RTI / STI under NRHM
(sub-district health facilities)
STIs/RTIs present a huge burden of disease and these adversely affect the
reproductive health of people. As per STI prevalence study (2003) over 6% of
adult population in the country suffers from STI/RTIs. These cause suffering for
both men and women but their consequences are far more widespread among
women than among men. These infections often go undiagnosed and untreated,
and when left untreated, they lead to complications such as infertility, ectopic
pregnancy and cervical cancer. Pelvic inflammatory diseases (PID) arising from
STI/ RTIs poses a major public health problem and adversely affects the
reproductive health of poor and untreated women. It also compromises with
contraceptive adhesion. In fact STI/ RTI rank second as the cause of healthy life
lost among women of reproductive age group, after maternal morbidity and
mortality.
For providing STI/ RTI services syndromic case management (SCM) is
the corner stone of STI/ RTI management, which is also approved by WHO.
This approach classifies STI/ RTI into syndrome (easily identifiable group of
symptoms and signs) and provides treatment for the most common organisms
causing the syndrome. Implementation of standardized SCM simplifies training,
supervision, reporting and drug management.
The technical strategy reflected in the RCH programme (PIP) aim to
create primary health care delivery system to improve the health of women and
children’s Government of India guidelines for 24 hrs. RCH services by PHCs,
list services of for prevention of STI/ RTI as a major package.
Implementation of STI/ RTI programme
NACO is implementing at district level and at sub-district level it is
implemented by NRHM by utilizing existing health care infrastructure. Under
NRHM, district RCH officer is responsible for implementation of programme in
the district.
The programme is being implemented at all sub-district health facilities
i.e. Sub-divisional Hospital, CHCs, PHCs, Block PHCs and Rural Hospital by
supplying colour coded STI/ RTI drug kits and test kits and fulfill minimum
standards of STI/ RTI service delivery.
NRHM Facilities
S.No.
District
1
2
3
4
5
Amritsar
Barnala
Bathinda
Faridkot
Fatehgarh
Sahib
Ferozepur
Gurdaspur
Hoshiarpur
Jalandhar
Kapurthala
Ludhiana
Mansa
Moga
Mohali
Muktsar
NawanShahar
Patiala
Ropar
Sangrur
Tarn Taran
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Satellite
Hospitals(PHC)
5
5
SDH
CHC
PHC
RH(PHC)
Total
2
0
2
1
1
4
4
9
4
4
31
8
17
8
13
2
3
3
0
1
39
15
31
13
19
3
2
3
2
2
4
1
0
1
2
1
3
1
4
1
36
8
15
10
10
4
9
4
5
3
5
3
11
2
6
9
129
31
38
29
26
10
28
12
20
13
14
15
29
12
27
20
396
3
2
3
3
3
5
2
2
0
3
2
0
2
4
2
45
45
57
45
41
19
46
19
27
17
24
21
43
17
41
32
611
Physical Achievement of NRHM:
Out of a target of 174790 the achievement up to December 2011 was 58753
(44.8%). The achievement was less due to non-reporting/ nil reporting by some
of the facilities.
State
PUNJA
B Total
PHYSICAL TARGETS FOR STI/RTI (NACO, NRHM, PVT SECTOR) 2012-13
Adult
STI/RTI
Total
NACO
NRHM
Private
Projected
Episodes
Annual
TargetTargets
Sector
Populatio Populatio
n(50%)
(6%)
STI/RTI
for
52% of
Targets
n 2011
targets for
Designate the total 19% of the
gov. health d STI/RTI Annual
total
facilities
clinics (
STI/RTI
Annual
(35% of
28% of
targets)
STI/RTI
Annual
the total
targets)
estimated
Annual
STI/RTI
STI/RTI
episodes in targets for
the State)
gov.
health
facilities )
27175000
NRHM backward
districts in RTI/
STI
Muktsar
Nawanshahr
Faridkot
Jalandhar
13587500
815250
285338
79895
148376
54214
NACP high
prev. dist.
NACP- Proposed New High prevalence Disricts
Ldh
Bhathinda
Moga
Patiala
Rupnagar
Mohali (Sahibzada Ajit Singh Nagar)
Nawanshahr(Shahid Bhagat Singh Nagar)
Tarn Taran
Amritsar
Ferozpur
Faridkot
Gurudaspur
Hoshiarpur
Jalandhar
NRHM Trainings:
The TOT for training of NRHM staff (MOs/ SNs/ LTs) has been done by
PSACS and following staff were trained in 2011-12.
Year
Medical Officer
Staff Nurse
Para Medical Staff
2011-12 upto January
289
479
635
List of Trained Staff in TOT 2011-12
Name of the
District
GMC, Patiala
MKH, Patiala
CH, Sangrur
CH, Fatehgarh
Sahib
CH, Roopnagar
CH,
Nawanshahar
CH, Ludhiana
CH, Mohali
Name of Doctors with Phone Numbers
Dept. of Skin
Dept. of Gynae
Dept. of Pathology
RCH Officer
Dr. R.K. Bahl
98784-19693
Dr. M.S. Dhaliwal
98140-81830
Dr. Shivali Aggarwal
94643-59359
Dr. Anju Singla
94174-49154
Dr. Ritu Banga
98728-96448
Dr. Manjeet Kaur
98148-01503
Dr. H.S. Gill
98155-04077
Dr. Geeta
94170-06080
Dr. Rama Garg
94632-07688
Dr. Neena Gupta
98141-29357
--
--
Dr.Kajal Dhingra,
93569-30460
Dr. Madhurima Chawla
98159-04424
Dr. Sumandeep
98761-78390
Dr. Bhupinder Kaur
94635-43726
Dr. Harpreet Kaur
94174-45398
Dr. Kulwinder Kaur
Dr. Inderjit Singla
98882-69466
Dr. Goldy Chhabra
94634-48383
Dr. Ravinder Pal Kaur,
98146-85405
Dr. Davinder Kataria
96464-85400
Dr. Bindu Nalwa
98557-21034
Dr. Kuldeep Singh
98144-98680
Dr. Nirwair Singh
98140-38889
Dr. Baljit Singh
81464-62300
--
Dr. K.S. Sandha
98765-02380
Dr. Neeraj Jindal
94176-91818
Dr. Ramesh Kumar
98882-50050
Dr. Ritu Jain
94640-94682
--
Dr. S.P. Surila
94171-77883
--
Dr. Iqbal
98145-36863
GGSMC,
Faridkot
CH, Faridkot
CH, Moga
CH, Muktsar
CH, Bathinda
-Dr. Murari Lal
98143-56633
Dr. Jagroop Singh
98724-26950
Dr. Satish Kumar
98142-15614
Dr. L.R. Jain
98551-64430
CH, Barnala
Dr. Tapinderjot
98149-31161
CH, Ferozepur
Dr. Neerja Puri
98146-16427
Dr. Naresh Bansal
94171-15210
CH, Mansa
GMC, Amritsar
CH, Amritsar
Dr. Ravi Saini
94172-78811
Dr. R.K. Gupta
94170-10394
98152-46911
Dr. Anantjit Kaur
98150-66733
Dr. Alka Mittal
98551-00261
Dr. Tamana
98149-70505
Dr. Parveen
99883-83140
Dr. Alka Goyal
98155-78218
Dr. Neelu Koura
94172-78732
Dr. Kavita Gawri
80549-23004
Dr. Dheera Gupta
98550-57998
Dr. Monica Gupta
94173-44644
Dr. Jasbir Singh
Aulakh
98723-78855
Dr. Shweta
98722-21312
Dr. Ritu Mittal
98728-14381
Dr. Asha Kiran
94176-82173
Dr. Surinder
98140-65527
Dr. R.S. Butter
95018-33665
Dr. Mrinalini
98729-68884
Dr. Sanjeev Kumar
Hans, 99880-01056
Dr. Jagraj Singh
98143-22718
Dr. Anupam Bansal
98158-99963
Dr. Sandeep Kumar
98154-37032
Dr. Ashok Monga, MO
CHC Bhucho mandi,
94634-64041
Dr. Harjinder Kaur
93572-52094
Dr. Bhalinder Singh Gill
88720-93355
Dr Sushma Thakur,
99140-12681
--
Dr. Reenu Singla
99142-60210
Dr. Harbhajan Singh
94174-37211
-Dr. Arun Sharma
98761-46538
Dr. Satish Dugal
CH, Gurdaspur
Dr. Rana Verma
94170-32688
CH, Hoshiarpur
Dr. Sham Sunder
94171-24488
CH, Kapurthala
Dr. Princejit Singh
98762-95191
Dr. Anoop Kumar
98144-30158
Dr. Brenna
98154-21898
CH, Jalandhar
CH, Tarn Taran
Dr. Ravinder Kaur
98155-54427
Dr. Tejinder Kaur
Tung, Batala
98143-34330
Dr. Bhupinder Jeet
Kaur
81461-1556
Dr. Rajinder Raj
95018-35572
Dr. Ritu Narad
81460-43400
Dr. Simmi Dhawan
98159-86369
Dr. Jaspreet Singh,
95010-20750
Dr. Jagjiwan Lal
98140-37798
Dr. Seema Garg
98155-51674
Dr. Chuni Lal
98720-44737
Dr. Prem Kumar
98151-85898
Dr. Chaman Lal Sharma
98143-19206
Dr. Varinder
98725-12260
Dr. Davinder Virdi
98154-21898
Dr. Balwinder Kaur
98727-43370
Dr. Damini
95010-44661
Dr. S.S. Cheema
98728-61472
Dr. Tarsem
94632-84321
Dr. Maninder Minhar
96460-65158
Dr. Surjit Singh Chhina
88720-94726
STI/ RTI Drugs: These were received in all the districts except for Barnala,
Bathinda & Moga and were distributed to the sub-district level health facilities.
District Ropar has received it in 2009 but not in 2010-11. Till now the drug kits
were being supplied directly by NACO but in this FY 2012-13 NRHM will
procure and supply the drugs & kits and the budget has been proposed in the
PIP as per guidelines of NACO.
Coordination Meeting with PSACS:
During 2011-12 convergence meeting were held with focal persons STI PSACS
every month regarding reporting, training and colour coded kits supply etc.
Budget in PIP:
Allocation of fund for STI/RTI services in the PIP 2011-12:
Activities
Training of Doctors, Nurse and Laboratory Technician
(Training cost, printing of module, stationary, venue
etc)
Fund allocated in the Expenditure till
PIP (in Lacs)
date (in Lacs)
4747200
1622391
Fund Proposed for the STI/RTI services in 2012-13.
Activities
Fund proposed in the PIP (in Lacs) for 2012-13
Training of Doctors, Nurse and Laboratory
Technician (Training cost, printing of module,
stationary, venue etc)
44.57
Monitoring and supervision of the facilities
12.83 L
Upgrading of infrastructure of the facilities (audiovisual privacy, examination facilities, speculum,
gloves etc)
RPR test Kits
130.15 L
Colour coded STI/RTI drug kits
22.85 L
IEC/BCC
7.41 L
Total Budget in PIP
Detailed break up of fund proposed in 2012-13
218.04
Schedules
of
Approximate
procurement (Kit No.)
Kit) (Rs.)
I (Kit-1)
22
II (Kit-2)
8
III (Kit-4)
IV (Kit-5)
V (Kit-6)
VI (Kit-7)
VII (Kit-3)-Inj. Benz
Penicillin
VIII (Kit-3) – Tab Azithro
IX(Kit-3)-Dispo
& Needle
5:4 L
Price (Per No. required
36
26
42
42
16
cost
18162
399564
48074
2137
5342
21367
1069
384592
76932
138892
897414
44898
10684
170944
10684
128208
10684
42736
2284180
12
Syringe
4
TOTAL COST
RPR TESTING KIT REQUIREMENT FOR NRHM 2012-13
State Name
NRHM
STI
target
Coverage
50%
Annual
Estimated no
of
pregnancies
Coverage
50%
Total
coverage
of RPR
testing
PUNJAB
148376
74188
527000
263500
337688
No of RPR kits
9005
RPR Test
Kits (50
Test per
Kit with
10%
wastage)
7504
Total
RPR Kits
Required
(with
20%
buffer)
9005
Approx cost/kit in Rs.
Total cost in Rs.
60
540300
Subject: STI/RTI Service Delivery.
S.N
O
Activity
Details of Activities
1
Training
2
Infrastructure
Strengthening
Detailed activities to be put
up by training wing
Each of the Health Facilities
to have audiovisual
privacy(partition), facility
for
examination(Examination
Table, flexi lamp etc),
instruments
(speculum, proctoscope) and
infection mechanism.
Remarks
Comments
Funds to
be
budgeted
in PIP
2012-13
(Rs. In
lakh)
44.57
Infrastructure
money should
be beed
based. Each
Health
Facility to be
assessed for
infrastructure
and
accordingly
existing gap
may be filled
through PIP.
Audio- Video privacy: a
separate
enclosure/cabin/Partition
with wash Basin, cabin fan
etc. to be provided in the
STI/RTI clinic room for
examination and
advice/councelling etc. at
an average estimated cost
of Rs. 12000/- per facility
for total 611 facilities:
SDHs: 36
CHCs:129
PHCs:446
 Examination table
& flexi lamp:
Estimated cost Rs.
6000per facility.
 Instruments: (at
average estimated
cost of Rs. 2000
per facility)
 Proctoscope
Rs.1000 per piece
 Cuscus Vaginal
Speculum
@Rs. 250 per
piece
8 per SDH for 36
SDHs
6 per CHC for 129
CHCs
3Per PHC for 446
PHCs
 Infection Control
mechanism:
 Hypochlorite
solution 5litre jar
@Rs. 200 per jar
5 jar/SDH/Year
3 jar/CHC/Year
2 Jar/PHC/Year
Medical Waste Disposal
Bins
@ Rs. 200 per Bin
Four differently coloured
bins per PHC for 446
PHCs.
73.32
36.66
12.22
4.38
3.57
Total Funds
PRPOSED
3
Mentoring and
supportive
Supervision
130.15
Each of the Health Care
Facility in the district to be
mentored by the STI mentors
once in every six month.
RCH Officer from the district
and RCH officer from state to
monitor at least 25% of
Health Facilities every six
month.
TA, DA for
the STI
mentors,
district &
state RCH
/MH Officer
to be put in
PIP.
For Mentoring:
Four district level STI/RTI
trainers will function as
District Mentors.

2 Institution to be
covered per visit
 Average 30 visits
per year
TA/DA for Mentors:
 Honorarium
Rs, 500 per
visit +POL
average Rs.
500 per visit
(Govt.
Vehicle@ Rs.
Per 6 km)
 TA/DA for
Supportive
Supervision
 District level: By
District Nodal
Officer STI/RTI








Total Funds
PRPOSED
2 Institution to be
covered per visit
Average 15 visit
per year
Per Visit:
Honorarium Rs.
500+
POL Rs. 500
(average)
6.00
3.00
3.83
State Level: By
State Nodel
Officer STI/RTI +
Any other officer
nominated
2 Institution to be
covered per visit
153 Visits per
year
Per Visit:
Honorarium
Rs. 500 + POL
Rs. 2000
(Average)
12.83
S.N
O
Activity
Details of Activities
Remarks
Comments
4
IEC and job
AIDS
Leaflets, posters and other
education material to be
budgeted for the patients. Job
AIDS like syndromic wall
posters, anaphylaxis chart,
STI counseling flip book,
infection control chart etc.
Funds for
printing of
IEC material
and job aids
to be put in
PIP.
Leaflets for Patients: 2.50
lakh leaflets @Rs. 0.60
paisa each
Posters for public (2
types):
(15000posters)
Size 18”*24” @ Rs. 5.00
each
 50 posters per DH
for 21 DHs
 30 posters per
SDH for 36 SDHs
 30 posters per
CHC for 129
CHCs
 20 posters per
PHC for 446
PHCs
Syndromic Wall Posters:
(1200 posters)
Size 18”*24” @ Rs.5.00
Each)
 3 posters per
DH/SDH/CHC
for total 186
institutions
 1 poster per PHC
for 446 PHCs
Infection Control Chart:
(1200 posters)
Size 18”*24” @ Rs. 5.00
each
 3 posters per
DH/SDH/CHC
for total 186
institutions
 1 poster per PHC
for 446 PHCs
Medical Waste Disposal
Chart:(1200 posters)
Size 18”*24” @ Rs. 5.00
each
 3 posters per
DH/SDH/CHC
for total 186
institutions
 1 poster per PHC
for 446 PHCs
Funds to
be
budgeted
in PIP
2011-12
(per in
lakh)
1.30
0.75
0.06
0.06
0.06
Anaphylaxis Chart:
(1200 posters)
Size 18”*24” @ Rs. 5.00
each
 3 posters per
DH/SDH/CHC
for total 186
institutions
 1 poster per PHC
for 446 PHCs
Oath of Confidentiality
Chart:
(1200 Chart)
Size 18”*24” @ Rs. 5.00
each
 3 posters per
DH/SDH/CHC
for total 186
institutions
 1 poster per PHC
for 446
Counceling Checklist
chart:
(1200 Chart)
Size 18”*24” @ Rs. 5.00
each
 3 posters per
DH/SDH/CHC
for total 186
institutions
 1 poster per PHC
for 446
Condom Demonstration
Chart:
(4000 charts)
Size 18”*24” @Rs.5.00
each
 3 charts per
DH/SDH/CHC
for total 186
institutions
 1 chart per PHC
for 446 PHCs
 1 chart per SC for
2950 SCs
0.06
Penis Model for condom
Demonstration:
4000 models @ Rs. 30.00
each.
 3 models per
DH/SDH/CHC
for total 186
institutions
 1 model per
PHCfor 446 PHCs
 1 model per SC
for 2950 SCs
Counseling Flip Books.
1.20
0.06
0.06
0.20
1.80
(1200 Flip Book)
Size 12”*8”@ Rs.150each
 3 flip books per
DH/SDH/CHC
for total 186
institutions.
 1 flip Book per
PHC for 446
PHCs.
Sign Board:
(1200 Sign Boards)
Size 18”*24” @ Rs. 150
each
 3 Sign Board per
DH/SDH/CHC
for total 186
institutions
 1 Sign Board per
PHC for 446
PHCs.
Total
Funds
PRP
OSE
D
1.80
7.41