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GOOD PRACTICE-INNOVATION • E-AUSHADHI-Transparency, Speed, Ease-On line transfer of medicine from one PHC to another when required • EPIMETRICS-Real time epidemic tracking system software for management of huge Congregations like Kumbhmela in Nashik • MATRUTVA APPs-Identifying High Risk Pregnancies at PHC level and focussed app based follow up by ANMs and Mos • HEAT ACTION PLAN-in Nagpur to fight heat waves in summer through Intersectoral Coordination • AYUSH GARDEN-in Ayush Centres to disseminate knowledge about Ayurvedic Herbs and Plants to the public
Main Findings • Free Diagnostics not up to mark and Hospital Fees still continues • HR Vacancies high, Rationalisation an urgent requirement • Functional FRUs are only 162/225; Irrational posting, No BSU • Supporting Supervision almost absent -Institutional mechanism in place but regular Meetings not taking place. Lack of Entomological Monitoring in VBD. Vacancies in Program management posts, no Coordination with ULBs
Main Findings • Proper Analysis of Data absent. Lack of Coordination and Silo- approach hinders proper conclusion • Intense and In-depth Monitoring of all the Outsourced/ PPP Programs lacking • Capacity Development at all Levels including Refreshers Training NCD Screening lagging. • Delayed Payment to ASHA- DBT not in use • Poor Convergence and Expenditure under ‘National Urban Health Mission’ mainly due to lack of ownership
Action Taken by State
10 th CRM Districts and Facilities visited Facilities Nashik Nagpur District Hospital DH Nasik WH-Daga SDH Kalwan, SDH Malegaon, SDH Ramtek RH Peth, RH Trimbak, RH Chandwad, Rural Hospital Umred FRU Primary Health Centre Umrale, Karanjali, Lohaner, Uswad, Amboli, Karangavan Makerdhokada (24 X 7) UPHC- Umred, Bhandarbodi, takalghat Sub Centre Anjaniri, Mangrood, Talwade, Shinde, Vitewadi Malewada (Bhivapur ) Navegam Sadhu Musewanda, Umri, Rohda Corporation Malegaon Phutala, Zingabai Takli School Waghera Sub-District Hospital Community Health Centre Others Palliative Centre-Igatpuri Medical College, Anganwadi, Village-Karangavan State TB Training Institute, & Waghera, Elected Bodies, STDC & IRL, PHI, FW Training Corporates, FW Training Centre Institute, UCHC Nasik, UPHC-Nasik Mental Hospital Malegaon
10 th CRM District- Nashik CRM Team Interacting with Districts Officers, ASHAs and Village Sarpanch
10 th CRM District- Nagpur CRM Team visiting Health Institutes in Nagpur
10 th CRM Observation Action Taken Report 1. State Should expedite universal implementation of Free Diagnostics program. 2. Implementation of Free diagnostics scheme and Hospital Fees Scheme/Policy. Biomedical Equipment Maintenance and Repair 1. As per Mo. U with M/s Faber Sindoori Management Services Private Limited for outsourcing of Biomedical Equipment Maintenance and Repair on dated 19/11/2016 services have been operational in all the Health Institutions. 2. Total breakdown calls registered till 29/05/2017 : - 4078 3. Historical Non-functional equipment: - 13420 4. Equipment Rectified : - 13376 (Approximate Cost Rs. 67 Crores)
Biomedical Equipment Maintenance and Repair HDU Machine Repair Hingoli Cell Counter Repair at SDH Basmat Radiant Warmer Repair at DH Hingoli
10 th CRM Observation 1. State Should expedite universal implementation of Free Diagnostics program. 2. Implementation of Free diagnostics scheme and Hospital Fees Scheme/Policy. Action Taken Report Outsourcing of Laboratory Services • As per Mo. U (time limit of 90 days with M/s HLL Life care ltd. dated 03/02/2017 for outsourcing of Laboratory services. for full implementation) • Services have been partially operationalised in 24 Districts established 26 Major labs & it covers 214 collection centres. Full complement of tests would be operationalised shortly. It is being monitored daily.
Outsourcing of Laboratory Services Mahalabs Pune Mahalabs Khargar
10 th CRM Observation: - DBT payment to the beneficiaries and in other transactions also needs to be made universal. • Action Taken Report Timeline given to Districts to ensure that: - 1. ASHA – Bank Account seeding to be done before payment of incentives for the month of May, 2017 2. ANC Mother- Updation of all registered ANC mothers’ Aadhaar and Bank account seeding to be completed by July, 2017 Instructions given to Districts: 1. Aadhaar based transaction for payment of all beneficiaries and employees. 2. All transactions to be strictly done through PFMS and hence forth no payment to be made through Cheque, RTGS, NEFT, Net Banking except TDS and PT. 3. Remuneration of Employees/ ASHA incentives for the month of June, 2017 must be made through Aadhaar based DBT payment
10 th CRM Observation: - DBT payment to the beneficiaries and in other transactions also needs to be made universal. • Current status of Payment through PFMS (FY 2016 -17) Beneficiaries Registered % of Aadhaar % of Bank No. Details 92 26 24 9 Beneficiaries Total Transaction % of Aadhaar based transaction % of Bank Account based transaction ASHA 21295 24. 26 75. 73 ANC Mother 7690 18. 61 81. 39 Family Planning 1287 16. 69 83. 44 ASHA ANC Mother 67271 1374183
10 th CRM Observation: - Delayed Payment to ASHA • ASHAs incentives are paid at PHC level and block level from various incentive sources e. g. RNTCP, Malaria, JSY, NLEP, NVBDCP, RI, which may cause delay in payment of incentives to ASHAs at PHC and Block level. • However due to initiation of PFMS systems for payment of incentives to ASHAs, this delay is reduced considerably. • During CRM team visit in Maharashtra PFMS implementation was in primary stage, however now ASHA incentives are paid through PFMS system only at block level. • in year 2016 -17, approximately 85% ASHAs payments are paid through the PFMS, as well as 92% ASHAs bank account linked with Aadhar number. • Issues with mapping of districts and banks
10 th CRM Observation: -“Proper Analysis of Data (Lack of Co-ordination / too many data to be handled in silo)” • To address this issue the State has decided to go for direct facility based reporting for the HMIS Portal from the year 2017 -2018 for all the HMIS reporting formats. • For the other State requirements mainly for data elements not available on the HMIS portal and requirement for CM Compliance, etc. the State Specific HMIS software will be customized and made compact. This will resolve the data quality issues and also will increase the use of HMIS Portal Data. • The reporting systems for various health programmes like IDSP for selected communicable diseases, NAMIS for Malaria, NIKSHAY (Real time Data Entry) and Epicenter (Quarterly) for RNTCP, programme specific software needs to be reconsidered and incorporated in the HMIS Portal to avoid duplication of data and minimize the work load at the grass
10 th CRM Observation: -Areas requiring more concentrated efforts to ensure better implementation and further strengthening of programs • “HMIS data should be analysed and used formulation of action plan and monitoring of programs – both at local and State level, including for Vector Borne Diseases. ü Analysis of HMIS data is done on monthly basis and the same is used for presentations during Review meetings and giving feedback to districts from the State ü Nodal officers appointed. ü For formulating Action plan more emphasis is given on the HMIS Portal and reporting systems introduced by the Go. I. ü State has decided to go for direct facility based reporting for the HMIS Portal from the year 2017 -2018 for all the HMIS reporting formats.
10 th CRM Observation 1. Quality Assurance needs to be assimilated as a systemic component as an all weather activity PHC Savargaon, Bhor Pune Action Taken Report 1. 2. 3. 4. Baseline Assessment: in 441 facilities Internal Assessment: in 339 State level assessment: 157 facilities National level assessment: 11 PHC Winners in Kayakalp activity for FY 2016 -17 § § § DH level CHC level PHC level 5 24 154 National NQAS Certification: 10 PHCs State NQAS certification: 12 PHCs NABH Accreditation: 34 PHCs
NQAS & Kayakalp in Maharashtra External Assessm ent Team PHC MAAN, Pune
10 th CRM Observation 1. Functional FRUs 162/225 (No Coordination in posting/No BSU) Action Taken Report 1. State has mapped 200 level-3 facilities including facilities in Corporation areas, as per population norm 2. 101 facilities (51%) are functional FRUs as performance norm of C-section and deliveries. 3. State is making all possible efforts to operationalize remaining FRUs as performance norm of 5 C-sections per month for CHCs and 10 C-section for district level facilities, besides 24 X 7 availability of Blood Transfusion and HR. 4. Out of total 207 BSUs currently 147 are operational and 60 BSUs are in various stages of operationalization
10 th CRM Observation 1. Urban Health Mission merits focused attention as well as convergence and coordination Action Taken Report 1. A meeting of officers from ULBs was conducted under Chairmanship of Hon. Joint Secretary (NUHM) in January, 2017. In the meeting, ULBs were oriented about NUHM program. This meeting has helped in better implementation of NUHM in ULBs. 2. A meeting of NUHM with other departments like Swachha Bharat Mission, National Urban Livelihood Mission and Urban Development Department was conducted in April, 2017 for convergence. Next meeting is scheduled in the
10 th CRM Observation Action Taken Report 1. The expenditure level in Urban Health component is very low and needs to be raised by undertaking approved activities under short and long term plans to make it viable 1. In the month of November (during CRM visit), total expenditure was 8. 44%. This expenditure has increased to 26. 30% against the approved PIP of Rs. 311. 52 Cr by March 2017. 2. In FY 2017 -18, steps would be taken for human resource recruitment and completion of infrastructure works for strengthening UPHCs, UCHCs and Maternity Homes. 3. Also other activities for community process like ASHA recruitment, UHNDs, MAS formation and outreach camps will be focused on.
10 th CRM Observation 1. HR Rationalisation. Laboratory Technicians, Counsellors, Doctors (Vertical nature of Programs) 2. HR Recruitment. Vacancy is at all level substantial( Less Wage than Market rate/Regular Services/PG opportunity /Remoteness) Action Taken Report 1. 2. 3. 4. Skill enhancement training for medical and para medical staff is planned. Lab Technicians under various programs are provided multi skilling training of other programs To minimize vacancy, as per Go. I guidelines, the process for empanelment with Recruitment agencies is started. For on time service delivery by Doctors and Specialist, lump sum amount is proposed in PIP 2017 -18 to receive the service on call basis. Along with the provision for minimizing vacancy, to retain the existing HR, loyalty bonus is proposed in PIP 2017 -18 for the employees delivering service for more than 3 years and 5 years in order to minimize the difference between market rate and wages under NHM.
10 th CRM Observation 1. Training at all levels needs to be completed and reorientation to be initiated to get desired results Action Taken Report 1. 2. 3. 4. 5. 6. Training of trainers is emphasized to make the trainers available in sufficient numbers. Training wise and Cadre wise training Load calculated at DHO and CS level Capacity building of Principal, faculties & MO DHTCs Monitoring, evaluation and feedback of trainings by SIHFW. Residential facilities at for hospital based training have been made available by HTC Training modules and matrix of all cadre have been prepared and updated at PHC, RH, SDH, WH level respectively
10 th CRM Observation 1. Supporting Supervision -Institutionalization of Governance Mechanism is in place but Regular Meeting with involving all does not take place Action Taken Report 1. Visits of regular and contractual cadres are monitored regularly from SPMU. 2. Monthly meetings of CPM, DPMs are arranged by SPMU 3. Weekly Video conference with districts is conducted on every Monday to address various administrative issues 4. Data of EC, GB meetings is collected and monitored by SPMU. Governing Executive Body Sr. Committee (District No. (CEO) Collector) 54 160 1.
10 th CRM Observation 1. All the outsourced/PPP programs require regular and intense monitoring at every level to ensure that they are not only need based but also cost effective Action Taken Report 1. 2. 3. 4. 5. 6. HACC program is regularly monitored through data generated from dash board of HACC. Also the payment of private agency is done on quarterly basis which is based on its performance. HACC has assisted medical officers at field level by providing 5992 expert opinions to them. ASHAs and ANMs have been given 145958 and 35027 advices respectively in year 2016 -17. MMU (40 MMUs, 13, 04, 189 patients seen) Telemedicine (62 Patient nodes, 29, 883 patient consulted) Epilepsy Camps- (10, Patients consulted 3272) Medical & Dental Camps- (50 Camps conducted, 79216 patients consulted)