REVIEW MEETING WITH STATE’S HEALTH SECRETARIES, MISSION DIRECTORS & DIRECTORS OF HEALTH SERVICES11th& 12th Sept. 2012

--- AS & MD (NRHM)

KEY CHALLENGES

1• Utilizing fully the NRHM funding

for 2012-13

2• Doing it Well…….i.e. More Health

for Money !!

3• Getting prepared to absorb the

enhanced funding from next year onward

HIGHLIGHTS OF PIP 2012-13

JANANI SHISHU SURAKSHA KARYAKRAM

Drugs, Rs. 549.40 Cr

Diagnostics & Blood,

Rs.130.79Diet, Rs.152.08

Cr

Referral Transport,

Rs. 1232.11 Cr

Rs. 2082.47 Crores Allo-cated under JSSK in 2012-

13

• An evaluation by NHSRC shows several gaps in implementation including non-availability of drugs

• Way forward is to ensure wide publicity, public grievance redressal mechanism and earnest implementation.

• Nation-wide IEC campaign on JSSK on the anvil.

Target Coverage1.13 Crore pregnant women 11.31 lakh sick neonates

MATERNAL & CHILD HEALTH WINGS - OVER 19,000 ADDITIONAL BED CAPACITY – A STEP TOWARD STRENGTHENING DELIVERY POINTS

950.44

32.02

176

Total Project Cost: Rs 3026.71 Crores

Funds Approved in 2012-13: Rs. 1158.46 Crores

100 bedded MCH wing at DH 50 bedded MCH wing at DH30 bedded/ 50 bedded CHCs/ SDH

Type of MCH wing

No. of MCH

wings100 bedded

MCH wing at DH 148

50 bedded MCH wing at DH

9

30 bedded/ 50 bedded CHCs/

SDH

110

TOTAL 267

PLUGGING THE GAPS IN INFRASTRUCTURE

• More than 3894 – Ongoing/ Spill Over works

• More than 3284 - Repair/renovation works

• More than 5196 –Hospital Strengthening/ IPHS works

• More than 1311 new construction works

Rs 1200.79 Crore

Rs 892.40 Crore

Rs 428.51 Crore

Rs 413.67 Crore

AUGMENTATION OF HUMAN RESOURCES

• Over 1.60 lakh service providers (specialists,

MOs, Staff Nurses, ANMs etc.)

Rs 2339.40 Crore

•13921 AYUSH MOs•6234 AYUSH Pharmacists

Rs 343.09 Crore

• Over 20 thousand staff in the Programme

Management Units Rs 445.79

Crore

DRUGS & EQUIPMENTS…

• Provision of Free Essential

Drugs

Rs. 1300.26 Cr.

• Procurement of Essential Equipments

Rs. 246.82 Cr.

Rs. 598.84 Crore

11736 ambulances (108-102)

Ambulances

Rs 304.38 Crore

1923 MMUs

MMUs

2820 New

Ambulances

341New

MMUs

SCHOOL HEALTH PROGRAMME

Rs 383.41 Crore

2398 Dedicated mobile teams

10.10 lakh

schools

22.54 Crore

students

Universal Screening to focus on 3 Ds:•Disease•Deficiency•Disability

ADDRESSING ADOLESCENT HEALTH

Rs 131.38 Crore

WIFS supplemen

tation

11.80 crore beneficiari

es

Rs 19.85 Crore

2376 Mobile

Clinics for Adolescent

s

251 ARSH counselors and ARSH trainings

Rs 2.93 Crore Menstrual Hygiene

Programme

Focus on rural

adolescent girls

JSY; 1784.45

Urban & Tribal RCH;

275.74

FBNC; 192.03

FP (Camps

& Comp.), 550.41 PC- PNDT; 14.86

Other Major Activities under RCH Flexipool (Rs.

In Crores)

762.74

1107.37246.52

299.12

289.9

433.6

Other Major Actitivties under MFP (Rs. In Crores)

ASHA

Corpus Grants

IEC/BCC

MMUs

M & E

New Initiatives/ Innova/PPP

8282.03

9615.24000000001

850.751451.76

4290.91

Programme-Wise Ap-provals (Rs. In Crores)

RCHMFPImmunizationNDCPsInfrastructure Main-tainance

Name of the State

Resource Envelope (Rs

in Crores)

Amount Approved

(Rs in Crores)

Cushion Available (Rs in Crores)

Uttar Pradesh 4672.75 4198.34 474.41Andhra Pradesh 1738.28 1552.54 185.74Assam 1618.46 1483.82 134.64

Bihar 2007.51 1894.1 113.41Delhi 373.52 281.18 92.34West Bengal 1420.87 1367.35 53.52Chhattisgarh 838.26 792.22 46.04Karnataka 1068.47 1032.75 35.72Tamil Nadu 1363.93 1332.35 31.58Sikkim 68.07 55.67 12.4

TASK STILL INCOMPLETE: CUSHION AVAILABLE WITH STATES

MEASURING PROGRESS

REVISITING KEY CONDITIONALITIES - AN OPPORTUNITY FOR INCENTIVESConditionality Incentive

Responsiveness, transparency and accountability

Incentive upto 8% of MFP

Quality assurance Incentive upto 3% of MFP

Inter-sectoral convergence Incentive upto 3% of MFP

Recording of vital events including strengthening of civil registration of births and deaths

Incentive upto 2% of MFP

Creation of a public health cadre (by states which do not have it already)

Incentive upto 10% of MFP

Policy and systems to provide free generic medicines

Incentive upto 5% of MFP

REVISITING KEY CONDITIONALITIES

Conditionality Disincentive

Rational deployment of HR with the highest priority accorded to high focus districts and delivery points/priority facilities

Reduction of up to 7 ½% of outlay

Facility wise performance audit and corrective action based thereon.

reduction of up to 7 ½% of MFP

Effective implementation of JSSK reduction in outlay upto 10% of RCH base flexi-pool

Improvement on ANC coverage and immunization as reflected in MCTS.

Discontinuation of support under NRHM for 2nd ANM

MANDATORY DISCLOSURESSr. No

Topic of Disclosure

What to Disclose??

1 Staff Facility wise deployment of all contractual staff engaged under NRHM with name and designation.

2 MMUs Total number of MMUs, registration numbers etc.

3 Ambulances

Patient Transport ambulances and emergency response ambulances - types of vehicle, registration number of vehicles, service delivery data etc

4 Procurements

All procurements- including details of equipments procured

5 Constructions

Buildings under construction/renovation - name of the facility/hospital along with costs, executing agency and execution charges (if any) etc

For Example:

Reviews on conditionalities to Commence from October 2012…..

STATE RANKING ON 16 ‘DASHBOARD’ INDICATORS’

1 Karnataka 6 Haryana2 Andhra Prades

h6 Kerala

3 Tamil Nadu 6 Uttarakhand 14 Madhya Pradesh

4 Gujarat 9 Arunachal Pradesh 14 Nagaland

5 Sikkim 10 Punjab 16 Manipur High

Performance (Contributing most positively to India's RCH indicators)

11 Mizoram 17 Bihar12 Maharashtra 17 Odisha 22 Jharkhand13 Goa 19 Chhattisgarh 22 Tripura

Satisfactory

Performance

19 Uttar Pradesh 22 West Bengal21 Himachal

Pradesh 25 RajasthanLow

Performance

26 Jammu & Kashmir

27 Assam28 Meghalaya

Very Low Performan

ce

Click here to view selected state specific scoring details

GEARING UP FOR 2013-14

FUND ABSORPTION CAPACITY Quantum Jump in Funding

anticipated from 2013-14 onwards

Absorptive capacity needs to be enhanced.

The challenge is of augmenting capacity To Build To Procure To Staff To Manage

SOME AREAS OF FOCUS:1. PLUGGING GAPS IN INFRASTRUCTURE Address the shortfall of Sub

centres, PHCs & CHCs based on Census 2011

Adding infrastructure in high case load facilities e.g. 100/50/30 bedded MCH wings

Adding infrastructure for training institutions for nurses & allied health professionals

Adding Drug Warehouses to strengthen the supply chain

2. AUGMENTATION OF HUMAN RESOURCES

Strengthen Sub Centre as first port of call- 2 ANMs

- 1 MPHW - 1 Community Health Officer - 1 LT cum drug dispenser HR augmentation at PHC/ CHC/ SDH/DH based on

case load with special attention to nurses & allied health professionals

Adding AYUSH doctors & using them for National Health Programmes & public health functions (including monitoring, supervision, SHP etc)

Planning for HR development – creating new training capacities

3. AMBULANCES & PATIENT TRANSPORT Universal penetration to be

ensured Response time not to

exceed 30 minutes Backward linkages for

patient transport to be strengthened

Provision for well-integrated Basic and Advanced level patient transport ambulances

4. ENSURING AVAILABILITY OF FREE DRUGS

Establishing Drug Warehouses with requisite HR

Ensuring Quality of Drugs

Prescription Audits

Monitoring of Per Capita Expenditure on Drugs separately for IPD & OPD

Robust Procurement Systems & Supply Chain Management

Standard Treatment Protocols

Preparation of Essential Drug List (EDL)

Clear Policy Articulation

Ensuring universal access to free generic medicines in government health facilities including Govt. Medical Colleges, IPD & OPD through…

5. STRENGTHENING DISTRICT HOSPITALS & COMMUNITY HEALTH CENTRES

District Hospitals For providing advanced multispecialty care To function as District knowledge centre for pre-service

and in service education To be upgraded as teaching hospitals particularly in

underserved areas Use district knowledge centres to act as resource centres

for planning, epidemiology and data analysisCommunity Health Centres

Ensuring functionality of CHC Adding beds/ HR etc as per case loads Strengthening CHCs

as a hub for holistic programme management

6. MOVING TOWARDS UNIVERSAL HEALTH COVERAGE JSSK – A Major Leap Way forward:

Expanding the gamut of guaranteed services. e.g. Coverage of ante natal and post

natal complications Children upto five years of age

Essential Health Package (EHP) covering RCH, communicable/ non -communicable diseases, injuries & trauma care etc. at primary & secondary level to start with

System building to realize this ambitious agenda

PLANNING FOR 2013-14

MERGER OF RCH & MISSION FLEXIBLE POOLS

One Common Flexible Pool for Health System

Strengthening & improvement of RMNCH +

A outcomes

MFP

Immunization

RCH

MERGER OF NATIONAL DISEASE CONTROL PROGRAMMES

One Common Flexible Pool

for DCPs

NLEP

NVBDCPRNTCP

NPCB

IDSP

To Definite Work

Plans !!

From Elaborate Write Ups

PIPs……

States to formulate a Perspective Plan for remaining three years of the 12th Plan period after the 12th Plan strategy is finalized by the

Planning Commission

TENTATIVE TIMELINESIssuing of Guidelines- 15th September 2012

Appraisal of PIPs- 15th December to 15th January

NPCC Meetings- 15th January to 15th February

We now have more money for health but …..do we have more health for money?

EXAMPLE – SCORING FOR AN INDICATOR

Jharkh

and

Megha

laya

Nagala

nd

Aruna

chal Pr

adesh

Chha

ttisga

rhOdis

haBih

ar

Himach

al Prad

esh

Rajas

than

Madhy

a Prad

esh Goa

Haryana

Tripu

ra

All In

dia

Uttarak

handAss

am

Jammu &

Kashm

ir

Andhr

a Prad

esh

Uttar P

radesh

Mizoram

Manipu

rSik

kim

Mahara

shtra

West Beng

al

Karna

takaPun

jabGuja

ratKe

rala

Tamil N

adu0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Proportion of 1st Trimester registration to ANC registration

+1+2

+3+4

-1-2

-3-4

Back

Megha

laya

Chhatt

isgarh

Jharkh

and

Himach

al Pra

desh

Bihar

Punja

b

All India

Haryan

a

Jammu &

Kashm

ir

Tripu

ra

Rajasth

an

Gujarat

Arunach

al Pra

desh

Tamil N

adu

Goa0.0

20.0

40.0

60.0

80.0

100.0

120.0

48.9 53

.6 60.4

61.6 67

.2 70.4

72.3

72.4

72.8 76

.9 80.6

81.1

81.2 83.8

84.3

85.9

86.1

86.9

87.3

89.6

91.1 94

.594

.895

.495

.897

.899

.199

.899

.9

Proportional of institutional deliveries to total reported deliveries

+1 +2 +3 +4-1-2-3-4

Back

Uttar P

radesh

Odisha

Assam

Tripu

raBiha

r

Madhy

a Prad

esh

Jharkh

and

Karna

taka

Nagala

nd

Haryan

aGoa

Himach

al Pra

desh

Tamil N

adu

Sikkim

Keral

a95.5

96

96.5

97

97.5

98

98.5

99

99.5

10097

.01

97.2

897

.39

97.4

497

.48

97.5

497

.78

97.8

997

.97

98.0

498

.05

98.1

298

.25

98.3

398

.38

98.4

98.4

398

.598

.5 98.6

98.6

598

.68

98.7

698

.89

98.8

999

.02

99.0

799

.34

99.5

6

Chart Title

+1 +2 +3 +4-1-2-3-4

Back

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