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High Focus Districts - Presentation For NIPI - DR Rajan Dubey (Compatibility Mode)
High Focus Districts - Presentation For NIPI - DR Rajan Dubey (Compatibility Mode)
TOTAL
28398 43.3 39540 60 46130 70
INSTITUTIONAL DELIVERIES FACILITY OPERATIONALISATION
2009-10 2010-11 2011-12 2009-10 2010-11 2011-12
No. % No. % No. %
Level 1 facility
TOTAL
28398 43.3 39540 60 46130 70
Sub-centers A type: remote areas- train SBAs- but
home is the focus: approximately 5%
Sub-centers B type: sub-center provides outreach
services- not delivery:
Sub-centers C type: approximately 10%: SBA
level -1.
Other PHCs: SBA level - 1
24* 7PHCs(mini/APHCs):50-100%:Bemonc level
CHCs as FRUs: 1/5 lakh at least as Cemonc
All district hospitals: FRUs+ Cemonc
Putting in place the additional HR needed
Defining Training needed and whom to prioritise
for training.
Supportive supervision to see that provider
practices have been revised as per protocols.
Developing infrastructure: equipment and civil
works
Supplies and minor equipment.
Getting the facility quality certified.
1. DH as SNCU 1. DH as SNCU+l FRUs at
2. All FRUs and CHCs as - in protocols
newborn stabilisation 2. All 24*7 PHCs: newborn
unit. Refer more, stabilisation unit- in
resolve less. clinical protocols.
3. All the rest as only 3. All level 1 facilities with
newborn corners. newborn corners only.
4. Home based care 4. Home based care –
based on AWW- limited, universal- resolve more,
refer more resolve less. refer less.
EQUIPMENT
Additional beds,
generators,
8/27/2010
States submit list of facilities so identified
Problems of varying definitions
Loose definitions; inconsistent application of
criteria
Incomplete identification
Facility wise criteria not indicated
Hence impossible to verify on any consistent basis.
Need for a standard criteria for assessing
inaccessibility of facilities across states
8/27/2010
Sl Score Criterion
no
1 A5/ A4 In accessible: PHC is not on road at one has to walk over 2 km to reach it. Over
three hours is an even greater level of inaccessibility. If road gets cut off for
over 6 months in the year
2 A3 Most difficult by itself: Same as A2 add one point each for get cut off for >1
months - one point and /or
no regular public transport – one point
2 A2 Difficult by itself : If distance from DHQ and/or nearest urban center is more
than 60 km and distance from and distance from BHQ is more than 30 km AND
distance from highway is more than 10 kms;
3 A1.5 Not Difficult by itself : If distance from DHQ and /or nearest urban center is
more than 60 km and distance from BHQ is more than 30 OR distance from
highway is more than 10 kms;
4 A1 Not difficult by itself : Only one of the above three criteria is positive: usually
distance from DHQ> 60km.
8/27/2010
Sl no Score Criterion
1 H0 Housing in government building or rent available, with
electricity > 8 hours per day and water.( tube well with hand
pump at least). HS school within 30 km of the place, and
primary school within 2 km of the place.
2 H1 One of three criteria above not available.
3 H2 Two of three criteria above not available.
4 H3 All three not available- available house is kutcha house and/or
inadequate to keep family for four. And also if there is no
housing facility either in government and rent.
8/27/2010
Sl Score Criterion
no
1 E1 Part of LWE district/block by definition
OR
Any Hilly over 3000 ft/ any tribal area or any desert area or within 3 km of any
forest area- 1 pt.
OR
Any island.
2 E2 E1 plus
Police stations managed as in LWE areas,, free movement not possible( in
holding phase)
OR
Tribal and forested/hilly or desert area with Falciparum malaria with API>5
3 E3 E1 plus Active conflict for most of the year, with armed special police forces
placed there( in clearing phase).
4 E0 When there is favorable environment.
The maximum score for Environment and Social and Natural is 5
8/27/2010
Sl Score Criterion
no
1 V0 If all MO posts sanctioned are filled in respective facilities
8/27/2010
Inaccessible
•Any primary health centre which is not on the Any A5 or Any A4
road, and doctor/nurse/ staff member have to irrespective of
walk more than 1 or 2 kilometres to reach the other scores.
facility is considered as inaccessible. Those who
have to walk more than 3 hours to reach is a A3 or A2 or A1
special subcategory of inaccessibility in it with any E3
•If it is on the road head, but the road is cut off for A3 with
more than six months irrespective of the public E2HnV0
transport it is classified as inaccessible. E2H0Vn
Where n is more
•If it is on the road head, but the road is cut off for than 0
more than one month in a year and there is no
public transport in any part of the year it is also in
the same category of inaccessible.
8/27/2010
Most Difficult
•Any PHC which is in a rural area and more than 60 Any A3
kilometres away from the district head quarters, or Any A2 with EHV
any urban area of more than 100000 and more scores totaling to
than 30 km away from the block head quarters three or more. (
and more than at least 10 kilometres away from give maximum of 1
the national high way or any other busy highway for any level of
and if public transport is non existent or poor(less housing and
than 2 buses/share taxis per day)will be difficulty or
considered most difficult vacancy)
Any E3
•These criteria apply irrespective of the
environment, housing or vacancy factors.
•If road cut off for less than 6 months but more
than a month, then irrespective of public transport
it is most difficult.
•desert/island/hilly/forest/tribal
8/27/2010
Rural but not difficult
•Motorable road to facility (>60 Kms from DHQ Any A0
and/or >60 Kms from nearest urban center); and Any A1
one of the criterion (>30 kms from BHQ or >10 With no adverse E,
kms from nearest state/national highway) with V or H score.
public transport in place, housing available either
in government /or rented building and no vacant
position of doctors.
8/27/2010
Should there be provider incentives to reach these
homes?
Should there be differential financing- more
incentives to reach the institution, more costs of
careK
Should there be special support for providers-
telemedicine, teleconferencing Klocal positive
practice environments.