Performance Based Incentives for High Priority Districts ...
Transcript of Performance Based Incentives for High Priority Districts ...
lR;eso t;rs
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
With Support from
other RCH Divisions 2014
RMNCH+A: IllustrativePerformance Based Incentives for
High Priority Districts (HPDs)
i
Preface
High burden of maternal and infant mortality reflects poor development of any society. The Government of India is committed to reduce this burden, both under MDGs and National Health Mission (NHM). Several initiatives both at community & facility level have been taken to accelerate its decline. However the challenge remains in providing the desired services in geographically isolated, inaccessible and remote areas particularly where the vulnerable population reside.
Unless there is equity and accessibility in service delivery, we will not be able to reach the most vulnerable and poor people. Our available human resource and health services are more polarized to urban than rural areas. One of the main hindrance is the non willingness of nurses, doctors and specialists to work in the rural and inaccessible areas.
In view of this, the Programme Divisions of this Ministry has worked with the Development Partners and other stakeholders in preparing suggestive performance based incentives for the High Priority Districts to motivate and retain critical manpower in these districts. This is an approach to reach all geographical areas with an intention to accelerate the functioning of health facilities with priority focus in HPDs. It is my belief that this guideline would be useful in operationalizing the services and also access to the poor and vulnerable.
(Anuradha Gupta)AS& MD (NHM)
06.05.2014
ii
National Rural Health Mission has contributed to strengthening of health systems including additional Human Resources for Health (HRH) to provide essential and emergency medical services. However, there is general view that the services have not improved commensurate with the increase in HR. One important way to improve productivity and efficiency is to monitor the performance of service providers, create incentives for them to render high quantity and quality of desirable services and recognise and reward high performing service providers. This has been a weakness of large part of our public health delivery system that there is rather poor performance monitoring and poor accountability towards outputs/ outcomes of the service providers.
It is felt that paying Performance Based Incentives (PBIs) besides the normal salary to the service providers or their team should lead to significant improvement in output and health outcomes. The improvement is most urgent in the High Priority Districts (HPDs) and it is therefore proposed to first implement these PBIs in the HPDs. To help improve the service delivery, we have designed the PBls so that they should not only help attract critical health manpower for working in such districts but also retain them and motivate them to perform. The PBIs have been designed for individual service providers as also for the team, depending upon whether the individual alone or the team can reasonably ensure the desired outputs/ outcomes. The PBIs require performance particularly on those activities/ interventions which are most critical to improving outcomes and also indicates the mechanism to measure them.
I am confident, that this document will facilitate the process of improving performance to achieve the set goals and targets for the different thematic areas under the program by monitoring and incentivising the performance and recognising the outstanding performers. I expect all states to use the PBIs particularly in the HPDs.
(Manoj jhalani)
fOreWOrD
4th June 2014
iii
Performance Based Incentives (PBIs) for 184 High Priority Districts have been developed by the Ministry of Health & Family Welfare, Government of India to motivate service providers to improve their performance particularly those posted at the more peripheral health facilities (Sub- Centre and Primary Health Centres).
Under the National Health Mission, incentives to service providers for sewing in difficult, remote and underserved areas and linked to benchmarks of performance have been allowed based on the State proposals in their annual plans.
However, there has been a felt need for providing guidelines to the States for proposing and administering these incentives to individual and to teams of service providers.
The Performance Based Incentives have been designed to maximise outputs and outcomes on key RMNCH+A interventions particularly for critical activities like Emergency Obstetric Care including C-section and Sick New-Born care which are instrumental in saving many lives in the labour rooms and special new-born care units.
I am confident that the policymakers and programme managers will make optimal use of this document to improve performance of service providers and hence the quality of service delivery at the health facilities particularly in the High Priority Districts.
(Dr Rakesh Kumar)05.06.2014
fOreWOrD
iv
acknOWleDgementThere is a wide gap between the demand and availability of healthcare services and this gap is widening because our facilities at and below sub district level remain either non-functional or not optimally utilized. The fact remains that out of total health facilities only about 10% of them are functional when a minimum performance benchmarking was applied to choose functional health facility which has been designated as delivery points.
During review and interactions with the state, non-availability of HR, absenteeism, giving equal pay to both performer and non-performer are identified as some of the demotivating factors resulting in a situation where our service providers do not want to go to a facility at or below sub-district level.
In view of above challenges, Performance Based Incentives (PBI) for High Priority Districts has been prepared as a suggestive guideline to improve service delivery and encourage the service providers for better performance particularly those working at Sub-centres and Primary Health Centres. The PBI also encourages delivery of critical services such as C-section and saving lives in critical areas such as in labour rooms, SNCUs etc. This will greatly help in improving accessibility of quality health care in India.
The illustrative framework on performance based incentives is a result of series of discussions and guidance given by Ms. Anuradha Gupta, Additional Secretary and Mission Director, National Health Mission, Ministry of Health and Family Welfare, Mr. Manoj Jhalani, Joint Secretary (Policy) and Dr Rakesh Kumar, Joint Secretary (RCH), National Health Mission.
The contribution of all technical divisions under RCH is highly appreciated. The concentrated effort rendered by BMGF particularly Dr. Devendra Khandait, Senior Program Officer and the team of experts at JSI, particularly, Dr. Rajesh Singh, Senior Technical Advisor, Dr. Sebanti Ghosh and Dr. Sudhir Maknikar, National RMNCH+A Experts were important and has resulted in framing the guidelines after several revisions of the draft.
I also thank my colleagues Dr. Manisha Malhotra and Dr. Dinesh Baswal and senior consultants Dr. Pushkar Kumar, Dr. Rajeev Agarwal and Dr. Ravinder Kaur for their valuable inputs and support.
It is expected that the operationalization of 5×5 matrix under RMNCH+A will get boosted with the implementation of PBI particularly in remote and hilly areas. However, this is flagged that any incentive should be proposed on the basis of need assessment and not as universal approach even in HPDs. I sincerely believe this will help and guide the Mission Directors, Program Managers and Service Providers to focus their attention on performance based indicators for different thematic areas of the RMNCH+A strategy for desired health outcomes in the coming years.
(Dr. Himanshu Bhushan)
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) v
list Of cOntributOrs
1. Ms. Anuradha Gupta, AS&MD (NHM), MoHFW
2. Mr. Manoj Jhalani, JS (Policy), MoHFW
3. Dr. Rakesh Kumar, JS (RCH), MoHFW
4. Dr. Himanshu Bhushan, DC (MH I/C), MoHFW
5. Dr. Manisha Malhotra, DC (MH), MoHFW
6. Dr. Dinesh Baswal, DC (MH), MoHFW
7. Dr. Ajay Khera, DC (CH & Imm I/C), MoHFW
8. Dr. S.K. Sikdar, DC (FP I/C), MoHFW
9. Dr.Haldar,DC(Immunization),MoHFW
10. Dr. P.K. Prabhakar, DC (CH), MoHFW
11. Dr. Sila Deb, DC (CH), MoHFW
12. Dr. Sushma Dureja, DC (AH), MoHFW
13. Dr Devendra Khandait, SPO, BMGF
14. Dr. Rajesh Singh, Senior Technical Adviser, JSI
15. Dr.SudhirMaknikar,NationalRMNCH+AExpert,JSI
16. Dr.SebantiGhosh,NationalRMNCH+AExpert,JSI
17. Mr. Niraj Agrawal, Knowledge Management Specialist, JSI
18. Dr. Pushkar Kumar, Lead Consultant, MH, MoHFW
19. Dr. Rajeev Agarwal, Sr. Consultant, MH, MoHFW
20. Dr. Ravinder Kaur, Sr. Consultant, MH, MoHFW
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)vi
list Of abbreviatiOns
anc Ante Natal Care
anm AuxiliaryNurseMidwife
aWW Anganwadi Worker
bOH Bad Obstetric History
cHc Community Health Centre
DH District Hospital
eag EmpoweredActionGroup
emOc EmergencyObstetricCare
fru FirstReferralUnit
goi GovernmentofIndia
Hmis HealthManagementInformationSystem
HPD High Priority District
lsas LifeSavingAnaesthesiaSkills
mctfc MaternalandChildTrackingFacilitationCentre
mcts Mother and Child Tracking System
mnH Maternal and Neonatal Health
mO MedicalOfficer
moHfW MinistryofHealthandFamilyWelfare
ne NorthEast
nHm NationalHealthMission
ObgYn Obstetrician and Gynaecologist
Pbi PerformanceBasedIncentive
PHc Primary Health Centre
PPiucD PostpartumIntraUterineContraceptiveDevice
rmncH+a Reproductive,Maternal,Neonatal,ChildandAdolescentHealth
sba SkillBirthAttendant
sDH Sub District Hospital
sncu SpecialNewbornCareUnit
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 1
rmncH+a: Illustrative Performance Based Incentives for
the 184 High Priority Districts (HPDs)
IntroductionSincethelaunchofNationalRuralHealthMissionin2005,therehasbeenasteadybutdefinitivesurgeinthedemandforservicesatpublichealthfacilities.WithinafewyearsthisdemandhasincreasedmanifoldnotonlyintermsofinstitutionaldeliveriesbutalsoinOut-PatientDepartment(OPD)andIn-PatientDepartment(IPD)services.Whileassessing theutilisationofhealth facilities, ithasbeenobservedthat thedemandforhealthserviceshasincreasedatthedistrictandsub-districtlevel,however,atthefacilitiesbelowsub-districtleveltheavailabilityandutilizationofessentialhealthservicesisstillsub-optimal.
NationalHealthMission (NHM) iscommittedtoprovideaccessible,affordableandqualityhealthcare toall,especiallythevulnerableandunreachedsectionsofsociety.Accordingly,‘reachingthosethatneeditmost’isthe topmost priority under theReproductive,Maternal,Newborn, ChildHealth andAdolescent (RMNCH+A)strategicapproachwhichprovidesacommitmentforcontinuumofcareunderNHM.
Governmentof India (GoI)has identified184highprioritydistricts (HPDs)with relativelyweakperformanceindicatorswithineachstate,basedonacompositeindex.Thesearethedistrictslocatedingeographicalregionswherereproductive,maternalandchildmorbidityandmortalityarehighandthereisaneedforfocusedplanningtomaintainequityandimprovingaccessforvulnerableandpoorsectionsofthesociety.Despiteavailabilityofinfrastructureandequipment,oneofthegapsassessedinthesedistrictsislackoftrainedandmotivatedserviceprovidersathealthfacilities.
UndertheMission,aprovisionhasbeenmadeforallocationof30%additionalfundingtoeachHPDwithintheoverallstateresourceenvelope.ThehigherfinancialallocationforHPDsallowsthedistrictsagreaterflexibilitytoupgradeinfrastructure,provideessentialdrugsandcommodities,provideessentialamenitiesforclientsandcreativelydesignperformancebasedincentivesforhumanresourcestoattractandretainskilledmanpower.
Inthiscontext,theGoIsuggestsaframeworkforprovidingPerformanceBasedIncentives(PBI)forhealthserviceproviders.Thesewouldincludeindividualserviceprovidersaswellasteamsofprovidersgivingcriticalservicesatvariousleveloffacilities.TheseadditionalincentiveswillnotonlyhelpinretainingthemanpowerbutalsomotivatethemtoperformbetterinHPDs.ThiswillfurtheraidinachievingtargetsandgoalsundertheRMNCH+Astrategy.
Objectives of the PBI schemeThe following are the objectives of the PBI scheme: • ToimproveprovisionandutilizationofRMNCH+Aservicesofferedtothepopulation;
• Tomotivateandretainexistinghealthpersonnel,particularlyAuxiliaryNurseMidwife(ANM)andstaffnursesinperipheralareas;
• Toincreaseequity,accessibilityandqualityofcareatthehealthfacilitylevel;and
• Toorganizehealthservicesefficiently.
Monitoring and verificationWhileimplementinganyfinancialschemeitiscriticaltodeveloparobustmonitoringandverificationprocess.Verificationprocesses for thePBIschemewouldensurethat thereporteddataaccurately reflects theactualperformancebothbydetectingandcorrectingmisreporting.Itispertinenttonoteherethattheseverification
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)2
processesaredynamicandwouldevolveovertimeastheschememovesupinscaleandthebehaviourofPBIrecipient(suchas,serviceproviders,facilityteams)changeinresponsetotheintroductionoffinancialincentivesandservicesimprovetoanoptimallevel.
TheMinistryofHealthandFamilyWelfare(MoHFW),GoIissettinginplacestrongverificationmechanismstodetectinconsistenciesthatmayresultfrominaccuraciesindataentryandrecordkeepingand/orfromimproperimplementation bymonitoring and evaluation teams.Hence, it is strongly recommended that the state anddistrictprogrammanagersbecautiousaboutimpreciseclassificationofcases,andincorrectuseofdatacollectiontools.TheplatformofmonthlymeetingsshouldbeusedfororientingthesupervisorsandserviceprovidersaboutthePBIsandprovidingclarityonassessingtheperformancebasedonthedifferentindicators.
Zero tolerance for irregularities All states shouldcloselymonitor the incentivespaidagainst theperformanceassessed.High transparency inbothverificationproceduresandsub-sequentcommunicationoftheresultsisalsoanimportantfeatureoftheverificationsystem.
Anyinstancesofirregularitiesshouldnotbetoleratedparticularlyinthefollowingareas:• Excessiveprovisionofunnecessaryorpotentiallyharmfulservicestoearnincentives
• Providingfalseinformation
• Compromisingthequalityofcareandservices
• Denialofservicestotheeligiblebeneficiaries
Quality assuranceThePBIschememakesalargepartoftheperformance-basedpaymentsconditionalontheprogressofindicatorsthat capture the number of services delivered. The schememay, for example, reward the providers on thenumber of Postpartum Intra Uterine Contraceptive Devices (PPIUCD) inserted, or the number of deliveriesattended at home.While these indicators are relatively easy tomeasure and verify through facility records,HealthManagement InformationSystem (HMIS)andMotherandChildTrackingSystem (MCTS), theydonotprovideinsightsonthequalityofcareprovided.Asmuchaspossible,thePBIshouldbelinkedwiththequalityofservicesrenderedincomparisonwiththeclinicaltreatmentguidelinesorqualitystandards,suchassafebirthchecklist,MaternalandNeonatalHealth(MNH)toolkit,infectionpreventionguidelinesetc.ThiswillrepresentauniqueapproachtopromotebetterqualityinRMNCH+Aservices.
Level of verificationBlockanddistrict level supervisorswill conductmonthly,quarterly,andannual verificationof thePBI resultsthroughfacilityrecords,HMIS,MCTS,etc.Verificationoftheresultscanbedoneattwolevels:atthelevelofPBIrecipients(doreportednumbersreflectthedatainthefacilityregisters?)andrandomlyatthelevelofbeneficiaries(is thedata in theregistersvalid, i.e.,havereportedservices indeedbeenprovidedtothebeneficiaries?).Attheprovider level, itwouldbeeasy to verify the results through their records. It is a challengingprocess toverifythePBIindicatorsatthecommunitylevel.However,thiscanbeexploredthroughtheMaternalandChildTrackingFacilitationCentre(MCTFC)bycommunityclientinterviewdonerandomlyonquarterlybasis.TheGoIalsosuggestsblockmonitoringvisitasanadditionalverificationmethodnecessary toextract indicators fromothersourcesthatmaynotbeincludedinthenationalHMISandMCTSdatabases.
Leveraging technology for the PBIGoIwill exploreanddevelopm-Health softwareor awebportal thatwill containPBI results andoutcomes,financialdata,andverificationreports. Informationandcommunicationtechnologies (ICT)canbeutilized fordatacollectionaswellasformonitoringandevaluationofthePBIactivities.
The detailed explanation for each PBI is provided in following pages in a tabular form:
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 3
RMN
CH +
A Th
emati
c Ar
ea: R
epro
ducti
ve H
ealth
Pbi
Indi
cato
rEl
igib
ility
Crit
eria
for
the
PBI
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of
addi
tiona
l in
centi
ve
Sour
ce o
f da
ta fo
r ve
rifica
tion
Addi
tiona
l Ve
rifica
tion
appr
oach
es
to tr
ack
and
valid
ate
resu
lts
Prop
ortio
nofPPIUCD
insertion
sin
institutio
nal
deliv
erie
s
Serv
ice
prov
ider
at
Bloc
k Pr
imar
y He
alth
Ce
ntre
(BPH
C)/
Com
mun
ity H
ealth
Ce
ntre(C
HC)/Sub
-Di
stric
t Hos
pita
l (SD
H)/
Dist
rict H
ospi
tal (
DH)
inH
PDso
fStates
men
tione
dbe
low*
Additio
nal `50fore
achPP
IUCD
insertion
beyon
dthe
insertion
rateof1
5%oftotaldeliveriesc
ondu
cted
by
that
pro
vide
r in
the
mon
th.
(E.g.Ifa
provide
rcon
ducts2
0de
liveries,th
enhe/she
willbeeligibleto
getPBIfrom
the4th
PPIUCD
insertion
on
war
ds.)
PPIU
CD sh
ould
be
offer
ed a
fter c
ouns
ellin
g a
nd a
s par
t of
bas
ket o
f con
trac
eptiv
e ch
oice
s
Serv
ice
prov
ider
re
ceiv
es
` 15
0 pe
r PP
IUCD
insertion
` 50
per
PP
IUCD
insertion
be
yond
the
insertion
rateof1
5%
ofto
tal
deliv
erie
s
•Fa
cilit
y re
cord
s
•HM
IS
Bloc
k m
onito
ring
visit
s
Cont
ext: Po
stpa
rtum
familyplann
ingha
sbee
ngivenspecialatte
ntion
utilizing
thehu
gewindo
wofo
pportunityprovide
dbycurrentin
crea
sein
institutio
nald
eliveryto
over80%
.PostpartumIU
CDse
rviceprovision
isone
ofthe
safestand
effe
ctivem
eansfo
renh
ancing
uptakeofsp
acingmetho
dsin
wom
enand
improvingbo
thm
aterna
lan
dchild
hea
lthoutcomes.Thisincen
tiveaimstomoti
vateperform
anceofserviceprovide
rsand
increa
seth
eprovision
ofP
PIUCD
servicesin
theHP
Ds.
Leve
l of i
ncen
tive:In
dividu
alse
rviceprovidersu
chasS
taffNurse(S
N),AN
Mand
Med
icalOfficer(MO)e
tc.
Pre-
requ
isite
: Provide
rmustb
etraine
dtoprovide
PPIUCD
asp
erth
ena
tiona
lguide
linefrom
app
rovedtraining
cen
tre.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:
Incenti
vesw
illbepa
idonaqu
arterly
basis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedSu
perviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofa
dheren
ceto
qua
litydu
ringinsertion
.
*Not
e: T
his P
BI is
onl
y ap
plic
able
for S
tate
s: B
ihar
, Jha
rkha
nd, U
ttar
Pra
desh
, Utt
arak
hand
, Mad
hya
Prad
esh,
Chh
attisg
arh,
Oris
sa, R
ajas
than
and
Ass
am
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)4
RMN
CH +
A Th
emati
c Ar
ea: R
epro
ducti
ve H
ealth
Pbi
Indi
cato
rEl
igib
ility
Crit
eria
for
the
PBI
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of
addi
tiona
l in
centi
ve
prop
osed
Sour
ce
of d
ata
verifi
catio
n
Addi
tiona
l Ve
rifica
tion
appr
oach
es
to tr
ack
and
valid
ate
resu
lts
Prop
ortio
nofpost-
part
um
sterilizatio
ns
(PPS
) in
institutio
nal
deliv
erie
s.
BPHC
/CHC
/Firs
t Re
ferralUnit(FR
U)/
SDH/
DH:Fam
ily
Plan
ning
surg
eon
and
team
inHPD
sofS
tates
men
tione
dbe
low*
Additio
nal `
150
perte
ambeyon
dthePP
Srateof5
%of
tota
l del
iver
ies c
ondu
cted
by
that
team
in th
e m
onth
in
afacility.
Ster
iliza
tion
shou
ld b
e off
ered
afte
r pro
per c
ouns
ellin
g an
d as
par
t of
bask
et o
f con
trac
eptiv
e ch
oice
s
The
sterilizatio
nte
am
rece
ives
`
150
per
sterilizatio
nop
erati
on
performed
Additio
nal
` 15
0 pe
r PPS
be
yond
the
PPSrateof
5%oftotal
deliv
erie
s
•Fa
cilit
y re
cord
s
•HM
IS
Bloc
k m
onito
ring
visit
s
Cont
ext: Cu
rren
tlyth
erearedisparitiesin
perform
anceofsteriliza
tionacrossstatesand
with
indistric
tsin
astatewith
perform
ancere
maining
below
desire
dlevelsin
theHP
Ds.M
oreo
ver,pe
rforman
celevelsofse
rviceproviderss
howvariatio
ns.Thisincen
tiveaimstoen
courageproviderstope
rformbett
erand
improvetheprovision
of
sterilizatio
nservices.
Leve
l of i
ncen
tive:ServiceProvide
rTea
mproviding
sterilizatio
nservicesin
clud
ingatt
enda
ntand
supp
ortstaff.
Distrib
ution
ofcashbe
nefitsa
mon
gtheteam
und
erth
isincenti
vewou
ldbede
cide
dbyth
estate.
Pre-
requ
isite
: Surgeon
mustb
eem
pane
ledbyth
eState/Distric
tand
traine
dtoprovide
sterilizatio
nservicesasp
erGoIguide
lines.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:
Incenti
vewillbepa
idonaqu
arterly
basiswhe
n(orw
ithhe
ldunti
l)repo
rted
/achievemen
tsareverified
byde
signa
tedState/Distric
tlevelofficialsincluding
review
of
adhe
rencetoqua
litystan
dardsa
ndinfecti
onpreventi
onpracti
cesa
sperGoIguide
lines.
*Not
e: T
his P
BI is
onl
y ap
plic
able
for S
tate
s: B
ihar
, Jha
rkha
nd, U
ttar
Pra
desh
, Utt
arak
hand
, Mad
hya
Prad
esh,
Chh
attisg
arh,
Oris
sa, R
ajas
than
and
Ass
am
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 5
RMN
CH +
A Th
emati
c Ar
ea: M
ater
nal
Heal
th
PBI I
ndic
ator
Elig
ibili
ty
Crite
ria fo
r the
Pb
i
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of
addi
tiona
l in
centi
ve
prop
osed
Sour
ce o
f dat
a ve
rifica
tion
Addi
tiona
l Ver
ifica
tion
appr
oach
es to
trac
k an
d va
lidat
e re
sults
Prop
ortio
nof
preg
nant
wom
en
line
liste
d an
d treatedforsevere
anae
mia
Allthe
Sub
-Ce
nter
AN
Ms
in 1
84 H
PDs
ANMsw
illbeen
titledtore
ceivean
incenti
ve
of `
100
percaseaft
erid
entifi
catio
n,line
listin
gofse
verelyana
emicpregn
antw
omen
an
dconfi
rmati
onofH
bpe
rcen
tage(<
7gm%)
at B
PHC/
CHC/
SDH/
DH b
y M
O.
ANM
shou
ld e
nsur
e th
at w
omen
get
s tr
eatm
ent a
s per
gui
delin
es a
nd sh
e m
akes
fo
llow
up
visit
s for
at l
east
two
cons
ecuti
ve
mon
ths.
Nil
` 10
0 pe
r cas
e•
Seve
re
anae
mia
tr
acki
ng
regi
ster
•Fa
cilit
y re
cord
whe
re
trea
tmen
t was
pr
ovid
ed
•M
CTS
•In
crea
se in
Hb
perc
enta
ge
reco
rded
by
MO
or
OBG
YN sp
ecia
list i
n tr
acki
ng re
gist
er
•Bl
ock
mon
itorin
g vi
sits
Cont
ext: Morethan
50%
ofthe
pregn
antw
omen
aresu
fferin
gfrom
ana
emiain
Indiaan
dthisison
eofth
emostcom
mon
und
erlyingcausesofm
aterna
ldeathin
our
coun
try.Itisestimated
that2-3%ofp
regn
antw
omen
can
develop
severeana
emiaamon
gthoseiden
tified
asa
naem
ic.Earlyid
entifi
catio
nofana
emicwom
enand
ad
equa
tetreatm
enta
ndfo
llowupofse
verelyana
emicpregn
antw
omen
isth
ereforeacriticalinterventi
onwhichhelpsto
prevent/red
uceasig
nifican
tpropo
rtion
of
materna
lmortalityan
dmorbidity.Thisincen
tiveisexpe
cted
tom
otivateANMstoprovidequ
ality
fullrang
ean
tena
talcareinclud
ingHb
estimati
on.
Leve
l of i
ncen
tive:
Individu
alse
rviceprovide
r-ANM
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
: Incenti
vesw
illbepa
idonqu
arterly
basis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedSu
perviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)6
RMN
CH +
A Th
emati
c Ar
ea: M
ater
nal
Heal
th
PBI I
ndic
ator
Elig
ibili
ty
Crite
ria fo
r the
Pb
i
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of
ince
ntive
pr
opos
ed
Sour
ce o
f dat
aAd
ditio
nal V
erifi
catio
n ap
proa
ches
to tr
ack
and
valid
ate
resu
lts
Prop
ortio
nof
preg
nant
wom
en
line
liste
d an
d treatedforh
igh
riskpregna
ncies-
Hype
rten
sion,
any
bl
eedi
ng d
urin
g AN
C, B
ad O
bste
tric
History(Excluding
an
aem
ia)
Allthe
Sub
-Ce
ntre
AN
Ms
in 1
84 H
PDs
ANMisenti
tledforIde
ntificati
onofh
igh
risk
preg
nanc
y (H
yper
tens
ion,
any
ble
edin
g du
ringAN
C,BOH*
)excluding
severeana
emia,
timelyreferraland
con
ducti
ngfo
llowupvisits
fora
tlea
st2con
secutiv
emon
ths.Ann
ual
incenti
veof
` 10
00 sh
all b
e pa
id to
any
individu
alANMifsh
eexceed
sdetectio
nan
dtim
elyreferralofa
tlea
st7%highriskcases
outo
ftotalANCsre
gistered
.
Nil
` 10
00 p
er
annu
mif
sheexceed
sde
tecti
on
andtim
ely
referralofa
tleast7
%high
risk
case
s out
ofto
talA
NCs
regi
ster
ed.
• M
CTS
•Fa
cilit
y re
cord
s
•Bl
ock
mon
itorin
g vi
sits
•Re
ferralslipat
faciliti
esfrom
whe
rere
ferralsa
re
mad
e to
hig
her
levelh
ealth
faciliti
es
Cont
ext:Everypregna
ncyispreciousand
shou
ldre
ceivego
odqua
lityan
tena
tal,intra-na
taland
postnatalcaresin
cecom
plicati
onsc
anoccurata
nypointofti
me.
However,asw
ekn
owth
atabo
ut15%
ofp
regn
antw
omen
can
develop
com
plicati
onsd
uringpregna
ncy,child
birthan
dinth
epo
stna
talp
eriod,th
usearlydetectio
nofhighriskpregna
ncies,timelyreferraland
man
agem
enta
tEmOCfaciliti
esm
ustb
een
suredforsuchhigh
riskpregn
ancies.Thisincen
tiveaimstomoti
vateANMsfor
provision
ofg
oodqu
ality
anten
atalcareinclud
ingtracking
ofh
ighriskpregna
ncies.
Defin
ition
of H
igh
Risk
pre
gnan
cy a
s per
SBA
gui
delin
es o
f GoI
:
1) H
yper
tens
ion isdiagno
sedwhe
ntw
oconsecuti
vere
adingsta
kenfourhou
rsorm
oreap
artsho
wth
esystolicblood
pressuretobe14
0mmHg
orm
orean
d/orth
edi
asto
lic b
lood
pre
ssur
e to
be
90 m
mHg
or m
ore.
2) A
ny b
leed
ing
durin
g AN
C isdefi
nedasanybleed
inginclud
ingspotti
ngofb
lood
anytimedu
ringan
tena
talp
eriod
3) B
ad O
bste
tric
His
tory
(BO
H*) include
spreviou
sH/O
follo
wing:i)S
tillbirthorneo
natallossii)Three
orm
orespon
tane
ousc
onsecutiv
eab
ortio
nsiii)Obstructed
labo
ur, P
re-m
aturebirths,twinso
rmultip
lepregn
anciesiv)W
eigh
tofthe
previou
sbab
y<2
500g
or>
4500
gv)Adm
issionforh
ypertensionorpre-eclam
psia/eclam
psia
inth
epreviouspregn
ancyvi)Su
rgeryon
thereprod
uctiv
etractvii)Co
ngen
italano
malyviii)Treatmen
tforinfertilityix)S
pina
ldeformities,suchassc
oliosis
/kyp
hosis
/po
liox)R
hne
gativ
einth
epreviouspregn
ancy.
Leve
l of i
ncen
tive:
Individu
alse
rviceprovider-ANM
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:Incenti
vewillbepa
idonan
ann
ualb
asis.ANMsh
ouldm
aintainprop
erre
cords.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
ts
areob
jecti
velyverified
bythede
signa
tedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 7
RMN
CH +
A Th
emati
c Ar
ea: M
ater
nal
Heal
th
Pbi
Indi
cato
rEl
igib
ility
Crit
eria
for t
he P
BIPe
rfor
man
ce ta
rget
s An
y ex
istin
g in
centi
ve
Amou
nt o
f in
centi
ve
prop
osed
Sour
ce o
f dat
a ve
rifica
tion
Addi
tiona
l Ve
rifica
tion
appr
oach
es to
trac
k an
d va
lidat
e re
sults
Prop
ortio
nofhom
ede
liver
ies
atten
dedby
SBA
trai
ned
ANM
SBA
trai
ned
ANM
in
the
HPDs
(*Statesm
entio
nedbe
low)
cond
uctin
gho
mede
liveriesin
villagesn
otifie
dba
sedon
GoI
crite
riafo
rhom
ede
liveriesa
nd
listo
fnoti
fiedvillagess
hared
with
GoI
Homede
liveriesa
ttend
edbySB
Asin
no
tified
villages,w
herem
othe
rand
ne
wbo
rn a
re re
gist
ered
in M
CTS,
mot
her
andne
wbo
rnhea
lthyatend
of4
2da
ys
or6wee
ksand
birthcertificateob
tained
forn
ewbo
rnand
han
dedoverto
the
mot
her.
Nil
` 10
00 p
er
deliv
ery
• M
CTS
•AN
M
reco
rds
•Bl
ock
mon
itorin
g vi
sits,
•Ra
ndom
verifi
catio
nth
roug
h M
CTFC
Cont
ext:De
spite
ahug
eincrea
sein
institutio
nald
eliveriesa
crossthe
cou
ntry(a
roun
d82
%asp
erHMIS),asig
nifican
tpropo
rtion
ofw
omen
livinginre
motean
ddifficult
tore
acharea
sareuna
bletoaccessp
ublichea
lthfa
ciliti
esfo
rdeliverycareand
con
tinue
todeliverath
omewith
outa
nysk
illed
assistan
ceatb
irth.Thiso
ftenexpo
ses
them
tohighe
rrisk
ofm
ortalityan
dmorbidity.
This
is to
flag
that
, thi
s is t
o be
seen
as e
xcep
tion
to th
e po
licy
whi
ch h
as fo
cus f
or in
stitu
tiona
l del
iver
ies a
nd h
ome
deliv
erie
s are
not
to b
e pr
omot
ed. H
owev
er, t
his
ince
ntive
can
be
give
n as
an
exce
ption
to th
e po
licy
whe
re S
BAs a
re e
ncou
rage
d to
con
duct
such
del
iver
ies o
nly
in n
otifie
d vi
llage
s.
Leve
l of i
ncen
tive:
Indi
vidu
al p
rovi
der –
AN
M
Pre-
requ
isite
:ANMm
ustb
eSB
Atraine
dan
dcertifie
dbydue
autho
rity.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:Incen
tivewillbedisbursedon
qua
rterlybasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/
achievem
entsareobjectiv
elyverifi
edbythede
signa
tedsupe
rviso
rs,d
esigna
tedbyth
eState/Dist.o
fficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityof
serv
ices
pro
vide
d.
*Not
e: T
his P
BI is
onl
y ap
plic
able
for S
tate
s: A
ll th
e EA
G st
ates
, NE
Stat
es, J
amm
u an
d Ka
shm
ir, H
P an
d As
sam
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)8
RMN
CH +
A Th
emati
c Ar
ea: M
ater
nal
Heal
th, N
ewbo
rn H
ealth
& R
epro
ducti
ve H
ealth
Pbi
Indi
cato
rEl
igib
ility
Crit
eria
fo
r the
PBI
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of i
ncen
tive
prop
osed
Sour
ce o
f dat
a ve
rifica
tion
Addi
tiona
l Ver
ifica
tion
appr
oach
es to
trac
k an
d va
lidat
e re
sults
Prop
ortio
nof
Institutio
nal
deliv
erie
s at
Sub-Ce
ntres
desig
nate
d as
del
iver
y po
ints
(DP)
cond
uctin
g>5
*de
liver
ies/
mon
th
SBA
trai
ned
ANM
pos
ted
atSub
-Cen
tre
desig
nate
d as
DPs
in184
HPD
s*
SBAtraine
dAN
Menti
tledtore
ceive
theincenti
veof `
300
per
cas
e w
hen
she
cond
ucts
bey
ond
5 de
liver
ies p
er
mon
th. P
aym
ent w
ill b
e su
bjec
t to
ensurin
gminim
um6hou
rstayfor
themothe
r,registratio
nofm
othe
ran
d ne
wbo
rn in
MCT
S, m
othe
r and
ne
wbo
rnsh
ouldbehe
althyatend
of
6wee
ks/42da
ysand
birthcertificate
shou
ldbeob
tained
forn
ewbo
rnand
de
livered
toth
emothe
r.In
add
ition
,AN
Mwillbeen
titledfora
nad
ditio
nal
`50
forP
PIUCD
insertion
percasefor
each
del
iver
y.
Nil
`30
0pe
rdeliveryfrom
6t
h de
liver
y on
war
ds
andad
ditio
nal `50for
PPIUCD
insertion
per
casefo
reachde
livery.
• M
CTS
•Fa
cilit
y re
cord
•M
O o
r any
des
igna
ted
bloc
k le
vel s
uper
viso
ry
officer
•Bl
ock
mon
itorin
g vi
sits
Cont
ext: Th
eprop
osed
incenti
vewillhelpinstreng
then
ingofSub
-Cen
trefunctio
ning
and
moti
vatin
gSB
Atraine
dAN
Msforcon
ducti
ngdeliveriesa
tperiphe
ry.Thisw
ill
also
hel
p in
impr
ovin
g ot
her d
esig
nate
d se
rvic
es.
Leve
l of i
ncen
tive:
Sub
-Cen
treserviceprovider–SBA
trained
ANMand
herassistan
t/supp
ortstaff
Pre-
requ
isite
:ANMm
ustb
eSB
Atraine
dan
dbe
traine
dan
dcertifie
d(bystate/ap
proved
training
cen
tre)to
provide
PPIUCD
asp
ernati
onalguide
lines.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
: Incenti
vewillbedisbursedon
qua
rterlybasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
*For
HPD
s of 8
Nor
th-e
ast s
tate
s inc
ludi
ng S
ikki
m: S
BA tr
aine
d AN
M e
ntitle
d to
rece
ive
the
ince
ntive
of `
300
per
case
whe
n sh
e co
nduc
ts b
eyon
d 3
deliv
erie
s per
mon
th.
That
m
eans
, ` 3
00 p
er d
eliv
ery
from
4th
del
iver
y on
war
ds a
nd a
dditi
onal
` 5
0 fo
r PPI
UCD
inse
rtion
per
case
for e
ach
deliv
ery.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 9
RMN
CH +
A Th
emati
c Ar
ea: M
ater
nal
Heal
th, N
ewbo
rn H
ealth
& R
epro
ducti
ve H
ealth
PBI I
ndic
ator
Elig
ibili
ty C
riter
ia fo
r th
e PB
IPe
rfor
man
ce ta
rget
s Ex
istin
g in
centi
ve
Amou
nt o
f in
centi
ve
prop
osed
Sour
ce
of d
ata
verifi
catio
n
Addi
tiona
l Ve
rifica
tion
appr
oach
es to
trac
k an
d va
lidat
e re
sults
Prop
ortio
nof
Institutio
nal
deliv
erie
s at
APHC
S/PH
Cs
desig
nate
d as
de
liver
y po
ints
(DPs)con
ducti
ng
>15*
deliveries/
mon
th
SBAs
pos
ted
at A
PHC/
PHC(excluding
BPH
C)
desig
nate
d as
DPs
in
184HP
Ds*
SBAen
titledtore
ceivetheincenti
ve
of `
300
per
cas
e w
hen
she
cond
ucts
m
ore
than
15
deliv
erie
s per
mon
th.
Thismea
nssh
ewillgetth
eincenti
ve
from
16thde
liveryon
wards.She
shou
ldensure:m
inim
um48ho
ur
stayfo
rthe
mothe
r,useofsa
febirth
checklistfo
radh
eren
ceto
qua
lity
stan
dards,Zerodo
sevaccina
tionfor
BCG,OPV
and
Hep
Bfo
rnew
born,
functio
nalN
BCC.In
add
ition
,ANMwill
beenti
tledfora
nad
ditio
nal `
50for
PPIUCD
insertion
percasefrom
16th
case
onw
ards
.
Nil
` 30
0 pe
r del
iver
y from
16th
del
iver
y on
war
ds a
nd
additio
nal `
50
per
caseofP
PIUCD
from
16th
del
iver
y on
war
ds in
a
mon
th.
• M
CTS
•Fa
cilit
y re
cord
s
•M
O o
r any
de
signa
ted
bloc
k/di
stric
t lev
el
supe
rviso
ryofficer
•Bl
ock
mon
itorin
g vi
sits
Leve
l of i
ncen
tive:
APH
C/PH
C(excluding
BPH
C)se
rviceproviderte
am–SBA
traine
dAN
M/SNand
herassistan
t/supp
ortstaff.
Pre-
requ
isite
: ANM/Staff
Nursem
ustb
eSB
Atraine
dan
dbe
also
traine
dan
dcertifie
d(bystate/ap
proved
training
cen
tre)to
provide
PPIUCD
asp
ernati
onalguide
lineby
due
auth
ority
.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:
Incenti
vewillbedisbursedon
aqua
rterlybasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
*For
HPD
s of
8 N
orth
-eas
t sta
tes
incl
udin
g Si
kkim
: SBA
trai
ned
ANM
will
be
entit
led
to re
ceiv
e th
e in
centi
ve o
f ` 3
00 p
er c
ase
whe
n sh
e co
nduc
ts b
eyon
d 10
del
iver
ies
per m
onth
. Th
at m
eans
, ` 3
00 p
er d
eliv
ery
from
11th
del
iver
y on
war
ds a
nd a
dditi
onal
` 5
0 pe
r cas
e of
PPI
UCD
from
11th
del
iver
y on
war
ds in
a m
onth
.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)10
RMN
CH +
A Th
emati
c Ar
ea: M
ater
nal
Heal
th, N
ewbo
rn H
ealth
& R
epro
ducti
ve H
ealth
PBI I
ndic
ator
Elig
ibili
ty C
riter
ia
for t
he P
BIPe
rfor
man
ce ta
rget
s Ex
istin
g in
centi
ve
Amou
nt o
f in
centi
ve p
ropo
sed
Sour
ce o
f dat
a ve
rifica
tion
Addi
tiona
l Ver
ifica
tion
appr
oach
es to
trac
k an
d va
lidat
e re
sults
Prop
ortio
nof
Institutio
nal
deliv
erie
s at
CHC
s (Non
FRU
)cond
uctin
g50
*de
liveries/
mon
th
SBAs
pos
ted
at
CHC(Non
FRU
)de
signa
ted
as D
Ps
in184
HPD
s*
SBAen
titledtore
ceivetheincenti
ve
of `
300
per
cas
e w
hen
she
cond
ucts
m
ore
than
50
deliv
erie
s per
mon
th.
Thismea
nssh
ewillgetth
eincenti
ve
from
51st
del
iver
y on
war
ds. S
he
shou
ldensure:m
inim
um48ho
ur
stayfo
rthe
mothe
r,useofsa
febirth
checklistfo
radh
eren
ceto
qua
lity
stan
dards,Zerodo
sevaccina
tionfor
BCG,OPV
and
Hep
Bfo
rnew
bornand
afunctio
nalN
BCCatth
efacility.
In a
dditi
on, A
NM
will
be
entit
led
for
` 50
for P
PIU
CD in
serti
on p
er c
ase
from
51st
cas
e on
war
ds.
Nil
` 30
0 pe
r del
iver
y from
51st
del
iver
y on
war
ds a
nd
additio
nal `50for
PPIUCD
insertion
pe
rcasefrom
51st
ca
se o
nwar
ds.
•M
CTS
•Fa
cilit
y re
cord
s
•Bl
ock
mon
itorin
g vi
sits
•MCT
FCfo
rPPIUCD
Cont
ext: Streng
then
ingCH
Cfunctio
ning
atthe
periphe
rywou
ldhelpinre
ducing
highcaselo
adin
clud
ingno
rmaldeliveriesa
ttertia
ry/referralcen
tresand
unn
ecessary
referrals.The
propo
sedincenti
vewou
ldm
otivateexisting
SBA
stoprovidequ
ality
deliveryservicesatC
HCleveland
helpinre
ducti
onofo
vercrowding
attertia
ry/referral
cent
res.
Leve
l of i
ncen
tive:CHC
(Non
FRU
)serviceprovide
rtea
m–M
edicalOfficera
ndSBA
traine
dAN
M/StaffNurse(w
hoactua
llycon
ductdeliveries)and
herassistan
ts/
clea
ning
staff
.
Pre-
requ
isite
:ANM/StaffNursem
ustb
eSB
Atraine
dan
dbe
also
traine
dan
dcertifie
d(bystate/ap
proved
training
cen
tre)to
provide
PPIUCD
asp
ernati
onalguide
lineby
due
auth
ority
.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
: Incenti
vewillbedisbursedon
qua
rterlybasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
*For
HPD
s of 8
Nor
th-e
ast s
tate
s inc
ludi
ng S
ikki
m: S
BA tr
aine
d AN
M w
ill b
e en
title
d to
rece
ive
the
ince
ntive
of `
300
per
cas
e w
hen
she
cond
ucts
bey
ond
20 d
eliv
erie
s pe
r mon
th.
That
mea
ns, `
300
per
del
iver
y fr
om 2
1st d
eliv
ery
onw
ards
and
add
ition
al `
50
per c
ase
of P
PIU
CD fr
om 2
1st d
eliv
ery
onw
ards
in a
mon
th.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 11
RMN
CH +
A T
hem
atic
area
: Mat
erna
l Hea
lth
PBI I
ndic
ator
Elig
ibili
ty C
riter
ia fo
r th
e PB
IPe
rfor
man
ce ta
rget
s Ex
istin
g in
centi
veAm
ount
of i
ncen
tive
prop
osed
Sour
ce
of d
ata
verifi
catio
n
Addi
tiona
l Ve
rifica
tion
appr
oach
es to
tr
ack
and
valid
ate
resu
lts
Prop
ortio
nof
C-secti
onsp
er
mon
thatS
ub-
dist
rict C
HC/
FRUs.
EmergencyObstetric
Care(E
mOC)te
amat
Sub-distric
tCHC
/FRU
at
184
HPD
s.
EmOCteam
enti
tledtore
ceive
` 30
00
perC
-sectio
nbe
yond
5C-sectio
ns
per m
onth
. Thi
s mea
ns te
am w
ill g
et
incenti
vefrom
6thC-sectio
non
wards.
Theteam
shou
ldadh
eretoinfecti
on
preven
tionprotocolsa
sperM
NHToolkit.
Nil
`30
00perC-sectio
nbe
yond
5C-sectio
nsper
mon
th.
•Fa
cilit
y re
cord
s
•HM
IS
Bloc
k m
onito
ring
visit
s
Cont
ext: Provision
ofC
-sectio
nservicesisahighim
pactcriti
calcom
pone
ntofcom
preh
ensiv
eem
ergencyob
stetric
careman
agem
enta
ndin
dicativ
eofqua
lityofEmOC.
Thisincenti
veaim
stomoti
vateand
retainth
eexisti
ngEmOCteam
sworking
inHPD
sand
increa
seprovisio
nofC-sectio
natSub
-distric
tFRU
ssothatwom
enhave
improved
and
timelyaccessto
com
preh
ensiv
eem
ergencyob
stetric
care.
Leve
l of i
ncen
tive:Sub
-distric
tFRU
-EmOCteam
includ
ingOBG
YNsp
ecialist,an
aesthe
tist,pa
ediatrician,staff
nurse,O
Tassis
tant,grade
IVstaff
.Distrib
ution
ofcashbe
nefitsa
mon
gtheteam
und
erth
isincenti
vewou
ldbede
cide
dbyth
estate.
Pre-
requ
isite
: OBG
YNsp
ecialisto
rserviceprovide
rmustb
etraine
dan
dcertifie
d(bystate/ap
proved
training
cen
tre)to
provide
EmOC,LSA
Sservicesasp
ernati
onal
guid
elin
e.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
: Incenti
vewillbedisbursedon
mon
thly/qua
rterlybasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
ed
byth
ede
signa
tedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)12
RMN
CH +
A T
hem
atic
area
: Mat
erna
l Hea
lth
PBI I
ndic
ator
Elig
ibili
ty C
riter
ia fo
r th
e PB
IPe
rfor
man
ce ta
rget
s Ex
istin
g in
centi
veAm
ount
of i
ncen
tive
prop
osed
Sour
ce
of d
ata
Addi
tiona
l Ve
rifica
tion
appr
oach
es to
tr
ack
and
valid
ate
resu
lts
Prop
ortio
nofC-sectio
ns
per m
onth
at
Dist
rict
Hospita
lFRU
s.
EmOCteam
at
Distric
tHospitalFRU
at
184
HPD
s
EmOCteam
enti
tledtore
ceive
` 30
00
perC
-sectio
nbe
yond
10C-se
ction
spe
rmon
th(o
nlyup
to20%
C-sectio
ns
ofto
tald
eliveries).Thism
eanste
am
willgetin
centi
vefrom
11thC-secti
on
onw
ards
.
The
team
shou
ld a
dher
e to
infe
ction
pr
even
tion
prot
ocol
s as p
er M
NH
Tool
kit.
Nil
` 30
00perC-sectio
nbe
yond
10C-secti
ons
per m
onth
(onl
y up
to
20%C-sectio
nsoftotal
deliv
erie
s)Ho
wev
er, C
-sec
tions
ca
nnot
be
deni
ed fo
r an
y cl
ient
whe
re th
ere
is cl
ear i
ndic
ation
s of
C-se
ction
.
•Fa
cilit
y re
cord
s
•HM
IS
Bloc
k m
onito
ring
visit
s
Cont
ext:
Provision
ofC
-sectio
nservicesisahighim
pactcriti
calcom
pone
ntofcom
preh
ensiv
eem
ergencyob
stetric
careman
agem
ent.TimelyavailabilityofC-sectio
nhe
lpsin
redu
cing
preventab
lem
aterna
lmortalityan
dmorbidity.Thisincen
tiveaimstomoti
vateth
eEm
OCteam
sworking
inHPD
sand
increa
sesp
rovisio
nofC-sectio
natDistric
tHo
spita
ls so
that
wom
en h
ave
impr
oved
acc
ess t
o co
mpr
ehen
sive
emer
genc
y ob
stet
ric c
are.
Leve
l of i
ncen
tive:
Distric
tHospitalFRU
-Em
OCteam
includ
ingOBG
Yspecialist,an
aesthe
tist,pa
ediatrician,staff
nurse,O
Tassis
tant,grade
IVstaff
.Distrib
ution
ofcashbe
nefitsa
mon
gtheteam
und
erth
isincenti
vewou
ldbede
cide
dbyth
estate.
Pre-
requ
isite
:OBG
YNsp
ecialisto
rserviceprovide
rmustb
etraine
dan
dcertifie
d(trainingcentrecertifi
ed/a
pprovedbyGoI)toprovideEm
OC,LSA
Sservicesasp
er
natio
nalguide
line.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:Incenti
vewillbedisbursedon
mon
thly/qua
rterlybasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
ed
byth
ede
signa
tedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs) 13
RMN
CH +
A th
emati
c ar
ea: N
ewbo
rn H
ealth
PBI I
ndic
ator
Elig
ibili
ty
Crite
ria fo
r th
e PB
I
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of
ince
ntive
pr
opos
ed
Sour
ce o
f dat
aAd
ditio
nal
Verifi
catio
n ap
proa
ches
to tr
ack
and
valid
ate
resu
lts
Prop
ortio
nofBed
oc
cupa
ncy
and
Neo
nata
l mor
talit
y rateatS
NCU
SNCU
team
at
184
HPDs
SNCU
team
enti
tledtore
ceive
` 25
000
perm
onthwhe
nSN
CUsrecordabe
doccupa
ncy>70
%,inbo
rnadm
issionrate
shou
ldnotexcee
d40
%and
neo
natal
mortalityshallb
e<1
5%
Nil
` 25
000
per
mon
thSN
CUre
cords
Bloc
k m
onito
ring
visit
s
Cont
ext: Facilityba
sedne
wbo
rncareinclud
ingsetting
upofSpe
cialNew
bornCareUnits(S
NCU
s)to
caterto
thene
edso
fsick,verylowbirthweigh
tand
pre-te
rm
newbo
rnisaflagshipprogram
meun
derN
HM.C
urrently84SN
CUsa
refu
nctio
nalinthe18
4HP
Ds.The
incenti
veaim
stoen
hancethequ
ality
functio
ning
ofS
NCU
sand
en
courage/moti
vateSNCU
team
sworking
inHPD
s
Leve
l of i
ncen
tive:
SNCU
serviceproviderte
am-M
O,SNand
supp
orttea
mDi
strib
ution
of c
ash
bene
fits a
mon
g th
e te
am u
nder
this
ince
ntive
wou
ld b
e de
cide
d by
the
stat
e.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:Incenti
vesw
illbepa
idonqu
arterly
basis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
RMNCH+A: Illustrative Performance Based Incentives for High Priority Districts (HPDs)14
RMN
CH +
A th
emati
c Ar
ea: M
ater
nal,
New
born
& C
hild
Hea
lth
Pbi
Indi
cato
rEl
igib
ility
Cr
iteria
for
the
PBI
Perf
orm
ance
targ
ets
Exis
ting
ince
ntive
Am
ount
of i
ncen
tive
prop
osed
Sour
ce o
f dat
aVe
rifica
tion
appr
oach
es to
trac
k an
d va
lidat
e re
sults
Com
posit
e in
dica
tor a
t Su
b-Ce
ntre
leve
l
ANM
, ASH
A AW
Ws a
t Su
b-Ce
ntre
leve
l in
184
HPDs
1.Early
ANCregistratio
nwith
in12wee
ks
->80
%pregn
antw
omen
outoftotal
regi
ster
ed
2.Four(4
)ANCcheck-up
->8
0%of
pregna
ntwom
enoutoftotalre
gistered
3.Exclusivebrea
stfee
ding
for6
mon
ths
>75%
forinfan
ts(>
6mon
ths),
4.
Com
mun
ity a
war
enes
s lev
el a
bout
use
ofORS
inDiarrho
ea,growthm
onito
ring
ofalltheeligiblechildrenasperM
CP
cards>
90%
5.Co
mpletevaccinati
onofthe
children
upto
1yea
r>80
%
6.
Awar
enes
s abo
ut th
e da
nger
sign
s du
ringpregna
ncy>95
%
7.>2
0%ofd
eliveriesinAN
MSub
-Cen
tre
area
havingPP
IUCD
insertion
Nil
`50
00perSub
-Cen
trepe
ran
numifth
eyachieved
targetso
f1st to
6th
in
dica
tors
.
In a
dditi
on to
the
abov
e in
centi
ves,
team
will
get
ad
ditio
nal `
100
0 pe
r an
num
if th
ey a
chie
ve th
e ta
rget
s for
the
indi
cato
r nu
mbe
r 7
•AN
M, A
SHA
and
AWW
re
cord
s
•M
CTS
•Feed
backfrom
be
neficiarie
sthroug
hfie
ld
visit
s/ca
lls
•Bl
ock
mon
itorin
g vi
sits
•Ra
ndom
verifi
catio
n(20%
)of
bene
ficiarie
sth
roug
h M
CTFC
Cont
ext: Su
b-Ce
ntreisth
efirstpointofcon
tactwith
pub
lichea
lthse
rvicede
liverysystem
.Stren
gthe
ning
Sub
-Cen
trelevelfun
ction
ingwou
ldlead
toim
proved
service
deliverytoth
ecommun
ityth
roug
hbo
thfa
cilityan
dou
trea
chapp
roache
s.Encou
raging
tea
mworkam
ongthefron
tline
workersand
moti
vatin
gthem
forb
etter
performan
cesisk
eyto
enh
ancedserviceprovision
asw
ellasu
tilisa
tionbycom
mun
itiesespeciallywom
enand
children.
Leve
l of i
ncen
tive:
Sub
-Cen
treteam
(ANM,A
WWand
ASH
A)Di
strib
ution
of c
ash
bene
fits a
mon
g th
e te
am u
nder
this
ince
ntive
wou
ld b
e de
cide
d by
the
stat
e.
Perio
d of
per
form
ance
and
freq
uenc
y of
PBI
:Incenti
vesw
illbepa
idonan
nualbasis.Paymen
twillbeprovided
whe
n(orw
ithhe
ldunti
l)repo
rted
perform
ance/achievemen
tsareobjectiv
elyverifi
edbythe
desig
natedsupe
rviso
rs,d
esigna
tedbyth
eState/Distric
tofficialso
ranyequ
ivalen
tofficersin
clud
ingreview
ofq
ualityofse
rvicesprovide
d.
lR;eso t;rs
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
With Support from
other RCH Divisions 2014
RMNCH+A: IllustrativePerformance Based Incentives for
High Priority Districts (HPDs)