43.nrhm incentive scheme

8/2/2019 43.Nrhm Incentive Scheme

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NRHM INCENTIVE SCHEMES

(Hardship allowances to paramedics in Vulnerable Institutions, all service providers in Specialist Care

Units, all employees in LWE affected areas and retainership allowance for Clinical Manpower)

Health equity is an integral part of Orissa’s vision for health and it is an essential prerequisite for

achieving the MDGs and 11th

plan goals. Availability of health professionals (especially for medical &

paramedic staff) in difficult areas is one important indicator of Government’s commitment to promote

equity.

It is observed that sourcing and retention of health professionals in these difficult areas is a concern

because of the multi faceted challenges that the service providers are regularly confronted with in an

effectively delivering health services.

1) Improvement in health outcomes in difficult areas is directly related to the availability of trained

human resources

2) Difficult geographical terrain and unavailability of basic infrastructure is a major deterrent

against getting good human resource

3) Extremist activities that provide life threats and other inconveniences

4) Low salary/remuneration and better job opportunities in private nursing homes in peripheral &urban areas

5) Low levels of remuneration also do not attract clinical staff from adjacent states which have

higher availability of appropriate clinical staff as compared to that of Orissa

6) Specialized care units require skilled care and intense responsibility

Currently Implemented Incentive Scheme: -

The Health department has made various efforts in retaining staff especially in KBK districts. But the same

is extended only to medicos and staff nurses, but the other paramedics do not come under this scheme.The amount of incentive is provided on 2 broad categories i.e. periphery and headquarter. Within the

periphery category, there is need for categorising the areas and providing incentive according to the

degree of difficulties to reach areas. Apart from this, in non-KBK districts, there are inaccessible areas

which are not covered under the current scheme.

As per the KBK incentives, if the employees are staying in the headquarters, they get an additional sum of

Rs4000 and Rs 8000 if they are residing in the periphery, which is an addition to their basic pay.



New Scheme - Features

Institution specific Incentive schemes instead of incentivisation of service providers as per 2 different

slabs are:

Headquarter and

Periphery

Vulnerability assessment & Mapping Parameters

Every Institution has been assessed for vulnerability and risk with respect to following broad

categories:

A. Inaccessibility and Location of Sub Centre.

B. Characteristics of Service area, which will be served by a service centre.

C. Assessment of conflict i.e. Left Wing Extremism (LWE).

Based on these 3 given principles, the criteria of scoring have been stated in annexure 1 & 2.

Vulnerability Assessment – Process

Self assessment by ANM

Desk appraisal by RKS Executive committee at Block level- To Cross check Profile of all SCs

Desk appraisal by District level Committee (Chairman-CDMO, Members- DPM, DHIO, Programme

Officers(3) as nominated by CDMO) – To cross check minimum 10% of the SC profile per block

Recommendations for incentivizing Service providers

Vulnerability Status

On the basis of total score, Institutions will be categorized as follows:

Sl. No. Score Vulnerability Assessment Category

1 Less than 20 marks Less vulnerable V-1

2 20 to 50 marks Moderate vulnerability V-2

3 >50 to 60 marks High Vulnerability V-3

4 More than 60 marks Extremely vulnerability V-4

OUTCOMES OF THE VULNERABILITY SCORING

DISTRICT TOTAL VI TOTAL V2 TOTAL V3 TOTAL V4

HIGH FOCUSED DISTRICTS 629 2977 546 177

OTHER DISTRICTS 2291 1742 12 11

GRAND TOTAL 2920 4719 558 188



STATE POLICY

HARDSHIP ALLOWANCE

Paramedics serving in V3 and V4 areas will be provided with hardship allowances.

Those serving in V4 areas will be privileged to get double the amount of incentives than the

employees serving in V3 areas.

Monetary and non – monetary benefits will be awarded to those engaged in V3 and V4 areas.

SPECIAL INCENTIVES FOR WORKING IN V3 AND V4 AREAS FOR STRENGTHENING COMMUNITY BASED

INITIATIVES

Each habitation needs to have one ASHA.

ASHA’s serving in V3 and V4 areas will be rewarded with 50 % and 100% extra benefitsrespectively in addition to their incentive.

Allowances on completion of 1 year term in MHU services

PERFORANCE INCENTIVES

Case based incentives for conducting institutional deliveries will be provided in V3 and V4 areas,

if they are labelled as L1 and L2

All staff engaged in specialized institutions like ICU, SNCU, NRCs will be provided a daily

allowance as per the mandated slabs confirming to their positions in the hierarchy

Regular clinical staff would receive a retainership allowance of 10% annually on completion of

one year as a special incentive.

SPECIAL ALLOWANCES FOR LWE AFFECTED AREAS

Insurance coverage for all employees.



HARDSHIP ALLOWANCES FOR SERVING IN V3 AND V4 AREAS

(Details of V3, V4 areas at Annexure-“A”)

Strategies Output Time Frame

Facility Specific Incentive Schemes

Hardship allowance to paramedics : Increased attendance to health

care needs at facility level

Scope: Service providers in V3 and V4 facilities will be awarded with incentives under this scheme.

An incentive amount for Rs 1000 and Rs 2000 will be given to V3 and V4 facilities respectively.

Eligibility Criteria : The following conditions will be admissible for incentives of paramedics for all

categories :

1 – Resides at head quarters of selected V3/V4 facilities

For Sub – Centres that do not have its own building but HW (F) who reside at any of its targeted

village are also eligible to get the incentive

2 – Incentive can also be provided if one avails CL or goes for on job training or any other official duty.

It is not applicable, if one proceeds for on maternity leave or El for more than 10 days.

Payment Modalities : Following documents have to be provided by the eligible Service providers for

getting the incentive:

Head Quarter staying certificate – Signed by :

1 – Self

2 – Chairperson, Gaon Kalyan Samiti of head quarter village /chairperson , GB , RKS , whichever is

applicable to that facility .

3 – Sector , MO /MO (i/c) , whichever is applicable to that particular facility

Incentive will be paid on a monthly basis along with their salary /remuneration

Non – Financial Incentives :

Provision to be made under NRHM PIP

Distance Education course with duty

leave to attend contact sessions

House rent allowances to retain rented

quarters at previous place of non difficult

posting.

District level Awards –Competition will be

organized amongst service providers working

in these areas.

Non – financial incentives

streamlined

SPECIAL INCENTIVES FOR WORKING IN V3 AND V4 AREAS FOR STRENGTHENING COMMUNITY BASED INITIATIVES

ASHA Incentive

Monthly ASHA Incentive for serving at most

difficult blocks :Plus (+)100% of total incentive

earned during the month

Monthly ASHA Incentive for serving at difficult

block:

Plus (+) 50% of total incentive earned duringthe month

Increase in motivation to

serve in difficult areas and

reduction in resistance to

serve in difficult areas by

service providers



Recognition for completing 1 year term in

MHU services

Annual incentive package- Doctor –

Rs.12000/-,Pharmacist / ANM- Rs.6000/-

Attendant /Driver- Rs.2500/-

Increase in motivation and

consensus to serve and

remain in difficult areas

thus reducing the

resistance to serve inthese areas by service

providers.

INCENTIVE FOR WORKING IN SPECIALIZED CARE UNITS

Incentive to Service Providers (Doctors/Staff

Nurse/LT/ANM) providing specialised

services in SNCU-II,NRC ,ICU

Incentives to be provided on the basis of daily

allowances.

For doctors it is Rs. 100/ per day, For

paramedics, Rs. 75/ per day and other support

staff get Rs. 50/ per day.

Improved quality of

health care services due

to high levels of

motivation.

SPECIAL ALLOWANCES FOR LWE AFFECTED AREAS

Sustained motivation for retention of Employees in life 87* blocks in 15 districts threatening conditions

Insurance coverage with money back policy.

*as per reports of the Planning Commission,

naxalism is insurgent movement has become

a force to reckon with in the districts like

Malkangiri , Rayagada ,Gajapati , Deogarh and

Sambalpur . However , district reports

received by the Health Department have

shown that the movement has affected 87

blocks in 15 districts inclusive of 37 blocks in

five districts mentioned above .This is based

on the consistent occurrence/threats of naxal

violence in the last five years.

Insurance coverage will be

done in all the 87 blocks

by the service providers.

Retainership Allowance for paramedic staff

Regular clinical staff will receive a retainership

allowance of 10% annually on completion of

one year as a special incentive.

Lower incidence of staff

turnover and increased

retention in one place of

posting

Budget in – B.17 (NRHM Initiatives)

43.nrhm incentive scheme

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