CURRENT STATUS
(Upto September,2004)
IN
6(six) identified Municipalities
under
URBAN HEALTH IMPROVEMENT PLAN
KOLKATA METROPOLITAN DEVELOPMENT AUTHORITY
Urban Health Improvement Programme Unit
Unnayan Bhavan, Bidhannagar,
Kolkata – 700 091.
Urban Health Improvement Plan, (UHIP)
Physical Progress Report (Current Status)
1. Background:
KMDA’s initiative in the Urban Health Sector started in the seventies on the request of the Health Department of the Govt. of West Bengal. Three Community based Health Programmes viz., CUDP-III ( 1984-1992), CSIP (1992-1998) and IPP-VIII (1994-2002) were taken up by the KMDA with financial assistance from the World Bank and DFID (formerly known as ODA). These 3(three) programmes contributed substantially to improve the Health Care Delivery System among the population living in Slums or in similar situation covering 56.75 lakhs of people of low income group under CUDP-III (16.00 lakhs) CSIP (2.75 lakhs) and IPP-VIII (38 lakhs) in the Kolkata Metropolitan Area comprising 38 Municipalities and 3 Municipal Corporations having an area of 1486 Sq. KM.
The major objectives were :-
F To improve Maternal and Child Health Status.
F To reduce Fertility among the target population.
F Upliftment of women through self employment.
F
The existing Health Care Infrastructures in the Kolkata Metropolitan Area under CUDP-III, CSIP and IPP-VIII Health Programme are as below :-
CUDP-III / CSIP / IPP-VIII / TOTALSubcentre / 317 / 55 / 725 / 1097
HAU / 50 / 8 / 116 / 174
ESOPD / 8 / 2 / 25 / 35
Maternity Home / - / 2 / 23 / 25
Regional Diagnostic Centre / - / - / 8 / 8
2. Genesis of Urban Health Improvement Plan :-
Although these projects have emerged somewhat successful, substantial gaps still remain to be plugged. The deficiency relating to inadequacy of some RCH component, Obstetric and Neo-natal Services, detection of RTI/STI, inadequacy of MTP services, lack of convergence, integration, partnership and weak capacity management at the municipal level has prompted KMDA authorities to formulate a reform based programme with substantial financial policy changes thereby ensuring an integrated approach with the existing State Government initiative on one hand and the similar activities on the other with formulation of a new project approach i.e. “Urban Health Improvement Plan” with European Commission funding. This Urban Health Improvement Plan is designed to address the above unfinished agenda requiring future attention to consolidate the existing Health Care Delivery System and attain sustainability to minimize financial dependence on the Government in a phased manner.
The goal is, therefore, to prepare a package to deal with the increasing burden of diseases and put in place a substantial Health Care System which should combine elements of public health and clinical services through Health Sector Reform with emphasis on integration of the existing Health Care Delivery System in 6(six) identified Municipalities viz. Bhadreswar, New Barrackpore, North Barrackpore, Naihati, Madhyamgram and South Dum Dum with other parallel departments and programmes for ultimate benefit to the vulnerable urban poor. On the achievement of successful reforms in these municipalities, it will be replicated in the remaining municipalities in the Kolkata Metropolitan Area in a phased manner.
The beneficiary population of these 6 municipalities is 7,45,539 with 184 Health Infrastructures. All the aforesaid municipalities are functioning with the infrastructures viz., Subcentre, HAU, ESOPD and Maternity Homes. Excluding South Dum Dum and Madhyamgram Municipalities, the rest of the four have got Regional Diagnostic Centre (RDC).
2.1. The existing Health Infrastructures in the six Municipalities are as follows : -
Type of Infrastructure / IPP-VIII / CUDP-III / Urban Agglomeration / Target for input (strengthening)1. Block / 527 / 169 / 50 / 400
2. Subcentre / 109 / 34 / 70
3. Health Administrative Unit (HAU) / 17 / 6 / Nil / 23
4. ESOPD / 6 / 2 / Nil / 6
5. Maternity Home / 6 / Nil / Nil / 6
6. Regional Diagnostic Centre (RDC) / 4 / Nil / Nil / 4
2.2. Though the aforesaid 6(six) Municipalities have developed and implemented the project components MCH & FW efficiently and effectively, yet the following components of RCH require adequate strengthening for rendering quality of services.
a) Adequate Obstetrical Emergencies and Neonatal care round the clock by qualified personnel effecting quality of services.
b) Widening the scope for RTI and STI detection and management including investigations for referred cases.
c) Management of MTP cases including prevention of unwanted pregnancy and management of complications of unsafe delivery.
d) Investigation facilities for the referred cases of RTI and STI along with other ailments.
e) At all level of service outlets from Subcentre onward will be manned by qualified personnel as relevant to the infrastructures
f) Convergence, integration with similar other projects
g) Resource generation by local bodies for sustainability
h) To establish a strong viable referral mechanism
i) By enhancing the capacity building for better management at all levels including training on Clinical, Administrative, Financial and Logistics.
j) Logical frame work of RCH under UHIP, KMDA
k) Disease surveillance – infectious and non-infectious
3. The performance indicators of six ULBs under UHIP for 2003-04 vis-à-vis other ULBs in the context of base line survey and end line survey as given below will highlight the impact of UHIP on the key indicators :-
Indicator / Baseline / ** Endline Evaluation Survey (2002) / Achievement (2003-2004) / Achievement for 6(six) ULBs under UHIP(2003-2004)
Crude Birth Rate (CBR) / 19.6 / 16.4 / 15.3 / 9.3
Crude Death Rate (CDR) / 5.9 / 5.8 / 4.5 / 2.9
Infant Mortality Rate (IMR) / 55.6 / 25.6 / 21.7 / 15.6
Maternal Mortality Rate (MMR) / 4.6 / - / 0.6 / 0.2
Couple Protection Rate (CPR) / 45.0% / 75.0% / 77.4% / 78.8%
Contraceptive Prevalence among couples having less than 2 children / * / - / 49.4% / 54.2%
Pregnant Women having 3 antenatal visits / * / - / 90.4% / 87.3%
Institutional Deliveries / 53.9% / 90.0% / 91.7% / 94.9%
No. of women using OP for more than 6 months / * / - / 88.5% / 86.1%
No. of women using IUD for more than 6 months / * / - / 71.3% / 72.3%
* The data have been introduced during the implementation of the Project as required by the World Bank, as such Baseline data not available.
** Conducted by Ministry of Health & Family Welfare, Govt. of India.
Institute for Research in Medical Statistics.
ICMR, New Delhi-1100019
The current status of the important activities taken up to strengthen, upgrade and extend the existing Health delivery system in the six Municipalities are summarized below : -
4. Component No – I - Upgradation of HAUs
23 identified Health Administrative Units with 143 Subcentres in the six Municipalities who are presently delivering Primary Health Care Services along with some amount of basic clinical services have been proposed to be upgraded to render the following services under UHIP : -
i) Specialised service delivery for detection and management of RTI and STI cases.
ii) Safe MTP services a) upto 10 weeks at HAU level (beyond 10 weeks at Maternity Home).
iii) Preliminary laboratory investigations for screening of RTI and STI cases.
iv) Organising female sterilisation/ IUD insertion .
v) Training programme to the service providers of the area.
The Current status is as follows :-
Sl. No. / Name of the Municipality / No. of HAU to be upgraded / No. of upgraded HAU where UHIP services operationalised / No. of HAU under upgradation1. / Bhadreswar Municipality / 4 / 3 / 1
2. / New Barrackpore Municipality / 3 / 2 / 1
3. / Naihati Municipality / 3 / 1 / 2
4. / South Dum Dum Municipality / 6 / 4 / 2
5. / Madhyamgram / 3 / 2 / 1
6. / North Barrackpore / 4 / 1 / 3
· The performance report of the renovated HAUs in respect of introduction of additional services under UHIP from April 2004 to August 2004 is annexed.
5. UPGRADATION OF MATERNITY HOME
Sl. No. / Name of the Municipality / No. of Mat. Home to be upgraded / No. of upgraded Mat. Home where UHIP service Operationalised / No. of Mat. Home under upgradation1. / Bhadreswar Municipality / 1 / 1 / -
2. / New Barrackpore Municipality / 1 / 1 / -
3. / Naihati Municipality / 1 / 1 / -
4. / South Dum Dum Municipality / 1 / 1 / -
5. / Madhyamgram Municipality / 1 / 1 / -
6. / North Barrackpore Municipality / 1 / 1 / -
· The performance report of the upgraded Maternity Homes for 2003-2004 is enclosed
6. UPGRADATION OF REGIONAL DIAGNOSTIC CENTRE
Sl. No. / Name of the Municipality / No. of RDC to be upgraded / No. of upgraded RDC where UHIP service Operationalised / No. of RDC under upgradation1. / Bhadreswar Municipality / 1 / 1 / -
2. / New Barrackpore Municipality / 1 / 1 / -
3. / Naihati Municipality / 1 / 1 / -
4. / South Dum Dum Municipality / 1 / - / -
5. / Madhyamgram / 1 / - / -
6. / North Barrackpore / 1 / - / 1
· The performance report of the upgraded RDC for 2003-2004 is enclosed.
SCHOOL HEALTH PROGRAMME (1ST PHASE)
School Health Programme was started in the six identified municipalities with the training of Primary School teachers and Medical teams.
In the 1st phase 120 Primary Schools located within and near the slums ware decided to be taken up to focus on the poor and vulnerable. The remaining Primary Schools located in the similar situation would be taken up in the last phase.
The coverage of students in the 1st phase is 14981 out of which 7421 boys and 7560 girls. For each student the programme would be for three years with necessary support of referral services. So far 120 Primary Schools in six identified municipalities have been visited. 2631 were treated on the spot and 1232 students were referred.
- Student health card has been issued to each student examined.
- Backup services are being provided by the ESOPD and RDC.
- A Monitoring Committee has been constituted at the ULB level.
In the 2nd phase started from Septermber,2004 the remaining schools have been taken up at a budget of Rs.. 4,92,500 for the activity.
The programme has been going on and expected to be completed within November, 2004.
7. Training at different levels.
7.1. CAPACITY BUILDING – MANAGEMENT
Sl. No. / Name of the Municipality / Categories of Trainee (No) / Total NumberAdministrative / Financial / Logistic
1. / Bhadreswar / 3 / 1 / 4 / 8
2. / Madhyamgram / 2 / 3 / 5 / 10
3. / Naihati / 2 / 1 / 3 / 6
4. / New Barrackpore / 4 / 2 / 2 / 8
5. / North Barrackpore / 3 / 1 / 4 / 8
6. / South Dum Dum / 2 / 1 / 3 / 6
Total / 16 / 9 / 21 / 46
7.2. CAPACITY BUILDING – SERVICE
Sl. No. / Name of the Municipality / Training of Trainers / Categories of Trainee (No)Grass root level workers
HHWs / FTS / STS / GNM / Total Number
1. / Bhadreswar / 6 / 115 / 23 / 6 / 1 / 145
2. / Madhyamgram / 8 / 95 / 19 / 6 / 1 / 121
3. / Naihati / 3 / 100 / 20 / 3 / 1 / 124
4. / New Barrackpore / 7 / 75 / 15 / 5 / 1 / 96
5. / North Barrackpore / 7 / 111 / 24 / 5 / 1 / 141
6. / South Dum Dum / 8 / 200 / 41 / 5 / 1 / 247
Total / 39 / 696 / 142 / 30 / 6 / 874
8. Activities of IEC (April 2003 to March, 2004).
Awareness Programme
Sl. No. / Name of the Municipality / Methods of communication / Total No. heldIPC / Group meeting/ Mothers’ meeting / Folk Media
*
(Folk song, music, drama & dancing dolls etc) / Exhibition/ Seminar
1. / Bhadreswar / 1815 / 48 / 51 / 6 / 1920
2. / Madhyamgram / 1915 / 42 / 32 / 6 / 1995
3. / Naihati / 1305 / 37 / 33 / 5 / 1380
4. / New Barrackpore / 1662 / 35 / 19 / 6 / 1722
5. / North Barrackpore / 1722 / 38 / 33 / 7 / 1800
6. / South Dum Dum / 2706 / 52 / 35 / 6 / 2799
Special emphasis has been given on Male participation in F.W. Programme and training of adolescent boys and girls. Training to the Trainers who are entrusted for training of HHWs were also organized. Awareness programmes were also organized by way of International Communication, Group meeting / Mothers’ meeting, Folk media, exhibition / seminar totaling number –11,616. In addition all IEC printed materials such as MIES Formats, Family Health Card, Antenatal card, ECCR, Student Examination Card, Folder etc. are also done and distributed in six identified municipalities. Repainting of Hoardings situated in 6 UHIP municipalities have also undertaken by IEC (UHIP). One set of photographic exhibition consisting of 8 panel boards has been prepared and supplied to the respective ULBs.
9. Development of an effective MIES for monitoring the UHIP Services:
To ensure effective monitoring of UHIP Services for maximum output formats have been devised for reporting at different levels. Training has been imparted to the grass root level workers, medical and para-medical staff to fill-up the newly devised formats as well as data validation. Steps have been taken to computerize the entire Health Information System from the block level to KMDA Headquarters. The Centre for Implementation of Integrated Technology, KMDA has been entrusted with the task of training the workers on handling the computerized data base and development of a software compatible with the needs of UHIP. The whole system is expected to be in place within September, 2004.