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Introduction
 
  • The National Rural Health Mission (2005-12) seeks to provide effective health care to rural population throughout the country.
  • It aims to undertake architectural correction of the health system to enable to effectively handle increased allocations as promised under the National Common Minimum programme and promote policies that strengthen public health management and service delivery in the country.
  • It has as its key components provision of a female health activist in each village; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); and integration of vertical Health & Family Welfare Programmes and funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare.
  • It seeks to revitalize local health traditions and mainstream AYUSH into the public health system.
  • It aims at effective integration of health concern with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health.
 
 
 
 
 
SITUATINAL ANALYSIS AND FUTURE PLAN
 
Aim of Mission Flexible pool is to support the health care delivery system by improving infrastructure, providing critical manpower, communitizing the health care delivery system, risk pooling for poor and improvement in quality of health care. Thus all the activities under Component – B are to support the remaining components of the NRHM.
 
It is most important to first establish community based institutions and provide essential manpower to health institutions to achieve the goal of NRHM. Considering this, main thrust given during 2008-09 was on establishment of various community based committees and to appoint critical staff to institutions. Accordingly, special drives were undertaken to establish or re-activate Village Health Committees, to form and register the Swasthaya Kalyan Samitees(SKS) and to make the planning and monitoring committees functional. This has lead to formation of VHCs in 92% villages and registration of SKS in over 97% health institutions. Guidelines were also issued to the committees and institutions about sources of funds and utilization of funds received by them. In addition, adequate powers were delegated to District Societies and SKS so that the districts can plan and implement activities as per their need. These important activities have resulted into almost three time utilisation of NRHM funds as compared to last year for making the health institutions functional and community friendly.
 
To meet the shortage of doctors a special recruitment drive was made during the year 2008-09. Appointment of doctors were taken out of the preview of staff selection commission and the appointment was done by departmental committee. 825 doctors including 525 specialists were recruited. State Govt has also revised its placement policy. Appointment of contractual staff including staff Nurses/ANMs etc. is done by the SKS and are area specifics.
 
Haryana could not do much progress in the field of Monitoring, trainings and demand generation measures. Although regular meetings of State Health Mission (SHM) and DHS and quarterly meetings of Chairman of DHM has resulted into making NRHM important and leading activity in District.
 
Training was another area which was streamline during this year. Considering the importance of training and strengthening of training infrastructure, lot of planning was carried out in last 2 quarters. We are sure that total training system will be further streamlined in 2009-10 with positive results.
 
Salient features of achievements of important areas are given below:
 
  1. Improving availability of critical manpower
It is important to provide ASHA, additional ANM at SCs, 3 staff nurses at 160 24x7 PHCs and 4 additional staff nurses at 40 FRU for round the clock services and close supervision. In addition to this, staff nurses and specialists are also required in Rural and District Hospitals to provide services as per Indian Public Health Standards.
 
Almost 14000 ASHAs have been appointed and their training has started. Time taken for translation of modules and printing has slowed the process of training. It was also revealed that it is difficult to find ASHA in Mewat and because of high illiteracy rate in this backward district. However steps have been taken to relax the conditions for ASHAs.
 
2.Institutionalising the community involvement in health care delivery
 
As mentioned initially, the main task of this year was to establish the VHSCs, SKS and Planning and Monitoring committees in the state. Out of these, VHSCs are formed in 92% villages, SKS in 97% institutions and Planning and Monitoring Committees are in process of formation. The formation of VHSCs in convergence with WCD in remaining villages is in progress. It is expected that by June 2009 almost 100% villages in the state will have VHSCs. The remaining health institutions without SKS are newly established PHCs. Haryana has also taken decision to transfer user fees in SKS accounts of hospitals. This has resulted into constant flow of resources to SKS and thus giving them more independence for activities.
 
3.Strengthening of physical infrastructure and facilities
 
Good physical infrastructure which includes cleanliness, availability of water and drainage system and other basic facilities is important for admitting patients and providing basic obstetric services. Considering this, emphasis was given to functionalize the health institutions , which were getting them repaired .Many of SKS started utilising AMG and SKS funds for repairs.Major part of budget received under Mission Flexi-pool was allowed to be utilized for repairs. It is also important to provide Computers and internet facilities to PHCs to improve the MIS and making all the records computerised. This will reduce the burden on health staff and also improve the quality of reporting.
 
4.Upgrading health institutions for quality services
It is important to make the health institutes capable for providing obstetric and paediatric services to achieve the NRHM goals. Government of India has developed Indian Public Health Standards for SCs, PHCs and Hospitals. During last year, 4 hospitals were identified for up gradation but no hospital except for GH Panchkula could be improved. Main constrains in this regard were availability of trained specialists and provision of blood storage units. Various measures including improved service conditions and hiring of private specialists and incentive to Govt  specialists and requirement for blood storage units are being taken up on priority with hospitals as well as provision of uninterrupted supply of essential drugs.
 
Considering the time line for IPHS up gradation of health institutions, SCs/PHCs, SD  Hospitals and 100% District Hospitals (total 21) are included for facility survey during 2006-07. As this will be a major task, the up gradation activity will be independently monitored from state and district level. AYUSH facility is also being established in IPHS as well as other hospitals. Benefit of availability of large number of ayurvedic graduate in health services will be taken for this purpose.
5. Services to vulnerable population and un-served areas
Various schemes have been proposed in 2007-08 PIP for vulnerable population and un-served areas such as anemia control Program, mass de worming, health check-ups for school children and Mobile Medical Units for un-served areas. During the current year, State is planning to provide higher incentive to   medical/ Para Medical staff in Mewat .
 
6. Improving quality of service delivery
Quality assurance project is being implemented in 6 district of the state. Monitoring and evaluation is another week area of NRHM in Haryana. Though Haryana has excellent web-based functioning MIS, the NRHM indicators could not be incorporated in it resulting in very poor flow of essential information, wasting a lot of time of DPM, SPMU in collecting same information again and again. This was more evident during the review meetings taken by SHM and FCHM. On this background, it is proposed to completely overhaul the MIS from village to state level and develop efficient feedback system.
 
7. Procurement plan of the state
Procurement is also one of the areas that need to be looked urgently. There are two important components of this plan. First is development of procurement policy, devising procurement mechanism and its implementation. Second is providing efficient distribution and demand generation system to get proper feedback to procurement system. To ensure quality and timely availability of drugs, dynamic Essential Drug List ( EDL) has been prepared. 102 drugs which are covered under PPP are being manufactured by CPSUs and shall be procured from them. Adequate provision of funds has been made in the State Budgets.
Presently there are warehouses with inadequate capacity in districts. The store record system is poor and demand generation is based more on assumption than actual demand at ground level. It is proposed to provide web-based medicine distribution system in the state along with the strengthening of warehouses.
 
8.    BCC/IEC activities in the state
Informing community about the services made available and providing correct information about important services is extremely important to achieve the goals of NRHM. Presently, IEC/BCC has become extensively technical subject. Considering the last few years experience of the state, it is proposed to involved community ,specially in the rural area through “Sakshar Mahila Samooh” (SMS) which is a self help group of educated women group of the village and are registered NGOs. These womens will take the health education to each and every house hold using specially designed IEC material in local language.  
 
The State Govt. has re-constituted the State Health Society, Haryana (SHSH) District Health & Family Welfare Societies (DHFWs) and Swasthya Kalyan Samitits (SKS) on recommendation from National Programme Coordination Committee, NRHM (NPCC ). These consists of officials from Government sector and members from local Panchayati Raj Institutions (PRIs), NGOs, local elected representatives who are responsible for proper functioning and management of the hospital / PHC.
 

Functions Of ASHA

 
 
Performance based Honorarium to ASHA and Their Main Functions
(Under NRHM and Other Health Programmes)

Revised Performance Based Incentive for ASHA
 
Total
(In Rs.)
 
Remarks
Budget Head
Case      
Load
Unit of
Measure
Physical Target
Unit / Rate
(In Rs.)
Complete ANC
(with 100 IFA Tab & III ANC)             
2 Case @
Rs. 75/- each
Number of
Complete ANC
2 Case
Per Month
150/-
150/-
Previous Incentive: @ Rs 25 per visit (2 Case per month at 1000 Population).                                            
Institutional Delivery                                        
2 Case @
Rs. 100/- each
Number of Institutional Deliveries Supported
2 Case
Per Month
200/-
200/-
Previous Incentive: @ Rs. 100 per case (2 Case per month at 1000 population)                                 
Complete Immunization of Children   Other than ICDS Coverage                                                 (0-23 Month)
Exact Case @
Rs. 100/- each
Number of Fully
Immunized Children
 
Exact Case
Per Month
100/-
100/-
New Incentive: Only those cases will be considered for payment to bring the children (between 0-23 Months), which left without registration under ICDC. Payment will be given after complete Immunization only.                                    
Tubectomy                                                                        
2 Case @
Rs. 100/- each
Number of Tubectomy Cases Conducted
2 Case
Per Month
200/-
200/-
Motivation Incentive as per GoI Rules: Incentive to be given and booked under Family Welfare Programme.
Vasectomy                                                                          
2 Case @
Rs. 150/- each
Number of Vasectomy Cases Conducted
2 Case
Per Month
300/-
300/-
IUD Insertion                                                                  
2 Case @
Rs. 50/- each
Number of
IUD Inserted
2 Case
Per Month
100/-
100/-
New Incentive: @ Rs. 50/- per case Payment to be made after consistency of the IUD at least upto six months.  (2 case per month at 1000 population).                           
Medical Termination of Pregnancy (MTP)                                                                                              
2 Case @
Rs. 50/- each
Number  of
MTP Cases  Conducted
2 Case
Per Month
100/-
100/-
New Incentive: @ Rs. 50/- per case (2 cases per month at 1000 population). Case must be medically fit under norms of PNDT Act.
Dot Provider under RNTCP
1 Case @
Rs. 250/-
Number  of Case Completed
1 Case
Per Month
250/-
250/-
Payment to be made only after completion of the Case as per RNTC Programme Guidelines and to be booked under RNTCP.
Community Mobilization for Village Health Nutrition Day (VHND)
1 Meeting @ Rs. 25/-
Number of VHND Meeting attended and  Community Mobilized
1 Meeting
Per Month
25/-
25/-
Incentive will be given only when, ASHA Mobilized the Community for participation and Attended herself the Meeting. Payment is subject to be verification of ANM/AWW for the same.
 
Total
Rs. 1425/-
Grand Total
1425/-
 

 
 
Fund-Flow Mechanism and Compensation Package to ASHA
 
              The compensation to ASHA based on measurable outputs is being given under the overall supervision of MOs/ANMs on a regular monthly basis. The mechanism adopted is to ensure performance based payment of incentives to ASHA during monthly meetings at PHCs under the overall supervision of MO-in-Charge. The monthly performance based incentives proposed under present State NRHM PIP 2009-10, as per one thousand populations would be @ Rs.1425/- p.m. Other Incentives to ASHA, which are being given to her, if she is found involved in different required activities:
·        Under Malaria Control Programme, interested and competent ASHA will be selected as Fever Treatment Depot Holders after imparting suitable training, where she will prepare the slides of fever cases and provide treatment to the Malaria cases. For which ASHA will be paid honorarium of Rs. 5/- per slide of fever case. The SMS workers in rural areas will also be provided honorarium of Rs. 1/- per house per month for covering 200 houses only during the Transmission Season for which they will be entitled to honorarium of Rs. 200/- per month. ASHA being a Health Link Worker in a village will also be entitled for this honorarium, if she performed her duty in the Transmission Season for Malaria Control Programme.
·        Special compensation package of Rs.500/- per case for ASHA under Janani Suraksha Yojana for facilitating pregnant women for Complete ANCs, Institutional Deliveries, PNCs and Exclusive Breast Feeding, Anemia Control etc. as per JSY Guidelines.
·        ASHA is also entitled for TA/DA for attending training programs, she would be given the amount at the venue itself. During training days each ASHA is paid Rs.125 (Rs.50 + Rs.75) per day.
·        During monthly meetings at PHCs, provision has been made to pay Rs.50/- to each ASHA at the spot of itself.
·        ASHA would be paid Rs.50 for facilitating the Adolescent Girl Peer Educators (AGPEs) during monthly meetings organized at the AWC for participants under Kishori Shakti Yojana and other adolescent girls at the village level.
·        Under Strengthening of Routine Immunization Programme ASHA would be paid Rs.25/- for community mobilization.
·        An incentive of Rs. 100/- will be given to ASHA, who identify a mentally retarded person in the community, which has not been picked-up in any handicap survey. The amount of incentive may be given out of the NRHM funds.  
 



 
Content on this website is published and managed by Health Department, Haryana Email id: dhs.dghs@hry.nic.in