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MD presentation for SFT Orientation 4th Feb 2008

MD presentation for SFT Orientation 4th Feb 2008. NRHM – State PIPs. Key reform issues for appraisal. NRHM – The Reform Agenda. Health is a State subject NRHM is a Centre – State Partnership Central funds to push reforms Accessible, affordable and accountable health care as priority

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MD presentation for SFT Orientation 4th Feb 2008

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  1. MD presentation for SFT Orientation 4th Feb 2008

  2. NRHM – State PIPs Key reform issues for appraisal

  3. NRHM – The Reform Agenda Health is a State subject NRHM is a Centre – State Partnership Central funds to push reforms Accessible, affordable and accountable health care as priority Addressing wider determinants of health Innovations in human resource engagement –THE RESIDENT HEALTH WORKER

  4. NRHM – State’s perception Source of funds for local action Opportunity to push reforms Using NRHM’s conditionality to convince State level decision makers – finance, planning, the health minister. Opportunity to bring in human resources Improve health sector performance Meet unprecedented demand for services

  5. NRHM – 5 MAIN APPROACHES COMMUNITIZE 1. Hospital Management Committee/ PRIs at all levels 2. Untied grants to community/ PRI Bodies 3. Funds, functions & functionaries to local community organizations 4. Decentralized planning, Village Health & Sanitation Committees MONITOR, PROGRESS AGAINST STANDARDS 1. Setting IPHS Standards 2. Facility Surveys 3. Independent Monitoring Committees at Block, District & State levels FLEXIBLE FINANCING 1. Untied grants to institutions 2. NGO sector for public Health goals 3. NGOs as implementers 4. Risk Pooling – money follows patient 5. More resources for more reforms IMPROVED MANAGEMENT THROUGH CAPACITY 1. Block & District Health Office with management skills 2. NGOs in capacity building 3. NHSRC / SHSRC / DRG / BRG 4. Continuous skill development support INNOVATION IN HUMAN RESOURCE MANAGEMENT 1. More Nurses – local Resident criteria 2. 24 X 7 emergencies by Nurses at PHC. AYUSH 3. 24 x 7 medical emergency at CHC 4. Multi skilling

  6. NRHM – ILLUSTRATIVE STRUCTURE Health Manager BLOCK LEVEL HEALTH OFFICE –--------------- Accountant Store Keeper Accredit private providers for public health goals 100,000 Population 100 Villages BLOCK LEVEL HOSPITAL Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics 30-40 Villages CLUSTER OF GPs – PHC LEVEL 3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses – 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests 5-6 Villages GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic 1000 Popu lation VILLAGE LEVEL – ASHA, AWW, VH & SC 1 ASHA, AWWs in every village; Village Health Day Drug Kit, Referral chains

  7. Key planning and appraisal issues Does the plan address the need ? Is it large enough to make an impact? Is there evidence to support the strategy? Have local communities been consulted? Is the programme delivery arrangement worked out to the last detail? Is the situation analysis objective? Have key governance issues been addressed? Evidence of inter sectoral convergence

  8. Key Appraisal issues Rational deployment of human resources Filling up of key vacancies Utilization of untied resources Service guarantees Capacity development plan Detailed analysis of programme delivery Evidence based thrust

  9. Appraisal/Approval Process State PIP emailed to all concerned State to make presentation on PIP before Appraisal Sub Group Nodal officer, Director/DS to collect written/oral comments of all Programme Divisions and send appraisal note to State within four days of the Sub Group Appraisal meeting State to submit revised proposal before NPCC Nodal Director to prepare Record of Proceedings in standard format

  10. NRHM Planning Framework District Planning Framework circulated to States covers all Programme Divisions and their key parameters in detail State PIP to have 5 parts – A, B, C, D & E Part A – RCH Flexi Pool proposals Part B – NRHM Mission Flexible proposals Part C – Immunization proposals Part D – Disease Control Programme proposals Part E – Inter-sectoral convergence proposals

  11. Classifying proposal appropriately As a principle, funding of programmes to be from Programme Division financial pool Cross cutting and health system strengthening funding from NRHM Mission Flexible pool Innovations in a particular sector for PPP etc. to be from programme funds of that sector

  12. A few issues from last year Overlap of proposals of RCH-II and NRHM Flexible Pool – largely due to large JSY demand Civil works programme without Sub Centre construction – UP – lack of understanding of guideline Delays in Programme Division specific appraisal of issues.

  13. NRHM sources of funding RCH flexible pool covering RCH activities, JSY and sterilization NRHM Mission Flexible pool providing for system strengthening and cross cutting activities Resources for immunization, pulse polio etc. Resources for Disease Control programmes (NVBDCP, NPCB, RNTCP, NLEP, NIDDCP, IDSP etc.) Inter-sectoral convergence resources from NRHM Mission Flexible Pool Infrastructure maintenance fund through treasury route, salary of ANM etc.

  14. NRHM Resource envelope for States Resource envelope communicated to States based on budget approval Approved formula for resource allocation – 1.0, 1.3, 2.0 15% share of overall NRHM resources from States State share to be credited to State Health Society account

  15. Reform issues in PIP Rational deployment of doctors and paramedics Filling up of existing vacancies of State Government posts, MPW, ANM, Doctors, Specialists etc. Establishing credible procurement and logistic system Creating sub-district Specialist cadre – identifying Post Graduate GDMOs Performance based payment criteria and proposals

  16. Preparedness to deliver PIP is an action plan – not only statement of intent States must specify how they will do, what they have proposed Systems for capacity building at each level needs to be specified Innovative PPP proposals must work out details Thrust on service guarantees with interventions need to be assessed

  17. Community Institutions Progress of community institutinos and their effectiveness needs monitoring RKS, VH&SC, PRIs at various levels, regularity of State and District Health Mission meetings Preparedness to implement seen in management structure at block, district and state level

  18. Important accounting parameters Common audit of all programmes – report by 31st July for accounts of previous year System of quarterly FMR due 30 days after end of quarter MIES format reporting Programme monitoring Delegation of administrative and financial powers Double entry book keeping

  19. System of monitoring review and evaluation Community monitoring initiated with a few States Concurrent evaluation finalization on 23rd February Common Review Mission and Joint Review Missions Structured State visits

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