RTI / STI under NRHM (sub-district health facilities) STIs/RTIs present a huge burden of disease and these adversely affect the reproductive health

Transcription

1 RTI / STI under NRHM (sub-district health facilities) STIs/RTIs present a huge burden of disease and these adversely affect the reproductive health of people. As per STI prevalence study (2003) over 6% of adult population in the country suffers from STI/RTIs. These cause suffering for both men and women but their consequences are far more widespread among women than among men. These infections often go undiagnosed and untreated, and when left untreated, they lead to complications such as infertility, ectopic pregnancy and cervical cancer. Pelvic inflammatory diseases (PID) arising from STI/ RTIs poses a major public health problem and adversely affects the reproductive health of poor and untreated women. It also compromises with contraceptive adhesion. In fact STI/ RTI rank second as the cause of healthy life lost among women of reproductive age group, after maternal morbidity and mortality. For providing STI/ RTI services syndromic case management (SCM) is the corner stone of STI/ RTI management, which is also approved by WHO. This approach classifies STI/ RTI into syndrome (easily identifiable group of symptoms and signs) and provides treatment for the most common organisms causing the syndrome. Implementation of standardized SCM simplifies training, supervision, reporting and drug management. The technical strategy reflected in the RCH programme (PIP) aim to create primary health care delivery system to improve the health of women and children s Government of India guidelines for 24 hrs. RCH services by PHCs, list services of for prevention of STI/ RTI as a major package.

2 Implementation of STI/ RTI programme NACO is implementing at district level and at sub-district level it is implemented by NRHM by utilizing existing health care infrastructure. Under NRHM, district RCH officer is responsible for implementation of programme in the district. The programme is being implemented at all sub-district health facilities i.e. Sub-divisional Hospital, CHCs, PHCs, Block PHCs and Rural Hospital by supplying colour coded STI/ RTI drug kits and test kits and fulfill minimum standards of STI/ RTI service delivery. NRHM Facilities S.No. District Satellite SDH CHC PHC RH(PHC) Total Hospitals(PHC) 1 Amritsar Barnala Bathinda Faridkot Fatehgarh Sahib 6 Ferozepur Gurdaspur Hoshiarpur Jalandhar Kapurthala Ludhiana Mansa Moga Mohali Muktsar NawanShahar Patiala Ropar Sangrur Tarn Taran

3 Physical Achievement of NRHM: Out of a target of the achievement up to December 2011 was (44.8%). The achievement was less due to non-reporting/ nil reporting by some of the facilities. State PUNJA B Total PHYSICAL TARGETS FOR STI/RTI (NACO, NRHM, PVT SECTOR) Projected Adult STI/RTI Populatio Populatio Episodes n 2011 n(50%) (6%) Total STI/RTI targets for gov. health facilities (35% of estimated STI/RTI episodes in the State) NACO Targetfor Designate d STI/RTI clinics ( 28% of the total STI/RTI targets for gov. health facilities ) NRHM Targets 52% of the total STI/RTI targets) Private Sector Targets 19% of the total STI/RTI targets) NRHM backward districts in RTI/ NACP high NACP- Proposed New High prevalence Disricts STI prev. dist. Muktsar Ldh Moga Nawanshahr Bhathinda Patiala Faridkot Jalandhar NRHM Trainings: Rupnagar Mohali (Sahibzada Ajit Singh Nagar) Nawanshahr(Shahid Bhagat Singh Nagar) Tarn Taran Amritsar Ferozpur Faridkot Gurudaspur Hoshiarpur Jalandhar The TOT for training of NRHM staff (MOs/ SNs/ LTs) has been done by PSACS and following staff were trained in Year Medical Officer Staff Nurse Para Medical Staff upto January

4 List of Trained Staff in TOT Name of the District GMC, Patiala MKH, Patiala CH, Sangrur CH, Fatehgarh Sahib CH, Roopnagar CH, Nawanshahar CH, Ludhiana CH, Mohali GGSMC, Faridkot CH, Faridkot CH, Moga CH, Muktsar CH, Bathinda CH, Barnala CH, Ferozepur CH, Mansa GMC, Amritsar CH, Amritsar Name of Doctors with Phone Numbers Dept. of Skin Dept. of Gynae Dept. of Pathology RCH Officer Dr. R.K. Bahl Dr. Rama Garg Dr. M.S. Dhaliwal Dr. Neena Gupta Dr. Shivali Aggarwal Dr. Anju Singla Dr. Sumandeep Dr. Ritu Banga Dr. Bhupinder Kaur Dr. Manjeet Kaur Dr. Harpreet Kaur Dr. H.S. Gill Dr. Kulwinder Kaur Dr. Geeta Dr. Anantjit Kaur Dr. Alka Mittal Dr. Iqbal Dr. Tamana Dr. Parveen Dr. Murari Lal Dr. Alka Goyal Dr. Jagroop Singh Dr. Neelu Koura Dr. Satish Kumar Dr. Kavita Gawri Dr. L.R. Jain Dr. Dheera Gupta Dr. Monica Gupta Dr. Tapinderjot Dr. Neerja Puri Dr. Naresh Bansal Dr. Ravi Saini Dr. R.K. Gupta Dr. Jasbir Singh Aulakh Dr. Shweta Dr. Ritu Mittal Dr. Asha Kiran Dr. Surinder Dr. R.S. Butter Dr.Kajal Dhingra, Dr. Inderjit Singla Dr. Goldy Chhabra Dr. Ravinder Pal Kaur, Dr. Davinder Kataria Dr. Bindu Nalwa Dr. Madhurima Chawla Dr. Kuldeep Singh Dr. Nirwair Singh Dr. Baljit Singh Dr. Sanjeev Kumar Hans, Dr. K.S. Sandha Dr. S.P. Surila Dr. Neeraj Jindal Dr. Ramesh Kumar Dr. Jagraj Singh Dr. Ritu Jain Dr. Anupam Bansal Dr. Sandeep Kumar Dr. Mrinalini Dr. Ashok Monga, MO CHC Bhucho mandi, Dr. Harjinder Kaur Dr. Bhalinder Singh Gill Dr Sushma Thakur, Dr. Reenu Singla Dr. Harbhajan Singh Dr. Arun Sharma Dr. Satish Dugal

5 CH, Gurdaspur CH, Hoshiarpur CH, Kapurthala CH, Jalandhar CH, Tarn Taran Dr. Rana Verma Dr. Sham Sunder Dr. Princejit Singh Dr. Anoop Kumar Dr. Brenna Dr. Ravinder Kaur Dr. Tejinder Kaur Tung, Batala Dr. Bhupinder Jeet Kaur Dr. Rajinder Raj Dr. Ritu Narad Dr. Simmi Dhawan Dr. Varinder Dr. Balwinder Kaur Dr. Jaspreet Singh, Dr. Seema Garg Dr. Prem Kumar Dr. Davinder Virdi Dr. Damini Dr. Jagjiwan Lal Dr. Chuni Lal Dr. Chaman Lal Sharma Dr. S.S. Cheema Dr. Tarsem Dr. Maninder Minhar Dr. Surjit Singh Chhina STI/ RTI Drugs: These were received in all the districts except for Barnala, Bathinda & Moga and were distributed to the sub-district level health facilities. District Ropar has received it in 2009 but not in Till now the drug kits were being supplied directly by NACO but in this FY NRHM will procure and supply the drugs & kits and the budget has been proposed in the PIP as per guidelines of NACO. Coordination Meeting with PSACS: During convergence meeting were held with focal persons STI PSACS every month regarding reporting, training and colour coded kits supply etc. Budget in PIP: Allocation of fund for STI/RTI services in the PIP : Activities Fund allocated in the PIP (in Lacs) Expenditure till date (in Lacs) Training of Doctors, Nurse and Laboratory Technician (Training cost, printing of module, stationary, venue etc)

6 Fund Proposed for the STI/RTI services in Activities Fund proposed in the PIP (in Lacs) for Training of Doctors, Nurse and Laboratory Technician (Training cost, printing of module, stationary, venue etc) Monitoring and supervision of the facilities Upgrading of infrastructure of the facilities (audiovisual privacy, examination facilities, speculum, gloves etc) RPR test Kits Colour coded STI/RTI drug kits IEC/BCC L L 5:4 L L 7.41 L Total Budget in PIP Detailed break up of fund proposed in Schedules of Approximate Price (Per No. required cost procurement (Kit No.) Kit) (Rs.) I (Kit-1) II (Kit-2) III (Kit-4) IV (Kit-5) V (Kit-6) VI (Kit-7) VII (Kit-3)-Inj. Benz 16 Penicillin VIII (Kit-3) Tab Azithro IX(Kit-3)-Dispo Syringe 4 & Needle TOTAL COST RPR TESTING KIT REQUIREMENT FOR NRHM State Name NRHM STI target Coverage 50% Estimated no of pregnancies Coverage 50% Total coverage of RPR testing RPR Test Kits (50 Test per Kit with 10% wastage) Total RPR Kits Required (with 20% buffer) PUNJAB Approx cost/kit in Rs. Total cost in Rs. No of RPR kits

7 Subject: STI/RTI Service Delivery. S.N O Activity Details of Activities Remarks Comments Funds to be budgeted in PIP (Rs. In lakh) 1 Training Detailed activities to be put Infrastructure Strengthening up by training wing Each of the Health Facilities to have audiovisual privacy(partition), facility for examination(examination Table, flexi lamp etc), instruments (speculum, proctoscope) and infection mechanism. Infrastructure money should be beed based. Each Health Facility to be assessed for infrastructure and accordingly existing gap may be filled through PIP. Audio- Video privacy: a separate enclosure/cabin/partition with wash Basin, cabin fan etc. to be provided in the STI/RTI clinic room for examination and advice/councelling etc. at an average estimated cost of Rs /- per facility for total 611 facilities: SDHs: 36 CHCs:129 PHCs:446 Examination table & flexi lamp: Estimated cost Rs. 6000per facility. Instruments: (at average estimated cost of Rs per facility) Proctoscope Rs.1000 per piece Cuscus Vaginal 250 per piece 8 per SDH for 36 SDHs 6 per CHC for 129 CHCs 3Per PHC for 446 PHCs Infection Control mechanism: Hypochlorite solution 5litre 200 per jar 5 jar/sdh/year 3 jar/chc/year 2 Jar/PHC/Year Medical Waste Disposal Rs. 200 per Bin Four differently coloured bins per PHC for 446 PHCs

8 Total Funds PRPOSED 3 Mentoring and supportive Supervision Each of the Health Care Facility in the district to be mentored by the STI mentors once in every six month. RCH Officer from the district and RCH officer from state to monitor at least 25% of Health Facilities every six month. TA, DA for the STI mentors, district & state RCH /MH Officer to be put in PIP. For Mentoring: Four district level STI/RTI trainers will function as District Mentors. 2 Institution to be covered per visit Average 30 visits per year TA/DA for Mentors: Honorarium Rs, 500 per visit +POL average Rs. 500 per visit (Govt. Vehicle@ Rs. Per 6 km) TA/DA for Supportive Supervision District level: By District Nodal Officer STI/RTI Institution to be covered per visit Average 15 visit per year Per Visit: Honorarium Rs POL Rs. 500 (average) 3.83 State Level: By State Nodel Officer STI/RTI + Any other officer nominated 2 Institution to be covered per visit 153 Visits per year Per Visit: Honorarium Rs POL Rs (Average) Total Funds PRPOSED 12.83

9 S.N O Activity Details of Activities Remarks Comments Funds to be budgeted in PIP (per in lakh) 4 IEC and job AIDS Leaflets, posters and other education material to be budgeted for the patients. Job AIDS like syndromic wall posters, anaphylaxis chart, STI counseling flip book, infection control chart etc. Funds for printing of IEC material and job aids to be put in PIP. Leaflets for Patients: 2.50 lakh 0.60 paisa Posters for public (2 types): (15000posters) 50 posters per DH for 21 DHs 30 posters per SDH for 36 SDHs 30 posters per CHC for 129 CHCs 20 posters per PHC for 446 PHCs Syndromic Wall Posters: (1200 posters) Size 18 Rs.5.00 Each) for 446 PHCs Infection Control Chart: (1200 posters) for 446 PHCs Medical Waste Disposal Chart:(1200 posters) for 446 PHCs

10 Anaphylaxis Chart: (1200 posters) for 446 PHCs Oath of Confidentiality Chart: (1200 Chart) for 446 Counceling Checklist chart: (1200 Chart) for 446 Condom Demonstration Chart: (4000 charts) Size 18 3 charts per 1 chart per PHC for 446 PHCs 1 chart per SC for 2950 SCs 0.20 Penis Model for condom Demonstration: 4000 Rs models per 1 model per PHCfor 446 PHCs 1 model per SC for 2950 SCs 1.20 Counseling Flip Books. 1.80

11 Total Funds PRP OSE D (1200 Flip Book) Size 12 Rs flip books per. 1 flip Book per PHC for 446 PHCs. Sign Board: (1200 Sign Boards) Size 18 Rs Sign Board per 1 Sign Board per PHC for 446 PHCs