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 (<3 pages) on the best practice on
Responsiveness, transparency and accountability separately
Suggested structure:
– Background: (Elaborate on the problem, which the innovation seeks to
address; and in particular, provide details of target group/ base line
data, if available)
– Description of the innovation: (Including date of commencement and
current status; coverage in terms of districts/ blocks/ villages; overall
approach / strategy; implementation/ institutional arrangements;
whether pilot / scaled up)
– Costs: (Broad break up of one-time and recurring costs; assessment of
cost effectiveness)
– Sustainability: (Assess organisational and financial sustainability and
approach to ensuring the same)
– Outcome: (Extent to which base-line conditions have improved; results
of third party evaluations, if carried out)
Thank You