Lok Sabha Question No. 1734 (UNSTARRED), answered on 2017-03-10
Subject: NRHM
Ministry: HEALTH AND FAMILY WELFARE
Asked by: GOWDAR MALLIKARJUNAPPA SIDDESHWARA

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 1734 TO BE ANSWERED ON 10 th MARCH, 2017

## NRHM

## 1734. SHRI G.M. SIDDESHWARA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has warned the State Governments that no more funds would be provided if National Rural Health Mission (NRHM) grant is misused, if so, the details thereof; and
- (b) whether the Government is also considering to provide additional funds to States that perform better in NRHM, if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE ( SHRI FAGGAN SINGH KULASTE)

- (a): Government  has  been  asking  the  State  Governments to  strengthen  the  financial management  system  and  ensure  that  National  Rural  Health  Mission  (NRHM)  grants  are  not misused. Central Government has issued operational guidelines, advisories and has impleme well  established  monitoring  mechanism  under  NHM to  strengthen  the  financial  management system.
- (b): Additional funds are given to States under NHM (earlier NRHM) that perform better specific performance parameters. That details of incentive/disincentive from F.Y.   2015 - 16 and 2016- 17 areprovided at annexure -I & II respectively.

ANNEXURE-I CONDITIONALITIES-FRAMEWORK FOR IMPLEMENTATION (2015-16)

|   S. No | Conditionality             | Description                                                                                   | Source for verification & indicator   | Incentive/Penalty                                                                                                                                                                                                                                                                                                                                      |
|---------|----------------------------|-----------------------------------------------------------------------------------------------|---------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|       1 | Reduction in IMR           | Percentage decrease over last year                                                            | SRS                                   | Maximum incentive of 5% - Weightage=5 • If decrease less than 5% - No incentive • If decrease between 5-7%- Incentive of 3% • If decrease greater than 7% - Incentive of 5%                                                                                                                                                                            |
|       2 | ReductionMMR               | Percentage decrease over last year (only for 16 States for which MMR is available)            | SRS                                   | Maximum incentive of 5% - Weightage= 5 • If decrease less than 5% - No incentive • If decrease between 5-10%- Incentive of 3% • If decrease greater than 10% - Incentive of 5%                                                                                                                                                                         |
|       3 | Full Immunization Coverage | During the current FY, as on December 31- infants fully immunised vs. estimated beneficiaries | MCTS                                  | Maximum penalty and incentive of 5%. Weightage= 5/(-)5 • If coverage less than 40% - Penalty of 5% • If coverage between 40-50% - No penalty • For coverage above 50% up to 100%- Incentive up to maximum of 5%, calculated as Coverage above 50% 10 i.e. if coverage is 65%, then incentive of 1.5%; and if coverage is 87%, then incentive is 3. 7%. |

|   S. No | Conditionality                                                       | Description                                                                  | Source for verification & indicator                                                                                                                                                                                                                                                                       | Incentive/Penalty                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
|---------|----------------------------------------------------------------------|------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|       4 | Functionality of FRUs/ CEmOC facilities (excluding Medical Colleges) | Adequacy of "functional" FRUs (conducting (- sections)                       | HMIS. Facilities conducting (-sections: 1. For Large States • Avg. 10 CS I month at DH level • Avg. 5 CS I month at SDH and CHC level 2. For NE states (excl. Assam), Hilly States (Uttarakhand, HP, J&K), and UTs (excl. Delhi) • Avg. 6 CS I month at DH level • Avg. 3 CS I month at SDH and CHC level | Maximum penalty and incentive of 5%. Weightage=5/(-) 5 Compared to required number of FRUs: 1. On a State-wide basis • If 50-75% FRUs "functional" - 3% penalty • If less than 50% FR Us "functional" - 5% penalty 2. On a State-wide basis, if more than 75% FRUs "functional", AND in HPDs - • If less than 50% FRUs "functional" - 5% penalty • If 50-75% FRUs "functional" - 3% penalty • If 75-90% FR Us "functional" - 3% incentive • If more than 90% FRUs "functional" - 5% incentive. |
|       5 | Quality Certification                                                | Percentage District hospitals and CHCs quality certified by State level body | N HSRC report                                                                                                                                                                                                                                                                                             | Maximum incentive of 5%. Weightage= 5 • 3% incentive if at least 50% of DHs certified • 2% incentive if at least 25% of CHCs / Block PHCs certified.                                                                                                                                                                                                                                                                                                                                           |
|       6 | JSSK Implementation                                                  | Implementation status of JSSK entitlements                                   | MCTFC Report (minimum sample of 300 beneficiaries for each state)                                                                                                                                                                                                                                         | Maximum penalty of 10%. Weightage= (- )10 More than 50% gap in any of the components (drug, diet, diagnostics and transport) 10% penalty                                                                                                                                                                                                                                                                                                                                                       |

|   S. No | Conditionality                                                     | Description                                                                                                                                                                                                                                                                     | Source for verification & indicator                                                              | Incentive/Penalty Less than 50% but more than 25% gap, 5%                                                                                                                                                                                                                                                                            |
|---------|--------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|       7 | Governance: Quality of services and functionality of public health | Star rating of facilities Based on the extent to which CHCs/PHCs meet the benchmark on Key indicators. Facilities Five Star indicator criteria: 1. Human Resource and Infrastructure 2. Service availability 3. Drugs and supplies 4. Client orientation 5. Service Utilization | HMIS report                                                                                      | No penalty if performance more than 75% (based on survey/MCTFC calls) Maximum penalty of 5%. Weightage= 5 • To avoid penalty minimum 50% of CHCs to have 3 or more star rating                                                                                                                                                       |
|       8 | Implementation of Free drugs &Diagnostic services                  | Free drugs & Diagnostic services to be implemented as per GOI mandate                                                                                                                                                                                                           | District report certified by State Nodal officers and assessments made by NHSRC teams and MCTFC. | Maximum incentive of 5% Weightage= 5 • 90% and above institutions effectively implementing free drugs &diagnostic services - 5% • 60% to 90% institutions effectively implementing free drugs &diagnostic services - 3% <60% institutions implementing free drugs & diagnostic services - No incentive (Based on survey/MCTFC calls) |

|   S. No | Conditionality                  | Description                                                                                           | Source for verification & indicator          | Incentive/Penalty                                                                                                                      |
|---------|---------------------------------|-------------------------------------------------------------------------------------------------------|----------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------|
|       9 | Increase in State Health budget | States providing more than 10% increase in its annual health budget as compared to the previous year. | State budgets I Information from State Govt. | Maximum incentive 5% Weightage= 5 • If no increase/ decrease - No incentive • If increase is 10 to 15% - 3% • If increase is> 15% - 5% |

ANNEXURE-II Framework for Assessment of Conditionalities 2016-17

| S. No.   | Conditionality             | Description                                                                                        | Source for verification& indicator   | Incentive/ Penalty                                                                                                                                                                                                                                                                                                                                    |
|----------|----------------------------|----------------------------------------------------------------------------------------------------|--------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1        | Reduction in IMR           | Percentage decrease over last year                                                                 | SRS                                  | Maximum incentive of 5% - Weightage = 5 If decrease less than 5% - No incentive If decrease between 5%-7% - Incentive of 3% If decrease greater than 7% - Incentive of 5%                                                                                                                                                                             |
| 2        | Reduction in MMR           | Percentage decrease over last year (only for 16 states for which MMR is available)                 | SRS                                  | Maximum incentive of 5% - Weightage = 5 If decrease less than 5% - No incentive If decrease between 5% - 10% - Incentive of 3% If decrease greater than 10% - Incentive of 5%                                                                                                                                                                         |
| 3        | Full Immunization coverage | During the current F.Y., as on November 30th - infants fully immunized vs. estimated beneficiaries | MCTS (For EAG / NE States)           | Maximum penalty and incentive of 5%. Weightage = 5/(-5) If coverage less than 35% - Penalty of 5% If coverage between 35% - 45% - No penalty For coverage above 45% up to 100% - Incentive up to maximum of 5%, calculated as: Coverage above 50% 10 i.e. if coverage is 65%, then incentive of 1.5%; and if Coverage is 87%. Then incentive is 3.7%. |
|          |                            |                                                                                                    | MCTS (For Other States)              | Maximum penalty and incentive of 5%. Weightage = 5/(-5) If coverage less than 40% - Penalty                                                                                                                                                                                                                                                           |

| S. No.   | Conditionality                                                                  | Description                                           | Source for verification& indicator                                                                                                                                                                                                                                                              | Incentive/ Penalty                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|----------|---------------------------------------------------------------------------------|-------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|          |                                                                                 |                                                       |                                                                                                                                                                                                                                                                                                 | of 5% If coverage between 40% - 50% - No penalty For coverage above 50% up to 100% - Incentive up to maximum of 5%, calculated as: Coverage above 50% 10 i.e. if coverage is 65%, then incentive of 1.5%; and if                                                                                                                                                                                                                                                                                                                                                     |
| 4        | Functionality of FRUs/ CEmOC facilities (excluding standalone Medical Colleges) | Adequacy of "functional" FRUs (conducting C-sections) | HMIS Facilities conducting C- Sections: 1. For Large States Avg. 10 CS/month at DH level Avg. 5 CS/ month at SDH and CHC level 2. For NE states (excl. Assam), Hilly States (Uttarakhand, HP, J&K), and UTs (excl. Delhi) Avg. 6 CS/ month at DH level 3. Avg. 3 CS/ month at SDH and CHC level | coverage is 87%. Then incentive is 3.7% Maximum penalty and incentive of 5%. Weightage = 5/(-)5 Compared to required number of FRUs: 1. On a State wide basis If 50% - 75% FRUs 'Functional' - 3% penalty If less than 50% FRUs 'Functional' - 5% penalty 2. On a State-wide basis, if more than 90% FRUs 'functional', and in each HPD. If 75% - 90% FRUs "functional" - 3% incentive If more than 90% FRUs "functional" - 5 incentive States which have earned incentive /no penalty for FRU conditionality must fulfil HPD criteria to earn incentive this year # |

|   5 | Quality Certification                                                         | Percentage District hospitals and CHCs quality certified by State level body in rural and urban areas.                                                                                                                                        | NHSRC Report                                                                                                                                                                          | Maximum incentive of 5% Weightage = 5 3% incentive if at least 20% of DHs certified 2% incentive if at least 10% of CHCs/ Block PHCs certified                                                                                                                     |
|-----|-------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|   6 | Governance: Quality of Services and functionality of public health facilities | Star rating of facilities based on the extent to which CHCs meet the benchmark Five star indicator criteria: 1. Human Resource and Infrastruct ure 2. Service availability 3. Drugs and supplies 4. Client orientation 5. Service utilization | HMIS Report (both rural and urban)                                                                                                                                                    | Maximum Penalty/ incentive of 5% Weightage = 5/(-) 5 To avoid penalty, minimum 50% of CHCs to have 3 or more star rating Incentive of 3% if more than 75% of CHCs have 3 or more star rating Incentive of 5% if more than 90% of CHCs have 3 or more star rating # |
|   7 | Implementation of Free drugs scheme                                           | Free drugs to be implemented as per GOI mandate                                                                                                                                                                                               | District report certified by State Nodal Officers. Assessments made by NHSRC teams MCTFC. In case no reports are available, data from MCTFC calls to PWs would be taken as proxy data | Maximum incentive of 5%. Weightage = 5 = or >90% institutions effectively implementing free drugs 5% 60% to 90% institutions effectively implementing free drugs 3% Less than 60% institutions implementing free drugs No incentive (Based on survey/MCTFC calls)  |

|   8 | Implementation of Free diagnostics Services                          | Free diagnostics to be implemented as per GOI mandate                                                                                                                                                                         | District report certified by State Nodal Officers. Assessments made by NHSRC teams and MCTFC. In case no reports are available, data from MCTFC calls to PWs would be taken as proxy data   | Maximum incentive of 5%. Weightage = 5 90% and above institutions effectively implementing free diagnostics 5% 60% to 90% institutions effectively implementing free diagnostics services - 3% Less than 60% institutions implementing free diagnostics services - No incentive (Based on survey/MCTFC calls)   |
|-----|----------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|   9 | Implementation of integrated HRIS and updated annual formats of HMIS | State which has integrated HRIS (for regular and contractual HR) with updated information and from which pay slips are generated every month. Also updated HR and other information in annual HMIS which is in sync with HRIS | HRIS generated summary and pay roll HMIS report                                                                                                                                             | Maximum incentive/penalty of 10% Weightage = 10/(-)10 5% penalty if HRIS not implemented fully 5% penalty if HMIS data in annual format not updated and is not in sync with HRIS 5% incentive if HRIS fully implemented 5% incentive if HMIS annual format is updated and is in sync with HRIS                  |

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

# Incentive only till the highest slab is achieved