HEALTH CARE, HUMAN SERVICES AND FAMILY WELFARE

INTRODUCTION

The real wealth of Sikkim is it’s people and the purpose of development is to create an enabling environment for people to enjoy long, healthy and creative lives. The vision of the State of Sikkim in the area of health care will be to foster a healthy society through provision of quality health care, services for all its citizens from womb to tomb and to reach up to remotest village of Sikkim. To realize this vision, the Department of Health Care, Human Services and Family Welfare, like in the previous years, during 2005 – 2006 continued to forge ahead witnessing vigorous implementation of various National and State run Programmes in the Health and Family Welfare sector and policy initiatives to improve and create quality health care facilities for general public in the State. Most of the resolutions relevant to this State adopted in the Eighth conference of Central Council of Health and Family Welfare held on 28th-29th August 2003 at Vigyan Bhawan in New Delhi have been actively taken up for implementation during the year under report. Major activities of the department during the year included consolidating, strengthening, modernizing the existing health care infrastructures and upgrading technical skills of Medical, Paramedics, Nursing Personnels and other Non-Medical Officers of the department by exposing them to workshops, seminars, reorientation training Programmes, sponsoring doctors for higher Medical education outside the State from time to time.

The Department is instrumental and responsible for implementation of various National Programmes in the areas of health care and family welfare as well as prevention and control of communicable diseases. All schemes related to health care and family welfare sector are continued to be implemented in the State through a network of 147 Primary Health Sub Centres (PHSC), 24 Primary Health Centres (PHC), 4 Community Health Centre (CHC) and one 300 bedded State Referral Hospital (STNM) at the State Capital, Gangtok A 400 bedded Central Referral Hospital – Cum – Medical College set up in collaboration with the Manipal Pai Foundation Group under Private management has also been functioning in the State for the last few years.

The Department has made rapid Progress in expanding overall  infrastructures  as well as trained manpower in the State. The Department headed by a full fledged Secretary to the Government is manned as on 31.03.2006 by 255 doctors including Consultants and specialists in different Medical Science, 26 Dentists,670 Nursing Personnels, 439 Paramedical. Besides 29 Non –Medical Officers from various Cadres have been posted in the Department. Out of the 255 doctors and Dentists, 132 doctors and Dentists have been posted in the East District including STNM Hospital, 32 doctors in the West District, 15 doctors in the North District and 38 doctors in the South District.  28 doctors have been assigned in charge of administration of the department and Programme Officers of various national programmes.

The technological advances and improved quality and coverage of  health care resulted in a rapid fall in crude Death Rate (CDR) from 7.5 in 1991 to 4.9 in 2004. There is considerable improvement in the Infant Mortality Rate which decreased from 51\1000 Live Births in 1997 to  32\1000 Live Births in 2004. In the case of contraceptive Prevalence Rate, significant improvement is noticed in the NFHS- II report. The CPR as per SRS in 1993 was 21.70% improved to 53.8% in 1998-99.In contrast to steep fall in death rate, the decline in CBR has been less steep from 22.5 in 1991 to 19.5 in 2004. Statistics on population per Doctor, Nurses, Health Assistants, Health Workers and Lab Technicians as also the ratio of bed-doctor, bed – Nurse indicate that they are well within the suggested National norms as on 31-03-2006. Despite such significant achievements, a lot more is still need to be done to improve  Contraceptive Prevalence Rate and deliveries assisted by Health Professional in which the State is lagging much behind the National Average Rate. Statistics of the above facts is appended in Part III of this report.

The financial outlay under the health sector have been increasing over the successive Five Year Plans. While the investment which was just Rs.60.00 crores in the Ninth Plan(1997–2002) has enhanced to Rs. 80.00 corers in the 10th Plan (2002–2006). During the  year  under  report, an  investment of  Rs. 1971.15 Lakhs under the State Plan and Rs. 3133.86 Lakhs under the Non Plan were made as against the expenditure of Rs. 2198.80 lakhs under State Plan and Rs.2622.88 lakhs under Non-Plan in 2004-05. In addition to this investment, Rs. 594.97 Lakhs was made under 100 % Centrally Sponsored Scheme (CSS) as against Rs.508.63 lakhs in 2004-05. Further to this, a grant of Rs.621.84 Lakhs was directly received from the Government of India to various Societies viz. State AIDS Control Society, RCH & Family Welfare , State  Leprosy Society, State Tuberculosis Society and State Blood Transfusion Council.

The Family Welfare Programme is a 100 % Centrally Sponsored Scheme (CSS) which is supplemented by the funds received under the RCH project. The Programme is under the charge of a full-fledged Director. Under this Programme, the department has been making all out efforts to achieve the goal set by the National Population Policy 2000. Sikkim is the first State in the country to have implemented immunization programme for child in the age group of (0-1) years with Hepatitis ‘B’ vaccine free of cost. The programme was started in 2001-02 and is being continued during 2005-06 and further more vigorously. The programme has received popular support of the Panchayats and is being taken up by them at the grass root level out of their own fund with wider coverage in age of children up to 5 years. The Pre Natal Diagnostic Technique (Regulation & Prevention of Misuse) Act, 1994 has been enforced in the State since 1.1.1996. To ensure the diligent implementation of the Act in compliance with the directives of the Supreme Court of India, Appropriate Authorities and Advisory Committees have already been constituted at State and District level. As of date, there is not a single report of violation of this Act in the State. The Authorities have, nevertheless, been vigilant despite Nil report. A GNM Training School under the charge of a Principal Nursing Officer has been functioning under the F.W. Programme. The School provisionally affiliated to the West Bengal Nursing Council runs a residential 3 and ½ years course with hostel facility to all selected trainees. Obstetric care is also improving in the State in access and coverage. While only 43% of pregnant women received full anti-natal care during 1998-99, it has improved to 72% during 2005-2006. The current status of institutional deliveries as per the service statistics which was 32% in 1998- 99 has now improved to 57.0% during 2004 – 2006. Breast-feeding is nearly universal in the State but only 16% are exclusively breast fed for the first four months, 5% of children less than 3 years are wasted and 21% to 32% are under weight or stunted. 11% of women in the State are under nourished and 24% have moderate to severe anemia (NFHS -II -1998- 99). Under Janani Suraksha Yojana scheme, a cash incentives of Rs 700 for institutional delivery  and Rs.500 for home delivery in rural areas and Rs.600 and Rs.500 respectively in urban areas are awarded to BPL Category mothers who have first child after 19 years of age, for birth of first or second child only. Fund for implementation of this scheme has been released to CMOs of all districts and  Medical Director of STNM Hospital. With regard to immunization, there has been a marked improvement in performance over the years. It was only 47.4% coverage in 1998- 99 which has improved to 90.0% (all vaccinations) during 2005 – 2006.

The performance of the Department under National Diseases, Control Programme has been good except for the National Programme for Control of blindness where achievement of targets and utilization of funds have been Sub – optimal during the year under report as also in previous years.

During 2005 – 2006, out of Rs 5.00 lakhs fund received from the Government of India, only Rs 2.98 lakhs could be utilized under this Programme resulting an achievement of only 35.10% physical target as against the target of 1000. The Sub – Optimal achievement of targets and low utilization of allocated fund under the Programme is attributable to shortages of trained ophthalmic manpower in the State.

Though the State is not endemic for Malaria, there has been some resurgence due to the projects under NHPC etc. As such, the Department has been making greater efforts to see that Annual Blood Examination Rate (ABER) of maximum 10% is achieved to ensure early detection and timely containment of spread of the disease. The main activities under the National vector Borne Disease Control Programme (NVBDCP) (a new nomenclature of National Malaria Eradication Programme –NMEP) includes early diagnosis and prevention of malaria cases, insecticide  spray – anti adult and anti – larval measures, establishment of Drug Distribution Centre/fever treatment depot (DDC/FTD) and IEC including Anti-Malaria Month. During 2005,an outbreak of Malaria was reported from the lower belt of East and South districts specially in the NHPC project area. However,only three deaths with 69 Cases of Malaria positive including 31 Plasmodium Falcifarum cases were reported.

Revised National Tuberculosis Control Programme (RNTCP), with the objective to achieve cure rate of 85% and detection of 70% cases was started in Sikkim w.e.f.1.03.2002. For implementation of the Programme, State and District T.B. Control Societies have been formed. The Programme is funded under the State Plan and grant- in – aid received from the Government of India directly to the State T.B Society. There are four District Tuberculosis Centres (DTCs) five Tuberculosis units (TUS),Eighteen Designated Microscopic Centres (DMCs) 11 Non Designated Microscopy Centre (NDMC) and 561 Directly observed Treatment (DOT) Centres in the State. During the year under report,as against the target of 85% of new smear positive patients detected and 70% of new smear positive cases, an achievement of 88% cure rate  was made by the Society. The  Society spent Rs 50.91 lakhs as grant received from the Government of India in addition to Rs 50.50 lakhs from the State Plan during the year under report. In the sphere of Leprosy elimination, the second phase of the National Leprosy Eradication Programme (NLEP) was vigorously taken up during the year under report. The Prevalence rate has now come down to 0.58/10,000 as against 1.10/10,000 in 2001 – 2002. Most of the Medical Officers and Health workers of the Department have been provided with training in treatment of Leprosy. Intensive as well as extensive IEC activities were undertaken all over the State using Print and electronic media. School Health Programme and quiz  context were organized in Sr. Secondary and Secondary Schools all over the State. During 2005 – 2005, the State Leprosy Society received Rs.15.68 lakhs from the Govt.of India and spent Rs.14.64 lakhs on meeting administrative expenses of the Society. Under this Programme, one temporary Hospitalization ward has been set up at Sajong, Rumtek, East District and one Leprosy Control unit at Gangtok.

To manage HIV/AIDS, State AIDS Control Society which is governed by Memorandum of Association framed and approved by a Governing Body with Chief Secretary, Government of Sikkim as Chairman and Secretaries of various departments as members has been registered. The Society has its own Bank A/C where the fund coming from NACO is directly remitted. One senior Doctor has been deputed by the Department of Health Care, Human Services, and Family Welfare to head the Society as project Director assisted by one Finance Officer on deputation from the Sikkim Finance Accounts Service of the Government of Sikim to look after the accounts matter of the Society. Under the National AIDS Control Organization (NACO) guidelines three Blood Banks have been set up in the State at STNM Hospital, Gangtok, at CHC Namchi, South District, and at Sikkim Manipal Institute of Medical Sciences and Hospital at Tadong, Gangtok East District. As of date, there are 49 HIV positive (male-36 and female-13) out of which 11 are full blown (male-9 and 2 female), total AIDS death-5 have so far been recorded in the State. During the year 2005 – 2006, the Society received Rs.196.00 lakhs directly from the NACO and approved allocation for the year was 405.29 lakhs and spent Rs.266.44  lakhs on meeting administrative expenses of the Society.

For effective Monitoring and proper implementation of National Iodine Deficiency Disorder Control Programme (NIDDCP) in the State, an IDD Control Cell has been created in the department. The main objective of the cell is to conduct surveys to assess the magnitude of the Iodine deficiency disorders, ensure supply of Iodated salt in place of common salt, to resurvey to assess Iodine deficiency disorders and the impact of Iodated salt after every 5 years, Laboratory Monitoring of Iodated salt and urinary Iodine excretion and Health Education and publicity. The main goal of the Government is to reduce prevalence of IDD to below 10% in the entire Country by 2010 AD. Sikkim falls under hyper endemic region of Iodine Deficiency Disorders. The Survey conducted by the Department during 1998 – 99 found 45.03% and 3.46% as the prevalence rate of goiter and cretinism respectively. After implementation of the Programme,aresurvey was conducted by the State Government which revealed remarkable improvement in the goiter and cretinism prevalence rate. The goiter prevalence rate come down to 16.8% from 54.03% and cretinism to 1.8% from3.46%. In order to ensure use of only Iodated salt, the sale of Non- Iodated salt      for human consumption has been completely banned under the PFA Act, 1954 in the whole of the State of Sikkim. A thyroid Centre has also been established at Namchi, South District.

The Department has taken over the responsibility of Civil registration activities in the year 1997 from the Bureau of Economics and Statistics, Government of Sikkim. The Birth & Death Act, 1969 and the Rules made there under are being implemented through a Birth & Death cell created in this department. The Principal Director, Health Services has been designated as the Chief Registrar who is assisted by Director, Dental Health Services as Additional Chief  Registrar and Deputy Chief Registrar, Assistant Director and other supporting Staff  With a view to ensure wider coverage of the Civil Registration on Birth & Deaths, the CMOs of District Hospitals and MOs in charge of PHCs have been declared Registrars and Anganwadi workers have been assigned the additional responsibilities of notifying cases of Birth & Deaths. The Tenth Plan has set the goal of 100% registration of Births and Deaths and use CRS data for Planning and Monitoring of the Programme in all districts by 2007. As against this goal, the Department has achieved 86% coverage in births and 83% in deaths during 2005-06

Under the Provisions of the Mental Health Act, 1987 which has come into force from 1st April  1993, State Government is required to constitute State Mental Health Authority and to meet  regularly. The Supreme Court of India in Suo-Moto writ petition has also directed all State Governments to constitute the State Mental Health  Authority. In compliance with the directives of the S.C of India, Sikkim Mental Health Authority has been constituted under the provision of the Mental Health Act, 1987 under Rule 3 of the Sikkim Mental Health Rules 2001 with Secretay Health as Chairman and Consultant Psychiatrist as Member Secretary. At the State level, a 20 bedded State Mental Hospital under the charge of a Senior Psychiatrist has been functioning at STNM, Gangtok. A Psychiatrist has also been appointed at District Hospital Namchi, South District.Besides, the Sikkim Manipal Institute of Medical Sciences, Tadong which is under private management has also set up a 6 – bedded Psychiatric unit under the charge of a Psychiatrist. During 2005 – 2006, extensive outreach programme has been organized for identification of mentally disabled people. A total of  175 cases with mental retardation and multiple disability has been identified

National surveillance Programme for Communicable Diseases (NSPCD), a pilot project of Government of India which was under implementation in the State since 1997-98 has now been completed on 31st March,2006. Now the same programme has been renamed  as Integrated Disease Surveillance Programme (IDSP) which includes both Communicable and Non-Communicable Diseases will be commencing from 1st April 2006 in the State.

National Cancer Control Programme was launched by the Government of India   in 1975 – 76. However, the Programme has been under implementation in the State since 1990 – 2000. As of date, Cancer Detection Centre at CHC, Namchi, Ravangla PHC, and Jorethang PHC in South District and at STNM Hospital, Gangtok, CHC, Singtam and Pakyong PHC, and Rongli PHC in East District  have been set up. By the year 2006-07, remaining two districts North and West are also included in the District Cancer Control Project. Proposal has already been submitted to the Govt. of India and will be implemented on receipt of fund. A sum of Rs.6.40 lakhs each for East and South district have been enmarked under National Cancer Control Programme.

During 1996, Government of India launched a Scheme called “National Illness Assistance Fund Scheme”. The main objective of the Scheme is to provide necessary financial assistance to poor persons suffering from life threatening diseases for Medical treatment in super specialty Hospitals. In pursuance to the Government of India’s Policy, the Scheme has also been started in the State. Sikkim State Illness Assistance Fund Association (SIAFA) has been registered in October 1998. The objective is the same as that of NIAF that is to provide financial assistance to BPL Sikkimese people suffering from life threatening diseases. As of date, a fund of Rs.80 lakhs is remaining with the Department.

Besides, the aforementioned National Programmes, the department runs Dental Oral Health Programme out of the State Plan fund. The Programme is manned by Director (Dental Health), assisted by Additional Director, Consultants and Dental Surgeons. Altogether, there are 26 Dental Surgeons posted at various PHCs, District Hospitals and STNM Hospital, Gangtok. Dental Health is although a major problem in the State nevertheless, the Programme has not been sponsored by the Government of India as National Programme.

For implementation of various educational Programmes on the preventive and promotive  aspects of health, a State Health Information, Education and Communication  Bureau has been functioning under the Department. The main objective of the Bureau is to bring about behavioral change in knowledge, attitude and practice of the community for promotion of better health. Activities undertaken by the Bureau during 2005 – 2006 involve IEC activities on various National Programmes.

The Drugs and Cosmetic Act 1940 and Rules 1945 has been enforced in the State in 1985. The objective is to provide quality medicines to patients at the right prices. A Drug cell has been functioning in the Department, which is headed by the Principal Director of Health as Ex – Officio Drugs Controller assisted by one full time Deputy Drug Controller, Pr. Drug Inspector and two Drug Inspectors.

The Prevention of Food Adulteration (PFA) Act, 1954 and Rules 1955 has been  enforced  in the State from March 1979. Under the Act, the Principal Director Health Services has been appointed as Food (Health) Authority and Licencing Authority. The Rules framed under the Act aims at curbing menaces of adulteration in all food available from manufactures to retailers. The State Government has framed Sikkim Prevention of Food Adulteration Rules 1991, which have been legislated duly regulating licensing provisions in all prepared and unprepared food stuff being marketed in the State since 1992. The State has no Food Testing Laboratory and therefore all the food samples collected in the State are being sent to Guwahati (Assam) for analysis. However, a Mini Food Testing Laboratory manned by a Public Analyst has been operating for the last four  years. During the year 2005-06,  the PFA  cell collected Rs 8.61 lakhs from license renewal fee. Out of 126 food samples  analyzed, 42 samples were found adulterated and 7 acquitted and 2 convicted.

To deal with the preventive aspect of Public Health with its advisory role with inter- related sectors, a Sanitation Cell has been set up in the department.    Routine  activities of the cell involve regular inspections of towns and rural Marketing centres, preparation of status report on environmental Sanitation, preparation of Advisory notes for improvement of drainage and public conveniences of towns, awareness campaign against indiscriminate handling and disposal of garbage. During the year 2005 – 2006, all the hospital staff were given training on Bio-Medical waste management.

In June’1990, the Department has established a State Health Mechanical workshop to take up repair and maintenance of Ambulance and Programme,     vehicles and Hospital equipments. The workshop is manned by a Divisional Engineer assisted by a State cold chain officer, Junior Engineer, Foreman, Refrigerator Technicians and Mechanics – all have completed training sponsored by UNICEF. During 2005-2006, the workshop has taken up major repairs including denting and painting of 23 Nos. of different types of vehicles.

To take up construction of new building under the department, repair and maintenance of existing buildings and Employees’ quarter, an Engineering cell (Civil) has been created and functioning. The cell is manned by one DivisionalEngineer (Civil) assisted by two Assistant Engineers, Junior Engineers, Draftsman and other supporting Ministerial Staff.

With the main objective to procure Drugs, Chemicals, Medical instruments, equipment and uniforms for Medical and Paramedical staff, a Central Health Stores Organization (CHSO) has been set up and functioning in the department. The CHSO is headed by one Additional Director assisted by two Store Officers and supporting Staff. All purchases are made by the CHSO as per the Sikkim Financial Rules and on the recommendation of the committees constituted for the purpose. During the year 2005 – 2006, the CHSO spent Rs.119.42 lakhs  from the State Plan Fund and Rs.406.58 lakhs from the Non – Plan Fund for purchase of various instruments, equipments, and for purchase of uniforms for the Medical/ Paramedical Officers and Staff.

What began with  50 bedded and 3 Doctors in 1917, Sir Thutob Namgyal  Memorial Hospital (STNM), Gangtok located in the heart of the town has now  expanded to a multi – specialty 300 bedded State Referral Hospital with 18 departments of different specialty,109 Doctors including Consultant/Specialists and 526 permanent employees. The Hospital is under the charge of Medical Director –cum – Superintendent. The Hospital has different investigative facilities like C.T.Scan, Ultra sound, X – Ray, Pathological, Microbiology, and  Electrocardiogram. Blood Bank Services are also available round the clock. Investigative facilities such as CT Scan, ultra – sound, X – Ray, Pathology, Microbiology and Electro- cardiogram including Blood Bank Services are provided round the clock for emergency patients. During the year 2005, 1,87,122 patients attended the general OPD out of which, 9607 in patients admitted and treated. Percentage of death in the hospital was only 3.71.During the year under report, 10406 major & minor operations performed in the hospital. 1169 patients (572 State Govt.employees and 597 general public) were sent outside the State for further treatment for which treatment facilities is not available in the hospital.

For effective implementation of HMIS and for Monitoring and Evaluation of the ongoing  National Programmes, a Planning, Monitoring and Evaluation Division has been functioning in the department since June 2002. The Division is under the charge of Additional Director, Health Services and manned by three Officers of the State Statistical Cadre. It has been equipped with one computer. The Division is responsible for Monitoring of Family Welfare Programmes, 20 Point Programme, collection, collation and compilation of various reports, evaluation including preparation of Health Bulletin and Annual Report of the department

The Department is endeavoring  to fulfill all the commitments and vision  towards Health and Family Welfare sector, under the overall guidance and directives of the  Hon’ble Minister, Health Care, Human Services and Family Welfare, Government of Sikkim.

PART-II

NATIONAL/STATE PROGRAMMES AND OTHER ACTIVITIES 

1. FAMILY WELFARE & MCH/REPRODUCTIVE & CHILD HEALTH PROGRAMME

The Government of India adopted the 1994 Cairo agenda with speed and commitment at the highest level, recognizing that improving reproductive health, including family planning, is essential to the development of the Family Welfare Programme. Subsequently, Government of India launched the Reproductive and Child Health (RCH) Programme throughout the country in October 1997, incorporating new approach to population and development issues as exposed in the International Conference on Population and Development held at Cairo in 1994

The programme aims to integrate and strengthen services/interventions under the Child Survival & Safe Motherhood Programme and Family Planning Services and also to tackle problems relating to Reproductive Tract/Sexually Transmitted Infections (RTI/STI) as well as Adolescent Health. It also aims at providing need based, client centered, demand driven, high quality services to the beneficiaries with a view to enhancing the quality of reproductive life of the population and enabling the country to achieve the population stabilization.

The first phase of the RCH Programme ended on 31st March 2004. The FY 2004-05 was the preparatory phase for the RCH Phase – II that has commenced from 1st April 2005. However, all the schemes/activities of the first phase of the programme were continued during the FY 2004-05.

SCHEMES / ACTIVITIES TAKEN UP DURING 2005-06

2.  Dais Training  - to create Trained Birth Attendant in each village for safe deliveries

GRANTS RECEIVED FROM GOVERNMENT OF INDIA DURING FINANCIAL YEAR 2005-2006

The financial assistance (Grants-in-aid) from the Government of India under the       RCH Programme during the financial year 2005-06 were as under:

(A) For Family Welfare Services (through State Exchequer/Finance Department)   

                                                                                              (Rupees in lakhs)

(B)  For RCH and ECSIP Schemes / Activities (directly to State Health & Family Welfare Society of the RCH Programme)                                                            (Rupees in lakhs)

 STRATEGIES FOR 2006-07. 

Achieve 100% coverage under Immunization Programme.

 100% coverage of Children in the age group of 0-5 years with oral polio vaccine during PPI Programme 2004-05.

To impart extensive training to field level workers for improving the performances and quality of services

Improve IEC Strategies in order to bring more awareness and community participation.

Training of Dias to improve the quality of deliveries and bring down death rates associated with pregnancy.

Further improve the performance under No Scalpel Vasectomy (NSV) and Laparoscopic Ligation.

The National Vector Borne disease Control Programme (NVBDCP) is an Umbrella programme for the prevention and control of Malaria and other Vector Borne diseases like Dengue, Filariasis, Kala Azar and Japanese Encephalitis with special focus on the vulnerable groups of the society. Under the programme, it is ensure that the disadvantaged and marginalized section benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission Goals are achieved.

THE OBJECTIVE OF THE PROGRAMME

-         To prevent death due to Malaria and other vector borne diseases.

-         To reduce Morbidity due to Malaria and other vector borne diseases.

OUTCOMES OF THE PROGRAMME UNDER NRHM  

-         Malaria mortality reduction rate 50% upto 2010, additional 10% by 2012.

-         Kala Azar to be eliminated by 2010. Filaria/Microfilaria reduction rate: 70% by 2010, 80% by 2012 and elimination by 2015. Dengue mortality reduction rate: 50% by 2010 and sustaining at that level until 2012.

-         Japanese Encephalitis mortality reduction rate: 50% by 2010 and sustaining at that level until 2010.

THE MAIN ACTIVITIES UNDER THE PROGRAMME

-         Early diagnosis and prompt treatment.

-         Integrated vector control.

-         Community based health education.

-         Training and capacity building of various cadres of medical and paramedical staff for prevention, management and control of vector borne diseases.

-         Effective monitoring, supervision and surveillance.

The valley of Southern and Eastern Sikkim are hot and humid throughout the year except in winter and these areas at and below 3500 ft. falls under Malarial Zone of the State having population of 1.44 lakhs. 

Under the programme there are 10 Malaria clinics where diagnosis of Malaria cases are done. Also there were 19 Drug Distribution Center (DDCs) and 31 Fever Treatment Depots (FTDs) in the State but presently all are non functional, as most of the sub-center are near the village and they are functioning as DDCs and FTDs.

EPIDEMIOLOGICAL SITUATION

The cases of Malaria has increases since 2001, and in the year 2003 outbreak of Malaria occurred in the South and East district where the total reported cases were 278 including 41 plasmodium falciparum malaria and one death. In the year 2004, total reported cases were 160 including 33 pf cases and three deaths, all three are imported from neighbouring state. During 2005 the total reported cases were 69 including 31 pf and three deaths

Three increase in the number of reported case of Malaria is due to the huge influx of labour population from our neighbouring states like West Bengal, Bihar, Orissa, Assam and neighbouring countries like Nepal, Bhutan and Bangladesh to work in the massive construction sites and project areas like NHPC. Since vector of Malaria and other vector borne diseases are present in the low lying areas of the state there is always threat of outbreak of vector borne diseases in the State as it happened in 1995 and 2003.

In the year 2004, first time in the history of Sikkim there was outbreak of Dengue Fever at Jorethang , South Sikim, where reported cases of fever were 4500. Out of 50 serum samples sent to National Institute of Communicable Disease, Delhi, 12 samples were found positive for Dengue. 

          INTEGRATED VECTOR CONTROL

We are still using DDT as important tool for vector control. While spraying DDY following areas will be given priority.

-         Project areas

-         Labour huts

-         River belts

-         Foothills bordering West Bengal  

SPRAY PLAN FOR 2005 

Population targeted for the spray were 48700 and total coverage was 46550.

This year under the financial assistant from Directorate of NVBDCP following training were conducted: 

         Sl.No. Categories of Staff                 Trained

          1.       MPHW                                     50

          2.       HA/LHVs                                  20               

          3.       Anganwadi workers                   150

          4.       Medical Officers                         25

          5.       Lab Technicians                         20

          IEC 

          This is the most important component of the programme. All the available medias in the state are being used to spread the message of prevention and control of Malaria and other vector borne diseases.  

          Community bases IEC activities in collaboration with IEC Bureau are carried out in all the Malarial Zone of four District like Advocacy Workshop for NGOs, FBOs and panchayat, awareness camp for community people, quiz competition for students, distribution of pamphlets, posters installation of hoarding etc. 

          Anti Malaria Month is observed during month of June. 

          MONITORING AND SUPERVISION  

          Regular field visit by State Officers are going on, during this visit discussed progress and problem with the Malaria Workers and Medical Officers concerned. This year focus has been given to Jorethang and surrounding areas for early detection of any outbreak and appropriate and timely response.            

BUDGETARY SUPPORT AND EXPENDITURE 

Regarding the budgetary support of the  programme, it is provided under – 

1.                  Fund received under the State Plan. During the year 2005-06 and expenditure of Rs.8175 lacks was incurred for all four districts.

                     Grand received from GOI

1  Grand received from GOI  Rs. 400000.00 for TSP/SC and General areas.

2. Grand received from Govt. of  India to Sikkim State Malaria Control Society.

(a)- Rs. 8,60,000.00 for BCC activates.

(b)- Rs. 435000.00 for Training of all categories of  health personals.                            

 Strategy for the year 2006-07

·  Early case detection and complete treatment.

·  Vector control and personal protective method including insecticides treated mosquito net.

·  Increase in ABER more than 10% of the population of Malaria zone.

·  More emphasis will made to screen the migratory  labour population especially in the project areas like NHPC.

·  Strengthening of IEC actives including observation of Anti Malaria month (June).

·  Epidemic planning and rapid response.

·  Training all categories of Health personals.       

3.NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS. 

National Programmme for Control of Blindness is being implemented in Sikkim since 1979 as 100% centrally sponsored scheme. Under this programme the Opthalmic Department of the District Hospital, Primary Health Centres are supported by providing manpower, equipments and instruments to provide basic Eye Care to the people. Under this programme the major emphasis is given to tackle the blindness caused by cataract which is about 81%. Tp achieve the Cataract Operation the target Central Mobile Units and District Unit Mobile were set up to clear the Cataract backlog and tackle the incident cases. To support this programme the Government ofIndia made provision to post Opthalmic Assistant in each and every Primary Health Centre to undertake the Eye Care and to establish proper referral system so that no eye go blind without proper treatment. With allthese facilities provided to the District Hospitals and Primary Health Centre the Cataract backlog can not be cleared satisfactorily. Hence, to facilitate proper implementation of this programme and to clear the Cataract backlog District Blindness Control societies were established, where both the Government and Non Government Organisation can take part in Eye Care services to the people. With the set up of the District Blindness Control Society it has become easier to implement this programme. In Sikkim we have only one ophthalmic Surgeon in the whole of the state posted in S.T.N.M. Hospital. There are 5 opthalmic Asstt. Out of which 2 are posted in STNM Hospital and 1 each in the District Hospital Mangan, Gyalshing and Namchi. The District Hospital s do not have any Opthalmic Department and manpower except Opthalmic Asstt. And hence, NPCB is not properly implemented in the districts and this is causing under-utilisation of the DBCs fund. 

          We have a State Opthalmic Cell manned by a part time Stte Programme Officer, one LDC-cum-typist and one peon. The basic function of this cell is to implement, monitor and evaluation of this programme.

          Keeping in view of vision 20.20 “Right to Sight” the National Programme for Control of Blindness has started School Eye Screening Programme for the school children up to the age of 14 years to detect and tackle the causes of Avoidable blindness in children. 

          With an effort to provide Eye Care Services to the people 10 bedded Eye Ward cum Operation Theatre is completed at the District Hospital, Namchi. This facility will be brought to use as soon as we get the basic facilities and minimum Opthalmic manpower. 

          BUDGETARY SUPPORT AND EXPENDITURE 

           The Budget for state Opthalmic Cell is Rs. 5.00 lakhs for 2005-06 and the expenditure is Rs. 2.98 lakhs.

PHYSICAL TARGET

            Cataract Operation target 1000          -    2005-06

            Achievement                                   -     351

            School Eye Screening target               -   9000 

            Achievement                                    -   3942 

STRATEGY AND PRIORITIES FOR 2006-07 

          The Eye Care Services has to be given priority so that no person go blind without getting proper care. Hence, the priority for 2006-07 is to fill up all the 11 posts of Opthalmic Asstt. and to place them in important PHCs. The 10 bedded Eye Ward and Operation Theatre has to be made functional by posting minimum ophthalmic manpower and providing basic instrument, equipments, hospital furnitures and office furnitures etc. The Government is giving priority under National Rural Health Mission to strengthen and to improve the health care serices at the District Hospitals. Hence, the department should take up proper steps to train the local Doctors for Post Graduate Courses immediately in Opthalmology and post them in the District Hospitals so that facilities given by Government of India under the District Blindness Control Society reaches to the needy rural population of the State.

4.NATIONAL AIDS CONTROL PROGRAMME 

AIDS Control Programme was launched in the year 1991-92 and the programme continued as Phase I AIDS Control Programme upto march, 1999. There after the programme entered into the PHASE II AIDS control Programme from April 1999 – March, 2006. Some of the salient features of the Phase - II AIDS Control Programme are given below:-

1.   There was a paradigm shift in the policy of the implementation of the programme.

2.   Society mode was adopted in compliance with the instruction of Government of India and the approval obtained from state government.

3.   Funds were directly released to the accounts of the society by NACO (Government of India.)

4.   Charter Accountant was appointed to carry out the audit of the accounts.

5.   Finance Control Unit was setup within the office of the society and a Computerized Project Financial Management System was introduced.

6.   Project implementation guideline was setup as mention below by NACO

A. Delivery of cost effective intervention against HIV/AIDS.

i)    Priority targeted intervention for high risk groups.

ii)   Preventive Intervention to General Community.

iii)  Low cost AIDS Care. 

B. Strengthening the capacity.

i)     Institutional Strengthening.

ii)  Intersect oral Collaboration.

        Implementation of AIDS Control Programme continued throughout the Phase II period. Main thrust was on mass awareness on HIV/AIDS, implementation of intervention programmes on HRG, bridge population, migrant laborers, transport workers, jail inmates etc. Some of the activities implemented   by AIDS Control Society under general intervention programme are as follows:-

1.   General awareness camp throughout the state from time to time.

2.   Advocacy for the opinion leaders.

3.   Implementation of School ADIS Programme.

4.   Media meet from time to time.

5.   Organization of Family Health Awareness campaigns

6.   Advocacy Programmes with law enforcement agencies.

7.   Advocacy and sensitization programme with Member of Legislative Assembly.

     8.   Sensitization programme for the religious leaders.

9.   Advocacy of the Head of Department and commissioners for implementation of Intersectoral collaborations on HIV/AIDS.

Training programmes conducted:-

i)   Training programme of the state trainers on management of HIV/AIDS and STD.

ii)   Training of the medical officers on management of opportunistic and syndromic management of STD and universal precaution.

iii)  Training of nurses on Awareness on HIV/ADIS, Management of AIDS cases, adoption of Universal Precaution and counseling.

iv)  Training of Lab Technicians on HIV Testing and universal precaution.

 v)  Training of Counsellors on counseling and awareness on HIV/AIDS and condom promotion.

vi)   Training of the class IV employees on HIV/AIDS awareness and Universal Precaution.

vii)   Training on NGOs on modalities of implementation of intervention programmes. 

Infrastructure setup for Service Delivery System. 

1.   Voluntary counseling and testing centre for HIV/AIDS established in al the four district hospitals and at STNM hospital.

2.   STD clinics established in STNM hospital and in all the four-district hospital.

3.   Centres Prevention of parent to child transmission of HIV were established at STNM Hospital, Sikkim Manipal Institute of Medical Sciences and all the district Hospital.

4.   Sentinel Surveillance activities conducted at STDs clinics STNM hospital, Antenatal Clinic STNM hospital, Antenatal clinic Pakyong PHC and Rhenock PHC and IDU of Gangtok.

5.   Establishment of Antiretro Viral Therapy Centre at STNM hospital Gangtok.

Blood Banks

1.   Central Blood bank at STNM hospital Gangtok where zonal Blood Testing Centre is also attached.

2.   Blood Bank at Sikkim Manipal Institute of Medical Sciences.

3.   District Level Blood Bank at District General hospital Namchi South Sikkim.

HIV/AIDS Scenario

1.   Total samples tested for HIV 9000 approx.

2.   Total HIV detected:  49

Male:                      36

Female:                   13

3.   Total AIDS Cases :    11

Male:                       9

Female:                    2

1.   Total AIDS death :      5

Physical Target and Achievement made for during the year 2005-2006.

VCCTC, STD Clinic, PPTCT Centres & ART Centres (Target & Achievement during 2005-2006.

                          Table – I

One PPTCT centre has been established in Sikkim Manipal Institute of Medical Sciences, 5th mile, Tadong.  

II. Reports of VCCTCs on Counselling and Testing for HIV from all four District Centres and VCCTC, STNM Hospital, Gangtok (31st March, 2005 to 31 March, 2006)                        

                                                                      Table - II

Table II shows that the total the total number of the persons tested for HIV is more in case of Sl. No. 1,2 &3 than the number provided counseling. The patients are referred by the Specialists and Medical Officers also in the hospitals after Counseling.                                                        

                                                                   Table III

PPTCT, STNM Hospital (31st March 2005 to 31 March 2006)

                              TRAINING (TARGET & ACHIEVEMENT DURING 2005- 2006)

                                                                  Table IV                  

Target Intervention Programme

                           (Target & Achievement during the financial year 2005-2006)                          

Table V.  

Target Intervention Programme

(Target & Achievement during the financial year 2005-2006)

                                         Table V.

CONSOLIDATED REPORT ON BLOOD DONOR SCREENING FOR HIV FROM 1997 – 2005 

 A. EXPENDITURE UTILIZED FOR THE YEAR 2005 – 2006 Rs in Lacs 

1. Carry Over Balance of Previous Year 2004-05 (Cash & Bank)              Rs.63.86 Lacs. 

2. Grant – in – aid from NACO (2005-06)                                            Rs.196.00Lacs 

3. Other receipt including interest earned from saving account               Rs.2.65    Lacs 

4. TOTAL   fund available as on 01.04.05(Cash & Bank)                         Rs.262.51 Lacs 

B. Expenditure 

 Note: The above shown Expenditure exceed the fund available during the year 2005-06 which is due to previous year advance adjustment during the year and net liabilities of the Current Year 2005 – 06. 

ACHIEVEMENTS OF SIKKIM STATE AIDS CONTROL SOCIETY IN PHASE 1999 – 2006 

 Future Plan of Action

           Phase II AIDS Control Programme was over on 31st March 2006. We are now entering into the Phase III AIDS Control Programme with effect form 1st April, 2006. Most of the afore - mentioned activities under the programme are likely to be continued during Phase II AIDS Control Programme. In addition the programme will be extended and expanded to the districts and sub districts level and the programme at the district level will be implemented and monitored by a district AIDS Nodal officer. More thrust will be given on service delivery system and focus on High-risk group and venerable population. Mapping will be conducted to know the extent of availability of high-risk group and the venerable population in the whole state. Programme will also be focused on migrant population and transport workers. A collaborative network will be set-up with the AIDS Control Society of the neighbouring state to know the extent of the operation of the high-risk groups across the border. Programmes will be amalgamative with the service delivery system of the RCH and TB Programme so that services of the health care workers and the facilities provided by the Government is used effectively and judiciously. This is expected to ensure a proper functioning without duplication. Training Programme will be organized in coordination with RCH and TB Programmes. Proper linkages will be established within the health care delivery system like STD, TB, RCH, and VCTC. In addition a good referral system will be worked out in coordination with the above-mentioned programmes.

           Implementation of the targeted intervention programme will be expanded to cover all the high risk groups in the state and massive condom promotion activities will be implemented through the social marketing networks and free distribution system.

The goal of the AIDS Control Programme Phase III

1. To arrest the further spread of HIV in the state.

2. Provide proper care and support to the infected and effected people with HIV/AIDS.     

2. NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (IDDCP)

I: The NIDDCP was implemented in the state with the following objectives:-

1.     Surveys to assess the magnitude of the iodine deficiency disorders.

2.   Supply of iodated salt in place of the common salt.

3.     Resurvey after every five years to assess the extent of iodine deficiency disorders and the impact of iodated salt.

4.     Laboratory monitoring of iodated salt and urinary iodine excretion and

5.     Health education. 

The goal is to reduce the prevalence of IDDs to <10% by 2010 in the entire country.

The iodized salt was introduced in Sikkim state in 1984 following the implementation of the IDD Control Programme. The sale of non-iodized salt is banned in the state of Sikkim under the provision of Food Adulteration Act 37 of 1954 since 1985. 

II:  Implementation Mechanism and Activities:

The different sections of NIDDCP are:-

1)     IDD Cell

2)     IDD Monitoring Laboratory,

3)     Publicity and Health Education and

4)     Survey and Re-surveys.

1. For proper implementation and effective monitoring of the programme IDD cell has been created in the department. Apart from conducting IDD surveys it is also imparting trainings to the medical officer, health workers, AWWs & NGOs regarding IDDs and its prevention. One of the achievements under this programme has been establishment of Thyroid centre at District Hospital Namchi in1989 which is financed by the state government.

The programme is manned by:-

1. Programme cum Technical Officer (I)

2. LDC (I)

3. Laboratory Technician (I)