Operational Issues

1. What are key activities for the year 2005-2006?

Broadly speaking, the common activities under NRHM, which are uniformly applicable across all States/Union Territories over and above those proposed under ongoing programmes like RCH and National Disease Control Programmes, are as follows:

  • Constitution of State and District Health Missions.
  • Merger of Health and Family Welfare Societies.
  • Preparation of State Action Plan, which identifies sectoral needs and priorities.
  • Finalising performance benchmarks for MoU.
  • Signing of MoU between State and GoI.
  • Preparation of District Action Plans.
  • Upgrading two CHCs in every district to the level of Indian Public Health Standards, including the provision for two rooms in these CHCs for bringing AYUSH practitioners under the same roof.
  • Formation of Hospital Management Committees (Rogi kalyan Samiti).
  • Immunisation strengthening through induction of Auto Disabled Syringes and arrangement for alternate vaccine delivery at immunisation sites.
  • Organising mobile medical services at district level.
  • Organising Health Camp at AWW level on a fixed day in a month for assured services for women and child health care.
  • Provision of household toilets.
  • Strengthening institutional delivery under Janani Suraksha Yojana (JSY) through provision of escort and referral services by ASHA & subsidised hospital services for BPL women.
  • Establishing system to increase accountability of health system to PRIs. In addition the following activities shall be funded in the 18 high focus States.
  • Selection and training of ASHA, including provision of drug kits.
  • Organising Health Melas as a platform to inform and educate the public on NEHM.
  • Provision of generic drugs, both AYUSH and allopathic, at village, Sub-Centre (SC)/Primary Health Centre (PHC)/Community Health Centre (CHC) level, for common ailments.

2. What additional inputs will States receive in Year 1?

  • Rs. 20 Iakhs/CHC to two CHCs in every district for bringing them on par with IPHs.
  • Maintenance giant of Rs. 1 lakh per CHC, after constitution of Rogi Kalyan Samiti at that level.
  • Untied fund of Rs. 10,000 per Sub-centre.
  • Supply of additional drugs (allopathic and AYUSH) at SC, PHC and CHC level.
  • Mobile Medical Unit for district.
  • 50% districts in EAG states to get Rs. 10 lakhs per district for district planning.
  • Funds for training of ASHAs.

3. When are State, District and Village Action Plans due?

State and District Action Plans are expected to be formulated within the first six months. Village Action Plans can be formulated during the second year.

4. What should State Action Plans include?

State Action plans in Year I should include outlays for RCH-II, National Disease Control programme and the Integrated Disease Surveillance programme. The State Action plan would also include funds under AYUSH, Finance Commission grants-in-aid, Rashtriya. Sam Vikas Yojana, external bilateral funding, and large NGO grants. Even though budgeting would remain separate for better convergence, the outlays and programmes to improve sanitation, nutrition, etc. should also be reflected in the State Action Plan. Once the District Plans arc ready, the State Action Plan should be based on those Plans.

5. What should a District Action Plan include?

For the year 2005-2006, districts should consolidate existing resources within the HFW sector, plan for convergence with nutrition, water and sanitation, and focus on identifying areas in the district with poor indicators and the greatest need of financial resources. After Year 2 detailed District Action Plans, based on Village Health Plans should be developed by the DHM. States are expected to procure technical assistance for districts to support the development of District Action Plans. Under RCH and other donor funded programmes, some districts have already prepared Action Plan for RCH. These will need to be reworked, to include other components under NRHM. The districts, which did not get such funding support, will receive funds for district planning @ Rs. 10 lakhs per district (in EAC States).

6. Will NRHM provide for additional project management cost?

Project Management cost for all districts is covered under the financial envelope of RCH II. Eighteen high focus States shall make contractual engagement of skilled professionals, viz. CA, MBA & MIS specialist at State and District level for enhancing capacities of programme management and technical support to the NRHM.

7. How to integrate Water, Sanitation, and Nutrition in NRHM?

The institutional arrangement for the NRHM as well as Total Sanitation Campaign will be the same at District and Village levels. However budgeting for the two programmes will remain separate. Integration with ICDS implies joint planning, use of AWC as the hub of the NRHM interventions in the village, joint reporting and monitoring on common indicators, and engagement with the AWW as a key figure in village planning and implementation.

8. What is the budget profile of NRHM? What will separate sub-budget lines look like?

In Year 1 (2005-06) there will be no separate Budget Head for NHRM. Creation of a new Budget Head for NRHM will be from 2006 onwards. The existing programmes would maintain sub-budget heads under the omnibus NEHM Budget Head.

9. Will the States have to sign separate MoUs for RCH-II and NRHM?

There will be only one MoU, subsuming the MoU for all programmes integrated under NRHM. Signing of this MoU shall be the precondition to release of second tranche of funds in October 2005.

10. What are key performance benchmarks for Year 1?

Performance benchmarks under NRHM would include performance indecators in respect of all integrated programmes. In addition, NRHM requires the following activities to be completed in Year 1:

  • Constitution of State and District Health Missions.
  • Merger of Health and Family Welfare Societies.
  • Signing of MoU for NRHM between State and GoI.

11. Does the NRHM exclude provision of Health Care to urban population?

Under the urban Component of RCH-II and the National Disease Control Programme, curative and referral interventions and other programmes for urban poor would continue as before. A Task Group on Urban Health is being constituted to recommend strategies for urban poor.