Revised_NRHM_Physical_Blue_background

Review Meeting with State’s Health Secretaries, Mission Directors & Directors of Health Services 11th& 12th Sept. 2012 --- JS (Policy)

1

• MMR (212 as per RGI report 2007-09) – Annual Rate of decline between 2004-06 and 2007-09 is 23% higher than annual rate of decline between 19992001 and 2004-06 – EAG States showed a decline of 67 points in MMR (in 2007-09 compared to 2004-06) against a National Decline of 42 points

Status of Drop in MMR (in points) from 2004-06 to 2007-09

Assam U P/Uttarakhand Rajasthan M P/Chhattisgarh Bihar/Jh. Orissa INDIA Karnataka Haryana Maharashtra Punjab Andra Pradesh TN Kerala Gujarat

90 81 70 66 51 45 42 35 33 26 20 20 14 14 12 0

20

40

60

2 80

• IMR reduced from 58 in 2005 to 47 as per SRS 2010 – Rate of Decline of IMR accelerated by 29 % between 2005-10 as compared to 2000-2005 – Decline in Rural IMR and U5MR is higher than the decline in urban areas, thereby narrowing the Rural - Urban Gap – Decline of U5MR & IMR is more in EAG States • India has remained free of Wild Polio for more than a year 3

Category

State

Bihar UP Very High Focus MP states for FP Rajasthan Jharkhand Chhattisgarh

SRS-2005

SRS-2010

Point Change

4.3 4.2 3.6 3.7 3.5 3.4

3.7 3.5 3.2 3.1 3.0 2.8

-0.6 -0.7 -0.4 -0.6 -0.5 -0.6

All India 2.9 2.5 0.4 • Nationally Rate of Decline of TFR between 2005-2010 increased by 47 % as compared to 2000-2005 • All the 6 very high focus states have shown a decline equal to or better than All India average • Steepest decline in annual growth rate from 1.97 to 1.64 since 4 independence

Malaria Mortality Reduction Rate

55% mortality reduction in malaria in 2010 as against 2006

Dengue Mortality Reduction Rate

26% mortality reduction in dengue in 2010 as against 2006

Cataract operations

More than 60 Lakh Cataract Operations every year

Reduced from 1.8 per 10000 in 2005 to Leprosy Prevalence Rate less than 1 per 10000 Tuberculosis

73% case detection rate and 88% Cure rate 5

• Over 1.5 lakh Human Resource added (on a baseline of 2.17 lakh) • 2315 Referral Hospitals strengthened to act as First Referral Units (FRUs) with capacity to provide comprehensive obstetric emergency care

• 8475 PHCs upgraded as 24x7 PHCs • 2012 Mobile Medical Units (MMUs) provided in 449 districts for delivery of health care in difficult areas • 7218 Emergency Response / basic ambulance service vehicles • Nation-wide system of HMIS and MCTS set up to ensure and monitor health interventions 6

SHORT FALL OF DOCTORS, SPECIALISTS AND NURSING STAFFS (IN PERCENTAGE OF TOTAL REQUIREMENT)

SHORT FALLS OF DOCTORS IN PHCs AND SPECIALISTS IN CHCs 80% 70% 60% 50% 40% 30% 20% 10% 0%

68% 65% 64% 63% 62%

58%

35%

SOURCE: RHS 2011

SHORT FALL OF NURSING STAFFS IN PHC AND CHC 80% 70% 60% 50% 40% 30% 20% 10% 0%

73% 64%

72% 63% 60%

23%

SHORT FALL OF PARAMEDICS AND MPW (In % of total requirement) SHORT FALL OF PARAMEDICS IN CHCS 100% 92% 90% 82% 80% 70% 70% 57% 56% 60% 50% 40% 30% 20% 10% 0%

42%

SHORT FALL OF MPW (MALE) IN SUB CENTERS 120% 100%100% 92% 89% 100% 86% 80% 65% 60% 40%

20% 0%

SOURCE: RHS 2011

INFRASTRUCTURE STRENGTHENING- I New Construction (Completion Rate < 30%)

SUB CENTRE (SC)

PRIMARY HEALTH CENTER (PHC) COMMUNITY HEALTH CENTER (CHC)

DISTRICT HOSPITAL (DH)

• J&K, CHATTISHGARH • ANDHRA PRADESH

• ANDHRA PRADESH, W.BENGAL, MAH., TN, DELHI • JHARKHAND, ODISHA, UTTARAKHAND, • ARUNACHAL PRADESH, MEGH. , NAGALAND, TRIPURA

• KERALA, W. BENGAL, HARYANA, KARNATAKA, MAHARASHTRA, UTTARAKHAND, UP • NAGALAND, ASSAM, MIZORAM

• KERALA • ODISHA, UTTARAKHAND, J&K

INFRASTRUCTURE STRENGTHENING- II Renovation And Up gradation SUB CENTER (SC)

(Completion Rate < 30%) • CHHATTISGARH, J&K, UTTARAKHAND • ARUNACHAL PRADESH, SIKKIM • A&N ISLANDS

• CHATTISHGARH, JAMMU & KASHMIR, SIKKIM PRIMARY HEALTH CENTER (PHC) • ANDAMAN & NICOBER , CHANDIGARH, DELHI, PODUCHERRY

COMMUNITY HEALTH CENTER(CHC)

• BIHAR, J&K, MANIPUR, GOA, WEST BENGAL • A&N ISLANDS, DELHI

DISTRICT HOSPITAL (DH)

• UP, J&K, MANIPUR, NAGALAND, ANDHRA PRADESH, HARYANA, KERALA, WEST BENGAL • A&N ISLANDS, CHANDIGARH, DELHI

CONSTITUTION OF VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEE (VHSNC) 100%

90%

PERCENT OF VHSNC CONSTITUTED OUT OF TOTAL VHSNC REQUIRED

80%

72%

93%

97%

97%

98%

78%

70% 60%

49%

50%

50%

54%

40% 30% 20%

16%

10% 0%

SOURCE: RHS 2011

STRENGTHENING HEALTH INSTITUTIONS- I (24X7 PHCs) 120% 100% 80%

States with less than 50% of total 77% PHCs as 24X7 PHCs

60% 35%

40% 20%

0%

4%

19% 14% 14% 13% 10%

96% 100% 100%

STRENGTHENING HEALTH INSTITUTIONS- II (FRUs) States with less then 50% of DH, SDH &CHC as FRUs 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

91% 92% 69% 71% 55% 36%

4%

18% 18% 19% 14% 11% 13%

Action Plan for the Year 2012-13

STATES WITH CUSHION MORE THAN Rs 10 Crores 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0

474.41

113.41

In Crores

185.74 134.64

53.52 31.58

35.72

46.04 92.34 12.4

RESOURCE ENVELOPE

AMOUNT APPROVED

CUSHION AVAILABLE

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 1. Rational deployment of HR with the highest priority accorded to high focus districts and delivery points (Non compliance would lead to reduction of up to 7½ %) Conditionalities and incentives

Progress by the State

1.1 Rational deployment policy including- Posting of staff on the basis of case load, rational deployment of specialists, priority to HF districts

In place by October, 2012

Minimum for all delivery 1.2.1 Preparation of baseline data for points and SCs in high HR focus districts; by Nov 2012 90% of all delivery points 1.2.2 Evidence of corrective action in staffed as per norms, line with the policy 90% of all SCs in high focus districts should have at least one ANM

% incentive/ Disincentive Otherwise, deduction of 2% of MFP

Method of verification Policy notification ; Website posting

Otherwise, deduction of 2% of MFP.

Website posting and state report

Otherwise, deduction of 2% and 1.5% of MFP respectively.

State report; website posting by December 2012.

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 2. Facility wise performance audit and corrective action based thereon. (Non compliance would lead to reduction of up to 7 ½% of MFP) Conditionalities and incentives

Progress by the State

% incentive/ Disincentive

2.1.1 Range of services (as in MNH guidelines for RCH services, OPD, IPD Up to 2½ % of and other services to be determined By September, 2012 MFP by the State) specified at least for delivery points

Method of verification State report and Website posting by September, 2012

State report ; Up to 2½ % of State HMIS By November, 2012 MFP October data to be uploaded by November State reports on 2.2.2 Corrective action (priority to be By November, 2012 Up to 2½ % of corrective action given to high focus districts) based on MFP by Nov, 2012. facility wise reporting. 2.2.1 Facility wise reporting on HMIS portal by all priority facilities/delivery points for October( SC data if needed be uploaded from PHC)

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 3. Gaps in implementation of JSSK (May lead to a reduction in outlay upto 10% of RCH base flexi-pool) Conditionalities and incentives

Progress by the State

% incentive/ Disincentive

Method of verification Copy of GO ; Website posting

3.1.1 Government order for coverage of By Sept’ entire State regarding JSSK 2012

Upto 2½% of RCH base flexi-pool

3.2.1 State wide dissemination of GO/policy, By Oct’ visible IEC in facilities and community 2012 awareness

Sample Up to 2½% of RCH community visits base flexi-pool

3.2.2 No user charges. Free Drugs, By Oct’ diagnostics, diet. Grievance redressal system 2012 operational

Upto 2½% of RCH base flexi-pool

Field visits; exit interviews grievance redressal records.

3.2.3 At least 50% of pregnant women and sick newborns coming in should be using By Nov’ assured and cashless means of transport- 2012, and getting a similar drop back home

Upto 2½% of RCH base flexi-pool

-do-

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 4. Continued support under NRHM for 2nd ANM would be contingent on improvement on ANC coverage and immunization as reflected in MCTS. Vaccines, logistics and other operational costs would also be calculable on the basis of MCTS data Conditionalities and incentives

Progress by the State

Method of verification

Increase in AprilMCTS website ; state 4.1 Increase in ANC coverage ( first ANC and full ANC) as per MCTS December 2012 over report by January, 2013 data in (1) State (2) High Focus the same period last year districts Increase in AprilMCTS website ; state 4.2 Increase in full immunization as December 2012 over report by January, 2013 per MCTS data in (1) State (2)High the same period last Focus districts year

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 5. Responsiveness, transparency and accountability ( incentive upto 8% of MFP) Conditionalities and incentives 5.1 Demonstrated including innovations for responsiveness in particular to local health needs e.g use of epidemiological data, active participation of public representatives in DHS / RKS meetings , etc. 5.2 Demonstrated evidence/innovation for transparency e.g. mandatory disclosures and other important information including HR posting etc. to be displayed in the State NRHM websites etc.

Progress by the % incentive/ State Disincentive

Innovation implemented and impact demonstrated; State to send brief report in format suggested by November, 2012. ( one 5.3 Demonstrated evidence/innovation for innovation in accountability: e.g. initiatives in community each of the monitoring, Jan sunwai etc three areas)

Method of verification

State report Up to 8% of (format in MFP Annex 1) by November, 2012 ; state visits for rapid appraisal

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 6. Quality assurance (incentive upto 3% of MFP) Conditionalities and incentives 6.1.1 States notify policy/strategy (align to policy) as well as standards

Progress by the State

% incentive/ Disincentive

quality In place by November national 2012

6.2.1 Constitute dedicated teams. Training of state and district quality team and DH quality team completed 6.2.2 Current levels of quality measured for all “priority facilities” and scored and available on public domain. Deadlines for each facility to achieve quality standards declared

Up to 3% of MFP

Method of verification Notification and state report by November, 2012

State team trained by November 2012 Quality scores of all priority facilities available in public domain

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 7. Inter-sectoral convergence (incentive upto 3% of MFP) Conditionalities and incentives

Progress by the State

% incentive/ Disincentive

7.1.1 Implementation frame work for intersectoral By Up to 1% of convergence with allied November MFP sectors/departments 2012

Method of verification

State report (copy of implementation framework )

7.2.1 Intersectoral convergence By Up to 2% of Government opportunities identified with November MFP order , State WCD, PHED, education, etc. 2012 report and action initiated.

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 8. Recording of vital events including strengthening of civil registration of births and deaths (incentive upto 2% of MFP). Conditionalities and incentives

8.1 A strategy paper identifying reasons and the road map for increasing registration

8.2 Death reports with cause of death (especially any under 5 child or any woman in 15 to 49 age group) shared with district health team on monthly basis.

Progress by the State

By October 2012

By November 2012

% incentive/ Disincentive

Method of verification

Strategy Up to 1% of document MFP and policy statement. Death reports Up to 1% of received at MFP district levelverified in sample of districts.

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 9. Creation of a public health cadre (by states which do not have it already) (incentive upto 10% of MFP) Conditionalities and incentives

Progress by the State

9.1.1 Stated policy and road map Policy & road map in (including career path on creation place by November , of a public health cadre) 2012

9.2.1 Notification for creation of Government order in public health cadre place.

% incentive/ Disincentive

Method of verification

State report Up to 4% of website MFP posting by November , 2012 Website Up to 6% of posting / MFP state report

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 10. Policy and systems to provide free generic medicines to all in public health facilities( incentive upto 5% of MFP ) Conditionalities and incentives

Progress by the State

10.1.1 Clear policy articulation of free By October generic medicines to all in public health 2012 facilities 10.2.1 EDLs finalised and drug formulary By published and made available in all public November health facilities 2012 10.2.2. Overall procurement and logistics strategy in place. Detailed design and plan By for rate contracting, regular stock up November dates, indent management, warehousing, 2012 promotion of rational drug use, contingency funds with devolution of financial powers etc. in place.

% incentive/ Disincentive

Method of verification

Website Upto 2% of posting / state MFP report Notification/ Publication/ Web posting Up to 3% of State report/ MFP strategy document

Responsiveness, transparency and accountability Format for state report State to provide a brief write up (