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Health Equipments Repair Units (HER Units)

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Introduction
Health Equipment Repair Organisation was established in the year 1971 as a Pilot Project funded by UNICEF and Maharashtra Government. The main objective is to maintain and repair various hospital equipment including cold chain equipment in the institutes and hospitals at rural level.

Activities of Health Equipments Repair Units
  • To monitor, to organize maintenance and repair units and to render technical assistance and guidance to the field officers.
  • To impart training to the technical staff from the state as well as the technicians from other states in the country.
  • To impart training to the Cold Chain Officers and Health Equipment Maintenance Officers in the country as well as the countries of South East Asia
Features of Health Equipments Repair Units
Maharashtra State Health System Development Project
The post of Bio-Medical Engineer is kept under the Administrative control of Respective Dy. Director of Circle. The Health Equipment Maintainance and Repair Work Shop have been Established under Maharashtra Health System Development Project and proposal regarding additional strength and proper facilities have been submitted to concerned Government Department Maharashtra State Public Health Department Resolution Dated 26/5/04. 44 Post have been sanctioned and proposal for total 78 Post has been submitted vide this Office Letter Dated 17 September 2004. The proposal of total 91 posts have been submitted to government which is under consideration of government.

Categorization of Equipment for Maintenance
It was decided by MHSDP and World Bank in the period 1999 to 2005.

Human Resources
Organisation Structure
Health equipment maintainance workshop Head Quarter at Pune.

Circle Level Units
One at each circle (total 8 units in the state)

District Level
One technician attached to district healh office at each district to maintain cold chain equipment except new district attached to district healh office. Objectives of Health Equipments Repair Units
  • To maintain and repair various hospital equipment and cold chain equipment.
  • To impart training to the technical staff and end users.
  • To undertake maintenance and repairs of advanced electronic hospital equipment provided to the hospitals.
Status
The HER Units have carried out maintenance and Repair of Health Equipment and Cold Chain Equipment during 1993 to 2006(upto May) as shown below.
Sr.No. Year Cold chain equip repaired. Cold chain equip inspected. Hospital equipment repaired Hospital equipment inspected
1 1993 1395 2928 3801 1997
2 1994 1034 4640 4896 1532
3 1995 1414 5888 3787 4099
4 1996 1244 10571 4630 2130
5 1997 1555 10818 3140 1811
6 1998 1288 8293 3168 2211
7 1999 1274 8135 2979 1521
8 2000 1830 8382 2631 822
9 2001 1567 8220 3096 1288
10 2002 1637 5634 3528 2517
11 2003 1290 4478 3741 4701
12 2004 953 3509 3732 5145
13 2005 3036
7797
3659
4024
14 2006 5414 9845 3248 5907

Present availability of Cold Chain Equipment
Total Cold Chain Equipment: 6363
Out of order Cold Chain Equipment: 64
Percentage of out of order Equipment: 1.0%

Strategy
  • To introduce computerisation.
  • To issue standing orders in order to enable the Technician to proceed for the repairs on the basis of reports received.
  • To introduce effective management information system.
  • To impart training to the existing Technicians in the field of advanced electronics at least to the inspection and carrying out preventative maintenance and minor repairs.
  • To maintain adequate stock of spare parts at each level.
  • To upgrade knowledge of all technician and staff various training programmes are being conducted at various institutes.

State Health Transport Organisation

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State Health Transport Organisation
Historical Background/Periodical Development
State Health Transport Organisation was established in the year 1962–63 by the Government on the recommendations made by Government of India and UNICEF.

The main reasons for establishing the State Health Transport Organisation was to maintain and repair the vehicles of Health Department. This was necessary, because, the vehicles of the Health Department are supplied to the Primary Health Centres, Rural Hospitals, Cottage Hospitals and other health institutions located in the remote and terrain areas where local facilities for maintenance and repairs of vehicles were not available.

Now a days though local facilities for maintain and repairs of vehicles are available at most of Areas the mobile maintenance units at District level and static workshops at three places are established by these organization for quick and instant repairs of vehicles to keep them on–road day to day and to insure reliable services of the same to the patient and the concerned staff.

Objectives of State Health Transport Organisation
  1. To provide efficient, economical and prompt mobility in order to implement various health programmes.
  2. To maintain minimum percentage of off road vehicles.
  3. To increase the life of vehicles by carrying out preventive maintenance.
  4. To repair vehicles promptly and economically.
  5. To procure tyre, tube, batteries, spare parts etc on DGS&D/CSPO rate contracts or directly from manufacturers, their authorised dealers or as per the Government laid down procedure.
  6. To purchase new/replacement vehicles as per need and their distribution.
  7. To condemn and dispose off the old, unuseful scrap, vehicles,tyres,tubes, batteries, spare parts etc. after its useful life is completed.
  8. To impart training to the technical staff of SHTO, drivers, vehicle users, Technicians and end users of all hospital and cold chain equipments.
  9. To carry out prompt and economical repairs to hospital equipment sand cold chain equipments.
  10. To monitor the vehicles
  11. To render the technical guidance and help relating to vehicles, hospital and cold chain equipments.
  12. To take prompt action on accidents and matters related to Motor Vehicle Act. etc.
Strategy
  1. The programme is functioning in three tier system i.e. from Mobile Maintenance Workshops at District level to Regional Workshops at Regional level to State H.Q. Implementation of the programme is monitored through Health Management Information System regularly in every month.
  2. Minor repairs of the vehicles are carried out by the Mobile Maintenance Workshops in the districts. Preventive maintenance of the vehicles are carried out at the H.Q. of the vehicle at PHC or Rural Hospital level.
  3. Major repairs including reconditioning of vehicles are carried out in the Central Static Workshop and Regional Workshops.
  4. Procurement of tyres, tubes, batteries, spare parts are made by the Central Store and as per the need they will be distributed amongst the workshops and users.
Activities of State Health Transport Organisation
Work Load
To Maintain, repair and monitor all vehicles of Health Department in the entire state.These vehicles are plying in rural, hilly, costal and urban areas.They also ply on kachha,murum tar and metal roads.

Head Quarter
  • Vehicle monitoring, administration and policy matters and related matters.
  • To monitor the vehicles, to render technical guidance/help, to arrange training of vehicle drivers, vehicle users and technical staff, to condemn and dispose off the vehicles, tyre, tube, batteries, spare parts, equipments etc.
  • To visit, inspect the regional workshops and mobile maintenance units.
  • Vehicle purchase, registration and distribution etc
Central Stores
To procure economically vehicle spares, tyres, tubes, batteries etc. from the companies/firms on DGS&D/CSPO rate contracts or directly from vehicle manufacturers or O.E. manufacturers or their authorized dealers/distributors or as per the prevailing rules laid down by the Govt.

To maintain the adequate stock of spares, tyres, tubes, batteries etc. in order to avoid the emergencies.

Central Static Workshop
To attend all types of repairs including reconditioning and to maintain the vehicles located at H.Q. i.e. Pune.

Regional Workshops
To attend the repairs of major nature.

Mobile Maintenance Units
To maintain and attend to the minor repairs of the vehicles.
To attend enroute breakdown. Service Centers of State Health Transport Organisation
Service Centers available in each District
One Mobile maintenance Workshop is functioning at the H.Q. of each district except the newly created district viz Washim, Hingoli and Gondiya.

Special Features of State Health Transport Organisation
Special Features of Programme
Responsibility of maintenance and repairing of all vehicles spread over in the entire state.

Span: Entire state
Head Quarter: Pune central Static workshop: Pune
Regional Workshop: 2 Nos. at Aurangabad and Nagpur
Mobile maintenance Units: 30 Nos. at each district H.Q. including Mumbai. Additional two mobile maintenance units functiong at Dhule and Chandrapr for Tribal areas.
Cental Store: At Pune in order to cater the needs of costly and vital spares, tyres, tubes and batteries resulting in 30-40 percent saving in the Govt. expenditure.
Monitoring: Through Management Information System.
Other: Techincal guidance, training to drivers, vehicle users, technical staff,condemnation and dispoal of vehicles, tyres, tubes, batteries spare parts etc.

Achievements
Achievements of the vehicles during the period from 1993 to 2006 & 2007 (upto May)

Year No.of vehicles available No.of on road vehicles Percentage of on road vehicles
1993 3339 2658 79.60
1994 3345 2668 79.76
1995 3223 2627 81.51
1996 3251 2642 81.27
1997 3100 2551 82.29
1998 3088 2526 81.80
1999 3108 2567 82.59
2000 3211 2607 81.19
2001 3270 2606 79.69
2002 3579 2709 75.69
2003 3000 2366 78.87
2004 2903 2496 85.98
2005 3594 2856 79.45
2006 3669 2832 77.19
2007 (Upto May 07) 3791 2944 77.66

Revised National Tuberculosis Control Programme

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Historical Background/Periodical Development
The Early Days
TB is one of the most ancient diseases. It has been referred to in the Vedas and Ayurvedic Samhitas.

A TB Division in the Directorate General of Health Services (DGHS), was established in New Delhi in 1946, with an Adviser in TB as its head. TB was also given a prominent place in the planning. Since the government was not only concerned with TB but with other diseases and health infrastructure, it constituted a committee under the chairmanship of Sir Joseph Bhore. Its secretary was Rao Bahadur KCKE Raja, who as the Director General of Health Services (DGHS) played a dominant role in the TB field during his tenure. The Bhore Committee, which published its report in 1946, placed organized domiciliary service at the forefront of the programme. It recommended setting up of a clinic for each district and the use of mobile clinics for rural areas.

BCG vaccine, named after the two scientists who developed it, stands for Bacillus Calmette Guerín. BCG work started in India as a pilot project in two centers in 1948. In 1949, it was extended to schools in almost all states of India. Under the aegis of the International Tuberculosis Campaign, which had considerable experience in BCG work in many countries, it was introduced in India on a small scale in Madanapalle with Dr Frimodt Moller in the lead. India started a mass BCG Campaign in 1951. A BCG Vaccine Production Center in Guindy, Madras was set up in 1948. WHO and UNICEF provided support.

The very notion that there could be effective drugs against the tubercle bacilli was so revolutionary that researchers began to experiment on the effective dosages and combinations of drugs to be used. The issue of affordability was also considered. In the 1949 Annual TB Workers’ Conference, several papers were presented on the effects of PAS and SM on the patients and on the distribution of SM in India. In 1952 Drs Robitzek and Selikoff revealed that INH is a miracle drug against TB and it continues as such till date.

In 1953, Frimodt Moller reported remarkable results with the regimen SM and INH, single and combined, in the treatment of pulmonary TB in Indian patients. In 1956, Drs Sikand and Pamra presented a paper on the “Effect of Streptomycin(SM),Para amino Salicylic Acid (PAS) and Isoniazid (INH) in 703 cases of pulmonary TB, diagnosed and treated during 1951–53”. They found that the results of domiciliary treatment were encouraging enough to warrant a shift of emphasis from hospitals and sanatoria to clinics without waiting for any further trials.

These studies would, in time, revolutionize the management of TB all over the world. However, it soon became apparent that the tubercle bacilli could not be destroyed easily even with drugs. The tubercle bacilli had powerful survival techniques, besides developing resistance to drugs. Trials indicated that the newly available drugs, when used singly, were effective only for short periods. To be effective, conventional treatment had to be continued for at least 12–18 months. This brought with it several problems. How many patients would continue to take medicines for such a long duration? How to keep track? Further research was, therefore, needed to harness the potential of these newly discovered drugs.

In the mean time, the government in 1956 had established the Tuberculosis Chemotherapy Center, later known as Tuberculosis Research Center (TRC) in Madras (Chennai), under the auspices of the ICMR, Government of Madras, WHO, and the British Medical Research Council (BMRC). This Center was to provide information on the mass domiciliary application of chemotherapy in the treatment of pulmonary TB. It demonstrated that the time–honoured virtues of sanatorium treatment such as bed rest, well–balanced diet and good accommodation were remarkably unimportant provided adequate chemotherapy was prescribed and taken.

Further, there was no evidence that close family contacts of patients treated at home incurred an increased risk of contracting TB. Therefore, it would be appropriate to treat infectious patients in their own homes. This finding revolutionized TB treatment the world over.

National Tuberculosis Institute (NTI) was established in 1959 to evolve through research a practicable TB programme that could be applied in all parts of the country. This Institute would train medical and para–medical workers to efficiently apply proven methods in rural as well as urban areas.

In 1950, Dr P V Benjamin reported that tuberculosis infection is so widespread that no part of the country is free from it. The subsequent BCG campaigns revealed similar findings. However, this needed to be checked by scientifically conducted surveys.

For a country as large as India, the sample of one area was inadequate. Reliable information on the magnitude and extent of the disease in the various cross sections of the population was required. This was not an easy task. Apart from resources, trained personnel to conduct large– scale surveys was not readily available. A special committee of the ICMR was set up to address the issue of obtaining this information expeditiously and rationally. It decided that a systematic survey on a countrywide basis should be undertaken.

District TB Programme
Based on the findings of the operational studies conducted, a draft recommendation for the District Tuberculosis Programme was prepared in 1961, keeping in mind an average Indian district, its population and health facilities available.

The national programme policy as enunciated in the introduction manual of DTP comprised
  • Domiciliary treatment.
  • Use of a standard drug regimen of 12–18 months duration.
  • Treatment free of cost.
  • Priority to newly diagnosed patients, over previously treated patients.
  • Treatment organization fully decentralized.
  • Treatment organization fully decentralized.
  • Efficient defaulter system/mostly self–administered regimen.
  • Timely follow up.
  • Chemoprophylaxis not recommended as it is impractical on mass basis.
Social sciences were consciously included as hard evidence and peoples’ voices were placed on par with science, technology and administration. The National Programme was fully integrated with the government health services of the country, thus extending the scope of TB work to be available through its vast reaches.

Controlled clinical trial for efficacy of BCG vaccine
NTI was also concerned with the efficacy of the BCG vaccine itself. BCG vaccination was the only available protective measure against TB. Different trials had not revealed credible proof of its efficacy. Many, including late Sri C Rajagopalachari, even thought that its efficacy was not fully proven and strongly advocated against its continued large–scale use. It would be in the interest of the country to undertake a well designed trial to seek clear answers to the major issues confronting it.

Therefore, the NTI had been vigorously planning to conduct a major BCG trial and had even reserved certain areas in the country as vaccination–free zones. It was in touch with the international scientific community, various vaccine production centres and in the field.

In January 1964, it initiated intensive discussions with the WHO experts and representatives from United States Public Health Service (USPHS). It was agreed that any trial undertaken must not interfere with the progress of NTI and NTP; and because such a trial was expensive and prolonged, it would have to be designed with utmost care and efficiency.

Ultimately, the project named Feasibility Study for TB Prevention Trials became part of the ICMR and moved out of the campus to its own building. In time, its studies showed that the major BCG trial would be best if conducted in Chingleput district of Tamil Nadu than in other areas reserved for the purpose.

Field work began and the office was moved to Madras. In spite of shifting of the project camp to Madras, NTI continued to assist the BCG Trial by providing technical guidance and replacement of staff. When Dr Raj Narain, Epidemiologist of NTI retired, Dr Baily, TB Specialist of NTI joined as the Director of this study and continued to serve till the first report was published.

The BCG trial was completed as scheduled. After a period of twelve and a half years, it brought out a revolutionary report. It showed that BCG vaccination did not offer significant protection against TB of the lung. Several expert committees appointed both by the authorities in India and by the WHO examined all the procedures followed up in the study and came to the conclusion that the study had been meticulously carried out and vaccine used in the trial were the best available ones. The implications of this study was: Should BCG vaccination be given up in India? Another committee appointed jointly by ICMR and the WHO went into the epidemiological aspects of the causation of TB under Indian conditions. It concluded that though BCG may not protect against TB of lung which occurs mostly in adults, it could provide substantial protection against childhood forms of TB such as tubercular meningitis, miliary TB. The protective effect of BCG against these forms of TB was not studied in Chingleput Trial. In India BCG vaccination policy was revised and it was recommended to be given at an early age preferably before the end of the first year after birth by integrating under UIP. BCG vaccination policies in many other countries were also revised as a consequence of the Chingleput study findings.

Era of short course chemotherapy
Chemotherapy of TB underwent revolutionary changes in the seventies owing to the availability of two well–tolerated and highly effective drugs – rifampicin and pyrazinamide. These drugs allowed short course chemotherapy (SCC) and made it possible to simplify treatment and reduce its duration. Discovery of rifampicin in 1967 is considered as one of the greatest achievements in the history of development of anti–TB drugs. After its discovery no new drug has been found.

Monitoring of the programme
It is not possible to measure disease burden accurately through monitoring. However, it is an important tool to evaluate the performance of the units of the DTPs in an ongoing manner and take corrective action simultaneously. This would improve the programme efficiency on a regular basis. Till 1978 monitoring of the programme was done by northern and southern regional centres and from then by NTI only.

The evaluation of the NTP
The NTI had believed in assessment and evaluation as an ongoing process. It welcomed the idea of periodic assessment, especially from experts, on scientific lines as they are vital to the growth and improvement in the programme.

The NTP was evaluated by three agencies, ICMR, Institute of Communication, Operations Research and Community Involvement (ICORCI) and WHO.

In 1992, the Government of India, together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA), reviewed the national programme and concluded that it suffered from managerial weakness, inadequate funding, over–reliance on x–ray, non–standard treatment regimens, low rates of treatment completion, and lack of systematic information on treatment outcomes. As a result, a Revised National Tuberculosis Control Programme (RNTCP) was designed.

Formulation of the RNTCP
In the light of the recommendations and concerns expressed by the Central Health Council, steps were taken since 1993 to implement the Revised National TB Control Programme (RNTCP) in selected areas with World Bank assistance.

The RNTCP builds on the very substantial strengths and accomplishments of the National Tuberculosis Programme (NTP).

The RNTCP strengthens the existing NTP infrastructure by creating a sub–district–level supervisory team (known as the TB Unit), consisting of a treatment supervisor (Senior Treatment Supervisor, STS) and a laboratory supervisor (Senior TB Laboratory Supervisor, STLS). These are new posts. In addition, a medical officer from the general health system serves as Medical Officer–TB Control at sub–district level who is specifically allocated TB control duties in addition to his other duties. These 3 individuals constitute the management unit, which is responsible for overseeing operations in approximately a 5 lakh population including, on average, 5 designated microscopy centers. All these three staff have been made mobile by giving vehicle/POL inputs. At each microscopy centre, a state–of–the art binocular microscope, good quality reagents and new recording and reporting proformae are available. More importantly, intensive modular training, supervision, and cross–checking of the work of the laboratory technician should ensure that reliable results are obtained.

The goal of RNTCP is to cure at least 85% of new smear–positive cases of tuberculosis and to detect at least 70% of such patients, after the desired cure rate has been achieved. Clearly, both good outcomes and high case detection rates are essential. But it is essential that the system is geared up to reliably cure patients, before any attempts are made at expanding case detection. In fact, experience clearly shows that reliably curing patients results in a “Recruitment effect” – wherever effective services are offered, case detection rates steadily increase. Cured patients act as one of the best motivators promoting case detection and patient adherence to treatment.

The basic principles of the RNTCP are
  • Political commitment to ensure adequate funds, staff, and other key inputs.
  • Diagnosis primarily by microscopy of patients presenting to health facilities.
  • Regular and uninterrupted supply of anti–TB medications including the use of a patient–wise box which contains the entire course of treatment for an individual patient so that no patient should ever stop treatment for lack of medicines.
  • Direct observation of every dose of treatment in the intensive phase and at least the first dose in the continuation phase of treatment.
Systematic monitoring, supervision and cohort analysis; one Senior Treatment Supervisor for organization of uninterrupted treatment and one Senior Tuberculosis Laboratory Supervisor for ensuring quality laboratory service for every 5 lakh population. Additional staff are provided for difficult hilly, tribal, and some urban areas.

If 3 AFB smears are negative and there is no response to 1–2 weeks of antibiotics, X–ray is taken, and, if consistent with TB, the patient is treated for smear–negative TB. If only one of three specimens is positive, an x–ray is taken and the patient is evaluated. All treatment is given thrice weekly on alternate days. During the intensive phase, every dose is directly observed; medications for the continuation phase are packaged into a weekly blister pack, at least the first dose of which is directly observed.

Policy direction, supervision, drugs and microscopes are provided by the central government. Modular training has been used for all staff from medical officers to health workers. Multi–purpose workers are responsible for treatment observation; where they are not available, treatment observation is done by community volunteers including Anganwadi workers, traditional dais, and community and religious leaders. Observation by a family member is not acceptable in the programme. In some larger cities with limited health infrastructure, the RNTCP has funded specialized, full–time staff for microscopy and for treatment observation. Maharashtra is second largest populous state in the country, but also first largest state to cover the entire population under RNTCP in India. Revised National Tuberculosis Control Programme (RNTCP) has been expanded rapidly in the past four years in Maharashtra without compromising quality of services. The state was covering only 20% of population till 1999. Now the RNTCP program has covered entire population in the state.

To implement this programme effectively State TB Society and 48 Districts/City TB Societies have been established. Detailed planning for implementation of the programme is done at State and District levels.

Phasewise implementation of RNTCP
Phase Year District Date of RNTCP implementation
I 1) Mumbai Nov–98
  2) Raigad Oct–98
  3) Pune Rural 2 TU August 98 &
4 TU November 98
  4) Pune Corporation Oct–98
  5) PCMC Oct–98
II 1) Thane Rural Aug–01
  2) Thane Corporation Jan–01
  3) Ulhasnagar Corporation 3rd October–2003
  4) Kalyan–Dombivli Corp. Jan–02
  5) Navi Mumbai Jan–01
  6) Ahmednagar Mar–01
  7) Nashik Rural Dec–00
  8) Nashik Corporation Dec–00
  9) Satara Dec–00
  10) Sangli Rural Dec–00
  11) Sangli Corporation Feb–01
  12) Kolhapur Rural Dec–00
  13) Kolhapur Corporation Mar–01
  14) Aurangabad Rural Dec–00
  15) Aurangabad Corporation Feb–00
III 1) Jalgaon Jun–01
  2) Beed Oct–01
  3) Osmanabad Oct–01
  4) Latur Aug–01
  5) Ratnagiri Sep–01
  6) Sindhudurg Sep–01
  7) Dhule Sep–01
  8) Nandurbar Sep–01
  9) Solapur Rural Dec–01
  10) Solapur Corporation Jan–02
  11) Jalna Jun–01
IV 1) Akola Feb–03
  2) Washim 6th October– 2003
  3) Amravati Rural 23rd October–2003
  4) Amravati Corporation Oct–02
  5) Buldhana Oct–03
  6) Yavatmal Aug–02
  7) Bhandara Apr–02
  8) Gondia Jul–02
  9) Chandrapur May–02
  10) Gadchiroli Oct–02
  11) Wardha Jul–02
  12) Nagpur May–02
  13) Nagpur Corporation Dec–02
  14) Nanded Jul–02
  15) Nanded Corporation Aug–03
  16) Parbhani Sep–02
  17) Hingoli Sep–02
Objectives of National Tuberculosis Control Programme
  1. To achieve and maintain at least 85% cure rate of new sputum positive patients.
  2. To achieve and maintain detection of at least 70% of estimated Sputum Positive Cases i.e. New Sputum Positive Case Detection Rate of 56/L/Y.
Strategy of Revised National Tuberculosis Control Programme
DOTS is a systematic strategy which has five components
  • Political and administrative commitment. TB is the leading infectious cause of death among adults. It kills more women than all causes associated with childbirth combined and leaves more orphans than any other infectious disease. And, since TB can be cured and the epidemic reversed, it warrants the topmost priority, which it has been accorded by the Government of India. This priority must be continued and expanded at the state, district and local levels.
  • Good quality diagnosis. Top quality microscopy allows health workers to see the tubercle bacilli and is essential to identify the patients who need treatment the most.
  • Good quality drugs. An uninterrupted supply of good quality anti–TB drugs must be available. In the RNTCP, a box of medications for the entire treatment is earmarked for every patient registered, ensuring the availability of the full course of treatment to the patient the moment he is registered for treatment. Hence in DOTS, the treatment will never fail for lack of medicine.
  • The right treatment, given in the right way. The RNTCP uses the best anti–TB medications available. But unless treatment is made convenient for patients, it will fail. This is why the heart of the DOTS programme is “Directly observed treatment” in which a health worker, or another trained person who is not a family member, watches as the patient swallows the anti–TB medicines in their presence.
  • Systematic monitoring and accountability. The programme is accountable for the outcome of every patient treated. The cure rate and other key indicators are monitored at every level of the health system, and if any area is not meeting expectations,supervision is intensified.The RNTCP shifts the responsibility for cure from the patient to the health system.
Service Centers

No District/Corporation Name Block/Street Address STD Code
1 Mumbai Mumbai District TB Control Society, New Mun. Store Bldg., Dr. E. Mozes Road, Worli Naka, Worli,
Mumbai – 400 018.
022
2 Thane Rural District TB Officer, District TB Centre, Thane, Civil Hospital Compound, O.P.D. Building, 4th floor, Thane–400601 022
3 Thane MC City TB Officer, C.R. Wadia Dispensary, Tembhinaka, Thane (West) 400 061 022
4 Navi–Mumbai City TB Officer, Navi Mumbai Muncipal Corp., Health Dept., 8th floor, Belapur Bhavan, Navi Mumbai– 400614. 9522
5 Ulhasnagar City TB Officer, Nagarpalika Hospital, Ulhasnagar– 3, 421003. 95251
6 Kalyan Dombivali City TB Officer, Kalyan Dobmbivli Municipal Corp., Shivaji Chowk, Kalyan: 421301. 95251
7 Raigad District TB Centre Raigad, Civil Hospital Campus, Alibaug, Raigad–402201.  
8 Ratnagiri District TB Officer, District TB Centre, Civil Hospital, Ratnagiri. 2352
9 Pune District TB Officer, District TB Centre, Sassoon Civil Hospital Compound, Ward No. 34, Pune– 411001 020
10 Pune Corp City TB Officer, Municipal Dispensary, Narbeer Tanajee Wadi, Pune– 411005 020
11 PCMC City TB Officer, City TB Control Society, Talera Hospital, Tanaji Nagar, Chinchwad, Pune– 411 033. 020
12 Solapur – Rural District Tb Officer, District TB Centre, Civil Hospital Compound,
Solapur – 413 004
0217
13 Solapur – Corp City TB Officer, Mother Teresa Polyclinic, Dufferin Chowk, Solapur – 413 001 0217
14 Satara District TB Officer, District TB Centre, Satara, Civil Hospital Compound, Satara – 415001 02167
15 Nashik District TB Officer, District TB Centre, Civil Hospital Compound, Trimbak Road, Nashik–422 002. 0253
16 Nashik MC City TB Officer, Opp. Anuradha Cinema, Behind Durga Garden, Near Nashik Road Court, Nashik Road, Pin code – 422101. 0253
17 Jalgoan District TB Officer, District TB Centre, Civil Hospital Compound, Jillapeth , Jalgaon– 425001. 0257
18 Nandurbar District TB Officer, District TB Centre, Dughdhasangh, Near Binea Market, Nandurbar – 425412. 0254
19 Dhule District TB Officer, District TB Centre, Dhule, Civil Hospital Compound , Dhule–424001 02562
20 Ahmednagar District TB Officer, District Tb Centre, Ahmednagar, Civil Hospital Compound, Manmad Road, Ahmednagar – 424001. 0241
21 Kolhapur District TB Officer,District TB Centre, Kolhapur, CPR Hospital Compound, Kolhapur–416002. 0231
22 Kolhapur Corp City TB Officer, Savitribai Phule Hospital, Kolhapur City – 416 002. 0231
23 Sangli District TB Officer, District TB Centre, Sangli, Civil Hospital Compound, Sangli–416416 0233
24 Sangli Corpn City TB Officer, Health Dept., MainBuilding, Sangli Miral Kupwad Municipal Corporation, Sangli–416416 0233
25 Sindhudurg District TB Officer, District TB Centre, Civil Hospital Compound, Oras, Sindhudurg – 416812 02362
26 Beed District TB Officer, District TB Centre, Beed, Civil Hospital Compound, Beed–431122 02442
27 Nanded R District TB Officer, District TB Centre Nanded, Guru Govindsingh Memorial Hospital Compound, Nanded – 431601. 02462
28 Nanded Corpn City TB Officer, Nanded Waghala Municipal Corporation, Nanded – 431601 02462
29 Latur District TB Officer, District TB Centre Latur, Civil Hospital Compound, OPD Building, 1st floor, Latur – 413512 02382
30 Osmanabad District TB Officer, District TB Centre Osmanabad, Civil Hospital Compound, Osmanabad –413501 02472
31 Aurangabad R District TB Officer, District TB Centre Aurangabad, Amkhas Maidan, Aurangabad –431001 0240
32 Aurangabad MC City TB Officer, City TB Centre,Health Department, Aurangabad Municipal Corporation, Aurangabad –431001 0240
33 Jalna District TB Officer, District TB Centre Jalna, Civil Hospital Compound, Jalna –431203. 02482
34 Parbhani District TB Officer, District TB Centre Parbhani, Civil Hospital Compound, Parbhani – 431401 02452
35 Hingoli District TB Officer, District TB Centre hingoli, Civil Hospital Compound, ZP Campus, Hingoli –413512 02456
36 Akola District TB Officer, District TB Centre Akola, Main Hospital Campus, Adarsh Colony, Akola – 444004. 0724
37 Washim District TB Officer, District TB Centre, Civil Hospital Compound, Washim – 444505. 07252
38 Amravati R District TB Officer, District TB Centre Amravati, G.G.Rathi TB Hospital Compound, Amravati – 444602. 0721
39 Amravati MC City TB Officer, Public Health Department, Amravati Municipal Corporation, Rajkamal Chowk, Above Punjab National Bank, Amravati – 444601. 0721
40 Buldhana District TB Officer, District TB Centre Buldhana, Civil Hospital Compound, Buldhana – 443001. 07262
41 Yavatmal District TB Officer, District TB Centre Yavatmal, Netaji Chowk, Yavatmal –447001. 0732
42 Nagpur R District TB Officer, District TB Centre Nagpur, Jagannath Budhwari, Nagpur. 0712
43 Nagpur MC City TB Officer, Sadar Diagnostic Centre, Nagpur Municipal Corporation. 0712
44 Wardha District TB Officer, District TB Centre Wardha, General Hospital Compound, Wardha. 07152
45 Bhandara District TB Officer, District TB Centre Bhandara, Civil Hospital Compound, Bhandara – 441904. 07184
46 Gondia District TB Officer, District TB Centre Gondia, Civil Hospital Compound, Gondia – 441601. 07182
47 Chandrapur District TB Officer, District TB Centre Chandrapur, District TB Hospital, Ramnagar, Chandrapur. 442101 07172
48 Gadchiroli District TB Officer, District TB Centre Gadchiroli, Civil Hospital Compound, 1st floor, Gadchiroli 07132
  State Training and Demonstration Centre, Nagpur Chief Medical Officer, State Training and Demonstration Centre, Nagpur. 0712
  TB Hospitals    
1 Aundh Chest Hospital. Pune Medical Superintendent, Aundh Chest Hospital, Pune 9520
      9520
      9520
2 TB Sanitorium, Buldhana Medical Superintendent, TB Sanitorium, Ajintha Road, Buldhana. 957262
3 G.G.Rati TB Hospital, Amravati Medical Superintendent, G.G.Rathi TB Hospital, Amravati. 95721
4 Shashikala TB Sanitorium (Jaisinghpur), Kolhapur Medical Officer, Shashikala TB Sanitorium, Jaisingpur, Kolhapur. 952322
5 Sewri Hospital, Mumbai Chief Medical Officer, G.T.B. Hospital, Jesbhai Wadia Road, Shiwari, Mumbai – 400015.  
6 TB Hospital, Chandrapur TB Hospital, Chandrapur 957172

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Services to Common People
  1. Free diagnosis of tuberculosis through sputum microscopy.
  2. Treatment is directly observed by Directly Observed Treatment (DOT) provider.
  3. Treatment on tuberculosis is available free.
Activities of Revised National Tuberculosis Control Programme
Quality diagnosis by sputum microscopy
  • 3 sputum examinations are done for each chest symptomatic patient for diagnosis purpose.
  • Sputum examinations are done at the upgraded microscopy centre using high quality binocular microscope by trained laboratory technician (LT).
  • Quality Assurance of Sputum Microscopy by Senior TB Laboratory Supervisor (STLS).
  • Diagnostic Algorithm is strictly followed by MOs for sputum negative cases.
Quality diagnosis by sputum microscopy
  • 3 sputum examinations are done for each chest symptomatic patient for diagnosis purpose.
  • Sputum examinations are done at the upgraded microscopy centre using high quality binocular microscope by trained laboratory technician (LT).
  • Quality Assurance of Sputum Microscopy by Senior TB Laboratory Supervisor (STLS).
  • Diagnostic Algorithm is strictly followed by MOs for sputum negative cases.
Treatment under direct observation
  • Un–interrupted supply of good quality drugs in patient wise boxes.
  • Treatment given under direct observation of DOT provider, at the convenient place and time to the patient.
  • Maintenance of records and reports.
  • Recording of every TB patient diagnosed, in the TB Register.
  • Sound and robust record keeping and reporting system.
  • All the districts and corporations are electronically connected and they are submitting their quarterly reports through EPI Centre software to the State and Central TB Division, Delhi.
Supervision & Monitoring
  • Supervision of overall RNTCP implementation by STS, STLS, MOTUs, DTOs.
  • PHI wise analysis and feedback of the performance from district.
  • TU Wise & District Wise Analysis of Performance from State.
  • Supervisory visits to the districts from State.
Training of MOs/LTs/Paramedical Staff as an ongoing activity to ensure availability of at least 80% trained staff at any point of time.

Involvement of Medical Colleges, Big Hospitals, Private Practitioners, Railways, ESIS and NGOs in RNTCP.

IEC activities at state, district, sub–district & village level
  • Sensitization of village level political leaders/CEOs etc.
  • Cinema slides/cable running message whenever applicable.
  • Patient Meetings etc.
Activities undertaken by STDC
  • Training.
  • Training need assessment.
  • Co–ordination, supervision and monitoring of all district level trainings in the state.
  • Management skill development training of DTO’s.
  • Supervision & Monitoring.
  • Appraisal.
  • Internal Evaluation.
  • Quality Control.
TB–HIV CO–Ordination, Maharashtra
I. Need for Co–ordination
As the epidemic of HIV is mushrooming it becomes necessary to intensify our efforts in developing strategies for providing supportive services to HIV infected persons. HIV infection has escalated the burden of TB, especially in countries where prevalence of HIV infection and TB infection is high. Though the exact number of HIV–TB co–infected persons is not known, it is estimated that 1/3rd of the 36.1 million PLWHA worldwide at the end of the year 2000 were co–infected with M.Tuberculosis.

HIV infection is the most powerful risk factor for progression from TB infection to disease. An individual with dual infection of HIV–TB has more than 50% lifetime risk of developing TB as compared to 10% in TB infected person without HIV infection. The rate of progression of TB is also 30 times more rapid in an HIV infected person. TB accelerates the progression of HIV by causing a six–seven–fold increase in viral load. It shortens the survival period of an HIV infected individual and is a cause of death for one in three cases of AIDS.

In a developing nation like ours, the burden posed by increasing number of HIV/AIDS and TB cases can overwhelm our available services and budget. It is therefore time for both the AIDS and TB programme to jointly make efforts to deal with the dual epidemic of HIV and TB.

In India, more than 60% of the reported AIDS cases suffered from TB. Though the life of an HIV infected individual appears bleak due to lack of definitive treatment or vaccine, what is encouraging to note is that TB can be cured by treatment with Directly Observed Treatment Short course (DOTS). Treatment with DOTS prolongs and improves the quality of life.

Recognizing this serious threat posed by HIV and TB, the State of Maharashtra has initiated the collaboration of the AIDS and TB Control Programme. Maharashtra is situated in the Western Region of India, with a population of more than one hundred million. It has 35 districts with a population ranging from 1–6 million. Maharashtra has one–tenth of India’s population and Mumbai has one–tenth of Maharashtra’s population.

In Maharashtra, an estimated 1,84,560 new TB cases occur. TB diagnostic services are provided at selected government health facilities called as Designated Microscopy Centres (DMCs) established for every 1,00,000 population. Directly Observed Treatment is provided at DOT centres. The TB treatment success rate in second quarter 2005/04 is 87% and TB case detection is 67% in second quarter 2005. There are 1026 DMCs within the state.

NACO estimates that 0.9% of the adult population is HIV infected. It is estimated that Maharashtra has 1.4 million HIV. Of the 35 districts, 22 districts (63%) have an HIV prevalence of more than 1% among pregnant women. There is atleast one VCTC in each of the districts, and now it is slowly being expanded to sub–district level, with the aim of establishing one VCTC for every 5,00,000 population.

II. Goal and Objectives of Co–ordination
The basic purpose of TB–HIV co–ordination programme initiated in 2001, is to ensure optimal synergy between the two programmes for the prevention and control of both diseases. The overall goal is to reduce TB–related morbidity and mortality in people living with HIV/AIDS while preventing further spread of HIV and TB through collaboration between NACP and RNTCP. The objectives of TB–HIV co–ordination programme is
  1. To reduce the TB burden among PLHA by early diagnosis and treatment
  2. To reduce the TB related mortality among PLHA’s by early diagnosis and treatment, and
  3. To provide counselling and testing facility for those diagnosed TB patients suspected to have HIV infection because of high risk behaviour or diagnosis of other opportunistic infections.
III. Action Plan on TB–HIV Co–ordination Programme
The basic purpose of HIV–TB coordination is to ensure optimal synergy between the two programmes for the prevention and control of both diseases. Key areas include:
  1. Commitment to HIV–TB coordination, through sensitization.
  2. Service delivery coordination and cross–referral, through training, provision of additional services, and coordination at the local level.
  3. Optimal and comprehensive use of the community reach of both programmes through the sensitisation and involvement of NGOs and private practitioners who are involved in both programmes.
  4. Infection control to prevent spread of TB in facilities caring for HIV–infected persons, and to prevent spread of HIV through safe injection practices in the RNTCP.
  5. Joint efforts at IEC particularly with regard to de–stigmatisation, TB being treatable, HIV being preventable, DOTS prolongs life of HIV infected persons and ensuring confidentiality of HIV– and TB–related information.
  6. Monitoring and evaluation at District, State and National level to assess the co–ordination between both these programmes.
  7. One of the Key service delivery areas for co–ordination is Co–ordination between Voluntary Counselling Testing Centre and Designated Microscopy Centre/Directly Observed Treatment Centre (VCTC – RNTCP Co–ordination).
Other areas for co–ordination that have been initiated are between NACP services like NGO’s implementing Targeted Interventions, PPTCT, Drop–in–centres and Community Care centres with the RNTCP diagnostic and treatment centre.

IV. Establishment of TB–HIV Co–ordination Programme in Maharashtra
  1. Sensitization of Key Policy Makers.
  2. State TB officer member of AIDS executive committee and project director member of State TB control society.
  3. State HIV–TB Co–ordination Committee.
  4. District Co–ordination Committee (HIV–TB).
  5. Training of RNTCP and NACP staff, NGO’s and General Health Care Staff.
  6. Establishment of referral linkages.
  7. Treatment of HIV Sero–positive TB patients.
  8. Infection Control Measures.
  9. HIV Surveillance in TB patients.
  10. Monitoring and Supervision.
V. Sensitization of key policy makers
The first step taken for establishing co–ordination was the sensitization of key policy–makers to address the importance of HIV–TB co–ordination.

Key Policy Makers like Principal Secretary–Public Health, Director General Health Services, Project Director of AIDS Control Societies, Deputy Director (TB and BCG), Programme Officers of AIDS control societies and TB Control Society, Medical Superintendent of TB Hospitals, Representative of NGOs, Municipal Corporation and Medical Superintendent of TB Hospitals participated in a one day discussion on the issue of HIV TB Co–infection and the need for collaboration between the two programmes. This one–day workshop, conducted by MSACS in February 2002 paved the way for smooth implementation and co–ordination of the HIV–TB activities in the State.

In June 2003, a similar sensitization workshop was conducted by MDACS for the Key Health Care Programme Officers of Mumbai Corporation.

Morbidity, mortality and socio–economic consequences of HIV, TB, and the interaction between HIV and TB was discussed. Emphasis was laid on the need for the co–ordination.

VI. State TB officer member of AIDS executive committee and project director member of State TB control society
State TB officer is a member of AIDS executive committee and Project Director of AIDS Control Society is a member of State TB control society.

VII. State HIV–TB Co–ordination Committee
Purpose
It reviews the performance of HIV TB activities in the state, formulate strategies for strengthening HIV TB co–ordination activity, and provide technical guidance for implementation of the activities in the state.

Government Resolution
The Government Resolution for the establishment of the State Co–ordination Committee is in the process of amendment as per the Revised NACO guidelines.

Members
Chairman: Addl. Chief Secretary (Public Health).
Vice Chairman: Director General Health Services.
Vice Chairman: Executive Health Officer (BMC).
Member Secretary: Addl. Project Director (MSACS).

Member
Director Medical Education and Research.
Project Director (MSACS).
Project Director (MDACS).
Project Director (AVERT Society).
Deputy Director TB–BCG.
Director State TB Training and Demonstration Centre, Nagpur.
Director (Health), Central Railways.
Director ESIS.
Deputy Director–VCTC (MSACS).
Deputy Director–VCTC (MDACS).
Deputy Director, Surveillance, MSACS.
Member Secretary (MDTCS)
Representative of Armed Forces
Representative of NGO working with NACP ––– Network of
Maharashtra Positive People (NMP+)
Representative of NGO working with RNTCP (Interaide)
State HIV–TB Consultant/Co–ordinator
HIV–TB Consultant (WHO)
RNTCP Consultant (WHO)

Terms of Reference
  1. To review the status on training of health care providers in HIV/TB and formulate strategies for ensuring that all the health care providers are trained in HIV/TB.
  2. To review the co–ordination between Voluntary Counselling and Testing Centre (VCTC) and Revised National TB Control Programme (RNTCP) and formulate strategies for strengthening VCTC and RNTCP Coordination.
  3. To review the participation of NGO’s and Private Medical Practitioners implementing NACP/RNTCP in the HIV/TB Co–ordination and formulate strategies for ensuring involvement of NGO’s and Private Medical Practitioner.
  4. To ensure and review the participation of Institute providing care and support to HIV/AIDS patients in RNTCP.
  5. To ensure that appropriate measures are taken to prevent the spread of TB in facilities caring for HIV/AIDS.
  6. To ensure the prevention of spread of HIV through safe injection practices in RNTCP.
  7. To ensure confidentiality of HIV status is maintained.
  8. To take policy decisions for the implementation of HIV/TB activities in the State.
  9. To ensure co–ordination between (National Aids Control Pogram)NACP and RNTCP at district level.
  10. To ensure development of effective IEC material and IEC Strategy on HIV/TB.
  11. To ensure optimum co–ordination in the delivery of DOTS and ART.
How often it meets
Initially the committee used to meet once in six months, now it is scheduled to meets once in three months, as per the revised guidelines of National AIDS Control Organisation(NACO).

VIII. District Co–ordination Committee (HIV–TB)
Purpose
Ensures the implementation of HIV–TB activities and reviews the performance of HIV–TB activities in the district.

Government Resolution
The Government Resolution for the establishment of the District Co–ordination Committee is in the process of amendment as per the Revised NACO guidelines.

Members
Chairman: Collector.
Co–Chairman: CEO.
Vice–Chairman: Civil Surgeon.
Member Secretary: District TB Officer.

Member
City TB Officer.
MO–Incharge VCTC.
HOD–Obstetrics and Gynaecology Dept of the hospital providing.
PPTCT Services (MO–Incharge of PPTCT).
Dean Medical Colleges (if any).
Medical Officer Incharge of ART Delivery site.
MO–STD.
District Health Officer.
District Publicity Officer.
Representative of NGO working with NACP – NGO’s attached to
VCTC for outreach activities or NGO working with PLHA or
a Targeted Intervention NGO.
Representative of NGO working with RNTCP.

Terms of References
  1. To ensure and review the co–ordination between VCTC and RNTCP.
  2. To ensure and review the participation of NGO’s and Private Practitioner implementing NACP/RNTCP in the HIV–TB co–ordination.
  3. To ensure and review the participation of Institutes providing care and support to HIV/AIDS patient in RNTCP.
  4. To ensure that appropriate measures are taken to prevent the spread of TB in facilities caring for HIV–AIDS.
  5. To ensure that prevention of spread of HIV through safe injection practices in RNTCP.
  6. To ensure Confidentiality of HIV related information.
  7. To develop strategies for strengthening the HIV–TB co–ordination.
How often it meets
Meetings are held every quarter.

IX. Training of RNTCP and NACP staff, NGO’s and General Health Care Staff
One of the pre–requisites for effective implementation of cross–referral system, is to train the staff directly involved in the programme i.e. Counsellors, Medical Officer VCTC, District TB Officer, Medical Officer–TB Control, TB treatment supervisor, TB Laboratory Supervisor and the Lab Technician of the DMC.

The objective of training NACP staff in RNTCP is to enable them to understand and be able to apply principles of diagnosis, treatment, monitoring, and reporting under RNTCP. Similarly the RNTCP staff if trained in HIV/AIDS will be able to understand and apply principles of HIV prevention and AIDS control, and specific concerns about diagnosis of TB in HIV–infected persons, about TB treatment in HIV–infected persons, and about the need for confidentiality. Further both the staff should be aware about the specific infection control measures to be taken for preventing the spread of TB and HIV infection.

One training was not sufficient, repeated discussion at individual programme reviews, joint review meetings were done. Supervisory visits helped to identify centre specific problems and resolve the issues.

Training of NACP staff
The NACP staff trained includes the Nodal Officers for HIV/AIDS, Medical Officers Incharge of VCTC and VCTC Counsellors. A two days training programme coupled with a field visit to Microscopy and DOT centre for District Nodal Officer and MO–VCTC. For Counsellors either one day training was taken or integrated into their basic induction training.

The training programmes for all the NACP staff started with the discussion on the need for HIV–TB Collaboration, Principles of RNTCP, Diagnosis and Treatment of TB. For the DNO’s and MO–VCTC, this was followed by lectures on Special issues in the diagnosis and treatment of HIV–TB patient, Infection Control Measures for TB and HIV, Anti–retroviral and anti–tuberculosis treatment. Initially when we did the training for the first time we took the participants for a field visit to Microscopy Centre and DOT Centre, but later on realised that we should take them to a VCTC also. Thus in the subsequent training programmes the participants were taken to VCTC also. Also three years back when we did the trainings, there were no operational guidelines for VCTC–RNTCP co–ordination, but as we became clearer on how to co–ordinate, this session was included in the training programme. The MO–VCTC were explained in detail about the reporting format and also given a feedback on the reports received from their VCTC. For the VCTC Counsellors, initially we took training only on aspects related to TB and explained them about reporting format. As we started implementing the programme we realised plenty of errors in reporting and understanding of the Counsellors and also with the field experience we realised the need to modify the training content. Initially we had done a separate one day training programme for Counsellors and subsequently the session on TB was integrated into their induction training curriculum. Now apart from the basic information on TB, we teach the counsellors how to fill the sputum requisition slip, Operationalisation of VCTC–RNTCP Co–ordination, documentation –record keeping, monthly report.

We also had undertaken a pilot project for developing the monitoring system for VCTC–RTNCP Surveillance system. During this pilot project we had 2 days training for Counsellors and STS, who came for the training simultaneously. The initial part i.e. 1 and1/2 days modular training was done separately and for the second half day the Counsellors and STS were brought together for discussing the operationalisation of VCTC–RNTCP Co–ordination. This greatly facilitated in establishing the co–ordination.

Training of RNTCP staff
The RNTCP staff trained includes the District TB Officers, MO–DTC, MO–TC and STS. Though STLS are not required to be trained as per action plan, we had trained the STLS too.

A two days training programme coupled with a field visit to VCTC for Medical Officers. The training programmes for all the RNTCP staff started with the discussion on the need for HIV–TB Collaboration, Epidemiology of HIV/AIDS, HIV Counselling and Testing Centre. For the DTO’s, MO–DTC and MO–TC, this was followed by discussion on Special issues in the diagnosis and treatment of HIV–TB patient and Infection Control Measures for TB and HIV.

The training for DTO’s was taken for 2 days in the lecture form coupled with a field visit to VCTC. For the MO–DTC/MO–TU and STS/STLS, training was 2 days of modular training along with refresher training on TB. The Medical Officers were taken for a visit to VCTC. For the STS/STLS a module –‘VCTC–RNTCP Co–ordination’ was jointly prepared by Maharashtra State TB Control Society and State AIDS Control Society. Facilitators Guide was prepared. For the Medical Officers, the training module on HIV/AIDS prepared by NACO was converted into module by adding exercises at the end of chapter. Chapters on Operationalisation of VCTC–RNTCP Co–ordination, Anti–TB and ART and Role of MO–TU were added. A Facilitator guide and supplementary training material was prepared by the State TB Society and AIDS Control Society.

Training of General Health Care staff
Training of General Health Care Staff is an ongoing activity. In Mumbai some training programmes for Medical Officers and paramedical staff of Public Health Department have been conducted. Since most of the Medical Officers and paramedical staff were already trained on HIV–TB only relevant aspects have been included. In rest of the Maharashtra, through the training on Clinical Management of HIV–AIDS, where a chapter on RNTCP has been added, Medical Officers are being trained. Similarly now in Mumbai, all trainings on HIV/AIDS for Medical Officers, Resident Doctors etc include discussion on TB.

Training of NGO’s
A one day joint sensitisation programme for both RNTCP and NACP NGO’s. In addition separate training programme for NGOs of TI was conducted at a later stage.

Training Material
  • Training module on HIV–TB for District Nodal Officers and MO I/c VCTC’s –NACO publication.
  • Training module on HIV–AIDS for Medical Officers –CTD publication.
  • Treatment guidelines for TB in HIV infected –NACO/CTD publication.
  • Standard Operative Procedures – Infection Control Measures – NACO publication.
  • TB–HIV: A guide for Health worker – CTD publication.
  • HIV–TB: A guide for Counsellors – NACO publication.
  • The HIV–TB Co–infection– Programme Coordination guidelines for clinicians and standard operating procedures. – NACO/CTD publication.
  • VCTC–RNTCP Operational Guidelines – Maharashtra State TB Society in collaboration with Maharashtra State AIDS Control Society and Mumbai District AIDS Control Society.
  • Training Module for RNTCP Health Worker on HIV–TB, VCTC–RNTCP Co–ordination– Maharashtra State TB Society in collaboration with Maharashtra State AIDS Control Society.
X. Establishment of VCTC–RNTCP cross–referral system
HIV voluntary counseling and testing has been shown to have a role in both HIV prevention and as an entry point to care. It provides people with an opportunity to learn and accept their HIV status in a confidential environment. VCTC has become an integral part of HIV prevention programs in many countries as it is relatively cost effective intervention in preventing HIV transmission. There is atleast one VCTC in each of the districts. These VCTC are located either in the Civil hospitals or Medical College. One – two Counsellors, one Laboratory Technician, staffs each VCTC. The activities of VCTC are under the supervision of Medical Officer designated as Incharge of VCTC. These VCTC Incharge are either the Pathologist or STD Medical Officer in case of Civil hospital and Microbiologist in Medical College.

Objective of Referral Linkage
The VCTC – DMC/DOT referral linkage was established with the objective of identifying TB suspects amongst VCTC clients and referring them to DMC for the early detection of TB and treatment initiation. Identification was done by the trained VCTC counsellors by asking for symptoms of TB, predominantly cough for more than three weeks. Second objective is to provide counselling and testing facility for TB patients referred by physician or health worker.

The national policy emphasizes on referrals from VCTC to DMC/DOT centres and HIV testing of TB patients is done only among those with symptoms/signs suggestive of HIV infection or history of high risk behaviour.

Process of referral from VCTC to RNTCP
The VCTC counsellors screen all clients at the time of pre–test counselling for symptoms of TB. If client is found to be chest symptomatic, client is referred to DMC for sputum examination by filling in the sputum examination form. Once the patient reaches the DMC, sputum examinations are done as per the protocol.

The patient is then referred to Medical Officer with the sputum results. Medical Officer will decide further management based on the sputum results and treatment is prescribed as per guidelines. Patient is referred to the nearest DOT centre for treatment.

In case of lymphadenitis, the patient is referred directly to the medical officer for diagnosis and treatment.

The counsellor gets feedback about the status on referral either from the patients themselves in few cases and definitely from the TB treatment supervisor.

Process of referral from RNTCP to VCTC
The Medical Officer refers known TB patients with symptoms/signs suggestive of HIV infection or high risk behaviour to the VCTC. At the VCTC the patient receives pre–test counselling, is tested for HIV after taking informed consent and receives the test result with post–test counselling. A few TB patients have come directly seeking VCT services on their own.

The feedback on HIV status is obtained by the physician from the patients themselves.

Issues related to cross–referral
While establishing referral linkage, one major issue was the issue of confidentiality. For TB diagnosis and treatment initiation, name and address is required whereas in the VCTC, the clients are not required to reveal name and address. There was reluctance on the part of VCTC to ask name and address. The VCTC programme officer and staff felt that confidentiality would be breached. But with repeated discussion, they were convinced that since the clients were being referred irrespective of HIV status, there would be no labeling of VCTC referral as HIV positive clients. Also during the referral to RNTCP, the counsellor is not required to mention the HIV status and in most of the cases the counsellor himself is not aware about HIV status of the client as the referrals are done at the time of pre–test counselling. HIV status is not mentioned in any of the RNTCP records like TB Laboratory Register, TB register, TB treatment card etc. As per NACO guidelines HIV status is revealed to client only, and they are encouraged to reveal the HIV status to the treating physician. Once the counsellors were convinced they were able to encourage their own clients about giving name and address. Now majority of clients reveal the name and address and only few of them are still reluctant.

Majority of the VCTCs have a DMC located in the same campus. The clients are mainly referred to DMC in same campus as VCTC, as most clients prefer to visit this DMC itself. Inspite of VCTC and DMC being in same campus, there was high drop–out of referrals initially. The counsellors then started accompanying the client to DMC, which has minimized drop–out.

A few VCTC especially those set up in an NGO facility, corporate sector do not have a DMC in same campus, in which case referral linkages are established to the nearest DMC.

Sometimes the patients travel a long distance to access VCTC, and if client is referred to the DMC situated in same campus as VCTC, the client has to travel once again for accessing DMC services. Therefore the counsellors are provided with directory of DMC, who then identifies and refers them to DMC nearest to their residence.

Reporting Format and System
The reporting format consisting of the line–list of referrals from VCTC to DMC/DOT centre and the monthly report. Considering the time taken for diagnosis, treatment initiation and TB registration, report is prepared after one month gap so that complete information is provided. e.g. Information on referrals in the month of July gets reported in September.

The documentation of referrals is integrated into the existing registers maintained by the VCTC and TB programe.

The line–list of referrals made from VCTC to DMC/DOT centre, is jointly prepared by the VCTC counsellor and the TB treatment supervisor. The first section is prepared by the counsellor and contains information on the name, address, age, sex, date of referral and name of DMC referred to. The first section is filled in by referring to the PID and Counselling Register. After completing the first section, the Senior TB treatment supervisor and counsellor, will jointly complete the second section, containing information on whether person has reported to DMC, sputum result, diagnosis, treatment category and date of starting treatment etc. For completing second section the STS and counsellor refer to the TB Laboratory Register, TB Register and Treatment for Referral Register. The STS of the Tuberculosis Unit, where the VCTC is located will co–ordinate with the Counsellor, and will be also responsible for getting the feedback from his colleagues if the referral has been made to other Tuberculosis Unit. On the basis of the completed line–list, the monthly report is prepared. The monthly report is prepared by each individual VCTC and consists of 4 section. First sections deals with information on new clients attending VCTC, HIV sero–positive amongst them and number of old clients. Second section deals with information on referrals from VCTC to DMC/DOT centre. Third section deals with information on TB patients tested for HIV at VCTC and last section deals with number of VCTC clients receiving information on TB. The monthly report is prepared by the VCTC Counsellor, by referring to the Counselling Register and the completed Line–List. VCTC’s give a copy of the monthly report including the completed line–list to the local District TB Officer. State AIDS control society compiles the information and sends a copy to National AIDS Control Organization, Central TB Division and State TB Office.

XI. Establishment of other referral linkages
  1. NGO (TI) – RNTCP Co–ordination
    NGO’S implementing Targeted Interventions Project of National AIDS Control Programme can contribute significantly to the control of HIV and TB in India. NGO’s work with target population like Truckers, Commercial Sex Workers, Migrants, MSM (Men having Sex with Men) that are a high risk group for HIV. Targeted Intervention NGO’s participate in the Revised National TB Control Programme in two ways: – Identification and Referral of suspected TB cases to the RNTCP and Providing DOTS (Directly Observed Treatment Shortcourse) to the TB patients.
  2. Community Care Centre – RNTCP Co–ordination
    We have been able to successfully involve one of the Community care centres in RNTCP. This community care centre’ Bel–Air’ is situated at Panchgani in Satara district. It has a Microscopy centre for Sputum examination. It also provides RNTCP for its inpatients as well for its outpatients. HIV positive patients with HIV are also being treated under RNTCP.
  3. Drop–in–centre – RNTCP Co–ordination
    Drop–in–centres are another potential are for referral linkages. Two way referral system has been initiated.
  4. PPTCT – RNTCP Co–ordination
    Efforts are being made to establish referral linkages between PPTCT and RNTCP diagnostic and treatment centres.
  5. ART–DOT centre linkage
    Referral linkages have been established between ART and DMC/DOT centre. Efavirenz based ART regimen have been provided to ART centres for the simultaneous administration of ART and ATT regimens, if need be.
XII. Infection Control Measures
All DTO’s have been provided with book on Standard Operative procedures – Infection Control Measures published by NACO, and the topic was discussed during training. Guidelines for prevention of nosocomial transmission of TB to HIV infected persons have been issued to all the Government hospitals by Directorate of General Health Services. The infection control committee of the hospital ensures safe disposal of hospital waste.

XIII. Sentinel Surveillance of HIV in diagnosed TB patients
The sentinel surveillance would provide point prevalence and identify trends of HIV prevalence amongst TB patients (which will be site specific). This information is of value in designing, implementing and monitoring public health programmes for the prevention and control of tuberculosis.

In the year 2004, sentinel surveillance for HIV in diagnosed TB patients was carried out in the Nashik and Mumbai. 400 new TB patients coming for first follow up examination were tested for HIV using the unlinked anonymous strategy. It was found that 5.75% of the TB patients were found to be HIV sero–positive in Nashik and 11% in Mumbai.

XIV. Monitoring and Supervision
State level
  1. Monthly Report of VCTC–RNTCP Co–ordination
    The VCTC’s submit a monthly report on HIV–TB related activities, which are compiled by AIDS Control Society and sent to NACO, CTD and STO. In case reports are not received letters are sent to the VCTC’s. DTO/CTO is also informed. In case of errors in reporting the VCTC’s are immediately informed. Now with monthly counsellors meeting held at state level, any discrepancy in the line–list and monthly report is discussed immediately and corrected.
  2. Quarterly Joint Regional Review Meetings
    Quarterly review meetings of VCTC–RNTCP staff have been initiated. These meetings are attended by the District/City TB Officers, Medical Officer Incharge VCTC. Each district’s performance on HIV–TB co–ordination is reviewed meticulously and actions for strengthening the HIV–TB co–ordination is discussed. These meetings have helped us to establish a rapport between the district level programme officers, understand their problems, bring about a sense of accountability into the programme officer and improve the co–ordination.
  3. Quarterly Performance Report of VCTC and VCTC–RNTCP Co–ordination
    The performance of each VCTC is reviewed for the activities related to Counselling, HIV testing and VCTC–RNTCP co–ordination. This performance report is prepared for each individual VCTC. Those indicators where the performance is poor is highlighted and a footnote at the end of the table specifies the reason for highlighting and the need for improving.
  4. Individual Programme Review
    HIV–TB activities is one of the point for discussion in the Quarterly Review Meeting of DTOs and Monthly Review Meetings of counselors.
  5. Supervisory visits by state level officer
    Supervisory visits by either of the state level programme officers to the VCTC–RNTCP Co–ordination sites.
  6. State HIV–TB Co–ordination Committee meetings
    At the state level, the state co–ordination committee for TB–HIV under chairmanship of Secretary Health who is the administrative head of public health programme in the state reviews the performance once in 3–6 months.
District Level
  1. Cross–Visits by RNTCP and VCTC staff
    At the field level the counsellors started visiting DMC, and the DTO and TB treatment supervisor visited VCTC. This has helped in establishing rapport, understanding each other’s programme and strengthened the co–ordination.
  2. Fortnightly/Monthly Meeting
    The DTO in addition conduct fortnightly or monthly review between the VCTC and TB programme staff.
  3. District Co–ordination Committee (HIV–TB) meetings
    Every quarter the regional director health, who heads the district co–ordination committee, reviews the performance, which has also contributed in strengthening the co–ordination.
XV. Constraints
  1. There was an initial difficulty in establishing rapport, between VCTC and TB programme staff. With the help of joint review meetings, cross–visits to the centres and discussions, the rapport was built up.
  2. In spite of the fact that the VCTC–DMC were located in same campus, and the counsellor accompanied the client, there was a drop–out of almost 10%.
  3. Incorrect address by the patient probably because of fear of stigmatization has made it difficult to ensure that they are taking treatment.
  4. Many clients attending VCTC, come from neighbouring districts, and were referred back to their district for treatment after diagnosis. Their treatment status could not be ascertained.
  5. Information on number of TB patients referred from DMC–DOT centre was not collected, and therefore it is not known whether all those referred have accessed VCTC services.
XVI. Conclusion
VCTC is a potential entry point for TB services not only for HIV ser–positives but also sero–negatives. Having successfully established the referral linkage between VCTC–DMC–DOT centre, Referral linkages have been initiated between TB diagnostic and treatment services and Drop–in–centre, Community Care centres, Anti–retroviral treatment centres, NGO’s working with sex workers, truckers, migrants etc, and Prevention of Mother to Child Transmission Projects.

No additional financial burden incurred except for training as the available logistic supports like sputum examination forms for referral, DMC/DOT directory, IEC material and existing recording keeping system were used. Training and repeated discussions with staff is essential for initiating and strengthening the referral mechanism.

Referral Linkage has benefited both the programme. It has been possible to diagnose TB and initiate them on treatment at an early stage. TB patients with high risk behaviour and clinical features suggestive of HIV benefited by counselling and testing facility. Continuous supervision and monitoring by district and state level has strengthened and sustained the co–ordination. Achievements of National Tuberculosis Control Programme
One State TB Society & 48 District TB Societies have been formed.
Detailed planning for implementation has occurred at the state & district level.
State TB Cell strengthened.
Two State Drug Stores have been established at Pune and Nagpur.
TU & MCs have been established as per the norm.
Civil Work of laboratories was completed.
Doctors, Laboratory technician and Health workers trained using high quality modular training. Appraisal teams from Government of India and National Institutes visited each and every district prior to service delivery to ensure that high standards are maintained.

Cure Rate of 87% and Case Detection of 66% of Sputum Positive cases has been achieved at the end of Dec 2004. Anganwadi workers, shop keeper, Sarpanch, religious leaders, dai, private pharmacist, private practitioners etc. are some of the examples DOT provider used effectively in various areas.

Performance – District Wise
District wise performance for II quarter of 2006

SR.NO. District No. of suspects examined % of OPD PT. Examined SP+ VE Diagnosed Sputum Positivity
1 Raigad 2783 2.2 475 17.3
2 Ratnagiri 2349 2.7 326 14.2
3 Thane Rural 6009 3.2 844 14.2
4 Greater Mumbai 18540 2.1 3332 18.1
5 Thane MC 1784 3.2 387 22

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District wise performance for IIIrd quarter of 2006

Sr No District No of Suspects examined % Of suspects examined out of total out patients No. of Smear Positve patients diagnosed % of S+ve cases among suspects
1 Akola 2353 3.2 299 13%
2 Amravati_Mun_Corp 1433 3.5 144 10%
3 Amravati_Rural 3812 4.3 369 10%
4 Buldana 4560
1 Akola 2189 3.2 313 14%
2 Amravati_Mun_Corp 1374 2.3 155 11%
3 Amravati_Rural 2907 3.8 293 10%
4 Buldana 3914 2.3 640 16%
5 Washim 808 2.2 143 18%

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District wise performance for IVth Quarter 2006

Sr No District No of Suspects examined % Of suspects examined out of total out patients No. of Smear Positve patients diagnosed % of S+ve cases among suspects
1 Akola 2353 3.2 299 13%
2 Amravati_Mun_Corp 1433 3.5 144 10%
3 Amravati_Rural 3812 4.3 369 10%
4 Buldana 4560 3.7 673 15%
5 Washim 852 2.1 92 11%
6 Yavatmal 3797 3.7 512 13%

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District wise performance for Ist quarter 2007

Sl No Region District OPD No Of Suspects examined
1 Akola Circle Akola 68424 2186
2   Amravati_Mun_Corp 35215 1148
3   Amravati_Rural 82623 3356
4   Buldana 108947 3796
5   Washim 37994 776
6   Yavatmal 98835 3722
    Akola Circle 432038 14984
7 Aurnagabad Circle Aurangabad_Muni_Corp 105125 1835

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Scatter Diagram Special Features of Programme
  • Use of sputum testing as the Primary method of diagnosis among self reporting patients.
  • Standardise treatment regimens.
  • Augmentaion of the peripheral level supervision through the creation of a sub–district supervisory unit. A sub–district tuberculosis unit (TU) will be established in an existing CHC/Block PHC/Taluka Hospital which will function as managerial unit of the programme for 5 Lakh population (for 2.5 Lakh population in tribal area) and will consist of a designated medical officer Tuberculosis Control (MO–TC) who does tuberculosis work, a senior treatment supervisor (STS) and a senior Tuberculosis laboratory supervisor (STLS). For diagnosis one Microscopic centre (MC) will be located at PHC/CHC/Taluka Hospital for 1 Lakh population(50 thousand in tribal area).
    DOTS – Centres will be located at places convenient to the patients and providers and should generally be available atleast at the subcentre level so that patient need not travel more than 5 km.
    DOTS–will be provided by
    MPWs, TBAs, AWWs, CHVs, who will be made accountable.
  • Ensuring a regular uninterrupted supply of drugs upto the most peripheral level.
  • Augmentation of organizational support at central and state levels for meaningful coordination.
  • Emphasise training, IEC, Operational Research and NGO Involvement in the programe.
  • Increase budgetary outlay.
    DOTS – (Directly Observed Treatment Short Course Chemotherapy).
Expected Community Participation
1) Community Participation as a DOTS Provider in RNTCP
Mumbai Municipal Corporation
Mr. Prem a 35 year old shopkeeper runs his Pan House at Nocil Naka Ghansoli which is a slum pocket under Urban Health Post Ghansoli. He started assisting the programme from beginning i.e.2001 and is one of our best DOTS provider till date. Prem has good knowledge in observing treatment. As a local person patients have respect for him and generally do not miss doses because his shop remains open from morning 6AM to 10 PM. He actively takes part in defaulter retrieval mechanism. Out of 58 patients of all categories at his center 50 patients have successfully completed treatment till date. He was selected our best DOTS provider for the year 2003.

2) Community Participation as a DOTS Promoter in RNTCP
Nashik District
Mr. Renukadas Manthekar, aged 50 years, residing at Tryambakeshwar, Dist., Nashik is working as a lifeguard at Kushavart lake. He was diagnosed as suffering from tuberculosis 3 years back and was registered and given DOTS treatment at Rural Hospital Tryambakeshwar. Now he is completely cured and is acting as DOTS promoter.

Every year, lakhs of people visit the Kushavart lake. Renukadas guides them over a loudspeaker and gives them instructions regarding swimming and bathing in the waters. Along with these instructions, he also gives them information regarding TB and DOTS. He actively takes part in case detection by sending tuberculosis suspect cases to the Rural Hospital for confirming diagnosis and putting on DOTS. Due to his efforts, 12 patients suffering from tuberculosis have successfully completed treatment till date.

Role of NGOs
Involvement of NGOs in RNTCP
NGO’s are involved in RNTCP in 5 schemes as follows

Scheme 1 Health Education and community outreach
Scheme 2 Provision of DOT
Scheme 3 In Hospital care for Tuberculosis
Scheme 4 Microscopic and Treatment Centre
Scheme 5 Tuberculosis unit Model

Involvement of PPs in RNTCP
Private Practitioners are involved in RNTCP in following schemes

Scheme 1 Referral
Scheme 2 Provision of DOTS
Scheme 3A Designated Paid Microscopic Centre- Microscopy Only.
Scheme 3B Designated Paid Microscopic Centre- Microscopy & Treatment.
Scheme 4A Designated Microscopy Centre-Microscopy
Important Health Education Messages
Tuberculosis is curable
Tuberculosis is not hereditary.

Tuberculosis is an infectious disease.

Tuberculosis spreads through sputum and cough.

Persistent cough is an important symptom of tuberculosis.

Tuberculosis is completely curable with regular and complete treatment.

DOTS – sure cure for TB.

Facilities for diagnosis and treatment are available free of cost at all Govt. health facilities.

Avoid spitting indiscriminately. Practice good hygienic habits.

Role of Other Sectors
Involvement of ESIS
ESIS caters to large number of beneficiaries (over 40 lakhs including insured persons & their family members).
ESIS involvement enable access to diagnosis & treatment services under DOTS free of cost.
There will be universality in management of TB patients in the Government sector – will prevent default from the treatment.

Current status
Directives issued by ESIS–Commissioner for involvement of all ESIS health facilities in RNTCP.
Sensitization of ESIS –Commissioner, Director & all chest physicians & Medical Superintendents completed.

Medical College involvement – Present Status
38 Medical Colleges involved in RNTCP.
Medical Colleges with TU – 3.
Medical Colleges with MC cum DOT center – 32.
Medical Colleges with DOT center –3.

Activities initiated
  • First zonal workshop for involvement of Medical Colleges was held at LTM Medical College, Mumbai.
  • State Task force established & first meeting held in July 2003.
  • All Medical Colleges formed Core committees.
  • Training/Sensitization of Core team members begun & will be completed before December 2003.
  • All District TB Officers to visit medical Colleges in their area, appraise core team members for establishing Microscopy cum DOT Center.
What core committees will do?
  • Core committee will meet once in a month & co–ordinate with RNTCP to ensure.
  • Establishment of microscopy & DOT center in all the Medical Colleges.
  • Practice of 3 sputum examinations for all chest symptomatics referred.
  • Maintaining only one laboratory register.
  • Up–gradation of laboratory through DTCS wherever required.
  • Orientation & sensitization of faculty members to ensure internal referrals of all chest symptomatics for diagnosis & treatment as per RNTCP guidelines.
  • Training of program staff whenever required.
  • Involvement in quality assurance network through Microbiology department.
  • Consultation & management of difficult cases.
  • Ensure availability of DOT directory of district & TU directory of state at the DOT Center for prompt & accurate referral of cases.
  • Display of IEC material at OPD’s & Health education to all patients attending OPD.
  • Teaching & training of paramedical staff, NGO’S, Railways, Private practitioners etc.
  • Ensure Co–ordination between Voluntary Counselling and Testing Centre (VCTC) & MC cum DOT Center.
Impact
Revised National Tuberculosis Control Program.

All services are free under DOTS.

Over 35000 patients are now being diagnosed and put on treatment each quarter.

Treatment success rates are more than 85%.

The State Bureau of Health Intelligence & Vital Statistics

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Historical Background/Introduction
Health services are mainly concerned with the well being of general masses. The availability of the Statistics related to health schemes is essential for planning & monitoring the impact of various services designed for improvement in the health status. Considering this need the responsibility of collection, compilation of Civil Registration data was entrusted to a separate Bureau of vital statistics in year 1955. After the integration of preventive & curative health services, the responsibility to handle hospital statistics was entrusted to the bureau in the year 1970.

Consequently the Bureau of vital statistics was upgraded & recognized as State Bureau of Health Intelligence & vital Statistics (SBHI & VS) from the year 1976.

Thus the main functions of SBHI & VS are collection, compilation & publication of comprehensive vital statistics for the entire state & maintaining liaison with the central Bureau of Health Intelligence, Director General of Health Services, Registrar General Cum Census Commissioner of India & State Directorates.

About the Bureau
The main activities carried out by the Bureau are
  • Development of a sound Civil Registration System (C.R.S.)
  • Monitoring of Medical Certification of Causes of Death Scheme.(M.C.C.D.)
  • Implementation of survey of Causes of Death (Rural) Scheme. (S.C.D.)
  • To handle establishment of statistical cadre in the Health Department.
Civil Registration System
Introduction & History
The history of Civil Registration System in Maharashtra State can be observed by 3 time span viz.
  1. The System prior to 1/4/1969.
  2. The System during the period 1/4/1969 to 6/2/1976.
  3. The System from 7/2/1976 & onwards.
I. The System prior to 1/4/1969
The registration & its monitoring were in the hands of the Revenue & police department, while collection, compilation & preparation of the reports on Vital Statistics, were assigned to the Directorate of Health Services, being a most immediate user of Vital Statistics data. Further the health personnel were very actively helping & also supervising registration activity.

II. The System during 1/4/1969 to 6/2/1976
With the formation of Zilla Parishad & in accordance with the provisions of section 45 of the Bombay Village Panchayat Act1958, the registration work was transferred to the Village Panchayat (VP) in the rural area of the entire State with effect from 1/4/1969. There is no change in urban area. Activity of registration is being carried out by Corporation & Municipal Councils, as previously.

III. The System from 7/2/1976 onwards
Realizing the growing importance of birth & death registration for the planning of socio–economic development, provisions for statutory registration was made in the entire country including Maharashtra under the Central registration of Birth & Death Act 1969, which was made applicable with effect from Apr. 1970 in Maharashtra. The State Rules i.e. The Maharashtra State registration of birth & death Rules 1976 were formed & notified in the Gazette dated 7/2/1978.

As per the guidelines from Govt. Of India, revised rules of Registration of Birth & Death were formed in the year 2000, known as Maharashtra state registration of Birth & death Rules 2000. These rules are enforcing from 1/4/2000.

Registration in Urban area
Registration of birth & death was statutory compulsory in all municipal & Corporation areas under the various Acts previously. After the formation of Registration of Birth & Death act 1969, the registration is made compulsory according to the Act 1969 & rules of 1976.

Medical Certification of Causes of Death
Introduction & History
Medical Certification of cause of Death is an important tool of obtaining authentic & scientific information regarding causes of mortality. The Scheme is formulated by Office of the Registrar General, India is a big step towards the establishment of a system in the country for obtaining data on causes of death. The Scheme had undergone phase – wise implementation in the State, starting from medical college hospitals. In second phase, District hospitals, specialized hospitals were covered. The office of the Registrar General had given necessary administrative guidelines regarding coverage of MCCD Scheme in both urban & rural area. Attempts are being made to cover all private & govt. hospitals since 1998.

M.C.C.D. scheme was introduced for the first time in Maharashtra State in Pune in 1951. Late on it was extended to the cities, nagpur (1957), Mumbai (1962) & Solapur (1969). the remaining urban areas of the state were covered in 1970 & onwards with the encouragement of the Director General Of Health Services, G.O.I. & with the co–operation of the director Of Municipal administration. a directive was issued to all the Municipalities towards the end of 1969 to bring into effect MCCD, in their respective areas, for certifying the cause of death under the Maharashtra Municipality Act 1965.

Survey of Causes of Death Scheme (Rural)
Introduction & History
Mortality influences the rate of growth of the population & provides a dimension of demographic perspective, which is vital for socio–economic planning. The pattern of deaths by causes, age & sex reflect the health status of the community & in turn provides a rational basis for health planning. It is not feasible to build up statistics of mortality by causes based on “Medical Certification of Causes of Death (MCCD)” due to paucity of medical institutions, & physicians in rural area. Still the percentage of non–institutional & unattended death is at higher side in the State as well as in the Country. This most important statistical gap has been bridged, to some extent by the scheme “Survey Of Causes Of Death”.
  1. The Office Of the Registrar General, India initiated in the 1960s a Scheme called as “Model Registration System” (MRS). With a view that, there should be some centers, which are to be model in Registration of vital events. The scheme was introduced according to recommendations made in the ‘Conference on improvement of Vital Statistics’ held in 1961.
  2. The Registrar General, India had launched the scheme in some States on pilot basis in 1965. Further the scheme has expanded in 10 states Andhra, Bihar, Asam, Gujrat, keral, Orisa, Punjab, Rajasthan, Tamilnadu, West Bengal, The states Maharashtra, Hariyana, Jammu & Kashmir, Karnataka, M.P., U.P. are covered under the scheme in 1967.
  3. The scheme was renamed in 1982 as “Survey of Causes of Death Scheme (Rural)”.
  4. The implementation of the scheme has stopped by Registrar General, India in 1997 at central level & merged in the S.R.S. Scheme.
  5. The progress & data received under the scheme was satisfactory in the Maharashtra State., & there was no any financial burden, in view of this, State has decided to continue the Scheme in Maharashtra.
Present Status
  1. The Scheme was implemented in 600 H.Q. villages of P.H.C. in the State previously.
  2. The enforcement of the SCD scheme has been included in the Project Implementation Plan of Maharashtra Health System Development Project in 2003–04 & received the financial support.
  3. The implementation of the Scheme has been shifted from P.H.C.H.Q. village to village level, without changing the nos. of villages.
  4. The lists of classification of the diseases have been modified base on ICD–10. Now the frame of 109 diseases through 19 major groups have been made available to the M.O. P.H.C. to select the cause of death, based on “Lay diagnosis reporting”.


Objectives of Health Intelligence & Vital Statistics
Civil Registration System
  1. To register all events of births & deaths on de–facto basis.
  2. To publish important fertility & mortality data based on registered events.
  3. To issue certificates as a proof of birth & death events, to the people.
Medical Certification of Causes of Death
  1. To provide scientific & authentic information on causes of death related to ages & sex.
  2. To study the trends & changes in mortality pattern over the years.
Survey of Causes of Death Scheme (Rural)
  1. The important objective of the Scheme is to build–up the statistics on Most probable Cause of Death according to age & sex in selected villages by adopting “Lay diagnosis reporting method (Post Death Verbal Autopsy Technique)” through post death enquiry based on signs, symptoms, conditions, duration & anatomical site of the disease as reported by family members of the deceased.
  2. To collect the data on fertility along with the mortality information & examine the status of fertility.
  3. To produce district wise fertility & mortality rates based on information collected under the Scheme.
  4. Evaluation of Civil Registration System.
Performance
Birth
Sr Circle Registered Births: Year 2001
RURAL URBAN
M F T M F T
1 Mumbai 37805 32727 70532 172637 151739 324376
2 Nasik 122477 96284 218761 81454 66082 147536
3 Pune 66356 49788 116144 77973 65147 143120
4 Kolhapur 39380 29760 69140 35504 28114 63618
5 Aurangabad 35642 25955 61597 32457 27478 59935
6 Latur 46152 36468 82620 38828 32122 70950
7 Akola 51349 41858 93207 54713 45667 100380
8 Nagpur 58354 47712 106066 52338 44825 97163
Total 457515 360552 818067 545904 461174 1007078
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Death
Sr Circle Registered Deaths: Year 2001
RURAL URBAN
M F T M F T
1 Mumbai 18829 11501 30330 68656 43193 111849
2 Nasik 32660 20322 52982 17750 11603 29353
3 Pune 23217 14064 37281 25742 15938 41680
4 Kolhapur 18210 12302 30512 10903 6224 17127
5 Aurangabad 10312 6287 16599 6762 3831 10593
6 Latur 13881 8684 22565 6384 2959 9343
7 Akola 19366 12101 31467 12107 7605 19712
8 Nagpur 23697 15857 39554 17613 10248 27861
Total 160172 101118 261290 165917 101601 267518
Click here to view Death Details

Infant Death
Sr Circle Registered Infant Deaths: Year 2001
RURAL URBAN
M F T M F T
1 Mumbai 288 228 516 4527 3899 8426
2 Nasik 820 590 1410 1030 774 1804
3 Pune 270 227 497 1608 1083 2691
4 Kolhapur 134 116 250 791 544 1335
5 Aurangabad 194 205 399 365 322 687
6 Latur 446 334 780 291 191 482
7 Akola 513 492 1005 489 347 836
8 Nagpur 835 651 1486 713 543 1256
Total 3500 2843 6343 9814 7703 17517
Click here to view Infant Death Details

Performance of Health Intelligence & Vital Statistics
District Wise
Birth
Sr District Registered Live Births: Year 2001
RURAL URBAN
M F T M F T
1 NANDURBAR 11553 8596 20149 3521 2863 6384
2 DHULE 12851 9723 22574 8319 6595 14914
3 JALGAON 24392 18388 42780 22262 17067 39329
4 BULDHANA 13138 10493 23631 11258 9532 20790
5 AKOLA 6030 5007 11037 12824 10833 23657
6 WASHIM 5212 3881 9093 3302 2568 5870
7 AMARAVATI 11847 10300 22147 16937 13729 30666
8 WARDHA 6570 5326 11896 5634 4893 10527
9 NAGPUR 11263 8913 20176 28280 24578 52858
10 BHANDARA 8400 7128 15528 4311 3873 8184

Statement showing Birth Registration during January to June 07
Provisional Report
Birth Registration (SRS 19)
Sr District Monthly ELA Rural Urban Total %
1 Raigad 3875 23249 7480 7596 15076 65
2 Ratnagiri 2839 17033 6364 4735 11099 65
3 Thane 15757 94541 18633 62228 80861 86
4 Ahmednagar 7190 43137 28572 14830 43402 101
5 Dhule 2942 17654 6203 8458 14661 83
6 Nandurbar 2320 13920 1963 608 2571 18
7 Jalgaon 6320 37920 13593 20687 34280 90
8 Nashik 9037 54220 21230 21498 42728 79
9 Pune 13134 78803 18563 17460 36023 46
10 Satara 4775 28649 9244 18498 27742 97
Click here to view Birth Details

Death
Sr District Registered Deaths: Year 2001
RURAL URBAN
M F T M F T
1 NANDURBAR 2950 1784 4734 590 377 967
2 DHULE 4048 2492 6540 2202 1472 3674
3 JALGAON 8366 5716 14082 4233 2725 6958
4 BULDHANA 4315 2668 6983 2186 1422 3608
5 AKOLA 2461 1500 3961 2845 1556 4401
6 WASHIM 1863 1118 2981 645 322 967
7 AMARAVATI 5455 3305 8760 4226 2805 7031
8 WARDHA 3573 2318 5891 1638 1010 2648
9 NAGPUR 4629 2878 7507 10892 6136 17028
10 BHANDARA 3731 2528 6259 1162 767 1929


Statement showing death Registration during January to June 07
Provisional Report
Death Registration (SRS 6.7)
Sr District Monthly ELA Rural Urban Total %
1 Raigad 1366 8199 3622 1247 4869 59
2 Ratnagiri 1001 6007 4654 652 5306 88
3 Thane 5556 33338 6757 18758 25515 77
4 Ahmednagar 2535 15212 7590 2669 10259 67
5 Dhule 1038 6225 2295 1989 4284 69
6 Nandurbar 818 4909 113 223 336 7
7 Jalgaon 2229 13372 6602 3921 10523 79
8 Nashik 3187 19120 5547 5854 11401 60
9 Pune 4631 27789 6594 6691 13285 48
10 Satara 1684 10103 4064 5877 9941 98
Click here to view Death Details

Infant Deaths
Sr District Registered Infant Deaths: Year 2001
RURAL URBAN
M F T M F T
1 NANDURBAR 74 51 125 4 2 6
2 DHULE 118 68 186 136 103 239
3 JALGAON 210 187 397 72 66 138
4 BULDHANA 97 118 215 86 47 133
5 AKOLA 51 35 86 38 36 74
6 WASHIM 62 43 105 12 10 22
7 AMARAVATI 144 118 262 195 158 353
8 WARDHA 232 162 394 93 82 175
9 NAGPUR 90 77 167 331 250 581
10 BHANDARA 99 82 181 121 80 201
Click here to view Infant Deaths Details

Civil Registration System
In Maharashtra state the Civil Registration System has been in operation as per the legal provision of Birth and Death registration Act 1969 and as per the revised rules framed by the Government of Maharashtra in the year 2000. The registration is done by DE–FACTO method, i.e. the events – births and deaths are registered where they are occurred.

The Civil Registration System is operational in five stages as follows
  • Registration of vital events
  • Preservation of records
  • Reporting
  • Analysis
  • Feedback, inspection and supervision
Registration of Vital Events
For registration of vital events, following Officers are declared as a Registrar of birth & death at various levels.
Designation of Officer Designation specified under the act Jurisdiction
The Director of Health Services, Maharashtra State Chief Registrar of Birth & Death Maharashtra State
The Deputy Director of Health Services (SBHI&VS), Maharashtra State Deputy Chief Registrar of Birth and Death Maharashtra State
The District Health Officer of all Zilla Parishad in Maharashtra State District Registrar of Birth and Death Concern Revenue district
The Dy. Chief Executive officer (Panchayat) of all Zilla Parishad in Maharashtra State Additional District Registrar of Birth and Death Concern Revenue district
The Block Development Officer of all Blocks in Maharashtra State Additional District Registrar of Birth and Death Concern Revenue Block
The executive Health Officer/Health Officer/Chief Officer of all urban areas in Maharashtra State Registrar of Birth and Death Concerned Municipal Corporation/Council
The Cantonment Executive Officer of all cantonment Boards in Maharashtra State Registrar of Birth and Death Concern area of cantonment board
The Gram Sevak or if there is no Gram Sevak, Assistant Gram Sevak of all Gram Panchayats in Maharashtra State Registrar of Birth and Death oncern area of Village/Gram panchayat
The Administrator of the specified area in Maharashtra state Registrar of Birth and Death Concern specified area



Analysis
On every 10th, monthly reports are received at state office of Deputy Chief Registrar of Birth and Death at Pune. From rural area 43,722 villages and from urban area 257 urban units are reporting every month to this office. Approximately 2,38,000 registered events of birth/death/stillbirths are reported to this office every month. The entire data is coded and computerized. Since Sept. 2004, decentralization of data is proposed at district level from rural area to begin with.

Feed back, inspection and supervision
In rural area, the Additional District Registrar for the block i.e. BDO and the Extension Officer (Panchayat) takes the review of village registrars for reporting as well as recording of events. In the same way the District Registrar i.e. District Health Officer (DHO), takes the review of the registration activities. At district, in Zilla Parishad, a Statistical Officer and a Statistical Investigator are specifically looking after reporting, monitoring analysis and feedback activities.

At the state level Bureau, the review of all districts is taken by analyzing the registered events. The activities are monitored and feedback is given to take corrective steps in the field. Regular inspection is also carried from state level/district level/block level officers in the field. Reporting
In rural area, the registrars submit the registered events of birth, death and stillbirth to additional district registrar at respective block level. At block level the village registers are maintained and updated every month, after the collection of reports from village registrars. The reports are compiled in a simple abstract. The copy of abstract is also given to district registrar i.e. District Health Officer, for monitoring and feedback at district level. The registrars of urban area send the monthly reports directly to Deputy Chief Registrar of birth and death – Pune, and a copy of abstract is submitted to District Registrar of respective district for monitoring and feedback at district level. Deputy Chief Registrar of Birth and Death – Pune, at the state level, complies & analyses the reports and district wise monthly and annual reports are submitted to Chief Registrar of Birth and Death, Maharashtra State and Registrar General, India, New Delhi.



Strategy: Medical Certification of Causes of Death
  • In the case of deaths occurred in the institutions, Head of the institution is responsible for submission of form no.4 to the Local Registrar.
  • In the case of domiciliary death attended by any physician prior to death is responsible to submit form no.4A to the local registrar.
  • It is the duty of the registrar to provide forms No.4 & 4A to the Institutions & Physicians in his jurisdiction.
  • It is the duty of Registrar, to ask about form No.4 & 4A according to occurrence of death, while entering the death event.
  • Civil Surgeon of District Hospital & District Health Officer Z.P. is responsible for review of quantity, quality & training of M.C.C.D. at district level.
  • Deputy Director is responsible for compilation, coding & analysis of data received through MCCD according to ICD–10.
Strategy: Survey of Causes of Death Scheme (Rural)
  1. The Paramedical staff (ANM & MPW) working in the selected villages is the important & root level worker called as “Field Agent”. The field agents are expected to keep House hold register, visit the community twice in a month & collect the data on fertility & mortality. In respect of mortality, they should contact the family members, collect the information on sign & symptoms, disease, duration of the diseased, by applying their experience in providing health services. The data collected under the scheme is according to De jury method.
  2. Field agents are expected to submit the collected information in the prescribed format to the M.O. PHC at the end of the month.
  3. Field recorder at PHC level is expected to supervise the villages selected under the scheme. He should consolidate the information received by the field agent every month. He should prepare the monthly report & submit to the Dist. level.
  4. Six monthly survey are to be conducted to detect the omissions if any, by field recorder.
  5. M.O.PHC is expected to verify all cause of death forms (C form). Based on sign & symptoms given by the field agent. He should write the probable cause of death, with the help of Classification of diseases made available to them. In case of Institutional deaths & the deaths in which any other Private Practitioners identify cause of death, MO should write the same cause of death.
  6. M.O. is also responsible for the development of technique of field agent in respect of Post death verbal autopsy.
  7. District Health Officer/Additional District Health Officer (A.D.H.O) are expected to monitor, supervise, evaluate, & verification of the scheme, time to time with the help of statistical wing at district level.
  8. Deputy Director (State Bureau Of Health intelligence & vital Statistics) is the whole in charge of the scheme at State level. He is expected to review the scheme, take corrective actions in respect of progress Further he should generate the information on mortality statistics related to Causes, age, & sex. of the scheme. Similarly District & Circle wise fertility & mortality rates in the form of State Annual Report.


Civil Registration System (CRS)
A) Registration of Births and Deaths of Rural and urban areas of the state.
  1. The Registration of Births and Deaths activity is carried out with the help of 256 Urban and 43722 Rural Centers. 100% work is expected from these centers (not only registration of Births and Deaths but submission of specific statutory obligated reports also). The efforts are being made to collect reports from all villages for 100% registration in time by contacting the Chief Executive Officer and concerning Block Development Officer in rural area. Multipurpose Health Worker, Auxiliary Nurse Midwife, Anganwadi Workers and Dais are also making attempts successfully in registration of Births and Deaths. The periodical review is taken to know the impact of their assistance in this respect in relation to the qualitative improvement in registration work.
  2. An effort had been made by this Bureau to decentralize the computerization of compilation of data at block level, regarding events registered in the jurisdiction of respective block in rural area.
  3. Meetings at various levels are conducted in rural as well as urban areas to improve the civil registration system.
    There are two types of meetings:
    1. Routine meetings
    2. Meetings of committees formed according to Government Resolution.
      Routine meetings: Annual Meeting of Chief Registrars at National level, Half Yearly Meeting of District Registrars at State level, Half Yearly Meetings of Statistical Officers of district at State level, Monthly Meetings of Medical Officers and Supervisors of Primary Health Centres at District level. Fortnightly Meetings of Village registrars at Block level.
      Meetings of committees formed according to Government Resolution: Half–yearly meeting of Interdepartmental Co–ordination committee at State level, Quarterly meeting of committee at District, Block and village level to improve Birth and death registration and vital statistics, Quarterly meeting of committee at Corporation level to improve Civil Registration System.
  4. Training: Training of newly recruited Statistical Investigators and officers, training of various software’s to health personnel, training of CRS to registration functionaries (as and when grants are available)
  5. IEC Activity
B) Medical Certification of Cause of Death (MCCD)
To improve coverage and quality of MCCD following activities are carried out.
  1. Meetings,
  2. Training
  3. Publication of data
    1. Meetings: Half Yearly Civil Surgeons at State level, Monthly of Superintendents of Rural and Cottage Hospitals at District level, Meetings of Private Practitioners and Medical Officers in corporation ares are taken as and when required by the corporation.
    2. Training: Continuous training of Civil Surgeons, Superintendents, Medical officers at Health and Family welfare Training Centres for ICD–10 and MCCD.
    3. Publication of data: Annual Publication is done on the basis of data received through MCCD.
With the help of World Bank Assistance, under Maharashtra Health System Development Project, the training of medical and paramedical personnel has been conducted to improve the quality of MCCD.

C) Survey of Cause of Death (Rural)
  • Half yearly Survey: the half yearly surveys are conducted in the villages selected under the scheme for detection of omissions of Births & Deaths event. The survey is expected to conduct by field recorder of respective PHCs.
  • To improve the quantitative and qualitative aspect of information collected under Survey of Cause of Death Scheme (Rural), as well as to receive the reports of this scheme in time, the scheme is monitored under Health Management Information System (HMIS). The system is monitored through the following indicators.
    Ind.70(i): Birth Reporting.
    Ind.70(ii): Death Reporting.
    Ind.70(iii): Infant death Reporting.
    Ind 70(iv): Cause of Deaths verified by MOPHC.
Meeting
  • Half yearly meeting of Statistical Officer/Statistical Inventigator (SO/SI) to review the performance, instructions, & to prepare plan of action, strategy at state level.
  • Monthly meeting of MOPHC & field agents/recorder at district level.
Training
  • This is the continues activity. Training is being given to the SI/SO regarding the scheme, as & when required according to availability of grants.
  • Training of field agent, field recorder & Mo is being carried out at district level by SO, Medical Officer District Training Team (MODTT), & ADHO.
Publication
The annual data compiled, analyzed & statistical inferences are published through annual report. The bureau is publishing the data through annual report from the year 2001 onwards.

D) Assistance in the work of Epidemiology
To accelerate the surveillance of epidemic disease and study related to epidemiology, the specific individual instructions to the Civil Surgeon and District Health Officers were given. Every month, collection, compilation of the information regarding causes of mortality was started since 1975–1976. The feedback is given to district health personnel, in alarming situation.

E) Health Management Information System (HMIS)
With the intention to keep the vigilance on progress of different health programmes, the Government has introduced the Health Management Information System. Health Management Information System involves information like comparative performance Status, Inter District ranking of performance and status of achievement of various indicators at State level etc.

How the programme is implemented.
Civil Registration System
This is implemented in Rural and Urban area. In case of rural area Gramsewak submits Birth and Death reports of the revenue villages under his jurisdiction to Block Development Officer (BDO). BDO submits consolidated reports to Deputy Chief Registrar, for Births and Deaths Pune In case of Urban area Exe. Health Officer/Health Officer/Chief Officer submits reports of Births and Deaths to Deputy Chief Registrar, Births and Deaths Pune. After receiving reports these are scrutinized, and computerized. At the end of the year Annual Vital Statistics Report is prepared and submitted to Higher Authorities.

Now this process is decentralized at district level. All the rural births and deaths reports will be computerized, in the office of the District Health Officer, of respective Zilla Parishad. The floppy or Compact Disc of the consolidated report will be sent to Dy. Chief Registrar, Births and Deaths Maharashtra State Pune.

Medical Certification of Cause of Death
Hospital incharge in urban area submits these certificates to Deputy Chief Registrar Pune. Recently from 1998 this scheme is extended in Rural Hospitals. After receiving the certificates causes of death are coded as per International Classification of Diseases revision 10 (ICD – X). After coding the information is compiled & analyzed. The report is submitted to Central Bureau of Health Intelligence, New Delhi. From this scheme we can observe medically certified causes of deaths by age sex in urban area.

Monthly Report of Communicable Diseases
The monthly report of 26 communicable diseases is collected from all district level officers – District Health Officers, Civil Surgeons Health officers of Corporations and identified Medical Colleges. After consolidations the report is sent to Director General Health Services Mumbai and Secretary Public Health Department, Mumbai, every month through Health Management Information System. Also this report is sent to Director, Central Bureau of Health Intelligence, New Delhi.

Information on identified 194 diseases
The report of 194 diseases is collected quarterly from all District officers i.e. District Health Officers, Civil Surgeons and identified Medical College Hospitals. After consolidation annual report is sent to Director, Central Bureau of Health Intelligence, New Delhi and Director General Health Services Mumbai. The morbidity pattern of the disease, prevalence in the state is known from this report.

Survey of Causes of Death (Rural)
  • The scheme is implemented in 600 villages, which are randomly selected among the 33 districts.
  • The scheme covers 12.5 lakhs (rural) population.
  • The health worker uses verbal autopsy technique instrument to collect the signs and symptoms of diseased, at the time of death.
  • Medical Officer of Primary Health Center writes the cause of death according to signs and symptoms collected by health worker by referring the list of causes based on ICD – X.
  • From this scheme, the mortality pattern existing in the rural community is known. The various mortality indicators are calculated from the available data and information.


Services to Common People
Village Level Service
Every birth or death event occurred in rural area is registered at Grampanchayat. Gramsevak or Village Development Officer does this registration. The procedure for registration is quoted in Maharashtra Births and Deaths Registration Rules 2000.

Hospital Service
  • Rural Hospitals, Sub–District Hospitals, Other Hospitals, District Hospitals, Super Specialty Hospitals.
  • At all these hospitals Birth Reports, Death Reports, Still Birth Reports, Medical Certificates of causes of death are filled and are sent to respective Registrars, Births and Deaths. This submission of reports is as per procedure in Maharashtra Births and Deaths Registration Rules 2000. After receiving the reports Registrar registers the events.
  • Services centers available in each district.
  • Service centers for registration of birth and death are nothing but Registrars office.
Service Centers available in each district
Service centers for registration of birth and death are nothing but Registrars office. In each district service centers are as follows:
Rural Area: Grampanchayat of every revenue village.
Urban Area: Municipal Corporation/Municipal Council/Cantonment Board/Ammunition Factory Hospital.

Role of NGOs
NGOs can help for improving the registration of birth and death in community. Awareness of registration is necessary especially in rural area. NGOs can arrange lectures, demonstrations on this topic in rural area.

Health Education Messages
Important Health Education Messages
  1. Ensure registration of every birth and death event.
  2. Birth certificate ensures a hurdle–free future for your child.
  3. Register the event of birth alongwith the name of child.
  4. Obtain the birth certificate with name of child.
Role of Other Sectors
Registration of Birth and Death is multidepartmental activity. In this activity Rural Development Department, Urban Development and Public Health Department are involved. Co–ordination of these three departments is necessary for effective registration.

Expected Community Participation
The registration of birth/death event is obligatory as per Registration of Births and deaths Act, 1969. Every parent is supposed to register the event of birth of their child, similarly every death event is supposed to be registered by the relative of deceased. After registration it is useful to take the certificate of birth or death for various purposes.

Birth Certificate is useful for
  1. Evidence of birthplace and date.
  2. For obtaining passport/visa, driving license etc.
  3. For admission in school.
Death Certificate is useful for
  1. Establishing the heritage.
  2. Evidence of place and date of death.
  3. For obtaining family pension and insurance claim.
Achievements of Health Intelligence & Vital Statistics
Birth, Death and Infant Death Efficiency
Year Estimated Population SRS Birth Rate Estimated Birth Registered Birth Efficiency % SRS Death Rate
1991 79476000 26.2 2082271 1607159 77.18 8.2
1992 81091000 25.1 2035384 1593276 78.28 7.9
1993 82706000 25.2 2084191 1591299 76.35 7.3
1994 84321000 25.7 2167050 1573255 72.6 7.5
1995 85936000 24.5 2105432 1642289 78 7.5
1996 87552000 23.4 2048717 1602407 78.22 7.4
1997 88964000 23.1 2055068 1635682 79.59 7.3
1998 90782318 22.5 2042602 1652244 80.89 7.6
1999 90450293 21.1 1908501 1739577 91.15 7.5
2000 95416116 21 2003738 1828027 91.23 7.5
2001 96752247 20.6 1993096 1825145 91.57 7.5
2002 99641086 20.2 2012750 1864859 92.65 7.3
2003 100903153 19.9 2007973 1863585 92.81 7.2
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Vital Statistics as per (SRS)
  1. Improvement in CBR from 26.2 in the year 1991 to 19.1 in 2004.
  2. Improvement in CDR from 8.2 in the year 1991 to 6.2 in 2004.
  3. Improvement in IMR from 60 in the year 1991 to 36 in 2004.
  4. CBR is less by 2.0 for urban area than rural.
  5. CDR is less by 1.4 for urban area than rural.
  6. There is vast difference in rural & urban areas for IMR. IMR for rural area is 42 & for urban area is 27.

Total Fertility Rate
As per SRS data, TFR of state is showing slow decline over a period of 10 years. It was 3 during 1991 & reduced to 2.5 in the year 2000.
Year Total Rural Urban Year Total Rural Urban
1991 3.0 3.4 2.5 1998 2.7 2.9 2.3
1992 2.9 3.3 2.3 1999 2.5 2.7 2.3
1993 2.9 3.2 2.7 2000 2.5 2.6 2.2
1994 2.9 3.0 2.6 2001 2.4 2.6 2.2
1995 2.9 3.3 2.5 2002 2.3 2.5 2.2
1996 2.8 3.2 3.0 2003 2.3 2.4 2.1
1997 2.7 3.0 2.3        


Total Fertility Rate

Public Health Labs

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Historical Background/Periodical Development
Public Health Laboratory, Pune is the pioneer Institute in the State for the development of Laboratory services. It came into existence as “Sanitary Board Laboratory” in 1912. The Laboratory works for statutory control of Water and Waste Water & Food examination bacteriological as well as chemical.

WHO recognized the Laboratory at Pune as District Referral Laboratory in 1960. In 1971 it was declared by WHO as Regional Referral Laboratory for receiving UNICEF Aid. In 1973 the laboratory was elevated to the status of State Public Health Laboratory. In 1975 Food and Agricultural Organization recognized the laboratory for monitoring metallic contaminants in food commodities. The State Public Health Laboratory, Pune, Regional Public Health Laboratory Nagpur & Aurangabad have been notified by Government as Water & Waste Water characterization laboratories under the Maharashtra Water (Prevention & Control of Pollution) Act 1974 from May 1976 & Public Analysts were declared as Government Analysts from 1977.

For proper coordination and rationalization of working of the laboratories under Urban Development and Public Health Department an expert committee was appointed in July 1974 and October 1975. As per the recommendations of this committee laboratory of the water pollution Board, Maharashtra prevention of Water Pollution Investigation Center Laboratory, Public Health Engineering Laboratories and Food and Drug Administration were transferred to the Directorate of Health Services. These laboratories were merged with Health Services to form 11 Public Health Laboratories. The places of these laboratories are as follows:
  1. Pune
  2. Aurangabad
  3. Nagpur
  4. Amravati
  5. Kolhapur
  6. Solapur
  7. Jalgaon
  8. Sangli
  9. Nasik
  10. Nanded
  11. Kokan Bhavan (Washi) Navi Mumbai
Besides 11 food testing laboratories, the D.P.H Laboratories at Ahmednagar, Satara, Thane,Jalna, Beed & Gadchiroli have been permitted to undertake the analysis of food samples under the provisions of the prevention of Food Adulteration Act 1954 & rules there under, as well as informal samples. These laboratories have started food analysis work from Nov. 2006 and at present 17 public health laboratories are functioning as Food Testing Laboratories.

Water and sanitation decade was observed from 1980 to 1990. During this period from 1985 to 1989 remaining 19 District Public Health Laboratories were created at the remaining districts for water quality monitoring.

Government of India has recognized State Public Health Laboratory, Pune as the Central Food Laboratory for the examination of Appellate food samples from Madhya Pradesh, Div, Daman and Dadra–Nagar Haveli 1978. The State of Karnataka and Union Territories of Delhi Corporation were added to Central Food Laboratory, Pune in 1980.

At present there are 30 Public Health Laboratories in the state. Laboratory at Pune functions as State Public Health Laboratory. Laboratories at Aurangabad and Nagpur are Regional level laboratories. And remaining 27 Public Health Laboratories are District Public Health Laboratories mainly engaged in chemical and bacteriological quality monitoring of drinking water.

Central Food Laboratory, Pune – 411001
In year 1976 Government of India had decided to have one Central Food Laboratory for each zone. Hence in addition to Central Food Laboratory, Calcutta, three more Central Food Laboratories at Ghaziabad, Mysore and Pune were created. The State Public Health Laboratory, Pune had been notified as Central Food Laboratory. This Laboratory is functioning since 1st April 1978 and it is performing various statutory functions as per PFA act 1954 and Rules 1955 as follows.
  1. To examine statutory appellate Food Samples received from various Courts of various States as per the jurisdiction and Port Health Authorities.
  2. To create data for fixing Standards for various Food commodities under the provisions of PFA Act and Rules.
  3. To participate in various collaborative projects pertaining to Food commodities sponsored by ICMR, New Delhi, CSIR, New Delhi, and WHO etc.
  4. To participate in various Sub–committee Meetings of Central Committee for Food Standards (CCFS).
The Scheme of Central Food Laboratory, Pune was accepted on the basis of 100% grant–in–aid from Central Government.

Objectives of Public Health Labs
To monitor the Quality of Water and Food by analyzing the samples of these articles and to submit the reports to the concerned authorities. The monitoring is carried out as per the guidelines under the following mentioned Acts and Rules thereafter.
  1. Water (Prevention and Control of Pollution) Act 1974.
  2. Prevention of Food Adulteration Act 1954 and Rules 1955.
Strategy
  1. Water Quality Monitoring, bacteriological as well as chemical, at each district level from rural as well as urban area through the application of Water(Prevention and Control of Pollution) Act 1974.
  2. Food Quality Monitoring trough the application of Prevention of Food Adulteration (PFA) Act 1954 and Rules 1955.
  3. Quality Monitoring of various chemical disinfectants used for treatment of water and maintaining of quality of water.
  4. Water Quality Control and Surveillance.
  5. Analysis of samples like Stool, Blood, Vomit etc. to determine/confirm bacterial organism causing water-borne diseases and food poisoning cases.
  6. Active participation in the control of epidemic due to water borne disease under Rapid Response Team/IDSP.
Services to the Common People
  1. To protect the interest of common people by using a tool of quality monitoring, whether they are provided pure and clean drinking water and wholesome food to the implementation of respective Statutory provisions.
  2. The common people can also avail the facility of testing water, food articles by paying nominal fees.
  3. To create awareness regarding drinking water quality and wholesome food through the organization of exhibition for common people.
Special Features of Public Health Labs
Special Features of Programme
  • Apart from the routine functions of Water and Food Quality monitoring, the Public Health Laboratories–especially State and Regional–are engaged in various Research Projects pertaining to the Food/Water sponsored by Different Organizations such as CSIR/ICMR/WHO/FAO etc.
  • SPHL has been identified as a State Referral Center for Bacterial Culture.
  • SPHL has also been identified as the State Referral Institute for Water Quality Monitoring and Surveillance Program of WSSD in the State.
Achievements
State Public Health Laboratory Pune Activities of Public Health Labs
Activities of Public Health Laboratories are divided in three main sections:
  1. Food Sections
  2. Water Section (Chemical Analysis)
  3. Bacteriology Section
Food Sections
Following are the functions carried out by food section of the 11 food testing public health laboratories in the state.
  1. Analysis of various kinds of food samples under the provisions of Prevention of Food Adultration Act, 1954 and Rules 1955, as per their Analysis of food samples collected in connection with food poisoning incidences for chemical toxicants like heavy metals, alkaloids, pesticide residues, cannabis constituents etc.
  2. To give thorough knowledge – technical as well as practical – about food analysis and food adulteration to visitors like Medical Officers Local Self Govt. people, College Students, Nursing Students, Medical Students from Govt. Medical College and Private Medical College, AFMC, School children etc. Analysis of food samples collected by the food Inspectors of Food and Drug Administration of the State at the time of VIP/VVIP visits.
  3. Analysis of Iodized salt samples under the National Iodine Deficiency Disorder Control Programme.
  4. Analysis of Urine samples of the patients collected by Primary Health Centers at the village level to locate the deficiency of iodine under the above–mentioned program. In near future, all District Public Health Laboratories will be strengthened to carry out the analysis of urine samples.
  5. Analysis of food samples, also from private organization/individual person etc. is carried out – as per desired/required parameters and fees are charged Samples received from private bodies is carried out by respective food standards specified in Appendix B of Rule 5 of the P.F.A. Rules 1955. The food articles having no specific standards under Appendix B are analyzed as per the general PFA Rules applicable to them.
  6. Analysis of various kinds of food samples received from Government bodies like Civil Supply, Govt. Hospitals, Social Welfare Dept., Tribal Welfare Dept., Police Dept. etc.
  7. To organize exhibitions related with “Food Adultration” as and when required.
  8. To organize Training Programs regarding Food Analysis, Methods in food analysis, Modification in methodology etc. to the technical staff engaged in food analysis at various Public Health Labs., and also to the Consumer Organization, NGO’s etc.
Implementation of PFA Act 1954 and Rules 1955
Since long period, food adulteration is well known aspect, The Central Govt. has passed the PFA Act in 1954. Earlier the PFA Act was enforced within Municipal Corporation and Council Areas only. Accordingly PFA Rules were framed in the year 1955 to carry out the provisions of this Act. To bring the rural areas within the purview of implementation of this Act, in 1970 the implementation was handed over to independent department – Food and Drugs Administration of Maharashtra State. The Commissioner – an IAS Officer – of the FDA is notified as the “Food (Health) Authority” for the entire State of Maharashtra. Apart from Food and Drug Administration, Municipal Corporations, Councils and Cantonment Boards in their respective areas also implement the Act.

The Aim and Objects of the PFA Act
  1. To prevent Food Adultration.
  2. To protect Consumer’s Interest.
Various Authorities responsible for implementation of the PFA Act 1954.
  1. Food Inspectors of FDA, Municipal Corporations, Councils and Cantonments, Railways.
  2. Local (Health) Authority of FDA, Municipal Corporations, Councils and Cantonments, Railways.
  3. Public Analyst.
  4. Licensing Authorities.
  5. Consenting Authority.
  6. Consumer Councils
  7. Courts of Law
Water Section
Following are the functions carried out in the Water Section of Public Health Labs. In the State under Water quality monitoring.
  • Chemical Analysis of water to ascertain its potability by performing various chemical parameters as per BIS specifications IS 10500: 1991.
  • Chemical analysis of Effluents, Trade waste, Domestic effluents as per the provisions of the Water (Prevention and Control of Pollution) Act 1974.
  • Analysis of water samples collected in connection with Food Poisoning incidents for chemical toxicants including pesticide residue, metals etc.
  • Chemical analysis of water disinfectants like Bleaching Powder (IS 1065:1989), Liquid Chlorine (IS 11673:1992), Chlorine tablets etc. as per BIS Specifications mentioned.
  • Chemical Analysis of Alum (Solid/Liquid){IS 299:1989}, Poly Aluminium Chloride (IS 15573:2005) as per BIS specifications mentioned.
  • Dose determination of chemical disinfectants mentioned above.
  • Analysis of water for construction purposes (IS 456:1978), Swimming pool (IS 3328:1993) as per BIS specifications mentioned.
  • Examination of various Kits made available in the market for the determination of various chemical constituents of water for assessing their quality, usefulness, durability and economic feasibility.
  • To give thorough Knowledge – theoretical as well as practical – about water analysis – water potability, water pollution, dose determination etc. to the visitors like Medical students, Medical Officers Local Self Govt. people, College Students, Nursing Students, School children etc.
  • To organize training programs regarding water analysis, methods in water analysis, modification in methodology etc. to the technical staff related to the water analysis, consumer organizations and NGO’s etc.
Collection of Water Sample for Chemical Examination
  • Collect the water sample in a plastic container.
  • Ideally a new container should be used, but if it is unavailable, wash the used containers with detergent, carefully rinse thoroughly with water.
  • Sample should be representative of the supply.
  • Avoid surface scum.
  • Before filling, rinse sample container two or three times with the water being collected. Collect at least 2.5 liters sample.
Collection of Bleaching powder Sample for Chemical Examination
  • Sample shall not be exposed to atmosphere for longer time than necessary and sampling shall be done as rapidly and thoroughly as possible.
  • Sampling instrument should be clean and dry when used.
  • To draw, a representative sample content of each container selected for sampling shall be mixed as thoroughly as possible by rolling, shaking or stirring by suitable means.
  • Sample shall be placed in clean, dry and airtight glass or polythene bag on which the material has no action.
  • Sample containers shall be of such a size that they are nearly filled by sample.
  • Each sample container so filled shall be sealed airtight after filling and marked with the full details of sampling, the date of sampling, the month and year of manufacture of material and its grade.
  • Precautions shall be taken to protect the sample, the material being sampled the sampling instrument and containers of the sample from adventitious contamination.
  • Care should be taken to avoid direct contact of bleaching powder with skin. Face should be kept at a safe distance from the container when it is opened.
Storage
  • Instruction for the storage of bleaching powder. Bleaching Powder must be stored in a cool and dry place and away from Sunlight.
  • Implementation of Water (Prevention and Control of Pollution) Act 1974.
  • An Act provides for the prevention and control of water pollution and the maintaining or restoring of wholesomeness of water.
Various Authorities responsible for the implementation of the Act
  • Central/State Board – To exercise the powers conferred on and perform the functions assigned – e.g. to collect the samples of Water/Waste water/Effluents/Trade waste etc. for the purpose of chemical analysis.
  • Government Analyst – An Officer appointed by the concerned State Board for analysis of sample is responsible for the analysis and submission of report in a prescribed form in triplicate to the State Board.
  • Appellate Authorities – It is constituted by the State Govt. for deciding the reasonability of the conditions imposed or the variation of any conditions imposed by the State Board.
  • Court of Law – To restrain the person/company who is likely to cause pollution by reason of disposal of any matter in any stream or well, which is likely to be polluted.
Bacteriological Examination
  • Bacteriological examination of water samples for potability.
  • Stool/Rectal Swabs/Vomit Samples Examination For Bacterio – logical Culture–For Cholera And Other Agents Of Diarrhoea, Dysentry, Gastroenteritis.
  • Blood Samples For Enteric Fever Cultures & Food Poisoning Agents.
  • Antimicrobial Susceptibility Testing of isolated bacterial cultures.
  • Microbiological – Samples received under Prevention of Food Adulteration Act 1954.
  • Suspected/leftover food, water and related samples to detect causative agent in food poisoning outbreak investigation.
  • Food served to VIP and VVIP is tested for bacteriological examination.
Training And Health Education
  • In service training to the technical staff.
  • Interstate training to the technical staff.
  • International training to the WHO fellows.
  • Training to the Med. DPH candidates.
  • Interstate training for members of consumer forum.
  • Health education through demonstration and exhibition.
  • To medical students.
  • To Local Self Govt. people
  • To collage students, catering diploma students.
  • To Nursing staff.
  • To sanitary & food inspectors.
  • To the public
Sample collection methods (Bacteriological Examination)
For effective bacteriological examination of water it is important that the water sampling should fulfill the following requirements.
  • Sampling should be properly planned.
  • Sampling points should be representative of water source.
  • Sampling points should be located in proportion to population served.
  • Samples should be collected, stored, dispatched in suitable sterilized glass bottles with properly fitting stoppers or caps.
  • At least 250 ml of sample should be collected.
  • Send the samples to the nearest district Public Health Laboratory at least within 24 hrs from the time of collection.
  • Samples should be sent in a cold chain.
Transportation
The shorter the time that elapses between collection of sample and its analysis the more reliable will be the analytical results. Therefore send the sample at destination at an earliest.

Concerned Laboratories
Samples should be sent to or to The District Public Health Laboratory at an earliest.
(Annexure I)

Collection of Stool Sample
Reliability of results obtained will depend largely on the care taken in collecting samples. Stool samples are collected for various different tests as follows.
  • Microscopic examination of parasites i.e. eggs or larvae of Parasitic worms.
  • To detect bacteriological pathogens like Vibrio, Salmonella and Shigella.
1) For Microscopic examination to detect the presence of eggs or larvae of parasitic worms.
  • Obtain sufficient quantity of stool samples approximately 4–5 Gms or 4 ml of stool sample depending on whether it is in solid or liquid in consistency.
  • Liquid stools containing mucus and blood must be examined first, which may contain motile amoeba that may die quickly on exposure to air.
  • Specimen should be collected in a waxed cardboard box or in a wide mouth plastic box with a lid.
  • Examine stools while fresh i.e. within 1 hr of collection.
2) To detect bacteriological pathogens like Vibrio, Salmonella and Shigella.
  • Collect stool samples before the patient receives an antibiotic.
  • Use clean cotton sterile tipped swab and introduce well into rectum. When this is done the swab becomes faecally stained and moist.
  • Alternately collect freshly passed liquid stools in a bottle or a cotton tipped swab.
  • Send the sample to the laboratory in a tightly sealed screw capped sterile bottle. In case of samples of suspected Bacillary dysentery the fresh stool sample is preferred but if it is impossible send the sample in Cary Blair transport medium having pH 7.2 to 7.4.
  • If it will take more than 2 hrs to reach laboratory send the sample in a Cary Blair transport medium.
  • For suspected Salmonella spp collect the sample in Cary Blair transport medium having pH 7.2 to 7.4.
Storage
Store the samples at 04 degrees C. Each sample should be properly & appropriately labeled. Detail information should be sent for each sample as below:
  1. Name of Patient.
  2. Name of Mother and Father.
  3. Address of Patient.
  4. Sex.
  5. Date of Onset of Symptoms.
  6. Provisional Diagnosis.
  7. Clinical Outcome.
  8. Antibiotic received prior to collection of sample – Yes / No / Not known.
Transportation
Transport the specimens preferably in cold chain. If not possible send them at ambient temperature at earliest.

Concerned Laboratories
Samples should be sent to or to The District Public Health Laboratory at an earliest.
(Annexure I).

Collection of Blood Sample for detection of pathogens causing Enteric fever
  • For detection of Salmonella typhi, Salmonella Para–typhi A and B collect blood sample in 5% bile broth medium. (Bile broth will be made available at District Public Health Laboratory).
  • Collect blood sample in the first week of illness.
  • Collect sample before antibiotics are administered to the patient.
  • If bile broth is unavailable, collect blood sample in sterile plain bulb and send to District Public Health Laboratory at an earliest.
Collection of food Sample for Food poisoning outbreaks
Food borne diseases include food poisoning due to toxins produced by microorganisms (e.g. Staphylococcus aureus). In fact, all the waterborne infections (Viral, bacteriological and parasitic) can be transmitted through contamination of food. Food borne outbreaks are very common in our country.
  • Collect sample in a clean, dry, sterile, leak proof container such as glass or plastic jar. If unavailable collect in a disposable new unused plastic bag. Do not add any preservative.
  • Collect minimum 250 gms/ml of sample depending upon whether it is solid or liquid.
  • If product is in big container representative sample should be collected in sterile container under aseptic conditions.
  • Sample should be labeled immediately after collection.
  • Collect patient’s stool/vomit sample and water sample, which is used for drinking and food preparation purpose. simultaneously, label properly and sent along with food sample.
  • Samples should be sent immediately along with as per standard proforma.
  • Samples should accompany relevant information as per Annexure B.
  • Samples should be sent in a cold chain so as to minimize the chances of deterioration of prepared food.
  • Sample should be sent to State or Regional Public Health Laboratory, which is at nearest distance. Addresses of these labs are given in Annexure I.
Collection of swabs for “Sterilization testing” of Operation theatre swabs
  • Collect swabs in Robertson’s cooked meat medium.
  • Collect samples from following points.
  • Operation table surface.
  • Instrument trolley.
  • Overhead lamp.
  • Boyle’s apparatus.
  • Floor near table.
  • Alternately walls of the theatre.
Storage
Store the collected swab at ambient temperature and not at freezing temperature.

Transportation
Transport swab to the laboratory at an earliest preferably within 24 hrs of collection.

Concerned Laboratories
Send operation theatre swabs to State Public Health Laboratory Pune–411001.Region Wise
Performance of all the Public Health Laboratories in the state pertaining to the activities in Food, Water and Bacteriological Section of the laboratories for the Calender Years 2003 and 2007 is mentioned as follows:

Regionwise Performance of Public Health Laboratories in The State of Maharashtra During Calender Year 2007
Sr. No. Name of Laboratory Food Section Water Section Bacteriology Section Total
1 Mumbai Region Total 3492 7303 55088 65883
2 Nashik Region Total 6581 8511 47858 62950
3 Pune Region Total 19371 8349 80681 108401
4 Kolhapur Region Total 4545 12401 25664 42610
5 Aurangabad Region Total 3611 2921 41098 47630
6 Latur Region Total 2890 3905 45361 52156
7 Akola Region Total 2951 9418 68120 80489
8 Nagpur Region Total 5425 10304 75758 91487
  Grand Total 48866 63112 439628 551606

Regionwise Performance of Public Health Laboratories in The State of Maharashtra for the Month JAN 2008
Sr. No. Name of Laboratory Food Section Water Section Bacteriology Section Total
1 Mumbai Region Total 324 524 8359 9207
2 Nashik Region Total 490 508 8912 9910
3 Pune Region Total 1738 747 9457 11942
4 Kolhapur Region Total 367 1018 4577 5962
5 Aurangabad Region Total 540 106 4680 5326
6 Latur Region Total 347 342 7179 7868
7 Akola Region Total 162 612 8090 8864
8 Nagpur Region Total 720 668 14132 15520
  Grand Total 4688 4525 65386 74599

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Performance of Public Health Lab
District Wise
Performance of all the Public Health Laboratories in the state pertaining to the activities in Food, Water and Bacteriological Section of the laboratories for the Calender Years 2003 to 2006 is as follows:

Calender Year: 2003
Sr.no Name of the Laboratory Food Water Chemical Bact. Section Total
1 Ahmadnagar 412 448 21345 22205
2 Akola 40 1808 20533 22381
3 Amaravati 2769 2107 37385 42261
4 Aurangabad 2433 1656 28661 32750
5 Beed 81 382 19279 19742
6 Bhandara 342 1555 19075 20972
7 Buldana 443 1063 20576 22082
8 Chandrapur 123 841 15740 16704
9 Dhule 407 791 8992 10190
10 Gadchiroli 119 417 11082 11618
11 Jalgaon 1911 208 26871 28990
12 Jalna 191 504 15273 15968
13 Kokan Bhavan 1737 247 23484 25468
14 Kolhapur 2386 5457 18877 26720
15 Latur 146 554 23740 2440
16 Nagpur 7002 5126 33767 45895
17 Nanded 1634 885 24772 27291
18 Nashik 1974 1043 21999 25016
19 Osmanabad 97 2260 17569 19926
20 Parbhani 0 600 22395 22995
21 Pune 13642 5439 20581 39662
22 Raigad–Alibag 0 2224 15506 17730
23 Ratnagiri 481 1748 18226 20455
24 Sangli 2070 6245 14705 23020
25 Satara 68 5129 12129 17326
26 Sindhudurg 0 1232 15853 17085
27 Solapur 2294 954 20107 23355
28 Thane 299 1582 17773 19654
29 Wardha 83 660 13163 13906
30 Yeotmal 347 2338 22724 25412
Total 43531 55503 602182 679219

Calender Year: 2004
Sr.no Name of the Laboratory Food Water Chemical Bact. Section Total
1 Ahmadnagar 653 2633 20658 23944
2 Akola 236 2391 14797 17424
3 Amaravati 3874 5949 37400 47223
4 Aurangabad 1852 1383 27140 30375
5 Beed 113 314 22925 23352
6 Bhandara 467 1703 18706 20876
7 Buldana 938 1616 21310 23864
8 Chandrapur 152 15 18603 18770
9 Dhule 666 1140 9083 10889
10 Gadchiroli 321 455 10961 11737
11 Jalgaon 1062 46 24906 26014
12 Jalna 561 586 16073 16715
13 Kokan Bhavan 1631 175 25260 27066
14 Kolhapur 2205 5550 18477 26232
15 Latur 282 622 21746 22650
16 Nagpur 6263 5611 34475 46349
17 Nanded 1852 564 28977 31393
18 Nashik 1195 1061 20024 22280
19 Osmanabad 60 1707 13128 14895
20 Parbhani 332 22914 23246
21 Pune 12308 4364 17412 34084
22 Raigad–Alibag 368 2978 16315 19661
23 Ratnagiri 695 1551 22024 24270
24 Sangli 1660 5746 15762 23168
25 Satara 107 5956 14872 20935
26 Sindhudurg 381 1611 16960 18952
27 Solapur 2420 709 17403 20532
28 Thane 399 1522 17406 19327
29 Wardha 112 1007 12933 14052
30 Yeotmal 423 4082 20866 25371
Total 42751 63379 599516 705646


Calender Year: 2005
Sr.no Name of the Laboratory Food Water Chemical Bact. Section Total
1 Ahmadnagar 1556 4475 31055 37086
2 Akola 247 2451 20664 23362
3 Amaravati 3846 1712 37014 42572
4 Aurangabad 1351 1593 25861 28805
5 Beed 150 428 24499 25077
6 Bhandara 435 2643 30573 33651
7 Buldana 979 1633 20687 23299
8 Chandrapur 431 1111 24189 25731
9 Dhule 1577 1826 18205 21608
10 Gadchiroli 154 390 76062 76606
11 Jalgaon 559 679 24952 26190
12 Jalna 246 548 15312 16106
13 Kokan Bhavan 2001 271 21068 23340
14 Kolhapur 2773 5571 23133 31477
15 Latur 499 938 22219 23656
16 Nagpur 7377 5894 46348 59619
17 Nanded 2643 663 30247 33553
18 Nashik 1972 948 37030 39950
19 Osmanabad 439 1683 22644 24766
20 Parbhani 263 759 23369 24391
21 Pune 14000 3874 28012 45886
22 Raigad–Alibag 537 2653 15959 19149
23 Ratnagiri 588 1665 22822 25075
24 Sangli 1631 4163 18656 24450
25 Satara 204 6388 27283 33875
26 Sindhudurg 1023 1932 16606 19561
27 Solapur 2355 582 17382 20319
28 Thane 555 1868 43158 45581
29 Wardha 186 1286 17355 18827
30 Yeotmal 278 4704 28507 33489
Total 50855 65331 810871 927057

Calender Year: 2006
Sr.no Name of the Laboratory Food Water Bacteriology Total
1 Ahmadnagar 1432 4916 10916 17264
2 Akola 343 1957 12352 14652
3 Amaravati 2697 1415 31555 35667
4 Aurangabad 1737 1215 19318 22270
5 Beed 456 568 12873 13897
6 Bhandara 1134 3153 14478 18765
7 Buldana 1049 1637 5907 8593
8 Chandrapur 582 1108 9537 11227
9 Dhule 1366 1419 9732 12517
10 Gadchiroli 765 936 11982 13683
11 Jalgaon 980 1151 10852 12983
12 Jalna 552 743 10700 11995
13 Kokan Bhavan 1799 230 17573 19602
14 Kolhapur 2493 5643 13494 21630
15 Latur 786 1191 10970 12947
16 Nagpur 4553 7987 30343 42883
17 Nanded 2707 931 9923 13561
18 Nashik 1882 738 18091 20711
19 Osmanabad 459 1677 10241 12377
20 Parbhani 493 628 10008 11129
21 Pune 18283 3849 20643 42775
22 Raigad–Alibag 668 2982 11700 15350
23 Ratnagiri 861 1906 10786 13553
24 Sangli 1539 4180 7256 12975
25 Satara 228 5811 11240 17279
26 Sindhudurg 1948 2321 6011 10280
27 Solapur 2122 627 10714 13463
28 Thane 984 1830 15473 18287
29 Wardha 319 995 7654 8968
30 Yeotmal 406 3686 12209 16301
Total 55623 67430 394531 517584


Calender Year: 2007
Sr.no Name of the Laboratory Food Water Bacteriology Total
1 Ahmadnagar 3119 5061 10776 18956
2 Akola & Washim 276 2430 13229 15935
3 Amaravati 2132 1376 28564 32072
4 Aurangabad 2908 1123 19420 23451
5 Beed 546 523 13783 14852
6 Bhandara & Gondia 0 2399 13657 16056
7 Buldana 543 1826 6214 8583
8 Chandrapur 0 1041 8844 9885
9 Dhule & Nandurbar 988 1183 9244 11415
10 Gadchiroli 0 652 11805 12457
11 Jalgaon 1382 1454 10311 13147
12 Jalna 703 1011 12019 13733
13 Kokan Bhavan 3267 447 16697 20411
14 Kolhapur 2526 5430 12068 20024
15 Latur 301 997 9953 11251
16 Nagpur 5389 5240 32810 43439
17 Nanded 2043 828 11328 14199
18 Nashik 1092 813 17527 19432
19 Osmanabad 0 1557 10297 11854
20 Parbhani & Hingoli 0 787 9659 10446
21 Pune 14088 3348 52839 70275
22 Raigad 0 2411 10304 12715
23 Ratnagiri 225 2342 9917 12484
24 Sangli 2019 4861 7801 14681
25 Satara 845 4267 12672 17784
26 Sindhudurg 0 2110 5795 7905
27 Solapur 4438 734 15170 20342
28 Thane 0 2103 18170 20273
29 Wardha 36 972 8642 9650
30 Yeotmal 0 3786 20113 23899
Total 48866 63112 439628 551606

Month – January 2008
Sr.no Name of the Laboratory Food Water Bacteriology Total
1 Ahmadnagar 233 324 2660 3217
2 Akola & Washim 14 176 1717 1907
3 Amaravati 40 120 2770 2930
4 Aurangabad 454 69 1714 2237
5 Beed 47 72 1809 1928
6 Bhandara & Gondia 65 132 2203 2400
7 Buldana 49 95 1530 1674
8 Chandrapur 8 49 1713 1770
9 Dhule & Nandurbar 108 95 1282 1485
10 Gadchiroli 21 28 5181 5230
11 Jalgaon 97 62 1914 2073
12 Jalna 56 16 1208 1280
13 Kokan Bhavan 210 6 1287 1503
14 Kolhapur 253 475 1927 2655
15 Latur 32 49 1344 1425
16 Nagpur 599 415 3792 4806
17 Nanded 225 74 2250 2549
18 Nashik 52 27 3056 3135
19 Osmanabad 43 147 1776 1966
20 Parbhani & Hingoli 30 21 1758 1809
21 Pune 1398 290 4808 6496
22 Raigad 17 202 1538 1757
23 Ratnagiri 28 198 1992 2218
24 Sangli 66 439 1382 1887
25 Satara 160 403 2268 2831
26 Sindhudurg 48 104 1268 1420
27 Solapur 180 54 2381 2615
28 Thane 69 118 3542 3729
29 Wardha 27 44 1243 1314
30 Yeotmal 59 221 2073 2353
Total 4688 4525 65386 74599


Detail Performance can be procured from the respective Annual Reports.

Yearly report of Iodized Salt Analysis January 2007 to December 2007
Sr.no Name of District No. of Samples Analysed Standred Samples Sub – Standard Samples Non – Iodized Salt
1 Ahmednagar 840 828 12 0
2 Akola & Washim 387 321 65 1
3 Amaravati 214 187 27 0
4 Aurangabad 628 580 48 0
5 Beed 613 586 21 6
6 Bhandara & Gondia 1057 895 162 0
7 Buldhana 1096 971 112 13
8 Chandrapur 319 302 17 0
9 Dhule & Nandurbar 750 596 154 0
10 Gadchiroli 482 453 29 0
11 Jalgaon 378 366 11 1
12 Jalna 937 821 104 12
13 Kokan Bahvan 2 2 0 0
14 Kolahpur 998 941 57 0
15 Latur 816 756 58 2
16 Nagpur 1790 1353 437 0
17 Nanded 359 317 42 0
18 Nashik 361 343 18 0
19 Osmanabad 380 339 15 26
20 Parbhani & Hingoli 449 368 81 0
21 Pune 1182 1113 68 1
22 Raigad 350 296 53 1
23 Ratnagiri 685 654 31 0
24 Sangli 266 266 0 0
25 Satara 378 374 4 0
26 Sindhudurg 680 668 12 0
27 Solapur 280 243 15 22
28 Thane 783 569 166 48
29 Wardha 275 274 1 0
30 Yeotmal 710 589 121 0
  Total 18445 16371 1941 133

Report of Iodized Salt Analysis in the month of January 2008
Sr.no Name of District No. of Samples Analysed Standred Samples Sub – Standard Samples Non – Iodized Salt
1 Ahmednagar 58 54 4 0
2 Akola & Washim 23 23 0 0
3 Amaravati 62 45 5 12
4 Aurangabad 94 88 6 0
5 Beed 31 31 0 0
6 Bhandara & Gondia 65 64 1 0
7 Buldhana 49 44 5 0
8 Chandrapur 8 8 0 0
9 Dhule & Nandurbar 53 48 5 0
10 Gadchiroli 21 19 2 0
11 Jalgaon 32 32 0 0
12 Jalna 36 34 2 0
13 Kokan Bahvan 0 0 0 0
14 Kolahpur 84 83 1 0
15 Latur 32 30 2 0
16 Nagpur 194 163 31 0
17 Nanded 10 7 3 0
18 Nashik 7 6 1 0
19 Osmanabad 43 38 5 0
20 Parbhani & Hingoli 30 25 5 0
21 Pune 82 78 4 0
22 Raigad 17 15 2 0
23 Ratnagiri 28 27 1 0
24 Sangli 13 13 0 0
25 Satara 28 28 0 0
26 Sindhudurg 48 48 0 0
27 Solapur 26 26 0 0
28 Thane 69 60 7 2
29 Wardha 27 27 0 0
30 Yeotmal 59 43 16 0
  Total 1329 1207 108 14
Expected Community Participation
Community Participation is expected in the various Exhibitions held by the Laboratory in relation with Food and Water Quality Programs like Jalswaraj, Blockwise development of Drinking Water Sources, Swajaldhara, Shivkalin Panni Sathvan Yogana of State Govt.

Community Participation is also expected in the implementation and monitoring (Build, Operate and Own) of various water supply schemes at village level.

Role of NGOs
NGO can participate in the various schemes of the government implemented for common people at rural and urban level, for creating awareness in the community regarding the benefits of the scheme. Information, Education and Communication (IEC) activities also may be effectively carried out by NGO.

NGO can also keep watch or be active like a watchdog over the implementation of the schemes. They can study results and cost–benefit ratio analysis of the schemes/programs.

Health Education Messages
Important Health Education Messages
Consumption of clean and safe water and unadulterated food should be actively adopted and strictly followed by the community.

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