Department of Health & Family Welfare
- Under the VII Schedule of the Constitution, Health is a state subject.
- Centre has concurrent jurisdiction only in a few areas.
DIRECTORATES / ORGANIZATIONS
National Health Mission (NHM)
Vision of NHM: "Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health".
Organizational Structure
District Level Vigilance & Monitoring Committee (DLVMC) in every district – Chaired by Hon’ble MP
Components under NHM
- RCH/ RMNCH+A
- Mission Flexible Pool
- Routine Immunization and Pulse Polio Immunization
- National Iodine Deficiency Disorders Control Programme (NIDDCP)
- National Urban Health Mission-Flexible Pool
- Communicable Disease Control Flexible Pool
- National Vector Borne Diseases Control Programme (NVBDCP)
- Revised National Tuberculosis Control
- Programme (RNTCP)
- National Leprosy Eradication Programme (NLEP)
- Integrated Disease Surveillance Programme (IDSP)
- Non Communicable Disease Flexible Poo
- National Programme For prevention and Control of Cancer, Diabetes, Cardiovascular diseases and stroke (NPCDCS)
- National Programme For Control of Blindness
- National Mental Health Programme
- National Programme for the Healthcare of the Elderly
- National Tobacco Control Programme
Physical Infrastructure
| Type | Required | Existing | Under Construction | Gap |
|---|
| DH | 27 | 25 | 2 | - |
| SDCH | 54 | 14 | 0 | 40 |
| CHC | 278 | 151 | 76 | 51 |
| PHC | 1112 | 1014 | 81 | 110 |
| SC | 6817 | 4621 | 626 | 1636 |
Referral Transport Services
| Type | Present Status |
|---|
| Mrityunjoy 108 | 380 |
| National Ambulance Service 102 | 316 |
| Boat Ambulance | 5 |
| Adarani – Drop Back Service | 235 |
Human Resource
| Post | Required as per IPHS | Sanctioned Post | In Position |
|---|
| Regular | NHM | Total |
|---|
Allopathic Doctor including Specialist | 4093 | 3470 | 2603 | 1019 | 3622 |
MO (AYUSH) | 1203 | 470 | 470 | 712 | 1182 |
Dental Surgeon | 189 | 118 | 118 | 209 | 327 |
ANM | 10256 | 5962 | 5762 | 5334 | 11096 |
Staff Nurse | 7036 | 1540 | 1540 | 2776 | 4316 |
Laboratory Technician | 1593 | 860 | 860 | 691 | 1551 |
Pharmacist | 1365 | 1293 | 1223 | 668 | 1891 |
Specialized Services
| Type | Present Status |
|---|
| Special care Newborn Unit (SCNU) | 22 |
| Newborn Stabilization Unit (NBSU) | 188 |
| Newborn Care Corner (NBCC) | 785 |
| Nutrition Rehabilitation Centre (NRC) | 18 |
Nutrition Counselling cum
Management Centre (NCMC) | 34 |
| First Referral Unit | 65 (23 DH + 42 SDCH/ CHC) |
Assam Vision Document 2016-2025
Setting up at least one multi-speciality hospital with round-the clock service in every subdivision.
Present Status
- There are 14 Sub Divisional Civil Hospital in the State.
- Total 116 numbers of Model Hospitals taken up out of which 42 are made operational.
Action Plan
- Strengthening of the existing Sub Divisional Hospitals by providing required Specialist Doctors/ Nurses upgradation of these facilities to provide specialized services by upgrading the physical infrastructure, providing required equipments, logistics, diagnostics services, increasing beds etc. Approximately, Rs. 280 Crores will be required considering Rs. 20 Crores for one SDCH.
- Construction of new Hospitals for the remaining 9 Sub Divisions with specialist services required manpower. Rs. 270 Crores will be required considering Rs. 30 Crores each for 9 SDCHs.
- Annual HR cost will be approximately 23 Crores.
Constructing one high-tech 500-bed hospital in every district.
Present Status
- At present there are 25 District Hospitals in the State.
- Construction of District Hospital at Naharkatia for Dibrugarh District and at Garmur for Jorhat District going on.
- Construction of 14 numbers of 100 bedded Mother & Child Health (MCH) Wings @Rs. 22.50 Crores has been taken up under NHM.
Action Plan
- Up gradation of existing 16 District Hospitals (200/300 bedded) where there is no Medical College can be upgraded to 500 bedded high-tech hospital. Approximately Rs. 1200 Crores required for upgradation of 16 Hospitals @Rs. 75 Crores each. Annual HR Cost will be approximately Rs. 16 Crores.
- Construction of new District Hospital for newly created Districts. Approximately Rs.900 Crores required @Rs. 150 Crores for 6 new Districts. Annual HR Cost will be approximately Rs. 6 Crores.
Making well-equipped round-the-clock ambulance service available in every nook and corner of the state
Present Status
- At present there are 380 numbers of ambulances running under Mritynjoy 108 Emergency Response Service. 1 Ambulance per 85,000 population.
- There are 5 numbers of Boat Ambulance under 108 functioning at Majuli, Na-sadiya, Dhubri, Dibrugarh and North Guwahati.
- Total 316 numbers of ambulances are functioning under 102 – National Ambulance Service.
- Total 235 numbers of vehicles under Adarani – Drop Back system (Under JSSK).
Action Plan
- Strengthen the Existing ambulances service:
- Additional 50 ALS (Advance Life Support) ambulances will be added in existing system and 20 nos of BLS (Basic life support) ambulance added as a backup ambulances to provide equipped ambulance services in 24x7 basis.
- 10 nos of additional Boat ambulance required for char and Island areas.
- Capital expenditure required for 50 nos ALS ambulances Rs 1000 Lakhs.
- Capital expenditure required for 20 nos BLS ambulances Rs 280 Lakhs.
- Capital expenditure required for 10 nos Boat ambulances appx Rs 150 lakhs.
- For inter transport referral transport 140 ambulances to be provided immediately.
Distributing sanitary napkins and iron pills free of cost to every household in Assam
Present Status
- Adolescent girls are provided sanitary napkins at subsidized rate under Menstrual Hygiene for Adolescent girls programme of GoI in all Districts of Assam.
- Education Department (Secondary) has implemented Free of Cost sanitary napkins for school going girls of class IX to XII.
- Iron tables/ syrup are providing free of cost under Weekly Iron Folic Acid Supplement (WIFS) and National Iron Plus Initiative (NIPI) programmes to all children/ adolescent up to 18 years and all pregnant women and lactating mothers.
Action Plan
- Strengthen the Existing ambulances service:
- By ensuring free distribution of sanitary napkins and iron pills free of cost to every household through ASHA.
- This may be considered at reduced cost all women.
Strengthening remote diagnostic services through telemedicine
Present Status
- Strengthening remote diagnostic services through telemedicine.
Action Plan
- Strengthen the Existing ambulances service:
- Comprehensive telemedicine services using State of the Art Technology.
- Tender is being floated for free diagnostics services by outsourcing model.
Carrying out awareness campaigns about various diseases like malaria, dengue, swine flu, etc
Present Status
- Audio Visual / print advertisement.
- School level awareness meetings.
- Sub Centre level awareness meetings.
- Group discussion.
- Distribution of leaflets.
Action Plan
- Strengthen the Existing ambulances service:
- Targeted and differential IEC/ BCC plan for each of the diseases depending upon social structure.
- Involvement of Panchayat Raj Institutions.
- Campaigning through schools.
- Involvement of linked departments and community groups.
- Print & Electronic advertisements
- Audio Visual advertisements.
- Print advertisements.
Commissionerate of Health and Family Welfare
A new office created in February, 2016 to oversee the functioning of four Directorates-
- Directorate of Health Services (DHS)
- Directorate of Health Services Family Welfare (DHS FW)
- Directorate of AYUSH
- Office of the Project Director, Assam AIDS Control Society
Main Roles and Responsibilities
- Link between the Government and the Directorates and the Directorates and the National Health Mission (NHM)
- Control, Supervision, Monitoring and Coordination of the Directorates and all field offices under these Directorates
- All Establishment matters of the Gazette officials including doctors up to the rank of SDM&HO under Health –A Department and of the staff of the Directorates.
Establish new medical facilities and up-gradation of the medical facilities to have at least five beds and at least five doctors per thousand population
- At present state has 16580 beds in Health Institutions & 7781 doctors @ 1 doctor per 4010 persons and 1 bed per 1905 persons.
- To achieve the objective over 10 years there is need to add additional 1,80,000 beds and 1,80,000 doctors (assessed based on 2011 census population with 18% increase per decade) @ 18000 beds and 18000 doctors per year along with additional Hospital building space, equipment and new Medical colleges and para medical collages
- Identify the extent of new resources needed along with mapping of existing resource for optimum utilisation
- Need for dedicated public spending coupled with Public Private partnerships (PPP) in Health Care delivery
- Incentives to encourage private sector participation in Medical Education and in Health Care delivery
- Sound Regulatory framework
Setting up institutes in every district to train nurses, technicians and para medical staff
- At present there are10910 ANMs and 6193 GNMs
- ANM Training Schools -Government -18 and Private – 20 and GNM Training Schools- Government -22 and Private –28
- 3 Government BSc Nursing Colleges and 6 Private BSc Nursing Colleges
- There are 1205 seats for ANM Training (Government - 690 and in Private -515) And 2412 seats for GNM Training (Government -912 and in Private- 1500)
- BSc Nursing Colleges have180 seats and in Private there are 250 seats
- There is need for about 35,000-40,000 additional GNMs over 10 years (5 beds per 1000 population).
- Need for dedicated public spending coupled with Public Private partnerships (PPP)
- Incentives to encourage private sector participation in Para Medical Education - need for a Sound Policy and Regulatory framework
Up-gradation of Dr. B B Barauh Cancer Institute into a state-of-art cancer care Institute
- Regional Cancer Care Centre for 8 NE states with a 209 bedded hospital.
- Funded by Department of Atomic Energy (DAE) GoI , North-eastern Council (NEC) and Government of Assam
- About 10000 new cancer cases are detected per annum and 50000 patients are treated every year
- DAE decided to takeover it as a grants-in-Aid institute of DAE and the process is at an advanced stage
- Once taken over, it will be developed as a Centre of Excellence for Cancer Treatment, Education and Research for the entire Northeast
Systematic child immunisation programme
- Universal Immunisation Programme -Government of India Initiative
- Protection to children against vaccine preventable diseases can be fully achieved under child immunisation programmes
- Improve Children health and wellbeing and prevent avoidable deaths (IMR -53/1000 LB, Under 5 Mortality Rate -73/1000 LB NMR-27/1000)
- Full immunisation coverage -64.4% (AHS 2012-13)
- Fully immunised infants in FY 2015-16 – 88.18%, FY 2014-15 - 86.15%
- Strengthening the infrastructure and manpower at field level
- Strengthening the Routine Immunisation for 8 diseases - (Mission Indradanush in left out areas to increase immunisation cover)
- Mission mode campaigns with robust implementation strategy to reach the unreached –chars, tea gardens and missed children, addressing information gaps and apprehensions
Health Insurance to all economically backward people & Universal insurance scheme for all the citizens of Assam for life threatening diseases upto Rs 2 lakhs as insurance cover
- Existing schemes - Rastriya Swasthya Bima Yojana (RSBP) of GoI up Rs 30000 per family of 5
- Government of Assam - Asom Arogya Nidhi –reimbursement of Rs 1.5 lakhs per patient on select diseases , Sushrusha/Sneeha Sparsha
- Various models are available – Telangana/Punjab/Gujarat CGHS/AGHS
- In Gujarat there is no Insurance scheme but government provides free treatment up to Rs. 2 lakhs for a family of 5. Telengana –Arogya Shri - not an insurance scheme - for BPL families upto Rs 2 lakhs reimbursed by government
- Implementation model
- Empanelment of Health Care provider
- Smart Card , TPA
- Cash less scheme
- Selection of insurance provider
- Ombudsman
Directorate of Medical Education
Medical College Institutions
| Sl | Establishment | MBBS | MD/ MS | DM/MCH | PG Diploma |
|---|
| 1 | AMCH, Dibrugarh | 170 | 110 | - | 34 |
| 2 | GMCH, Guwahati | 156 | 131 | 18 | 28 |
| 3 | SMCH, Silchar | 100 | 41 | - | 7 |
| 4 | JMCH, Jorhat | 100 | 18 | - | - |
| 5 | FAAMCH, Barpeta | 100 | - | - | - |
| 6 | TMCH, Tezpur | 100 | - | - | - |
| | Total | 726 | 300 | 18 | 69 |
Other Health Education Institutions
| Sl | Establishment | UG | PG |
|---|
| 1 | Regional Dental College (1) | 50 | 10 |
| 2 | Nursing Colleges (3) | 180 | 25 |
| 3 | DMRHC (1) Jorhat | 100 | - |
| 4 | Pharmacy Institute (3) | 200 | - |
| 5 | Paramedical Institute (5) | 332 | - |
| | Total | 862 | 35 |
Total admission per annum 2010
Directorate Of Medical Education
| Sl | Establishment | Human Resources (Number of Posts)
(Teaching faculty) | Bed Strength | Infrastructure Status/Issues |
|---|
| | | Sanctioned | In Position | Vacancy | Addl MCI Requirement | | |
|---|
| 1 | DME Office | 9 | 2 | 7 | - | - | - |
| 2 | AMCH, Dibrugarh | 427 | 345 | 82 | - | 1500 | Super Specialty Wing |
| 3 | GMCH, Guwahati | 506 | 429 | 77 | - | 2200 | Super Specialty Wing Cancer Hospital |
| 4 | SMCH, Silchar | 251 | 206 | 45 | - | 1000 | Trauma Centre |
| 5 | JMCH, Jorhat | 207 | 154 | 53 | 4 | 500 | Phase II Construction |
| 6 | FAAMCH, Barpeta | 192 | 152 | 40 | 3 | 500 | Phase II Construction |
| 7 | TMCH, Tezpur | 202 | 157 | 45 | 3 | 500 | Phase II Construction |
| 8 | RDC, Guwahati | 42 | 17 | 25 | - | 20 | Construction of Wards |
Way Forward:
- Nine More Medical Colleges (from Assam Vision Document 2016-2025)
- Two more BBCI like Cancer Institutes
WAY FORWARD AS PER ASSAM VISION DOCUMENT 2016-2025
- Nine More Medical Colleges
- Two more BBCI like Cancer Institutes
NINE MORE MEDICAL COLLEGES
5 New Colleges already Identified
- Diphu (40% work completed)
- Nagaon (civil work started)
- Dhubri , Lakhimpur and Kokrajhar (being processed for Administrative Approval)
4 New places will be identified soon
Infrastructure, physical and HR will be assessed, and action initiated thereafter in coordination with MCI / Government of India.
TWO NEW MORE CANCER HOSPITAL (BBCI LIKE)
One in GMCH already in final stage of completion
- Civil works completed, major equipment are already in place
- HR recruitment process has been initiated
Location for one more cancer hospital will be shortly identified
Vision: Setting up & upgrading a wide network of Blood Banks Across the State
Present Status
- 66 blood banks in the state.
- 26 run by Government under DME (medical college blood banks) and DHS (civil hospital blood banks).
- 25 Government blood banks are supported by the NACO.
- Besides, 53 Blood Storage Centers, Blood storage facilities exist in 116 Model Hospitals as well.
- Three Medical College Blood Banks at Guwahati, Silchar and Dibrugarh designated as Regional Blood Transfusion Centers, and are functioning as Mother Blood Banks under the Hub & Spoke Model.
- All blood banks linked under the e-blood bank online system.
- Donor information too is collated and shared.
Gaps
- Government and private blood banks often struggle to meet the statutory requirements prescribed in Drugs & Cosmetics Rules on building/ staff/ equipment/ SOPs, thus casting a shadow over quality.
- Availability too is not as per the requirement.
Action Plan to achieve the vision
- Assessing the actual requirement of blood based on the hospital bed strength in the state
- Calculating the space/ HR/ equipment requirement interims of the stipulations under the Drugs & Cosmetics Act for the required blood,
- Creating a voluntary blood donor base as per the requirement,
- Modernization & upgradation through technological interventions
- Training & activity calender.
Banning use of Cigarette & Tobacco products in public places
Statutory Provisions
Section 4 of the Cigarettes & Other Tobacco Products Act, 2003:
- "No person shall smoke in any public place."
Section 21 of COTPA:
- Whosoever contravenes the provisions of section 4 shall be punishable with fine which may extend to two thousand rupees.
Action Initiated
- Hotels having more than thirty rooms, and restaurants having more than thirty seats can provide smoking lounges under the Act. Provision for summary trial exists for offenses under COTPA. Twenty one authorities (depending on the public place involved) are authorised to impose fine under section 4
- Fine Collected under COTPA in Assam till Date – Rs.5,30,200/- (Which has been deposited through treasury Challan in "Major head-0210-Medical & Public Health MH 104-Fees & Fines etc. SH.3879-Fees realized under Tobacco Control Act".)
Food Safety Establishment
- Two wings under the control of Commissioner, Food Safety.
- Food Analyst to Government of Assam heads a laboratory with 134 staff, established in 1949. Also serves as Food Analyst to Arunachal, Meghalaya, Mizoram and Sikkim Governments.
- Designated Officers of Food Safety (5), Sr. Food Inspectors (18) & Food Inspectors (33) in the districts. DOs report to the Joint Directors (H&FW).
Task ahead
- No Service Rules. Service Orders of 1966 & 1986 were issued under the now repealed Food Adulteration Act, 1954. Nomenclature & responsibilities changed under the FSSA, 2006. File under circulation with the draft Service Rules.
- No NABL accreditation for the laboratory. Not in a position to challenge the findings of the NABL accredited private laboratories. Applied for NABL accreditation this year.
- Highly inadequate number of DOs / Sr.FSOs/FSOs. Enhanced strength is being proposed.
- FBOs are switching from the old regulatory regime governed by 9 different Central Acts, to the new licencing / registration regime under the FSSA. The process has been slow. Regulations for several kinds of food and are still under the process of enactment by the Parliament. Legality of the Advisories issued is under challenge.
Immediate Concerns
- Monson and Flood session ahead- preparation for vector borne diseases for example, JE, Malaria, Dengue etc.
- Payment of salaries of NHM employees
- Operations of 108 / 102 Ambulance services – need for immediate payment
- Filling up of the vacancies of Doctors & Paramedics
- Extensions of 3(f) appointees
- Approval of the Rules of Clinical Establishment Act - Cabinet approval
- Operationalization of Commissionerate of Health & Family Welfare.
- Operationalization of Commissionerate of Food Safety and Drug Administration
- Operationalization of Assam Medical Services Corporation
- Blood Bank activity Plan
