Handbook on Health & Family Welfare Sector Investment Programme
Item
- Title
-
Handbook on
Health & Family Welfare
Sector Investment Programme - extracted text
-
Handbook
on
Health & Family Welfare
sector investment programme
fl ■) 1’
State/ Di.st.rict Programme Managers.,
ECTA Facilitators and Consultants
Department of Family Welfare
Government of India 8c
EC Health &C FW programme office
New Delhi
March 2000
1
1
MR«=<I< +r-^llaT feWT
'*><r4idi
'ktsr,
A.R. NANDA
Secretary
Phone : 3018432
Fax : 301 88 87
E-mail: secytw@nb.nic.in
fqrrdl -
110011
GOVERNMENT OF INDIA
DEPARTMENT OF FAMILY WELFARE
MINISTRY OF HEALTH & FAMILY WELFARE
NIRMAN BHAVAN, NEW DELHI -110011
Dated the 19th May, 2000
FOREWORD
It gives me pleasure in releasing the Handbook for
programme managers for the Government of India European Commission Sector investment Programme. The
Family welfare Programme has undergone
certain
fundamental changes in recent years, we have not only taken
a policy decision at the Central and state levels to decentralise
the working in this sector and to replace the earlier top down,
command-driven approach by the new bottom-up Community
Needs Assessment Approach, but the Government Is also
committed to facilitating real operationalisation of this
approach at the district, block and village levels.
The
Reproductive and Child Health Programme seeks nationwide
acceptance of a client driven implementation strategy with
full-fledged inter-sectoral coordination and building up
partnerships with the NGOs and the private sector at the
grassroot level.
The EC is providing substantial grant^to the Family
welfare sector. The expectation is that this grant and the
technical assistance which goes with itx should help in
broadening and deepening the reform process in the health
and family welfare sector and also in creating sustainable and
replicable models for real and effective decentralisation at the
operational level.
This Handbook which has been prepared after indepth
consultations with the stakeholders, should help In realising
this objective. I am sure the programme Managers will put this
to good use.
(A.R. Nan da)
i i
Contents
Chapter
No.
Contents
Page No.
Preface
1
Introduction
1.1 -1.4
2
Role of Sector Reform Cell
2.1 -2.6
3
Guidelines for preparing State EC Programme
Implementation Plan (SECPIP)
3.1 -3.15
4
Role of District Health & FW Agency / Society
4.1 -4.11
5
Guidelines for preparing district action plan (DAP)
5.1-5.19
6
Funds flow, reporting and accounting system
6.1 -6.6
7
Carrying out the policy reviews
7.1 -7.10
8
The benchmark funding system
8.1 -8.22
i i
Sector Investment Programme
Handbook for Programme Managers
Chapter-1: Introduction
A: Sector Investment Programme - An Introduction
In 1996, Department of Family Welfare (DoFW), Government of India (Gol) released
its policy document 'The Paradigm Shift’ declaring a shift from the decades old
practice of method-specific targets in family planning. This document announced
Gol’s intention to reformulate its family welfare interventions into a Reproductive and
Child Health (RCH) Programme which would seek to introduce a more decentralised
environment, where the implementing levels of administration would plan and
manage with greater autonomy, under broad policy guidelines from the Centre.
In 1997, DoFW launched the World Bank assisted Reproductive and Child Health
(RCH) Programme.
The RCH has been positioned as a major vehicle for
implementing the reforms identified in “The Paradigm shift”. For instance, resource
required for service delivery is sought to be planned on the basis of Community
Needs Assessment Approach (CNAA). Similarly, decentralisation is to be promoted
through capacity building of the States through setting up of State level training and
procurement support agencies and performance based funding will be an area of
attention.
The Sector Investment Programme (SIP) seeks to supplement and strengthen the
reform initiatives with a view to make the RCH investments more fruitful. In particular,
the SIP will seek to:
♦
♦
♦
Develop, at the State level, the technical skills and relevant inputs for
implementing the financial and managerial decentralisation process, including
those in terms of managerial structures, infrastructure rationalisation and
financial mechanisms;
Reinforce the organisation and implementation of decentralisation process at
district level and below; and,
Promote attitudinal changes, programming abilities and managerial skills of the
decision makers, both at Central and State levels.
The SIP is an integral part of the National Family Welfare Programme. It will
support efforts at bringing about structural, systemic and operational reforms to
as to create synergies with the RCH and other Family Welfare schemes and
help improving quantity and quality of service on an accelerated pace. The
structural, systemic and operational changes undertaken under the SIP may,
however, have positive implications for the larger health sector as well.
Chapter-1
1.1
ii
Sector Investment Programme
Handbook for Programme Managers
B: Operational stages for the SIP
fndLstai^hTr9^316 Wi"
UP ' SeCt°r Ref°rm 08,1 (SRC) which wi" drive
and sustain the reform process. The SRC is an arrangement consistinq of an
empowered body, a secretariat and technical expertise.
9
See chapter-2.
Conduct of Policy Reviews will be among the immediate tasks for the SRC.
See chapters 3 and 7.
Providing support to (he participating districts w»l be another key function of the
OixL/.
See chapter-3.
ft
Every participating district will set up a District Health & FW Agency Structurally
etc What^
3 S°Ciety’ StatUtOry b°dy’ committee’ an elected local body
and
I6' t
tUre’ the DiStriCt AgenCy must have sufficient functional
and financial autonomy to be able discharge management functions.
See chapter-4.
ft
Districts and States will make plans for reform and improved programme
to meTl!31'0" a,nd,mara9ement- The>' wi" be
»!»’ additional funding
RCH nr^e
9e' 3"d '0 br'd9e reSOUrca 9aps ln Irnp'enneoting (he
KCH programme.
y
See chapters 3 and 5.
ft
The plans will have a longer term perspective, with
more detail for the things to
be done in the first year. Thus, the plans for
year-1 will ‘roll-over’ into the next
year’s plan.
See chapters 3 and 5.
ft
Continued funding will be subject to satisfactory progress.
perforn^ance^iased. lndlCat°rS
Progress will be
benChmarks and 3,1 Ending will be
See chapter-8.
ft
Benchmarks will be part of each plan.
See chapters 3, 5 and 6.
ft
Evey participating State will create a Sector Reform Fund (SRF). The SIP funds
to finance State and districts plans will be lodged into the State SRF. The SRF
wi be non-lapsing and will be kept free of debilitating financial controls.
See chapter-6.
Chapter-1
1.2
Ii
Sector Investment Programme
Handbook for Programme Managers
C. Key ideas for reform
real problemsthe symptom? ms SlX^a0?,?™09 de"''e,y’ ra,her ,ha" ™rely
the potential underlying causes.
In9ness to have open discussion of
n™
,ha'
'e-X^toeXX* “ - can a.
performance-based funding.
*
W be 3 majOr step and just|fy
^-ovir|q decisions to the right level •
T
’
vop may ffnd that too
higher level to avoid duplication or poo^MnltoT'’ '0
•
m0''e*1 ‘0 a
Community involvement •
’ XmmXTXtto'or"! T03' S'ateS a"d
The
help changes to be implemented" and^b
members can also
than the health worirers Also the.
030 °ften CCSQ651 better ways
household prXs o7
b
° "* effeC6''e
°'
•
integrated service delivery-
=SES=S==
*
gsHaboration across the health system :
* Collaboration will need to be improved between different levels of rb.
government hearth system. « „» als0 „eed ,0 be impX'bXe'
government andI non-govemment sectors.
* Collaboration imay mean sharing resources and re-allocating
responsibilities.
lnClUde WOrkin9 t09ether to help provide an
integrated set of services.
Chapter-1
1.3
i I
Culture and attitudes of health workers:
❖ Many of the difficulties are caused by attitudes and working styles of the
health workers themselves. They need to be helped to recognise both
positive and negative ways of thinking and acting, and to change where
•
appropriate.
•
Looking for under-used resources:
« It is important to make the best use of resources already available, and
not simply to try to find more resources. Examples may be staff who
could do more if better-trained and motivated, buildings that are being
little-used, and so on.
Sustainability:
.
A change is of little value if it cartnot sustain itself. For example, there is
no point in constructing a health centre if there will be no guarantee of
staff and funds to maintain it.
to be sustainable if they have strong
Services are much morei likely
I
community support. In some circumstances, a service may be more
easily sustained if it is possible to raise some continuing funding through
user charges.
User charges:
* This may be a good way of improving health, if carefully designed. For
example, fees raised from people who can afford to pay can be used to
❖
provide better services for the most disadvantaged.
Effective user charges, however, require that the charging institution has
the autonomy to retain and use the collections.
•
Prioritisation and a focus of effort:
e There is a risk that too much will be attempted, and consequently many
reforms are started but never finished. You need to prioritise, and you
then need to make sure everyone works together to complete the work.
•*★*★**★★*
Chapter-1
1.4
.
1 i
Sector Investment Programme
Handbook for Programme Managers
Chapter-2: Role of State Sector Reform Cell
A: Background
While all stakeholders in the nation’s health and family welfare sector
are agreed on the
need for sector reform and its direction, no reliable institutional i
arrangements
exist in a
majority of the States for driving and sustaining the reform process
x
. x ,
*
------- the absence of such
an arrangement, r~
r—Ltends
- '• to
‘ become
•
reform
a series of individual initiatives, sporadic in nature
and fragile.
mechanism, named the ‘ State Health and Family Welfare Sector Reform Cell’, is as follows:
“Each of the non-SHS participating States will create or so desianate an exi^tinn
body as the State Health & Family Welfare Sector Reform Cell. This Cell will have
taL nnd f16’ authority and autonomy to drive the sectoral reform process and to
S? I
"ecessary In Pursuance of that objective. The SH&FWSRC shall be
H
I
the State
hS ,
It Iq r
overall charge of the H & FW
,S recommended that this Cell acquire management expertise
by appropriate
B: Why Sector Reform Cell ?
In the Government, decisions on major policy issues are generally taken by the political
execut've after a thorough examination of issues; analytical reporting of status and causative
factors and fomulation of feasible options/alternatives etc. The nature of the consultations
may be legISla ive (i.e. consideration by a legislative committee), or statutory (i.e. publication
of draft for public reaction), or administrative (e.g. consideration by an administrative body or
by a technical committee), or even informal (e.g. meetings with interest groups). Whatever
may be the mechanism, the decision making process, particularly relating to policy changes
must be backed by well-articulated options with adequate analytical support. The
Government Department concerned needs enhanced capacity to be able to focus upon and
steer the reform process in its respective sector. The Sector Reform Cell (SRC) aims to
provide this enhanced capacity within the department concerned.
C: What is the Sector Reform Cell ?
P; What the Sector Reform Cell is not
The Sector Reform Cell is not an academic or research institution, but will provide technical
an secretariat support within the State Department of Health & FW. Although the Cell will
X3hapter-2
2.1
1J
Sector Investment Programme
Handbook for Programme Managers
need a degree of autonomy to reconsider existing structures and systems, it need not be an
autonomous society, unless it is also to serve as a mechanism for flow of funds. The Cell
should not be a new body if another mechanism already exists which can carry out the
functions described here - or one can be given extended powers and/or membership to carry
out those functions. States where there are or will be World Bank SHS Project are expected
to have a Strategic Management body, and to avoid duplication, the two functions could be
merged in a single body.
E: Components of a Sector Reform Cell
The Cel! will consist of:
(a) an empowered committee / board / council / bureau to direct and oversee the
reform activities;
(b) a secretariat; and,
(c) dedicated or hired technical expertise and capacity.
As explained below, these functions may overlap, depending upon the choices made by the
State.
: The Committee / Board / Council (the name does not matter) will,
E-1: Empowered body
among other things:
receive proposals for policy reforms,
establish priorities for analysis or implementation,
agree modalities for carrying out analysis,
agree implementation strategies,
allocate funds,
monitor and evaluate reforms against anticipated results, and
□
□
□
□
□
□
□
advocate changes with other stakeholders.
C—7/ Board "ouncX '^‘"and
bodies, key institutions, district representatives, donors. NGOs, pnvate sector, consumer
activists or forum etc.
E-2: Secretariat: The Empowered Committee will need secretarial support to keep.records
ordinate activities, follow up on decisions, etc. The Secretariat can be eithe
of meetings, co-<
of the following:
One or more consultants or an institution;
□
□
□
□
sufficiently related to mean that it gets proper attention,
A combination of the above.
Chapter-2
2.2
J
Sector Investment Programme
Handbook for Programme Managers
E-3: Technical expertise and capacity: The Empowered Body and Secretariat will need
to^use technical specialists, among other things, to:
secretariat will need
□
□
□
□
□
□
carry out or commission studies of various sorts;
review literature;
design and carry out pilot projects;
participate in policy assessment;
formulate new measures; and,
ca^y out monitoring and evaluation.
Technical capacity to perform the above functions can be acquired in several ways:
□
□
□
□
some technical specialists may be on the empowered body itself;
some may be recruited part time or full time for the Secretariat for general purposes;
Xesa^™" C°nSUltantS
°r
subcommittees or task groups of technical people may be established to take
responsibility for specific components of the overall activities.
Sector Reform (Jell
Empowered Committee/
Council/ Task Force
Secretariat
Technical Capacity
(Consultants, Institutions, etc.)
\
Functional Linkages to the
State administration and
Pilot d istricts
Linkages to academic
professional sources
oftechnical assistance
The diagram given above separates out these three discrete functions, but it will be seen
that there are likely to be overlaps e.g. a consultant could be hired to assist with the
secretariat, could carry out activities as part of the technical capacity and be a member of
the empowered body at the same time .
The Cell is not just a 'think-tank' of the State; it has to be involved in the entire range of
policy and operational reforms in the State, both for health as well as family welfare schemes
on the one hand and internally financed as well as externally assisted schemes and
Chapter-2
2.3
ii
Sector Investment Programme
Handbook for Programme Managers
programmes on the other. Though the Cell is supported financially and technically by the
SIP, its jurisdiction and functions are sector-wide, not confined to SIP.
F: Immediate tasks for the SRC:
In the context of preparation of State’s SECPIP and preparation of plans for the
demonstration districts, however, the Cell’s immediate tasks.would include the following:
• Undertake or commission policy reviews and policy research, including associated
studies and surveys. For some of these, help may need to be taken from outside
agencies (e.g. for resource mapping in the districts). The Cell will identify all such tasks
and would prepare the Terms of Reference under which the identified tasks are to be
contracted out.
•
•
•
•
•
•
•
Prepare Year-1 SECPIP. Preparation of SECPIP need not wait for the policy reviews to
be completed; the States can take up any policy or operational reform activities which
may have a potential for improving the delivery of services1. The Cell, in this regard, is
expected to identify the new activities that could be taken up. These could include (a)
new activities that could be taken up on a State-wide basis; (b) felt needs that are not
met from any other source; and (c) operational research and / or pilot activities2.
Preparation of detailed activity plans and budgets for activities/interventions included in
Year-1 SECPIP.
Provide technical support and guidance to the district Agency/Society and district
programme managers in the formulation and implementation of district action plans
(DAPs).
Review the achievement of benchmarks by districts and release funds against
benchmarks achieved.
Develop an agenda and priority list for policy changes as an outcome of the policy
reviews; formulate appropriate policy documents; and provide technical support for
approval at various levels in the government.
Prepare a comprehensive SECPIP, based on the inputs from the policy reviews,
indicating the agenda and plan of action for operational and policy reform in the State3.
Encourage and enable every member of the Department / Directorate to contribute to
system reform, through dissemination of information and analysis, and participatory
processes for policy formulation.
1 Govt, of Himachal Pradesh, for instance, issued a Notification in November, 1999, announcing
functional integration of department of Indian Systems of Medicine with Department of Health &
Family Welfare for the purpose of implementation of RCH and other national programmes in the
State. In the same month, the State Govt, also issued a Notification announcing delegation of
administrative and financial powers, applicable on a State-wide basis.
2 Govt, of Himachal Pradesh have launched a 'quality assurance’ scheme on pilot basis in three city
hospitals. The scheme seeks to ensure greater accountability of the doctors and other serving staff
toward patient care through a feedback system. The feed back would be analysed by the
Superintendent of the hospital for taking remedial measures to improve the functioning of the
institution.
3
The year-one SECPIP, as mentioned, would only have been prepared on the basis of felt needs of
the State and, therefore, may have only have a limited reform agenda, pending completion of the
policy review exercise.
Chapter-2
2.4
11
Sector Investment Programme
Handbook for Programme Managers
G; Future Tasks of the SRCthe key ST3 that the Ce" Wil1 need t0 undertake in future are described below
he States may add to or modify these, depending on the State-specific conditions.
Policy Analysis: Go beyond the issues covered by the four Policy Reviews and look
at the entire spectrum of policies, procedures, structures, strategies, practices
organ's at.anal cuHure, resourcing, provider capacity, quality of services, cost
effectiveness of different items of service, distribution of services against user
demand m case of private goods and distribution of public and merit goods according
satisfactiorT^5’
m°St Cr'tiCal element in se,vice delivery: consumer
Policy Formulation: Identify the domains for action for health sector reform at
systemic level to ensure equity, at programmatic level to achieve allocative efficiency,
at the organisational level to improve productivity and technical efficiency, and at the
instrumental level for performance enhancement and human resource development.
Advise the health planners to prioritise the reform agenda within the framework of
overall resource availability and design alternative financing mechanisms to broaden
Systems analysis and development: Assess the progress of systemic changes
included in the SECPIP and suggest mid-course corrections. Prepare further
systems development/improvement plans. Provide support, where necessary, in the
testing, evaluation and integration of new systems. Quantify and present the savings
accruing to the public exchequer and to the community, as a result of policy reforms
initiated at its instance.
Management information systems development and integration: Assess the
information needs of programme managers and supervisors at various levels and
develop/upgrade information collection, analysis, response and feedback systems to
improve overall programme management. Provide the necessary technical expertise
o in egrate the newly developed systems with the operational divisions and partner
programmes/ initiatives.
Behavioural and attitude change management; advocacy support mobilisation:
ndertake advocacy measures for public acceptance of new policies. Plan and
support interventions to improve work attitudes of health functionaries.
Operational research, pilots, their documentation and dissemination: Undertake or
commission operational research and / or pilot activities on an on-going basis.
Document and disseminate the results of such initiatives, for possible replication.
Chapter-2
2.5
d
Sector Investment Programme
Handbook for Programme Managers
H: Costs and Budget
The investment and operational costs of the Ceil and associated committees etc. can be
debited to the EC supported SIP for the duration of the SIP. The operational cost of the Cell
can be shown in the indicative budget for the SECPIP (see Chapter-3: Guidelines for
preparing SECPIP for more details).
I: Terms of engagement of experts and institutions
States may decide to engage a consultant or an institution to provide the secretarial or
technical support to the Cell or for carrying out such tasks as may be decided by the Cell.
States are encouraged to evolve their own terms of reference for engaging consultants
and/or institutions. It is suggested that the services are hired on contractual basis, with a
limited period of engagement. Remuneration packages may be decided in consonance with
the guidelines / instructions circulated in connection with engagement of RCH consultants. In
case of any difficulty, reference may be made to the PMB.
In the case of engagement of individual experts, the names and CVs of persons selected
may be sent to Joint Secretary (RCH), Department of Family Welfare, with a copy to the EC
Technical Asistance (ECTA) Team. Either Gol or ECTA Team may convey their
objection/reservation in writing within two weeks, failing which their concurrence will be
assumed.
J: Support Staff for the SRC:
The number and cost of support staff shall be kept to the absolute minimum. Hiring may be
on contractual basis (annual with provision for extension after performance review). No
vehicle shall be purchased for the Cell. Any need for mobility shall be met by hiring of
vehicle, either on trip basis or monthly basis.
*********
Chapter-2
2.6
u
Sector Investment Programme
Handbook for Programme Managers
Chapter-3: Guidelines for preparing Year-1 State EC Programme
Implementation Plan (SECPIP)
A: Introduction
The distncts will evolve their own reform plans, with more details about the things to
be done in year-1. The district plans, thus, will have a longer term perspective but
the specific activities towards achieving the plan objectives will have a one-year
focus so that the activities to be taken up in year-2 can take note of successes
achieved and obstacles experienced in the previous year. In other words, the plans
or the previous year will ‘roll over' into the next year’s plan. (See Chapter-5Guidelines for preparing District Action Plan).
A similar approach is suggested for the SECPIP. It is recognised, however, that a
clearer perspective for the reform programme in a State will emerge only after the
policy reviews have been completed. As such, the agenda for year-1 SECPIP has
been determined before hand
,
I
B: SECPIP Focus in year-1
The Sector Investment Programme (SIP) envisages that the States’ year-1 SECPIP
will consist of the following:
♦ Reform activities which States may wish to take up on their own initiative, without
waiting for the outcomes of the policy reviews (e.g. the Order issued by Govt, of
-Himachal Pradesh announcing integration of ISM and delegation of financial and
administrative powers - see footnote-1 to Chapter-2: Role of State Sector Reform
Cell). Such initiatives, which may or may not involve an expenditure, could be
included in year-1 SECPIP.
♦ Plan of action for the Policy Reviews, indicating (a)
who will do what, (b) the
time schedule, and (c) the cost.
♦ State-wide activities which a State feels are necessary for improving the delivery
of services, but can not be taken up because funds are not available from other
sources.
♦
♦
‘Pilots’ to test one or more 'ideas’ aimed at improving the delivery of services.
Technical assistance and policy support to the SIP districts.
All of the above, taken together, will constitute the year-1 SECPIP. After the
outcomes from the policy reviews are available, year-1 SECPIP will ‘roll-over’ into
year-2 SECPIP.
C. Minimum Contents of the SECPIP proposals
Ideally, details for all of the above should be included in the year-1 SECPIP
proposals. However, a State may not be ready with the proposals for all and it may
only delay the year-1 SECPIP if the Programme Management Bureau (PMB) insisted
to have a proposal on all of them. It has, therefore, been agreed that year-1 SECPIP
proposals can be submitted in parts. For example, if the plan of action for the Sector
Chapter-3
3.1
u
Sector Investment Programme
Handbook for Programme Managers
Reform Cell (SRC) has been prepared and arrangements for the policy reviews have
been finalised, they can be sent to the PMB for approval. The proposals for pilots and
State-wide activities can be submitted subsequently.
Addition of a component later in the year will involve (a) revision to the list of
benchmarks (including, if necessary, the values assigned to them) and (b) re
calculation of funds requirement for the revised SECPIP. Such revisions may
be time consuming both for the State as well as the PMB. Therefore, it is
advisable that the initial proposals as comprehensive as possible.
The first set of year-1 SECPIP proposals must have the following:
C-1: Situation Analysis:
• Mortality and morbidity pattern in the State.
• Description of Family Welfare, MCH, CSSM, RCH and related projects completed
in the last five years or ongoing in the State and their impact on the mortality and
•
•
•
•
morbidity sitliation.
On-going Family Welfare, MCH, CSSM, RCH and related projects. Indicate how
they relate to mortality issues across the districts and problems specific to areas
having higher incidence of mortality.
Donor specific project information — geographic area covered, project objectives,
components, duration, and financial outlay.
Utilisation of inputs in the recent past (say, in the three financial years, including
1999-2000). Indicate sanctioned financial outlay, financial outlay utilised, and
reasons for shortfall in spending / achievement and other related information.
Reasons for shortfalls. Outline problem caused by policy, systems, norms and
procedures which are felt to be coming in the way of effective programme
implementation in the State.
Exhaustive details are not necessary, but all the above elements must be
included. This will help appraisal of the proposals included in the SECPIP.
C-2: Year-1 agenda for the SRC:
•
The Government Order / Resolution constituting the SRC giving details of
members, areas of expertise and nature of association with the SRC, such as
ex -officio, part time, full time, on deputation, contractual etc.
•
•
•
Terms of reference of the SRC.
Agreed first year work priorities of the SRC with detailed year-1 work plan .
Estimates of incremental operational expenses of the SRC giving basis of
estimates (please do not include salaries or other costs already being met
from on going programme/project funds). [As mentioned in Chapter-2, the
SRC is an arrangement rather than a separate body by itself. However,
depending upon the choice made for the ‘arrangement, funds may be needed
to meet the operational costs of the SRC. For example, costs may be
Chapter-3
3.2
Ii
Sector Investment Programme
Handbook for Programme Managers
' COnSul,a"te to work M or
part time for the SpTor
9
on behalf of the SRC.j
n,Cal assiotance to the SIP dlstnot
or proposed to
In other words, policy initiatives which do not r
‘V03™3’ ass's‘ance is needed,
be included. These, in fact, can be proposed Sh"’6 k"3™3' assistance sb°uld also
SECPIP components (see example component 4 inTpX\^X^
reviews are ProP°sed to be conducted.
Details of the talk foris lef6 up wlh-08^ t0
•
1 ln he DePartment for conducting each
review.
Srnn
°Ut
°f the reviews
D?7 anr meth0d0l°9y proposed to be adopted for each
review.
saiecXieaisuch ““
indlCa,i"9 ^ncy/insfitutionfind^o,,
.
•
•
Undertaken in the state.
Estimated expenditure for each i
review, iincluding
‘
the basis of calculation.
Measurable indicators proposed
J to be used for monitoring
review.
J progress of each
Proposed mechanism for lJ..3
" J nomrrUl,S °' reVieWS '°r imProvemen<
policy, systems, proceduresUSl
and
at anv
0:1 ■
needs, not covered elSewh
lere: Activities (these can even be State-wide)
b^illi3^ 9r°p0Sed to be taken up under the SECPIP
Only such activities may
be included for which no funds are available from a
ny other existing source or, if
available, they are not sufficient
: Include the pilots that are proposed to be undertaken.
E: State’s role in the imi jementation of District Action Plan (DAP)
districts Include^in'the SIP « be tfiam Tn^h”1' tt'e impleraentln» lhe DAP In the
(SRF) and the task of releasingt
:°U8h ,he 8,3,6 SeC,or R6,°""
level. However, the State will have tn ‘
Jstr,cts Wll< be handled at the State
benchmarks demonstrating the technicafaT ’ 6
f°r DAPS throiJ9h a set of
the districts in the l-plemen^
to
approval of a DAP by the PMB the State u,iii h
i Accord|ngly. immediately after
supporting the DAP This
° Pr6P6re and sul>”t lte 0'="
exampie Lponent ^“^hTcteT COmPOnen,
SE°PIP
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F: Formats to be used for presenting SECPIP proposals
To facilitate quick review and also to ensure that all essential details for review are
included, SECPIP proposals should be prepared in a three-part format, called
Component Management Protocol.
The Year-1 agenda for the SRC, each of the policy reviews, each of the State-wide
activities, each of the pilots proposed and every policy initiative will constitute a
‘component’. Management of DAP for each of the SIP districts will also constitute a
component.
For each component, the ‘Component Management Protocol’ will have the following
three parts:
♦ Part-l: ‘Component description’. As the name suggests, this is nothing but a
description of the Component. For instance, if the component relates to year-1
agenda for the SRC, the summary will be with reference to the points mentioned
under sub-section-ll of Section C above.
♦ Part-ll: Time Schedule’. This is to be prepared as a Gantt chart for all the
activities to be undertaken under the component.
♦ Part-Ill: ‘Cost estimates’, including the basis of cost calculations.
To facilitate reference, the Components should be serially numbered.
G: Illustrative examples
Four illustrative examples are given in Appendix to this chapter: one for SRC action
plan (Component-1, all parts), one for a policy review (Component-2, parts-l and II
only), one for DAP management (Component-3, parts I and II only), and one for a
policy initiative which does not require any financial assistance (part-l only). These
may be used to formulate these components of the SECPIP.
For all other
components of the SECPIP, formats will be the same as shown in the illustrative
components for the district action plan.
As will be observed, formats for SRC action plan, policy review, DAP management
and policy initiatives are slightly different than those for the pilots, state-wide activities
and policy initiatives of the SECPIP. Formats for the latter are exactly same as for
the district action plan components. The changes are as follows:
♦ items for component description (part-1 of component management protocol)
for SRC action plan, policy reviews, DAP management, and policy initiatives
are different (see examples in Appendix to this chapter and those in
Appendix to Chapter-5: Guidelines for preparing District Action Plan);
♦ the time schedule (part-ll) for these do not go beyond 2000-01 because
(a) the SRC agenda and DAP management plan will be sought on an annual
basis, (b) policy initiatives have either been taken or would be taken well
within year-1, and (c) the policy reviews are expected to be completed within
year-1.
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H: Benchmarks
States will have to negotiate two sets of benchmarks with the PMB:
• the benchmarks related to Components constituting the State plan proper,
i.e. the SRC agenda for year-1, policy initiatives, policy reviews, pilots and
•
State-wide activities; and
benchmarks related to the management of and support to the DAP. [DAP
related benchmarks in the State Plan will naturally be broader in scope
than the benchmarks in the DAP itself (see example component-4 in
Appendix to this chapter).]
Approval of SECPIP by PMB will be the first benchmark for State plan proper. The
State will have to determine the value of this ‘trigger’ benchmark on the basis of
funds required for implementing the SECPIP activities until the funds linked to the
first benchmark derived from the SECPIP components become available.
Similarly, ‘approval of DAP by PMB' will also be an automatic benchmark and will
‘trigger’ release of a part of year-1 outlay for the DAP. The State will have to
indicate, at the time of forwarding the DAP, the amount that should be released by
PMB on approval of the DAP. These funds will be lodged in the State s Sector
Reform Fund (SRF) and released in full to the district
Additional funds for SECPIP proper components will be released upon achievement
of benchmarks derived from them.
Additional funds for the DAP (along with any requirements of the State for the
activities relating to management of and support to DAP) will be linked to the
benchmarks set by the State for itself in this regard (see example component 3 in
Appendix to this chapter). These will be lodged in the SRF and released to the district
upon the achievement of benchmarks derived from the DAP.
I: Assigning values to benchmarks
After the component details have been prepared, a set of benchmarks are to be
derived from these. Then, appropriate values are to be attached to them in such a
way that their achievement will provide enough funds to ensure that there are no
funds shortages at any time during implementation phase (see section E.5 of
chapter-8 for more details).
The value attached to each benchmark would be related generally to sustainable
impact the connected activity has on health status. The value of a benchmark may,
therefore, not have any relation to the cost of the connected activity.
For instance, a construction activity may have a high cost. However, since the health
benefit from the construction would be indirect and would take long in coming, a
benchmark related to civil works should have a lower value than one related to, say,
improving immunisation coverage.
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suggested for assigning values to the benchmarks:
Following operational steps are
following format (see next page), leaving the values
* list the benchmarks in the
column blank:
List of benchmarks
Benchmark
description
SI.
No.
*
Related Component
Com. Description
Com. No.
I Expected
of
month
achieving
Value
attached
Rs. Lakh
Indicator
of
achievement
summarise the expenditure estimated to occur in each quarter of the year
Next,
2000-01 for all components included in your plan for year 2000-01 nc u e e
district requirement also, if the relevant DAP management is one of the
components of the proposals. Use the following format.
Funds needed for implementing components
Compo
nent
No.
Component description
April-June
Total
requirement
components_______
*
for
Funds needed in year 2000-01
Oct-Dec.
July-Sept
Jan-March
ail
Now, determine the values to be assigned to the benchmarks in such a way that
the total expected receipts for each quarter cover the total expected expenditure.
However, do not try to draw funds far in excess of the need. The money sitting
idle in one place may deprive another of funds.
If an additional SECPIP component is proposed (this may happen when the
State submits a new component on pilots, State-wide activities or po icy
initiatives), a revised benchmark list for the SECPIP as a whole will have to be
prepared and submitted along with the component management protocols^for
the additional component(s). The revision may be on account of adding new
benchmarks derived from the additional components or on account of changes
in the values assigned to the existing benchmarks, or both.
When a DAP is approved by PMB, the State will submit its plan for supporting it
as an additional Component of SECPIP. In this case, there will always be an
additional set of benchmarks.
________
**★★*★★*★
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11
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Appendix to Chapter-3
Examples of SECPIP components
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : State ABC_________
I
Component Number
Composition of the SRC
1
Component
Title
SRC agenda for year 2000-01
___________________________
Govt, have set up a task force under the Chairmanship of
Principal Secretary (Health) for developing a health and
family welfare vision document for the State and to prepare
the agenda for policy reform. This task force will also be
responsible for monitoring implementation of policy reform.
The terms of reference of the Task Force are enclosed.
A special unit has been set up in the State Health & Family
Welfare Institute to function as the secretariat for the Sector
Reform Cell. An Officer, drawn from the State
administration, with previous experience in the sector, has
been selected to work as Secretary to the SRC. She will be
assisted by a team of doctors placed in the SRC secretariat
on deputation basis and experts hired in the areas of
(a) change process management, (b) health financing, and
(c) communication for behaviour change. A copy of the
Order creating the SRC Secretariat is enclosed.
Priorities for year-1
Activity Plan for the year
A rate structure for hiring of experts as consultants has been
approved for the State and henceforth all consultants under
various programmes and schemes will be hired accordingly.
■ Undertake/commission the policy reviews.
■ Share the outcomes of the policy reviews with the
programme managers with a view to evolve an agenda
for policy changes.
■ Develop a perspective for the SECPIP, based on the
outcomes of policy reviews and reflecting State
priorities.
■ Prepare SECPIP action plan for year 2001-02.
■ Assist the SIP districts in formulating, implementing and
monitoring their reform plans.
■ Undertake capacity building measures for district
programme managers.
■ Undertake pilots of innovative approaches.
■ Undertake policy reform measures based on policy
review outcomes.____________
This is given in Part-ll for this component.
Financial assistance needed for Rs. 30.50 lakh (as per details given in Part-Ill)
[Cost of policy reviews and technical support to SIP districts
SRC activities in the year
______________________________ i are shown under relevant components.]__________
1
Benchmark(s) derived from this I Policy reviews commissioned. Value: Rs. 35.00 lakh,
Policy reform measures announced. Value: Rs. 30.00 lakh.
component
SECPIP plan for 2001-02 approved. Value Rs. 25.00 lakh
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Handbook for Programme Managers
EC-Gol Sector Investment Programme
Component Management Protocol
Part-ll: Time Schedule for the Year 2000-01
Implementing Agency: State ABC
Component Number
1
Component
Title
SI.
No.
Activity description
1
Policy review on work force
management (further details are
given in part-ll for this component).
2
Policy review on delineation of roles
and responsibilities (further details
are given in part-ll for this
component).
3
Policy review on rational use of
infrastructure (further details are
given in part-ll for this component).
4.
Policy review on performance based
funding options (further details are
given in part-ll for this component).
5
Workshops for sharing outcomes
from policy reviews
6
Developing a perspective for SECPIP
7
Preparation of SECPIP for year
2001-02
8
Capacity building: management
training for district programme
managers
9
Assisting SIP districts in formulating,
implementing and monitoring their
reform plans
10
Undertake policy reform measures
based on policy review outcomes.
SRC agenda for year 2000-01
Months (Apri , 2000 to March 2001)
A
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Component Management Protocol
Part-Ill: Cost Summary
Implementing Agency: State ABC
Component Number
Expenditure category
Component
Title
1
Expenditure (Rupees in lakh) estimated to occur in 2000-2001
July-Sept.
| Oct.-Dec. | Jan- March | Total
April-June
A: Mon-recurrent Costs
Civil works including
renovation
Vehicles___________
Medical Equipment
Non-medical equipment
including___________
Training and workshops
Consultants* fees_____
Other non-recurrent
costs
_______
0.50
4.00
6.00
B: Recurrent costs
5.50
5.50
5.50
20.50
14.00
6.00
30.50
1.00
Contractual staff
payments_________
Health consumables
Non-heaith
consumables______
Vehicle maintenance
including POL
expenses_________
Building maintenance
Other recurrent costs
4.00
Total for the component
4.00
Chapter-3
SRC agenda for year 2000-01
6.50
2.50
6.00
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Calculation Norms for Component Number-1
A: Workshops:
♦ Number of workshops : 2
♦ Number of participants per workshop : 40
♦ Duration of each workshop : 2 days
♦ Timing : September, 2000 and October, 2000
♦ Cost per workshop:
♦ Workshop material: Rs. 10,000/♦ TA/DA for participants : Rs.60,000/♦ Working lunch: Rs. 5,000/♦ Venue, documentation and other expenses: Rs. 25,000/♦ Total: Rs. 1.00 lakh per workshop
B: Management training for district programme managers
• Number to be trained : 100
• Location: Institute XXX in 4 batches of 25 each.
• Timings: 1 batch in November, 2000, 2 batches in December, 2000 and 1
batch in January, 2001
• Cost per batch: Rs. 2.00 lakh
• payment to the institute : Rs. 1.50 lakh (including boarding and
lodging)
• TA/DA to participants : Rs. 50,000/.
• Payment timings for the Institute : Rs. 3.00 in Cct.2000 and Rs. 3.00 lakh
in December, 2000.)
• The TA/DA allowances will be paid separately in the months of training.
• Payment to the Institute has been included under “consultants’ fees”
category. The TA/DA to be paid to the medical officers has been placed
under training costs.
C: Contractual staff payments
0
❖
Three experts @ Rs. 50,000 per month, starting from May, 2000.
Other secretarial assistance @ Rs. 1.00 lakh per quarter.
Please note
In case of items to be procured, supporting documentation reflecting prevalent
market rate should invariably be attached.
Chapter-3
3.10
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Component Management Protocol
Part-1: Component Description
implementing Agency : State ABC
Component Number
2
Key terms of reference for the
review
Component
Title
Policy
review
management
on
workforce
[ summarise the ToRs as adopted. If no changes were made
to the ToRs provided by DoFW, mention so.]
Methodology for the review
A task force has been set up to conduct the review.
Tasks to be contracted out
No task has been contracted out. However, a team of
experts has been identified to assist the Task Force. The
CVs of the experts are enclosed.
Time schedule for the review
This is given in Part-ll for this component.
Estimated expenditure
Rs. 20.00 lakh.
Benchmark(s) derived from this
component
Field work commenced. Value: Rs. 10.00 lakh.
Report finalised and submitted to the SRC. Value: Rs. 15.00
lakh
Mechanism proposed for using
the results of the review
Results of the review will be used by the SRC for
undertaking policy reform measures.
ChaotAr-3
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EC-Gol Sector Investment Programme
Component Management Protocol
Part-ll: Time Schedule for the Year 2000-01
Implementing Agency: State ABC
Component Number
SI.
No.
1
2
Component
Title
Policy review on workforce management
________________ ______
Months (April 2000 to March 2001)
Activity description
A
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Development of methodology and
study tools, including literature review
2
Data collection and field work
3
Interim report preparation
4.
Presentation of interim report
5
Final report preparation
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Component Management Protocol
Part-1: Component Description
Implementing Agency : State ABC----- --------Component Number
3
Component
Title
Management of and support to DAP for
district XYZ
State GO empowering district Agency / Society to
Technical assistance / Policy
support needed for the DAP.
specialists from identified CHCs/PHCs to sub-divisional
State^GO enhancing delegation of financial powers,
including maintenance funds.
State GO allowing the district Agency / Society
determine and introduce user charges.
❖ Central Govt, orders allowing the district Pr09™£
managers to shift non-salary funds under Centrally
Sponsored Schemes from one sub-head to another
(within same head).
a work and motion
❖ Technical assistance for conducting
study in the district.
❖
Funds requirement
Time schedule for the policy
support activities
A: For the DAP — Rs. 150.00 lakh
❖ 1st Quarter: Rs. 30 lakh
❖ 2nd Quarter: Rs. 30 lakh
❖ 3rd Quarter: Rs. 40 lakh
4th Quarter: Rs. 50 lakh
B: For providing technical assistance - Rs. 5.00 lakh
(consultancy fee to research institution PQR for
providing technical assistance to the district for the time
and motion study).
C: Total-Rs. 155.00 lakh
This is given in Part-ll for this component.
SteteGO on deplo^Fof medical Tpara-medical staff iT
Benchmark(s) derived from this
component
GO^n^hlnced d^egXiJn of financial powers issued.
USe'
to
charges, issued. Value: Rs. 50.00 lakh
Note: It is assumed that the 'trigger1 benchmark (linked to approval of DAP) had a
value of Rs. 50.00 lakh.
3.13
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EC-Gol Sector Investment Programme
Component Management Protocol
Part-ll: Time Schedule for the Year 2000-01
Implementing Agency: State ABC
Component Number
3
Management of DAP for district XYZ
Component
Title
SI.
No.
Activity description
1
Issue of GO on deployment of medical /
pare-medical manpower
receive proposal
❖ SRC examines the proposal and
obtains necessary approvals
❖ GO is issued
2
Issue of GO on enhanced delegation of
financial powers
receive proposal
SRC examines the proposal and
obtains necessary approvals
❖ GO is issued
A
M
Months (Apri 2000 to March 2001)
F
J
N
D
O
A
S
J
J
$■
<$■
3
Issue of GO empowering district Agency
/ Society to introduce user charges
❖ receive proposal
❖ SRC examines the proposal and
obtains necessary approvals
❖ GO is issued
4
Engage an expert agency / institution to
provide technical assistance to the
district for conducting work and motion
study
❖ identify the agency / institution
❖ receive, examine and approve study
tools
& observe and review the field work
participate in the dissemination of
results
assist the district in streamlining MIS
in the district
5
Obtain Central Govt, orders allowing
concurrence the district programme
managers to shift non-salary funds under
Centrally Sponsored Schemes from one
sub-head to another.
send proposal to DoFW
* obtain the Order
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Component Management Protocol
Part-1: Component Description
implementing Agency : State ABC
Component Number
4
Brief description of the policy
initiatives
Component
Title
Policy initiatives
❖ Integration of Indian Systems of Medicines.
& Policy framework for certification / grading of hospitals in
the public and private sectors.
Policy framework for contracting out support services in
the public sector hospitals.
$
0
Improvement service delivery.
Involvement of policy framework.
Perceived benefits / impact of
the policy initiatives proposed
Activity Plan for the year
This is given in Part-11
Financial assistance needed for
SRC activities in the year
None
Benchmark(s) derived from this
component
0
❖
❖
GO on integration of ISM issued. Value: Rs. 15.00 lakh
Policy framework on grading / certification released.
Value Rs. 20.00 lakh
50% of public sector hospitals assessed for grading.
Value: Rs. 15.00 lakh.
Policy framework on contracting out of support services
at public sector hospitals released. Value: Rs. 40.00
lakh.
___________________ —
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Chapter-4: Role of District Health & Family Welfare Agency / Society
Background
Starting with the District Rural Development Agencies (DRDAs) in the late 1970’s, a number
of district level agencies have been set up by various donor-assisted and domestically
funded programmes. Mainly, these societies have functioned as entities facilitating the flow
of funds, relatively free of the rigid Governmental financial procedures.
A multiplicity of such agencies have begun operating in the health and family welfare field as
well, in response to demands from Gol and donors for easier and smoother flow of funds.
Typically, the societies have been formed according to the vertical programmes they service.
Also, with the exception of the SIFPSA in Uttar Pradesh, these societies do not have much
management or technical skills or expertise.
Experience indicates that a multiplicity of such ‘shell’ societies, all of which rely on the same
public sector health delivery infrastructure, creates internal contradictions and fragments
effort. Since much of the official membership is common, there is also no logic in preserving
the independent identity of these societies.
The SIP, therefore, envisages that an integrated ‘District H & FW Agency’ would be set up
in each of the demonstration districts. This agency will be expected to plan and manage
local services according to the CNAA planning and resources available to it. It may receive
on-going consultancy and institutional support, and be granted special status by the State
Government in regard to identified and agreed areas of authority and expenditure.
In other words, the district agency will be expected to discharge management functions
rather than being a mere funds-flow mechanism.
Is there a ‘recommended’ model ?
It is not recommended that an additional society be set up.
Nor is it recommended that all districts create an identical structure. Following
considerations, however, should guide the organisational set up for the district body:
• The agency will be responsible for managing all health and family welfare programmes
in the district.
• The agency will also have to create conditions conducive to involving the private sector
as well as the NGOs present in the district.
• It may have to generate additional resources to supplement those available from the
State and Centre.
• It must have sufficient decision making powers (e.g for recruitment and deployment of
staff, introduction of cost recovery measures, procurement of emergency drugs,
construction and maintenance of health facilities etc.).
11
Sector Investment Programme
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Handbook for Programme Managers
It should have sufficient representation from the <
community (e.g. prominent private
practitioners and other citizens; representatives of Rotary, Lions ClubsSnd other NGOs^
and consumer activists/forum etc.).
Options for the structure of district agency
Several options may be available for creating the district body:
the Zilla Panshad may itself take up the role of overall coordinating body even while the
vertical management structures continue for the various schemes and programmes;
3n eXeCUt'Ve °rder t0 take up the ro,e of coordinating
'
boXmrn'ttee Can be SSt UP
•
a statutory body could be created by an Act of the legislature with a mandate to manage
all health and family welfare schemes in the district, including measures for involvement
of NGOs and private sector;
a corporation or a company may be set up; or,
a District Health & FW Society could be created by merging all existing health and family
welfare societies and providing it with sufficient functional and financial autonomy.
•
•
Merger of all existing societies would appear to be the optimal solution simply because every
district already has at least two or three societies (District Leprosy Society, District Blindness
Control Society, District Malaria Society, District TB Society, Zilla Swasthya Samiti etc.)
which have mainly functioned as a mechanism for flow of funds. Their merger will, therefore,
help in focussing on the ‘people’ rather than the requirement of the programmes (e.g. that
there must be a district society for it to receive the funds). Another distinct advantage of a
Society is that it can raise resources and own assets.
Details of two examples (Zilla Swasthya Samiti in Orissa and district H&FW Society, Kangra,
HP) are presented in Appendices to this chapter to assist States/districts think through their
preferences. These are essentially a merger of all existing societies with:
•
•
•
representation from non-officials,
provision for separate accounts for the schemes where this is a requirement,
powers to design local resource generation instruments.
Features of Orissa and Kangra (HP) models are also summarised below to provide a an
overview of their structure and role.
Zilla Swasthya Samitis in Orissa
In Orissa, various societies have been merged into the Zilla Swasthya Samiti (ZSS) to form
a single Society under the Chairmanship of Collector.
The ZSS is mandated, among others, to
(a) assist the Health Department in the implementation of various health and family
welfare programmes;
(b) organise and involve the voluntary organisations of the district interested in
health;
(c) improve existing infrastructure of the health department, including maintenance;
| Chapter-4
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Handbook for Programme Managers
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(d) provide training to medical and para-medical staff as well as voluntary workers;
and,
(e) strengthen the management information system by standardising returns and
reports and computerisation.
The ZSS consists of three bodies :
(1) a General Body of patrons, life members, annual members, ex-officio members,
nominated/co-opted members and special invitees of the chairman,
(2) an Executive Body with the Collector as chairman, Zilla Parishad Chairman as
Co-chairman and Chief District Medical Officer as Vice Chairman-cum-MemberSecretary, and
(3) an advisory body consisting of State level officials.
The day-to-day activities of the ZSS are supervised by the Executive Body.
The ZSS funds include
(a) membership fees,
(b) contributions and donations by individuals and institutions,
(c) Govt, aid and Grants-in-Aid,
(d) funds mobilised through the Samiti’s publications and programmes, and
(e) funds collected as user charges.
The details of the structure and organisation of the ZSS in Orissa is given in Appendix-1 to
this chapter. It is reported that merger has resulted in better implementation and co
ordination and smoother management of the programmes at the district level.
District Health & Family Welfare Society, Kanqra
District Kangra (Himachal Pradesh) is the first participating district in the SIP to have formed
an apex body for coordinating all health and family welfare programmes and activities in the
district.
The 'District Health & Family Welfare Society’ in Kangra consists of two bodies :
(a) a Governing Council with the Deputy Commissioner of the district
Chairman and Chief Medical Officer of the district as the Secretary, and
(b) an Executive Body with the CMO as the Chairman.
as the
The composition and Bye-laws of the Society are reproduced in Appendix-2 to this Chapter.
The Society or Agency (or any other alternative mechanism proposed) must be
empowered to discharge management functions rather than being a mere fundsflow mechanism, so it must have sufficient degree of functional and financial
autonomy. The ZSS in Orissa and the Society created in Kangra are only
examples to help you construct your own model.
*★★*★★**
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Appendix-1 to Chapter-4
Structure and Organisation of Zilla Swasthya Samitis in Orissa
I.
Aims & Objectives:
I.
To create awareness among the people about their rights and their responsibilities
towards the health services.
To assist the Health Dept, in implementation of various health programmes, national,
state, as well as donor funded, with special emphasis on priority sectors like
population control, child survival and safe motherhood, immunization, control of T.B.
& leprosy, prevention of blindness, control of malaria, health sector reform and health
systems development.
To organise and involve in various programmes, the voluntary organisations of the
district interested in health care, and to utilise their services in the implementation of
health progrmmes of the district.
To work in coordination with different departments of the Govt, for successful
implementation of the health programmes.
To improve the existing infrastructure of the health department by way of construction
of buildings both institutional and residential, provision of equipment and medicines,
maintenance of all physical infrastructure.
To provide training to medical and paramedical staff of the district and to disseminate
information.
To provide training to voluntary workers, samiti workers and general public.
To strengthen the management information systems in the district by standardising
the returns and reports and computerisation.
II.
III.
IV.
V.
VI.
VII.
VIII
II
MEMBERSHIP:
Any citizen of the country who has an interest in health activities and an aptitude towards
social work can on request and by application become a member of the Samiti, irrespective
of cast, creed and sex. There shall be following varieties of the members:
a)
Patron member : Persons who pay Rs. 1,000/- only at one time, with an application
can become a Patron Member subject to approval of the executive body.
b)
Life Member : Those who pay Rs. 500/- only at one time with application for
membership can be a Life Member subject to approvalof te executive body.
c)
Annual Members : Those who pay Rs.250/- on or before 31st March of the year with
application for membership can be an Annual Member for next financial year subject
to approval of the Executive body.
d)
Ex-Officio Members : The following officers of the Govt, and others will be ex-officio
members of the Samiti by designation : Collector & District Magistate; Chief District
Medical Officer; Executive Engineer (R&B)/P.W.D./R.W.S.S./G.E.D.; A.G.M.
(Gridco); GM (IDCO); Project Director, DRDA; DSWO; DIPRO; ADMO (PH)/ DLO /
DMO, ADMO (Med)/ DTO; ADMO (FW) / DIO; DPM (Ophth.); Zonal Joint Directors of
Health Services; ZMO; Sub-collectors; SDMOs; MEIOs; District Coordinator, NGOs;
Secretary, IMA; Principal, FW Trg. School; and two representatives from local NGOs.
e)
Nominated/ Co-opted members: The Chairman can co-opt/ nominate any official or
non-official to the general body and the executive body as and when necesssary.
III
GENERAL BODY :-
The Genera! body will be constituted by all the members described above. In addition, the
Chairman can invite Zilla Parishad Chairman/ Local MPs and MLAs as special invitees to the
general body meeting. The General Body meeting will meet at leaset twice in a year.
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EXECUTIVE BODY:-
Executive Body will be constituted by Ex-Officio office bearers, nominated members from 2
NGOs, co-opted members and elected members from the general body.
Collector & District magistrate
Chairman
Xo3"™0
SanZiliaParishad
ii.
iii.
Vlce Chairman-cum-Member Secretary
iv
State Programme officers like TB, leprosy,
Members
Ophth., AIDS, Malaria, Planning, Medical,FW etc
v.
ADMO (PH)/DLO/DMO/DTO/ADMO(Med)
Jt. Secretaries.
ADMO (FW)/DIO
vi.
Zonal Joint Directors
Members
vii.
ZMO
Member
viii.
Project director, DRDA
Member
ix.
DSWO
Member
x.
Executive Engineer (R&B)/PWD/
Member
xi.
AGM(GRIDCO)
Member
: xii.
GM (IDCO)
Member
xiii.
2 Representatives from 2 NGOs
Nominated
members
xiv.
Project Coordinator, UK Aid Project
Member
xv.
Project Coordinator, World Bank Project
Member
xvi.
Representatives of Donor agencies working
Member
in the District.
FUNCTIONS OF THE EXECUTIVE BODY
•
•
•
•
•
V
To execute the programmes and policies of the Samiti.
To approve the annual budget.
To regulate the expenditure of the Samiti and to rectify all expenditures.
To review the implementation of the different programmes and
To appoint Auditors for auditing the accounts of the Samiti.
OFFICE BEARERS OF ZSS:1.
2.
3.
Ex-officio Chairman
Collector
Ex-officio Vice-Chairman-cum-Member Secretary CDMO
Ex-officio Joint Secretaries
ADMO (PH)/DLO/DMO/
DTO/ADMO(Med)/ADMO(FW)/DIO
FUNCTIONS OF OFFICE BEARERS
2haema?/ Co-Chairman: They will jointly or severally, preside over all the meetings of
the bamiti. The Chairman shall have full financial powers and can delegate all or any
powers to Vice-Chairman as and when required. He can nominate any official or nonotficial having interest and aptitude for social work to the General Body or to the
when^e^uire5^
030
disipliriary actl0n against any office bearers as and
(b) Vice-Chairman-cum-Member secretary : He shall nominate Jt. Secretaries to the
Body/rom amongst the members of the General Body after taking approval of
me chairman. He can delegate financial powers to the respective Jt. Secretaries. He
fh
meet'n9s °f ^6 Executive Committee at least once in a quarter and appraise
the Chairman about the progress of the work. He will execute and monitor all the health
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programmes. He will be the custodian of all records of the Samiti. He will be the officer
responsible to sue or to be sued by the Samiti. The account of the Samiti will be
operated by him. He will prepare the annual budget for placement and approval in the
Executive Body meeting in consultation with Joint Secretaries.
(c) Joint Secretaries :They shall work as per the direction and guidance of the ViceChairman-cum-Member Secretary of the Samiti. They will prepare budget for their
respective programmes and submit it before the vice-chairman for approval and
placement in the Executive Body meeting. They shall monitor the implementation and
expenditure on their programme. They shall jointly with the Member Secretary operate
the account for their programme.
(d) Members: All the members of the Executive Body shall be expected to attend all the
meetings of the Executive Body. If a member is absent in 3 consecutive meetings,
his/her membership shall be deemed to have been automatically cancelled. Members
are free to give their opinion in the meeting. The tenure of the nominated and co-opted
members shall be one complete year from the date of nomination.
VI
QUORUM
At least two third of the members which include office bearers shall be necessary to form the
quorum for the executive body meeting.
VII
FUNDS OFTHESAMITI
The Sources of the funds of the Samiti will be
Membership fees
1)
Contribution and donations by individuals and institutions
2)
Govt, aid and grant in aids
3)
Funds mobilised by the Samiti by its publications and other programmes
4)
Funds collected as users* charges
5)
The Samiti shall have exclusive right over the property acquired by it through purchase or
gift. The funds of the Samiti shall be deposited in the Savings account of any nationalised
bank in the designation of the Member Secretary. The account shall be operated jointly by
the Member Secretary and the Joint Secretary concerned in respect of each programme.
VIII
FINANCIAL RULES
The annual budget for the respective programmes will be prepared by the respective Joint
Secretaries in consultation with the Vice-Chairman-cum-Member Secretary of the Samiti
strictly observing the operational guidelines issued by the agencies providing funds for the
purpose. The Vice-Chairman can delegate the drawing and disbursing powers to his Joint
Secretaries for respective programmes. Different cash books will be maintained for the funds
received for different programmes. After approval of the budget in the executive committee
meeting, all the expenditure will be made strictly in accordance with approvals. Further
approval from the State Programme Officer will not be required. Any expenditure which is a
deviation from the official guidelines of the programme can be incurred with prior permission
of State Programme Officer, and after approval in the Executive Committee Meeting. All the
cheques of any amount will be signed jointly by the Member Secretary and the respective
Joint Secretary.
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IX
AUDIT
The Executive Body shall appoint an auditor from the Govt, or a qualified Chartered
Accountant to audit the funds of the Samiti at the closure of each financial year. The
Secretary who is the custodian of ail records and accounts shall produce all documents for
the audit and assist in the smooth auditing of the accounts. Audited account of the Samiti
should be sent to the different funding agencies well in time. This will also ensure early
release of subsequent instalments.
X
AMENDMENT OF THE RULES AND REGULATIONS OF THE SAMITI
Whenever it shall appear to the Samii that it is desirable to amend the rules and regulations
of the Samiti or to amalgamate the Samiti either totally or partially with any other society, a
special general body meeting shall be convened to consider the issue. A notice shall be
issued to all members of the Samiti to attend such special meeting of the general body. The
proposal for amendment for rules and regulations or amalgamation of the Samiti shall be
agreed to by the votes of atleast two third members of the Samiti present in the meeting. A
copy of such proposal when accepted by the General Body shall forthwith be forwarded to
the Additional Registrar of the Societies within one month of its acceptance.
XI
DISSOLUTION OF THE SAMITI
If two third of total members of the Samiti decide for dissolution of the Samiti, it shall be
dissolved forthwith.
All assets of the Samiti upon its dissolution shall become the property of the Health
Department of Govt, of Orissa after clearance of all debts and liabilities of the Samiti. No
property of the Samiti shall be distributed amongst its members.
XII
ADVISORY BODY OF ZSS
The following personnel will be in the Advisory Board of the ZSS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Secretary, Health &FW, GOO
Director of Health Services, Orissa.
Director of Family Welfare, Orissa
Director, SIHFW, Orissa
Director, MET, Orissa
Drugs Controller, Orissa
Project Director, World Bank Health Project
Project Coordinator, UK aid Project
Joint Directors of respective programmes.
////////////##
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Appenidx-2 to Chapter-4
District Health and Family Welfare Society, Kangra (HP)
Objectives of the H & FW Society: Health & Family Welfare Society will work for the
effective coordination and speedy implementation of GOI Health and Family Welfare
Programmes including Sector Investment Programme. The Society will function as
coordinating body in the District of Kangra for all Health and Family Welfare related activities
including the private health sector.
The Bodies of H & FW Society: The society will have two main bodies. They are THE
GOVERNING COUNCIL and EXECUTIVE BODY.
I.
THE GOVERNING COUNCIL: - This will be supreme body for guiding, planning,
coordination and implementation of District Health & FW Programmes and related
activities.
All Policies decisions will be taken by or with the consent of governing Council. Its
constituents will be as follow.
1.
Deputy Commissioner Kangra
Chairman
2.
Chief Medical Officer Kangra
Secretary
3.
Additional Deputy Commissioner Kangra
Member
4.
District Project Officer DRDA Kangra
Member
5.
District Education Officer Prim. & Sec.
Member
6.
District Programme Officer ICDS
Member
7.
Executive Engineers HPPWD (B&R) Kangra
Member
8.
District Programme Officers Kangra
Members
(DHO, DFPO, DTO, DLO, AIDS Nodal Officer and
Distt. Eye Surgeon)
9.
Principal HFTC Kangra
Member
.10.
NGO Representative DPES, Chinmaya Tapovan
Trust, ERA
Members
11.
Chairman Zilla Parishad
Member
12.
Representative, European Commission
Member
13.
Deputy Director RCH
Member
14.
Officer Incharge looking after Projects in the
Health Directorate
Member
15.
District Ayurvedic Officer
Member
The Governing Council will meet at least once in six months.
II.
THE EXECUTIVE BODY:- This body of H & FW Society Kangra will be responsible
for day to day Implementation, Monitoring and Evaluation of the H & FW Sector
Programme. It will be take decisions from time to time for speedy and effective
implementation of District Plan of Action to achieve the objectives. Executive Body
will have full financial powers in this regard. It will have the following constituents:-
1.
2.
3.
4.
5.
Chapter-4
CMO Kangra
All District Programme Officer in Health Deptt.
(DHO, DTO, DAPO, DFPO, DLO, & DPO-NPCB)
All BMOs, District Kangra
MEIO,. District Kangra
Principal Health & FW Training Centre Kangra
Chairman
Members
Members
Member
Secretary
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Rules and Regulations of District Health & FW Society Kanqra:-
ii.
iii.
Short title:- These rules will be called "Rules of District H & FW Society Kangra.”
Scope
These rules will be applicable to all the units of H & FW Department in
District Kangra and will cover all the activities and personnel of H & FW Society
Kangra. These rules will come into force from the day the Society is registered under
Societies Registration Act of 1860.
Definitions:- For these rules, the definitions will have the following meanings.
a)
b)
c)
d)
e)
0
g)
h)
i)
j)
Act - Act shall mean - Societies Registration Act 1860.
Government of India - will mean Ministry of Health & FW New Delhi.
"The. State health & FW Sector Reform Advisory Committee” - shall mean the
committee constituted by the HP Government.
The Governing Council" - shall mean Governing Council constituted under
these rules for guiding, coordinating & planning of various activities in District
Kangra for implementation of EC Sector Investment Programme.
"The Executive Committee" - will mean the Executive Committee constituted
under these rules for day to day implementation & monitoring of H & FW
Programme including RCH in District Kangra.
Non Government Organisations, "NGOs" under these rules - will mean NonGovernmental, Voluntary Organisations working in the health sector in
execution of different activities pertaining to H & FW including RCH.
"Community Based Organisations" (CBOs) under these rules - will mean NonGovemment Organisations working and representing community other than
the NGOs, like Mahila Mandals etc. who can be involved in implementation or
monitoring of health related activities.
"SCOVA" SCOVA under these rules - will mean State Council for Voluntary
Organisations at the state level as constituted by the State Government.
State Government under these rules - will mean Government of Himachal
Pradesh.
PRIs under these rules will mean Panchayati Raj Institutions like Gram
Pancharyats etc.
Functions of Health & FW Society District Kanqra:-
1.
2.
3.
4.
5.
6.
7.
8.
9.
Chapter-4
To undertake all activities pertaining to Health Sector reforms as envisaged in
District Plan of Action in District Kangra.
To undertake operational and applied research activities related to H & FW
including RCH.
To create, recruit and manage, technical, administrative, managerial,
academic, consultancy and other posts in the society and to make payments
for those according to rules & regulations of the society.
To make rules & regulations for managing the affairs of the society and to
make additions, deletions and amendments in them from time to time as
needed in the interest of society and programme.
To accept grant in aid, donations or funds in any form for the society.
To incur expenditure for managing the affairs of the society.
To purchase, hire, take on lease, exchange or otherwise acquire property,
movable or immovable including funds, construct & maintaining building /
buildings in the manner deemed fit as may be necessary for carrying out the
objectives of the society.
To prepare district Plan of Action and other project reports for different
activities, implement them and monitor in a time bound manner.
To lay down appropriate financial norms for different activities and their
auditing from time to time. The Executive body shall nominate a Chartered
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10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Handbook for Programme Managers
Accountant to audit the accounts of the society every year. The annual audit
report will be placed every year in the meeting of the Governing Council.
To enter into agreement or contract as may be deemed necessary and
sequential upon or incidental to carrying out the aims and objectives of the H
& FW Society.
To coordinate with and monitor the functioning of other District level societies
in Health Department and outside.
To coordinate / associate with and monitor the activities of NGOs/CBOs and
PRIs in the manner deemed necessary for achieving the objectives of the
European Commission assisted Sectoral Investment Programme.
To accept contributions both in cash and kind from any NGOs/agencies in the
field of Health & FW in the state or outside the state.
To appoint short time consultant / consultants as may be required to carry out
activities to achieve aims and objectives of the society.
H & FW Training Centre Kangra will act as nodal centre for implementation
and monitoring of the activities of European Commission Sector Investment
Programme.
To decide and levy user-fee for various Health & Family Welfare related
services and utilise the same for improvement of Health services in the
District.
To plan and manage Social Marketing Programmes.
To enter into joint ventures with other institutions / organisations in the Health
& Family Welfare Sector.
Regional Health & Family Welfare Training Centre Kangra as Nodal Institution
for implementation and monitoring of the activities of this Health Sector
Investment Programme Project.
Properties and Assets:- The income and property of H & FW Society Kangra, derived in any
manner however, shall be applied towards promotion of objectives thereof as laid down in
this memorandum of association, subject nevertheless, in respect of the expenditure of
grants made by the Government of HP, Government of India or donor agencies to such
limitations as these Governments / agencies may from time to time impose. No portion of
income and property of the society shall be paid or transferred directly or indirectly by way of
dividend bonus or otherwise, however, to persons who at any time have been members of
the society or at any one of them or to any person claiming through them provided that
nothing therein contained shall prevent the payment in good faith of remuneration of any
service rendered to the society or travelling allowance, halting or other similar charges.
Quorum : -The quorum for the meeting of Governing Council and Executive body will be half
of the total members.
Government Powers:-State Government and Central Government may jointly or individually
may appoint one or more persons to review the work and progress of H & FW Society and
may hold inquiries into the affairs thereof and to report thereon, in such manner as the
Government may stipulate and upon receipt of report may jointly take such actions and
directions as they may consider necessary in respect of any of them as dealt with in the
report. The society shall be bound to comply with such directions. In addition, the Central or
State Government may at any time issue directions on matters of policy to the society and
society will be bound to promptly comply with such directions. Where there are different
views between the State Government and the Central Government, the views of Central
Government shall prevail.
Financial Management:- The H & FW Society shall maintain the account in a Public Sector
or Cooperative Bank at Dharamsala / Kangra. The account shall be jointly operated by
Chairman and Secretary of the Executive Committee. Proper cash book and records of all
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accounts shall be maintained by the Society for which some part time help may be engaged.
The accounts shall be got audited annually from the authorised agency like Chartered
Accountant or others as per requirement of Govemment/Donor agency.
Dissolution:- If on winding up of the society due to any circumstances, there shall remain,
after dealing with all its debts and liabilities, any assets or properties whatsoever it may be,
shall not be paid to or distributed among the members of the society or any relations of them
but shall be dealt with in such manner as the State Government may determine.
The Governing Council of the society with majority of two third of its members can pass a
resolution for dissolution of the society.
Amendment of By Laws:- The By Laws can be amended any time by the Governing Council.
Legal Matters:- In case of legal proceedings by or against the Society, the Secretary of the
Society shall be authorised to file and sign affidavits, replies etc., on behalf of the Society, to
appear in various courts and authorities. Any legal help, if so required, can be engaged for
this purpose and expenditure for that can be incurred out of the funds of the Society.
However, all pleadings, statements/replies shall have prior or ex-post facto approval of the
Executive Committee.
*********
| Chapter-4
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Chapter-5 : Guidelines for preparing the District Action Plan (DAP)
A: Background
The Gol policy statement, The Paradigm Shift1, calls for
■ Decentralisation (delegating responsibilities) and devolution (delegating
authority);
■ Community needs based planning;
■ Sustainability of infrastructure and workforce;
■ More efficient financial management, specially ways of linking funding to
performance;
■ Improved quality of clinical services.
How can the above aspirations be turned into reality ? Can this be possible under guidelines
and directions from above which may fail to take note of the local realities ?
i,
There is overwhelming evidence that the absorptive capacity of the system has been
incapacitated due to decades long practice of designing top-down schemes on the one hand
and a near complete absence of freedom of action (e.g. alternative deployment of existing
resources that may be somewhat different from the laid down ‘norms') on the other.
The SIP has been designed on the premise that there is an urgent need to introduce
operational or micro policy changes that will turn the aspirations of The Paradigm Shift into
reality. Many changes are needed to develop holistic improvements to the ways services
are planned and managed at the district level. There is an urgent need to concentrate on
improving management of existing resources and activities rather than extending the
coverage of services, or extending infrastructure which may add to existing problems.
Money and effort devoted to improved management will have a considerable impact on the
effectiveness of existing services. It will also increase the sector's capacity to absorb
resources effectively, and will lead to the extension of services and improvement of quality.
This can be depicted as in the diagram below:
Policy and operational reforms
Improved management of existing resources
U
Improved capacity to undertake additional activities
1 See Chapter-1 : Sector Investment Programme: An Introduction
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B: What is the focus of DAP ?
The focus of the district action plan (DAP) will be on reform. That is, the DAPs will focus on
identification of factors that inhibit ’functionality’ of the Family Welfare Programme. This is
why the terms of reference for group work at district workshop focussed at identification of
problems hindering implementation of existing programmes and possible solutions to
overcome the same.
The problems hindering the Programme may be structural, systemic or operational.
Structural problems may emanate from division of labour or administrative structures. For
example, civil hospitals in a district may be under a separate line of command than the Sub
centres, PHCs and CHCs and this separation may be a cause of poor referral practices
because functional linkages are not clearly laid down. A problem can be termed as
systemic if it is caused by rules, norms and procedures. For example, maintenance is poor
even though funds were there but they were placed at the disposal of the PWD whose
priorities were new constructions rather than repairs. The operational problems refer to
staffing and resource gaps.
Very often, an identified problem can not be clearly placed under one category or the other
because they are inter-linked. For example, it may be possible to minimise lack of staff or
resource gap through managerial action locally, but the existing procedures do not allow
freedom of deployment to the district programme managers.
The DAP will be nothing but a series of reform oriented initiatives addressing structural,
systemic and operational problems. The DAP can, thus, be described as articulated
responses to the following inter-related questions:
■
Certain structural / systemic / operational problems were identified during the
district planning workshop and subsequent consultation process at lower levels.
■
Which of these problems do you propose to address in year-1?
■
What is the support needed for implementing the changes / solutions?
[For some of the operational problems, you might want to pilot (test on a small
scale) the solutions proposed which will cost money. You may also want some of
the managers to be trained in managing facilities, funds and changes proposed,
which will also cost money. On the other hand, for the structural and/or systemic
problems, you may need intervention from the State level - e.g. issuing a
Government Order (GO) allowing deployment of staff, levying user charges and
so on, which do not involve any costs to you.]
■
On what basis you want your progress (in overcoming the problems) to be
measured?
Each of the changes proposed will constitute a component of the DAP. Some components
may take very little time for implementation while others (e.g. piloting a new approach to
service delivery) may take longer (more than a year).
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C: Planning horizon
Overcoming policy and operational problems is a complex task. It may not be feasible to
address the entire range of problems simultaneously. The SIP, therefore, does not envisage
the District (or State Plans) to be a comprehensive 5-year document. Rather, it envisages
that the districts will evolve:
• a vision statement as to what the district wants to achieve in the next five years, or, in
other words, where it wants to go from where it is now;
• a prioritisation of the current problems and gaps;
• an action plan for addressing the systemic and operational problems which should be
tackled in the first year; and,
• proposals for taking up new activities which the local programme managers feel must be
taken up but can not be taken up because no funds are available.
Towards the end of the first year, a review of progress will be made which will set the
agenda for the next year. Thus, the plans for year-1 will roll over into the second year’s plan
for
(a) replicating ideas which proved to be worthwhile,
(b) correcting ideas which did not yield desired results,
(c) continuing new activities, if they prove to be yielding reasonable improvements,
and
(d) continuing with the experiments (which needed more than one year time span to
show results) started in the previous year.
This rolling nature of the planning process could be depicted as shown in the diagram below.
'
Plan for Year-1
• Policy changes
• Operational changes to be tested
• New ideas to be tested
• New activities to be taken up
• Facility level needs to be met______________
______ u______
•
•
•
Implement the plan
Monitor implementation
Evaluate outcome
________________ U_______________
•
•
•
•
•
•
Chapter-5
Plan for year-2
Replicate successful pilots
Continue new activities started, if found to be
effective
Adjust / correct activities facing problems
Introduce further policy changes
Take up new pilots and activities
Continue facility level improvements
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D: Essential Contents of the DAP document
District.Profile: Present the demographic and health related information for the district as a
whole as well as for each of its development Blocks. Provide information on mortality and
morbidity pattern in the district, including seasonal variation. List out the primary causes of
infant mortality, low birth weight, malnutrition, RTIs, low contraceptive prevalence, high birth
rate, high maternal mortality and disability.
State clearly if the above details are not available for
the district. Creating this information base can, in fact,
become a component of the DAP.
Situation analysis: Provide a summary of (a) the availability of all health facilities in the
district — public sector as well as the NGO and private sectors (use a map indicating road
and railway infrastructure in the district as also the population of all the towns where
hospitals and nursing homes etc. are located), (b) present status of availability of referral
services provided by the public sector health facilities, (c) the problems caused by the
existing norms, rules and procedures.
Components for first year’s plan: State which of the problems identified during the
consultation process you want to address in the first year. The write-up should explair! the
logic for selection and sequencing.
For each component, prepare a three-part 'Component Management Protocol' to provide a
summary of what the component seeks to achieve, what will be the time needed to
implement the component , what is the cost involved and what will be the criteria for
assessment of progress and release of funds. The three parts are:
•
Part-1: ‘Component description’. This should summarise the problem identified, solutions
proposed, the support (funds or State/Central level approval to policy changes) needed
to implement the solution, the time frame and the costs involved2. [The components may
be serially numbered to facilitate reference.]
2 Some operational problems can be solved without any external support but may require funds which
are not available. Adopting modified OPD timings at a health facility to suit the ‘clients’ can be done
without any external intervention or financial assistance. Launching a continuing skill development
training for the paramedical workers at larger hospitals (where there is enough case load) through a
system of roster can also be done without any external interventions but the funds may not be
available.
For some other problems, State Govt, intervention / approval may be called for. Allowing the district
Society/Agency to introduce measures for enhancing financial and functional autonomy of the
programme managers at lower levels and to introduce user charges for some of the services may
require the approval of the State Govt.
For still others, piloting may be called for to test the feasibility of solutions before higher level
intervention can be sought, e.g. alternative arrangements for locating medical and paramedical
workers and adoption of an alternative referral system.
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Part-ll: ‘Time Schedule'. This is to be prepared as a Gantt chart for all the activities to be
undertaken under the component.
•
Part-Ill: ‘Cost estimates’.
E: Assigning values to benchmarks
After the component details have been prepared, a set of benchmarks are to be derived
from these. Then, appropriate values are to be attached to them in such a way that their
achievement will provide enough funds to ensure that there are no funds shortages at any
time during implementation phase (see chapter-8 for more details).
Following operational steps are suggested for this exercise:
* list the benchmarks in the following format, leaving the values column blank:
Benchmark
description
SI.
No.
List of benchmarks
Value
Expected
Related Component
attache
month
of
Com.
Description
Com.
d
Rs.
achieving
No.
Lakh
Indicator of
achievement
Next, summarise the expenditure estimated to occur in each quarter of the year 2000-01
for all components included in your plan for year 2000-01. Use the following format:
Comp
onent
No.
Funds needed for implementing components
Funds needed in year 2000-01
Component
Oct-Dec.
July-Sept
description
April-June
Jan-March
Total requirement for all
components
Now, determine the values to be assigned to the benchmarks in such a way that the
total expected receipts for each quarter cover the total expected expenditure. However,
do not try to draw funds far in excess of the need. The money sitting idle in one place
may deprive another of funds.
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F: Illustrative examples:
The formats to be used can best be described with practical examples. These are presented
in the Appendix to this chapter to explain how the components may be formulated. Based on
discussions in the district level workshops held in the past few months, these are only
illustrative and in no way should be treated as ‘the recommended solutions’.
Only Part-1 (component description) has been presented for all example components while
Parts II and III have been presented only for the first example component This is because
preparation of time and cost estimates is rather straight forward. [Do note that you have to
add the details for the cost calculations, as illustrated for Example Component-1 in the
Appendix.] '
G: Approval process and role of State Sector Reform Cell (SRC)
The Programme Management Bureau (PMB) in Department of Family Welfare has decided
that the resources needed for the DAPs will flow through the State Sector Reform Fund
(SRF) and the task of releasing funds to the districts will be handled at the State level.
Except for a start-up amount, the State will have to ‘earn’ the funds for DAPs through a set
of benchmarks demonstrating the technical assistance and policy support provided to the
districts in the implementation of the DAPs.
Accordingly, after the DAP proposals have been prepared and submitted to SRC, following
sequence of activities will take place:
• SRC will examine the DAP proposals and may ask the district Core Team to incorporate
•
changes, if any.
After the SRC has aporoved the DAP proposals, the same will be forwarded to the PMB.
At this stage, the SRC will propose the amount that should be released by PMB on
approval of the DAP.
The ‘approval of DAP by PMB’ will be an automatic benchmark and will ‘trigger’
! release of a part of year-1 outlay for the DAP to the SRF. The SRC will
! determine the amount to be released on approval on the basis of funds required
I for implementing
the DAP activities until the funds linked to the early
benchmarks derived from DAP components become available.
•
After the DAP has been approved by PMB, the State Will prepare and submit its plan for
supporting the DAP, as a separate component of State EC Programme Implementation
Plan (SECPIP), to the PMB. This will contain a set of benchmarks against which the
PMB will release the funds (for DAP) to the State.
I Except for the trigger amount linked to approval of DAP, the district will receive
1 the funds only against the achievement of benchmarks indicated in the DAP.
i
Chapter-5
5.6
u
Sector Investment Progiamme
^rs
Handbook for Programme M'
Management of DAP will become a component in the SECPIP to ensure that the State
provides the necessary support that the districts will need for the smooth implementation of
their plans. It is essential, therefore, that the DAP proposals are finalised in consultation with
the SRC so that the time schedule for components involving technical assistance and policy
support as reflected in the DAP proposals is consistent with the time schedule that the SRC
will indicate in this regard.
After a plan has been approved by SRC, the PMB would presume that any
deviations from existing State policies would have been agreed to. Similarly,
approval of a plan by PMB will imply approval of any deviations (included in the
proposals) by the Department of Family Welfare, Govt, of India.
H: Evaluation Criteria
The SRC / PMB will examine if provisions already exist for one or more of the components of
a plan and may send it back for clarification. It must be ensured, therefore, that a
component is not merely a duplication of effort.
After the preliminary screening as above, SRC / PMB will evaluate the components of a plan
on following criteria:
•
Necessity : problems identified for resolution should be clearly stated, bringing out
why a proposed component should be taken up ahead of other interventions which
do not find a place.
•
Cost effectiveness : is the proposed component the optimum solution among all
possible solutions?
Improvement: will the implementation of the proposed component improve the health
situation in the district ?
Replicability : does the proposed component hold the potential for being replicated
elsewhere in the district / State / country ?
•
•
•
Sustainability : is the component sustainable after the SIP funding ceases ?
********
Chapter-5
5.7
Handbook for Programme Managers
Sector Investment Programme
Appendix to Chapter-5
Examples of DAP components
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : District ABC
Component Number
Component
Title
1
Problems identified
■
■
■
Solutions proposed
■
■
for
Support
needed
implementing changes
■
Cost of implementing changes
Time needed
changes
to
implement
Sustainability of the changes
Benchmark(s) derived from this
component__________________
Chapter-5
•
Decentralisation of functions and devolution of
powers
_________
Programme managers at district and sub-district levels are
unable to deploy medical and para-medical staff as they have no
control over subordinate staff.
Inability to use available resources fully because the programme
managers do not have any flexibility.
Maintenance of buildings is poor because (a) funds provided are
not sufficient and (b) allocations for maintenance are placed at
the disposal of PWD whose priorities may are different.
Allow deployment of para-medical staff within PHC areas by the
Medical Officer; and transfer of para-medical staff and
deployment of medical officers within the district by the Chief
Medical Officer.
Allow non-plan, non-salary State grants to be used in a flexible
manner, subject to overall limits and allow shifting from one sub
head to another (within same head) for all Centrally Sponsored
Schemes.
Transfer funds and responsibility of maintenance to the district
level coordinating body which will distribute the resources taking
into account resources generated through user charges vis-a-vis
funds needed for maintenance.
State government to issue a G.O. on the first and third and the
Central Government on the second.
Training of medical officers in personnel
oersonnel and financial
management.
Rs. 6.50 lakh (as per details given in Part-Ill)
■ Total planned time : 6 months
■ Expected month of start: May, 2000
■ Expected month of completion: October, 2000
[ Identified training institutions will continue to provide on-the-job
problem solving advice. This will be an integral part of the MOU with
the institution(s).]
Not applicable for this component. The fees payable to the training |
institutions will include the cost of on-the-job problem solving support
for one year.
GO for decentralisation of functions and devolution of powers issued.
Value: Rs. 20.00 lakh.
5.8
iI
h
Handbook for Programme Managers
Sector Investment Programme
EC-Gol Sector Investment Programme
Component Management Protocol
Part-ll: Time Schedule for the Year 2000-01
Implementing Agency: District ABC
Example
Number
Component
1
Component
Title
Decentralisation of functions and devolution of
powers
Months (Apri, 2000 to March 2001)
Activity description
SI.
S | O | N | D | J | F ~[~M
A
|
M
|
J | J | A
No.
A: dep oyment of staff
submit proposal to SRC_________________ —__________________________
A-1
discuss and negotiate with SRC____________ ■—
____________________
A-2
State Govt, order is issued
|
|
|—j
A-3
B: delegation of financial powers
_
_____
submit proposal to SRC_________________—
B-1
discuss and negotiate with SRC____________ _______________ _______________
B-2
"State
Govt, order is issued
|—
I
I
I
I
I
B-3
C: introduction of user charges____________
develop proposal______________________ —______________________________
C-1
submit proposal to SRC____________________ —______________
C-2
discuss and negotiate with SRC_________________ —
C-3
obtain State orders empowering
C-4
district Agency /Society__________________________________________________
issue orders for introduction of user
C-5
charges and retention/utilisation of
•—
_____ collections_______________________ I
I
I
I
I
I
I
I
I
I
D: Flexibility to use non-salary funds/allocations available for Centrally Sponsored Schemes
[To be taken up by SRC ]
Training of medical officers in personnel and financial management
Identify training instituticn(s) [about
'
“
5
150 officers are to be trained]
Prepare the course content______
6
Prepare training schedule________
Conduct the training
9
Note: The identified training institution(s) will continue to provide on-the-job problem solving
support to the officers trained. A Memorandum of Understanding will be executed
with the identified training institution(s) to this effect.
Chapter-5
5.9
Sector Investment Programme
Handbook for Programme Managers
II
EC-Goi Sector Investment Programme
Component Management Protocol
Part-Ill: Cost Summary
Implementing Agency: District ABC
Example
Number
Component
Expenditure
category
April_____________ June
A: Non-recurrent Costs
Civil works
including
______
renovation___________
Vehicles--------------------Medical
Equipment
______
Non-medical
equipment
including
Training and
0.30
workshops
Consultants’
2.50
fees______
Other non
recurrent
costs_____
B: Recurrent costs
Contractual
staff
payments
Health
consumables
Non-health
consumables
Vehicle
maintenance
including
POL
expenses
Building
maintenance
Other
recurrent
costs_____
Total for the
2.80
component
1
Component
Title
Decentralisation of functions and devolution of
powers
Expenditure (Rupees in lakh) estimated to occur in
Financial year 2000-01
After 2000-01 | Total
JulyOct.JanTotal
Sept,
Dec.
March
Not applicable for this component--------
------ Not applicable for this component
— Not applicable for this component------
------ Not applicable for this component------0.90
0.30
2.50
1.50
1.50
5.00
5.00
------ Not applicable for this component------
3.40
0.30
6.50
6.50
[ Norms for calculations are attached]
Chapter-5
5.10
I
u
Sector investment Programme
Handbook for Programme Managers
Calculation Norms for Component Number-1
Number to be trained: 150 medical officers
Assumptions and calculations:
• Training will be conducted at Institute XXX in 5 batches of 30 officers each.
• The Institute has agreed to provide training (including post training on-the-job
problem solving support) @ Rs. 1.00 lakh per batch of 30 officers. In addition to
course material, the Institute will provide boarding and lodging within the agreed
cost. The duration of the course will be one week. Due to other commitments,
the Institute has agreed to schedule one batch per month.
• Payment to the Institute will be made in two installments of Rs. 2.50 lakh each:
first installment is to be paid immediately before the start (i.e. in May, 2000) and
the other after completion of three batches, i.e. in September, 2000.
• The TA/DA allowances will be paid separately. These are estimated to cost Rs.
1000/- per officer on an average. Total TA/DA cost will therefore be Rs. 1.50
lakh. In first quarter (April-June, 2000), the expenditure on this account will be Rs.
30,000; that in the second quarter Rs. 90,000 and the remaining Rs. 30,000 in
the third quarter.
• Payment to the Institute has been included under “consultants’ fees” category.
The TA/DA to be paid to the medical officers has been placed under training
costs.
Chapter-5
5.11
hector investment Programme
Handbook for Programme Managers
Sector Investment Programme
Component Management Protocol
Part-I: Component Description
implementing Agency : District ABC
Component
Number
2
Component Title
Problems identified
*
•
Rationalising ANMs’ work routine and streamlininq
their MIS
ANMs complain that they are over-burdened and most of their
time is taken away by preparation of returns prescribed for various
schemes and programmes.
On the other hand, however, data is not available on a sizeable
number of RCH indicators.
Solution proposed
■
Undertake a work & motion study of ANMs and Male workers with a
view to rationalise their roles and responsibilities with reference to the
existing programmes.
Streamline the management information system with a view to
eliminate un-necessary documentation load and to devise a system
for eliciting information from a relatively small number of basic
records.
Support needed for
implementing change
■
Sector Reform Cell to identify and engage a suitable agency for the
field work and subsequent data analysis.
MIS streamlining will be carried out through a team of programme
managers with the help of the agency engaged for work and motion
study.
Cost of implementing
changes
■
Rs. 7.00 lakh (does not include the payments to be made to the
agency)
Time
needed
to
implement changes
■
■
Total planned time: 4 months
Expected month of start: May, 2000 (assumes that SRC will be able
to identify the agency in April, 2000)
Expected month of completion: August, 2000
■
Sustainability
changes
of the
Benchmark(S) derived
from this component
Chapter-5
Not applicable for this component
■
Launch of revised work schedule and revised MIS set up Value: Rs.
15.00 lakh.
5.12
u
i1
Sector Investment Programme
Handbook for Programme Managers
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : District ABC
Component
Number
3
Component Title
Improving community's access to the health worker.
Problem
The access to the health worker is limited, since the worker visits a
village only twice a month and is not available at her/his Sub-centre more
than twice a week. As a result, any citizen coming to the Sub-centre,
whether for cure or prevention, usually finds the facility locked.
Solution proposed
Ask the Panchayat to identify and place a para-medical worker at the
Sub-centre on a full time basis.
Such a para-medical worker should
know basics of preventive health as well as basic cures for common
diseases along with a medicine shop catering 'to the entire catchment
area of the Sub-centre. The Panchayat may finance this worker or,
alternatively, allow the person to charge for the services.
The above mode! will be piloted in a few Panchayats having Sub-centres
with ANM quarters and, if found useful, will be extended to all such
village Panchayats.
Support needed for
implementing change
A one-time grant to the Panchayat (@ Rs. 1.00 lakh per Panchayat) for
upgrading the facilities at the selected Sub-centres (e.g. to add another
room to house the medicine shop or to construct a delivery room or to
improve the existing building and facilities).
Cost of implementing
changes
Rs. 17.00 lakh [ Rs. 15 lakh for 15 Panchayats and Rs. 2.00 lakh for
meetings, travel and other related expenses, including a sample
household survey by PSM Department of Medical College XXX.]
Time
needed
to
implement changes
■
■
■
Total expected time : 10 months : 1 month for identification of
Panchayats, 3 months for preparatory activities (dialogue with the
community, identification of para-medics and their training,
upgradation of facilities) and 6 months for recording observations.
Expected month of start: May, 2000
Expected month of completion: February, 2001
Sustainability of the Not applicable as this is a pilot.
changes____________
Benchmark(S) derived ■ Placement of paramedics at the identified Sub-centres. Value: Rs.
from this component
10.00 lakh.
Chapter-5
5.13
Sector Investment Programme
Handbook for Programme Managers
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : District ABC
Component
Number
4
Component Title
Improving referral set-up
Problem
The referral services in the district are very poor due to lack of blood banking
facilities, specialists, lab facilities and other infrastructure.
Solution proposed
At present, blood banking facilities are available only at 5 hospitals, other than
the district hospital. In the first instance, therefore, these hospitals will be
strengthened to provide the full range of emergency services, on a 24-hour
basis. The available strength of specialists and general duty medical officers will
be re-located from CHCs to these places where providing accommodation is not
a problem. These hospitals will also be used as the sites for providing skill
development training for the ANMs.
In addition, three private sector hospitals located at towns X, Y and Z, will also
be recognised as a referral centre. In return for the recognition, the hospitals
have agreed to provide free ante-natal care to below poverty line (BPL) clients
and to promote ORS and breast feeding. They are also prepared to train Govt.
ANMs in handling normal deliveries and minor obstetric complications. A
memorandum of understanding will be signed with them in this regard under
which they will also display the charges for the various package of RCH
services.
Support needed for
implementing change
State Govt, concurrence will be needed for redeployment and re-location of
medical and paramedical staff from other facilities as may be recommended by
the district Society / Agency. State Govt, orders will also be needed to delegate
powers to contract the private practitioners.
i
Cost of implementing None [costs relating to facility improvement are included in the relevant
components (*)]
changes
Time
needed
to
implement changes
•
•
•
Sustainability of the
changes_____________
Benchmark(s) derived
from this component
Total planned time: 6 months [includes time needed for drawing up the re
worked implementation for referral services and obtaining the approval of
district Society/Agency and/or Sector Reform Cell, execution of MOU with I
the private sector hospitals and effecting staff re-deployment/re-location. I
Time required for facility level improvements etc. are reflected in the relevant
components]
Expected month of start: June, 2000
j
Expected month of completion: November, 2000
Not applicable
Re-worked referral plan approved by State Govt. Value Rs. 40.00 lakh.
(*): Requirements will vary from facility to facility. Therefore, while deployment needs etc. must be
assessed in an integrated manner, fresh investments should be assessed separately for each facility.
This will later help in monitoring improvements made by each of the facilities.
Chapter-5
5.14
Ii
i
Handbook for Programme Managers
Sector Investment Programme
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Impiementing Agency : District ABC
Component
Number
Component Title
5
| Improvement of services at Civil Hospital XYZ
Problem
Hospital located at XYZ has access to blood bank and is capable of
providing the full range of RCH referral services on a 24-hour basis.
However, the existing services are of poor quality due to
(a) vacancies
of specialists, (b) lack of facilities (running water, waiting hall / room for
patients/escorts, toilets) and (c) lack of funds for day-to-day operations.
Solution proposed
■
■
■
■
Support needed for
implementing change
Cost of implementing
changes____________
Time
needed
to
implement changes
■
■
of
the
Benchmark(s) derived
from this component
Chapter-5
Funds for one-time investment for improvement of facilities.
Approval of the proposal (for setting up the governing / management
body by district Society / Agency and/or Sector Reform Cell.
[Proposal for re-location of staff is included in component-4]
Rs. 20.00 lakh as one-time investment
■
■
■
Sustainability
changes
Improve facilities.
Meet specialists’ shortage by withdrawing them from the hospitals
where no blood banking facilities are available or where their skills
can not be optimally utilised.
Introduce user charges which may be retained at the facility for
maintenance.
Constitute a governing / management body with the medical-officer
in-charge as the member-secretary and local community leaders-not
necessarily limited to PRI representatives - as the members and
allow them to fix the user charges and generate additional resources
for further improvement of the facilities.
Total planned time : 12 months [including time needed for new
construction]
Expected month of start: June, 2000
Expected month of completion: May, 2001
Services and facilities created will be sustained by using the collections
made through introduction of user fees.
■
Identified shortcomings rectified and hospital made fully functional..
Value: Rs. 30.00 lakh.
_________________________________
5.15
i
Sector Investment Programme
d
Handbook for Programme Managers
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : District ABC
Component
Number
6
Component Title
Improvement of services at Civil Hospital DEF
Problem
Hospital located at DEF does not have access to blood banking facility
at present but is otherwise well placed to provide all other RCH services.
Utilisation has also been good. However, there has been a fall in the
quality of services (reflected in a fall in the utilisation rates) due to (a) lack
of facilities (running water, waiting hall / room for patients/escorts, toilets)
and (b) lack of funds for day-to-day operations.
Solution proposed
■
■
■
Support needed for
implementing change
Cost of implementing
changes___________
Time
needed
to
implement changes
■
■
Improve facilities.
Generate resources through user charges to ensure maintenance of
services.
Constitute a governing / management body with the medical-officer
in-charge as the member-secretary and local community leaders-not
necessarily limited to PRI representatives - as the members and
allow them to fix the user charges and generate additional resources
for further improvement of the facilities.
Funds for one-time investment for improvement qf facilities.
Approval of the proposal (for setting up the governing / management
body which would be competent to decide the user charges) by
district level coordinating body (which may only prescribe an upper
limit for the user charges for different types of services).
Rs. 12.00 lakh as one-time investment.
■
■
■
>
Total planned time: 9 months
Expected month of start: June, 2000
Expected time of completion: February, 2001
Sustainability of the Services and facilities will be sustained by using collections made
changes____________ through introduction of user charges
___________________________
Benchmark(s) derived ■ Management Board set up and user charges introduced. Value: Rs.
from this component
25.00 lakh.
Chapter-5
5.16
i1
Handbook for Programme Managers
Sector Investment Programme
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : District ABC
Component
Number
7
Component Title
Improved utilisation of manpower
Problem
The doctors’ positions remain perpetually vacant at a large number of
rural PHCs. In many of the rest, doctors are day-time visitors as the
support services/facilities (e.g. schools for children) are not available at
their places of posting.
Solution proposed
Concentrate the doctors at the facilities/ locations where the support
services are available. Adjust the timings for the outlying PHCs (from
where the doctors have been re-located) so that the facilities (where the
doctors have been re-located) can provide 24-hour delivery services and
(if the facility has easy access to blood bank) the full range of referral
services.
The outlying PHCs will revert to being dispensaries with pre-declared
timings. The doctors have agreed to use their personal vehicles for
attending the PHCs if they are paid a monthly transport allowance,
calculated on the basis of distance involved.
The above concept will be piloted in one or two sub-divisions before
considering replication / extension.
Support needed for Approval of the State Government to the proposal.
implementing change
Cost of implementing Rs. 2.00 lakh, (one year’s cost of monthly transport allowance for the re
located doctors)
changes
Time
needed
to
implement changes
•
•
•
Total planned time: 4 months
Expected month of start: August, 2000
Expected month of completion: November, 2000
Sustainability of the Not applicable as this is a pilot
changes____________
Benchmark(s) derived None.
from this component
Chapter-5
5.17
Sector Investment Programme
Handbook for Programme Managers
Sector Investment Programme
Component Management Protocol
Part-1: Component Description
implementing Agency : District ABC
8
Component
Number
Component Title
Improved utilisation of sub-centres.
Problem
In a significant number of cases, the ANMs are not staying at the place oi
their posting because the Sub-centres are located well outside the village
and the ANMs have a sense of insecurity. In many such places, there
have been cases of theft and break-in.
Solution proposed
Adopt and announce a policy for locating a Sub-centre which takes due |
note of the personal safety of the ANM on the one hand and the
responsibility to the community on the other.
■
Identify the location of all existing Sub-centres with a view to identify the
most vulnerable.
Negotiate with the Panchayat concerned to make arrangements to re- '
locate the sub-centre at a secure place within the village. Offer the
Panchayat a one-time grant (say, Rs. 1.00 lakh) in return for providing an i
alternative accommodation for the Sub-centre. The grant may be used to '
part-finance the rent for the alternative accommodation for the Sub
centre. The Panchayat may also be allowed to decide alternative use of i
the existing Sub-centre building.
If the Panchayat does not agree to the suggestion, the Sub-centre may ,
be shifted to another Panchayat village which is willing to offer |
appropriate accommodation.
This proposal will initially be piloted in respect of 10 most vulnerably |
located Sub-centres.
Support needed for
implementing change
Cost of implementing
changes____________
Time
needed
to
implement changes
Approval of the Sector Reform Cell to the proposal.
Rs. 10.00 lakh (for providing the one-time grant to the Panchayats).
•
•
•
Total planned time : 4 months
Expected month of start: September, 2000
Expected month of completion: December, 2000
Sustainability of the Not applicable
changes____________
Benchmark(s) derived Sub-centre started functioning from the new location. Value: Rs. 5.00
from this component
lakh.
Chapter-5
5.18
u
H
Handbook for Programme Managers
Sector Investment Programme
Sector investment Programme
Component Management Protocol
Part-1: Component Description
Implementing Agency : District ABC
Component
Number
Component Title
9
Improving community awareness and involvement
Problem
Community involvement is the weakest link in the system.
Solution proposed
Launch a campaign in every Panchayat to involve the members of existing
committee's (e.g. Mahila Swasthya Samiti, Mahila Mandal, Water users'
Committee etc.) in the Panchayat village. Train/reorient them in basics of
preventive care at the Sub-centre serving their village.
To instill a sense of importance, special letters will be written to each one of
them by the district programme manager. A system will be put in place to collate
the responses which will be placed before the executive body of the district
Society / Agency, detailing action taken on the suggestions received from the
members.
A newsletter will be launched for distribution among the members focussing at
selected RCH topics and for disseminating their experiences, ideas, suggestions
and complaints.
Special recognition / appreciation letters will be written by the Chairperson of the
Society / Agency to the individuals whose contribution has been outstanding.
The district Society / Agency will set up a Community Response Cell at the
district headquarters with the involvement of leading NGOs to look after the
above activities. The district media officer and his/her staff will act as the
secretariat for the Cell.
To begin with, this component will be taken up in all villages of the district. Later,
it may be extended to cover the urban areas also.
Support needed for
implementing change
The training / orientation material will be developed in-house, with the help and
involvement of leading NGOs active in the district.
Cost of implementing
changes
Rs. 20.00 lakh (for preparing training / orientation material, organisation of
training/ orientation camps and for preparation and dissemination of monthly
newsletter.)
Time
needed
to
implement changes
•
•
•
Sustainability
changes
the
The cost of continuing this activity is estimated to cost less than Rs. 1.00 lakh
per annum (most of it on the newsletter). The Society / Agency will allocate
sufficient funds to continue this activity.
Benchmark(s) derived
from this component
Survey among recipients of letter and newsletter completed to assess the
effectiveness of this intervention. Value: Rs. 10.00 lakh.
Chapter-5
of
Total planned time: 6 months
Expected month of start: July, 2000
Expected month of completion: December, 2000
5.19
u
Sector Investment Programme
Handbook for Programme Managers
Chapter- 6: Flow of funds, reporting and accounting systems
A: Approval process for the plans and initial release of funds
A-1: State EC Programme Implementation Plan (SECPIP)
The State EC Programme Implementation Plan (SECPIP) will be submitted to the
Programme Management Bureau (PMB) in the Department of Family Welfare, Govt, of
India. The Sector Reform Cell (SRC) of the State, while submitting its proposals, will
determine and communicate to the PMB, the amount of funds needed on approval of the
SECPIP. This ‘trigger’ amount will be the first benchmark for every SECPIP and will be
determined on the basis of funds required for implementing the SECPIP activities until
the funds linked to the first benchmark derived from the SECPIP components become
available (see Section-H, Chapter-3: Guidelines for preparing SECPIP).
If no changes are needed, the PMB will convey its approval and release the ‘trigger’
amount. Otherwise (i.e. if any modifications are needed) the PMB will notify the SRC
suitably and the latter will submit a revised plan after (a) revising the relevant component
management protocols taking into account the comments / suggestions of the PMB, and
(b) modifying the list of benchmarks (if necessary).
A-2: District Action Plan
After the DAP proposals have been prepared, they will be submitted to the SRC. The
SRC will examine the DAP proposals and may ask the district Core Team to incorporate
changes, if any.
After the SRC has approved the DAP proposals, the same will be forwarded to the PMB.
At this stage, the SRC will propose the amount that should be released by PMB on
approval of the DAP. Approval of DAP by PMB will also be an automatic benchmark
and will ‘trigger’ release of a part of year-1 outlay for the DAP. The SRC will determine
the amount to be released on approval on the basis of funds required for implementing
the DAP activities until the funds linked to the early benchmarks derived from DAP
components become available.
The PMB will examine the DAP proposals and, if necessary, may suggest modifications
to the SRC. The SRC, in this case, will carry out the necessary amendments with the
help of district Core Team and send the revised proposals (along with the revised list of
benchmarks, if necessary) to the PMB.
As soon as the DAP has been approved by PMB, the State will prepare and submit its
plan for supporting the DAP, as a separate component of SECPIP, to the PMB. This will
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contain a set of benchmarks against which the PMB will release the funds (for DAP) to
the State (see Section-G, Chapter-5: Guidelines for preparing DAP).
B: Flow of funds to the States
Funds will be channelled through State Finance Department where the States have a
demonstrated efficient past financial record. Otherwise, they will be released to a
designated State Society (like the SCOVA).
Ail States which receive SIP funds through the normal Government budgetary
mechanism will create a State Sector Reform Fund (SRF), designated as such in an
appropriate budget line, with effect from the Gol financial year 2000 - 2001. All SIP
funds received by the State Government will be credited to this State SRF. The State
SRF will be kept free of debilitating financial controls (e.g. periodic freezes on drawals).
I
In respect of States which receive SIP funds through the SCOVAs or similar agencies,
separate accounts will be maintained for the SIP funds. To maintain a separate
accounting identity for the funds provided out of EC assistance, the SCOVA or other
agency may open a separate bank account titled ‘ State Sector Reform Fund’. If it has a
common bank account, the title ‘ Sector Reform Fund’ may be given to ledger heading
in which the SIP funds are accounted for.
Every participating State will also furnish an Assurance of having instituted adequate
budgetary safeguards to ensure that StP funds do not lapse at the end of a financial year
or end of a Plan period and are also protected from calls other than activities included in
the approved plans. The Assurance will include creation of a State SRF free of
debilitating controls, as described above.
The benchmarks against which funds will flow to the States from DoFW will be of two
types, namely,
• those related to activities associated with State-wide activities, pilots, policy
•
reviews etc.
those related to management of and support to the DAPs.
(see Section-H, Chapter-3: Guidelines for preparing SECPIP)
C: Flow of funds to the Districts
After a DAP has been approved by the PMB, funds linked to DAP approval (the trigger
benchmark) will be placed in the State SRF. The trigger amount will be passed on to the
SIP district to start the DAP activities.
Additional funds for DAP will be released upon achievement of benchmarks identified by
the State relating to its role in the management of and support to the DAP and will be
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credited to SRF. Additional funds to the district will be released from the State SRF upon
the achievement of benchmarks derived from the DAP.
When a DAP benchmark is achieved in time or where the delay is nominal, the SRC will
satisfy itself with the evidence presented as the means of verification of the benchmark
approved pfan" am°Unt equivalent t0 the value attached to the benchmark(s) in the
h case of serious delays, ihe SRC will seek PMB’s advice, forwarding its comments on
the reasons cited for the delay. [See chapter-8: The benchmark funding system, to
know more about what could happen when the benchmarks are not achieved as
planned.]
D: Quarterly Progress Report (QPR)
er implementation has started, every implementing agency will submit a quarterly
progress report (at the end of every June, September, December and March) to the
agency providing funds to it. That is, from the State to PMB in respect of the SECPIP
and from the district to the SRC in respect of DAP.
The format for submitting the QPR is given at Appendix-1 to this chapter.
E: Plan for the next year
The planning cycle will be the Government financial year, namely, I51 April to 31s1 March.
yearfirSt
m37' h°WeVer' be f°f a part of the year if the P|an is starting later in the
Towards the end of first year of implementation, an Annual Plan proposal will be
submitted for the next year. Plan for the next year should reach the PMB end of January
of the coming financial year (i.e. plans for year 2001-02 should reach the PMB by
January, 2001). The plan should consist of
(a) a component-by-component review of the first year’s plan,
(b) monthly time schedule for the components to be continued in year-2,
(b) component management protocol for new component(s), and,
(c) list of benchmarks for year-2.
II For every implementing
:------------------------------------------agency, components will be serially numbered throughout.
For example, if a year-1 SECPIP had 10 components, and 4 of these are continued in
year-2, their numbers will not change. Therefore, for new components to be taken up
I *n year-2, the numbers will start at 11.
- -------------------------------------------------------- ---------
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F: Release of funds against benchmarks
After one or more benchmarks in the approved plan (DAP or SECPIP) have been
achieved, an authorised officer of the implementing agency will submit a request letter
to its funding agency (PMB in respect of SECPIP and SRC in respect of DAP). The
format for requesting release of funds upon achievement of a benchmark is given at
Appendix-ll to this chapter.
In the case of a SECPIP, the PMB will authorise release of the amount equal to value
attached to the benchmark, after examining the evidence/documentation in support of
the achievement of the benchmark.
In the case of a DAP, this function (as mentioned above) has been assigned to SRC,
and the release will be made from the funds available in the State SRF.
Implementing agencies have the freedom to combine request for more than one
benchmarks. The format makes a provision for this possibility.
G: Accounts to be maintained and Audit
Every implementing agency will maintain full account of expenditure incurred against
each item of expenditure included under the approved plan.
The audit arrangements for the RCH Project will be made use of under this programme
as well.
Start up funds were provided against qualifying benchmarks (Rs. 20.00 lakhs to a
State for setting up Sector Reform Cell and Rs. 15.00 lakhs to each district for
setting up the District Agency / Society). These funds were provided to meet the
expenses relating to preparation of State / district plans and for operationalising SRC
/ District Agency. It is necessary, therefore, that full accounts are maintained for the
utilisation of the start-up funds provided.
Balances may be used as buffer and carried over for implementation of activities in
______________________
the approved plan.
********
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Appendix-I to chapter-6
Format for Quarterly Progress Report
Sector Investment Programme
Quarterly Progress Report
Quarter ending
Implementing Agency:
Component
ID number
Budgeted Expenditure
During
Cumulative
the
(Upto the
quarter
quarter)
Actual Expenditure
During
Cumulative
the
(Upto the
quarter
quarter)
Status of Component (tick one box)
On target
Q
Complete
Q
Delay
On target
Q
Complete
FJ
Delay
On target
Q
Complete
Q
Delay
On target
Complete
Q
Delay
On target
Complete
Q
Delay
On target
Q
Complete
Q
Delay
On target
Q
Complete
Q
Delay
□J
Notes on de/ayed Components
Component
ID number
Reason for delay
Intended corrective action
Note: Use additional sheets if space is insufficient.
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Appendix-ll to chapter-6
Format for request for release of funds upon achievement of a benchmark
Sector Investment Programme
Implementing Agency
To,
Sir/Madam,
This is to inform you that this implementing agency has achieved the following
benchmark(s) in respect of the plan for the year........................... :
Bench-mark
Benchmark title
Value
attached
serial
number(*)
I
Means of verification
(Rs. Lakhs)
(*) as appearing in the approved plan
Evidence/documentation in suoport of the achievement of the above benchmark, as stipulated in
the approved plan, is enclosed.
Kindly arrange to release the amount equal to the value attached to the above mentioned
benchmark.
Yours sincerely,
(authorised signatory)
Notes:
♦
(along
with
evidence/documentation in support of the achievement of the benchmark) to
EC
States
/
districts
should
send
a
copy
of
the
requests
Family Welfare Programme Office, New Delhi.
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Chapter-7: Carrying out the Policy Reviews
The RCH Programme promises the community that a well-defined set of services will be
available to them in an assured manner. It also emphasises the quality of these
services, and their user-friendliness. The Community Needs Assessment Approach
requires a consultative and participatory planning approach for the RCH services, as
well as for all other services rendered by the primary healthcare system, including the
CHCs.
Commitments of this order call for serious consideration of the capacity of the system to
deliver, and require changes to that end. The following questions are examples of the
issues that need to be addressed:
Are the present population based infrastructure norms for health infrastructure
appropriate to meet the demands of the RCH Programme?
Should decisions about infrastructure also take account of private and NGO
facilities available?
How to identify and grade private and NGO facilities?
If first referral services are not available for want of specialists, what changes to
personnel policies are needed to attract and retain specialists?
Should the list of FRUs be changed, to take into account present and future
availability of specialists?
Are job definitions up to date?
What administrative and financial powers are to be delegated to various levels?
Identification of positions that must have female service providers preferably, and
building this requirement into the transfer / posting rosters.
How to encourage greater and better performance by linking funds to
performance?
Can some of the national programmes or parts of them be stopped in areas
where the disease burden or the presence of alternative service facilities does
not warrant these services?
How can the Government facilities become more sustainable, in terms of
material, human and financial resources?
Such questions and their answers lie primarily within the jurisdiction of the State
Governments. A policy debate between the States, the Centre and other stakeholders,
based on a competent analysis done by the States, should therefore be an ongoing
process. This has not taken place, though the experience of the RCH and other national
programmes points to the need for such review of policy, followed by appropriate
restructuring, wherever needed.
The Sector Investment Programme (SIP) offers the opportunity for these Policy Reviews
and supports changes in policy, improvement in systems, procedures and norms.
Though the SIP will provide the financial resources and technical expertise for the Policy
Reviews, the Reviews are not confined to the SIP or to the activities supported by the
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SIP. The Reviews would he sector-wide, i.e. covering the entire Health and Family
Welfare sector.
Definition of the Sector: In the Gol-EC Financing Agreement (1997), the sector is
defined as the ‘National Family Welfare Programme of the Gol’. This includes
improvement and integration of women and children’s health included in primary health
care, as well as public health activities upto the emergency or first referral obstetric care
level. Also included is referral care for sick children aged 0-5 years. The existing
linkages and the impact of tlie outcome of these reviews on curative medicine and public
health should not, however, be ignored. The review is expected to cover not only the
public sector (i.e. Government), but also the private and NGO sectors.
According to the SIP Document agreed between the EC and the Gol, States
implementing the World Bank supported State Health Systems (SHS) Projects have the
option of not carrying out the Policy Reviews, if similar exercises have taken place under
the SHS. So far, however, all such State Governments with which the ECTA team has
interacted, have decided to carry out these Policy Reviews.
The Policy Reviews have been grouped under four multi-dimensional headings, namely:
1.
2.
3.
4.
Workforce Management Options;
Delineation / Decentralisation;
Rational Use of Infrastructure; and
Performance Based Funding Options.
Four Task Forces were set up in the Department of Family Welfare for discussing and
finalising the Terms of Reference (ToRs) for each of the policy areas. A set of model
terms of reference were finalised by the Task Forces, and have been provided to the
States selected for intensive work in the first year of SIP. The States may add to or
modify these, in order to accommodate any State specific or other aspect that may be
considered relevant. While seme States have suggested minor changes, the ToRs have
been mostly accepted as relevant in States where the workshops have been held so far.
ECTA facilitators, Programme Managers and others using this Handbook are strongly
urged to read and familiarise themselves with the Model Terms of Reference for Policy
Reviews finalised by the Gol Task Forces. For convenience, a summary of the Model
ToRs is given in the Appendix to this chapter. The summary contained in the Appendix
is by no means comp'ete or comorehensive. The complete Model ToRs for Policy
Review is available separately, and is recommended for thorough study.
Apart from policy changes as such, the Policy Reviews are also expected to provide
leads and inputs for the SECPIP from year 2 onwards. Pending the completion of the
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Policy Reviews, State Governments have been requested to formulate a SECPIP for
year 1, which can merge into the plans for year 2 onwards.
Gol wants the Policy Reviews to be done by State Governments themselves. The
temptation to contract out the Review to an institution and then to sit back should be
resisted. The State Governments may, of course, use institutions or research agencies
to carry out specific parts of the Reviews, particularly those requiring extensive fieldwork,
information gathering, resource mapping, computerisation of data etc.
Wherever institutions / agencies are used, the State Government’s guidelines and
procedures for procurement of services will apply. Engagement of institutions/ agencies
should preferably be done through a competitive bidding process. Institutions/ agencies
should be informed of expected outcomes, processes, methodologies, sample sizes etc.
in the form of clearly and unambiguously written Terms of Reference (ToRs). All bidding
(technical and financial) should take place on the basis of these ToRs.
The Policy Reviews are intended to collate, analyse and present viable policy options,
rather than to collect information. Fresh baseline surveys, KAP surveys etc. are
therefore not to be encouraged. These tend to consume a disproportionate amount of
time and money.
A large amount of State and district specific information is available in existing literature,
which must be accessed and used. Some examples of such literature are:
Census Reports.
National Family Health Surveys (NFHS) I and II.
Surveys done by the National Sample Survey Organisation.
Rapid Household Surveys and Facility Surveys under the RCH, commissioned
by Gol.
Documentation (Appraisal Reports, Review Mission Reports, Baseline Reports,
Project-end Evaluation Reports) of present or past donor assisted projects.
Performance Reports submitted by the State or district.
Plans prepared under the CNAA, or under other national programmes.
Record of the consultative planning process adopted under the SIP.
Reports of Government Committees, Administrative Reforms Commissions etc.
Press Reports and complaints / suggestions from the public and public
representatives.
Litigation under the Consumer Protection Act and public interest litigation
relevant to the State.
Debates about Government policy often tend to remain confined to Government offices.
A deliberate attempt must therefore be made to carry the debate into the community.
This effort could take several forms, some of which could be:
Associating consumer rights activists or organisations with the SRC or Task
Forces overseeing the Policy Review;
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Associating elected public representatives with the SRC or Task Forces;
Interviews or Focus Group Discussions with past, present or potential users of
public healthcare systems;
Discussions with private and NGO healthcare providers, aimed at developing
partnerships;
Inviting public opinion through advertisement (if nothing else, this strengthens
commitment to reform, and shows the level of public interest in the issue);
Opening up the entire process of policy debate to the Press to and other media.
It is crucial that all actual and potential stakeholders in the sector reform process are
enabled and encouraged to contribute. The community has the right to information, as
much as it has the right to services. The Policy Reviews should, therefore, be open and
transparent.
The Policy Reviews will read competent persons with vision to carry them out. The task
can possibly be entrusted tc the H&FW Sector Reform Cell. Alternatively, task Forces
can be constituted to oversee the Policy Reviews. In case the task is given to more than
one group of persons, they must meet often enough to ensure an integrated approach.
The Policy Reviews would definitely need a capacity within the State Government, to
handle at least the following tasks:
Literature review;
Identification of collaborating institutions / agencies;
Development of ToRs for any institutions / agencies that would be used;
Guiding the institutions / agencies;
Compilation / collation of information acquired from diverse sources, including the
institutions / agencies;
Preparation of background papers, discussion papers, situational analyses,
policy drafts etc;
Incorporating various inputs into a draft report, and its eventual development into
the final report of the Policy Review.
Subsequent actions like preparing papers for policy decisions on the
recommendations of the Policy Reviews;
Incorporating the results of the Policy Reviews into the SECPIP for year 2
onwards.
The functions of the Sector Reform Cell (see chapter-2: Role of SRC) take note of these
requirements. The Cell is expected to have:
•
An empowered body to take decisions on policy reforms;
•
•
Technical expertise to study, analyse and present the reforms needed;
A secretariat to handle the documentation.
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Whatever be the mechanism and process adopted for the Policy Reviews, a clear
Workplan for handling the Policy Reviews must be the first step to be taken by the Cell
or Task Force given the job of carrying out the Policy Reviews. The Workplan must
include the methodology, scope, responsibility, time and cost estimates for the task.
Indicative time estimates are given in chapter 7 of the Model ToRs for Policy Reviews.
The Model ToRs for Policy Reviews mention (in chapter 8 of the Model ToRs) a meeting
of State Government representatives and institutions selected by them. This is to be
organised by Department of Family Welfare (DoFW). Work pertaining to the Policy
Reviews should not be held up for this meeting.
Gol may undertake preparation of a national level summary of States’ Policy Reviews or
commission a set of national policy reviews. These are decisions yet to be taken by
DoFW.
The cost of the Policy Reviews, including institutional costs and consultancy fees,
constitutes a part of the SIP. Funds released against benchmarks achieved are the
source of funds for the SIP. Benchmarks consisting of processes or outcomes related to
the Policy Reviews are recommended for use in the first year of the SIP.
Inclusion of the Policy Reviews as a key activity in the SIP offers a unique opportunity. It
may be regarded as the beginning of an iterative policy debate. It is expected that the
policy reviews would lead to the many micro policy and operational reforms needed to
make the system deliver on the promises implicit in the macro policy reforms like the
CNAA and the RCH Programme.
****★★★★★
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Appendix to Chapter-7
Summary of ToRs for Policy Reviews
A: Work Force Management Options
The shift from target driven family planning and other vertical family welfare
programmes to a holistic, integrated and demand driven RCH Programme
requires a substantial reorientation of the existing health and family welfare
workforce and a new way of involving the private medical sector and indigenous
systems of medicine in a more integral, meaningful and sustainable manner.
While several initiatives have been taken to develop the capabilities and capacities of
the workforce in the health and family welfare sector in the country, there have been
critical shortcomings. Some of them have had to do with the sporadic nature of various
vertical interventions, which led to a mismatch between skills and required job functions.
Others were related to lack of relationship between demand and availability of health
services at designated or suitable health facilities. Besides, there are wide gaps
between notional and real availability of health services. Fragmentation, overlap, poor
integration of knowledge and skills has plagued training interventions, which have
otherwise been of sizeable proportions. These and several other factors have resulted in
lack of job satisfaction and motivation amongst the workforce.
the objective of this Policy Review will, therefore, be to develop and articulate a State
Policy on Workforce Management in the health & family welfare sector, which can
effectively attract, recruit, post, develop and retain competent and trained health care
personnel at their designated places of work. The review would present the policy
framework with particular focus, inter-alia, on the following:
• Projected demand and supply of each staff category for the next five years
and action to be taken to redress the imbalances;
• Relevance of the policy of deploying two multipurpose workers, one female
and one male, at the peripheral level, in view of the experiences with
differences in staff supply rates and resultant workloads;
• An assessment of existing job descriptions vis-a-vis the technical capability
required for delivery of RCH services at sub-centre, PHC and referral facilities
and recommendations for more meaningful job descriptions for each
functionary category;
• An assessment of the design and content of basic training for the ANM and
LHV vis-a-vis the technical capability required of them for delivery of RCH
services, with recommendations for strengthening the basic training;
• A review of in-service training set up in the State and its effectiveness with
recommendations for an appropriate system;
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• An assessment of the feasibility of introducing skills audit system as part of
the in-service training systems proposed for districts to measure the impact of
in-service training interventions with recommendations on its structure and
necessary protocols;
• A review of the training capacity of the training institutions in the State with
plans to strengthen it;
• A review of the remuneration packages of
the trainers and
stipends/allowances with recommendations for rationalisation, including
performance based oayment;
• A review of existing policy/measures for career development of trainers and
recommendations on improvements needed.
• Suggest ways of imparting a client friendly face to the public sector services.
I
I
I
1
I
I
Workforce policy review will also examine the feasibility of introducing a new level of
medical competence for handling all but surgical interventions related to the RCH.
1
It will also review the existing incentives for encouraging public sector specialists and
other functionaries to work in the rural areas and their effectiveness.
I
I
I
B: Delineation of Roles and Responsibilities
The RCH envisages that services are planned on the basis of Community Needs
Assessment Approach (CNAA). However, if the existing administrative structures and
practices continue and tight budget lines are retained, the district administration may not
be able to respond well to the changes necessary in implementation. Thus, the success
of the CNAA based planning of services will depend on how well and fast the existing
administrative structures and practices are modified to provide the district administration
the autonomy that is implied in the approach. A more advanced form of decentralisation
would mean conferring greater autonomy not only on districts, but on blocks and village
administration, and extending further to the individual service institutions.
The objective of Review for Delineation of Roles and Responsibilities, therefore, will be
to prepare a framework and plan of action for decentralisation at district and below
district levels. This would , inter-alia, include the following:
I
•
identification of the appropriate level (State, district, below district and facility) for
each major area of responsibility - technical, managerial and financial,
criteria for measuring the preparedness at each level in taking over the functions
•
•
•
hitherto discharged at higher levels;
technical assistance required for facilitating the preparedness for decentralisation,
a time schedule for the transfer of functions to the appropriate levels, and
the indicators that can be used for measuring the process of decentralisation.
•
I
I
I
The Review would also suggest (a) a framework for enhancing the financial and
functional autonomy of the local bodies in the State in relation to the National Family
Welfare Programme in general and the RCH Programme in particular; (b) a framework
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I
I
a buffer.
What happens if a benchmark is not fully achieved?
❖
I
t
There are many reasons why benchmarks might not be achieved,. One is that they
might be unrealistic. Another is that there may be accidents or <other
----- uncontrollable and
unpredictable events.
Suppose a benchmark payment claim is submitted, but the benchmark has not been
met. If the paying agency (Slate or PMB) believes the benchmark can be fully met with
a little more time and effort, it will ask the implementing agency (district or State) to ma e
I
I
further efforts and re-submit the claim after achievement.
I
Suppose a benchmark has not been met, and the paying agency believes it is either not
possible or no longer desirable to try to fulfil the benchmark. In this case, the paying
I
agency is likely to authorise payment of the full amount if
0
«
the benchmark was nearly achieved.
there is a good explanation of why it could not be fully achieved.
|
I
If two or more benchmarks have not been met, and the paying agency believes too little
effort is being made, the implementing agency will be warned about its performance In
extreme cases, payments may be denied for one or more benchmarks, or
implementing agency removed from further participation in the Programme.
❖
I
■
What happens if a benchmark is attained later than expected?
The timing of achievement of each benchmark must be noted in the implementing
agency's action plan. However, there are many reasons why delays could occur, and
consequence it can be anticipated that some of tfie scheduled dates of actmevement w
not be met.
I
I
■
If a benchmark is not achieved exactly on time, there will usually be no f'^ncial
penalties. If, for example, the intention was to attain the benchrnark m June but d .not
in fact attained until August, this will mean only that the payment against the benchmark
will be a little later than expected. The full payment will be made, but later than planned.
Of course, this might create difficulties of cash flow for the implementing agency. It will
obviously be preferable to avoid late completion of several benchmarks, and to avo
very long delays.
I
I
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If there are repeated and lengthy delays in achievement of benchma^ks’
me^
that the whole programme of reform will be delayed.
e
dementing agency if its plan is faiiing to meet expectations.
n extreme
I
circumstances, the PMB may decide to remove the implementing agency from furthe
Chapter-8
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participation in the Programme.
-e-
Must benchmarks be met in the planned sequence?
This issue is best explained by example. Suppose the first scheduled benchmark is the
establishment of the State Health and Family Welfare Sector Reform Cell, and the
second is devolution of medical staff selection to Districts. The implementing agency
experiences difficulties in establishing the Sector Reform Cell, but proceeds with — and
successfully implements — the second reform. Can the implementing agency then
submit a claim for payment for the second benchmark?
There is no simple answer to this question. On the one hand, if it is always acceptable
to skip a benchmark, then activities might not be performed in the most efficient and
effective sequence. On the other hand, if it is never acceptable to “skip” a benchmark,
some much-needed reforms will be slowed down.
The PMB will use judgement on this matter, when reviewing benchmarks in the State’s
action plan. The State will similarly apply judgement when deciding whether to make
payments against benchmarks in a District’s action plan.
When deciding whether it is acceptable to “skip” a benchmark, the paying agency will
ask these questions.
Are the reasons for delay in achieving an early benchmark understandable? If
the implementing agency has obviously tried very hard, and the delays are
outside its control, then the PMB will be more inclined to make payments against
later benchmarks.
Is the implementing agency still committed to completing the early benchmark?
The PMB will expect to be convinced that the early (and delayed) benchmark is
likely to be attained in due course, and that the implementing agency has a plan
to overcome the delay.
•G
Is there reason to believe that good progress is being made? The PMB is mainly
interested in progress on reform. If work is proceeding efficiently and effectively,
even though the early benchmark has not been met, it is likely to authorise
payment against the later benchmarks.
Is there any point in exceeding a benchmark?
Experience shows there is a risk that the performance goal specified as a benchmark
can be seen as the maximum improvement necessary. This is usually undesirable.
Suppose, for example, that the implementing agency is committed to a benchmark
promising a 10% improvement in immunisation coverage. It initiates a campaign in a
few villages that proves to be very successful, and the benchmark is achieved much
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sooner than was anticipated. The implementing agency then decides not to continue the
activities that were causing the improvement in coverage. It decides no more efforts are
necessary, because there will be no additional payment for exceeding the benchmark.
In fact, the paying agency will take note of performance exceeding the agreed
benchmarks, and will balance high performance in one area against a failure to attain a
benchmark in another area. It will therefore always be wise for the implementing agency
to show improvements in performance - and in particular to continue those activities
which are contributing to success.
A good way of continuing the successful initiatives is to develop and negotiate further
benchmarks based on the same activities. For example, if the implementing agency has
successfully achieved a 10% improvement in immunisation coverage, it can benchmark
itself to a further 10% impiovement in the next financial year. Alternatively, if measles
vaccine coverage is poor compared to other antigens, a benchmark can commit the
implementing agency to improvement in measles vaccine coverage.
e-
Which benchmarks are best: input, process or outcome benchmarks?
It was noted earlier that a benchmark must prove there is a worthwhile change. This
means it must be both strongly related to health improvement and it should be verifiable.
An input benchmark is easy to measure but does not guarantee improved health. An
outcome benchmark guarantees health improvements but may be much more difficult to
measure.
Planning teams must use their judgement. However, it will probably make sense to
make use of input and process benchmarks initially, and then progressively change over
to process and outcome benchmarks. This means there will be the time to develop
better measures of the more informative process and outcome benchmarks. Here is an
example of a set of benchmarks that progresses from being input-based to being
process- and outcome-based over time.
Benchmark
Means of verification
Expected time of
achievement
FRU fully staffed, equipped and buildings
renovated, (input)
Verified by observation.
August 2000
Referral protocol established and all identified
FRU services functioning fully, (process)
Verified by observation.
March 2001
65% bed occupancy rate in the FRUs made
operational, (process)
Verified from hospital data.
October 2001
Reduction in MMR by 2/1000 as compared to the
baseline, (outcome)
Verified from the rapid household
survey.
March 2003
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Handbook for Programme Managers
How many benchmarks should there be?
It will probably be unwise to have only a small number of benchmarks, each with a large
money value. This increases the risk of failure to obtain payments matching or
exceeding expenditures. The risks are particularly high if there is only a small number of
linked benchmarks - that is, where the likelihood of meeting subsequent benchmarks is
dependent on meeting the first.
However, there should not be too many benchmarks. There is a cost associated with
measurement and documentation.
A balance is needed. For example, it might be expected that a District Action Plan
would contain 5 to 15 benchmarks per year. The number depends, however, on the
type of benchmark, and fhe consequent degree of effort required for measurement and
documentation.
☆
Will benchmark funding be unfair to disadvantaged States and Districts?
Benchmarks are intended to measure sustainable improvement. Each State and District
may be starting at a different level, but the starting differences are largely neutralised by
measuring the change or rate of change, rather than absolute values.
For example, the vacancies in Medical Officers’ posts is a widespread problem, but its
magnitude varies from district to district. A benchmark related to this issue can specify
that 50% of the vacancies should be filled up within six months, and the doctors found
physically in place after one year. This benchmark neutralises the difference in the
actual number of vacancies of MOs. Fulfilling this benchmark would require adoption of
personnel policies (such as district cadres for doctors) which enable easy recruitment
and retention.
*
How far ahead should the benchmarks be set?
There is a requirement that annual plans be prepared by each State and District, and
that benchmarks are included which cover the full year. However, the implementing
agency will have the opportunity to revise aspects of its plan (including the benchmarks)
during the year.
There must also be an outline plan for the full SIP period, and this should be a rolling
plan (updated each year so it always looks five years ahead). This will help ensure
investments are appropriately staged and that there is a sense of the long-term direction
of reform. However, there is also a need for flexibility: reform will not always proceed
smoothly, and changes of direction may be required on the basis of experience.
In summary, the best strategy is to plan ahead as far as possible but also make sure that
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the plans are regularly reviewed and revised as necessary.
Are benchmarks restricted to activities supported by SIP funding?
No, they are not. Benchmarks can also be related to activities funded from the
Government Budget, or by other donors. How far the activity is critical to system
improvement should be the main factor in choosing the benchmark.
For example, there might be a UNICEF-supported project intended to establish child
growth monitoring activities in villages. Successful completion of the project could serve
as a benchmark, even though there is little or no cost to the SIP.
#
Will total payments always equal total expenditures?
Generally, yes. However, as mentioned before, there may be unspent balances
available from the start-up funds (provided against the qualifying benchmark, viz., .setting
up of SRC in the case of a State and the District Agency in the case of a district).’These
unspent balances will serve as a buffer.
In earlier phase, values to the benchmarks should be so assigned that the implementing
agency has a positive balance at the end of the year. This will enable the implementing
agency to continue activities which were started in the previous year, until the payments
related to benchmarks foi the next year’s plan become available.
In the last year of the plan, however, balances available from previous year may be
adjusted against the total requirement in the last year. Or, the implementing agencies
may be allowed to retain the earlier balances to continue one or more of the activities
beyond the last year. In any case, implementing agencies will be required to obtain the
approval of the SRC / PMB in deciding the utilisation of whatever balances may remain
available with them at the and of the SIP.
Is it best to set easily achieved benchmarks?
1
There may be a temptation to set benchmarks that are easy to achieve and have a high
payment, in the expectation that the implementation agency will get a lot of easy money.
This should not be done, because the implementation agency probably will not be able
to spend this money sensibly. Moreover, the PMB is unlikely to approve such an action
plan because it fails to meet the key criterion: whether as much will be achieved in terms
of the health of women and children as could reasonably be expected.
Idle or unspent money is as undesirable as shortage of money. Money sitting idle in one
district has an opportunity cost. Another district may be suffering for want of the same
money. The inflows against benchmarks likely to be achieved must therefore be
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balanced against likely expenditure in a comparable time period.
G: A footnote: openness, collaboration and mutual learning
When benchmark funding is introduced for the first time, there is a tendency towards
optimism. Funding agencies believe it will be easier to distribute funding without
constant dispute, service providers think they will be obtaining additional funding with
little effort (as long as the benchmarks are conservative), and both parties tend to
believe a simple change in funding incentives will be sufficient to overcome the many
longstanding constraints to change (like attitudes, mindless rules, lack of training,
professional jealousies, self-serving behaviour, and so on).
The reality is usually quite different, and it will soon become clear that a new kind of
working rules have to be learnt. One aspect is that service providers may form the view
that it is in their interest to set easily achieved benchmarks and to negotiate the highest
possible funding level for each. The funding agencies will tend to have the opposite
view, and friction is inevitable.
Another aspect of the new system is that there is no easy and entirely objective way of
deciding the value of one benchmark relative to another. One implementing agency will
begin to look at how much it is being paid in comparison to another implementing
agency, and start to question whether it is fair.
These kinds of problems are resolvable. However, the benchmark funding approach is
not simple, and much time and effort is needed in designing the details if it is to deliver
the intended benefits. All parties must be open about their attitudes, and be willing to
have frank discussions about their concerns. If the process is open and collaborative,
much progress will be possible in improving the health status of the people.
F
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Annex-1 to chapter 8
/
Some process indicators that might be used as benchmarks
Child Health
Proportion of children immunised before their first birthday with 6 antigens
Proportion of hospitals and maternity facilities officially designated baby friendly
Proportion of diarrhoreal episodes treated with ORT
Proportion of children under 1 year receiving measles vaccine along with Vitamin A
Proportion of scheduled immunisation sessions actually held in the district compared to the
scheduled sessions
Percent newborn initiated breast feeding (BF) within half an hour of birth in public facilities
Incidence of low birth weight
DPT1 - DPT3 dropout rate
Proportion of villages in outreach having regular and dependable supplies of oral rehydration salt
(ORS)
Maternal Health
Maternal Mortality Rate
Average number of married women receiving attention (MWRA) per ANM
Average number of ANC visits per pregnant woman
Proportion of institutional deliveries (can be classified by female literacy status or caste /
economic status)
Proportion of districts reporting maternal deaths more than 4/1000 live births
Average number of EOC facilities/20000 births
Mean age at effective marriage (for use late in the programme)
Number of maternal deaths per thousand live births
Proportion of all births in the EOC facilities
Proportion of women with complicat;ons treated in the EOCs
Obstetric case fatality rate (CFR)
Caesarean section rate
Proportion of institutional deliveries
Proportion of pregnant women receiving first ANC before 16 weeks
Proportion of women receiving any PN care visit
Median distance for an EOC facility in the district
Number of days ambulance is available compared to days off road
Proportion of vacancies/days doctor is available, compared to days scheduled
Proportion of ANMs/LHVs with appropriate personal transport
Proportion of deliveries with trained assistance
Average time lag between arrival of patient at facility and initiation of treatment
Obstetric CFR
Total number of maternal deaths
Proportion of pregnant women immunised against Tetanus
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Abortion Services
Abortion rate
Abortion death as a percentage of maternal deaths
Percentage of districts with safe abortion facilities (1 facility per 20,000 births)
Age-specific abortion rate
Repeat abortion rate
Percent of service delivery points equipped for safe abortion care
Proportion of admitted obstetric complications that are abortion related
CFR for abortion complications
Proportion of clients seeking MTP services accepted contraception
Proportion of MTPs in the first trimester
Proportion of MTPs performed using vacuum suction
Family Planning
Existence of an approved State Population Policy addressing fertility and family planning
Proportion of State Budget allocated to Family Welfare
Proportion of districts reporting adequacy of staffing in programme managers
Total and Age specific Fertility Rates
?
Contraceptive Prevalence Rate (CPR)
Method Mix
Crude Birth Rate (CBR)
Percentage of high order births (more than 3)
Median length of open birth methods and closed birth intervals
Proportion of districts having a Logistics Management Information System (LMIS)
Total and Age Specific Fertility Rates
CPR
Method mix
Discontinuation rate for spacing contraceptives due to negative reasons
Existence of Annual Programme (including financial) Plan for the district
Unmet demand for contraception
Vacancy rate for Male Health Workers
Discontinuation Rate
Use failure rate for contraceptives
RTIs and STDs
Average number of facilities/ district having laboratory facilities for diagnosis of common RTIs/
STDs
HIV prevalence (age and sex distribution)
Use of epidemiological data (hospital based) for developing annual programmes
RTI/ STD prevalence (age and sex distribution)
Proportion of service providers trained in RTI/ STD management
VDRL positivity among pregnant women among institutional deliveries
Incidence of opthalmia neonatarum among institutional deliveries
Percent clients properly screened for RTIs before trans-cervical procedures
Percent facilities stocked with adequate condoms and STD education material
Stock-out of Doxycycline capsules
Partner management rate
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Re-occurrence/ re-infection rate
Policy reforms
Days of delay in releasing funds from State to districts
Days of delay in PWD starting building construction
Days of delay in filling posts
Proportion of funds allocated by Gol and remaining unspent
Setting up of State Health and Family Welfare Sector Reform Cell
Completion of Policy Reviews
Setting up of District H & FW Authorities/Agencies
Decentralisation of key activities (eg, drug purchase, staff appointments)
Agreed pilots successfully completed
Preparation of agreed DAP with evidence of community participation
Setting up of district agency and number of meetings
Setting up of monitoring and supervisory systems
Percentage of staff attending training
Percentage of facilities (by type) staffed
Mean time drug unavailable in facilities
Reported satisfaction of beneficiaries ascertained by structured surveys
Percentage of unspent funds to allocation
Provision of audited accounts
Completion of epidemiological/demographic surveys
Percentage of facilities with water, power and working equipment
Reported satisfaction of beneficiaries
Evidence of increased utilisation of the facility
Evidence of information based planning (eg, scheduling of clinics locally)
Number of hours/days for which key equipment/vehicle is non-functioning
Number of days lost through staff absence
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Annex-Il to chapter-8
An illustration of first-year benchmarks for a District Action Plan
[ This is only an example of the benchmarks that might be included in a District Action
Plan. It is not intended that they should be copied uncritically in real life.]
The district of Charapani in Apna Pradesh is participating in the EC supported SIP. It
has two distinct parts in terms of terrain. A riverine valley area with prosperous irrigated
agriculture, agro-industries and trade, constitutes about 40% of the area of the district.
The rest is upland, consisting of a plateau rising into the Madhya Bharat hill range. The
uplands constitute 60% of the district, and of this half is forest, including reserve forest.
The forest area is home to a scattered tribal population. The uplands have only rainfed
or tank fed agriculture, subject to monsoon failures.
In years of severe drought, the marginal cultivators and landless labour migrate either to
the more prosperous parts of the district, or to other districts. A large part of the upland
area is good only for pasture, though some enterprising farmers have started tree crops
dr orchards on such lands, in the last 10 years.
District population (1991) is 13.75 lakh. Male literacy is 59%, about the same in all rural
areas of the district, but only 34% among S.T. males. Female literacy is 43%, but there
is a marked difference from the valley area to the upland area. Female literacy among
S.T. women is only 18%.
There are 11 Blocks and 11 Tehsils, with coterminous boundaries. Two of the Blocks
are predominantly forested and these also have the S.T. population. Of the other nine,
four Blocks constitute the uplands and five fall in the valley area.
The district town, also named Charapani, is an A-grade Municipality, and had a
population of 2.5 lakh in 1991. It is expected to grow to about 4 lakh by 2001, and may
then be converted into a Municipal Corporation. The increase in urban population is
accounted for equally by three reasons: in-migration, natural growth, and expansion of
municipal boundaries.
The metre gauge railway line through Charapani town may be converted to broad gauge
soon, and then it will grow even faster. There are two other large habitations with about
50,000 population each. These have C-grade municipalities. The public sector health
infrastructure is as shown below.
137
District Hospital (150 beds)
1
Sub-centres______________
Municipal Hospital (30 beds)
1
4
Municipal Dispensaries
5
PP Centres (Taluk Hospitals)
2
Taluk Hospitals
CHCs__________________
PHCs
7 UFWC (District Hospital)
28 | Health Posts
__ 1_
14
Private sector practitioners have a strong presence at the district headquarters and are
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also present in the two smaller towns. There is a rundown NGO hospital in one of the
forest Blocks, but the uplands and forest Blocks are generally very short of medical
facilities.
District IMR is 65, but is probably about 100 in the uplands and forest areas. MMR is
unknown, but may be around 4/1000 and possibly 6/1000 in the uplands.
The district workshop for the SIP has been done, and has decided to carry out the
participative planning process at Block level and separately in the three Municipalities.
The work done so far indicates the following activities to be started in year 1, though civil
works and equipment procurement may continue beyond year 1.
Estimated cost
(Rs. Lakhs)
Activity
Complete the participative planning process.
6.00
2.
Prepare the DAP, mainly for the rural areas.
1.50
3.
Carry out health KAP study and facility survey in urban areas.
1.00
4.
5.
Prepare a sub-Plan for the urban areas.
.25
Study tour to Kerala and Orissa for 5 district officials, followed by a small workshop to
disseminate the knowledge gained
1.50
6.
Renovation of buildings and addition of equipment, blood storage, O.T. and generator for
NGO hospital in forest Block (doctors/staff are available there).
39.75
7.
Retraining of all ANMs with over 10 years service in a package of skills, including
counselling and supervision.
5.00
8.
9.
Training Needs Assessment for M.O.s and ANMs.
0.50
2.00
1.
Close down beds in the two outlying PHCs in the forest Blocks, convert them to
dispensaries, and relocate staff and equipment to the Block headquarters CHCs. Doctors
will operate from the CMC.
1.00
10. Manual of responsibilities and powers for all levels of H&FW personnel.
11. Increased delegation of powers (Government Order needed).
12. Quarters for Specialists and MGs and essential paramedical staff at 3 CHCs (2 forest
area + 1 uplands).
60.00
13. Addition to CHC buildings, O.T.s, labour rooms, water supply, generators at 3 CHCs.
38.00
8.50
0.20
14. Blood storage facility at two Taluk hospitals in the smaller Municipalities.
15. Study of caseload and facilities at all Taluk hospitals and CHCs to correctly identify FRUs
for the district (1 forest Block CHC + 1NGO facility to be included as FRUs anyway).
16. Full operationalisation of 3 public sector FRUs in Taluk hospitals.
27.00
17. Crash recruitment of ANMs at district level.
0.50
18. Spot recruitment of doctors.
0.30
19. Renovation of cold chain (cost bome by UNICEF - Rs. 40 lakhs).
7.00
20. Addition of RTI/STI clinic in district hospital, including additional posts cost for one year.
21. Monitoring and concurrent evaluation
Total
5.00
205.00
Of these listed activities, Rs.42 lakh approximately are expected to be spent in the first
half year, Rs.72 lakh in the second half-year and the rest will spill over to the later part of
the District Action Plan (DAP) period. Possible benchmarks could be as follows.
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For first half-year
S.No
Value | Means of Verification
Benchmark
(Rs. lakh)
1
D H & FW Agency constituted
15.00
Registration and bye-laws.
2
DAP approved by PMB in Gol
10.00
Approved DAP Document.
3
Plans/estimates for constructions
5.00
Approved plans/estimates.
4
Orders placed for cold chain
7.00
Confirmation by UNICEF.
5
TNA for M.O.s and ANMs done
3.00
TNA document.
6
All vacant positions advertised
5.00
G.O. and advertisement.
Total
45.00
For second half-year
Value
Benchmark
S.No.
Means of Verification
(Rs. lakh)
5.00
Retraining done for 25% of the ANMs
7
evaluation.
needing retraining
NGO Hospital upgraded and functioning
8
Trained ANMs’ list, training module, random
20.00
Observation, interview with hospital
management, patient interview.
as FRU
9
MoU with NGO Hospital
5.00
Signed MoU.
10
Manual of Responsibilities/ Duties
4.00
Copy of Manual supplied. MOs found to be
generally aware of it.
prepared and sent out
11
Delegation of powers done
6.00
G.O. issued, widely known.
12
Urban areas sub-Plan
12.00
Sub-Plan approved by PMB.
50% of MO vacancies filled
7.00
MOs physically in place- check.
1 Forest CHC+1 Taluk Hospital fully
13.00
Observation, interview with hospital managers,
patient interview.
13
■■
14
operational as FRU
15
New blood storages functional
6.00
Certification, observation.
16
Concurrent evaluation done
3.00
Concurrent evaluation report.
Total
81.00
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