3 rd

1. 3rd National Rural Health Mission Ministry of Health & Family Welfare Government of India Common Review Mission Nov 2009

2. Outcomes of today’s workshop • Introduction to ToRs of CRM • Understanding the Constituents of NRHM • Understanding the Resource Documentation of CRM • Logistics of 3rd CRM. • Team Building

5. Perspective of 3rd CRM

6. Historical Perspective of NRHM • 1st year (2005-06) was Preparatory phase • 2nd year (2006-07), Framework for Implementation approved. • 3rd year (2007-08) was the 1st full year of Implementation. • 4th year (2008-09) most strategies were consolidated • FY 2009-10 early gains becoming apparent • All State PIPs appraised and approved by NPCC • THE entire 12 month period available for implementation. • CRM is part of overall monitoring and evaluation framework

7. 3rd 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.

8. Desk Review under 3rd CRM • The following information has been sought from states under desk review : • List of health facilities segregated in difficult, most difficult, inaccessible areas - format as per Annexure 7 in ToR. • Summary of above - format as per Annexure 8 in ToR. • Physical progress against Record of Proceedings of National Programme Coordination Committee. Format at Annexure 9 in ToR. • Proforma for Rural Health Statistics Bulletin - formats at Annexure 10. • Statement of progress of NRHM - state data sheets- Annexure 11. • Some states need more time for Data compilation for 3rd CRM desk review • Visiting teams may obtain the filled up formats. • Kindly ensure that the formats are fully filled up to allow collation.

9. Items to be reviewed during 3rd CRM Part 1 Change in key aspects of Health delivery system Part 2 Progress against the approved PIP of the state

10. Part 1 Change in key aspects of Health delivery system 22 key indicators (Refer ToR)

14. Part 2 Progress against the approved PIP of the state

15. All state PIPs for FY 09-10 were appraised/approved in time . • Funds have been released to states on basis of approved plans • Teams may chart progress of implementation for 2009-10 • of initiatives which have been approved in state PIP. • Chart progress of implementation of PIPs 2005 to 2010. • RoP mapping of all years is in resource material. • Give objective, measurable data for 09-10 • Comment on quality

19. Format of Report 3rd CRM

20. Format for Report of 3rd CRM • Introduction • Introduction of the state. • Base line of Public Health System in the state • Infrastructure, HR, Indicators • Status of the PRI framework in the state • Others, Special Constraints • The complete list of the facilities visited by the team • 2 Chapter on Desk Review of 3rd CRM • Information sought as part of desk review : • Facilities segregated - difficult, most difficult, inaccessible. • Summary of above. • Physical progress against RoP mapping 2005-2010. • Proformas of RHS Bulletin • Comment on the quality of data and fill up the gaps if any in the report.

21. Format for Report of 3rd CRM • 3.Chapter on findings of the 3rd CRM in the state • This chapter should contain the following details • Progress of operationalisation of Institutional Framework of NRHM • (VHSC, RKSs, State and District Health Missions etc), • b. Comment of issues in ToRs of 3rd CRM (22points) • c. Map progress against PIP for 09-10 • 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 .

23. CRM Report Check List

27. Report preparation may be completed on email between team members. Draft report may be shared with state to eliminate possible factual/name errors. File the final report by end of November 2009

28. Logistics

29. Teams

30. Teams for 3rd CRM • Each team has six members comprising : • Two Government Officials (Any two out of the following) • Officials of the MoHFW, GoI • Representatives of state Governments • (Health Secretary/ Mission Director/Director of Health) • Regional Directors of Health & Family Welfare • One Public Health Expert (either of the following) • Non-official member of MSG of NRHM • Non-official member of EPC of NRHM • Representative of NHSRC • One Representative of Development Partners • Two Representative of Civil Society • Representative of Civil Society Organisations • Representatives of AGCA • Representatives of AMG • team leader & rapportteur to be decided by the teams

37. Time Line of 3rd CRM

38. Day One ( 3rd November 2009) • National Level Briefing of all teams • Day Two ( 4th November 2009) • 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.

39. Day Three to Day Seven • ( 5th Nov to 9th Nov 2009) • 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.

40. Day Eight (10th Nov 2009 ) • 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 ( 11th to 13th Nov 09) • The Teams shall return to their respective HQ • Finalise report through email & submit to NRHM by end Nov 2009

41. Dissemination Workshop • NHSRC to assist in collection & collation of reports. • Dissemination workshop towards end of December 2009 or early January 2010 • All CRM teams shall present their reports during workshop. • States present plan for operationalisation of learning from CRM. • Final report to be published.

42. Resource Documentation

43. Resource Documentation to be given to all participants of 3rd CRM during National Briefing on 3rd November 2009 • Hard Copy Books : • Framework for Implementation of NRHM • Report of 2nd CRM(full report) • NRHM – 4 years of NRHM- May 2009 • NRHM – Newsletter for Community Monitoring • Special edition on RCH-published in Sept 2009 • Community Monitoring guidelines (three books and set of posters). • Books published by NHSRC and distributed during the Bhubaneshwar workshop. • Briefing note on RCH for each of the 18 states/ Uts covered in 3rd CRM. • outcomes • physical achievement • allocation and expenditure for RCH • assessment of  overall progress and key issues to be addressed. • A truncated checklist for operationalisation of FRUs & 24/7PHCs , ARSH and VHNDs ( as a follow up to the  themes in  the last JRM).  • Bound book of RoP mapping of all states

44. Resource Documentation to be given to all participants of 3rd CRM during National Briefing on 3rd November 2009 • Hard Copy Prints bound in a single, indexed book : • Constitution of 3rd CRM Teams. • List of important addresses for the 3rd 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 under NRHM to the state concerned. • Presentation of States before the NPCC during 2009-10 • Report of 1st and 2nd CRM for the state concerned. • Reports of all JRMs of RCH II for the state concerned. • Status report of progress of Phase I of community monitoring in the state • Report of Desk Review of states containing tables recd from state/UT.

45. Documentation expected from all participants of 3rd CRM • Please share the photos shot during the CRM. • Please collect state presentations and copies of 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. • You may leave your copies of the resource documentation with interested state /district officials. We shall replenish your copies.

46. Please feel free to take soft copies of the presentations made today in case you need them. All these presentations shall also be posted on website of 3rd CRM http://www.mohfw.nic.in/NRHM/CRM/CRM_files/Third_CRM.htm Contact details have been shared 24x7 e-help desk on healthmission@nic.in

47. Sharing of Information

48. thank you email : healthmission@nic.in web : www.mohfw.nic.in