NATIONAL HEALTH MISSION (NHM), HARYANA

KEY HEALTH INDICATORS

The detail of year-wise budget approved and expenditure

under National Health Mission (NHM), Haryana

(Figures in Crore)

ECRP-II

1.       Ministry of Health & Family Welfare, Govt. of India has provided additional resource to manage the COVID pandemic under “India Covid-19 Emergency Response and Health Systems Preparedness Package - Phase- II” amounting to Rs. 304.04 cr for FY 2021-22 in sharing pattern.

2.      Against the approved amount of ECRP-II, funds amounting to Rs.25.84 crore has been sanctioned to districts, Rs 167.23 crore has been transferred to HMSCL/ PWD (B&R)/HLL.

3.  Sanction of funds have been given under, ECRP-II for opening of 8 molecular labs in districts Kaithal, Kurukshetra, Fatehabad, Charkhidadari, Jhajjar, Mahendragrah, Palwal and Hisar.

MATERNAL HEALTH

·        The current Maternal Mortality Ratio (MMR) of Haryana is 110 (SRS-2018-20).

·        Promotion of Institutional deliveries through operationalizing 24x7 delivery facilities. Institutional Deliveries increased to 97.5% (2022-23).

·        Operationalization of 55 First Referral Units (FRUs) for providing emergency Obstetric care services including C-section services.

·        For ensuring quality in ANC services, months of April and May, 2023 was celebrated as Surakshit Janani Maah (SJM) across district. In the month of April, 2023, more than 76000 pregnant women have been examined out of which around 16000 have been identified as high risk pregnancies.

·        Availability of free Injection Iron Sucrose for treatment of severe Anaemia in pregnant ladies

·        eSanjeevaniOPD” an online Stay Home OPD under National Tele - Consultation services of Govt. of India has been initiated in Haryana and Haryana is on board since 01.05.2020. One can consult a Doctor by using laptop/ desktop or an android smart Phone with internet while staying at home through video call / live chat. Using this platform report of the investigations can be uploaded and seen by consulting doctor and then Doctor can prescribe lab tests or medicine on e-prescription and is valid in all Health Facilities of Haryana. This service is completely free. As per orders by the Hon’ble Health Minister Haryana, services of eSanjeevaniOPD are made available 24X7 from 16.08.2021 in the state. In 2022-23, total of 1.02 Lac consultations were given through eSanjeevaniOPD.  

·        Implementation of eSanjeevani OPD was awarded Good Governance award 2020-21 by Hon’ble Chief Minister Haryana and Digital Technology Sabha Excellence Award by The Express Group

·        6 specialized MCH hospitals are being established in the state at:

1.   District Civil Hospital Panchkula,

2.   District  Civil Hospital, Panipat and

3.   Shaheed Hasan Khan Mewati Govt Medical College, Nalhar, Nuh.

4.   District Civil Hospital Faridabad

5.   District Civil Hospital Palwal

6.   District Civil Hospital Sonipat

Also in RoP 2023-24, 2 new MCH Wings at Kaithal and Sirsa have been approved.

·      Till date, 8 obstetric HDU/ICUs are being established in the State. 5 at govt. Medical Colleges and 3 at Civil Hospitals- Faridabad, Panchkula and Sector 10 Gurugram (Obs. ICU/HDU at MAMC Agroha, BPSGMC Sonipat, CH Faridabad and CH Sector 10 Gurugram are functional. At PGIMS, Rohtak Obs. HDU is functional).

CHILD HEALTH

Currently Infant Mortality Rate (IMR) of Haryana is 28 per 1000 live births (as per SRS 2020) which has decreased remarkably by 13 points since 2013 (IMR-41in 2013). Under Five mortality Rate (U5MR) has declined by 12 points .i.e from 45 (As per SRS 2013) to 33 (As per SRS 2020).

Activities done under Child Health Division

·        24 Special Newborn Care Unit (SNCU) along with Kangaroo Mother Care Units (KMCU), 66 New born Stabilization Unit (NBSU), 439 Newborn Care Corner (NBCC) and 11 Nutritional Rehabilitation Centre (NRC)are functional in state.

·        Special Newborn Care Unit (SNCU) - Total 26860 newborns were admitted in FY 2022-23 in 24 SNCUs of the State..

·        15.2  Lac children received vitamin A dose in Vitamin A supplementation round  conducted in  November–December 2022

·        Under Micronutrient Supplementation Program (MSP), Approx. 35.71 lakh IFA (Including buffer stock) syrup bottles were provided for IFA syrup supplementation among 22.71 lakh targeted 6-59 month children through ASHA workers .

·        Intensified Diarrhoea Control Fortnight (IDCF) round was celebrated in month of July 2022 for 15 days in which 19000 children suffering from diarrhoea were treated with tab Zinc and ORS. Approx 23.92 Lakhs children  under Five children were prophylactically given ORS packets in IDCF round.

·        Under Mother Absolute Affection (MAA) program, pregnant & Lactating women’s were sensitized.

·        Under Emergency Covid Response Package ECRP-II, Pediatric care units  including HDU/ICU are being established in 20 district hospital of Haryana . Panchkula and Gurugram already have functional paediatric HDU/ICU.

ROUTINE IMMUNIZATION & COVID 19 VACCINATION

·        In National Family Health Survey - 5(NFHS-5) Routine Immunization coverage of Haryana has increased to 77 % as compared to 62% in NFHS-4.

·        Atal Bihari Vajpyae Good Governance Award from Hon’ble Chief Minister, was conferred to Immunization division on 25^th December 2020 for providing effective immunization services during Covid-19 pandemic.

·        In current year 2022-23 the FIC is 94 % with 5.47 lac beneficiaries vaccinated against a target of 5.8 lac beneficiaries.

·        Intensified Mission Indradhanush (IMI4.0): IMI 4.0 was held in 3 districts i.e (Nuh, Palwal, Panipat). Total 6274 sessions were held in which 69835 children and 19203 pregnant women were immunized.

·        National Immunization Days (NID)-During NID round in January2022 total 3573705 children (0-5 year’s age) were being given polio drops.

·        Sub-National Immunization Days (SNID) -:. Total 2565813 (101%) children (0-5 year’s age) in high risk areas of 13 districts were given polio drops. In second round:  Total 1546534 children (0-5 year’s age) were given polio drops in 6 selected districts of Haryana.

·        Special Immunization week in each quarter was conducted in all the districts with an objective to improve full immunization coverage among 0-2 years age group along DPT booster, TD10 & Td 16 to achieve key deliverables of Immunization.

COVID-19 Vaccination Status-

·        Haryana has administered a total of 4.55 Cr doses till 1^st April’23.

·        1^st dose administered to 2.36 Cr beneficiaries

·        2^nd dose administered to 1.98 Cr beneficiaries

·        Total precaution doses administered to 20 lac  beneficiaries.

Measles Rubella Elimination by December 2023

·        India is committed to achieve the goal of achieving MR Elimination by December 2023.

UWIN (Winning over Universal Immunization)–

·        MoHFW has planned to build UWIN, based on the existing eVIN and Co-WIN platforms for digitizing the routine immunization services in the country.

·        It is a digital solution for Universal Immunization Program (UIP) - facilitate tracking of every pregnant woman, new born, child & adolescent vaccination.

NATIONAL AMBULANCE SERVICE

·        Presently 617 ambulances (153 Advance Life Support, 167 Basic Life Support ambulances, 257 Patient Transport Ambulances and 34 Kilkari/Back to home, 6 Neonatal ambulances) operational, which are managed by Decentralized Control Rooms operational in 21 districts of Haryana except Charkhi Dadri.

·        Services provided : 24 X 7” Free transportation services are provided within the district Any patient in emergency, Pregnant women, Victims of road side accident, Post-natal cases in case of emergency till 6 weeks after delivery, Sick infants and sick child till 5 years of age, Severe Acute Malnutrition (SAM) Children, Back home to women after delivery and Children upto 5 years of age, Freedom fighters/ Ex-servicemen/ their dependent to Military Hospital within the district. If there is no Military Hospital within the district then free transportation will be provided to the appropriate public health facility within the district, Mental/ psychiatric emergencies, pickup and drop before and after blood transfusion, Inter facility transportation, all transportation from home/site to Private health facility in case of emergency. The objective is to provide pre-hospitalization care and transport to the patients in emergency, and to increase institutional delivery by transporting pregnant women to health facilities and to tertiary care health facilities and back-home services within the districts. These ambulances are providing transport services to approx. 4.5 lakh patients per year.

ACHIEVEMENTS

·        The average response time in reaching the patient is 13 minutes and for drop-in the patient at nearest health facility is 33 minutes.

·        A total of 420495 cases have been transported out of which 214892 were pregnant women, 27257 were roadside accident cases, 81722 referral cases from one facility to other and 96624 were other emergencies F.Y. 2021-22.

o   3129 were corona suspected

o   10797 were corona positive

o   6914 dead bodies of COVID-19 suspected/ Positive patients have been transported by Hearse Van.

o   A total of 465691 cases have been transported, out of which 245013 were pregnant women, 33563 were roadside accident cases, 93496 referral cases from one facility to other and 93619 were other emergencies F.Y. 2022-23.

ADOLESCENT HEALTH - RASHTRIYA KISHOR SWASTHYA KARYAKRAM (RKSK)

Objective: To improve the health and wellbeing of the adolescents in the age group of 10-19yrs.

·        Weekly Iron Folic Acid Supplementation (WIFS) Blue tablet:-As per the monthly reports from districts, 13.50 lacs (85%) children consumed WIFS IFA Blue tablet through schools and AWCs.

·        National De-worming Day:NDD February 2023 on 10^thFebruary followed by Mop-up on 17^th February 2023. Approx. 87 lacs (98%) children (1-19 yr) & 6.05 lakh (97%) WRA.

·        Adolescent Friendly Health Clinics (AFHCs)/Mitrata Clinics functional at 19 DH, 15 SDH, 77 CHC & 90 PHCs.  2.12 lakh adolescent availed counselling, clinical and referral services through 67 Counsellors and 320 trained Doctors.

·        School Health and Wellness Programme (SHWP)-  It is a joint initiative of Mohfw&MoHRDto address the need for comprehensive preventive and promotive health education program at school for children. Two teachers from Govt. Schools (6^th – 12^th Classes) trained as “Health and Wellness Ambassadors” (HWAs) to teach curriculum developed by NCERT. 10447 teachers trained as HWAs and 5334 principals oriented.

RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

RBSK is an important initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability.

The program includes two major components:-

SCREENING

The program outline the following mechanism to reach the target group of children for health screening-

For new born:

·        Facility based newborn screening at all health facilities where deliveries are taking place by existing health functionaries especially at the delivery points.

·        Community based newborn screening at home through ASHAs (Accredited Social Health Activist) during “Home based post natal care” visits after the delivery.

For children (6 weeks-18 years):

·        By Mobile Health Teams (consisting of AYUSH doctors (One Male and One Female), one pharmacist and one ANM). 211 dedicated teams have been recruited throughout the State of Haryana .Biannual screening in Anganwadis and one round in Govt./Govt. aided schools.

REFERRAL AND MANAGEMENT

·      At Govt. health facilities, depending upon the health condition of the child and type of intervention required.

·      DISTRICT EARLY INTERVENTION CENTRE (DEIC) established at Civil Hospital Level in all 21 districts under RBSK where management and early intervention services are provided and it also provides referral linkages.

·      Financial aid is given for free treatment of selected conditions (Congenital and Rheumatic  Heart Disease, Congenital Deafness, Neural Tube Defect, Cleft Lip and Palate, Talipes (Clubfoot), Developmental Dysplasia of hip, Congenital Cataract, Retinopathy of Prematurity, Otitis Media and Strabismus )

Eligibility criterion includes children in age group of 0-6 years who are resident of Haryana and 6-18 years studying in Govt./Govt. aided schools only.

·        Children are referred at 4 Govt. Institutions viz. PGIMER Chandigarh, PGIMS, Rohtak, GMCH 32 Chandigarh and AIIMS New Delhi and 15 empanelled Private Hospitals.

·        RBSK Haryana has also signed a MoU with Smile Train Clinics for the free of cost treatment of children identified with Cleft lip/ palate.

·        Orthopedicians, posted in Civil Hospitals have been trained to treat club foot through Ponseti technique. Apart from this, an MoU has been signed with “Cure International India Trust” and they have established Clubfoot clinics in 6 districts and an MoU has also been signed with Miracle Feet Organization and 16-Club foot clinics In these clinics, counseling of parents of children suffering from clubfoot is done for taking proper care of these children and they also support in providing treatment to these children.

Achievements under RBSK

·        Health screening of around 35-40 Lakh children is done every year.

·        Approximately 7.3 Lakh children were confirmed with Health problems and 7.1 Lakh availed treatment services at various health facilities including District Early Intervention centers (FY 2022-23).

·        83732 New cases and 41634 follow up cases availed services at DEIC (FY 2022-23).

·         Children Managed at Private Empanelled Hospitals and Govt. Tertiary institutions (FY 2022-23).

§      872 children were given permission for treatment at Private Hospitals

§   619  children were managed for health conditions at Private Hospitals

§   165 children were given financial sanction for treatment at Govt. tertiary level Hospitals

§   96 children were managed for health conditions at Govt. tertiary institutions

NATIONAL URBAN HEALTH MISSION (NUHM)

NUHM launched in May, 2013 as a submission of NHM with high focus on urban poor population living in slums and all other vulnerable population ( homeless, rag pickers, slum dwellers, sex workers, rickshaw pullers, construction workers, street children etc.)All the services delivered are being provided through Urban PHCs. At present, 107 Urban PHCs are operational in Haryana running OPD services with average monthly OPD of approximately 2500- 3000. Each UPHC  is staffed by 1 M.O, 1 Staff Nurse, 1 Pharmacist,1 Lab Technician,1 Information Assistant cum Account Assistant,1 Class-IV and for outreach sessions 4-5 ANMs (depending upon Population, 1 ANM @ 10000 population) and 1 Urban ASHA on 1500- 2000  slum population.

·        Each UPHC is providing  a package of preventive , promotive and curative care with all National Health Programmes, Referral Services, Laboratory Services, Counseling services, Services for non-communicable diseases, Family Planning, Social  mobilization and community level activities.

Up-gradation to Health and Wellness Centers

·        All the UPHCs have been upgraded to Health Wellness Centres (HWC) to provide 12 Comprehensive Primary Health Care services (CPHC).   

·        Yoga sessions are being held at all the UPHCs regularly.

·        e-sanjeevani tele-consultation services have been initiated at all the UPHCs.

·        Urban Health Nutrition Day (UHND) is being celebrated by all the ANMs in all the districts. 16115 Urban Health Nutrition Days have been organized in FY 2022-23.

·        Special Outreach Camps providing services of Specialist Doctors are being organized in the catering areas of the UPHCs. 817 Special Outreach camps have been celebrated in FY 2022-23.

Dedicated vehicles (E-rickshaw) equipped with miking and GPS enabled have been hired for conducting immunization sessions in urban slums. It has been initiated in all the districts of Haryana

Quality Assurance

·        NQAS certification: 17 UPHCs have been granted NQAS certification by GoI.

·        Kayakalp Implementation under NUHM:  In FY 2021-22, 55 Urban Facilities (53 UPHCs + 2 UCHCs) have been awarded for Kayakalp. In FY 2022-23, 59 urban facilities (55 UPHCs + 4 UHCs) have been awarded for Kayakalp activity.

·        Any other new initiatives/programmes to be started by the Department in 2022-23: 

o  Urban Health and wellness centres: The urban HWCs are expected to increase its reach in the urban areas and cover the vulnerable and the marginalized by acting as satellite centres to be established under the UPHCs. In FY 2022-23, 187 UHWCS were approved, out of which 91 have made operational and rest will be operationalized soon. In FY 2023-24, 12 more UHWCs have been approved in FY 2023-24

Achievements under NUHM

·        NUHM Haryana, got 1^st prize for poster presentation on Vulnerability Assessment of urban slum population at 6^th National Summit on Good & Replicable practices and Innovation held at Gandhinagar, Gujarat in 2019.

·        U-PHC (Krishna Nagar Gamri- Kurukshetra) is the first UPHC in India which has undergone National External assessment and has been granted “Quality Certification” under NQAS by MoHFW with an overall score of 91.2%.   

·        UPHC Chabiyana, Ambala was facilitated as Best UPHC-HWC at National Level by MoHFW on Universal Health Coverage Day  2020.

COMMUNITY PROCESSES: Accredited Social Health Activist (ASHA) and Recruitment of Community Health Officers (CHO):

·        Total 20372 ASHA (98.55%) are enrolled against the target of 20676 by 30/04/2023 in the State; out of which 249 new ASHA are enrolled during the FY 2022-23, and trained in different modules, as per the GoI norms.

·        Selection Criteria for enrollment of ASHA was revised to ensure transparency in the engagement of ASHA. According to revised selection criteria, total 643 ASHA enrolled from Nov. 2020 onwards; out of which 249 new ASHA are enrolled during the FY 2022-23.

·        Provision for retrenchment of ASHA after attaining the age of 60 years has been made; accordingly services of 142 ASHA have been dispensed with from November 2020 onwards; out of which services of 42 retrenched during the FY 2022-23.

·        Apart from this, under the provision of Golden Handshake, ASHA who wish to voluntarily leave their work after completion of 10 years successful services, are facilitated with Rs. 20,000/- from NHM funds. Under this Scheme, total 117 ASHA have voluntarily left after completion of 10 years’ service from November 2020 onwards; out of which 59 ASHA have left their services during the FY 2022-23.

·        The 100% enrolled ASHA are trained in Module 1-6, and other relevant trainings as per the GoI/MoHFW mandate. Further, 19152 ASHA (i.e. 93.98%) are trained for Home Based Young Child Care (HBYC), and training of remaining 1222 ASHA is in process. Trained ASHA have started home Visits for HBYC in the State.

·        Provision of financial assistance of Rs. 3.00 has been made under State Budget for the families of deceased ASHA w.e.f. 1^st April 2018. Till time, total 149 families of deceased ASHA are required to be supported; out of which 123 ASHAs’ families already supported upto March 2023. Total 24 ASHAs’ cases are in process, out of which 21 cases are with Districts, and remaining 3 cases at NHM SHQ.

·        Drugs & HBNC Kits provided to 100% trained ASHA and Kits are replenished regularly in their monthly meetings at PHCs or from Sub Centres, as and when required.

·        ASHA are being covered under the Ayushman Bharat - Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) for providing treatment facility upto Rs. 5.00 lakh per annum to them & their family members in the empaneled hospitals by Haryana Government. Out of 20372 ASHA, Golden Cards of 6213 ASHA are made as per SECC Data, and 6017 more ASHA have been provided CHIRAYU Cards (State Scheme) and remaining 8142 ASHAs’ Family Income is being assessed through CRID, so that they may also be covered under CHIRAYU Scheme.  

·        As per the Announcement of Hon’ble Chief Minister, Rs. 5000/- each are provided to 19233 ASHAs in the State upto April 2023 and remaining 143 cases are in process of payment at district level. Further, out of 738 ASHA, data of 421 has been validated by CRID for which financial sanctions are being issued by NHM State HQ for their payments by the districts. Remaining 317 ASHAs’ data is in process of further validation.

·        Total 2568 posts of CHOs have been advertised from 2018 onwards and till time 1824 CHOs have been appointed; out of which 1745 CHOs are in place as on 02/06/2023 and recruitment of 48 more CHOs is in process of completion. Further, 181 posts of CHOs are under subjudication, for whom seats are reserved and they will be appointed/advertised as per the decision of the Hon’ble High Court in the matter. 

 AYUSHMAN BHARAT-HEALTH & WELLNESS CENTRES

Under Ayushman Bharat, the Health & Wellness Centres (HWCs) deliver Comprehensive Primary Health Care, that is universal and free to users, with a focus on wellness and the delivery of an expanded range of services closer to the community which includes:-

1.   Care in pregnancy and childbirth.

2.   Neonatal and infant health care services

3.   Childhood and adolescent health care services.

4.   Family planning, Contraceptive services and Other Reproductive Health Care services

5.   Management of Communicable diseases: National Health Programs

6.   Management of Common Communicable Diseases and General Out-patient care for acute simple illnesses and minor ailments

7.   Screening, Prevention, Control and Management of Non-Communicable diseases and chronic communicable disease like TB and Leprosy

8.   Basic Oral health care

9.   Care for Common Ophthalmic and ENT problems

10.    Elderly and Palliative health care services

11.    Emergency Medical Services

12.    Screening and Basic management of Mental health ailment

·          Under Ayushsman Bharat, provision of additional human resource for Sub Health Centre level Health & Wellness Centres has been made; who are Community Health Officers (i.e. BAMS or BSc. Nursing with 6 month certificate course in community health). Presently, Total 1285 Community Health Officers are working at the Sub Centre level Health & Wellness Centres. The exam for next phase of recruitment of 527 CHOs has been conducted and consequently their joining at respective SC-HWC is under process.

·      As on 06/06/2023, Total 2055 Ayushman Bharat-Health & Wellness Centres are operational in the State: out of which 1466 are Sub Centres, 391 are Rural PHCs, 107 are Urban PHCs and 91are UHWCs.

·      In Aspirational District Mewat / Nuh, all standalone 17 Rural-PHCs and 44 Sub Centres have been transformed into HWCs in 2018-19, itself.

·      Best HWCs were facilitated at National Level by MoHFW on Universal Health Coverage Day i.e. 12.12.2020

·      SC Shekrawa (Mewat)

·      PHC, Wazirabad (Gurugram)

·      UPHC, Chabyana (Ambala)

·      E- Sanjeevani Tele- consultation --- E- Sanjeevani HWC Tele-consultation services have been initiated among all the Districts in the State. Approx. 2,23,921 Tele-consultation have been conducted till date i.e., 06-06-2023 through AB-HWCs. (Source: esanjeevani.mohfw.gov.in)

·      45 SC: HWCs have been taken up for NQAS Certification by HSHRC. 73 PHCs and 11 UPHCs are NQAS certified.

·      Total Kayakalp Award winning PHCs has been increased from 128 to 143 and SHCs from 39 to 105 for the FY 2022-23 in the state.

·      AB: HWC App. – AB: HWC App. Adoption status is 98%.

·      During COVID pandemic, HWCs’ staff did excellent work related to management of COVID-19 in their respective health centers as well as in COVID designated government facilities. Many of them were involved in COVID related surveillance, reporting, testing, home visits (of home isolation cases), COVID positive ward duties. Home visit by health teams of all COVID positive cases under home isolation is unique in Haryana.

ADMINISTRATION DIVISION

·        Hon'ble CM Announcement for the financial Assistance of
Rs. 5000/- to NHM and NUHM Workers, who have PPP ID:-

·      The following status is submitted in reference with the CM's Announcements No. 26273 Dated 09.05.2022 regarding additional Incentive payment of Rs. 5000/- to NHM and NUHM workers for COVID-19 activities:

·      As on date, payment to 8421 NHM and NUHM workers have been given @ Rs.5000/- each against the sanction issued for 9089 NHM and NUHM workers.

·      File for releasing the payment of Rs. 5000 to 3583 NHM and NUHM workers is under process after the verification of the data from CRID.

·      And the data of the remaining 1645 NHM and NUHM workers needs to be verified from the CRID, After the verification of data from the CRID, the payment shall be done.