Demographic Profile & Health Care

Delivery System

1
Demographic Profile:
Uttar Pradesh is the most populous state with 199.6 million people and Lakshadweep the least
populated with 64,429 people. The contribution of Uttar Pradesh (UP) to the total population of the
country is 16.5% followed by Maharashtra (9.3%), Bihar (8.6%), West Bengal (7.6%), Andhra
Pradesh (7.0%) and Madhya Pradesh (6.0). The combined contribution of these six most populous
States in the country accounts for 55% to the country’s population.

The state of Uttar Pradesh has an area of 240,928 sq. km. and a population of 199.6 million.
There are 18 revenue divisions, 75 districts, 822 blocks and 107452 villages. The State has
population density of 689 per sq. km. (as against the national average of 312). The decadal growth
rate of the state is 25.85 (against 20.02% for the country) and the population of the state continues
to grow at a much faster rate than the national rate.

It has been noticed in 2011 that the absolute increase in population is more in urban areas
than in rural areas. The current Rural – Urban distribution is 68.84% & 31.16%. Level of
urbanization has increased from 27.81% in 2001 to 31.16% in 2011. The proportion of rural
population declined from 72.19% to 68.84% over this period. Between 2001 and 2011, the
population of the country increased to 199.6 million (17.58 %), of which in rural areas the
increase was of 90.4 million (12.1 %) and for urban areas the increase was 91.0 million (31.8
%).This spurt in population of urban areas in the country could be attributed to – Migration,
natural increase and inclusion of new areas in ‘Urban’

Service Delivery System:

In Health Infrastructure, the State has two Directorates each one is head by (i) Director
General, Medical Health services, (ii) Director General, Family Welfare. All the health programmes
are being implemented by both the Directorates. NRHM has a separate unit- “State Project
Management Unit (SPMU)” for effective programme management of NRHM. Programme
Managers, for each component of NRHM are designated as ‘General Manager’. Most of the staff
has been hired on contract; some have been brought on deputation. Programme management units
(PMUs) have also been established in 18 divisional PMUs, 75 Districts PMUs and 820 Block
PMUs. State Institute of Health & Family Welfare (SIHFW), Directorate of Family Welfare,
Directorate of Medical Health and Directors (MH and FW) are involved in effective programme
management.

At Divisional level Additional Directors are providing leadership for implementation of

programme and Divisional PMU is working as monitoring cell . In districts ,Chief Medical Officer
is the in charge of health department and Chief Medical Superintendents of Male, Female and
Combined hospitals are the heads of the hospitals.

2
 Health services are being provided by District Male, Female and combined hospitals
Community Health Centres, Primary Health Centres and Health Sub centre.

The health services are provided through a huge network of facilities both in urban and rural
areas. Still the Urban Population in Uttar Pradesh has been Increasing rapidly in recent decades
along with rapid urbanization .As per 2011 census, 4.44 crores persons are residing in towns and
cities of Uttar Pradesh.

The health status of people in Uttar Pradesh is amongst the lowest in the country, especially
for the urban poor. To improve the health status of the urban poor by provisioning of quality
Primary Health Care services and decentralized health facilities it is pertinent to ensure one
urban health post (UHP) per 50,000 populations having urban slum of 20000-30000 population in
the city. Lot more needs to be done in this area as the number of operational UHPs/Centres is very
less and unable to cater to the need of the urban slum population and reducing the work load of
District Women Hospitals.

Health care network is poor in urban areas.

URBAN HEALTH FACILITIES

Medical Colleges All India Institute of Medical Sciences , SGPGI, BHUIMS
State and Private
District Male & Other Hospitals

District Women Hospital Combined Hospital

Urban FP Centres Urban Health Post PPCs Maternity Homes

Health Infrastructure in Rural Areas :

RURAL HEALTH FACILITIES

Community Health Centres Maternity Sterilization Annexes CHC as FRUs

Block PHCs

Additional PHCs

Subcentres – 1370 (>5 deliveries) + other subcentre

Village Health, Nutrition a& Sanitation Committee

3
Vision, Objectives & Structure of NRHM

4
Vision of NRHM:
National Rural Health Mission (NRHM) provided the strong, framework for implementation
of primary level healthcare services by the Ministry of Health and Family Welfare (MoHFW) for
the period, 2005-2012 and extended as II phase for the period – 2012-2017. NRHM is the response
to the urgent need to transform the Indian Public Health System into an accountable, accessible and
affordable system that provides quality services to its users.

NRHM operates as an omnibus broadband programme by integrating all vertical

health programmes of the Departments of Health and Family Welfare including Reproductive &
Child Health Programme and various diseases control Programmes. The NRHM has emerged as a
major financing and health sector reform strategy to strengthen States Health Systems.

Objectives of the Mission:

The aim of National Rural Health Mission is to ensure effective and quality healthcare,
especially to the poor and vulnerable sections of the society. It is being implemented in the State
with the aim of reducing Infant Mortality Rate & Maternal Mortality Ratio, ensuring Population
Stabilization, Prevention & Control of Communicable & Non-communicable diseases. Significant
progress has been made in terms of implementation of various activities under NRHM. A
number of new schemes have also been launched over a period of time.

The overall objective of the State is to have the highest attainable standards (IPHS) of
services at the public health institutions coupled with the recent technical advances in terms of well
equipped facilities and adequate skilled manpower at every level.
• Access to integrated comprehensive primary health care.
• Universal access to Public services for food, nutrition, sanitation, hygiene & public health
care services.
• Reduction in maternal & child mortality.
• Prevention & control of communicable & non communicable diseases.
• Revitalize local health traditions & mainstream AYUSH.
• Promotion of healthy life styles.
• Address inter-state and inter-district disparities.
• Time-bound goals and report publicly on progress.
• To improve access to rural people, especially poor women and children to equitable,
affordable, accountable and effective primary healthcare.
• To ensure the safety of the patient and of the healthcare worker.
5
Structure of Mission:

State Health Mission: State Government has set the State Health Mission headed by the Chief
Minister for providing guidance to State Health Mission activities. Functions under the mission
would be carried out through the State Health Society . Constitution of State Health Mission is
given as below:

State Health Mission

Chairman- Hon'ble Chief Minister

Co-chairman-Hon'ble Minister Medical Health & Family Welfare
Member Secretary- Principal Secretary, Medical Health & Family Welfare

Nominated
Hon'ble Ministers for Chief secretary ,UP Govt,
Community
Rural Development, Representatives Principal Secreataries- Women Representative
Medical Education (5-10) Welfare& Child Development , Govt. of India,
/AYUSH,Panchayati MLA/MLC/President Panchayati Raj,Rural Representative
Raj, Women& Child Dist. board Development ,Urban from IMA,WHO
Development , /Representatives of Development ,Planning,Finance ,UNICEF,etc,
Finance , Social Urban/Local ,Social Welfare, PWD, Basic Representative
Welfare,Planning, Institutions (suitable Education, Medical from identified
Basic Education, Representation of Education/AYUSH, Secretary Development
Urban Development Women) Medical Health & Family Welfare partners
, MD NRHM-UP

State Health Society: The State has merged existing State level vertical societies in the health
sector and created an integral Society, called State Health Society. State Health Society has two
bodies. Governing Body of the State Health Society is being headed by Chief Secretary. The rules/
by laws of State Health Society provide for a permanent secretariat headed by Mission Director and
multidisciplinary team of experts and consultants to provide management support to mainstream
implementing agencies. Secretariat of the State Health Society is also performing the function of
State Health Mission.

6
 State Health Society
Medical Health Family Welfare
Governing Body
Executive Committee Programme Programme
Chairman -Chief
Chairman -Principal Implementation Implementation
Secreatry
Secretary MH& FW Committe Committe
Vice Chairman-
Convenor-MD,NRHM, Chairman -Principal Chairman -Principal
Principal Secretary
Members- Secretary Secretary MH& FW Secretary MH& FW
MH& FW
MH & FW, Medical Cochairman - Secretary Cochairman - Secretary
Convenor-
Education MH & FW MH & FW
MD,NRHM,
DG MH and DGFW, Member Secretary - Member Secretary -
Members-Principal
Directors DGMH DGFW
secreatry/Secretary
of concerned Deptt.& Members- MD,NRHM, Members- MD,NRHM,
of concerned
representatives of DG FW, DGMH, DG ME
Deptt.&
concerned Deptt.& DG ME representatives representatives of
representatives of
Organizations of concerned Deptt.& concerned Deptt.&
concerned Deptt.&
Organizations Organizations Organizations

District Health Mission: State has ordered merger of all District Level Vertical Societies into
an integrated District Health and Family Welfare Society. District Health Mission shall guide the
integrated District Health Society in Policy and operations.

District Health Mission

Chairman- Hon'ble Minister

Cochairman-District Magistrate

Convenor- Chief medical officer

Members Concerned-Hon'ble MP's & MLA's (local) or their Rep.&

Rep. of Department & Organization

7
 District Health Society

Governing Body Chairman - Executive Committee

District Magistrate Convenor- Chairman -CMO
CMO, Convenor-ACMO (Nodal for NRHM),
Members-Representatives of Members-Representatives of concerned
concerned Deptt.& Organizations Deptt.& Organizations

ORGANOGRAM NRHM UP
Principle Secretary, M H & FW, GOUP

Mission Director, NRHM, GOUP

Director General Medical Health State Project implementation Unit-Programme wings Director General FW,MCH,M & E

Maternal Health cell - GM1,DyGM1, Tech. Consultant 6,

Prog. Coordinator 1,Prog. Assist1,Data Asstt 1, Data analyst 1 DG FW Support Staff
Admin, HR, DAP & Legal cell Data Analyst - 1
GM1,DyGM2,HRspecialist1, legal Child Health cell – GM1,DyGM1, Tech. Consultant 2, Accountant - 1
expert 1 ,Prog. Coordinator 2 Programme Assistant - 6
Prog. Coordinator 1, Prog. Assist1,
Data Assistant - 5
School & Adolescent Health- Data cum Account Assistant
Construction cell
Exc. Eng.1, architect 1, Assist. Eng.1,
GM1,DyGM1, Tech. Consultant 2, Prog. Coordinator 1,Prog. Assist1, – 1, Computer Assistant - 1
Jr. Eng. 4, accountant1, data Assist.1
Routine Immunization Cell - GM-1 + Dy. GM-1+
Technical Consultant-2, Prog. Coordinator-2,Prog. Asstt.1,Data Asstt.1 Div. PMU (18)
Project Manager
MIS & MCTC Cell MMU & Urban Health cell- GM-1, Dy. GM-1, Officer Accounts cum MIS
GM,DGM,Prog. Coordinator 1 Consultant-1, Prog. Coordinator-2, Com.Oper-1 Audit cum data officer
Data Assist. 1
National Disease Control Prog. Cell- GM-1,
Dy. GM-2, Consultant-5, Prog. Coordinator-2, Prog. District PMU (75)
Asstt.-1, Statistical Assistant-1) Programme Manager
Finance Cell Community Mobilizer
Finance Controller-1 + Manager Monitoring & Evaluation CellGM-1, Dy. GM-1,
Consultant-2, Prog. Coordinator-1, Data Analyst-1, Accounts Manager
Finance-5+ Accountant-5+Internal
Auditor-6+ Data Analyst-1 + Prog. Computer Operator 1 Programme Coordinator (2 in
Asstt.-1+ Data Asstt.-1+PS to FC-1+ each district)
Planning Cell- GM1,Dy. GM 1,Consultant1, Data cum account assistant
Computer operator cum account
Prog. Coordinator1, Prog. Asstt.1, Data Asstt.1 Data Analyst

8
Goals & Achievement during 1st Phase of
NRHM (2005-12)

9
Goals and Achievements during 1st phase (2005-12)

Sr. Indicator Unit Status in the Targets for Achievement 2012

No. beginning 05-06 2012
India U.P. India U.P. India U.P.

Infant Mortality Per thousand 58 73 -- -- 44 57

1. Rate (SRS)
Maternal Per lac live 301 517 100 258 212 359
2 Mortality Rate births (01-03) (01-03) (07-09) (07-09)
(SRS)
Total Fertility Per 2.9 4.1 2.1 2.8 2.7 3.7
3 Rate (NFHS) productive (NFHS-2) (NFHS-2) (NFHS-3) (NFHS-3)
couple
Institutional Percentage 40.9 20.6 70 70 72.9 62.1
4 Delivery (NFHS-3) (NFHS-3) (CES-2009) (CES-2009)
Complete Percentage 54 30.3 100 100 61.0 40.9
5 immunization (DLHS-III) (DLHS-III) (CES-2009) (CES-2009)
Sex ratio Per thousand 927 916 935 924 916 899
6 (Census data) (2001) (2001) (2011) (2011)

Maternal Health:
Maternal Mortality in the state has continued to remain high for several decades but with
introduction of several programme packages during last 15 years, the MMR has started declining.
However there is still long way to go to achieve the declined objective for the state under NRHM
programmes i.e. MMR 100/100000 live births.

MMR India MMR UP

800
707
600
517
400 408 440 359 345
301 300
254 212
200

0
1997 2001-03 2004-06 2007-09 2010-11 2011-12

10
 The implementation of focus interventions under NRHM such as Janani Suraksha
Yojana has helped in increasing institutional deliveries and bringing down MMR. The affords have
been made to operationalize more facilities such as FRUs and 24X7 BPHCs/CHCs, accreditation of
Subcentres have also contributed in minimizing the tremendous case load of deliveries at District
Women Hospitals.

State progress at a glance on key maternal health indicators is given below:

Indicators in % DLHS III CES HMIS HMIS

(2007-08) (2009) (2010-11) (2011-12)
Any ANC 64.4 71.6 96.92% 88.6%
3 + ANCs 21.9 38.2 71.11% 68.5%
Full ANC 2.8 12.4 NA NA
Institutional Delivery 24.5 62.1 43.59% 43.2%
Home Delivery 74.5 20.30% 27.5%
% of C-Sections out of total 3.3%
institutional deliveries

Source: *NFHS III(2005-06)

Achievements: JSY achievement over the years

30

25.15
27
23.41

23.28
25

21.76
25
20.82

21

20
18
15.63
15

15
9.64
7.33

10

5
1.68
0

0
2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
Target in lakh Achievement in lakh

11
Specific Objectives Specific Implementation strategy
Objective - 1 Strategy -1
To increase complete ANC from 2.8% to Strengthening outreach services
40% (DLHS III)
Objective - 2 Strategy - 1 Implementation of JSY
To increase institutional delivery from Strategy - 2 Support for Operationalization of L-1
43.9% to 50% in Public sector MCH Centre (SC Delivery Points)
Strategy -3 Operationalization of Level-2 MCH
services at all BPHC and selected APHCs
Objective -3 Strategy - 1 Operationalization of FRU selected as
L-3
To increase access to emergency obstetric Strategy - 2 Implementation of JSSK at all 132
care (increase C-Section Rate from 3.68% functional FRUs
to 6 % in public sector)
Objective -4 Strategy -1 Early detection through regular
screenings in OPD and treatment at all district
level facilities.
Reduce incidence of RTI/STI Strategy - 2 Similar services at Sub district level
(PHC/CHC) in 16 NACP HPDs
Objective -5 Strategy : 1 Making available Comprehensive
Abortion Care services at all district level L-3
Reduce incidence of unsafe abortion
MCH centres
Objective -6 Strategy -1 To ensure reporting of 40% of
expected maternal deaths in the districts
Institutionalization of Maternal death Strategy -2 To ensure maternal death Audit of
Audit system 50% of the deaths reported
Objective -7 Strategy -1 Establishment of QAC at all levels
Improve Quality of services Strategy -2 Improve quality of delivery services at
all levels at all levels

Support to implement the JSSK schemes:

• Govt. order in support to Janani Shishu Suraksha Karyakram (JSSK) has been issued for
total user free services at government facilities
• The state & district programme officers have been nominated and oriented
• In phase one JSSK implemented in 165 unit (all DWHs, all combined hospitals & CHCs
designated as FRUs)
• Food facility is available in 134 facilities

12
From 2006 to 2010- Initially very good response. Institutional deliveries increased from 20.3% to
62.1% in 4 years.
>80% deliveries were accompanied by ASHAs
Contractual ANMs and staff nurses were provided
More number of Sub centers were accredited
Focus on strengthening delivery facilities through RKS/Untied funds
2011 onwards- Fall in achievement started due to
• With increased load riders were inserted for payments- Photo identity proof made mandatory for
Beneficiaries, ASHA incentives were restricted to their respective areas only

• CAG/CBI inquiry led to blocking of fund flow hence Institutional deliveries accompanied by ASHAs
decreased

• MCTS enrolment of pregnant woman made mandatory for ASHA payments

Child Health :

Infant Mortality rate has been declining by 2 points every year since the inception of NRHM in
the State. The fall was by 4 points between year 2008-09, but in the year 2010 it has declined by 2
points only. Again in the year 2010 -11 it has been decreased from 61 to 57 (4 points)

13
Child health indicators

Child Mortality Survey reference

NFHS I NFHS II NFHS III SRS 2010 SRS 2011
Neo Natal 59.9/1000 54.9/1000 59.4/1000 45/1000 LB
Mortality Rate LB LB LB
Infant mortality 69 67 63 61 57
Rate (SRS 2007) (SRS 2008) (SRS 2009) (SRS 2010) (SRS
2011)
Under 5 Mortality 125/1000 LB 112/1000 94/1000 LB
LB
Nutrition NFHS III
% of children (under 5 years) of age with anaemia 85.1
% of children (under 5 years) 47.3
who are underweight (< -3SD)
% of children (under 5 years) 13.5
who are severely wasted /SAM (< -3SD)

Infant & Young Child Feeding DLHS III NFHS III CES 2009
Children age <6 months exclusively breastfed 19.4 51.3 58.9
Children under 3 yrs. breastfed (within 1 hr after 15.4 7.2 15.6
birth
Children (6-9 months) Complementary feeding 54.5 45.5 45.9
Diarrhoea & ARI NFHS III DLHS III CES 2009
Children with Diarrhoea in the last 2 weeks who 12 17.3 29.2
received ORS
Children with ARI or fever in the last 2 weeks 63.6 72.2 72.3
who were given treatment at facilities

Vitamin A Supplementation NFHS III DLHS III CES 2009

Percentage of children (age 9 months and above) 7.3 32.2 48.2
received at least one dose of Vitamin A
supplement

14
 Achievements
Care of sick newborn:
• 7 Sick Newborn Care Units have been established to provide comprehensive management of the
sick newborn, the efforts are being made to establish newborn Stabilization Unit (NBSUs) in all
FRUs and Sick newborn Care units (SNCUs) in the district hospitals.

Sick Newborn care units in Lalitpur

Managing Children With Malnutrition

Status of Malnutrition in Uttar Pradesh - Like in other parts of India, malnutrition is an

important public health problem in Uttar Pradesh. According to NFHS-3 (2005-06), 42% of
children under three years are underweight (thin for their age), 52% of them are stunted (short for
their age) and 19% are wasted (thin for their height). With specific reference to severe acute
malnutrition (SAM), 5% of children below five years are severely malnourished. This means that
there are over 13 Lakhs children below 5 years who suffer from severe acute malnutrition in the
State. Total 6 NRCs have been established in 2010-11.

15
Child health Indicator under Malnutrition

Indicator India UP
Children under 3 years breastfed within one hour of birth (%) 23.4 7.2
Children age 0-5 months exclusively breastfed (%) 46.3 51.3
Children age 6-9 months receiving solid or semi-solid food and 55.8 45.5
breastmilk (%)
Children under 3 years who are stunted (%)(chronically malnourished) 44.9 46.0
Children under 3 years who are wasted (%) (acutely malnourished) 22.9 13.5
Children under 3 years who are underweight (%) 40.4 47.3

Nutritional Rehabilitation centre in J.N. Medical College Aligarh

16
Immunization Programme
Routine Immunization Programme is the cornerstone of public health, world over. Vaccination
was practiced in India since the early 1900s, especially against small pox, in late 1940’s. In 1962,
BCG inoculation was included in the National Tuberculosis Control Program. A formal
programme under the name of Expanded Programme of Immunization (EPI) was launched in 1978.
This gained momentum in 1985 under Universal Immunization Programme (UIP). UIP was merged
in child survival and safe motherhood programme (CSSM) in 1992-93. Since 1997 immunization
activities are an important component of Reproductive and Child Health (RCH) programme. A
National Technical Advisory Group on Immunization (NTAGI) was set up in 2003, and a Midterm
Strategic Plan (MTSP) developed in 2004. From April 2005, immunization is an important
component of RCH-II under the National Rural Health Mission (NRHM).

In the state, the RI sessions are held for 2 days in a week – Wednesdays and Saturdays, thus 8
sessions per sub center per month are planned. The state proposes to hold 4-8 session in a month for
any sub-centre as required according to its population and beside this immunization sessions are
also being held in District Hospital, PPC, Urban Health Posts and outreach sessions in slums of big
cities. Strategy aims to improve equity in access to immunization by targeting difficult-to-reach
populations

State Level Coverage

Sl Coverage BCG DPT OPV Measles Fully Immunized

1. DLHS-3 73.4 38.9 40.4 47.0 30.3
2. CES-2009 76.4 58.1 53.9 52.8 40.9
JE vaccination has been included in 36 Districts in Routine Immunization and Hep. B vaccination is
being implemented State since Oct 2011.

80
70 64.5
60
50 45.3
40.9
40 30.3
30 23
20
10
0
NFHS-III [2005-06]DLHS-III [2007-08] CES [2009] AHS [ 2010-11] AHS as on [Nov. 2012]

17
Steps taken for Improvement:

• Intensive micro planning and due lists have been prepared in all the Districts to cover left
out and drop out children .
• Fixed sessions at facilities District Hospital (Male and Female), Combined Hospitals ,
CHCs, PHCs and Additional PHCs and UHPs
• Outreach sessions in outreach areas of Rural and Urban Slums
• Sessions in Urban Slums of 11 big cities and other cities having urban slum population
• Mobile sessions for vacant sub centre and Hard to reach areas
• Enlisting of all beneficiaries by “Pregnant Woman and Child Tracking Strategy” by ASHA,
AWW and ANM
• Preparation of due lists of left out and dropout children
• Registration of PW and preparation of “Mother and Child Protection Cards”
• Registration and immunization of children (0-1year)
• ANM will collect relevant data in respect of all cases of pregnant women registered and
children
• Computerization of all beneficiaries at Block level
• Maintenance of MCH registers and update of counterfoil
• Name wise Tally Sheet (Tracking formats) for beneficiaries in all RI sessions
• Routine Immunization Weeks

Family Planning Programme :

The Total Fertility Rate of the State is 3.7(NFHS III). The Population Policy of UP (2000)
looks at the issues related to population stabilization and improvement of the health status of
people, particularly women and children in a holistic manner. Total Fertility Rate (TFR) of Uttar
Pradesh has declined from 4.1 to 3.7(NFHS 2 and NFHS 3). However; compared to the national
average of 2.7, the rates are still very high. To enhance the performance of family Planning it is
important to meet the desired unmet needs .The unmet need for spacing method has increased from
9% in 1998-99 to 12% in 2005-06.

As per the projections in the Population Policy of UP (2000), to reach the policy objectives
of a replacement level of TFR of 2.1 by 2016, 12.1 Lakhs couples should be providing limiting
method of family planning. In this endeavor UP is way behind.

18
 Goals for Population Stabilization
Target Area Baseline Goals by 2012 Current status
TFR 3.99% 2.8% 3.8 % (SRS 2009)
CPR 29.3% ( NFHS 3) 44% 31.6 % (RHIS UP 2010)
Objectives to achieve goal
CPR 25% 44% 43.6% (NFHS-3)
Sterilization 16.8% 31% 17.9%
Spacing 7.8% 13.2% 11.8%
Reduction of women 34% 15% 20.5 (DLHS 3)
reporting RTI/STI

Achievement under Family Planning programme

2500000

2105501
2000000 1991819 1943474
1855238
1544271 1390745 1392238
1500000 1522226

1000000

500000 450431 471891 479513

429620 420397 379491 318943 307648
0
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Sterilisation IUD

Issues and Concerns

The following Constraints were noticed-

• Non availability of skilled service providers especially for NSV.

• Limited no. of facilities providing daily family planning services.
• Inadequate counseling of post partum and post abortion family planning services.
• Comprehensive spacing choices not reaching consistently to rural clients.
• Preference for male child has been a consistent barrier for TFR.
• Areas of missed opportunities did not trapped.

19
Following strategy has been adopted during the year to address the above mentioned issues.

• Deployment of family planning counselors to counsel women and address their concerns for
small family norms along with counseling for adaptation of Post Partum family planning
methods.
• Training of doctors and paramedical to provide special thrust on IUCD 380 A & post
partum sterilization.
• Scaling up post partum IUCD 380-A programme to 30 centers covering 23 districts services.
• Scaling up No Scalpel Vasectomy. Strengthening of 3 Satellite Centers and one Centre of
Excellence for Male Contraception (NSV) in the Medical Colleges of Lucknow, Meerut,
Allahabad and Kanpur. Additional 2 centers are being proposed in District hospitals
• Partnership development for advocacy, leadership support with Population Foundation of
India (PFI) and Scaling up partnership with RESPOND (engender health) from 9 to 15
districts, districts to promote NSV.
• UHI (Urban Health Initiative) is partnering for IEC/BCC activities by sharing 300 copies of
films produced by JHU-CCP for promotion of Family planning methods, limiting and
spacing both, to be used by FWCs in ANC Clinics and post partum wards.
• Implementation of BCC strategy for promotion and creating awareness related to family
planning services including interpersonal communication, community engagement and mass
media under NRHM.
• Involvement of private sector providers, accreditation of private facilities and service
providers for family planning services.

Daily and Fixed day FP services:

All 51 District women hospitals, 15 DCHs and 66 FRUs (132) are providing female sterilization
services on daily basis. In addition, 150 CHCs are providing fixed day services under “fixed day
sterilization services” (ligation/abdominal tubectomy) are having a trained Gyn/ LMO preferably on
Tuesdays and Fridays.

NSV camps in districts

Besides providing NSV services on regular basis, it is proposed that each district hospital will
organize NSV camps.

Accreditation of Private centers /NGOs

In the year 2011-12, as accreditation was taken up by DHS very late in the year, only 38 private
facilities were accredited for sterilization services in the state and around 4450 Sterilizations were
compensated through them.

20
Post Partum Family Planning Services at Hospitals

Family Welfare Counselors: In view of large number of institutional deliveries under JSY
scheme the Family Planning counselors were deployed, one per FRU to promote post partum
family planning acceptance. 180 FWCs appointed in the last week of March 2011.

Promotion of Post Partum IUCD

Postpartum IUCD technique was piloted in the state at CSMMU, Lucknow in the year 2008-09 and
doctors of District Women Hospital, Jhansi and Allahabad were trained in PPIUCD insertion
technique through SIFPSA funds under technical supervision of JHIPIEGO, although Service
delivery could not be started in that year. In the year 2010-11 standardization of the IEC material,
follow up mechanism and reporting systems were developed and the programme implementation
was expanded to Veerangana Avanti bai Mahila Chikitsalya, Lucknow as 4th center. In 2010-11
service delivery started in 4 centers after follow up. Support provided by trainers from CSMMU,
Lucknow. In the year 2011-12, the programme was further expanded to 8 district women hospitals
and 5 medical colleges (total 17 sites) and service providers could be trained from 11 sites (4
medical colleges and 7 DWH) (Table 1)and reporting on services delivery started from total 9 sites
the achievement for the year 2011 – 12 was total of 735 PPIUCD

Pre-Conception, Pre-Natal Diagnostic Technique Act (PC&PNDT Act).

Sex ratio in the state is likely to create severe gender imbalance that can destroy the social fabric. It
should also viewed both as child right issue (girls are killed either through sex selective abortions or
die prematurely due to violence and neglect). Figures below indicate the trend in sex ratio over the
years of India and Uttar Pradesh.

Year 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
India 972 964 955 950 945 946 941 930 934 927 933 940
UP 942 916 908 903 907 908 907 876 882 876 898 908
(Source: NRHM PIP- 2012-13)

But the results about the sex ratio among the children between ages 0 to 6 years have
decreased remarkably at national as well as state level.

Year Sex Ratio India Sex Ratio UP

1991 945 927
2001 927 916
2011 914 899

21
National Programmes

Integrated Disease Surveillance Project (IDSP)

IDSP started in 2004 with support from World Bank, to improve and Integrated
Disease Surveillance in pursuance of recommendations by high powered committees like Public
Health System Committee, Technical advisory committee and committee of secretaries on
Environmental Sanitation. In 2007 with Avian Influenza outbreak, human and animal
components were added along with additional budget.

In Jan 2009 after detailed analysis of the situation, World Bank agreed to restructure the
project and extend it for 2 years focusing on what can be achieved by the end of two years.
Keeping this in mind PDOs (Project Development Objectives) was revised and a proposal for
restructuring and extension of IDSP up to 2012 had been prepared.

The aim of establishing IDSP is to assist the Government to:

1. Survey a limited number of health conditions and risk factors.
2. Strengthen the linkages, data quality & analysis.
3. Improve lab support.
4. Train stakeholders in disease surveillance and action.
5. Coordinate and decentralize surveillance activities
6. Integrate Disease Surveillance at state and district level and involve communities specially
Pvt. Sectors.

National Programme for control of blindness

India was first country to launch the National Programme for Control of Blindness in
1976. The goal of the programme was to reduce the prevalence of blindness. Out of the total
estimated 45 million blind people (3/60) in the world, 7 million are in India and 1.85 million in
Uttar Pradesh. This is due to the large population base and increased life expectancy. Every year
0.3% of the population, which means about 5.5 lac blind persons, are added to the total blind
population. Out of 5.5 Lakhs total blind 3.5 Lakhs become blind every year due to cataract. As the
number of cataract patient is reducing because of clearance of backlog, blindness due to
degenerative diseases like diabetes and glaucoma and injuries related corneal opacities are
increasing. The programme has to tackle emerging challenges

Goal – Prevalence rate of blindness in Uttar Pradesh is 1.0% (Survey-2004). Goal of the programme
is to reduce prevalence rate of blindness to - 0.3% by the end of year 2020

22
Activities to achieve goal:

The main activities are - Cataract Surgery, School Eye Screening, Eye banking for keratoplasty
and to treat Corneal Blindness. Other important activities are ‘Management of diseases other
than Cataract’ such as Diabetic Retinopathy, Glaucoma management, Laser Techniques, Corneal
Transplantation, Vitreoretinal Surgery and treatment of Childhood blindness)

National Leprosy Eradication Programme

In the National Leprosy Eradication Programme following main thrust areas have been
identified during 12th Five Year Plan:

• Sustaining leprosy elimination at the state level

• Achieving elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population
in all the districts of the state
• Reduction in Grade-II disability through prevention of disability (POD) and reconstructive
surgery of disabled persons affected by leprosy.

Performance under NLEP

S
Indicators 2007-08 2008-09 2009-10 2010-11 2011-12
N
1. No. of new cases
detected 31028 7577 27473 25509 24530
(ANCDR/100,000) (15.9) (13.8) (13.4) (12.52) (12.03)

2. No. of cases on record 18254 16206 16484 15719 13939

at year end (PR/10,000) (0.94) (0.81) (0.81) (0.77) (0.68)
3. No. of Grade II
disability among new 471 555 (2.01)
594 645
671 (2.74)
cases (%) (1.52) (2.16) (2.53)

4. Treatment Completion
Rate 91.32 91.26 92.81 93.1 94.78

5. Reconstructive Surgery
conducted 610 476 405 190 295

23
National Vector Borne Disease Control Programme
In the state of Uttar Pradesh, Vector borne diseases are a major public health problem.
Malaria is prevalent in all 72 districts and a matter of concern in interstate border districts. Filaria
continues to be endemic in 50 districts with a micro filarial rate of 1.5% and above, although there
has been a steady decline in the cases in the last five years. Kala-azar is endemic in 4 districts of
eastern UP, ie Kushi Nagar, Deoria, Ballia and Varanasi. In around 27 districts Japanese
encephalitis is widespread and hyper endemic in 4 Districts viz Gorakhpur, Kushinagar, Deoria,
Maharajganj. Rapid urbanization has contributed to the transmission of the Dengue in the
state. Dengue is endemic in 54 districts and hyper endemic in 5 Districts viz Lucknow, Ghaziabad,
Kanpur Nagar, Agra, G.B.Nager. Chikungunya, also caused by the Aedis mosquito is endemic in
two districts viz Kanpur Nagar, Lucknow. Components of the Program
• Malaria Control Programme
• Filaria Control Programme
• Kala-azar
• Japanese Encephalitis
• Dengue & Chikungunya
National Goal
GOI in its National Health Policy (2002) had pledged commitment to reduce mortality on
account of malaria by 50% by 2010 and efficient morbidity control and elimination of lymphatic
filariasis by 2015.

Goals of NVBDCP

• Reduction in morbidity and mortality of all vector borne diseases.

• Prevention and Control of vector borne diseases by giving area specific priorities.
• Universal access to public health services and promotion of healthy life styles with the help
of Integrated Vector Management.

NRHM Objectives
• Malaria: Annual Parasite Incidence of 1.3 and morbidity & mortality reduction rate 50% up
to 2010, additional 10% by 2012.
• Filaria: Microfilaria Rate below by 1% in each endemic district. MDA Coverage more than
85% of population.
• Kala-azar: Cases less than 1 per 10,000 populations at sub district level.
• J.E.: Reduction in mortality rate by 50% taking the base of 2006.
• Dengue: Reduction in mortality rate by 50% taking the base of 2006.
• Chikungunya: Effective Control over Chikungunya morbidity.
24
Strategy for Prevention & Control of Vector Borne Diseases –
• Integrated Vector control (IRS, fish, Chemical & Bio-larvicide and Source Reduction)
• Early diagnosis & Complete Treatment
• Behaviour Change Communication
• Vaccination against J.E.
• No Specific drugs against Dengue, Chikungunya & J.E.
• Annual Mass Drug Administration for Lymphatic Filariasis Elimination
Objectives with their achievements having the base of 2005-
06

Targets set by NVBDCP- NRHM Achievements

Malaria morbidity and mortality Malaria morbidity reduced by 36 percent and mortality
reduction by 50 per cent by 2010 reduced 100 percent by 2010.
Elimination of Falaria by 70 percent Elimination of Falaria by 70 percent by 2010 is achieved.
by 2010
Elimination of Kala-Azar by 2010 Elimination of Kala-Azar by 2010 is 80 percent
achieved.
Reduction in Dengue mortality rate Reduction in Dengue mortality rate by 50 percent 2010,
by 50 percent 2010 we achieved 80% so target is achieved
Effective control over Chikungunia There are no cases of Chikungunia reported in last five
morbidity years.

Objectives of the State

• Malaria Morbidity & Mortality reduction by 60% upto the year 2012 & 80% upto the
year
2017.
• Elimation of Filaria by the year 2015 & 80% reduction upto the year 2012.
• Elimation of Kala-Azar by the year 2015 & 90% reduction upto the year 2012.
• Reduction of J.E. Mortality rate by 50% by 2017 having the base 2011.
• Reduction of Dengue Mortility rate by 50% by 2017 having the base 2011.
• Effective Control on Chikungunia Morbidity.
Malaria
Objectives

• To bring down annual incidence of malaria cases to less than 1 per 1000 at state level by
the year 2017.
• To increase annual blood slides examination rate more than 10 per 1000 at state level by
the year 2017.

25
Dengue & Chikungunia

Objective

• To reduce Dengue Mortality Rate by 50% by the Year 2017 having the base Year 2011.
• To reduce the incidence of Dengue & effective control on Chikungunia Morbidity.
• Strengthen the state wise surveillance mechanism for Dengue & Chikungunia
• Functional Sanctioned Surveillance Hospitals in all Endemic Districts/ Town/ Cities.
• Functional Rapid Response Teams in all the Endemic Districts.

As per guideline of GOI, the State of U.P. has established 22 Sentinel Surveillance Hospitals
with Laboratory facilities, for enhancing the Dengue facility in the State. For backup support these
institutes were linked with SGPGI, Lucknow, which has been identified as one of the Apex
Laboratories in the Country with advanced diagnostic facility.

Strategy and Innovations Surveillance –

• Epidemiological Surveillance & Disease Management.

• Strengthening the existing surveillance.
• Strengthening referral surveillance.
• Epidemic preparedness & Rapid Response Team.
• Involvement of Private providers.
• Integrated Vector Management
• Effective Entomological Surveillance.
• Source reduction using Minor Engineering Method.
• Biological control, Larvicides ( Biolarvicides ).
• Larvicide (Chemical).
• Timly & Good quality of IRS is important & implemented with sound technical skill
• LLIN.

Operational Research Capacity Building-

• Training of ASHA in making Blood Smears.

• Training of ASHAs using Rapid Diagnostic Kit by MO/IC specified PHCs. Training of LTs
of PHC in identifying Malaria parasite by Experts Pathologists & LTs.
• Training of Health Workers & Supervisors in making Solutions of Insecticides in using
spray pumps & fogging machines by D.M.O.s & Malaria Inspector.

26
BCC/IEC activities -

• Information, Education & Communication before spraying and fogging operation about
precautions to make it successful.
• Health Education Material supplied to ASHAs, Village Health Sanitation Societies, Health Sub
Centres, P.H.C.s, C.H.C.s and other Govt Hospitals for proper display.

General Vector Control Strategy-

• Main strategy for control of vector borne disease is vector management.

• To control condition promoting mosquitoes breeding.
• One week day –Saturday to be made dry day (emptying over head tanks, coolers, defrost pans
and plant pots etc.)
• Larvicide in open drains with stagnant water.
• Two round of IRS DDT -50% & three rounds of Malathian 25% WDP in High Risk Districts.
• Spray wages from state resource for technical skilled labours.
• Fogging by malathion technical at dawn and dusk.
• To control outdoor misquotes density in village affected with JE/AES (Larvicidal activity in
morning).

Revised National Tuberculosis Control Programme

Goal – “Universal Access to TB Care”, To ensure that all TB patients are registered and treated
under the programme.

Objectives –
1. To achieve and maintain a cure rate of at least 85% among newly detected infectious
(New sputum smear positive) cases
2. To achieve and maintain detection of at least 70% of such cases in the population
The State has identified priority areas for achieving the objectives planned

S.N. Priority area Activity planned under each priority area

1 Early identification of all 1 a) Improve integration with general health system and
infectious cases of TB leverage field staff for home based case finding, improve
communication and outreach
1 b) Screening clinically and socially vulnerable groups
for TB

27
S.N. Priority area Activity planned under each priority area
1 c) Catch patients already diagnosed through better
notification from all sources, better referral for treatment
2 To maintain 90% success rate 2 a) Promptly and appropriately treating TB
for all new and 85% for re- 2 b) Making DOTS more patient friendly- more
treatment cases community DOT, better monitoring through Information
Technology
2 c) Improving partnerships between public and private
sector
3 To scale-up treatment of Drug 3 a) To achieve complete geographical coverage by end
Resistant TB Cases of 2012
3 b) Strengthening of reference labs
3 b) Strengthening of reference labs
4 To achieve decreased morbidity 4 a) Early, rapid TB diagnosis with high sensitivity tests
and mortality of HIV associated for HIV-infected TB patients
TB 4 b) CPT/ART for all HIV-infected TB patients
4 c) Full training coverage on intensified TB-HIV
package, joint field visits of STC/UPSACS
To improve outcomes of TB 5 a) Include lab. & pharmacies to detect patients at
care in the private sector earliest points of care
5 b) Increase involvement of private medical colleges
5 c) Move from sensitization model to output-based
contracting of services

National Iodine Deficiency Disorder Control Programme

Iodine Deficiency Disorders continue to be one of the major public health problems in India
with around 200 million people estimated to be at risk. Uttar Pradesh with a population of 190
million is known to be IDD endemic and no district in the State is reported to be free from IDD.
Iodine deficiency can be prevented by using salt that has been fortified with iodine. Iodine
deficiency is particularly damaging during early pregnancy as it retards foetal brain development,
resulting in a range of intellectual, motor and hearing deficits. Following disorders are associated
with iodine deficiency:

• Goiter, Retarded mental & physical development

• Cretinism in children
• Repeated abortion & Still birth
• Poor school performance etc.

28
Magnitude of the problem in Uttar Pradesh State –

As per the NFHS-3, in Uttar Pradesh while 77 per cent of households are using iodized salt
only 36% households use adequately iodized salt. Furthermore 23 per cent of the population in the
state is using non-iodized salt, thus over twelve lakhs out of fifty-five lakh children born every
year in the state are at a greater risk of not reaching their physical and mental development
potential. The Coverage Evaluation Survey of 2009 shows the coverage with adequately iodised
salt at 42.5%. NIDDCP focuses on the following:

• Survey and Resurvey every 5 years to know prevalence rate.

• Supply of only Iodized salt for human consumption (salt having 15 ppm Iodine at consumer
level)
• Creating demand for Iodized salt especially in rural area.
• IEC & Health education

Goals & Objectives of state NIDDCP

• To bring down total Goiter rate (TGR) less than 10%

• To ensure 90% household consume Iodized salt by 2017 (15ppm Iodine at consumer level).
Presently 77% of the households are consuming Iodized salt; only 36% households use
adequately iodized salt.
• Supply of Iodized salt through Public Distribution System.

Physical Achievement under the programme –

• No kits were received from GOI in 2011. The testing results shared below are of the samples
received directly from districts at IDD Cell and the sample report of USI Cells set up by UNICEF

SALT SUPPLY
Year Allotment (Tonnes) Supplies (Tonnes)
2010 -11 777528 831861
2011-12 777528 443041 (upto Sep.2011)

29
National Programme for prevention control of deafness
National Programme for Prevention and Control of Deafness is newly introduced Programme
which has been launched to prevent hearing impairments found in children.

The burden of deafness is relatively high in India with respect to world scenario.

As per estimate prevalence of severe to profound hearing loss is 291 per lac population
(NSSO,
2001). 26.4 million of children in India are suffering from hearing loss which adversely effect their
educational performance during their studies. Over 50 % causes of hearing impairment are
preventable and 80 % of all deafness is avoidable by medical or surgical method.

Objective of the programme:

• To prevent the avoidable hearing loss on account of disease or injury.

• Early identification, diagnosis and treatment of ear problems responsible for hearing loss and
deafness.
• To medically rehabilitate persons of all groups, suffering with deafness.
• To strengthen the existing inter-sectoral linkage for continuity of the rehabilitation programme
for persons with deafness.
• To develop institutional capacity for ear care services by providing support for equipments and
material and training personnel.

Long term objective: To prevent and control major causes of hearing impairment and deafness, so
as to reduce the total disease burden by 25 % of the existing by the end of twelfth five year plan.

Phase wise coverage

YEAR 2006-2007- Gorakhpur & Barabanki

YEAR 2008-2009- Banda, Varansi and Lucknow.
YEAR 2009-2010- Agra ,Saharanpur and Moradadabad (included)
In Twelfth Five Year Plan we propose to add seven uncovered district under the programme in
year2012-13 and ten to twelve districts each year subsequently.

Strategy
• Capacity building of District Hospital, Community Health Centre and Primary Health Centre.
• Identification of potential District hospital/ large hospital to provide preventive/screening /
curative service on daily basis.
• To provide above services following action is proposed:

30
• Strengthening of district hospital in terms of equipment / instrument. Sound proof room for
audiometry.

o Adequate manpower will be ensured (one ENT specialist and one Audiologist at least at
District level )
o Skill development for service provider and paramedics
o IEC for dissemination of information about availability of services / site/importance etc.

• Sensitization of service providers and paramedics PHN, MPW, CDPO, AWS, ASHA,
teachers about NPPCD through training camps.
• Awareness generation in community through NGO, VHSC etc. through sensitization
workshop with IEC support.
• Involvement of schools and ICDS for screening of children up to 14 years.
• The ENT department of CSMMU, Lucknow would be the Centre of Excellence which
will support the programme in the state with provision of expertise for training as well as
patient care and referral.

31
Proposed targets and strategy for Phase-II
(2012-17)

32
Proposed Target for IInd Phase (2012-17)
Cumulative
Current Status

2012 -13

2013 -14

2014 -15

2015 -16
target for

2016 -17
Indicators as per
next five
available data
years
Maternal
359
Mortality 200 310 280 250 225 200
(SRS- 2009)
Ratio (MMR)
Infant
57
Mortality 32 56 51 45 38 32
(SRS -2011)
Rate (IMR)
Total Fertility 3.7
2.8 3.6 3.5 3.4 3.1 2.8
Rate (TFR) (SRS -2009)
Full 40.9%
90% 50% 60% 70% 80% 90%
Immunization (CES - 2009)
Contraceptive
43.6%
Prevalence 53% 45% 47% 49% 51% 53%
(NFHS- III)
Rate (CPR)
Institutional 62.1%
85% 65% 70% 75% 80% 85%
Delivery (CES – 2009)

Service Delivery Targets

Indicators DLHS-2 DLHS-3 CES State Targets
(2002-04) (2007-08) -2009
2012-13 2013-14 2014-15
Maternal Health
Mothers who had 3 or 21.50% 21.80% 38.20% 4411778 4813357 5227201
more Ante Natal Check- (4 ANCs) (4ANCs) (4ANCs)
ups
Institutional delivery in 22.40% 24.50% 62.10% 65% 70% 75%
public health facilities
(%)
Line listing and follow NA NA NA 76275 77538 78824
up of Severely Anaemic
pregnant women (Nos.)

33
Child Health
Full Immunization (%) 53.80% 50% 60% 70%

Line listing and follow 16% 22% 29%

up of Low Birth Weight 707858 991002 1344931
babies RURAL Nos; (%
of live births)
Family Planning
Female sterilizations 370478 (HMIS; 2010-11) 475000 550000 600000
(lakhs)
Post-Partum 42787 55000 65000 75000
sterilizations (lakhs) (HMIS; 2010-11)
Male sterilizations 9013 15000 20000 25000
(lakhs) (HMIS; 2010-11)
IUD insertions (lakhs) 1570880 1500000 1650000 1800000
(HMIS; 2010-11)
Disease Control
ABER for malaria (%) To sustain the ABER at least
about 10 %
API for malaria (per Surveillance may be improved
1000 population) in all the districts to obtain the
real magnitude of Malaria
Annualized New Smear 72%-75%
Positive Detection Rate
of TB%
Success Rate of New 85% - 88%
Smear positive treatment
initiated on DOTs %

Cataract
operations(lakhs) 11.62

34
Maternal Health FY 2012-13

30.00 27.00
25.00
21.76
20.00

15.00

10.00

5.00

0.00
Target Achievement

Strategy to increase JSY beneficiaries

• Increasing number of accredited sub-center

• Increasing no of beds by 8000
• Contractual HR (ANMs,SNs & Doctors) at all levels
• Incentives to ASHA has been linked with quality care and birth planning
• Free entitlements under JSSK to all pregnant women and JSY beneficiaries
• 108 ambulances for free transport from home to hospitals
• AADHAAR card linked payment system and payments through account payee cheques only
being introduced
• More number of PHC, CHC are being made functional for deliveries

Janani Sishu Suraksha Karyakarm (2012-13)

To ensure no “Out Of Pocket expenses” for Pregnant Women & Newborn

• No user charges for pregnant women and newborn
• Free medicines and consumables
• Free essential investigations
• Free food for all admitted Pregnant women & JSY beneficiaries
• Free blood at all FRU- L-3 facilities

35
 • Free transport-
o from home to facility
o Drop back from Facility to home
o Referral to higher centers
• Free treatment and referral of sick neonates.
• Grievance redressal system at all facilities.

Target for year Achievement

Free services started Achievement in %
2012-13 (in lakhs ) (in Lakhs)
Free diet 15.53 6.61 43%
Free treatment 26.88 15.97 59%
Free drop back 16.35 3.49 21%

Child Health-
Strategy to reduce IMR and U5MR :
• Achieve the target of the NSSK training at functional delivery points
• Increase referral of the malnourished children to NRCs

Activity Proposed Functional

Sick Newborn Care Unit (SNCU) 20 10
Nutritional Rehabilitation Center (NRC) 32 10

Routine Immunization :

• 4 Special RI Weeks in 2012-13 to increase coverage in low coverage areas.

• 4 RI Weeks being conducted in 2013-14 also.
• Measles catch up campaign in all Districts, with 94 % coverage.
• Second dose of measles started in 2013-14.
• Training to all frontline workers planned in the year 2013-14.

36
Antigen wise Coverage of RI (2012-13)

1
90% 87% 87%
0.9 84% 83%
0.8
68%
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
BCG DPT III OPV III Measles Full JE
immunization
2012-13

Family Planning programme:

NRHM Phase – II (2012-2017)

Outcome Indicators
2012-13 2013-14 2014-15 2015-16 2016-17
TFR 3.8 (SRS) 2007-09 3.75 3.6 3.4 3.1 2.8

Output Indicators for Population stabilization

Activity/ Monitor Current Cumulative Targets for 2nd phase of NRHM 2
able Indicators status
2012-13 2013-14 2014-15 2015-16 2016-17
1 Male sterilization 8,199 15000 20000 25000 30000 40000

2 Female 371237 450,000 450,000 450,000 450,000 450,000

sterilization
3 IUDs 1543354 20 Lakhs 21 Lakhs 22 Lakhs 23 Lakhs 24 Lakhs

37
Achievement in 2012-13
1500000 1392238

1000000

500000 307648

0
Sterilisation IUD
2012-13
PCPNDT Act (2012-13)
The ‘Civil Registration Data’ clearly shows that the sex ratio is declining in most of the
commercially viable districts where ultra Sonography centers are in abundance indicating a direct
correlation. Consequently, the strategies of the state now focus on these districts. Near about 4430
centers have been registered under the PCPNDT Act in the state. It is well known that it is difficult
to regulate the private sector and therefore initiatives to monitor the implementation of the PC
PNDT Act become even more essential. Given the above scenario, effective implementation of the
PCPNDT Act together with social reform efforts including enhancing the value of a daughter is a
significant step towards the prevention of female feticide. During year 2012 – 13, a State Level
PCPNDT Cell has been established. Due emphasis has been given for inspection and Monitoring of
all actionable points. Which are mainly focused on inspection visits to USG centers, documentation,
filling cases, perusal in the court and action against defaulters.

No. of suspended No. of Inspection Court Advisory Total No. No of

Registered centers Inspected through cases committee Of machines
centers centers False filed Meetings Ultrasound sealed
client held machines
4620 316 5121 252 75 340 4566 73

38
National Disease Control Programme

National Program for Control of Blindness

• All the reports to be sent online.

• MIS training has been imparted to all the DPMs (Eye) of the state by the experts
• Online Reporting system is mandatory for NGO payments.
• Rates of Cataract Operation increased from Rs.750 to Rs.1000/operation to NGO.

National Leprosy Eradication Programme:

Following 8 objectives are set to achieve during the period of 5 years - 2012 -17

• Deployment of early case detection

• Improved case management
• Reduced stigma
• Sustained development of leprosy expertise
• Research supported evidence based programme practices
• Monitoring Supervision and Evaluation system improved
• Increased participation of persons affected by leprosy in society
• Ensured Programme management

Projected target for District level elimination i.e. PR < than1 per 10,000 population

Prevalence Period wise details of the districts

Rate 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17
<1 57 59 60 65 68 72 75
1 -2 13 12 15 10 7 3 0
2-5 2 1 0 0 0 0 0
>5 0 0 0 0 0 0 0

State has also projected targets for Annual case detection rate(ANCDR), Number of cases on record
at the end of the year (PR), Number of grade II disability among new case(%), Treatment
Completion Rate(TCR) and Re-constructive Surgery.

39
Strategy:

• Ensuring improved early case detection; performance based ASHA incentive is there and
special activities in form of ‘Awareness creation and Active case detection Campaign’ in
147 high endemic blocks having ANCDR more than 20 in35 high endemic districts.
• Programme ensures improved case management disability prevention provision of providing
MCR footwear, aids appliances, supportive medicines, lab reagents and printing of records
and reporting formats are there.
• Need based assistance to inmates of 72 Leprosy colonies in the state.screening camps in the
districts and person found fit for RCS listed and referred to nearby Leprosy Care Centres in
the state.
• In Urban leprosy Control programme 52 urban colonies have been covered the urban areas
are categorized as Townships (40), Medium Cities I(2), Medium Cities II (8), Mega Cities
(2) in which non government hospitals are involved, NGO participation is ensured, MDT
drugs distribution is also ensured.

Revised National Tuberculosis Control Program

• All the districts of the State have been covered under Programmatic Management of Drug
Resistant Tuberculosis in March 2013.
• Additional target for state Diagnostic Labs at 5 more sites (Agra, Aligarh, Bareilly, SGPGI,
Lucknow, Meerut)
• Additional target for Specialised Drug Resistant TB Care centres will be made functional
this year. eg. Etawah, Jhansi, Meerut, Basti, Aligarh, Allahabad & Gorakhpur approved by
GoI.

Japanese Encephalitis(JE)/Acute Encephalitis Syndrome (AES)

• 10 bedded pediatric ICU in 10 hospitals of 9 districts (Gorakhpur, Kushinagar, Deoria,

Maharajganj, Basti, Siddharthnagar, Sant Kabir Nagar, Behraich, Lakhimpur Kheri) and 100
bedded ICU ward at BRD Medical College Gorakhpur.
• The activities done by other department as follows:-
• Jal Nigam department has established 12435 India Mark II hand pumps against
target of 16888 India Mark II hand pumps up to June, 2013.
• Jal Nigam department has also completed 54 percent of establishment of Tank Type
Stand post (TTSP) against target of 2795 TTSP up to June, 2013.
• Panchayati Raj Department has completed the construction of 53103 (41.56%) water
sealed latrines against the fixed target of 127757.

40
OTHER IMPORTANT COMPONENTS OF NRHM PROGRAMME

Referral Transport/Emergency Medical Transport Services (EMTS)

An Effective perinatal referral transport service is critical for preventing maternal

emergency care to reach an adequately resourced facility safely and well in time and condition that
provides them a fair chance for survival and to receive treatment in time.

GoI has a mandate to establish a network of basic patient-care transportation ambulances

whose objective would be to reach beneficiaries in rural areas within 30 minutes of receiving a call.
Under NRHM

In view of the importance of access to ambulance services for reducing delays in access to
care during various emergencies the ambulance services were started in all districts of UP.
These services are basically of three types depending upon need and mode of operation.

1. “108” – EMTS
2. U.P. Ambulance Sewa
3. “102” Ambulance Sewa

Emergency Medical Transport Service (EMTS) “108”

• “108” EMTS sewa launched by Honorable Chief Minister on 14 Sep’2012.

• The ambulances under the scheme launched in phased manner and achieved target of total
988 ambulances on 10 Feb’2013.
• Total 3,39,274 patients (1,86,418 Pregnancy related, 47,235 Accidental cases) benefited by
“108” Service till 31st Mar’2013.
• This service was utilized in Maha Kumbh, Allahabad and 33,341 patients benefited.
• Uttar Pradesh at present has a functional “dial 108” model, across all the districts, under
Public Private Partnership (PPP) mode. This model cater to transporting patients in all kinds
of emergencies, free of cost to all citizens.
• The objective is to provide immediate response during emergency with basic first aid to the
patient and transport them to nearest government health facility. Total 988 Ambulances are
functional till date

U.P. Ambulance Sewa

Under State Basic Ambulance Services: 972 ambulances are already functional in all the 75
districts of Uttar-Pradesh. These ambulances are used for inter facilities transport of patient, Sick
New Born Children and for the purpose of drop back under Janani Shishu Suraksha Karyakram
(JSSK).

41
“102” SEWA (not yet initiated, under consideration)

These ambulances are expected to serve transportation of pregnancy cases as well as neonatal
cases from home to the health facility. State proposes to operate 1000. such ambulances (Yet to
procure.). The required operational cost is (@Rs. 1,28,700.00 per ambulance per month including
operation of centralized call center

Urban Heallth Programme

The Urban Population in Uttar Pradesh has been Increasing rapidly in recent decades along
with rapid urbanization .As per 2011 census 4.44 crores persons are residing in towns and cities of
Uttar Pradesh. The health status of people in Uttar Pradesh is amongst the lowest in the
country, especially for the urban poor.

The health indicators among urban poor are significantly lower than in rural areas of the
state. More than half of the urban poor women in UP are anaemic. High prevalence of
anaemia contributes to high infant and maternal mortality, premature births and low birth
weight babies. Only one in five urban poor women receives the recommended three antenatal
checkups

Mere 24.4% of urban poor couples in UP use modern methods of contraception. This results
in a large number of unwanted pregnancies and child births and deprives women to control their
fertility and childbearing. Infectious diseases are more prevalent among the urban poor in Uttar
Pradesh. The prevalence of medically treated TB (per 100,000 populations) is 532 as
compared to 321 among average urban population and 425 in the state (NFHS 3).

Challenges

1. Lack of primary health care in urban areas

2. Poor quality care due to stretching of already constrained resources.
3. Ineffective Referral System from the community level to the second tier results in loss of
trust in the public health care system making them turn to irrational treatments from
unqualified providers.

Goals and Objectives

To improve the health status of the urban poors by provision of quality Primary Health Care
services and decentralized health facilities by ensuring atleast one urban health post (UHP) per
50,000 populations having urban slum of 20000-30000 population in the city.

42
Target Population

• Poor & Under Served Population

• Inaccessible and Migrant Populations
• People live in temporary shelters
• People working in construction sites
• BPL people

Type of Services

Outpatient services, MCH services and referral service

134 Urban Health Post (UHP) established in different cities are providing primary health
services to the urban poor. There are 45 Urban FP centers (17 Type II and 28 type III), lucknow has
a urban project also. Besides that there are 7 Maternity homes in Lucknow and 2 in Varanasi,
catering maternal child health services, reducing the client load on District Women Hospital.

Supporting Organizations: Urban Health Initiative (UHI) UHI supports Government of

Uttar Pradesh in eleven cities (Agra, Aligarh, Allahabad, Gorakhpur, Bareilly, Kanpur, Varanasi,
Moradabad, Mathura, Farrukhabad and Lucknow) through 21 local NGOs, with a network of 1,665
trained peer educators (on the USHA model), together working to serve poor communities in 1,705
urban slums. UHI aims to increase contraceptive use as a key intervention to reduce maternal and
infant mortality. The over all objectives are as follows

i) To integrate family planning counselling and services with maternal, newborn, post
partum, and post abortion services;
ii) To expand access to quality family planning services in health facilities;
iii) To test innovative private sector approaches to increase access to family
planning;
iv) Create demand for sustained use of contraceptives and;
v) To increase funding, financial mechanisms, and a supportive policy environment to
ensure continuity of family planning supplies and services for the urban poor.

UHI works in partnership with 122 facilities (public and private) to implement fixed day
approach and strengthens counseling and interpersonal communication, at clinics and in
communities through counselors and community based workers. It supports social marketing of
condoms and pills, in nontraditional as well as traditional outlets. It uses mid-media and mass-
media to market supplies and services and shape demand and practice for targeted groups.
43
Rashtriya Bal Swasthaya Karyakarm/Bal Swasthya Guarantee Yojana
Coverage: As per an estimate received from primary education department and middle education
department, there are on an average 150 such schools in each block. Thus, the total no. of schools
comes to about 1,47,895 and with an average of 200-250 children in each school, the estimated
number of children to be covered under the scheme is about 4 crores. As per census report 2011,
there are about 8.2 crore children of age group 2-18 years in the State. Out of these about 2.58 crore
are in the urban area and 5.62 crore in rural areas. These 5.62 crore children are proposed to be
covered under the scheme in a phased manner. In the first year it is proposed to cover about 1 Lakh
schools and reaching out to about 2 crore children.

Three pronged programme strategy is mentioned below

1. Screening of School going children and preparing health card for each child Screening of
non School going children and preparing health cards for each child
2. Health check up by dedicated medical team in schools on pre-fixed days and at
VHNDs/SCs/ AWCs for non school going children as per micro plans
3. Referral of sick children and ensuring their treatment
4. At each CHC on a fixed day, one specialist camp will be organized every month where
physician, surgeon, paediatrician and opthalmologist will be available to examine and
advise the referred children.

Adolescent Health Programme

Nearly 25 percent of the population of Uttar Pradesh is adolescents (415 Lakhs). Of these
approximately 200 Lakhs are adolescent girls. As per NFHS -3 adolescent girls getting married
below 18 years of age are 59% and out of these 38% begin child bearing when less than 19 years of
age. As per NFHS-3, teenage pregnancy is 14.3% and unmet need for contraception is 21%.
Prevalence of Anaemia in this age group is about 49% and adolescents seeking treatment at health
facilities is only 31%. There is poor awareness in this age group regarding different problems
occurring such as RTI/STIs and way to address them. NFHS-3 data also indicates that there is poor
knowledge regarding problems of unsafe sex, personal hygiene and nutrition. Only 33% of girls in
age group of 15-19 years knew that condom can prevent HIV transmission and 36% males had
heard of STDs.

Given the above scenario, the State under NRHM programme has planned to design and
implement such projects that address and influence the health seeking behaviour of adolescents
which will eventually determine mortality, morbidity, population growth and health in the
community. This will also influence adolescents for delaying the age at marriage, reducing

44
teenage pregnancy, meeting unmet need of contraceptives, reducing incidents of RTI/STIs and
reducing maternal deaths in this age group. Taking above mentioned situation into consideration, the
state has implemented following schemes for adolescents in the State.

Establishing AFHS clinics* - During 2012-13, 36 AFHS clinics have been established in premises
of Divisional Head Quarter level District Male and Female Hospitals. These clinics are providing
services after Hospital working hours (2-5 p.m.), so that adolescents may reach there and get
solution for their queries. One Counselor is recruited at each clinic.

A large percentage of adolescents in Uttar Pradesh do not go to the schools and are often in a
more disadvantageous situation than those, who attend school. Hence, it is important that weekly
Iron Folic Acid supplementation, Bi-annual de-worming and Family Life Education-with counseling
on nutrition & personal hygiene should be incorporated for non-school going adolescent girls in the
community under the adolescent health programme. This scheme was implemented during year
2012-13. the strategy envisages the two pronged strategy.

Programmes Districts Age Target IFA Distribution De-worming

covered Group beneficiaries distribution
Rashtriya Bal 75 2-18 Girls/boys Yes Yes
Swasthaya
Karyakarm
Menstrual 13 10-19 Girls Yes Yes
hygiene scheme
SABLA scheme 22 10-19 Girls Yes (non-school Yes
going girls)
AFHS Clinics* 18 10-19 Girls / Boys Yes Yes
(2 in each district)

Quality Assurance for RCH services

Quality enhancement in health care has been recognized as an essential cornerstone for
promoting equity and maximizing health gain. With the event of NRHM in the state of Uttar
Pradesh, significant improvement has been made on multiple health indicators and promotional
schemes for institutional deliveries have led to tremendous increase in utilization of public health
facilities. The State now strives to address the issue of enhancing the quality of health care services
rendered through establishment of Quality Assurance network at all level.

In continuation to our quest for delivering high quality health services, Quality
Assurance Cell at State level has been established and State Quality Assurance Working

45
 Groups have been formed. State is in process of finalizing the checklists as per GOI guideline
with the help of GOI and NHSRC Officers which will be used by Quality Assurance working
groups and other officers during field visit. Quality Assurance Cell at State level: Cell has been
established under the chairmanship of Mission Director and a full time Deputy General manager
has been appointed State Nodal Officer: Director, Medical Care Medical Health and Family
Welfare Department U.P.
• State Working Groups: 4 State Working Groups have been formed , RCH services, NRHM
Additionalties, Routine Immunization and National Programmes.
• Monitoring and Evaluation Cell for Quality Assurance Cell at State level has been
established and State is in process of filling the posts for M&E cell . M& E cell at the State
level will support Quality Assurance Cell.
• In order to establish and institutionalized Quality Assurance and improvement , Monitoring
and Evaluation an attempt is being made by Government of Uttar Pradeh to set up a
functional district quality assurance mechanism through District Quality Assurance cell . 18
Divisional and 75 District Quality Assurance Cells have been formed

Quality Assurance Cell Divisional and District level: To ensure the self driven quality
improvement at PHC for improved quality of care, earlier we had planned to reach upto district
level to assure the quality of services. With the support of Bill and Melinda Gates Foundation, State
plan to take this initiative upto facility level at Block PHC.

Objective :
• Increase participation of all Stakeholders in a facility through development of Quality
Teams
• Increase engagement with District Quality Assurance Cell to ensure achievement of District
Health Plan.
• Orient Facility level Staff towards Quality Management System
• Motivate Facility level Staff to envision, plan and execute standard quality assurance
paradigms like IPHS and Family Friendly Hospital Initiative
• Improve the quality of care provided to beneficiaries
Essential elements:
• District QA Cell workshop - Orienting district officials on facility solution levers
• Block Level workshops - Orienting block officials on facility solution.Creation of facility
QA team – Monthly QA team meeting with recorded minutes
• Facility Assessment Toolkit – Standardized toolkit (paper/software based) for gap
assessment and comprehensive facility assessment for readiness for IPHS and FFHI,
• Creation of Comprehensive Action Plan – Gap assessment and achievement monitored
through monthly/Quarterly QA team meetings
• DQAC field visits – periodic engagement of DQAC with the facility to assess and monitor
progress on comprehensive action plan.

46
Expected Outcomes:

• As a result of quality improvement, early identification of maternal and new born

complication, stabilization and timely referral to appropriate facility
• IPHS and FFHI accreditation by state government

THE SOCIAL DETERMINANTS OF HEALTH

Nutrition
The persistence of malnutrition in India is a cause for serious concern. The Prime Minister
has rightly referred to the prevailing situation as a “national shame”. Malnutrition, particularly in
the case of pregnant women leads to the birth of babies with a low birth weight. Such children suffer
from many handicaps in later life, including impaired cognitive abilities.

We are far from achieving the goal set by Mahatma Gandhi at Noakhali in 1946, that the first
and foremost duty of independent India should be to achieve freedom from hunger. To quote
Gandhiji, “There are people in the world so hungry that God cannot appear to them except in the
form of bread”.

UP has many programmes for fighting malnutrition like Integrated Child Development
Services (ICDS), School Noon Meal Programme. Nevertheless, the prevalence of both endemic and
hidden hunger is not showing a downward trend. It is in this context that there is need for
convergence and synergy among various programmes dealing with nutrition, drinking water,
sanitation and primary health care.

60 percent of severely wasted children in India live in 6 states Malnutrition underlies up to

half of under-five deaths.
1,194,190

1,049,161

1,250,000
1,032,259

1,000,000

750,000
596,668

560,150

512,752

435,974

329,523
387,287

500,000
345,309

264,366

209,988

155,223

137,137

128,110

250,000

47
 In September 2012, the government of UP took a decision to set up Nutrition Mission in the
state following a visit and recommendation by a team of young parliamentarians (Citizen’s Alliance
against malnutrition) in UP. The objective of Nutrition Mission is to reduce the proportion of
moderate and severe malnourished children in the age group of 0 to 2 years in the State by having a
dedicated focus on selected health and ICDS preventive and curative interventions.

It has been proposed that the Nutrition Mission be set up initially for a period of three years
and subsequent decision be taken based on the results delivered by the Mission. UNICEF will be
the lead technical partner in supporting the Nutrition Mission.

Nutrition Mission will be an autonomous flexible body which will liaise with Medical
Health and Family Welfare department and ICDS for strengthening select interventions.

Under nutrition accounts for one third of under-five mortality. The following figures reveal
the poor nutritional situation of children in UP.

• Only around 33% of under-3 children (1 out of every 3) being breastfed within one hour of
birth (AHS-2011).
• Only around 18% of 6-35 months children (1 out of every 5) have been exclusively
breastfed for at least six months(AHS 2011)
• About 96,000 under five children lost every year because of lack of optimal IYCF practices.
• Uttar Pradesh has around 1.3 million severe acute malnourished children. In UP there are
about
• 95,000 child deaths per year as a result of severe acute malnutrition, or 260 deaths per day
or 10-11 deaths per hour.
• Under-nutrition figures of Uttar Pradesh
Stunted (chronic under nutrition): 57% in UP, compared to 48% in India;
Wasted (acute under nutrition): 15% in UP compared to 20% in India.

Underweight (acute and chronic under nutrition): 42% in UP compared to 43% in India.More
worrisome, the nutrition situation of children has not improved significantly over the last decade.
For example, according to NFHS-3, there has only been a very slight 0.5 per cent annual decrease
in the prevalence of underweight children over the past sixyears.

48
Convergence
As adolescents are in arena of various schemes of inline department there is enough scope of
working in convergence to maximize outcome of the schemes being undertaken under Adolescent
Reproductive and Sexual Health. State has already been working with few of them.
• Village Health Sanitation and Nutrition Committee: VHSNC members help in preparing
village health plan and in organizing the periodical meetings of VHSNC.
• Convergence with ICDS - To address the issue of anaemia in adolescent age group it is being
planned to provide IFA and De-worming tablets for non school going girls covered in districts
under SABLA scheme. ANM & HV/ AYUSH lady will address issues of health, personal
hygiene and nutrition arising in adolescent age group during quarterly Kishori Diwas with
support of AWW. It will also be ensured to provide IFA and De-worming tablets to the
beneficiaries.
• Convergence with Uttar Pradesh State AIDS Control Society - State will be working in
convergence with UPSACS for establishment of AFHS clinics at ICTC and PPTCT in identified
facilities so as to provide counseling to adolescents on specific issues pertaining to this age
group and appropriate referral.

Other New Achievement in year 2012-13

FY 2012-13 has been a year of intense activity.

States have responded very positively to conditional ties and incentives, programme
management has been strengthened with the appointment of nodal persons for each thematic areas
and introduction of Score Cards, JSSK has made further inroads, RBSK has been initiated and Child
Survival Summit at Mahabalipuram provided an opportunity to take stock of our achievements and
reflect on the challenges ahead.

The Reproductive and Child Health Programme (RCH), under the umbrella of NRHM,
addresses the issue of reduction of Infant Mortality Rate, Maternal Mortality Ratio and Total
Fertility Rate through a range of initiatives. The most important of these is the Janani Suraksha
Yojana, which has led to a huge increase in institutional deliveries within just four years, the
number of beneficiaries rising from 9.64 lakhs per year during 2007-08 to 23.28 lakhs in the year
2011-12. In FY 2012 – 13 the annual achievement is 21.76 lakhs To cope with the tremendous
increase in the work load of institutional deliveries the additional maternity bedded wings have been
approved for construction. They are as follows:

• 100 bedded maternity wing in 50 District Hospitals

• 50 bedded Maternity wings in 12 CHCs
• 30 bedded Maternity wings in 78 CHCs.

49
 Massive training of ANMs and staff nurses for safe delivery ensured through 2400 trained
ANMs/SNs and training in ‘management of sick children, to nurses, has also helped in a major way.
In parallel to these efforts the up gradation of health facilities to provide emergency obstetric care
and to improve access to Skilled Birth Attendants made a significant difference to health outcomes.

NRHM has also contributed by increasing the human resources in the public health sector,
by up- gradation of health facilities and their flexible financing, and by professionalization of
health management. State is trying to meet the huge gap in human resource by hiring the services of
different levels of health providers (such as Gynaecologist, Pediatricians, Anaesthetist, ANMs, Lab.
technicians etc.)

Disease Control Programmes have also shown considerable improvements. Polio is near
Elimination and diseases like Tuberculosis, Neonatal Tetanus, Measles and even HIV have shown
decreasing trends. However, Malaria continues to be a challenge. A number of newly emerging
diseases like H1N1 have made it essential for us to strengthen surveillance and epidemic response
capacities.

NRHM also aims at mainstream of AYUSH cadre of service providers who have very
well out reach, so as to make the health services available in far flung rural areas.

Due attention has been given in improving the Health Management Information System
HMIS. A separate division of Monitoring and Evaluation for quality Assurance has been
developed during FY 2012-13, staff have been hired in form of data analyst, Project coordinator
MIS, Consultant management and quality assurance etc. State has started operating HMIS and
has started developing, analyzing performance reports from second quarter of the FY 2012-13.

The area of ‘NGO participation’, a greater engagement with the private sector is required to
harness their resources for achieving public health goals. NRHM UP has a substantial focus
on Public Private Partnership (PPP) component also. The state has active ‘Developing Partner’s
Forum’, the meeting of this forum help in allotting districts to the developing partners for specific
activity, eg. The project of ‘Urban Health Initiative’ is working in urban slums of 11 districts of UP.
HLFPPT with the assistance from State Innovations in FP Services Agency (SIFPSA) has
developed a net work of Private Hospitals/Providers under the banner of Marry Gold Hospitals in
UP for providing FP and RCH services.

The current policy shift is towards addressing inequities, though a special focus on
inaccessible and difficult areas and poor performing districts (45 high risk districts are in UP, out of
which 19 have been selected as “High Priority Districts” on the basis of poor composite index ).

50
Financial Progress 2012-13

51
FINANCIAL PROGRESS UNDER NRHM FOR THE YEAR 2012 -13

FMR Activities Budget Allotted as

per PIP Actual %
(including SPIP) Expenditure Expenditure
A RCH -
TECHNICAL
STRATEGIES
& ACTIVITIES 121954.89 67470.6 55.32
B (RCH Flexible Pool)
Additionalities 215770.43 49779.78
under
NRHM 23.07
C (Mission Flexible Pool)
IMMUNISATION 20467.78 20646.83 100.87
D IDD 175.13 0 0
E IDSP 650.8 338.32 51.99
G NLEP 605.7 387.78 64.02
H NPCB 2453.68 1674.02 68.22
I RNTCP 5674.56 4269.22 75.23
J N.M.H.P 600.21
K N.P.P.C.D 3.68
L NTCP 7.21
National Program
for 81.12
Health
NationalCare of the for
Pro.
Prev.& Control of
Cancer,Diabetes,Cardio
& Stroke 199.61
GT Grand
Total 371855.27 146928.09 39.51
(A+B+C+D+E+F+G+H+
Infrastructure
Maintenance
( treasury Route) 63388 189855.26 299.51
TOTAL 435243.27 336783.35 77.38

52
Total Approved Budget(In Lakhs ) in PIP 2013

Total Expenditure (In Lakhs ) in PIP 2013

Mission RCH Immunization National Pro. For N.M.H.P. NTCP RNTCP N.P.P.C.D. N.P.C.B. N.L.E.P. I.D.S.P. I.D.D.
Flexible Flexible Prev. & Control of
Pool Pool Cancer, Diabetes,
Cardio & Stroke

49779.78 6740.60 20646.83 199.61 600.21 7.21 4269.22 3.68 1674.02 387.78 338.31 0

53
RCH Flexi pool
% of Expenditure against allotted budget in
RCH Flexi pool 2012-13

Mission Flexipool
% of Expenditure against allotted budget in Mission Flexipool 2012-13

54
Immunization

National Disease Control Programme

% of Expenditure against allotted budget in

National Disease Control Programme 2012-13
IDD
0%

IDSP
RNTCP
20%
29%

NLEP
25%
NPCB
26%

55
New Initiatives for year 2013-14

56
Hausla:

• Aimed to give momentum to existing schemes by catalyzing momentum and inter-sectoral

collaboration.
• Objective : Sharp reduction in maternal & infant mortality by delivering better health
services in the spectrum of RMNCH+A ( Reproductive, Maternal, Neonatal, Child and
Adolescent health )
• Scope : All Districts. Special focus on 25 High priority Districts.
• Launch : Proposed on 15 July 2013.
• Special efforts :An year long Mass media campaign – airing messages through TV and
Radio channels, to raise community awareness.

State Nutrition Mission

Mission being set up for a period of three years in the first phase
Objective of the Mission:-
• Reduce mild/moderate under nutrition among children below three years
• Reduce the prevalence of severe under nutrition in the state
Key Stakeholders:-
• National Rural Health Mission
• Department of Women and Child Development
Technical support from UNICEF
Initial funding support is being proposed by NRHM

• Governing Body has been formed under the Chairmanship of Hon’ble Chief Minister.
• Executive Body under the Chairmanship of Chief Secretary.
• Monitoring Committee under the Chairmanship of Principal Secretary Woman and Child
Development and Health & Family Welfare.
• Implementation Committee under the Director General State Nutrition Mission

Proposed “ 102 ” Sew a :

• Operation of “102” ambulance sewa has been approved by Cabinet of Uttar Pradesh.
• Total 972 ambulances will be operated 24 X 7 through “102” toll free number, centralized
call center and as per ‘National Ambulance Guidelines’.
• In first phase 972 ambulances and in second phase 1000 ambulances will be made
operational under this scheme.
• Looking at success of “108” EMTS sewa this services will also be operated through private
service provider.

57
 • Facility of transportation and drop back of pregnant women, sick new born (under JSY and
JSSK) and Inter facility referral of severely ill patients will be provided to all rural and
urban areas of state.

National Urban Health Mission

The Union Cabinet approved National Urban Health Mission (NUHM) as a new sub-mission
under the over-arching National Health Mission (NHM). The structure would be:
• One Urban Primary Health Centre (U-PHC) for every fifty to sixty thousand population.
• One Urban Community Health Centre (U-CHC) for five to six U-PHCs in big cities.
• One Auxiliary Nursing Midwives (ANM) for 10,000 population.
• One Accredited Social Health Activist ASHA (community link worker) for 200 to 500 households.
• NUHM is approved for 5 years period; the Centre-State funding pattern will be 75:25.
• Fund allocated for UP : Rs. 235 cr. (Sep. 2013 – Mar 2014)
• 164 Cities with more than 50,000 population
o 9 Cities with more than 10,00,000 pop
o 84 Cities with population between 1-10 lakh
o 71 Cities with population between 50,000 -1 lakh
o 5 District HQs with urban population of less below 50,000 Siddharthnagar, Mahrajganj,
Kaushambi , Shrawasti &Amethi

Conclusion :

This ‘Annual Health Report’ provides valuable insights into proven approaches to reduce
TFR, MMR, IMR in the state of UP. The major areas of operation/ interventions to achieve the
desired goal of NRHM. The challenges the state is facing in operationalizing various vertical
interventions, the convergence and synergy among various programmes dealing with nutrition,
drinking water, sanitation and primary health care, the state has brought under the edges of NRHM
to achieve the indicators under the Social Determinants of Health.

This ‘Annual Health Report’ is a report to the People on Health, examines the progress made
in the health sector, identifies the constraints in providing universal access and provides
options and future strategies. In terms of life expectancy, child survival and maternal mortality,
Uttar Pradesh’s performance has improved substantially & steadily. However there are wide
divergences in the achievements across districts and there are also inequities based on rural urban
divide.

58