Capacity Need Gap Analysis of

Implementing Ayushman Bharat Pradhan M

Instructions: * This document should be filled in only by the authorised officer/s in SHA in consultation with each divisio
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designed cells which are colour coded. *Refer to the right side of this instruction box to see the index of clours. * There
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specify any points that you want to highlight. * Annexures to support the claims should be numbered and attached as p
section. *Sheet 1 & 5 have printer friendly layout (A4 Landscape). *Do not modify the structure of this document.

Basic Profle of the State

Name of the State Maharashtra Date on PM-JAY was launched

Total Population Err:508 Mode of Implementation

Census 2011

Total Beneficiary State Category

families covered Brownfield / Greenfield
under PM-JAY Year in which State Scheme Started (opti

1 Institutional Structure including the policy framework, governance, power structur

1.1 Legal Validity of the SHA

1.1.1 Has the SHA been registered as a Society / Trust Under Department of Health & Family Welafre

1.1.2 If Yes, Date of Incorporation of Society

1.1.3 When is the next date of renewal ?

1.1.4 Whether the Governing Body has representation from Dept. of Finance, Rural Development, Labour, SC/ST
(Mark "Yes" If any two deapartments are part and provide details in the remarks section)

1.1.5 Whether the regular meetings of Governing Body are held as per the Memorandum of Association

Supporting Documents:
Annexure 1 Government Order on formation of State Health Agencies with its responsibilities
Annexure 2 Memorandum of Association (relevant sections showing date of incorporation and
Annexure 3 Minutes of the last 3 Governing Body Meeting (only front page containing date of

Remarks:
1.2 Formation of DIU

1.2.1 Whether personnal have been approved for DIUs

1.2.2 Number of districts where dedicated peronnal (one person in each district) is appointed

1.2.3 Mention the date on which first DIU personnel was appointed

Supporting Documents:
Annexure 4 Government Order on formation of District Implementation Unit
Annexure 5 Provide DIU personnel details in the "DIU HR Status Sheet"
Annexure 6 Joining report of the first DIU Staff

Remarks:

1.3 Formation and Functioning of Grievance Rederssal Committees

State Grievance Redressal Committee (SGRC)

1.3.1 Has the State Grievance Redressal Committee been constituted and State Grievance Nodal Office is identifie
(Mark "Yes" only if both the conditions are met)

1.3.2 Is there a fixed day in a month for convening State Grievance Redressal Committee Meeting

1.3.3 Has orinetation been given to the State Grievance Redressal Committee Members

1.3.4 Mention the date on which the first State Grievance Redressal Committee Meeting held

1.3.5 Mention the date on which the last State Grievance Redressal Committee Meeting held

District Grievance Redressal Committee (DGRC)

1.3.6 Has the District Grievance Redressal Commmittees been formed in all the Districts

1.3.7 Mention the number of districts where District Grievance Redressal Committees had atleast one meeting in

1.3.8 Is there a fixed day in a month for District Grievance Redressal Committee meetings
1.3.9 Has orientation been given to the District Grievance Redressal Committee Members

1.3.10 Monthwise Number of Districts where DGRC meeting held (inser the number only if the meetings are minut
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7

1.3.11 Percentage of regular monthly DGRC Meeting during the assessment period

1.3.12 Has the action taken on grievances been updated in the online Central Grievance Redressal Management S

Supporting Documents:
Annexure 7 Government Order on formation of Grievance Redressal Committees at State & Di
Annexure 8 Minutes of the State Grievance Redressal Committees for the last quarter of asses
Annexure 9 Minutes of the District Grievance Redressal Committees for the last quarter of ass
Training Report
Remarks: sample text

1.4 Formation and Functioning of Hospital Empanelment Committees

State Empanelment Committee (SEC)

1.4.1 Has the State Empanelment Committee been constituted

1.4.2 Has the State Empanelment Committee been oriented on the processess to be followed

1.4.3 Mention the date on which last State Hosptial Empanelment Committee meeting was held

1.4.4 Has the District Empanelment Committees been constituted

1.4.5 Number of Districts in which District Empanelment Committees been constituted

1.4.6 Total Number of Hospitals Empanelled in the State as end of assessment year

1.4.7 Out of the total empanelled Hospitals, how many hospitals were physically inspected and documented by t

Supporting Documents:
Annexure 10 Government Order on formation of Empanelment Committees at State & District L
Annexure 11 Minutes of the State Empanelment Committees for the last quarter of assessment
Annexure 12 Minutes of the District Empanelment Committees for the last quarter of assessme

Remarks: sample text

 sample text

1.5 Internal Procedures for Review & Planning

1.5.1 Whether Monthly meetings are held to review SHA & DIU activities

1.5.2 Whether the minutes is circulated among the staff for follow-up on decisions

Supporting Documents:
Annexure 13 Minutes of the last three meetings
Annexure 14 Copy of the communication sent to staff ?

Remarks: 1.5 remrks

2 Operational & Management Capacity

2.1 Convergence & Adoption of National Guidelines

2.1.1 Whether the implementation agency for State Scheme and PM-JAY are the same?

2.1.2 Whether the IT platfrom used for State scheme and PM-JAY scheme are the same?

2.1.3 Whether the benefit package for Non PM JAY beneficiaries (State scheme) and PM-JAY beneficiaries are sam
(If the State does not have a State scheme, mark the answer as "Yes")

2.1.4 Whether the hospitals part of the state scheme and PM-JAY are common and provide same service?

2.1.5 Whether the sum insured for state scheme beneficiaries and PM-JAY beneficiaires are the same

Remarks:
2.2 Recruitment policy, Positions sanctioned, filled and vacant at State & District level

Data in this section will be autocalculated based on the input given in SHA & DIU HR tables
2.2.1 Whether the CEO is appointed?

2.2.2 Whether the CEO appointed is fulltime?

2.2.3 Total Number of possition Sactioned at State Level

2.2.4 Total Number of Possitions filled at State Level

2.2.5 Total Number of State level possitions vacant for more than 3 months

2.2.6 Total number of possitions sanctioned at District level

2.2.7 Total number of possitions filled at District level

2.2.8 Total number of district level possitions vacant for more than 3 months
(Assessed only if possitions are sanctioned)

Supporting Documents:
Annexure 15 Copy of the Government Order on posions sanctioned
Annexure 16 Relevant sections of establishment register showing staff strength for last 3 month

Remarks:

2.3 Support provided by external agencies (paid & non-paid), expertise and duration

2.3.1 Are there any external agency (PMU / Development Partner) supporting the SHA in the implementation of P

2.3.2 Whether the scope of work for engagement of external agency in supporting SHA is defined?

2.3.3 Since when the agency support has been extended to SHA?

2.3.4 What is the agreed duration of the support provided by the external agency? (in months)

2.3.5 Whether there is an approved proposal with transition plan for the external support?

2.3.6 Whether periodic review meetings are conducted with support agency ?
 Supporting Documents:
Annexure 17 ToR for assignment / communications issued by SHA / support agency
Annexure 18 Review meeting minutes / reports

Remarks:

2.4 Administrative & Finance Powers

For information purpose only.
2.4.1 What are the financial powers of CEO

2.4.2 What are the financial powers of Dy CEO

2.4.3 What are the financial powers of Administrative Officer / Finance Officer

2.5 Budget and Financial Allocation

2.5.1 Whether Annual Budget is prepared

2.5.2 Whether division wise budget allocation is prepared

Supporting Documents:
Annexure 19 Annual Budget of SHA for the assessment year
 Remarks:

2.6 Infrastructure facilities at State & District level (space, computer & other equipment’s for all personnel su

2.6.1 Whether official workstation (computer, seating arragnement and storage) provided for all Staff

2.6.2 Whether DIU personnel are provided with computer with internet connectivity

2.6.3 Whether Clean & Healthy work environment is provided at SHA (self certification by SHA)

2.6.4 Whether the SHA office is located in the State Capital

2.6.5 Whether the CEO is operating primarily from the SHA office in case of additional charges

Remarks:

2.7 Partnerships with other Government Departments / External Agencies for specific tasks

2.7.1 Whether scope of work for other department / agency partnership is defined?

2.7.2 Whether review meetings are held on regular basis to review the activities under the partnership?

2.7.3 Whether the review meetings are chaired by Dy. CEO or higher official?

2.7.4 Whether the partner review meetings are documented?

Supporting Documents:
Annexure 20 ToR for partnership / other communications
Annexure 21 Minutes of review meetings

Remarks:
2.8 Flow of information & knowledge management

2.8.1 Whether the any document management system is being followed (electronic / paper file) in the SHA?

2.8.2 Whether systems established for communicating important information with DIUs and other Stakeholders ?

2.8.3 Whether any mechanism is established for collecting feedback from stakeholders at State level?

2.8.4 Whether best practices and challenges are documented?

2.8.5 Whether the best practice / learning documents produced by SHA are available in a central repository?

Supporting Documents:
Annexure 22 Annual Budget of SHA for the assessment year

Remarks:

2.9 Availability of technical resources for learning (both infrastructure & manpower)

2.9.1 Whether SHA maintains a library of documents and circulars issued on PM-JAY implementation (both from
either in digital format or in hard copy which can be accessed by all authorised personnel in SHA.

2.9.2 Has any need gap analysis conducted to understand the training needs of stakeholders

2.9.3 Whether state specific learning materials are developed addressing Hospitals. Learning materials for other t

2.9.4 Has annual training calendar been prepared ?

2.9.5 Whether Master Trainers are identified, assigned and equiped for specific topics

2.9.6 Whether budgetary provisions are made for training and other capacity building related activities

Remarks:
3 Divisional Performance

3.1 IEC & Demand Generation

3.1.1 What is the total number of families eligible for PM-JAY & State Scheme combined

3.1.2 How many unique families were issued PM-JAY e-card as on 31st March 2020

3.1.3 How many villages are there in the State

3.1.4 How many villages have reported atleast one e-card issurance till 31st March 2020

3.1.5 How many villages have reported atleast one claim till 31st March 2020

3.1.6 Provide Details of the communication materials developed in regional language

3.1.7 Provide details on Partnerships made by SHA/DIU for community reachout

3.2 Hospital Empanelment & Quality Assurance

3.2.1 How many Public Hospitals are empanelled under PM-JAY in the State as per HEM

3.2.2 How many Private Hospitals empanelled under PM-JAY in the State as per HEM

3.2.3 How many Beds are avaialbe in PM-JAY Empanelled Public Hospitals in the State

3.2.4 How many Beds avaialbe in PM-JAY Empanelled Private Hospitals in the State

3.2.5 Average time taken for empanellment of Private Hosptials after submitting the application in HEM during th

3.2.6 How many public hospitals have filled in information on all heads in Hospital Empanelment Module
3.2.7 How many public Hospitals are active

3.2.8 How many private Hospitals are active

3.2.9 How many hospitals (public & prrivate) have initiated Quality Certification

3.2.10 How many public hospitals have silver or above certification

3.2.11 Specify the details on mechanism put in place for collecting feedback from the Hospitals

3.3 State Anti Fraud Unit

3.3.1 Whether the manpower allocation in SAFU is as per the NHA Anti Fraud Guideline

3.3.2 How many entities have been identified committing fraud

3.3.3 Number of entities against which punitive action is taken as per NHA guidelines

3.3.4 Total Number of claims raised for the assessment period

3.3.5 Number of claims audited (direct audit) by SAFU team during the assessment period

3.3.6 Total number of mortality cases reported in the assessment period

3.3.7 Number of mortality cases audited by SAFU team

3.3.8 Total number of LAMA/DAMA cases reported during the assessment period

3.3.9 Total number of LAMA/DAMA cases audited by SAFU

Remarks:

3.4 Monitoring & Evaluation

3.4.1 Whether in-house analytics team is appointed

3.4.2 Whether periodic bulletins / reports / factsheets (internal/external) are published?

3.4.3 Specify the details of publications / reports

asd

3.5 Operations & Grievance Redressal

3.5.1 How many claims were raised during the assessment period

3.5.2 How many claims were settled within the timline defined by NHA

3.5.3 How many ISA/IC review meetings, chaired by CEO, were organised during the assessment period

3.5.4 How many grievances were received in total through CGRMS/CPGRAMS/Other Sources during the assessme

3.5.5 How many grievances were settled within the timeline defined by NHA during the assessment period

Remarks:

3.7 IT

3.7.1 Number of IT Product wise personnel allotted (mention the fraction of manpower, if same person is assigne

3.7.1.1 Transaction Management System

3.7.1.2 Beneficiary Identification System

3.7.1.3 Hospital Empanelment Module

3.7.2 Whether data warehouse is set-up and NO requests are sent to NHA for report generation

3.7.3 Status of API Intgration

3.7.3.1 Whether the basic number are transferred from SHA to NHA through API
3.7.3.2 Whether the data fields in SHA have been mapped with NHA data fields

3.7.3.3 Whether all the data fields mapped are shared from SHA to NHA

3.7.4 Specify the details of applications for which data field mapping has been completed and status of pending a

3.8 Innovations & Best Practices

Attach annexures for each case study

Remarks
 CONFIDENTIAL: Not to be Published without approval of CEO

Gap Analysis of State Health Agencies

arat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

Data entry NOT permitted

ultation with each division within SHA. * This worksheet contains 5 sheets. SHA is
ows the results of the indicators from sheet 1. * Data entry is allowed only in the Auto Calculate
index of clours. * There are also validations in cells and input format (Date / Number /
ut format is incorrect. * Each section has a remarks colum (free text) where you can
bered and attached as per the numbering sequence given at the bottom of each Dropdown
of this document.
Manaul Entry

was launched Number of Districts

Assessment Period 2019-20

ate Scheme Started (optional)

nce, power structures

mily Welafre (Yes/No)

DD/MM/YYYY

DD/MM/YYYY

elopment, Labour, SC/ST Development and Local Self Governance (Yes/No)

m of Association (Yes/No)

s with its responsibilities

date of incorporation and GB members)
page containing date of meeting)
 (Yes/No)

Number

DD/MM/YYYY

e Nodal Office is identified (Yes/No)

(Yes/No)

(Yes/No)

DD/MM/YYYY

DD/MM/YYYY

(Yes/No)

ad atleast one meeting in last three months Number

(Yes/No)
 (Yes/No)

f the meetings are minuted and documentary evidence is available)

Month 8 Month 9 Month 10 Month 11 Month 12 Total

0% Auto Calculated

edressal Management System (CGRMS) (Yes/No)

Committees at State & District level

the last quarter of assessment year
or the last quarter of assessment year (Any three districts)

(Yes/No)

(Yes/No)

DD/MM/YYYY

(Yes/No)

Number

Number

ed and documented by the District Empanelment Committee Number

ttees at State & District Level

st quarter of assessment year
last quarter of assessment year (Any three districts)
 (Yes/No)

(Yes/No)

(Yes/No)

(Yes/No)

-JAY beneficiaries are same in the State ? (Yes/No)

ide same service? (Yes/No)

are the same (Yes/No)

 (Yes/No)

(Yes/No)

Err:507 Auto Calculated

Err:508 Auto Calculated

Err:508 Auto Calculated

Err:507 Auto Calculated

Err:508 Auto Calculated

Err:508 Auto Calculated

strength for last 3 months

n the implementation of PM-JAY (Yes/No)

(Yes/No)

DD/MM/YYYY

Number

(Yes/No)

(Yes/No)
pport agency

(Yes/No)

(Yes/No)
ent’s for all personnel supporting the SHA) & Proximity to Administrative Structure

ed for all Staff (Yes/No)

(Yes/No)

(Yes/No)

(Yes/No)

(Yes/No)

(Yes/No)

he partnership? (Yes/No)

(Yes/No)

(Yes/No)
per file) in the SHA? (Yes/No)

and other Stakeholders ? (Yes/No)

t State level? (Yes/No)

(Yes/No)

a central repository? (Yes/No)

lementation (both from State & National level) (Yes/No)

sonnel in SHA.

(Yes/No)

ning materials for other target audiance is preferred? (Yes/No)

(Yes/No)

(Yes/No)

lated activities (Yes/No)

 Number

Number

Number

Number

Number

Number

Number

Number

Number

lication in HEM during the assessment year (in days) Number

nelment Module Number

Number

Number

Number

Number

(Yes/No)

Number

Number

Number

Number

Number

Number

Number

Number

(Yes/No)
 (Yes/No)

Number

Number

essment period Number

urces during the assessment period Number

assessment period Number

if same person is assigned to multiple products)

Number

Number

Number

(Yes/No)

(Yes/No)
 (Yes/No)

(Yes/No)

d and status of pending activities.

without approval of CEO
o Calculated
o Calculated

o Calculated

o Calculated

o Calculated

o Calculated

o Calculated