At the State
level, a State Health Mission headed by the Chief Minister has
been constituted with similar composition, as that of the National
Steering Group. State Health Mission’s role include the
will review and amend existing policies (cadre management arrangements,
financial and administrative authority at various levels, role
of PRIs, procurement and logistics systems etc.) to ensure that
the policy environment is consistent with the Mission objectives.
Additional resources to be provided to the states under the
Mission would require policy reforms to be in place.
Health Plan (long term/annual) has been developed in accordance
with the GoI Guidelines and necessary approvals from GoI and
signing of a Memorandum of Understanding (MoU) with the MoHFW
need to be taken. Implementation will have to be facilitated
in line with the approved plan, monitor and take corrective
action as and when necessary and carry out independent impact
assessment studies (base-line, periodic) and take appropriate
will provide support in preparation of health plans by districts
in accordance with the GoI guidelines through mobilization of
technical assistance. The District Action Plans will be assessed
on the basis of appropriate evaluation criteria that have to
be made available to the districts in advance. A system for
monitoring performance of districts against their own work plans
and comparison across districts will also be developed.
training programmes are being developed including management
training modules for the programme managers and the staff of
the State and district societies, designing “multi-skilling”
training packages for doctors (e.g. anesthesia training for
MBBS doctors) and paramedical workers (e.g. “multi-skilling”
of lab technicians) and facilitate selection and training.
have been put in place to ensure coordination across Departments
especially Health and Family Welfare, AYUSH, Department of Women
and Children, and the Public Health and Engineering Department;
to identify bottlenecks for effective delivery of services and
to take necessary action through government orders or other
will be conducted during various phases to disseminate experiences/
innovations/ lessons learnt across districts.
are being put in place for annual/ quarterly cash flow projections;
closely monitoring and highlighting, well in advance, anticipated
temporary shortage of funds. It will be ensured that funds are
released to districts in accordance with the agreed district
plans. The State will ensure that districts send their expenditure
reports and other consolidated statements to GoI/ concerned
agencies. Stringent monitoring mechanisms will be in place to
ensure that all conditions are met for subsequent release of
will ensure maintenance of necessary books of accounts and ensure
adherence to procedures laid out for procurements and payments.
They will carry out audits of a sample of districts in each
quarter, and facilitate the sharing of audit findings across
In order to meet the above objectives/ outcomes and carry out
necessary tasks, the state has registered a single State Health
Society through merger of all state level societies in the Health
and Family Welfare sector, except the State Aids Control Society.
These Societies will maintain separate Bank Accounts even under
the unified structure. Funds for separate programmes would continue
to flow under Sub-Budget Heads of the omnibus NRHM Budget Head.
The Integrated State Health and Family Welfare Society has a
full-time secretariat to act as the State Programme Management
Support Unit (SPMSU), headed by a full time Executive Director.
The SPMSU will (a) assist the Directorate of Health & FW
in implementation, (b) act as the coordinating agency with other
Departments for the Mission and (c) perform the role of the
secretariat of the State Health Mission
of the Society
Name of the Society shall be Rajasthan State Health Society,-
hereinafter referred to as the Society
area of operation of the Society shall be whole of the State
Society shall have its office at Directorate of Medical
& Health, Swasthya Bhawan, Jaipur in the State of
Rajasthan with liberty for it to establish one or more
subordinate offices or outlets elsewhere in the State,
if so required.
Society shall serve in an additional managerial and technical
capacity to the Department of Health & Family Welfare,
Government of Rajasthan for the implementation of National
Rural Health Mission (NRHM) in the State.
achieve the above objectives, the Society shall direct
its resources towards performance of the following key
manage (including disbursement to implementing agencies
e.g. Directorate, District Societies, NGOs etc.) and
account for the funds received from the Ministry of
Health & Family Welfare, Government of India and
the NGO / PPP (public–private partnership) components
of the NRHM in the State, including execution of contracts,
disbursement of funds and monitoring of performance.
as a Resource Centre for the Department of Health
& Family Welfare in policy/situational analysis
and policy development (including development of operational
guidelines and preparation of policy change proposals
for the consideration of State Government).
Strengthen the technical / management capacity of
the State Directorate as well as of the Districts
Societies by various means including through recruitment
of individual / institutional experts from the open
market (with total programme management costs for
the State as a whole not exceeding 6% of the total
financial / non-financial resources for complementing/supplementing
the NRHM activities in the State.
training, meetings, conferences, policy review studies
/ surveys, workshops and inter-State exchange visits
etc. for deriving inputs for improving the implementation
of NRHM in the State.
such other activities for strengthening NRHM in the
State as may be identified from time to time, including
mechanisms for intra and inter-sectoral convergence
of inputs and structures.
For performing the above tasks, the Society shall:
and carry out the administration and management of
the Society’s Secretariat, which will serve
as the implementation arm of the Society.
Create administrative, technical and other posts in
the Secretariat of the Society as deemed necessary.
its own compensation package and employ, retain or
dismiss personnel as required.
Establish its own procurement procedures and employ
the same for procurement of goods and services.
Make rules and bye-laws for the conduct of the activities
of the Society and its Secretariat and add, rescind
or vary them from time to time, as deemed necessary.
of the Governing Body
names, addresses, occupations and designations of the
First Members of the Governing Body of the Society to
whom by the rules and regulations of the Society, the
management of the affairs of the Society is entrusted
as required under the Societies Registration Act, 1958
are as follows:-
Chief Secretary, GOR, Chairperson.
Addl. Chief Secretary (Development), GOR, Co-Chairperson.
Principal Secretary, Health & Family Welfare,
Principal Secretary-Finance, Member.
Principal Secretary-Panchyati Raj and Rural Development,
Principal Secretary-Women & Child Development,
Secretary FW & Mission Director-NRHM, GOR, Executive
A copy of the rules of the Society certified to be a
correct copy by three members of the Governing Body
is filed along with this Memorandum of Association.
the several persons whose names and addresses are given
below having associated ourselves for the purpose described
in this Memorandum of Association do hereby subscribe
our names to this Memorandum of Association and set
our several and respective hands hereunto and form ourselves
into a Society under the Societies Registration Act,
1958, this………….day of 2005 at……………...
Secretary (Development), GOR.
Secretary, Health & Family Welfare, GOR.
Secretary-Panchyati Raj & Rural development,
Secretary-Women & Child Development, GOR
FW & Mission Director-NRHM, GOR.
Health Mission & Society
the district level all existing societies have been merged into
the District Health Society with its apex body performing the
functions of the District Health Mission(DHM). NRHM envisages
financial autonomy and delegation of powers at the district level,
to the District Health Mission led by the Zila Parishad. The DHM
controls, guides and manages all public health institutions in
the District. The NRHM hasl assisted in setting up the full time
secretariat of the DHS. It is envisaged that the Secretariat of
the District Health Society should have a small but dedicated
unit for inter-sectoral co-ordination, which may directly report
to the CEO, Zilla Parishad.
and Responsbality of District Health Mission include:
health planning, implementation and monitoring
Districts would have to ensure preparation of a District Action
Plan (long term/ annual) in accordance with the guidelines provided
by the State (For Generic Guidelines on the District Action Plan
please see Annexe 10) and obtain necessary approvals from the
State Health Mission. Districts would have to facilitate implementation
in line with the approved Plan. They would have to establish a
system for monitoring performance against the approved plan, review
monitoring reports, identify corrective action to be taken and
follow up to ensure implementation. Monthly and quarterly progress
reports would be sent to the State Mission while a block-wise
monthly report will have to be provided to the members of the
Governing Board of the District Health Mission.
Coordination across relevant Departments
The DHM will have to ensure coordination across Departments especially
Health and Family Welfare, AYUSH, Department of Women and Children,
Rural Development, and the Public Health and Engineering Department,
identify bottlenecks to effective delivery of services and take
necessary action through government orders or other means.
Districts will have to prepare annual/ quarterly cash flow projections;
closely monitor and highlight, well in advance, anticipated shortage
of funds. The DHM will have to follow up with State Mission to
ensure that funds are released as per schedule.
Financial accounting/ administration
Districts will have to ensure maintenance of necessary books of
accounts and ensure adherence to procedures laid out for procurements
and payments. Districts will provide necessary assistance to the
auditors in carrying out their functions as and when required.
of District Health Society
in charge-Total Sanitation Campaign.
Education Officer-Primary & Secondary
Representative of Medical Associations/MNGOs/SNGOs to be
dominated by collector.
Programe Management Unit(SPMU)
response to the lessons learnt from RCH-I and programme management
support needs of RCH-II and National Rural Health Mission, the
State Programme Management Unit (SPMU) have being established.
The main objective of establishing this unit is to strengthen
the existing management structures/functions at the state and
district levels respectively as RCH-II is characterised by allocation
of flexible funds to states, preparation of programme implementation
plans by States and districts and performance linked disbursement
based on MOU. Consultants recruited under SPMU are expected to
improve the performance levels of the public health infrastructure
and functionaries and to make the system more responsive and transparent.
All these positions are on contract basis.
The SPMU consists of
following four positions.
- State Programme
- State Finance Manager
- State Accounts Manager
- State Data Officer
The SPMU is responsible for the overall state level planning and
monitoring for NRHM, management of flexipool funds, initiation
of health sector reforms, continuous process improvement and for
secretarial functions to the State Health Mission and State Health
Programme Management Unit(DPMU)
districts, the cornerstone for smooth and successful implementation
of NRHMI programme is dependent on the management capacity of
District Programme Managers, smooth functioning of District RCH
Society and empowerment of the programme implementation structure.
The District Health Society is being strengthened through the
integration of all societies in the district and this society
will be responsible for project management in districts. While
the Collector would continue to be the Chairperson of District
RCH Society, suitable manpower resources for programme management
and finance/accounts functions has been provided. The district
level functions include planning, implementation and monitoring
of all EAPs including RCH II, finance and accounting, training
and capacity building, MIES and district plans etc.
district PMU is composed of three skilled personnel i.e. Programme
Manager, Accounts Manager and Data Assistant have been provided
in each district. These personnel are there to provide the basic
support for programme implementation and monitoring at district
level. The District Programme Manager is responsible for providing
support to all programmes and projects in the Districts, planning,
implementation and monitoring of all EAPs including RCH II, training
and capacity building, MIES, development of district plans, regular
reporting and feedback,. The District Accounts Manager is responsible
for the finance and accounting function of District RCH Society
including grants received from the state society and donors, disbursement
of funds to the implementing agencies, preparation of submission
of monthly/quarterly/annual SoE, ensuring adherence to laid down
accounting standards, ensure timely submission of UCs, periodic
internal audit and conduct of external audit and implementation
of computerized FMS. The Data Assistant in close consultation
with district officials has to facilitate working of District
RCH Society, maintain records, create and maintain district resource
database for the health sector, inventory management, procurement
and logistics, planning and monitoring and evaluation. District
Data Assistant is responsible for MIS and data collection and
reporting at district level.
District Action Plan
Health Action Plan 2005-2012 is being prepared by each District.
The Key strategies suggested for DAP are as follows:
Block will be the key level for development of decentralized
plans so each block will be covered under the
and a block level plan will be prepared for each block in
resource agency/ groups will be identified for each block
to assist in planning.
technical resource agency would be identified for the District
to support the implementation of the DAP.
broad categories of programmes have been indicated under NRHM.
o RCH-II activities and programmes
o NRHM activities such as IPHS, Untied funds, JSY, and integration,
AYUSH, nutrition and child development
o National Disease Control Programme
of inputs have been suggested under NRHM implementation framework.
A detailed plan for additionalities will be incorporated in
survey of the PHCs, CHCs and Sub Centre is a critical part
of the DAP. As State has taken the decision to conduct the
Facility Survey of health institutions (CHC/PHC) separately,
from the DAP but in the frame work of DAP there should be
clearly indicated the provision of facility survey under NRHM.
Cost for the facility survey will not be the part of DAP.
NRHM there is provision of untied fund for the different levels
Village, Block and District. GoI is yet to indicate the amount
of untied funds. So under plan there should be the action
points for utilizing the untied funds.
NRHM & RCH-II, a list of proposed activities have been
worked out and a templates of the activities have been developed
this template will be used as worksheet for the action plan
for each year activities.
coordination is the key strategy of the NRHM. Under NRHM DAP
will be prepared with involvement of different sectoral departments
such as DWCD, PHED and Rural Development, Panchayati Raj and
AYUSH etc. All the activities of NRHM related to other departments
will be spelt out clearly with budget provisions.
agencies have been selected for preparation of all the District
Action Plans and there is a need to ensure uniformity of the
Frame Work of DAP and Budget lines. In each District Plan
district specific priorities, issues and budget requirements
should be indicated but the pattern of Frame Work, structure
and guidelines will be on same lines. It is anticipated that
DAP will be finalized up to December 2007.
Health Sanitation Committee
Health Sanitation Committee (VHSC)
NRHM framework support decentralized planning & monitoring
up to the grass root level. Therefore it was decided to entrust
village level committees of the users group, community based organization
for the planning monitoring & implementation of NRHM activities
into the 41000 revenue villages of the State.
Village Health & Sanitation committee (VHSC) feed such groups,
which is the fifth committee (Development Committee) of the Gram
Panchayat. The VHSC will be the key agency for developing Village
Health Plan & the entire planning of village Panchayat for
NRHM. This committee comprises of Panchayat representatives, ANM,
MTW, Aganwari workers, Teachers, Community health volunteers,
The State is presently having 9189 Gram Panchayats where such
committees exist. It is planned to organize the training of at
least 25 % of these committees on village health need identification
& local action under NRHM. It is also proposed to provide
Rs.10000/- to all VHSC for supporting their efforts in developing
Village Health Plans.
Role of Village
Public Awareness about the essentials of health programmes.
and develop a Village Health Plan based on an assessment of
the village situation and priorities identified by the village
Analyze key issues and problems related to village level health
and nutrition activities, give feedback on these to relevant
functionaries and officials. Present annual health report
of the village in the Gram Sabha.
Participatory Rapid Assessment: to ascertain the major health
problems and health related issues in the village. Estimation
of the annual expenditure incurred for management of all the
morbidities may also be done. The mapping will also take into
account the health resources and the unhealthy influences
within village boundaries.
Maaintenance of a village health register and health information
board/calendar: The health register and board put up at the
most frequented section of the village will have information
about mandated services, along with services actually rendered
to all pregnant women, new born and infants, people suffering
from chronic diseases etc.
Ensure that the ANM and MPW visit the village on the fixed
days and perform the stipulated activity; oversee the work
of village health and nutrition functionaries like ANM, MPW
Get a bi-monthly health delivery report from health service
providers during their visit to the village.
into consideration of the problems of the community and the
health and nutrition care providers and suggest mechanisms
to solve it.
Discuss every maternal death or neonatal death that occurs
in their village, analyze it and suggest necessary action
to prevent such deaths. Get these deaths registered in the
Managing the Village health fund.
Composition of the Village Health Committee
This committee would be formed at the level of the revenue village
(more than one such villages may come under a single Gram Panchayat).
Composition: The Village Health Committee would consist of:
- Gram Panchayat
members from the village.
- ASHA, Anganwadi
- SHG leader,
the PTA/MTA Secretary, village representative of any community
based organization working in the village, user group representative.
of Village Health Committee