Health

Source: Department of Planning, U.P. (as per Annual Plan 2014-15)

Medical and Public Health

U.P. having a total population of 21.19 corers at the end of 2014 and 78% of its population is residing in rural areas. It has problematic areas of bundel khand and border area, water logging etc. cause many diseases all over the State, particularly in eastern district, diseases like Vector Borne Diseases (V.B.D.) and Japanese Encephalitis (J.E.) including Dengue & Malaria & naxal problems are prevalent in 3 districts.viz :- Sonbhadra, Mirzapur and Chandauli. As per Annual health survey 2012-13, the health indicator of Uttar Pradesh like crude birth rate is 24.8, crude death rate is 8.3, Infant mortality rate is 68, neonatal mortality rate is 49, Post Neonatal Mortality Rate is 19, Under five Mortality Rate is 90 and Maternal Mortality Ratio is 258.

Population of U.P. is growing with the natural growth rate of 16.5 which is very much on higher side. However as far as sex ratio is concerned U.P is showing excellent performance as it has been increased to 921 in 2012-13 in comparison of 904 earlier.

The highest rates of childhood malnutrition are in the central region, but the severest cases are in the western region. In general the southern region has better indicators for nutrition, however, anemia is relatively high. As per National Family Health Survey 3, 85 % of children of age 6-35 months are anemic, 50.9 % of ever-married women of age group 15-49 are anemic, 51.6 percent of pregnant women of age group 15-49 are anemic. 52.4 percent of children under 3 years are stunted, 19.5 percent of children under 3 years are wasted 41.6 percent of children under 3 years are underweight.

Immunization rates vary by vaccine, although complete vaccination is worst in the southern region. Broadly aggregated, poor performing district are clustered in the north-central area of the state; these figures are consistent with low rates of literacy and education for females.

Majority of medical & health facilities in U.P. are covered by private sector in urban areas. The priority should be to reduce infant, child and maternal mortality, the incidence of communicable diseases and to improve reproductive health. The achievement of these goals will require improved essential health care services, such as coverage for immunization, family planning and institutional (or safe) deliveries, early recognition and prompt and effective treatment of life threatening illnesses, especially acute respiratory infections (ARI), Diarrhoea, Malaria and T.B. and access to reliable basic health care, as well as health advocacy for increased and understanding of appropriate health behaviour. It is also necessary to increase promotion in nutrition, water and sanitation and to improve regulation of the iodine content in salt.

Government of U.P. has setup and manages a vast network of health facilities. It consist of 20521 sub centre, 3496 P.H.C. (440 P.H.C. under construction) ,773 C.H.C. (207 C.H.C. under construction), 150 district male/female and combined district hospitals (50 district hospitals male, 45 combined hospitals & 55 female hospitals), and 03 Super specialty Hospitals are providing a range of preventive and curative health services to the public of the state in line with the health policies and strategies of the government. Seven Trauma Centre are completed, 5 are in the process of completion by U.P. Govt. and 8 are being made by Central Govt.

Priorities

To reduce IMR & MMR by increasing institutional deliveries & establishing neo-natal care centre & infant care units
Strengthening of PHC & CHC's for better health services
Mobile medical units for out reach areas
Blood bank in each district & FRU'S
Establishment of trauma centre's specially on the National Highways.
To maintain staff as per IPHS standards
To fill up the vacant post of medical officer & other paramedical staff
To convert all block PHC's into CHS's
24 hours electric and water supply in the district hospital
To strengthen the rogi kalyan samiti
To implement fully RSBY yojna for BPL
Death audit of every death in district hospital
The Govt. is strengthening the hospitals, P.H.C.'s, CH.C.'s standards, establishing many super specialty hospitals and medical colleges and also establishing Trauma centres with ambulance services on highways and Mobile Medical Units for distant and out reach arcos.
There is substantial scope for improvement in inpatient care in public facilities for bed utilization. For this there is Infrastructure strengthening of District Male and Female Hospitals, CHCs, PHCs Sub Centers & various training centers and also the hospitals of the State have been strengthened by. hi-tech equipments. The Govt. of U.P. is also establishing many Trauma Centers with ambulatory services at Highways, Mobile Medical Units for distant areas and Contractual human resource to overcome the gaps, For Capacity building of functionaries & medical officers for skill development & better performance, the department started short course training program for Medical Officers and Para Medical Staff. In additions to the above programmers few new programmers have to be started -
Construction of GNM Training Centre
Construction of "Medical Tower" for officers adjacent to Transit Hostel, Nishatganj, Lucknow
Construction of Rural Medical Officers Residential of Campus in each district
Starting of P.P.P. Model in health care services
The State shows significant variation in health related burden and disability across regions and income groups. Both the rich and poor face a very high burden of health related disability. However, the poor and women seem to be at greater disadvantages with incidence of IMR alone at two and a half times higher amongst the poor public sector's role in health service delivery is very marked in U.P. Much of mortality reduction during the past few decades is traceable to government-driven efforts, particularly, through institutional deliveries immunization campaigns and focus on specific challenges like TB etc.
Health care in UP can be summarized as a composite challenge of access, quality and demand. The large public sector does not have adequate access besides being found wanting in quality of care at the cutting edge (PHCs and Sub-Centres). The private sector has access but poses a challenge on account of a serious lack of quality to the extent that it often becomes a threat to the health of people. It appears that orientation of health strategies in UP, where the focus is increasingly on functionalizing existing structure; synergy through public private partnership particularly for reaching out for the poor and marginalized, and on finding solution through innovative interventions that can meet UP's health challenge.
Maternal mortality rate: MMR has been reduced to 258 as per AHS 2012– 13 from 300 as per AHS 2011 – 12. JSSK and JSY scheme are launched to reduce MMR.
IMR: As per SRS 2011 IMR is 57, which is further reduced to 53 as per SRS 2012.
NBCC: NBCC has been establish in the labour room of female district hospital, combined district hospital and primary health centres to provide care to newborn.
SNCU: SNCU has been established in identified 23 districts. At present 27 SNCU are working in 19 district female hospital and 8 medical colleges. 19 more SNCU has been planned to be established in financial year 2014 to 15.
NUTRITION REHABILITATION CENTERS: 25 nutrition rehabilitation centres have been established in 20 districts against the target of 26 districts to reduce malnutrition in children in financial year 2012 -13.
ROUTINE IMMUNIZATION: Under the banner of routine immunization, infants of less than one year is been vaccinated against seven fatal diseases. As per AHS 2012, 48 % infants has been vaccinated and as per NPSP- WHO monitoring report 62 % infants has been vaccinated between April 2013 to march 2014.
JANNI SURAKHSHA YOJANA: Pregnant women is availing the facility of institutional deliveries with the help of janni surakhsha yojana. Percentage of institutional deliveries for the year 2013-14 is 94.97 and for the Year 2014 -15 target of 26.69 lakh institutional deliveries has been proposed.
JANANI SHISHU SURAKHSHA KARYAKARAM: this scheme has been launched to provide services of institution deliveries to all pregnant women with the aim to zero down the personal expenditure on delivery.
NATIONAL AMBULANCE SERVICE 102 has been launched on 17 January 2014 with the fleet of 972 ambulances in coordination of service provider company “GVK EMRI”. This service has been provided free of cost to pregnant women and infants of age less than one year.
RBSK (RASTRIYA BAL SWASTHA KARYAKARAM): It has been launched in NRHM Phase II to provide health check-up facility for school going children of age group 2 yrs to 16 yrs under the banner of child health guarantee scheme. In this scheme child has been screened to detect 3 D’s (deficiencies, disease and disability).
POPULATION STABILIZATION: As per national population policy, government of India has fixed the target to reduce the TFR to 2.1 from current 3.4.
PC & PNDT Act 1994: PC & PNDT act has been introduced to control the falling ration of male and female. As a result ratio has been improved in Uttar Pradesh in adult age group. But child sex ratio needs more intervention for improvement.

Family Welfare

Janani Suraksha Yojana

The aim of Janani Suraksha Yojna is to provide safe delivery services and promotion of institutional delivery, so that the MMR and IMR may be reduced. This programme is being implemented under National Rural Health Mission since April 2005 in all districts of U.P. In this programme all the services provided to pregnant women- Ante-Natal, Post-Natal and Neo Natal care, have been integrated under one umbrella. These services are provided to beneficiaries by ANM/Asha and other workers.

Under this scheme, the pregnant women delivering at sub-centre/Block PHC/CHC/ FRU/general ward of district/ state government hospitals, are provided financial assistance, of Rs 1400/ to women residing in rural area, Rs 1000/ for urban area and Rs 500/- for BPL beneficiary for home delivery. To provide safe delivery/Institutional delivery services, the ASHA worker, selected from the area of beneficiary, help the pregnant women and provide Ante natal care, make arrangement for transportation to take her to health institution/hospital for delivery and take care during post natal period.

The JSY scheme is being implemented successfully across all the districts in the State. JSY scheme has given a boost in the deliveries being conducted at institutions. In the Year 2013-14 (Upto March-2014) 23.88 lacs institutions deliveries were performed. The financial assistance of Rs 600/- is being provided to ASHA. The progress of last three years is as follows.

2011-12			2012-13			2013-14
Target	Ach.	%	Target	Ach.	%	Target	Ach.	%
25.00	23.28	93.11	27.00	21.76	80.61	25.15	23.88	94.97

Janani Shishu Suraksha Karyakram

This Programme is being implemented under National Rural Health Mission since August, 2011 in all Districts of U.P. In this Programme the following Guarnteed Cashless Delivery services are being provided to pregnant women delivering at PHC/CHC/FRU/DWH/ State Government Hospitals,
Free drugs and consumables
Free essential diagnostics (Blood, Urine tests and Ultra-sonography etc.
Free diet during stay in the health institutions (up to 3 days for normal)
Free provision of blood
Free transport from home to health institution
Free transport from health institution to home
Free transport between facilities in case of referral
Drop back from institutions to home after 48 hrs. stay
Exemption from all kinds of user charges.

Physical Progress (no.)

Free Facility	Achievement 2012-13	Achievement 2013-14
Free diet	660949	1550275
Free Drop back	348832	822372
Free Treatment	1596743	2767754
Free Diagnostics	-	2753430

Maternal Death Review Programme

In UP under this programme various committees have been formed at all levels to review maternal death. All maternal deaths occurring in the district are Identifies and audited so that the case of death could be ascertained and remedial measures could be taken. 3274 maternal death reported in the Year 2013-14. Audit of 2970 maternal death have been completed.

UNIVERSAL IMMUNIZATION PROGRAMME

Routine Immunization Programme is being running successfully in all 75 districts of the State for the prevention of 7 childhood diseases like Polio, TB, Dipitheria, Tetanus, whooping Cough, Hepatitis-B, Measles and for the prevention of tetanus in the pregnant women.
Increasing trend in percentage of fully immunized children in evaluated from the various surveys. (As per CES (2009)-41%, As per AHS (2011)-45%, As per AHS (2012)-48%, As per monitoring data of NPSP-WHO (from April, 2013 to March, 2014)-62%.)
WHO has given Polio Free Certificate to whole south east Asia Region. (11 Countries including India).
International travelers going to 8 countries (Pakistan, Afganistan, Kenya, Syria, Nigeria, Somaliya, Kamroon, Ethopia) are being given 1 dose of Polio Vaccine 4 weeks before there departure.
During Year 2014-15 four special RI weeks (For High Risk Groups/ Areas) has been planned in the month of May, June, August and September, 2014.
Under Routine Immunization Two doses of Measles & JE Vaccine are being given (1st Dose-09 month to 12 months & 2nd Dose-16 to 24 months).
Measles Outbreak Surveillance has been started now in 75 districts from October, 2013.
Bal Swasthya Poshan Maah (BSPM) is being conducted twice in a year during June & December month for Vitamin A supplementation for 09 months to 05 years children.
JE vaccination is being done in 36 districts.
04 SNID (Sub National Immunization Day) & 02 NID (National Immunization Day) of Pulse Polio Programme have been completed during in the month of April, June, September, November, 2013 & January, February, 2014.
In current Year 2014-15, 02 NID & 03 SNID of Polio Campaign have been planned.

National Urban Health Mission (NUHM)

Uttar Pradesh is densely populated state, population growth is very rapid in urban health indicators are very poor in urban slums. The state having many establishments of vulnerable sections of society BPLs/dalit/minority community with very poor socio-economic status/vulnerable groups/nomadic population etc. In urban slums, who do not have easy access to health services.
National Health Mission is having 2 sub missions – NRHM & NUHM
NUHM is approved with the Centre - State funding pattern of 75:25.
Expansion of the State Health Mission/ State Health Society and District Health Mission /District Health Society is under process
Coverage –Towns & cities, having population above 50,000 (cities less than 50000 population are being covered under(NRHM)
All district HQ Irrespective of population size
Cities covered: 131 (based on census 2011)
Urban population covered: 3.14 crores (in 131 cities)
Slum and vulnerable population covered: 1.42 crores (45% of Urban population)

Family Planning Programme

For the population stabilization on increase population of U.P and improvement of the health of people, population policy of U.P was launched on 11th July 2000. The main objective of which was to reach TFR upto 2.1 by 2016, while at present T.F.R is 3.4(2011)
Family Planning programme is being running since 1950 in Uttar Pradesh. Under this programme permanent and temporary methods are provided free of cost to maintained limited family. This is totally voluntary programme. In permanent method, tubectomy and vasectomy are done free of cost and inserting of Copper-T 380 A, distribution of contraceptive pills and condoms done under temporary method. In the rural areas, distribution of contraceptives is being done by ASHA at the door step of beneficiaries. Apart from this, at service centres, M.T.P service is providing free of cost and Post Partum Intra Uterine Device (PPIUCD) has been started at 57 selected facilities of the State. In 2013-14, the progress of family planning is as follow-

Tubectomy - 319917
Vasectomy - 7046
I.U.D - 1484877
C.C Users - 897910
O.P.Users - 349203

Child Health Programme

According to SRS Survey 2011, Infant Mortality Rate (IMR) of UP was 57 per thousand live birth which further reduced to 53 per thousand live birth in SRS Survey 2012. The following programmes/schemes are being run by U.P Government under the umbrella of National Health Mission to reduce IMR-

Establishment of NBCC (New Born Care Corner)

At delivery points a new born care corner has been identified with the facility of radiant warmer and the other necessary instruments. Till now 1473 units are functional and 1000 new units are proposed for the year 2014-15.

Establishment of New Born Stabilizing Unit (NBSU)-

These units are established in district women hospital and functional FRU’s at CHC with necessary instruments and equipments. Till now 120 NBSUs are functional and 85 units are proposed for the financial year 2014-15.

Establishment of Sick New Born Care Unit (SNCU)

These units are established in District Women Hospitals and Medical Colleges of selected 23 districts. At present 27 SNCU units are functional. These units are functional at 19 District Women Hospital respectively (1). Aligarh (2). Azamgarh (3). Awanti Bai, Lucknow (4). Lalitpur (5).Pratapgarh (6).Shahjahanpur (7).Saharanpur (8).Banda (9).Faizabad (10).Lakhimpur Kheri (11).Meerut (12).Bulanshaher (13).Mirzapur (14).Muradabad (15).Behraich (16).Varanasi (17).Basti (18).Jhalkari Bai, Lucknow (19) Etawah and 8 Medical Colleges – (1). Lucknow, (2). Allahabad, (3). Kanpur, (4).Jhansi, (5).Agra, (6).Meerut, (7).Gorakhpur and (8). Aligarh. For the year 2014-15, 19 new SNCUs are proposed in High Priority Districts.

Establishment of Nutrition Rehabilitation Centre (NRC)

To manage under weight and severely malnourished children, NRC’s have been established in Districts Male Hospitals and Medical Colleges of 20 districts. In the year 2012-13, 25 NRC’s are functional against the target of 26. These NRC’s are functional in 5 medical colleges (Gorakhpur, Allahabad, Kanpur, Jhansi and Aligarh) 14 district male hospitals (Farrukhabad, Shahjahanpur, Banda, Pratapgarh, Unnao, Sonbhadra, Raibarely, Pilibhit, Maharajganj, Kannauj, Chitrakoot, Hardoi, Kheri and Lalitpur) and in 6 CHC/PHC of Lalitpur.

For the year 2013-14, 22 new NRC’s have been sanctioned by Govt of India, out of which establishment of 16 NRC’s (Behraich, Balrampur, Barabanki, Bareilly, Badaun, Etah, Kaushambi, Mirzapur, Rampur, Bijnor, Sant Kabir Nagar, Sitapur, Agra, Azamgarh, Etawah, Deoria) are completed and another 6 NRC’s (Shrawasti, Faizabad, Varanasi, Siddharth Nagar, Baghpat and Kasganj) are expected to get complete by June 2014. In addition to this, 10 more NRCs units are proposed for the year 2014-15.

Home Based New Born Care (HBNC)-

Programme is being implemented from 1st October 2012 in 36 districts. . Trained ASHA’s are visiting new borns 6/7 times in first 42 days of life. They have to ensure-Birth Registration, Zero dose of Polio and BCG Vaccination, Birth Weight and Identification, treatment and referral of sick baby and mother and ensuring that the baby and mother is alive upto 42 days. ASHA’s are being given Rs 250/- as incentive for this activity.

According to Govt of India Guidelines, from the year 2013-14 ASHA would not be given CCSP training, only 6-7 module training would be given to ASHA. In the state out of 1,21,640 module (5) trained ASHA, 21,206 ASHA are trained in first round of Module 6 and 7th training upto 31st Dec 2013 in the sixteen districts Jhansi, Kannauj, Mirzapur, Bulandshahar, Aligarh, Muradabad, Saharanpur, Gorakhpur, Banda, Pratapgarh, Behraich, Lakhimpur Kheri, Varanasi, Faizabad, Azamgarh and Shahjahanpur.

National Ambulance Service(NAS)- 102

As per guidelines of Govt. of India and scenario of success of 108 EMTS in U.P., 102 NAS was launched on 16 Jan.2014 in the State with 972 ambulances in first phase, and 1000 new ambulances in second phase to reduce the Infant Mortality Rate and Maternal Mortality Rate in the state as per need of the public as this have been seen that more than half of death occurs within one month of age, after birth in age upto one year and MMR is also high in comparision to other state.

NAS-102 is in operation throughout the State in rural as well as in urban area through 102 centralized call centre 24x7,for pregnant women and neonates(children upto one month). As per agreement with GVK-EMRI in U.P .for transport from Home to nearest Health facility, Inter facility transfer on advice of Physician and drop back to home, in Emergency is being provided.This service is free of cost to above beneficiaries in the state and running 24 hrs x 365 days .

Rashtriya Bal Swasthya Karyakram (RBSK)

This Programme was started in year 2012-13 as Bal Swasthya guarantee Yojna in State. The objective of this Programme was to create awareness regarding health & nutrition amongst parents & children aged 2-18 year in rural areas in Uttar Pradesh. To prevent and treat anaemia in this target age group weekly iron Folic acid supplimentation and 6 monthly Albendazole was to be distributed among all these children. This Programme also included 3Ds – screening, Deficiency, Disease and Disability among these children & treating them either at the spot or reffering them to higher centres.

In the year 2013-14 Government of India extended this programme including all the children from birth to 19 year of age as RASHTRIYA BAL SWASTHYA KARYAKRAM all over India. This includes 4Ds Birth Defects, Deficiency, Disease and Developmental delays leading to Disability for which health Examination referral & Treatment has to be ensured. At present in the first phase of implementation of the programme covers children of all government school/ govt aided school from class 1-12(year 6-19) & children at AW centres (3-6years). Screening of the children is done by Two dedicated medical teams of each blocks in all 75 districts. At present 1.64 lacs school having around 166 lacs children have been coverd In addition to this we are covering 1.70 lacs AWC where 42.6 lacs children between the age of 3-6 year are covered.

In the next phase new born children born at govt. delivery points will be covered For this Doctors & health workers (staff Nurse, ANM) at delivery points will be trained. Soon HBNC trained ASHA will also be trained to identify birth defects & diseases so that they can reffer them to high centres. Till now(March 2014) we have already covered 4.09 lacs schools & AWC, have examined a total of 187.06 lacs children and have referred 12.62 lacs children to higher centres.