Strengthening Health Systems with NRHM: Sector-wide Reform Strategies

1. Tarun SFTs orientation Feb 2008

2. What is NRHM Sector wide reform agenda. All component programmes can adopt its paradigms. Align IEC, Training, MIS, Procurement and Finance protocols to facilitate greater synergy. The central, non negotiable theme is : “Pre stated Service entitlements” All inputs/procedures to be (re) computed as a function of this. Key Principles include Enhanced funding, Untied funding, Decentralisation, Community ownership, capacity building, No new posts at this stage Recruit contractually with local residency criteria Recruit against specific facility & remunerate realistically Fill up state vacancies if they exist

3. NRHM is not a scheme/project/programme It is a overarching umbrella to strengthen health system and improve efficiency of constituent initiatives NRHM is not ‘expanded RCH II’ Cross cutting / common strategies Expanded paradigm for Health sector reform NRHM is not about substitution of state funding by GoI Performance & milestone based funding 15 % funding by state in XI plan Increase state budget by 10 % annually Rationalise administrative and financial sanction powers NRHM is not about contractual workers Decentralised articulation of need and local site solutions instead of centrally driven recruitment/procurement/planning. What NRHM is not

4. The Strategies Infrastructure upgradation Sub Centres made functional Additional contractual ANMs Untied funds Community link worker Village Health Nutrition committees Expanded Medicines supply PHCs made 24 x7 Three staff nurses Annual maintenance grant Untied funds AYUSH Integration Rogi Kalyan Samiti

5. Infrastructure upgradation CHCs upgradation First Referral Units Facility survey IPHS Untied funds Rogi Kalyan Samiti District Hospital upgradation Facility survey IPHS Rogi Kalyan Samiti The Strategies

6. Manpower augmentation Filling up vacant posts/Creating more posts Contractual positions to fill gaps Trainings / expanding training capacity Rational transfer and posting policy Health sector planning Household surveys & Village Health Plans. Integrated District Health Action Plans. Annual PIPs / Perspective Plans. SPMUs/ DPMUs/ Block PMUs NHSRC/ SHSRC The Strategies

7. Improved service delivery Citizen’s charter Monthly Health & Nutrition Day Outsourcing critical service gaps Catch up rounds of Immunisation Improved IP & OP utilisation Mobility Support / Mobile Medical Units Maternity Benefit Schemes Systemic improvements Improved logistics. Rational / Optimal positioning of manpower Rational delegation (financial & Administrative) Decentralised procurement The Strategies

8. Monitoring & Evaluation Review meetings State visits – evaluation teams, RDs Integrated MIS External Surveys Immunisation - UNICEF ASHA & JSY – UNICEF, UNFPA, GTZ Financial protocols- Institute of Public Auditors Concurrent External Evaluations Community monitoring Encouraging State Innovations The Strategies

9. Check List

36. Differences in Norms of High Focus & Other States 18 High Focus states which include : 8 Empowered Action Group States : Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Orissa and Rajasthan 8 NE States Himachal Pradesh and Jammu & Kashmir. High Focus states are entitled to : Fund allocation with weightage of 1.3 (for NE states 3.2) Upto 30 % of allocation may be deployed for civil construction Other than High Focus states are entitled to : Fund allocation with weightage of 1.3 (for NE states 3.2) Upto 25% allocation may be deployed for civil construction All other strategies are applicable in the same manner uniformly across all states.