AYUSHMAN BHARATH-PROGRAMME MANAGEMENT INCLUDING SUPERVISION AND MONITORING

1. AYUSHMAN BHARATH
PROGRAMME MANAGEMENT INCLUDING MONITORING AND
SUPERVISION
 Presented by
Mrs Anuradha
Associate Prof
SGCON

2. Programme Management

3. In order to improve the management mechanisms,
following processes would be institutionalized:
 Performance based payments:
❖ Mechanisms of performance linked payments and team-based incentives
would be introduced to improve the performance of the service providers at
HWCs and the overall performance of health systems.
 Use of IT tool for periodic review, supervision and monitoring: Reports
generated and data captured by the IT system should be used during district
and block level monthly meetings to encourage “conversations on data”.

4.  Capacity Building:
❖ Regular capacity building of programme managers at all levels and service providers
through periodic workshops at state and district level should be conducted for refreshing
skills and dissemination of new guidelines and protocols.
 Supportive Supervision:
❖ Monthly visits would be undertaken by the PHC MOIC to the SHC to provide on the job
mentoring and hand holding support. In addition, quarterly review meetings of block nodal
officers at district level and biannual meetings of district nodal officers at the state level
should be planned to act as a forum for performance review and problem solving.
 Social Recognition:
❖ In addition to team-based incentives, annual awards based on pre-defined criteria can be
introduced for Primary Health Care teams as well as individual performers at state and
district level. This would create a sense of social recognition and may enhance the
motivation levels of the Primary Health Care team to improve the performance

5.  Monitoring
❖ The designated programme management team at state and district level
would be responsible for overall monitoring and supervision of the HWCs.
❖ At field level, the block nodal officer oversees the HWC roll out and
monitors the progress made on a monthly basis.
❖ The IT platform would support generation of reports for population-based
indicators and disease surveillance for effective programme monitoring at
block, district and state level.
❖ States should use the existing indicators and data sources for monitoring
till the IT system is able to provide programme specific reports.
❖ In addition to the regular supervision and monitoring by the programme
managers, states can also make the provision for Independent Monitoring
to assess the effectiveness of the programme, evaluate the service delivery
outputs, track improvements in health outcomes or for assessing the
performance of HWCs team for the disbursal of team-based incentives

6.  States can identify technical agencies, public health organizations,
academic institutions and research organizations to serve as
Independent Monitors.
 .

7. The following indicators may be used for monitoring the
HWC services during the first phase
• Out-patient (OP) visits per capita
population in each district/state
• Hospitalization Rate (per 100,000
population) in each district/state
• proportion of families in district who
are registered with a health and
wellness centres
• Four ANC care: Proportion of pregnant
women receiving four ANCs
• SBA assisted delivery rate/
Institutional Delivery Rate:
• Maternal deaths
• Perinatal Mortality Rate
• Under 5 mortality Rate
• Full Immunization Rate
• Rate of patients with chronic
NCDs on regular medication or
other follow up at the HWC
• Case detection rate for tuberculosis

8.  Grievance Redressal Mechanism
 The existing mechanisms for grievance Redressal should be also
extended to cover all services at Health and Wellness Centre. Dial
104 Helpline should be universalised and capture grievances or gaps
relating to HWCs.

9. Community Based Monitoring and Social Accountability
❖ The institutional frameworks set up for Community Based Monitoring and
ensuring social accountability under the National Health Mission would
continue to be strengthened to support the process of CPHC
implementation.
❖ Institutional structures operational for community-based monitoring such
as Village Health Sanitation and Nutrition Committees and Community
Action for Health will monitor delivery of preventive, promotive and
curative service as part of CPHC and will continue to provide relevant
inputs for decentralized health planning. This will support in increasing the
accountability of the primary healthcare system to the Community and
service users.
❖ The facility surveys, preparation of score sheets and wide dissemination of
the results through public hearings and dialogues will also be applicable
for Health and Wellness Centres.

10.  As has been made mandatory for other public health facilities under
NHM, it would be compulsory for all the Health and Wellness Centres to
prominently display information regarding financial support received,
medicines and vaccines in stock, services provided to the patients etc.
 The VHSNCs/MAS facilitated by ASHAs/MPWs-F at the community
level, the Rogi Kalyan Samitis at the facility level and structures for
Community Action for Health would monitor the performance of the
Health and Wellness Centres and other facilities and suggest corrective
measures for improving the performance

11.  All Public Reports on Health at the National, State and the district
levels would report progress made on implementation of
Comprehensive Primary Health Care. States should nominate and
involve Civil Society Organizations, NGOs and other resource
institutions and create a monitoring arrangement to track the
progress, effectiveness and quality of health services.