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Introduction

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The DANIDA Tamil Nadu Area Health Care Project is a centrally sponsored externally aided project. The phase III currently in progress was implemented since 24.12.1996, covers the districts?of Dharmapuri, Thanjavur, Nagapattinam and ?Thiruvarur for most of the activities, extends some of the activities to the old districts of Salem, Namakkal, Cuddalore & Villupuram and supports some state level activities like training, drug supply logistics etc., at a total outlay of? Rs. 59.10 crores (including direct ?funding of Rs. 6.00 crores). The overall objective of this project is to improve the ?health and family welfare status of the rural population in the ?project area, especially of the weaker sections. With a view to improving and strengthening the facilities for the delivery of health?and family welfare services in an integrated manner?in accordance with the National Health Policy, DANIDA ?is ?one of the bilateral donors in the Health ?Sector in providing financial assistance to the Government of Tamil ?Nadu. ?The funding is on reimbursement basis with 85% share by DANIDA, 5% by Government of India and 10% by Government of Tamil Nadu.

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Based on the recommendation of the Mid Term Review (MTR), the project outlay was revised to Rs 70.76 crores including direct funding Rs 7.89 crore and extended the project period upto 31.12.2002. Further to fully achieve the objectives of the phasing out plan recommended in the MTR, the State Project Coordinating Committee (SPCC) meeting held on 26.08.2002 has agreed to extend the project period by one year upto 31.12.2003 with no extra cost. Accordingly the GOI/RDE has extended the project period till 31.12.2003.?

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Achievements and Progress during Phase III

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Construction activities

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??????? Out of 368 community supported HSCs sanctioned for construction in the new project districts, 352 HSCs have been completed and functioning, 13 are in finishing works and the remaining 3 are above the foundation level.

??????? All the planed 82 HSCs have been renovated and 646 old HSCs have been provided with water supply and electricity facilities in the project districts.

??????? 1000 old HSCs have been provided with gas connection facilities in the project districts.

??????? All the planed 113 PHCs (including the Marandahalli PHC) have been renovated in the new project districts.

??????? Infrastructure facilities have been strengthened in all the 5 ANM training schools in the state.?

??????? Infrastructure facilities of 18 RHTCs have been strengthened and work was dropped for the remaining 2 centers due to damaged condition of the building.

??????? Infrastructure facilities of MPHS(F) training school at Chennai,? IVCZ at Hosur,? HFWTCs at Chennai, Madurai and Gandhigram, IPH at Poonamallee and the HMDIs at Salem and Villupuram were strengthened.

??????? Central Drug Warehouses for TNMSC have been constructed at Dharmapuri and Thiruvarur.

??????? Decentralized preventive maintenance and cleaning up campaign of PHCs and HSCs is underway in the project districts.

??????? Minor repair works to old PHCs including equipment support were provided to about 253 PHCs in the project districts.

??????? Minor repair works to old HSCs including equipment support were provided to about 809 HSCs in the project districts.

??????? The training centre at Marandahalli was renovated.

??????? A compound wall has been constructed for Central Drug Warehouse at Villupuram.

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Improving Awareness (IEC)

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??????? Street corner drama (Kalaipayanam) troupes have performed about 2150 health IEC programmes in Dharmapuri and 930 programmes in Thiruvarur districts.

??????? About 9265 elected local body members including block level trainers were trained in orientation training on health issues in Dharmapuri district.

??????? Conduct of school health competitions in new project districts is underway.

??????? ICE related wall painting, hoarding, stickers etc were disseminated in the old and new project districts.

??????? A radio serial Budding Blossoms on adolescent health was broadcasted in AIR for 78 weeks.

??????? Health messages will be propagated to the community (Social Marketing Modal) in Salem district for which pilot testing has been done in a block and block level training has been completed. Activity will be implemented during the Feburuary03.

??????? Mass Media campaign on health ICE is underway through AIR in the form of jingles and DD in the form serial.

??????? Exhibition panels, portable photographic posters were produced supplied to all DDHSs in the project districts and conduct of school exhibitions are under way.

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Improved Technical Knowledge & Skills of Service Providers (Training)

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??????? A State Training Cell (STC) was created in the O/o the DPH&PM to help implement the entire training programmes in the state.

??????? District Training Teams (DTTs) were created in 10 districts including the 8 project districts to cover the staff of Health Subcentres (HSCs) by periodic in-service training and continuing education

??????? The 6 RTIs in addition to IVCZ at Hosur and LHV School at Chennai were provided with uniform stipend for the trainees.

??????? The 6 RTIs, IVCZ at Hosur, LHV School at Chennai, Marandahalli Training Centre, 5 ANM Schools and 20 RHTCs were provided with equipment and library facilities.?

??????? Printing and supply of Indian Systems of Medicine training manuals is completed and supplied to all end users.?

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Health Services Management

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??????? A PHC services monitoring system using OMR machine, was developed and mainstreamed to DPH&PM, Chennai.

??????? The monitoring system of the DDHSs of the project districts has been strengthened by providing vehicles, additional fuel, computers and necessary office equipments.

??????? Management training has been imparted to 517 MOs of PHCs in the state.

??????? Integrated district health plans were developed for the project districts.

??????? HMIS registers and records for HSCs have been simplified and revised records and registers were printed and supplied to all HSCs in the state.

??????? Simplified HMIS registers and records for PHCs/VBDCs and FRUs/GHs are designed. Printing of the registers and records are underway by TNMSC.

??????? To improve HMIS capability, computers were provided to block PHCs of Salem and Namakkal districts. About 2496 state and district level staff of health and family welfare department have been given basic training and 364 staff have been given in-depth training on computer.?

??????? Vital Events Surveys has been conducted for the reference years 1996,1997,1998 and 1999 and district wise rates arrived and sensitized the health staff with respect ot IMR, MMR, FI etc.

??????? About 3513 female field health functionaries in the project districts have been trained in moped driving. Two set of uniforms were also provided to all the VHNs/ANMs as part of training kit.? About 1106 were given loan for purchase of mopeds. A revolving fund has been created for this purpose.

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Improvement of Medical Supplies

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??????? Equipment like computers and warehouse equipment were supplied to all the 23 CDWs of TNMSC. Procurement of additional equipment to these CDWs is underway by TNMSC for which funds released.

??????? ?All the 4 regional managers of TNMSC were provided with LMV vehicle.?

??????? A drug quantification study was conducted and the findings are incorporated in the drug management training.

??????? About 3,000 staffs in the category of VHNs / SHNs /CHNs have so far been trained in basic treatment procedures? on ASM and ISM drugs against the planned 10,000 staff.

??????? The services of Drug Logistics Expert have been utilized by Tamil Nadu Medical Services Corporation.

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Budget performance 2002-03

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Sl. No	Scheme Code/Name/ Activity ?	B.E 2002-03	R.E 2002-03	Actual Expenditure (upto 31.01.03)
1	Inservice Training and Manpower Development under DANIDA Project (SB)	253.93	149.45	146.70
2	Construction of Community Supported Health Subcentres under DANIDA Project (TF)	75.63	24.86	24.73
3	Project Organisation by State and District level establishment under DANIDA Project (SY)	35.01	28.40	23.18
4	Monitoring and Evaluation under DANIDA Project (SC)	28.73	254.45	352.91*
5	Construction Cell under DANIDA Project (TJ)	20.75	20.75	13.15
6	Communication Component under DANIDA Project (SE)??	1.05	112.51	62.07
7	Improvement of drug supplies under DANIDA Project (TE)	5.75	152.50	152.50
8	Infrastructure Development under DANIDA Project (JD) State share	217.72	150.00	149.25
?	Total	638.57	892.92	924.49

* Includes Rs 100.00 lakhs sanctioned under contingent fund.