GUIDELINES REGARDING ENTITLEMENT & UTILIZATION OF UNTIED GRANT

AREAS WHERE UNTIED FUNDS, ANNUAL FUNDS & GRANT TO SKS CAN BE USED

• 1.    Infrastructure modifications to the center- These could relate to interior decoration like curtains to ensure privacy, or to water supply and lightning or to civil work repairs or changes, or the provision of any amenities’ which make it more convenient for patients, their attendants or the health care providers. In case of civil works the hospital development committee would be the contracting and where needed tendering, agency unless the district health society records a reason for employing another agency hired centrally and gets the assent of the hospital development society to do so. The desirable level of infrastructure for each facility is specified in the IPHS guidelines and this could be aimed for providing plans for finding the necessary human resources to use the infrastructure are also out in place.
• 2.    Contracting in a specialist or skilled staff or skills of any sort required to meet the service guarantees as apply to the facility and laid down in the NRHM framework for implementation and IPHS standards.
• 3.    Provision of running water supply. Normally water costs should be paid from the State Budget, but as a temporary measure till the State budget is adequate to the purpose, it could be paid for the untied funds.
• 4.    Provision of electricity or electrical fittings- lights, fans, etc
• 5.    Labour & Supply for environmental sanitation, such as clearing or source reduction measures for vector control in the facility and its adjacent area.  Ad hoc payments for cleaning up the Center, especially in the labour room could also be made.
• 6.    Water Coolers and water purifiers.
• 7.    Transport emergencies to appropriate referral centres
• 8.    Transport of samples during epidemics

• 9.    Equipment Purchase: Equipment needed for each facility are specified in IPHS guidelines. Equipment purchase done from untied funds the following conditions shall apply:
• a.    It shall not be done through bulk orders for al CHCs/ district hospitals placed centrally
• b.    The district or state could facilitate their purchase by the CHC/ district hospitals by issuing rates for each rates for each equipment and indicating a list of suppliers from where they can be produced.
• c.    If needed minor equipment (eg. BP apparatus, weighing machines, etc) could  be stocked at a cooperative/ government store or warehouse at the district or state level from which the CHC/ DH can place an order without going into the problems of procurement from the open market
• d.    Normally this provision shall be used to fill gaps, specific to each CHC/ DH. This is not to prevent the State from the option of centralized procurement of equipment. Where all facilities or a large number of facilities need an up gradation in some specific equipment.
• 10.  Purchase of consumables such as bandages or drugs, bleaching powder provided they are in the essential list approved for that facility in the IPHS  standards & the provision is used to tied over temporary gaps due to logistics failures.
• 11.  IEC/ BCC to reach out key health messages to those who come to the facility for care of illness or as attendants.
• 12.  Improved signages in the hospital- so as to make it easier for patients to locate services and so as to assist health care providers to provide quality services.
• 13.  Payment/ Reward to ASHA and NGOs for certain identified activities which support the work of the facility and help it reach its service guarantees..
• 14.  Repair/ operationalising soak pits or drainage , sewerage or sanitation systems for the facility.
• 15.  Reception and patient waiting hall amenities and services as well as patient assistance and grievance redressal mechanisms.
• 16.   Establishing a kitchen or outsourcing of dietary arrangement for feeding in patients and where needed their attendants.
• 17.  Security arrangements for the hospital baby- friendly and handicapped friendly and safe for women.
• 18.  Special measures to ensure against stray dogs, rats and other vermin entering or being resident in hospital premises.
• 19.  Medical care to BPL families.
• 20.  Any consultancy costs it may incur to secure professional help for making its development plan for planning in any of the above areas.

UNTIED FUNDS NOT TO BE USED FOR:

• 1.            Purchase of motorized vehicle
• 2.            Payment towards advertisement in Newspapers/ Journal/ Magazine
• 3.            Giving stall in any mela for ostensible purpose of awareness generation of health schemes.
• 4.            Salary of full time/ part time staff.

GUIDELINES FOR UTILIZATION OF UNTIED FUNDS FOR SKS (PHCs) IN HARYANA

National Rural Health Mission aims to increase functional, administrative and financial resources and autonomy to  field  units.  Every SKS (PHC )  will  get the funds as under:-

• 1.   A sum  of  Rs.  25,000/- per annum as untied funds for local health action.
• 2.    Rs. 50,000/- for improvement and maintenance of physical infrastructure.
• 3.    Rs. 1,00,000/- as grant to SKS for any activity to provide facilities to the patients (Provision of Drinking Water, toilets, etc).

 Objective: To increase functional, administrative and financial resources and autonomy to the field units, as part of Health Sector Reforms under National Rural Health Mission(NRHM)  as  united  grant  for  local  health  action.  Allotment  of  funds  to  the  States  has traditionally  been  of  the  nature  of  tied  fund  for  implementing  a  particular  activity  / scheme  and  this  hardly  left  any  funds  with  the  public  health  facilities.  Centralized management and schematic in-flexibility in the use of funds allotted did not provide any scope for local initiative and flexibility for local action at block and down below level. This scheme aims at enabling innovative /institution specific/need based activity in the Primary Health Centres.

• 1.    The date of meeting should be fixed and there will be a pre-informed agenda for every meeting and MO/ SMO I/c shall make the proceeding book of the meeting, work register & cash book. There will be a double entry in all accounts of SKS.
• 2.    Since there would be substantial fund flow to the districts to be utilized for the Centres under NRHM/RCH-II and other programmes, the united funds should not  duplicate what is/can be taken up under other programmes. Each activity planned by the Centre should have clear rationale so that the impact of the united fund can be distinctively assessed.
• 3.    Untied  funds  to  Primary  Health  Centers  is  to  make  funds  available  for  undertaking innovative  institution  specific  and  need-based  activities.  Most  of  the  Primary  Health Centres  are  not  maintained  properly  due  to  lack  of  steady  fund,  available  locally  for repair / refurbishing of infrastructure and basic facilities.
• 4.    The Centres are not required to take prior approval of District Health and Family Welfare Society/Civil Surgeon before implementing the schemes/incurring expenditure from the untied funds. Monthly expenditure reports indicating the aggregate expenditure and containing details of activities carried out and improvements effected, should be furnished by 5th  of the  succeeding  month  to  the  District  Medical  Officer  of  Health/District  Programme Manager. Expenditure should be restricted to funds actually received by the centre.
• 5.    A  separate  register  is  to  be  maintained  in  the  PHC  duly  signed  and  certified  by  the Medical Officer giving sources of funds, clearly for various activities and details of work carried  out  with  values,  details  of  vouchers,  files  etc.  A  copy  of  the  register  is  to  be furnished   to   District   Health   and   Family   Welfare   Society/Civil Surgeon   at   the   time   of settlement of accounts. Unutilized amount, if any, will at the end of the project period have  to  be  refunded  by  means  of  a  crossed  Demand  Draft  to  the  District  Health  and Family Welfare Society/Civil Surgeon, who shall in turn refund the same to the State Mission Director.
• 6.    Utilization  of  funds  should  be  with  the  mandate  of  the  Swasthya Kalyan  Samitti  (SKS)who shall undertake and supervise the work. Swasthya Kalyan  Samitti  will monitor the quality and  quantity  of  work  undertaken  under  the  scheme.  The repairs and renovations are carried out on the basis of Facility Survey conducted and approved at the institution level. There should be proper scrutiny of estimates / accounts by the Medical Officer.
• 7.    The  progress  of  work  should  be  monitored  by  the  Swasthya Kalyan  Samitti.
• 8.    There should not be duplication of work with other schemes carried out in the Institution.
• 9.    Untied Funds will be used only for the common good and not for individual needs, except in the case of referral and transport in emergency situations.

AREAS WHERE UNTIED FUNDS, ANNUAL FUNDS & GRANT TO SKS CAN BE USED

• 1.    Infrastructure modification like curtains to ensure privacy, repair of taps, bulbs, tubes, other minor repairs
• 2.    Provision of running water supply
• 3.    Provision of electricity or electrical fittings – lights, fans, etc
• 4.    Ad hoc payments for cleaning of center, especially after child birth
• 5.    Transport of emergencies to appropriate referral centers
• 6.    Transport of samples during epidemic
• 7.    Purchase of minor equipment such as examination table, delivery table, BP apparatus, HB Meter, Copper-T insertion kit, Instrument Tray, Baby tray, weighing scale for mother and new born, dressings scissors/material ,Stethoscope, Attendant Stool, mackintosh sheet or any of the equipment required for full functioning of PHC as per IPHS norms.
• 8.    Purchase of consumables such as bandages or drugs, bleaching powder provided they are in the essential list approved for PHC.& use only to tied over temporary gaps.
• 9.    Payment reward to ASHA for identified activities.

GUIDELINES FOR UTILIZATION OF UNTIED FUNDS FOR SKS (CHCs) IN HARYANA

National Rural Health Mission aims to increase functional, administrative and financial resources and autonomy to field units.  Every SKS (CHC )  will  get the funds as under:-

• 1.   A sum  of  Rs.  50,000/- per annum as untied funds for local health action.
• 2.    Rs. 1,00,000/- for improvement and maintenance of physical infrastructure.
• 3.    Rs. 1,00,000/- as grant to SKS for any activity to provide facilities to the patients (Provision of Drinking Water, toilets, etc).

To increase functional, administrative and financial resources and autonomy to the field units, as part of Health Sector Reforms under National Rural Health Mission (NRHM) as united grant for local health action.  Allotment  of  funds  to  the  States  has traditionally  been  of  the  nature  of  tied  fund  for  implementing  a  particular  activity  / scheme  and  this  hardly  left  any  funds  with  the  public  health  facilities.  Centralized management and schematic in-flexibility in the use of funds allotted did not provide any scope for local initiative and flexibility for local action at block and down below level. This scheme aims at enabling innovative /institution specific/need based activity in the Community Health Centres.

• 1.    Since there would be substantial fund flow to the districts to be utilized for the Centres under NRHM/RCH-II and other programmes, the united funds should not  duplicate what is/can be taken up under other programmes. Each activity planned by the Centre should have clear rationale so that the impact of the united fund can be distinctively assessed.
• 2.    Untied  funds  to  Community  Health  Centers  is  to  make  funds  available  for  undertaking innovative  institution  specific  and  need-based  activities.  Most  of  the  Community  Health Centres  are  not  maintained  properly  due  to  lack  of  steady  fund,  available  locally  for repair / refurbishing of infrastructure and basic facilities.
• 3.    The Centres are not required to take prior approval of District Health and Family Welfare Society/Civil Surgeon before implementing the schemes/incurring expenditure from the untied funds. Monthly expenditure reports indicating the aggregate expenditure and containing details of activities carried out and improvements effected, should be furnished by 5th  of the  succeeding  month  to  the  District  Medical  Officer  of  Health/District  Programme Manager. Expenditure should be restricted to funds actually received by the centre.
• 4.    A  separate  register  is  to  be  maintained  in  the  CHC  duly  signed  and  certified  by  the Senior Medical Officer giving sources of funds, clearly for various activities and details of work carried  out  with  values,  details  of  vouchers,  files  etc.  A copy of the register is to be furnished   to   District   Health   and   Family   Welfare   Society/Civil Surgeon   at   the   time   of settlement of accounts. Unutilized amount, if any, will at the end of the project period have  to  be  refunded  by  means  of  a  crossed  Demand  Draft  to  the  District  Health  and Family Welfare Society/Civil Surgeon, who shall in turn refund the same to the State Mission Director.
• 5.    Utilization  of  funds  should  be  with  the  mandate  of  the  Swasthya  Kalyan  Samitti  (SKS) who shall undertake and supervise the work. Swasthya Kalyan  Samitti  will monitor the quality and  quantity  of  work  undertaken  under  the  scheme.  The repairs and renovations are carried out on the basis of Facility Survey conducted and approved at the institution level. There should be proper scrutiny of estimates / accounts by the Senior Medical Officer.
• 6.    The  progress  of  work  should  be  monitored  by  the  Swasthya Kalyan  Samitti.
• 7.    There should not be duplication of work with other schemes carried out in the Institution.
• 8.    Untied Funds will be used only for the common good and not for individual needs, except in the case of referral and transport in emergency situations.

GUIDELINES FOR USE OF SUB CENTRE FUNDS UNDER NRHM

            As a part of NRHM, each Sub Centre is entitled for Rs. 10,000/- as untied fund & a sum of Rs. 10,000/- as maintenance grant which would be spent as per the following guidelines:-

1. Both these funds will be kept in the joint account of ANM & Sarpanch
2. Decision regarding activities for which the funds are to be used shall be approved by the Panchayat Sarpanch, ANM & VHSC.
3. The untied fund will be used only for common goods and not for individual need except in the case of referral transport in emergency situations.
4. Minor modification to Sub Centre i.e. curtains to ensure privacy, repair of taps, installations of bulbs, other minor repairs
   1. Adhoc payment for cleaning of sub centre, especially after child birth. ANM can spent Rs. 500/- PM for this purpose.
   2. Transport of emergency
   3. Transport of sample during epidemic
   4. Purchase of consumables such as bandages, etc.
   5. Purchase of bleaching powder & disinfectant for use in common areas of village.
   6. Labour & Supply for environmental sanitation, such as cleaning or larvicidal measures for stagnant water.
   7. Payment/ Reward to ASHA for certain identified activities.
   8. Any other activity that is part of approved village health plan.
5. These untied funds shall not be used for any monthly salary though they can be used to make payment for services rendered.
6. These untied funds should not be used to meet the expenses of Gram Panchayat which do not relate directly or indirectly to health care.( Funds cannot be used to meet administrative or establishment expenditure of Gram Panchayat)

Village Level Committee-cum-Village Health & Sanitation Committee

(VLC-cum-VHSC)

Funds:

      Every committee would be entitled for an annual untied grant of Rs. 10,000/-. However, every village is free to contribute additional grant toward VLC-cum-VHSC. In the villages where the community contributes financial resource to the VLC-cum-VHSC, the matching additional incentive and financial assistance to the village would be explored.

• ·         Intention of this untied grant is to enable local action and to ensure that public health activity at village level receive priority attention.
• ·         The untied grant shall be used for community activities that involve and benefit more than one household.
• ·         The funds can be used for area concerning public health, nutrition, education and sanitation, environmental protection, household survey, etc.
• ·         Health awareness activities, source reduction measures for Vector Control, building of transport communication link that can be used to access Emergency Ambulance Services, publication of IEC material or notice, etc.
• ·         The committee will oversee the village level implementation of all programs relating to women & children and will receive feed back from beneficiaries under various programs.
• ·         It will maintain child tracking record in every village in the Anganwari Centers in order to monitor every child birth survival, nutrition, health education and protection etc.
• ·         It will in addition deal with social issues pertaining to women such as domestic violence, dowry, female feticide, early marriage etc.
• ·         The committee will meet at least once a month and the proceeding of the meeting will be recorded by the convener in a register
• ·         The Committee will act as a catalyst in taking forward new initiatives such as supply of food items to Anganwari through women self help groups, mobilization of mothers to keep watch over quality of food and other services.

Maintenance of Bank Accounts/ Accountability:

• ·         Funds under NRHM meant for VHSC will be transferred into bank accounts of VLC cum VHSC. Civil Surgeons will initiate and coordinate with Programme Officers (ICDS) and ensure that untied funds meant for VHSC are immediately transferred into the bank account of VLC cum VHSC. Funds will be deposited into these accounts directly from district office of the Civil Surgeon.
• ·         VLC cum VHSC will maintain separate cash book for funds provided by Health Department.
• ·         VLC cum VHSC will nominate one member to maintain cash book of funds given by Health Department and will be paid Rs 50/- per month for maintaining the cash book out of the untied funds available with VHSC
• ·         The accounts shall be available for public scrutiny and shall be inspected from time to time by Gram Panchayat
• ·         Each committee shall maintain a record of money received and expenditure incurred & relating it to the activities under taken and the same shall be available for placing before the committee/ public scrutiny and for review by Health Department’s representative.
• ·         Each VLC cum VHSC shall maintain a register for recording significant activities undertaken.
• ·         The SKS(PHC) shall review the functioning & progress of activities undertaken.

Desirable Outcome:

            Each VLC-cum-VHSC is free to decide which outcome it would prioritize. However, the following actions are required:-

• 1.    Maintain accounts and timely submission of Utilization Certificate & the Statement of Expenditure for the money received.
• 2.    Ensuring 100% registration of all birth and death.
• 3.    Making a village health plan by way of understanding the health priorities of the village