this is a ppt related to finance..

1. Kavita Singh, Director -Finance
National Health
Mission (NHM)

2. Need of Investment in Public Health
• Healthcare spending in India for 2014 is about 4.7% of its GDP.
• Of this Government Health Expenditure (GHE) is 30%. A
majority, 62% of healthcare expenditure is Household out of
pocket (OOPE).
• Nearly 55 million people getting impoverished on account of
health care expenditure.
• India ranks a low 175/188 in OOPE and 154/185 in terms of
Public Health Expenditure out of Total Current Health
Expenditure in 2015.
• Increase health expenditure by Government as a percentage of
GDP from the existing 1.15% to 2.5 % by 2025 (NHP 2017).
Source: Health financing indicators for India 2014; Global Health Expenditure Data Base (GHED), World Health Organization

3. Health Policy -2017
•New Health Policy 2017 emphasizes the proposed
Health Financing -
• Increase health expenditure by Government as a
percentage of GDP from the existing 1.1 5 % to 2.5 %
by 2025.
• Increase State sector health spending to > 8% of their
budget by 2020.
• Decrease in proportion of households facing
catastrophic health expenditure from the current levels
by 25%, by 2025.
Source: New Health Policy 2017

4. Year wise Expenditure to achieve 2.5% of GDP
(Rs. In Lakh Crore)
Year
% of
expenditure
GDP assuming
@7.5% at current
prices of 2017-18
GDP with Rate
of Inflation
@4%only
Expenditure
on Health (%
of GDP)
32% of
Expend. for
Centre
68% of
Expend. for
State
1 2 3 4 5=4*2 7 8
2017-18 1.20% 166.28 172.93 2.08 0.66 1.41
2018-19 1.20% 178.75 185.90 2.23 0.71 1.52
2019-20 1.27% 192.15 199.84 2.54 0.81 1.73
2020-21 1.45% 206.56 214.83 3.11 1.00 2.12
2021-22 1.70% 222.06 230.94 3.93 1.26 2.67
2022-23 1.95% 238.71 248.26 4.84 1.55 3.29
2023-24 2.20% 256.61 266.88 5.87 1.88 3.99
2024-25 2.50% 275.86 286.89 7.17 2.30 4.88
Source: GDP of 2017-18, as per Economic Survey, Vol.II for the year 2017-18 .

5. Particulars
12th Plan
Approved
Outlay
12th Plan Actual
Budgetary Allocation
BE
(2018-19)
BE
(2019-20)
NHM
(NRHM+
NUHM)
1,93,405.71 91,022.82
(47.06% of 12th Plan
Outlay)
25,155.00
(15.6 % increase over
last BE)
26,945.00
(7% increase over last
BE)
Total
(DoHFW-
NHM +
Health)
2,68,551.00
(Depart of
H&FW)
1,29,150
(48.09% of 12th Plan
Outlay)
52,800.00
(11.5% over last BE)
61,398.12
(16% increase over last
BE)
Rs. in Crore
Allocation –DoHFW
# New Streams of Health Financing –
Health & Education Cess - Existing 3% education Cess to be replaced by 4% health
and education cess.
Higher Education Funding Agency (HEFA) to be restructured to fund infrastructure
and research in medical Institutions.
India Infrastructure Finance Corporation Limited (IIFCL) will be utilized to raise
funds for Health Projects.

6. Department
B.E.
2018-19
B.E.
2019-20
Health 20671.00 23,097.12
NHM 25154.00 26,945.00
RSBY 2,000.00
156.00
PMJAY 6400.00
HRH & Medical
Education
4,225.00 4250.00
Tertiary Care Programme 750.00 550.00
Annual Budget 52,800.00 61,398.12
Rs. in Crore
Department-wise Budget Estimate (Gross) 2018-19

7. Strengthen hands of the State Governments in improving health care
delivery by providing technical and financial support.
Architectural correction through integration of vertical programmes,
decentralization and communitization.
To bring greater focus on high focus States and rural population,
particularly marginalized and vulnerable population.
National Rural Health Mission (NRHM) launched on 12th
April, 2005

8. To strengthen the existing primary health care facilities and provide
new facilities for the un-served population.
Strengthening facilities in urban area in term of infrastructure,
equipment and manpower.
1057 cities and towns covered.
National Urban Health Mission (NUHM) launched on
1st May, 2013

9. “Attainment of Universal Access to Equitable,
Affordable and Quality health care services,
accountable and responsive to people’s needs,
with effective inter-sectoral convergent action to
address the wider social determinants of
health”.
National Health Mission - Vision

10. NATIONAL HEALTH MISSION
Flexible Pools under NHM

11. National Health Mission (NHM)
NCD Pool
Infrastructure
Maintenance
NRHM –Flexible pool-
(I) RCH Pool
(II) Health System
Strengthening
Pool
(i) Other Health
System Strengthening
(ii) Comprehensive
Primary Health Care
(iiI) ASHA Benefit
Package including
social benefits
NRHM
`
Health System Strengthening- includes components -- NPCD, NOHP, Burns &
Trauma, NPCF and other New Initiatives under NCD
NUHM
Communica
ble Disease
Pool
2 Sub-Missions
Health System
Strengthening
Comprehe
nsive
Primary
Health
Care

12. NATIONAL HEALTH MISSION - COMPONENTS
NRHM- RCH
Pool
National Urban
Health Mission
 RCH Flexipool-
• RMNCH + A - Reproductive, Maternal, Neonatal, Child &
Adolescent Health.
• Immunization- Routine Immunization & Pulse Polio
Immunization.
• NIDDCP- National Iodine Deficiency Disorder Control
Programme
 Health System Strengthening – ASHAs, Human Resources including
AYUSH, Mobile Medical Units, Referral Transport, Free Drugs & Free
Diagnostics, Biomedical Equipment Management, Quality Assurance
& Kayakalp, Infrastructure, etc.
• To strengthen the existing primary health care facilities and provide
new facilities for the un-served population in urban areas & urban
poor. Major components Planning & Mapping, Programme
Management, Training, Human Resources, Community process.

13. NATIONAL HEALTH MISSION - COMPONENTS
Communicable
Diseases Pool
Infrastructure
Maintenance
• RNTCP – Civil Works, Laboratory materials for testing etc.
• NVBDCP- Malaria, Dengue, AES etc.
• NLEP- HR, Mobility support
• IDSP- HR, Mobility support
• NVHCP-National Viral Hepatitis Control Programme, Drugs
• To meet salary requirement of Auxiliary Nurse Midwives
(ANMs) and the Lady Health Visitors (LHVs) etc.
Non
Communicable
Diseases Pool
• National Prog. For Prevention & Control of Cancer, Diabetes,
Cardiovascular Diseases & Stroke (NPCDCS)
• National Prog. for Control of Blindness (NPCB).
• National Mental Health Prog.(NMHP)
• National Tobacco Control Prog. (NTCP)
• National Prog. for Health Care of Elderly (NPHCE)

14. Progress

15. National Health Mission
(NHM)
Two Sub Missions
(NRHM &NUHM)
Progress under NHM
Central Grants of Rs.222,114 Crore has been
released to strengthen Health System under NHM.
The States have contributed Rs.64,647 crore
towards State share under NHM in the 60:40/90:10
ratio.
Total funds of Rs. 286,761 crore was made available
till 2018-19.
Financial Progress under NHM

16. PLAN WISE ALLOCATION & RELEASE UNDER NHM
Sr. No. Financial Year B.E. R.E.
Central
Expenditure
% Expenditure
against R.E.
1 10th FYP (2 years) 15,424 13,951 13,771 99%
2 11th FYP 70,030 68,064 66,131 97%
3 12th FYP 1,00,748 91,023 90,184 99%
9 2017-18 21,941
26,110 25,975
99%
10 2018-19 25154
26,118 26,053
100%
Total (NHM) 233,297 225,266 222,114 99%
(Rs. in crore)

17. Absorption capacity of States (Budget Vs Release)
Rs.in crore
6,000
7,951
10,669
11,930
13,378
14,960
17,127
17,000
18,100
17,628 18,295
20,000
26,111
26,118
6,285 7,487
10,380
11,239
13,306
14,696
16,509
16,76318,215 18,038 18,282
18,872
25,975
26,053
0
5,000
10,000
15,000
20,000
25,000
30,000
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016–17 2017–18 2018-19*

18. Proposed Vs. Available Budgetary Outlay for National Health Mission
Sl. No.Name of the Scheme
2018-19
(Proposed)
2018-19
(Approved)
2019-20
(Proposed)
2019-20
(Approved)
1 NRHM-RCH Flexible Pool 16,019.60 15,006.33 22350.00 16,885.73
a
RCH Flexible Pool including RI, PPI and
NIDDP
7,000.00 5253.51 8720.00 5253.51
b Health System Strengthening under NRHM 9,019.60 9752.82 13850.00 11,632.22
2 NUHM -Flexible Pool 1,000.00 875.00 1400.00 950.00
3 Flexible Pool for Communicable Diseases 2,620.40 1928.00 3200.00 1928.00
4
Flexible Pool for Non-Communicable
Diseases, Injury & Trauma
2,000.00 1004.67 3100.00 717.00
5 Infrastructure Maintenance 6,360.00 5693.41 6643.00 6043.52
6 Others including Pilot Projects, NPMU, DR 78.71 373.49 231.00 357.36
10 PMDP For Jammu & Kashmir 273.71 273.71 63.36 63.36
Total 28,352.42 25154.61 36,987.36 26,945.00

19. Need for Enhanced Allocation
Strengthening of Sub Health Centers as Health & Wellness
Centers to provide comprehensive primary care.
Comprehensive Primary Health Care including screening of
common NCD such as Hypertension, Diabetes, common Cancer.
Increasing number of PHCs and CHCs as per IPHS norms and up-
scaling of existing initiatives e.g. strengthening facilities to IPHS
Up- scaling Free Drugs & Diagnostics Scheme.

20. Need for Enhanced Allocation
Need to eliminate TB and Measles
Strengthening of District Hospitals to provide multispecialty care
& Training and e-Hospital Implementation
Universal Health Coverage (UHC) Pilots
Scaling up of new life saving vaccines
Budgetary provision for Diagnosis, Treatment and e-health
initiatives
Strengthening of Drug regulatory system in the country

21. ALLOCATION FOR 2019-20 UNDER DIFFERENT POOLS OF NHM
Sl. No. Name of the Flexible Pools
Allocation
(Rs.in crore)
% of Allocation
A NRHM-RCH Flexible Pool 16,885.73 63%
1
RCH Flexible pool including Routine Immunization, Pulse Polio Immunization,
National Iodine Deficiency Disorders Control Programme etc.
5,253.51 19%
2 Health System Strengthening under NRHM 11,632.22 43%
B National Urban Health Mission-Flexible Pool 950.00 4%
C. Flexible Pool for Communicable Diseases 1,928.00 7%
D. Flexible Pool for Non-Communicable Diseases, Injury & Trauma 717.00 3%
E. Infrastructure Maintenance 6,043.41 22%
F.
Misc. Programme
(NPMU, Pilot projects, SDRS, PMDP etc.)
420.86 2%
Grand Total
26,945.00

22. ALLOCATION FOR 2019-20 UNDER NHM
19%
43%
4%
7%
3%
22%
2% RCH Flexible pool
Health System Strengthening
under NRHM
National Urban Health Mission-
Flexible Pool
Flexible Pool for Communicable
Diseases
Flexible Pool for Non-
Communicable Diseases, Injury
& Trauma

23. ACTIVITY-WISE APPROVALS UNDER NRHM-RCH FLEXIBLE POOL 2018-19
S.No RCH Flexible Pool Activities
Amount(Rs. in
Lakhs) %
1 Maternal Health (including JSY & JSSK) 329,436.45 40.28
2 Programme / NRHM Management Cost 229,498.43 28.06
3 Family Planning 93,243.92 11.40
4 RBSK 74,261.74 9.08
5 Training 50,390.50 6.16
6 Child Health (including JSSK) 32,419.32 3.96
7 Adolescent Health / RKSK 5,132.68 0.63
8 Tribal RCH 1,518.55 0.19
9 Vulnerable Groups 816.57 0.10
10 PNDT Activities 1,238.45 0.15
TOTAL 817,956.62 100

24. ACTIVITY-WISE APPROVALS UNDER NRHM-RCH FLEXIBLE
POOL 2018-19
Maternal Health (including
JSY & JSSK)
40%
Programme / NRHM
Management Cost
28%
Family Planning
12%
RBSK
9%
Training
6%
Child Health (including JSSK)
4%
Adolescent Health / RKSK
1%
Tribal RCH
0% Vulnerable Groups
0%
PNDT Activities
0%

25. ACTIVITY-WISE APPROVALS UNDER HEALTH SYSTEM
STRENGTHENING POOL 2018-19 (in descending order)
S.No. Activity
Amount
(Rs. in Crore)
%
1 Human Resources 9471.33 0.62
2 PROCUREMENT 527871.46 34.55
3 ASHA 248867.42 16.29
4 Hospital Strengthening 192092.83 12.57
5 National Ambulance Service 111052.46 7.27
6 UF/AMG /RKS 119635.08 7.83
7 Planning, Implementation and Monitoring 112270.49 7.35
8 IEC-BCC NRHM 64629.85 4.23
9 Innovations 40320.57 2.64
10 National Mobile Medical Vans 25324.28 1.66
11 PPP/ NGOs 69686.22 4.56
12 Other Expenditures 3317.14 0.22
13 Drug Ware Housing 3219.97 0.21
14 Mainstreaming of AYUSH 229.22 0.02
Total 1527988.33 100

26. NHM PLANNING PROCESS

27. PIP Guidelines and
resource envelopes
Based on State
priorities and PIP
guidelines
Divisions examine PIP
and share
comments/
recommendations
MOHFW holds pre
appraisal meeting/
consultation with
States to obtain
details
Consolidated
comments received
from all divisions
States/UTs to submit
revised PIP based on
discussions during
pre-appraisal/1st Draft
comments
Revised proposals
accepted only on
sections where
additional information
has been sought.
NPCC meetings
PIPs appraised in NPCC
meetings as per the
Resource Envelope of
States and ROPs issued
accordingly
Communicated to States States submit Draft PIP
When States/UTs do not respond to
request of supporting details
Communicated to States/ UTS
To be circulated to Divisions

28. BOTTOM -UP APPROACH FOR PLANNING
Gram
Panchayat
Gram
Panchayat
Gram
Panchayat
Gram
Panchayat
Gram
Panchayat
CHC/PHC CHC/PHC CHC/PHC CHC/PHC
Block Block Block
District District
State
Integrate
Integrate
Integrate
Integrate
Block Health
Action Plan
District Health
Action Plan
State Programme
Implementation Plan
Inputs from Gram
Panchayat level and
CHC/PHCs

29. Financial implications
Total Resource envelope
Unspent
balance
Central
Share
State
Share

30. RESOURCE ENVELOPE
 Unspent balance (Committed & Un-committed) at the
beginning of the Year
 Central (GOI) Allocation to the States/UTs
--80% (assuming no reduction on account of fulfillment of
conditionalities) and
--20% for Incentives
 State Share 40% or 10% (NE and Hilly States)
Less: Committed Un-spent Balance for validation
Net Resource Envelope Available for Fresh Approvals
From FY 2019-20, Separate proposals are asked on unspent balances
as supplementary proposals

31. WEIGHTAGE FOR ALLOCATION OF FUNDS
Population of Each State is given a weightage as
under:
NE and 3 Hilly States (H.P., J&K & Uttrakhand) (11) : 3.2
Small UTs : (4)
(Lakshadweep, Daman & Diu, D& N Haveli & Andaman) : 3.0
EAG States, Except Chhattisgarh, Jharkhand (5) : 1.3
Chhattisgarh & Jharkhand (2) : 1.5
All other States/UTs (14) : 1.0

32. BASIS OF CENTRAL ALLOCATION TO STATES/UTS
Name of the Pool Basis of Allocation
RCH Flexible Pool 75% Total population & 25% Rural area
Mission Flexible Pool now Health Systems
Strengthening
75% Rural Population & 25% Rural Area
National Urban Health Mission (NUHM)
Flexible Pool
50% weightage on Urban Population & 50% weightage
on slum population
(Covering Cities in State Capital and Distt. HQ with Population 30,000
and Other Cities with 50,000 & above population) – 1000 + Cities
Flexible Pool for Communicable Disease Disease burden basis
Flexible Pool for Non-Communicable Disease 75% Total population & 25% Rural area

33. COMMITTED & UN-COMMITTED BALANCE
Committed Unspent Balance comprises of ----
(i) All advances given to Subsidiary Units, Implementing Agencies,
(ii) Work orders issued for any work but not paid (such as Procurements,
Civil Works etc.)
(iii) Any other activity committed for implementation but not initiated
during the current financial year e.g. ASHA’s, Training, JSY, JSSK.
 All such activities need to be revalidated for expenditure in the next
financial year.
 No fresh approvals is required for these activities.
 These Committed activities are against the ROP approvals already given.

34. COMMITTED & UN-COMMITTED BALANCE
Uncommitted Unspent Balance :
Unspent Balance remained for those activities which could not be
commenced in the current financial year and expected not to be utilized
further.
The unspent balance assigned under the pools for expenditure becomes
free for fresh approval in the next financial year .
Letter on disclosure of Unspent Balances though Supplementary
PIPJS P letter on USB.pdf for 2019-20 have been issued
JS P letter on USB.pdf

35. FUNDING PATTERN UNDER NHM
• From F.Y. 2015-16, keeping in view of the recommendation of 14th
Finance Commission the Centre- State funding pattern has been
revised to 60: 40 from 75:25 in all States excluding NE & 3 Hill
States where it is 90:10.
• All UTs are 100% Centrally funded except Delhi & Puducherry.
• Incentive Pool of 20% of Central allocation has been created from
2018-19 to be effected from 2019-20 on the basis of
conditionalities of 2018-19.

36. FLEXIBILITIES UNDER NHM
A. In–built flexibility as PIPs are proposed by States.
B. Utilise the amount of matching State share under any of the
programme /schemes under any of the flexible pools of NHM as
per the need of the State.
C. Under Infrastructure Maintenance (IM), 100% releases are
made by way of reimbursement on the basis of ASE and
instalment payment made towards salary, therefore the State
share accrued under IM can be used as per the discretion of the
State.
D. Pay demand based activities, salaries not to be withhold.
Payment can be made from savings available under any pool.

38. Release under NHM
 Two types of Grants in aid are released to States
a) Cash Grant b) Kind Grant
Funds are released in 3 parts ---
 General , Scheduled Caste Sub Plan (SCSP), Scheduled Tribe Sub Plan (STSP).
 All releases are made on the basis of Census Population of 2011.
 Further break up releases in Revenue and Creation of Capital Assets.
Creation of capital assets involved in Health System Strengthening, NUHM and NCD.
Basically where civil construction is involved.

39. CRITERIA FOR RELEASE OF FUNDS
First release of 75% of 80% of B.E.
a) No shortfall under State’s Matching contribution.
b) Provisional UCs of last F.Y.
c) Regular Financial Reporting and Physical Reporting in FMR & SFP
d) Considering the Unspent balance
e) Transfer of fund from Treasury to SHS.
Final release of balance 25% of 80% of B.E
Same as (a) to (e) above.
Receipt of Statutory Audit Report and Audited UC
Ensure the increase in State Health Budget by 10% over last year.
20% of funds under Flexi Pools have been earmarked towards
Incentivization of States/Uts.

40. New Initiatives
•Single Bank Account to avoid parking of funds and
better financial utilisation.
•National Consultation with Banks for finalisation
of RFP has been held and is in the process of
dissemination.
•Dash Board is being developed in support of NIC
for online booking of expenditure in FMR from
peripheries.
40

41. Cost Benefits & Cost Control Practices
Cost Control Mechanisms in NHM Context:
• Procurements through Competitive Bidding
• Differential Financing under Untied funds, Referral Transport etc.
• Need based procurements.
• Centralized procurement of medicines through bulk purchases.
• Single bank account system to avoid loss of interest.

42. Auditing under NHM
• Performance Audit under NHM by CAG
• Statutory Audit by CAG empanelled major CA Audit firms.
(Mandate – 100% for DHS and 40% for Blocks)
• Concurrent Audit by CA Audit firms on monthly basis.
However, reports to be issued on quarterly basis.
(100% for all Blocks)
• IPAI Audit for selected States.
• Internal Audit.

43. Critical Observations
Avoid parking of funds as that would hamper the implementation.
 Not to include the Bank balances of Non-NHM Schemes such as
Finance Commission, NABARD, State Health Schemes as that would
make the overall balance under NHM heavier in the Balance sheet and
leading to CAG’s observation on high unspent balance with State Health
Societies.
Prohibit the diversion of NHM funds to State run health schemes.

44. Critical Observations
Civil works: Rule 351 of PWF&AR provides that the availability of land should
be ensured before awarding the construction work.
Bank accounts needs to be operated by Joint signatories, at least one person
must be regular.
Closure of Non-Operative Banks Accounts.
Mapping of All Banks with PFMS application.
Funds received at SHS , DHS and Blocks need to be transferred immediately
to subsidiary units after considering the unspent balances.

45. Critical Observations
Ensure Compliance of GFR Rules, 2017 for release of funds, procurement of Services,
Goods etc.
 State Finance Rules for Procurement of Services, Goods may be followed.
Temporary loans can be taken and to be returned to original pool on receiving of funds.
Permanent diversion is prohibited.
Regular monitoring of advances with Age wise analysis
Ensure JSY and ASHA Payments through DBT
Ensure submission of Consolidated FMR with Physical achievements on monthly basis
covering all programmes of NHM (including IM)

46. Critical Observations
FMR includes expenditures from each programme and of all levels.
Monitoring and ATR on the findings of the Concurrent Audit and
Statutory Audit.
Plan training programmes on FM within the State and District
Understand and implement the concept of ongoing activities and
issue directions for continuation of such activities after 31st March
without waiting for ROP.
46

47. Critical Observations
Non preparation of Bank Reconciliation Statement (BRS).
Non-maintenance of Fixed Assets Registers.
Splitting of Invoices to avoid competitive bidding – Especially Procurement Processes.
Booking of expenditure without approvals or more than approvals.
Non compliance of procurement procedures.
Books of accounts not closed at year end and interest nor accounted for.

48. Important Communications
Advances to Implementing Agencies for Civil works, Procurements may be
treated as deemed Expenditure for the purpose of Release proposals.
 Refer to D.O. Letters issued from time-to-time providing instructions/
guidelines – such as Banking Arrangement, Temporary diversion of funds,
non- holding of committed liabilities etc.
Refer D.O. letters on separate reporting of expenditure given under Tribal
Sub Plan (TSP). etc.

49. CHALLENGES
Compliance of DOE conditionalities on just in time basis
Ensure to receive funds from State Treasury to SHS within 15 days of
transfer.
Fulfillment of ROP conditionalities to earn Incentives.
Increase in Health Budget at least by 10% over last year.
Improve the pace of utilization to avail the full Central Grant.

50. CHALLENGES
 Timely submission of Audited UCs
 Submission of Certified Audited Expenditure on time to claim
arrears under IM.
 Contribution of Matching State Share simultaneously with Central
Grants including IM
 Statutory Audit Report to be approved by Governing Body.
 Also laying of Audit Report in the house of State Legislative Assembly.

51. CHALLENGES
Timely appointment of Auditor (Statutory and Concurrent Audit)
Sharing of Concurrent Audit Summary with the Ministry.
Creation of Internal control team to monitor the progress on Civil works,
HR placement , Procurements etc.
Review of Financial progress on regular basis against the monitorable
indicators.

52. CONDITIONALITIES
FRAMEWORK: 2018-19

53. Conditionality Incentive/penalty
Source of
verificatio
n
Incentive/
Penalty
1. Incentive or
penalty based on
NITI Aayog
ranking of States
on ‘Performance
on Health
Outcomes’
Based on the ranking which will measure
incremental changes:
1. States showing overall improvement to be
incentivized
2. States showing no overall increment get no
penalty and no incentive
3. States showing decline in overall
performance to be penalized
(% of incentive/penalty to be in proportion to
overall improvement shown by the best
performing State and the worst performing
State: +40 to -40)
NITI
Aayog
report
+40
to
-40

54. Conditionality Incentive/penalty
Source of
verification
Incentive/
Penalty
2 Ranking of District
Hospitals in terms
of input and
service delivery
At least 75% (in Non EAG) and 60%
(in EAG and NE states) of all District
Hospitals to have at least 8 fully
functional specialties as per IPHS :
10 points incentive
Less than 40% in Non EAG and 30%
in EAG to be penalized up to 10
Points
HMIS and NITI
Aayog DH ranking
report
+10
to
-10

55. Conditionality Incentive/penalty
Source of
verification
Incentive/
Penalty
3 Operationalization
of Health and
Wellness Centers
(HWC)
At least 5% of the total budget to be
proposed for HWC and CPHC. State to
operationalize 15% of SCs and PHCs as
HWCs.
State report
NHSRC report
RHS
+20
to
-20

56. Conditionality Incentive/penalty
Source of
verification
Incentive/
Penalty
4 % districts covered
under Mental
health program
and providing
services as per
framework
75% of the districts covered-10 points
50% of the districts in Non EAG and
40% of the districts for EAG- incentives
6 Points
Less than 40% EAG and less than 50%
Non EAG to be penalized 6 Points
Less than 30% in EAG and 40% in Non
EAG to be penalized 10 Points
Report from
Mental Health
Division
MoHFW
+5
to
-5

57. Conditionality Incentive/penalty
Source of
verification
Incentive/
Penalty
5 % of 30 plus
population
screened for NCDs
15% of 30 plus population screened for
NCDs: 10 Points incentive
7% of 30 plus population screened for
NCDs : 6 Points Incentives
Less than 3% of 30 plus population
screened for NCDs : 6 Point penalty
Less than 2% of 30 plus population
screened for NCDs : 10 Points penalty
(Out of total State population)
Report from
NCD division
MoHFW and
State reports
Any Survey
data available
+5
to
-5

58. Conditionality Incentive/penalty
Source of
verification
Incentive/
Penalty
6 HRIS implementation Ensure implementation of HRIS for
all HRH (both regular and
contractual ) in the State. Salary
invoice and transfer order to be
generated by HRIS. Line listing of all
staff for all facilities to be available.
HRIS data should match with HMIS
reporting. Cases where it does not
state should provide reason and
numbers. +10 to -10 for HRIS
operationalization and +5 to -5 for
synchronization with HMIS State
where data matches: 5 points
HRIS (State)
and HMIS
report
+15
to
- 15

59. Conditionality Incentive/penalty
Source of
verification
Incentive/
Penalty
7 Star rating of PHCs
(both Urban and
rural) based on
inputs and
provision of the
service package
agreed
75% (in Non EAG) and (60% in EAG and
NE) of the PHCs having 3 or more star
rating : 5 Points incentives
50% (in Non EAG) and 40% (in EAG and
NE) PHCs having 3 or more star rating: 2
Points incentive
Less than 40% (in Non EAG) and 30% (in
EAG and NE) of PHCs having 3 or more
star rating to be penalized: 5 Points
HMIS +5
to
-5

60. PFMS

61. PFMS
Public Financial Management System (PFMS) is an application developed by the
Ministry of Finance (CGA) for on line tracking of funds on real time basis.
Continuous refresher trainings and assistance are being provided to States/UTs with
the coordination of PFMS Technical Team for implementation by the Ministry under
NHM.
CGA Office has chosen NHM for EAT Module to implement beyond block level.
CGA office has created SPMU/ Local Chapters in 30 States/UTs to provide support to all
36 States/UTs for the full implementation of PFMS in respective States/UTs.
State wise PFMS Registration Status

62. PFMS -CHALLENGES
• PFMS and Treasury integration is completed in 30 States.
• Inadequate Internet connectivity in North Eastern States and
Rural Areas.
• Integration of Government Tax Agencies on PFMS.
• Complete Accounting Package for Audit Purpose.
• Synchronization of various state run applications with PFMS such
as ASHA Soft, OJAS etc.

64. Health Care Financing
S.No. Indicator
NHA
(2004-05)
NHA
(2013-14)
NHA
(2014-15)
1. Total Health Expenditure (THE) as percent of GDP 4.2 4.0 3.9
2.
Government Health Expenditure as percent of Total
Health Expenditure
22.5 28.6 29.0
3.
Private Health Insurance Expenditure as percent of
Total Health Expenditure
1.6 3.4 3.7
4.
Out of Pocket Expenditure as percent of Total Health
Expenditure
69.4 64.2 62.6