ANNUAL PLAN 2002-03
Medical & Public Health

DEMAND NO. 14

Size of the Annual Plan: Rs 1600.00 lakhs (includes Capital component of Rs 322.45)

The emphasis in the Annual Plan 2002-03 has been made with the objective of ensuring affordable and more equitable access to better health care facilities, besides consolidating and upgrading the gains made during the Ninth Five year Plan period as well as establishing infrastructures in the deficient areas with the view to improve the standard of health and living.

The annual allocation for 2002-03 under health sector has been fixed at Rs 1600.00 lakhs as against the annual requirement of Rs 2256.75 lakhs proposed in the draft 10^th Plan proposal resulting in a short fall of Rs 656.75 lakhs. Therefore, the activities for the current financial year has been curtailed within the fund available. The reduction in the allocation has been further aggravated due to additional requirement of Rs 42.00 lakhs for salary payment of personnels under Family Welfare Services (199% CSS) who have been integrated into Plan sector following withdrawal of funding by the Government of India from 1/4/2002 in respect of programmes such as Post Partum Unit, Rural Family Welfare Centre and Village Health Guide Scheme.

During the year 2001-02, as per the policy decision of the State Government, the Department has already initiated a proposal for reconstruction of the STNM hospital at Gangtok with modern state of the art facility with about 500 bedded capacity. A project report in this regard has already been prepared by Messrs Hospital Consultancy Corporation(I) Ltd., which is a Government of India Enterprise. The total investment on this account towards Building & Services including Additional Equipment has been estimated at Rs 110.00 crores. However, considering the shortfall in the proposed 10^th Plan outlay, the project is being taken up separately outside the Plan fund.

In order to bring about improvement in facilities, a provision of Rs 200.00 lakhs has been made towards procurement of equipments and instruments. In addition a sum of Rs 30.00 lakhs has been provided for procurement of Hepatitis-B vaccine, T.B. drugs, galsswares etc. The Hepatitis Vaccination Programme is a continuing programme initiated during the year 2001-02. A provision of Rs 20.00 lakhs has also been earmarked to take care of maintenance of medical equipment.

In terms of infrastructure establishment, the department proposes to take up the construction of two PHSCs, one at Sangmo and the other at Suvaney dara in South and East district respectively at an estimated cost of Rs 38.00 lakhs during the year 2002-03. The department shall also make necessary efforts to complete all the ongoing projects pertaining to construction works in respect of PHSCs and PHCs. The spillover amount of the ongoing project taken up during the Ninth Plan period is estimated at Rs 153.00 lakhs. The provision earmarked for the year 2002-03 for construction of PHCs and PHSCs is Rs 140.00 lakhs excluding Rs 30.00 lakhs earmarked for Panchayati Raj Institution for construction of three PHSCs at Naku Chumbung, Salim Pakyal, Middle Camp in West, North and East District respectively.

With regard to the ongoing construction work of the Community Health, Centre at Gyalshing and Mangan, the former is anticipated to be completed by December 2002 and the latter the end of 2004. The anticipated expenditure for completion of the CHCs at Mangan and Gyalshing has been estimated Rs 343.00 lakhs as against the provision of Rs 72.45 lakhs for 2002-03. Further, an expenditure of Rs 15.00 lakhs has been estimated on additional works under other CHCs to be executed by the department during 2002-03.

The department has already taken up the construction of Mechanical-Workshop-Cum-Central Health Stores at an estimated cost of Rs 265.00 lakhs. During the year 2002-03, a sum of Rs 65.00 lakhs only has been earmarked.

The Hospital Waste Management System with the funding from the GOI is anticipated to be functional during 2002-03 as per the Biomedical Waste (Management and Handling) Rules 1998. For this purpose, adequate fund has been earmarked for maintenances and procurement of waste disposal transport vehicles for each of the Community Health Centres including the STNM Hospital at Gangtok.

The programmes such as Reproductive and Child Health Programmes (RCH), National Aids Control Programme, Leprosy Control Programme, National Tuberculosis Control Programme, National Mental Health Programme etc., funded by the government of India are being implemented with active support from NGOs, private sectors and communities, Besides, the State Blood Transfusion Council (SBTC), AIDS Society, Leprosy Society etc. have also been constituted for smooth and effective implementation of the schemes and programmes. The involvement of the PRI for maintenance of the PHSCs has also been taken up. The delegation of powers to the PRI for running of the PHSCs is already under process with the objective of establishing local accountability of the public health care providers, so that problems relating to poor performance can be sorted out locally.

With the implementation of schemes and programmes through NGOs and community participation there is now a paradigm shift to involve community in taking up the Family Welfare and Health Schemes with the objective of providing bottom up planning process. There is now greater awareness among the community regarding the need to participate in all the Health and Family Welfare activities in order to bring about better standard of living.

The State Illness Fund Association which is funded by the Centre and the State on 75:25 basis has since been established for providing financial assistance to the poor people of the State lying below the poverty line. As soon as the Notification of the Below Poverty Line (BPL) is issued, all B.P.L. patients requiring specialised treatment will be given full monetary assistance under the scheme. The feasibility of introducing health Insurance Schemes for the public is also an area which is being explored into.

With a view to achieving the goal set by the National Health Policy for universal registration by the year 2010 and in order to give a thrust for strengthening of the Civil Registration Cell, a provision of Rs 26.00 lakhs is earmarked for 2002-03.

The Health Care needs a holistic approach for effective linkages with other social sectors like education, water supply, sanitation and nutrition which are essential for improving the general health status of the community. Therefore, convergence of socially-relevant programmes in these sectors with the health sector as has been envisaged in the National Health Policy would bring in grater effectiveness in the implementation of the health programmes.

The break-up of the annual Plan outlay for 2002-03 are as follows:-

1. DIRECTION & ADMINISTATION

The annual outlay is intended to meet cost for maintaining and strengthening the Planing. Monitoring and Evaluation Cell. The preliminary work on computerisation has been initiated and it is proposed to be operational by 2003-04. The allocation also includes cost of replacement of two vehicles during 2002-2003.

2. HOSPITAL & DISPENSARIES

A.P. 2002-03
Total Outlay 515.30 lakhs
Capital Component 110.00 lakhs

The revenue component includes procurement of critical equipments and hepatitis-B vaccine, maintenance of medical equipments, limited appointment of specialised and trainined man power. Etc. The capital component includes token provision for shifting of STNM hospital, provision for construction of Mechanical Workshop-Cum-Central Health Stores and additional civil construction works in the STNM complex.

3. INDIGENOUS SYSTEM OF MEDICINE

Annual Outlay 2002-03
Rs 8.00 lakhs

The provision includes cost of medicines and basic equipment for running of the Amjila’s Clinic in the STNM Hospital.

4. PRADHAN MANTRI GRAMODAYA YOJANA (PMGY)

A.P. 2002-03
Total Outlay Rs 500.00 lakhs
Capital Component Rs 212.45 lakhs

The Pradhan Mantri Gramodaya Yojana (PMGY) is aimed at reducing the infrastructural gaps as well as to improve delivery of health care services in the rural areas. The budgeted outlay under capital is Rs 192.45 lakhs only which is being proposed to be revised to Rs 212.45 lakhs by way of adjustment within the PMGY component. The revision has been inevitable due to shortfall in the annual allocation following downward revision in the 10^th Plan outlay and also additional requirement of fund to meet the establishment cost of personnel taken under Plan Sector due to withdrawal of funding by the GOI under Family Welfare Services 100% CSS). The additional requirement on this account has been worked out at Rs 35.00 lakhs

(i) PRIMARY HEALTH SUB-CENTRES

A.P. 2002-03
Total Outlay 119.00 lakhs
Capital Component 70.00 lakhs

During the year 2002-03 the department proposes to construct two PHSCs, complete all the ungoing projects which were taken up during the Ninth Plan period. The provision earmarked for construction of PHSCs is Rs 70.00 lakhs excluding Rs 30.00 lakhs earmarked for Panchayati Raj Institution to take up construction of three PHSCs. The budgeted outlay of Rs 46.20 lakhs under revenue section is being revised to Rs 49.00 lakhs by way of adjustment of fund from serial no. (iv) below. The additional requirement of Rs 2.80 lakhs been necessitated due to integration of personnel from Family Welfare Sevices (100%CSS) following withdrawal of funding by the GOI.

(ii) PRIMARY HEALTH CENTRES

A.P. 2002-03
Total Outlay 148.85 lakhs
Capital Component 70.00 lakhs

The department proposes to complete the ongoing civil works taken up during the ninth plan period. Besides the department also proposes to strengthen the trained manpower with a view to make the health care system more effective. The budgeted outlay for capital component is only Rs 50.00 lakhs which is being revised to Rs 70.00 lakhs by way of reduction in the provision made under serial no. (iv) following downward revision in the 10^th Plan outlay. The budgeted outlay for revenue component of Rs 49.45 lakhs only is being revised to Rs 78.85 lakhs by way of reduction in the provision made under serial no. (iv) below due to additional requirement of fund to meet the establishment expenses of personnel integrated from Family Welfare Services as in the above case.

(iii) COMMUNITY HEALTH CENTRES

A.P. 2002-03
Total Outlay 222.15 lakhs
Capital Component 72.45 lakhs

The ungoing construction work of the Community Health Centre at Gyalshing and Mangan is anticipated to be completed by the end December 2002 and 2004 respectively. The anticipated expenditure for completion of the CHCs at Mangan and Gyalshing has been estimated Rs 343.00 lakhs as against the provision of Rs 72.45 lakhs for 2002-03. Further, an expenditure of Rs 15.00 lakhs has been estimated on additional works under other CHCs to be executed by the department during 2002-03

The revenue allocation is for strengthening and upgradation of the specialised services at Community Health Centres and also includes procurement of ambulances. The short fall of Rs 2.80 lakhs under revenue section is being proposed to be met by way of adjustment of fund from serial no. (iv) below to meet the additional establishment cost of personnel integrated into the plan sector from Family Welfare Services as indicated above. The Community Health Centre being a referral centres, the proposal includes provision for appointment of selected trained personnel in the CHC on need basis.

(iv) PURCHASE OF DRUGS/DIAGNOSTICS/DDK AND REPAIRES OF EQUIPMENT/ FURTIRE

A.P. 2002-03
Total Outlay 10.00 lakhs
Capital Component NIL

The allocation includes revised provision of RS 5.00 lakhs for procurement of Drugs/ Diagnoistics/DDK and Rs 5.00 lakhs for maintenance of equipment/ furniture as envisaged under the PMGY programme. The budgeted outlay of 65.00 lakhs (45.00+20.00) is being revised to Rs 10.00 lakhs due to downward revision in the 10^th five year plan proposal by way of adjustment as indicated at (i) to (iii) above.

5. MEDICAL EDUCATION, TRAINING AND CIVIL REGISTRATION

Annual Outlay 2002-03 Rs 33.00 lakhs

The outlay for the year 2002-03 is intended meet the establishment expenses of the Birth & Death Cell and training of the technical personnel to update with the latest development in the in the field of Health Education in as much as to impart orientation of the field functionaries.

6. PREVENTION AND CONTROL OF COMMUNICABLE DISEASES (NMEP/NTCP/LEPROSY)

A.P. 2002-03 Rs 147.50 lakhs

As envisaged in the National Health Policy by the year 2010 Malaria, Kalazar and Leprosy is to be eliminated. Due to ongoing hydel projects, a lot of migrant labourers from the neighbouring States may give rise to resurgence of these diseases. Proper disease surveillance and rapid response team are being established. As far as Tuberculosis is concerned, it is quite relevant in the State. With the introduction of DOTS programme, the cure rate would be increased to eighty five per cent. The allocation for 2002-03 includes provision of Rs 32.00 lakhs earmarked for National Leprrosy Eradication Programme taken up during the eyar under the plan sector as per guidelines of the GOI.

7. OTHER DISEASES CONTROL PROGRAMME

Annual Plan (2002-03) Outlay    Rs 8.00 lakhs

The allocation for 2003-04 is earmarked for upgradation of the thyroid Cente at Namchi to make the investigative procedures more effective.

8. PREVENTION OF FOOD ADULTERATION

Annual Plan (2002-2003) Outlay    Rs 15.00 lakhs

The provision of Rs 15.00 lakhs is for meeting the establishment expenses of the PFA Cell.

9. DRUGS AND COSMETIC CELL

Annual Plan (2002-03) Outlay    Rs 12.70 lakhs

Although the Drugs & Cosmetic act 1940 and Rules 1945 was enforced in the Stateh in 1985, due to paucity of fund a full fledge Cell could not to be materialised. However, in view of the importance of the detection of spurious drugs and drug abuses, Drug Inspectors would be posted.

10. PUBLIC HEALTH EDUCATION/ SCHOOL

Annual Plan (2002-03) Outlay    Rs 20.50 lakhs

(i) PUBLIC HEALTH

This is an ongoing scheme and top priority has been given towards dissemination of information through IEC.

(ii) SCHOOL HEALTH:

This is an ongoing programme and importance is given to the screening and imparting proper health care to the students.

11. ASSISTANCE TO STATE BLOOD TRANSFUSION COUNCIL

Annual Plan (2002-03) Outlay    Rs 5.00 lakhs

In keeping with the directives of the Supreme Court of India, the State Blood Transfusion Council (SBTC) has been established for which funding between the Centre and the State has been fixed on 50:50 basis. However, now that the SBTC has been receiving the central share directly, a provision of Rs 5.00 lakhs has been earmarked as State’s share of assistance to the SBTC for 2002-03.

12. STATE ILLNESS ASSISTANCE FUND

Annual Plan (2002-03) Outlay       Rs 1.00 lakhs

The State Illness Assistance Fund is a 75:25 C.S.S. with the State funding 75%. A token provision of Rs 1.00 has been earmarked for 2002-03. The BPL Identification Certificate is being issued very soon in which case the scheme can be taken in earnest.

13. PURCHASE OF EQUIPMENT – EXTERNALLY AIDED PROJECT (EAP)

Annual Plan (2002-03) Outlay      Rs 200.00 lakhs

The provision has been made with a view to upgrade and modernise the facilities in the hospitals of the State.

14. ELEVENTH FINANCE COMMISSION

Annual Plan (2002-03) Outlay    Rs 60.00 lakhs

The provision of Rs 60.00 lakhs has been earmarked towards spill-over payments against upgradation Grants under the Eleventh Finance Commission.

ABSTRACT
A.P. 2002-03

Sl. No Scheme Outlay Capital Component 1. Direction & Administration 74.00 - 2. Hospital & Dispansaries 513.30 110.00 3. Indigenous System of Medicine 8.00 - 4. Pradhan Mantri Gramodaya Yojana 500.00 212.45** 5. Medical Edn. & Training/ Civil Regd. and GNM Training School 33.00   6. Prevention & C. of Communicable Diseases (NMEP/ NTCP/ Leprosy) 147.50 - 7. Other Diseases C. Programme (Thyroid/ OCD) 8.00 - 8. Prevention of Food Adulteration 15.00 - 9. Drugs & Cosmetic Cell 12.70 - 10. Public Health Edn/ School Health 20.50 - 11. Asst. to State Blood T. Council 5.00 - 12. State Illness Assistance Fund 1.00 - 13. Purchase of Equipment (EAP) 200.00 - 14. Upgradation Grant under E.F.C. 60.00 -   Grand Total 1600.00 322.45

** excluding Rs 30.00 lakhs provided as assistance to PRI under revenue section for construction of PHSCs.