National Rural Health Mission Review Workshop - Progress & Recommendations in 13 States

1. 2nd National Rural Health Mission Ministry of Health & Family Welfare Government of India Common Review Mission

2. Outcomes of today’s workshop • Introduction to CRM • Presentations by Constituents of NRHM • Logistics of 2nd CRM. • Format of Report

5. Perspective of 2nd CRM

6. Historical Perspective of NRHM • 1st year (2005-06) was Preparatory phase • 2nd year (2006-07), Framework for Implementation approved. • 3rd year (2007-08) was the 1st full year of Implementation. • FY 2008-09 is the most crucial year for the Mission. • This is also the year of consolidation • All State PIPs appraised and approved by NPCC • Almost the entire 12 month period available for implementation. • CRM is part of overall monitoring and evaluation framework

7. 2nd CRM is being undertaken with following overall mandate • To review changes in health system since launch of NRHM • through field visits and spot examination of relevant records. • To document evidence for validating key paradigms of NRHM • including decentralization, infrastructure and HR augmentation, communitisation and others, • To identify key constraints limiting the architectural correction. • To recommend policy and implementation level adaptations • to accelerate achievement of the goals of NRHM.

8. The Mission will cover thirteen States, • selected with a view to provide a representative picture of the progress made • Assam • Bihar • Chhattisgarh • Jharkhand • Karnataka • Kerala • Madhya Pradesh • Maharashtra • Mizoram • Orissa • Rajasthan • Tamil Nadu • Uttar Pradesh

9. The Mission will cover thirteen States, • selected with a view to provide a representative picture of the progress made • Assam • Bihar • Chhattisgarh • Jharkhand • Karnataka • Kerala • Madhya Pradesh • Maharashtra • Mizoram • Orissa • Rajasthan • Tamil Nadu • Uttar Pradesh 1st CRM covered Andhra Pradesh, Assam, Bihar, Chhattisgarh, Orissa, Madhya Pradesh, Gujarat, Jammu and K, Rajasthan, Tamil Nadu, Tripura, Uttar Pradesh and West Bengal.

10. The Mission will cover thirteen States, • selected with a view to provide a representative picture of the progress made • Assam • Bihar • Chhattisgarh • Jharkhand • Karnataka • Kerala • Madhya Pradesh • Maharashtra • Mizoram • Orissa • Rajasthan • Tamil Nadu • Uttar Pradesh

11. The Mission will cover thirteen States, • selected with a view to provide a representative picture of the progress made • Assam • Bihar • Chhattisgarh • Jharkhand • Karnataka • Kerala • Madhya Pradesh • Maharashtra • Mizoram • Orissa • Rajasthan • Tamil Nadu • Uttar Pradesh

12. Items to be reviewed during 2nd CRM Part 1 Change in key aspects of Health delivery system Part 2 Progress against the approved PIP of the state

13. Part 1 Change in key aspects of Health delivery system 19 key indicators (Refer ToR)

14. Assessment of case load at Public System at all levels Preparedness of facilities for patient care, utilization of services Quality of services Utilisation of diagnostic facilities and their Drugs and Health Human Resource Planning Infrastructure Empowerment for effective decentralization, local action. ASHA Systems of financial management

15. HMIS and its effectiveness • Usernames, password, formats, training • Community Processes under NRHM • Assessment of NGO partnerships for public health goals • Systems in place for outreach activities of Sub-centre • Thrust on difficult areas and vulnerable social groups • Preventive, promotive health aspects, inter-sectoral convergence and links with social determinants of health • Effectiveness of the disease control programmes • Quality of MCH and FP services • Assessment of management structure at district and state level

16. Time Lines of NRHM

17. Progress against Time Lines (nov 2008)

29. Time Lines Check List for State level discussion

35. Progress of Community Mon For information

36. Progress of community monitoring Assam Out of total 135 VHSCs envisaged to be constituted in Phase-I, 124 have already been formed out of which orientation of 30 committees has been completed. Out of 27 PHC level Community Monitoring Committees envisaged to be constituted in Phase-I, only six have been constituted in Chirang District. Government orders for constitution of PHC level committees in other districts are awaited. Out of the nine block level and three district level Committees envisaged to be constituted none have been operationalised as on date. The block orientation workshops are also pending. Out of three media workshops to be undertaken in this phase, only one has been conducted. 25 village level report cards have been generated in Chirang district.

37. Chhattisgarh All 135 VHSC, all 27 PHC level committees and all nine block level committees have been constituted. The orientation of all these is pending. Constitution of district level committees is pending. All nine block provider workshops have been completed.. The other activities envisaged in this phase are also pending. Jharkhand All 135 VHSCs envisaged to be constituted in phase one has been operationalised. 27 SC level committees (out of 27) have been constituted out of which all 27 have also been oriented. All nine block level committees have been constituted. The district level committees are yet to be formed. Six (out of nine) block providers orientation workshops have been conducted till date. The other activities envisaged in phase I are still pending.

38. Progress of community monitoring as on 15th August 2008 Karnataka All 180 VHSCs have been constituted. The orientation however, is still pending. Committees at PHC, Block, district and the state level are still pending. The block provider workshops, media workshops and other activities envisaged in phase-I are also pending. Tamil Nadu All 225 VHSCs, 45 PHC level, 15 Block level and five district level CMCs have already been constituted and oriented. All 15 block providers’ orientation workshops have been constituted. 210 village report cards have been generated,The other activities including media workshops and Jansunwai are pending.

39. Part 2 Progress against the approved PIP of the state

40. All state PIPs for FY 08-09 have been appraised, approved. • Funds being released to states on basis of approved plans • The teams may chart progress of implementation for 2008-09 • of initiatives which have been approved in state PIP. • Blank fill up forms of RoP for easy writing are enclosed. • Earlier years RoP mappings is given only for information • Checklist for charting progress against approved activities enclosed. • Give objective, measurable data for 08-09 • Comment on quality

41. PIP Mapping Check List

42. Kerala Activities supported under NRHM 2008-09 MISSION FLEXIBLE POOL (Amount in lakhs)

43. Kerala Activities supported under NRHM 2007-08 MISSION FLEXIBLE POOL (Amount in lakhs)

44. Kerala Activities supported under NRHM 2006-07 MISSION FLEXIBLE POOL (Amount in lakhs)

45. Kerala Activities supported under NRHM 2005-06 MISSION FLEXIBLE POOL (Amount in lakhs)

46. Other Checklists in the folders

47. Other Checklists in the Resource material Folder • Child Health Checklist • Family Planning Checklist • Financial Management Group Checklist. • NVBDCP Checklist • IDSP Checklist • RNTCP Checklist

48. Format of Report 2nd CRM

49. Format for Report of 2nd CRM • Introduction • Introduction of the state. • Base line of Public Health System in the state • Infrastructure, HR, Indicators • Status of the PRI framework in the state • Others, Special Constraints • The complete list of the facilities visited by the team • Chapter on the Mandate of CRM • Draft the mandate of CRM for respective state keeping in mind the overall mandate of 2nd CRM & state specific issues which come up during the initial briefings and discussions with state officials. • Ensure sharp focus on felt needs. • Be amenable to drafting of a clear road map for future. • Be objective as well as sensitive to the local constraints

50. Format for Report of 2nd CRM • 3.Chapter on findings of the 2nd CRM in the state • This chapter should contain the following details • Progress of operationalisation of Institutional Framework of NRHM • (VHSC, RKSs, State and District Health Missions etc), • b. Comment of issues in ToRs of 2nd CRM (19 points) • c. Map progress against PIP for 08-09 • d.Map progress against time lines of NRHM • 4.Chapter on recommendations • Report should mention specific suggestions, recommendations for accelerating implementation. • 5.Chapter on other State Specific issues • This chapter may include observations, suggestions on issues not covered in any other chapter of the report .