National Rural Health Mission

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National Rural Health Mission
NRHM-indianbureaucracy

Government has been asking the State Governments to strengthen the financial management system and ensure that National Rural Health Mission (NRHM) grants are not misused. Central Government has issued operational guidelines, advisories and has implemented well established monitoring mechanism under NHM to strengthen the financial management system.

Additional funds are given to States under NHM (earlier NRHM) that perform better on specific performance parameters. That details of incentive/disincentive from F.Y.   2015-16 and 2016-17 are given below:

CONDITIONALITIES-FRAMEWORK FOR IMPLEMENTATION (2015-16)

S. No Conditionality Description Source for verification & indicator Incentive/Penalty
1 Reduction in IMR Percentage   decrease    over last year SRS Maximum   incentive  of 5% – Weightage=5
•  If  decrease    less than  5% –  No incentive
•  If  decrease  between   5-7%-  Incentive  of 3%
•  If  decrease greater  than   7% –  Incentive   of 5%
2 Reduction MMR Percentage decrease    over last year   (only   for  16 States   for which  MMR  is   available) SRS Maximum   incentive    of 5% – Weightage=  5
•   
If decrease      less  than   5% –  No  incentive
•    If decrease  between  5-10%-  Incentive    of 3%
•    If decrease  greater  than  10% –  Incentive    of 5%
3 Full Immunization Coverage During the current   FY,   as on December 31- infantsfully immunisedvs.  estimated beneficiaries MCTS Maximum penalty    and incentive    of 5%. Weightage= 5/(-)5
•    If  coverage  less  than  40% –  Penalty  of 5%
•    If  coverage  between    40-50% –  No  penalty
•    For coverage   above   50% up to 100%-   Incentive     up   to maximum    of 5%, calculated  as
Coverage   above 50%
10
i.e. if coverage  is  65%, then   incentive    of 1.5%;   and if coverage  is  87%,  then  incentive    is  3. 7%. 
4 Functionality     of FRUs/ CEmOCfacilities
(excluding    Medical Colleges)
Adequacy   of “functional” FRUs (conducting   (-sections) HMIS.
Facilities   conducting    (-sections:
1.   For Large   States
•   Avg. 10 CS I month  at DH level
•    Avg.  5 CS I month at SDH and CHC level
2.    For NE states (excl.   Assam), Hilly States (Uttarakhand,   HP, J&K), and UTs (excl. Delhi)
•   Avg.  6 CS I month at DH level
•    Avg.  3 CS I month  at SDH and CHC level
Maximum    penalty andincentive    of 5%.  Weightage=5/(-) 5
Compared  to required  number   of FRUs:
1.    On a  State-wide   basis
•    If  50-75% FRUs “functional”   –  3% penalty
•    If  less  than  50% FR Us “functional”  –  5% penalty
2.   On a State-wide   basis,   if more  than  75% FRUs
“functional”,  AND in HPDs –
•    If less than  50% FRUs  “functional”  –  5% penalty
•    If  50-75% FRUs  “functional” –  3% penalty
•    If 75-90% FR Us “functional” –  3% incentive
•    If more than  90% FRUs “functional”   –  5%
incentive.
5 Quality
Certification
Percentage District  hospitals and CHCs quality  certified by State  level  body NHSRC  report Maximum   incentive of 5%. Weightage= 5

•   3% incentive if at least 50% of DHs certified
•   2% incentive if at least 25% of CHCs / Block PHCs
certified.

6 JSSK
Implementation
Implementation  status  of JSSK entitlements MCTFC Report  (minimum    sample of 300 beneficiaries   for  each state) Maximum   penalty of 10%. Weightage= ()10

More than 50% gap in any of the  components  (drug,  diet, diagnostics  and transport)   10%  penalty

Less than 50% but more than 25% gap,  5%  penalty

No  penalty   if performance     more  than  75% (based on survey/MCTFC  calls)

7 Governance:
Quality of services and    functionality of    public    health
Star rating of facilities Based on the extent to which CHCs/PHCs meet the benchmark on Key indicators. Facilities                      Five Star indicator   criteria:
1.    Human     Resource    and Infrastructure
2.    Service availability
3.    Drugs and supplies
4.    Client orientation
5.   Service Utilization
HMIS report Maximum   penalty of 5%. Weightage= 5

•  To avoid  penalty minimum  50% of CHCs to have  3 or more star rating

8 Implementation   of    Free drugs & Diagnostic services Free drugs & Diagnostic services to be implemented as per GOI mandate District report certified by State Nodal officers and assessmentsmade by NHSRC teams and MCTFC. Maximum  incentive of 5% Weightage=  5

•  90%      and      above      institutions       effectively
implementing free drugs & diagnostic services – 5%
60% to  90% institutions   effectively  implementing
free drugs & diagnostic services – 3%
<60% institutions implementing free drugs &
diagnostic

services –  No incentive
(Based on survey/MCTFC calls)

 

9 Increase in State Health budget States providing more than 10% increase in its annual health budget as compared to the previous year. State budgets I Information from
State Govt.
Maximum incentive  5% Weightage= 5

•    If no increase/  decrease – No incentive
•    If increase is 10 to 15% – 3%
•    If increase  is>   15% – 5%

Framework for Assessment of Conditionalities 2016-17

S. No. Conditionality Description Source for verification&indicator Incentive/Penalty
1 Reduction in IMR Percentage decrease over last  year

 

SRS Maximum incentive of 5% – Weightage = 5

·         If  decrease less than 5%  – No incentive

·         If  decrease between  5%-7% – Incentive of 3%

·         If  decrease greater than 7% – Incentive of 5%

2 Reduction in MMR Percentage decrease over last year (only for 16 states for  which MMR is available) SRS Maximum incentive of 5% – Weightage = 5

·         If decrease less than 5% – No incentive

·         If decrease between 5% – 10% – Incentive of 3%

·         If decrease   greater   than  10% – Incentive   of 5%

3 Full   Immunization coverage During the current F.Y., as on November 30th – infants fully immunized vs. estimated beneficiaries MCTS (For      EAG / NE States) Maximum penalty and incentive of 5%. Weightage  =  5/(-5)

·         If coverage less than 35% – Penalty of 5%

·         If coverage between 35% – 45% – No penalty

·         For coverage above 45% up to 100% – Incentive up to maximum of 5%, calculated as:

Coverage above 50%

10

i.e. if coverage is 65%, then incentive of 1.5%; and if

Coverage is 87%. Then incentive is 3.7%.

MCTS (For Other States) Maximum penalty and incentive of 5%. Weightage  =  5/(-5)

·         If coverage less than 40% – Penalty of 5%

·         If coverage between 40% – 50% – No penalty

·         For coverage above 50% up to 100% – Incentive up to maximum of 5%, calculated as:

Coverage above 50%

10

i.e. if coverage is 65%, then incentive of 1.5%; and if

coverage is 87%. Then incentive is 3.7%

4 Functionality of FRUs/

CEmOC

facilities

(excluding standalone Medical

Colleges)

Adequacy of “functional”

FRUs (conducting C-sections)

HMIS Facilities conducting C-Sections:

1.       For Large States

·         Avg. 10 CS/month at DH level

·         Avg. 5 CS/ month at SDH and CHC level

2.       For NE states (excl. Assam), Hilly States (Uttarakhand, HP, J&K), and UTs (excl. Delhi)

·         Avg. 6 CS/ month at DH level

3.       Avg. 3 CS/ month at SDH and CHC level

Maximum penalty and incentive of 5%. Weightage = 5/(-)5

Compared to required number of FRUs:

1.       On a State wide basis

·         If 50% – 75% FRUs “Functional” – 3% penalty

·         If less than 50% FRUs “Functional” – 5% penalty

2.       On a State-wide basis, if more than 90% FRUs “functional”, and in each HPD.

·         If 75% – 90% FRUs “functional” – 3% incentive

·         If more than 90% FRUs “functional” – 5 incentive

States which have earned incentive /no penalty for FRU conditionality must fulfil HPD criteria to earn incentive this year #

5 Quality

Certification

Percentage District hospitals and CHCs quality certified by

State level body in rural and

urban areas.

NHSRC Report

 

Maximum incentive of 5% Weightage = 5

·         3% incentive if at least 20% of DHs certified

·         2% incentive if at least 10% of CHCs/ Block PHCs certified

6 Governance: Quality of

Services and

functionality of public health

facilities

Star rating of facilities based on the extent to which CHCs meet the benchmark

Five star indicator criteria:

1.    Human Resource and Infrastructure

2.    Service availability

3.    Drugs and supplies

4.    Client orientation

5.    Service utilization

HMIS Report (both rural and urban) Maximum Penalty/ incentive of 5% Weightage = 5/(-) 5

·         To avoid penalty, minimum 50% of CHCs to have 3 or more star rating

·          Incentive of 3% if more than 75% of CHCs have 3 or more star rating

·         Incentive of 5% if more than 90% of CHCs have 3 or more star rating #

7 Implementation

of Free drugs scheme

Free drugs to be implemented as per GOI mandate District report certified by State Nodal Officers. Assessments made by NHSRC teams MCTFC.

In case no reports are available, data from MCTFC calls to PWs would be taken as proxy data

Maximum incentive of 5%. Weightage = 5

·         = or >90% institutions effectively implementing free drugs 5%

·         60% to 90% institutions effectively implementing free drugs 3%

·         Less than 60% institutions implementing free drugs No incentive

(Based on survey/MCTFC calls)

8 Implementation of Free diagnostics Services Free diagnostics to be implemented as per GOI mandate District report certified by State Nodal Officers. Assessments made by NHSRC teams and MCTFC. In case no reports are available, data from MCTFC calls to PWs would be taken as proxy data Maximum incentive of 5%. Weightage = 5

·         90% and above institutions effectively implementing free diagnostics 5%

·         60% to 90% institutions effectively implementing free diagnostics services – 3%

·         Less than 60% institutions implementing free diagnostics services – No incentive

(Based on survey/MCTFC calls)

9 Implementation of integrated HRIS and updated annual formats of                HMIS State which has integrated HRIS (for regular and contractual                 HR) with updated information and from which pay slips are generated every month. Also updated HR and other information in annual HMIS which is in sync with HRIS HRIS generated summary and pay roll

 

HMIS report

Maximum incentive/penalty of 10% Weightage = 10/(-)10

·         5% penalty if HRIS not implemented fully

·         5% penalty if HMIS data in annual format not updated and is not in sync with HRIS

·         5% incentive if HRIS fully implemented

·         5% incentive if HMIS annual format is updated and is in sync with HRIS

Note: 1) EAG states would be evaluated as a separate category.

# Incentive only till the highest slab is achieved

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