NEW STRATEGIES FOR IMPLEMENTATION OF THE PNDT ACT BY THE HEALTH DEPARTMENT 

BALRI RAKSHAK YOJNA a state funded scheme has been launched in the state for promotion of cause of the girl-child.  Incentive will be paid for adopting terminal method of sterilization after the birth of only one or two girl children @Rs.500/- and Rs.700/- respectively. 

New strategies for implementation of the PNDT Act which include incentives and administrative setup, specific for the Punjab state, have been approved under the RCH-2 Project.  These include; 

·        A prize of Rs.3 lac for Panchayats that achieve a child sex-ratio(0-6 years) of 1000 in a financial year. Similarly a prize of Rs.2.5 lac for Panchayats which achieve child sex-ratio of 951 to 1000 in a financial year.

·        A prize of Rs.5000/- for each informer who helps the department in nabbing a centre indulging into sex-determination/ selection.

·        An incentive of Rs.5000/- for arranging decoy patient to nab violators of the PNDT Act.

·        Establishment of computerized PNDT cell at the State HQ with contractual appointment of a Computer Assistant, a Statistical Assistant a part time advocate.

·        Mobility support to the Appropriate Authorities for undertaking routine/surprise inspections of the ultrasound/genetic centres.

·        Engagement of private advocates to follow-up important/ difficult cases of violations of the PNDT Act.

·        Prizes for informers and decoy patients to nab the violators of the Act.

CHILD HEALTH

The IMR in Punjab is 49 as per SRS 2003 in contrast to 60 of the country. The state has made a big achievement in the indicator of fully-immunized child as per the report of the Rapid House-hold Survey 2002-03 vide which the state is placed at 3^rd position amongst the bigger states.

The concern of the state is the IMR and the objective is to bring down IMR to 30 in the span of 2 years. Majority of the infant deaths occur in the early neo-natal period and the neo-natal period and accordingly the following activities are being undertaken under the RCH-II Project in Punjab:-  

·        Enhanced social mobilization and awareness for promotion of institutional deliveries and care of the newborn.

·         Incidental charges/ incentive @Rs.100/- will be paid to health workers/ ICDS workers/ Istri Sehat Sabha members/ members of the PRIs for taking the delivery cases to the near by health institution.

·         Health education on benefits of institutional deliveries and delivery related dangers.

·         Stress on deliveries by skilled birth attendants.

·         Re-sensitization of birth attendants at the PHC/ Mini PHC level by medical officers.

·         Ensured and timely supply of Disposable Delivery Kits to the birth attendants for domiciliary deliveries. 

·         Provision of manual mucus sucker to the birth attendants with training for management of birth asphyxia.

·        For social mobilization and awareness of the masses, key messages on neonatal care will be painted on walls in the villages at prominent places. 

·         Stress on spacing methods and small family by promotion of family welfare services.

·         Health education for promotion of balanced diet and weight monitoring in the Mother Child Protection sessions.

·         Sensitization of the private practitioners to neonatal care and management of childhood diseases at the PHC level. 

·         The Multi-year Plan under the Strengthening of Immunization Project under the NRHM has been launched for assured 100% immunization coverage with stress on dropouts from BCG to Measles by repeated sensitization of the DIOs and block level SMOs during review meetings at state head quarter and district level monthly meetings. 

·         Mobility support for all the DIOs and block level SMOs for adequate supervision of the immunization sessions.

·         Provision of Primary Health Care facilities including immunization in the urban slums through contractual appointment of MPHWs.

ACHIVEMENTS UNDER THE IMMUNIZATION PROGRAMME DURING THE YEAR 2004-05 to 2006-07 

	2004-05	2005-06	2006-07 (Upto June,06)
BCG	105.3%	110.1%	94.8%
OPV	100.9%	104.3%	97.1%
DPT	100.9%	104.3%	97.1%
Measles	99.2%	100.2%	91.3%
TT(PW)	87.5%	90.4%	85.7%

TARGETS TO BE ACHIEVED

·         Target of institutional deliveries (Govt. instt.) for the Year 2005-06:  1.0 lac

·           Control of childhood illnesses including IMNCI by the year 2010.

·            Reduced IMR of 30 in the year 2007 and 20 in the year 2010.

·           Management of malnutrition by the year 2010. 

MATERNAL HEALTH

The MMR in Punjab as per SRS 2002 is 2 in contrast to 4 at the National level.  The state has made a big achievement in the indicator of safe-deliveries as per the report of the Rapid House-hold Survey 2002-03 vide which the state is placed at 3^rd position amongst the bigger states. 

The objective of the programme is to bring down the MMR further by promoting complete ANC registration & check-up and increase in number of institutional deliveries as also to enhance health care of the women during the reproductive period. The following activities are being undertaken under the                 RCH - II Project in Punjab:- 

·         Involvement of Link Workers from the community with provision of cash incentives for promoting early registration of pregnant women, ANC checkups, institutional deliveries. Sensitization of these link workers done through workshops.

·         Provision of grant-in-aid to NGOs to undertake projects for delivery of services under RCH-II programme.

·         Introducing Best Worker Award at Block/ District and State level on annual basis.

·         Integrated skills training of ANMs and LHVs in proper conduction of ANCs and identification of high-risk cases for referrals, use of reporting formats etc.

·         BCC inputs on communicating importance of early registration, ANCs, dietary needs during pregnancy, institutional deliveries, postnatal care etc.

·         Strengthening of Referral Systems by provision of telephone connections.

·         MTP services will be provided at least in 50 PHCs for reducing the unwanted maternal deaths.

·         Provision of services of obstetricians, pediatrician, anesthetists, staff nurses on contract basis at selected CHCs/ FRUs(25)

·         Provision of new-born care corners in selected CHCs/ FRUs.

·         BCC in the community regarding MTP, Spacing methods, RTI & STI, promotion of PNDT awareness and uplifting cause of girl child.

·         Training of service providers for conducting safe MTPs.

·         RTI & STI Counselling Clinics at FRUs level and treatment centres at 50 PHCs level and above.

·         Effective implementation of MTP Act through regular monitoring and supervision.

TARGETS TO BE ACHIEVED

·         ANC Registration coverage  to 100% by 2010.

·         Complete ANC - III check-up coverage to 100% by 2010. 

Increase in the Institutional deliveries to 80 % by 2010.

14.     INFORMATION, EDUCATION AND COMMUNICATION ACTIVITIES

Information, Education and Communication has a vital role in bringing about behaviour -change in the community regarding Health and Family Welfare Programmes. The main objective of all IEC activities is to encourage people for adopting positive attitude towards issues related to reproductive and Child Health issues thereby improving the quality of life. One important aspect of any IEC interventions is to maintain the continuity and consistency of the messages so that the same are re-enforced and strengthened and ultimately are adopted by the people as way of life. The transition from one pattern of behaviour to the other is made smooth by a fair mixture of modern scientific knowledge and popular folk­lore which has been in vogue for centuries.

In the context of the above, all IEC inputs made by Health and Family Welfare Department are aimed at building and nurturing positive health attitude. Implementation of all IEC plans is done under the overall control of Director, Health and Family Welfare through our network of I EC professionals headed by the State Mass Media and Education Officer at the State-level. The districts are looked after by District Mass Media Education and Information Officers and at the Block-level Block Extensions Educators are responsible for these activities. Work at the grass root level is carried out with the help of members of Mahila Swasthya Sanghs (MSSs) popularly called Istri Sehat Sabhas which exits for each and every village and urban slum areas of the State. At present there are 25784 MSSs functioning in the State. An overwhelming number functions voluntarily without any financial support from Govt. of India. Our endeavour has been to institutionalise community participation so that the community ultimately starts on in the cause of population stabilisation and make it a mass movement. For achieving this goal all vehicles of mass media alongwith inter-personal communication has been widely used for reaching all segments of the society especially the under privileged and women. The salient features of this concept are as under:-
1.   Besides making the community self-reliant for primary health care. The intention is to also make it more aware about curative, preventive, promotive, interventive, referral and rehabilitative services.
2.    Well established NGOs both in the voluntary and organised sector are being encouraged to support the MSSs in logistics.

New Schemes/Strategies

1. BALRI RAKSHAK YOJNA

Balri Rakshak Yojna, a welfare scheme for the cause of the girl-child has been launched in Punjab with the following objectives:

• ·         To encourage the birth of girls to balance the skewed sex-ratio in the state as there has been a considerable decline in the child sex-ratio (0-6 years) during the 1991 to 2001 decade.

• To motivate couples to adopt terminal method of sterilization in order to stabilize growth rate of population.

• To reduce Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) by reducing the number of pregnancies.

• To further bring down Total Fertility Rate from the level of 2.5 to 2.1.

•  The scheme has initially been introduced for a period of 5 years to gauge the response of the community and will be further extended or revised as per the requirement of the community.

Incentives under the scheme:

An incentive of Rs.500/-PM will be given to the female child provided the parents adopt terminal method of sterilization after the birth of only one girl. An incentive of Rs.700/- (Rs.350+Rs.350) will be available for two girls provided the family adopts terminal method of sterilization after the birth of the second girl-child (only if the first child is also a girl-child). The incentive will be available till the age of 18 years unless the beneficiary becomes an income tax assessee.

Eligibility criteria:

Couples upto the age group of 45 years for husband and 40 years of the wife are eligible under the scheme.   The incentive will be available to the child/ children    those couples who have adopted terminal method of sterilization and age of the youngest child is less than 5 years.  The birth of the child must have been registered with the Appropriate Registration Authority within the stipulated period.   In case couple is blessed with twins girls during the first delivery, monthly incentive Rs.700/-(Rs.350+Rs.350 each) will be paid provided either of the partner adopts vasectomy/ tubectomy. In case of death of the only child of such family which adopts the scheme, facility of recanalisation at state expenses will be available, but the monthly payment shall stop. In the event of death of one of the partner, the surviving partner shall intimate Civil Surgeon and the Gram Panchayat/ Municipal Committee regarding the death and remarriage if planned. In case of remarriage due to death / divorce the benefit would stop. However in case of death of both the partners the surviving child / children shall keep on receiving the payment for the duration of the scheme. The state government can stop new registration under the scheme at any time without affecting the earlier beneficiaries. The payment will be credited to a joint account of the eligible couple in the post office by the Civil Surgeon.

2. JANANI SURAKSHA YOJANA (JSY)

National Social Assistance Scheme was launched by Govt. of India in the year 1995. One of the components of this programme was national maternity benefit scheme (NMBS). Under this scheme a cash assistance of Rs. 5007- is given to pregnant ladies from below poverty line of both Urban and Rural Areas for first two live births provided age of the lady is 19 years or above. This incentive is given in third trimester of pregnancy so that the nutritional status of these poor ladies can be improved.

Beneficiaries under this scheme directly come in contact with functionaries (mostly ANMs) of the Health Department so the scheme was shifted from the department of Rural Development and Panchayats to the department of family welfare from 1.4.2001.

In order to reduce maternal mortality rate (MMR) and infant mortality rate (IMR), a new scheme named Janani Suraksha Yojna was launched in April, 2005 under RCH project with some modifications of NMBS. Janani Suraksha Yojna (JSY) lays special emphasis on :-

• Early registration of pregnancy

•  Three antenatal Check Ups

•  Institutional Delivery

• Immunization of pregnant ladies and new born

The idea behind all these steps is to increase institutional delivery, so that MMR and IMR can be reduced. Punjab being high performing state, the scheme was started in the Rural Areas only and cash assistance has been increased to Rs. 700- for institutional delivery instead of Rs. 500/- of NMBS, and in case of home delivery under JSY incentive of Rs. 500- (equal to that if NMBS) is provided. Facilities in Primary Health Centers have been updated for 24 hour institutional delivery. Referral system has been strengthened at Community Health Centers and Civil Hospital Level, so that complicated delivery cases can be dealt with by Caesarian section operation. Wherever services of experts are not available at these institutions, the same can be hired from private sector and a cash assistance of Rs. 15007- is given to the Specialist.

Wherever facilities for the conduction of normal delivery do not exist in the Govt. Institutions to private Accra dated Hospitals (Nursing Homes) have been identified in each block which will boost Public Private Participation. From 1.4.2006 incentive under Janani Suraksha Yojna has been made available for Urban Area also. It is further expected that more and more beneficiaries will be brought under this scheme by relaxing the conditions of the eligibility further.

The year wise achievements under NMBS/ JSY are as follows:-

Under Janani Suraksha Yojna Govt. of India released funds of Rs. 98.89 lac to the state of Punjab through RCH II project. The allocation has been increased to Rs. 137 lac for the year 2006-07.

3. National Rural Health Mission 

The National Rural Health Mission was launched by the Hon'ble Prime Minister on 12^th April 2005 with the objectives of providing  effective health care to the entire rural population in the country with special  focus  on  18  states  which  have  weak public  health indicators. The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP, over the next 5 years. It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme.

Key Components of NRHM

• Accredited Social Health Activist(ASHA)
• Involvement of Panchayati Raj Institutions(PRI)
• Village Health Plans
• Strengthening Public Health Infrastructure
• Strengthening Disease Control Programmes and Integrated Disease Surveillance Programme
• Inter-sectoral convergence
• Fostering Public Private partnership, including regulation
• Integration of new health financing mechanisms
• Reorienting medical education
• Involving the non-profit sectors
• Mainstreaming AYUSH and revitalizing indigenous/ traditional practices that foster good health
• Special strategy for the North East States

Goals of National Rural Health Mission

• Reduction in Infant Mortality Rate and Maternal Mortality Ratio
• Universal immunization against major childhood illnesses
• Prevention   and   control   of   communicable   and   non-communicable diseases, including locally endemic diseases Integrated comprehensive primary healthcare leading to population stabilization in high fertility districts Provision   of village  level   health   activists   (ASHA)   in underserved villages
• Preparation of Panchayat level Health Action Plan Strengthening Sub-centres/PHCs Raising CHCs to the level of IPHS

Institutionalizing District level Management of Health (all districts) Increase utilization of First Referral Units from less than 20% (2002) to more than 75% by 2010 A.D. A proposal for providing funds under National Rural Health Mission for the following programmes have been sent to Govt. of India

Programme Implementation of NHRM

NRHM is to be implemented in 5 parts as follows:
Part-A                             :      Activities under RCH-II
Part-B                             :      Initiatives under the NRHM
                                             ·     ASHA 
                                             ·     Untied funds at sub-centre level
                                             ·     Upgrading CHCs to Indian Public Health Standards (IPHS)
                                             ·     Corpus Grant for Hospital Management Societies (Rogi Kalyan Samitis)
                                             ·     Mobile Medical Units 
Part-C                             :     Immunization
Part-D                             :     National Disease Control Programmes (NDCP)
Part-E                             :     Inter-sectoral Convergence Scheme under the NRHM

·      Untied Fund at Sub-Centre Level An untied funds of Rs.10,000/- is envisaged at sub-centre level to address the unmet need reflected in the Village Health Plan. Rs.285.80 lakh have already been allotted to 2858 Sub-Centres (i.e. @ Rs.10,000/- ) of the State for this purpose.

·         Upgrading CHCs to Indian Public Health Standards (IPHS)

In the State there are 117 CHCs. 103 CHCs have been upgraded under the World Bank project to some extent. As per the new guidelines of the GOI in order to provide round the clock referral care services as well as specialist healthcare specifically for obstetric care to the rural population, the State Govt. will further upgrade two CHCs in every district in the first year up to the level of Indian Public Health Standards (IPHS). The services of Anaesthesiologist, Public Health Programme Manager and Eye Surgeon will be augmented along with Paramedic Staff. While working out different requirements in view of the available infrastructure provision of two rooms for bringing AYUSH Practitioners under the same roof will be kept in mind. 51 CHCs have been identified for this and the list has been sent to Govt. of India for release of funds.

·  Corpus Grant for Hospital Management Society (Rogi Kalyan Samiti)

The Rogi Kalyan Samiti (RKS), or Patient Welfare Committee (PWC) is a concept of managing public institutions/hospitals through community participation, which has been internationally recognized as a very successful model. In the State, there are 18 District Hospitals including 2 Special Hospitals, 37 Sub Divisional Hospitals and 117 Community Health Centres. The RKS were constituted for the hospitals under the Word Bank project for the District Hospitals, Sub-Divisional Hospital and Community Health Centres. These RKS will be activated. The broad objectives of RKS are; (i) Improve the institutions/hospitals, upgrade the equipment and modernize the health services; (ii) Ensure discipline in the institutions and supervise the staff; (\\\) Undertake construction and expansion in the hospital buildings; (iv) Ensure optimal use of hospital land according to government guidelines; (v) Improve participation of the committees in the running of the institutions/hospitals; (vi) Ensure scientific disposal of hospital waste; (vii) Ensure proper training for doctors and staff; (viii) Ensure subsidized food, medicines and drinking water to the patients and their attendants; (ix) Ensure proper implementation of National Health Programmes; and (x) Ensure proper use, timely maintenance and repair of institution/hospital equipment and machinery. The total requirements under this proposal has been worked out to 2.44 crore. The amount will be availed during the current FY 05/06.

 Mobile Medical Units

Access to healthcare and equitable distribution of heath services are the fundamental requirements for achieving Millennium Development Goals. Many areas in State lack basic healthcare infrastructure limiting access to health services. The State is in the process of drawing up of a comprehensive scheme for launching of Mobile Medical Units. GOI is in the process of issuing necessary guidelines under which it is envisaged that two small vehicles will be provided for the purpose with NRHM Logo. One will for the transportation of personnel with seating capacity of 10. The other vehicle may be for accessories and need not have any seating arrangement at the back. Instead, the space may be utilized for placing a small bed and all the accessories. This bed can be used as the examination table during camps and for transfer of patients at times of emergency. The State will finalize the model of the vehicle and will initiate the procurement. Operational aspects, Administrative aspects, Monitoring & Evaluation aspects will be defined along with Coordination aspects. A proposal for Rs.783.70 lakh has been submitted to the Govt. of India under this activity.

XIV      DRUG CONTROL ORGANISATION OF PUNJAB STATE.

The   main  function of the Drugs Control Department  is  to protect  and  take  care  of  the  health  of  the  consumers  by exercising  strict  control  and vigilance on the drugs which are being manufactured and marketed in the State  so  that  drugs  of standard quality are made available to the ailing humanity.

Drugs    Control   Department   of  the  State   of   Punjab discharges the statutory function involved in the enforcement  of the following Drugs and allied Legislations.

1.    The   Drugs   and   Cosmetics  Act,1940  and   Rules   made  there under.

2.       The Drugs (price control) order 1995.

3.       The Drugs and Magic Remedies (Objectionable-Advertisement) Act, 1954 and Rules there under.

4.       The Poisons Act, 1919 (Act 12 of 1919).

5.       The Tobacco & Tobacco Containing Products Act, 2004.

These   programmes   are   being   administered    by    the  Director,  Health  and  Family Welfare, Punjab.  At   the   State Headquarter, the State Drugs Controlling Authority is assisted by  two Assistant   Drug Controllers for the enforcement of Drugs &  Cosmetics Act & Rules there under and all the above  said  Act/ Rules.

(A)     For Sale Premises i.e. wholesale and retail sale etc.

(B)      For Manufacturing Premises:-

          1)       Allopathic manufacturing units

          2)       Homoeopathic manufacturing units

          3)       Cosmetics manufacturing units etc.

The  Drugs Inspectors posted at the   district   headquarter are  the  main  implementing  officers of the Drugs and Cosmetics Act/ Rules and other allied enactments.  One  Drug  Inspector  is posted  at each of the 14 districts except Nawan Shahar,  Mansa and Mukatsar. There are total 15 Drug Inspectors in the State out of which 6 posts have been filled up and 9 are lying vacant.

In  order to check and detect the manufacture and  sale   of drugs which are not of  standard   quality/misbranded/adulterated, the  drugs  Inspectors seize  fixed  number   of   samples  every month.  Joint raids are also conducted under the  supervision  of State   Drugs  Controller / Assistant Drugs Controller  /  Senior Drugs  Inspectors.  The samples so seized are   analysed  in  the State Drugs Laboratory located at Chandigarh under the  charge of  the Government  Analyst  who  is  authorised  to  do analysis  of both biological and non-biological drugs.    

Show  Cause  notice & contraventions are also dealt  by  the Controlling Authority as well as Licensing Authority. In spurious & serious contravention the prosecution orders are signed by  the State  Drugs Controlling Authority and the cases are launched  by the concerned Drugs Inspector at the Distt. Headquarters.      

The  cases of offences under the Drugs and  Cosmetics   Act/Rules  are launched in the Distt. Courts by the Drugs  Inspectors and  are  conducted by them in the Courts of Law  as  they  stand notified  as Assistant Public Prosecutors.

The    Drugs   Control   Organisation   has    also   issued instructions to the Drug  Inspectors to make   surprise   checks /raids  especially in order to detect the manufacturing and  sale of  intoxicating  drugs  in  the  State.  For this purpose,  Four Joint raiding parties each consisting of three  Drug   Inspectors  have been  formed  which  inspect  jointly under the  supervision of  the team leaders. Each raiding team raids   the   district so  that atleast  four  Joint  raids  are conducted every  month.

The  State  Drugs  Controller/Assistant  Drugs  Controller   also  lead joint raiding parties for this purpose.

The Civil Surgeons in the State have also been instructed to send  a  joint team  consisting  of   Drugs  Inspectors, District Health  Officer  and Senior Medical Officer to development blocks to cover the rural area in order to detect Un-Registered  Medical Practitioners  and  other  un-authorised persons selling drugs in the field. Intoxicating drugs and narcotics drugs are often  sold by the anti-social elements.

The   number of licensed establishments both  manufacturing and  sale in the State of Punjab from the year  2002-03 to 2004-05 are as under:-

MANUFACTURING ESTABLISHMENTS. 

Item	2002-03	2003-04	2004-05
1.      Allopathic Drugs	246	269	289
2.             Cosmetics	70	74	77
Total	316	343	366

NUMBER OF LICENCES.

	2002-03	2003-04	2004-05
1.  Granted	2434	2587	2624
2.  Suspended	122	160	192
3.  Cancelled	152	367	389
Total	2708	3114	3205

The performance of the drugs work from the year 2002-03 to 2004-05 is given as under:

NATURE OF WORK.

	2002-03	2003-04	2004-05
1.   Number of sample taken	1956	1853	1997
2. Number of samples found not of            standard quality	188	107	128
3.    Number of samples found       misbranded	19	31	83
4.    Number of samples found spurious	13	7	7
5.    No. of prosecutions launched	8	34	34

INFORMATION ON DRUG WORK DONE DURING THE YEAR 2004 & 2005

 

S.No	Particulars	2004	2005	2006 (Upto June,06)
1.	No. of Drugs Samples Taken	1893	2068	1241
2.	No. of Samples Tested	2046	1891	1327
3.	No. of Samples Declared "Spurious"	9	9	3
4.	No. of Samples Declared As "Not of Standard Quality"	97	149	98
5.	No. of Samples Declared "Misbranded"	61	121	58
6.	No. of Chemists From Where Drugs Seized	176	229	117
7.	No. of Licences Cancelled Due to Contravention Relating to Habit Forming Drugs	5	15	14
8.	Licences Cancelled Due to General Contravention	0	1	88
9.	No. of Licences Suspended	260	263	208
10.	Suspended for Contravention Relating to Habit Forming Drugs	157	56	51
11.	Licences Suspended Due to General Contravention	103	207	157
12.	No. of Licences Cancelled Due to Firm's Own Request without any Contravention	211	204	88
13.	No. of Court Cases Under Trail	162	195	217
14.	No. of Prosecution orders issued against Defaulters	26	54	25
15.	No. of Prosecution Launched	29	52	29
16.	No. of Cases Decided	7	17	7
17.	No. of Persons Convicted	4	9	4
18.	No. of Persons Acquitted	2	4	2
19.	No. of Persons Discharged	1	4	1
20.	No. of Persons Declared P.O.	4	4	4
21.	No. of Joint Raids	403	427	102
22.	No. of Inspections	4418	3865	1760