Districts 20

Divisions 5

Sub divisions/ Tehsils 81

Towns 142

Blocks 144

Health Blocks 118

Inhabited villages 12,278

Punjab ProfilePopulation : 2.77 crores (2011 Census)

INSTITUTIONS GOVTSECTOR

PRIVATE SECTOR

Medical Colleges 3 6

Secondary Level Hospitals (District/ Sub-Divisional / Community Health Hospitals)

176 983

Primary Level Health Institutions (Primary Health Centres/ Clinics/ Poly-Clinics/ Dispensaries)

1761 3046

Sub-Centres at Village Level 2950 --

Mobile Hospitals 26 10

Total 4916 4045

CATEGORY INDIA PUNJAB

1Crude Birth Rate (per thousand)(SRS 2010 published in December 2011)

22.1 16.6

2Total Fertility Rate (SRS 2010 published in March 2012),NFHS-III (2005-06)

2.52.7

1.82.0

3Death Rate(SRS 2010 published in December 2011)

7.3 7.0

4Sex Ratio (per thousand)Census 2001Census 2011

933940

876893

5Sex Ratio (0 to 6 years) (per thousand)Census 2001Census 2011

927914

798846

6

Maternal Mortality Ratio (per lakh) live births(SRS data of 2001-03 published in 2005)(SRS data of 2004-06 published in April 2009)(SRS data of 2007-09 published in June 2011)

301254212

178192172

SN CATEGORY INDIA PUNJAB

7.

Infant Mortality Rate (per thousand) live births(SRS 2008 published in October 2009)(SRS 2009 published in January 2011)(SRS 2010 published in December 2011)

535047

413834

8.Any Ante Natal Care (%)DLHS – III (2007-08)CES 2009 published in 2010

75.289.6

83.395.3

9.

Ante Natal Care (%)(3 or more visits)NFHS-III (2005-06)DLHS – III (2007-08)CES 2009 published in 2010

5275.368.7

7565.173.4

10.Institutional deliveries (%)NFHS – III (2005-06)DLHS – III (2007-08)

4147

5363.3

11.

% age of children fully immunizedNFHS-III (2005-06)DLHS-III (2007-08)CES 2009 published in 2010

44.054.161.0

60.079.983.6

Year/Item 2007-08 2008-09 2009-10 2010-11 2011-12

Budget

Plan 103 95 169 150 315

Non Plan 686 739 930 1054 1344

Centrally Sponsored Schemes

162 173 218 246 277

Total (Rs. Cr) 951 1007 1317 1450 1936

Per capita Outlay (Rs.)

389 412 539 595 794

Expenditure

Plan 4 44 16 88 115

Non Plan 649 691 821 951 1133

Centrally Sponsored Schemes

105 158 211 278 305

Total (Rs. Cr) 758 893 1048 1317 1553

Per capita Expenditure (Rs.)

289 334 388 481 560

%age GSDP 0.52 0.51 0.51 0.54 0.56

• Director Health and Family Welfare

– Primary Health Care, Disease Control Programme, Regulations of Act (Food and Drug) and General Administration.

• Director Health Services (Family Welfare)

– Implementation of Family Welfare, Maternal RCH, Immunization, JSY and PNDT Act.

• Director Health Services (Social Insurance)

– Manages 7 ESI Hospitals, 70 ESI Dispensaries for the insured industrial and other workers.

• Punjab Health Systems Corporation

Manages 176 secondary level hospitals.

Main agency of the Department for infrastructure development.

• State Health Society

Manages and monitors implementation of NRHM in the state.

• Directorate of Ayurveda

– Manages 5 Ayurvedic Hospitals and 524 Ayurvedic Dispensaries.

– Licensing Authority of Ayurveda Manufacturing Units.

– Handles around 21 lac OPD patients per annum.

• Homoeopathy Directorate

– Manages 264 dispensaries and handles around 27.00 lacs OPD patients per annum.

• Punjab State AIDS Control Society

– Implement Government of India sponsored National AIDS Control Programme.

Infrastructure Development

• The Government of India in its 4th report of the Common Review Mission published in January, 2011 rated our health infrastructure as excellent and stated that the Punjab would be the first state to close the gap by 2012.

• Major initiatives for upgradation of infrastructure under the Core Plan.

Two district hospitals (Nawan Shahar, Muktsar under construction)

Five new Sub-Divisional Hospitals at Khadoor Sahib (complete), Bholath, Moonak, Tappa, and Guddha in advanced stage of completion and other 3 will be completed by 31.5.2012.

Upgradation of Sub-Divisional Hospitals at Baba Bakala and Badal to be completed by 31.5.2012.

• Construction of 32 new Community Health Centres. 10 to be completed by 30.4.2012 and the remaining 22 by 31.7.2012.

Manpower

• Major recruitment drive in the last two years Doctors recruited …

804 Doctors to be recruited by Aug 2012 …

525 Ayurvedic and Homoeopathy Doctors …

330 Staff Nurses …

1455 Paramedical Staff …

1600Total No. of doctors presently available … 2143

• Recruitment under process for 574 Specialist doctors, 518 Medical Officers, 114 Dental Doctors and 1650 paramedics.

Free Emergency Response Services

• 240 Ambulances operationalized.

• These Ambulances attend to trauma, medical emergencies and delivery cases.

• Daily 800 emergencies are attended. 1.60 lacs lives have been saved (till 14.4.2012).

• Total project cost is Rs.70 crore.

Advanced medical Equipment

• Aphersis machines, Blood separators, Phaco machines, Dialysis units, New Dental Chairs, Laboratory equipment provided in the hospitals.

Drug-De-addiction Centre

• 20 Bedded Drug De-addiction Centres operationalized at Talwandi Sabo. Drug De-addiction Centres in 7 district hospitals operationalized. In the remaining 13 districts, these would be operationalized in the current year.

• 252 Awareness camps were organized for school children by Homoeopathy Department.

Cancer Control Programme

•A corpus of Rs.30 crore was set up for financial assistance up to Rs.1.5 lac per cancer patient. 2329 patients were given assistance of Rs.25 crore.

Rashtriya Swasthya Bima Yojana

• An insurance cover of Rs.30,000/- to BPL families extended. 2.04 lacs BPL families enrolled. Rs.16 crore claims paid to the BPL families.State Illness Fund•A corpus of Rs.2.50 crore established to provide financial assistance to BPL families up to Rs.1.50 lacs for treatment of terminal illness. Trauma Centres•Three Trauma Centres at a cost of Rs.12 crore set up in Civil Hospitals, Pathankot, Amritsar and Jalandhar. 1 more at Khanna will be operational by May, 2012.

Nursing Schools

• 3 Nursing Schools i.e. at Jalandhar, Patiala and Amritsar were operationalized. 4 more at Gurdaspur, Bathinda, Sangrur and Ropar would be operationalized during the current year.

Super Specialty Cancer Hospital under PPP format• Two 200 bedded super specialty hospitals have been set up

under PPP format at Mohali and Bathinda. • 5% of the revenue to be paid by the private providers (MAX

Healthcare) to be utilized for treatment of poor patients

• The state signed a Memorandum of Understanding with Government of India on 15.6.2006 for implementation of NRHM in the state.

• The main aim of the NRHM is to fill critical gaps in the delivery of Rural Healthcare Services in terms of civil infrastructure, equipment and manpower.

• Implementation of Family Welfare, Mother and Child Healthcare Programmes alongwith selected Disease Control Programme in an integrated manner.

• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR).

• Universalize access to Public Health Services for Women’s Health, Child Health, Water, Hygiene, Sanitation and Nutrition.• Prevention and control of Communicable and Non-Communicable Diseases, including locally Endemic Diseases• Access to integrated comprehensive Primary Healthcare.• Ensuring population stabilization, gender and demographic balance.• Revitalize local health traditions and mainstream AYUSH.• Promotion of healthy life styles.

As per latest official figures published so far:-

• Infant Mortality Rate declined by 4 points from 38 in 2009 to 34 in 2010 as per SRS bulletin 2011 (very few states have achieved this target). IMR indicator of India is 47.

• Maternal Mortality Ratio has come down from 192 (2004-06) to 172 (2007-09) as per SRS bulletin 2011. MMR indicator of India is 212.

• Sex Ratio improved from 876 (Census 2001) to 893 (Census 2011). Sex Ratio of India is 914 (Census 2011).

• 2011-12 IS THE FIRST AND ONLY YEAR SINCE 2005-06 (The first year of start of NRHM in India)

during which fund utilization has been more than 100% over approved plan

Year Financial Achievements (Rs. in Crores)

Allocation/approved plan

by GOI

Expenditure %age over

allocation

2005-06 (100:0) 98.24 59.71 61%

2006-07 (100:0) 162.71 83.26 51%

2007-08 (85:15) 190.37 104.69 55%

2008-09(85:15) 272.44 186.97 69 %

2009-10(85:15) 252.90 220.84 87 %

2010-11(85:15) 382.52 317.11 83 %

2011-12(85:15) 365.83 375.78 103%

• Again, 2011-12 emerged as the First and only Year during which NRHM Punjab managed to get released additional Rs 22 Crore in excess of the approved GOI allocation to the state during the year as depicted below

Year Financial Achievements (Rs. in Crores)

Allocation/approved

plan by GOI

Receipts +/- receipts

2005-06 to 2009-10

844 738 -106

2010-11 283 251 -33

Sub Total 1127 989 -139

2011-12 276 298 +22

• Janani Shishu Suraksha Karyakaram - A new scheme - JSSK was introduced during 2011-12 for providing ‘Free Delivery Services’ to pregnant women. Under this scheme free admission, diagnostics, drugs, consumables, blood and referral transport are provided. Institutional Deliveries in Government Hospitals have registered phenomenal increase as shown below:.

Year Total Institutional Deliveries in Government Hospitals

Percentage Increase over last year

2008-09 66533

2009-10 87954 32.20

2010-11 114811 30.54

2011-12 157018 36.76

Janani SurakshaYojana- (Cash incentive to BPL mothers for institutional deliveries @ Rs.700 for Rural & Rs 600 for urban area and Rs 500 for home delivery)Under this scheme during 2011-12, there has been a spurt in number of beneficiaries availing benefits as shown below:-

Year Total JSY beneficiaries

Institutional Deliveries JSY

Percentage of Institutional deliveries

2008-09 67911 27561 41

2009-10 96721 42589 44

2010-11 107861 610610 56.5

2011-12 109405 81948 75

• Strengthening of healthcare deliveries specifically Emergency Obstetric Care in Community Health Centres and strengthening of 24x7 delivery services in Primary Health Centres.

• Establishment of 25 Blood Storage Units in 25 CHCs and in remaining 89 CHCs, the work is in progress.

• For proper implementation of these schemes, 19 Gynecologists, 24 Pediatricians, 40 Female Medical Officers, 1131 Staff Nurses and 1282 ANMs have been recruited on contract basis under NRHM.

National Vector Borne Disease Control Programme:For effective control of the endemic Dengue and

Malaria in the state.

National Iodine Deficiency Disorder Control Programme:

The Government of India has appreciated the efforts of the State IDD Cell in effectively implementing the programme and considers the model adopted as “Unique” in the country.• State and District IDD Labs established.• Survey completed in five districts (2011-12).

School Health Programme•Extensive School Health Check-ups in all 19810 (Government + Government aided/recognized) undertaken.

•Out of 33224 school visits planned, 32458 (98%) visits completed.

•Under this programme 22.80 lacs students were examined and advised to get services through State Health Network where ever required .

•School going children suffering from Congenital Heart Disease, Rheumatic Heart Disease, Cancer and Thalassemia are provided free treatment in PGI, CMC, DMC, Silver Oak, IVY and MD Oswal Cancer Hospitals – 735 RHD & CHD cases operated. 221 Cancer and 108 Thalassemia ailing children put on treatment.

ASHA (Community Level Healthcare)

• Total number of ASHAs selected : 16800 in villages.• Total number of ASHA Facilitators selected: 898• Total number of ASHAs trained : 16214• Total number of ASHAs provided with drug kits: 16463• State trainers have been trained • ASHAs have been provided with I-cards.• ASHAs have been provided with Uniform.• Bank accounts of ASHAs have been opened up and payment is being made through Bank account only

Infrastructure Upgradation under NRHM•Continuing the effort, infrastructure up gradation of Health Institutions (All DHs, 25 SDHs, 123 CHCs, 246 PHCs and 460 Sub- Centres) undertaken.•Civil Works of Rs. 90 crores completed and of Rs. 50 crores under progress• The Maternity Wards and Labour Rooms of the District Hospitals are being upgraded. 11 work completed.• Major Civil Work has been taken up in 3 SDHs Patti, Pathankot & Batala work has been completed.• CHCs Lehragagga being upgraded to 50-bedded Hospital at

the cost of Rs. 3.08 Crore• CHC Dhakoli (Mohali) has been taken up for major construction at a cost of Rs. 292.25 lakh work and the work is completed.

Infrastructure Upgradation under NRHM

Other important Civil Work under NRHM• Major Civil Work of 5 District Hospitals were undertaken. 4 Completed (Mohali, Ludhiana, Patiala & Bathinda) and 1 in progress (40% completed in Gurdaspur)• Civil Work at 211 PHCs undertaken. Work completed

140, Work assigned to Department of Rural Development 46. • Repair & Renovation of 253 Sub-Centres undertaken –

Work at 127 completed, rest in progress. • 207 New Buildings of existing Sub-Centres are being

constructed – 84 work completed.

• No polio case in the state since 2009.• 2nd doze of measles – launched on 20/12/2010. All children receive Measles-2 along with DPT Booster at the age of 1½ years.

DPT3 vaccine Measles vaccine

Full Immunization(children (12-23 month) receiving 1 dose BCG, 3 doses of DPT/OPV each and 1 measles vaccine)

DPT Booster Dose(children aged 18-23 months who received DPT booster dose)

India 71.5 74.1 61 41.4

Punjab 91.4 87.3 83.6 39.9

Ranking in country 3 7 1 17

Accessibility and promotion of Health Schemes

Service Guarantee •IEC & reference material for service guarantee designed and displayed for the service provider and community.•Unique Signages for the FRUs and 24x7 PHCs. •Protocol for EmOC displayed at labour room for reference.•IEC material on available services for community.•Radio & TV Spots, Print Media, Hoardings, LED Displays at prominent places and other folk media.

Mainstreaming of AYUSH

Ayurveda•524 Dispensaries and 5 (50-bedded) Hospitals, 7 ISM Wings in District Hospitals operational –Medical Officers & Dispensers provided alongwith that there is a provision of Rs. 50,000 for drugs for each institution.Homeopathy •111 Dispensaries operational –Medical Officers & Dispensers provided. Drugs worth Rs. 7 Lakh provided.Co-location under NRHM•Provision of one Ayurvedic Doctor and Dispenser in 236 PHCs (24x7), one Homeopathy Doctor & Dispenser in 114 CHCs and two Homeopathy Doctor & Dispenser 20 DHs•205 Ayurvedic doctors in PHCs and 104 Homeopathic doctors in CHCs recruited on contract basis under NRHM.•182 Ayurvedic Dispensers in PHCs and 107 Homeopathic Dispensers in CHCs recruited on contract basis under NRHM.

Proposed PIP Budget for the Financial Year 2012-13 Rs. in Crores

Part Scheme/Programme Proposed Amount

A RCH Flexible Pool 118.69

B&E NRHM Mission Flexible Pool 206.22

C Immunization and PPI Operation Cost 14.69

D NIDDCP 0.22

IDSP 2.78

NVBDCP 3.55

NLEP 1.84

NPCB 6.61

RNTCP 10.00

Proposed PIP Budget for the Financial Year 2012-13

Part Scheme/Programme Proposed Amount

(Rs in Crores)

Tobacco Control 0.67

Cancer Control 0.18

11 Direction & Admn. (Treasury route) 75.48

  TOTAL 440.93

New initiatives proposed in PIP 2012-13

• Free diagnostics through Mammography Units & cervical cancer among women.

• Setting up of New Born Stabilization Units at 10 DHs, 12 SDHs and 6 CHCs conducting more than 50 deliveries.• Infant Death Audit – approximately 16000 deaths apprehended.• Programme for Cancer Control – screening camps in districts –

1080 camps and IEC. • Tobacco Control Programme – public awareness material & mobility support.• Capacity Building Programme for management units under NRHM

i.e. Training of Government rules/ procedures etc. to all employees, employed under NRHM but never trained (Around 4,000)

• Dental check-up of all school going children.• Besides this, during discussion with GOI a pilot project on universal

screening of 40+age will be discussed to approve over and above the NRHM PIP.

Highlights of the proposed PIP 2012-13

• Implementation of Janani Shishu Suraksha Karyakaram, JSY and Family Welfare.• School Health Programme including routine check-up of all school going children and treatment of complicated diseases among children – CHD/ RHD, Thalassemia, Cancer etc. • Tracking Machines for 900 ultrasound centres.• Trainings - focusing on Maternal, Child Health and other programmes.• ASHA Programme – trainings, drug kits & incentives.• Mandatory Grants.

Highlights of the proposed PIP 2012-13

• Infrastructure up-gradation of 10 DH and 5 SDH based on NABH / ISO standards. • Construction of Maternity Ward at District Hospital Barnala and

OPD Block at Sub-Divisional Hospital Khanna.• Construction of new building of 40 Sub-Centres and repair and

renovation of 75 Sub-Centres. • Procurement and supply of equipment and drugs.• Contractual appointment of one AYUSH Doctor and Dispensers in all 24x7 PHCs (Ayurveda) in all CHCs, SDH and 2 in all DH (Homoeopathy).

Punjab Nirogi Yojana: Financial assistance to the tune of Rs. 1.50 lacs is being provided to BPL families for treatment of life threatening diseases

Rashtriya Swasthya Bima Yojana: Under this scheme, indoor medical care is being provided to a BPL family up to Rs.30000/- in the 147 Government and 185 Private Hospitals.

Establishment of Trauma Centre: It is a 100% Government of India sponsored scheme, 3 Trauma Centres has been set up and 1 is under completion.

Upgradation and Strengthening of Nursing Services (Human Resource Health): The Government of India has sanctioned Rs.50 crore for establishment of 5 Nursing Schools in the District Hospitals.

Strengthening of Teaching Facilities in Government Mental Hospital, Amritsar : This is a 100% centrally sponsored scheme.

Mainstreaming of AYUSH under NRHM for procurement and supply of essential drugs:

Upgradation of AYUSH hospitals.

Strengthening of Drug Testing Laboratory of Ayush.

Establishment of ISM & H Wing of District Allopathic Hospitals.

Establishment of 116 OPD clinics in PHCs.

Upgradation of Government Ayurvedic Dispensaries.

• Providing Hotline facilities in the District and Sub Divisional Hospitals

• Strengthening of Logistic Services

• Strengthening of Hospital Management Information Systems

• Strengthening of Fire Safety Services

• Strengthening of Drug De-addiction Centres

• Cancer Relief Fund

• Strengthening of Urban Health Infrastructure

• Establishment of Mobile Cancer Detection Units

• Incentive for delivery under Mata Kaushalya Scheme

• Incentives for IMR

• Strengthening of Civil Registration System

• Upgradation and extension of Ayurvedic Pharmacy and Stores.

Tuberculosis Control Programme

All 20 Districts implementing DOTS programme and by July

2012, all will start implementing DOTS plus programme.

During 2011, total 39,206 patients enrolled.

Cure Rate of TB is 88%.

AIDS Control Programme

Punjab State is a high vulnerable State.

Estimated adult prevalence 0.32% (India : 0.31%)

Total HIV cases detected in ICTC 30466 cases

8719 AIDS Cases undergoing treatment in 6 ART Centres in the

state.

Leprosy Control Programme

State is a low prevalence State.

Prevalence rate is 0.23 per 10000

532 patients are under treatment

State has achieved the GOI goal i.e. <1/10000

Polio Eradication ProgrammePolio free State.

No case of Polio in the State in 2010 and 2011

Blindness Control Programme

2.10 lakh cataract operations done in State in the year 2011-12 which

is amongst highest per lakh population in the country.

National School Health Programme

34.59 lakh students were medically checked up in 2011.

4.03 lakh schools covered under Intensive Dental Health School

Programme

PHSC MANAGES 176 SECONDARY LEVEL HOSPITALS

19 District Hospitals (DH)

2 Special Hospitals (SH)

36 Sub-Divisional Hospitals (SDH)

119 Block Level Community Health Centres (CHC)

One special Institute of Mental Health (Government Mental Hospital),

Amritsar.

New Upgradation and construction under Core Plan:

District Hospitals – 2 Sub-Divisional Hospitals : New – 5, Upgradation – 2 Community Health Centres : New – 29, Upgradation – 3

INDICATOR Comparative Position

Jan-Dec2009

Jan-Dec2010

Jan- Dec2011

%age Increase / Decrease 2010 /

2011

Admissions 506444 566790 617743 8.99

Out Patients 10667090 11082390 11358126 2.49

BOR %age

DH 84.57 90.77 90.76 0.00

SDH 72.28 76 76.36 0.47

CHC 36.23 41.92 43.24 3.14

Surgeries 467656 516229 531339 2.93

Deliveries 62793 78094 108979 39.55

X-ray and Scanning Tests 869105 943047 982204 4.15

Lab. Tests 6207645 6988173 7567543 8.29

User Charges which are collected by the Secondary level Health Institutions are being utilized by the hospitals itself

45% of collections are being spent for purchase of drugs

25% on improving facilities to patients

15% each on building and equipment maintenance.

During the FY 11/12, Rs.30.28 crore user charges were collected as against Rs.26.33 crore during the FY 10/11.

CONT…

PARTICULARS Period (FY) Audited Tentative FY 11-12

Expected %age increase in FY 11-12 as

compared to FY 10-11

09-10 10-11

Collections 2267.80 2633.58 3028.62 15

Utilization 2052.65 2433.28 2848.67

Drugs 883.16 1102.65 1323.16 20

Imp. Facilities to Patients 712.68 855.66 1026.79 20

Maintenance of building 233.13 230.11 241.62 5

Maintenance of equipment 223.68 244.86 257.10 5

{Rs. Lakhs}

Jan Aushadhi Stores in Districts

Implementation of Telemedicine Project

Monitoring Referral Ambulances Project

Strengthening of Mortuary Services

Accreditation of Hospitals with NABH and ISO

Strengthening of Physiotherapy Services

Single rate contract in the state for purchase of

Medicines, Consumables, Scanning Material, Lab. Reagents, Hospital Linen and Hospital Furniture

Under different packages for the purchases being made by different Directorates / Wings of the Department from State Plan, Non-Plan, NRHM funds, Zila Parishads funds and user charges collections.

The tenders for all packages have been invited which are being received and will be evaluated.

The Government of India has notified the Food Safety and Standard Rules, 2011 w.e.f. 5.8.2011.

The State Government has already appointed Commissioner for Food Safety.

The State Government has prepared a proposal to set up a separate Food and Drug Administration to fulfill the following objectives.

• To enforce the Food, Drugs and Cosmetics Act fairly, to uphold safety standards and to protect consumers.

• To set up the Drugs Technical Advisory Board, Drugs Consultative Committee, Indian Pharmacopoeia Committee and Central Committee for Food Standards.

• To regulate the analysis of samples of drugs and food through Drug and Food Control Laboratories.

• To give additional revenue generation through an increase in fees.

• To facilitate Human Resources Development through training and encouraging self-developmental efforts of employees.

• To disseminate useful information to the public, industry and trade through meetings, lectures, organization of seminars, exhibition, workshops and brainstorming sessions.

Inadequate and untimely release of state plan scheme funds and state share of centrally sponsored schemes.

Vacant posts of doctors and paramedics. Presently, 1250 posts of doctors and 3600 posts of paramedics are vacant.

Non-availability of doctors of critical specialties like Gynaecologists, Paediatrics, Radiologists, Anaesthetists in the state

(overall shortage)

Inadequate administrative staff in the Directorate, districts and specifically in newly formed districts.

Inadequate provision for office and POL expenses in Non Plan Budget.

Deteriorating conditions of residential quarters and non-availability of adequate funds for maintenance for which approximately Rs.25 crore is required.

Virtually non-existent maintenance provisions for hospitals. Around Rs. 15 crore is required every year.

Totally inadequate provision for security services in the hospitals. There is an immediate requirement of security personnel and installation of CCTV cameras.

Requirement of additional DG sets in the hospitals.

Requirement of additional ambulances in the hospitals

Insufficient provision for continuous trainings for clinical skills and hands on trainings.

Insufficient provision for maintenance of equipment.