HEALTH AL M N IS S O I I O T N A N 12th COMMON REVIEW MISSION REPORT 2018 CONTENTS 01 Executive Summary 41 Mandate & Methodology 47 Term of Reference 247 Team Composition and Facilities Visited ABBREVIATIONS AGCA - Advisory Group on Community Action AMTSL - Active Management of Third Stage of Labour ANC - Ante-Natal Care ANM - Auxiliary Nurse Midwife ANMTC - Auxiliary Nurse Midwife Training Centre APHC - Additional Primary Health Centre API - Annual Parasite Index ARC - ASHA Resource Centre ART - Anti Retroviral Treatment ASHA - Accredited Social Health Activist AWC - Anganwadi Centre AWW - Anganwadi Worker AYUSH - Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homeopathy BCC - Behaviour Change Communication BEmONC - Basic Emergency Obstetric & Neonatal Care BMO - Block Medical Officer BMWM - Bio-Medical Waste Management BPHC - Block PHC BPM - Block Programme Manager BPMU - Block Programme Management Unit BPL - Below Poverty Line iv 12th Common Review Mission | Report - 2018 12th Common Review Mission | Report - 2018 CAH - Community Action for Health CBOs - Community Based Organizations CEmONC - Comprehensive Emergency Obstetric & Neonatal Care CHC - Community Health Centre CMO - Chief Medical Officer CMOH - Chief Medical Officer Health CRM - Common Review Mission CT-Scan - Computed Tomography Scan DH - District Hospital DHAP - District Health Action Plan DLHS - District Level Household Survey DOTS - Direct Observation Therapy – Short course DPM - District Programme Manager DPMU - District Programme Manager Unit DTC - District Training Centre DWCD - Department Women & Child Development EDL - Essential Drug List EmONC - Emergency Obstetric & Neonatal Care EMRI - Emergency Management and Research Institute FMG - Financial Management Group FP - Family Planning FRU - First Referral Unit GNM - General Nursing Midwife HMIS - Health Management Information System HMRI - Health Management & Research Institute HR - Human Resource HRD - Human Resource Development HRIS - Human Resource Information System HSC - Health Sub-centre 12th Common Review Mission | Report - 2018 v ICDS - Integrated Child Development Scheme ICTC - Integrated Counselling and Testing Centre IDSP - Integrated Disease Surveillance Project IEC - Information Education Communication IMNCI - Integrated Management of Neonatal and Childhood Illnesses IMR - Infant Mortality Rate IPD - In Patient Department IPHS - Indian Public Health Standards ISO - International Organization for Standardization IUCD - Intra-uterine Contraceptive Device JE - Japanese Encephalitis JPHN - Junior Public Health Nurse JSSK - Janani Shishu Suraksha Karyakram JSY - Janani Suraksha Yojana LHV - Lady Health Visitor LLIN - Long Lasting Insecticide Treated Nets LR - Labour Room LSAS - Life Saving Anaesthesia Skills LT - Laboratory Technician MB - Multi-bacillary cases MCTS - Mother and Child Tracking System MDR - Multi-drug Resistant (TB) MIS - Management Information System MHW - Male Health Worker MMR - Maternal Mortality Ratio MMU - Mobile Medical Unit MO - Medical Officer MoHFW - Ministry of Health & Family Welfare MOIC - Medical Officer In-charge vi 12th Common Review Mission | Report - 2018 12th Common Review Mission | Report - 2018 MoU - Memorandum of Understanding MPW - Multi-purpose Worker MTP - Medical Termination of Pregnancy NFHS - National Family Health Survey NGO - Non-Government Organisation NHSRC - National Health Systems Resource Centre NICU - Neonatal Intensive Care Unit NIHFW - National Institute of Health & Family Welfare NIPI - Norway India Partnership Initiative NPCB - National Programme for Control of Blindness NLEP - National Leprosy Eradication Programme NRC - Nutritional Rehabilitation Centre NRHM - National Rural Health Mission NSSK - Navjat Shishu Suraksha Karyakram NSV - Non-scalpel Vasectomy NUHM - National Urban Health Mission NVBDCP - National Vector Borne Disease Control Programme OPD - Out Patient Department PCPNDT - Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex-selection) Act - 1994 PHC - Primary Health Centre PHN - Public Health Nurse PIP - Programme Implementation Plan PMU - Programme Management Unit PPP - Public Private Partnership PRI - Panchayati Raj Institutions PWD - Public Works Department RCH - Reproductive and Child Health RDK - Rapid Diagnostic Kit 12th Common Review Mission | Report - 2018 vii RHFWTC - Regional Health & Family Welfare Training Centre RHP - Rural Health Practitioner RKS - Rogi Kalyan Samiti RKSK - Rastriya Kishor Swasthya Karyakram RMP - Rural Medical Practitioner RMSCL - Rajasthan Medical Services Corporation Limited RNTCP - Revised National Tuberculosis Control Programme RSBY - Rashtriya Swasthya Bima Yojana SBA - Skilled Birth Attendant SDH - Sub Divisional Hospital SHC - Sub Health Centre SHSRC - State Health Systems Resource Centre SIHFW - State Institute of Health and Family Welfare SIMS - Softline Intelligent Micro Systems SNCU - Special Newborn Care Unit SPMU - State Programme Management Unit STG - Standard Treatment Guideline TB - Tuberculosis TNMSC - Tamil Nadu Medical Services Corporation Limited VHND - Village Health and Nutrition Day VHSNC - Village Health and Sanitation and Nutrition Committee viii 12th Common Review Mission | Report - 2018 12th Common Review Mission | Report - 2018 EXECUTIVE SUMMARY The Twelfth Common Review Mission (CRM) is the The 12th CRM was organised from September 5 first one to be undertaken after the announcement to September 12, 2018 in eighteen states, and the of Ayushman Bharat – Health and Wellness visit to the nineteenth state, Karnataka took place Centres, earlier this year. Ayushman Bharat builds from October 8 to October 14, 2018. The preceding on the health systems strengthening platform, eleven Common Review Missions were focused on which started as the National Rural Health Mission assessing the inputs provided to states through the in 2005 and with the addition of the National Urban Programme Implementation Plans and correlating Health Mission in 2013, became the National Health them with the broad outcomes. The approach of Mission. the 12th CRM was to assess community perceptions of the key interventions of the NHM, and to The National Health Mission, of which the Common understand the organization of service delivery Review Mission is an integral part, was intended to from community to district levels, so as to assess the strengthen primary and secondary care services readiness of health systems to undertake delivery of with substantial investments in maternal, new- comprehensive primary health care through Health born and child health and nutrition, focused on and Wellness Centres. strengthening these services through building a robust health systems platform. In addition, the Six of the nineteen visited states belonged to High NHM also provided significant support to enabling Focus category; Bihar, Jharkhand, Chhattisgarh, states to address communicable diseases and Madhya Pradesh, Rajasthan, Uttar Pradesh. All a range of programmes that related to chronic three hill states, namely, Uttrakhand, Himachal diseases. Support to the latter two components Pradesh, and Jammu and Kashmir were included, were focused on rationalizing Human Resources, and three were from the North Eastern region - financial incentives, reporting systems, access to Assam, Arunachal Pradesh, and Tripura. Of the Non medicines and diagnostics, laboratory support High focus states, seven states: namely Punjab, and engaging frontline workers, all building on Tamil Nadu, Gujarat, Andhra Pradesh, Telangana, the health systems platform intended to integrate Maharashtra, and Karnataka and were visited. services with a people centred focus. Members of the Mission included senior officials In April 2018, the Prime Minister launched the from the Ministry of Health and Family Welfare, first Health and Wellness Centre (HWC) in (MoHFW), including programme divisions and from Bijapur, Chhattisgarh, signalling a strong political the office of the Director General of Health Services commitment to comprehensive primary health care (DGHS), National Health Systems Resource delivered through Health and Wellness Centres, in Centre (NHSRC), public health experts from civil keeping with the mandate of the National Health society organizations, academic institutions, other Policy, 2017. related departments, NitiAayog, representatives 12th Common Review Mission | Report - 2018 1 of the Mission Steering group of the National levels, HWC-PHC level and referral, thus ensuring Health Mission, National ASHA Mentoring Group continuum of care. In addition, the implementation and Advisory Group on Community Action, and of HWC represent moving towards a team based development partners. approach to delivering comprehensive primary health care. The nineteen state teams were provided with a briefing on the variation in approach to the 12th CRM One of the objectives of this CRM was to assess the and to the various Terms of Reference by concerned planning and implementation readiness of states nodal officers. As has been the pattern, two districts and districts to operationalize HWC. While it may in each state were visited, and the district teams appear that the findings for the services of HWC presented the findings and recommendations focus on largely on non-communicable diseases, this emerging from the rapid review and assessment, was deliberately highlighted in the ToR, since there which were subsequently distilled into a report, is sufficient evidence that substantial progress has incorporating the state’s feedback. The