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.
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 5 2 4 31 2 39 2 Barnala 0 4 8 3 15 3 Bathinda 2 9 17 3 31 4 Faridkot 1 4 8 0 13 5 Fatehgarh 1 4 13 1 19 Sahib 6 Ferozepur 3 8 31 3 45 7 Gurdaspur 2 15 38 2 57 8 Hoshiarpur 3 10 29 3 45 9 Jalandhar 2 10 26 3 41 10 Kapurthala 2 4 10 3 19 11 Ludhiana 4 9 28 5 46 12 Mansa 1 4 12 2 19 13 Moga 0 5 20 2 27 14 Mohali 1 3 13 0 17 15 Muktsar 2 5 14 3 24 16 NawanShahar 1 3 15 2 21 17 Patiala 3 11 29 0 43 18 Ropar 1 2 12 2 17 19 Sangrur 4 6 27 4 41 20 Tarn Taran 1 9 20 2 32 5 36 129 396 45 611
Physical Achievement of NRHM: Out of a target of 174790 the achievement up to December 2011 was 58753 (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) 2012-13 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) 27175000 13587500 815250 285338 79895 148376 54214 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 2011-12. Year Medical Officer Staff Nurse Para Medical Staff 2011-12 upto January 289 479 635
List of Trained Staff in TOT 2011-12 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 98784-19693 Dr. Rama Garg 94632-07688 Dr. M.S. Dhaliwal Dr. Neena Gupta 98140-81830 98141-29357 Dr. Shivali Aggarwal 94643-59359 Dr. Anju Singla Dr. Sumandeep 94174-49154 98761-78390 Dr. Ritu Banga Dr. Bhupinder Kaur 98728-96448 94635-43726 Dr. Manjeet Kaur Dr. Harpreet Kaur 98148-01503 94174-45398 Dr. H.S. Gill Dr. Kulwinder Kaur 98155-04077 98152-46911 Dr. Geeta Dr. Anantjit Kaur 94170-06080 98150-66733 Dr. Alka Mittal 98551-00261 Dr. Iqbal Dr. Tamana 98145-36863 98149-70505 -- Dr. Parveen 99883-83140 Dr. Murari Lal Dr. Alka Goyal 98143-56633 98155-78218 Dr. Jagroop Singh Dr. Neelu Koura 98724-26950 94172-78732 Dr. Satish Kumar Dr. Kavita Gawri 98142-15614 80549-23004 Dr. L.R. Jain Dr. Dheera Gupta 98551-64430 98550-57998 Dr. Monica Gupta Dr. Tapinderjot 98149-31161 Dr. Neerja Puri 98146-16427 Dr. Naresh Bansal 94171-15210 Dr. Ravi Saini 94172-78811 Dr. R.K. Gupta 94170-10394 94173-44644 Dr. Jasbir Singh Aulakh 98723-78855 Dr. Shweta 98722-21312 Dr. Ritu Mittal 98728-14381 Dr. Asha Kiran 94176-82173 Dr. Surinder 98140-65527 Dr. R.S. Butter 95018-33665 -- -- Dr.Kajal Dhingra, 93569-30460 Dr. Inderjit Singla 98882-69466 Dr. Goldy Chhabra 94634-48383 Dr. Ravinder Pal Kaur, 98146-85405 Dr. Davinder Kataria 96464-85400 Dr. Bindu Nalwa 98557-21034 Dr. Madhurima Chawla 98159-04424 Dr. Kuldeep Singh 98144-98680 Dr. Nirwair Singh 98140-38889 Dr. Baljit Singh 81464-62300 -- Dr. Sanjeev Kumar Hans, 99880-01056 Dr. K.S. Sandha 98765-02380 Dr. S.P. Surila 94171-77883 Dr. Neeraj Jindal -- 94176-91818 Dr. Ramesh Kumar Dr. Jagraj Singh 98882-50050 98143-22718 Dr. Ritu Jain Dr. Anupam Bansal 94640-94682 98158-99963 -- Dr. Sandeep Kumar 98154-37032 Dr. Mrinalini Dr. Ashok Monga, MO 98729-68884 CHC Bhucho mandi, 94634-64041 Dr. Harjinder Kaur 93572-52094 Dr. Bhalinder Singh Gill 88720-93355 Dr Sushma Thakur, Dr. Reenu Singla 99140-12681 99142-60210 -- Dr. Harbhajan Singh 94174-37211 -- Dr. Arun Sharma 98761-46538 Dr. Satish Dugal
CH, Gurdaspur CH, Hoshiarpur CH, Kapurthala CH, Jalandhar CH, Tarn Taran Dr. Rana Verma 94170-32688 Dr. Sham Sunder 94171-24488 Dr. Princejit Singh 98762-95191 Dr. Anoop Kumar 98144-30158 Dr. Brenna 98154-21898 Dr. Ravinder Kaur 98155-54427 Dr. Tejinder Kaur Tung, Batala 98143-34330 Dr. Bhupinder Jeet Kaur 81461-1556 Dr. Rajinder Raj 95018-35572 Dr. Ritu Narad 81460-43400 Dr. Simmi Dhawan 98159-86369 Dr. Varinder 98725-12260 Dr. Balwinder Kaur 98727-43370 Dr. Jaspreet Singh, 95010-20750 Dr. Seema Garg 98155-51674 Dr. Prem Kumar 98151-85898 Dr. Davinder Virdi 98154-21898 Dr. Damini 95010-44661 Dr. Jagjiwan Lal 98140-37798 Dr. Chuni Lal 98720-44737 Dr. Chaman Lal Sharma 98143-19206 Dr. S.S. Cheema 98728-61472 Dr. Tarsem 94632-84321 Dr. Maninder Minhar 96460-65158 Dr. Surjit Singh Chhina 88720-94726 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 2010-11. Till now the drug kits were being supplied directly by NACO but in this FY 2012-13 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 2011-12 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 2011-12: 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) 4747200 1622391
Fund Proposed for the STI/RTI services in 2012-13. Activities Fund proposed in the PIP (in Lacs) for 2012-13 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 44.57 12.83 L 130.15 L 5:4 L 22.85 L 7.41 L Total Budget in PIP 218.04 Detailed break up of fund proposed in 2012-13 Schedules of Approximate Price (Per No. required cost procurement (Kit No.) Kit) (Rs.) I (Kit-1) 22 18162 399564 II (Kit-2) 8 48074 384592 III (Kit-4) 36 2137 76932 IV (Kit-5) 26 5342 138892 V (Kit-6) 42 21367 897414 VI (Kit-7) 42 1069 44898 VII (Kit-3)-Inj. Benz 16 Penicillin 10684 170944 VIII (Kit-3) Tab Azithro 12 10684 128208 IX(Kit-3)-Dispo Syringe 4 & Needle 10684 42736 TOTAL COST 2284180 RPR TESTING KIT REQUIREMENT FOR NRHM 2012-13 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 148376 74188 527000 263500 337688 7504 9005 Approx cost/kit in Rs. Total cost in Rs. No of RPR kits 9005 60 540300
Subject: STI/RTI Service Delivery. S.N O Activity Details of Activities Remarks Comments Funds to be budgeted in PIP 2012-13 (Rs. In lakh) 1 Training Detailed activities to be put 44.57 2 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. 12000/- 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. 2000 per facility) Proctoscope Rs.1000 per piece Cuscus Vaginal Speculum @Rs. 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 jar @Rs. 200 per jar 5 jar/sdh/year 3 jar/chc/year 2 Jar/PHC/Year Medical Waste Disposal Bins @ Rs. 200 per Bin Four differently coloured bins per PHC for 446 PHCs. 73.32 36.66 12.22 4.38 3.57
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 130.15 6.00 3.00 2 Institution to be covered per visit Average 15 visit per year Per Visit: Honorarium Rs. 500+ 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. 500 + POL Rs. 2000 (Average) Total Funds PRPOSED 12.83
S.N O Activity Details of Activities Remarks Comments Funds to be budgeted in PIP 2011-12 (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 leaflets @Rs. 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 *24 @ Rs.5.00 Each) for 446 PHCs Infection Control Chart: (1200 posters) for 446 PHCs Medical Waste Disposal Chart:(1200 posters) for 446 PHCs 1.30 0.75
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 *24 @Rs.5.00 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 models @ Rs. 30.00. 3 models per 1 model per PHCfor 446 PHCs 1 model per SC for 2950 SCs 1.20 Counseling Flip Books. 1.80
Total Funds PRP OSE D (1200 Flip Book) Size 12 *8 @ Rs.150 3 flip books per. 1 flip Book per PHC for 446 PHCs. Sign Board: (1200 Sign Boards) Size 18 *24 @ Rs. 150 3 Sign Board per 1 Sign Board per PHC for 446 PHCs. 1.80 7.41