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Facility surveys were carried out for District Hospitals, Sub District

Hospitals, Community Health Centers and Primary Health Centers in

the state. Facility survey was not carried out for sub centers. The finding

of the surveys of District Hospitals, Sub District Hospitals, Community

Health Centers and Primary Health Centers were used for district levelplanning followed by state planning. The extent of deficiencies in

existing levels of available facilities and services like availability of

building to house the center, health worker, medical equipment,

medicine etc. for sub centers were identified with the help of the

meetings conducted at various levels during planning process. The sub

centers level deficiencies were identified with the help of the meetings

conducted at PHC level. A complete set of requirements were prepared

at block health office level by consolidation of the requirements at

different levels within the block.

Para 1.3.7.1

Facility survey was not carried out for any Sub Centre in the State till March-2009

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All the districts had prepared the District Health action Plan by considering the

need for the healthcare services including the sub centers, primary health

centers, community health centers and block health offices. All the DHAPs were

prepared by considering the demands and requirements for better healthcare

delivery at every level.

All districts prepared their plan as per the generated demands at every levelincluding villages, sub centers, PHCs, CHCs and block health offices. The

requirements raised by the lower level were consolidated at block level and these

requirements were taken into consideration while preparing the DHAPs.

All the requirements were considered during preparation of DHAPs but in some

districts these requirements and demands were not documented in form of the

Block Plans and Village level action plans.One of the important reasons is the lack of awareness at PRI level about the

NRHM framework. The state has started training and mentoring of village health

and sanitation committee members to build their capacity for making their own

village action plan. 3800 VHSCs were trained in the year 2009-10 and all VHSC

will be trained in three years. .In future the state will focus on documenting the

block plans and village level action plans in all the districts.

Para 1.3.7.2

District Health Action Plans were prepared without preparation of Block and Village Level

Plans

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As of 31 march 2009,funds of Rs.103.77 Crore remained

unutilised. Untied Fund and Maintenance Grant were not

released to any Rogi Kalyan Samities at Community Health

Centres during 2005-07 and 2005-09 respectively.

Para 1.3.8.1 & 1.3.8.2

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8.1-There is huge fund availability and flexibility for expenditure under

NRHM. The fund were distributed to lower level including Village Healthand Sanitation Committees, Rogi Kalyan Samities, Sub Centers etc. and

the autonomy have also been given to the lower level staff. There were

delays in expenditure or low expenditure as lower level staff suddenly got

the autonomy for huge funds. The expenditure trend for NRHM is

showing that the state is having good absorbent capacity for NRHM

funds. The expenditure for the year 2007-08 was 58.72% where as it hasincreased to 92.62% (Un-audited) in the year 2008-09,and 80.39% (un

audited) in the year 2009-10.

State was having 273 CHCs and 1073 PHCs. There are different source

of money for facilities up gradation and new construction i.e. NRHM,

European Commission, State Budget, Donation etc. There are only 29

PHCs to plan for new construction. The details have given in the tablebelow as on 31st March 2009.

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8.2 Untied funds are meant to meet expenditure for local healthactivities while maintenance grant was meant for upkeep of

facilities and to ensure quality services at CHCs and PHCs. In

the year 2006-07 PHCs were maintaining account with joint

signature of medical officer and one of the PHC staff members.

The maintenance grant and untied funds were released in joint

accounts for up gradation of PHC environment.In the year 2005-06 no grant were released to CHCs and PHCs

because of the lack of clarity as it was the first year of the

mission. In the year 2006-07 the untied fund and maintenance

grant were provided by the district health societies to the CHCs as

per their demands. But in the year 2007-08 and 2008-09 the

untied funds and maintenance grants were released to the CHCsand PHCs. The expenditure for PHC Untied fund and Annual

Maintenance in the year 2009-10 is 91.28%,97.63%

respectively,and 104.62% for CHC Rogi kalyan samiti .

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Para 1.3.9.2 & 1.3.9.2.1

Infrastructure provided at health centre was inadequate at critical equipments

were found wanting in the Community Health Centres test checked

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9.2 There is a shortage of specialists and MBBS doctors in the state

because of which it is not possible to have specialists on each CHC and

MBBS doctors on each PHC. Because of the shortage of specialists, the

CHCs are run by one medical officer who can not manage criticaloperation theater.

State is in a quality improvement phase including infrastructure. State is

trying to upgrade its facilities as per the IPHS and NABH standards to

provide quality services to the community. Some of the CHCs are

developed in PHCs building and physical up gradation has been taken

up in a phased manner. That may have lead to unavailability of separate

wards for male and female at some of the CHCs. In Annual Development

Plan 2010-11 of state budget remaining 37 CHC and 26 PHC have been

sanctioned to fullfill the population standard. Also 50 CHC will be

upgrated as per IPHS standard.

Where the health centers are not functional because of lack of facilities;

the state has taken alternative ways to provide services to the community

in term of Chiranjeevi Scheme, EMRI-108 and Bal Sakha Scheme etc.

Total 721 Gynecologist has been enrolled under Chiranjeevi scheme to

provide maternal care and 322 Pediatrician has been enrolled under Baal

Sakha Yojna to provide child care.

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9.2.1 There is a shortage of specialists and MBBS doctors in the state because

of which it is not possible to have specialist on each CHC and MBBS doctors on

each PHC. Most of the CHCs are being run by the Medical Officers and some

PHCs by AYUSH doctors. Because of the above reasons; the operation theaters

are not functional in some of the health facilities and critical equipments were

absents. In 2009-10, 500 seats for undergraduates and 175 seats for Postgraduated has been increased and in 2010-11 it is planned to furhter increase

750 seats for Undergraduates and 347 seats for Postgraduates to fulfill the

gaps.

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Para 1.3.10.3

Vacancies of medical and para-medical staff in Community Health

Centres,Primary Health Centres and Sub-Centres in the State ranged

between 12 and 100per cent with refrence to sanctioned strength andbetween 16 and 100 per cent with refrence to Indian Public Health

Standards.

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As per the IPHS norms, there should be seven specialists in each CHC. The

state is not able to fulfill the requirement because of the shortage of specialists

in the state. The state has taken an alternative way to overcome the situation

and better healthcare provision for the community.

The state has started Public Private Partnership model to involve private

service providers. Chirnjeevi Scheme and Bal Sakha Scheme are the example

of PPP model adopted by the state.

Chiranjeevi scheme is to provide safe delivery services to the community by the

private service providers. Initially the scheme was started in five districts on

pilot basis and expended in the entire state later by seeing the success of the

scheme. All the expenses for these deliveries are paid by the government. Till

March 2010 total 467969 deliveries has been conducted under Chirnjeevi

scheme including 23651 complicated and 28252 cesarean deliveries. The state

has received many awards and appreciation for the scheme. 721 Gynecologist

has been enrolled under Chiranjeevi Yojna till march 2010,

Similarly Bal Sakha Scheme is to provide healthcare services to the Neonatesby the private pediatricians. 322 Pediatrician has been enrolled under Baal

Sakha Yojna and 66500 Neonates has been attended by them till march 2010,

There is a provision to call private specialist at public health facility to provide

better and free health services to the community under NRHM.

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Para 1.3.11.1

Printing work of Rs.1.08 crore was got executed without inviting open tenders

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Printing works amounting to Rs. 1.08 crores for 70,500 flip books for ASHAs (Rs. 66.27 lakh) and

50,000 Swarnim Gujarat calendars (Rs. 41.50 lakh) were awarded to M/s. Smart Graph Art

Advertisement Pvt. Ltd. Company, Ahemdabad and M/s. Gujarat Offset Pvt. Ltd., Ahemdabad

respectively (between December 2008 and March 2009) on quotation instead of inviting open

tenders.

The state formed a committee for the entire tendering process including major departments of thestate government for Swarnim Gujarat. The formed committee did the entire process of tendering

for printing of pamphlets, stickers and calendars for all the IEC work for Swarnim Gujarat. The

printing work of Rs. 41.50 lakhs were given to M/s. Gujarat Offset Pvt. Ltd. on the basis of the

letter by under secretary stating that the company and rates have been decided by doing the

complete procedure of tendering by the decided committee.

(The letter of Under Secretary is attached for your reference)

The permission for the same was taken by the Commissioner (Health), Joint Secretary (Medicalservices) and Principal Secretary (Health).

Involvement of ASHA is an important strategy under NRHM. The selection process was started in

December 2006 onward only in 11 tribal districts and for rest of the districts in September 2008.

The training of ASHA is an important component in the entire process of ASHA involvement. The

training flip books were required to train ASHAs on urgent basis.

The work for printing of the flip books was given to M/s Smart Graph Art Advertisement Pvt. Ltd.

Ahmedabad. The total cost of the printing for 30,000 flip books was Rs. 28,20,000 which was

done by inviting the quotations for fast process. To expedite the process of placing ASHAs into

the field the printing work was given by inviting quotations. The complete and correct process was

adopted in inviting quotation with the permission of Mission Director, NRHM.

The second order for 39,815 flip books of Rs. 38,07,000 was given on the basis of the first order

but these were not for ASHAs. These flip books were for Anganwadi workers and link works. The

cost of flip books for Anganwadi worker was Rs. 35,72,000/- and for Link worker was Rs.2,35,000/-.

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Para 1.3.11.2

Medicines worth Rs.1.45 Crore were purchased from two de-registered companies

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All the purchase from the deregistered companies are carried out as per the

rate contract done in the year 2006-07 and 2007-08 and that point of time

CMSO was not informed about the debarring/deregistration of the companiesas mentioned in the Annexure-A of File no Y11014/7/2008 St III, Directorate

General of Health Services (Medical Stores Organization) which is made

available in 2009.

As per the letter issued to The Director, NIC, MOH&FW, Delhi for the display

of deregistered/debarred companies on the website is written in the year

2009 which is sufficient to explain that all the information regardingderegistration/ debarring is made available in the year 2009 as per the

Annexure A&B of File no. Y11014/7/2008 St III, Directorate General of Health

Services (Medical Stores Organization).

After receiving the information of debarring/deregistration of companies as

per the Annexure A&B of File no Y11014/7/2008 St III, Directorate General of

Health Services (Medical Stores Organization), all the rate contract withdebarred/deregistered companies are cancelled and no further purchase will

be made from these companies in the future.

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Para 1.3.11.3

Printing work of Rs.1.44 Crore was got done by three black listed parties

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The entire rate contract process was done by the Health Education

Bureau (HEB) for the printing work and the orders were placed by the

HEB of Family Welfare branch.

Commissioner of Health, Medical Services and Medical Education (HS)

letter no.TB/382007/ATR/SGS Rpt/08 issued from TB branch for

blacklisting party was only for RNTCP programme. It is nothing to do with

other branches.These mentioned 11 parties were black listed by RNTCP

programme sub committee, Gujarat on the basis of small lapses in

procurement. These lapses were not actually serious malpractices. Thisprocurement review was done on the basis of international standards not

on the local availability and requirements. It is merely restricted to the

RNTCP programme subcommittee at state level and district level.

Because of which the information was not circulated to the other

branches of state health society and district health societies. It is difficult

of follow the international standards for other programmes. Otherprogrammes are having flexibilities and the rules are not very strict as

word bank guidelines which are for RNTCP

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Para 1.3.12.3

Number of pregnant women registered at any health centre in the State as a

whole indicated a decline as of 31 march 2009.Iron Folic Acid was administered

during 2008-09 to only 44 per cent of pregnant woment registered.The

achievement of Institutional Deliveries vis-a-vis the the target ranged between

63 and 82 percent during 2005-09

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Para 1.3.12.4

Annual targets for Pulse Polio Immunisation was achieved during the period 2005-09

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Due to the dedicated efforts of health team, our state has been able

to prevent polio cases. The effective Polio vaccination coverage

through routine immunization and pulse polio rounds has helped in

moving towards polio eradication. The state of Gujarat has notreported a single case of polio since 2 and half years. The state

has achieved more than 100% coverage trough booth and house

activities with effective utilization of Polio funds. The below

mentioned reasons can be the cause for more than 100%

Coverage.

Migration from other areas or state

As verification of age is not possible in the field, inclusion of

children older than 5 year of age may take place

The main aim of the pulse polio rounds is to cover every child with

two drops of polio vaccine & eradicate the disease

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Para 1.3.12.5

Percentage of vasectomy to the total sterilisations was a meager 2.92

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Male sterilization is always been an issue in sterilization services. In Gujarat

during the year 2005-06 and 2006-07 we have only 31 trained NSV surgeons

and NSV was not in practice. We have started focusing on male participation

and an extensive campaign was done in 2007-08. That year Gujarat has done

more than 20000 NSV and we got a 1st prize at national level for better

performance in male sterilization. But it was started in campaign mode just to

sensitized the system that the male sterilization can also be done. Now the

government is trying to bring this in routine family planning activities and our last

two years performance says that trend has already started after the extensive

campaign of 2007-08.During the year 2005-06 & 2006-07 the male participation

was only 0.2 and 0.1 percent. After that it was improved and in the year 2007-08

it was 6.65% and in 2008-09 it was 3.54%. This year in 2009-10 the total male

sterilization is 2.89% of total sterilization done in the state. Also to increase the

male sterilization, the mind set of the people is needed to be changed which is a

slow process. The state is focusing on extensive IEC/BCC campaign to bring

the change in the mind set of the people. The state is also determined to trainmore and more surgeons for NSV. In the year 2007-08 we have trained 128

doctors in NSV and now Gujarat is having more than 200 trained doctors for

providing NSV services. The Health & Family Welfare department is working on

the re positioning of the surgeons in the area where the male sterilization is in

practice.