13 th Common Review Mission October 16 October

13 th Common Review Mission October 16 -October 23, 2019 Objectives, Processes and Terms of Reference

Why another CRM? • Twelve Common Review Missions so far: Janani Shishu Suraksha Karyakram to Comprehensive Primary Health Care born out of CRM findings • Opportunity to get both a macro and field perspective • Participation of a transdisciplinary/multi-stakeholder team allows for different perspectives – inclusion of reps from Tribal Affairs, WCD • Provides a rapid assessment of the health systems functionality – allows assessment of progress and maturity of health system • Tools and Processes changed over the years; but the essence and spirit remain the same • Helps reflect on the promise and potential of newer interventions • Enables cross learning and sharing across states and captures divergence across and within states

S. No. States 1 Andhra Pradesh 2 3 4 5 6 Bihar Chhattisgarh Delhi Gujarat Jharkhand Madhya Pradesh Manipur Meghalaya Mizoram Nagaland* Odisha Rajasthan Tamil Nadu Uttarakhand 7 8 9 10 11 12 13 14 15 Districts High density of Aspirational HWCs Vishakhapatnam Kadapa Delayed to Nov Korba East Delhi Surat Gumla Rajnandgaon New Delhi Dahod West Singhbhum Khandwa Bishnupur West Garo Hills East Aizwal Phek Mayurbhanj Churu Villupuram Udham. Singh Nagar Chhindwara Chandel Ri-Bhoi Mamit Kiphire Kandhamal Sirohi Virudhnaga Haridwar

Bihar 1 st, 3 rd, 5 th, 7 th, 9 th, 10 th and 12 th 1 st, 2 nd, 3 rd, 5 th, 6 th, 7 th, 8 th, 10 th, 11 th and 12 th Chhattisgarh 1 st, 2 nd, 3 rd, 4 th, 5 th, 6 th, 8 th, 9 th, 11 th and 12 th 6 th, Gujarat 1 st, 3 rd, 5 th, 7 th, 10 th and 12 th 2 nd, 4 th, 5 th, 7 th, 9 th, 10 th, 11 th and 12 th Jharkhand 1 st, 2 nd, 3 rd, 4 th, 6 th, 8 th, 9 th, 10 th and 12 th 6 th, 9 th and 11 th Manipur Andhra Pradesh Madhya Pradesh 9 th and 10 th Delhi

Meghalaya Nagaland Rajasthan Uttar Pradesh 3 rd, 4 th, 7 th, 9 th 10 th and 11 th 2 nd and 8 th and 11 th 1 st, 2 nd, 3 rd, 4 th, 5 th, 6 th, 7 th, 8 th, 9 th and 11 th 1 st, 2 nd, 3 rd, 4 th, 5 th, 6 th, 8 th, 9 th and 12 th 1 st, 2 nd, 4 th, 6 th, 8 th, 10 th and 12 th 1 st, 2 nd, 3 rd, 4 th, 5 th, 6 th, 7 th, 8 th, 9 th, 10 th, 11 th and 12 th 3 rd, 4 th, 5 th, 6 th, 8 th, 9 th, 11 th and 12 th Mizoram Odisha Tamil Nadu Uttarakhand

Common Review Mission Visit and Report: Timelines October 16 • National: Briefing/Orientation to To. R/Team Building/District Allocation between teams October 17 • State Briefing October 17 October 22 • District Visits/District Briefing October 23 • State Debriefing

Team Deliverables: Timelines October 24 • Submit three products to NHM • Detailed Power. Point presentation • Brief note- three to four pager: strengths and weaknesses To. R wise • Letter from AS&MD with key actions to be taken on a priority basis November 8 • Final Draft Report : Team leaders to submit to NHM/NHSRC • (i) To. R wise detailed state report • analytical depth, • completion of all To. Rs, • Specific recommendations supported by evidence (data/observations) • relevant photographs • follow up on past recommendations, and • nclusion of best practices. • (ii) Positives and Challenges: summary two pager December 15 • Synthesis Report: NHSRC to Mo. HFW

District Visit District Hospital Sub District Hospital Urban CHC 1 HWC - Urban PHC Slums covered by UPHC/non-notified Community interaction ASHA/MAS PHC /HWC CHC 2 PHC /HWC - Sub Centers – One HWC-SC under each PHC One village visit under each HWC-SC Community interaction, ASHA/VHSNC/AWC Training Centres/ Empanelled private sector facilities

Processes Community/outreach Interviews in SHC-HWC/Village ASHA, AWW, ANM, CHO community representatives, including beneficiaries Focus Group Discussions (FGDs)- at least one in every facility/village ASHAs, VHSNC/MAS, Community Groups, RKS Visit beneficiaries in Under-served hamlet slum Interviews Beneficiaries/service providers Distict level briefing

Terms of Reference (TOR) for 13 th CRM Service delivery TOR-1 Ayushman Bharat- Health and Wellness Centres TOR-2 RMNCH+A TOR-3 Non-Communicable Disease Control Program TOR-4 Communicable Disease Control Program TOR-5 Urban Health Systems TOR-6 Community Process and Gender TOR-7 Quality Assurance TOR-8 Human Resources for Health TOR-9 Governance, Finance and Accountability TOR-10 Access and Equity • Infrastructure • Medicines, Diagnostics & equipment maintenance • Blood bank/ Blood storage unit • Ambulances & MMUs • Strengthening District Hospitals and knowledge hubs

Objectives • Assess the organization of services at district and sub district levels and ascertain the extent to which continuum and quality of care is enabled for responsive community/outreach, primary and secondary health care services. • Appraise the extent to which the health system is prepared to address persistent challenges related to RMNCH and infectious diseases and address newer challenges related to non-communicable diseases. • Evaluate the mechanisms in place for secondary and tertiary care referrals, (including linkages with social protection schemes) with respect to access, equity and affordability. • Comment on the adequacy of strategies adopted by the state to reduce Out of Pocket expenditures related to primary and secondary care services. • Review current Public Private Partnerships and comment on their functionality, outcomes and regulatory structures.

Objectives • Identify areas of progress in NUHM and the key challenges facing scaling up of NUHM in respect of infrastructure, Human Resources, Primary Health Care models, community mobilization, and convergence with Urban Local Bodies • Assess improvements in creating institutional capacity for strengthening programme management, review, monitoring and accountability systems and building partnerships for capacity building, training, and research. • Review the extent to which equity is considered in policy and programmatic actions, record progress, and identify challenges to social inclusion. • Document best practices, innovations and lessons from scaling up best practices. • Assess progress towards conditionalities and follow up on recommendations of past CRMs.

Background • The Briefing/Guidance Book includes: a. Terms of Reference which are broadly divided under two themes i. e. , Service delivery and Health System Strengthening including 10 TORs with heir objectives. b. Facility wise checklists (Community, HWC, PHC/UPHC, CHC/UCHC, District Hospitals, State and District) c. Annexures for equity and HRH for an in depth understanding of the broad TOR areas • Other background material provided include: a. CRM Agenda, CRM TOR, Frameworks, Guidelines, MIS Reports, NUHM factsheets, Survey reports (RHS, SRS, NFHS, NSSO, HMIS) etc. b. Specific reports and studies for the state and districts, data collected from the state with respect to the To. Rs c. Relevant findings from past CRM reports

Additional Secondary Data • Ro. Ps over past few years • Programme data from states/districts • Background information on specific programmes- related to policies and guidelines • Specific state and district level studies and assessments • National, State and district briefing material

Priority Areas • Progress on Health and Wellness Centres- Enabling Comprehensive Primary health Care • Wellness Promotion – Yoga, school health, lifestyle change, • Strategies to reduce OOPE: Free Medicines, Free Diagnostics, Entitlement schemes • Mechanisms for social inclusion: community engagement • Human Resources for Health: Rational Deployment • Digital Technology: enumerating and tracking populations/sub-population groups and extent to which it empowers users and reduces workloads • Use of untied funds - extent to which flexible funds are used? • Direct Benefit Transfers/Public Finance Management Systems • NGO partnerships: nature of partnerships; role in capacity building; • PPP: Opportunities/challenges

Key Points to Remember • Make use of the To. Rs and checklists • For facility and community visits: go by the state’s recommendations: but select at least half of facilities and village/slum areas randomly/focus on remote/hard to access population sub groups in village and slums • Look specifically for marginalization in community and facilities • Capture diversity within and across districts – try and find explanations • Also look at the big state picture – correlate with findings on the ground • There are lessons on what has not happened and on what works • Look for potential partnerships with NGOs /private sector in all areas- and identify why state has/has not been able to leverage this. • Look for and document unintended outcomes

Key Points to Remember • Look at TOR allocation and match with team member expertise – identify gaps at the outset and see who can take on additional work • Support team leader in ensuring findings are documented across TORs - discuss findings as a group each day; recording daily observations is helpful • Likely that one of the two districts will have more findings in To. R- live with it/consult the other expert on the phone and fill gaps • Don’t get bogged down by "this is how it should have been done”! – look beyond ask why?

Welcome to Veterans and First timers Enjoy Your Participation In The th 13 Common Review Mission