F. No. M11011/5/2010 NRHM-III Government of India Ministry of Health & Family Welfare Department of Health & Family Welfare Nirman Bhawan, New Delhi

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1 F. No. M11011/5/2010 NRHM-III Government of India Ministry of Health & Family Welfare Department of Health & Family Welfare Nirman Bhawan, New Delhi Dated: April 28, 2010 To, The Mission Director, (NRHM) Government of Meghalaya Subject: Approval of State Programme Implementation Plan of NRHM for the year Madam/Sir, Please refer to your letter submitting draft Programme Implementation Plan (PIP) for the year and the discussions of the same in the meeting of NPCC held on 10/03/2010 at New Delhi and subsequent deliberations The administrative approval of the PIP for your State is conveyed for an amount of Rs Cr. (Detail at Table C below) against the resource envelope available comprising of the following:- Table A Likely Uncommitted Unspent Balance Available under NRHM as on GOI Resource Envelope for under NRHM (on a 15% higher than current year s Budget Estimate for Rs Cr. Rs Cr. over planning purpose) 2 15% State share Rs Cr. Total(**) Rs Cr. 1.Budgets may be realigned within 3 months of the issue of the Order, to achieve Monitorable Targets indicated in Attachment F, in case there has been inadequate provision in the PIP, to meet national goals. 2. The actual resource allocation shall be in accordance with the budgetary allocation of and may be lower than the resource envelope being approved 1

2 The Resource Pool wise break up of total NRHM resources is as follows: (Rs. in Crores) Table B Sl No. Likely GoI Resource Total Uncommitted Unspent balance available as on Envelope under NRHM 1 RCH Flexible Pool Rs Cr. Rs Cr. Rs Cr. 2 NRHM Flexible Pool Rs Cr. Rs Cr. Rs Cr. 3 Immunization ( from RCH Flexible Pool) 4 NVBDCP - Rs Cr. Rs Cr. 5 RNTCP - Rs Cr. Rs Cr. 6 NPCB - Rs.2.30 Cr. Rs.2.30 Cr. 7 NLEP - Rs.0.40 Cr Rs.0.40 Cr 8 IDSP - Rs.0.31 Cr. Rs.0.31 Cr. 9 NIDDP - Rs.0.36 Cr Rs.0.36 Cr 10 Director & Admn. - Rs Cr. Rs Cr (Treasury route) 11 PPI Oper. Cost - Rs.1.48 Cr Rs.1.48 Cr % State share - Rs Cr Rs Cr 13 15% over and above GoI - RS Cr RS Cr resource envelope for purpose of PIP approval Total (**) Rs Cr. Rs Cr. Rs Cr Committed Unspent Balance up to to be Revalidated in Rs Cr. 2

3 SUMMARY OF APPROVAL (Details provided in respective Annexes) Table C 1. RCH Flexible Pool (Details at Attachment A) Scheme/Programme 2. NRHM Mission Flexible Pool (Details at Attachment B) 3. Immunization ( from the RCH Flexible Pool) (Details at Attachment C) 4. NVBDCP (Details at Attachment D) 5. RNTCP (Details at Attachment D) 6. NPCB (Details at Attachment D) 7. NIDDCP (Details at Attachment D) 8. IDSP (Details at Attachment D) 9. NLEP (Details at Attachment D) Approved Amount ( In Rs. Crores) PPI Operation Cost Infrastructure Maintenance TOTAL In addition to above following activities under NPPCD for provisioning of funding from National Programme for Prevention and Control of Deafness. Scheme/Programme Approved Amount ( In Rs. Crores) 12 NPPCD (Details at Attachment E)

4 3. The above approval is subject to the following mandatory requirements. Non compliance to any of the following requirement may entail in suspension of grant to the State. A. Monitoring Requirements 1. State/UT shall ensure submission of quarterly report on the Measurable Target/indicators at the end of every quarter as per Attachment F and expected outputs stated in the Record of Proceeding in Annexures of Attachment G. Budgets may be realigned within 3 months of the issue of the Order to achieve Monitorable Targets indicated in Attachment F in case there has been inadequate provision in the PIP, to meet national goals, 2. All approvals are subject to the observations made in the RoP of NPCC for NRHM (Attachment G) which is inclusive of commodity grants under Disease Control Programme in the respective Annexures. B. Human Resource 3. All Posts under NRHM shall be on contract and for the Plan period. All such appointments would be for a particular facility and non transferable in nature. Priority in contractual recruitments and placements would be for backward districts, difficult, most difficult and inaccessible health facilities. 4. All States would ensure that appropriate skill mix of human resource is made available to ensure provision of minimum service guarantee to health facilities. All professionals multi skilled under NRHM shall be placed in facilities where the skills can be utilized. 5. State shall submit action plan for recruitment, deployment and training of human resources within six months from the issue of the Order. C. Infrastructure 6. All civil works undertaken to achieve IPHS standards, would be based on expected patient load and priority would be accorded to inaccessible and remote areas as per prescribed criteria. 7. In all new constructions, care should be taken to ensure that the locations of these facilities are such that beneficiary households can access them easily. They should preferably be located in the midst of habitation and definitely not in agriculture fields, and outskirts of villages, under any circumstances. Any deviation from the above would be treated as ineligible expenditure under NRHM. 4

5 8. All new constructions would require prior approval of GoI if names of facilities have not been mentioned in the NRHM-PIP, and also if any shift is proposed. No shift from backward and inaccessible areas would be allowed. 9. The State shall set up implementation arrangement to monitor all civil works being undertaken, on a monthly basis, to ensure quality of works and completion as per schedule. D. Communitization 10. The State shall ensure that all operational guidelines relating to VH&NDs are complied with. 11. The State shall ensure timely performance based payments to ASHAs/Community Link Workers. State to ensure that supportive supervision mechanism is put in place within six months. 12. The State shall ensure that RKS meets as frequently as possible and mandatorily at least once in every quarter to review proper utilisation of allocated funds for achievement of goals. The proceedings of such meetings should be maintained for scrutiny. E. Financial 13. The State shall not make any change in allocation among different components/ activities without approval of GoI. Any proposal for re-appropriation between activities within activities should be informed to GoI in advance. However, such re-appropriation should reflect realignment of activities in accordance with priority to high focus districts/involvement of NGOs etc. 14. The State shall ensure that 15% of the State share, based on release of funds by Government of India, is credited on the account of the State Health Society, within one month of issue of the release order. The over-all expenditure on health by the State Government should also go up by a minimum of 10 percent each year. 15. The State shall ensure the completion of delegation of administrative and financial powers during the current financial year. Funding of NRHM to the State in will be based on clear delegation as per earlier directions. 16. The State shall follow all the financial management systems under operation under NRHM and shall submit Audit Reports, Quarterly Summary Concurrent Audit Report, FMRs, Statement of Fund Position, as and when they are due. State also agrees to undertake Monthly District Audit and periodic assessment of the financial system. 5

6 17. The accounts of the State/ grantee institution/ organization shall be open to inspection by the sanctioning authority and audit by the Comptroller and Auditor General of India under the provisions of CAG (DPC) Act 1971 and internal audit by Principal Accounts Office of the Ministry of Health & Family Welfare. 18. State shall ensure submission of details of unspent balance indicating, inter alia, funds released in advance and funds available under State Health Societies. The State shall also intimate the interest amount earned on unspent balance. This amount can be spent against activities already approved and will also count towards the central share. F. Miscellaneous 19. The State shall ensure establishment of supportive supervisory structures for RCH and other national programmes in lagging districts and for ensuring quality services, within six months of the issue of the Order. 20. The State shall maintain essential drug list /develop Standard Protocols, and enforce its implementation through State machinery. 21. Component for the salary of staff and mobility support which is being approved in IDSP Annexure would be subject to approval of EPC/MSG under NRHM. The support for expenditure to be incurred by Central Surveillance Unit (CSU) and the State is subject to approval of World Bank for restructuring and Extension. 22. State shall ensure taking appropriate action to monitor the performance of the cold chain /ILR Points and implementation details of ProMIS. Yours faithfully Copy to: (G.R. Khetarpal) Under Secretary to the Govt. of India 1. All JSs in the Ministry of Health and Family Welfare 1. All Programme Division Heads of NRHM/ RCH/ Disease Control Programmes 2. DS/Director Finance (NRHM) 3. All Under Secretaries concerned 4. IFD 5. PPS to Secretary(H&FW)/PS to AS&MD, NRHM 6. Sanction Folder

7 S. No Activity Proposed 1 Maternal Health (Excl. JSY) 2 Janani Suraksha Yojana Approval of RCH II PIP ATTACHMENT A Approved Major Expected Output In The PIP amount (Rs. In lakhs) 30 Conduction of 60 outreach camps, provision of 1 lakh MCH cards and 4 district level meetings; 2 state level meetings; training of ASHA and VHSC members Home Deliveries beneficiaries, Rural 8585 beneficiaries, Urban 3353 beneficiaries and Other JSY activities 3 Child Health School Health Programme (Teachers from 280 schools to be trained in health screening; 30 dental and oral hygiene camps; salary of 1 MOs and 2 GNMs; CHC level school health festival (29) and referral transport to sick infants(5000 beneficiaries) 4 Family Planning (Excl. Compensation) 5 Sterilisation & IUD Compensation contraceptive update seminars; printing of manuals, 1 state level QAC meeting and 28 district level QAC meetings. 74 Compensation for female sterilisations (5000), Male sterilisations (1000) and IUD insertions. 6 ARSH baseline surveys; 1 state level conference; salary and mobility of counsellors; renovation of 29 counselling centres; quarterly meeting in 200 selected villages. 7 Urban RCH UHCs (Salaries of staff and performance incentive to link workers, Annual maintenance, rent for UHC and mobility. Drugs approved and Miscellaneous expenditure. 8 Innovations/PPP/N GO 44.7 PNDT & Sex Ratio (Surprise visit to Diagnostic centres, Annual Review Meeting and capacity building) & Grant to MNGOs 9 Infrastructure & HR 263 Setting up of 5 Blood Storage Units. Transit home for ASHAs/attendants, Repair and renovation of 14 labor rooms, RTI/STI room for privacy and audio-visual; Computers for RT/STI clinics, ORT corners in CHCs 10 Institutional Salary for Office Asst., Mobility support and Reorientation Strengthening training and field visit for SQAG anddqag members 11 Training Strengthening of Training Institution (RHFTC, Shillong), training on SBA, EmOC, Life saving Anaeathesia, MTP, RTI/STI, MH, IMNCI, CH, Minilap, NSV, IUD Insertion and ARSH and other trainings, to MOs, SNs, LHVs, ANMs, CDPOs and AWWs 12 BCC / IEC For information, Education and communication 13 Procurement Procurement of Equipments & Drugs Labor Tables, Inverters/generators-ray Machines, MVA Kits, shadow less lamps, radiant warmers etc. and General drugs and supplies. 14 Program Strengthening of SPMU, DPMU and Financial Management Management systems. GRAND TOTAL RCH II 7

8 S.No Activity APPROVAL OF MISSION FLEXI POOL Approved Amount (Rs. In Lakhs) ATTACHMENT-B Major Expected Output in the PIP 1 ASHA ASHAs to be trained up to 6 modules along-with drug kits and ASHA Support system (AMG, SARC, ASHA Facilitators, District Community Process Coordinator and Block ASHA Coordinators) to be in place. 2 Untied Funds Untied Funds to be provided to 26 CHCs, 103 PHCs, 407 SCs, and 625 VHSCs in order to strengthen the quality of the health facilities. 3 Hospital Strengthening 4 Annual Maintenance Grants Funds provided for ensuring equipment and furniture in Jowai DH and Ganesh Das Hospital. CHCs: construction of 12 MO quarters & 18 GNM quarters at CHC, construction of annex building at Sohra CHC, Upgradation of Selsella CHC and Extension of Umsning CHC. PHCs: Construction of 1 new PHCs, 30 MO quarter, 48 GNM quarter for 3 GNMs, 20 major repair, 20 minor repair and 2 maternity wards. SCs: Renovation of 17 existing old SCs, repairing of 50 old SCs, construction of 40 ANM quarters AMG to be provided to 26 CHCs, 103 PHCs, and 393 SCs for institutional strengthening. 5 Corpus Grant to HMS/RKS RKS fund to be provided to 7 DH, 26 CHCs and 103 PHCs 6 IEC-NRHM One health mela each will be conducted in 7 districts to create awareness. 7 Mobile Medical Units Funds to be provided for recurring cost of MMU (Trained Manpower, Drugs, PoL & Maintenance) for ensuring regular health camps at periphery with drugs and diagnostics. 8 Referral Transport Funds to be provided for procurement of 15 ambulances and referral transport for 5 High Focus District 9 Additional Contractual Staff Funds to be provided to contractual staffs and specialists for improving service quality. 10 PPP/NGOs EMRI services: fund to be provided to run the 24 new and & 30 Existing 108 ambulances. PPP operationalization for 8

9 24 PHCs, 1 SD and 2 CHCs to ensure services. 11 Training Funds to be provided for strengthening of Nursing Training Centre, Civil Hospital, Shillong, ANM training School, Tura and orientation training of District and Block level officials. 12 Incentive Schemes Incentives to be provided to 20 Multi skilled MOs, 44 Mos, 104 SNs, 288 ANMs, 30 LTs and 26 supervisors posted in difficult areas to sustain services. 13 Monitoring & Evaluation Funds to be provided for mobility support, implementation of ProMIS, implementation of Hospital MIS, Name Based Tracking System, GIS Mapping of health facilities and strengthening of HMIS infrastructure. 14 Procurement Funds to be provided for procurement of essential drugs for 105 PHCs, 29 CHCs and 7 DH, procurement of equipment & furniture for 43 new SC, equipments for 24 PHCs, 2 ultra sound machine for 2 CHCs and generator for 10 PHCs. 15 Drug Warehouse Fund to be provided for strengthening the State Drug Warehouse and 7 District Warehouse & ProMIS to be operationalized. 16 New Initiatives Mobility Support to be provided for IDSP and operational expenses of treatment of bed nets. 17 NRHM Management Costs/ Contingencies NRHM Flexi Pool (Total) Funds to be provided to BPMU, PHC Accountant (118 Nos.), District Vaccine & Logistic Handler (7 Nos.), District Store Keeper (7 Nos.) and other support staffs to strengthen Program Management structure at Block, District and State level

10 ATTACHMENT- C Approval for Immunization Strengthening Programme S. No Activity Approved Amount (Rs. In Lakhs) Major Expected Output in the PIP 1. Mobility support for Supervision and Monitoring at districts and state level Improved supervision for programme 2 Cold Chain Maintenance 2.04 Strengthening of cold chain 3 Alternate Vaccine Delivery to Session sites Timely supply of vaccine to session sites 4 Focus on urban slum & underserved areas 7.22 Conduction of 2400 session to urban area/urban slums 5 Social Mobilization by ASHA /Link Ensure universal access workers 6 Computer Assistants support at State Level Computer Assistants support at District 8.40 Level 8 Printing and dissemination of Strengthen Monitoring immunization cards, tally sheets, charts, registers, receipt book, monitoring formats etc Quarterly review meeting at state level 0.80 Regular meeting for Programme 10 Quarterly review meeting at District level 1.56 Review 11 Quarterly review meeting at block level District level Orientation for 2 days ANMs, MPHW,LHV 2.67 Capacity building of Medical Officers, Health Workers and other Immunization related staffs 13 Three days training of Mos on RI To develop micro plan at sub-centre level 0.40 Conduction of 401 session 15 For consolidation of micro plan at block level regularly POL for vaccine delivery from state to 7.00 District and PHC/CHCs 17 Red/Black/Zipper bags 0.90 Injection waste disposal as per 18 Bleach/Hypochlorite solution 0.40 CPCB guidelines 19 State Specific (10% of total amount of 0.00 approved PIP) Total

11 S. No Activity ATTACHMENT- D Approval for NVBDCP Approved Amount Major Expected Output in the PIP (Rs. In Lakhs) 1 Malaria-(Domestic Budgetary Support) Enhanced Early Cases detection and prompt treatment (EDPT) - Increase in no. of blood sample examination & ASHA Incentives, Effective Indoor Residual Spray in 2 rounds, Timely reporting by PHCs, districts and states.timely reporting by PHCs, districts and states, Increased awareness of community regarding early treatment and acceptance of IRS and use of LLINs, Trained manpower in malaria available at all levels GFATM 2 Human Resource Planning and Administration 4 Monitoring and Evalution IEC /BCC Grant Total Malaria JE 8.00 GRAND TOTAL (Cash Grant) Assistance for decentralized commodities 11.2 The project monitoring unit at state as well as district level strengthened, Microscopy services functional in PHC labs, Recording and reporting capacity built up Functional Project Monitoring Units at state and district level established Increase no. of supervisory visits by different level of programme officials at districts, PHCs, Sub-centers and villages, Quarterly review meeting conducted Increase compliance for Diagnosis and treatment and Increase acceptance of IRS other Vector control measures by the community TOTAL Cash Assistance including cost of decentralized commodities Commodities support by GoI for VBD Grand Total (Cash +Commodities)

12 S. No Activity Approved Amount (Rs. In Lakhs) Approval for RNTCP Major Expected Output in the PIP 1 Civil works ) Civil work Up gradation and maintenance 2 Laboratory materials ) Sputum of TB Suspects Examined per lac population per quarter; 2) All districts subjected to IRL OSE and Panel Testing in the year; 3) IRLs accredited and functioning optimally 3 Honorarium All eligible Community DOT Providers are to be paid honorarium. 4 IEC/ Publicity Increase in case detection and improved case holding 5 Equipment maintenance ) Maintenance of Office Equipments at State/Districts and IRL equipments as planned 6 Training ) Induction training, Update and Re-training of all cadre of staff as planned 7 Vehicle maintenance ) All 4 wheelers and 2 wheelers in the state to be kept in running condition and maintained 8 Vehicle hiring ) Increase in supervisory visit of DTOs and MOTCs; 2) Increase in case detection and improved case holding 9 NGO/PP support ) Increase in number of NGOs/PPs involved in signed schemes of RNTCP; 2) Contribution of NGOs/PPS in case detection and provision of DOT 10 Miscellaneous ) All activities proposed under miscellaneous head in PIP. 11 Contractual ) All contractual staff appointed and paid regularly as planned. services 12 Printing ) All printing activities at state and district level as planned. 14 Medical Colleges ) All activities proposed under Medical Colleges head in PIP. 15 Procurement ) Procurement of vehicles as planned. vehicles 16 Procurement ) Procurement of equipments as planned equipment Total

13 S. No Activity Approval for NPCB Approved Amount Major Expected Output in the PIP 1 Recurring Grant-In-Aid 1.1. Free Cataract Per case and other approved schemes as per financial norms (*) School Eye Screening 6.75 Lakhs Specs Lakhs Vehicle hiring & POL 1.3. State Society NPCB. 10 i) Staff remuneration i) Staff remuneration ii) other Contingencies ii) other Contingencies District Health Society NPCB Training I.E.C Maintenance of Ophthalmic Equipments 8 2 Non Recurring Grant-In-Aid 2.1. Furnishing the State Eye Hospital 7 Presently Occupied by Office of SPO, NPCB, CMU & MBCS Medical College 40 Applied for by NEIGRIHMS 2.3. Eye Wards & Eye O.T For Jaintia Hills 3 Contractual Man Power 3.1. Ophthalmic Surgeon Ophthalmic Assistants 4.8 Total

14 S. No Activity Approval for NIDDCP Approved Amount Major Expected Output in the PIP 1 Establishment of IDD Control Cell 2 Establishment of IDD Monitoring Lab 3 a)health Education and Publicity Better implementation and monitoring of programme activities. Monitoring of iodine content of salt and urine samples in districts. Increased awareness about IDD and iodated salt. Creating iodated salt demand and b) Salt Testing Kits monitoring of the same at community supplies by GOI (30,000 level. No) IDD surveys Prevalence of IDD in 1 district of state 0.50 Total Approval for IDSP S. No Activity Approved Amount Major Expected Output in the PIP Surveillance preparedness, training & staff salary 3. Outbreak investigation 4. Analysis & use of data Rs 0.67 Crore 1.Training of professionals (DSO, Epidemiologists, Microbiologists, Entomologists 2. IT network for transmission of data and outbreak reporting 3. Strengthening of lab. 4. Surveillance and reporting of disease outbreaks 5. Strengthening of AI surveillance 14

15 Approval for NLEP S. No Activity Approved Amount Major Expected Output in the PIP 1 Contractual Services Functional leprosy cell at state/district level 2 Services through ASHA/USHA 0.50 Increase in percentage of cases reported by ASHA 3 Office expenses & Consumables 3.00 Functional leprosy cell at state/district level 4 Capacity building 4.00 Improvement in skills in diagnosis & treatment of leprosy 5 Behavioral Change Communication 5.00 Better self reporting as a result of increased awareness 6 POL/Vehicle operation & hiring 6.50 Improvement in mobility of SLOs & DLOs 7 DPMR 3.50 Decrease in recurrence of foot ulcers and reduction in grade II disability through RCS 8 Material & Supplies 3.50 Management of reaction cases 9 Urban Leprosy Control 0.50 Better diagnosis & treatment of leprosy in urban areas 10 Supervision, Monitoring & Review 2.00 Better, supervision & monitoring of programme 11 Cash assistance 2.00 Better, supervision & monitoring of programme TOTAL

16 S. No Activity Approval for NPPCD Approved Amount ATTACHMENT-E Major Expected Output in the PIP 1. Training of Manpower 24,00,000 Trained manpower 2 Capacity building District 28,50,000 Strengthened ear care service delivery system Hospitals 3 Capacity building of 5, 20,000 PHCs/CHCs 4 Manpower at district level 5,40,000 Strengthened ear care service delivery system 5 Screening Camps 3,60,000 Early identification of Hearing impaired 6 Hearing Aids 14,59,800 Medical rehabilitation of Hearing impaired children 7 Central Cell at state level 5,72,000 Coordinate, liaison with central and district level for better and speedy implementation of the programme Misc. & Contingency Nil Total 87,01,800 16

17 MONITORING TARGETS TO BE ACHIEVED IN ATTACHMENT- F I Activity / Measurable indicator Monitoring Progress Against Standards Achievement in/ up to Target in(cumulative) up to Addition during the year A Maternal Health 1 Institutional Deliveries 43% 48% 5% increase 2 24x7 Facilities Functional First Referral Units Functional Sub Centres B Child health 5 Sick New Born Care Units Not proposed 6 Stabilization Units in CHCs/ BPHCs 0 0 Not proposed 6.1 New Born Care Corner at PHCs Full Immunization 65.93% 80% 15 % enhanced coverage C Population Stabilization 8 Male Sterilization Female Sterilization No. of IUD insertions D Disease Control 11 Annualized New Smear Positive Detection Rate 89% >89% To be maintained Case Detection Rate of TB among new sputum positive patients 12 Success Rate of New Smear Positive 83% 85% 2% increase Treatment Success Rate among new sputum positive patients initiated on DOTS 13 ABER for malaria 18.30% 20% 1.70 % increase 14 API for malaria 28.1 <30 17

18 Activity / Measurable indicator 15 No. of Reconstructive surgeries performed under NLEP Achievement in/ up to Target in(cumulative) up to Not proposed Addition during the year 16 Annual New Case Detection Rate for Leprosy 11 cases (0.42/ pop) 15 cases 17 Cataract Surgeries performed II Human Resources including Training 18 Appointment of ANMs Appointment of staff nurses Percent of ANMs trained as Skilled Birth Attendant 50% 80% 30% increased 21 Doctors trained on EmOC Doctors trained on LSAS Doctors trained in NSV/ Conventional vasectomy 24 Doctors trained in Abdominal Tubectomy (Minilap) 25 Doctors trained in laparoscopic Tubectomy Personnel trained in IMNCI III Communitisation Processes 27 Functional VHSCs ASHAs completed four modules of training (minimum 15 days training) 29 ASHAs with Drug kits Percent expenditure of NRHM funds through NGOs 31 Percentage Districts having community monitoring system in place 47% of funds allocated to NGOs 100% of fund allocated to NGOs 0 43% (3 districts) 43% (3 districts) 18

19 Activity / Measurable indicator Achievement in/ up to Target in(cumulative) up to IV Flexible Financing 32 Percent utilization of untied grants 80% 100% Addition during the year V Improved Management 33 Percent districts uploading timely HMIS Data and confirming 100% 100% 100% 34 Tracking of pregnant mothers and children 0 100% all facilities 35 Computerisation of HMIS (level of data entry, and unit of data entry) District level Facility level Facility level 36 Cold Chain Management NA NA NA (number of functional ILR points) 37 Procurement System (implementation of ProMIS / TNMSC like structure) Nil Proposed during Proposed during VI Backward District Focus S 38 Functional Mobile Medical Units 7 7 to sustain 39 Poor performing districts sub-plan made with targets, and quarterly review shows progress District Sub-pan for 5 high focus districts made 5 districts 40 Difficult, Most Difficult, inaccessible area thrust in provision of infrastructure and human resources. 5 districts 19

20 NATIONAL RURAL HEALTH MISSION RECORD OF PROCEEDINGS Attachment G Record of Proceedings of the National Programme Coordination Committee (NPCC) for Meghalaya held under the Chairmanship of Shri P.K. Pradhan, Additional Secretary and Mission Director, NRHM for approval of NRHM Programme Implementation Plan (PIP) of State and UTs for the year I. A meeting of the NPCC of NRHM was held under the Chairmanship of AS & MD, NRHM, to approve the PIP of Meghalaya on 10/03/2010. The list of members who attended the meeting is placed at Annex. VI. The NPCC meeting was convened after the pre-appraisal meeting for the State, with written and oral comments provided to the State to modify the proposal before the NPCC. II. State Government apprised about the likely uncommitted unspent balance available under NRHM as on , and were apprised of the GOI Resource Envelope for under NRHM which is 15% higher than current year s Budget Estimate for over planning purpose and 15% State share. It was also clarified that the actual resource allocation shall be in accordance with the budgetary allocation of and may be lower than the resource envelope indicated. The Monitorable Targets for the State was also indicated. It was stated that the budgets may be realigned to achieve Monitorable Targets in case there has been inadequate provision in the PIP, to meet national goals. After detailed discussions and subsequent deliberations, the PIP was finalised for amounts indicated under different components as detailed in the Annexure I to V. III. The attention of the State was drawn to the following areas for further action : A. Planning 1. The State Government shall, within 45 days of the issue of Record of Proceedings by the Ministry of Health and Family Welfare, issue detailed Record of Proceedings for each district. B. Human Resource 2. All posts under NRHM on contract and based on local criteria shall be done by the Rogi Kalyan Samiti /District Health Society. Residence at place of posting must be ensured. 20

21 3. Blended payments comprising of a base salary and a performance based component, should be encouraged. 4. Transparent transfer and career progression systems should be implemented in the State. 5. The State shall put in place a transparent and effective human resource policy so that difficult, most difficult and inaccessible areas attract and retain human resources for health. C. Infrastructure 6. The State shall furnish list of facilities to be upgraded with identification of inaccessible and remote facilities and finalization of district action plans for the identified backward districts within three months. 7. The State shall furnish information relating to physical and financial status of infrastructure and building works already taken up every quarter to Infrastructure Division. 8. The State shall under take all construction activities in meeting health infrastructure gaps with particular focus in backward districts and inaccessible facilities. D. Communitisation 9. The State shall take up capacity building exercise of Village Health and Sanitation Committees, Rogi Kalyan Samitis and other community /PRI institutions at all levels, involving Non Governmental organizations after a selection process. 10. The State shall ensure regular meetings of all community Organizations /District /State Mission with public display of financial resources received by all health facilities. 11. The State shall also make contributions to Rogi Kalyan Samitis besides introducing user charges wherever feasible protecting the interest of the poor. 12. All performance based payments/incentives should be under the supervision of Community Organizations (PRI)/RKS. 13. The State shall focus on the health entitlements of vulnerable social groups like SCs, STs, OBCs, minorities, women, disabled friendly, migrants etc. E. HMIS 14. State shall set up a transparent and credible procurement and logistics system. State agrees to periodic procurement audit by third party to ascertain progress in this regard. 15. The State shall undertake institution specific monitoring of performance of Sub Centre, PHCs, CHCs, DHs, etc. in the prescribed format which is to be regularly uploaded as Monthly, Quarterly and Annual Data on the HMIS. 21

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