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  • 3 BLOCK LEVEL HOSPITAL 30-40 Villages Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE --------------- Accountant CLUSTER OF GPs PHC LEVEL 3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic1000 Popu lation VILLAGE LEVEL ASHA, AWW, VH & SC 1 ASHA, AWWs in every village; Village Health Day Drug Kit, Referral chains 100,000 Population 100 Villages 5-6 Villages Accredit private providers for public health goals Health Manager Store Keeper NRHM ILLUSTRATIVE STRUCTURE
  • 4 NRHM- Institutional framework 1 Departments of H & FW merged 34 states except UP 2 State Health Missions Constituted 34 states except Delhi 3 District Health Missions Constituted 33 states except Haryana, Delhi 4 Merger of Societies State Level 29 States except Jharkhand, Rajasthan, U.P., Tripura, Delhi Chandigarh, Karnataka, Pondicherry 5 MoU with Government of India 30 States except U.P., Lakshadweep, Delhi, Tamil Nadu, A&N Islands Health is also Economic
  • 5 Operationalise the State/District/Block health Missions. Suitable officials - Stable tenures / accountability Administrative and financial delegations Review of Acts, Regulations & guidelines for decentralisation Health facilities to be planning and budgeting Units upto Block level. Set up procurement/logistics system Health is also Womens empowerment Administrative Actions
  • 6 Manpower Strengthening Attend to Shortfall of 84,000 staff nurses, 2 lakh ANMs, 5000 to 7000 Specialists in each specialty. Multi-skilling, incentives for rural posting, Compulsory Rural Posting, Block pooling, Rational cadre policy, Management through PRIs/ Rogi Kalyan Samitis, Increasing the age of retirement Appointment on contractual basis and local criterion. Empower BMO designate as Chief BMO - to optimally deploy doctors /paramedics in facilities within the block Strengthen SIHFW, ANM schools, nursing / medical colleges/ increase seats Health is Womens
  • 7 DECENTRALISATION & CONVERGENCE Over 20% of the funds to be spent at the District level and 70% below the block level. Review of Acts, Regulations & guidelines for decentralisation Health facilities to be planning and budgeting Units upto Block level. Monitor preparation of Integrated District Plans. Review health camps in each village by ANM, AWW and ASHA. Regular meeting of State Committee on Intersectoral Convergence. Healthy family Healthy
  • 8 Operationalisation of Mission structure & managerial support at state /District / Block levels. Selection, training and support for ASHA. Availability & Utilisation of service delivery at facilities. Immunisation & Institutional deliveries District wise. Preparation of District Plans Interdepartmental Coordination for convergence Release & Utilisation of funds. Training/Capacity Building-Health Planning-District training Centre Delegation of administrative & financial powers to various levels. AGENDA FOR CHIEF SECRETARIES
  • 9 Activity Phasing and time line Outcome Monitoring 1 Fully trained Accredited Social Health Activist (ASHA) for every 1000 population/large isolated habitations in 18 Special Focus States 50% by 2007 100% by 2008 Quarterly Progress Report 2 Village Health and Sanitation Committee constituted in over 6 lakh villages and untied grants provided to them. 30% by 2007 100% by 2008 Quarterly Progress Report 3 2 ANM Sub Health Centres strengthened/established to provide service guarantees as per IPHS, in 1,75000 places. 30% by 2007 60% by 2009 100% by 2010 Annual Facility Surveys External assessments 4 30,000 PHCs strengthened/established with 3 Staff Nurses to provide service guarantees as per IPHS. 30% by 2007 60% by 2009 100% by 2010 Annual Facility Surveys External Assessments 5 6500 CHCs strengthened /established with 7 Specialists and 9 S Nurses to provide service guarantees as per IPHS. 30% by 2007 50% by 2009 100% by 2012 Annual Facility Surveys External assessments.
  • 10 6 1800 Taluka/ Sub Divisional Hospitals strengthened to provide quality health services. 30% by 2007 50% by 2010 100% by 2012 Annual Facility Surveys External assessments. 7 600 District Hospitals strengthened to provide quality health services. 30% by 2007 60% by 2009 100% by 2012 Annual Facility Surveys External assessments. 8 Rogi Kalyan Samitis /Hospital Development Committees established in all CHCs/Sub Divisional Hospitals/ District Hospitals. 50% by 2007 100% by 2009 Annual Facility Surveys External assessments. 9 District Health Action Plan 2005- 2012 prepared by each district of the country. 50% by 2007 100% by 2008 Appraisal process External assessment. 10 Untied grants provided to each Village Health and Sanitation Committee, Sub Centre, PHC, CHC to promote local health action. 50% by 2007 100% by 2008 Independent assessments Quarterly Progress reports.
  • 11 THANK YOU
  • 13 STATE INITIATIVES Andhra Pradesh Woman Health Volunteers in each of the rural and tribal habitations. Setting up an additional 100 round-the-clock women health centres. A subsidized Emergency Health Transportation Scheme. Incentives to women health volunteers, village Panchayats that promote Immunization Institutional delivery etc. Arunachal Pradesh 16 PHCs contracted out to NGOs and Private practitioners. Link workers at village level. Outreach camps for service delivery at remote and inaccessible areas. Assam RMP Act enacted. Transfer and Postings of Medical Staff has been decentralized. Involvement of private sector to render ANC services under PPP. Infection Control System in all District Hospitals. Health Insurance Scheme introduced. 32 FRUs
  • 14 STATE INITIATIVES Bihar Data centre for daily monitoring of OPD output by each participating institutions. 8000 villages covered with mobile medical units for under served population. Telephone connection to all PHCs of the state. CHhattisgarh Strengthening the role of the Panchayat and building on the community based link worker. Promoting emergency referral to public/private facility using coupons by Mitanins. Establishment of State Health Resource Centre. Delhi Basti Sevikas for Urban Slums as linked
  • 15 STATE INITIATIVES Gujarat Chiranjivi Yojana scheme to contract out private providers for delivery care and management obstetric complications Block Level Programme Management arrangements. Haryana Health link workers in every village. A couple aged 60 years with only a girl child is being given a pension of Rs. 300/- per month and Rs. 500/- per month to the girl child under Ladli Scheme. Himachal Pradesh Rs. 30,000 to FRUs as untied fund for emergency transport. PPP Cell at State and District level. Involvement of departments like Ayurveda, social justice and woman empowerment for distribution of
  • 16 STATE INITIATIVES Jammu & Kashmir Granting autonomy to hospitals Utilizing the Rehbat-I-Sehat (RIS) teachers network for providing access to health services to tiny villages scattered in the district. Karnataka Incentives to Doctors and Staff Nurses for providing 24x7 services. Health insurance for SC/ST population Kerela RCH services at medical colleges Maternity Security Scheme Tribal and Coastal Health Plans. Involvement of ISM and homeopathy system with the health facilities.
  • 17 STATE INITIATIVES Madhya Pradesh Outsourcing PHCs to NGOs. State Logistics Management Unit at State level Prasav Hetu Parivahan Yojana(LY85000 benefici