MANIPUR

STATE REPORT
 Manipur

Index

S. No. Content Page No.

1 Summary of Approvals 2–5

2 Demographic Profile 6–7

3 Progress of NRHM 8 – 11

4 Reproductive & Child Health 12 - 15

5 Immunization 16 – 16

6 Revised National Tuberculosis Control Programme (RNTCP) 17 – 18

7 National Vector Borne Disease Control Programme (NVBDCP) 19 – 19

8 National Leprosy Eradication Programme (NLEP) 20 – 20

9 Integrated Disease Surveillance Project (IDSP) 21 – 21

10 National Programme for Control of Blindness (NPCB) 22 – 23

11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 24 – 24

12 RoP Approvals under Mission Flexible Pool 25 – 29

1 Manipur
 MANIPUR

Summary of Approvals

Financial Management under NRHM (Rs. in crore)

% Release
% Expenditure
Years Allocation Release Expenditure against
against Release
Allocation
2005-06 33.63 26.97 9.80 80.21 36.35
2006-07 53.75 38.68 18.01 71.96 46.56
2007-08 66.68 47.64 30.86 71.44 64.77
2008-09 62.62 56.30 57.95 89.91 102.93
2009-10 73.97 0.00
Total 290.65 169.59 116.62 58.35 68.77

S. No. Timeline Activities Achievement %

Selection 3225 203
1 ASHA
Training 3225
2 VHSC 3498 146
3 24X7 PHCs 20 28
4 Mobile Medical Unit 9 100
5 Rogi Kalyan Samiti 96 100

Budget Allocations (2005-09) ( Amount in Crores)

Allocation Releases Expenditure
RCH Flexipool
2005-06 13.58 7.43 1.29
2006-07 10.67 4.32 4.69
2007-08 14.24 14.25 2.35
2008-09 18.25 15.66 8.72
2009-10 23.03
Total (A) 79.77 41.66 17.05
NRHM Flexipool
2005-06 7.52 0.00
2006-07 25.15 20.48 0.87
2007-08 28.83 14.92 13.43
2008-09 20.38 19.06 30.39
2009-10 22.85
Total (B) 97.21 61.98 44.69
National Disease Control Programme
2005-06 8.98 6.05 3.13
2006-07 7.99 7.01 5.93
2007-08 10.52 4.93 2.58
2008-09 9.71 5.90 2.87
2009-10 11.66 0.79 0.00
Total (C) 48.86 24.69 14.51
Grand Total (A + B + C)

2 Manipur
 Record of Proceedings (2005-2009) for Mission Flexible Pool

Approval for Infrastructure Facilities (Rs. in Crore)

S. No Health Facilities 2005-06 2006-07 2007-08 2008-09 2009-10

1 Sub C 0.42 6.00 1.14 0.00 0.00
2 PHC 1.13 0.14 0.00 0.12
3 CHC 4.60 2.90 0.00 0.00 0.70
4 DH 2.00 3.35 0.71
5 Eqpmt 0.00 0.00 0.00
6 Transp 0.00 0.00
7 Others 4.28 0.05 10.09 18.84
Total 5.02 14.31 3.34 13.44 20.37

Approval for Human Resource Support (Rs. in Crore)

S. No Personnel 2005-06 2006-07 2007-08 2008-09 2009-10
1 Doctors 0.00 0.00 0.50
2 Specialists 0.00 0.00 0.00
3 Staff Nurses 0.39 0.00 0.00
4 ANM 1.38 0.00 1.60 3.02
5 Others 2.30 4.28 0.00 3.65
Total 0.00 3.68 4.67 1.60 7.17

Approval of other activities (2005-2009) in Rs. Lakh

2005-06 2006-07 2007-08 2008-09 2009-10
S.No Initiative Remarks
Released Approved Approved Approved Approved
ASHAs
1 ASHA 300 127.66 387.8
TOTAL 300 127.66 387.8
Untied Funds, Annual Maintenance Grants and RKS funds related matters
2 Rogi Kalyan Samiti- DH 41 40 40
Rogi Kalyan Samiti-
3 SDH 1
Rogi Kalyan Samiti-
16 17
4 CHC 16
Rogi Kalyan Samiti-
72 72
5 PHC 72
Untied Fund for Health
8
6 Facilities
Untied Fund for
5
7 DH/SDH
Untied Fund for SDH,
8 Moreh 0.5

3 Manipur
 9 Untied Fund for CHC 8 8.5 8
Untied Fund for
18 18 18
10 PHC/APHC 18
11 Untied Fund for SC 42 42 42 39.1 42
12 Untied Fund for VHSC 10.95 190.4 320.3 320.3
Annual Maintainence
Grant for Urban 0.5 1 1
13 Hospital, Moreh
Annual Maintenance
16 16 16 16
14 Grant - CHC
Annual Maintenance
36 36 36 35
15 Grant -PHC
Annual Maintenance
42 39.1 23
16 Grant- SC
TOTAL 42 130.95 486.9 607 592.8
Infrastructure related matters
17 MMU 374.13 5.35 30.94 101.86
Emergency & Referral
54 61.2
18 Services
TOTAL 428.13 5.35 92.14 101.86

Status of Infrastructure 2005-2010

Health Facilities As per RHS 2008 New Construction Upgradation / Renovation

Number of Sub Centre 420 165 0
Number of PHC 72 0 30
Number of CHC 16 0 15
Number of DH 7 0 2
As per State Data
Sheet, NRHM

Status of NRHM as on 15.05.2009

Selection 3225
1 ASHA
Training 3225
2 VHSC 3470
3 Joint A/C @ Sub Centre and VHSC 2711

4 24X7 Facility
36
5 FRU 1
Doctors & Specialist 106
AYUSH Doctors 68
6 Contractual Manpower Staff Nurse 79
Paramedics 490
ANM 427
7 JSY Beneficiaries (in Lakhs) 0.24

4 Manipur
National Disease Control Programme

NLEP
The state has already achieved the goal of elimination of leprosy. The state is advised to carry out
in depth situational analysis in districts/blocks reporting large number of new cases and take
suitable actions.

IDSP
It is a Phase II state. The data reporting should start from all the districts.

NBCP
The performance of Cataract Surgery needs to be further improved in NE States in view of large
cataract backlog.Eye care infrastructure need to be strengthened. Shortage of eye surgeons,
PMOAs etc. All the NE States are required to furnish utilization certificates in respect of funds
released to them under NPCB timely for release of next installment.

NVBDCP
The state is showing consistent decline during the last three years however, the surveillance is
very poor. The state is being covered under Global Fund Supported Intensified Malaria Control
Project. Filaria and Kala-azar, are not reported from the state of Haryana.

RNTCP
Overall performance of the State has a shown improvement in the near past. Sputum conversion
rate remains near satisfactory.

5 Manipur
 Demographic, Socio-economic and Health profile

HEALTH INDICATORS OF MANIPUR

The Total Fertility Rate of the State is NA. The Infant Mortality Rate is 12 and
Maternal Mortality Ratio is NA (SRS 2004 - 06). The Sex Ratio in the State is 978 (as
compared to 933 for the country). Comparative figures of major health and demographic
indicators are as follows:

Table I: Demographic, Socio-economic and Health profile of Manipur State as

compared to India figures

S. No. Item Manipur India

1 Total population (Census 2001) (in million) 2.17 1028.61
2 Decadal Growth (Census 2001) (%) 17.94 21.54
3 Crude Birth Rate (SRS 2007) 14.6 23.1
4 Crude Death Rate (SRS 2007) 4.4 7.4
5 Total Fertility Rate (SRS 2007) NA 2.7
6 Infant Mortality Rate (SRS 2007) 12 55
7 Maternal Mortality Ratio (SRS 2004 - 2006) NA 254
8 Sex Ratio (Census 2001) 978 933
9 Population below Poverty line (%) 28.54 26.10
10 Schedule Caste population (in million) 0.06 166.64
11 Schedule Tribe population (in million) 0.74 84.33
12 Female Literacy Rate (Census 2001) (%) 60.5 53.7

Table II: Health Infrastructure of Manipur

Item Required In Position Shortfall

Sub-centre 412 420 -
Primary Health Centre 64 72 -
Community Health Centre 16 16 0
Multipurpose Worker (Female)/ANM 492 990 -
Health Worker (Male)/MPW(M) 420 420 0
Health Assistants(Female)/LHV 72 55 17
Health Assistants(Male) 72 52 20
Doctor at PHCs 72 115 -
Surgeons 16 0 16
Obstetricians & Gynaecologists 16 0 16
Physicians 16 0 16
Paediatricians 16 0 16
Total specialists at CHCs 64 0 64
Radiographers 16 12 4
Pharmacist 88 96 -
Laboratory Technicians 88 64 24
Nurse Midwife 184 172 12
(Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)

6 Manipur
The other Health Institution in the State are detailed as under:

Health Institution Number

Medical College 1
District Hospitals 7
Referral Hospitals 8
City Family Welfare Centre 4
Rural Dispensaries 42
Ayurvedic Hospitals -
Ayurvedic Dispensaries -
Unani Hospitals -
Unani Dispensaries -
Homeopathic Hospitals 1
Homeopathic Dispensary 9

7 Manipur
 Note on Progress of NRHM in Manipur
(June 2009)

Manipur has implemented the activities of National Rural Health Mission efficiently and
effectively for attaining the goals and objectives of National Population Policy and Millennium
Development Goals. NRHM has transformed public health service delivery in the State. The
decentralization, responsiveness to local needs, paradigm shift in health system management and
availability of untied funds has improved the facilities and their credibility among members of the
public. The performances of JSY, community mobilization by ASHAs, proper referral transport and
number of deliveries have significantly improved and a larger portion of societies are getting benefit
under Mission. Brief information on progress vis-a-vi issues have been highlighted which are as
follows

Institutional Framework of NRHM

Meeting of State & District Health Mission has been held regularly. Meeting of State Health
Mission held 20 times and of State Health Mission held 427 times. Merger of societies is completed in
9 districts. 3498 VHSCs have been constituted & 2760 Joint Accounts have been operationalised.
Rogi Kalyan Samities are operational at 7 DH, 16 CHCs & 72 PHCs. All districts have started
developing their own IDHAP.

Infrastructure Improvements

A total of 12 PHC have been strengthened with three Staff Nurses to make them functional
for 24x7 work. State has 16 CHC are functioning on 24X7 basis & facility survey completed in 13
CHC including other health institutions below district level. Only one District Hospital is functioning
as FRU. All districts have functional Mobile Medical Unit (MMU)

Human Resources

A total of 3225 ASHAs have been selected & 3225 have been trained upto 2nd
Module. And, 3000 ASHAs have been provided with drug kits. 420 Sub-centres are functional with
an ANM and 420 SCs have been strengthened with 2nd ANM. State has appointed 68 Contractual
AYUSH Doctors. As far as manpower increase is concerned, 2 specialists, 104 Doctors, 79 SN, and
427 ANMs recruited on contractual basis to provide quality health services.

Services

Institutional deliveries improved from 0.16 lakhs (2006-07) to 0.20 lakhs (2007-08) and
further 0.20 lakhs Institutional deliveries in the state during the year 2008-09. The number of JSY
beneficiaries increased from 0.08 lakhs (2006-07) to 0.09 lakhs (2007-08). For the year 2008-09 the
numbers of JSY beneficiaries are 0.11 lakh. Female sterilizations have increased from 0.005 lakh
(2006-07) to 0.01 lakh (2007-08) and male sterlisation has decreased from 4000 (2006-07) to 47
(2007-08). During year 2008-09, there are 1265 female & 901 male sterilization have been reported.
All 9 districts are implementing IMNCI & 96 people have been trained so far. 15777 VHND held
since the launch of NRHM.

8 Manipur
General

Overall improvement in health system since NRHM

Achievements Made

• Encouraging trend in the number of meetings of all the management structures.

• VHNDs conducted as effective forums for increasing community ownership and convergence
• Improved human resource in the system rendering services especially at the SCs
• Availability of Programme Management Units
• Increased availability of AYUSH in health facilities
• State and District IDSP Units functional

Areas for Further Improvement

• FRU operationalisation
• All the health facilities must achieve IPHS norms.
• IMNCI roll out needs to be given high priority.

Infrastructure
• Need to rationalise and fast track upgradation of public health Infrastructure being funded
under NRHM
• Need to optimise utilisation of existing infrastructure through HR rationalisation and better
supervision to ensure accountability.

Human Resources
• Finalise Cadre rules & undertake Cadre review (make gradation list), rationalise transfer and
promotion policy.
• The state need to ensure Multiskilling training.
• Shortage of specialists, nurses may be taken care as well as their accommodations as per IPHS
norms.

Service Delivery
• The State need to improve Health MIS.
• There is an increase in institutional deliveries and JSY beneficiaries.

9 Manipur
 An Analysis of Financial Monitoring Report for the FY 2008-09

RCH Flexible Pool

Component wise expenditure & Utilization under RCH against the approved PIP
Manipur Rs. in lakhs
Activities SPIP Expenditure % of Utilization
against PIP
A.1 Maternal Health 180.44 171.88 95.26%
A.2 Child Health 20.63 4.65 22.54%
Family Planning
A.3 Services 23.20 19.68 84.83%
Adolescent Reproductive
and Sexual
A.4 Health/ARSH 14.70 15.13 102.93%
A.5 Urban RCH 75.96 173.46 228.36%
A.6 Tribal RCH 10.20 5.65 55.39%
A.7 Vulnerable Groups 26.70 26.70 100.00%
A.8 Innovations/PPP/ NGO 23.80 43.19 181.47%
Infrastructure & Human
A.9 Resources 917.53 153.24 16.70%
Institutional
A.10 Strengthening 32.48 27.94 86.02%
A.11 Training 80.62 57.77 71.66%
A.12 BCC / IEC 50.69 53.53 105.60%
A.14 Programme Management 114.76 119.36 104.01%
Total 1571.71 872.18 55.49%
Based on table above and records available in FMG, the observations and areas of concern are as
under:-
General Observation:
1. Rs.8.72. crore, i.e.55% of the PIP approved, Rs 15.71 Crore, has been
utilized by the state of Manipur under RCH-II as compared to average
national level expenditure of 71%.
2. There is 18% increase in expenditure as compared to 2007-08.
3. Since the launch of RCH-II programme, Rs.22.04 crore i.e. 53% has been
utilized by the state against the release of Rs.41.66 crore during the period
2005-06 to 2008-09.
4. The 95.26%, expenditure under MH, is a significant achievement.
5. The 84.83%, expenditure under Family Planning Services, is also a good
achievement of the state.

Areas of concern:
1. Expenditure on Child Health component is very low.

2. Expenditure on Urban RCH has crossed the approved PIP limit by over 128%. which
should be looked into.

3. The expenditure on Innovations/PPP/ NGOs has crossed the approved PIP limit by over
81%. Which should be looked into.

4. Expenditure in Infrastructure & Human Resources is less than 20%, performance needs to
be improved.

10 Manipur
A. Mission Flexible Pool

Component wise expenditure & Utilization under NRHM against the approved PIP

Manipur Rs. in lakhs

Activities SPIP Expenditure % of Utilization
against PIP
B1 ASHA 127.66 90.79 71.12%
B2 Untied Funds 385.90 250.46 64.90%
B3 Hospital Strengthening 907.02 631.62 69.64%
B4 Annual Maintenance Grants 92.10 70.46 76.50%
B5 New Constructions/ Renovation and Setting up 182.00 350.77 192.73%
B6 Corpus Grants to HMS/RKS 129.00 67.30 52.17%
B7 District Action Plans (Including Block,
Village) 0.00 23.85 Error
B9 Mainstreaming of AYUSH 0.00 120.06 Error
B10 IEC-BCC NRHM 65.00 60.50 93.08%
B11 Mobile Medical Units (Including recurring
expenditures) 0.00 39.00 Error
B12 Referral Transport 61.20 42.44 69.35%
B14 Additional Contractual Staff (Selection,
Training, Remuneration) 162.12 434.67 268.12%
B16 Training 162.72 2.87 1.76%
B19 Procurements 346.67 718.27 207.19%
B27 NRHM Management Costs/ Contingencies 213.92 136.16 63.65%
Total 2835.31 3039.22 107.19%
Based on table above and records available in FMG, the observations and areas of concern are as
under:-

General Observations:
1. Out of Rs.28.35 crores approved by NPCC and released Rs.19.06 crores, the
state has utilised Rs.30.39 crores i.e. 107% of approved PIP, which is a
good achievement.
2. There is 113% increase in the expenditure as compared to 2007-08.
3. Since the launch of the programme, against Rs.61.98 crores released to the
state, the utilization is Rs.45.63 crores (74%) and Rs. 16.35 Crores (26%)
remains unutilized.
4. State incurred more than 60% expenditure on activities like ASHA , Untied
Fund, Hospital Strengthening , Annual Maintenance Grants, , IEC-BCC NRHM, Referral
Transport , NRHM Management Costs/ Contingencies , which is a good achievement.

Areas of Concern:
1. The expenditure of Rs.4.35 crore incurred by the state under Additional Contractual Staff
(Selection, Training, and Remuneration) under NRHM is two times more than the approved PIP
of Rs.1.62 crore, which shows excess utilization against the approved PIP amount.
2. Procurement expenditure of Rs 7.18 crore incurred by the state against the PIP aproval of Rs.3.46
crore is excess utilization of sanction funds.
3. Mission Flexible Pool part of FMR is not in the prescribed format.
4. No allocation was made under District Action Plans, Mainstreaming of AYUSH and Mobile
Medical Unit activities but the expenditure has been incurred during the year.
5. Expenditure under Training component is less than 10%, performance needs to be improved.

11 Manipur
 BRIEFING NOTE ON RCH II: MANIPUR

A. Background/ current status

1. RCH II Goals

Manipur’s MMR data is not available. Manipur’s IMR (SRS 2007) at 12 has decreased from 16 (SRS
2003), and is the lowest in the country. TFR at 2.8 (NFHS-3, 2005-06) has decreased from 3.0
(NFHS-2, 1998-99) but is still higher than the target of 2.1 for 2012 (refer Annex 1).

2. RCH II Outcomes

DLHS-3 results are not available for the state. Manipur’s progress during the six year period between
NFHS 2 (1998-99) to NFHS-3 (2005-06) is mixed (refer Annex 1):
• Mothers who had at least 3 antenatal care visits increased from 54.7% to 68.6%.
• Institutional deliveries have increased from 34.5% to 45.9%.
• Full immunisation in children 12-23 months increased from 42.3% to 46.8%.
• Initiation of breastfeeding within one hour of birth more than doubled, from 27.0% to 57.4%.
• Children with diarrhoea receiving ORS has decreased from 50.7% to 36.2%.
• Unmet need for family planning has declined from 23.6% to 12.4%. Further, use of modern
contraceptives has decreased from 25.9% to 23.6%.

3. Expenditure

Audited expenditure has increased from Rs. 1.29 crores in 05-06 to Rs. 4.62 crores in 06-07 and Rs.
7.40 crores in 07-08; reported expenditure in 08-09 has increased to Rs. 8.72 crores i.e. 55.5% of
allocation (Rs. 15.71crores).

B. Key achievements

1. Maternal Health, including JSY

• Number of JSY beneficiaries in the state increased from 7,602 in 06-07 to 8,664 in 07-08. A
total of 10,726 beneficiaries have availed of the services in 08-09. State has accredited 12
private institutions under the scheme.
• Five private hospitals/ clinics have been accredited for providing maternal health services.
• Emergency referral service through EMRI has been initiated in Imphal District
• Based on PPP model, two Maternity Waiting Centres are functional
• At present the 96 staff nurses, LHVs and ANMs have been trained in SBA against the state
roadmap of 114.

2. Child Health
• 9 districts are implementing IMNCI and around 96 personnel have been trained so far.
• Pre-service IMNCI is being implemented in RIMS (Regional Institute of Medical Sciences),
which has been identified as the nodal agency for IMNCI training.
• Essential Newborn and Child Care activities are being carried out in non-IMNCI Districts.
• School Health Program consisting of continuous screening by trained primary school
teachers, with weekly visit by ANM and planned MO’s visit in a school per week is being
carried out
• Verbal autopsy for deaths of new born children is undertaken.

3. Other initiatives
• Performance-based honorarium is given to contractual staff

12 Manipur
C. Key issues

1. Maternal Health, including JSY

• Operationalisation of facilities is lagging behind. State has operationalised only one DH as a
FRU against the target of 16 (none of the 16 CHCs planned could be operationalised).
• As per the NRHM monthly report, state has operationalised 20 PHCs as 24x7 (against the
target of 38).
• There is a need to scale up all skill based trainings with linkages to the functionality of FRU.
• 2 MBBS doctors have been trained in LSAS and currently 2 are under training at RIMS,
Imphal, against the target of 16.
• 4 MBBS doctors are have been trained in EmOC against the target of 16

2. Child Health
• Anaemia among children increased by 7.6% points between NFHS-2 & 3 (from 45.2 % to
52.8%)
• ORS coverage in children with diarrhoea dropped sharply by 14.5% points between NFHS-2
& 3 (from 50.7% to 36.2%)

13 Manipur
 ANNEX 1

A. Progress on Key Indicators

1. RCH II Goals

INDICATOR MANIPUR INDIA

Trend (year & source) Current status RCH II/ NRHM
(2012) goal
Maternal Mortality Ratio NA NA 254 <100
(MMR) (SRS 04-06)
Infant Mortality Rate (IMR) 16 (SRS 2003) 12 (SRS 2007) 55 (SRS 2007) <30
Total Fertility Rate (TFR) 3.0 (NFHS2 2.8 (NFHS3 2.7 (SRS 2007) 2.1
1998-99) 2005-06)

2. RCH II Outcomes

MANIPUR INDIA
S.
RCH OUTCOME INDICATOR NFHS–2 NFHS–3 NFHS–2 NFHS–3
No.
(1998-99) (2005–06) (1998-99) (2005–06)
Mothers who received 3 or more antenatal care
1. 54.7 68.6 44.2 52.0
checkups (%)
2. Institutional deliveries (%) 34.5 45.9 33.6 38.7
Children 12-23 months age fully immunised
3. 42.3 46.8 42.0 43.5
(%)
Children under 3 years, breastfed within one
4. 27.0 57.4 16.0 23.6
hour of birth (%)
Children with diarrhoea in the last 2 weeks who
5. 50.7 36.2 26.9 26.0
received ORS (%)
6. Use of any modern contraceptive method (%) 25.9 23.6 42.8 48.5
Total unmet need for family planning - both
7. 23.6 12.4 15.8 12.8
spacing methods and terminal methods (%)

B. Trends in Financial Expenditure

(Rs. crores)
FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09
Release 7.43 4.32 14.24 15.66
Audited Expenditure 1.29 4.62 7.40 8.72*
* - Audited expenditure for 2008-09 is not yet available; reported expenditure is provided.
- Allocation for 2008-09: Rs. 15.71 crores.

C. Progress on Key Strategies

1. Demand side interventions

S. Indicators Achievement (no. of beneficiaries)

No. 2005–06 2006–07 2007–08 2008–09
1 Janani Suraksha Yojana NA 7,602 8,664 10,726
2 Total Sterilisation 1,687 406 220 na
3 IUD Insertions 7,053 4,455 3,584 na
(Source: M&E Division reports, and JSY reports from the states)

14 Manipur
 2. Technical interventions

S. Achievement upto March 2009

Indicators
No. Number %
1. No. of First Referral Units (FRUs) operationalised 6.3 (against the
1
target of 16 FRUs)
2. No. of PHCs operationalised to provide 24-hour 52.6 (against the
20
services target of 38 PHCs)
3. No. of private institutions accredited under JSY 12 NA
4. No. of districts implementing Integrated Management 100 (out of 9
9
of Neonatal & Childhood Illness (IMNCI) districts)
5. No. of people trained in IMNCI 96 NA
6. No. of Village Health & Nutrition Days (VHNDs) held 15,777 NA
(Source: NRHM MIS report, April 2009)

15 Manipur
 Immunization

Manipur

Evaluated Immunization Coverage

Survey NFHS 1 NFHS 2 NFHS 3 CES CES DLHS 2 DLHS3

Indicator (1992-93) (1998-99) (2005-06) (2005) (2006) (2002-04) (2007-08)
FI 29.1 42.3 46.8 NA 64.8 34.4 NA
BCG 63.8 71.0 80.0 80.8 90.3 85.3 NA
Measles 37.0 45.8 52.8 63.4 73.7 53.3 NA
DPT 3 43.3 59.1 61.2 94.5 70.8 46.0 NA

Progress

The State is showing an improving trend in immunization coverage.

The State has completed the Health Workers training.

Issues

The State needs to address the issue of the dropout from BCG- DPT3. and Measles
The AEFI Surveillance needs to be strengthened as only Five out of nine districts have an AEFI
committee set up and no Cases have been reported in 2008, even though there has been increase
in immunization coverage.
The fund utilization under Immunization is poor for 2008-09.
Revision of Microplans to strengthen outreach services especially in the districts with low BCG
coverage reflecting poor accessibility.

16 Manipur
 Brief on Revised National TB Control Programme (RNTCP) in Manipur

1. Infrastructure
Total Districts - 9, TUs – 14, DMCs - 45
Total Population - 26.00 lakh

2. Status of Implementation

• The whole of Manipur is implementing RNTCP since January 2002.

3. State level performance (Based on the quarterly reports for 1st quarter 2009)
• Overall performance of the State is not satisfactory and needs improvement.

Annualized New Smear-Positive Case Detection Rate

and Treatment Success Rate in DOTS Areas, Manipur, 2000-2009*

140%
130%
120%
110%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Qtr1-00
Qtr2-00
Qtr3-00
Qtr4-00
Qtr1-01
Qtr2-01
Qtr3-01
Qtr4-01
Qtr1-02
Qtr2-02
Qtr3-02
Qtr4-02
Qtr1-03
Qtr2-03
Qtr3-03
Qtr4-03
Qtr1-04
Qtr2-04
Qtr3-04
Qtr4-04
Qtr1-05
Qtr2-05
Qtr3-05
Qtr4-05
Qtr1-06
Qtr2-06
Qtr3-06
Qtr4-06
Qtr1-07
Qtr2-07
Qtr3-07
Qtr4-07
Qtr1-08
Qtr2-08
Qtr3-08
Qtr4-08
Qtr1-09
Annualised New S+ve CDR Success rate
•Population projected from 2001 census
•Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)

4. District wise Performance: (Based on the quarterly reports for 1st Quarter 2009)

Suspects Annualised total Annualised new Sputum

examined per case detection sputum positive Cure rate
conversion
District lakh new cases
rate (against case detection rate rate new cases
population (against >53/ lakh (>85.0%)
>144/lakh (>90.0%)
Bishnupur 73 84 30 40% 89% 71%
Chandel 182 155 15 20% 100% 94%
Churachandpur 214 291 31 42% 76% 90%
Imphal East 100 145 37 49% 91% 82%
Imphal West 157 131 29 39% 89% 87%
Senapati 73 63 27 37% 90% 91%

17 Manipur
 Tamenglong 78 74 32 43% 92% 100%
Thoubal 73 106 39 52% 70% 89%
Ukhrul 125 92 28 37% 60% 80%

5. Fund Status as on 31st March 2009 (Rs. in Lakh)

C/F Release Other Income Expenditure Balance

20.06 185.00 1.29 202.39 3.96

6. Drugs- Drugs have been supplied on the basis of requirement projected in the quarterly report.

7. Issues:

• Performance
– Overall performance of the State has a shown improvement in the near past.
– Sputum conversion rate remains near satisfactory

• Manpower
– Post of 1STS is also vacant. Posts of 8 out of 45 LTs are vacant which may be one of
the reasons for low new sputum positive case detection rate in the State. Only 61% of
MOs are trained in RNTCP. More MOs must be trained so that at least 80% are
trained in RNTCP.

• Other Sectors – 99 NGOs are participating in RNTCP but only 8 PPs in the State are
participating in the programme. More PPs/nursing homes need to be motivated to
participate in the programme.

• Supervision and Monitoring – Supervision by state level is suboptimal. Supervision and

monitoring need to be strengthened at all levels (state/district/sub-district).

• STDC/IRL – Staff of Intermediate Reference Laboratory (IRL) have been recruited. One
Director and one Microbiologist (contractual) and one LT (contractual) are in place.
Action is hand to recruit one more LT. Renovation/civil work of IRL building completed.

• Referral & Feedback Mechanism – 95 patients were referred outside the districts for
treatment in 1st quarter 07 but feedback of only 40 patients received. Referral mechanism
needs to be streamlined. Referred out cases, not acknowledged by the receiving districts
should be discussed during quarterly review meetings.

18 Manipur
 Fact Sheet on NVBDCP-Manipur

• The State has 9 districts with a population 2.17 million. There are 16 CHCs, 72 PHCs, 420 Sub-
centres and 2391 villages. There are 487 Multipurpose Workers (Female)/ANM, 420 Health
Worker (Male), 55 Health Assistants (Female)/LHV, 52 Health Assistant (Male) and 41
Laboratory Technician. In addition, the state has 837 functioning Fever Treatment Depots
(FTDs).
Malaria
Epidemiological Situation
Year Total Slide Total Malaria Total Pf Cases Deaths
examined Cases
2006 94608 2709 1301 8
2007 120895 1194 400 4
2008 134755 708 356 2
2009 (Upto Mar.) 19953 89 44 0
• The incidence of total malaria, Pf cases and deaths due to malaria in the state is showing
consistent decline during the last three years however, the surveillance is very poor.
• The state is being covered under Global Fund Supported Intensified Malaria Control Project.
• State is being provided RD Kits for early diagnosis of Pf cases and ACT for effective
treatment of P.falciparum cases.

JAPANESE ENCEPHALITIS

Year Cases Deaths

2006 0 0
2007 65 0
2008 4 0
2009 (Up to March.) 4 0

Dengue : In the year 2007, 51 dengue cases and 1 death was reported. In the year 2008 and 2009 till
27th May no case has been reported.

Other vector Borne diseases namely filaria, Kala-azar & Chikungunya are not endemic in the state.

Cental assistance
(Rs. In lakhs)
Year Allocation Release/Expenditure
Cash Kind Total Cash Kind Total
2004-05 56.78 133.28 190.06 0.00 73.39 73.39
2005-06 64.99 111.78 176.77 164.61 105.05 269.66
2006-07 242.47 246.14 488.61 189.19 177.96 367.15
2007-08 263.37 424.92 688.29 133.18 235.95 369.13
2008-09 326.11 268.94 595.05 238.05 85.80 323.85
2009-10(B.E.) 272.12 365.38 637.50

Issues:
Malaria:
• Over all surveillance is very poor and state should gear up by recruiting adequate numbers of
surveillance workers/Male multipurpose workers.
• State has yet to train around 25% ASHAs out of total deployed.
• The quality spray has to be ensured through intensive supervised spray activities.

19 Manipur
 STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN MANIPUR

• Epidemiological scenario-
Manipur is low endemic for leprosy and has already achieved the goal of elimination of
leprosy (i.e. prevalence rate of less than 1 case /10000 population). There were 28 leprosy
cases on record as on March 2009.

• New case detection and treatment completion-

During 2008-09, a total of 38 new leprosy cases were detected as compared to 54 new cases
detected during the corresponding period of previous year. All the 53 (100%) cases
discharged during the year were released as cured after completing treatment.

• During 2008-09, NLEP action plan amounting to Rs.51.30 lakh has been approved for the
State.

Issues -

1. The state is advised to carry out in-depth situational analysis in districts/blocks reporting
more number of new cases and take suitable actions like –

(i) Ensuring completion of treatment in each of the new cases detected.

(ii) Enhance awareness of the community to improve self reporting of suspected
cases to health facility and
(iii) Carrying out family contact survey against all multibacillary and child cases.

2. There are few leprosy colonies in the state. The state should ensure provision of proper health
care facilities like ulcer care, provision of supportive drugs and dressing materials to the
persons affected with leprosy residing in these colonies.

20 Manipur
 State: Manipur
Integrated Disease Surveillance Project (IDSP) –Fact sheet as on 17 June 2009

The state of Manipur has an area of 22327 sq. km. and a population of 2.17 million. There are 9
districts, 36 blocks and 2391 villages. The State has population density of 97 per sq. km. (as against
the national average of 312). The decadal growth rate of the state is 17.94% (against 21.54% for the
country) and the population of the state continues to grow at a much faster rate than the national rate.
(source:www.mohfw.nic.in/nrhm.htm.)

Manipur is a phase-II state under IDSP and has been inducted in the program during April 2005. Dr
Bhubanchandra Singh, from Directorate Health Services, Govt of Manipur has been designated as the
State Surveillance Officer (IDSP).

The component wise action points are as under

1. Manpower
Surveillance Officer and RRT team at state and district Headquarter designated.
Consultant finance, Consultant Training, Administrative assistant and Accountant appointment
pending at State Surveillance Unit.
The offer letter to the recommended candidates for the positions of state/district epidemiologists were
issued by state/district NRHM society and 3 epidemiologists and 1 microbiologist have joined
already.
2. IT & EDUSAT
EDUSAT (Total=11)
SIT equipments installed at State Headquarter, 9 DSUs and Regional Institute of Medical Sciences,
Imphal
3. Laboratory Strengthening
One priority district laboratory identified by the state was surveyed and state was given sanction in
February 2009 to procure required equipments for that laboratories. This procurement is under
progress.
4. Data Reporting
Manipur has 9 districts. Four out of nine DSUs are reporting weekly data and outbreak report but data
need to be entered in IDSP portal i.e. www.idsp.nic.in .
5. Outbreaks
Year Number Type
2008 1 Fever of Unknown Origin
2009 (upto May) 0
6. Training
Training of Medical officers completed. State is yet to train 489 Health Workers, 18 DLTs and 16
PLTs in state.
State is yet to identify and suggest names of core trainers for undertaking trainings at all levels under
IDSP
7. Finance
Year Release(in lakhs) Expenditure(in lakhs)
2005-06 94.20
2006-07 1.25
2007-08
2008-09 1.85
Total 94.20 3.10
Balance amount 91.10 lakhs
FMR received upto March 2009.
Audited Accounts and Utilization Certificate for the year 2007-08 received

21 Manipur
 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

STATUS OF IMPLEMENTATION of NPCB IN NORTH-EASTERN STATES

Performance of Cataract Surgery during X Plan

State 2005-06 2006-07 2007-08 2008-09

Tar. Ach. Tar. Ach. Tar. Ach. Tar. Ach
Arunachal Pradesh 1000 993 1000 776 1000 1043 2000 1172
Assam 45000 47100 45000 23500 45000 48346 50000 47749

Manipur 1000 1014 2000 604 1000 1156 2000 1744

Meghalaya 2000 1372 2000 827 2000 1023 2000 2308
Mizoram 1000 1211 800 859 1000 2715 3000 2397
Nagaland 500 741 500 450 500 583 1500 1048
Sikkim 500 351 1000 241 500 571 800 690
Tripura 8000 4359 8000 5186 8000 6708 7000 8429
Total 59000 57141 60300 32443 59000 62145
65537
68300

Grant-in-aid released & Expenditure Incurred by District/State Blindness Control Societies in NE

States (X Plan) (Rs. In lakhs)

States 2006-07 2007-08 2008-09

Released Exp Released Exp Released Exp

Arunachal 77.00 12.65 56.75 45.30 162.60 115.41

Pradesh

Assam 150.00 0.00 322.15 155.73 671.66

Manipur 42.41 21.01 124.50 43.36 106.47

Meghalaya 120.00 95.05 183.50 100.4 158.60 99.10

Mizoram 74.00 66.76 78.22 77.21 177.35 144.78

Nagaland 24.00 24.00 178.49 59.78 144.60

22 Manipur
 Sikkim 0 0 67.00 26.47 133.35

Tripura 175.50 28.86 184.63 20.90 24.35

Total 662.91 248.33 1195.24 529.12 1578.98

Major Issues:-

1. The performance of Cataract Surgery needs to be further improved in NE States in view of

large cataract backlog.
2. Eye care infrastructure need to be strengthened.
3. Shortage of eye surgeons, PMOAs etc.
4. All the NE States are required to furnish utilization certificates in respect of funds released to
them under NPCB timely for release of next installment.

23 Manipur
 NIDDCP

Manipur

Rs.in lakh
Activity Amount Amount Remarks
proposed Approved

Establishment of IDD 0.00 7.00 There is no provision for

control cell strengthening states IDD
Establishment of IDD 0.00 4.00 Cell capacity building/Trg.
Laboratory/monitoring etc.
Monitoring Lab
under NIDDCP the state
Health Education and 17.00 24.50
Govt. may carryout
Publicity activities as per the fund
IDD Surveys 4.50 0.50 allocation of Govt. of India.
Strengthening State 14.90
IDD Cell capacity
building/Trg. laboratory
monitoring etc.
Total 36.40 36.00

24 Manipur
 Mapping of Record of Proceedings of the NPCC of NRHM for
2005-06 to 2009-10
The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in
following broad thematic chapters

1. ASHA (including selection, training, drug kits, mentoring, specific performance

incentives and anything else associated with ASHA)
2. Infrastructure related matters (including construction, strengthening, renovation, new
construction etc), equipments, transport (ambulances, EMRI, associated expenses) and
others)
3. Human Resource related matters (including HR salary, contractual payments,
incentives, etc)
4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC,
IDHAP, M&E, Mobility support to SHS etc)
5. Untied funds, AMG & RKS related mattes
6. Training & Capacity Building related matters (including trainings, workshops, training
institutions including their upgradation or new construction, courses, etc)
7. Innovations (including Procurement of medicines, School Health, Health Mela,
Insurance, Accreditations, Monthly VHND etc)

NATIONAL RURAL HEALTH MISSION

Manipur
Total MFP
2325.32 1357.65 2835.31 5113.14
Approvals
RoP Approvals for Various Years in Rs. Lakh
2005-06 2006-07 2007-08 2008-09 2009-10
S.No Initiative Remarks
Released Approved Approved Approved Approved
ASHAs
1 ASHA 300 127.66 387.8 1
TOTAL 300 127.66 387.8
Infrastructure related matters
Civil works for
operationalisation
of FRU- new
2 Construction 660.3
Construction of
building-less
3 PHCs 1017.55
Construction of
4 SC 572
Upgradation of
200
5 DH to IPHS
Upgradation to
460
6 CHCs to IPHS

25 Manipur
 Upgradation of
PHCs to IPHS- 14.4
7 PHNs/Nurses
Upgradation of
SC to IPHS
(Recurring Salary 114
(honorarium) of
8 230 ANMs)
Improving
physical
289.528
infrastructure of
9 CHC
Improving
physical
113.40
infrastructure of
10 PHC
Improving
physical
600
infrastructure of
11 SCs
Strengthening 70.99
of District
Hospitals to
12 IPHS norm 335.02
13 MMU 374.13 5.35 30.94 101.86
Emergency &
54 61.2
14 Referral Services

TOTAL 460
1431.058 333.75 999.16 1850.7
Human Resources related matters
Salary of MO
133.56
15 AYUSH
Provision of
additional staff at 215.16
16 CHCs 176.34
Provision of
additional GNM 14.4
17 at PHC 63.84
Additional ANM
138
18 for SCs 302.4
19 Lab Tech-PHC 14.4
Staff Nurses-
38.88
20 CHC
21 PHN-CHC 11.76
22 Lab Tech-CHC 21
23 Pharmacist-CHC 6.48
Radiographer-
3.6
24 CHC
25 Specialists-CHC 144
26 BPM 43.2
27 BFM-Accountant 32.4

26 Manipur
 Provision of
PHC cum
28 Accounts Officer 64.8
29 BDM 32.4
Incentive for staff
30 nurses 160
Incentives to 63.84
31 GNM
Incentives to 14.4
32 Lab-Tech
33 Drivers 45.36
TOTAL 367.56 467.28 160 745.38
Programme Management related matters
Preparation Of
90
34 DHAP
Programme
35 Management 213.92 236.6
Block Level
59.4 151.2
36 Resource Group
Office
equipments, 108
37 accessories
State NRHM 6
38 website 5
Decentralized
39 Planning 45
Monitoring & 62.98
Evaluation /
HMIS
40
TOTAL 90 59.4 259.2 218.92 350.58
Untied Funds, Annual Maintenance Grants and RKS funds related matters
Rogi Kalyan
41 40
41 Samiti- DH 40
Rogi Kalyan
42 Samiti-SDH 1
Rogi Kalyan
16 17
43 Samiti- CHC 16
Rogi Kalyan
72 72
44 Samiti-PHC 72
Untied Fund for
8
45 Health Facilities
Untied Fund for
5
46 DH/SDH
Untied Fund for
47 SDH, Moreh 0.5
Untied Fund for
8 8.5
48 CHC 8
Untied Fund for
18 18 18
49 PHC/APHC 18

27 Manipur
 Untied Fund for
42 42 42 39.1
50 SC 42
Untied Fund for
10.95 190.4
51 VHSC 320.3 320.3
Annual
Maintainence
0.5 1 1
Grant for Urban
52 Hospital, Moreh
Annual
Maintenance 16 16 16 16
53 Grant - CHC
Annual
Maintenance 36 36 36 35
54 Grant -PHC
Annual
Maintenance 42 39.1 23
55 Grant- SC
TOTAL 42 130.95 486.9 607 592.8
Training & Capacity Building related matters
Training of 14.28
AYUSH Doctors
& Re-orientation
of PRI
56 members
Establishment of
03 GNM
57 training Schools 162.72 206.22
TOTAL 220.5
162.72
Innovations related matters
58 Health Melas 36 45 45
Procurement and
distribution of
quality
258.82 155.73
equipments and
drugs in the
59 health system 200
Provision of
40 160
60 Drugs
61 Equipments-SC 4.2
Out sourcing of 4
vehicles for State
7.2
Mission
62 Secretariat
AYUSH-
Honorarium to
63 staff 162.12
Sterile Surgical 6
64 Glove
Portable 43.84
Emergency
65 Resuscitati on

28 Manipur
 Kit-16
Addl. PHC
66 equipments 107.06
Maintenance of
Mobile Medical
67 Units
68 POL & Maint 11.5
Drugs/Repair 45
69 of gadget
Mainstreaming
70 of AYUSH 187.32
Procurement
of mosquito bed
71 nets 170.26
School 30
Health
Programme
72 for drugs
Urban RCH 8
Services
for drugs (5.3.
Drugs &
73 medicines)
Tribal RCH 5
Services
drugs (6.1.4.
Drugs &
74 Medicines)
Procurement 5
of equipment:
75 MH
Drugs & 44.5
76 supplies
General drugs 222
& supplies for
77 health facilities
Elbow length 15
hand-glove 18"
(for
gynaecological
78 procedures
Drug supply for
105
79 CHC/FRU
Supplementary
equipments &
furniture for
CHCs, PHCs, &
80 SCs 171.9
81 Other activities 392.76
TOTAL 105 298.82 440.16 522.85 1317.38

29 Manipur