performance based incentives for high priority districts

lR;eso t;rs

Maternal Health Division

Ministry of Health & Family Welfare

Government of India

With Support from

other RCH Divisions 2014

RMNCH+A: IllustrativePerformance Based Incentives for

High Priority Districts (HPDs)

i

Preface

High burden of maternal and infant mortality reflects poor development of any society. The Government of India is committed to reduce this burden, both under MDGs and National Health Mission (NHM). Several initiatives both at community & facility level have been taken to accelerate its decline. However the challenge remains in providing the desired services in geographically isolated, inaccessible and remote areas particularly where the vulnerable population reside.

Unless there is equity and accessibility in service delivery, we will not be able to reach the most vulnerable and poor people. Our available human resource and health services are more polarized to urban than rural areas. One of the main hindrance is the non willingness of nurses, doctors and specialists to work in the rural and inaccessible areas.

In view of this, the Programme Divisions of this Ministry has worked with the Development Partners and other stakeholders in preparing suggestive performance based incentives for the High Priority Districts to motivate and retain critical manpower in these districts. This is an approach to reach all geographical areas with an intention to accelerate the functioning of health facilities with priority focus in HPDs. It is my belief that this guideline would be useful in operationalizing the services and also access to the poor and vulnerable.

(Anuradha Gupta)AS& MD (NHM)

06.05.2014

ii

National Rural Health Mission has contributed to strengthening of health systems including additional Human Resources for Health (HRH) to provide essential and emergency medical services. However, there is general view that the services have not improved commensurate with the increase in HR. One important way to improve productivity and efficiency is to monitor the performance of service providers, create incentives for them to render high quantity and quality of desirable services and recognise and reward high performing service providers. This has been a weakness of large part of our public health delivery system that there is rather poor performance monitoring and poor accountability towards outputs/ outcomes of the service providers.

It is felt that paying Performance Based Incentives (PBIs) besides the normal salary to the service providers or their team should lead to significant improvement in output and health outcomes. The improvement is most urgent in the High Priority Districts (HPDs) and it is therefore proposed to first implement these PBIs in the HPDs. To help improve the service delivery, we have designed the PBls so that they should not only help attract critical health manpower for working in such districts but also retain them and motivate them to perform. The PBIs have been designed for individual service providers as also for the team, depending upon whether the individual alone or the team can reasonably ensure the desired outputs/ outcomes. The PBIs require performance particularly on those activities/ interventions which are most critical to improving outcomes and also indicates the mechanism to measure them.

I am confident, that this document will facilitate the process of improving performance to achieve the set goals and targets for the different thematic areas under the program by monitoring and incentivising the performance and recognising the outstanding performers. I expect all states to use the PBIs particularly in the HPDs.

(Manoj jhalani)

fOreWOrD

4th June 2014

iii

Performance Based Incentives (PBIs) for 184 High Priority Districts have been developed by the Ministry of Health & Family Welfare, Government of India to motivate service providers to improve their performance particularly those posted at the more peripheral health facilities (Sub- Centre and Primary Health Centres).

Under the National Health Mission, incentives to service providers for sewing in difficult, remote and underserved areas and linked to benchmarks of performance have been allowed based on the State proposals in their annual plans.

However, there has been a felt need for providing guidelines to the States for proposing and administering these incentives to individual and to teams of service providers.

The Performance Based Incentives have been designed to maximise outputs and outcomes on key RMNCH+A interventions particularly for critical activities like Emergency Obstetric Care including C-section and Sick New-Born care which are instrumental in saving many lives in the labour rooms and special new-born care units.

I am confident that the policymakers and programme managers will make optimal use of this document to improve performance of service providers and hence the quality of service delivery at the health facilities particularly in the High Priority Districts.

(Dr Rakesh Kumar)05.06.2014

fOreWOrD

iv

acknOWleDgementThere is a wide gap between the demand and availability of healthcare services and this gap is widening because our facilities at and below sub district level remain either non-functional or not optimally utilized. The fact remains that out of total health facilities only about 10% of them are functional when a minimum performance benchmarking was applied to choose functional health facility which has been designated as delivery points.

During review and interactions with the state, non-availability of HR, absenteeism, giving equal pay to both performer and non-performer are identified as some of the demotivating factors resulting in a situation where our service providers do not want to go to a facility at or below sub-district level.

In view of above challenges, Performance Based Incentives (PBI) for High Priority Districts has been prepared as a suggestive guideline to improve service delivery and encourage the service providers for better performance particularly those working at Sub-centres and Primary Health Centres. The PBI also encourages delivery of critical services such as C-section and saving lives in critical areas such as in labour rooms, SNCUs etc. This will greatly help in improving accessibility of quality health care in India.

The illustrative framework on performance based incentives is a result of series of discussions and guidance given by Ms. Anuradha Gupta, Additional Secretary and Mission Director, National Health Mission, Ministry of Health and Family Welfare, Mr. Manoj Jhalani, Joint Secretary (Policy) and Dr Rakesh Kumar, Joint Secretary (RCH), National Health Mission.

The contribution of all technical divisions under RCH is highly appreciated. The concentrated effort rendered by BMGF particularly Dr. Devendra Khandait, Senior Program Officer and the team of experts at JSI, particularly, Dr. Rajesh Singh, Senior Technical Advisor, Dr. Sebanti Ghosh and Dr. Sudhir Maknikar, National RMNCH+A Experts were important and has resulted in framing the guidelines after several revisions of the draft.

I also thank my colleagues Dr. Manisha Malhotra and Dr. Dinesh Baswal and senior consultants Dr. Pushkar Kumar, Dr. Rajeev Agarwal and Dr. Ravinder Kaur for their valuable inputs and support.

It is expected that the operationalization of 5×5 matrix under RMNCH+A will get boosted with the implementation of PBI particularly in remote and hilly areas. However, this is flagged that any incentive should be proposed on the basis of need assessment and not as universal approach even in HPDs. I sincerely believe this will help and guide the Mission Directors, Program Managers and Service Providers to focus their attention on performance based indicators for different thematic areas of the RMNCH+A strategy for desired health outcomes in the coming years.

(Dr. Himanshu Bhushan)

RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) v

list Of cOntributOrs

1. Ms. Anuradha Gupta, AS&MD (NHM), MoHFW

2. Mr. Manoj Jhalani, JS (Policy), MoHFW

3. Dr. Rakesh Kumar, JS (RCH), MoHFW

4. Dr. Himanshu Bhushan, DC (MH I/C), MoHFW

5. Dr. Manisha Malhotra, DC (MH), MoHFW

6. Dr. Dinesh Baswal, DC (MH), MoHFW

7. Dr. Ajay Khera, DC (CH & Imm I/C), MoHFW

8. Dr. S.K. Sikdar, DC (FP I/C), MoHFW

9. Dr.Haldar,DC(Immunization),MoHFW

10. Dr. P.K. Prabhakar, DC (CH), MoHFW

11. Dr. Sila Deb, DC (CH), MoHFW

12. Dr. Sushma Dureja, DC (AH), MoHFW

13. Dr Devendra Khandait, SPO, BMGF

14. Dr. Rajesh Singh, Senior Technical Adviser, JSI

15. Dr.SudhirMaknikar,NationalRMNCH+AExpert,JSI

16. Dr.SebantiGhosh,NationalRMNCH+AExpert,JSI

17. Mr. Niraj Agrawal, Knowledge Management Specialist, JSI

18. Dr. Pushkar Kumar, Lead Consultant, MH, MoHFW

19. Dr. Rajeev Agarwal, Sr. Consultant, MH, MoHFW

20. Dr. Ravinder Kaur, Sr. Consultant, MH, MoHFW

RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)vi

list Of abbreviatiOns

anc Ante Natal Care

anm AuxiliaryNurseMidwife

aWW Anganwadi Worker

bOH Bad Obstetric History

cHc Community Health Centre

DH District Hospital

eag EmpoweredActionGroup

emOc EmergencyObstetricCare

fru FirstReferralUnit

goi GovernmentofIndia

Hmis HealthManagementInformationSystem

HPD High Priority District

lsas LifeSavingAnaesthesiaSkills

mctfc MaternalandChildTrackingFacilitationCentre

mcts Mother and Child Tracking System

mnH Maternal and Neonatal Health

mO MedicalOfficer

moHfW MinistryofHealthandFamilyWelfare

ne NorthEast

nHm NationalHealthMission

ObgYn Obstetrician and Gynaecologist

Pbi PerformanceBasedIncentive

PHc Primary Health Centre

PPiucD PostpartumIntraUterineContraceptiveDevice

rmncH+a Reproductive,Maternal,Neonatal,ChildandAdolescentHealth

sba SkillBirthAttendant

sDH Sub District Hospital

sncu SpecialNewbornCareUnit

RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 1

rmncH+a: Illustrative Performance Based Incentives for

the 184 High Priority Districts (HPDs)

IntroductionSincethelaunchofNationalRuralHealthMissionin2005,therehasbeenasteadybutdefinitivesurgeinthedemandforservicesatpublichealthfacilities.WithinafewyearsthisdemandhasincreasedmanifoldnotonlyintermsofinstitutionaldeliveriesbutalsoinOut-PatientDepartment(OPD)andIn-PatientDepartment(IPD)services.Whileassessing theutilisationofhealth facilities, ithasbeenobservedthat thedemandforhealthserviceshasincreasedatthedistrictandsub-districtlevel,however,atthefacilitiesbelowsub-districtleveltheavailabilityandutilizationofessentialhealthservicesisstillsub-optimal.

NationalHealthMission (NHM) iscommittedtoprovideaccessible,affordableandqualityhealthcare toall,especiallythevulnerableandunreachedsectionsofsociety.Accordingly,‘reachingthosethatneeditmost’isthe topmost priority under theReproductive,Maternal,Newborn, ChildHealth andAdolescent (RMNCH+A)strategicapproachwhichprovidesacommitmentforcontinuumofcareunderNHM.

Governmentof India (GoI)has identified184highprioritydistricts (HPDs)with relativelyweakperformanceindicatorswithineachstate,basedonacompositeindex.Thesearethedistrictslocatedingeographicalregionswherereproductive,maternalandchildmorbidityandmortalityarehighandthereisaneedforfocusedplanningtomaintainequityandimprovingaccessforvulnerableandpoorsectionsofthesociety.Despiteavailabilityofinfrastructureandequipment,oneofthegapsassessedinthesedistrictsislackoftrainedandmotivatedserviceprovidersathealthfacilities.

UndertheMission,aprovisionhasbeenmadeforallocationof30%additionalfundingtoeachHPDwithintheoverallstateresourceenvelope.ThehigherfinancialallocationforHPDsallowsthedistrictsagreaterflexibilitytoupgradeinfrastructure,provideessentialdrugsandcommodities,provideessentialamenitiesforclientsandcreativelydesignperformancebasedincentivesforhumanresourcestoattractandretainskilledmanpower.

Inthiscontext,theGoIsuggestsaframeworkforprovidingPerformanceBasedIncentives(PBI)forhealthserviceproviders.Thesewouldincludeindividualserviceprovidersaswellasteamsofprovidersgivingcriticalservicesatvariousleveloffacilities.TheseadditionalincentiveswillnotonlyhelpinretainingthemanpowerbutalsomotivatethemtoperformbetterinHPDs.ThiswillfurtheraidinachievingtargetsandgoalsundertheRMNCH+Astrategy.

Objectives of the PBI schemeThe following are the objectives of the PBI scheme: • ToimproveprovisionandutilizationofRMNCH+Aservicesofferedtothepopulation;

• Tomotivateandretainexistinghealthpersonnel,particularlyAuxiliaryNurseMidwife(ANM)andstaffnursesinperipheralareas;

• Toincreaseequity,accessibilityandqualityofcareatthehealthfacilitylevel;and

• Toorganizehealthservicesefficiently.

Monitoring and verificationWhileimplementinganyfinancialschemeitiscriticaltodeveloparobustmonitoringandverificationprocess.Verificationprocesses for thePBIschemewouldensurethat thereporteddataaccurately reflects theactualperformancebothbydetectingandcorrectingmisreporting.Itispertinenttonoteherethattheseverification

RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)2

processesaredynamicandwouldevolveovertimeastheschememovesupinscaleandthebehaviourofPBIrecipient(suchas,serviceproviders,facilityteams)changeinresponsetotheintroductionoffinancialincentivesandservicesimprovetoanoptimallevel.

TheMinistryofHealthandFamilyWelfare(MoHFW),GoIissettinginplacestrongverificationmechanismstodetectinconsistenciesthatmayresultfrominaccuraciesindataentryandrecordkeepingand/orfromimproperimplementation bymonitoring and evaluation teams.Hence, it is strongly recommended that the state anddistrictprogrammanagersbecautiousaboutimpreciseclassificationofcases,andincorrectuseofdatacollectiontools.TheplatformofmonthlymeetingsshouldbeusedfororientingthesupervisorsandserviceprovidersaboutthePBIsandprovidingclarityonassessingtheperformancebasedonthedifferentindicators.

Zero tolerance for irregularities All states shouldcloselymonitor the incentivespaidagainst theperformanceassessed.High transparency inbothverificationproceduresandsub-sequentcommunicationoftheresultsisalsoanimportantfeatureoftheverificationsystem.

Anyinstancesofirregularitiesshouldnotbetoleratedparticularlyinthefollowingareas:• Excessiveprovisionofunnecessaryorpotentiallyharmfulservicestoearnincentives

• Providingfalseinformation

• Compromisingthequalityofcareandservices

• Denialofservicestotheeligiblebeneficiaries

Quality assuranceThePBIschememakesalargepartoftheperformance-basedpaymentsconditionalontheprogressofindicatorsthat capture the number of services delivered. The schememay, for example, reward the providers on thenumber of Postpartum Intra Uterine Contraceptive Devices (PPIUCD) inserted, or the number of deliveriesattended at home.While these indicators are relatively easy tomeasure and verify through facility records,HealthManagement InformationSystem (HMIS)andMotherandChildTrackingSystem (MCTS), theydonotprovideinsightsonthequalityofcareprovided.Asmuchaspossible,thePBIshouldbelinkedwiththequalityofservicesrenderedincomparisonwiththeclinicaltreatmentguidelinesorqualitystandards,suchassafebirthchecklist,MaternalandNeonatalHealth(MNH)toolkit,infectionpreventionguidelinesetc.ThiswillrepresentauniqueapproachtopromotebetterqualityinRMNCH+Aservices.

Level of verificationBlockanddistrict level supervisorswill conductmonthly,quarterly,andannual verificationof thePBI resultsthroughfacilityrecords,HMIS,MCTS,etc.Verificationoftheresultscanbedoneattwolevels:atthelevelofPBIrecipients(doreportednumbersreflectthedatainthefacilityregisters?)andrandomlyatthelevelofbeneficiaries(is thedata in theregistersvalid, i.e.,havereportedservices indeedbeenprovidedtothebeneficiaries?).Attheprovider level, itwouldbeeasy to verify the results through their records. It is a challengingprocess toverifythePBIindicatorsatthecommunitylevel.However,thiscanbeexploredthroughtheMaternalandChildTrackingFacilitationCentre(MCTFC)bycommunityclientinterviewdonerandomlyonquarterlybasis.TheGoIalsosuggestsblockmonitoringvisitasanadditionalverificationmethodnecessary toextract indicators fromothersourcesthatmaynotbeincludedinthenationalHMISandMCTSdatabases.

Leveraging technology for the PBIGoIwill exploreanddevelopm-Health softwareor awebportal thatwill containPBI results andoutcomes,financialdata,andverificationreports. Informationandcommunicationtechnologies (ICT)canbeutilized fordatacollectionaswellasformonitoringandevaluationofthePBIactivities.

The detailed explanation for each PBI is provided in following pages in a tabular form:


RMN

CH +

A Th

emati

c Ar

ea: R

epro

ducti

ve H

ealth

Pbi

Indi

cato

rEl

igib

ility

Crit

eria

for

the

PBI

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of

addi

tiona

l in

centi

ve

Sour

ce o

f da

ta fo

r ve

rifica

tion

Addi

tiona

l Ve

rifica

tion

appr

oach

es

to tr

ack

and

valid

ate

resu

lts

Prop

ortio

nofPPIUCD

insertion

sin

institutio

nal

deliv

erie

s

Serv

ice

prov

ider

at

Bloc

k Pr

imar

y He

alth

Ce

ntre

(BPH

C)/

Com

mun

ity H

ealth

Ce

ntre(C

HC)/Sub

-Di

stric

t Hos

pita

l (SD

H)/

Dist

rict H

ospi

tal (

DH)

inH

PDso

fStates

men

tione

dbe

low*

Additio

nal `50fore

achPP

IUCD

insertion

beyon

dthe

insertion

rateof1

5%oftotaldeliveriesc

ondu

cted

by

that

pro

vide

r in

the

mon

th.

(E.g.Ifa

provide

rcon

ducts2

0de

liveries,th

enhe/she

willbeeligibleto

getPBIfrom

the4th

PPIUCD

insertion

on

war

ds.)

PPIU

CD sh

ould

be

offer

ed a

fter c

ouns

ellin

g a

nd a

s par

t of

bas

ket o

f con

trac

eptiv

e ch

oice

s

Serv

ice

prov

ider

re

ceiv

es

` 15

0 pe

r PP

IUCD

insertion

` 50

per

PP

IUCD

insertion

be

yond

the

insertion

rateof1

5%

ofto

tal

deliv

erie

s

•Fa

cilit

y re

cord

s

•HM

IS

Bloc

k m

onito

ring

visit

s

Cont

ext: Po

stpa

rtum

familyplann

ingha

sbee

ngivenspecialatte

ntion

utilizing

thehu

gewindo

wofo

pportunityprovide

dbycurrentin

crea

sein

institutio

nald

eliveryto

over80%

.PostpartumIU

CDse

rviceprovision

isone

ofthe

safestand

effe

ctivem

eansfo

renh

ancing

uptakeofsp

acingmetho

dsin

wom

enand

improvingbo

thm

aterna

lan

dchild

hea

lthoutcomes.Thisincen

tiveaimstomoti

vateperform

anceofserviceprovide

rsand

increa

seth

eprovision

ofP

PIUCD

servicesin

theHP

Ds.

Leve

l of i

ncen

tive:In

dividu

alse

rviceprovidersu

chasS

taffNurse(S

N),AN

Mand

Med

icalOfficer(MO)e

tc.

Pre-

requ

isite

: Provide

rmustb

etraine

dtoprovide

PPIUCD

asp

erth

ena

tiona

lguide

linefrom

app

rovedtraining

cen

tre.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:

Incenti

vesw

illbepa

idonaqu

arterly

basis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedSu

perviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofa

dheren

ceto

qua

litydu

ringinsertion

.

*Not

e: T

his P

BI is

onl

y ap

plic

able

for S

tate

s: B

ihar

, Jha

rkha

nd, U

ttar

Pra

desh

, Utt

arak

hand

, Mad

hya

Prad

esh,

Chh

attisg

arh,

Oris

sa, R

ajas

than

and

Ass

am


RMN

CH +

A Th

emati

c Ar

ea: R

epro

ducti

ve H

ealth

Pbi

Indi

cato

rEl

igib

ility

Crit

eria

for

the

PBI

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of

addi

tiona

l in

centi

ve

prop

osed

Sour

ce

of d

ata

verifi

catio

n

Addi

tiona

l Ve

rifica

tion

appr

oach

es

to tr

ack

and

valid

ate

resu

lts

Prop

ortio

nofpost-

part

um

sterilizatio

ns

(PPS

) in

institutio

nal

deliv

erie

s.

BPHC

/CHC

/Firs

t Re

ferralUnit(FR

U)/

SDH/

DH:Fam

ily

Plan

ning

surg

eon

and

team

inHPD

sofS

tates

men

tione

dbe

low*

Additio

nal `

150

perte

ambeyon

dthePP

Srateof5

%of

tota

l del

iver

ies c

ondu

cted

by

that

team

in th

e m

onth

in

afacility.

Ster

iliza

tion

shou

ld b

e off

ered

afte

r pro

per c

ouns

ellin

g an

d as

par

t of

bask

et o

f con

trac

eptiv

e ch

oice

s

The

sterilizatio

nte

am

rece

ives

`

150

per

sterilizatio

nop

erati

on

performed

Additio

nal

` 15

0 pe

r PPS

be

yond

the

PPSrateof

5%oftotal

deliv

erie

s

•Fa

cilit

y re

cord

s

•HM

IS

Bloc

k m

onito

ring

visit

s

Cont

ext: Cu

rren

tlyth

erearedisparitiesin

perform

anceofsteriliza

tionacrossstatesand

with

indistric

tsin

astatewith

perform

ancere

maining

below

desire

dlevelsin

theHP

Ds.M

oreo

ver,pe

rforman

celevelsofse

rviceproviderss

howvariatio

ns.Thisincen

tiveaimstoen

courageproviderstope

rformbett

erand

improvetheprovision

of

sterilizatio

nservices.

Leve

l of i

ncen

tive:ServiceProvide

rTea

mproviding

sterilizatio

nservicesin

clud

ingatt

enda

ntand

supp

ortstaff.

Distrib

ution

ofcashbe

nefitsa

mon

gtheteam

und

erth

isincenti

vewou

ldbede

cide

dbyth

estate.

Pre-

requ

isite

: Surgeon

mustb

eem

pane

ledbyth

eState/Distric

tand

traine

dtoprovide

sterilizatio

nservicesasp

erGoIguide

lines.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:

Incenti

vewillbepa

idonaqu

arterly

basiswhe

n(orw

ithhe

ldunti

l)repo

rted

/achievemen

tsareverified

byde

signa

tedState/Distric

tlevelofficialsincluding

review

of

adhe

rencetoqua

litystan

dardsa

ndinfecti

onpreventi

onpracti

cesa

sperGoIguide

lines.

*Not

e: T

his P

BI is

onl

y ap

plic

able

for S

tate

s: B

ihar

, Jha

rkha

nd, U

ttar

Pra

desh

, Utt

arak

hand

, Mad

hya

Prad

esh,

Chh

attisg

arh,

Oris

sa, R

ajas

than

and

Ass

am


RMN

CH +

A Th

emati

c Ar

ea: M

ater

nal

Heal

th

PBI I

ndic

ator

Elig

ibili

ty

Crite

ria fo

r the

Pb

i

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of

addi

tiona

l in

centi

ve

prop

osed

Sour

ce o

f dat

a ve

rifica

tion

Addi

tiona

l Ver

ifica

tion

appr

oach

es to

trac

k an

d va

lidat

e re

sults

Prop

ortio

nof

preg

nant

wom

en

line

liste

d an

d treatedforsevere

anae

mia

Allthe

Sub

-Ce

nter

AN

Ms

in 1

84 H

PDs

ANMsw

illbeen

titledtore

ceivean

incenti

ve

of `

100

percaseaft

erid

entifi

catio

n,line

listin

gofse

verelyana

emicpregn

antw

omen

an

dconfi

rmati

onofH

bpe

rcen

tage(<

7gm%)

at B

PHC/

CHC/

SDH/

DH b

y M

O.

ANM

shou

ld e

nsur

e th

at w

omen

get

s tr

eatm

ent a

s per

gui

delin

es a

nd sh

e m

akes

fo

llow

up

visit

s for

at l

east

two

cons

ecuti

ve

mon

ths.

Nil

` 10

0 pe

r cas

e•

Seve

re

anae

mia

tr

acki

ng

regi

ster

•Fa

cilit

y re

cord

whe

re

trea

tmen

t was

pr

ovid

ed

•M

CTS

•In

crea

se in

Hb

perc

enta

ge

reco

rded

by

MO

or

OBG

YN sp

ecia

list i

n tr

acki

ng re

gist

er

•Bl

ock

mon

itorin

g vi

sits

Cont

ext: Morethan

50%

ofthe

pregn

antw

omen

aresu

fferin

gfrom

ana

emiain

Indiaan

dthisison

eofth

emostcom

mon

und

erlyingcausesofm

aterna

ldeathin

our

coun

try.Itisestimated

that2-3%ofp

regn

antw

omen

can

develop

severeana

emiaamon

gthoseiden

tified

asa

naem

ic.Earlyid

entifi

catio

nofana

emicwom

enand

ad

equa

tetreatm

enta

ndfo

llowupofse

verelyana

emicpregn

antw

omen

isth

ereforeacriticalinterventi

onwhichhelpsto

prevent/red

uceasig

nifican

tpropo

rtion

of

materna

lmortalityan

dmorbidity.Thisincen

tiveisexpe

cted

tom

otivateANMstoprovidequ

ality

fullrang

ean

tena

talcareinclud

ingHb

estimati

on.

Leve

l of i

ncen

tive:

Individu

alse

rviceprovide

r-ANM

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

: Incenti

vesw

illbepa

idonqu

arterly

basis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedSu

perviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.


RMN

CH +

A Th

emati

c Ar

ea: M

ater

nal

Heal

th

PBI I

ndic

ator

Elig

ibili

ty

Crite

ria fo

r the

Pb

i

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of

ince

ntive

pr

opos

ed

Sour

ce o

f dat

aAd

ditio

nal V

erifi

catio

n ap

proa

ches

to tr

ack

and

valid

ate

resu

lts

Prop

ortio

nof

preg

nant

wom

en

line

liste

d an

d treatedforh

igh

riskpregna

ncies-

Hype

rten

sion,

any

bl

eedi

ng d

urin

g AN

C, B

ad O

bste

tric

History(Excluding

an

aem

ia)

Allthe

Sub

-Ce

ntre

AN

Ms

in 1

84 H

PDs

ANMisenti

tledforIde

ntificati

onofh

igh

risk

preg

nanc

y (H

yper

tens

ion,

any

ble

edin

g du

ringAN

C,BOH*

)excluding

severeana

emia,

timelyreferraland

con

ducti

ngfo

llowupvisits

fora

tlea

st2con

secutiv

emon

ths.Ann

ual

incenti

veof

` 10

00 sh

all b

e pa

id to

any

individu

alANMifsh

eexceed

sdetectio

nan

dtim

elyreferralofa

tlea

st7%highriskcases

outo

ftotalANCsre

gistered

.

Nil

` 10

00 p

er

annu

mif

sheexceed

sde

tecti

on

andtim

ely

referralofa

tleast7

%high

risk

case

s out

ofto

talA

NCs

regi

ster

ed.

• M

CTS

•Fa

cilit

y re

cord

s

•Bl

ock

mon

itorin

g vi

sits

•Re

ferralslipat

faciliti

esfrom

whe

rere

ferralsa

re

mad

e to

hig

her

levelh

ealth

faciliti

es

Cont

ext:Everypregna

ncyispreciousand

shou

ldre

ceivego

odqua

lityan

tena

tal,intra-na

taland

postnatalcaresin

cecom

plicati

onsc

anoccurata

nypointofti

me.

However,asw

ekn

owth

atabo

ut15%

ofp

regn

antw

omen

can

develop

com

plicati

onsd

uringpregna

ncy,child

birthan

dinth

epo

stna

talp

eriod,th

usearlydetectio

nofhighriskpregna

ncies,timelyreferraland

man

agem

enta

tEmOCfaciliti

esm

ustb

een

suredforsuchhigh

riskpregn

ancies.Thisincen

tiveaimstomoti

vateANMsfor

provision

ofg

oodqu

ality

anten

atalcareinclud

ingtracking

ofh

ighriskpregna

ncies.

Defin

ition

of H

igh

Risk

pre

gnan

cy a

s per

SBA

gui

delin

es o

f GoI

:

1) H

yper

tens

ion isdiagno

sedwhe

ntw

oconsecuti

vere

adingsta

kenfourhou

rsorm

oreap

artsho

wth

esystolicblood

pressuretobe14

0mmHg

orm

orean

d/orth

edi

asto

lic b

lood

pre

ssur

e to

be

90 m

mHg

or m

ore.

2) A

ny b

leed

ing

durin

g AN

C isdefi

nedasanybleed

inginclud

ingspotti

ngofb

lood

anytimedu

ringan

tena

talp

eriod

3) B

ad O

bste

tric

His

tory

(BO

H*) include

spreviou

sH/O

follo

wing:i)S

tillbirthorneo

natallossii)Three

orm

orespon

tane

ousc

onsecutiv

eab

ortio

nsiii)Obstructed

labo

ur, P

re-m

aturebirths,twinso

rmultip

lepregn

anciesiv)W

eigh

tofthe

previou

sbab

y<2

500g

or>

4500

gv)Adm

issionforh

ypertensionorpre-eclam

psia/eclam

psia

inth

epreviouspregn

ancyvi)Su

rgeryon

thereprod

uctiv

etractvii)Co

ngen

italano

malyviii)Treatmen

tforinfertilityix)S

pina

ldeformities,suchassc

oliosis

/kyp

hosis

/po

liox)R

hne

gativ

einth

epreviouspregn

ancy.

Leve

l of i

ncen

tive:

Individu

alse

rviceprovider-ANM

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:Incenti

vewillbepa

idonan

ann

ualb

asis.ANMsh

ouldm

aintainprop

erre

cords.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

ts

areob

jecti

velyverified

bythede

signa

tedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.


RMN

CH +

A Th

emati

c Ar

ea: M

ater

nal

Heal

th

Pbi

Indi

cato

rEl

igib

ility

Crit

eria

for t

he P

BIPe

rfor

man

ce ta

rget

s An

y ex

istin

g in

centi

ve

Amou

nt o

f in

centi

ve

prop

osed

Sour

ce o

f dat

a ve

rifica

tion

Addi

tiona

l Ve

rifica

tion

appr

oach

es to

trac

k an

d va

lidat

e re

sults

Prop

ortio

nofhom

ede

liver

ies

atten

dedby

SBA

trai

ned

ANM

SBA

trai

ned

ANM

in

the

HPDs

(*Statesm

entio

nedbe

low)

cond

uctin

gho

mede

liveriesin

villagesn

otifie

dba

sedon

GoI

crite

riafo

rhom

ede

liveriesa

nd

listo

fnoti

fiedvillagess

hared

with

GoI

Homede

liveriesa

ttend

edbySB

Asin

no

tified

villages,w

herem

othe

rand

ne

wbo

rn a

re re

gist

ered

in M

CTS,

mot

her

andne

wbo

rnhea

lthyatend

of4

2da

ys

or6wee

ksand

birthcertificateob

tained

forn

ewbo

rnand

han

dedoverto

the

mot

her.

Nil

` 10

00 p

er

deliv

ery

• M

CTS

•AN

M

reco

rds

•Bl

ock

mon

itorin

g vi

sits,

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ndom

verifi

catio

nth

roug

h M

CTFC

Cont

ext:De

spite

ahug

eincrea

sein

institutio

nald

eliveriesa

crossthe

cou

ntry(a

roun

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%asp

erHMIS),asig

nifican

tpropo

rtion

ofw

omen

livinginre

motean

ddifficult

tore

acharea

sareuna

bletoaccessp

ublichea

lthfa

ciliti

esfo

rdeliverycareand

con

tinue

todeliverath

omewith

outa

nysk

illed

assistan

ceatb

irth.Thiso

ftenexpo

ses

them

tohighe

rrisk

ofm

ortalityan

dmorbidity.

This

is to

flag

that

, thi

s is t

o be

seen

as e

xcep

tion

to th

e po

licy

whi

ch h

as fo

cus f

or in

stitu

tiona

l del

iver

ies a

nd h

ome

deliv

erie

s are

not

to b

e pr

omot

ed. H

owev

er, t

his

ince

ntive

can

be

give

n as

an

exce

ption

to th

e po

licy

whe

re S

BAs a

re e

ncou

rage

d to

con

duct

such

del

iver

ies o

nly

in n

otifie

d vi

llage

s.

Leve

l of i

ncen

tive:

Indi

vidu

al p

rovi

der –

AN

M

Pre-

requ

isite

:ANMm

ustb

eSB

Atraine

dan

dcertifie

dbydue

autho

rity.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:Incen

tivewillbedisbursedon

qua

rterlybasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/

achievem

entsareobjectiv

elyverifi

edbythede

signa

tedsupe

rviso

rs,d

esigna

tedbyth

eState/Dist.o

fficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityof

serv

ices

pro

vide

d.

*Not

e: T

his P

BI is

onl

y ap

plic

able

for S

tate

s: A

ll th

e EA

G st

ates

, NE

Stat

es, J

amm

u an

d Ka

shm

ir, H

P an

d As

sam


RMN

CH +

A Th

emati

c Ar

ea: M

ater

nal

Heal

th, N

ewbo

rn H

ealth

& R

epro

ducti

ve H

ealth

Pbi

Indi

cato

rEl

igib

ility

Crit

eria

fo

r the

PBI

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of i

ncen

tive

prop

osed

Sour

ce o

f dat

a ve

rifica

tion

Addi

tiona

l Ver

ifica

tion

appr

oach

es to

trac

k an

d va

lidat

e re

sults

Prop

ortio

nof

Institutio

nal

deliv

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s at

Sub-Ce

ntres

desig

nate

d as

del

iver

y po

ints

(DP)

cond

uctin

g>5

*de

liver

ies/

mon

th

SBA

trai

ned

ANM

pos

ted

atSub

-Cen

tre

desig

nate

d as

DPs

in184

HPD

s*

SBAtraine

dAN

Menti

tledtore

ceive

theincenti

veof `

300

per

cas

e w

hen

she

cond

ucts

bey

ond

5 de

liver

ies p

er

mon

th. P

aym

ent w

ill b

e su

bjec

t to

ensurin

gminim

um6hou

rstayfor

themothe

r,registratio

nofm

othe

ran

d ne

wbo

rn in

MCT

S, m

othe

r and

ne

wbo

rnsh

ouldbehe

althyatend

of

6wee

ks/42da

ysand

birthcertificate

shou

ldbeob

tained

forn

ewbo

rnand

de

livered

toth

emothe

r.In

add

ition

,AN

Mwillbeen

titledfora

nad

ditio

nal

`50

forP

PIUCD

insertion

percasefor

each

del

iver

y.

Nil

`30

0pe

rdeliveryfrom

6t

h de

liver

y on

war

ds

andad

ditio

nal `50for

PPIUCD

insertion

per

casefo

reachde

livery.

• M

CTS

•Fa

cilit

y re

cord

•M

O o

r any

des

igna

ted

bloc

k le

vel s

uper

viso

ry

officer

•Bl

ock

mon

itorin

g vi

sits

Cont

ext: Th

eprop

osed

incenti

vewillhelpinstreng

then

ingofSub

-Cen

trefunctio

ning

and

moti

vatin

gSB

Atraine

dAN

Msforcon

ducti

ngdeliveriesa

tperiphe

ry.Thisw

ill

also

hel

p in

impr

ovin

g ot

her d

esig

nate

d se

rvic

es.

Leve

l of i

ncen

tive:

Sub

-Cen

treserviceprovider–SBA

trained

ANMand

herassistan

t/supp

ortstaff

Pre-

requ

isite

:ANMm

ustb

eSB

Atraine

dan

dbe

traine

dan

dcertifie

d(bystate/ap

proved

training

cen

tre)to

provide

PPIUCD

asp

ernati

onalguide

lines.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

: Incenti

vewillbedisbursedon

qua

rterlybasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.

*For

HPD

s of 8

Nor

th-e

ast s

tate

s inc

ludi

ng S

ikki

m: S

BA tr

aine

d AN

M e

ntitle

d to

rece

ive

the

ince

ntive

of `

300

per

case

whe

n sh

e co

nduc

ts b

eyon

d 3

deliv

erie

s per

mon

th.

That

m

eans

, ` 3

00 p

er d

eliv

ery

from

4th

del

iver

y on

war

ds a

nd a

dditi

onal

` 5

0 fo

r PPI

UCD

inse

rtion

per

case

for e

ach

deliv

ery.


RMN

CH +

A Th

emati

c Ar

ea: M

ater

nal

Heal

th, N

ewbo

rn H

ealth

& R

epro

ducti

ve H

ealth

PBI I

ndic

ator

Elig

ibili

ty C

riter

ia fo

r th

e PB

IPe

rfor

man

ce ta

rget

s Ex

istin

g in

centi

ve

Amou

nt o

f in

centi

ve

prop

osed

Sour

ce

of d

ata

verifi

catio

n

Addi

tiona

l Ve

rifica

tion

appr

oach

es to

trac

k an

d va

lidat

e re

sults

Prop

ortio

nof

Institutio

nal

deliv

erie

s at

APHC

S/PH

Cs

desig

nate

d as

de

liver

y po

ints

(DPs)con

ducti

ng

>15*

deliveries/

mon

th

SBAs

pos

ted

at A

PHC/

PHC(excluding

BPH

C)

desig

nate

d as

DPs

in

184HP

Ds*

SBAen

titledtore

ceivetheincenti

ve

of `

300

per

cas

e w

hen

she

cond

ucts

m

ore

than

15

deliv

erie

s per

mon

th.

Thismea

nssh

ewillgetth

eincenti

ve

from

16thde

liveryon

wards.She

shou

ldensure:m

inim

um48ho

ur

stayfo

rthe

mothe

r,useofsa

febirth

checklistfo

radh

eren

ceto

qua

lity

stan

dards,Zerodo

sevaccina

tionfor

BCG,OPV

and

Hep

Bfo

rnew

born,

functio

nalN

BCC.In

add

ition

,ANMwill

beenti

tledfora

nad

ditio

nal `

50for

PPIUCD

insertion

percasefrom

16th

case

onw

ards

.

Nil

` 30

0 pe

r del

iver

y from

16th

del

iver

y on

war

ds a

nd

additio

nal `

50

per

caseofP

PIUCD

from

16th

del

iver

y on

war

ds in

a

mon

th.

• M

CTS

•Fa

cilit

y re

cord

s

•M

O o

r any

de

signa

ted

bloc

k/di

stric

t lev

el

supe

rviso

ryofficer

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ock

mon

itorin

g vi

sits

Leve

l of i

ncen

tive:

APH

C/PH

C(excluding

BPH

C)se

rviceproviderte

am–SBA

traine

dAN

M/SNand

herassistan

t/supp

ortstaff.

Pre-

requ

isite

: ANM/Staff

Nursem

ustb

eSB

Atraine

dan

dbe

also

traine

dan

dcertifie

d(bystate/ap

proved

training

cen

tre)to

provide

PPIUCD

asp

ernati

onalguide

lineby

due

auth

ority

.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:

Incenti

vewillbedisbursedon

aqua

rterlybasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

*For

HPD

s of

8 N

orth

-eas

t sta

tes

incl

udin

g Si

kkim

: SBA

trai

ned

ANM

will

be

entit

led

to re

ceiv

e th

e in

centi

ve o

f ` 3

00 p

er c

ase

whe

n sh

e co

nduc

ts b

eyon

d 10

del

iver

ies

per m

onth

. Th

at m

eans

, ` 3

00 p

er d

eliv

ery

from

11th

del

iver

y on

war

ds a

nd a

dditi

onal

` 5

0 pe

r cas

e of

PPI

UCD

from

11th

del

iver

y on

war

ds in

a m

onth

.


RMN

CH +

A Th

emati

c Ar

ea: M

ater

nal

Heal

th, N

ewbo

rn H

ealth

& R

epro

ducti

ve H

ealth

PBI I

ndic

ator

Elig

ibili

ty C

riter

ia

for t

he P

BIPe

rfor

man

ce ta

rget

s Ex

istin

g in

centi

ve

Amou

nt o

f in

centi

ve p

ropo

sed

Sour

ce o

f dat

a ve

rifica

tion

Addi

tiona

l Ver

ifica

tion

appr

oach

es to

trac

k an

d va

lidat

e re

sults

Prop

ortio

nof

Institutio

nal

deliv

erie

s at

CHC

s (Non

FRU

)cond

uctin

g50

*de

liveries/

mon

th

SBAs

pos

ted

at

CHC(Non

FRU

)de

signa

ted

as D

Ps

in184

HPD

s*

SBAen

titledtore

ceivetheincenti

ve

of `

300

per

cas

e w

hen

she

cond

ucts

m

ore

than

50

deliv

erie

s per

mon

th.

Thismea

nssh

ewillgetth

eincenti

ve

from

51st

del

iver

y on

war

ds. S

he

shou

ldensure:m

inim

um48ho

ur

stayfo

rthe

mothe

r,useofsa

febirth

checklistfo

radh

eren

ceto

qua

lity

stan

dards,Zerodo

sevaccina

tionfor

BCG,OPV

and

Hep

Bfo

rnew

bornand

afunctio

nalN

BCCatth

efacility.

In a

dditi

on, A

NM

will

be

entit

led

for

` 50

for P

PIU

CD in

serti

on p

er c

ase

from

51st

cas

e on

war

ds.

Nil

` 30

0 pe

r del

iver

y from

51st

del

iver

y on

war

ds a

nd

additio

nal `50for

PPIUCD

insertion

pe

rcasefrom

51st

ca

se o

nwar

ds.

•M

CTS

•Fa

cilit

y re

cord

s

•Bl

ock

mon

itorin

g vi

sits

•MCT

FCfo

rPPIUCD

Cont

ext: Streng

then

ingCH

Cfunctio

ning

atthe

periphe

rywou

ldhelpinre

ducing

highcaselo

adin

clud

ingno

rmaldeliveriesa

ttertia

ry/referralcen

tresand

unn

ecessary

referrals.The

propo

sedincenti

vewou

ldm

otivateexisting

SBA

stoprovidequ

ality

deliveryservicesatC

HCleveland

helpinre

ducti

onofo

vercrowding

attertia

ry/referral

cent

res.

Leve

l of i

ncen

tive:CHC

(Non

FRU

)serviceprovide

rtea

m–M

edicalOfficera

ndSBA

traine

dAN

M/StaffNurse(w

hoactua

llycon

ductdeliveries)and

herassistan

ts/

clea

ning

staff

.

Pre-

requ

isite

:ANM/StaffNursem

ustb

eSB

Atraine

dan

dbe

also

traine

dan

dcertifie

d(bystate/ap

proved

training

cen

tre)to

provide

PPIUCD

asp

ernati

onalguide

lineby

due

auth

ority

.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

: Incenti

vewillbedisbursedon

qua

rterlybasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.

*For

HPD

s of 8

Nor

th-e

ast s

tate

s inc

ludi

ng S

ikki

m: S

BA tr

aine

d AN

M w

ill b

e en

title

d to

rece

ive

the

ince

ntive

of `

300

per

cas

e w

hen

she

cond

ucts

bey

ond

20 d

eliv

erie

s pe

r mon

th.

That

mea

ns, `

300

per

del

iver

y fr

om 2

1st d

eliv

ery

onw

ards

and

add

ition

al `

50

per c

ase

of P

PIU

CD fr

om 2

1st d

eliv

ery

onw

ards

in a

mon

th.


RMN

CH +

A T

hem

atic

area

: Mat

erna

l Hea

lth

PBI I

ndic

ator

Elig

ibili

ty C

riter

ia fo

r th

e PB

IPe

rfor

man

ce ta

rget

s Ex

istin

g in

centi

veAm

ount

of i

ncen

tive

prop

osed

Sour

ce

of d

ata

verifi

catio

n

Addi

tiona

l Ve

rifica

tion

appr

oach

es to

tr

ack

and

valid

ate

resu

lts

Prop

ortio

nof

C-secti

onsp

er

mon

thatS

ub-

dist

rict C

HC/

FRUs.

EmergencyObstetric

Care(E

mOC)te

amat

Sub-distric

tCHC

/FRU

at

184

HPD

s.

EmOCteam

enti

tledtore

ceive

` 30

00

perC

-sectio

nbe

yond

5C-sectio

ns

per m

onth

. Thi

s mea

ns te

am w

ill g

et

incenti

vefrom

6thC-sectio

non

wards.

Theteam

shou

ldadh

eretoinfecti

on

preven

tionprotocolsa

sperM

NHToolkit.

Nil

`30

00perC-sectio

nbe

yond

5C-sectio

nsper

mon

th.

•Fa

cilit

y re

cord

s

•HM

IS

Bloc

k m

onito

ring

visit

s

Cont

ext: Provision

ofC

-sectio

nservicesisahighim

pactcriti

calcom

pone

ntofcom

preh

ensiv

eem

ergencyob

stetric

careman

agem

enta

ndin

dicativ

eofqua

lityofEmOC.

Thisincenti

veaim

stomoti

vateand

retainth

eexisti

ngEmOCteam

sworking

inHPD

sand

increa

seprovisio

nofC-sectio

natSub

-distric

tFRU

ssothatwom

enhave

improved

and

timelyaccessto

com

preh

ensiv

eem

ergencyob

stetric

care.

Leve

l of i

ncen

tive:Sub

-distric

tFRU

-EmOCteam

includ

ingOBG

YNsp

ecialist,an

aesthe

tist,pa

ediatrician,staff

nurse,O

Tassis

tant,grade

IVstaff

.Distrib

ution

ofcashbe

nefitsa

mon

gtheteam

und

erth

isincenti

vewou

ldbede

cide

dbyth

estate.

Pre-

requ

isite

: OBG

YNsp

ecialisto

rserviceprovide

rmustb

etraine

dan

dcertifie

d(bystate/ap

proved

training

cen

tre)to

provide

EmOC,LSA

Sservicesasp

ernati

onal

guid

elin

e.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

: Incenti

vewillbedisbursedon

mon

thly/qua

rterlybasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

ed

byth

ede

signa

tedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.


RMN

CH +

A T

hem

atic

area

: Mat

erna

l Hea

lth

PBI I

ndic

ator

Elig

ibili

ty C

riter

ia fo

r th

e PB

IPe

rfor

man

ce ta

rget

s Ex

istin

g in

centi

veAm

ount

of i

ncen

tive

prop

osed

Sour

ce

of d

ata

Addi

tiona

l Ve

rifica

tion

appr

oach

es to

tr

ack

and

valid

ate

resu

lts

Prop

ortio

nofC-sectio

ns

per m

onth

at

Dist

rict

Hospita

lFRU

s.

EmOCteam

at

Distric

tHospitalFRU

at

184

HPD

s

EmOCteam

enti

tledtore

ceive

` 30

00

perC

-sectio

nbe

yond

10C-se

ction

spe

rmon

th(o

nlyup

to20%

C-sectio

ns

ofto

tald

eliveries).Thism

eanste

am

willgetin

centi

vefrom

11thC-secti

on

onw

ards

.

The

team

shou

ld a

dher

e to

infe

ction

pr

even

tion

prot

ocol

s as p

er M

NH

Tool

kit.

Nil

` 30

00perC-sectio

nbe

yond

10C-secti

ons

per m

onth

(onl

y up

to

20%C-sectio

nsoftotal

deliv

erie

s)Ho

wev

er, C

-sec

tions

ca

nnot

be

deni

ed fo

r an

y cl

ient

whe

re th

ere

is cl

ear i

ndic

ation

s of

C-se

ction

.

•Fa

cilit

y re

cord

s

•HM

IS

Bloc

k m

onito

ring

visit

s

Cont

ext:

Provision

ofC

-sectio

nservicesisahighim

pactcriti

calcom

pone

ntofcom

preh

ensiv

eem

ergencyob

stetric

careman

agem

ent.TimelyavailabilityofC-sectio

nhe

lpsin

redu

cing

preventab

lem

aterna

lmortalityan

dmorbidity.Thisincen

tiveaimstomoti

vateth

eEm

OCteam

sworking

inHPD

sand

increa

sesp

rovisio

nofC-sectio

natDistric

tHo

spita

ls so

that

wom

en h

ave

impr

oved

acc

ess t

o co

mpr

ehen

sive

emer

genc

y ob

stet

ric c

are.

Leve

l of i

ncen

tive:

Distric

tHospitalFRU

-Em

OCteam

includ

ingOBG

Yspecialist,an

aesthe

tist,pa

ediatrician,staff

nurse,O

Tassis

tant,grade

IVstaff

.Distrib

ution

ofcashbe

nefitsa

mon

gtheteam

und

erth

isincenti

vewou

ldbede

cide

dbyth

estate.

Pre-

requ

isite

:OBG

YNsp

ecialisto

rserviceprovide

rmustb

etraine

dan

dcertifie

d(trainingcentrecertifi

ed/a

pprovedbyGoI)toprovideEm

OC,LSA

Sservicesasp

er

natio

nalguide

line.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:Incenti

vewillbedisbursedon

mon

thly/qua

rterlybasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

ed

byth

ede

signa

tedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.


RMN

CH +

A th

emati

c ar

ea: N

ewbo

rn H

ealth

PBI I

ndic

ator

Elig

ibili

ty

Crite

ria fo

r th

e PB

I

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of

ince

ntive

pr

opos

ed

Sour

ce o

f dat

aAd

ditio

nal

Verifi

catio

n ap

proa

ches

to tr

ack

and

valid

ate

resu

lts

Prop

ortio

nofBed

oc

cupa

ncy

and

Neo

nata

l mor

talit

y rateatS

NCU

SNCU

team

at

184

HPDs

SNCU

team

enti

tledtore

ceive

` 25

000

perm

onthwhe

nSN

CUsrecordabe

doccupa

ncy>70

%,inbo

rnadm

issionrate

shou

ldnotexcee

d40

%and

neo

natal

mortalityshallb

e<1

5%

Nil

` 25

000

per

mon

thSN

CUre

cords

Bloc

k m

onito

ring

visit

s

Cont

ext: Facilityba

sedne

wbo

rncareinclud

ingsetting

upofSpe

cialNew

bornCareUnits(S

NCU

s)to

caterto

thene

edso

fsick,verylowbirthweigh

tand

pre-te

rm

newbo

rnisaflagshipprogram

meun

derN

HM.C

urrently84SN

CUsa

refu

nctio

nalinthe18

4HP

Ds.The

incenti

veaim

stoen

hancethequ

ality

functio

ning

ofS

NCU

sand

en

courage/moti

vateSNCU

team

sworking

inHPD

s

Leve

l of i

ncen

tive:

SNCU

serviceproviderte

am-M

O,SNand

supp

orttea

mDi

strib

ution

of c

ash

bene

fits a

mon

g th

e te

am u

nder

this

ince

ntive

wou

ld b

e de

cide

d by

the

stat

e.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:Incenti

vesw

illbepa

idonqu

arterly

basis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.


RMN

CH +

A th

emati

c Ar

ea: M

ater

nal,

New

born

& C

hild

Hea

lth

Pbi

Indi

cato

rEl

igib

ility

Cr

iteria

for

the

PBI

Perf

orm

ance

targ

ets

Exis

ting

ince

ntive

Am

ount

of i

ncen

tive

prop

osed

Sour

ce o

f dat

aVe

rifica

tion

appr

oach

es to

trac

k an

d va

lidat

e re

sults

Com

posit

e in

dica

tor a

t Su

b-Ce

ntre

leve

l

ANM

, ASH

A AW

Ws a

t Su

b-Ce

ntre

leve

l in

184

HPDs

1.Early

ANCregistratio

nwith

in12wee

ks

->80

%pregn

antw

omen

outoftotal

regi

ster

ed

2.Four(4

)ANCcheck-up

->8

0%of

pregna

ntwom

enoutoftotalre

gistered

3.Exclusivebrea

stfee

ding

for6

mon

ths

>75%

forinfan

ts(>

6mon

ths),

4.

Com

mun

ity a

war

enes

s lev

el a

bout

use

ofORS

inDiarrho

ea,growthm

onito

ring

ofalltheeligiblechildrenasperM

CP

cards>

90%

5.Co

mpletevaccinati

onofthe

children

upto

1yea

r>80

%

6.

Awar

enes

s abo

ut th

e da

nger

sign

s du

ringpregna

ncy>95

%

7.>2

0%ofd

eliveriesinAN

MSub

-Cen

tre

area

havingPP

IUCD

insertion

Nil

`50

00perSub

-Cen

trepe

ran

numifth

eyachieved

targetso

f1st to

6th

in

dica

tors

.

In a

dditi

on to

the

abov

e in

centi

ves,

team

will

get

ad

ditio

nal `

100

0 pe

r an

num

if th

ey a

chie

ve th

e ta

rget

s for

the

indi

cato

r nu

mbe

r 7

•AN

M, A

SHA

and

AWW

re

cord

s

•M

CTS

•Feed

backfrom

be

neficiarie

sthroug

hfie

ld

visit

s/ca

lls

•Bl

ock

mon

itorin

g vi

sits

•Ra

ndom

verifi

catio

n(20%

)of

bene

ficiarie

sth

roug

h M

CTFC

Cont

ext: Su

b-Ce

ntreisth

efirstpointofcon

tactwith

pub

lichea

lthse

rvicede

liverysystem

.Stren

gthe

ning

Sub

-Cen

trelevelfun

ction

ingwou

ldlead

toim

proved

service

deliverytoth

ecommun

ityth

roug

hbo

thfa

cilityan

dou

trea

chapp

roache

s.Encou

raging

tea

mworkam

ongthefron

tline

workersand

moti

vatin

gthem

forb

etter

performan

cesisk

eyto

enh

ancedserviceprovision

asw

ellasu

tilisa

tionbycom

mun

itiesespeciallywom

enand

children.

Leve

l of i

ncen

tive:

Sub

-Cen

treteam

(ANM,A

WWand

ASH

A)Di

strib

ution

of c

ash

bene

fits a

mon

g th

e te

am u

nder

this

ince

ntive

wou

ld b

e de

cide

d by

the

stat

e.

Perio

d of

per

form

ance

and

freq

uenc

y of

PBI

:Incenti

vesw

illbepa

idonan

nualbasis.Paymen

twillbeprovided

whe

n(orw

ithhe

ldunti

l)repo

rted

perform

ance/achievemen

tsareobjectiv

elyverifi

edbythe

desig

natedsupe

rviso

rs,d

esigna

tedbyth

eState/Distric

tofficialso

ranyequ

ivalen

tofficersin

clud

ingreview

ofq

ualityofse

rvicesprovide

d.

lR;eso t;rs

Maternal Health Division

Ministry of Health & Family Welfare

Government of India

With Support from

other RCH Divisions 2014

RMNCH+A: IllustrativePerformance Based Incentives for

High Priority Districts (HPDs)

performance based incentives for high priority districts

Documents