Institutional Framework & Fund flows

1. What is the institutional set up at National, State and District levels?

The Mission Steering Group under the chairmanship of the Union Minister for Health & Family Welfare (MHFW) will provide policy guidance and operational oversight at the National level. Ministerial/Secretary level representatives of Planning Commission, Rural Development, Panchayati Raj, Human Resource Development and Health and Family Welfare Secretaries of four States and ten public health professionals nominated by the Prime Minister will be members of the Mission Steering Group.

At the State level, the State Health Mission shall be led by the Chief Minister. It shall be co-chaired by the Health Minister with the State Health Secretary, as convener and along with representation from related Departments, NGOs, private professionals, etc.

The District Health Mission shall be led by the Chairman, Zila Parishad, and be convened by the District Head of the Health Department. It shall have representation from all relevant departments, NGOs and private professionals. However, States can choose their State specific models. The district and sub district arrangements for the Total Sanitation Campaign would be similar to those of the NRHM, and the activities of the Sanitation will be guided by the District Health Mission.

2. What will be the role of the State Governments under the NRHM?

The State Governments have been part of the Stakeholder Consultations for finalisation of the strategy of the Mission. The States shall enter into a Memorandum of Understanding (MoU) with the Government of India (GoI), stating their agreement to the policy framework of the Mission and the timelines and performance benchmarks against identified activities. The States shall establish State and District Health Missions, and integrate the multiple Societies for Health and Family Welfare Programmes at State and District levels, as envisaged under the NRHM. A State Action Plan shall be formulated reflecting the needs of the Health Sector, including determinants of Health like Sanitation, Nutrition and Safe Drinking Water, and the unmet needs which shall be addressed under the NRHM. The State shall also commit undertake systemic reform, including devolution of powers to Panchayati Raj Institutions and decentralisation of the programme to district levels as envisaged under NRHM, and ensure smooth fund flow, technical and MIS support.

3. What will be the roles of the State and District Health Missions?

The State Health Mission shall prepare the roadmap for architectural correction of the Health System, including merger/integration of vertical structures; delegation and decentralisation of administrative and financial powers; empowering the PRIs; preparation of Operational Guidelines for the implementation of the Mission; logistics arrangements; disease surveillance; IEC; and MIS.

The District Health Mission shall control, guide and manage all public health institutions at the district and sub-district levels. It will be responsible for preparation and implementation of an integrated District Action Plan in respect of funds received from all funding agencies into the District Health Fund. It shall guide the micro-planning for selection and training of ASHAs, organisation of Health Camps at Anganwadi levels, services related to immunisation and institutional delivery, mainstreaming of AYUSH infrastructure, supply of drugs, upgrading CHCs to IPHS, utilisation of Untied Fund at Sub-centre level, and strengthening outreach services through operationalisation of mobile medical unit. It shall also ensure intersectoral convergence among related Departments at district and sub-district levels. Above all, the DHM shall ensure the accountability of the public health system to the Panchayati Raj Institutions and the community.

4. What are the flexibilities available to the States under the NRHM?

The NRHM provides broad operational framework for the Health Sector. Suggestive guidelines are being issued on key interventions like ASHA, Indian Public Health Standards (IPHS), institutional deliveries, immunisation, preparation of District Action Plan, role of Panchayati Raj Institutions, etc. The States shall have flexibility to project operational modalities in their State Action Plans, which would be decided in consultation with the Mission Steering Group.

The NRHM is being launched as a framework of partnership among Government of India, related departments of the Government, especially Departments of Women & Child Development, Drinking Water Supply, Panchayati Raj, and Development of North Eastern Region State Governments, Panchayat Raj Institutions, NGOs, and private health providers. The detailing of strategies will continue during the Mission with the combined effort of all the stakeholders.

5. What is the outlay of NRHM?

The outlay of the NRHM for the year 2005-06 is Rs. 6,713 crores. The outlay of the Mission in subsequent years will be dependent on the outlay of the Ministry of Health and Family Welfare. The State-wise allocation under NRHM for the year 2005-06 are enclosed in a separate sheet.

6. Can the States expect an increased outlay in the coming years?

The budget outlay of the Ministry of Health and Family Welfare has increased by 30% in 2005-06 over the previous financial year. The States would prepare comprehensive Action Plans for NRHM, indicating priorities for funding, which shall be covered under the increased outlays expected in the coming years.

7. What shall be the State contribution under the NRHM?

The State Action Plan shall reflect the outlays available for public health expenditure under Centrally Sponsored Schemes, State Budget, State Finance Commission, major Bilaterally funded Programmes and schemes funded by the Planning Commission like Rashtriya Samvikas Yojana. The States are required to sign MoU with the GoI, committing a minimal increase of 10% for Public Health expenditure in the State Budget each year.

8. What is the fund flow mechanism?

The States will be given an advance indication of funds to be devolved. State Action Plan would be prepared for outlays conveyed for the NRHM. The Societies for Health and Family Welfare programmes shall merge into one integrated Society at State and District level to enable "funneling" of funds. The NRHM Budget Head would retain Sub-Budget Heads for the erstwhile Societies.

9. What is the role of Panchayati Raj Institutions (PRI) In the NRHM?

One of the core strategies of the NRHM is to empower local governments to manage, control and be accountable for public health services at various levels. The Village Health & Sanitation Committee (VHC), the Standing committee of the Gram Panchayat (GP) will provide oversight of all NRHM activities at the village level and be responsible for developing the Village Health Plan with the support of the Auxiliary Nurse Midwife (ANM), ASHA, Anganwadi Worker (AWW) and Self Help Groups (SHGs). Block level Panchayat Samitis will co-ordinate the work of the GP in their jurisdiction and will serve as link to the DHM. The DHM will be led by the Zila Parishad and will control, guide and manage all public health institutions in the district. States will be encouraged to devolve greater powers and funds to Panchayati Raj Institutions.