2 nd

Common Review Mission

National Rural Health Mission

Ministry of Health & Family Welfare
Government of India
 Outcomes of today’s workshop

•Introduction to CRM

•Presentations by Constituents of NRHM

•Logistics of 2nd CRM.

•Format of Report
 Briefing for 2nd CRM
Inauguration by Secretary (HFW) 10.00 am to 10.10 am

Introduction to CRM by the Mission Director 10.10 am to 10.20 am

Detailing of format of 2nd CRM by JS (AS) 10.20 am to 10.35 am

Briefing on constituents of NRHM

Health System reforms under NRHM by JS AS 10.35 am to 10.50 am

Reproductive & Child Health (II) by JS AJ 10.50 am to 11.05 am

NVBDCP by DDG 11.05 am to 11.20 am

RNTCP by DDG 11.20 am to 11.35 am

NPCB by DDG 11.35 am to 11.50 am

NIDDCP by DDG 11.50 am to 12.05 noon

National Leprosy Eradication Programme by DDG 12.05 pm to 12.20 pm

Integrated Disease Control Programme by NPO 12.20 pm to12.35 pm

Working Lunch
 Briefing for 2nd CRM
Briefing on key themes under NRHM

Financial Protocols under NRHM – by FMG 12.45 pm to 1.00 pm

M & E under NRHM – by Dir (Stats) 1.00 pm to 1.15 pm

Procurement under NRHM – by Dir SSM 1.15 pm to 1.30 pm

Trainings under NRHM – by DC Training 1.30 pm to 1.45 pm

IEC under NRHM – by Dir (IEC) 1.45 pm to 2.00 pm

Briefing on progress of NRHM in states covered

2.15 pm to 2.45 pm
by the 2nd CRM – by NHSRC

Open Discussions by participants & team

2.45 pm to 4.00 pm
building
Perspective of
2 CRM
nd
2nd CRM is being undertaken with following overall mandate

•To review changes in health system since launch of NRHM

through field visits and spot examination of relevant records.

•To document evidence for validating key paradigms of NRHM

including decentralization, infrastructure and HR augmentation,
communitisation and others,

•To identify key constraints limiting the architectural

correction.

•To recommend policy and implementation level adaptations

to accelerate achievement of the goals of NRHM.
1st CRM covered Andhra Pradesh, Assam, Bihar, Chhattisgarh, Orissa, Madhya Pradesh,
Gujarat, Jammu and K, Rajasthan, Tamil Nadu, Tripura, Uttar Pradesh and West Bengal.
 Items to be reviewed during 2nd CRM

Part 1
Change in key aspects of Health delivery
system

Part 2
Progress against the approved PIP of the
state
 Part 1
Change in key aspects of Health delivery system
19 key indicators
(Refer ToR)
1.Assessment of case load at Public System at all levels

2.Preparedness of facilities for patient care, utilization of services

3.Quality of services

4.Utilisation of diagnostic facilities and their

5.Drugs and

6.Health Human Resource Planning

7.Infrastructure

8.Empowerment for effective decentralization, local action.

9.ASHA
10.Systems of financial management
11. HMIS and its effectiveness
Usernames, password, formats,
training
11. Community Processes under NRHM

12. Assessment of NGO partnerships for public health goals

13. Systems in place for outreach activities of Sub-centre

14. Thrust on difficult areas and vulnerable social groups

15. Preventive, promotive health aspects, inter-sectoral

convergence and links with social determinants of health

16. Effectiveness of the disease control programmes

17. Quality of MCH and FP services

18. Assessment of management structure at district and state level

Time Lines of
NRHM
Progress against
Time Lines (nov 2008)
 Time Lines
Check List for
State level discussion
 National Rural Health Mission
2nd Common Review Mission - Nov-Dec 2008
Progress Against Time Lines
Quality & Quality
Sn Phasing and As of
o Activity time line Mar Dec
Mar 05
08 08
50% by 2007
Fully trained Accredited Social Health
1 Activist (ASHA) for every 1000 100% by 2008
population/large isolated habitations.
30% by 2007
Village Health and Sanitation
2 Committee in over 6 lakh villages and 100% by 2008
untied grants provided to them.
30% by 2007
2 ANM Sub Health Centres
3 60% by 2009
strengthened 1,75000 places. 100% by 2010
30% by 2007
30,000 PHCs strengthened/established
60% by 2009
4 with 3 Staff Nurses to provide service
guarantees as per IPHS. 100% by 2010
 National Rural Health Mission
2nd Common Review Mission - Nov-Dec 2008
Progress Against Time Lines
Quality & Quality
Sn Phasing and As of
o Activity time line Mar Dec
Mar 05
08 08
6500 CHCs strengthened/established 30% by 2007
50% by 2009
with 7 Specialists and 9 Staff Nurses to
5
provide service guarantees as per 100% by 2012
IPHS.
1800 Taluka/ Sub Divisional Hospitals 30% by 2007
50% by 2010
6 strengthened to provide quality health
100% by 2012
services.
600 District Hospitals strengthened to 30% by 2007
7 60% by 2009
provide quality health services. 100% by 2012
50% by 2007
Rogi Kalyan Samitis established in all
8 CHCs/Sub Divisional Hospitals/ District 100% by 2009
Hospitals.
 National Rural Health Mission
2nd Common Review Mission - Nov-Dec 2008
Progress Against Time Lines
Quality & Quality
Sn Phasing and As of
o Activity time line Mar Dec
Mar 05
08 08
District Health Action Plan 2005-2012 50% by 2007
9
prepared by each district 100% by 2008
Untied grants provided to each Village 50% by 2007
Health and Sanitation Committee, Sub
10
Centre, PHC, CHC to promote local 100% by 2008
health action.
Annual maintenance grant provided to 50% by 2007
every Sub Centre, PHC, CHC and one
11
time support to RKSs at Sub Divisional/ 100% by 2008
District Hospitals.
State and District Health Society 50% by 2007
12 established and fully functional with 100% by 2008
requisite management skills.
 National Rural Health Mission
2nd Common Review Mission - Nov-Dec 2008
Progress Against Time Lines
Quality & Quality
Sn Phasing and As of
o Activity time line Mar Dec
Mar 05
08 08
50% by 2007
Systems of community monitoring put
13 100% by
in place. 2008.
Procurement and logistics streamlined 50% by 2007

14 to ensure availability of drugs and 100% by

medicines at Sub Centres/PHCs/ CHCs. 2008.

30% by 2007
SHCs/PHCs/CHCs/Sub Divisional
50% by 2008
Hospitals/ District Hospitals fully 70% by 2009
15
equipped for intra health sector 100% by
convergence 2012.
30% by 2007
District Health Plan reflects the
16 60% by 2008
convergence with wider determinants 100% by 2009
 National Rural Health Mission
2nd Common Review Mission - Nov-Dec 2008
Progress Against Time Lines
Quality & Quality
Sn Phasing and As of
o Activity time line Mar Dec
Mar 05
08 08
50% by 2007
Facility and household surveys carried
17 out in each and every district of the 100% by 2008
country.
30% by 2008
Annual State and District specific Public 60% by 2009
18
Report on Health published 100% by
2010.
30% by 2008
Institution-wise assessment of
60% by 2009
19 performance against assured service 100% by
guarantees carried out. 2010.
Mobile Medical Units provided to each 30% by 2007
20 60% by 2008
district of the country. 100% by 2009.
 Progress of
Community Mon
For information
 Progress of community monitoring Assam

Out of total 135 VHSCs envisaged to be constituted in

Phase-I, 124 have already been formed out of which
orientation of 30 committees has been completed. Out of 27
PHC level Community Monitoring Committees envisaged to be
constituted in Phase-I, only six have been constituted in
Chirang District. Government orders for constitution of PHC
level committees in other districts are awaited.

Out of the nine block level and three district level

Committees envisaged to be constituted none have been
operationalised as on date. The block orientation workshops
are also pending. Out of three media workshops to be
undertaken in this phase, only one has been conducted.

25 village level report cards have been generated in

Chirang district.
 Chhattisgarh
All 135 VHSC, all 27 PHC level committees and all nine
block level committees have been constituted. The
orientation of all these is pending. Constitution of district level
committees is pending. All nine block provider workshops
have been completed.. The other activities envisaged in this
phase are also pending.

Jharkhand

All 135 VHSCs envisaged to be constituted in phase one

has been operationalised. 27 SC level committees (out of 27)
have been constituted out of which all 27 have also been
oriented. All nine block level committees have been
constituted. The district level committees are yet to be
formed. Six (out of nine) block providers orientation
workshops have been conducted till date. The other activities
envisaged in phase I are still pending.
 Progress of community monitoring as on 15th
August 2008
Karnataka
All 180 VHSCs have been constituted. The orientation
however, is still pending. Committees at PHC, Block, district
and the state level are still pending. The block provider
workshops, media workshops and other activities envisaged
in phase-I are also pending.

Tamil Nadu

All 225 VHSCs, 45 PHC level, 15 Block level and five

district level CMCs have already been constituted and
oriented. All 15 block providers’ orientation workshops have
been constituted. 210 village report cards have been
generated,The other activities including media workshops and
Jansunwai are pending.
 Part 2
Progress against the approved PIP of the state
•All state PIPs for FY 08-09 have been appraised, approved.

•Funds being released to states on basis of approved plans

•The teams may chart progress of implementation for 2008-09

of initiatives which have been approved in state PIP.

•Blank fill up forms of RoP for easy writing are enclosed.

•Earlier years RoP mappings is given only for information

•Checklist for charting progress against approved activities enclosed.

•Give objective, measurable data for 08-09

•Comment on quality
PIP Mapping
Check List
 Kerala
Activities supported under NRHM 2008-09
MISSION FLEXIBLE POOL
(Amount in lakhs)

S. Amount
No.
Name of Activity Remarks Progress
Approved
Hospital
1 Management Society 1214.00 Approved
(RKS)
Annual Maintenance
2 993.80 Approved
Grant
Approved. All
3 Untied funds 1474.30 institutions must get
their annual grants
Ward Health &
4 1600.90 Approved
Sanitation Committee
Approved for NRHM
5 Drug Kits 200.00 drug procurement
only
Renovation of Basic
6 170.00 Approved
Trg. Schools
 Kerala
Activities supported under NRHM 2007-08
MISSION FLEXIBLE POOL
(Amount in lakhs)
Sl. Cost
Name of Activity Observations of NPCC Progress
No Approved
Approved. Registration
Hospital Management Society
details with bank
1. for Ditrict/General/Taluk/WC 1384.00
accounts may be sent to
Hospital/CHC/Block PHC/PHC
the Ministry.
Annual Maintenance Grant for
2. 3548 Sub-centers, 430 PHCs 976.80 Approved
and 224 Block PHCs/CHCs
Untied funds for 5568 Sub-
3. canters, 830 PHCs, 224 Block 876.30 Approved
PHCs/CHCs
Grant to 16009 Ward Health and
4. 1600.90 Approved
Sanitation Committees
 Kerala
Activities supported under NRHM 2006-07
MISSION FLEXIBLE POOL
(Amount in lakhs)
Amount
S
Name of Activity released by Observation Progress
No
GOI
Released as
1 Upgradation of CHCs to IPHS 1280.00 per GoI
norms
Released as
2 Mobile Medical Unit 154.75 per detailed
proposal.
3 AMG to PHCs 455.50

4 Untied Funds for PHCs 227.75

5 Health Melas 160.00

 Kerala
Activities supported under NRHM 2005-06
MISSION FLEXIBLE POOL
(Amount in lakhs)

S. No. Family Welfare Schemes Amount Progress

1 RCH (Flexipool) 2143.50

2 Routine Immunization 234.40
3 Pulse Polio Immunization 192.54
4 NRHM Activities
a. Untied Fund for SC 509.40
b. Selection & Training of ASHA 0
c. Upgradation of CHC to IPHS 840.00
d. ASHA kit 0
e. Drug Supply for CHC/FRU 680.00
f. Drug Supply under RCH 357.00
Other Checklists
in the folders
 Other Checklists in the Resource material
Folder
1.Child Health Checklist
2.Family Planning Checklist

3.Financial Management Group Checklist.

4.NVBDCP Checklist
5.IDSP Checklist
6.RNTCP Checklist
Format of Report
2 CRM
nd
 Format for Report of 2 CRM
1.Introduction
1.Introduction of the state.
2.Base line of Public Health System in the state
a.Infrastructure, HR, Indicators
b.Status of the PRI framework in the state
c.Others, Special Constraints
d.The complete list of the facilities visited by the team

•Chapter on the Mandate of CRM

Draft the mandate of CRM for respective state keeping in
mind the overall mandate of 2nd CRM & state specific
issues which come up during the initial briefings and discussions
with state officials.
a.Ensure sharp focus on felt needs.
b.Be amenable to drafting of a clear road map for
future.
c.Be objective as well as sensitive to the local
constraints
 Format for Report of 2nd CRM
3.Chapter on findings of the 2nd CRM in the state
This chapter should contain the following details
a.Progress of operationalisation of Institutional
Framework of NRHM
(VHSC, RKSs, State and District Health
Missions etc),
b. Comment of issues in ToRs of 2nd CRM (19 points)
c. Map progress against PIP for 08-09
d.Map progress against time lines of NRHM

4.Chapter on recommendations
Report should mention specific suggestions,
recommendations for accelerating implementation.

5.Chapter on other State Specific issues

This chapter may include observations, suggestions on
issues not covered in any other chapter of the report .
 2nd Common Review Mission
Name of State
Names of Districts visited
Sno Name District HQ Name of DM Name of CMO
1
2
Add more rows if required
Health Facilities visited
Level (SC / Name of the
Address /
Sno Name PHC / Person in
Location
CHC/other) Charge
1
2
Add more rows if required
CRM Report
Check List
 Checklist for prepraration of report for 2nd CRM
Please tick mark if the items listed below are contained in the report
Sno Item Done or Not Remarks
1 Mention addresses/emails of state officials
List of facilities visited by the team should
2
be compiled in format given in the ToRs
State specific mandate of the CRM
3
articulated in the report
Are all aspects mentioned in ToRs included in the reports.
These include
Assessment of case load being handled
1
by the Public System at all levels
Preparedness of health facilities for
4 2
patient care and utilization of services
3 Quality of services provided
Diagnostic facilities at facilities and
4
their effectiveness
5 Drugs and Supplies
 Checklist for prepraration of report for 2nd CRM
Please tick mark if the items listed below are contained in the report
Sno Item Done or Not Remarks
Are all aspects mentioned in ToRs included in the reports.
These include
6 Health Human Resource Planning
7 Infrastructure
Progress of decentralization and
8
flexibility for local action
4 9 Systems of financial management
10 HMIS and its effectiveness
11 Community Processes under NRHM
Assessment of non-governmental
12
partnerships for public health goals
Systems in place for outreach activities
13
of Sub-centre
 Checklist for prepraration of report for 2nd CRM
Please tick mark if the items listed below are contained in the report
Sno Item Done or Not Remarks
Are all aspects mentioned in ToRs included in the reports.
These include
Thrust on difficult areas and vulnerable
14
social groups
Preventive/promotive health aspects & inter-
4 15 sectoral convergence, social determinants
16 Effectiveness of the NDCPs
17 Quality and Performance of RCH
18 Assessment of PM structures
1 Progress against approved PIP

5 2 Progress against Time Lines

Quality and Progress of Community
3
Monitoring in the state
Logistics
Teams
 Government Public Health Civil Societies (Two
Officials (2 Expert (One) DPs (One Person)
State
Persons) (MSG/ EPC/ Person) (AGCA/ AMG/
(GoI / State Govt.) NHSRC) Medical coll
Dr Tarun Seem,
Director Ms. N.Angami, Sh. Gerard La
Assam
MSG Forgia, WB Sh.Shyam Astekar,
Dr Anil Kumar
AGCA
Dr Jagvir Singh,
NICD Dr.T.Sunadara Sh.Billy Stewart,
Bihar
man DFID Dr.Rajesh Kr PGI
Chd
Sh.Amarjeet Dr.Nupur Basu,
Sinha, JS CINI
Dr.J.N.Sahay, Sh Manoj Kar,
Jharkhand Dr GK Ingle, HoD,
Dr.Dinesh Baswal, NHSRC NHSRC
PSM, MAMC, New
AC(Trg)
Delhi
Dr.
Dr Aditi Iyer (rep
Muralidharan
Ms. Ganga Dr. Dinesh Gita Sen)
Karnataka MSG
Murthy, EA Agarwal
Sh.AKShiva Dr.D.Nandan,
Kumar MSG Dir(NIHFW)
 Government Public Health
DPs (One Civil Societies (Two
State Officials (2 Expert (One)
Person)
Persons) (MSG/ EPC/ Person)
(AGCA/ AMG/ Med coll
(GoI / State Govt.) NHSRC)
Dr.Rattan Chand,
CD(Stat) Dr.K.S.Jacob, Sh.Sunil
Kerala Dr Narendra, AGCA
Sh Amardeep MSG Nandraj, WHO
Bhatia, Director
Sh Rajesh Kumar
Sh.T.V.Antony, Dr.K.B.Singh, Ms. Sushama Rath,
Maharashtra Dr.A.C.Baishya,
MSG GTZ NHSRC
RCC, NE
Dr. Ritu Priya, Dr.H.Sudarshan,
Dr P K Ms.Deepika
NHSRC AGCA
Orissa Shrivastava, JD Srivastava,
A K Antony,
NVBDCP UNICEF Sh.Raj panda, PHFI
SRC, Cht
Ms.Sheena Prof AT Kaanan, Univ
Tamil Dr.Thamma
Nadu
Chhabra Coll of Med Sci,
Rao, NHSRC
Dr S K Sikdar USAID Delhi.
Sh.Gopi
Uttar Dr Sunil D Dr.P.Padmanab Dr.N.C.Saxena, Gopalakrishanan
Pradesh Kharpade han, NHSRC UNICEF Prof Arun Kr Sharma
 National Rural Health Mission - 2nd Common Review Mission
25th November 2008 to 5th December 2008
Sno State MD NRHM
Nodal Officer for 2nd CRM Districts to be visited

Dr. Joydeep Das,Guwahati - 22 Tel No. +91-361-2363061/62

1 Assam MR. John Ekka 09954095488 Fax No. +91-361-2363058 Mobile No. +91-9435100728 nodal officer Mr. A. Haque, Exec Dir, Shivsagar Bongaigaon
NRHM, GoAssam 09435054118

Bihar Mr Abhay Kumar Singh

2 Mr. Ranjit Samaiyar Consultant 09430027092, [email protected],[email protected] Jahanabad, Vaishali
9431083310

3 Jharkhand Sh Pradeep Kumar 9431100022 Vijay N Singh 09431715050 Hazaribagh Chaiwasa

Dr. Mohan Raj, Project Director (RCH), Bangalore Office: 080-22201980, Fax- 080-22870224,
4 Karnataka Sh Nilaya Mitash 94498 43005 / 98450 78474 Belgam, Tumkur
Dr. Amrutheshwari, DD (IUD): 99005 81953, [email protected]

Thiruvananthpuram,
5 Kerala Dr Dinesh Arora 946066660 Dr Dinesh Arora 946066660
Wayanad

Dr Satish Pawar, 9869410521 , (o) 22622027 , (r) 22021489 , 22821228 email

6 Maharashtra Sh Madhukar Choudhary Pune , Nashik
[email protected]

7 Orissa Sh Sushil Lohani Mrs Seemapati, SPManager 9937556416, [email protected], [email protected] Sonapur, Dhenkanan

Ms Girija Vaidyanathan
8 Tamil Nadu Dr Arun Murugan 9940610126 Villupuram
9940674396

Uttar
9 Sh Rajeev Kapoor 9415328911 Dr Aruna Narayan 9839070824 Saharanpur Unnao
Pradesh

Go India Contact
Sh Ganga Kumar 011-23062998 , 09891117373 , 9871396038
Person

NHSRC contact
Ms Sushma Rath 011-26107067 , 9968116216
person
Time Line
of 2 CRM
nd
 Day One ( 25th November 2008)
National Level Briefing of all teams

Day Two ( 26th November 2008)

Teams to reach State Headquarters and receive state briefing by

various Divisions on progress of NRHM in the State.

•The presentation would cover all the parameters on which the

CRM is mandated to appraise the progress of NRHM.
•All State specific documents and progress Reports will also be
made available to the team.
•The State will also report progress with respect to the
timelines. The States will also highlight the key reforms that
have been initiated in the State.
•The Report of the First CRM and its findings needs to be kept
in view during discussion with the State.
 Day Three to Day Seven
( 27th November to 1st December 2008)

•The Mission team breaks up into groups

•Each group visits one district each for a detailed assessment.

•One of districts selected by State & other by CRM Team.

•The field visits should cover

•District Hospital
•Sub District Hospital
•At least two CHCs/Block PHCs
•At least three PHCs
•At least five Sub Centres

•Interaction with village communities in at least ten villages.

•Focus mainly on parameters on which the CRM is mandated.

 Day Eight (2nd December 2008)

•Teams returns to State Headquarter for debriefing.

•Prepare a 12-15 page Report & ppt.
•Discuss report with state during debriefing session.
•The Secretary (HFW) of the state shall chair these sessions.

Day Nine to Eleven ( 3rd to 5th December 2008)

The Teams shall return to their respective HQ

Finalise report through email & submit to NRHM by 15 th Dec 08.
 Dissemination Workshop

•NHSRC to assist in collection & collation of reports.

•Dissemination workshop towards end of December 2008

•All CRM teams shall present their reports during workshop.

•States present plan for operationalisation of learning from CRM.

•Final report to be published.

 Resource
Documentation
Resource Documentation to be given to all participants of
2nd CRM
Hard Copy Books :

1. Framework for Implementation of NRHM

2. Report of 1st CRM (full report)
3. NRHM – Progress so far – Published in August 2008
4. NRHM – Agenda for Action– Published in August 2008
5. Report of Independent Commission on Health – VHAI.

Hard Copy Anenxures:

1. Child Health Checklist

2. Family Planning Checklist
3. Financial Management Group Checklist.
4. NVBDCP Checklist
5. IDSP Checklist
6. RNTCP Checklist
Resource Documentation to be given to all participants of
2nd CRM

Hard Copy Prints bound in a single, indexed book :

• Statement of constitution of 2nd CRM Teams.
•List of important addresses for the 2nd CRM.
•Profile of the state being visited
•NRHM progress - state data sheet for the state being visited.
•Health indicators of the state concerned.
•NHFS data sheet and DLHS results of the state concerned.
•Statement of funds released to the state concerned.
•Activities supported in the state under NRHM
•Statement of Releases under NRHM during 2005-06
•Record of Proceedings – 2006-07, 2007-08, 2008-09
•Presentation of States before the NPCC during 2008-09
•Report of 1st CRM for the state concerned.
•Reports of all JRMs of RCH II for the state concerned.
•Status report of progress of community monitoring
Resource Documentation to be given to all participants of
2nd CRM
Soft Copy on Pen Drive
All of the hard copy material
Various guidelines
Institutional Framework of NRHM
MSG, EPC AGCA,SHM,DHM,RKS VHSC
Community Monitoring Committees at various levels
Accredited Social Health Activist (ASHA)
Guidelines, Mentoring Structure
Compensation Package
Correspondence regarding ASHA
Village Health & Nutrition Day - Guidelines
Indian Public Health Standards (IPHS) guidelines
Draft Finance & Accounts Manual for NRHM
Other guidelines
PIPs and presentation of all states made before NPCC 08-09
Record of Proceedings of all states for all years.
Resource Documentation expected from all participants of
2nd CRM

Please share the pictures relating to health sector shot by you

during the CRM for wide dissemination

Please collect the state presentations and copies of all

notifications, Govt. Orders relating to NRHM. Take soft copies also
if possible.

No strict data collection is expected.

Data formats are for your assistance. Intended to facilitate

discussion but not stifle independent thought.
Resource Documentation to be given to all participants of
2nd CRM

Please feel free to take copies of the presentations made today in

case you need them.

All these presentations shall also be posted on wiki of 2 nd CRM at

www.commonreviewmission.wetpaint.com

Contact details have been shared. 24x7 e-help desk on

[email protected] or send message on wiki.
 Sharing of
Information
74
75
 thank you
email : [email protected]

web : www.mohfw.nic.in

www.commonreviewmission.wetpaint.com

78