Guidelines of the School Health Programme

Transcription

1 Guidelines of the School Health Programme 1 Brief on the Programme: Introduction: School Health program is a program for school health service under National Rural Health Mission, which has been necessitated and launched in fulfilling the vision of NRHM to provide effective health care to population throughout the country It also focuses on effective integration of health concerns through decentralized management at district with determinant of health like sanitation, hygiene, nutrition, safe drinking water, gender and social concern. 2. The School Health Programme intends to cover 12,88,750 Government and private aided schools covering around 22 Crore students all over India. Rationale for School Health Programme 3. The School health programme is the only public sector programme specifically focused on school age children. Its main focus is to address the health needs of children, both physical and mental, and in addition, it provides for nutrition interventions, yoga facilities and counseling. It responds to an increased need, increases the efficacy of other investments in child development, ensures good current and future health, better educational outcomes and improves social equity and all the services are provided for in a cost effective manner. 4. The programme at the national level has been developed to provide uniformity/guidance to States who are already implementing or plan to implement their own versions of programme and to give guidance in proposing a coherent strategy for school health programme in next year s NRHM PIP to those States who have not yet started their programme. Process adopted for developing the Programme 5. The decentralized framework of implementation under NRHM has enabled various states to devise and implement their own version of School Health Programme. A detailed study was undertaken through which the programmes being implemented in various States was documented. Through the analysis of the strengths and weaknesses of these programmes being implemented in various 1

2 States a broad strategy for the school health programme was developed. This strategy was shared in meeting chaired by HFM and attended by Secretary (HFW) apart from various other senior officers. The contours of the programme was shaped after this consultation. 6. Components of School Health Program: Health service provision: Screening, health care and referral: o Screening of general health, assessment of Anaemia/Nutritional status, visual acuity, hearng problems, dental check up, common skin conditions, Heart defects, physical disabilities, learning disorders, behavior problems, etc. o Basic medicine kit will be provided to take care of common ailments prevalent among young school going children. o Referral Cards for priority services at District / Sub-District hospitals. Immunisation: o As per national schedule o Fixed day activity o Coupled with education about the issue Micronutrient (Vitamin A & IFA) management: o Weekly supervised distribution of Iron-Folate tablets coupled with education about the issue o Administration of Vitamin-A in needy cases. De-worming o As per national guidelines o Biannually supervised schedule o Prior IEC o Siblings of students also to be covered Health Promoting Schools o Counseling services o Regular practice of Yoga, Physical education, health education o Peer leaders as health educators. 2

3 o Adolescent health education-existing in few places o Linkages with the out of school children o Health clubs, Health cabinets o First Aid room/corners or clinics. Capacity building Monitoring & Evaluation Mid Day Meal The strategy suggested for the programme: 7. Various options of implementation have been suggested under the programme based on the assessment of various on-going school health programmes in various States. Out of these options, one main strategy (Option-1) has been recommended which tries to bring uniformity/give guidance to the school health programmes being implemented in various States and provide a framework for initiating the programme in those states who have not yet started the programme. Within these guidelines, it is proposed that ANM may be apared once a week for school health only if she has either MPW(male) or second ANM to support her at the health subcentre. The Multi Purpose Worker(male) will be more appropriate for exclusive boys senior basic schools.the guidelines along with indicative costing will help the States where the programme has not been started to propose the programme in next year s PIP in a more structured and realistic manner. 8. Based on a cascading training strategy involving Health and Education Departments ToTs will take place at State and District levels and teachers will be oriented on the programme so that they internalize the core values and strategies of the programme. Apart from the teachers screening the children, area ANMs/MPWs will visit one school every week on an average for detailed screening and treatment of minor ailment and required referral. In addition, a Medical Officer will also visit one school per week for additional screening, treatment and referral. 9. Inferring from the indicative costing, it has been proposed that the programme may be taken up in a phased manner covering schools in the first year and schools each in second and third year. The proposed cost of implementation so phased can then be met out of RCH-II Flexible Pool/Mission Flexible Pool. 3

4 10. Management Structure for effective management: Management structure has been provided for in the guidelines at national, State and District levels. The NRHM convergence mechanism will apply to this programme as well. The involvement of MSG, State Health Mission and District Health Mission has been ensured by placing the school health programme management committees under the overall supervision/guidance of these overarching structures. In addition, emphasis has been placed at making these management committees multi-departmental involving the functionaries of various related departments/organisations such as Education, Rural Development, WCD, NACO, etc. Various School Health Promotion Committees recommended at State, District, Block and School levels is detailed in the enclosed write-up of the programme. School Health Coordinator on contract basis at the State and District levels has been provided to support the programme in the areas of coordination and monitoring and evaluation. 11. These management committees have been proposed in a manner that they bring in convergence between related departments/organizations. The main convergence required in the programme is between the Ministry of Health & Family Welfare, Ministry of Human Resources Development (MHRD) and Ministry of Rural Development (MRD). MHRD will be partner in capacity building, IEC, Monitoring & Evaluation. MRD needs to take care of water, safety education, Sanitation Education and Garbage disposal waste management. The MoHFW will take care of screening, health care services, immunization, referral, micronutrient management, health education, capacity building, monitoring and evaluation, etc. 12. Cost of implementing the strategy: 12.1 The cost of implementing the strategy will include: i. Cost of training and orientation at all levels, mobility support to functionaries and incentives to them for carrying out this additional work; ii. Fixed costs, such as hardware & medical supply, IEC, printing of 4

5 training manual, additional manpower provisioning at State and District Health Society levels for monitoring and evaluation. iii. Provisioning of School Health Coordinator, 1 each at the State and District Health Society level for programme coordination, monitoring and evaluation The indicative cost for the programme at the all India level, including the three components mentioned above, is estimated at approximately Crores in the 1 st year, Crores in the 2 nd year, Crores in the 3 rd year and Crores from 4 th year onwards The guidelines and indicative costing will not be mandatory to be followed by States who have already initiated their own school health programmes, although they can borrow from these guidelines if it helps them to better structure their programme. The costing is also indicative and for the purpose of helping the States cost their interventions under the programme in a better way while proposing the programme in their NRHM PIP for the next year. 5

6 Indicative costing for major activities under School Health Programme 1. Common Costs for all options: A. Additional manpower requirement at the State Health Society: 1 Renumeration to School Health Programme Coordinator (1 post): (MBA/ Master of Sociel Work (with experience in training and outreach social work) 2 Mobility support to the School Health Coord. TOTAL STATE LEVEL: Monthly per State 25,000 Annual per State 3,00,000 Total Annual Cost (All States/UTs) 1,05,00,000 5,000 60,000 21,00,000 30,000 3,60,000 1,26,00,000 B. Additional manpower requirement at the District Health Society: 1 Remuneration to School Health Programme Coordinator (1 Post): (Master of Social work with commerce background at +2 level and experience in training and outreach social work). The Coordinator will coordinate School Health Programme and also the fund flow for the programme. S/he will also assist the District Accounts Manager in releasing funds and maintaining the accounts for the SHP. District Accounts Manager will look after the overall accounting of School Health programme in the District. Mobility support to the School 2 Health Coord. Monthly per District Annual per District Total Annual Cost (All States/UTs) (600 Districts) 15,000 1,80,000 10,80,00,000 5,000 60,000 3,60,00,000 TOTAL AT DISTRICT LEVEL: 20,000 2,40,000 14,40,00,000 6

7 Cost of hiring School Health Coordinator at the District Health Society level as per phasing of coverage of Districts (These costs are estimates for entire country and would vary from State to State based on number of Districts covered in each year) Districts Districts Districts 100% districts (4 th Year Onwards) 2,88,00,000 5,76,00,000 5,76,00,000 14,40,00,000 C. Hardware and Medical Supply (for a Unit of 250 students) / annum One time capital cost: Weighing scale (500) and height measurement equipment (wall mounted) (100) and Snellen s Chart for bigger schools (80) - Student health cards, referral cards, 2 registers per year 1 st year Medical Kit 140 2nd Year onwards NIL IFA Tablet Albendazole Spectacles (@ 125/being revised to 200 per 250 students)- The cost may be borne by National Programme for Control of Blindness 7. Hearing aid - (@ 2 per 250 students)- The cost may be borne by National 0 0 Programme for Control of Deafness 8. Travel cost for referral (1% of all per referral Total cost for a Unit of 250 students 2,402 1,707 Total cost for all students in schools (Govt. & aided) in India = 22,00,00,000 (NCERT data), which would constitute 8,80,000 units of 250 students each 2,11,37,60,000 1,50,21,60,000 7

8 No. of units of 250 students each Expenditure in 3 years for new units taken up for the first time Expenditure in 3 years for old units Expenditure from 4th Year onwards Total Expenditure: of cost incurred on Hardware and Medical supply (These costs are estimates for entire country and would vary from State to State based on number of Districts & schools covered in each year) 1st Year () 2nd Year () 3rd Year () 4th Year onwards/per year ,27,52,000 (with capital expenditure) 84,55,04,000 (with capital expenditure) 1,14,59,36,000 84,55,04,000 (with capital expenditure) 1,74,68,00,000 1,50,21,60,000 42,27,52,000 1,99,14,40,000 2,59,23,04,000 1,50,21,60,000 D. Printing of Training Manual (for 13 lakh Unit cost 100 per copy): of printing and supply of training manual (These costs are estimates for entire country and would vary from State to State based on number of Districts & schools covered in each year) 3rd Year 1st Year (: 2,60,000 schools) 2nd Year (: 5,20,000 schools) (: 5,20,000 schools) 2,60,00,000 5,20,00,000 5,20,00,000 E. IEC: Cost with phasing for entire country (state-wise costs would depend on no. of schools taken up every year): Posters: (4 each 10 each) Leaflet: (170 per 0.50 each) Repeat requirement of Posters Repeat requirement of Leaflets Cost for 1st Year No. of Schools (): Cost for 2nd Year No. of Schools (): Cost for 3rd Year No. of Schools (): ,04,00,000 2,08,00,000 2,08,00,000 2,21,00,000 4,42,00,000 4,42,00,000 3,25,00,000 9,75,00,000 1,04,00,000 3,12,00,000 Cost from 4th Year Onwards No. of Schools (100%): ,21,00,000 6,63,00,000 11,05,00,000 16,25,00,000 11,05,00,000 8

9 2. Cost of various options: A. OPTION-1 : Teachers screen students on a continuous basis and ANMs and a 3. Doctor visit the schools for treatment of minor ailments and referral A.1 State level: Training of Master Trainers from Districts at SIHFW: (1 batch i. Cost of engaging State level Resource persons (3) for 5 for imparting training: Per day cost/ person Total per day (3 persons) Total all 5 Total 35 States Honorarium 700 2,100 10,500 3,67,500 Refreshment , ,250 11,250 3,93,750 State level training will take place in all States, thus, no phasing is possible. ii. Cost of training of participants from Districts For the sake of costing if we take 35 Districts, 70 participants would be trained at the State level - 1 from DIET (Education Dept.) and 1 MO from Health Department Per day cost/ person Total per day 70 persons Total for 70 persons for 5 Total for 35 States/UT Honorarium ,000 1,75,000 61,25,000 6,12,500 2,45,000 69,82,500 13,96,500 27,93,000 consisting of 2 personnel from each District trained for 5 ): Refreshment 50 3,500 17,500 Stationery 20 1,400 7,000 TOTAL: ,900 1,99,500 27,93,000 9

10 A.2 District level: Training of Block trainers at DIET (District Institute of Education & Training) for 3 : 1 batch of 20 trainees from 10 blocks in the District (no. of blocks here has been taken only for costing purpose): i. Cost of engaging 2 Master Trainers (who have been trained at State level) for imparting training to Block level trainers: Per day cost/person Total per day (all persons) Honorarium Total all 1,800 Refreshment ,100 Total 600 District 10,80,000 1,80,000 12,60,000 (1st Year) 2,52,000 (2nd Year) 5,04,000 5,04,000 ii. Cost of training trainees from Blocks within the District (10 blocks have been taken for calculation purposes) for 2 : 2 persons from each block need to be trained - 1 from BRC (Block Resource Centre of Education Department) and 1 Doctor from CHC/PHC. (1 st Year) (2 nd Year) (3 rd Year) TA/DA 200 4,000 Refreshment 50 1,000 8,000 2,000 Stationery ,400 10,800 5,20,00,000 1,30,00,000 52,00,000 7,02,00,000 1,40,40,000 2,80,80,000 2,80,80,000 10

11 i. Cost of engaging 2 Master Trainers who have been trained at District level (1 from BRC and 1 Doctor from CHC/PHC) for 2 Per day cost/ person Total per day (2 persons) Total all (2 X 8 batches = 16 ) Total 6500 Blocks Honorarium ,400 Refreshment ,600 Stationery ,640 4,16,00,000 1,04,00,000 41,60,000 5,61,60,000 1,12,32,000 2,24,64,000 2,24,64,000 ii. Cost of training Teachers from schools in the Block (2 teachers from each school) As there are approximately 1500 schools in a District, there would be 150 schools in a block. Thus, teachers per school need to be trained. If the BRC can take a batch of 40 teachers, 8 batches would be needed to cover 300 teachers. Per day cost/ person Total per day (40 persons) Total all (2 X 8 batches = 16 ) TA/DA 100 4,000 64,000 Refreshment 50 2,000 32,000 Stationery , ,800 1,08,800 Total 6500 Blocks 41,60,00,000 20,80,00,000 8,32,00,000 70,72,00,000 14,14,40,000 28,28,80,000 28,28,80,000 A.3 Block level: Training of School Teachers at BRC (Block Resource Centre of Education Department) for 2 (2 Master Trainers who have been 11

12 trained at DIET (I from BRC and 1 from Health Deptt.) would provide training to School Teachers for the Schools in the Block) A.4 In addition to continuous screening by teachers, the existing ANMs/MPWs (in a team of 2 each) visit on a fixed day for treatment of minor ailments and referral. These teams will take care of the students already screened by teachers. In addition, a Doctor from CHC/PHC will also visit one school per week based on the screening reports submitted by the teams of ANMs. Presumptions for calculation: Taking total number of students in India (in Government and Aided private schools) to be 22 Crores, on an average there would be approximately students in approx. 211 schools in a block. Thus, there would be approx. 169 students in each School. As there are on an average 30 ANMs in a Block, 15 Teams of 2 ANMs each can be formed for School Health Programme. If a Team of 2 ANMs can cover 1 school in a day, it will take211 to cover 211 schools in a Block. Thus, time taken to cover 211 schools by 15 teams of ANMs will be 14. One Doctor from CHC/PHC will also visit one school per week. As there are 32 weeks in a school session 32 such visits will be possible. i. Orientation of ANMs for SHP in Block CHC for 2 : Each ANM each day Each ANM for 2 Block level For 30 ANMs in a Block for 2 District Level All India for 300 ANMs in a District 600 (2 ) Districts TA/DA ,000 60,000 Refreshment ,000 30,000 Stationery ,200 12,000 10,200 1,02,000 3,60,00,000 1,80,00,000 72,00,000 6,12,00,000 1,22,40,000 2,44,80,000 2,44,80,000 12

13 ii. Mobility support to ANMs to visit schools: Per day For 14 working For 1 ANM each day 100 1,400 For 1 team (of 2 ANMs) 200 2,800 For 15 teams in a Block 3,000 42,000 For 150 teams in a District 30,000 4,20,000 For (150*600)= Teams in 600 Districts 1,80,00,000 18,00,00,000 3,60,00,000 7,20,00,000 7,20,00,000 iii. Incentive to ANMs for covering each school Incentive to 1 ANM for covering 1 school 100 Incentive to 1 ANM for 14 schools in a year 1,400 Incentive to 1 Team (2 ANMs) for 14 schools in a year 2,800 Incentive to 15 teams of ANMs in a Block for covering 14 schools in a year 42,000 Incentive to 150 teams in a District in a year for covering 14 schools in each Block 4,20,000 For (150*600)= Teams in 600 Districts 25,20,00,000 5,04,00,000 10,08,00,000 10,08,00,000 iv. Incentive to Doctor: A Doctor from Block CHC/any PHC will visit one school per week to cover 32 schools per annum. The selection of school will be based on the screening reports submitted by ANMs. 13

14 Per visit Incentive to 1 Doctor to visit 1 school per week (32 weeks are available during school session) 300 For 32 visits 9,600 For 6500 Blocks 6,24,00,000 1,24,80,000 2,49,60,000 2,49,60,000 Mobility support to Doctors to visit schools ,000 10,40,00,000 2,08,00,000 4,16,00,000 4,16,00,000 TOTAL OPTION- 1: YEAR-1 YEAR-2 YEAR-3 30,06,74,250 60,09,54,750 60,09,54,750 YEAR-4 ONWARDS 3,16,05,56,250 OPTION-2: Existing ANM/MPW visits on a fixed day for screening, treatment of minor ailments and referral and a Doctor visits 1 school per week Presumptions for calculation: Taking total number of students in India (in Government and Aided private schools) to be 22 Crores, on an average there would be approximately students in approx. 211 schools in a block. Thus, there would be approx. 169 students in each School. As there are on an average 30 ANMs in a Block, 15 Teams of 2 ANMs each can be formed for School Health Programme. If a team of 2 ANMs can cover 40 students in a day, it will take 4 working to cover a school having 169 children. 14

15 Thus, the time taken to cover 211 schools by 15 teams of ANMs will be 56 working. i. Orientation of ANMs for SHP in Block CHC for 2 : Each ANM each day Each ANM for 2 Block level For 30 ANMs in a Block for 2 District Level All India for 300 ANMs in a District 600 (2 ) Districts TA/DA ,000 60,000 Refreshment ,000 30,000 Stationery ,200 12,000 10,200 1,02,000 3,60,00,000 1,80,00,000 72,00,000 6,12,00,000 1,22,40,000 2,44,80,000 2,44,80,000 ii. Mobility support to ANMs to visit schools: Per day For 56 working For 1 ANM each day 100 5,600 For 1 team (of 2 ANMs) ,200 For 15 teams in a Block 3,000 1,68,000 For 150 teams in a District 30,000 16,80,000 For (150*600)= Teams in 600 Districts 1,80,00,000 1,00,80,00,000 20,16,00,000 40,32,00,000 40,32,00,000 iii. Incentive to ANMs for covering each school Incentive to 1 ANM for covering 1 school

16 Incentive to 1 ANM for 14 schools in a year 1,400 Incentive to 1 Team (2 ANMs) for 14 schools in a year 2,800 Incentive to 15 teams of ANMs in a Block for covering 14 schools in a year 42,000 Incentive to 150 teams in a District in a year for covering 14 schools in each Block 4,20,000 For (150*600)= Teams in 600 Districts 25,20,00,000 5,04,00,000 10,08,00,000 10,08,00,000 iv. Incentive to Doctor: A Doctor from Block CHC/any PHC will visit one school per week to cover 32 schools per annum. The selection of school will be based on the screening reports submitted by ANMs. Per visit Incentive to 1 Doctor to visit 1 school per week (32 weeks are available during school session) 300 For 32 visits 9,600 For 6500 Blocks 6,24,00,000 1,24,80,000 2,49,60,000 2,49,60,000 Mobility support to Doctors to visit schools ,000 10,40,00,000 2,08,00,000 4,16,00,000 4,16,00,000 TOTAL OPTION-2 YEAR-1 YEAR-2 YEAR-3 29,75,20,000 59,50,40,000 59,50,40,000 YEAR-4 ONWARDS 1,48,76,00,000 16

17 OPTION-3: Two ANMs/MPWs/GNMs/PHNs/JPHNs are engaged per Block on contractual basis i. Remuneration for 2 ANMs/MPWs/GNMs/PHNs/JPHNs Per Month (2 ANMs) 10,000 Per Annum (2 ANMs) All 6500 Blocks 1,20,000 78,00,00,000 15,60,00,000 31,20,00,000 31,20,00,000 ii. Orientation of ANMs for SHP in Block CHC for 2 TA/DA Refreshment Stationery TOTAL Each ANM each day Each ANM for 2 For 2 ANMs in a Block for 2 for 20 ANMs in a District (2 ) , , , Districts 24,00,000 12,00,000 4,80,000 40,80,000 8,16,000 16,32,000 16,32,000 iii. Mobility support for all 240 For 1 ANMs/day For 2 ANMs for 240 For a District (20 ANMs) for 240 ALL INDIA For 600 Districts

18 48,000 4,80,000 28,80,00,000 5,76,00,000 11,52,00,000 11,52,00,000 TOTAL OPTION- 3 YEAR-1 YEAR-2 YEAR-3 21,44,16,000 42,88,32,000 42,88,32,000 YEAR-4 ONWARDS 1,07,20,80,000 GRAND TOTAL ALL OPTIONS (entire country): (Including PROG. MANAGEMENT MANPOWER + HARDWARE/MEDICINE + PRINTING OF MANUAL + IEC) OPTION-1: Teachers screen on continuous basis + ANMs/Doctors visit YEAR-1 ( Schools) YEAR-2 ( Schools) YEAR-3 ( Schools) periodically OPTION-2: Existing ANMs screen children + Doctor visit OPTION-3: Two ANMs are engaged on contract in each Block In Crores YEAR-4 onwards (100% Schools)