1 Review Meeting with State’s Health Secretaries, Mission Directors & Directors of Health Services 11 th & 12 th Sept JS (Policy)

MMR (212 as per RGI report ) – Annual Rate of decline between and is 23% higher than annual rate of decline between and – EAG States showed a decline of 67 points in MMR (in compared to ) against a National Decline of 42 points 2 Status of Drop in MMR (in points) from to

IMR reduced from 58 in 2005 to 47 as per SRS 2010 – Rate of Decline of IMR accelerated by 29 % between as compared to – Decline in Rural IMR and U5MR is higher than the decline in urban areas, thereby narrowing the Rural - Urban Gap – Decline of U5MR & IMR is more in EAG States India has remained free of Wild Polio for more than a year 3

CategoryStateSRS-2005SRS-2010Point Change Very High Focus states for FP Bihar UP MP Rajasthan Jharkhand Chhattisgarh All India Nationally Rate of Decline of TFR between increased by 47 % as compared to All the 6 very high focus states have shown a decline equal to or better than All India average Steepest decline in annual growth rate from 1.97 to 1.64 since independence 4

5 Malaria Mortality Reduction Rate 55% mortality reduction in malaria in 2010 as against 2006 Dengue Mortality Reduction Rate 26% mortality reduction in dengue in 2010 as against 2006 Cataract operations More than 60 Lakh Cataract Operations every year Leprosy Prevalence Rate Reduced from 1.8 per in 2005 to less than 1 per Tuberculosis 73% case detection rate and 88% Cure rate

Over 1.5 lakh Human Resource added (on a baseline of 2.17 lakh) 2315 Referral Hospitals strengthened to act as First Referral Units (FRUs) with capacity to provide comprehensive obstetric emergency care 8475 PHCs upgraded as 24x7 PHCs 2012 Mobile Medical Units (MMUs) provided in 449 districts for delivery of health care in difficult areas 7218 Emergency Response / basic ambulance service vehicles Nation-wide system of HMIS and MCTS set up to ensure and monitor health interventions 6

SHORT FALL OF DOCTORS, SPECIALISTS AND NURSING STAFFS (IN PERCENTAGE OF TOTAL REQUIREMENT) SOURCE: RHS 2011

SHORT FALL OF PARAMEDICS AND MPW (In % of total requirement) SOURCE: RHS 2011

INFRASTRUCTURE STRENGTHENING- I New Construction (Completion Rate < 30%) J&K, CHATTISHGARH ANDHRA PRADESH SUB CENTRE (SC) ANDHRA PRADESH, W.BENGAL, MAH., TN, DELHI JHARKHAND, ODISHA, UTTARAKHAND, ARUNACHAL PRADESH, MEGH., NAGALAND, TRIPURA PRIMARY HEALTH CENTER (PHC) KERALA, W. BENGAL, HARYANA, KARNATAKA, MAHARASHTRA, UTTARAKHAND, UP NAGALAND, ASSAM, MIZORAM COMMUNITY HEALTH CENTER (CHC) KERALA ODISHA, UTTARAKHAND, J&K DISTRICT HOSPITAL (DH)

INFRASTRUCTURE STRENGTHENING- II Renovation And Up gradation (Completion Rate < 30%) CHHATTISGARH, J&K, UTTARAKHAND ARUNACHAL PRADESH, SIKKIM A&N ISLANDS SUB CENTER (SC) CHATTISHGARH, JAMMU & KASHMIR, SIKKIM ANDAMAN & NICOBER, CHANDIGARH, DELHI, PODUCHERRY PRIMARY HEALTH CENTER (PHC) BIHAR, J&K, MANIPUR, GOA, WEST BENGAL A&N ISLANDS, DELHI COMMUNITY HEALTH CENTER(CHC ) UP, J&K, MANIPUR, NAGALAND, ANDHRA PRADESH, HARYANA, KERALA, WEST BENGAL A&N ISLANDS, CHANDIGARH, DELHI DISTRICT HOSPITAL (DH)

CONSTITUTION OF VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEE (VHSNC) SOURCE: RHS 2011 PERCENT OF VHSNC CONSTITUTED OUT OF TOTAL VHSNC REQUIRED

STRENGTHENING HEALTH INSTITUTIONS- I (24X7 PHCs) States with less than 50% of total PHCs as 24X7 PHCs

STRENGTHENING HEALTH INSTITUTIONS- II (FRUs) STRENGTHENING HEALTH INSTITUTIONS- II (FRUs) States with less then 50% of DH, SDH &CHC as FRUs

Action Plan for the Year

STATES WITH CUSHION MORE THAN Rs 10 Crores

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 1. Rational deployment of HR with the highest priority accorded to high focus districts and delivery points (Non compliance would lead to reduction of up to 7½ %) Conditionalities and incentivesProgress by the State % incentive/ Disincentive Method of verification 1.1 Rational deployment policy including- Posting of staff on the basis of case load, rational deployment of specialists, priority to HF districts In place by October, 2012 Otherwise, deduction of 2% of MFP Policy notification ; Website posting Preparation of baseline data for HR Minimum for all delivery points and SCs in high focus districts; by Nov 2012 Otherwise, deduction of 2% of MFP. Website posting and state report Evidence of corrective action in line with the policy 90% of all delivery points staffed as per norms, 90% of all SCs in high focus districts should have at least one ANM Otherwise, deduction of 2% and 1.5% of MFP respectively. State report; website posting by December 2012.

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 2. Facility wise performance audit and corrective action based thereon. (Non compliance would lead to reduction of up to 7 ½% of MFP) Conditionalities and incentivesProgress by the State % incentive/ Disincentive Method of verification Range of services (as in MNH guidelines for RCH services, OPD, IPD and other services to be determined by the State) specified at least for delivery points By September, 2012 Up to 2½ % of MFP State report and Website posting by September, Facility wise reporting on HMIS portal by all priority facilities/delivery points for October( SC data if needed be uploaded from PHC) By November, 2012 Up to 2½ % of MFP State report ; State HMIS October data to be uploaded by November Corrective action (priority to be given to high focus districts) based on facility wise reporting. By November, 2012Up to 2½ % of MFP State reports on corrective action by Nov, State visits

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 3. Gaps in implementation of JSSK (May lead to a reduction in outlay upto 10% of RCH base flexi-pool) Conditionalities and incentives Progress by the State % incentive/ Disincentive Method of verification Government order for coverage of entire State regarding JSSK By Sept’ 2012 Upto 2½% of RCH base flexi-pool Copy of GO ; Website posting State wide dissemination of GO/policy, visible IEC in facilities and community awareness By Oct’ 2012 Up to 2½% of RCH base flexi-pool Sample community visits No user charges. Free Drugs, diagnostics, diet. Grievance redressal system operational By Oct’ 2012 Upto 2½% of RCH base flexi-pool Field visits; exit interviews grievance redressal records At least 50% of pregnant women and sick newborns coming in should be using assured and cashless means of transport- and getting a similar drop back home By Nov’ 2012, Upto 2½% of RCH base flexi-pool -do-

CONDITIONALITIES: IMPLEMENTATION FRAMEWORK 4. Continued support under NRHM for 2nd ANM would be contingent on improvement on ANC coverage and immunization as reflected in MCTS. Vaccines, logistics and other operational costs would also be calculable on the basis of MCTS data Conditionalities and incentivesProgress by the StateMethod of verification 4.1 Increase in ANC coverage ( first ANC and full ANC) as per MCTS data in (1) State (2) High Focus districts Increase in April- December 2012 over the same period last year MCTS website ; state report by January, Increase in full immunization as per MCTS data in (1) State (2)High Focus districts Increase in April- December 2012 over the same period last year MCTS website ; state report by January, 2013

5. Responsiveness, transparency and accountability ( incentive upto 8% of MFP) Conditionalities and incentives Progress by the State % incentive/ Disincentive Method of verification 5.1 Demonstrated including innovations for responsiveness in particular to local health needs e.g use of epidemiological data, active participation of public representatives in DHS / RKS meetings, etc. Innovation implemented and impact demonstrated; State to send brief report in format suggested by November, ( one innovation in each of the three areas) Up to 8% of MFP State report (format in Annex 1) by November, 2012 ; state visits for rapid appraisal 5.2 Demonstrated evidence/innovation for transparency e.g. mandatory disclosures and other important information including HR posting etc. to be displayed in the State NRHM websites etc. 5.3 Demonstrated evidence/innovation for accountability: e.g. initiatives in community monitoring, Jan sunwai etc CONDITIONALITIES: IMPLEMENTATION FRAMEWORK

6. Quality assurance (incentive upto 3% of MFP) Conditionalities and incentivesProgress by the State % incentive/ Disincentive Method of verification States notify quality policy/strategy (align to national policy) as well as standards In place by November 2012 Up to 3% of MFP Notification and state report by November, Constitute dedicated teams. Training of state and district quality team and DH quality team completed State team trained by November Current levels of quality measured for all “priority facilities” and scored and available on public domain. Deadlines for each facility to achieve quality standards declared Quality scores of all priority facilities available in public domain CONDITIONALITIES: IMPLEMENTATION FRAMEWORK

7. Inter-sectoral convergence (incentive upto 3% of MFP) Conditionalities and incentives Progress by the State % incentive/ Disincentive Method of verification Implementation frame work for intersectoral convergence with allied sectors/departments By November 2012 Up to 1% of MFP State report (copy of implementation framework ) Intersectoral convergence opportunities identified with WCD, PHED, education, etc. and action initiated. By November 2012 Up to 2% of MFP Government order, State report CONDITIONALITIES: IMPLEMENTATION FRAMEWORK

8. Recording of vital events including strengthening of civil registration of births and deaths (incentive upto 2% of MFP). Conditionalities and incentivesProgress by the State % incentive/ Disincentive Method of verification 8.1 A strategy paper identifying reasons and the road map for increasing registration By October 2012 Up to 1% of MFP Strategy document and policy statement. 8.2 Death reports with cause of death (especially any under 5 child or any woman in 15 to 49 age group) shared with district health team on monthly basis. By November 2012Up to 1% of MFP Death reports received at district level- verified in sample of districts. CONDITIONALITIES: IMPLEMENTATION FRAMEWORK

9. Creation of a public health cadre (by states which do not have it already) (incentive upto 10% of MFP) Conditionalities and incentivesProgress by the State % incentive/ Disincentive Method of verification Stated policy and road map (including career path on creation of a public health cadre) Policy & road map in place by November, 2012 Up to 4% of MFP State report website posting by November, Notification for creation of public health cadre Government order in place. Up to 6% of MFP Website posting / state report CONDITIONALITIES: IMPLEMENTATION FRAMEWORK

10. Policy and systems to provide free generic medicines to all in public health facilities( incentive upto 5% of MFP ) Conditionalities and incentives Progress by the State % incentive/ Disincentive Method of verification Clear policy articulation of free generic medicines to all in public health facilities By October 2012 Upto 2% of MFP Website posting / state report EDLs finalised and drug formulary published and made available in all public health facilities By November 2012 Up to 3% of MFP Notification/ Publication/ Web posting Overall procurement and logistics strategy in place. Detailed design and plan for rate contracting, regular stock up dates, indent management, warehousing, promotion of rational drug use, contingency funds with devolution of financial powers etc. in place. By November 2012 State report/ strategy document CONDITIONALITIES: IMPLEMENTATION FRAMEWORK

Responsiveness, transparency and accountability Format for state report State to provide a brief write up (<3 pages) on the best practice on Responsiveness, transparency and accountability separately Suggested structure: – Background: (Elaborate on the problem, which the innovation seeks to address; and in particular, provide details of target group/ base line data, if available) – Description of the innovation: (Including date of commencement and current status; coverage in terms of districts/ blocks/ villages; overall approach / strategy; implementation/ institutional arrangements; whether pilot / scaled up) – Costs: (Broad break up of one-time and recurring costs; assessment of cost effectiveness) – Sustainability: (Assess organisational and financial sustainability and approach to ensuring the same) – Outcome: (Extent to which base-line conditions have improved; results of third party evaluations, if carried out)

Thank You