QUARTERLY REVIEW MEETING THEMES PRESENTER Ayushman Bharat HWCs

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QUARTERLY REVIEW MEETING THEMES PRESENTER Ayushman Bharat - HWCs & Health Systems Strengthening JS

QUARTERLY REVIEW MEETING THEMES PRESENTER Ayushman Bharat - HWCs & Health Systems Strengthening JS (Policy) Dr. Manohar Agnani National Urban Health Mission JS (NUHM) Ms. Preeti Pant EA (Finance) Ms. Preeti Nath NHM Finance 19 th – 20 th September 2019 Dr. Ambedkar International Centre Janpath, New Delhi

Ayushman Bharat – Health and Wellness Centres Comprehensive Primary Health Care – Oral, Mental,

Ayushman Bharat – Health and Wellness Centres Comprehensive Primary Health Care – Oral, Mental, Geriatric etc. Preventive and Promotive Non Communicable Diseases RMNCHA+N a Platform to integrate service delivery – provide comprehensive care Moving towards Universal Health Coverage 2

CHC / SDH / District Hospitals / Medical Colleges, PMJAY empanelled Pvt. facilities TERTIARY

CHC / SDH / District Hospitals / Medical Colleges, PMJAY empanelled Pvt. facilities TERTIARY SECONDARY CPHC through HWCs Referral/Return Gatekeeping PRIMARY Unmet need: NCDs/other Chronic Diseases Existing services: RMNCH+A Preventive, Promotive, Curative, Rehabilitative & Palliative Care AYUSHMAN BHARAT – HEALTH AND WELLNESS CENTRES 3

AB-HWCs- Field visits conducted States covered (20) Andhra Pradesh, Karnataka, Kerala, Odisha, Tamil Nadu,

AB-HWCs- Field visits conducted States covered (20) Andhra Pradesh, Karnataka, Kerala, Odisha, Tamil Nadu, Telangana, Bihar, Goa, Jharkhand, Maharashtra, Uttar Pradesh, Punjab, Haryana, Rajasthan, Himachal Pradesh, Jammu & Kashmir, Gujarat, Uttarakhand, Chhattisgarh, Madhya Pradesh UTs covered (6) Chandigarh, Puducherry, Lakshadweep, A&N Islands, Dadra & Nagar Haveli, Daman & Diu 4

AB-HWCs - What has changed? • Improved infrastructure including branding Up to an extent

AB-HWCs - What has changed? • Improved infrastructure including branding Up to an extent • Human Resources at AB-HWCs only!!! • Strengthening of existing services – RMNCHA+N • Availability of essential medicines • Availability of essential diagnostic services • Population Based Screening for 30+ (NCD – diabetes/hypertension, 3 Common Cancers) • Emergence of IT – AB-HWC portal and NCD Application • Wellness activity – YOGA and others 5

AB-HWCs- Good practices observed Andhra Pradesh: • Safe Delivery Calendar Karnataka: • Streamlined recruitment

AB-HWCs- Good practices observed Andhra Pradesh: • Safe Delivery Calendar Karnataka: • Streamlined recruitment process and Performance Linked Payments of CHOs Kerala: • PRI Involvement in Palliative Care • SN designated for NCD screening, also working as Ophthalmic Assistant, ECG technician- UPHC -HWC • Arogya Sena / Health Ambassadors Odisha: • Population Based Screening – Campaign mode • Yoga and Meditation – for pregnant women • Mahila Aarogya Samitis (SHG) actively involved for in house profiling, IEC and health promotional activities – urban areas • Weekly Specialist services in UPHCs 6 • Mental Health Services provided by trained MO and SN through NIMHANS (R/U)

AB-HWCs- Good practices observed Tamil Nadu: • 3 months of buffer stock of medicines

AB-HWCs- Good practices observed Tamil Nadu: • 3 months of buffer stock of medicines at SHC, PHC • Population being served is defined with SHC – PHC linkages • 96 Poly clinics providing Specialist services in UPHCs • SN designated for NCD screening- UPHC-HWC Telangana: • Basti Dawa Khanas in Urban Areas • State run diagnostic hub • Streamlined collection of samples and reporting Maharashtra: • Model AB-HWCs – SHC layout-3 Designs • Certificate Course in Community Health through MUHS (6300 candidates/batch) • Netradan trust – NGO collaboration for diagnosis and treatment for cataract etc. Jharkhand: • ATAL Clinic (Community Clinic) to cater to health care needs of urban marginalised population by Nagar Nigam 7

AB-HWCs- Good practices observed Gujarat: • Arogya Samanwaya – Integration of Ayurvedic and Yogic

AB-HWCs- Good practices observed Gujarat: • Arogya Samanwaya – Integration of Ayurvedic and Yogic practices with Allopathy • Yoga at SHC/PHCs - daily by trained CHO/MPW-M/ANM, twice weekly by trained ANMs at UPHCs • Meditation and Saptdhara Uttar Pradesh: • Community Health Officer – Virtual Classrooms • Curriculum for CHOs improvised. Himachal Pradesh: • Expansion of Population based NCD screening to 18 -30 yrs age group • Alcohol Cess Goa: • Linkages with School Health Programs - Identified Health & Wellness Ambassadors 8 • Expanded Wellness Activities – laughter clubs etc.

AB-HWCs- Good practices observed Dadra & Nagar Haveli: • Upgradation of Infrastructure using MPLAD

AB-HWCs- Good practices observed Dadra & Nagar Haveli: • Upgradation of Infrastructure using MPLAD / CSR funds Daman & Diu: • e-Arogya (Cloud based health ecosystem) at all public health facilities Haryana: • VIA screening started at PHCs by trained staff nurses. • CSR leveraging – TATA Steel and Indian Oil • Eye Camps in Urban Areas for Drivers to reduce accident cases Chhattisgarh: • NCD Suraksha Maah • Attractive & Informative Internal branding for AB-HWCs • Collaboration with Govt. Medical Colleges for community outreach and service delivery in urban areas. • Mental Health Services provided by trained MO and SN through NIMHANS (R/U) 9

AB-HWCs- Functional Status as on 17. 09. 2019 STATE/UT Andhra Pradesh Bihar Chhattisgarh Total

AB-HWCs- Functional Status as on 17. 09. 2019 STATE/UT Andhra Pradesh Bihar Chhattisgarh Total facilities (NUHM Approvals Accorded FUNCTIONAL HWC as on 17. 09. 19 + RHS 2018) Till date SHC PHC UPHC 7680 3616 789 1145 243 10048 2856 82 433 95 5236 1900 594 197 21 25% of Total facilities TOTAL AB-HWC FUNCTIONAL as on 17. 09. 19 1920 2512 1309 2177 610 812 Dadra & Nagar Haveli 73 60 24 7 0 18 31 Delhi 256 0 0 64 0 Goa 218 58 4 20 4 55 28 Himachal Pradesh 2092 785 0 37 2 523 39 Jammu & Kashmir Jharkhand Kerala Lakshadweep Meghalaya Nagaland Odisha Puducherry Sikkim Tamil Nadu Telangana Tripura West Bengal 3016 3907 5463 14 462 401 6781 59 153 9132 4991 1027 10816 1185 1797 1308 3 113 327 2057 121 20 2866 1705 485 3230 113 244 0 0 29 49 96 2 22 418 332 40 143 115 108 641 0 9 2 824 22 8 1200 613 26 256 4 53 30 0 1 3 82 0 0 312 238 5 0 754 977 1366 4 116 100 1695 15 38 2283 1248 257 2704 232 405 671 0 39 54 1002 24 30 1930 1183 71 399 10

AB-HWCs- Functional Status as on 17. 09. 2019 STATE/UT FUNCTIONAL HWC as Total facilities

AB-HWCs- Functional Status as on 17. 09. 2019 STATE/UT FUNCTIONAL HWC as Total facilities Approvals TOTAL AB-HWC on 17. 09. 19 25% of Total (NUHM + RHS Accorded Till FUNCTIONAL as facilities 2018) date on 17. 09. 19 SHC PHC UPHC Andaman & Nicobar Islands 128 85 27 0 2 32 29 Arunachal Pradesh 316 222 34 34 4 79 72 Chandigarh 20 34 0 0 10 5 10 Daman & Diu 27 28 19 4 0 7 23 Manipur 438 352 57 6 1 109 64 Mizoram 378 198 0 2 2 95 4 Uttarakhand 1847 996 87 88 34 462 209 11

AB-HWCs- Functional Status as on 17. 09. 2019 STATE/UT FUNCTIONAL HWC as Total facilities

AB-HWCs- Functional Status as on 17. 09. 2019 STATE/UT FUNCTIONAL HWC as Total facilities Approvals TOTAL AB-HWC on 17. 09. 19 25% of Total (NUHM + RHS Accorded Till FUNCTIONAL as facilities 2018) date on 17. 09. 19 SHC PHC UPHC Assam 4683 1720 628 252 49 1171 929 Gujarat 9471 3480 767 778 72 2368 1617 Haryana 2685 1504 168 212 85 671 465 Karnataka 9807 2740 464 146 119 2452 729 Madhya Pradesh 11333 2871 0 764 108 2833 872 Maharashtra 11151 9035 1111 1325 416 2788 2852 Punjab 3043 1833 428 348 91 761 867 Rajasthan 14650 4806 130 423 57 3663 610 Uttar Pradesh 21113 7570 780 945 392 5278 2117 12

Field findings suggest We need to move away from Adhocism to Comprehensive thinking &

Field findings suggest We need to move away from Adhocism to Comprehensive thinking & planning… Request to have a Vision Document on it… 13

AB-HWCs- Vision Document • Financial planning – NHP 2017 (2/3 rd allocation to Primary

AB-HWCs- Vision Document • Financial planning – NHP 2017 (2/3 rd allocation to Primary Care) • Infrastructure strengthening • Strengthening of Drug Distribution and Management Systems and Expansion of essential Diagnostic services • Expanded package of services • Capacity building of the existing staff • Bidirectional referral and return • CHOs retention and motivation 14

National Health Policy 2017 Increase Govt. Health Expenditure as % of GDP from existing

National Health Policy 2017 Increase Govt. Health Expenditure as % of GDP from existing 1. 15% to 2. 5% by 2025 Increase State sector health spending to >8% of their budget by 2020 Increase in State Health Budget by 10% every year 15

Year-wise health expenditure to achieve 2. 5% of GDP (Rs. in Lakh Crore) Year

Year-wise health expenditure to achieve 2. 5% of GDP (Rs. in Lakh Crore) Year Expenditure on Health as a % of GDP ( assuming [email protected] 5% at current prices over baseline of 2017 -18) GDP with Rate of Inflation @4%only 1 2 3 4 5=4*2 7 8 2018 -19* 1. 40% 178. 75 185. 90 2. 60 0. 91 1. 69 2019 -20* 1. 40% 199. 83 207. 84 2. 91 1. 02 1. 89 2020 -21 1. 58% 223. 42 232. 36 3. 67 1. 28 2. 39 2021 -22 1. 76% 249. 79 259. 78 4. 57 1. 60 2. 97 2022 -23 1. 98% 279. 26 290. 43 5. 75 2. 01 3. 74 2023 -24 2. 22% 312. 22 324. 70 7. 21 2. 52 4. 68 2024 -25 2. 50% 349. 06 363. 02 9. 07 3. 17 5. 90 35% of 65% of Expenditure Expend. for on Health Centre State * Assuming that Govt. health expenditure is 1. 4% of GDP, as in 2017 -18, as per Economic Survey, 2017 -18 16

State Health Budget Status for FY 2019 -20 No. of State/UTs States/UTs 7 Andhra

State Health Budget Status for FY 2019 -20 No. of State/UTs States/UTs 7 Andhra Pradesh (35%), Delhi (18%), Nagaland (77%), Tamil Nadu (11%), Haryana (12%), Uttarakhand (24%) and Gujarat (11%) 13 Bihar, Chhattisgarh, Jammu and Kashmir, Jharkhand, Meghalaya, Puducherry, Telangana, Arunachal Pradesh, Madhya Pradesh, Manipur, Punjab, Rajasthan and Uttar Pradesh State increased less than 10% 7 Himachal Pradesh (8%), Kerala (0%), Odisha (3%), West Bengal (9%), Assam (2%), Maharashtra (8%) and Karnataka (0%) State Health Budget decreased from last year 4 Goa (-22%) and Sikkim (-10%), Tripura (-9%) and Mizoram (-14%) Category State increased by 10% and above over last yr. SHB not reported for the FY 2019 -20 over last yr. 17

AB-HWCs- Financial Resources required for. . • Infrastructure • Human Resource • Training and

AB-HWCs- Financial Resources required for. . • Infrastructure • Human Resource • Training and Capacity Building • Medicines (0. 5% of the GDP) • Diagnostics • IT – tablets / laptops • Telemedicine- Hubs and Spokes • Enhanced Untied funds for AB-HWCs 18

AB-HWCs- Infrastructure • As per RHS 2018, a number of facilities (PHCs and SHCs)

AB-HWCs- Infrastructure • As per RHS 2018, a number of facilities (PHCs and SHCs) are without regular electricity and water supply. The number exceeds 50% in Bihar, J&K, Jharkhand, Manipur, Meghalaya, Mizoram and Nagaland. • Additional space for lab services, drug dispensation & drugs storage cabinets, patient waiting area, etc. • Space for YOGA / other wellness activities • Rooms for MPW / CHO etc. 19

AB-HWCs-SHC- Status of CHOs Sr. No. States 1 2 3 4 5 6 7

AB-HWCs-SHC- Status of CHOs Sr. No. States 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 A & N Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Number of SHCs approved for 2018 -20 58 2250 130 1233 726 0 1500 52 26 0 9 2303 562 354 574 1452 1705 728 0 1015 CHO recruited (as per portal as on 29. 08. 2019) (a) 28 780 62 635 85 2 729 24 20 0 14 786 178 0 131 245 537 0 0 5 *Based on estimated admissions reported by States and assuming 80% pass rate Estimated Number of CHOs available for July 2019 and Jan 2020* (b) 24 342 73 412 526 0 1154 22 48 0 0 1571 344 384 298 915 902 728 0 862 Total CHO available (a+b) 52 1122 135 1047 611 2 1883 46 68 0 14 2357 522 384 429 1160 1439 728 0 867 DEFICIT CHO based on Total SHCs approvals 6 1128 NIL 186 115 NIL 6 NIL NA NIL 40 NIL 145 292 266 0 0 148 20

AB-HWCs-SHC- Status of CHOs Sr. No. States Number of SHCs approved for 2018 -20

AB-HWCs-SHC- Status of CHOs Sr. No. States Number of SHCs approved for 2018 -20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu* Telangana Tripura Uttar Pradesh Uttarakhand West Bengal Total 6791 220 132 120 152 1321 1 1640 2909 60 985 987 332 5050 739 1660 37776 CHO recruited (as per portal as on 29. 08. 2019) (a) 1135 81 42 1 49 123 1 481 138 53 605 336 40 900 145 8531 *Based on estimated admissions reported by States and assuming 80% pass rate Estimated Number of CHOs DEFICIT CHO based Total CHO available for July 2019 and Jan on Total SHCs (a+b) 2020 (b) approvals 6300 96 130 56 96 921 0 1136 2736 48 664 465 251 3186 474 1368 26, 532 6175 177 172 57 145 1044 1 1617 2874 101 1269 801 291 4086 614 1513 33, 803 0 43 NIL 63 7 277 0 23 35 NIL 186 41 964 125 147 21

AB-HWC-SHC- Community Health Officers: Retention and Motivation üDefined career pathways üStreamlined recruitment procedures –

AB-HWC-SHC- Community Health Officers: Retention and Motivation üDefined career pathways üStreamlined recruitment procedures – preference postings üPerformance linked payments üTraining at District level – National Health Programmes üConstant Supportive Monitoring and Mentoring üTimely provision of tablets Delay in admission process of CHOs for July 2019 session. Rajasthan, Bihar, Uttar Pradesh, Haryana, Telangana, Jammu & Kashmir and Uttarakhand. 22

AB-HWCs- Basket of Wellness activities • YOGA – the only activity being focused on

AB-HWCs- Basket of Wellness activities • YOGA – the only activity being focused on – can CHOs be trained as Yoga instructors? • Different options: • Open Gyms – in collaboration with the local panchayats • Sahi Bhojan, Behtar Jeevan – Eat Right Campaign • Nutrition Counselling – expanded to adolescents, patients suffering with chronic conditions, awareness building (BMI), lifestyle modifications – less salt, less sugar • Food adulteration kits • Medicinal Plants and their use • Health Talks / Discussions / Counselling / Laughter Clubs • Health Calendar / Planning of Events 23 • Cycling / Zumba/ Cyclathons Activities

Free Drugs Service Initiative • • Strengthening of Drugs and Vaccine management systems till

Free Drugs Service Initiative • • Strengthening of Drugs and Vaccine management systems till AB-HWC-SHC level Field visits suggest that all States/UTs need to expand their Essential Medicine List (EML). Status: • 32 States/UTs have centralized procurement: • Andaman & Nicobar, Chandigarh, Dada & Nagar Haveli & Lakshadweep yet to implement. • 29 States/UTs have operationalized IT enabled logistics & supply chain system/DVDMS: • Mizoram, Nagaland, Sikkim, A&N Island, Chandigarh, Lakshadweep & Puducherry yet to implement. • 28 States/UTs have NABL accredited labs to ensure quality of drugs provided. • Uttar Pradesh, Himachal Pradesh, Manipur, Meghalaya, Goa, A&N Islands, Chandigarh & Daman & Diu yet to implement. 24

Free Drugs Service Initiative • 31 States/UTs have facility wise EDL: • Manipur, Sikkim,

Free Drugs Service Initiative • 31 States/UTs have facility wise EDL: • Manipur, Sikkim, A&N Island, Chandigarh & Lakshadweep do not have facility wise EDL. • 14 States/UTs have prescription audit mechanism: • Assam, Bihar, D&N Haveli, Delhi, Himachal Pradesh, Jammu & Kashmir, Lakshadweep, Mizoram, Odisha, Rajasthan, Telangana, Tripura (under process), Uttarakhand, West Bengal • 20 States/UTs have established call centre based grievance redressal mechanism with dedicated toll-free number: • Andhra Pradesh, Assam, Bihar, Chhattisgarh, D&N Haveli, Daman & Diu, Delhi, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Lakshadweep, Madhya Pradesh, Maharashtra, Punjab, Rajasthan, Tamil Nadu, Telangana, Tripura (under process), Uttarakhand 25

Free Diagnostics Service Initiative • Enhanced range of free diagnostics: 14 tests at AB-HWC-SC

Free Diagnostics Service Initiative • Enhanced range of free diagnostics: 14 tests at AB-HWC-SC and 63 tests at AB-HWC-PHC. • FDI Pathology- laboratory services implemented in 33 States /UTs • Yet to be implemented in Mizoram, Nagaland, Uttarakhand • FDI- Tele-radiology implemented in 10 States only • Andhra Pradesh, Assam, HP, Meghalaya, Odisha, Rajasthan, Tripura, Uttar Pradesh, Uttarakhand, West Bengal • FDI CT scan implemented in 23 States/UTs • Yet to be implemented in Arunachal Pradesh, Chandigarh, Chhattisgarh, D&NH, Jammu & Kashmir, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Uttarakhand 26

ac ha De l l Ut Pra hi ta de r P sh ra

ac ha De l l Ut Pra hi ta de r P sh ra de s Pu h nj a Od b i M sha M an An aha ipur dh ras ra ht P ra W rad es es t B h e Ra nga Da ja l s dr a & Jha than N rkh ag an ar H d An av da e m an As li & sa N m ico b Ha ar Ta rya m na il N ad M u ad hy Sikk a P im ra de Ja m sh m K u & era Ka la sh m Gu ir ja ra Da Tri t m pur a a Ut n & ta Di ra u kh Ka an rn d Pu ata du ka ch Ar un N erry ac aga ha la l p nd ra d M esh izo ra m Go a Bi ha r m Hi State Performance on Free Diagnostics at SHC 14 12 10 8 6 4 2 12 Telangana: 54 tests 7 7 7 6 6 6 6 5 5 5 No. of tests available at SHC 9 4 4 3 3 3 2 2 2 0 27

M an a ah De ar lhi M ash eg tra ha la ya

M an a ah De ar lhi M ash eg tra ha la ya Ch Bi an ha Pu dig r du arh An da Ta che m m rr an il y An & Nad Ar dh Nic u un ra ob ac Pr ar ha ad l p es ra h de s As h sa m G uj Hi a m ac Ha rat ha ry l P an ra a d M esh an ip Ch Si ur ha kki tti m sg a Od rh M ish ad P hy u a a P nja ra b de Da Tr sh m ipu an ra & Ra D ja iu Ka stha rn n Ja at m ak m a u & G Ka oa sh Ut K mir ta er r a W Prad la es e t B sh e Da M nga i dr l a & Jh zora N ark m ag ha ar nd H Na ave Ut ga li ta lan ra d kh an d ng la Te State Performance on Free Diagnostics at PHC 70 60 54 40 30 20 10 Lakshadweep: 71 tests 25 25 24 No. of tests available at PHC 50 38 20 20 20 19 19 19 18 17 17 16 16 15 15 14 12 12 12 10 9 8 6 5 0 28

ar Ch Hav La and eli ks iga ha rh dw ee p Pu

ar Ch Hav La and eli ks iga ha rh dw ee p Pu G du oa ch er Da Gu ry m jar an at & D An dh Od iu ra is P ha ra Hi de m ac A sh ha ss l P am ra de s Sik h Ra kim ja st ha Pu n Te nja la b ng M ana an ip ur M ah Bih ar ar a M Ka sht ad rn ra hy at a ak Ch Prad a ha es tti h Ar sg un ar ac h K ha er l p al An r a da M ade m eg sh an ha & la N ya Ta icob m a Ut il N r ta ad ra u kh a Tr nd Jh ipu U a ra Ja tta rkha m r P n m u rad d & e Ka sh sh M mi izo r Na ram ga la nd ag a & N dr Da State Performance on Free Diagnostics at DH 120 103 100 80 60 40 20 94 Delhi: 200 Tests 76 72 70 68 64 64 62 No. of tests available at Delhi: 200 tests 58 57 57 56 55 54 53 52 52 52 50 50 49 46 46 45 44 32 30 25 23 20 29 12 8 0

Bi-directional Referral and Return Linkages • Facility mapping for secondary and tertiary care– CHC/SDH/DH/MC/PMJAY

Bi-directional Referral and Return Linkages • Facility mapping for secondary and tertiary care– CHC/SDH/DH/MC/PMJAY • Referral to be prioritized (non-financial incentives) – referral slips / cards / point person at the referred facility • Return linkages – information to be provided to the linked CPHC team for follow up 30

AB-HWCs- IEC • Uniform IEC display at facilities – local language • State /

AB-HWCs- IEC • Uniform IEC display at facilities – local language • State / District specific media plan / IEC strategy • Use of Social Media platform for wider dissemination of services • IEC on prevention, promotion (Eat Right), early diagnosis and improved treatment outcomes (with regular treatment) – need to be emphasized 31

AB-HWCs- Strengthening the IT systems • Daily reporting and Monthly reporting at AB-HWC portal

AB-HWCs- Strengthening the IT systems • Daily reporting and Monthly reporting at AB-HWC portal to be ensured • IT Systems – to be standardized and integrated with Go. I applications • In the mean-time, manual records – allowed for Performance Linked Payments till December 2019. 32

Monthly Reporting Status on AB-HWC Portal 33

Monthly Reporting Status on AB-HWC Portal 33

Monthly Reporting Status on AB-HWC Portal 34

Monthly Reporting Status on AB-HWC Portal 34

Daily Reporting Status on AB-HWC Portal (1 st- 17 th September, 2019) Total- 20366

Daily Reporting Status on AB-HWC Portal (1 st- 17 th September, 2019) Total- 20366 8628 8977 8897 8714 8484 8311 8240 6683 7928 7664 7152 6865 5429 4495 1895 9/ 10 /2 01 9 9/ 11 /2 01 9 9/ 12 /2 01 9 9/ 13 /2 01 9 9/ 14 /2 01 9 9/ 15 /2 01 9 9/ 16 /2 01 9 9/ 17 /2 01 9 20 19 9/ 9/ 20 19 8/ 9/ 20 19 7/ 9/ 20 19 6/ 9/ 20 19 5/ 9/ 20 19 4/ 9/ 20 19 3/ 9/ 20 19 2494 2/ 9/ 9/ 1/ 20 19 2824 35

Daily Reporting Status on AB-HWC Portal (1 st- 17 th September, 2019) 36

Daily Reporting Status on AB-HWC Portal (1 st- 17 th September, 2019) 36

Daily Reporting Status on AB-HWC Portal (1 st- 17 th September, 2019) 37

Daily Reporting Status on AB-HWC Portal (1 st- 17 th September, 2019) 37

Monitoring of AB-HWCs Facility based Monitoring: Medicines, Diagnostics, Swachhta related activities, Counselling, Wellness, Patient

Monitoring of AB-HWCs Facility based Monitoring: Medicines, Diagnostics, Swachhta related activities, Counselling, Wellness, Patient records, Teleconsultation Utilization of untied funds Constitution of RKS (facility based) VHSNCs / SHGs (community based) Social Audits: PBS, CBAC, Immunization, ANC, Other outreach activities, Health Promotion and Wellness Activities 38

Health Systems Strengthening 39

Health Systems Strengthening 39

Human Resources for Health • No Specialist Cadre: UP, MP, Chhattisgarh, HP, Rajasthan, Uttarakhand,

Human Resources for Health • No Specialist Cadre: UP, MP, Chhattisgarh, HP, Rajasthan, Uttarakhand, Punjab, Haryana, Assam, Nagaland, Meghalaya, Mizoram, Tripura • High Vacancy reported in many States (Source: PIP 2019 -20) • States Not using NHM flexibility especially for specialists entirely Vacancy Specialists • Chhattisgarh (91%) • Jharkhand (80%) Regular • Bihar (71%) • MP (68%) • Gujarat (64%) • Rajasthan (90%) • Meghalaya (85%) Contractual • MP (81%) • J&K (77%) • Ar. Pradesh (77%) MO-MBBS Staff Nurse Lab Technician • Sikkim (74%) • Gujarat (47%) • Manipur (45%) • Chhattisgarh (44%) • Sikkim (80%) • Gujarat (70%) • Odisha (63%) • Jharkhand (55%) • Bihar (81%) • HP (67%) • Jharkhand (62%) • Haryana (50%) • HP (97%) • Rajasthan (78%) • Odisha (77%) • Bihar (74%) • Maharashtra (63%) • Rajasthan (81%) • HP (74%) • Bihar (77%) • Jharkhand (70%) • Maharashtra (61%) • Ar. Pradesh (76%) • Rajasthan (69%) • Jharkhand (63%) 40

Human Resources for Health • Number of sanctioned regular position of Staff Nurse is

Human Resources for Health • Number of sanctioned regular position of Staff Nurse is much less than the requirement as per IPHS in most of the states: • Jharkhand (13%)*, Assam (19%), Uttar Pradesh (20%), Nagaland (24%), Karnataka (30%), Uttarakhand (34%), MP (40%), Maharashtra (48%) • Assessment of all staff on Minimum Performance Benchmarks to be conducted on quarterly basis: • Report to be shared with Mo. HFW twice a year (October and March) • First round of report card expected in first week of October from all states • Human Resource Management Information System (HRMIS): • Implemented in Chhattisgarh, Kerala, Punjab, Haryana and Assam • Partial in Tripura, UP, AP and Odisha • Not yet functional in other states *Figures in Brackets are IPHS required vs sanctioned positions e. g. Jharkhand has only 13% of the required IPHS staff 41 nurses posts sanctioned

Quality Assurance • NQAS: • A total of 441 Public Health facilities certified under

Quality Assurance • NQAS: • A total of 441 Public Health facilities certified under NQAS at national level; 66 more under process in 28 States/UTs. • 8 States/UTs yet to submit applications (A&N Islands, Arunachal, Chandigarh, Daman&Diu, Goa, Puducherry, Sikkim, Lakshadweep) • Kayakalp: 12% of facilities scored >70% scored in External Assessment in 2018 -19 % of Facilities (DHs, SDHs, CHCs, UCHCs, PHCs & UPHCs) scored >70% on External Assessment 90 80 70 79 60 45 50 40 30 20 10 22 10 10 8 7 5 5 4 4 47 42 29 28 20 19 16 15 20 13 12 11 11 1 8 19 15 28 25 17 13 5 4 0 NE States N nd H ig ar h D el hi Pu D du &D ch er ry La A ks ha &N dw I ee p P ha D C Ar G ar oa as h M tra iz or am Si kk M im an N ipu ag r al an Tr d M ipu eg ra ha la y As a sa m ah la Non High Focus Large States M ra AP Ke T Pu N n H jab ar Ka yan a r U nat tta ak ra a kh an d W B P Bi H J& K ha r Jh M ar P kh an d C hh at UP tis ga r O h di sh G a u Te jar la at ng an a R aj as th an 0 Non-NE High Focus States 15 UTs 42

Mera Aspataal • Currently functioning in 25 States and 5 UTs (3106 Facilities) •

Mera Aspataal • Currently functioning in 25 States and 5 UTs (3106 Facilities) • Arunachal Pradesh, Nagaland, Sikkim, Kerala, A&N Islands, Lakshadweep yet to implement • Sub-district facilities are covered in 10 States (Gujarat, AP, Rajasthan, Karnataka, Mizoram, Jharkhand, Telangana, HP, Goa and Delhi). Gujarat & Himachal covered PHCs too. • National level Patient Satisfaction Score remained stagnant from 2018 -19. PSS of States/UTs except Tamil Nadu remained constant or shown downward trend. Reasons of Dis-Satisfaction Staff Behavior Cleanliness Cost of Treatment Quality of Treatment Other Reasons (Long waiting time, lack of amenities, inadequate information etc. ) India 5. 91 Lakh Responses 39 12 18 0 State health Facilities (3. 41 lakh Responses) 40 13 19 0 31 28 43

Blood Services • 24 Districts [Arunachal (2), Bihar (5), Jharkhand (5), HP (1), Manipur

Blood Services • 24 Districts [Arunachal (2), Bihar (5), Jharkhand (5), HP (1), Manipur (3), UP (3), Maharashtra (1), Karnataka (3), J&K (1)] do not have Govt. Blood Banks. • Gap between supply & demand – States are collecting blood units of <1% as against the requirement of 2% of the population • Jharkhand, UP, Chhattisgarh, Punjab, Rajasthan, Andhra Pradesh, Telangana, MP, Orissa, Uttarakhand, J&K, Bihar, Assam, Nagaland) • Voluntary blood donation is 40 -55% in these states. • Transfusion transmitted infections are high in UP, MP, Jharkhand, Meghalaya, Chhattisgarh, Bihar, Maharashtra, Haryana, Punjab, West Bengal, Assam, Manipur & Nagaland. 44

National Ambulance Service National Average Response Time (Emergency referral services) Rural Urban ALS 21

National Ambulance Service National Average Response Time (Emergency referral services) Rural Urban ALS 21 Min 14 Sec 14 Min 11 Sec BLS 20 Min 14 Sec 14 Min 56 Sec • 7 States/UTs do not have Emergency Referral Services under NHM. • A&N Islands, Lakshadweep, Manipur, Mizoram, Nagaland, Tripura & West Bengal • Manipur, Mizoram, Nagaland & West Bengal (BLS) has Dial 102 services only. • Arunachal Pradesh does not maintain average response time (call to scene) currently at the centralised call centre. 45 • Haryana is yet to operationalise centralised call centre.

Biomedical Equipment Management & Maintenance Programme (BMMP) • BMMP - Uptime of equipment (95%

Biomedical Equipment Management & Maintenance Programme (BMMP) • BMMP - Uptime of equipment (95% in District Hospital, 90% in Community Health Centres and 80% in Primary Health Centres). • Implemented in 28 States/UTs: • 22 States/UTs in PPP mode: • Andhra Pradesh, Arunachal Pradesh, Assam, Chhattisgarh, Goa, Himachal Pradesh, Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Meghalaya, Mizoram, Nagaland, Puducherry, Punjab, Telangana, Tripura, Rajasthan, Uttar Pradesh, West Bengal, Jammu & Kashmir, and Manipur. • 6 States/ UTs in In-House mode: • Gujarat, D&N Haveli, Daman & Diu, Delhi, Lakshadweep, and Tamil Nadu. • Tender for outsourcing in progress in 4 States/UTs: • Haryana – Tender pending for approval by State. • Karnataka – Tender complete but yet to be implemented • Uttarakhand – Tender failed. • Sikkim – Tender pending with the state for approval. Not implemented in 4 States/UTs - A&N Islands, Bihar, Chandigarh, Odisha 46

National Urban Health Mission (NUHM) 47

National Urban Health Mission (NUHM) 47

Infrastructure- AB-HWCs/ UPHCs 7542 8000 7000 6000 5000 4000 3000 2000 1000 0 Gap

Infrastructure- AB-HWCs/ UPHCs 7542 8000 7000 6000 5000 4000 3000 2000 1000 0 Gap of 2711 U-PHCs as per urban population 4831 4586 (95%) 2930 (64%) 1656 (36%) No. UPHCs as PHCs per urban approved population No. UNo. UPHCs functional infunctional in rented Govt. building 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 4586 Gap of 1286 HWCs 3300 (72%) No. of U-PHCs functional No. of HWCs approved 2372 (72%) No. of HWCs functional §Maximum gaps of UPHCs in 5 States- Maharashtra (398), U. P- (298), T. N (278), Kerala (236), Gujarat (201) §States with maximum U-PHCs running in rented building- U. P, Bihar, Delhi, Jharkhand, Madhya Pradesh, Meghalaya etc. §States with maximum U-PHCs running in Govt. building- Tamil Nadu, Odisha, Gujarat, Karnataka, Chhattisgarh, Kerala, West Bengal, Telangana § Maximum gaps of HWCs approval in 4 States- W. B (373), Delhi (242), Gujarat (209), Maharashtra (205) 48

Human Resource - UPHCs HR In-position 78% 77% 76% 75% 74% 73% 72% §More

Human Resource - UPHCs HR In-position 78% 77% 76% 75% 74% 73% 72% §More than 60% of SN vacant- West Bengal, M. P, Rajasthan and Jharkhand 70% 68% 66% 64% 62% l ta To se ur f N af §More than 35% MPW (F) vacant- Rajasthan, Karnataka, Tripura. Bihar- None of LT is in place St ed M La b- Te ica ch l O ni ffi cia ce r n ist ac m ar Ph Pu bl ic H ea lth M M an PW ag (F ) er 60% Source: QPR / MIS Report ending March, 2019 §More than 40% Positions of Medical Officers vacant – Bihar, Jharkhand, Madhya Pradesh, Maharashtra and Punjab §More than 50% LTs vacant- Jharkhand, Maharashtra, Madhya Pradesh, Rajasthan, Bihar- None of LT is in place 49

State wise Performance (In respect of Physical Progress) Best performing States (More than 80%)

State wise Performance (In respect of Physical Progress) Best performing States (More than 80%) Mid performing States (50 -80%) 300 250 100 94 100 99 80 91 100 200 150 100 100 98 88 90 100 83 84 Assam Chhattisgarh Harayana Kerala Odisha Tamil Nadu Human Resource UPHC Functionality 100 50 77 99 92 90 97 81 99 100 98 91 100 76 78 71 77 74 89 Gujarat Karnataka Maharashtra Punjab Telangana Uttar Prasesh 100 0 Human Resource ASHAs Engaged / MAS UPHC Functionality ASHAs Engaged / MAS Low performing States (Less than 50%) Source: QPR Report ending March, 2019 ra ip u Tr ra k. . . tta B. es t W UPHC Functionality 100 71 30 100 . . M ad hy. . . Jh ar kh. ha r Bi Human Resource 81 98 52 79 53 39 U 94 97 50 93 89 24 ASHAs Engaged / MAS 50

Cumulative Financial Progress of NUHM 74% 71% 2018 -19 2019 -20 66% 51% 31%

Cumulative Financial Progress of NUHM 74% 71% 2018 -19 2019 -20 66% 51% 31% 17% 1% 2013 -14 2014 -15 2015 -16 2016 -17 2017 -18 Fund utilization of 40%-60% Fund utilization of 70%- 75% 108% 58% an kh ar Jh la ng an d a . . . Te ht as ar M ah l ga es t B en W Ta m il Na du at ja r Gu hi De l a at rn Ka tti sg ar ak h an Ch a th Ra ja s UP 42% Pr 41% 58% 45% a 74% hy 75% M ad 79% r 80% ra 80% ha 82% Bi 83% 51

UPHC - Public Private Partnerships • e-UPHC management on PPP mode by e-Vaidya &

UPHC - Public Private Partnerships • e-UPHC management on PPP mode by e-Vaidya & Apollo agencies -Andhra Pradesh • HR, Tele-consultation, IT, Diagnostic services: Supported by Agency • Building, Drugs: Provided by State Health Department • Partnership between State and TATA Trust in developing 26 U-PHCs as Model centres in Nagpur corporation- Maharashtra • Infrastructure, IT, investigations through Hub & Spoke model : Supported by Agency. • Building, Drugs: Provided by State Health Department • Provision of Eye care at U-PHC- Partnership with Susrut Eye Foundation - Kolkata Municipal Corporation, West Bengal 52

AB-HWC-UPHC- Health Service Delivery Models • 96 Polyclinics providing Specialist services as per weekly

AB-HWC-UPHC- Health Service Delivery Models • 96 Polyclinics providing Specialist services as per weekly roster in each UPHC - Tamil Nadu • 104 Basti Dawakhana functional in urban areas for covering 5000 to 10000 population with focus on slum population- Telangana • Atal Mohalla Clinic is being initiated for urban slum dwellers to impart health services including NCD screening with support from ULBS- Jharkhand Specialist services Schedule - Tamil Nadu v Monday – General Medicine & Dermatology v Tuesday – Obs/ Gynae & Dental v Wednesday – Pediatrics and Ophthalmology v Thursday – Ortho and Physiotherapy v Friday – ENT and Dental v Saturday - Psychiatry 53

AB-HWCs - Vision document for urban areas • Criteria for establishing AB-HWCs • Population

AB-HWCs - Vision document for urban areas • Criteria for establishing AB-HWCs • Population based / Ward based ? • Infrastructure (Buildings) - Community Halls of Urban Local Bodies / Corporation • Assigning the Population to the AB-HWC • Defining referral linkages – Secondary and Tertiary • Facility based services - Specialty Services - Model ? (Facility based / Tele-consultation) • Outreach – Can we have a different Model ? • Basti Dawa Khana , Telangana – thinking for performance linked payments for outreach activities ? • In areas where there are no ASHAs - Can existing community volunteers, SHGs, NGOs, Nursing students etc. be utilized ? 54

AB-HWCs - Vision document for urban areas • Human Resources • Norms for ASHAs

AB-HWCs - Vision document for urban areas • Human Resources • Norms for ASHAs (1 ASHA for 1000 - 2500 population)? • MPWs (Introduction of MPW-Male) If yes – at what population? • Specialist services – Odisha / Rajasthan model – part-time weekly services • Wellness – Linkages with open spaces or gyms 55

NHM Finance 56

NHM Finance 56

Status of State Share pendency up to 31 -03 -2019 (Withheld 1 st Tranche

Status of State Share pendency up to 31 -03 -2019 (Withheld 1 st Tranche Release) S. No. States/UTs Outstanding after consideration of G. O. (Rs. in Crore) 1 Nagaland 13. 80 10% 2 Puducherry 8. 65 36% 3 Delhi 12. 33 12% 4 Uttar Pradesh 614. 39 5% % of Outstanding Amount 57

Status of State Share pendency up to 31 -08 -2019 (for 2 nd Tranche

Status of State Share pendency up to 31 -08 -2019 (for 2 nd Tranche release) Category No of State/UTs States/UTs No pendency under State Share 6 Chhattisgarh, Himachal Pradesh, Tripura, Sikkim, Manipur and Karnataka Up to 2 % 4 Meghalaya (2%), Odisha (2%), Arunachal Pradesh (2%) and Mizoram(2%) From 3% to 5% 5 Andhra Pradesh (4%), Tamil Nadu (5%), Gujarat (4%), Haryana (3%) and Uttarakhand (3%) From 6% to 10% 8 Bihar (8%), Goa (9%), Jammu & Kashmir (10%), Jharkhand (8%), Madhya Pradesh (8%), Maharashtra (10%), Punjab (8%) and Rajasthan (6%) Above 10% 4 Kerala (16%), West Bengal (11%), Telangana (21%) and Assam (23%) 58

Delay in Transfer of Funds from State Treasury to SHS for the FY 2018

Delay in Transfer of Funds from State Treasury to SHS for the FY 2018 -19 Category No of State/UTs States with Days 0 to 15 days - - 22 Odisha (18), Puducherry (20), Andhra Pradesh (25), West Bengal (25), Kerala (31), Chhattisgarh (32), Tamil Nadu (36), Meghalaya (37), Delhi (45), Sikkim (61), Jammu & Kashmir (63), Tripura (92), Bihar (99), Madhya Pradesh (20), Gujarat (24), Assam (27), Uttarakhand (46), Mizoram (70), Punjab (72), Haryana (88), Maharashtra (89), Rajasthan (96) 100 -200 days 8 Telangana (115), Jharkhand (121), Nagaland (128), Himachal Pradesh (186), Goa (190), Karnataka (104), Arunachal Pradesh (106), Uttar Pradesh (124) 200 -300 days - - More than 300 days 1 Manipur (313) Above 15 to 100 days 59

Status of Statutory Audit for the FY 2018 -19 • Only 7 States have

Status of Statutory Audit for the FY 2018 -19 • Only 7 States have submitted their Statutory Audit Report for the FY 2018 -19: • Andhra Pradesh • Tamil Nadu • Goa • Jharkhand • Gujarat • Haryana • Maharashtra (Due date for submission was 31/7/2019) 60

1 st Tranche Release of Funds for the FY 2019 -20 (No fund Release)

1 st Tranche Release of Funds for the FY 2019 -20 (No fund Release) Category No of State/UTs States/UTs (1)NRHM RCH Flexible Pool (i) RCH 8 Lakshadweep, Delhi, Puducherry, Nagaland, Rajasthan, Uttar Pradesh, A & N Islands, Arunachal Pradesh (ii) HSS 4 Puducherry, Nagaland, Delhi, Uttar Pradesh (iii) Ayushman Bharat (HWC) 4 Puducherry, Nagaland, Delhi, Uttar Pradesh 28 Chhattisgarh, Jharkhand, Odisha, Jammu & Kashmir, Andhra Pradesh, Telangana, Goa, Kerala, Tamil Nadu, West Bengal, Nagaland, Sikkim , D & N Haveli, Delhi, Puducherry, Lakshadweep, Madhya Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Gujarat, Haryana, Karnataka, Punjab, Mizoram, A & N Islands, Chandigarh, Daman & Diu (i) Other NUHM 10 Goa, Delhi, Puducherry, Meghalaya, Tripura, Nagaland, Uttar Pradesh, A&N Islands, Daman & Diu, Arunachal Pradesh (ii) Ayushman Bharat (HWC) 8 Goa, Delhi, Puducherry, Nagaland, Uttar Pradesh, A&N Islands, Daman & Diu, Arunachal Pradesh (iv) ABP (2) NUHM Flexible Pool 61

1 st Tranche Release of Funds for the FY 2019 -20 (No fund Release)

1 st Tranche Release of Funds for the FY 2019 -20 (No fund Release) No of State/UTs States/UTs (i) NLEP 18 Bihar, Chhattisgarh, Jharkhand, Odisha, Himachal Pradesh, Jammu & Kashmir, Goa, Kerala, Lakshadweep, Delhi, Meghalaya, Nagaland, MP, Rajasthan, Uttar Pradesh, Karnataka, Maharashtra, Arunachal Pradesh (ii) RNTCP 11 Bihar, Jharkhand, Goa, Lakshadweep, Delhi, Meghalaya, Nagaland, Rajasthan, Uttar Pradesh, Arunachal Pradesh, Manipur 26 Bihar, Chhattisgarh, Jharkhand, Odisha, Himachal Pradesh, Jammu & Kashmir, Andhra Pradesh, Goa, Telangana, Kerala, Lakshadweep, Delhi, Meghalaya, Sikkim, Nagaland, Tripura, MP, Rajasthan, Uttar Pradesh, Haryana, Karnataka, Maharashtra, Punjab, Arunachal Pradesh, Assam, Manipur Category (3) NDCP Flexible Pool (iii) NVBDCP 62

1 st Tranche Release of Funds for the FY 2019 -20 (No fund Release)

1 st Tranche Release of Funds for the FY 2019 -20 (No fund Release) No of State/UTs States/UTs (iv) IDSP 16 Chhattisgarh, Jharkhand, Odisha, Goa, Kerala, Lakshadweep, Delhi, Meghalaya, Sikkim, Nagaland, Tripura, MP, Rajasthan, Uttar Pradesh, Maharashtra, Arunachal Pradesh (v) NVHCP 36 All states/UTs have been released (4) NCD Flexible Pool 20 Bihar, Chhattisgarh, Jharkhand, Odisha, Himachal, Jammu & Kashmir, Andhra Pradesh, Goa, Lakshadweep, Delhi, Puducherry, Meghalaya, Nagaland, Tripura, Rajasthan, Uttar Pradesh, Uttarakhand, Haryana, A & N Islands, Arunachal Pradesh (5) IM Pool 7 Bihar, Jharkhand, Odisha, Delhi, Meghalaya, Uttarakhand, Maharashtra Category (3) NDCP Flexible Pool 63

Central Health Dashboard States to provide and update data for the following thematic areas

Central Health Dashboard States to provide and update data for the following thematic areas on a regular basis: 64

Upcoming Events!! • 13 th Common Review Mission (16 th – 23 rd October,

Upcoming Events!! • 13 th Common Review Mission (16 th – 23 rd October, 2019) • District 1: District with maximum no. of functional HWCs • District 2: Aspirational District • 6 th Best Practices & Innovations Summit (16 th – 18 th November, 2019) • Venue: Statue of Unity, Gujarat • Best Practices to be uploaded on innovations portal latest by 23 rd September, 2019. 65