National Rural Health Mission
"Memorandum of Understanding (MoU)
between Ministry of Health & Family Welfare, Government of India and the
Government of Rajasthan for National Rural Health Mission"
1.1 WHEREAS the National Rural Health Mission hereinafter referred to as NRHM, has been launched for nation-wide implementation with effect from April 12, 2005.
1.2 WHEREAS the NRHM aims at providing accessible, affordable, effective, accountable and reliable health care to all citizens and in particular to the poorer and vulnerable sections of the population; consistent with the outcomes envisioned in the Millennium Development Goals and general principles laid down in the National and State policies, including the National Health Policy, 2002 and National Population Policy, 2000.
1.3 AND WHEREAS the ‘architectural correction’ of the health sector is a key objective for the NRHM, to be carried out through integration of vertical programs and structures; delegation and decentralization of authority; involvement of Panchayati Raj Institutions and other supportive policy reform measures in the areas of medical education, public health management, incorporation of Indian Systems of Medicine, regulation of health care providers and new health financing mechanisms.
1.4 NOW THEREFORE the signatories to this Memorandum of Understanding have agreed as set out here in below.
2. Duration of the MoU
2.1 This MoU will be operative with effect from ______________________ and will remain in force till March 2012 or till its renewal through mutual agreement whichever is earlier.
3. State Sector PIP and its financing
3.1 The MoHFW will provide a resource envelope to support the implementation of an agreed State NRHM Sector Programme Implementation Plan (PIP), hereinafter referred to as Sector PIP, reflecting:-
(a) All sources of funding for the health sector, including State’s own contribution.
(b) A convergence plan for NRHM related sectors.
(c) Proposals and time frame for institutional reforms referred to in para 1.3 here in above.
3.2 The agreed outlay for the Sector PIP for financial year 2005-06 and 2006-07 and the sources for the funding of the same will be as given at Appendix-I hereto.
3.3 The State will prepare a Programme Implementation Programme (PIP) and a Log Frame based upon the quantum of funds provided to it. The PIP will be consistent with the general principles laid down in the National and State policies relevant to the Sector and other agreed action plans. The Log Frame will, in particular, reflect the core indicators agreed to be adopted by the programme.
3.4 Based upon its PIP and Log Frame, the State will set its own annual level of achievement for the programme core indicators in consultation with GoI and subsequently, States will have similar arrangements with the Districts.
3.5 The Government of India may issue mandatory core financial and programme indicators as well as institutional process as well as output indicators, which would need to be adhered to by the States.
3.6 The implementation of the action plan as set out in the PIP shall be reviewed at the State level once in every month.
3.7 A review would be held every six months by the MoHFW. The States would also carry out the district level reviews of districts every month.
3.8 The Sector PIP will be jointly reviewed by GOI and State to arrive at an agreed Sector PIP for the subsequent year.
3.9 The NRHM contribution to support the Sector PIP will cover, among others, implementation of RCH phase II, National Vector Borne Disease Control Program, National Leprosy Eradication Program, National Iodine Deficiency Disorder Program, Revised National Tuberculosis Program, National Blindness Control Program, AYUSH scheme on hospitals and dispensaries, Integrated Disease Surveillance Program and the thrust areas identified under the NRHM.
3.10 The NRHM would operate as an omnibus broadband programme by integrating all vertical programmes of the Departments of Health and Family Welfare. However, independent sub-budget lines will be retained to provide independent ‘financial’ identity to the different programmes (EC) till the expiry of existing bilateral agreements.
3.11Although the AIDS control program and the National Cancer Control Program is not merged into the NRHM budget head, the planning and monitoring functions for these shall remain a specific task for the institutional arrangements agreed through this MoU.
4. Funds Flow arrangements
4.1.The first installment of grant-in-aid under this MoU shall be made during the second half year of financial year 2005-06 and will be contingent upon execution of this MoU.
4.2 Subsequent six-monthly releases shall be regulated on the basis of a written report to be submitted by the State indicating the progress of the agreed State Sector PIP including the following:
- Documentary evidence indicating achievement of targets / milestones for the agreed performance indicators (Reference Appendix-II).
- Statement of Expenditure confirming utilization of at least 50% of the previous release(s),
- Utilization Certificate(s) and Audit reports wherever they have become due as per agreed procedures under General Financial Rules (GFR).
5. Performance Indicators
5.1 Release of grants-in-aid will be subject to satisfactory progress of agreed Performance Indicators relating to implementation of agreed State PIP including institutional reforms.
5.2 The agreed Performance Indicators are as given at Appendix-II.
6. Performance Awards
6.1 The State shall be eligible to receive an Annual ‘performance award’ to the tune of 10% of its actual utilization of cash assistance in the previous financial year provided that the State has successfully achieved the criteria set out in para 5.2 above.
6.2 The releases under the performance award mechanism will be over and above the agreed allocations for supporting the agreed State Sector PIP and will become an untied pool which may be used for such purposes as may be agreed by the State Mission Steering Group.
7. Institutional Arrangements: National Level
7.1 At the National level, Mission implementation will be steered by a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Programme Committee (EPC) headed by the Union Secretary for Health & Family Welfare.
7.2 The State Sector PIPs shall be appraised for approval and sanctioned by duly authorized Committee.
7.3 The representatives of the State Government shall also be invited to the meeting of the Committee whenever their proposal are listed for consideration / approval.
7.4 The Committee may also seek written feedback on the State Plan from the representatives of the Development Partners providing financial and technical assistance to the Mission in the concerned State.
8. Institutional Arrangements : State, District and Hospital Levels
8.1. The State Government has set up the State Health Mission headed by the Chief Minister for providing guidance to State Health Mission activities. The constitution and terms of reference of the State Health Mission are as given at Appendix-III hereto.
8.2 The State has merged existing State level vertical societies in the health sector and has created an integrated Society, called "Rajasthan State Health Society" The said society shall receive the funds from the MoH&FW and other sources. The Society shall also perform the functions of a flexible mechanism for sourcing program management support for the State Directorate and district health administration in the State. The Rules and bye-laws of the State Society as filed with relevant registration authorities are as given at Appendix-IV hereto.
8.3 The State has completed the merger of the Departments in the Health and Family Welfare sector and has issued necessary orders for appointing the State NRHM- Director.
8.4 The State has ordered merger of all District level vertical societies into an integrated District Health and Family Welfare Society called" District health Society-(Name of the district)" The District Health Mission shall guide the Integrated District Health Society in policy and operations. The Rules / bye-laws of the district Society as notified through Resolution / Notification are as given at Appendix-V hereto.
8.5. The State has also ordered creation of a Hospital Management Society called "Rajasthan Medical Relief Society (RMRS)" The model Rules / bye-laws of the Rajasthan Medical Relief Society as notified through notification are as given at Appendix-VI
9 Performance Review
9.1 The Department of Health & Family Welfare shall convene national level meetings to review progress of implementation of the agreed State Sector PIP.
9.2 The department of Health and Family Welfare may also organize
a State level review.
9.3 The review meetings may lead to proposals for adding to or modifying one or more Appendices of this MoU. These will always be in writing and will form part of the minutes of meetings referred to here in above.
10 Government of India Commitments
10.1 The funds committed through this MoU may be enhanced or reduced, depending on the pace of implementation of the agreed State PIP and achievement of the milestones relating to the agreed Performance Indicators.
10.2 The MoH&FW also commits itself to:-
(a) Ensuring that the resources available under the State Partnership Programs outside the MoH&FW budgets are directed towards complementing and supplementing the resources made available through the MoH&FW budget and are not used to replace the recurring expenses hitherto provided for under the Centrally Sponsored Schemes under the health and family welfare sector.
(b) Ensuring that multilateral and bilateral development partner’s co-ordinate their assistance, monitoring and evaluation arrangements, data requirements and procurement rules etc. within the framework of an integrated State Health Plan.
(c) Facilitating establishment of District Health Missions and development of District Action Plans through such means as may be mutually agreed.
(d) Assisting the States in mobilizing technical assistance inputs to the State Government including in the matter of recruitment of staff for the State and district societies.
(e) Developing social / equity audit capacity of the States through joint development of protocols for assessing access levels for the most disadvantaged groups.
(f) Developing and disseminating protocols, standards, training modules and other such materials for improving implementation of the program.
(g) Consultation with States, at least once a year, on the reform agenda and review of progress.
(h) Prompt consideration and response to requests from states for policy, procedural and programmatic changes.
(i) Release of funds on attainment of agreed performance indicators, within an agreed time.
(j) Holding joint annual reviews with the State, other intereste Central Departments and participating Development Partners; and prompt corrective action consequent on such reviews.
(k) Dissemination of and discussion on any evaluations, reports etc., that have a bearing on policy and/or have the potential to cause a change of policy.
11. State Government Commitments:
11.1The State Government commits to ensure that the funds made available to support the agreed State Sector PIP under this MoU are:
(a) Used for financing the agreed State Sector PIP in accordance with agreed financing schedule and not used to substitute routine expenditures which is the responsibility of the State Government.
(b) Kept intact and not diverted for meeting ways and means crises.
11.2 The State Government also commits to ensure that:
(a) The share of public spending on Health & FW from state’s own budgetary sources will be enhanced at least at the rate of 10% every year.
(b) Its own resources and the resources provided through this MoU flow to the districts on an even basis so as to ensure regular availability of budget at the district and lower levels. Of these, at least 5.% of funds will be devolved to the Districts with provision for flexible programming.
(c) Structures for the program management are fully staffed and the key staff related to the design and implementation of the agreed State Sector PIP, and other related activities at the State and district level are retained as far as possible, in their present positions at least for three years.
(d) Representative of the MoH&FW and/or development partners providing financial assistance under the MoU mechanism as may be duly authorized by the MoH&FW from time to time, are allowed to undertake field visits in any part of the State and have access to such information as may be necessary to make an assessment of the progress of the health sector in general and the activities related to the activities included under this MoU, subject to such arrangements as may be mutually agreed.
(e) The utilization certificates (duly audited) are sent to the Ministry of Health & after close of the financial year, within the period stipulated in the General Financial Rules.
(f) The State shall take steps for decentralization and promotion of District level planning and implementation of various activities, under the leadership of Panchayati Raj Institutions.
(g) The State shall endeavor to implement models of ‘Community Health Insurance’. Technical assistance in this regard will be provided by GOI wherever it will require by the state.
11.3 The State Govt. agrees to abide by all the existing manuals, guidelines, instructions and circulars issued in connection with implementation of the NRHM, which are not contrary to the provisions of this MOU.
11.4 The State Government also commits to take prompt corrective action in the event of any discrepancies or deficiencies being pointed out in the audit. Every audit report and the report of action taken thereon shall be tabled in the next ensuing meeting of the Governing Body of the State Society.
12. Bank Accounts of the Societies and their Audit:
12.1 State and district society funds will be kept in interest bearing accounts
in any designated nationalized bank or any other such bank as may be specified by the MoHFW.
12.2 The State will organize the audit of the State and district societies
within six-months of the close of every financial year. The State Government will prepare and provide to the MoH&FW, a consolidated statement of expenditure, including the interest that may have accrued.
12.3 The funds routed through the MoU mechanism will also be liable to statutory audit by the Comptroller and Auditor General of India.
13.1 Non compliance of the commitments and obligations set hereunder and/or upon failure to make satisfactory progress may require Ministry of Health & Family Welfare to review the assistance committed through this MOU leading to suspension, reduction or cancellation thereof. The MoH&FW commits to issue sufficient alert to the State Government before contemplating any such action.
Signed this day, the of 200 .
For and on behalf of the Government of Rajasthan
Principal Secretary (HFW), Government of Rajasthan.
For and on behalf of the Government of India,
Secretary, Ministry of Health & Family Welfare,
Government of India