2.1.1 Terminal/Limiting 2.1.1.1 % of terminal/limiting
female sterlization female Methods methods use
sterilsation 2.1.2 All PHCs must be 2.1.2.2 No of facilities providing
equipped with all quality manuals on
logistics. sterilization standards of
Dissemination of sterilization services.
manuals on
sterilization standards
& quality assurance of
sterilization services
2.1.3 Female Sterilization 2.1.3.3 No of camps orgnised for
camps female sterlization .

126
 2.1.4 Compensation for 2.1.4.4 % of Female received
female sterilization compensation
2.1.5 IUD camps 2.1.5.5 No of IUD used in Camps
2.1.6 Accreditation of 2.1.6.6 No of Private providers
private providers for accrediate for IUD Insertion
IUD insertion services services.
3 To increase male 3.1 % increase in 3.1.1 3.1.1.1 No of NSV Camps
sterilization from male NSV camps orgnised.
which is almost sterilization 3.1.2 3.1.2.2 % of Male received
Compensation for
nil only one compensation
male sterilization
sterilization done.
3.1.3 Accreditation of 3.1.3.3 No of Private providers
private providers for accrediated for Sterilization
sterilization services services.
4 To increase use of 4.1 % increase in the 4.1.1 Promotion to Social 4.1.1.1 No of Condoms distributed
condoms from use of condoms Marketing of condoms through Social Marketing.
0.4% to 5% 4.1.2 4.1.1.2 No of Seminars Orgnised
Contraceptive Update
seminars on Contraceptive Update.
5 To increase use of 5.1 % increase in the 5.1.1 5.1.1.1 No of Pills distributed
pills from 1.2% to use of pills Promotion to Social through Social Marketing.
5% Marketing of pills
Sl. Gaps Activities
Strategy
Ensure one MO
trained on minilep
and NSV up to PHC
Training of nurses
Lack of
and ANMs on IUD
Terminal/Limiting knowledge of
Methods
and other spacing
small family
methods at PHC
norms.
level.
Ensure availability
of contra ceptives
(indenting , logistic
Trained doctors on
laparoscopy.
Female Laparoscopy Procure
Sterilization surgery not Laparoscopy
camps done. equipments for
trained doctors
Training of doctors
needed.
Procurement of
Trained
NSV camps doctors are not equipment.
available.
Immediate
Compensation for
disbursement of
female
sterilization incentive after
sterilization camps.
Logistic planning is
Compensation for
male sterilization
needed before
organizing camps.

127
 Block Health
manager can hire
one support staff for
logistic support.
Immediate
disbursement of
incentive after
sterilization camps.
Logistic planning is
needed before
organizing camps.
Block Health
manager could be
hire one support
staff for
disbursement for
logistic support.
Accreditation of
private nursing
home. As per GOB
Training of ANM &
IUD camps Camps not held staff nurse for IUD
insertion.
Procurement of IUD.
No Equipments for IUD
Accreditation of accreditation of insertion
private providers private Accreditation of
for IUD insertion providers for private providers for
services IUD insertion IUD insertion
services services. As per GOI
guide lines.
Social marketing of
need based OC &
IUD.
Monitoring of
Increasing access to
Social Marketing Social Markiting
of contraceptives is not monitored
contraceptive
by PHC. through
communities based
distribution system
free of cost.
seminars for MO
and other through
Professional bodies
(FOGSI. BMA,
Nursing association
Contraceptive etc..on
Update seminars
Not being held.
Copper-T 380-A
should be
popularized.
Awareness for
emergency
contraceptive.

128
 INSTITUTIONAL STRENGTHENING IN TERMS OF SERVICE
Logical Framework
Sl. Goal Sl. Impact
indicators
1 To improve 1. Improved service delivery for women and children friendly with quality
institutional 1
setup as per
IPHS norms
2 To bring
required
architectural
correction in the
Institutional
System
Sl. Objectives Sl. Outcome Sl. Strategy Sl. Output
indicators indicators
1 To strengthen 1. No and Type of 1.1.1 To enforce PNDT 1.1.1.1 % decrease in
NGOs 1 MOU signed Act and to sex selective
Partnership/ PPP between NGO increase sex ratio abortions. %
for and DHS/RKS of female child increase in
communitization for birth of female
of Health strengthening of babies (
services . communitization delivery
of health servies registers)
and NGO 1.1.2 To make Public 1.1.2.1 No of cases
partnership/ PPP Private supported by
in place Partnerships for referral
referral transport, transport
IPD care canteen system under
facility, STD PPP.
booth and other 1.1.2.2 No of canteen
routin facility facility
where it is not functional at
functional. insttutional
facility level.
1.1.2.3 No of STD
booth and
other routine
facility carried
out under PPP.
1.1.2.4 No of cases
supported and
payments
made by RKS/
DHS to BPL
families in
availing these
services

129
 1.1.2 To develop 1.1.2.1 No of partnership
partnership with with NGO for
programme
NGO implementation
Programmes in for MCHN,
the districts Micronutrient
supplimentation,
national
programme
implementation
specially Kalazar
elimination
Strengthen 1.1.2.2 No and % of
Logistics drug &
management equipments
system for regular available and
supply of Drugs supplied (
and equipments stock ledger)
Devlop a strong 1.1.2.3
Regular
Monitoring &
monitoring
Evaluation /
and evaluation
HMIS System in
reports
all PHC
3 To devlop IEC 3. No of IEC 3.1.1 Establising BCC 3.1.1.1
Functional
and BCC and 1 materials and training cell
BCC cell at
Training support developed and at District &
DHS/ RKS
system . BCC event BPHC level
level
carried out
No of training Net working with 3.1.1.2 No of folk
support system folk media team media team
developed engaged in
BCC activity.
Type and No.
of BCC event
oragnised
4 To strengthen 4. No of ASHA 4.1.1 Develop ASHA 4.1.1.1 Establishment
ASHA support 1 capacities support System in of ASHA
System all PHC(One support
person per 20 system at DHS
ASHA) and RKS level
4. No of activities 4.1.2 Strengthening 4.1.1.2 No of RKS
2 carried out by RKS having
RKS monthly
meetings.
4.1.1.3 % of untied
fund, JSY
fund, referral
transport etc
utilised
Sl. Strategy Gaps Activities

130
To make Public Out sourcing of
Private services is not as District /PHC
Partnerships for per the need of level managers
referral local Need and should be aware
transport, IPD BPL families are about the TOR of
care canteen not exampted PPP which is
facility, STD from Fee of out finalized at State
booth and other source services level.
routeen facilty Build the capacity
where it is not of manager to
functional. manage contracts
of PPP
There is an Accreditation of NA
acute shortage institutions and to
of para medics set standards, an
like institute of
radiographer, paramedical
lab technician, sciences may be
ECG technician started in the
etc. in the state. This would
District. create more
employment
opportunities in
addition
availability of
para medical
personnel for
absorption into
the government
health system.
Devlop listing of NGOs NA
partnership with those who are
NGO working in F.P
Programmes in A few ,MTP,programme,
the districts involvement of Institutional
NGO in F.P delivery,
programme, Blindness control
Institutional programme.
delivery, Accreditation of NA
Blindness these facility from
control state Health
programme. Socity.
There is no Process of MOU NA
MOU with should be
NGO/VO dicentralization
/individuals for and it should
Donation and oprationlise
voluntary through RKS.
support in PHC

131
 Strengthening of NGO NA
DMU management
process in the
NGOs district and
Management ASHA Faclitators
aspects is one of will be managed
the area of at the PHC level
improvement Honourarium to
DPM, DAM and
DA
Capacity building
training
programme for
NGOs office
bearer with the
help of
professionals on
linkage with
health system
strengthening
component.
Mentoring Group NA
at district level.
Reporting NA
mechanism
should be
developed of
NGOs work in the
district.
There is no any Co-ordination NA
VHSC in the with community
district. based orgnisation
at SHG, LRG,
VEC, ,PRI for
VHSC formation.
Capacity Expoure visit of
building of DPM/BHM
Managers and selected ASHA to
Doctors. other state where
facility is
comparatively
working better.

132
 ASHA/ AWW If ASHA
career worker is
advancement trained
programme may then she
be planned to would be
retain them in the able to
system. Seats in inject
the ANM course, medicine
staff nurses and s and
other paramedical immuniz
courses may be ation.
reserved for the
qualified ASHAs
Preparation of First time five Trainings of
decentralized members of the DPMU,BPMU
District Health districts were members on
Action Plan trained on implementation of
DHAP services/ various
National program
preparation and district Health
action Plan through
distance education
Start prepration of
plan from the
month of October
with situtional
anlysis,Facility
survey, line
reporting system
and qulitative
finding from
Community and
users of facility.
Devlop a strong Monitoring of Distribution of NA
Monitoring & all programme is role and
Evaluation / one of the responsbility
HMIS System in weakest link of among MO and
all PHC all programme. Managers of
programme
Lack of implementation.
Supervisers in Use Process NA
all PHC indicatore as
monitoring of
Lack of skill of respective
use of data programme.
Devlop NA
Community is Programme
not aware about review calander
monitoring for review of
aspects of HSC/PHC
Health performance as

133
Programme. per form 6 & 7

Gradation of NA
Health Sub
centers in three
categories.
Information NA
exchange visits
among ANM
acording to
Grade.
Social recognition NA
of Grade one
ANM.
Devlop four
potentioal
VHSCs in all
PHC on
Community based
Monitoring of
Health and
Nutrition
programme.
Organise"JAN
ADALAT" in
with PRI &
VHSC and invite
nearby VHSC to
observe thr
process of "JAN
ADALAT"
Devlop Health
and Nutrition
Report Card by
using growth
monitoring
chartsof Village
and present in
"JAN ADALAT"
By VHSC

134
 Strengthen There is no Weekly meeting
Logistics system of of HSC staffs at
management logistic PHC for
system for management of promoting HSC
regular supply Drugs and other staffs for regular
of Drugs and supply at any and timely
equipments level. submission of
indents of drugs/
Only vaccine vaccines
supply according to
management is services and
comparatively reports
stronger than Hiring vehicles
other logistic for supply of drug
work. kits
Hiring of
courriers as per
need
Developing three
coloured
indenting format
for the HSC to
PHC(First
reminder-Green,
Second reminder-
Yellow, Third
reminder-Red)
Training of all
ANM and Stock
keepers on
Indenting and
Logistic
Management.
Develop TMC
model for
Logistic
Management in
the state.
Strengthening RKS are not Ensure
RKS uniformally registration of
functioning in RKS of all
the district functional PHC &
APHC
Training of RKS
signatory and
BHM on financial
Management of
RKS

135
 Presentation of
case study of
functional RKS in
district level
Meeting.
Strengthening Poor monitoring Appointment of
community mechanism of PHC level ASHA
process through ASHA program facilitator
supportive
supervision of
ASHA program
Provide training
cum supervisory
support @ one
supervisor for 20
ASHA
Media Wrong and Media
Sensitization provocative Sensitization
Reporting work shop
Having baseless
News.

SITAMARHI DISTRICT

DISTRICT HEALTH ACTION PLAN

2012-13

136
 DDA DCM DPM Civil Surgeon
DHS,Sitamarhi DHS, Sitamarhi DHS, Sitamarhi DHS, Sitamarhi

Geographical Profile:
 Latitude - 260 12' 51'' N to 260 49' 17'' N
 Longitude – 850 12' 0'' E to 850 42' 48'' E
 Height – 85m above sea level
 International Border – 90 kms
 Total Area – 2294 Sq. Kms.
 Irrigated Land – 737.33 Sq. Kms.

Bordering Districts/ Countries:

 North – Nepal
 South –Muzaffarpur
 East – Darbhanga, Madhubani ,
 West – East Champaran, Sheohar

Agriculture: Paddy, Wheat, Sugar cane, Maize, Lentils

Industries : Sugar Factory (RIGA), Rice and Oil Mills.
Rivers: Bagmati, Lakhandei

It is situated in the northern part of Bihar. The district headquarter is located in Dumra, five
kilometers south of Sitamarhi.

 Festivals: Deepawali, Eid, Chhath Puja, Durga puja, Vishwakarma puja, Sarswati
puja, Maha-shivratri, Holy deep in Baghmati on kartik Purnima and other festivals are
celebrated with great enthusiasm.
 Fairs: Maha Shivratri Mela, Vivah-Panchami Mela & Ramnavami Mela (huge market
of cattles, horses and elephants are the main feature of these fairs)
 Languages: Vajjika, Maithili, Hindi, Urdu

Temple: Maa Vaishno Devi Mandir & Maa Janki Madir.

Government Health Infrastructure:

137
Block 17
Town 2
Sub Division 3
Nagar Parisada 1
Nagar Panchayat 05
Primary Health Center 17
Additional PHCs 36
Gram Panchayats 273
Revenue Village 835
Sub Centers 273
Sub divisional Hospital 1
District Hospital (Sadar Hospital) 1
Referral Hospital 1

Nepal

Nepal
Sheohar

Darbhanga

Motihari

Madhubani

Darbhanga
Muzaffarpur

Profile of the district:

Total Population Male Population Female Population

34,34,108(2011sensus Projected) 18,14,662 16,19,446
Total Area – 2294 Sq. Kms.
Urban Population 119593 Rural Population 1894203
Percentage of SC 12.1 Percentage of ST 0.02

Literacy rate 38.46%

Sex Ratio (Total):- Male-1000 Female-892

HR POSITION (ARC), SITAMARHI

138
SL.NO NAME OF THE POST SANCTIONED Working VACANT
POST POST
1 District Community 1 1 0
Mobilizes
2 District Data Assistant 1 1 0

2 Block Community 17 16 1
Mobilizes
3 ASHA Facilitator 142 112 30
4. ASHA 2965 2662 303

Profiles of ASHA Resource Centre/ASHA Mentoring System

 ASHA Resource Centre/ASHA Mentoring group will oversee the
implementation of the scheme and facilitate in developing the policy
guidelines.
 It will act as a think-tank for the programme.
 It will provide technical inputs and support mechanism.
 It will provide support to implementation of all health programmes at
village
level through ASHA.
Roles & Responsibility are following:-

 Create awareness to ASHA.

 Support to ASHA for Health, Nutrition, basic sanitation, hygienic practices,
healthy living and working conditions, information on existing health
services and need for timely utilization of health, nutrition and need
for timely utilization of health, nutrition and family welfare
services.
 To Organise village level meeting.
 In one month BCM will organise more than 08 meeting at village level.
 In village level meeting he will see the work of ASHA & give necessary
sugestion to Asha &Villager.
 Supportive Supervision of ASHA Worker.
 Ensure timely incentive Paid to ASHA.
 Motivate to ASHA.
 Participate in VHSC Meeting.
 Ensure utilization fund of VHSC.
 Regular & Supportive Supervision of VHSND Programme by DCM, DDA
& BCM.
 Participate in VHSND Meeting.

Major Issue
139
 No Proper office is available at District level & Block level.
 Not any amount given for office setup.
 Mobility fund available for only two days at district level.
 Few amounts given for office expenses.
 Incentive payment of ASHA not given timely.
 No monthly incentive given to ASHA.

Major Stakeholder and her roles

Accredited Social Health Worker (ASHA)
One of the key components of the National Rural Health Mission is to provide every village
in the country with a trained female community health activist-„ASHA‟ or Accredited Social
Health Activist. Selected from the village itself and accountable to it, the ASHA will be
trained to work as an interface between the community and the public health system.
Following are the key components of ASHA :

 ASHA must primarily be a women resident of the village –

married/widowed/divorced, preferable in the are group of 25 to 45 years.
 She should be a literate woman with formal education up to class eight. This may be
relaxed only if no suitable person with this qualification is available.
 ASHA will be chosen through a rigorous process of selection involving various
community groups, Aganwadi Institutes, the Block Nodel Officer, District Nodal
Officer, the village Health Committee and the Gram Sabha.
 Capacity building of ASHA is being seen as a continuous process. ASHA will have to
undergo series of training episodes to acquire the necessary knowledge, skills and
confidence for performing her spelled out roles.
 The ASHAs will receive performance based incentives for promoting universal
immunization, referral and escort services for Reproductive & Child Health (RCH)
and other healthcare programmes, and construction of household toilets.
 Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every
ASHA is expected to be a fountainhead of community participation id public health
programmes in her village.
 ASHA will be the first port of call for any health related demands of deprived sections
of the population, especially women and children, who find it difficult to access
health services.
 ASHA will be a health activist in the community who will create awareness on health
and its social determinants and mobilize the community towards local health planning
and increased utilization and accountability of the existing health services.
 SHE would be a promoter of good health practices and will also provide a minimum
package of curative care as appropriate and feasible for that level and make timely
referrals.

140
  ASHA will provide information to the community on determinants of health such as
nutrition, basic sanitation & hygienic practices, health living and working condition,
information on existing health services and the need for timely utilization of health &
family welfare services.
 She will counsel women on birth preparedness, importance of safe delivery, breast-
feeding and complementary feeding, immunization, contraception and prevention of
common infection including Reproductive Tract infection/Sexually Transmitted
infection (RTIs/STIs) and care of the young child.
 ASHA will mobilize the community and facilitate them in accessing health and health
related services available at the Anganwadi/sub-centre/primary health centers, such as
immunization, Ante Natal Checkup (ANC), Post Natal Check-up supplementary
nutrition, sanitation and other services being provided by the government.
 She will act as a depot older for essential provisions being made available to all
habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet (IFA),
Chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.

B.1.1.5 ASHA Resource Center, Sitamarhi Budget for the year 2012-13
Strategies Activity Budget
Total
Total
Sl. Amount
S.No. Physical Target Rate Amount
No. (in
(in Rs.)
lakh)
1.1 Salary of DCM 1 290400 290400 2.90
1.2 Salary of DDA(ASHA) 1 198000 198000 1.98
1.3 Accounts Manager 1 150000 150000 1.50
1.4 Data entry operator 1 120000 120000 1.20
1.5 Peon 1 96000 96000 0.96
Asha 1.6 Office expense:-
Resource
1.6.1 Office Rent 12 5000 60000 0.60
centre/
1.6.2 Office setup (one time) 1 150000 150000 1.50
Asha
1 1.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 12 10000 120000 1.20
mentoring
1.6.4 Mobility Support for DCM & DDA(ASHA) 12 18000 216000 2.16
group at
District 1.6.5 Laptop for DCM & DDA(ASHA) for one time 2 35000 70000 0.70
level 1.6.6 Purchase of Mobile Phone for DCM & DDA (ASHA) 2 5000 10000 0.10
1.6.7 ASHA Sammelan for one time 1 500000 500000 5.00
1.7 Capacity Building for District level ARC staff 2 50000 100000 1.00
1.8 Capacity Building for Block level ARC staff 5 25000 125000 1.25
1.9 Capacity Building for ASHA Facilitator 34 10000 340000 3.40
Sub Total A 2057000 20.57
2.1 Salary of BCM 17 174240 2962080 29.62
2.2 Salary of Block Accountant 17 144000 2448000 24.48
2.3 Salary of office Assistant 17 96000 1632000 16.32
Asha 2.5 Incentive for ASHA Facilitator 150 36000 5400000 54.00
Resource 2.6 Office expense:-
centre/ 2.6.1 Office Rent 17 36000 612000 6.12
2 Asha 2.6.2 Office setup (one time) 17 50000 850000 8.50
mentoring 2.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 17 72000 1224000 12.24
group at 2.6.4 Mobility Support for BCM 17 180000 3060000 30.60
Block level 2.6.5 Laptop for BCM for one time 17 30000 510000 5.10
2.6.6 Purchase of Mobile Phone for BCM (One time) 17 3000 51000 0.51
2.6.7 ASHA Saree & others 5930 1000 5930000 59.30
2.6.8 CUG Mobile with Sim for ASHA 2965 1500 4447500 44.48

141
 2.6.9 Mobile Recharge for ASHA 2965 1200 3558000 35.58
Sub Total B 29126580 291.27
Grand Total (A+B) 31183580 311.84

HMIS
Strengthening Computer System for HMIS
Additional skilled persons are required at District level for effective implementation and
maintenance of HMIS in the District. The details of skilled persons with their job
responsibilities and salary are as follows-

SN Designation No. Positioned Job responsibilities Salary Total

of Staff of at (Rs.) Salary
Staff per per year
month (Rs.)

1 Jr. System 1 DHS Data entry, preparation 15,000/- 1,80,000/-

Administrator ,Sitamarhi of
Cum Data documents and reports
Operator etc
(HMIS)
Total 1,80,000/-

Strengthening Computer System for HMIS

SN Items Amount in
Rs.(Approx)
1. Up gradation of Computer with hardware/software as per 50,000/-
requirement. As like RAM, Hardisk, Stable Storage, Devices,
Switch, Firewall etc.
2. Anti- Virus (Quantity 4) 20,000/-
3. Designing, Creation, Maintenance, Registration, Hosting of 40,000/-
Website of District.
4. Laptops for DPM, DAM , M & E Officer, DPC , & DCM 2,00,000/-
5. USB Data Card ( For Internet Connection) (Quantity 23) 92,000/-
6. BSNL Post Paid Mobile Connection with Mobile Set and 525 30,000/-
Monthly Plan For DPMU (QTY-5)
Total 4,32,000/-
HMIS Training
District as well as Block level Capacity Building Workshop (HMIS Training) for the year
2012-13 on Revised HMIS Reporting Formats and Web Portals of NRHM and NHSRC has
been completed with the help of resource persons from National Health System Resource
Centre (NHSRC), New Delhi for District M & E Officer, District Programme Manager,DPC ,
DCM , DS of District/Sub Div. Hospital,Hospital Manager , MOIC, BHM,BCM and BAM
but training on HMIS is the continuous process for quality movement.

Therefore in FY 2012-13, Training on HMIS for the whole state is required for
 District Level other Programme Officers/Consultants
 MOIC

142
  BHM
 BCM
 BAM
 Health Educator
 Grade “A” Nurses
 ANM
 LHV etc.

The details are as follows:-

SN Designation Number
1. District Level other Program 10
Officers/Consultants
2. DS/MOIC 19
3. MO (APHC) 36
4. Hospital Manager 02
5. BHM 17
6. BCM 17
7. BAM 17
8. Health Educator 17
9. Computer 17
10. ANM (Regular & contractual) 273+19=292*2
11. Grad- „A‟ Nurse 36*2
12. LHV 17
13. Data Operators 19
Total 844

Budget
(i) TA/DA Cost for Trainees (for 2 days) = Rs. 200/- per day per trainee x 2 days x 844
= Rs3,37,600/- per annum
(ii) Miscellaneous for Trainees (for 2 days) = Rs. 100/- Per day Per trainee x 2 days x844
= Rs. 1,68,800/-
Total annual Budget = Rs. 5,06,400 /- per annum.

Total Annual Budget

SN Activities Budget
1. Strengthening HR for HMIS 1,80,000/-
2. Strengthening Computer System for 4,32,000/-
HMIS in DHS
3. HMIS Training 5,06,400 /-
Total 11,18,400/-
Total :- Eleven Lac Eighteen thousand four hundred rupees only.

143
 Aim is to immunize all pregnant Women for TT & Children up to 1 year for BCG, 3
Doses of DPT & POLIO & Measles
Under this programme all PHCs are to be covered on all Wednesday & AWCs are to be
covered at least once a month on Friday. HD & PHCs will provide Immunization services on
all working days. Incentives are provided under this achievements. Contractual ANMs have
been provided training for RI with the help of UNICEF regular ANMs have poor skill even
after training, so training for Routine Immunization has to be taken on a regular basis.
There is shortage of Cold Chain equipments such as ILR, DF, Cold Boxes & Vaccine
Carriers. This year the RI coverage is low due to Strike by Employees. PHCs have been
instructed to do RI works other than Wednesday & Friday in the week. There is no provision
for maintenance and repair of cold chain. Repairing of cold chain equipments should &
available at district level. Currently appointed company do nothing in this regard in our
district. Wast Management practices for the disposal of syrings & needles are to be improved.
Strategies :
 Increasing awareness generation of society through AWW & ASHA
 Insuring regular monthly tracking of pregnant women & new born child
 Availability of cold chain equipment.
 Maintenance and repair of cold chain equipment within the District.
 Maintenance & repairing of Vaccine Van.
 Ensuring vehicle of PHC especially for Muskan Supervision.
 Safe disposal of syring & needles.

144
 Availability of skilled vaccinator.
 Supervisory level staff of PHCs to be involved in Muskan supervision.
 Special provision in case of flood situation.
Activities :
 Regular training of RI/IEC/IPC & BCC
 Organizing regular meeting of ANM, AWW & ASHA to brief the importance of
tracking.
 State to ensure availability of cold chain equipment.
 Maintenance of cold chain at district level.
 State to allot fund for maintenance and repair Vaccine Van.
 State to decide for the funds of vehicle for supervision at the PHCs level.

VITAMIN-A SUPPLEMENTATION PROGRAMME

Background
The National Policy Guidelines (N. Z. 28020/ 30/ 2003-CH, GOI, MOHFW, dated 02
November 2006) recommends Vitamin-A Supplementation Program for the children of age
group 9 months to 5 years should receive two doses of Vitamin at 6 months interval which is
considered adequate. These months would have intensive activities during which it was
suggested that health sub-center level workers in close coordination with the ICDS workers
and ASHAs will deliver services in the given month as per detailed micro-plans. All children
should receive prophylactic nine doses of Vitamin A before the fifth birthday at the interval
of six months. Post measles Vitamin A supplementation is the part of strategy.

The National Workshop on Micronutrients organized by ICMR on the 24-25 November 2003
which recommended that Biannual Child Health and Nutrition Promotion Months be held, six
months apart i.e. usually in April/May and October/November which would offer a package
of child health & nutrition services of which Vitamin-A supplementation of target children
would be an integral part.
1. Vitamin-A Supplementation: Provide prophylactic dose of Vitamin-A solution to all
children between 9 months to 5 years. The recommended dosage schedule is as under:
a)The 1st dose 1, 00,000 I.U. (1 ml or half spoon) is given with routine measles immunization
at 9 months completed age;
b)The 2nd dose 2, 00,000 I.U. (2ml or full spoon) is given with First DPT/OPV booster (16-
18 months) and
c)The next 7 doses (each dose 2 ml or full spoon) are given After every 6 months up to 5yrs
of age.

2. Promotion of Breast feeding and timely introduction of complementary feeding:

Accelerating community
Participation and BCC on components of breast-feeding, i.e.
a) Early Initiation
b) Exclusive Breastfeeding
c) Introduction of Complimentary feeding at the age of 6 months

145
Problematic Areas
Objective:-
1. Achieve universal coverage of 9 doses of Vitamin-A
2. Reduce the prevalence of night blindness to below 1% and Bitots spots
To below 0.5% in children 6 months to 6 years age.
3. Eliminate Vitamin-A deficiency as public health problem.
Strategies:
1. Biannual Rounds of Vitamin-A Supplementation in fixed months, i.e. April & October
every year.
2. To Cover the Children through 4 days Strategy
Day 1- Cover children of 9m-5yrs at site i.e. AWCs/ HSCs/ APHCs/ PHCs
Day 2- Cover children of 9m-5yrs through house to house visits
Day 3- Cover children of 9m-5yrs at site i.e. AWCs/ HSCs/ APHCs/ PHCs
Day 4- Cover children of 9m-5yrs through house to house visit: mopping-up
Gaps:
1. Infrastructure - Urban strategy for Identification of stakeholders and service providers in
urban agglomerations,
slums, notified areas to cover left out children residing in areas devoid of health & ICDS
infrastructure.
2. Manpower- Lack of skilled manpower for implementation of program
3. Drugs- a) Non-supply of RCH Kit-A for ensuring first dose of Vitamin-A along with the
measles vaccination at
9 months.
b) Procurement of Vitamin-A bottles by the district for biannual rounds
4. Reporting. Lack of coordination among health & ICDS workers for report returns &
existing MIS ( form-VI)
5. Monitoring- Lack of joint monitoring & supervision plans & manpower
Activities:
1. Updation of Urban and Rural site micro .plan before each round.
2. Improving intersectional coordination to improve coverage
3. Capacity building of service provider and supervisors
4. Bridging gaps in drug supplies
5. Urban Planning for Identification of Urban site and urban stakeholder
6. Human resource planning for Universal coverage
7. Intensifying IEC activities for Community mobilization
8. Strengthening existing MIS system and incorporating 9 doses of Vitamin-A in existing
reporting structure
9. Strong monitoring and supervision in Urban areas

Goal
 To reduce the burden of morbidity and mortality due to various diseases in the
district.

Objective
 Establishing a sustainable decentralized system of disease surveillance for timely and
effective public health action.
 Integrating disease surveillance activities. To avoid duplication and facilitate sharing
of information across all disease control programmes so that valid data are available
for appropriate health decision.

146
Epidemic branch deals with Communicable Diseases, i.e. Waterborne Diseases such as
Cholera, Gastroenteritis, Typhoid and Infective hepatitis, Zoonotic Diseases like, Plague and
Leptospirosis, Arthropod borne diseases like, Dengue fever, Kala-azar and Malaria , Air
borne disease like Meningococcal Meningitis and provides health relief services in the wake
of natural calamities like heavy rain, floods, draught, cyclone etc. to prevent post calamity
disease outbreak. The collection and a good analysis of data analysis of this data gives us the
indication when to apply what method to stop epidemic and control it.

Strategies adopted
 Operationalization of norms and standards of case detection, reporting format.
 Streamlining the MIS system- Establishing Web based & channels for data collection
within the district and transmission mechanisms to state level.
 Analyzing line listing of cases and Geographical Information Systems (GIS) mapping
approach Preparation of graphs & charts on the basis of reports for planning
strategies during epidemic outbreak.
 Training to all the grass root level workers, MO’s & CHC staff in Data
Collection, and data transfer mechanisms.

Summary of Proposed Budget for the Year 2012-13, Sitamarhi

Total Amount
FMR Code Budget Head Proposed
(in Rs.)
A Reproductive and Child Health-II 839181284
B NRHM Additionalities 1192647018
C Immunization + Pulse Polio 37735099
D Iodine Deficiency Disorder 54000
E Integrated Disease Survillance Project 1602000
F National Vector Borne Disease Control Programme 74964865
G National Leprosy Elimanation Programme 1230115
H National Programme for Control of Blindness 34046500
I Revised National Tuberoculosis Control Programme 8869800
Grand Total 2190330681

DPM CS cum member Secretary DM cum Chairman

DHS, Sitamarhi DHS, Sitamarhi DHS, Sitamarhi

147
Detail Proposed Budget for the year 2012-13,
Sitamarhi

148
Annexure 2 Proposed Budget for the year 2012-13, Sitamarhi

Budgetary Proposal:
FMR Budget Head/Name Baseline Physical Target (where applicable) Unit Cost Financial Requirement (in Rs.) Committe Responsib
Code of activity /Curren (in Rs.) d Fund le Agency
t Status requireme (State/SH
(as on nt (if any SB/Name
Decemb Q1 Q2 Q3 Q4 Total Q1 Q2 Q3 Q4 Total Annual in Rs.) of
er 2011) no of proposed budget (in Developm
Units Rs.) ent
Unit
of Partner)
meas
H Sta ure H S H S HF S HF S HF S HFD S HFD S HFD S HFD S HFD S Remarks
F te (in F t FD t D t D t D t t t t t t
D Tot word D a a a a a a a a a a
al s) t t t t t t t t t t
* e e e e e e e e e e
T T T T T T T T T T
o o o o o o o o o o
t t t t t t t t t t
a a a a a a a a a a
l l l l l l l l l l
A RCH Flexipool
MATERNAL
A.1
HEALTH
Operationalise
A.1.1
Facilities
No. of
A.1.1 Operationalise FRUs 1460
2 2 730000 0 0 0 1460000 730000 See detail in Annexure
.1 FRUs- opera 000
tional
Dissemination
A.1.1 Workshop
0 0 0 0 0 0 348000
.1.1 for FRU
Guidelines
No. of
Monitor Progress
revie
A.1.1 and Quality 2500 2500 2500 2500 quaterly meeting to monitor the
w 1 1 1 1 4 25000 100000 37500
.1.2 of Service 0 0 0 0 progress
meeti
Delivery
ngs
No. of
APHC
Operationalise opera 14 APHC has been proposed in the
A.1.1 24x7 PHCs 1 tional 4000 4000 6000 year 2011-12,for MCH center which
4 4 6 0 14 100000 0 1400000 348000
.2 (Mch Center- 4 ise as 00 00 00 are not fully functional yet; so, we are
Aphc) MCH not incresing the target.
cente
r- L1
A.1.1 MTP Services at
0
.3 Health Facilities
RTI/STI Services
A.1.1
at Health 0 0
.4
Facilities

DHS Sitamarhi
 No. of
HSCs
Operationalise opera 2 HSC has been proposed in the year
A.1.1 Sub-Centres tional 1000 1000 2011-12, which are not fully functional
2 1 1 0 0 2 100000 0 0 200000 96000
.5 (MCH Center- ise as 00 00 yet; so, we are not incresing the
Hsc) MCH target.
cente
r L-1
Referral
A.1.2
Transport
Integrated
A.1.3 Outreach RCH
Services
No. of
Outre
ach
A.1.3 RCH Outreach 3 5 20 5100 5100 5100 5100
camp 51 51 51 10000 2040000 223000 1 Camp per PHC per month
.1 Camps/ Others 2 1 4 00 00 00 00
s
organ
ised
2
5
5
7
Monthly Village See budget detail in Annexure.
No. of 8
Health Sanitation p 35 No. of Sanctioned AWW-
A.1.3 VHSN 9 89 89 89 5399 5399 5399 5399
and Nutrition Day e 61 2159700 1303200 2642+Additional AWW=
.2 D 0 04 04 04 25 25 25 25
(VHSND) r 6 173+sanctioned mini AWW 153=2968.
Nutrition Days held 4
m So, 2968 VHSND per month
o
n
t
h
No. of ELA for ANC for the yaer 2011-12 is
Benifi 5 107205. ELA for 2012-13 will be
Janani Suraksha 3 22 107205+10% of 107205 = 117926.
A.1.4 cairy 5 55 55 55 2786 2786 2786 2786
Yojana / JSY 6 28 500 11144000 180000 Considering 10% pregnancy wastage
.1 got 7 72 72 72 000 000 000 000
Home 2 8 the ELA for delivery will be-106133.
the 2
benit Considering the guideline of JSY i.e.
the benefit will be given to only those
person having age more than 19 yrs
and up to 2 child; we will take 70% of
A_1. Institutional ELA for delivery for ELA of JSY for the
4.2 Deliveries year 2012-13, whic is- 74293. Now
considering 30 % Home delivery,
Home delivery will be 22288.
No. of Considering 70% institutional delivery,
1 1 Institution Delivery will be- 52005 in
Benifi
4 1 11 11 11 45 which we consider 8% C- Section
A.1.4 Institutional cairy 2258 2258 2258 2258
8 2 29 29 29 17 2000 90350000 31500000 delivery which will be 4160 and as per
.2.A Deliverie-Rural got 8000 6000 8000 8000
8 9 3 4 4 5 census 2011 Rural Population is
the
8 4 94.42% and Urban Pouplation is
benit

1
 No. of 5.58%. so, Institutional delivery rural
Benifi will be 45175 and Institutional
4 6 Delivery urban will be 2670
A.1.4 Institutional cairy 66 66 66 26 8016 8004 8016 8004
5 6 1200 3204000 745000
.2.B Deliveries-Urban got 7 8 7 70 00 00 00 00
8 8
the
benit
No. of
Benifi 1
Institutional
A.1.4 6 cairy 0 10 10 10 41 1560 1560 1560 1560
Deliveries- C- 1500 6240000 450000
.2.C 6 got 4 40 40 40 60 000 000 000 000
section
the 0
benit
No. of 1 visit per PHC per quarter
visit
A.1.4 Administrative 1 1 4250 4250 4250 4250
and 17 17 17 68 25000 1700000 1223445
.3 Expenses 7 7 00 00 00 00
expen
ces

A.1.4 Incentive to
.4 ASHAs

No. of
meeti
Maternal Death 1000 1000 1000 1000
A.1.5 ng 1 1 1 1 4 100000 400000 94000 1 meting per quarter at district level
Review 00 00 00 00
organ
ised
Other
Strategies/Activiti
es
A.1.6 0
(ICTC for HIV
Testing of ANC
Cases)

No. of This is to orient the private health

Quaterly meeting meeti facilities regarding data collection for
A.1.6 5000 5000 5000 5000
with Private ng 1 1 1 1 4 50000 200000 all indiactors, so that it will
.1 0 0 0 0
Health Facilities organ incorporate in district data every
ised month

A.2 CHILD HEALTH

A.2.1 IMNCl 50000

Implementation of No. of
A.2.1 IMNCI 1500 1500 1500 1500 Monthly meeting and monitoring of
meeti 3 3 3 3 12 50000 600000
.1 Activities in 00 00 00 00 IMNCI activities
ngs
Districts
Monitor Progress
Against
A.2.1
Plan; Follow Up 0 0 0 0 0 0
.2
with Training,
Procurement, Etc

2
 No. of
Incentive for 3 PNC 1 ELA for delivery for the year 2012-13=
9
HBNC to ASHA Visit 0 10 10 10 42 106133. Considering complication,
A.2.1 4 1061 1061 1061 1061
/AWWs(State per 6 61 61 61 45 100 4245300 Low Birth Weight and other factors,
.3 1 300 300 400 300
Iniative) 3 PNC Nora 1 3 4 3 3 Normal Baby will be 40% of 106133=
for Normal Baby 9
ml 3 42453.
Baby
No. of
6 PNC
Incentive for visit 1
3 ELA for delivery for the year 2012-13=
HBNC to ASHA per 3 13 13 13 55
A.2.1 8 2759 2759 2759 2759 106133. Considering Low Birth
(State Iniative) Low 7 79 79 79 19 200 11038000
.4 3 600 400 600 400 Weight Baby 52%, Low Birth Weight
6PNC for Low Birth 9 7 8 7 0
Birth Baby 9 Baby will be 52% of 106133= 55190.
weigh 8
t
Baby
Facility Based
Newborn Care/ No. of
FBNC NBSU 1000 1000
A.2.2 1 1 1 2 1000000 0 0 2000000 For 2 FRUs
(Operationalise opera 000 000
40 tional
NBSUs)
Home Based
A.2.3 Newborn Care/ 0 0 0 0 0 0 3644100
HBNC
Infant and Young
A.2.4 Child Feeding 0 0 0 0 0 0
/ IYCF
Care of Sick
Children and
A.2.5 0 0 0 0 0 0
Severe
Malnutrition(NRC)

Management of No. of
Diarrhoea, ARI Batch
and Micronutrient 1126 1126 1126
disch 1126
A.2.6 Malnutrition 1 3 3 3 3 12 375461.25 383.7 383.7 383.7 4505535 2424689 See detail in Annexure
arged 383.8
( Nutritional 5 5 5
Rehabilitation from
Centres) NRC

Childhood
A.2.6 diarrhea 7073
1 1 7073840 0 0 0 7073840 3500000 See detail in Annexure
.1 Management 840
Programme
Other
Strategies/activiti
5687 5687
A.2.7 es 1 1 2 568738.5 0 0 1137477 0 See detail in Annexure
38.5 38.5
(Vitamin A
Biannual Round)
No. of
Meeti 5000 5000 5000 5000
A.2.8 Infant Death Audit 0 1 1 1 1 4 50000 200000 0 Quaterly Meeting
ngs 0 0 0 0
held

3
 Incen
tive
to
ASHA
Incentive to 2 5000 5000 5000 5000
A.2.9 for 20 20 20 20 25000 2000000 0
ASHA Under CH 0 00 00 00 00
Newb
orn
Child
care
FAMILY
A.3 0 0 0 0 0 0 0
PLANNING
Terminal/ Limiting
A.3.1 0 0 0 0 0 0
Methods
No. of
Healt
Dissemination of h
Manuals on
facilit Distribution of Manuals, Statndard
A.3.1 Sterilisation 1 34 41 1700 5600 3410
1 y 56 10000 0 4140000 20000 Protocols and QA manuals in each
.1 Standards & QAC 7 1 4 00 00 000
reciev health facilities
of Sterilisation
Services d the
manu
als
No. of
Female 4 Camp 1
A.3.1 12 12 12 48 6000 6000 6000 6000 2 camp per month for 17 PHC, 2
Sterilisation 5 s 2 5000 2400000 150000
.2 0 0 0 0 00 00 00 00 referrals and 1 sadar hospitals
Camps 6 organ 0
ised
No. of
Camp
A.3.1 2500 2500 2500 2500 1 camp in a year for 17 PHC, 2 Referral
NSV Camps 1 s 5 5 5 5 20 5000 100000 35000
.3 0 0 0 0 and 1 for sadar Hospital
organ
ised
ELA for the year 2011-12 for Family
3 Planning services is 34196. so, ELA for
1
1 the year 2012-13 will be
Compensation for 8 No. of 63 11 11 31
A.3.1 9 3191 6382 1116 1116 34196+34196*10%= 37616. ELA for
Female 3 Sterili 82. 17 17 91 1000 31914000 2167895
.4 1 400 800 9900 9900 Female Streriization will be- 36864
Sterilisation 7 sation 8 0 0 4
. and ELA for NSV will be- 752 (2% of
5
4 total ELA) . From the above ELA we
have taken 5000 for private facilities
(3950 for Female sterilization and 50
Compensation for for NSV). so, ELA for Female
Male sterilization will be- 31914 and NSV
3 No. of
A.3.1 Sterilisation 7 14 24 24 70 1053 2106 3685 3685 will be 702.
1 Sterili 1500 1053000 150000
.5 (Compensation 0 0 6 6 2 00 00 50 50 We have distributed the ELA in the
8 sation
for NSV formula of 10% for 1st quarter, 20%
Acceptance) in 2nd Quarter, 35% in 3rd Quarter
and 35% in 4th Quarter.

4
 Accreditation of 3
Private No. of 5
A.3.1 1 10 17 17 50 7500 1500 2625 2625
Providers for Sterili 0 1500 7500000 3000000
.6 8 00 50 50 00 00 000 000 000
Sterilisation sation 0
Services 4

A.3.2 Spacing Methods

No. of
Camp 1 camp in each quarter for 36
A.3.2 1 5 22 1960 1960 1960 1960
IUD Camps s 56 56 56 3500 784000 functional APHC, 17 PHC, 2 Referral
.1 9 6 4 00 00 00 00
organ and 1 Sadar Hospital
ised
No. of
Healt
h
4 Facilit 1
A.3.2 IUD Services at 12 12 12 50 1250 1250 1250 1250
4 y 2 1000 500000
.2 Health Facilities 5 5 5 0 00 00 00 00
9 havin 5
g IUD
servic
es
Accreditation of
Private
A.3.2
Providers for IUD 0 0 0 0 0 0 0
.3
Insertion
Services
No. of
Contraceptive semin
A.3.2 5000 5000
Update 0 ars 0 1 0 1 2 50000 0 0 100000 0
.5 0 0
Seminars organ
ised
POL for Family No. of
Planning (for Monit Rs. 12,000 for Per PHC per Year and
1 3400 1360 1190
A.3.3 District Level + oring 0 2 8 7 17 17000 0 289000 120000 Rs. 5,000 at District for per PHC per
7 0 00 00
State Level visit year
Monitoring) done
Repairs of 1000
A.3.4 1 1 100000 0 0 0 100000 0
Laparoscopes 00
Other Strategies/
A.3.5 0 0 0 0 0 0 0
Activities
State Level
A.3.5
Worshop/Review 0 0 0 0 0 0
.1
for FP
A.3.5
Orientation 0 0 0 0 0 0 0
.2
Family Planning
Incentive/
A.3.5 Award to Best
0 0 0 0 0 0
.3 Performer
District/other
Personel

5
 Provide IUD
Services at
A.3.5
Health 0 0 0 0 0 0 135000
.4
Facility (IUD
Camps)
Social Marketing
A.3.5
of 0 0 0 0 0 0 0
.5
Contraceptives
Awar
A.3.5 Award for best 3 1000 Yearly award, 1st- Rs. 50,000; 2nd Rs.
d 0 0 0 1 1 100000 0 0 0 100000 0
.6 performer 00 30,000; 3rd Rs. 20,000.
given
ADOLESCENT
REPRODUCTIVE
A.4 AND 0
SEXUAL HEALTH
/ ARSH
No. of
Adolescent facilit
Services at y
We are planning to develop ARSH
Health provi 5000
A.4.1 0 0 2 0 0 2 250000 0 0 0 500000 0 center at Sadar Hospital, Sitamarh and
Facilities (ARSH ding 00
Corners in 3 1 FRU
ARSH
DHs and PHCs) servic
es
School Health
A.4.2 0 5000000 0 0 0 0 5000000 5000000
Programme
Other Strategies/
Activities 5000
A.4.3 1 1 5000000 0 0 0 5000000 2500000
(Menstrual 000
Hygiene)
A.5 URBAN RCH 0 0 0 0 0 0
URBAN
RCH(Urban
A.5 Health 0 0 0 0 0 0 4000000
Center Through
PPP)
A.6 TRIBAL RCH 0 0 0 0 0 0 0

A.6 TRIBAL RCH 0 0 0 0 0 0 0

A.7 PNDT & Sex Ratio 0 0 0 0 0 0

Support to PNDT
A.7.1 0 0 0 0 0 0 0
Cell
PNDT
cell
Other PNDT functi
Activities
oning 4760
A.7.2 (Monitoring of 0 1 0 0 1 476000 0 0 0 476000 50000 See detail in Annexure
and 00
Sex Ratio at
Birth) activit
ies
done

6
 INFRASTRUCTUR
E (Minor Civil
A.8 Works) & HUMAN 0 0
RESOURCES
(Except AYUSH)

Contractual Staff
A.8.1 0 0 0 0 0 0
& Services

ANMs, Staff
Nurses,
A.8.1 Supervisory
0 0 0 0 0 0
.1 Nurses (Salary of
Contractual ANM/
Contractual SN)
No. of
Staff 1
A.8.1 Contractual Staff 11 3062 Total Sanctioned Post of Staff Nurse=
Nurse 1 0 0 0 264000 0 0 0 30624000 13440000
.1 Nurse 6 4000 116 @ Rs. 22000 pm
Recru 6
ited
No. of
3
A.8.1 Contractual ANM 34 5176 Total Santioned Post for ANM=
4 0 0 0 151800 0 0 0 51763800 16871000
.1 ANM® Recru 1 3800 341HSc @ Rs 12650 pm
1
ited
No. of
LT
Laboratory recrui
A.8.1 9504 3LT for 2 Blood Bank=6 @ Rs 13200 as
Technicians/(LT ted 6 0 0 0 6 158400 0 0 0 950400 360000
.2 00 RNTCP Technician
in Blood Banks) for
Blood
Bank
No. of
Laboratory LT
A.8.1 1 2692
Technician at recrui 0 0 0 17 158400 0 0 0 2692800 1 LT in each HC
.3 7 800
PHC ted at
PHC

6 MPW for 6 ward at DH, 3 MPW each

No. of
MPW 5 for 2 referral, 17 PHC and 56 APHC
A.8.1 MPW 57 5148
(honorarium to 7 0 0 0 90000 0 0 0 51480000 0 and 1 MPV each at 341 HSC. Total
.2.1 recrui 2 0000
voluntary worker) 2 MPW proposed= 6+6+51+168+341=
ted
572

Specialists
(Anaesthetists,
Paediatricians,
Ob/Gyn, No. of
Surgeons,
Speci Total Sanctioned post of Specialist= 68
A.8.1 Physicians, 2 1200 7800
alists 13 0 0 33 600000 0 0 19800000 in which 35 are filled and 33 are
.3 Dental 0 0000 000
Surgeons, recrui vaccant
Radiologist, ted
Sonologist,
Pathologist,
Specialist for

7
 CHC )

No. of
A.8.1 PHNs at CHC, PHN 1 3000 2100
7 0 0 17 300000 0 0 5100000 We are proposing PHN for 17 PHC
.4 PHC Level recrui 0 000 000
ted
No. of
Medical Officers Speci
at CHCs /
A.8.1 alists 8400
PHCs (Salary of 1 2 0 0 0 0 420000 0 0 0 840000 5040000 M.D. Patho for Blood Bank
.5 for 00
MOs in Blood
Banks) Blood
Bank
Additional
Allowances/
A.8.1
Incentives to M.O. 0 0 0 0 0 0
.6
of PHCs
and CHCs
A.8.1 Others - FP 4800
2 2 0 0 0 2 240000 0 0 0 480000
.7 Counsellors 00
Incentive/ Awards
Etc. to SN,
ANMs Etc. 8
35
A.8.1 (Muskaan 8 88 88 88 2668 2668 2668 2668 2965AWC for 12 Months @ Rs 100 for
58 300 10674000 3145000
.8 Programme- 9 95 95 95 500 500 500 500 ANM & Rs 200 for ASHA=10674000
0
Incentive to 5
ASHA
and ANM)
Human
Resources HSc-2,45,52,000,APHC-
Development 1
11,49,12,000,PHC-12,97,92,000,RH-
A.8.1 (Other Than 2 12 12 12 50 8963 8963 8963 8963
859827.34 358548000 5,68,08,000 & DH-3,24,84,000,For
.9 Above)As per 5 51 51 51 04 7000 7000 7000 7000
IPHS Norms for Details see Situation analysis of
1
DH,RH,PHC,APH HSC,APHC,PHC,RH & DH.
C & HSC
Other Incentives
A.8.1
Schemes 0 0 0 0 0 0
_10
(Pl. Specify)
A.8.2 Minor Civil Works 0 0 0 0 0 0
Minor Civil Works
A.8.2 for
0 0 0 0 0 0
.1 Operationalisatio
n of FRUs
Minor Civil Works
for
A.8.2
Operationalisatio 0 0 0 0 0 0
.2
n of 24 Hour
Services at PHCs

8
A.9 TRAINING 0 0
Strengthening of
Training
Institutions
1000
A.9.1 (Repair/renovatio 1 1 1000000 0 0 0 1000000
000
n
of Training
Institutions)
Development of
A.9.2 Training 0 0 0 0 0 0
Packages
Maternal Health
A.9.3 0 0 0 0 0 0
Training
No. of
Skilled
A.9.3 SBA 5000 5000 5000 5000
Attendance at 5 5 5 5 20 100000 2000000 592350 1 batch per month
.1 traini 00 00 00 00
Birth
ng
Comprehensive
No. of
A.9.3 EmOC Training 1000 1000
traini 1 1 2 100000 0 0 200000 0 2 training in a year
.2 (Including C- 00 00
ngs
Section)
Life Saving
A.9.3 Anaesthesia
0 0 0 0 0 0
.3 Skills
Training
No. of
A.9.3 1500 1500 1500 1500
MTP Training traini 3 3 3 3 12 50000 600000 0 1 batch per month
.4 00 00 00 00
ngs
No. of
A.9.3 6000 6000 6000 6000 2 batch for MOIC and 2 batch for
RTI / STI Training traini 1 1 1 1 4 60000 240000 0
.5 0 0 0 0 SN/ANM/LT)
ngs
No. of
A.9.3 5000 5000 5000 5000
BEMOC Training traini 1 1 1 1 4 50000 200000 1 batch per quarter
.6 0 0 0 0
ngs
Other MH
Training (Any
Integrated
Training, Etc.)-
No. of
A.9.3 Training of MOs 1000 1000 1000 1000
traini 1 1 1 1 4 100000 400000 230000 1 per quarter
.7 and 00 00 00 00
ngs
Paramedics at
Sub-District Level
(Convergence
with BSACS)

A.9.4 IMEP Training 0 0 0 0 0 0

Child Health
A.9.5
Training
No. of
A.9.5 2 4200 4200
IMNCI traini 28 56 150000 0 0 8400000 5261420
.1 8 000 000
ngs
A.9.5
F-IMNCI 0 0 0 0 0 0
.2

9
 No. of
A.9.5 Home Based 5000 5000 5000 5000
traini 1 1 1 1 4 50000 200000 1 per quarter
.3 Newborn Care 0 0 0 0
ngs
Care of Sick
A.9.5 Children and
0 0 0 0 0 0
.4 Severe
Malnutrition A.9
Other CH Training
A.9.5 5140
(Training Plan for 68 68 756 0 0 0 51400 0 As per SHS guidelines
_5 0
MAMTA Training)
A.9.5
TOT on FBNC 0 0 0 0 0 0 0
.5.1
Training on FBNC
A.9.5
for Medical 0 0 0 0 0 0 0
.5.2
Officers
No. of
A.9.5 NSSK Training 1200 1200 1200 1200
5 traini 2 2 2 2 8 60000 480000 264500 2 per quarter
.5.3 (SN/ANM) 00 00 00 00
ngs
Family Planning
A.9.6 0 0 0 0 0 0 0
Training
Laparoscopic
A.9.6
Sterilisation 0 0 0 0 0 0
.1
Training
No. of
A.9.6 7500 7500 7500 7500
Minilap Training 1 traini 1 1 1 1 4 75000 300000 70237 1 per quarter
.2 0 0 0 0
ngs
No. of
A.9.6 5000 5000
NSV Training traini 1 1 2 50000 0 0 100000 0 2 in a year
.3 0 0
ngs
A.9.6 IUD Insertion
0 0 0 0 0 0 0
_4 Training
Training of
No. of
A.9.6 Medical Officers 6000 6000 6000 6000
1 traini 1 1 1 1 4 60000 240000 55289 1 per quarter
.4.1 in IUD 0 0 0 0
Insertion ngs

Training of ANMs No. of

A.9.6 8000 8000 8000 8000
/ LHVs/SN in IUD 3 traini 2 2 2 2 8 40000 320000 88260 2 per quarter
.4.2 0 0 0 0
Insertion ngs
A.9.6 Contraceptive
0 0 0 0 0 0 0
.5 Update
A.9.6 Other FP Training
0 0 0 0 0 0
_6 (Pl.SSpecify)
Post Partum
Family Planning
(With
Emphasis on
A.9.6
IUCD Insertion) 0 0 0 0 0 0 0
.6.1
Master
Trainers at All 38
Districts
Hospitals
Training of Family
A.9.6
Planning 0 0 0 0 0 0
.6.2
Counsellors

10
 ARSH Training
No. of
(MOs, 5000
A.9.7 traini 1 1 50000 0 0 0 50000 0
ANM/Nurses, 0
ngs
Nodal Officers)
Programme No. of
1000
A.9.8 Management traini 4 4 25000 0 0 0 100000 0 For all Blocks
00
Training ngs
A.9.8
SPMU Training 0 0 0 0 0 0 0
.1
No. of
A.9.8 5000 5000 5000 5000
DPMU Training traini 1 1 1 1 4 50000 200000 50000
.2 0 0 0 0
ngs
Other Training
A.9.9 0 0 0 0 0 0 0
(Pl. Specify)
Continuing
A.9.9 Medical and
0 0 0 0 0 0 0
.1 Nursing
Education

Post Graduate
A.9.9
Diploma in Family 0 0 0 0 0 0 0
.2
Medicine for MO

A.9.9 DNB in Family

0 0 0 0 0 0 0
.3 Medicine for MO
PGD in Public
A.9.9 Health
0 0 0 0 0 0
.4 Management for
MO (IIPH)
PGD in Public
Health
Management for
A.9.9 2 2000 PGD in Public Health for Capacity
Health and 20 100000 0 0 0 2000000 0
.5 0 000 Building to all Health Managers
Management
Personnel
(IIPH at SIHFW)
A.9_ Training
0
10 (Nursing)
Strengthening of
A.9.1 Existing Training 5347
1 1 53475000 0 0 0 53475000 See Deatil in Annexure
0.1 Institutions/ 5000
Nursing School
New Training
A.9.1
Institutions/ 0 0 0 0 0 0 0
0.2
School
A.9_ Training (Other
0 0 0 0 0 0 0
11 Health Personnel)

Promotional
Training of Health
A.9.1
Workers 0 0 0 0 0 0 0
1.1
Females to Lady
Health Visitor Etc.
Training of ANMs, No. of
A.9.1 1000 1000 1000 1000
Staff Nurses, traini 1 1 1 1 4 100000 400000 0 1 per quarter
1.2 00 00 00 00
AWW, AWS ngs

11
 Other Training
No. of
A.9_ and Capacity 5000 5000 5000 5000
traini 1 1 1 1 4 50000 200000 0
11_3 Building 0 0 0 0
ngs
Programmes
Training of
A.9.1 Faculty / Post
0 0 0 0 0 0 0
1.3.1 Basic B.Sc /
Basic B.Sc
Community Visit
A.9.1
for Students & 0 0 0 0 0 0 50000
1.3.2
Teachers
PROGRAMME /
NRHM
A_10 MANAGEMENT 0 0
COSTS

Strengthening of
SHS/ SPMU
(Including HR,
A.10.
Management 0 0 0 0 0 0
1
Cost, Mobility
Support, Field
Visits )
Liability on
A.10.
Current Staff at 0 0 0 0 0 0
1.1
Prevailing Salary
Additional
A.10.
Manpower Under 0 0 0 0 0 0
1.2
SHSB
State Monitoring
A.10.
Cell for Blood 0 0 0 0 0 0
1.3
Banks/BSUs
Provision of
Equipment/furnitu
A.10.
re and Mobility 0 0 0 0 0 0
1.4
Support for SPMU
Staff
Mobility Support
A.10. 1800
(District Malaria 1 1 1 180000 0 0 0 180000 180000
1.5 00
Office)
A.10. Strengthening of
0 0 0 0 0 0
1.6 Directorate
Liability on
Various New
Posts Approved
A.10. in PIP 2010-11,
0 0 0 0 0 0
1.7 Already
Advertised and
Shortlisting
Underway
Strengthening of
DHS/ DPMU
(Including HR,
A.10.
Management 0 0 0 0 0 0 0
2
Cost, Mobility
Support, Field
Visits )

12
 Contractual Staff
A.10. for DPMU 2717
1 1 1 2717312 0 0 0 2717312 989284 See deatil in Annexure
2.1 Recruited and in 312
Position
Provision of
Equipment/furnitu
A.10. 3000
re and Mobility 1 1 300000 0 0 0 300000
2.2 00
Support for
DPMU Staff
A.10. Strengthening of 1 1 1375
17 809160 0 0 0 13755720 10710200 See detail in Annexure
3 Block PMU 7 7 5720
A.10. Strengthening
0 0 0 0 0 0 0
4 (Others)
A.10. Tally Purchase
0 0 0 0 0 0 0
4.1 for RAM
A.10. Renewal 5000
1 1 1 50000 0 0 0 50000 8100
4.2 (Upgradtion) 0
A.10. AMC (State, 1000
1 1 1 100000 0 0 0 100000 22500
4.3 Regional & DHS) 00
A.10. AMC (Block 1 1700
1 17 10000 0 0 0 170000 0
4.4. Level) 7 00
A.10. 1 5000 3500
Training on Tally 7 17 5000 0 0 85000
4.5 0 0 0
Training in
A.10. 1 5000 3500
Accounting 7 17 5000 0 0 85000 0
4.6 0 0 0
Procedures
Capacity Building
A.10. 1 1000 7000
& Exposure Visit 7 17 10000 0 0 170000 0
4.7 0 00 0
of Account Staff
Regional
A.10.
Programme 0 0 0 0 0 0
4.8
Management Unit
Management Unit
A.10. at FRU ( Hospital 6600
2 2 2 330000 0 0 0 660000 500000
4.9 Manager & FRU 00
Accountant)
A.10.
Audit Fees 0 0 0 0 0 0
5
Annual Audit of
A.10. 1 5000 3500
the Programme 7 17 5000 0 0 85000 63000
5.1 0 0 0
(Statutory Audit)
A.10.
Internal Auditor 0 0 0 0 0 0
5.2
A.10. TA for Internal
0 0 0 0 0 0
5.3 Auditor
Training of
A.10.
Internal Audit 0 0 0 0 0 0 0
5.4
Wing
A.10. Concurrent Audit 3000
1 1 1 300000 0 0 0 300000 120000
6 (State & District) 00
Mobility Support
A.10. 1 3060
to BMO/ MO/ 17 180000 0 0 0 3060000 0 For each block
7 7 000
Others

13
A RCH Flexipool 0 0 0 0 0 0
117541048
Total 839181284
1
Mission Flexible
B 0 0 0 0 0 0 0
Pool
B.1 ASHA 0 0 0 0 0 0 0

B.1.1 ASHA COST 0 0 0 0 0 0 0

No. of 2
11 30 ASHA per Batch for 6 days @ Rs.
B.1.1 Selection & ASHA 9 29 29 29 6855 6855 6855 6855
86 2312 27420320 27420320 69350. so, for 2965 ASHA, 100 Batch is
.1 Training of ASHA Train 6 65 65 65 080 080 080 080
0 required 4 times.
ed 5
No. of
ASHA
ASHA facilitator 1
B.1.1 Facilit 4942 30 ASHA Facilitator per Batch for
Training for 1st 5 3295 0 0 0 494250 1341900
.1.1 ator 50 round 1
Round 0
Train
ed
No. of
ASHA
ASHA facilitator 1
B.1.1 Facilit 15 15 3754 3754 3754 30 ASHA Facilitator per Batch for
Training for 2,3 & 5 2503 0 1126350 1126350
.1.2 ator 0 0 50 50 50 round 2,3,4
4th round 0
Train
ed
No. of
ASHA 2
Procurement of
B.1.1 havin 9 29 1482
ASHA Drug Kit & 500 0 0 0 1482500 741250
.2 g 6 65 500
Replenishment
Drug 5
Kit
No. of
ASHA
got
the 8
Other Incentive to 35
B.1.1 TA/D 8 88 88 88 8895 8895 8895 8895
ASHAs (TA/DA 58 100 3558000 2700000 Rs. 100 per ASHA/Month/ASHA diwas
.3 A per 9 95 95 95 00 00 00 00
for ASHA Divas) 0
mont 5
h for
ASHA
Diwas
Awards to
B.1_
ASHA's/Link 0
1.4
Workers
No. of
Best Performance Yearly award- 1st prize- Rs. 2500, 2nd
B.1.1 awar 9350
Award to ASHAs 17 17 5500 0 0 0 93500 34000 Prize- Rs. 1500. 3rd Prize- 1000 and
.4.A ds 0
at District Level 500 for printing per block
given
No. of
Torch 2
B.1.1 Rechargeable distri 9 29 7412
250 0 0 0 741250 593000
.4.B Torch to ASHA buted 6 65 50
to 5
ASHA

14
 No. of
Identi 2
B.1.1 Identity Card to ty 9 29 7412
25 0 0 0 74125 13700
.4.C ASHA Card 6 65 5
Issue 5
d
No. of
2
Umbr
B.1.1 9 29 4447
Umbrella to ASHA ella 150 0 0 0 444750
.4.D 6 65 50
distri
5
buted
ASHA Resource
B.1.1 3118
Centre/ASHA 1 1 31183580 0 0 0 31183580 1500000 See detail in Annexure
.5 3580
Mentoring Group

B.2 Untied Funds 0 0 0 0 0 0 0

Untied Fund for 1000

B.2.1 2 2 50000 0 0 0 100000 100000
SDH/CHC 00
B.2.2 Untied Fund for 1 4250
17 25000 0 0 0 425000 425000
.A PHCs 7 00
B.2.2 Untied Fund for 5 1400
56 25000 0 0 0 1400000 900000
.B APHC 6 000
3
Untied Fund for 34 3410
B.2.3 4 10000 0 0 0 3410000 2130000
Sub Centres 1 000
1
8
Untied Fund for 84 8460
B.2.4 4 10000 0 0 0 8460000 8460000
VHSC 6 000
6
Annual
B.3 Maintenance 0 0 0 0 0 0 0
Grants
6000
B.3.1 CHCs 2 2 300000 0 0 0 600000
00
B.3.1
SDH 0 0 0 0 0 0 0
.A
1 3400
B.3.2 PHCs 17 200000 0 0 0 3400000 1700000
7 000
B.3.2 5 5600
APHC 56 100000 0 0 0 5600000 1800000
.A 6 000
3
34 8525
B.3.3 Sub Centres 4 25000 0 0 0 8525000
1 000
1
1000
B.3.4 DH 1 1 1000000 0 0 0 1000000 1000000
000
Hospital
B.4 0 0 0 0 0 0 0
Strengthening
Up Gradation of
CHCs, PHCs, 2 2000 for 17 PHC, 2 Referral and 1 Sadar
B4.1 20 1000000 0 0 0 20000000
Dist. Hospitals to 0 0000 Hospital
IPHS)
B.4.1
District Hospitals 0 0 0 0 0 0 0
.1

15
 Construction of
B.4.1 7500
SNCU in District 1 1 7500000 0 0 0 7500000
.1.A 000
Hospitals
Up Gradation of 1000
B.4.1 05 DHs by 10000000 Upgradation of Sadar Hospital from 90
1 1 0000 0 0 0 100000000
.1.B Increase Number 0 Bedded to 500 Bedded.
0
of Beds 900
B.4.1 CHCs (Hospital
0 0 0 0 0 0 0
.2 Strengthening)
PHCs
(Construction of 3 1700
B.4.1 1 Construction of Doctors & Staff
Doctors & 4 Staff 17 10000000 0000 0 0 0 170000000
.3 7 Quarters for all 17 PHCs.
Nurse Quarters in 0
38 PHCs)\
Sub
B.4.1
Centres(Hospital 0 0 0 0 0 0 0
.4
Strengthening)
Others (Up
Gradation of 2
Health Facilities
(Rajendra Nagar)
B.4.1 Eye Hospital &
0 0 0 0 0 0 0
.5 Lok Nayak Jay
Prakash Narayan
Hospital) Into
Super Speciality
As Per IPHS
Strengthening of
Districts, Sub-
B4.2 Divisional 0 0 0 0 0 0 0
Hospitals, CHCs,
PHCs
Installation of
Solar Water
B4.2. 2 1000 for 17 PHC, 2 Referral and 1 Sadar
System in 25 20 50000 0 0 0 1000000 179500
A 0 000 Hoapital
SDH, 10 RH and
150 PHC
Accreditation /
ISO : 9000
B4.2. Certification of 90 1000
2 2 500000 0 0 0 1000000 for 2 Referral hospital
B Health Facilities ( 000
15 DH+15 SDH+
10 RH+ 50 PHC)
Sub Centre Rent 2
27 3300
B.4.3 and 7 12000 0 0 0 3300000 612000
5 000
Contingencies 5
B.4.3 4 1152
APHC Rent 48 24000 0 0 0 1152000 785400
.1 8 000
Logistics
Management/
Improvement
B.4.4 (G2P Bihar Health 0 0 0 0 0 0 0
Operations
Payment Engine
HOPE)

16
 New
Constructions/
B.5 Renovation and 0 0 0 0 0 0 0
Setting Up

Construction of
Complete Office
1250
B.5.1 Set up & 1 1 12500000 0 0 0 12500000
0000
residential
quarter for DPMU

B.5.1 CHC 0 0 0 0 0 0 0
1500
1 Construction of Runni Saidpur, Dumra,
B5.2 PHCs 10 15000000 0000 0 0 0 150000000
0 Sursand, Bazpatti and Bathnaha PHC
0

Construction of Lalpur, Bhuthi, Barri

Bheta, Basotara, Premnagar, Patahi
2000
B5.2. Construction of 2 Chowk, Rasalpur, Sahiyara, Sirsiya,
20 10000000 0000 0 0 0 200000000
A APHC (PHC) 0 Paktola, Raipu, Suthihara, Gisara,
0
Rewasi, Sasaula, Lalpur, Rajwada,
Ratanpur, Kanhauli APHC

17
 Construction of Kumma, Akhtha,
Bachharpur, Amanpur, Bhantawari,
Gadha, Ramnagar bedaul,
Dumharpatti, Singhyahi, Madhopur
Chatri, Mirzapur, Barharwa,
Madhurapur, Madhuban Got, Mohni,
Bahera, Sirsi, Bath, Janipur, Dhadhi,
Sirkhiriya, Korlahiya, Lalpur, Kodariya,
Baligadh, Koria lalpur, Balua, Govind
Pitozha, Kharka, Hanuman Nagar,
Baghari, Gadhwa Sukhi, Hira Kanhauli,
Pachnaur, Patahi, Madanpur, Chakki,
1 2000
B.5.2 Construction of Kachor, Parsa Mahind, Bisanpur,
0 2000000 0000 0 0 0 200000000
.B HSC Rasulpur, Gharwara, Pachharwa,
0 0
Betha, Sisiya, Sahargama, Lahuria,
Bhawanipur, Indarwa, Laxmipur,
Pachtaki, Patahi, Musachak, Masha,
Majhaulia, Tirkaulia,Mahuwa,
Diankothi, Haribela, Mahadev,
Pasurampur, Sonar, Imlibazar,
Babhangama, Rampur Ganguli,
Muradpur, Bhubharo, Maniyari,
Amghatta, Bariyarpur, Bhithha, Quari,
Sundarpur, Sahniyapatti, Jawahi,
Baghari, Parsa, Tikauli, Rakasia, Belahi
HSC

Construction of
Residential
B5.2. Quarters for 2 4000
20 2000000 0 0 0 40000000
B Doctors & Staff 0 0000
Nurses in 38 Old
APHC

B5.2. Strengthning of 1000

1 1 1000000 0 0 0 1000000 800000
C Cold Chain 000

Infrastructure of
B_5_
Training 0 0 0 0 0 0 0
10
Institutions
Strengthening of
Existing Training
Institutions/Nursi
ng School( Other
B.5.1
Than HR)- 0 0 0 0 0 0 0
0.1
Strengthening of
Nursing
Education- at
IGIMS Bihar

18
 New Training
B.5.1
Institutions/Scho 0 0 0 0 0 0 0
0.2
ol(Other Than HR)
SHCs/Sub
B5.3 0 0 0 0 0 0 0
Centres
Setting Up
Infrastructure
Wing for Civil
Works (9
Executive Eng, 38
B5.4 0 0 0 0 0 0 0
Asst. Eng & 76 JE
Under Bihar
Medical Services
and Infrastructure
Corporation Ltd)
Govt.
Dispensaries/
B5.5 0 0 0 0 0 0 0
Others
Renovations
Construction of
BHO, Facility
Improvement,
B5.6 0 0 0 0 0 0 0
Civil Work,
BemOC and
CemOC Centers\
Major Civil Works
for
B.5.7 0 0 0 0 0 0 0
Operationalisatio
n of FRUS
Major Civil Works
for
1 2550 Upgradation & Boundarywall to all 17
B.5.8 Operationalisatio 17 1500000 0 0 0 25500000
7 0000 PHCs
n of 24 Hour
Services at PHCs
Civil Works for
Operationalising
Infection
B.5.9 Management & 0 0 0 0 0 0 0
Environment Plan
at Health
Facilities
Corpus Grants to
B.6 0 0 0 0 0 0 0
HMS/RKS
5000
B6.1 District Hospitals 1 1 500000 0 0 0 500000 500000
00
2000
B6.2 CHCs (SDH) 2 2 100000 0 0 0 200000
00
1 1700
B6.3 PHCs - RKS 17 100000 0 0 0 1700000 1700000
7 000
5 5600
B6.4 Other (APHC) 56 100000 0 0 0 5600000 3700000
6 000
District Action
Plans (Including 2222
B.7 Block, Village) 1 1 2222000 0 0 0 2222000 689256 See Detail in Annexure
000

19
 Panchayati Raj
B.8 0 0 0 0 0 0 0
Initiative
Constitution and
Orientation of No. of
4
Community orient 42 84 8460 8460
B8.1 2 2000 0 0 1692000 409500
Leader & of ation 3 6 00 00
3
VHSC,SHC,PHC,C done
HC Etc
Orientation
Workshops,
Trainings and No. of
4
Capacity Building works 42 84 8460 8460
B.8.2 2 2000 0 0 1692000 180150
of PRI at hop 3 6 00 00
3
State/Dist. Health done
Societies,
CHC,PHC
Others State
Level Activities
(IEC+Monitoring+
Need Based
B.8.3 0 0 0 0 0 0 0
Training for VHSC
Members in 5
CBPM Focus
Districts)
Mainstreaming of
B.9 0
AYUSH
No. of
Medical Officers
AYUS
at DH/CHCs/ 5 1344
B.9.1 H 56 240000 0 0 0 13440000 7900000
PHCs (Only 6 0000
recrui
AYUSH)
ted
B.9.1 AYUSH
0 0 0 0 0 0 0
.A Specialists
Other Staff Nurse/
Supervisory
B.9.2 0 0 0 0 0 0 0
Nurses (for
AYUSH)
B_9. Activities Other
0 0 0 0 0 0 0
3 Than HR
Training of
AYUSH Doctors &
Paramedical
B.9.3 Staffs W.R.T
0 0 0 0 0 0 0
.1 AYUSH Wing and
Establishment of
Head Quarter
Cost
B_10 IEC-BCC NRHM 0 0 0 0 0 0 0
Strengthening of
BCC/IEC Bureaus
B.10 0 0 0 0 0 0 0
(State and District
Levels)
Development of
B.10. 1104
State BCC/IEC 1 1 11040000 0 0 0 11040000 315390 See Seatil in Annexure
1 0000
Strategy

20
B_10 Implementation of
0 0 0 0 0 0 0
.2 BCC/IEC Strategy

B.10. BCC/IEC 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at

21 10000 0 0 0 210000
2.1 Activities for MH 1 00 District level

B.10. BCC/IEC 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at

21 10000 0 0 0 210000
2.2 Activities for CH 1 00 District level

B.10. BCC/IEC 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at

21 10000 0 0 0 210000
2.3 Activities for FP 1 00 District level
BCC/IEC
B.10. 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at
Activities for 21 10000 0 0 0 210000
2.4 1 00 District level
ARSH
No. of
Healt
2
B.10. h 27 2730
Health Mela 7 10000 0 0 0 2730000 4000 1 Health Mela per Panchayat
3 Mela 3 000
3
Organ
ised
No. of
meeti
Creating
ngs 2
B.10. Awareness on 27 2730
and 7 10000 0 0 0 2730000
4 Declining Sex 3 000
orient 3
Ratio Issue.
ation
done
B.10.
Other Activities 0 0 0 0 0 0 0
5
Mobile Medical
Units (Including
Recurring 5616
B_11 1 1 5616000 0 0 0 5616000 4212000
Expenditures) 000

Referral
B_12 0 0 0 0 0 0 0
Transport
Ambulance/
B.12.
EMRI/Other 0 0 0 0 0 0 0
1
Models
Ambulance/
B.12.
EMRI/Other 0 0 0 0 0 0 0
1
Models
B.12. Operating Cost
0 0 0 0 0 0 0
2 (POL)
Emergency
Medical
B.12.
Service/102- 0 0 0 0 0 0 0
2.A
Ambulance
Service
B.12. 1911- Doctor on
0 0 0 0 0 0 0
2.B Call & Samadhan
Advanced Life
B.12. Saving 1800
1 1 1800000 0 0 0 1800000 900000
2.C Ambulance (Call 000
108)

21
 Referral
B.12. 2 3120 For 17 PHC, 2 Referral and 1 Sadar
Transport in 20 1560000 0 0 0 31200000 1404000
2.D 0 0000 Hospital
Districts
B_13 PPP/ NGOs 0 0 0 0 0 0 0
Non-
Governmental
B.13.
Providers of 0 0 0 0 0 0 0
1
Health Care
RMPs/TBAs
Non-
Governmental
B.13.
Providers of 0 0 0 0 0 0 0
1
Health Care
RMPs/TBAs
B.13. Public Private
0 0 0 0 0 0 0
2 Partnerships
NGO Programme/
B_13
Grant in Aid to 0 0 0 0 0 0 0
.3
NGO
Setting Up of
Ultra-Modern
Diagnostic
Centers in
Regional
B.13.
Diagnostic 0 0 0 0 0 0 0
3.A
Centers (RDCs)
and All
Government
Medical College
Hospitals of Bihar
Outsourcing of
Pathology and Sadar Hospital 1- @ Rs 2500000 per
B.13. 2 1200
Radiology 20 600000 0 0 0 12000000 1500000 year, Referral Hospital and PHC-19 @
3.B 0 0000
Services From Rs. 500000 per year
PHCs to DH
Strengthening of 2 1000 One unit for each DH,2RH & 17 PHC @
20 500000 0 0 0 10000000
Govt. Laboratory 0 0000 cost of Rs 500000.
Outsourcing of
B.13.
HR Consultancy 0 0 0 0 0 0 0
3.C
Services
B.13. IMEP(Bio-Waste 7 1900 For 56 APHC, 17 PHC, 2 Referral and 1
76 25000 0 0 0 1900000
3.D Management) 6 000 Sadar Hospital

B_14 Innovations 0 0 0 0 0 0 0

Innovations( If
Any) (Rajiv
B.14. Gandhi Scheme 7612
1 1 761270 0 0 0 761270 330050 See detail in Annexure
A for Empowerment 70
of Adolescent
Girls Or SABLA)\

YUKTI Yojana
Accreditation of
B.14. 5000
Public and 1 1 500000 0 0 0 500000 305274
B 00
Private Sector for
Providing Safe

22
 Abortion Services

Planning,
B_15 Implementation 0
and Monitoring
Community
Monitoring
B (Visioning
0 0 0 0 0 0 0
.15.1 Workshops at
State, Dist, Block
Level)
B15.
State Level 0 0 0 0 0 0 0
1.1
District Level
(Purchase of 830 3
B15.
Mobile Handsets 9 0 0 0 0
1.2
From BSNL/By 7
Tender Process)
B15.
Block Level 0 0 0 0 0 0 0
1.3
Mobile Handsets for 56APHC & 341
B15. Other(APHC & 39 1071
2700 0 0 0 1071900 HSc@Rs 1500+Exp Rs 1200/Yr for 397
1.4 HSC) 7 900
units.
B.15. Quality
0 0 0 0 0 0 0
2 Assurance
B15. Quality 6000
1 1 600000 0 0 0 600000
2 Assurance 00
B.15. Monitoring and
0 0 0 0 0 0 0
3 Evaluation
Monitoring &
Evaluation/HMIS/
For 17 Block, 2 Referral and 1 Sadar
B.15. MCTS (State, 2 1500
20 75000 0 0 0 1500000 Hospital. Including 1 Data assistant for
3.1 District , Block & 0 000
MCTS @ Rs. 10000 per month
Divisional Data
Centre)
State, District,
B15. 1 1800
Divisional, Block 18 10000 0 0 0 180000 1200000 For 17 Block and 1 District Data Center
3.1.A 8 00
Data Centre
B15.
CBPM 0 0 0 0 0 0 0
3.1.B
Computerization
HMIS and E-
B.15. Governance, E- 3000
1 1 300000 0 0 0 300000 256031
3.2 Health (MCTS, RI 00
Monitoring,
CPSMS)
B.15.
MCTS and HRIS 0 0 0 0 0 0 0
3.2.A
B.15. 1800
RI Monitoring 1 1 180000 0 0 0 180000 180000
3.2.B 00
B.15.
CPSMS 0 0 0 0 0 0 0
3.2.C

23
 Hospital
Management
B.15. System,
0 0 0 0 0 0 0
3.2.D Telemedicine and
Mobile Based
Monitoring
B.15. Other Activities 1000
1 1 100000 0 0 0 100000
3.3 (HMIS) 00
Strengthening of
HMIS (Up-
B.15. Gradation and 5000
1 1 50000 0 0 0 50000
3.3.A Maintenance of 0
Web Server of
SHSB)
Plans for HMIS
B15. Supportive 5000
1 1 500000 0 0 0 500000
3.3.B Supervision and 00
Data Validation
B_16 PROCUREMENT 0 0 0 0 0 0 0

Procurement of For 1 Sadar, 2 Referral, 17 PHC, 14

B.16. 3 7200
Equipment MH 36 200000 0 0 0 7200000 2300000 APHC identified for MCH Center L-1
1.1 6 000
(Labor Room) and 2 HSc identified for HSC
Procurement of
B.16. 6795
Equipment : CH 3 3 2265258 0 0 0 6795774 393750 For 2 Referrals and 1 Sadar Hospital
1.2 774
(SCNU- NBCC)
B.16. Procurement of
0 0 0 0 0 0
1.3 Equipment: FP
1
B16. Procurement of 10 3000 For 17 PHC, 2 Referral, 1 sadar
0 3000 0 0 0 300000 255000
1.3.A Minilap Set (FP) 0 00 Hospital, 5 Kit per center
0
B16. Procurement of
5 5 1100 5500 0 0 0 5500 5500
1.3.B NSV Kit (FP)
Procurement of
B16. 7 1140 For 56 APHC, 17 PHC, 2 Referrals and
IUD Kit (FP) (PHC 76 15000 0 0 0 1140000 15000
1.3.C 6 000 1 Sadar Hospital
Level)
B16. Procurement of
0 0 0 0 0 0
1.4 Equipment: IMEP

B16. Procurement of
0 0 0 0 0 0 0
1.5 Others(Furniture)
B16. Dental Chair
0 0 0 0 0 0 1357894
1.5.A Procurement
B16. Equipments for 6
0 0 0 0 0 0 0
1.5.B New Blood Banks

A.C. 1.5 Ton

B16. Window for 28 2500
1 1 25000 0 0 0 25000 25000
1.5.C (Running Blood 0
Banks)
POL for Vaccine
B16. Delivery From
0 0 0 0 0 0 0
1.5.E State to District
and to PHC/CHC

24
 Procurement of
B.16.
Equipment: MH 0 0 0 0 0 0 0
1.1
(Labour Room)
Procurement of
B.16. Bed, ANC
0 0 0 0 0 0 0
1.1A Instrument and
ARI Timer
B Procurement of
16.1. Equipment : CH 0 0 0 0 0 0 0
2 (SCNU- NBCC)
Procurement of
B
Drugs and 0 0 0 0 0 0 0
16.2
Supplies
Drugs & Supplies
B16. for MH 0 0 0 0 0 0 0
2.1

Parental Iron
Sucrose (IV/IM)
As Therapeutic
B16. 5000
Measure to 1 1 500000 0 0 0 500000 500000
2.1.A 00
Pregnant Women
with Severe
Anaemia
5
IFA Tablets for 3 53 53 53 21
B.16. 1061 1061 1061 1061
Pregnant & 0 06 06 06 22 20 4245320 135271
2.1.B 320 340 320 340
Lactating Mothers 6 7 6 7 66
6
B16. Drugs & Supplies
0 0 0 0 0 0 0
2.2 for CH
1
Budget for IFA 1
Small Tablets and 11 11 11 46
B.16. 6 7859 7859 7859 7859
Syrup for 69 69 69 78 6.72 3143629 420844
2.2.A 9 04 11 11 04
Children (6 -59 51 51 50 02
Months) 5
0
2
10
B16. 5 25 25 25 6250 6250 6250 6250
IMNCI Drug Kit 00 250 2500000 1440000
2.2.B 0 00 00 00 00 00 00 00
0
0
B16. Drugs & Supplies
0 0 0 0 0 0 0
2.3 for FP
B16.
Supplies for IMEP 0 0 0 0 0 0 0
2.4

General Drugs & 4

B16. 41 2085
Supplies for 1 50000 0 0 0 20850000 14841100
2.5 7 0000
Health Facilities 7

Regional Drugs
Warehouses
(PROMIS to Be
B.17 Established and 0 0 0 0 0 0 0
Implemented in
District Drug
Warehouse)

25
 New Initiatives/
Strategic
Interventions (As
Per State Health
Policy)/
Innovation/
Projects
(Telemedicine,
B.18 Hepatitis, Mental 0 0 0 0 0 0 0
Health, Nutrition
Programme for
Pregnant Women,
Neonatal) NRHM
Helpline) As Per
Need (Block/
District Action
Plans)

Health Insurance
B_19 0 0 0 0 0 0 0
Scheme
Research,
Studies, Analysis
(Research Study
to Be Conducted
B.20 on Assessment of 0 0 0 0 0 0 0
New Initiative
Taken for
Enhancing R.I.
Coverage)
State Level Health
B_21 Resource 0 0 0 0 0 0 0
Centre(SHSRC)
B_22 Support Services 0 0 0 0 0 0 0
Support
B.22.
Strengthening 0 0 0 0 0 0 0
1
NPCB
Support
Strengthening
B.22.
Midwifery 0 0 0 0 0 0 0
2
Services Under
Medical Services
Support
B.22.
Strengthening 0 0 0 0 0 0 0
3
NVBDCP
Support
B.22. 1 3060
Strengthening 17 18000 0 0 0 306000 234000
4 7 00
RNTCP
Contingency
B.22.
Support to Govt. 0 0 0 0 0 0 0
5
Dispensaries
Other NDCP
B.22.
Support 0 0 0 0 0 0 0
6
Programmes
Other
Expenditures
B_23 0 0 0 0 0 0 0
(Power Backup,
Convergence

26
 Etc)-

Payment of
B.23. 5000
Monthly Bill to 1 1 500000 0 0 0 500000 280630
A 00
BSNL
Mission Flexible
B 0 0 0 0 0 0
Pool
Total 0 0 0 0 0 1192647018
Routine
C Immunisation & 0 0 0 0 0 0
PP
Routine
C.1 0 0 0 0 0 0
Immunisation
Mobility Support
1800
C.1.a for Supervision 1 1 180000 0 0 0 180000
00
for DIO
C.1b Review Meetings 0 0 0 0 0 0
Printing &
dissemination of 1
Imm formats,tally 2
12
sheets,monitorin 3 6810
C.1.c 38 5 0 0 0 681049
g formats forms 8 49
27
etc(@Rs 5/-per 2
beneficiaries)+10 7
%extra
Out reach
C.1.d 0 0 0 0 0 0
services
Qtrly Review
meeting
exclusive for RI at
district level with 1000 1000 1000 1000
C.1.e 1 1 1 1 4 10000 40000
MOIC,CDPO & 0 0 0 0
other stake
holders @Rs
100/participants
Qtrly Review
meeting
exclusive for RI at
block level 2
11
@Rs50/-PP as 9 29 29 29 2223 2223 2223 2223
C.1.f 86 75 889500
travel for ASHA & 6 65 65 65 75 75 75 75
0
Rs 25 per 5
persons for
meeting
expenses
Focus on slum &
underserved
areas in urban 2500
C.1.g 1 1 250000 0 0 0 250000
areas/Alternate 00
Vaccinator for
slums
Mobilization of 8
35
Children through 8 88 88 88 1779 1779 1779 1779
C.1.h 58 200 7116000
ASHA under 9 95 95 95 000 000 000 000
0
Muskan Ek 5
27
 Abhiyaan

Alternate Vaccine 6
60 60 60 24 6000 6000 6000 6000
C.1.i delivery in hard to 0 100 240000
0 0 0 00 0 0 0 0
reach areas 0
7
Alternate Vaccine 29
4 74 74 74 3715 3715 3715 3715
C.1.j delivery in Other 72 50 1486200
3 31 31 31 50 50 50 50
areas 4
1
To develop 3
34 3410
C.1.k microplan at sub- 4 100 0 0 0 34100
1 0
centre level 1
For consolidation
1 1700
C.1.l of microplans at 17 1000 0 0 0 17000
7 0
block level
POL for Vaccine
C.1. Delivery From 1 1830
17 9000 0 0 0 183000
m State to District 7 00
and to PHC/CHC
Consumables for
computer
including
provision for 1 2160
C.1.n 18 12000 0 0 0 216000
internet access 8 00
for RIMs Rs 400
per month per
district
1
Red/Black Plastic 2
bags etc 12
C.1.o 3 2476
Bleach/Hypchlorit 38 2 0 0 0 247654
&p 8 54
e Solution/twin 27
bucket 2
7
Safety Pits for
those
PHC/Hospitals 1 1020
C.1.q 17 6000 0 0 0 102000
where there is no 7 00
Pit or is not in
working condition
Alternate
vaccinator hiring
for Access
Compromised
Areas,POL of
1000
C.1.r Generators for 1 1 100000 0 0 0 100000
00
Cold Chain & for
serious AEFI
cases
investigation for
every district
Salary of
C.2A 0 0 0 0 0 0
contractual staff

28
 Computer
Assistants
support for
District level @Rs 1320
C.2.b 1 1 132000 0 0 0 132000
10000/-per person 00
per month for one
computer
assistant
District level
orientation
training including
Hep- 1000
C.3.a 1 1 1000000 0 0 0 1000000
B,Measles,JE for 000
2 days
ANM,MHW,LHV &
Other staffs
Training under 2500 2500 2500 2500
C.3.b 1 1 1 1 4 25000 100000
immunization 0 0 0 0
One day cold
chain handlers
1 8500 8500
C.3.d training for block 17 34 5000 0 0 170000
7 0 0
level cold chain
handlers
One day cold
chain handlers
1 3400 3400
C.3.e training for block 17 34 2000 0 0 68000
7 0 0
level data
handlers
Cold Chain 2 2400
C.4 20 12000 0 0 0 240000
Maintenance 0 00
Vaccine van 4000
C.4a 1 1 40000 0 0 0 40000
repairing 0
c5 ASHA Incentive 0 0 0 0 0 0
6050 6050 6050 6050
c6 Pulse Polio 3 3 3 3 12 2016883 24202596 See deatil in Annexure
649 649 649 649
Total 0 0 0 0 0 37735099

D IDD 0 0 0 0 0 0

Establishment of
D.1 0 0 0 0 0 0
IDD Control Cell
D.1.
Technical Officer 0 0 0 0 0 0
A
D.1. Statistical Officer
0 0 0 0 0 0
B / Staffs
D.1.
LDC Typist 0 0 0 0 0 0
C
Establishment of
D.2 IDD Monitoring 0 0 0 0 0 0
Lab
D.2.
Lab Technician 0 0 0 0 0 0
A
D.2.
Lab Assistant 0 0 0 0 0 0
B

29
 IEC/ BCC Health
Education and 5400
D.3 Publicity 1 1 54000 0 0 0 54000 see detail in annexure
0

IDD Surveys/Re-
D.4 0 0 0 0 0 0
Surveys
Supply of Salt
D.5 Testing Kit (Form 0 0 0 0 0 0
of Kind Grant)
D DD 0 0 0 0 0 0

Total 0 0 0 0 0 54000

E IDSP 0 0 0 0 0 0
4950 4950 4950 4950
E.1 Operational Cost 3 3 3 3 12 16500 198000
0 0 0 0
3750 3750 3750 3750
E.1.1 Mobility Support 3 3 3 3 12 12500 150000
0 0 0 0
E.1.1 1500 1500 1500 1500
Office Expense 3 3 3 3 12 5000 60000
.1 0 0 0 0
ASHA incentives
E.1.1 3 12
for Outbreak 30 30 30 100 3000 3000 3000 3000 12000
.2 0 0
reporting
Collection &
E.1.1
transportation of 1 1 1 1 4 2500 2500 2500 2500 2500 10000
.3
samples
1000
E.1.2 Lab Consumables 1 1 100000 0 0 0 100000
00
E.1.3 Review Meetings 1 1 1 1 4 5000 5000 5000 5000 5000 20000

E.1.4 Field Visits 0 0 0 0 0 0

Formats and
E.1.5 1 1 1 1 4 2500 2500 2500 2500 2500 10000
Reports
Human
E.2 0 0 0 0 0 0
Resources
Remuneration of 4320
E.2.1 1 1 432000 0 0 0 432000
Epidemiologists 00

Remuneration of
E.2.2 0 0 0 0 0 0
Microbiologists

Remuneration of
E.2.3 0 0 0 0 0 0
Entomologists
Consultant- 1800
E.3 1 1 180000 0 0 0 180000
Finance 00
Consultant-
E.3.1 0 0 0 0 0 0
Training
1620
E.3.2 Data Managers 1 1 162000 0 0 0 162000
00
Data Entry 1200
E.3.3 1 1 120000 0 0 0 120000
Operators 00
4800
E.3.4 Others 1 1 0 0 0 48000
0
E.4 Procurements 0 0 0 0 0 0

30
 Procurement -
E.4.1 0 0 0 0 0 0
Equipments
Procurement -
E.4.2 0 0 0 0 0 0
Drugs & Supplies
Innovations
E.5 0 0 0 0 0 0
/PPP/NGOs
IEC-BCC
E.6 0 0 0 0 0 0
Activities
Financial Aids to
E.7 Medical 0 0 0 0 0 0
Institutions
1000
E.8 Training 1 1 100000 0 0 0 100000
00
E IDSP 0 0 0 0 0 0

Total 0 0 0 0 0 1602000
7496
F NVBDCP 1 0 0 0 1 74964865 0 0 0 74964865 See deatil in Annexure
4865
Total 0 0 0 0 0 74964865
1230
G NLEP 1 1 1230115 0 0 0 1230115
115
Total 0 0 0 0 0 1230115 See deatil in Annexure
3404
H NPCB 1 1 34046500 0 0 0 34046500
6500
Total 0 0 0 0 0 34046500
8869
I RNTCP 1 1 8869800 0 0 0 8869800 See deatil in Annexure
800
Total 0 0 0 0 0 8869800

Grand Total 0 0 0 0 0 2190330681

31
 Annexure

DHS Sitamarhi
 A.1.1.1 Operationalise FRU
S. No. Activity Physical Target (Unit) Unit Cost Total Amount (in Rs.) Remarks

1 Purchese of Generator of 10 KVA 2 250000 500000

2 Geanerator and Fuel+ POL+ Misc. exp 2 288000 576000

3 Contingency Fund 2 72000 144000
4 Blood Donation Camp 2 120000 240000
Total 1460000
730000

A.1.3.2 VHND
S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 District level meeting 1 2500 2500
ANM participation in Microplanning and
2 500 200 100000
Capacity building for 2 days @ Rs. 100

AWW participation in Microplanning and

3 2968 200 593600
Capacity building for 2 days @ Rs. 100
ASHA participation in Microplanning and
4 2965 200 593000
Capacity building for 2 days @ Rs. 100
VHSC-PRI member participation in
5 Microplanning and Capacity building for 2 273 200 54600
days @ Rs. 100
POL for monitoring VHSND site for MOIC,
6 85 9600 816000
CDPO, BCM, BHM, PHED Er. @ Rs. 100
Total 2159700
539925

DHS Sitamarhi
 A.2.6 Nutrition Rehabilitation Center
S. Physical Total Cost per Total Cost/Month Total Amount
Activity Unit Cost Remarks
No. Target Batch (in Rs.) (in Rs.) (in Rs.)
1 Running Cost
Will be Those medicine which are not
1.1 Medicines provided by available should be procurred by
the govt DHS

1.2 Incentive to Mobilizer 20 100 2000 4000 ASHA/AWW will work as mobilizer

1.3 Food for child 420 70 29400 42000

1.4 Food for Mother 420 70 29400 42000
1.5 Loss of wages to mother 420 100 42000 63000
1.6 Transportation cost to bring Children 20 125 2500 5000 Will be given to ASHA/AWW
1.7 Transportation cost after 21 days 20 125 2500 2500 Will be given to ASHA/AWW
Will be given to mother to bring
1.8 Transportation cost for Follow up visit 80 100 8000 12000
the child to NRC
1.9 Fuel and Generator 15000 15000
1.10 Miscellaneous 16000
1.11 Paediatrician-1 1 35000 35000 35000
1.12 A- Grade Staff Nurse-3 3 20000 60000 60000
1.13 CBC Extender-1 1 9500 9500 9500
1.14 Feeding Demonstrator-2 2 9000 18000 18000
1.15 Caretaker-3 3 3800 11400 11400
1.16 Cook-2 2 3800 7600 7600
1.17 security Guard-3 3 3800 11400 11400
1.18 Sweeper/Cleaner-2 2 3300 6600 6600
Total 361000 4332000
2 Training
Training of ANMs and Local Supervisors
2.1 2 10000
on NRC of 2 focused block
Training of ASHA/AWW of 2 focussed
2.2 2 60000
block
3 Annual Maintanance cost (one Time) 1 103535
Grand Total 4505535
1
 A.2.6.1 Childhood Diarrehea Management Programme
Physical Unit Cost Total Cost
Sl.No. Name of Activity
Target (Rs.) (Rs.)
1 Procurement
1.1 Zinc Sulphate Suspension (20mg/5 ml-100 ml bottle) 4,09,328 5.58 22,84,050.2
1.2 ORS Packet 8,18,657 2.29 18,74,725
Sub Total 41,58,775
2 Refresher Training
Refresher training of ANMs (384) at block level ( @ Rs. 200 /per participant which includes
2.1 384 200 76,800
TA (Rs.100) & Food ( Rs.75),Stationaries (Rs.25) (Writing pad, pen & folder)
Refresher training of ASHAs (2965) & AWWs (2567) at block level ( @ Rs. 200 /per
2.2 participant which includes TA (Rs.100) & Food ( Rs.75), Stationeries (Rs.25) (Writing pad, 5532 200 11,06,400
pen & folder)
Refresher training of BCMs (17) at district level ( @ Rs. 250 /per participant which
2.3 17 250 4,250
includes TA (Rs.150) & Food ( Rs.75),Stationaries (Rs.25) (Writing pad, pen & folder)
Refresher training of Data Entry Operators (28) at district level ( @ Rs. 250 /per participant
2.4 which includes TA (Rs.150) & Food ( Rs.75), Stationaries (Rs.25) (Writing pad, pen & 20 250 5,000
folder)
2.5 Design & Print training module for ANM (384), ASHA (2965), AWW (2565) 5914 40 2,36,560
Sub Total 14,29,010
3 Recording & Reporting
3.1 Design & Print Registers for HSCs (213), ASHAs(2965), AWWs (2565) 5743 20 1,14,860
Design & Print Reporting forms for Sadar Hospital (1), PHC (17), APHCs (37),HSCs (213),
3.2 5585 20 1,11,700
ASHAs (2965, AWWs (2565)
Sub Total 2,26,560
4 Mobility Support
4.1 Hiring Vehicle for transportation of Zinc syrup and ORS from the district to PHCs 17 3000 51,000
Hiring vehicle for visit by DCM to blocks and field for monitoring supportive supervision
4.2 48 1000 48,000
visits undertaken by BCM(@4 visits/month)
Sub Total 99,000
5 Review Meeting
2
 TA to BCMs to attend the monthly review meeting at the district level (@Rs.150/- per
5.1 204 150 30,600
BCM per month)

Provision of refreshment (working lunch) for monthly review meeting of BCMs at district
5.2 204 100 20,400
level including logistics arrangements like hiring chairs etc.(@ Rs.100/- per BCM)

Sub Total 51,000

6 BCC and Social Mobilization activities
Design and print poster on Zinc-ORS for Sadar Hospital (1), PHC(17), APHC (37), HSCs (213)
6.1 2833 25 70,825
& AWCs (2565)
6.2 Design and Print Display Board for Sadar Hospital (1), PHC(17), APHC (37), HSCs (213) 268 300 80,400
Wall Painting (4*4)(@ 2 numbers in HSC catchment villages)(213HSC*2=426)(@Rs.12 per
6.3 426 192 81,792
sqft)
Design & Print Inter Personal communication Tool kit for HSC (213), ASHA (2965), AWW
6.4 5743 50 2,87,150
(2565)
Design & Print Compliance Cards for 5,22,030 diarrheal cases which would be distributed
6.5 409328 1 409328
to the care givers through ASHA, AWW, ANM, APHC, PHC, Sadar Hospital.
Sub Total 9,29,495
7 Celebration of ORS-Zinc Week/Day at District and Block levels
Rallies and other mobilization activities at block PHCs (20) and district (1) (Drawing, prize,
7.1 18 10000 180000
banners, refreshment for rally, poster competition)
Sub Total 180000
Grand Total 70,73,840

3
 A.2.7 Vitamin A Biannual Round
S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 Meeting of District Coordination Committee 2 2500 5000
2 Meeting of Block Coordination Committee 36 1000 36000
3 Orientation of ANM/AWW/ASHA 6068 25 151700
4 Monitoring support for ASHA as additional site worker 792 300 237600
5 Monitoring support for ASHA Facilitator for additional site 79 400 31680
6 Monitoring by district official 2 3000 6000
7 Monitoring by Block official 36 500 18000
8 Fund requirement for Vitamin A bottles 12010 44.32 532283
9 Marker pen 6444 18.5 119214
Total 1137477

A.7.2 PNDT Activities

S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 District level meeting 4 25000 100000 Quaterly Meeting
2 Honorarium of Data Entry Operator 1 96000 96000 One time expenditure
Minimum 2 visit per
3 Mobility support for field visit 24 5000 120000
month
Cost of establishment of PNDT Cell
4 (including Computer, Hard Disk, Printer, 1 100000 100000 Recurring expenditure
Scanner, Fax, Internet, Furniture)
5 Contingency (paper, internet and others 12 5000 60000
Total 476000

A.9.10.1 Stregthening Nursing School, Sitamarhi

S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 Junior Sister Tutor 3 246000 738000
2 PHN 4 246000 984000
3 Data Entry Operator 1 120000 120000
4 Class -IV 3 96000 288000
5 Contingency (paper, internet and others) 1 18000 18000

4
 6 Demonstartion 1 843000 843000
7 Audio/Video Lab 1 334000 334000
8 Library 1 150000 150000
Construction and Rennovation of Nursing
9 1 50000000 50000000
School and Hostel
Total 53475000

A.10.2.1 District Programme Management Unit

S. No. Activity Physical Target Per month Unit Cost Total Amount (in Rs.) Remarks
10% increment from last
1 District Programme Manager 1 42858 514298 514298
year
10% increment from last
2 District Accounts Manager 1 35937 431244 431244
year
10% increment from last
3 District M&E Officer 1 29948 359370 359370
year
10% increment from last
4 District Planning Coordinator 1 24200 290400 290400
year
10% increment from last
5 Recurring Expenditure 1 93500 1122000 1122000
year
Total 2717312

A.10.3 Block Programme Management Unit

S. No. Activity Physical Target Per month Unit Cost Total Amount (in Rs.) Remarks
1 Block Health Manager 1 23958 287496 287496 10% increment from last year
2 Block Accountant 1 15972 191664 191664 10% increment from last year
3 Recurring Expenditure
3.1 Mobility Expenses 1 16500 198000 198000 10% increment from last year
3.2 Office Expenses 1 11000 132000 132000 10% increment from last year
Total 809160

5
 B.1.1.1 Training of ASHA
S. No. Activity Physical Target Unit Cost No. of Days Total Amount (in Rs.) Remarks
1 ASHA Compensation 30 100 6 18000
2 ASHA food, Accomodation, Venue 37 150 6 33300
3 TA ASHA 32 100 1 3200
4 Honoraruim for Trainers 3 350 6 6300
5 TA for Trainers 3 150 1 450
6 ASHA Facilitator 2 150 6 1800
Total 63050
7 Miscellaneous 10% 6305
Grand Total 69355
2312
Unit Cost Per ASHA per batch = Rs. 2312

B.1.1.1.1 Training of ASHA Facilitator 1 Batch (30 ASHA Facilitator) for Module 5,6 & 7 (1st Round)
S. No. Activity Physical Target Unit Cost No. of Days Total Amount (in Rs.) Remarks
1 ASHA Facilitator Compensation 30 150 8 36000
2 ASHA Facilitator food, Accomodation, Venue 35 150 8 42000
3 TA ASHA Facilitator 30 100 1 3000
4 Honoraruim for Trainers 3 350 8 8400
5 TA for Trainers 3 150 1 450
Total 89850
6 Miscellaneous 10% 8985
Grand Total 98835
Unit Cost Per ASHA Facilitator Round-1 = Rs.
3295
B.1.1.1.2 Training of ASHA Facilitator 1 Batch (30 ASHA Facilitator) for Module 5,6 & 7 Round 2,3 & 4
S. No. Activity Physical Target Unit Cost No. of Days Total Amount (in Rs.) Remarks
1 ASHA Facilitator Compensation 30 150 6 27000
2 ASHA Facilitator food, Accomodation, Venue 35 150 6 31500

6
 3 TA ASHA Facilitator 30 100 1 3000
4 Honoraruim for Trainers 3 350 6 6300
5 TA for Trainers 3 150 1 450
Total 68250
6 Miscellaneous 10% 6825
Grand Total 75075
Unit Cost Per ASHA Facilitator Round-2,3 & 4 =
Rs. 2503

B.1.1.5 ASHA Resource Center, Sitamarhi Budget for the year 2012-13
Strategies Activity Budget
Total Total
Sl.
S.No. Physical Target Rate Amount Amount Remarks
No.
(in Rs.) (in lakh)
1.1 Salary of DCM 1 290400 290400 2.90
1.2 Salary of DDA(ASHA) 1 198000 198000 1.98
1.3 Accounts Manager 1 150000 150000 1.50
1.4 Data entry operator 1 120000 120000 1.20
1.5 Peon 1 96000 96000 0.96
1.6 Office expense:-
Asha Resource 1.6.1 Office Rent 12 5000 60000 0.60
centre/ 1.6.2 Office setup (one time) 1 150000 150000 1.50
1 Asha mentoring 1.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 12 10000 120000 1.20
group at District 1.6.4 Mobility Support for DCM & DDA(ASHA) 12 18000 216000 2.16
level
1.6.5 Laptop for DCM & DDA(ASHA) for one time 2 35000 70000 0.70
1.6.6 Purchase of Mobile Phone for DCM & DDA (ASHA) 2 5000 10000 0.10
1.6.7 ASHA Sammelan for one time 1 500000 500000 5.00
1.7 Capacity Building for District level ARC staff 2 50000 100000 1.00
1.8 Capacity Building for Block level ARC staff 5 25000 125000 1.25
1.9 Capacity Building for ASHA Facilitator 34 10000 340000 3.40
Sub Total A 2057000 20.57
7
 2.1 Salary of BCM 17 174240 2962080 29.62
2.2 Salary of Block Accountant 17 144000 2448000 24.48
2.3 Salary of office Assistant 17 96000 1632000 16.32
2.5 Incentive for ASHA Facilitator 150 36000 5400000 54.00
2.6 Office expense:-
Asha Resource 2.6.1 Office Rent 17 36000 612000 6.12
centre/ 2.6.2 Office setup (one time) 17 50000 850000 8.50
2 Asha mentoring 2.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 17 72000 1224000 12.24
group at Block 2.6.4 Mobility Support for BCM 17 180000 3060000 30.60
level 2.6.5 Laptop for BCM for one time 17 30000 510000 5.10
2.6.6 Purchase of Mobile Phone for BCM (One time) 17 3000 51000 0.51
2.6.7 ASHA Saree & others 5930 1000 5930000 59.30
2.6.8 CUG Mobile with Sim for ASHA 2965 1500 4447500 44.48
2.6.9 Mobile Recharge for ASHA 2965 1200 3558000 35.58
Sub Total B 29126580 291.27
Grand Total (A+B) 31183580 311.84

B.7 District Action Plan

S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 Workshop for DPIP 2 25000 50000
2 Preperation of DPIP at district level 1 50000 50000
3 Preperation of BHAP 17 10000 170000
4 Preperation of HSC Plan 341 5000 1705000
5 Coputer Assistant at district Level 1 96000 96000
6 Laptop Purchase for DPC 1 35000 35000
7 Mobile recharge for DPC 1 6000 6000
8 Furniture 1 50000 50000
9 Contingency 12 5000 60000
Total 2222000

8
 B.10.1 BCC/IEC Activity
S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 BCC/IEC Consultant 1 240000 240000
For 56 APHC, 17 PHC, 2 Referrals and 1
2 Hoardings 76 25000 1900000
Sadar Hospital
3 Wall Painting 846 10000 8460000 For 846 Revenue Village
For 56 APHC, 17 PHC, 2 Referrals and 1
4 Sign Board 76 5000 380000
Sadar Hospital
5 Contingency 12 5000 60000
Total 11040000

B.14.A SABLA
S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 District Level Orientation
1.1 TA for 1 MOIC/CDPO per PHC 34 200 6800
1.2 Refreshment 34 50 1700
1.3 Stationery 34 50 1700
1.4 Contingency 1 1000 1000
Sub Total 11200
2 Block Level Orientation
2.1 TA for MO/BHM/BCM/ANM/AWW/ASHA 6518 50 325900
2.2 Refreshment 6518 40 260720
2.3 Stationery 6518 25 162950
2.4 Contingency 1 500 500
Sub Total 750070
Grand Total 761270

9
 C.6 Pulse Polio
Total Amount
Total Amount (in
S. No. Activity Physical Target Unit Cost (in Rs.) for 1 Remarks
Rs.) for 12 round
round
Incentive Money to vaccinator (H-H)
1 6976 100 697600 8371200
team (working days) 1057*6+10%=6976.2
Incentive Money to vaccinator transit
2 1240 100 124000 1488000
team (working days) 188*6+10%=1240
Incentive Money to vaccinator Mobile
3 284 100 28400 340800
team (working days) 43*6+10%=283.8
Incentive Money to vaccinator One
4 85 100 8500 102000
Man team (working days)
Incentive to Supervisor (Working
5 2300 100 230000 2760000
Days)
6 POL for Supervisor (working days0 2300 100 230000 2760000
Incentive to Cold Chain Hander per
7 102 100 10200 122400
Sub- Depot
Hiring Vehicle for District and Sub-
8 71 5000 355000 4260000
Depot
9 Ice Pack for Vaccinator/Supervisor 29437 4 117748 1412976 6976(V)*4+384(S)*4=29437.33333333333
10 Ice pack for Sub Depot 12240 4 48960 587520 102*6*20=12240
11 Ice pack for DHQ 1 3000 3000 36000
Logistics supply for Team and
12 1967 25 49175 590100
Supervisor
13 IEC and Social Mobilization 26 1000 26000 312000
14 Contingency for DHQ 1 5000 5000 60000
15 Contingency for PHC 17 2500 42500 510000
Per diem for Cold Chain Handler at
16 18 100 1800 21600
PHC and DHQ
17 Hiring Vehicle at District 1 5000 5000 60000
18 Hiring vehicle at PHC 17 2000 34000 408000
Total 2016883 24202596
2016883

10
 D.3 BCC/IEC Health education and Publicity
S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks
1 Orientation of AWW/ASHA 17 2000 34000
2 Meeting at district level 2 10000 20000
Total 54000

National Vector Borne Disease Control Programme Proposed Budget for the Year 2012-13, Sitamarhi

During Spray Period (IRS operational Cost, intensive spray for 2 round ,120 days(4 months):-

HEADS Unit cost Total Amount in Rs.

1 Wages For FW & SFW(Intensive spray) For 191 squads x 2 round 16846200
2 Office expenses for (@Rs 250 /per squad) @ Rs. 250 x191 x 2 round 95500
3 Contingency for Dist.( @Rs 250 / per squad) @ Rs. 250 x 191 x 2 round 95500
4 Dist. Mobility for CS Vehicles @ Rs. 10,000 x 2 months x 2 rounds 40,000
5 Dist. Mobility for ACMO Vehicle @ Rs. 10,000 x 2 months x 2 rounds 40,000
6 Mobility for DMO and VBD Consultant vehicle. @ Rs.20,000 x 2months x 2 rounds 80,000
7 Mobility For PHCs MOs @Rs.650/day X120 days X 17 1326000
8 Transportation of DDT (including loading and unloading) Dist. To PHCs 17 x @ Rs. 2000 x 2 round 68000
@Rs 2000/per affected PHCs
9 Transportation of DDT( including loading and unloading) PHCs to Villages 17 x@1500 X 2 round 51000
@Rs 1500/per affected PHCs
10 Repair of equipments @ Rs150/per squad @150 x 191 x 2 round 114600
11 Purchase of Nozzle tips @ Rs 800/squad (Rs 40 x 16 nozzles tips x 8 weeks) @Rs 800 x 191 x 2 round 152800
12 DA for supervision of IRS @ Rs 2000/per affected PHCs 17 x @ Rs. 2000 x 2 rounds 68000
13 POL for KTS motorcycle@ Rs100/per day @Rs 100 x 60 days x 6 KTS= 72000
14 IEC @ Rs 3000/per PHCs @Rs3000 x 17 x 2 round 102000
15 Evening Debriefing DHQ @Rs 200 x 120days 24000
16 Evening Debriefing PHCs @Rs 150 x 120days x 17 306000
TOTAL GROSS 19481600

Budget during non spray period

11
 HEADS Unit cost Total Amount in Rs.
1
2 Office expenses. @ Rs 5000/per months(8 months) 8 X Rs.5000/- 40000
3 Hiring of ware house for DDT storage @ Rs 5000/per months for 12 months 12 X Rs. 5000/- 60000
4 Kala Azar search programme@ Rs 750/PHC x 8 months 17 X 8 months X @Rs.750/- 102000
5 IEC visibility during search programme @ Rs 750/PHCs @Rs.750/- X 17 12750
6 Miking during kala azar camp @ Rs 500 per camp/PHCs x 8 months @ Rs. 500/- X 17 X 8 CAMP 68000
7 For refreshment @ Rs 250 per camp/Per PHCs x 8 months @ Rs.250/-per camp X 8 X 17 34000

8 For camp Box @ Rs 1000/Per PHCs 17 X Rs 1000/- 17000

10 Mobility for DMO and VBD Consultant vehicle.@ Rs 20000/per month during 8 X Rs 20000/- 160000
non spray period
11 Loss Of Wages to KA patients @ Rs 100/per day/30 days/per case for 1500 1500 X @Rs. 3000/- 4500000
Cases
12 Incentive to ASHA @ Rs 200/per case for1500 Cases 1500 X @Rs 200/- 300000
13 Food supplement for KA patients @ Rs 35/- per patient/day x 45 days x total 1500 X @Rs 35/- X 45 days 2362500
patients
14 Ampho-B storage at Dist. Level @ Rs 500 x 12 months 12 X Rs 500/- 6000
15 Mobile phones for DMO, VBD Consultant and other KA concerning staffs @ 10 X Rs.5000/- 50000
Rs 5000 x 10 nos.
16 For strengthening of office Computer, printer, Photo copier ,UPS etc. 200000
17 IEC @ Rs 5000 /per PHCs 17 X Rs 5000/- 85000
18 Treatment card @Rs 5.00/treatment card for 2 cards per case.+ 20% extra 3300 X @Rs 5/- 16500
19 Registers for (line listing ,loss of wages, ASHA Records, Drug records)@ Rs @ Rs.50/- X 90 Reg.(17 PHCs + 22 reg for D.HQ) 4500
50.00/ register-4 registers / PHC)and 20 registers for District
20 Training to MOs, BCM(ASHA)& paramedical in the district 500000
21 Training of ASHA @ Rs 2000/-per batch(50 participants in each batch) @Rs 2000 x46 batch(2300 ASHA) 92000
22 Training of spray workers @ Rs 2000/-per batch(50 participants in each batch) @Rs2000/- X 50 batch 100000
23 VBD Consultant salary @ Rs 40,000 x 12 months @Rs.40000/-per month 480000
24 KTS salary @ Rs 12500 x 6 x 12 months @Rs.12500/-per month 900000
25 DEO salary @ Rs 7500 x 12 months @ Rs.7500/- per month 90000
26 FLA salary @ Rs 9000 x 12 months @Rs.9000/-per month 108000
27 Short funding by State(LOWs head) Rs.3614000=00( up to Nov.11) +Rs426000=00(284 cases 4040000
projected from Dec.11 to mar.11)
28 Short funding by State(ASHA Incentive head) @Rs200/-per pts. x 1000 pts 200000
29 Short funding by State (DDT Store)17/12/2009 to Mar-12(Committed @ Rs5000/-/month 137742
Expenditure)
30 IRS committed expenditure of 4 PHCs 414941
Total 15080933
Budget for curative measures of kala azar Budget for Preventive measures of kala azar 2012- Committed expenditure during financial year 2011-12 with short funding Grand Total
2012-2013 2013 by state.
Rs. Rs.10288250=00 Rs. 19481600=00 12
Rs.4792683=00 Rs. 34562533=00
Budget for MDA 2012-13

District Name: Sitamarhi Budget in Rs. Short funding by SHSB for MDA(Filaria) Prog.
District Coordination Meeting(Two Meeting) 20000
IEC(for DHQ) 50,000
Publicity campaign 40000
Handbills and hoarding for BCC 50000
Training for MO 60,000
Training for Para medical staff 70,000
Line Listing 50,000
Night Blood survey 20,000
POL 50.000
Honorarium of Supervisors @145/- x 1078 156310
Training of Supervisors@145/- x 1078 156310
Training of Drug Distributors@118/- x 11447 1350746
Honorarium of Drug Distributors@118/-x 11447 1350746
Office expenses 60000
Incentive for hydrocele operation (Target 1000 pts.) @Rs1500/- 1500000
Short funding by SHSB for MDA (Filaria)Prog. (Committed expenditure) 740687
Total 5724799
Grand Total

Budget for Malaria control Programme:

District Name-Sitamarhi Total Amount in Rs. Remarks

IEC Materials for PHCs @Rs.5000 x 17 PHCs= 85000

For Malaria Month 30000

Grand Total 115000

13
 National Leprosy Elimination Programme proposed budget for the year 2012-13, Sitamarhi
Total Amount
S.No. S.No. Activity
(in Rs.)
1 Rural 1 1. One Day Training of Trained M.O. 24050
2 2. Training of New Entrance M.O. 24750
3 3. Sensitization of AWW/ ASHA 364000
4 4. School Quiz 85000
5 5. PRI Meeting 68000
6 6. Incentive of ASHA 93500
7 7. Training of Supervisor 12640
Rural Total 671940
2 Urban 1 1. One Day Training of Trained M.O. 6925
2 2. Training of New Entrance M.O. 11950
3 3. Sensitization of IMA Members 5000
4 4. Training of AWW/ NGO Volunteers 17000
5 5. School Quiz 5000
6 6. Leprosy Awareness 6000
7 7. Incentive 7000
8 8. Health Mela 5000
9 9. Slide 1000
10 10. Cable 5000
11 11. Leprosy Day Rally 10000
12 12. Hand Bill 10000
Urban Total 89875
3 District Level Expenses 1 1. Remuneration of Driver 295000
2 2. Honorarium for A/C 4800
3 3. Audit fee 6000
4 4. Rent/Tel/P&T/Elec./Misc 18000
5 5. Stationary 14000
6 6. Vehicle Operation 75000
7 7. Supportive Medicine 25000
8 8. Lab Reagent 12000
9 9. Patient Welfare 6000
10 10. D.P.M.R 12500
District Level Expenses Total 468300
Grand Total 1230115

Remarks: Lack of fund 2 (Two) Contractual Driver‟s remuneration Rs. 187,000 (One Lack Eighty Seven Thousnd) are pending.

14
 National Programme for Control of Blindness
Annexure 1
IEC CAMPAIGN: PROPOSED BUDGET FOR IEC ACTIVIYIES DURING 2012-2013
Sl. No. IEC Materials Tentative Quantity Estimated Cost (Rs)
1 Hand Bill (For eye) 70000 35000
2 Hand Bill ( For children) 70000 35000
3 Leaflet 35000 52000
4 Poster 35000 140000
5 Banner 200 80000
6 Hoarding & Hanging 20 240000
7 Tin Plate Poster & wall Painting 100 96000
8 Doordarhan Telecast, scroll for TV channel,slogan & broadcasting in Radio channels 85000
9 IEC Activities:- 150000
1. Eye donation fornight. 19
2. World sight day. 19 200000
3. World glaucoma day. 19 100000
TOTAL 1213500

Annexure B
Grant in Aid other components-
1 Recurring GIA for Eye Donation
2 Vision Center 150000
3 Eye Bank 2500000
4 Eye Donation Center 1500000
5 Non-recurring Grant to NGO for strengthening/ expansion of eye
care unit on 1:1 sharing basis 2 @ 30 lakh 3000000
6 Traning of Ophehalmic & support man power 50000
7 IEC - Annex.1 1213000
8 GIA for free cataract Operation for DHS-Blindness Division 1500000
9 GIA for School Eye Screening for DHS-Blindness Division @ 2 lakh per district 500000
10 For eye ward end eye Ots @ Rs 75Lakhs for district 8500000
Support towards salaries of Ophtalmic Man power to State
A. Demand for Manpower 7140000
11 1. Demand surgeon in district for dist. @ 35000/- per month
2. Ophthalmic Assistant in district Hospital/PHC @ 15000
per month. 1980000
12 Strengthening/ setting up of Regional Institutes of Ophthalmology(Non Recuring Assistance for pediatrics Ophthalmology). 0
13 Strengthening of medical colleges @ 40 Lakh for Medical Colleges. 0
14 Strengthening of District hospital @ 20 Lakhs For dist. 2500000
15 Grant-in-aid to district Health Societies ( Recurring Assistant) @ 5 lakhs. 700000
16 Back log dues in district (Approx.) NGO payment 800000
17 Non-recurring GIA for maintenance of Ophthalmic equipment @ 5lakhs per unit. 800000
Total 32833000

15
 Revised National Tuberculosis Control Programme Proposed Budget for the year 2012-13, Sitamarhi

Budget estimate for the coming FY 2010- 11

S.No. Category of Expenditure
(To be based on the planned activities and expenditure in Section C)
1 Civil works 10,60,500
2 Laboratory materials 4,65,000
3 Honorarium 11,23,000
4 IEC/ Publicity 2,25,000
5 Equipment maintenance 69,000
6 Training 3,61,700
7 Vehicle maintenance 1,50,000
8 Vehicle hiring 5,58,000
9 NGO/PP support 1,68,000
10 Miscellaneous 4,50,000
11 Contractual services 38,79,600
12 Printing 30,000
13 Research and studies 0
14 Medical Colleges 0
15 Procurement –vehicles 2,50,000
16 Procurement – equipment 80,000
TOTAL 88,69,800

Additionality Funds from NRHM-Details of the activities for which Additionality Funds are proposed to be sought.
 Rs. 9,95,500 for the major repair of the DTC building for which estimate from PWD Building Dept.
 Rs. 2,34,000 for 13 LTs @ the rate of Rs. 1500/month at par with the NRHM LTS
 Total Fund under NRHM Additionality is Rs. 12, 29, 500

16
DHS Sitamarhi