CONFIDENTIAL: Not to be Published without approval of CEO

Capacity Need Gap Analysis of State Health Agencies

Implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

Data entry NOT permitted

Instructions: * This document should be filled in only by the authorised officer/s in SHA in consultation with each division within SHA. * This worksheet contains 5 sheets. SHA is
allowed to input information only in the first four sheets while the last sheet (output sheet) shows the results of the indicators from sheet 1. * Data entry is allowed only in the Auto Calculate
designed cells which are colour coded. *Refer to the right side of this instruction box to see the index of clours. * There are also validations in cells and input format (Date / Number /
Text) is specified on right side of each data entry field. *You will get an error message if the input format is incorrect. * Each section has a remarks colum (free text) where you can
specify any points that you want to highlight. * Annexures to support the claims should be numbered and attached as per the numbering sequence given at the bottom of each Dropdown
section. *Sheet 1 & 5 have printer friendly layout (A4 Landscape). *Do not modify the structure of this document.
Manaul Entry

Basic Profle of the State

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

Total Population 112,374,333 Mode of Implementation

Census 2011

Total Beneficiary State Category Assessment Period 2019-20

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

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

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 (Yes/No)

1.1.2 If Yes, Date of Incorporation of Society DD/MM/YYYY

1.1.3 When is the next date of renewal ? DD/MM/YYYY

1.1.4 Whether the Governing Body has representation from Dept. of Finance, Rural Development, Labour, SC/ST Development and Local Self Governance (Yes/No)
(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 (Yes/No)

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 GB members)
Annexure 3 Minutes of the last 3 Governing Body Meeting (only front page containing date of meeting)

Remarks:

SHA Capacity Need Gap Analysis Page 1 of 29

 1.2 Formation of DIU

1.2.1 Whether personnal have been approved for DIUs (Yes/No)

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

1.2.3 Mention the date on which first DIU personnel was appointed DD/MM/YYYY

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 identified (Yes/No)
(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 (Yes/No)

1.3.3 Has orinetation been given to the State Grievance Redressal Committee Members (Yes/No)

1.3.4 Mention the date on which the first State Grievance Redressal Committee Meeting held DD/MM/YYYY

1.3.5 Mention the date on which the last State Grievance Redressal Committee Meeting held DD/MM/YYYY

District Grievance Redressal Committee (DGRC)

1.3.6 Has the District Grievance Redressal Commmittees been formed in all the Districts (Yes/No)

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

1.3.8 Is there a fixed day in a month for District Grievance Redressal Committee meetings (Yes/No)

1.3.9 Has orientation been given to the District Grievance Redressal Committee Members (Yes/No)

1.3.10 Monthwise Number of Districts where DGRC meeting held (inser the number only if the meetings are minuted and documentary evidence is available)
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Total

1.3.11 Percentage of regular monthly DGRC Meeting during the assessment period 0% Auto Calculated

SHA Capacity Need Gap Analysis Page 2 of 29

 1.3.12 Has the action taken on grievances been updated in the online Central Grievance Redressal Management System (CGRMS) (Yes/No)

Supporting Documents:
Annexure 7 Government Order on formation of Grievance Redressal Committees at State & District level
Annexure 8 Minutes of the State Grievance Redressal Committees for the last quarter of assessment year
Annexure 9 Minutes of the District Grievance Redressal Committees for the last quarter of assessment year (Any three districts)
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 (Yes/No)

1.4.2 Has the State Empanelment Committee been oriented on the processess to be followed (Yes/No)

1.4.3 Mention the date on which last State Hosptial Empanelment Committee meeting was held DD/MM/YYYY

1.4.4 Has the District Empanelment Committees been constituted (Yes/No)

1.4.5 Number of Districts in which District Empanelment Committees been constituted Number

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

1.4.7 Out of the total empanelled Hospitals, how many hospitals were physically inspected and documented by the District Empanelment Committee Number

Supporting Documents:
Annexure 10 Government Order on formation of Empanelment Committees at State & District Level
Annexure 11 Minutes of the State Empanelment Committees for the last quarter of assessment year
Annexure 12 Minutes of the District Empanelment Committees for the last quarter of assessment year (Any three districts)

Remarks: sample text

SHA Capacity Need Gap Analysis Page 3 of 29

 1.5 Internal Procedures for Review & Planning

1.5.1 Whether Monthly meetings are held to review SHA & DIU activities (Yes/No)

1.5.2 Whether the minutes is circulated among the staff for follow-up on decisions (Yes/No)

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? (Yes/No)

2.1.2 Whether the IT platfrom used for State scheme and PM-JAY scheme are the same? (Yes/No)

2.1.3 Whether the benefit package for Non PM JAY beneficiaries (State scheme) and PM-JAY beneficiaries are same in the State ? (Yes/No)
(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? (Yes/No)

2.1.5 Whether the sum insured for state scheme beneficiaries and PM-JAY beneficiaires are the same (Yes/No)

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? (Yes/No)

2.2.2 Whether the CEO appointed is fulltime? (Yes/No)

SHA Capacity Need Gap Analysis Page 4 of 29

 2.2.3 Total Number of possition Sactioned at State Level Err:507 Auto Calculated

2.2.4 Total Number of Possitions filled at State Level 0 Auto Calculated

2.2.5 Total Number of State level possitions vacant for more than 3 months 0 Auto Calculated

2.2.6 Total number of possitions sanctioned at District level Err:507 Auto Calculated

2.2.7 Total number of possitions filled at District level 0 Auto Calculated

2.2.8 Total number of district level possitions vacant for more than 3 months 0 Auto Calculated
(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 months

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 PM-JAY (Yes/No)

2.3.2 Whether the scope of work for engagement of external agency in supporting SHA is defined? (Yes/No)

2.3.3 Since when the agency support has been extended to SHA? DD/MM/YYYY

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

2.3.5 Whether there is an approved proposal with transition plan for the external support? (Yes/No)

2.3.6 Whether periodic review meetings are conducted with support agency ? (Yes/No)

Supporting Documents:
Annexure 17 ToR for assignment / communications issued by SHA / support agency
Annexure 18 Review meeting minutes / reports

Remarks:

SHA Capacity Need Gap Analysis Page 5 of 29

 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 (Yes/No)

2.5.2 Whether division wise budget allocation is prepared (Yes/No)

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

Remarks:

SHA Capacity Need Gap Analysis Page 6 of 29

 2.6 Infrastructure facilities at State & District level (space, computer & other equipment’s for all personnel supporting the SHA) & Proximity to Administrative Structure

2.6.1 Whether official workstation (computer, seating arragnement and storage) provided for all Staff (Yes/No)

2.6.2 Whether DIU personnel are provided with computer with internet connectivity (Yes/No)

2.6.3 Whether Clean & Healthy work environment is provided at SHA (self certification by SHA) (Yes/No)

2.6.4 Whether the SHA office is located in the State Capital (Yes/No)

2.6.5 Whether the CEO is operating primarily from the SHA office in case of additional charges (Yes/No)

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? (Yes/No)

2.7.2 Whether review meetings are held on regular basis to review the activities under the partnership? (Yes/No)

2.7.3 Whether the review meetings are chaired by Dy. CEO or higher official? (Yes/No)

2.7.4 Whether the partner review meetings are documented? (Yes/No)

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

Remarks:

SHA Capacity Need Gap Analysis Page 7 of 29

 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? (Yes/No)

2.8.2 Whether systems established for communicating important information with DIUs and other Stakeholders ? (Yes/No)

2.8.3 Whether any mechanism is established for collecting feedback from stakeholders at State level? (Yes/No)

2.8.4 Whether best practices and challenges are documented? (Yes/No)

2.8.5 Whether the best practice / learning documents produced by SHA are available in a central repository? (Yes/No)

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 State & National level) (Yes/No)
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 (Yes/No)

2.9.3 Whether state specific learning materials are developed addressing Hospitals. Learning materials for other target audiance is preferred? (Yes/No)

2.9.4 Has annual training calendar been prepared ? (Yes/No)

2.9.5 Whether Master Trainers are identified, assigned and equiped for specific topics (Yes/No)

2.9.6 Whether budgetary provisions are made for training and other capacity building related activities (Yes/No)

Remarks:

SHA Capacity Need Gap Analysis Page 8 of 29

 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 Number

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

3.1.3 How many villages are there in the State Number

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

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

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 Number

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

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

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

3.2.5 Average time taken for empanellment of Private Hosptials after submitting the application in HEM during the assessment year (in days) Number

SHA Capacity Need Gap Analysis Page 9 of 29

 3.2.6 How many public hospitals have filled in information on all heads in Hospital Empanelment Module Number

3.2.7 How many public Hospitals are active Number

3.2.8 How many private Hospitals are active Number

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

3.2.10 How many public hospitals have silver or above certification Number

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 (Yes/No)

3.3.2 How many entities have been identified committing fraud Number

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

3.3.4 Total Number of claims raised for the assessment period Number

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

3.3.6 Total number of mortality cases reported in the assessment period Number

3.3.7 Number of mortality cases audited by SAFU team Number

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

3.3.9 Total number of LAMA/DAMA cases audited by SAFU Number

Remarks:

SHA Capacity Need Gap Analysis Page 10 of 29

 3.4 Monitoring & Evaluation

3.4.1 Whether in-house analytics team is appointed (Yes/No)

3.4.2 Whether periodic bulletins / reports / factsheets (internal/external) are published? (Yes/No)

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 Number

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

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

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

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

Remarks:

SHA Capacity Need Gap Analysis Page 11 of 29

 3.7 IT

3.7.1 Number of IT Product wise personnel allotted (mention the fraction of manpower, if same person is assigned to multiple products)

3.7.1.1 Transaction Management System Number

3.7.1.2 Beneficiary Identification System Number

3.7.1.3 Hospital Empanelment Module Number

3.7.2 Whether data warehouse is set-up and NO requests are sent to NHA for report generation (Yes/No)

3.7.3 Status of API Intgration

3.7.3.1 Whether the basic number are transferred from SHA to NHA through API (Yes/No)

3.7.3.2 Whether the data fields in SHA have been mapped with NHA data fields (Yes/No)

3.7.3.3 Whether all the data fields mapped are shared from SHA to NHA (Yes/No)

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

3.8 Innovations & Best Practices

Attach annexures for each case study

Remarks

SHA Capacity Need Gap Analysis Page 12 of 29

Summary of Possitions Santioned and filled in SHA/DIU (Do not include the ISA, Project Management Unit or Development Partner resources here)

Number of persons Number of

Number of persons
State Level / District Number of Posts appointed on Total Number of Number of Possitions Vacant If vacant, mention since when
Sl No. Designation Level Assinged Primary Role Sanctioned appointed on contract (included persons appointed possitions vacant for more than 3 the possitions are vacant
deputation outsourced) Months

1 State Level Pre-auth & Claim Adjudication 0 0

2 0 0
3 0 0
4 District Level District Programme Coordination 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
32 0 0
33 0 0
34 0 0
35 0 0
36 0 0
37 0 0
38 0 0
39 0 0
40 0 0
41 0 0
42 0 0
43 0 0
44 0 0
45 0 0
46 0 0
47 0 0
48 0 0
49 0 0
50 0 0
Part 2 Details of manpower available in SHA/DIU including manpower provided by ISA/IC, PMU and Development Partners
Roles & Responsibilities (specify the percentage of resource being utilised in

Is on deputation Has the person Has the person Has Job Has the person
from Appointing Agency - If vacant, sicne got relevant got relevant Desciption been undergone any Pre-auth & Claim Beneficiary State Anti Fraud
Designation as Full time / Part SHA / IC/ ISA/ PMU / academic
Sl No. Name State / District Level assigned by SHA time Government Other Agency when? experience in given to the
qualification for personnel training relevant Adjudication identification Unit & Medical
service ? (DD/MM/YYYY) assigned at the to the assigned System Audit
(Yes/No) Personnel possition the assigned time of joining? possition
possition

1 Not Applicable
2
3
4
5
6
7
8
9
10
the percentage of resource being utilised in each division)

Management of Finance & Grievance IT & Data Capacity District District Medical Remarks (If DIU Personnel, specify the district/s in
Empanelled Account Administration Management Operation Policy M&E Management IEC Development Programme Officer Others charge of
Hospitals Coordinator

25% 25% 50%

Information on the agencies supporting SHA including development partners and PMU

Number of Personnel Monitory Value of the

Number of Personnel Date of first person Date of expiry of last
Sl No State Support Agency Name Funded by SHA (Yes/No) If paid, annual fee. appointed at regional/District Services available to SHA Remarks
appointed at State Level appointed contract
level (FY 2019-20)

1
2
3
 CONFIDENTIAL: Not to be Published without approval of CEO

Result Sheet
Capacity Need Gap Analysis of State Health Agencies
Implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

Basic Profle of the State

Name of the State Maharashtra Assessment Period 2019-20

Total Population (Census 2011) 112,374,333

Total Beneficiary families covered under PM-JAY 0

Date of Launch of Scheme 12/30/1899

State Category 0

Mode of Implementation 0

Number of Districts 0

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

1.1 Leagl Validity of the SHA

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

1.1.1 SHA registeration status as a Society / Trust Under Department of Health & 0 1 0
Family Welafre
1.1.2 If registered, Data of Incorporation of Society 12/30/1899 NA 0
The SHA should be a registered Society/Trust
1.1.3 Date of next date of renewal ? under Departemnt of Health while the Governing Indicator 1.1.1, 1.1.3 and 1.1.4 12/30/1899 NA 0
carried 1 mark if the answer is
Body should have representatiion from other key "Yes"
1.1.4 Representation from Deartment of Finance, Rural Development, Labour, SC/ST departments. 0 1 1
Development and Local Governance in Governig Body
1.1.5 Whether the regular meetings of Governing Body are held as per the 0 1 0
Memorandum of Association

3 1 33%

Remakrs 0

SHA Capacity Assessment Page 18 of 29

 1.2 Formation of DIU

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

1.2.1 Status of personnal have been allotted for DIUs 0 1 1

Proportional Scoring -
(depending on the % of
The District Implementation Units should be districts - >=90% - 1 Mark,
formed, and dedicated officials should be assigned <90% -70% 0.75 Marks, <70% -
1.2.2 Number of districts where dedicated peronnal is deployed for each role. 40% 0.50 Marks, <40% - 0 (0%) 1 1
Marks)

1.2.3 Date on which first DIU personnel was appointed NO SCORING 12/30/1899 NA 0

2 2 100%

Remakrs 0

1.3 Formation and Functioning of Grievance Rederssal Committees

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained
Status of State Grievance Redressal Committee constituted and State
1.3.1 Grievance Nodal Office is identified 0 1 0

1.3.2 Is there a fixed day in a month for convening State Grievance Redressal 0 NA 0
Committee Meeting

1.3.3 Orinetation given to the State Grievance Redressal Committee Members 0 0.5 0
Indicator 1.3.1 and 1.3.3
carries 1 mark each if the
1.3.4 Date on which the first State Grievance Redressal Committee Meeting held answer is "Yes" 12/30/1899 NA 0

1.3.5 Date on which the last State Grievance Redressal Committee Meeting held The grievance redressal committees should be Indicator 1.3.3 and 1.3.9 12/30/1899 NA 0
formulated at State & District Level and officials carries 0.5 marks each if the
should be aware of all the guideline related to PM- answer is "Yes"
Status of District Grievance Redressal Commmittees been formed in all the
1.3.6 JAY. Regular meeting of grievance redressal 0 NA 0
Districts
committees should be held as per the guideline. Indicator 1.3.7 and 1.3.11 has
Mention the number of districts where District Grievance Redressal Action on Grievances submitted should be taken proportional Scoring -
1.3.7 Committees had atleast one meeting in last three months within the time limit defined by NHA. (depending on the % of (0%) 1 0
districts / regular meetings -
Is there a fixed day in a month for District Grievance Redressal Committee >=90% - 1 Mark, <90% -70%
1.3.8 0 NA 0
meetings 0.75 Marks, <70% - 40% 0.50
Marks, <40% - 0 Marks)
1.3.9 Orientation been given to the District Grievance Redressal Committee 0 0.5 0
Members

1.3.11 Percentage of regular monthly DGRC Meeting during the assessment period 0% 1 0%

Whether the action taken on grievances been updated in the online Central
1.3.12 0 1 0
Grievance Redressal Management System (CGRMS)

5 0 0%

Remakrs sample text

SHA Capacity Assessment Page 19 of 29

 1.4 Formation and Functioning of Hospital Empanelment Committees

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained
1.4.1 Has the State Empanelment Committee been constituted 0 1 0

1.4.2 Has the State Empanelment Committee been oriented on the processess to be Indicator 1.4.1 and 1.4.2 0 1 0
followed carries 1 mark each if the
answer is "Yes"
1.4.3 Mention the date on which last State Hosptial Empanelment Committee Empanelment Committees should be formulated 12/30/1899 NA 0
meeting was held at State & District levels and personnel should be
Indicator 1.4.5 and 1.4.7 has
1.4.4 Has the District Empanelment Committees been constituted aware of guideline for empanelment of hospitals. proportional Scoring - 0 NA 0
All the hospitals empanelled should be physically
(depending on the % of
1.4.5 Percentage of Districts in which District Empanelment Committees been verified and approved by the committees and 0% 1 0
districts / physically verified
constituted documentation in this regard is maintained for hospitals - >=90% - 1 Mark,
future reference.
<90% -70% 0.75 Marks, <70% -
1.4.6 40% 0.50 Marks, <40% - 0 0 0 0
Total Number of Hospitals Empanelled in the State as end of assessment year
Marks)
1.4.7 Percentage of hospitals where physical inspection completed and documented 0% 1 0
by the District Empanelment Committee

4 0 0%

Remakrs sample text

1.5 Internal Procedures for Review & Planning

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

1.5.1 Whether Monthly meetings are held to review SHA & DIU activities Internal systems for regular review of SHA and DIU 0 1 0
performance should be laid down. The meetings Indicator 1.5.1 and 1.5.2
should be recorded, and minutes circulated. There carries 1 mark each if the
should also be system for systematic consolidation answer is "Yes"
1.5.2 Whether the minites is circulated among the staff for follow-up on decisions of matters that require further deliberation 0 1 0

2 0 0%
Remakrs 1.5 remrks

SHA Capacity Assessment Page 20 of 29

 2 Operational & Management Capacity

2.1 Convergence & Adoption of National Guidelines

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained
2.1.1 Implementation agency for State Scheme and PM-JAY are the same 0 1 0
2.1.2 IT platfrom used for State scheme and PM-JAY scheme are the same? 0 1 0
There should be convergence of State & Central
2.1.3 Benefit packages in State scheme and PM-JAY are the same? health financing programmes in terms of 0 1 0
Each indicator carries 1 mark if
2.1.4 Hospitals part of the state scheme and PM-JAY are common and provide same uniformity in implementation agenyc, IT platform, the answer is "Yes" 0 1 0
service? benefit package, health care providers and sum
assured.
2.1.5 Sum insured for state scheme beneficiaries and PM-JAY beneficiaires are the 0 1 0
same

5 0 0%

Remakrs 0

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

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

2.2.1 Status of appointment of CEO 0 1 0

2.2.2 CEO appointed is fulltime Indicator 2.2.1 and 2.2.2 0 1 0

carries 1 mark each if the
answer is "Yes"
2.2.3 Number of possition Sactioned at State Level 0 NA 0
Indicator 2.2.4 and 2.2.7 has
Day to day activities of SHA should not be affected proportional Scoring -
2.2.4 Percentage Possitions filled at State Level due to non-availability of the leadership possitions (depending on the % - >=90% - 0% 3 0
3 Mark, <90% -70% 2 Marks,
Sufficient man power should be sanctioned. All the <70% - 40% 1 Marks, <40% - 0
sanctioned positions are filled within 3 months of Marks)
2.2.5 Percentage of State level possitions vacant for more than 3 months notification. Vacancy if any due to 0% 2 0
transfer/attrition should also be filled in 3 months. Indicator 2.2.5 and 2.2.8 has
proportional Scoring -
2.2.6 Total number of possitions sanctioned at District level (depending on the % - >=40% - 0 NA 0
0 Mark, <40% -26% 0.5 Marks,
<25% - 16% 1 Marks, <15% -
2.2.7 Percentage of possitions filled at District level 5% 1.5 Marks <5% - 2 Marks) 0% 3 0

2.2.8 Percentage of district level possitions vacant for more than 3 months 0% 2 0

12 0 0%

Remakrs 0

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

SHA Capacity Assessment Page 21 of 29

 Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

2.3.1 Are there any external agency (PMU / Development Partner) supporting the 0 NA 0
SHA in the implementation of PM-JAY
2.3.2 Whether the scope of work for engagement of external agency in supporting If the SHA has limited capacity for managing 0 1 0
SHA is defined? various portfolios, support may be sought from
2.3.3 Since when the agency support has been extended to SHA? external agencies on temporary basis. The scope 12/30/1899 NA 0
of work in this regard should be pre-defined and Indicator 2.3.2, 2.3.5 and 2.3.6
What is the agreed duration of the support provided by the external agency? carries 1 mark each if the
2.3.4 SHA should have strategy for transition to inhouse answer is "Yes" Months NA 0
(in months) capacity building in near future. The support
extended by the external agencies should be
2.3.5 Whether there is an approved proposal with transition plan for the external quantified and documented for reference. 0 1 0
support?
2.3.6 0 1 0
Whether periodic review meetings are conducted with support agency ?

3 0 0%

Remakrs 0

2.4 Administrative & Finance Powers

2.4.1 What are the financial powers of CEO

0

2.4.2 What are the financial powers of Dy CEO

0

2.4.3 What are the financial powers of Administrative Officer / Finance Officer
0

SHA Capacity Assessment Page 22 of 29

 2.5 Budget and Financial Allocation

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

2.5.1 Whether Annual Budget is prepared Indicator 2.5.1 and 2.5.2 0 1 0

Annual budget has been prepared and allocations carries 1 mark each if the
made for operational components
2.5.2 Whether division wise budget allocation is prepared answer is "Yes" 0 1 0

2 0 0%

Remakrs 0

2.6 Infrastructure facilities at State & District level (space, computer & other equipment’s for all personnel supporting the SHA) & Proximity to Administrative Structure

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

Whether official workstation (computer, seating arragnement and storage)

2.6.1 0 1 0
provided for all Staff
The SHA and DIU staff are provided working space
2.6.2 Whether DIU personnel are provided with computer with internet connectivity with seating arrangement, desk, computer with 0 1 0
internet connectivity, communication aid,
stationaries and other essential facilities for
Whether Clean & Healthy work environment is provided at SHA (self All indicators carry 1 mark
2.6.3 certification by SHA) smooth functioning of the office. The day to day each if the answer is "Yes" 0 1 0
work of the personnel should not be affected and
active effort should be taken for a healthy working
2.6.4 Whether the SHA office is located in the State Capital condition. It is also preferred that the SHA office is 0 1 0
located in the State Capital
Whether the CEO is operating primarily from the SHA office in case of
2.6.5 additional charges 0 1 0

5 0 0%

Remakrs 0

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

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

2.7.1 0 1 0
Whether scope of work for other department / agency partnership is defined? Partnerships can be built on areas which require
Whether review meetings are held on regular basis to review the activities joint effort for success of PM-JAY scheme
2.7.2 (including capacity building). The scope of Indicator 2.7.1 and 2.7.3 0 NA 0
under the partnership?
partnership should be clearly defined and proper carries 1 mark each if the
2.7.3 documentation on this should be available. The answer is "Yes" 0 1 0
Whether the review meetings are chaired by Dy. CEO or higher official? progress of the partnerships should be monitored
on a regular basis.
2.7.4 0 NA 0
Whether the partner review meetings are documented?

2 0 0%

SHA Capacity Assessment Page 23 of 29

 Remakrs 0

2.8 Flow of information & knowledge management

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

2.8.1 Whether the any document management system is being followed (electronic / 0 1 0
paper file) in the SHA?
2.8.2 Whether systems established for communicating important information with 0 1 0
DIUs and other Stakeholders ? SHA should have document management system
either in electronic format or paper file with seats All indicators carry 1 mark
2.8.3 Whether any mechanism is established for collecting feedback from each if the answer is "Yes" 0 1 0
stakeholders at State level? assigned for each division/personnel.
2.8.4 Whether best practices and challenges are documented? 0 1 0

2.8.5 Whether the best practice / learning documents produced by SHA are available 0 1 0
in a central repository?

5 0 0%

Remakrs 0

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

Indicator Ideal Condition Scoring Methodology Response Given Maximum Score Score Obtained

Whether SHA maintains a library of documents and circulars issued on PM-JAY

2.9.1 implementation (both from State & National level) either in digital format or in 0 1 0
hard copy which can be accessed by all authorised personnel in SHA.
The SHA should have sufficient learning materials
Has any need gap analysis conducted to understand the training needs of (hard copy or digital version) for facilitating the
2.9.2 trainings either provided by NHA with 0 1 0
stakeholders
customisation or prepared in-house for each
technical component. The SHA should also arrange
Whether state specific learning materials are developed addressing Hospitals. All indicators carry 1 mark
2.9.3 for master trainers and venue arrangement (tie-up each if the answer is "Yes" 0 1 0
Learning materials for other target audiance is preferred? with external agency, rent a place, own space).
There should also be budgetary provisions
(approval, money and timely disbursal) for
2.9.4 Has annual training calendar been prepared ? meeting expenses related to capacity 0 1 0
development activities.
2.9.5 Whether Master Trainers are identified, assigned and equiped for specific 0 1 0
topics
Whether budgetary provisions are made for training and other capacity
2.9.6 building related activities 0 1 0

6 0 0%

SHA Capacity Assessment Page 24 of 29

 Remakrs 0

3 Divisional Performance

3.1 IEC & Demand Generation

Indicator Scoring Methodology Response Given Maximum Score Score Obtained

3.1.1 What is the total number of families eligible for PM-JAY & State Scheme combined 0 NA 0

3.1.2 How many unique families were issued PM-JAY e-card as on 31st March 2020 (0%) 1 0
Indicator 3.1.2 carries
proportional marks based on
the % of beneficiaries covered
3.1.3 How many villages are there in the State >=20% - 1 Mark, <20% -10% 0 NA 0
0.75, <10%-5% 0.50 Marks,
<5% 0 Mark

3.1.4 How many villages have reported atleast one e-card issurance till 31st March 2020 Indicator 3.1.4 and 3.1.5 has (0%) 1 0
proportional Scoring -
(depending on the % of villages
covered - >=40% - 0 Mark,
<40% -26% 0.5 Marks, <25% -
3.1.5 How many villages have reported atleast one claim till 31st March 2020 16% 1 Marks, <15% - 5% 1.5 (0%) 1 0
Marks, <5% - 2 Marks)

3 0 0%
3.1.6 Provide Details of the communication materials developed in regional language
0

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

0

SHA Capacity Assessment Page 25 of 29

 3.2 Hospital Empanelment & Quality Assurance

Indicator Scoring Methodology Response Given Maximum Score Score Obtained

3.2.1 How many Public Hospitals are empanelled under PM-JAY in the State as per HEM 0 NA 0

3.2.2 How many Private Hospitals empanelled under PM-JAY in the State as per HEM 0 NA 0
Indicator 3.2.5 has
proportional scoring based on
the days <=15 days 1 mark,
3.2.3 How many Beds are avaialbe in PM-JAY Empanelled Public Hospitals in the State >15-30 days 0.5 marks and >30 0 NA 0
days 0 marks

3.2.4 How many Beds avaialbe in PM-JAY Empanelled Private Hospitals in the State Indicator 3.2.6, 3.2.7, 3.2.8 has 0 NA 0
proportional Scoring -
(depending on the % - >=90% -
3 Mark, <90% -70% 2 Marks,
3.2.5 Average time taken for empanellment of Hosptials during the assessment year (in days) <70% - 40% 1 Marks, <40% - 0 0 1 0
Marks)

3.2.6 How many public hospitals have filled in information on all heads in Hospital Empanelment Module Indicator 3.2.9 has (0%) 1 0
proportional marks based on
the % of hospitals >=20% - 1
Mark, <20% -10% 0.75, <10%-
3.2.7 How many public Hospitals are active 5% 0.50 Marks, <5% 0 Mark (0%) 1 0

Indicator 3.2.10 has

3.2.8 How many private Hospitals are active proportional marks based on (0%) 1 0
the % of hospitals >=10% - 1
Mark, <10% -5% 0.75, <5%-1%
0.50 Marks, <1% 0 Mark
3.2.9 How many hospitals (public & prrivate) have initiated Quality Certification (0%) 1 0

3.2.10 How many public hospitals have silver or above certification (0%) 1 0

6 0 0%
3.2.11 Specify the details on mechanism put in place for collecting feedback from the Hospitals
0

SHA Capacity Assessment Page 26 of 29

 3.3 State Anti Fraud Unit

Indicator Scoring Methodology Response Given Maximum Score Score Obtained

3.3.1 Whether the manpower allocation in SAFU is as per the NHA Anti Fraud Guideline 0 1 0

3.3.2 How many entities have been identified committing fraud Indicator 3.3.1 carries 1 mark 0 NA 0
if the answer is "Yes"
3.3.3 Number of entities against which punitive action is taken as per NHA guidelines 0 1 0
Indicator 3.3.3, 3.3.7 and 3.3.9
3.3.4 Total Number of claims raised for the assessment period has proportional marks based 0 NA 0
on % of cases audited >=90%
- 3 Mark, <90% -70% 2 Marks,
3.3.5 Number of claims audited by SAFU team during the assessment period <70% - 40% 1 Marks, <40% - 0 0 1 0
Marks)
3.3.6 Total number of mortality cases reported in the assessment period Indicator 3.3.5 has 0 NA 0
proportional makrs based on %
3.3.7 Number of mortality cases audited by SAFU team of claims audited >=2% - 1 0 1 0
Mark, <2% -1% 0.5, <1% 0
3.3.8 Total number of LAMA/DAMA cases reported during the assessment period Mark 0 NA 0

3.3.9 Total number of LAMA/DAMA cases audited by SAFU 0 1 0

5 0 0%

Remakrs 0

3.4 Monitoring & Evaluation

Indicator Scoring Methodology Response Given Maximum Score Score Obtained

3.4.1 Whether in-house analytical team is appointed All indicators carry 1 mark 0 1 0
3.4.2 Whether periodic bulletins / reports / factsheets (internal/external) are published? each if the answer is "Yes" 0 1 0

2 0 0%
3.4.3 Specify the details of publications / reports
asd

SHA Capacity Assessment Page 27 of 29

 3.5 Operations & Grievance Redressal

Indicator Scoring Methodology Response Given Maximum Score Score Obtained

3.5.1 How many claims were raised during the assessment period 0 NA 0
Indicator 3.5.2 and 3.5.5 has
proportional marks based on %
3.5.2 How many calims were setlled within the timline defined by NHA of cases audited >=90% - 3 0 1 0
Mark, <90% -70% 2 Marks,
<70% - 40% 1 Marks, <40% - 0
Marks)
3.5.3 How many ISA/IC review meetings were organised during the assessment period Indicator 3.5.3 has 0 1 0
proportional scoring of >=4
meetings a year (quarterly) 1
mark, 3 meetings a year 0.75
3.5.4 How many grievances were received in total through CGRMS/CPGRAMS/Other Sources during the assessment period marks, 2 meetings a year 0.5 0 NA 0
marks, <2 meeting a year 0
marks
3.5.5 How many grievances were settled within the timeline defined by NHA during the assessment period 0 1 0

3 0 0%

Remakrs 0

3.6 IT

Indicator Scoring Methodology Response Given Maximum Score Score Obtained

3.6.1 Number of IT Product wise personnel allotted

3.6.1.1 Transaction Management System 0 1 0
3.6.1.2 Beneficiary Identification System 0 NA 0
3.6.1.3 Hospital Empanelment Module 0 NA 0
Each indicator except 3.6.1.2
3.6.2 Whether data warehouse is set-up and NO requests are sent to NHA for report generation and 3.6.1.3, carries 1 mark if 0 1 0
the answer is "Yes"
3.6.3 Status of API Intgration
3.6.3.1 Whether the basic number are transferred from SHA to NHA through API 0 1 0
3.6.3.2 Whether the data fields in SHA have been mapped with NHA data fields 0 1 0
3.6.3.3 Whether all the data fields mapped are shared from SHA to NHA 0 1 0

5 0 0%
3.7.4 Specify the details of applications for which data field mapping has been completed and status of pending activities.
0

SHA Capacity Assessment Page 28 of 29

 Summary of Score

Maximum Score Score Obtained %

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

1.1 Leagl Validity of the SHA 3 1 33%
1.2 Formation of DIU 2 2 100%
1.3 Formation and Functioning of Grievance Rederssal Committees 5 0 0%
1.4 Formation and Functioning of Hospital Empanelment Committees 4 0 0%
1.5 Internal Procedures for Review & Planning 2 0 0%
2 Operational & Management Capacity
2.1 Convergence & Adoption of National Guidelines 5 0 0%
2.2 Recruitment policy, Positions sanctioned, filled and vacant at State & District level 12 0 0%
2.3 Support provided by external agencies (paid & non-paid), expertise and duration 3 0 0%
2.4 Administrative & Finance Powers
2.5 Budget and Financial Allocation 2 0 0%
2.6 Infrastructure facilities at State & District level (space, computer & other equipment’s for all personnel supporting the SHA) & Proximity to Administrative Structure 5 0 0%
2.7 Partnerships with other Government Departments / External Agencies for specific tasks 2 0 0%
2.8 Flow of information & knowledge management 5 0 0%
2.9 Availability of technical resources for learning (both infrastructure & manpower) 6 0 0%
3 Divisional Performance
3.1 IEC & Demand Generation 3 0 0%
3.2 Hospital Empanelment & Quality Assurance 6 0 0%
3.3 State Anti Fraud Unit 5 0 0%
3.4 Monitoring & Evaluation 2 0 0%
3.5 Operations & Grievance Redressal 3 0 0%
3.6 IT 5 0 0%

Total 80 3 4%

4/4/2022 Signature

SHA Capacity Assessment Page 29 of 29