Government of Jharkhand

BACKGROUND AND SITUATIONAL ANALYSIS

Background History
State of Jharkhand was formed Some facts of Jharkhand* on 15th November 2000. Some 15 November 2000 of the important movements in Established Capital Ranchi pre-independence era were Jamshedpur Bhumij rebellion, Santhal Largest city rebellion, Ho insurrection, Birsa Government Syed Ahmed Ulgulan movement, Tana Governor Arjun Munda (BJP) Bhagat movement, etc. At the Chief Minister Legislature Unicameral (81 seats) time of independence, a 14 demand was made for a Parliamentary constituency C.P.Singh separate state of Jharkhand for Speaker Area the benefit of the tribes, but Total 79,714 km2 (30,777.7 sq mi) was rejected. Time and again Area rank 15th these demands were put up Population (2011) over more than five decades of Total 32,966,238 independence by Jharkhand Rank 13th leaders. All these efforts Density 413.6/km2 (1,071.1/sq mi) impelled the government to Literacy 67.63% establish the Jharkhand Area Autonomous Council in 1995 and finally a full-fledged State in 2000. The state was formed with 5 Commissionaires consisting of 24 districts. Commissioner South Chotanagpur North Chotanagpur Districts Ranchi, Ramgarh, Khunti, Lohardaga, Gumla, Simdega Hazaribagh, Giridih, Chatra, Kodarma, Bokaro, Dhanbad

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Government of Jharkhand

Santhal Parganas Kolhan Palamau

Dumka, Godda, Pakur, Deoghar, Jamtara, Sahebganj East Singhbhum, West Singhbhum, Saraikela-Kharsawan Palamau, Latehar, Garhwa

Largest cities in Jharkhand (2011 Census of India estimate)*

Rank City 01 Jamshedpur 02 03 04 05 Dhanbad Ranchi Bokaro Steel City Phusro District East Singbhum Dhanbad Ranchi Bokaro Bokaro Population Rank City 1,337,131 06 Deoghar 1,195,298 1,126,741 563,417 186,139 07 08 09 10 District Deoghar Population 203,116 153,599 132,441 118,822 143,529

Hazaribagh Hazaribagh Ramgarh Ramgarh Chirkunda Dhanbad Giridih Giridih

Geography and climate

Jharkhand lies on 21 degree 59 minute to 25 degree 18'30 North Latitude and 83 degree 59' to 25 degree 18'30 East Longitude. It shares its border with the states of Bihar to the north, Uttar Pradesh and Chhattisgarh to the west, Orissa to the south, and West Bengal to the east. Most of the state lies on the Chota Nagpur Plateau, which is the source of the Koel, Damodar, Brahmani, Kharkai, and Subarnarekha rivers, whose upper watersheds lie within Jharkhand. Much of the state is still covered by forest. Forest preserves support populations of tigers and Asian Elephants. The climate of the state is of the hot tropical with hot summer. Most of the rainfall takes place between July and September. The maximum temperature ranges from 35 degree C and 40 degree C. In winter temperature ranges from 2 degree C to 28 degree C. May-June is the hottest month and December January are the coldest months. The average annual rainfall in Jharkhand is 125-150 cm.

Demography
The state of Jharkhand has an area of 79,714 sq. km. and a population of 32,966,238 (2011 Census). It is 13th most populous state of India. Looking at the population break-up, there are 16931688 million males and 16034550 million females. The sex ratio is 947 females to 1000 males. The State has population density of 413.6/km2 (1,071.1/sq mi).
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Provisional Population Totals (Population by Residence-Persons) Census 2011 SL India/Jharkhand/District India Jharkhand 1 Garhwa 2 Chatra 3 Kodarma 4 Giridih 5 Deoghar 6 Godda 7 Sahibganj 8 Pakur 9 Dhanbad 10 Bokaro 11 Lohardaga 12 Purbi Singhbhum 13 Palamu 14 Latehar 15 Hazaribagh 16 Ramgarh 17 Dumka 18 Jamtara 19 Ranchi 20 Khunti 21 Gumla 22 Simdega 23 Pashchimi Singhbhum 24 Seraikella- Kharsawan Total 1210193422 32966238 1322387 1042304 717169 2445203 1491879 1311382 1150038 899200 2682662 2061918 461738 2291032 1936319 725673 1734005 949159 1321096 790207 2912022 530299 1025656 599813 1501619 1063458 Rural 833087662 25036946 1252709 979406 575783 2237300 1233652 1246998 990592 831718 1123246 1078585 404341 1018352 1710626 674503 1458681 530284 1230976 714192 1654682 485195 959676 556880 1283442 805127 Urban 833087662 7929292 69678 62898 141386 207903 258227 64384 159446 67482 1559416 983333 57397 1272680 225693 51170 275324 418875 90120 76015 1257340 45104 65980 42933 218177 258331

The Scheduled Tribes Population

Jharkhand has remained a home to a number of tribal communities, with 26,945,829 tribal populations as per the census 2001. Some of the districts have a predominant tribal population; it has 32 primitive tribal groups. The state has a total of thirty (30) Scheduled Tribes.
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The Scheduled Tribes are predominantly rural (91.7 is rural). The overall sex ratio and the child sex ratio of the ST population in Jharkhand are higher than the national average (978 and 973 respectively. The overall literacy rate among the STs has increased from 27.5 per cent at 1991 census to 40.7 per cent at 2001census. Despite this improvement, the literacy rate among the tribes is much below in comparison to that of all STs at the national level (47.1per cent). Out of the total 19.8 lakh tribal children in the age group 5 -14 years, only 8.5 lakh children have been attending school constituting 43.1 per cent.

The Scheduled Caste Population

According to 2001 census, the Scheduled Caste (SC) constitutes 11.8 per cent of the total population of the state. It holds 14th position among all the States / UTs in terms of the Scheduled Caste population. The State has a total of twenty two (22) Scheduled Castes. The SCs are predominantly rural (81.1 per cent is rural). The literacy rate among the Scheduled Castes of Jharkhand is low. Though there is an improvement in the overall literacy rate of SCs from 23.7 per cent at 1991 census to 37.6 per cent at 2001 census, it is still lower if compared with that of all SCs at the national level (54.7 per cent).

Mineral Resources
Jharkhand is known as mineral state of India. It contains 36 % of minerals of the whole country. By value factor it produces 26% of mineral wealth in India. The major minerals found in Jharkhand are Iron ore, manganese, copper, Bauxite, chromite (Chromium), coal, mica, graphite, limestone, kyanite, lead, gold, silver, tin, graphite, asbestos, thorium, uranium, dolomite, beryllium, berayetes, china clay, Garnet, zircon and some others. Such a large and variety of minerals available at one place gives Jharkhand a unique distinction in world.

Agriculture
Agriculture dominates the economic scene .The average land holding per family varies from 2.5 to 5 Acres. Due to uneconomic and small holdings, mono-cropping, and un-scientific agriculture practices, poor agriculture base prevails in the state, which leads to subsistence economy. Though 70 % of the population is depending up on the agriculture it is unable to provide steady source for income.
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Industry

Jharkhand has a concentration of some of the countrys highly industrialized cities such as Jamshedpur, Ranchi, Bokaro Steel City and Dhanbad. It also has several firsts in India, including:

Largest fertilizer factory of its time in India (since shut down) at Sindri, Dhanbad First Iron & steel factory at Jamshedpur Largest Steel plant in Asia, Bokaro steel plant, Bokaro. Biggest explosives factory at Gomia, Bokaro. First methane gas well at Parbatpur, Bokaro.*

Education

The literacy rate in Jharkhand is 67.63% (2011). As per the 2011 census conducted by Government of India the official literacy rate for the state was 67.63% (Male: 78.45%; Female: 56.21%) with 9 districts above the average literacy rate: 1. Purvi Singhbhum (Jamshedpur): 77.13% (Male: 85.53%; Female: 68.20%) 2. Ranchi: 76.13% (Male: 84.51%; Female: 67.33%) 3. Dhanbad: 75.71% (Male: 85.68%; Female: 64.70%) 4. Ramgarh: 73.92% (Male: 83.51%; Female: 63.49%) 5. Bokaro: 73.48% (Male: 84.50%; Female: 61.46%) 6. Hazaribagh: 70.48% (Male: 81.15%; Female: 59.25%) 7. Saraikela Khasawan: 68.85% (Male: 81.01%; Female: 56.19%) 8. Kodarma: 68.35% (Male: 81.25%; Female: 54.77%) 9. Lohardaga: 68.29% (Male: 78.62%; Female: 57.86%)* There is an average availability of one school for every two villages. At many places education has become a mere tokenism. Only people with little surplus money prefer to send their children to private schools. Education that students do receive is so basic that they are ill equipped to face competition.

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Medical Colleges and others

There are three medical colleges in Jharkhand namely Rajendra Institute of Medical Sciences (RIMS) at Ranchi, M.G.M. Medical College at Jamshedpur and Patliputra Medical College and Hospital (PMCH) at Dhanbad. There are two institutes imparting education in the field of Psychiatry- Ranchi Institute of Neuro-Psychiatry and Allied Sciences and Central Institute of Psychiatry both located in Ranchi. There are three Dental Colleges- Awadh Dental College in Jamshedpur, Hazaribag College of Dental Sciences and Hospital in Hazaribagh and Vananchal Dental College and Hospital in Ranchi. There are three Homeopathy Colleges and two Ayurveda Colleges as well. Jharkhand has a number of engineering colleges: Indian School of Mines University, Dhanbad, National Institute of Technology, Jamshedpur,Birla Institute of Technology, Ranchi, Birsa Institute of Technology Sindri, Dhanbad, and the National Institute of Foundry and Forge Technology (NIFFT). Among which BIT mesra, NIT Jamshedpur and ISM Dhanbad are among top 15 technical colleges in the country. The state Veterinary department runs Veterinary Dispensaries located throughout Jharkhand and posts Touring Veterinary officers, Block Animal Husbandry Officers, Touring Veterinary officers (mobile), Assistant Poultry Officers and Veterinary Surgeons to support the agricultural industry. The state has a Veterinary College located at Kanke, Ranchi.*1

* Refer from http://en.wikipedia.org/wiki/Jharkhand

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Organogram of Jharkhand Rural Health Mission Society

Principal Secretary

MD-NRHM

DIRECTOR IN CHIEF

DIRECTOR FINANCE

SRCHO

STO

SMO

SIO

SLO

SFM/AO

SBCO

ADDL DIRECTOR/DE PUTY DIRECTOR (MATERNAL HEALTH)

ADDL DIRECTOR/ DEPUTY DIRECTOR (CHILD HEALTH)

RNT CP CELL

ADDL DIRECTOR/DE PUTY DIRECTOR (QA & DATA ANALYSIS

ADDL DIRECTOR/D EPUTY DIRECTOR (IEC & SAHIYA CELL)

NVBDCP CELL

ADDL DIRECTOR/DEPU TY DIRECTOR (LOGISTIC & PROCUREMENT)

ADDL DIRECTOR/DEPUT Y DIRECTOR (NIDDCP CELL)

NLEP CELL

ADDL DIRECTOR/DEPUT Y DIRECTOR (HR & TRAINING CELL)

ADDL DIRECTOR/DEPUTY DIRECTOR (INFRASTUCTURE & M&E CELL)

ADDL DIRECTOR/DEPUTY DIRECTOR (FAMILY PLANING CELL)

SPM

STATE CONSULTANT MCH

CONSULTANT QUALITY ASSURANCE

CONSULTANT DATA ANALYSIS

CONSULTANT IEC

CONSULTANT SAHIYYA

CONSULTANT LOGISTIC & PROCUREMENT

CCO

NIDDCP CELL

SAM

CONSULT ANT HR

CONSULTANT INFRASTRUCT URE

CONSULTANT M&E

STATE TRAINING CONSULTANT

CONSULTA NT FAMILY PLANNING

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Situational Analysis
Key Health Indicator NHFS & DLHS trend Last Six yrs HMIS trend Annual Health Survey (AHS) 2010-11 of Jharkhand Health Indicators Maternal Health Child Health Family Planning Adolescent and Reproductive Sexual Health NRHM Additionalties

Key Health Indicators for Jharkhand

YEAR Total 26.3 26.2 26.8 26.2 26.1 25.8 25.6 25.3

Birth Rate Rural 28.5 28.1 28.8 28 27.8 27.5 27.1 26.7 Urban Total 18.9 8 18.5 8 18.7 7.9 18.8 7.5 19 7.3 18.9 7.1 19.2 7 19.3 7

Death Rate Rural 8.7 8.7 8.4 7.9 7.6 7.5 7.4 7.4 Urban 5.5 5 5.7 5.9 5.8 5.2 5.3 5.4

SRS 2003 SRS 2004 SRS 2005 SRS 2006 SRS 2007 SRS 2008 SRS 2009 SRS 2011 (Dec.)

Natural Growth Infant Mortality Rate Rate Total Rural Urban Total Rural Urban 18.3 19.8 13.5 51 54 34 18.2 19.4 13.4 49 51 34 18.9 20.4 13 50 53 33 18.6 20.1 12.8 49 52 33 18.8 20.1 13.2 48 51 31 18.7 19.9 13.7 46 49 32 18.6 19.7 13.9 44 46 30 18.3 19.3 13.9 42 44 30

Source: SRS Data

Trend:
Birth Rate Death Rate Natural Growth Rate Infant Mortality Rate

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NHFS and DLHS Trend of Jharkhand Health Indicators

S. No. A 1 2 3 B 1 2 3 4 5 6 7 B.1 8 9 10 C 1 2 3 4 5 D 1

Name of the Indicators

NFHS-2 NFHS-3 (1998(200599) 06) Marriage and Fertility 64.1 NA 2.76 61.2 47.1 3.31

Trend

DLHS-2 (200204) 48 38.8

DLHS-3 (200708) 36 32.3

Trend

Women age 20-24 married by age 18 Men age 25-29 married by age 21 Total Fertility Rate

+ + -

+ +

Family Planning Women who are using any method of Family Planning Devices Any Modern Methods Female Sterilization Male Sterilization IUD Oral Pill Condom 27.6 24.9 21.1 0.9 0.3 1.5 1.1 35.7 31.1 23.4 0.4 0.6 3.8 2.8 + + + + + + 35.3 31.1 24.3 0.4 0.7 3.1 2.3 34.9 30.8 24.6 0.4 0.5 3.3 2.0 + +

Unmet Need for Family Planning Total Unmet Need For Spacing For Limiting 21 11.1 9.9 23.7 11.6 12.2 34.2 14.3 19.9 34.7 13.6 21.1 + -

Maternal and child Health Mothers who had at least 3 ANC Mothers who consumed IFA for 90 days Birth Assisted by a Doctor/ Nurse/ ANM/ LHV/ Other Health Personnel Institutional Delivery Mothers who had received PNC after 2 days of delivery 24.5 *NA 17.5 13.9 NA 36.1 14.6 28.7 19.2 17 + + 21.2 NA 17.8 30.9 + 30.7 12 30.5 19.1 +

Child Immunization and Vitamin A supplement Full Immunization (12-23 months) 8.8 34.5 + 25.7 54.1 +

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2 3 4 5 6 D 7 8 9 E 1 2 3 4 5 F 1 2 3 4 G 1 2 Children 12-23 months who have received BCG Vaccine Children 12-23 months who have received 3 dose of Polio Vaccine Children 12-23 months who have received 3 dose of DPT Vaccine Children 12-23 months who have received Measles Vaccine Children 12-35 months who have received a Vitamin A dose 44.3 36.4 21.6 18.2 NA 72.9 79.6 40.3 48 23.3 + + + + 50.8 34.8 35.6 31.2 11.3 85 64.4 62.6 70.5 61.6 + + + + +

Treatment of Childhood Diseases Children with Diarrhoea in the last 2 weeks who received ORS Children with Diarrhoea in the last 2 weeks taken to a Health Facility Children with ARI or fever in the last 2 weeks taken to a Health Facility 20.3 33.5 NA 17.8 32.5 46.3 24.9 67.2 58.4 21.3 52.3 56 -

Child Feeding Practices and Nutritional Status Children under 3 years breastfed within one hour of birth Children age 0-5 months exclusively breastfed Children age 6-9 months receiving solid or semi-solid food and breast milk Children under 3 years who are stunted (below average height) Children under 3 years who are underweight Children age 6 month - 3year who are anaemic Anemia among the ever married women Anemia among the pregnant women Anemia among the ever married men 9 NA NA 49 54.3 10.9 57.8 65.3 41 59.2 + + 14.5 NA NA 34.6 75.3 53.6 +

Anaemia among Children and Adults 82.4 72.9 64 NA 77.7 70.4 68.4 37.4 + + -

Knowledge of HIV/AIDS among ever-married Adults (age 15-49) Women who have heard of AIDS Men who have heard of AIDS 15.4 NA 28.9 52.8 + 26.4 25.4 -

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3 Women who know that consistent condom use can reduce the chances of getting HIV/AIDS 21.8 NA 46.7 NA 52.9 +

Men who know that consistent condom use can reduce the chances of getting HIV/AIDS *NA = Not Available

HMIS Trend of Jharkhand Health Indicators

Sl No. A 1 2 3 4 5 B 1 2

Name of the Indicators

HMIS (06-07)

HMIS (07-08)

HMIS (08-09) Family Planning

HMIS (09-10)

HMIS (2010-11)

HMIS 2011-12 till Nov. 19,131 5,693 61,328 6,34,438 50,69,274

Trend

Female Sterilization Male Sterilization IUD Oral Pill Condom

94,934 6,461 73,867 9,04,372 83,80,986

1,01,636 17,380 85,376 10,76,478 1,20,69,194

1,14,014 12,129 82,955 10,61,525 1,10,63,293

1,06,210 7,144 88,961 11,18,654 1,19,53,670

1,14,537 13,182 1,14,408 11,52,343 90,29,783

+ + + + +

Maternal and child Health Mothers who had at least 3 ANC Mothers who consumed IFA for 90 days Home based Delivery Home delivery conducted by SBA persons Institutional Delivery Mothers who had received PNC after 2 days of delivery (with in 48 hrs and 14 days) 30.23 69.1 34.23 83.59 39.07 65.73 44.25 60.75 51 59 32 15 + +

3 4

23.08 NA

21.91 NA

34.93 13.01

30.39 12.32

26 28

11 21

+ -

5 6

7.94 22.54

8.22 23.18

21.32 34.9

30.50 40.07

35 44

25 53

+ +

C 1 Full Immunization (12-23 months) 78

Child Immunization and Vitamin A supplement 74 77 80 71 52 +

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2 Children 12-23 months who have received BCG Vaccine Children 12-23 months who have received 3 dose of Polio Vaccine Children 12-23 months who have received 3 dose of DPT Vaccine Children 12-23 months who have received Measles Vaccine Children 12-35 months who have received a Vitamin A dose 87 82 93 86.31 92 57 +

82

74

77

86

79

46

83

78

77

86

84

51

78

74

78

80

71

52

NA

NA

79

83

86

47

D 1 Children with Diarrhoea in the last 2 weeks taken to a Health Facility Children with ARI or fever in the last 2 weeks taken to a Health Facility NA

Treatment of Childhood Diseases NA 143099 42624 35378 30068 -

NA

NA

133530

9813

6097

1241

E 1 Children breastfed within one hour of birth NA

Child Feeding Practices and Nutritional Status NA 0.69 43.47 83 90 +

Annual Health Survey (AHS) 2010-11 of Jharkhand Health Indicators

District

Crude Birth Rate(CBR) Total Rural 25 24 Urban 20 20.3

Crude Death Rate (CDR) Total 6.1 5.1 Rural 6.5 5.2 Urban 5 4.7 Total 41 40

IMR Rural 45 39 Urban 26 46

Natural Growth rate Total 17.6 18.6 Rural 18.6 18.8 Urban 15 15.6

Jharkhand Garhwa

23.7 23.8

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Palamu Chatra Hazaribagh Kodarma Giridih Deoghar Godda Sahibganj Pakaur Dumka Dhanbad Bokaro Ranchi Lohardaga Gumla Pashchimi Singhbhum Purbi Singhbhum District 22.8 24.3 20.5 23.2 22.5 22.5 23.6 24.4 29.7 25.7 24.3 23.6 23.5 27.9 26 25.8 21 22.9 24.4 21.4 23.6 22.7 23.1 23.8 25.2 30.3 26.3 28.8 27.5 25.8 28.8 26.5 26.9 24.6 20.7 23.7 17.6 21.1 18.8 19.2 18.8 18.7 19.8 19.2 21.4 20.1 20.1 20.8 19.6 20.5 18.4 5.9 5.4 5 5 4.6 5 7.2 7.3 7.3 6.9 5.2 5.6 6.3 8.3 9.1 7.8 5.6 5.9 5.5 5.1 5 4.6 5.1 7.3 7.5 7.4 6.9 6.3 6.5 6.6 8.5 9.3 8.4 6.6 5.7 4.8 4.8 4.8 4.3 4.4 5.2 5.6 6 6 4.6 4.8 5.8 6.5 6.9 4.8 4.9 49 52 37 36 36 40 64 59 59 45 28 29 35 54 48 55 26 50 53 38 36 36 39 65 61 59 46 37 33 40 57 49 59 31 30 21 21 24 25 29 40 33 33 26 42 16.9 18.9 15.5 18.2 17.9 17.5 16.3 17.1 22.4 18.9 19.1 18.1 17.2 19.6 16.9 18 15.4 17.1 18.9 16.3 18.6 18.2 17.9 16.5 17.7 22.9 19.3 22.5 21.1 19.2 20.3 17.2 18.5 18 15 18.9 12.8 16.3 14.5 14.8 13.6 13.1 13.8 13.2 16.9 15.4 14.4 14.3 12.7 15.7 13.5

Neo-natal Mortality Rate Total Rural 29 25 29 32 19 24 22 22 35 37 37 34 27 25 Urban 17 20 15 22 19 20 29 16 16 26 24 28 31 18 23 22 22 35 37 36 34 21 21

Post Neo-natal Mortality Rate Total 15 16 20 21 18 12 14 18 29 23 22 11 7 8 Rural 16 15 21 21 18 13 14 17 29 24 22 12 9 8 Urban 9 26 18 11 6 22 11 5 8

Under Five Mortality Rate (U5MR) Total 59 55 64 66 46 45 49 52 93 88 83 59 43 43 Rural 66 54 66 68 47 47 50 53 95 93 85 59 58 52 Urban 35 61 40 39 28 43 48 30 33

Jharkhand Garhwa Palamu Chatra Hazaribagh Kodarma Giridih Deoghar Godda Sahibganj Pakaur Dumka Dhanbad Bokaro

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Ranchi Lohardaga Gumla Pashchimi Singhbhum Purbi Singhbhum 24 41 33 36 17 28 43 33 38 22 16 20 21 12 11 13 15 19 9 12 14 15 21 9 9 9 9 10 53 72 75 92 36 60 77 77 101 48 41 35 42 27

District

Sex Ratio at Birth Total Rural 936 957 955 946 908 984 974 928 941 932 927 925 893 920 920 921 934 995 872 Urban 880 959 785 983 840 894 1207 926 1104 890 527 759 887 862 864 864 1016 871 897

Sex Ratio (0-4 Years) Total 937 943 970 976 924 962 963 952 973 930 943 922 893 895 920 942 951 998 901 Rural 951 947 978 968 936 973 958 951 972 937 958 928 888 928 937 954 949 1020 906 Urban 889 886 843 1064 875 905 1068 957 978 865 617 833 896 858 890 838 981 866 896

Sex Ratio (All Ages) Total 942 922 945 980 950 951 1002 901 923 934 945 955 896 901 952 973 983 976 928 Rural 957 923 946 984 968 957 1005 907 926 941 950 959 914 925 968 977 985 987 960 Urban 901 918 923 943 894 919 956 868 864 889 866 901 885 879 928 941 948 928 906

Jharkhand Garhwa Palamu Chatra Hazaribagh Kodarma Giridih Deoghar Godda Sahibganj Pakaur Dumka Dhanbad Bokaro Ranchi Lohardaga Gumla Pashchimi Singhbhum Purbi Singhbhum

923 957 944 949 894 969 985 928 947 928 909 914 890 893 900 915 938 977 884

Maternal Health
Pregnant women Registration Ante natal care, PNC, TT, Institutional delivery, Home delivery and IFA tablets consumption. Mukhya Mantri Janani Sishu Swasthya Abhiyan (MMJSSA)
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Referral Transport

Maternal Health Status of Jharkhand Registration, Antenatal care, IFA tablet consumption, Institutional delivery, Post natal care are some of the indicators determining the maternal health status. It is indispensable for a woman to get her pregnancy registered so that the first ANC is ensured. A pregnant woman is given guidance about her pregnancy, food habits, regular checkups, counseling for institutional delivery and so on. Hence registration of pregnancy is imperative for the monitoring of pregnancy

I Pregnant women Registration

HIMS - District wise registration of pregnant women

Sl No. 1 2 District 200607
(%)

200708
(%)

2008 09
(%)

200910
(%)

201011
(%)
75 67

2011-12 till No. 11

(%)

2011-12 Projection 85 77

Projected trend 11 -12 FY

Bokaro Chatra

55 20

35 41

45 86

63 62

42 39

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3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Deoghar Dhanbad Dumka E. Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Khunti Koderma Latehar Lohardaga Pakur Palamau Ramgarh Ranchi Sahebganj Saraikela Simdega W. Sing. Jharkhand 62 57 61 61 52 26 57 80 46 88 NA 41 64 62 74 46 NA 277 104 75 72 63 81 77 56 69 78 54 27 52 80 48 52 NA 58 76 81 71 51 NA 87 71 71 73 73 61 72 54 66 77 94 42 75 96 66 81 85 82 89 90 93 97 49 53 109 97 200 89 74 67 63 67 73 78 65 67 80 61 78 79 100 85 85 78 77 42 65 99 97 72 82 71
83 74 79

42 27 45 43 44 31 47 45 50 39 42 36 49 49 51 50 36 33 55 47 37 51
42

84 54 91 86 87 62 95 91 100 77 84 72 98 98 102 99 72 66 110 95 75 102 84

72
83 72 78 97 83 85 85 79 97 72 92 79 117 80 108 93 77

97 81

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*Note Symbols; Red down indicate negative trend, Green up indicate positive trend, Green Horizontal indicate stable trend, Red down within brackets () indicate projected negative trend and Green up within bracket () indicate projected positive trend. Comparison; data is compared with the previous year. Projected trend; For FY 10-11 we have only data up to Oct. so one months average was taken and got 12 months projected data. The mixed trend performance of some of the districts will be noted and worked upon for consistency. II. Ante natal care, PNC, Institutional delivery, Home delivery and IFA tablets consumption.

DLHS 3 data indicates that there has been a slight decrease in three Antenatal care check-up status of mothers. Moreover, there has been a significant decline in the total percentage of institutional delivery from 21.2% to 17.8%. However, there has been an improvement in consumption of IFA tablets to 19.1% as against 12% in DLHS-2. It can be seen that almost the same percent of mothers who received ANC had their PNCs done. Hence it is essential to increase the percentage of ANC as it will reflect on the PNC status.

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Government of Jharkhand

The HMIS data over the past six years discloses that the pattern of ANC, PNC has been on the increase. The target for the ANC and PNC for FY 11-12 was 70% and 50% respectively. The half yearly performance of PNC till November 2011 shows that we are going in right way. Regarding Institutional delivery the HMIS data shows that there has been a dramatic increase in the year FY 10-11 and last year also. There has been a lot of follow up and dedicated work to increase the rate in institutional delivery since the DLHS 3 data of 17.8%. II. A) Antenatal care Women getting 3 ANCs

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Government of Jharkhand

It is essential for pregnant woman to receive good quality antenatal care comprising of at least three antenatal checkups with a minimum of two tetanus toxide injections and at least 100 Iron folic tablets. It can be seen from the above mention table depicting that Kolhan district has nearly 50% ANC coverage as registration whereas again Santhal Paragana and Palamu division falls on the lower side. It is found out that registration of pregnancy is very crucial for the women to have her first ANC. Hence strategies can be devised to increase the ANC coverage especially for hard to reach areas. District wise ANC status

Figure:

Source: DLHS 3

A district wise analysis shows that Pakur ranks lowest at 17% in the ANC coverage similar to registration of pregnancy followed by Sahebganj and Garhwa at 19.9% and 20.3 % respectively while East Singhbhum, Saraikela and Dhanbad have more than 50% coverage of Antenatal care status. HMIS data of 3 ANCs
Sl No. 1 2 3 4 5 6 District
200607 (%) 20 31 31 23 39 42 200708 (%) 19 29 50 28 46 51 200809 (%) 29 44 38 29 42 39 200910 (%) 46 36 39 42 41 46 2010-11 (%) 46 44 56 42 48 49 2011-12 till Nov. 11 (%) 26 23 25 16 27 27 Projected achievement 11-12 FY 51 46 49 32 53 54

Bokaro Chatra Deoghar Dhanbad Dumka E. Singhbhum

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Government of Jharkhand
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Garhwa Giridih Godda Gumla Hazaribagh Jamtara Khunti Koderma Latehar Lohardaga Pakur Palamau Ramgarh Ranchi Sahebganj Saraikela Simdega W. Sing. Jharkhand
27 16 29 50 23 34 NA 22 40 44 31 26 NA 27 39 43 45 41 30 31 21 28 52 26 28 NA 36 47 65 28 28 NA 32 33 46 50 46 34 53 24 40 50 35 40 46 42 44 48 46 48 26 27 55 47 96 45 39 48 33 41 56 35 60 57 48 62 54 39 54 25 34 50 64 49 57 44 48 40 43 67 49 53 68 43 71 47 44 62 89 44 46 64 52 66 50 22 17 27 30 26 29 31 19 37 29 23 31 26 21 22 31 27 33 25 43 34 54 61 51 57 62 38 73 57 46 63 52 42 44 63 54 66 50

ANC Comparative GIS Mapping of FY 06-07 and FY 10-11 06-07 10-11

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Government of Jharkhand

II. B) Status of TT injection As we looking at the status of women receiving at least one TT injection again Kolhan tops the list with 72.77% followed by South Chotanagpur at 65.08%. While Santhal Paraganas remains still at the bottom, there has been a marked improvement when compared to the DLHS 2 data. However the state still needs to improve on this indicator which is still low at 54.9% though there is an improvement of the previous percentage of 48.2%

HMIS Data of TT Injection

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Government of Jharkhand

Sl No . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

District

06-07 (%)

07-08 (%)

08-09 (%)

09-10 (%)

2010-11 (%)

2011-12 Achievem ent till Nov. 11 35 36 40 23 40 27 37 28 45 41 38 37 41 29 53 42 50 39 30 29 36 38 35 45 70

Projected achievem ent 11-12 FY (%) 69 72 79 46 80 54 75 57 91 82 77 73 82 59 106 85 100 78 60 58 72 77 69 90 140

Projecte d trend 11 -12 FY

Bokaro Chatra Deoghar Dhanbad Dumka E. Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamau Ranchi Sahebganj Saraikela Simdega W. Sing. Khunti Ramgarh

81 92 63 50 44 33 39 24 45 69 40 78 37 47 54 48 38 44 46 48 53 45 NA NA 47

29 36 57 46 50 44 38 33 40 70 39 37 44 60 68 48 47 40 36 50 50 56 NA NA 44

45 85 72 53 66 77 93 42 75 96 66 81 93 103 56 178 206 81 121 32 107 136 77 24

48 62 63 68 59 45 69 60 66 76 53 73 77 89 48 150 154 84 66 27 36 114 67 28 62

59 67 67 70 72 81 70 60 71 83 63 75 64 79 81 82 74 68 62 71 64 45 82 39 67

Jharkhand

74

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Government of Jharkhand

II. C) Institutional delivery Institutional Delivery Jharkhand India NFHS 2 13.9 34 NFHS 3 19.2 41 DLHS 2 21.2 DLHS 3 17.8 CES 09 40.1 72.9

One of the main objectives of the NRHM is to promote institutional delivery by providing better health care services through skilled birth assistnce. Promoting institutional deliveries is one of the strategies to reduce maternal mortality to 100 by 2015. Institutional delivery has the advantage that there is greater certainity for the pregnant woman of finding skilled assistance and access to drugs and equipment than when she would receive at home. When compared to the countrys status of institutional delivery at 41%, Jharkhand stands at 19.2% as per the NFHS 3 and at 17.8% according to DLHS 3 data. District wise institutional delivery status Below figures Illustrates the status of institutional delivery from the DLHS 3 data. East Singhbhum is ranking the highest which is still below 50%. East Singhbhum which figures better in registration, antenatal care and institutional delivery has most of the population in the urban settlement. Thereby the Kolhan region stand in a better position when compared to the other commissionaries. This is also because Kolhan division has less number of districts in comparison to others. On the other hand the graph shows that Sahebganj is the lowest at 6% followed by Dumka at 9.2%. More than half of the total districts of the state falls below the state average which is 18%. Strategies like close monitoring, facilities upgradation should be devised for the improvement of the status.

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Government of Jharkhand

Institutional delivery status Almost 3 out of 5 commissioneries in Jharkhand state is less than the states average of 17.8% according to DLHS 3.In such a state of affairs, when compared to the countrys status of 41% the state at 19.2% according to NFHS 3, However the State HMIS data shows a positive example with its increasing figures at 30% in 09-10 HMIS - District wise data for Institutional delivery
Sl No. District 200607 (%) 22 2 6 2 13 17 8 3 7 5 8 3 NA 6 3 9 13 4 NA 8 9 5 4 7 8 200708 (%) 9 4 9 5 10 22 17 4 7 7 6 3 NA 7 5 17 8 6 NA 10 5 7 4 6 8 200809 (%) 15 22 29 13 21 35 31 18 17 23 18 20 16 18 18 33 24 26 17 24 21 15 29 15 21 200910 (%) 25 26 29 47 19 32 29 22 20 30 30 26 32 41 17 39 20 29 23 55 25 24 20 31 31 2010-11 (%) 2011-12 till Nov. 2011 (%) 17 13 23 14 20 23 23 12 17 24 25 18 25 20 30 13 21 21 15 20 19 15 19 13 19 Projected achievement 11-12 FY 34 26 45 28 40 46 46 24 34 47 50 37 50 40 59 25 42 42 30 40 37 30 38 26 38 Projected trend 11 -12 FY () () () () () () () () () () () ()

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Bokaro Chatra Deoghar Dhanbad Dumka E. Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamau Ranchi Sahebganj Saraikela Simdega W. Sing. Khunti Ramgarh Jharkhand

38 37 44 34 28 34 38 30 34 42 45 44 53 30 37 24 43 47 26 39 38 35 40 54 37

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Government of Jharkhand

Institutional Delivery Comparative GIS Mapping of FY 06-07 and FY 10-11 06-07 10-11

II. D) Status of home delivery Source DLHS 2

JHARKHAND RURAL HEALTH MISSION SOCIETY

Home deliveries 78.5%

Conducted by skilled birth attendants 7.7%

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Government of Jharkhand

Given in table of status of home DLHS 3 81.8% 8.9% delivery are the DLHS figures for home deliveries and those whose deliveries were conducted at home with the help of skilled birth attendants. We find that the home deliveries have increased to 81.8%, DLHS 3 from 78.5%, DLHS 2 when compared to the institutional deliveries as per the DLHS 3 data. HMIS District wise data of Home Delivery
Sl. No. District 06-07 (%) 07-08 (%) 08-09 (%) 09-10 (%) 201011 (%) 2011-12 till Nov. (%) 10 11 10 6 17 6 9 13 14 15 13 18 20 8 25 12 19 11 13 7 17 16 12 17 11 Projected trend 1112 FY

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Bokaro Chatra Deoghar Dhanbad Dumka E. Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Khunti Koderma Latehar Lohardaga Pakur Palamau Ramgarh Ranchi Sahebganj Saraikela Simdega W. Sing. Jharkhand

20 29 55 14 19 15 19 11 18 41 20 22 NA 22 33 42 26 22 NA 17 30 58 31 33 23

21 28 42 13 30 15 18 10 17 45 20 22 NA 20 38 54 21 25 NA 16 22 30 30 27 22

28 42 27 21 31 19 44 20 31 59 40 41 40

18 23 17 16 28 15 24 28 29 38 23 39 25 30 58 31 39 63 25 39 38 56 46 34 30

16 30 24 12 31 13 22 28 22 32 20 39 33 25 54 21 34 26 30 17 35 40 28 36 23

32 59 52 31 60 31

26 39 54 72 45 35

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Government of Jharkhand

Home Delivery Comparative GIS Mapping of FY 06-07 and FY 10-11 06-07 10-11

II. E) Post Natal Care status Above figures shows the districts which provided ANC are also showing results for PNC care.
Percent of mothers who received post natal care from any health personnel within 48 hours of delivery of their last child, Jharkhand, DLHS 3
60 50 40 30 21.4 20 10.4 10 0
a nj eg ga d b he Sim a S r a a ar d ra ka i ku m d dh ta m a hw eh u o u P iri h m G ar at D G b L G Ja i g Sn st e W i a d la a g ro rh l a tra g ch a a m m ea la u m a n u ga um C a h nb ar a h ok rib o rik G a rd d R B e a h Pa o za gb Sa D h D K a o H L Sin t as E

46.9 43.9 45.3 38.4 39.4 27.5 27.8 28.5 25.3 25.3 25.4 26.9 30.5 31.4

49.4

52.4

24.2

25

13.8

16.6

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Government of Jharkhand

Once again most of the districts from the Santhal paraganas and the Palamu regions need greater attention. At least 3 visits of the lactating mother to the Aaganwadi centre or sub centre is essential so that she will get proper services. Reporting of the cases for immunization is also an area which needs more concentration. Proper counseling on breast feeding habits, immunization of the new born and timely referral when required is the essentials of Post natal care. Right through all the indicators of maternal health, registration of pregnant women, Ante natal checkups, natal care and post natal care, we find that most of the districts in the Santhal Paraganas and that of Palamau division remains in the low performing area. Some of the challenges faced in these areas are Low performing region based on maternal health indicators: Santhal Paragana and Palamu Santhal Paraganas Distance from the headquarter leads to monitoring, inadequate infrastructure hard to reach areas Palamu division Hard to reach areas Presence of left wing extremist groups Inadequate infrastructure due to incomplete construction

State poor

HMIS District wise date of PNC

Sl No. District 06-07 (%) 07-08 (%) 08-09 (%) 09-10 (%) 201011 (%) 201112 till Nov. 11 (%) 85 76 52 66 57 67 63 58 81 67 66 80 88 39 68 85 Project ed trend 11 -12 FY () () () () () () () () () () () () () () () ()

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bokaro Chatra Deoghar Dhanbad Dumka E. Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Khunti Koderma Latehar Lohardaga NA

10 22 19 27 20 35 19 12 17 37 18 21 NA 21 31 37

14 22 27 17 29 31 15 14 18 46 23 20

19 38 32 25 35 40 49 21 25 51 28 38 18

21 23 57 40 37 20 37 26 29 59 27 45 46 41 74 48

58 44 56 63 63 62 52 62 69 57 53 77 82 31 66 73

26 40 50

38 56 49

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17 18 19 20 21 22 23 24 Pakur Palamau Ramgarh Ranchi Sahebganj Saraikela Simdega W. Sing. Jharkhand NA 19 26 30 29 38 23 20 20 NA 17 22 34 39 27 23 20 25 38 51 25 28 38 50 69 47 35 51 27 32 50 49 75 63 73 40 58 44 89 58 60 64 67 56 60 61 64 66 54 65 86 46 83 68 () () () () () () () () ()

PNC Comparative GIS Mapping of FY 06-07 and FY 10-11 06-07 10-11

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Government of Jharkhand

III. Mukhya Mantri Janani Sishu Swasthya Abhiyan (MMJSSA) The Mukhya Mantri Janani Sishu Swasthya Abhiyan is a scheme that provides financial support to the poor women to promote institutional delivery. The State has made amendments within the broad guidelines issued by the GoI in this regard. With the goal to increase the institutional deliveries and thereby promote safe delivery, Mukhiya Mantri Janani Shishu Swasthya Abhiyan

(MMJSSA) was initiated in 2006.

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Total JSY Mothers package package Rs. 1400/on institutional delivery Rs. 2000

ASHAs package Rs.600/ Rs.250/- for referral transportation Rs.150/- bringing and accompanying woman in the hospital for 24 hours. Rs.200/- for post natal care and BCG

Accredited health facility for MMJSSA District Bokaro Chatra Dhanbad Giridih Hazaribag Koderma Khunti Dumka Deoghar Godda Pakaur Sahibganj Total No of accredited health facility 44 0 54 5 30 11 2 0 0 3 3 0 152 District Jamtara Palamu Garhwa Latehar Simdega Gumla Ranchi Lohardaga Ramgarh West Singhbhum East Singhbhum Saraikela No of accredited health facility 4 10 1 1 8 3 16 2 6 5 13 15 84

IV. Referral Transport Referral transport arrangements means the availability of ambulance services or at least private means of transport on payment with little time delay. Jharkhand is predominantly a tribal state with tough geographical terrain with hilly and difficult to reach areas. Most of the tribal villages have very poor transportation and communication infrastructure. The economic status of most of the families is also very poor. Because of this even if a complication is identified, women have to undergo delivery at home. To promote institutional delivery, referral transportation was initiated to provide transport facility to deal with the emergency complications during pregnancy or delivery. The table exhibited below shows the ambulance services received for each districts in the year 09-10 and 10-11 till Oct 10. Barring 2-3 districts all the others are tapping the services of referral transportation to save lives. Palamu has not shown any progress and specific strategies should be devised for that district to break the trend.

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HMIS Districts wise data on Referral (Ambulance) services SL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 District Bokaro Chatra Deoghar Dhanbad Dumka E. Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamau Ranchi Sahebganj Saraikela Simdega W. Sing. Khunti Ramgarh Jharkhand 09-10 (Achievement) 4849 68 331 114 24 202 181 21 360 455 87 104 NA 681 15 60 NA 90 91 129 272 621 462 255 9472 10-11 up to Oct.10 (Achievement) 3065 71 129 142 132 76 185 11 207 260 199 74 47 545 12 24 NA 158 94 26 97 370 396 11 6331 Projected Trend () () () () () () () () () () () () () () () () NA () () () () () () () ()

Since some of the commissionaires have hard to reach areas and difficult geographical terrains as well as poor transport facilities there is a need to strengthen the transportation facilities for the patients. Last year 9472 and in the current year till Oct. 10 6331 patients respectively made use of the ambulance services and is shows a positive trend which also shows the constant increase in institutional delivery.

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Child Health Immunization and Vitamin A supplement Child feeding practices and nutritional status Anemia Treatment of childhood diseases

The two most important overarching determinants of child mortality, predictably, are poverty and gender with all their consequences on nutrition, access to health care, environment and education. Other social determinants like caste, religion, and culture also play a significant role. IMR trend in Jharkhand

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Government of Jharkhand

Source: SRS

IMR Infant Mortality Rate is the number of deaths that occur within the first year of birth per 1000 live births in the same duration of time. The immediate goal of National Rural Health Mission is to bring down IMR up to 30/1000 live births. In above Figure representing the IMR trend in Jharkhand over a period of years reveals that Jharkhand state has put in great efforts to bring down the rate from 51 to 41 in 2011 according to the SRS bulletin. I Immunization and Vitamin A supplement Universal immunization is considered the best and fastest way of reducing child deaths. The United Nations Millennium Development Goal Four Reducing Child Mortality aims to decrease the under five mortality by two thirds by 2015.

Child Immunization and Vitamin A supplement S. No. 1 2 3 4 5 6 Name of the Indicators Full Immunization (12-23 months) Children 12-23 months who have received BCG Vaccine Children 12-23 months who have received 3 dose of Polio Vaccine Children 12-23 months who have received 3 dose of DPT Vaccine Children 12-23 months who have received Measles Vaccine Children 12-35 months who have received a Vitamin A dose DLHS-2 % 25.7 50.8 34.8 35.6 31.2 11.3 DLHS-3 % 54.1 85 64.4 62.6 70.5 61.6 Trend + + + + + +

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Government of Jharkhand

Illustration of the DLHS 2 and 3 data reveals a very assuring trend which shows that the States coverage of children immunized of BCG, DPT 3, OPV 3 and Measles to be 85, 64.4, 62.6, 70.5 respectively in DLHS 3 when compared to 50.8, 34.8, 35.6, 31.2 as recorded in DLHS 2. Only 54.1% children aged 12-23 months were found to be fully immunized (all the four vaccinations BCG, DPT 3, OPV 3 and measles) was twice when compared to DLHS 2 but still half times below the goal of 100% immunization. There is also a positive trend seen for Vitamin A which recorded a percent of 61.6 during DLHS 3. Vitamin A doses Full immunization

As per figure of full immunization there has been a definite rise in the percentage of immunization in DLHS 3 when compared to DLHS 2. Except for Santhal Paragana (which has shown a steep rise) and North Chotanagpur which falls below the states average and Palamu just slightly above the states average, Kolhan and South Chotanagpur were reported to be performing well. The State has been showing improved result when it comes to the status of vitamin A doses with once again North Chotanagpur and Santhal Paragana falling below the State average. HIMS trends of Child Immunization and Vitamin-A supplement
S. No. Name of the Indicators MIS (0607) % 78 87 82 MIS (0708) % 74 82 74 HMIS (0809) % 77 93 77 HMIS (0910) % 80 86 86 HMIS (10-11) % 70 91 78 HMIS - 11-12 (up to Nov.'11) % 55 57 46 Trend

1 2 3

Full Immunization (12-23 months) Children 12-23 months who have received BCG Vaccine Children 12-23 months who have received 3 dose of Polio Vaccine

Negative Negative +

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Government of Jharkhand
4 Children 12-23 months who have received 3 dose of DPT Vaccine Children 12-23 months who have received Measles Vaccine Children 12-35 months who have received a Vitamin A dose 83 78 77 86 83 51 +

78

74

78

80

91

53

NA

NA

79

83

65

45

Negative

Jharkhand HMIS data of last six years indicate that there is mix trend in immunization in last year. If we compare the last six years figure against target Vs achievement, it shows 70 - 85% of targeted children were covered throughout the FY. Those children who were covered under the fully immunization have received only 65% Vit-A dose.

Vitamin A coverage Catch-up round December, 2004 to July, 2011 in %

Dec, 2004 Jun, 2005 Dec, 2005 Jun, 2006 Dec, 2006 Sept, 2007 Feb ,2008 Aug ,2008 Feb, 2009 Dec, 09 Jul11

Jharkhand

69

74

71

77

77

73

83

85

89

85

93

II - Child feeding practices and nutritional status Breastfeeding is universal in the state, but few infants are breastfed immediately after birthonly about 35% in the first hour. Only 75% of the children under five-months of age are exclusively breastfed. Early Breastfeeding and exclusive Breastfeeding are important indicators of child health. Not breastfeeding can increase the risk of death up to 6 times from diarrhea. Breastfeeding is the single most preventive intervention which could prevent 13-16% of all childhood deaths. According to fig no the state has done a tremendous improvement in increasing the percentage of colostrums feeding from a mere 14.5% to 34.6% as per the DLHS 3 data. Even the % of exclusive breastfeeding and complementary feeding habits are showing 75.3% and 53.6% respectively.
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Breast feeding habits If we see the district wise segregation as per the DLHS 3 data, colustrum feeding is just a six percentage points above the state average. Except for Kolhan and South Chotanagpur who has 41% and 40.95% respectively the other divisions are just nearby or below the state average. These data calls for immediate attention and intervention in this area. Cultural practices and lack of awareness contribute to the low performance but strategic interventions can bring a change in the coming years. Exclusive breastfeeding Complementary feeding

Source: DLHS 3 The tables above reveal the status of exclusive breast feeding and complementary feeding habits in Jharkhand. Though the target is 100% exclusive breastfeeding for children between 6 months and above in Santhal paragana and Kolhan divisions are fairly good at 61.43% and 58.93% respectively. All the other divisions have reached nearly 50% targets but the objective would be to enable all the districts to reach the full target in the coming years so as to address the issue of malnourishment. Children age 0-5 months exclusively breastfed is 75.3% according to DLHS 3. To prevent malnutrition, the state makes effort to ensure early and exclusive breastfeeding for 6 months and start complementary feeding from 6 month onwards. Similarly the DLHS 3 data reveals that all the divisions rank above 90% in terms of complementary feeding habits along with breast feeding for the age group 6-24 months. Whereas children age 6-9 months receiving solid or semi-solid food and breast milk is 53.6% HIMS district wise trends of Child Breastfeeding within 1hrs Sl No. 1 District *08-09 % NA 09-10 % 25 10 - 11 % 78 11 - 12 (up to Nov'11) % 89 Trend

Bokaro

()

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2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Chatra Deoghar Dhanbad Dumka Garhwa Giridih Godda Gumla Hazaribagh Jamtara Khunti Kodarma Latehar Lohardaga Pakaur Palamu W. Singhbhum E. Singhbhum Ramgarh Ranchi Sahibganj Saraikela Simdega Jharkhand

NA NA NA 4 6 NA 2 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1

44 49 35 42 27 40 15 48 67 29 47 55 73 25 71 38 56 114 16 113 63 126 31 43

66 85 88 87 89 79 87 83 82 92 97 79 90 97 71 75 86 77 91 77 89 90 99 83

91 88 86 89 96 86 94 88 90 96 97 84 96 100 94 95 96 89 97 82 94 95 94 91

() () () () () () () () () () () () () () () () () () () () () () () ()

*Data available from 08-09 onwards

If we look at the HMIS data of breastfeeding within 1 hrs, there is a positive trend. Only Ramgarh district is low at 16% even after the projected data. Plans can be made to counsel the women through the services of the Sahiyyas and the anganwadi workers. State have achieved DLHS-3 figure (34%) in 09-10 FY (44%). Breast Feeding Comparative GIS Mapping of FY 06-07 and FY 10-11 06-07 10-11

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Government of Jharkhand

III - Anemia Preventing malnutrition, identifying malnutrition early and managing it is one of the areas of convergence of the health department with Integrated Child Development Scheme (ICDS). Fig shows the status among children aged 6 months 3 years have reduced from 82.4% to 77.7%. Whereas on the other hand the situation among pregnant women has risen up from 64 to 68.4 %. Meticulous strategies have to be sorted out to reduce this figure to have an impact on the reduction in IMR. Iron deficiency is believed to be the most important cause of anemia among infant and young children; it is attributed to poor nutritional iron intake and low iron availability, hookworm infestation, B12 and vitamin deficiency. Further, anemia develops when iron deficiency is severe and for a prolonged duration. Individuals with iron deficiency anemia may be two to five times more than the individuals with anemia. Child anemia, especially iron deficiency anemia, comes as a public health problem of immense magnitude as it impairs the mental development, physical capacity, cognitive ability, social and emotional development and results in reduced immunity. In addition, it also increases morbidity and susceptibility to heavy metal poisoning. Some studies suggest that iron supplementation at a later stage in life may not reverse the effect of moderate to severe iron deficiency anemia occurring during the first eighteen months of life.

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Government of Jharkhand

IV - Treatment of childhood diseases

S.No. 1 2 3

Name of the Indicators Children with Diarrhoea in the last 2 weeks who received ORS Children with Diarrhoea in the last 2 weeks taken to a Health Facility Children with ARI or fever in the last 2 weeks taken to a Health Facility

DLHS-2 (200204) 25 67 58

DLHS-3 (2007-08) 21 52 56

Trend -

Source: DLHS The other important child health indicators are the treatment of childhood diseases like diarrhea and ARI. Above Table illustrates that there is a downward trend in the situation of treating diarrhea and ARI. Children who received ORS are only 21.3% when compared to 24.9% and those who were taken to the health facility have dropped down from 67.2%. Only 52.3% of the children were given treatment at the health facility. Similarly only 56% children received treatment for ARI at the hospitals when compared to 58.4% according to the DLHS reports. It is vital that services are available at the health facility and increase awareness of the community concurrently. Pneumonia is one of the commonest causes of mortality among the children. It is evident from CES 2009 data 19 percent of under 5 mortality is attributed to Pneumonia.

Family Planning
METHODS OF FAMILY PLANNING Family planning Permanent Methods Family Planning Temporary Methods
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Government of Jharkhand

Unmet Need for Family Planning

Population expansion in India has been taken as severe alarm since commencement of First Five Year Plan as it has direct impact on the socio-economic rank of the country resulting in to poor living standards for large section of its people. Hence, family planning still an essential part of the family welfare programmes in India. Family planning services deals with educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to decide on the means by which this may be achieved. Government of India has come up with measures to control population and increase awareness of the benefits of reducing population growth, which include better lifestyle, education, environment, health and well being of every individual. Under NRHM, family planning services given utmost importance as mean to population stabilization and efforts in this regard is being taken up.

S. No. 1

Name of the Indicators Women who are using any method of Family Planning Devices Any Modern Methods Female Sterilization Male Sterilization IUD Oral Pill Condom

NFHS-2 (1998-99) 27.6

NFHS-3 (2005-06) 35.7

Trend +

DLHS-2 (02-04) 35.3

DLHS-3 (2007-08) 34.9

Trend -

2 3 4 5 6 7

24.9 21.1 0.9 0.3 1.5 1.1

31.1 23.4 0.4 0.6 3.8 2.8

+ + + + +

31.1 24.3 0.4 0.7 3.1 2.3

30.8 24.6 0.4 0.5 3.3 2.0

+ + -

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Government of Jharkhand METHODS OF FAMILY PLANNING

The NFHS and DLHS data from the above table depicts that women resort to contraceptive

measures as there is an upward trend from 24.3% DLHS 2 to 24.6% DLHS 3 in the rate of female sterilization and the use of oral pills. The graph shows a vast difference in the figures indicating vasectomy which is less than 1%.
I - Family planning Permanent Methods District wise coverage of family Planning method (Vasectomy) of last Six FY years
Sl District 06-07 % 07-08 % 08-09 % 09-10 % 10-11 % 11-12 up to Nov. '10 % Trend based on Projected data of 2011 -12 FY () () () () () ()

1 2 3 4 5 6

Bokaro Chatra Deoghar Dhanbad Dumka Garhwa

460 110 64 55 30 30

103 81 401 33 61 49

70 1 4 15 26 3

9 11 5 8 38 8

128 34 31 19 16 15

21 72 5 12 6 4

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7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Giridih Godda Gumla Hazaribagh Jamtara Khunti Koderma Latehar Lohardaga Pakur Palamau E. Singhbhum W.Sing. Ramgarh Ranchi Sahebganj Saraikela Simdega 95 13 94 66 17 NA 0 106 34 40 45 30 58 NA 96 8 14 101 32 215 100 333 51 79 NA 77 200 205 170 34 41 60 NA 240 25 25 408 116 50 10 99 34 NA 27 17 71 25 43 17 114 77 05 372 5 16 66 33 4 101 115 7 0 26 27 61 11 20 07 00 77 02 66 3 69 78 24 48 40 104 12 8 64 11 80 62 17 37 14 53 25 124 16 63 184 53 18 45 61 2 4 37 23 24 44 17 23 8 27 19 19 5 16 27 19 () () () () () () () () () () () () () () () () () () ()

Jharkhand

Data Source: State MIS

Graph showing the trend of Vasectomy of last six FY

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Vasectomy Comparative GIS Mapping of FY 06-07 and FY 10-11 06-07 10-11

District wise use of family Planning method (Tubectomy) of last Six FY years

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Government of Jharkhand
Sl. District 06-07 (in fig.) 12384 2009 6618 11647 2674 2072 5147 4188 1512 8863 67 NA 735 2576 1148 1762 9411 4589 1361 NA 11572 1474 2179 946 94934 07-08 (in fig.) 08-09 (in fig.) 09-10 (in fig.) 10-11 (in fig.) 11-12 (up to Nov. 11) FY ( in fig.) 785 565 645 978 508 1171 347 1026 597 779 159 1551 627 562 374 2187 1551 2580 319 262 1599 682 389 134 19131

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Bokaro Chatra Deoghar Dhanbad Dumka Garhwa Giridih Godda Gumla Hazaribagh Jamtara Khunti Koderma Latehar Lohardaga Pakur Palamau E. Singhbhum W.Sing. Ramgarh Ranchi Sahebganj Saraikela Simdega

8191 1910 6598 8467 3245 6258 6346 4251 1981 15481 1532 NA 2027 2327 1640 928 10933 5464 619 NA 9788 2050 739 861 101636

8706 1078 6437 10160 2029 6177 6499 5975 3214 1557 18179 3063 464 4688 2226 1282 2225 11397 4798 8699 1537 1997 628 711 114014

7155 1358 7320 11128 2575 5575 7038 4600 1530 7680 2664 942 2370 3323 744 1563 9812 1521 4735 4213 10095 2004 1321 739 106210

9507 4244 6381 12077 4200 7589 6491 4572 1882 7485 2324 221 4142 3554 945 1629 10365 6688 2039 2524 9187 2136 2772 1030 114537

Jharkhand

Data Source: State MIS

In the above shown tables data of Vasectomy and Tubectomy has been compared with its previous years achievement. Projected achievement in 2010-11 is compared with the achievement of FY 2009-10. Upward arrow shows increase in no. of beneficiaries/coverage while down ward arrow shows decrease in no. of beneficiaries/coverage. Data in last column is projecting the achievement of FY 2010-11.

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Government of Jharkhand Graph showing the trend of Tubectomy of last six FY

Source: State HMIS

II Family Planning Temporary Methods Use of family Planning method State wide (IUD, Condoms & OP) of last six FY year
Methods of FP IUD Condoms Oral Pills 2006-07 73867 8380986 904372 2007-08 85376 12069194 1076478 2008-09 103469 619952 54759 2009-10 88961 1118654 11953670 2010-11 113811 9007176 1003909 2011-2012 (Up to Nov. 11) 61328 5069274 634438

Source: State HMIS Graph showing the State wide trend of IUD, Condoms & Oral Pills of Six FY

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Government of Jharkhand

It is noticeable in the above table and graph that the family planning measure IUD has a good reach whereas Condom has less and Oral Pills have the least reach. But more significant is to notice that the graph shows a consistent downfall from the year 2008-9 in reach of IUD and Condoms which is alarming in regards to bring down the TFR. Therefore it needs more emphasis.

III - Unmet Need for Family Planning Sl . 1 2 3 Name of the Indicators Total Unmet Need For Spacing For Limiting NFHS-2 (1998-99) % 21 11.1 9.9 NFHS-3 (2005-06) % 23.7 11.6 12.2 Trend DLHS-2 (2002-04) % 34.2 14.3 19.9 DLHS-3 (2007-08) % 34.7 13.6 21.1 Trend

+ -

From table, we understand that the upper limit of female sterilization is 39%. But from the above table it is clearly seen that the figures of both the NFHS and DLHS shows an increase in the total unmet need from the previous years. There is a huge gap between the need and the availability of the programme. It is imperative that plans are made to reduce the unmet needs. It is quite satisfactory to note
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that the DLHS 3 shows a positive trend for spacing whereas there is a negative trend seen in the cases for limiting the number of offsprings thereby focusing once again to population stabilization programmes.

Adolescent Reproductive Sexual Health (ARSH)

District Level Household Survey - Indicators The Coverage under the Programme so far Adolescent Reproductive and Sexual Health Programme in Jharkhand Kishori Swasthya Saptah

Adolescents cover around one fourth of the total population in the state of Jharkhand. The morbidity pattern and the psychosocial needs of this segment of population are different from others.
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Government of Jharkhand

About one-fifth of Indias population is in the adolescent age group of 1019 years. It is estimated that there are almost 200 million adolescents in India (ages 1524) and is expected that this age group will continue to grow reaching over 214 million by 2020. The pervasiveness of discrimination, lower nutritional status, early marriage, complications during pregnancy and childbirth among adolescents contribute to higher female mortality (CSO 2002, SRS 1999). The adolescent population group has specific health and developmental needs and requires special attention. Realizing this Adolescent Reproductive and Child Health (ARSH) component included as important strategy in NRHM to comply the needs of adolescents. District Level Household Survey - Indicators Indicators ( Based on Currently Married Women 15-44 years) Currently married non-literate women Girls married below 18 yrs Birth to women during 15-19yrs Current use of Family Planning Method: Any method DLHS 3 63% 36% 06% 35%

Indicators (Based on unmarried women 15-24years) Unmarried non-literate women Unmarried women with 10 or more years of schooling

DLHS 3 21% 31%

Counseling and educating the adolescent group towards improved life skill are key components of ARSH. DLHS data shows that there is negligible increase in mean age of marriage, 22.9 from 22.4 among boys and 18.3 from 17.9 among girls of which 36 percent of girls are married below 18 years (DLHS 3). 5.9 % of women giving birth to their first child during the
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age of 15-19 years. The DLHS 3 data reveals that about 79 percent of young women (15-24 years) are literate and 31.4 percent have completed their 10 year of schooling. It is interesting to know that the 70.8 percent of young women (unmarried 15-24 years) think that family life education / sex education is very much important for them. 40.8 percent of young women have received family life education / sex education. 75.1 percent of young women know the legal minimum age at marriage for girls in India.

Figure above on the right depicts the awareness about conceptive methods among young women ((unmarried 15-24 years). 52.9 percent young women knows about condom and 69. 2 percent young women know about pills as methods of contraception. 17.9 percent of young women knows about emergency contraceptive pills. 23.4 percent of young women having discussion on contraception. It is very much clear that educational status and plays significant role in awareness level of women about the health concerns of them.

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Government of Jharkhand

The above figure gives current status of knowledge of HIV/AIDS and STI among young women (unmarried women 15-24 years). 54 percent of young women of Jharkhand heard about HIV/ AIDS while only 17.2 percent heard about RTI/STI. North Chhotanagpur division having least awareness level on HIV/ AIDS and RTI/ STI (10.03 % in HIV/ AIDS and 6.99 % in RTI/ STI). Kolhan division has high awareness level on HIV/AIDS (63.63%) whereas South Chhotanagpur division has high awareness level on RTI/ STI (41.35 %) among young women in comparison to other divisions. This scenario is perpetrated by a host of determinants, such as lack of education, poor exposure to information, limited role of women in decision-making, and social and economic considerations. Above discussed all the indicators have significant implications in terms of adolescent health particularly girls. Reducing maternal mortality, one of goal of NRHM can be achieved if the adolescent group sensitized and empowered with life skill education. With improved health and nutritional status, and adolescents being future mother and father can ensure healthy life for themselves and their future generations. Here ARSH programme has significant role. Kishori Swasthya Saptah The statewide Kishori Swasthaya Saptah campaign 5.6% of the girls were found out to be severely anemic and 82.56% of the girls were found to be mild and moderately anemic. In the FY 2011-12, the following strategy will be implemented as a follow up of the Kishori Swasthya SaptahNo. of Schools covered 21650 Number of girls covered 1032435 No. of girls whose BMI calculated 526082 Girls reffered for treatment 4547

The Coverage under the Programme so far The State proposed to implement the ARSH Programme in the State in Phased manner. The Districts were decided by the Adolescent Technical Advisory Sub-group keeping in mind that each region of the state is represented and that the performance of the districts in terms of RCH indicators. The table below shows the phased coverage:
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Health Facility
Districts Dist. Hospitals/Sadar Hospitals BPHC/CHC Health Sub-centre

2008-09
12 10 60 120

2009-10
12 10 60 120

2010-11
24 22 154 2166

2011-12
24 22 194 4359

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