Annual Report

Department of Health & Family Welfare

Ministry of Health & Family Welfare

Government of India

ANNUAL REPORT

2013-14

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Ministry of Health & Family Welfare

Government of India

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iAnnual Report 2013-14

This Annual Report outlines the activities of theDepartment of Health & Family Welfare and of schemesimplemented over the year 2013-14.

Under the VIIth Schedule of the Constitution of India, itis the responsibility of the State Governments to providefor health care; however, the Government of India playsa vital role in supporting State Governments in theirefforts towards achieving the targets of National HealthPolicy, 2002.

The obligation of the Government to ensure the highestpossible health status of India's population and to ensurethat all people have access to quality health care has beenrecognized by a number of key policy documents. Thepolicy directions of the "Health for All" declarationbecame the stated policy of Government of India withthe adoption of the National Health Policy Statement of1983. Driven by this declaration there was someexpansion of primary health care in the eighties. Further,the National Health Policy of 2002 and the Report of theMacro-Economic Commission on Health andDevelopment (2005) emphasized the need to increasethe total public health expenditure from 2 to 3% of theGDP. They also stressed the need to strengthen the roleof public sector in social protection against the risingcosts of health care and the need to provide acomprehensive package of services without reducing theprioritization given to women and children's health.

India's health challenges are diverse. Communicablediseases, notably Tuberculosis and Malaria, continue toconstitute a major part of the country's disease burden.At the same time the threat of Non-communicableDisease (NCD) including diabetes, hypertension, cancerand mental illness is clearly perceived. It is also cruciallyrelevant that maternal and infant mortality continue toremain unacceptably high in several parts of the country.

The Ministry of Health & Family Welfare isimplementing various schemes, programmes and nationalinitiatives to provide universal access to qualityhealthcare. The approach is to increase access to thedecentralized public health system by establishing new

INTRODUCTION

infrastructure in deficient areas and by upgrading theinfrastructure in the existing institutions. As part of theplan process, many different programmes have beenbrought together under the overarching umbrella of theNational Health Mission (NHM) with National RuralHealth Mission (NRHM) and National Urban HealthMission (NUHM) as its two Sub-Missions. The majorprogrammes being implemented are RoutineImmunization (RI), National Vector Borne DiseaseControl Programme (NVBDCP), Revised National TBControl Programme (RNTCP), Integrated DiseasesSurveillance Programme (IDSP), National Programmefor Control of Blindness (NPCB), National Mental HealthProgramme (NMHP), National Programme for HealthCare of the Elderly (NPHCE) and National Programmefor Prevention and Control of Cancer, Diabetes,Cardiovascular Diseases and Strokes (NPCDCS).Besides, central assistance is also being provided tostrengthen the medical, disaster management,redevelopment of hospitals and dispensaries etc.

By the end of the 12th Plan (i.e. 2017) the National HealthMission endeavors to reduce Maternal Mortality Ratio(MMR) from 1.78 to 1 per 1000 live births, InfantMortality Rate (IMR) from 42 to 25 per 1000 live births,Total Fertility Rate (TFR) from 2.4 to 2.1, prevent andreduce incidence of anaemia in women aged 15-49 years,prevent and reduce mortality & morbidity fromcommunicable, non-communicable, injuries andemerging diseases and reduce household out-of pocketexpenditure on total health care. India's public spendingon core health as a proportion of GDP is approximately1.04% and the 12th Plan goal is to increase it to 1.87%by the end of the Twelfth Plan.

NATIONAL HEALTH MISSION

The National Health Mission (NHM) with its two Sub-Missions, the National Rural Health Mission (NRHM)and the National Urban Health Mission (NUHM) wasapproved by the Cabinet in May, 2013. The NHMenvisages universal access to equitable, affordable &quality healthcare services that are accountable and

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Annual Report 2013-14

responsive to people's needs. The main programmaticcomponents include Health System Strengthening in ruraland urban areas, Reproductive- Maternal- Newborn-Child and Adolescent Health (RMNCH+A) and controlof Communicable and Non-Communicable Diseases.The framework for Implementation of National HealthMission was approved in December, 2013. Under NHM,substantial achievements have been made, the details ofwhich are available in the report. The 7th CommonReview Mission (CRM) under NHM was conducted fromNovember 2013 in 14 States / UTs namely Bihar,Jharkhand, Odisha, Uttar Pradesh, Jammu & Kashmir,Himachal Pradesh, Arunachal Pradesh, Meghalaya,Nagaland, Andhra Pradesh, Haryana, Karnataka,Maharashtra, and Gujarat. The CRM observed increasedchild survival, population stabilization and utilization ofhealth services, though the progress across States wasnot analogous. The Infant Mortality Rate (IMR), thedeaths of children before age 1 per 1000 live-births, hasfallen steadily every year, with an all India average of42. While this is short of the 12th Plan target of 25, someStates have made remarkable progress with Goa havingan IMR of 10, Kerala 12, Nagaland 18, Manipur 10 andTamil Nadu 21. The Maternal Mortality Ratio (MMR),which measures the number of women of reproductiveage (15 to 49) dying due to maternal causes per 1,00,000live-births, has come down to 178, though this is far shortof the 12th Plan target of 100. Some States have registeredsignificant reduction in MMR with Kerala at 66,Maharashtra at 87 and Tamil Nadu at 90.

There has been a significant improvement in creation ofnew facilities and infrastructure, though adequate staffingof these facilities by qualified health personnel remainsa problem. Availability of drugs has improved at all levelsand the robust logistic arrangements for procurement andstorage of these drugs are being put in place. An importantachievement of NHM has been a considerable reductionin out of pocket expenses from 72% to 60%.

Recently, new initiatives have been launched underNHM. Rashtriya Bal Swasthya Karyakram (RBSK)was launched to provide comprehensive healthcare andimprove the quality of life of children through earlydetection of birth defects, diseases, deficiencies, anddevelopment delays including disability. Anotherinitiative, viz. Rashtriya Kishor Swasthya Karyakram

(RKSK) was launched to comprehensively address thehealth needs of the 253 million adolescents, whoaccount for over 21% of the country's population, bybringing in several new dimensions like mental health,nutrition, substance misuse, injuries and violence andnon-communicable diseases. The programme hasintroduced community based interventions throughpeer educators and is underpinned by collaborationswith other Ministries and State Governments andknowledge partners, coupled with operationalresearch. In addition to these initiatives, the WeeklyIron Folic Acid Supplementation Programme (WIFS)was launched to address adolescent anaemiawhereunder supervised Iron-Folic Acid (IFA) tabletsare given to adolescent population between 10-19years of age in both rural and urban areas throughoutthe country. NUHM, a sub-mission under the NHM,caters to the healthcare needs of the urban populationwith the focus on urban poor and is aimed at reducingout of pocket expenses for treatment. NHM is a steptowards realizing the objective of Universal HealthCoverage in the country.

Maternal Health is an important aspect for thedevelopment of any country in terms of increasing equityand reducing poverty. The survival and well being ofmothers are not only important in their own right butalso central to solving broader, economic, social anddevelopmental challenges. Janani Suraksha Yojna (JSY)has resulted in a steep rise in demand for services inpublic health institutions with the institutional deliveriesregistering a substantial increase since its inception in2005. The number of JSY beneficiaries has risen from7.3 lakhs in 2005-06 to about 105.48 lakhs in 2013-14.Capitalizing on the surge in institutional deliveriesbrought about by JSY to provide service guarantees athealth facilities, Government of India has launched JananiShishu Suraksha Karyakaram (JSSK) on 1st June, 2011to eliminate out of pocket expenditure for pregnantwomen and sick new- borns on drugs, diet, diagnostics,user charges, referral transport, etc. This has now beenexpanded to cover the complications during ANC, PNCand also sick infants.

In a remarkable turn of events, India reported only onecase of the crippling disease of polio in January 2011and after that not a single case of polio was reported

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over the years. The World Health Organization (WHO)has taken India off its polio endemic list and declaredthe whole South-East Asia Region including India freeof polio on 27 March, 2014, a major milestone. Hibcontaining pentavalent vaccine has been introduced in 8States in 2012-13 and country wide expansion is plannedin 11 States from October 2014 and remaining 16 States/UTs from April 2015. Elimination of Maternal andNeonatal Tetanus is validated in 18 States (2005-2013)and there is a plan to validate 9 States by 2014 and theentire country by 2015.

FAMILY PLANNING

The Family Planning programme has been repositionedas a critical intervention to reduce maternal and childmortality and not just as a strategy for populationstabilization. At present the emphasis is being placed onspacing between births along with terminal methods.Strengthening community based service delivery isanother key focus area; where ASHAs are deliveringcontraceptives at the doorstep of beneficiaries and arecounseling them for maintaining spacing.

HEALTH POLICY

The Five Year Plans outline the strategy for implementingthe policy, bearing in mind the dynamics of a developingeconomy. Accordingly, the Twelfth Five Year Plan forthe health sector envisages transformation of the NationalRural Health Mission into a National Health Missioncovering both rural and urban areas. It envisagesproviding public sector primary care facilities in selectedlow income urban areas, expansion of teaching andtraining programmes for health care professionalsparticularly in the public sector institutions giving greaterattention to public health, strengthening the drug and foodregulatory mechanism, regulation of medical practice,human resource development, promoting informationtechnology in health and building an appropriatearchitecture for Universal Health Care. The Twelfth Planstrategy is to strengthen initiatives taken in the EleventhPlan to expand the reach of health care with focus onvulnerable and marginalized sections of population andtherefore, envisages substantial expansion andstrengthening of the public health systems and provisionof robust primary health care.

MEDICAL EDUCATION (ME)This year the Cabinet Committee on Economic Affairs(CCEA) has approved Centrally Sponsored Schemes forEstablishment of new medical colleges attached withexisting district/referral hospitals and CentrallySponsored Schemes for Strengthening & Up-gradationof State Government/Central Government medicalcolleges for increasing the number of MBBS seats in thecountry. The objective is to utilize the existinginfrastructure of district hospitals for increasingundergraduate seats in a cost effective manner byattachment of new medical college with existing district/referral hospitals and to mitigate the shortage of doctorsby increasing the number of undergraduate seats in thecountry for equitable health care across the country andto achieve the desired doctor population ratiorespectively.

At present, there are 387 medical colleges in the countryout of which 181 are in the public and 206 in the privatesector with annual admission capacity of about 51,979MBBS and 24,196 Postgraduate students per year. 25new medical colleges have been granted permission forthe academic year 2013-14 and a total of 6350 MBBSseats and 1081 PG seats have been increased for the year.

There are two Centrally Sponsored Schemes for theFinancial Year 2013-14 regarding ParamedicalEducation. These are "Establishment of National Instituteof Allied Health Sciences (NIAHS) and Eight RegionalInstitute of Allied Health Sciences (RIAHS) andsupporting the State Govt. Medical Colleges forconducting paramedical courses through one time grant"and "Setting up of State institutions of paramedicalsciences in States and setting up of college of paramedicaleducation".

Further, two Centrally Sponsored Schemes regardingPharmacy Education are "Strengthening/Up-gradationof Pharmacy Institutions" and "Setting up of College ofPharmacy in Government Medical Colleges".

The National Florence Nightingale Award was given on12.5.2013 by the Hon'ble President of India to 35 nursingpersonnel as a mark of the highest recognition formeritorious services in the nursing profession in thecountry.

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The National Nursing Portal, designed and developedby National Informatics Centre was launched on 14thFebruary, 2013. It is an online resource centre for nurses,students, nursing institutions, national and State nursingcouncils and boards and the Ministry of Health & FamilyWelfare.

PRADHAN MANTRI SWASTHYA SURAKSHAYOJANA (PMSSY)The Pradhan Mantri Swasthya Suraksha Yojana(PMSSY) envisaged the establishment of six AIIMS-likeinstitutions and upgradation of the existing 13 medicalcollege institutions in the first phase. It provided for theestablishment of two AIIMS like institutions in UttarPradesh & West Bengal and upgradation of 6 moremedical college institutions in the second phase, withthe objective of correcting regional imbalances in theavailability of affordable/reliable tertiary healthcareservices and to also augment facilities for quality medicaleducation in the country. The PMSSY up-gradationprogramme broadly envisages improving healthinfrastructure through construction of Super SpecialityBlocks/Trauma centres etc. and procurement of medicalequipments for existing as well as new facilities.

Out of 13 medical college institutions taken up for up-gradation in the first phase of PMSSY, upgradation workat 8 medical colleges has been completed. Out of 6medical college institutions being upgraded in secondphase, five institutions involve civil work. The civil workat Dr. Rajendra Prasad Government Medical College,Tanda has been completed. The civil work at the otherfour institutions, namely Aligarh Medical College,PGIMS-Rohtak, Amritsar Medical College and MaduraiMedical College is in progress. At one institution whereup-gradation programme involves only procurement ofequipments, the procurement process has already beeninitiated. In addition, the Central Government hasapproved up-gradation of additional 39 medical collegesunder the third phase of PMSSY upgradation.

COMMUNICABLE DISEASES

The incidence of vector borne diseases viz. Malaria,Filaria, Kala-azar, Acute Encephalitis Syndrome (AES)including Japanese Encephalitis (JE), Dengue andChikungunya is linked with economic and social

development of the community. Among all the vectorborne diseases, malaria is still a major problem in thecountry though the reported figures from the States haveshown a decline. Various initiatives have been taken forprevention and control of malaria such as upscaling ofrapid diagnostic tests, use of effective drugs i.e.Artemisinin Combination Therapy (ACT), use of LongLasting Insecticidal Nets (LLINs) and providingadditional manpower. In the North-Eastern States earlysigns of resistance to currently used SP-ACT has beennoticed and to tackle that an effective combination ofArtemether-Lumefantrine (ACT-AL) has beenrecommended for the treatment of Pf cases in the NorthEastern States. To intensify the malaria control activitiesin high malarious endemic districts, additional inputs arealso provided in projects under the aegis of World Bankand Global Fund.

The cases of viral diseases such as J.E., Dengue andChikungunya are managed symptomatically. However,the surveillance and diagnosis have been strengthenedto detect more cases and provide early case managementby the States/UTs. Kala-azar has been targeted forelimination by 2015 as per tripartite agreement betweenIndia, Nepal and Bangladesh. Lymphatic Filariasis hasbeen targeted for elimination by 2015 as per NHP - 2002,however, the global elimination target is 2020. Effortshave been initiated to achieve the target for eliminationof these diseases. In filaria elimination, 186 out of 250districts have achieved a microfilaria prevalence less than1%. The validation process has been initiated in a phasedmanner and 5 districts have successfully completed thetransmission assessment survey indicating thattransmission has been interrupted. The process is on inanother 50 districts which is likely to be completed in2013-14.

National Leprosy Eradication Programme wasintroduced in 1983. Since then, remarkable progress hasbeen achieved in reducing the disease burden. Indiaachieved the goal set by the National Health Policy, 2002of elimination of leprosy as a public health problem,defined as less than 1 case per 10,000 population, at theNational level in December 2005. Still around 1.30 lakhnew cases are detected & put on treatment every year.The budgetary outlay has been increased to Rs. 500 crorein the 12th Plan from Rs. 221 Crore in the 11th Plan.

vAnnual Report 2013-14

Tuberculosis continues to be a major public healthproblem, with an estimated 3 million people in Indiasuffering from the disease. 2 million cases are estimatedto be added every year of which 7% are children andaround 3 lakh people still die from this disease everyyear, despite availability of an effective treatmentstrategy. The Revised National Tuberculosis ControlProgramme (RNTCP) is working on strategies to provideUniversal Access to quality TB Diagnosis and treatmentfor all TB cases, finding unreached TB cases before theycan transmit infection, treating all of them moreeffectively and preventing the emergence of DrugResistant TB. The Government has approved theStandards of TB Care in India, which will be instrumentalin addressing diagnosis and treatment practices in thecountry along with many non-medical aspects that impactthe care of TB patients. The programme is activelyinvolving Information Communication Technology (ICT)which gives unprecedented opportunities to ensure thatTB cases are promptly diagnosed and optimally treated.Nikshay, a case-based, web enabled system for recordingand reporting of TB cases, developed by NIC incollaboration with the RNTCP, will enable bettersurveillance and tracking of all TB cases, including thosein the private sector.

NON-COMMUNICABLE DISEASES (NCDS)The Government of India has launched the "NationalProgramme for Health Care of the Elderly" (NPHCE)to address health related problems of elderly people withthe basic aim to provide separate, specialized andcomprehensive health care to senior citizens at variouslevels of the State health care delivery system includingoutreach services, in 100 identified districts of 21 Statesduring the 11th Plan period. Eight Regional GeriatricCentres as referal units have also been developed indifferent regions of the country under the programme. Itis expected to cover 225 more districts during the 12thFive Year Plan in a phased manner. 12 more RegionalGeriatric Centres in selected Medical Colleges of thecountry are also expected to be developed under theprogramme.

In the 12th Five Year Plan, the National Programme forPrevention and Control of Cancer, Diabetes,Cardiovascular Diseases and Strokes (NPCDCS) is being

implemented in 35 States/UTs from 2013-14. NPCDCShas now been brought under the umbrella of NHM inPIP mode. Interventions upto District level and belowhave been integrated under the Mission and fundsprovided through NCD Flexipool.

The National Programme for Control of Blindness(NPCB) is an ongoing centrally sponsored scheme since1976 with the goal of reducing the prevalence ofblindness to 0.3% by 2020. The Plan of Action toimplement NPCB has been prepared in line with theGlobal Initiative: "Vision 2020: the Right to Sight". Theprogramme continues to focus on development ofcomprehensive eye care services targeting commonblinding disorders including Cataract, Refractive Errors,Glaucoma, Diabetic Retinopathy, Childhood Blindness,Corneal Blindness etc. during the 12th Five Year Plan tocombat blindness.

Nutritional Iodine Deficiency can result in abortions,stillbirth, mental retardation, dwarfism, deafness, mutism,squint, goiter, neuromotor defects, loss of IQ,compromised school performance etc. A centrallysponsored programme namely National IodineDeficiency Disorders Control Programme (NIDDCP)formerly known as the National Goiter ControlProgramme (NGCP) is being implemented in the entirecountry with focus on provision of iodated salt, districtIDD survey/resurvey, laboratory monitoring of iodatedsalt and urinary iodine excretion, community awarenessand monitoring of household salt by ASHAs, healtheducation and publicity.

INFORMATION, EDUCATION ANDCOMMUNICATION (IEC)Information, Education and Communication (IEC) isnow rightfully recognized as an integral part of policymaking procedure. Over the years, the thrust of theDepartment has been to place IEC as an interventiontool to generate demand for the range of services underthe National Rural Health Mission and various otherschemes implemented by this Department. Thecommunication strategy aims to facilitate awareness anddisseminate information regarding availability andaccess to quality health care within the Governmentrun public health system.

The sustained IEC campaign on Polio and hard work ofhealth functionaries over several years had unprecedentedsuccess as no incident of Polio has been reported since13th January, 2011, thus paving the way for a Polio freeIndia. It was without doubt the result of a focused andwell-coordinated IEC campaign for Polio free India. TheWorld Health Organization has given official certificationto India for its 'Polio Free' status on 27th March, 2014.

The health magazine programme "Swasth Bharat" hasbeen produced & telecast and broadcast through 30Regional Kendras of Doordarshan and 29 stations of AllIndia Radio covering 27 States to reach out to a widerspectrum of population with information on health relatedissues. Among the important print materials publishedfor IEC campaign during the year were 20 folders onvarious National Health Programmes/schemes, NRHMnewsletter and Hamara Ghar (Hindi journal) and leafletson different health issues. These print materials weredistributed across the country for dissemination,information and generation of awareness of people onhealth issues. The annual exhibition at Health Pavilionwas organized at Pragati Maidan during the IndiaInternational Trade Fair 2013 with the theme 'Health withEquity' and was awarded a silver medal among thepavilions of "Ministry" category.

ASSISTANCE TO PATIENTS

Health Minister's Cancer Patient Fund (HMCPF) withinthe Rashtriya Arogya Nidhi (RAN) has also been set upin 2009. In order to utilize the HMCPF, the revolvingfund as under RAN, has been established in the variousRegional Cancer Centres (RCCs). Such steps wouldensure and speed up financial assistance to needy cancerpatients and would help to fulfill the objective of HMCPF.The financial assistance to the cancer patient up toRs.1.00 lakh would be processed by the concerned

Institutes/Hospitals at whose disposal, the revolving fundhas been placed. Individual cases which requireassistance of more than Rs.1.00 lakh but not exceedingRs.1.50 lakh are to be sent to the concerned State IllnessAssistance Fund of the State/UT to which the applicantbelongs or to this Ministry in case no such scheme is inexistence in the respective State or the amount is morethan Rs.1.50 lakh. Initially 27 Regional Cancer Centres(RCCs) were proposed at whose disposal revolving fundof Rs. 10.00 lakh was placed. An amount of Rs. 440 lakhwas released to 16 Institutes during the year 2013-14.

FUTURE COMMITMENTS

The National Urban Health Mission (NUHM), launchedas a Sub-Mission of National Health Mission (NHM),has been identified as an area of priority attention forscaling up effective roll out during 2014-15. Importantlegislative measures like amendments to the MentalHealth Care Bill and the Indian Medical Council, 1956(Amendment) Bill have to be pursued vigorously toachieve the desired objectives in Mental Health Care andMedical Education. Further expansion of the project ofsetting up of AIIMS in remaining States under PradhanMantri Swasthya Suraksha Yojana (PMSSY) and takingeffective steps for introducing Injectable Polio Vaccine(IPV) as a part of Global Polio Endgame Strategy areother areas of priority for this Ministry to deliveracceptable standards of good health amongst the generalpopulation in the country.

(Lov Verma)Secretary


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ORGANIZATION CHARTOF

DEPARTMENT OF HEALTH&

FAMILY WELFARE

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SUMMARY OF IMPORTANT AUDIT OBSERVATIONS

The summary of important audit observations, appearing in the following most recent Audit reports of the yearended March 2012 are given below in the table:

1. Report No. 19 of 2013 Union Government (Civil)

Ministry of Health and Family Welfare

Pradhan Mantri Swasthya Suraksha Yojana An audit of the process of selection and payments madeto consultants and contractors for different stages ofconstruction of the six AIIMS like institutions wasconducted. Audit noted deficiencies in selection ofproject consultants and payment processes to consultantsand contractors. Cases of irregular release of mobilizationadvances were also noticed.

(paragraph 6.2)

Procurement of Allopathic drugs in CGHS Audit noted that 71 per cent of the drugs procuredconsisted of drugs outside the formulary despite the factthat prices of drugs in the formulary are comparativelylower. CGHS resorted to procurement of higher pricedbranded despite availability of low cost brands.

Branded drugs continue to be preferred over genericdrugs despite adverse remarks of the Parliamentarycommittee. This caused significant additional financialburden on the exchequer. The money value included inthis report relates to only test checked cases whichconstitutes only a small percentage of actual procurement.Therefore, the monetary impact of such irregular practicewould be much higher if the entire procurement wereto be reckoned.

(paragraph 6.3)

Loss due to expiry of anti-TB drugs Improper planning in procurement of anti-TB drugs bythe Central Tuberculosis Division the Ministry resultedin losses due to the expiry of drugs valuing 5.06 crore.

(paragraph 6.4)

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Department of Health & Family Welfare, Ministry of Health & Family Welfare

All India Institute of Medical Sciences Un-authorised expenditure on learning resourceallowance

All India Institute of Medical Sciences reimbursedlearning resource allowance to its faculty members andGroup A officers in violation of instructions of theMinistry.

(paragraph 4.1)

All India Institute of Medical Sciences Excess payments on procurement of surgical items

Delay in initiating tendering process resulted procurementof surgical items at higher prices resulting inviolablepayment of 51.53 lakh.

(paragraph 4.2)

1. Report No. 23 of 2013 Union Government (Civil)

SUMMARY OF IMPORTANT AUDIT OBSERVATIONS

1Annual Report 2013-14

1.1 INTRODUCTION

In view of the federal nature of the Constitution, areasof operation have been divided between UnionGovernment and State Governments. Seventh Scheduleof Constitution describes three exhaustive lists of items,namely, Union list, State list and Concurrent list.Though some items like public health, hospitals,sanitation etc. fall in the State list, the items havingwider ramification at the national level like FamilyWelfare and Population Control, Medical Education,Prevention of Food Adulteration, Quality Control inmanufacture of Drugs etc. have been included in theConcurrent list.

The Union Ministry of Health & Family Welfare isinstrumental and responsible for implementation ofvarious programmes on a national scale in the areasof health and family welfare, prevention and controlof major communicable diseases and promotion oftraditional and indigenous systems of medicines. Inaddition, the Ministry also assists states in preventingand controlling the spread of seasonal disease outbreaksand epidemics through technical assistance.

Expenditure is incurred by Ministry of Health &Family Welfare either directly under Central Schemesor by way of grants-in-aids to the autonomous/statutory bodies etc.and NGOs. In addition to the

Chapter 1

ORGANIZATION & INFRASTRUCTURE

centrally sponsored family welfare programmes, theMinistry is implementing several World Bankassisted programmes for control of AIDS, Malaria,and Tuberculosis in designated areas. Besides, StateHealth Systems Development Projects with WorldBank assistance are under implementation in variousstates. The projects are implemented by therespective State Governments and the Departmentof Health & Family Welfare only facilitates theStates in availing of external assistance. All theseschemes aim at fulfilling the national commitmentto improve access to Primary Health Care facilitieskeeping in view the needs of rural areas and wherethe incidence of disease is high.

The Ministry of Health & Family Welfare comprises thefollowing four departments, each of which is headed bya Secretary to the Government of India:-i. Department of Health & Family Welfareii. Department of AYUSHiii. Department of Health Researchiv. Department of AIDS Control

Organograms of the Department of Health & FamilyWelfare are at Annexure at the end pages of the AnnualReport.

Directorate General of Health Services (DGHS) is anattached office of the Department of Health & FamilyWelfare and has subordinate offices spread all over thecountry. The DGHS renders technical advice on allmedical and public health matters and is involved in theimplementation of various health schemes.

1.2 MINISTER IN CHARGE

The Ministry of Health & Family Welfare is headed byUnion Minister of Health & Family WelfareDr. Harsh Vardhan since 27th May 2014.

Dr. Harsh VardhanUnion Minister of Health & Family Welfare


1.3 ADMINISTRATION

The Department has taken new initiatives and steps toimplement Government programmes and policies inan efficient and time-bound manner as part ofGovernment's commitment for better health care forall its citizens.

Administration Division attends to service relatedgrievances of the staff in the Department of Health &Family Welfare. Secretary (Health & Family Welfare)also gives personal hearing to staff grievances.

File Tracking System has been operational sinceDecember 2011, e-governance initiative has beenstrengthened further by introduction of e-office systemin a phased manner. Biometric attendance system hasalso been introduced in the Department.

1.4 CENTRAL HEALTH SERVICE (CHS)

The Central Health Service was restructured in 1982 toprovide medical manpower to various participatingunits like Directorate General of Health Services (Dte.GHS), Central Government Health Service (CGHS),Government of National Capital Territory (GNCT) ofDelhi, Ministry of Labour, Department of Posts, AssamRifles, etc. Since inception, a number of participatingunits like ESIC, NDMC, MCD, Himachal Pradesh,Manipur, Tripura, Goa, etc. have formed their owncadres. JIPMER, Puducherry which has become anautonomous body w.e.f. 14th July, 2008 has gone outof CHS cadre. The latest in the list of institutions whichhas gone out of CHS cadre is Govt. of NCT of Delhi.Consequent upon the formation of Delhi Health Service906 posts (14 SAG, 150 Non-Teaching, 742-GDMO)belonging to Govt. of NCT of Delhi, have been decadredfrom CHS. At the same time, units like CGHS have alsoexpanded. The Central Health Service now consists of

the following four Sub-cadres and the present strengthof each Sub-cadre is as under:

i. General Duty Medical - 2152Officer Sub-cadre

ii. Teaching Specialists Sub-cadre - 987

iii. Non-Teaching Specialists - 647Sub-cadre

iv. Public Health Specialists - 104Sub-cadre

In addition to the above there are 19 posts in the HigherAdministrative Grade, which are common to all the foursub cadres.

1.5 RECRUITMENT & PROMOTIONS

1.5.1 Recruitment in GDMOs:- On the basis ofCombined Medical Services Examination- 2012,dossiers of 672 candidates have been received fromUPSC and they have been allocated to different cadresviz: Ministry of Defence, Ministry of Railways, MCD,NDMC besides Central Health Services on the basisof their Rank, preference and availability of vacancies.Further from the reserve list of CMSE-2012, dossiersof 41 candidates also have been received which havealso been distributed to participating cadres based onthe demand. Offer of appointment have been issued to110 candidates under CHS cadre. 14 AssistantProfessors have joined CHS on recruitment.Appointment of 36 GDMO Officers has been notifiedin the Gazette of India.

1.5.2 Promotions: During the year, the followingnumber of promotions took effect in various sub-cadresof the Central Health Service:


Sub- Sr. Designation of posts No.cadre No.

1. Promotion to the post of Special DGHS in Dte. General of Health Service 01

G 1. Senior Medical Officer (Grade Pay Rs. 6600/- in PB-3) to Chief Medical Officer 1D (Grade Pay Rs. 7600/- in PB-3)MO 2. Chief Medical Officer (Grade Pay Rs. 7600/- in PB-3) to Chief Medical Officer 47

(NFSG) (Grade Pay Rs. 8700/- in PB-4)

3. Chief Medical Officer (NFSG) (Grade Pay Rs. 8700/- in PB-4) to Senior 138Administrative Grade (Grade Pay of Rs. 10000/- in PB-4)

T 1. Assistant Professor (Grade Pay Rs. 6600/- in PB-3) to Associate Professor 03E (Grade Pay Rs. 7600/- in PB-3).AC 2. Associate Professor (Grade Pay Rs. 7600/- in PB-3) to Professor 32H (Grade Pay of Rs. 8700/- in PB-4).ING

N 1. Specialist Grade-II (Jr. Scale) (Grade Pay Rs. 6600/- in PB-3) to Special Grade-II 09O (Sr. Scale) (Grade Pay Rs. 7600/- in PB-3).NT 2. Specialist Grade-II (Sr. Scale) (Grade Pay Rs. 7600/- in PB-3) to Special Grade-I 15E (Grade Pay Rs. 8700/- in PB-4).ACHING

P 1. Specialist Grade-II (Jr. Scale) (Grade Pay Rs. 6600/- in PB-3) to Special Grade-II 05U (Sr. Scale) (Grade Pay Rs. 7600/- in PB-3).BL 2. Specialist Grade-I Officers (Grade Pay Rs. 8700/- in PB-4) to the post of SAG 04I (Grade Pay Rs. 10000/- in PB-4)CHEALTH


1.5.3 Confirmation of CHS Officers: Confirmationorders in respect of 19 GDMO officers and 70 Assistant/Associate Professors have been issued.

1.5.4 CHS-Rules, 2014: Recruitment Rules, 2014for Central Health Service has been finalized & notifiedby Ministry of Health & Family Welfare.

1.5.5 Other Service related matters:

(i) RTI: The number of RTI cases received in thisDivision is 279.

(ii) Court Cases: There were 81 Court cases pendingin the Hon'ble CAT, the High Courts and the SupremeCourt in the beginning of financial year 2013-14.However, vigorous efforts are taken by CHS Divisionto get disposal of the cases in the courts.

(iii) Study Leave: 06 officers of GDMO Sub-cadrewere granted study leave during the period

1.5.6 Considering the representations of CHSOfficers for Upgradation of below bench Markgrading in the ACRs: Consequent to the instructionscontained in Department of Personnel and Training'sO.M. No. 21011/1/2010-Estt.A dated 13.4.2010 andalso under Annual Performance Appraisal Report(APAR) guidelines, the representations of 16 CHSofficers for upgradation/retention of the below benchmark grading in their ACRs/APARs were considered bythe Competent Authority.

1.5.7 Non-Medical Scientists 2012-13: A proposalis under process for holding the DAB (DPC) to considerthe cases of Non-Medical Scientists from S-IV level forIn-situ promotion against the 06 vacant posts (floating)for the post of S-V level working under Ministry ofHealth and Family Welfare/Directorate General of HealthServices (DGHS).1.5.8 Dental Doctors 2013-14: 03 posts of AssistantProfessor of Dentistry in the Department of Dentistry,LHMC, New Delhi under Ministry of Health andFamily Welfare had been filled. Orders for promotionof 02 officers from Jr. Staff Surgeon (Dental) to the postof Staff Surgeon (Dental) for which DPCs were held in2012-13, have been issued. DPC was held for promotionunder DACP Scheme for 05 officers from DentalSurgeon to the post of Jr. Staff Surgeon during the

current year and the orders for the promotion have alsobeen issued. The process has also been initiated toamend the Dental Posts Recruitment Rules-1997.

1.6 e-GOVERNANCE INITIATIVES OF THEMINISTRY OF HEALTH AND FAMILYWELFARE

Health Informatics Division of National InformaticsCentre (NIC) provides MIS and Information &Communication Technology (ICT) support to Ministryof Health & Family Welfare. More than 1800 PCs ofthe Ministry are connected to the Local Area Network(LAN) at Nirman Bhawan, which in turn, are connectedto NICNET through RF Link and leased line circuits.Salient features of important projects handled by NICare as follows:

i) Website of the Ministry of Health & FamilyWelfare & of various bodies under Ministry

The redesigned website of the Ministry of Health &Family Welfare http://mohfw.nic.in with new additionalURL (http://mohfw.gov.in) is under process forrestructuring and making it content-rich, user-friendly.At present, the old website is operational for public andnew one is likely to be made available to public soon.Various other websites under the ministry are updatedon a regular basis, as and when the information isprovided by the users. Critical information such asnotifications of the CGHS, tenders and advertisementsunder the Ministry, Sanction. Details of the PrincipalAccounts Office & Public Expenditure Management,etc are uploaded in the website on regular basis. Inaddition a no. of websites under the MoHFW are beingmaintained by the respective users on their own usingContent Management System.

Many new websites have been designed, developed andhosted on NIC servers while many others are beingre-designed to incorporate recent technologies viz. websiteof Sports Injury Centre, Safdarjung Hospital, website ofLRS Institute of TB & Respiratory Diseases, website ofNational Rural Health Mission, to name a few.

ii) ICT Infrastructure SupportNIC provides new LAN connections; network basedAnti-virus solution in addition to maintaining existing


network users. At present over 1800 LAN nodes havebeen provided in the Department of Health & FamilyWelfare, Directorate General of Health Services andover 300 LAN nodes at Department of AYUSH. NICNETSupport is also provided at Department of HealthResearch (ICMR) and Department of AIDS Control(DAC). A number of organizations under MoHFW areunder NICNET domain. An NKN node has also beenprovided in each Government Medical College acrossCountry. The email and internet usage has grownsignificantly and officials prefer email communicationover other means. The network maintenance and desktopsrequire constant updation from the operating systemservice providers and hence the un-authorized access iscontrolled effectively. The migration to the new ipv6from ipv4 is underway.

iii) e-Office / FTS implementation in MoHFWThe File Tracking System (FTS) has been implementedsuccessfully in the Department of Health & FamilyWelfare with over 1200 users. Now all the files andreceipts are being diarized online and essentially moveusing online system, ensuring an easy mechanism forall the users to track the files and receipts anywhere inthe network. The e-Office system of NIC is underimplementation in Department of Health and FamilyWelfare. The Knowledge Management System (KMS)and e-leave module have been implemented inDepartment of Health and Family Welfare andDte. GHS. The e-File has been started in NRHM andAdministration Divisions on a selective basis. The FileTracking System (FTS) has been in continued usage inDepartment of AYUSH and Dte. GHS.

iv) e-Tendering implementation in MoHFWThe Department of Expenditure, Ministry of Financehas vide office memorandum dated 30th Nov. 2011,made e-publishing of all tenders mandatory, followingwhich e-Procurement has also been made mandatory.For this purpose a Central Procurement Portal has beendesigned (http://eprocure.gov.in). The DirectorProcurement has been designated as Nodal Officer.NIC-HID has assisted him and also various sub-ordinatebodies under the Ministry of Health & Family Welfareto successfully implement e-publishing and e-Tenderinghas also been implemented in certain Departments.

MSO, CGHS, to name a few have completed livee-tenders with the help of NIC. NIC-HID has co-ordinated with the CPP Team at HQ to conduct varioussensitization workshops for awareness of the users.Recently a new Autonomous Body under Ministry ofHealth and Family Welfare named Central MedicalServices Society is being roped in for usage ofe-Procurement in a large scale for the Ministry ofHealth and Family Welfare. While most of theorganizations have started e-Publishing, the entireprocess of e-tendering is being taken up by variousorganizations in phased manner.

v) Mother & Child Tracking System (MCTS)Mother and Child Tracking System (MCTS) facilitateto create the work plan, its execution and monitoringtowards Anti Natal Care and Post Natal Care of motherand child. It includes registrations; SMS basedverification of health facilities in English/Hindi orpreferred language, validation, the work plans forservices through SMS to ANMs, ASHAs. UnstructuredSupplementary Service Data (USSD) based service forMCTS Data updating has been made operational inHaryana State. Direct Benefit Scheme for JananiSuraksha Yojna (JSY) has been made operational throughCPSMS. MCTS have been integrated with MaternalDeath Review (MDR) software. 5 crores women and 4crores children are being tracked using MCTS software.The URL is http://nrhm-mcts.nic.in/ .

vi) NIKSHAY - Web based Tracking of TB PatientsNIKSHAY facilitates tracking of Normal TB Patients,Multi-Drug Resistant (MDR) TB patients and TB patientsbeing treated by the private sector under Notificationfrom Government of India. SMS is sent to the CentralTB Division (CTD) Officers, State and District TBOfficers for monitoring purposes. SMS is sent to TBPatient on registration. More than 20 lakhs patients aremonitored using NIKSHAY. This application has beenimplemented across India in all states. The URL ishttp://nikshay.gov.in.

vii) Computerization of Central Govt. HealthScheme (CGHS)

The computerized system is aimed at computerizing allfunctions of the dispensary such as Registration, Doctor'sprescription, Pharmacy Counter, Stores, Laboratory &


Indent etc. The system has been successfullyimplemented for the last 5 years in all the 24 cities ofCGHS including NCR Delhi covering 270 allopathicWellness Centers (WCs). On an average 50,000 patientsare registered in CGHS WCs daily in all locations. TheCGHS wing of Dr. Ram Manohar Lohia Hospital,New Delhi is already computerized, while of SafdarjungHospital, New Delhi is under progress. The mergedP&T dispensaries have been also computerized.

The plastic card for every individual CGHS beneficiaryhas been provided in NCR Delhi. The implementationfor outside delhi has also been initiated. The provisionhas been made for uploading of individual beneficiaryphoto while applying for plastic card online. Thepreventive Health Check-up for 40+ aged CGHSbeneficiaries is being implemented in 8 CGHS WellnessCenters in 4 Zones at NCR Delhi. The Rate ContractMedicines (Most Consumable Medicines, which areindented) are procured locally from supplier for instantavailability to the beneficiaries. Permission and Claimmodule for pensioners are started online in NCR Delhi.For outside Delhi it has been implemented in 9 cities.

The computerization of AYUSH CGHS WCs has beensuccessfully implemented in NCR Delhi. The store ofhomeopathic has been made online also. There are total38 units in Delhi/NCR which include Homeopathic,Ayurvedic, Unani and Sidha WCs & their Stores. TheSMS facility is also integrated for increased transparencyto the beneficiaries. The beneficiary now can see theirprescribed medicine history online.

To improve the network performance the alternateconnectivity of 4mbps optical fiber leased line has beenimplemented in 12 CGHS WC initially in Delhi. Proposalfor rest of the WC is under progress.

viii) National Programme for Control of Blindness(NPCB) MIS

Ministry of Health & Family Welfare had launched awebsite and online application in 2009 for their NationalProgramme for Control of Blindness in India. This isa national level project wherein following stake holdersare involved:

The NGOs enter the details of the patients operatedupon for cataract surgeries, get paid from Ministry for

various activities done under the programme and thissystem isable to generate the actual funds that need tobe provided to NGOs. Currently 2311 NGOs and 497District Hospitals and District Programme Managers(DPMs) are using NPCB MIS.The system also has the provision for informationexchange between Districts, States and Ministrypertaining to work execution and expenditure detailsand through this system the state and district users cangive their annual PIP (Programme Implementation Plan)and utilization of funds allocated by Ministry. Thesystem is also able to provide eye disease wise MISreports. The URL of the site is http://npcb.nic.in

ix) MIS for CHS (Central Health Services)CHS (Central Health Services) was constituted with aview to manage various medical posts for Doctorsunder the Central Government, Union Territories andcertain other organizations. Presently, it caters to theneeds of various participating units like DirectorateGeneral of Health Services including the organizationsunder its control, Central Government Health Scheme,Govt. of NCT of Delhi, Ministry of Labour, Ministryof Finance, Department of Posts etc. There is a webbased application for information management about allDoctors online with assigned roles to update the recordsof the doctors. Currently 75 Organizations where CHSDoctors are posted, use online CHS MIS. The URL ofthe MIS is http://chsmohfw.nic.in/

x) e-Hospital@NIC - A Hospital ManagementSystem from NIC

The e - Hospital is a workflow based ICT solution forHospitals specifically meant for the hospitals inGovernment Sector. This is generic software whichcovers major functional areas like patient care,laboratory services, workflow based document/information exchange, human resource and medicalrecords management of a Hospital. It is a patient-centric system rather than a series of add-ons to afinancial system. e-Hospital Product is beingimplemented in more than 25 Hospitals of the countryincluding All India Institute of Medical Sciences(AIIMS), New Delhi, NIMHANS, Bengaluru, GasRahat Hospitals in Bhopal.


xi) All India Quota Counseling for Medical andDental Seats

In order to reduce the time span for counseling andfacilitate students to take part in the counseling processfrom their homes or nearest internet access point, onlinesystem has been designed for allotment of All-IndiaQuota of Medical/Dental Seats from 2012. This webbased application (http://mcc.nic.in) facilitatesend-to-end support towards streamlining the admissionprocesses in all phases like Counseling and postcounseling operations in Medical Institutions.

xii) National Eligibility cum Entrance Test(NEET) - UG

In order to conduct NEET for Medical aspirants, a webbased solution http://cbseneet.nic.in was developed byNIC, which facilitates applying online by candidates,printing of Bank e-Challan for depositing fee in Banksacross India, Pay the examination fee through ElectronicPayment Gateway using Credit/Debit cards, Post Officee-Challan for depositing fee in Post Offices acrossIndia, application status, online correction in particulars,download admit card. Apart from this, information onvarious notices, facilitation centres, information at aglance, RTI, useful links and contact information hasbeen provided on the website. The result of the NEETwill be published on the http://results.nic.in websitewith a link on the NEET website. The website hasprovided information about latest news, important datesdownload and help.

xiii) MIS for National Organ and Tissue TransplantOrganization (NOTTO)

The Transplantation of Human Organs (Amendment)Act (THOA), 2011 is an Act, to provide the regulationof removal, storage and transplantation of human organsand tissues for therapeutic purposes and for preventionof commercial dealings in human organs. Hence,Ministry of Health and Family Welfare has decided toset up an organization named as National Organ andTissue Transplant Organization (NOTTO) which willlinked with Regional Organ and Tissue TransplantOrganization (ROTTO) and State Organs and TissueTransplant Organization (SOTTO). This National Organand Tissue Transplant Organization has been set up on

the 4th and 5th Floor of Indian Institute of Pathology(IoP) Building, inside Safdarjung Hospital, New Delhi.A web based application has also been designed andhosted to facilitate the Donors who are willing toDonate their Organs or Tissue after his/her death so thattheir organs may be used for saving the life of those whoare in need of Organ or Tissue. A Donor can pledge fordonation of their organs through this web basedapplication system. A Donor pledge card is also beingissued to him so that their Family Members or nearrelatives may also aware that he/she has pledged forDonation of Organ or Tissue. Through this web basedapplication, hospitals who are actively involved inOrgan Retrieval and Transplantation activity or goingto start this activity, would be authorized to do Retrievaland Transplantation of Organ or Tissue after registeringthrough this web based system and finally approved bythe Ministry of Health and Family Welfare (MoHFW).xiv) MIS for Health Accounting Scheme (ICMR)A web based application named ashttp://healthaccountsscheme.nic.in has been hosted as apilot project by Indian Council of Medical Research,Govt. of India, for online updation of Health Record onmonthly basis of individuals. Under this scheme aperson get Health Diary with carbon page. Originalcopy of the Health Diary remains with the user andcarbon copy is used for feeding information of individualhealth account through this web based system. Theinformation of health of individuals remains confidentialso that no one, other than concerned person, may knowabout health data. A health account number is allottedto individual person and based on that number furtheranalysis and reports are prepared for study and providinghealth services as per need of your area.

xv) Medicinal Plants database for NationalMedicinal Plant Board (NMPB)

The National Medicinal Plants Board (NMPB) andCentral Council for Research in Ayurvedic Science(CCRAS), under Department of AYUSH, Governmentof India, proposed the idea of developing a database inwhich, all the available published information on selectedmedicinal plants, covering every subject area can beaccessed at one place.


xvi) MIS for online Clinical EstablishmentRegistration and Regulation

The Clinical Establishments (Registration andRegulation) Act, 2010 has been enacted by the CentralGovernment to provide for registration and regulationof all clinical establishments in the country with a viewto prescribing the minimum standards of facilities andservices provided by them. The Act has taken effect inthe four states namely, Arunachal Pradesh, HimachalPradesh, Mizoram, Sikkim, and all Union Territoriessince 1st March, 2012 vide Gazette notification dated28th February, 2012. The States of Uttar Pradesh,Rajasthan and Jharkhand have adopted the Act underclause (1) of article 252 of the Constitution.The Ministry has notified the National Council forClinical Establishments and the Clinical Establishments(Central Government) Rules, 2012 under this Act videGazette notifications dated 19th March, 2012 and23rd May 2012 respectively.

The Act is applicable to all kinds of clinicalestablishments from the public and private sectors, ofall recognized systems of medicine including singledoctor clinics. The only exception will be establishmentsrun by the Armed forces.

The web based system http://clinicalestablishments.nic.in/ provides easy mechanism for anyclinical establishment to register for provisionalcertification online and get the same after the approvalby the District Registering Authority. PresentlyHimachal, Jharkhand and Daman and Diu started OnlineRegistration process.

xvii) MIS for Medical Stores Organization (MSO)The procurement, storage and distribution of medicines,surgical items and other hospital consumables by MedicalStores Organizations (MSO) and/or its subordinateorganizations/Warehouse under Director General ofHealth Services (DGHS), Ministry of Health & FamilyWelfare (MoHFW). There was a need of computerizationof this application to create the transparency and quickresponse. Hence a web based application(http://msotranparent.nic.in) has been designed whichis running since 2007. All the GMSDs have been linkedwith this website.

Now this application has been upgraded having followingfeatures:

Dynamic and CMS based.

Multi-users features at difference levels havingdifferent roles.

User can upload Tenders related to MSO throughthis website.

User can upload Photos in Photo gallery as pertheir requirements.

Presently total 16 users at MSO level, 27 users atGMSD level, 1513 Indentors, 199 Suppliers and 35Labs are using this online application.

1.7 ACCOUNTING ORGANIZATION

General Accounting set up

As provided in Article 150 of the Constitution, theAccounts of the Union Government, shall be kept insuch form as the President of India, may on the adviceof Comptroller & Auditor General of India prescribe.The Controller General of Accounts (CGA) in theM/o Finance shall be responsible to prepare and compilethe Annual Accounts of the Union Government to belaid in Parliament. The CGA performs this functionthrough the Accounts Wing in each Civil Ministry. TheOfficials of Indian Civil Accounts Organization areresponsible for maintenance of Accounts in Ministry ofHealth & Family Welfare. They have dual responsibilityof reporting to the Chief Accounting Authority of theMinistry/Department through the Financial Adviser foradministrative and accounting matters within theMinistry, as well as to the Controller General ofAccounts, on whose behalf they function in this Ministryto carry out its designated functions under the Allocationof Business Rules. The administration of AccountsOfficials in Ministry of Health & Family Welfare isunder the control of the office of the CGA.

The Secretary of each Ministry/Department is the ChiefAccounting Authority. This responsibility is to bedischarged by him through and with the help of theChief Controller of Accounts (CCA) and on the adviceof the Financial Advisor of the Ministry. The Secretaryis responsible for certification of Appropriation Accounts


and is answerable to Public Accounts Committee andStanding Parliamentary Committee on any observationsof the accounts.

Accounting set up in the Ministry

The Ministry of Health & Family Welfare has fourDepartments viz. Department of Health & FamilyWelfare, Department of AYUSH (Ayurveda, Yoga,Unani, Sidha & Homeopathy), Department of HealthResearch & Department of AIDS Control (NACO).There is a common Accounting Wing for all theDepartments. The Accounting Wing is functioning underthe supervision of a Chief Controller of Accountssupported by a Controller of Accounts (CA), Dy. CAand eleven Pay & Accounts Officers (PAOs) (SevenPAOs in Delhi & One each at Chennai, Mumbai,Kolkata & Puducherry). The CCA is also entrusted withthe responsibility of Budget Division of the Ministry.

In addition, there are fourteen encadred posts of theAccounts Officers located at various places. There is acommon Internal Audit Wing for all the Departments,which carry out the inspection of all the ChequeDrawing and Non-Cheque Drawing Offices, Pr. AccountsOffice and all the PAOs. There are 5 Field InspectionParties located at Delhi, Chandigarh, Mumbai, Kolkataand Bengaluru.

Accounting functions in the Ministry

The Accounting function of the Ministry comprises ofvarious kinds of daily payments and receipts, compilingof daily challans, vouchers, preparation of dailyExpenditures Control Register etc. Monthly expenditureaccounts, monthly receipts and monthly net cash flowstatements are being prepared for submission to Ministryof Finance through the CGA's office. The entire workof payment and accounts has been computerized.

The Pr. Accounts Office prepares Annual FinanceAccounts, Annual Appropriation Accounts, Statementof Central Transactions, Annual Receipts Budget, ActualReceipts and Recovery Statement for each grant of theMinistry. The head wise Appropriation Accounts aresubmitted to the Parliament by the CGA along with theC & AG's report.

In addition, the Pr. Accounts Office issues orders ofplacement of funds to other civil Ministries, issues

advices to Reserve Bank of India (RBI) for release ofloans/grants to State Governments and LOC to theaccredited Bank of the Ministry for placing funds withDDOs. Apart from general accounting functions, theAccounts Wing gives technical advices on variousBudgetary, Financial and Accounting matters.

The Accounting Wing also functions as a coordinatingagency on all accounts matters between Ministry andthe Office of the Controller General Accounts & theComptroller and Auditor General. Similarly itcoordinates on all budget matters between Ministry andthe Budget Division of the Ministry of Finance.

Internal Audit Wing

The Internal Audit Wing of the Department of Healthand Family is handling the internal audit work of all thefour Departments. There are more than 600 audit unitsof the Department of Health and Family Welfare, 24units of Department of AYUSH and 25 units ofDepartment of Health Research. The Internal Auditplays a significant role in assisting the Departments toachieve their aims and objectives.The CCA is submitting internal audit observationsand matter related to financial discipline to theSecretary in respect of each Department and itssubordinate organizations. The Annual Review Reportof the Internal Audit is also subject to scrutiny by theCGA and Ministry of Finance. The role of InternalAudit is growing and shifting from Compliance auditconfined to examining the transaction with referenceto Government rules and regulations to complexauditing techniques of examining the performanceand risk factors of an entity. In 2012-13, 811 auditparas have been raised which include observations tothe tune of Rs. 5686.73 crores. A total No. of 293paras have been settled during 2012-13. Besides thisin 2012-13 Internal Audit Wing had conductedPerformance/Special Audit of following schemes andInstitutions implemented/working under Ministry ofHealth & Family Welfare:

1. Engagement of Security Personnel in All IndiaInstitute of Medical Science, Delhi.

2. Procurement of Medicines and Consumables in AllIndia Institute of Medical Sciences, Delhi.

10


3. Govt. Medical Supply Depot, Chennai.4. Govt. Medical Supply Depot, Hyderabad.5. Govt. Medical Supply Depot, Kolkata.6. Govt. Medical Supply Depot, Guwahati.7. Govt. Medical Supply Depot, Mumbai.8. Govt. Medical Supply Depot, Delhi.

1.8 IMPLEMENTATION OF THE RTI ACT,2005

Under the Right to Information Act, 2005, 55 CentralPublic Information Officers (CPIOs) and 30 AppellateAuthorities (A/As) have been appointed in the Ministryof Health & Family Welfare (Department of Health &Family Welfare).In the light of directions of DOP&T, Shri S. K. Rao,Joint Secretary (CDN) has been nominated as NodalOfficer for ensuring the compliance with the proactivedisclosure guidelines within the Department of Health& Family Welfare and also for the formations.Department of Health & Family Welfare has placed allobligatory information pertaining to their office, underSection 4(1) (b) of the RTI Act, 2005 on the Websiteof this Ministry.The facility of filing Application and 1st Appeal underRTI Act, 2005 online through RTI online Web Portaldeveloped by DOP&T has been introduced inDepartment of Health & Family Welfare w.e.f.3rd June 2013 and the general public is sending theirRTI query(ies) through this facility in a large number.Besides, the Applications and Appeals under the RTIAct, received physically through post or by hand, arealso accepted by Receipt & Issue (R&I) Section andRTI Cell, Room No.216, D Wing, Nirman Bhawan,New Delhi.During 2013-14, 5432 RTI applications received throughR&I and Online in the RTI web portal and 385 RTIappeals (RTI appeals received physically and onlinethrough RTI web portal) have been received till datedi.e. 29.10.13 and handled efficiently & timely.

1.9 VIGILANCEVigilance Wing of the Department of Health and FamilyWelfare is under the control of an officer of the rank

of Joint Secretary to the Government of India who alsoworks as part time Chief Vigilance Officer (CVO). TheCVO is assisted by a part time Director (Vig.), an UnderSecretary and staff of Vigilance Section. During theperiod, Dr. Vishwas Mehta, IAS has been looking afterthe charge of Chief Vigilance Officer (CVO).The Vigilance Division of the Ministry deals withvigilance and disciplinary cases having vigilance angleagainst the officers of Dte. GHS and CGHS of theDepartment of Health and Family Welfare. The VigilanceWing also monitors vigilance enquires, disciplinaryproceedings having vigilance angle, in respect of doctorsand non-medical/technical personnel borne on theCentral Health Service (CHS) Dte. GHS/PNTDispensaries and other institutions like Medical StoresOrganization, Port Health Organization, LabourOrganization etc.

In year 2013-14 (ending December, 2013) followingaction/cases have been taken/dealt with by VigilanceDivision:-

Sl. Item NumberNo.

1. Charges Sheet issued under Rule 14 3of CCS (CCA) Rules

2. Instances of sanction for prosecution 3accorded

3. Finalization of Disciplinary cases 84. Instances of appointment of IOs/POs 175. Instances of permission accorded to CBI 1

for registration of case against seniorlevel Officers

6. Instances of suspension/revocation/extension 77. No. of Disciplinary cases live at the end 24

of the period8. No. of complaints received form CVC 76

for appropriate action and which areunder examination/processed

9. Misc. complaints received from CBI 60for appropriate action

10. Complaints received from other sources 9711. Cases sent to CVC for advice 1312. Cases sent to UPSE for advice 713. Matter referred to DOPT for advice 1

11


14. Cases referred to Ministry of Law 1and Justice for advice

15. RTI application received and disposed 2916. No. of Court cases processed during 3

the period17. Vigilance clearance granted during 7020

the period18. VIP/PMO reference received/processed 4

1.10 PUBLIC GRIEVANCE CELL

Public Grievance Redressal Mechanism is functioningin the Ministry of Health & Family Welfare as well asin the attached offices of the Directorate General ofHealth Services and the other Subordinate offices ofCGHS (both in Delhi and other Regions) CentralGovernment Hospitals and PSUs falling under theMinistry for implementation of the various guidelinesissued from time to time by the Government of Indiathrough the Department of Administrative Reforms &Public Grievances.

Sh. S. K. Rao, Joint Secretary in the Department ofHealth & Family Welfare has been designated as NodalOfficer for Public Grievances relating to the Department.Shri Mahendra Singh, Deputy Secretary in theDepartment of Health & Family Welfare is functioningas Public Grievance Officer. Similarly otherorganizations under the Ministry have also senior levelofficials functioning as Public Grievances Officers.

Pursuant to the instructions of the Govt. for creation ofSevottam Compliant System to redress and monitorpubic grievances under Results Framework Documentsfor 2012-13 and implementation of Centralized PublicGrievances Redress and Monitoring System(CPGRAMS) in the Ministries/Departments. CPGRAMShas been implemented in the Department, AttachedOffice i.e. Directorate General of Health Services(Dte.GHS), Central Govt. Health Scheme and extendedto Autonomous Bodies/PSUs. It is being extended toother Subordinate Offices of Dte.GHS. It is a web basedportal and a citizen can lodge grievance through thissystem directly with the concerned Departments. A linkof CPGRAMS has also been provided on the websiteof the Ministry i.e. www.mohfw.nic.in.

The number of written Grievance petitions received/disposed of and pending during 2012 & 2013 are asfollows:

Year Opening Grievance Grievance PendingBalance petitions petitions

received disposedduring the of duringyear the year

2012 90 175 210 55

2013 55 154 179 30

The position in regard to grievance received throughCPGRAMS is as under:-

No. of Grievances Disposal PendencyReceived

9268 8704 564(As on 19.12.2013)

1.11 INFORMATION & FACILITATIONCENTRE

To strengthen the Public Redressal Mechanism in theMinistry of Health & Family Welfare an Information &Facilitation Centre is functioning adjacent to Gate No.5,Nirman Bhawan. The facilitation center provides thefollowing information to public: -

Circulars/ Booklets/ Pamphlets/ Posters/ NGOGuidelines and forms for public use.

Information and Guidelines to avail the financialassistance from Rashtriya Arogya Nidhi and HealthMinister's Discretionary Grants.

Guidelines and instructions regarding issue of NoCto Indian Doctors to pursue higher medical studiesabroad.

Information and guidelines relating to CGHS andqueries relating to the work of the Ministry.

Receiving Petitions/Suggestions on PublicGrievances.

General queries regarding the work of the Ministryreceived at the Information and Facilitation Centreon telephone and personally were disposed of tothe satisfaction of all concerned.

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allopathic and indigenous medicines and provision ofan additional ANM. Annual maintenance grant ofRs. 10,000/- is also made available to every Sub-centreto undertake and supervise improvement andmaintenance of the facility. Up gradation of existingSub-centres, including building for Sub-centersfunctioning in rented premises and establishing new onebased on population and time to care norms to beingundertaken.

Primary Health Centre (PHC)PHC is the first contact point between village communityand the Medical Officer. It is manned by a MedicalOfficer and other support staff. It acts as a referral Unitfor 6 Sub-Centres and many PHCs as 4-6 beds forpatients. It provides curative, preventive, promotive andFamily Welfare services.

The PHCs are being strengthened under NRHM toprovide a package of essential public health services,and support for outreach services including for regularsupplies of essential drugs and equipment, upgradingsingle doctor PHC to 2 doctors PHC by postingAYUSH practitioners at PHC level, provision of 3Staff Nurses in a phased manner based on patientload and delivery load. The States/UTs have toincorporate their proposals and requirement of fundsin their Programme Implementation Plans underNRHM. Untied Grant of Rs. 25,000/- per PHC forlocal health action and Annual Maintenance Grant ofRs. 50,000/- per PHC and Rs. One Lakh to RogiKalyan Samiti (RKS) to undertake and superviseimprovement and maintenance of physicalinfrastructure is provided.

Community Health Centre(CHC)CHC is established and maintained by the StateGovernments and as per standards it is supposed to bemanned by four Medical specialists i.e. Surgeon,Physician, Gynecologist and Pediatrician supported by21 paramedical and other staff. It normally has 30 in-door beds with one OT, X-ray, and Labour room andLaboratory facilities and serves as a referral centre for4 PHCs. It provides facilities for emergency obstetricscare and specialist consultations. Indian Public Healthstandards lays down that this CHC should be manned

1.12 RURAL HEALTH INFRASTRUCTURE

The Health and Family Welfare programme in thecountry is being implemented through primary healthcare system. In rural areas, primary health care servicesare being provided through a network of 148366Sub-centres, 24049 Primary Health Centres and 4833Community Health Centres as on March 2012 based onthe following norms of population. The populationnorms for SC/PHC/CHC are as follows:

Centre Population Norms

Plain Hilly/Area Tribal

Area

Sub-Centre 5000 3000

Primary Health 30,000 20,000Centre (PHC)Community Health 1,20,000 80,000Centre (CHC)

The Ministry has recently decided to provide a sub-Health Centre within 30 minutes of walk of habitationin certain districts of hill states.

Sub-Centre

Sub-centre is the first peripheral contact point betweenPrimary Health Care system and the community. It ismanned by at least one Female (Auxiliary NurseMidwife) and also one Male Health Worker, One LadyHealth Visitor (LHV) is provided for six suchSub-Centres. Sub-centres are assigned task relating toMaternal and Child Health, Family Welfare, Nutrition,Immunization, Diarrohea and Pneumonia Control andcontrol of Communicable Diseases. ANMs and alsoprovided drugs for minor ailments and for essentialmaterial and child health care. ANMs also provideFamily Planning counseling and supplies.

Government of India bears the salary of ANM and LHVwhile the salary of the Male Health Worker is borne bythe State Governments.

Under NRHM Sub-centers are being strengthened byprovision of untied funds of Rs.10,000/- per year whichis operated by the ANM and the Sarpanch, supply of

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by 6 Medical Specialists including an Anaesthetics andGynecologist supported by 24 paramedical and otherstaff with inclusion of two nurse midwives in thepresent system of seven nurse midwives.

Funds are being provided every year as requested by theStates in their Programme Implementation Plan underNRHM to strengthen CHCs as per IPHS standards andmake them First Referral Unit. Untied Grant ofRs. 50,000/- AMG of Rs. One lakh and RKS couponGrant of Rs. One lakh is also provided under NRHMto all CHCs.

Strengthening of the Sub-Divisional/Sub-District andDistrict Hospitals

Strengthening of sub-divisional /sub-district and districthospitals is also an approved activity under NRHM. Thestates propose their requirement in their PIPs, which areapproved by the NPCC and approvals are generated inlight of the appraisal. Funds and release to carry outapproved activities.

Indian Public Health Standards (IPHS)Indian Public Health Standards (IPHS), detail thespecifications of standards to which institutions ofprimary health care should be raised to so that thecitizen is confident of getting public health services inthe hospital that can be measured to be of acceptablestandards. Indian Public Health Standards (IPHS) forSub-centres, PHCs, CHCs, Sub-divisional/Sub-districtHospitals and District Hospitals lay down Standards notonly for personnel and physical infrastructure, but alsofor delivery of services, and management.

Each hospital as part of IPHS, is required to set up aRogi Kalyan Samittee (RKS)/Hospital ManagementCommittee (HMC). This brings in community controlinto the management of public hospitals. The objectiveis to provide sustainable quality care with accountability,people's participation and total transparency.

Mobile Medical Units/Health Camps

With the objective of taking health care to the door stepof the public in the rural areas, especially in under-served areas, Mobile Medical Units (MMUs), havebeen provided, upto 5 MMUs can be provided in adistrict.

The States are required to involve District HealthSociety/Rogi Kalyan Samiti/NGOs in deciding theappropriate modality for operationalization of theMMUs. The MMUs can generally operated with thehelp of NGOs.

Tackling the problem of lack of manpower in RuralAreas

The Government is seized of the problem of lack ofskilled manpower in rural areas. Augmentation ofhuman resources is one of the thrust areas under theNational Rural Health Mission [NRHM]. Financialsupport is provided under NRHM for engagement ofstaff on contractual basis. Multi-skilling of doctors toovercome the shortage of specialists, provision ofincentives to serve in rural areas, improvedaccommodation arrangements, measure to set up moremedical colleges and increase seats in existing medialcolleges, measures to open new GNM/ANM Schools toproduce more doctors and nurses are also measures tobridge the gap in human resources. Overall 1.55 lakhadditional human resources have been provided to thestates under NRHM.

1.13 ACTIVITIES OF THE COMPLAINTCOMMITTEE ON SEXUAL HARASSMENTOF WOMEN EMPLOYEES

Under Secretary (Vig.) being of the member of thecomplaints committee is not aware of any sexualharassment complaint received during 2013-2014.Further on the nomination of US (Vig.) as one of themembers, clarification has been sought fromEstablishment Division, in terms of Gazette Notificationprescribing the constitution of complaints committee.As Joint Secretary & Chief Vigilance Officer (CVO)does not handles, complaints of sexual harassment, thenil information for 2013-2014 is being furnished byUnder Secretary (Vig.) as per available information.1.14 CENTRAL MEDICAL SERVICES

SOCIETY (CMSS)To streamline drug procurement and distribution systemof Department of Health and Family Welfare and toeliminate existing deficiencies, Central Medical ServicesSociety (CMSS) has been established and registered as

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a society on 22 March, 2012 under the SocietiesRegistration Act of 1860.

The CMSS will function as a professional andautonomous agency for purchasing medicines, vaccines,contraceptives and medical equipments for all diseasecontrol, family welfare & immunization programme ofthe Union Health Ministry. It will also procure variouscommodities for the National Aids Control Programme(NACP) of Department of Aids Control (DAC). TheCMSS is also responsible for distribution of abovementioned health sector goods to the state and UTGovernments by setting up IT enabled State levelwarehouses at different locations spread across thecountry.

An action plan to make the CMSS operational has beenprepared. As per the action plan, regular requirement ofthe year 2015-16 shall be supplied to States/UTs by theCMSS from its own network of IT enables warehouses.

Standard Tender documents have been prepared. Qualitypolicy has also been prepared. At present, action toacquire warehouses, IT software and empanelment oflaboratories is in hand.

1.15 EMPOWERED PROCUREMENT WINGProcurement Division deals with the procurement ofdrugs and commodities supply under the National

Vector Borne Disease Control Programme (NVBDCP),Revised National Tuberculosis Control Programme(RNTCP), Reproductive Child Health (RCH),Immunisation Programmes.

In addition, operationalisation of Central MedicalServices Society (CMSS), autonomous body ofMinistry of Health and Family Welfare (MoHFW) isalso handled in the Procurement Division. CMSS islikely to be operationalised by the end of the currentfinancial year.

MoHFW has appointed M/s RITES as ProcurementAgent to assist the Ministry for procurement of drugsand commodities under various diseases controlprogramme viz- RNTCP, NVBDCP, RCH, Immunizationduring the year 2012-13. The following drugs/commodities were procured by EPW and supplied to theState Government during 2012-13:-

S.No. Drugs/Commodities Value (Rs. in crores)1 Anti Malarial Drugs 146

2 Anti TB Drugs 112

3 RCH supplies 42

4 Polio supplies 100

Total 400

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2.1 THE NATIONAL HEALTH MISSION(NHM)

The National Health Mission (NHM) encompasses itstwo Sub-Missions, the National Rural Health Mission(NRHM) and the newly launched National Urban HealthMission (NUHM). The main programmatic componentsinclude Health System Strengthening in rural and urbanareas- Reproductive-Maternal- Neonatal-Child andAdolescent Health (RMNCH+A), and Communicableand Non-Communicable Diseases. The NHM envisagesachievement of universal access to equitable, affordable& quality health care services that are accountable andresponsive to people's needs.

National Rural Health Mission (NRHM): NRHM seeksto provide accessible, affordable and quality health care tothe rural population, especially the vulnerable groups.Under the NRHM, the Empowered Action Group (EAG)States as well as North Eastern States, Jammu and Kashmirand Himachal Pradesh have been given special focus. Thethrust of the mission is on establishing a fully functional,community owned, decentralized health delivery systemwith inter-sectoral convergence at all levels, to ensuresimultaneous action on a wide range of determinants ofhealth such as water, sanitation, education, nutrition, socialand gender equality.

National Urban Health Mission (NUHM): NUHMseeks to improve the health status of the urban populationparticularly urban poor and other vulnerable sections byfacilitating their access to quality primary health care.NUHM would cover all state capitals, districtheadquarters and other cities/towns with a populationof 50,000 and above (as per census 2011) in a phasedmanner. Cities and towns with population below 50,000will be covered under NRHM.

Major initiatives under NRHM:2.1.1 ASHA: More than 8.94 lakh community health

Chapter 2

NHM, HEALTH & POPULATION POLICIES

volunteers called Accredited Social Health Activists(ASHAs) have been engaged under the mission to workas a link between the community and the public healthsystem. ASHA is the first port of call for any healthrelated demands of deprived sections of the population,especially women and children, who find it difficult toaccess health services in rural areas. ASHA Programmeis expanding across States and has particularly beensuccessful in bringing people back to Public HealthSystem and increase in the utilization of their out-patient services, diagnostic facilities, institutionaldeliveries and in-patient care.

2.1.2 Rogi Kalyan Samiti (Patient WelfareCommittee) / Hospital Management Society is asimple yet effective management structure. Thiscommittee is a registered society whose members actas trustees to manage the affairs of the hospital and isresponsible for upkeep of the facilities and ensureprovision of better facilities to the patients in thehospital. Financial assistance is provided to theseCommittees through untied fund to undertake activitiesfor patient welfare. 31,109 Rogi Kalyan Samitis (RKS)have been set up involving the community members inalmost all District Hospitals (DHs), Sub-DistrictHospitals (SDHs), Community Health Centres (CHCs)and Primary Health Centres (PHCs) till date.2.1.3 The Untied Grants to Sub-Centres (SCs) hasgiven a new confidence to our ANMs in the field. TheSCs are far better equipped now with Blood Pressuremeasuring equipment, Hemoglobin (Hb) measuringequipment, stethoscope, weighing machine etc. Thishas facilitated provision of quality antenatal care andother health care services.

2.1.4 The Village Health Sanitation and NutritionCommittee (VHSNC) is an important tool of communityempowerment and participation at the grassroots level.The VHSNC reflects the aspirations of the local

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community, especially the poor households and children.Untied grants of Rs. 10,000 are provided annually to eachVHSNC under NRHM, which are utilized throughinvolvement of Panchayati Raj representatives and othercommunity members in many states. Till date, 5.12 lakhVHSNCs have been set up across the country. In manystates, capacity building of the VHSNC members withregards to their roles and responsibilities for maintainingthe health status of the village is being done.

2.1.5 Health care service delivery requires intensivehuman resource inputs. There has been an enormousshortage of human resources in the public health caresector in the country. NRHM has attempted to fill thegaps in human resources by providing nearly 1.69 lakhadditional health human resources to states including7,659 GDMOs, 2,973 Specialists, 71,946 ANMs, 38,339Staff Nurses etc. on contractual basis. Apart from providingsupport for health human resource, NRHM has alsofocused on multi skilling of doctors at strategicallylocated facilities identified by the states e.g. MBBSdoctors are trained in Emergency Obstetric Care (EmOC),Life Saving Anaesthesia Skills (LSAS) and LaparoscopicSurgery. Similarly, due importance is given to capacitybuilding of nursing staff and auxiliary workers such asANMs. NRHM also supports co-location of AYUSHservices in health facilities such as PHCs, CHCs andDHs. A total of 12,357 AYUSH doctors have beendeployed in the states with NRHM funding support.

2.1.6 Janani Suraksha Yojana (JSY) aims to reducematernal mortality among pregnant women byencouraging them to deliver in government healthfacilities. Under the scheme, cash assistance is providedto eligible pregnant women for giving birth in agovernment health facility. Since the inception of NRHM,7.04 crore women have benefited under this scheme.

2.1.7 Janani Shishu Suraksha Karyakarm (JSSK):Launched on 1st June, 2011, JSSK entitles all pregnantwomen delivering in public health institutions toabsolutely free and no expense delivery, includingc

Annual Report

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