National Rural Health Mission

A Promise of
Better Healthcare Service for the Poor

A summary of
Community Entitlements
and
Mechanisms for Community Participation and Ownership
For
Community Leaders
Prepared for
Community Monitoring of NRHM - First Phase
 National Rural Health Mission
A Promise of
Better Healthcare Service for the Poor

A summary of

Community Entitlements
and

Mechanisms for Community Participation and Ownership

For

Community Leaders

Prepared for

Community Monitoring of NRHM - First Phase

NRHM
A Promise of Better Healthcare Services For The Poor

Briefing Note Compiled by: Abhijit Das, Gitanjali Priti Bhatia

Illustrations by: Ganesh

Printed at: Impulsive Creations - 9810069086

 NRHM
A Promise of Better Healthcare Services For The Poor

Contents
Preface 04

An Introduction- NRHM 05

Service Guarantees Important Schemes and

Provisions under NRHM 06

ASHA

ANM

JSY

Service guarantees from Sub Health Center

Service guarantees from Primary Health Center

Service guarantees from Community Health Center

AYUSH

Community Participation in NRHM 14

Village Health and Sanitation Committee

PHC Monitoring and Planning Committee

Block Monitoring and Planning Committee

District Health Monitoring and Planning Committee

State Health Monitoring and Planning Committee

Rogi Kalyan Samiti

Some Frameworks for Community Monitoring 20

Indian Public Health Standards

Charter of Citizen’s Health right

Concrete Service Guarantees

Annexure 23

Model Citizens Charter for CHCs and PHCs
NRHM
A Promise of Better Healthcare Services For The Poor

Preface
he National Rural Health Mission has been launched with the

T objective of improving the access to quality healthcare services for

the rural poor, especially women and children. The Mission
recognizes that good health is an important component of overall socio-
economic development and an improved quality of life.

The most significant aspect of NRHM is that it is not a new health

scheme or programme but a new approach to providing healthcare
services. Some of the important components of this approach is that it

 recognizes the importance of integrating the determinants of health,

like nutrition, water and sanitation with healthcare systems

 aims at decentralizing planning and management

 integrates organizational structures–i.e. the different vertical health

schemes

 improves delivery of healthcare services through upgrading and

standardizing health centres

 introduces standards and guarantees for service quality and

triangulated monitoring systems for assuring quality

 provides mechanisms for community participation and management

This short briefing note has been prepared by pooling together all the
manuals and guidelines that have been prepared to guide the
implementation of NRHM and highlights its key components which
relate to Entitlements, Mechanisms for Community Participation and
Yardsticks for Community Monitoring. It is expected that this
information will prove useful for all those involved in the Community
Monitoring processes at the district, block and village levels.

This briefing note has been prepared as a part of the Community

Monitoring of NRHM (first phase) being implemented by the Advisory
Group on Community Action.
 NRHM
A Promise of Better Healthcare Services For The Poor

Some of the Core Strategies through which

the mission seeks to achieve its goals:

 Train and enhance capacity of Panchayati Raj

An Introduction to Institutions (PRIs) to own, control and manage
public health services

NRHM  Promote access to improved healthcare at

household level through (ASHA)

he Government of India launched the National  Health Plan for each village through Village

T Rural Health Mission (NRHM) on the 12th of

April 2005.The vision of the mission is to
undertake architectural correction of the health system 
Health Committee

Strengthening existing sub-centre, PHCs and

and to improve access to rural people, especially poor CHCs
women and children to equitable, affordable,
accountable and effective primary health care  Preparation and Implementation of an inter-
throughout the country with special focus on 18 states, sectoral District Health Plan
which have weak public health indicators and/or weak
infrastructure.  Integrating vertical Health and Family Welfare
programmes at National, State, Block, and District
18 special focus states are Arunachal Pradesh, Assam, levels
Bihar, Chattisgarh, Himachal Pradesh, Jharkhand,
Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Unlike previous health programmes, the government
Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, has clearly defined the roles of Non governmental
Tripura, Uttaranchal and Uttar Pradesh. organization (NGOs) in the Mission. NGO’s are not
only included in institutional arrangement at National,
NRHM is a 7 years programme ending in the year State and District Levels but also they are supposed to
2012. It has time bound goals and its progress will be play an important role in monitoring, evaluation and
reported publicly by the government. social audit.

Some of the goals of the Mission: Source of Information: Mission document http://
mohfw.nic.in/NRHM/Documents/NRHM%20Mission%
 Reduction in child and maternal mortality 20Document.pdf

 Universal access to public health care services For more Information on NRHM vision, goals,
along with public services for food and nutrition, objectives, strategies and outcomes go to:
sanitation and hygiene
1) Framework for Implementation. http://mohfw.
 Prevention and control of communicable and non- nic.in/NRHM/Documents/NRHM%20-%20Framework
communicable diseases, including locally endemic %20for%20Implementation.pdf
diseases
2) Website on NRHM by Ministry of Health and Family
 Access to integrated comprehensive primary health care Welfare http://mohfw.nic.in/NRHM/NRHM.htm

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NRHM
A Promise of Better Healthcare Services For The Poor

Roles and Responsibilities

ASHA is responsible for creating Awareness on Health

Service Guarantees and including

Important Schemes and  Providing information to the community on

nutrition, hygiene and sanitation
Provisions under NRHM  Providing information on existing health services
and mobilizing and helping the community in
accessing health related services available at
Health Centers
Accredited Social Health Activist
 Registering pregnant women and helping poor
(ASHA) women to get BPL certification
ith the launch of NRHM, the Government of

W India proposed Accredited Social Health

Activist (ASHA) to act as the interface
between the community and the public health system.
 Counseling women on birth preparedness, safe
delivery, breast feeding, contraception RTI/STI and
care of young child

Since Sub centers were serving much larger population  Arranging escort/accompany pregnant women and
than they were expected to and ANMs were heavily children requiring treatment/admission to the
overworked, one of the core strategies of NRHM is to nearest health centre.
promote access to improved healthcare at household
level through ASHA.  Promoting universal immunization

 ASHA is a Health Activist in the community  Providing primary medical care for minor ailments.
Keeping a drug kit containing generic AYUSH and
 Every village will have 1 ASHA for every 1000 allopathic formulations for common ailments
persons
 Promoting construction of household toilets
 She will be selected in a meeting of the Gram Sabha
 Facilitating preparation and implementation of the
 She will be chosen from women (married/widowed/ Village Health Plan through AWW, ANM,SHG
divorced between 25-45 years) residing in the members under the leadership of village health
village with minimum education up to VIIIth class. committee

 ASHA is accountable to the Panchayat  Organizing Health Day once/twice a month at the
anganwadi with the AWW and ANM
 ASHA will work from the Anganwadi Centre
 ASHA is also a Depot holder for essential services
 ASHA is honorary volunteer and she is entitled to like IFA, OCP, Condoms, ORS DDK etc, issued by
receive performance based compensation. Her AWW
services to the community are Free of cost
Timeline: Fully trained ASHA for every 1000
 ASHA will receive trainings on care during population/large-isolated habitations in 18 Special
pregnancy, delivery, post partum period, New born Focus States-30% by year 2007, 60% by 2009 and 100%
care, sanitation and hygiene by 2010

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A Promise of Better Healthcare Services For The Poor

Source of Information:  Maintenance of all relevant records concerning

(1) Guidelines on ASHA- It has been envisaged that mother, child and eligible couples in the area
states will have flexibility to adapt these guidelines
keeping their local situations in view.  Providing information on different family planning
http://mohfw.nic.in/Guidelines%20on%20ASHA- and Contraception methods and Provision of
Annex%201.pdf Contraceptives

(2) Framework for Implementation (*) http://mohfw.nic.  Counseling and correct information on safe
in/NRHM/Documents/NRHM%20-%20 Framework abortion services
%20for%20Implementation.pdf
 Coordinates services with AWWs, ASHA, Village
For more Information on ASHA go to: Health & Sanitation Committee and PRI for
1) Guidelines on JSY http://mohfw.nic.in/dofw%20website/ observance of Health Day at AWW center at least
JSY_features_FAQ_Nov_2006.htm once a month

2) Website of Ministry of Health and Family Welfare  Coordination and supervision of ASHA
http://mohfw.nic.in/NRHM
 The Untied grant to the Sub Center is kept in a
joint account, which is operated, by the ANM and
Auxiliary Nurse Midwife (ANM) the local Sarpanch

ANM is a government paid health worker who provides ANM is answerable to Village Health and Sanitation
free maternal and childcare services within a sub committee, which will oversee her work.
center area. The Mission seeks to provide minimum
two ANMs at each Sub Health Centre to be fully Source of Information:
supported by the Government of India. Framework for Implementation http://mohfw.nic.in/
NRHM/Documents/ NRHM%20-%20Framework%20for
Primary tasks of ANM %20 Implementation.pdf

 Registration of all pregnancies (ANM along with For more Information on JSY go to:
ASHA will ensure that all BPL women get benefits 1) Guidelines on JSY http://mohfw.nic.in/dofw%20
under Janani Suraksha Yojna) website/JSY_features_FAQ_Nov_2006.htm

 Ensure Minimum 4 antenatal check ups along 2) Website of Ministry of Health and Family Welfare -
with 100 IFA tablets and two T.T. Injections to http://mohfw.nic.in/NRHM
pregnant women

 Appropriate and prompt referral in case of high- JANANI SURAKSHA YOJANA

risk pregnancies
(JSY)
 Provide Skilled Attendance at home deliveries, JSY is meant to reduce maternal mortality and neo-natal
post partum care and contraceptive advice mortality by promoting deliveries at health institutions
by skilled personnel like doctors and nurses.
 Newborn Care (full immunization and Vitamin A
doses to children, prevention and control of JSY is a 100% centrally sponsored scheme. It
childhood diseases like malnutrition, infections etc. integrates cash assistance to women from poor families
for enabling them to deliver in health institutions along
 Curative Services like treatment for minor ailments with anti natal and post natal care.

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NRHM
A Promise of Better Healthcare Services For The Poor

The scheme applies differently to LPS and HPS.While Assistance for Home Delivery
states having low institutional delivery rates have been
named as Low Performing States (LPS), the remaining In LPS and HPS States, BPL pregnant women, aged 19
states have been named as High Performing States years and above, preferring to deliver at home is
(HPS). LPS states include the states of Uttar Pradesh, entitled to cash assistance of Rs. 500/- per delivery.
Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Such cash assistance would be available only upto 2
Chhattisgarh, Assam, Rajasthan, Orissa and HPS states live births and the disbursement would be done at the
include Maharashtra and Tamilnadu. time of delivery or around 7 days before the delivery by
ANM/ASHA/any other link worker. The rationale is
Eligibility for Cash Assistance: that beneficiary would be able to use the cash
assistance for her care during delivery or to meet
LPS States All pregnant women delivering in incidental expenses of delivery.
Government health centres like Sub-
centre, PHC/CHC/FRU/general Role of ASHA or other link health worker
wards of District and state Hospitals associated with JSY
or accredited private institutions. No
age constraint Along with fulfilling their usual duties of providing anti
natal and post natal care to woman, ASHA/other health
HPS States BPL pregnant women, aged 19 workers would be responsible for
years and above
 Identifying pregnant woman as a beneficiary of the
LPS & HPS All SC and ST women delivering in a scheme
government health centre like Sub-
centre, PHC/CHC/FRU/general ward  Assisting the pregnant woman to obtain necessary
of District and state Hospitals or certifications
accredited private institutions. No
age constraint  Identifying a functional Government health centre
or an accredited private health institution for
Limitations of Cash Assistance for referral and delivery
Institutional Delivery:
 Escorting the beneficiary women to the health center
In LPS States All births, delivered in a health and stay with her till the woman is discharged
centre – Government or Accredited
Private health institutions. Source of Information: Website of Ministry of Health
and Family Welfare
In HPS States Upto 2 live births.
For more Information on need of BPL certification,
Scale of Cash Assistance for Institutional Delivery Disbursement of Cash
Assistance, flow of
Category Rural Area Total Urban Area Total fund (from state
Mother’s ASHA’s Rs. Mother’s ASHA’s Rs. district authority to
Package Package Package Package ANM to ASHA),
ASHA’s package under
LPS 1400 600 2000 1000 200 1200 JSY, Subsidizing cost
HPS 700 700 600 600 of Caesarean Section ,
Grievance Redressal
cell, display of names of JSY beneficiaries in health
Generally the ANM/ASHA should carry out the entire centers go to: http://mohfw.nic.in/dofw%20website
disbursement process. /JSY_features_FAQ_Nov_2006.htm

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 NRHM
A Promise of Better Healthcare Services For The Poor

Service Guarantees from Sub  Correct doses of Vitamin A

Health Center
 Prevention and control of childhood diseases like
(Services provided at the Sub Center are Free malnutrition, infections, etc.
of Cost for a person from BPL family)
Family Planning and contraception
Maternal Health
 Provision of contraceptives and counseling to adopt
Antenatal care: appropriate Family planning methods
 Early registration of all pregnancies
 Counselling and appropriate referral for safe
 Minimum four antenatal check-ups abortion services (MTP) for those in need

 General examination such as weight, BP, anaemia, Adolescent health care

abdominal examination, height and breast examination
Providing education, counselling and referral services
 Iron and Folic Acid supplementation Assistance to school health services.

 T.T.Injection, treatment of anaemia, etc. Control of local endemic diseases

Disease surveillance
 Minimum laboratory investigations like
haemoglobin, urine albumen and sugar  Disinfection of water sources

 Identification of high-risk pregnancies and  Promotion of sanitation including use of toilets and
appropriate and prompt referral appropriate garbage disposal

Intranatal care: Curative Services

 Promotion of institutional deliveries
 Provide treatment for minor ailments including
 Skilled attendance at home deliveries as and when and First Aid in accidents and energencies
called for
 Appropriate and prompt referral
 Appropriate and prompt referral
 Organizing Health Day at Anganwadi centres at
Postnatal care: least once in a month
 A minimum of 2 postpartum home visits
Training, Monitoring and Supervision
 Initiation of early breast-feeding within half-hour
of birth  Training of Traditional Birth Attendants and
ASHA
 Counselling on diet and rest, hygiene,
contraception, essential new born care, infant and  Coordinated services with AWWs, ASHA, Village
young child feeding and STI/RTI and HIV/AIDS Health and Sanitation Committee, PRI

Child Health Record of Vital events

 Promotion of exclusive breast-feeding for 6 months  Recording and reporting of Vital statistics
including births and deaths, particularly of
 Full Immunization of all infants and children mothers and infants

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NRHM
A Promise of Better Healthcare Services For The Poor

 Maintenance of all the relevant records concerning untied_funds_NRHM.pdf

mother, child and eligible couples in the area
2) IPHS for Subcenters http://mohfw.nic.in/NRHM/
The Sub Health Centre will be accountable to the Gram Documents/IPHS_for_SUBCENTRES.pdf
Panchayat and shall have a local Committee for its
management, with adequate representation of Village
Health and Sanitation Committee. Services Guarantees from Primary
Health Centre (PHC)
ANM and Multi purpose Health worker MPW works
from the Subcentre and deliver the above-mentioned (All services provided at PHC are free of cost
service with the help of ASHA. for BPL families)

Funds Every PHC has to provide OPD services, Inpatient

Service, referral service and 24 hours emergency
 The Gram Panchayat SHC Committee has the service for all cases needing routine and emergency
mandate to undertake construction and treatment including treatment of local diseases.
maintenance of SHC. An annual maintenance grant
of Rupees 10,000 will be available to every SHC All services provided by Sub centers are also
provided by PHC.
 Every SHC gets Rs.10,000 as Untied grants for
local health action. The resources could be used for Some additional services provided in a PHC are as
any local health activity for which there is a follows:
demand. The fund would be kept in a joint account
to be operated by the ANM and the local Sarpanch Maternal Health

Time Line:  24-hour delivery services both normal and assisted

 2 ANM Sub Health Centres strengthened/
established to provide service guarantees as per  Appropriate and prompt referral for cases needing
IPHS, in 1,75000 places - 30% by 2007, 60% by specialist care
2009, 100% by 2010
 Pre-referral management (Obstetric first-aid)
 Untied grants provided to each Sub Centre to promote
local health action. 50% by 2007, 100% by 2008  Facilities under Janani Suraksha Yojana

 Annual maintenance grant provided to every Sub Family Planning

Centre - 50% by 2007, 100% by 2008
 Permanent methods of Family Planning
 Procurement and logistics streamlined to ensure
availability of drugs and medicines at Sub Centres-  Facility for Medical Termination of Pregnancies
50% by 2007,100% by 2008 (wherever trained personnel and facility exists)

Source of Information: Treatment of RTI/ STIs

1) Framework for Implementation http://mohfw.nic.in/ Basic laboratory services
NRHM/Documents/NRHM%20-%20Framework Referral services
%20for%20Implementation.pdf
Appropriate and prompt referral of cases needing
For more Information go to: specialist care including:
1) Guidelines for VHSCs, SCs, PHCs AND CHCs
http://mohfw.nic.in/NRHM/Documents/Guidelines_of_  Stabilisation of patient

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 NRHM
A Promise of Better Healthcare Services For The Poor

 Appropriate support for patient during transport Source of Information:

Framework for Implementation http://mohfw.nic.in/
 Providing transport facilities NRHM/Documents/NRHM%20-%20Framework
%20for%20Implementation.pdf
A Charter of Citizen’s Health Rights should be
prominently displayed outside all PHCs. For more Information go to:
Guidelines for VHSCs, SCs, PHCs AND CHCs
The Primary Health Centre (not at the block level) will http://mohfw.nic.in/NRHM/Documents/Guidelines_of_
be responsible to the elected representative of the untied_funds_NRHM.pdf
Gram Panchayat where it is located.

The Block level PHC will have involvement of Service Guarantees from
Panchayti Raj elected leaders in its management even
Community Health Centre (CHC)
though Rogi Kalyan Samiti would also be formed for
day-to-day management of the affairs of the hospital.  Care of routine and emergency cases in surgery
and medicine
The Mission seeks to provide minimum three Staff Nurses
to ensure round the clock services in every PHC.  24-hour delivery services including normal and
assisted deliveries
Funds
 Essential and Emergency Obstetric Care including
 Each PHC is entitled to get an annual maintenance surgical interventions
grant of Rs. 50,000 for construction and
maintenance of physical infrastructure. Provision  Full range of family planning services
for water, toilets, their use and their maintenance,
etc, has to be priorities. PHC level Panchayat  Safe Abortion Services
Committee/Rogi Kalyan Samiti will have the
mandate to undertake and supervise improvement  Newborn Care and Routine and Emergency Care of
and maintenance of physical infrastructure sick children

 Every PHC is entitled to get Rs. 25,000 as Untied  Diagnostic services through the microscopy centers
grants for local health action. The resources could
be used for any local health activity for which there  Blood Storage Facility
is a demand
 Essential Laboratory Services
Time Line:
 30,000 PHCs strengthened/established with 3 Staff  Referral Transport Services
Nurses to provide service guarantees as per IPHS -
30% by 2007, 60% by 2009 and 100% by 2010  All National Health Programmes should be delivered
through the CHCs. e.g. HIV/AIDS Control Programme,
 Untied grants provided to each PHC to promote National Leprosy Eradication Programme, National
local health action - 50% by 2007 and 100% by 2008 Programme for Control of Blindness

 Annual maintenance grant provided to every PHC Over the Mission period, the Mission aims at
- 50% by 2007 and 100% by 2008 bringing all the CHCs on a par with the IPHS to
provide round the clock hospital-like services.
 Procurement and logistics streamlined to ensure According to IPHS, it is mandatory to display
availability of drugs and medicines at PHCs - 50% Charter of Citizen’s Health Rights outside all CHCs.
by 2007 and 100% by 2008 The dissemination and display of charter is the

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A Promise of Better Healthcare Services For The Poor

responsibility of Block Health Monitoring and AYUSH

Planning Committee.
The term AYUSH covers Ayurveda, Yoga &
According to IPHS, it is mandatory for every CHC to Naturopathy, Unani, Siddha and Homeopathy. These
have “Rogi Kalyan Samiti” to ensure accountability.^ systems are popular in a large number of States in the
country. e.g. Ayurved system is popular in the States of
Mission also seeks to provide separate AYUSH set up Madhya Pradesh, Rajasthan, and Orissa, the Unani
in each CHC. system is particularly popular in Tamil Nadu and
Maharashtra.This is to imply that the AYUSH systems
Funds of medicine and its practices are well accepted by the
community, particularly, in rural areas. The medicines
 Every CHC gets Annual maintenance grant of are easily available and prepared from locally available
Rs. 1 lakh for construction and maintenance of resources, economical and comparatively safe.
physical infrastructure. Rogi Kalyan Samiti/Block
Panchayat Samiti has a mandate to undertake One of the objectives of the mission is to revitalize local
construction and maintenance of CHC health traditions and mainstream AYUSH into the
public health system.
 Every CHC gets Rupees 50,000 as Untied grants for
local health action. The resources could be used for Modalities For Integration
any local health activity for which there is a demand
 For mainstreaming, the personnel of AYUSH may
Time Line work under the same roof of the Health
 6500 CHCs strengthened/established with 7 Infrastructure, i.e., PHC, CHC; However, separate
Specialists and 9 Staff Nurses to provide service space should be allocated exclusively for them in
guarantees as per IPHS-30% by 2007,50% by 2009 the same building
and 100% by 2012
 The Doctors under the Systems of AYUSH are required
 Untied grants provided to each CHC to promote to practice as per the terms & conditions laid down for
local health action- 50% by 2007 and 100% by 2008 them by the appropriate Regulatory Authorities

 Annual maintenance grant provided to every CHC  Provision of one Doctor of any of the AYUSH
-50% by 2007 and 100% by 2008 systems as per the local acceptability assisted by a
Pharmacist in PHC
 Procurement and logistics streamlined to ensure
availability of drugs and medicines at CHCs-50%  Provision of one Specialist of any of the AYUSH
by 2007 and 100% by 2008 systems as per the local acceptability assisted by a
Pharmacist in CHC
Source of Information:
1) Framework for Implementation http://mohfw.nic.in/  Supply of appropriate medicines pertaining of
NRHM/Documents/NRHM%20-%20Framework AYUSH systems
%20for%20Implementation.pdf
 The already existing AYUSH infrastructure should
2) IPHS for CHC(^) http://mohfw.nic.in/NRHM/ be mobilized. AYUSH dispensaries that are not
Documents/Draft_CHC.pdf functioning well should be merged with the PHC or
CHC barring which, displacement of AYUSH clinic
For more Information on Guidelines for Village is not advised
Health and Sanitation Committees, Sub Centres. PHCs
and CHCs go to: http://mohfw.nic.in/NRHM/Documents  Cross referral between allopathic and AYUSH streams
/Guidelines_of_untied_funds_NRHM.pdf should be encouraged based on the need for the same

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A Promise of Better Healthcare Services For The Poor

 AYUSH Doctors shall be involved in IEC, health Source of Information:

promotion and also supervisory activities Mainstreaming of AYUSH Systems in the National
Health Care Delivery System- Mohfw.nic.in/ayush%
 The IPHS pertaining to AYUSH and also the 2015th%20march.pdf
detailed manpower and other requirements and
financial projections for the same will be provided For more Information go to:
by the Department of AYUSH for further Website of Department of AYUSH http://indianmedicine.
consideration nic.in/

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NRHM
A Promise of Better Healthcare Services For The Poor

constitution and orientation of VHSC. The Untied

grant to be used by this committee for household
surveys, health camps, sanitation drives, revolving
fund etc.
Community Participation in  A revolving fund for providing referral and

NRHM transport facilities for emergency deliveries as well

as immediate financial needs for hospitalization
would also be operated by the VHSC

Some roles of the VHSC

Village Health and Sanitation  Create Public Awareness about the essentials of
health programmes, with focus on People’s
Committee (VHSC) knowledge of entitlements to enable their
involvement in the monitoring
illage level Health and Sanitation Committee

V will be responsible for the Village Health

Plans.
 Discuss and develop a Village Health Plan based
on an assessment of the village situation and
priorities identified by the village community
This committee would be formed at the level of the
revenue village (more than one such villages may come  Analyse key issues and problems related to village
under a single Gram Panchayat). level health and nutrition activities, give feedback
on these to relevant functionaries and officials.
Composition Present an annual health report of the village in
the Gram Sabha
The Village Health Committee would consist of:
 Gram Panchayat members from the village  Participatory Rapid Assessment to ascertain the
major health problems and health related issues in
 ASHA, Anganwadi Sevika, ANM the village. Mapping will be done through
participatory methods with involvement of all
 SHG leader, the PTA/MTA Secretary, village strata of people. The health mapping exercise shall
representative of any Community based organisation provide quantitative and qualitative data to
working in the village, user group representative understand the health profile of the village

The chairperson would be the Panchayat member  Maintenance of a village health register and health
(preferably woman or SC/ST member) and the convenor information board/calendar: The health register
would be ASHA; where ASHA not in position it could be and board will have information about mandated
the Anganwadi Sevika of the village. services, along with services actually rendered to
all pregnant women, new born and infants, people
Training suffering from chronic diseases etc. Similarly dates
of visit and activities expected to be performed
The members would be given orientation training to during each visits by health functionaries may be
equip them to provide leadership as well as plan and displayed and monitored by means of a Village
monitor the health activities at the village level. health calendar

Grants available  Ensure that the ANM and MPW visit the village on
the fixed days and perform the stipulated activity;
 Every village with a population of upto 1500 gets oversee the work of village health and nutrition
an annual Untied grant of up to Rs. 10,000, after functionaries like ANM, MPW and AWW

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A Promise of Better Healthcare Services For The Poor

 Get a bi-monthly health delivery report from Officer – Primary Health Centre and at least one
health service providers during their visit to the ANM working in the PHC area
village. Discuss the report submitted by ANM and
MPW and take appropriate action  Chairperson: Panchayat Samiti member,
Executive chairperson: Medical officer of the PHC,
Time Line Secretary: NGO/CBO representatives
Village Health and Sanitation Committee constituted
in over 6 lakh villages and untied grants provided to Role & Responsibilities
them - 30% by 2007, 100% by 2010
 Consolidation of the village health plans and
Untied grants provided to each Village Health and charting out the annual health action plan in order
Sanitation Committee to promote local health action. of priority
50% by 2007, 100% by 2008
 Presentation of the progress made at the village
Source of Information: level, achievements, actions taken and difficulties
Framework for implementation http://mohfw.nic.in/ faced followed by discussion on the progress of the
NRHM/Documents/NRHM%20-%20Framework achievements of the PHC, concerns and
%20for%20Implementation.pdf difficulties faced and support received to improve
the access to health facilities in the area of that
For more Information go to: particular PHC
Guidelines for VHSCs, SCs, PHCs AND CHCs
http://mohfw.nic.in/NRHM/Documents/Guidelines_of_  Ensure that the Charter of citizen’s health rights
untied_funds_NRHM.pdf is disseminated widely and displayed out side the
PHC informing the people about the medicine
facilities available at the PHC, timings of PHC
PHC Monitoring and Planning and the facilities available free of cost. A
suggestion box can be kept for the health care
Committee
facility users to express their views about the
This Committee monitors the functioning of Sub- facilities. These comments will be read at the
centres operating under jurisdiction of the PHC and coordination committee meeting to take necessary
developes PHC health plan after consolidating the action
village health plans.
 Monitoring of the physical resources like,
Composition infrastructure, equipments, medicines, water
connection etc at the PHC and inform the
 30% members from PRI (from the PHC coverage area; concerned government officials to improve it
2 or more sarpanchs of which at least one is a woman)
 Discuss and develop a PHC Health Plan
 20% members non-official representatives from based on an assessment of the situation and
VHSC, (under the jurisdiction of the PHC, with priorities identified by representatives of village
annual rotation to enable representation from all health committees and community based
the villages) organizations

 20% members representatives from NGOs / CBOs and  Share the information about any health awareness
People’s organizations working on Community health programme organized in the PHC’s jurisdiction, its
and health rights in the area covered by the PHC achievements, follow up actions, difficulties faced etc.

 30% members representatives of the Health and  Coordinate with local CBOs and NGOs to improve
Nutrition Care providers, including the Medical the health scenario of the PHC area

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A Promise of Better Healthcare Services For The Poor

 Review the functioning of Sub-centres operating  Chairperson: Block Panchayat Samiti

under jurisdiction of the PHC and taking representative, Executive chairperson: Block medical
appropriate decisions to improve their functioning officer, Secretary: NGO / CBO representatives

 Initiate appropriate action on instances of denial of Role & Responsibilities

right to health care reported or brought to the
notice of the committee  Consolidation of the PHC level health plans and
charting out of the annual health action plan for
Time Line: the block.
Systems of community monitoring put in place - 50% by
2007 and 100% by 2008.  Review of the progress made at the PHC levels,
difficulties faced, actions taken and achievements
Source of Information: made, followed by discussion on any further steps
Framework for implementation http://mohfw.nic.in/ required to be taken for further improvement of
NRHM/Documents/NRHM%20-%20Framework health facilities in the block, including the CHC
%20for%20Implementation.pdf
 Analysis of records on neonatal and maternal deaths;
and the status of other indicators, such as coverage
Block Monitoring and Planning for immunization and other national programmes
Committee
 Monitoring of the physical resources like,
This Committee monitors the progress made at the infrastructure, equipments, medicine, water
PHC level health facilities in the block, including CHC connection etc at the CHC; similar exercise for the
and develops annual action plan for the Block after manpower issues of the health facilities that come
consolidating PHS level health plans. under the jurisdiction of the CHC

Composition  Coordinate with local CBOs and NGOs to improve

the health services in the block
 30% members representatives of the Block
Panchayat Samiti (Adhyaksha/Adhyakshika or  Review the functioning of Sub-centres and PHCs
members with at least one woman) operating under jurisdiction of the CHC and taking
appropriate decisions to improve their functioning
 20% members non-official representatives from the
PHC health committees in the block, with annual  Initiate appropriate action on instances of denial of
rotation to enable representation from all PHCs right to health care reported or brought to the notice
over time of the committee; initiate an enquiry if required and
table report within two months in the committee.
 20% members representatives from NGOs/ The committee may also recommend corrective
CBOs and People’s organizations working on measures to the district level
Community health and health rights in the block,
and involved in facilitating monitoring of health Time Line:
services Systems of community monitoring put in place - 50% by
2007 and 100% by 2008.
 20% members officials such as the BMO, the BDO,
selected MO’s from PHCs of the block Source of Information:
Framework for implementation http://mohfw.nic.in/
 10% members representatives of the CHC level NRHM/Documents/NRHM%20-%20Framework
Rogi Kalyan Samiti %20for%20Implementation.pdf

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District Health Monitoring and related information and necessary steps required
to correct the discrepancies
Planning Committee
This Committee contributes to the development of  Progress report of the PHCs emphasising the
District Health plan. information on referrals utilisation of the services,
quality of care etc.
Composition
 Contribute to development of the District Health
 30% members representatives of the Zilla Parishad Plan, based on an assessment of the situation and
(esp. convenor and members of its Health priorities for the district. This would be based on
committee) inputs from representatives of PHC health
committees, community based organisations and
 25% members district health officials, including NGOs
the District Health Officer/Chief Medical Officer
and Civil Surgeon or officials of parallel  Ensuring proper functioning of the Hospital
designation, along with representatives of the Management Committees
District Health planning team including
management professionals  Discussion on circulars, decisions or policy level
changes done at the state level; deciding about
 15% members non-official representatives of block their relevance for the district situation
committees, with annual rotation to enable
successive representation from all blocks  Taking cognizance of the reported cases of the
denial of health care and ensuring proper
 20% members representatives from NGOs/CBOs redressal
and People’s organizations working on Health
rights and regularly involved in facilitating Time Line:
Community based monitoring at other levels Systems of community monitoring put in place- 50% by
(PHC/block) in the district 2007 and 100% by 2008.

 10% members should be representatives of Source of Information:

Hospital Management Committees in the district Framework for implementation http://mohfw.nic.in/
NRHM/Documents/NRHM%20-%20Framework
 Chairperson: Zilla Parishad representative, %20for%20Implementation.pdf
preferably convenor or member of the Zilla
Parishad Health committee, Executive
chairperson: CMO/CMHO/DHO or officer of State Health Monitoring and
equivalent designation, Secretary: NGO/CBO
Planning Committee
representatives
This Committee reviews and contributes to the
Role & Responsibilities development of State Health plan.

 Discussion on the reports of the PHC health Composition

committees
 30% of total members should be elected
 Financial reporting and solving blockages in flow of representatives, belonging to the State legislative
resources if any body (MLAs/MLCs) or Convenors of Health
committees of Zilla Parishads of selected districts
 Infrastructure, medicine and health personnel (from different regions of the state) by rotation

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 15% would be non-official members of district would be discussed an appropriate action initiated
committees, by rotation from various districts by the committee. Any administrative and
belonging to different regions of the state financial level queries, which need urgent
attention, will be discussed
 20% members would be representatives from State
health NGO coalitions working on Health rights,  Institute a health rights redressal mechanism at
involved in facilitating Community based all levels of the health system, which will take
monitoring action within a time bound manner. Review
summary report of the actions taken in response to
 25% members would belong to State Health the enquiry reports
Department
 Operationalising and assessing the progress made
 Secretary Health and Family Welfare, Commissioner in implementing the recommendations of the
Health, relevant officials from Directorate of Health NHRC, to actualize the Right to health care at the
Services (incl. NRHM Mission Director) along with state level
Technical experts from the State Health System
Resource Centre/Planning cell  The committee will take proactive role to share any
related information received from GOI and will also
 10% members would be officials belonging to other will share achievements at different levels. The
related departments and programmes such as copies of relevant documents will be shared
Women and Child Development, Water and
Sanitation, Rural development Time Line:
Systems of community monitoring put in place - 50% by
 The Chairperson would be one of the elected 2007 and 100% by 2008.
members (MLAs)
Source of Information:
 The executive chairperson would be the Secretary Framework for implementation http://mohfw.nic.in/
Health and Family Welfare NRHM/Documents/NRHM%20-%20Framework
%20for%20Implementation.pdf
 The secretary would be one of the NGO coalition
representatives
Rogi Kalyan Samiti (RKS)
Role & Responsibilities
For efficient management of Health Institutions
 The main role of the committee is to discuss the NRHM has proposed Rogi Kalyan Samiti
programmatic and policy issues related to access to (RKS)/Patient Welfare Committee/Hospital
health care and to suggest necessary changes Management Committee (HMC) . This initiative
is taken to bring in the community ownership in
 This committee will review and contribute to the running of rural hospitals and health centres,
development of the State health plan, including the which will in turn make them accountable and
plan for implementation of NRHM at the state responsible.#
level; the committee will suggest and review
priorities and overall programmatic design of the Broad Objectives of RKS#
State health plan
 Ensure compliance to minimal standard for facility
 Key issues arising from various District health and hospital care
committees, which cannot be resolved at that level
(especially relating to budgetary allocations,  Ensure accountability of the public health
recruitment policy, programmatic design etc.) providers to the community

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 NRHM
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 Upgrade and modernize the health services Grants

provided by the hospital
To motivate the states to set up RKSs, a support of
 Supervise the implementation of National Health Rs.5.0 lakhs per rural hospital, Rs.1.00 lakh per CHC
Programme and Rs.1.00 per PHC per annum would be given to
these societies through states. The societies would be
 Set up a Grievance Mechanism System eligible for these grants only where they are authorized
by the States to retain the user charges at the
Apart from this, RKS at PHC and CHC will have the institution level.*
mandate to undertake and supervise improvement and
maintenance of physical infrastructure. RKS would Time Line*:
also develop annual plans to reach the IPHS  Rogi Kalyan Samitis/Hospital Development
standards.* Committees established in all CHCs/Sub
Divisional Hospitals/ District Hospitals - 50% by
RKS would be a registered society. It may 2007, 100% by 2009
consists of following members#
 One time support to RKSs at Sub Divisional/
 Group of users i.e. people from community District Hospitals - 50% by 2007, 100% by 2008

 Panchayati Raj representatives Source of Information:

1) Framework for implementation (*) http://mohfw.
 NGOs nic.in/NRHM/Documents/NRHM%20%20Framework%
20for%20Implementation.pdf
 Health professionals
2) Guidelines for IPHS for CHC(^)
According to IPHS, it is mandatory for every CHC
to have “Rogi Kalyan Samiti” to ensure 3) Guidelines for Rogi Kalyan Samiti (#) http://
accountability.^ mohfw.nic.in/NRHM/RKS.htm

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NRHM
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including safe delivery. The RKS would develop

annual plans to reach the IPH standards.*

Time line*
Some Frameworks for In the first six months since the launch of the mission,
following work should have been completed:

Community Monitoring  Selection of and 2 CHCs in each State for

upgradation to IPHS

Indian Public Health Standards (IPHS)  Release of funds for upgradation of two CHCs per
district to IPHS
PHS are being prescribed to provide optimal expert

I care to the community and to achieve and maintain

an acceptable standard of quality of care. These
standards help in monitoing and improving the
 2 ANM Sub Health Centres strengthened/
established to provide service guarantees as per
IPHS, in 1,75000 places- 30% by 2007, 60% by 2009
functioning of public health centers.# and 100% by 2010

IPHS for CHCs provides for “Assured services” that  30,000 PHCs strengthened/established with
should be available in a Community health centre 3 Staff Nurses to provide service guarantees as
along with minimum requirements for delivering these per IPHS - 30% by 2007, 60% by 2009 and 100%
services such as: by 2010
 Minimum clinical and supporting manpower
requirement  6500 CHCs strengthened/established with 7
Specialists and 9 Staff Nurses to provide service
 Equipments guarantees as per IPHS - 30% by 2007, 50% by
2009 and 100% by 2012
 Drugs
Source of Information:
 Physical Infrastructure 1) Framework for Implementation (*) http:// mohfw.nic
.in/NRHM/Documents/NRHM%20-%20Framework
 Charter of Patients’ rights %20for%20Implementation.pdf

 Requirement of quality control 2) IPHS for CHC (#) - http://mohfw.nic. in/NRHM/

Documents/Draft_CHC.pdf
 Quality assurance in service delivery-standard
treatment protocol# For more Information go to:
Link given on Ministry of Health and Family Welfare
Similar standards are being developed for PHCs & Sub website: http://mohfw.nic.in/NRHM/iphs.htm
Center.*

Over the Mission period, the Mission aims at bringing Charter of Citizen’s Health Rights
all the CHCs on a par with the IPHS in a gradual
manner. In the process, all the CHCs would be Charter of Citizen’s Health Rights seeks to provide a
operationalized as first Referral Units (FRUs) with all framework which enables citizens to know.
facilities for emergency obstetric care. *
 What services are available?
It will be for the States to decide on the configuration of
PHCs to meet IPH Standards and offer 24X7 services  The quality of services they are entitled to.

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 NRHM
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 The means through which complaints regarding  Emergency Obstetric care

denial or poor qualities of services will be
addressed.#  Basic neonatal care for new born

A Charter of Citizen’s Health Rights should be  Full coverage of services related to childhood
prominently displayed outside all District Hospitals, diseases/health conditions
CHCs and PHCs. While IPHS makes the display
mandatory for every CHC.*  Full coverage of services related to maternal
diseases/health conditions
The dissemination and display of charter is the
responsibility of Health Monitoring and Planning  Full coverage of services related to low vision and
Committee at that level. E.g. Block Health Monitoring blindness due to refractive errors and cataract.
and Planning Committee has the responsibility to
ensure display of the charter at CHC.*  Full coverage for curative and restorative services
related to leprosy
While the Charter would include the services to be
given to the citizens and their rights in that regard,  Full coverage of diagnostic and treatment services
information regarding grants received, medicines and for tuberculosis
vaccines in stock etc. would also be exhibited.
Similarly, the outcomes of various monitoring  Full coverage of preventive, diagnostic and
mechanisms would be displayed at the CHCs in a treatment services for vector borne diseases
simple language for effective dissemination.*
 Full coverage for minor injuries/illness (all
The charter seeks to increase transparency that would problems manageable as part of standard
help the community to better monitor the health outpatient care upto CHC level)
services.*
 Full coverage of services inpatient treatment of
Source of Information: childhood diseases/health conditions
1) Framework for implementation(*) http://mohfw.nic
.in/NRHM/Documents/NRHM%20-%20Framework  Full coverage of services inpatient treatment of
%20for%20Implementation.pdf maternal diseases/health conditions including
safe abortion care (free for 50% user charges from
2) IPHS for CHC(#)- http://mohfw.nic.in/NRHM/ APL)
Documents /Draft_CHC.pdf
 Full coverage of services for Blindness, life style
For more information go to: diseases, hypertension etc.
Link given on Ministry of Health and Family Welfare
website: http://mohfw.nic.in/NRHM/iphs.htm  Full coverage for providing secondary care services
at Sub-district and District Hospital

Concrete Service Guarantees  Full coverage for meeting unmet needs and spacing
and permanent family planning services
Concrete Service Guarantees that NRHM provide are
the benchmarks against which mission functioning can  Full coverage of diagnostic and treatment services
be monitored and its success can be measured. These for RI/STI and counseling for HIV–AIDS services
guarantees are as follows: for adolescents

 Skilled attendance at all Births  Health education and preventive health measures.

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NRHM
A Promise of Better Healthcare Services For The Poor

Time Line: 60% by 2009 and 100% by 2010.

SHCs/PHCs/CHCs/Sub Divisional Hospitals/ District
Hospitals fully equipped to develop intra health sector Source of Information:
convergence, coordination and service guarantees for Framework for Implementation http://mohfw.nic.in
family welfare, vector borne disease programmes, TB, /NRHM/Documents/NRHM%20-%20Framework
HIV/AIDS, etc.-30% by 2007, 50% by 2008, 70% by 2009 %20for%20Implementation.pdf
and 100% by 2012
For more information on:
Institution-wise assessment of performance against Institution wise service guarantees go to Annex–III of
assured service guarantees carried out-30% by 2008, Framework for Implementation.

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Annexure
Model Citizens Charter for CHCs and PHCs

1. Preamble
Community Health Centres and Primary Health Centres exist to provide health care to every
citizen of India within the allocated resources and available facilities. The Charter seeks to provide
a framework which enables citizens to know.

what services are available?

the quality of services they are entitled to.

the means through which complaints regarding denial or poor qualities of services will be
addressed.

2. Objectives

to make available medical treatment and the related facilities for citizens.

to provide appropriate advice, treatment and support that would help to cure the ailment to
the extent medically possible.

to ensure that treatment is best on well considered judgment, is timely and comprehensive and
with the consent of the citizen being treated.

to ensure you just awareness of the nature of the ailment, progress of treatment, duration of
treatment and impact on their health and lives, and

to redress any grievances in this regard.

3. Commitments of the Charter

to provide access to available facilities without discrimination.

to provide emergency care, if needed on reaching the CHC/PHC.

to provide adequate number of notice boards detailing the location of all the facilities.

to provide written information on diagnosis, treatment being administered.

to record complaints and designate appropriate officer, who will respond at an appointed time,
that may be same day in case of inpatients and the next day in case of out patients.

4. Component of service at CHCs

access to CHCs and professional medical care to all.

making provision for emergency care after main treatment hour whenever needed.

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NRHM
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informing users about available facilities, costs involved and requirements expected of them
with regard to the treatment in clear and simple terms.

informing users of equipment out of order.

ensuring that users can seek clarifications and assistance in making use of medical treatment
and CHC facility.

informing users about procedures for reporting in-efficiencies in services or nonavailability of
facilities.

5. Grievance redressal

grievances that citizens have will be recorded.

there will be a designated officer to respond to the request deemed urgent by the person
recording the grievance.

aggrieved user after his/her complaint recorded would be allowed to seek a second opinion
within the CHC.

to have a public grievance committee outside the CHC to deal with the grievances that are not
resolved within the CHC.

6. Responsibilities of the users

users of CHC would attempt to understand the commitments made in the charter

user would not insist on service above the standard set in the charter because it could
negatively affect the provision of the minimum acceptable level of service to another user.

instruction of the CHC’s personnel would be followed sincerely, and

in case of grievances, the redressal mechanism machinery would be addressed by users
without delay.

7. Performance audit and review of the charter

performance audit may be conducted through a peer review every two or three years after
covering the areas where the standards have been specified.

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 Published on behalf of
Advisory Group for Community Action
by
National Secretariat on Community Action - NRHM
Population Foundation of India (PFI)
&
Centre for Health and Social Justice (CHSJ)
3-C, First Floor, H-Block, Saket, New Delhi - 110 017.
Tel.: +91 11 40517478 Telefax: +91 11 26536041
E-mail: [email protected] Website: www.chsj.org