NRHM INCENTIVE SCHEMES

(Hardship allowances to paramedics in Vulnerable Institutions, all service providers in Specialist Care Units, all employees in LWE affected areas and retainership allowance for Clinical Manpower)

Health equity is an integral part of Orissas vision for health and it is an essential prerequisite for achieving the MDGs and 11th plan goals. Availability of health professionals (especially for medical & paramedic staff) in difficult areas is one important indicator of Governments commitment to promote equity. It is observed that sourcing and retention of health professionals in these difficult areas is a concern because of the multi faceted challenges that the service providers are regularly confronted with in an effectively delivering health services.

1) Improvement in health outcomes in difficult areas is directly related to the availability of trained human resources 2) Difficult geographical terrain and unavailability of basic infrastructure is a major deterrent against getting good human resource

3) Extremist activities that provide life threats and other inconveniences 4) Low salary/remuneration and better job opportunities in private nursing homes in peripheral & urban areas 5) Low levels of remuneration also do not attract clinical staff from adjacent states which have higher availability of appropriate clinical staff as compared to that of Orissa 6) Specialized care units require skilled care and intense responsibility Currently Implemented Incentive Scheme: The Health department has made various efforts in retaining staff especially in KBK districts. But the same is extended only to medicos and staff nurses, but the other paramedics do not come under this scheme. The amount of incentive is provided on 2 broad categories i.e. periphery and headquarter. Within the periphery category, there is need for categorising the areas and providing incentive according to the degree of difficulties to reach areas. Apart from this, in non-KBK districts, there are inaccessible areas which are not covered under the current scheme.

As per the KBK incentives, if the employees are staying in the headquarters, they get an additional sum of Rs4000 and Rs 8000 if they are residing in the periphery, which is an addition to their basic pay.

New Scheme - Features Institution specific Incentive schemes instead of incentivisation of service providers as per 2 different slabs are: Headquarter and Periphery Vulnerability assessment & Mapping Parameters Every Institution has been assessed for vulnerability and risk with respect to following broad categories: A. Inaccessibility and Location of Sub Centre. B. Characteristics of Service area, which will be served by a service centre. C. Assessment of conflict i.e. Left Wing Extremism (LWE). Based on these 3 given principles, the criteria of scoring have been stated in annexure 1 & 2. Vulnerability Assessment Process Self assessment by ANM Desk appraisal by RKS Executive committee at Block level- To Cross check Profile of all SCs Desk appraisal by District level Committee (Chairman-CDMO, Members- DPM, DHIO, Programme Officers(3) as nominated by CDMO) To cross check minimum 10% of the SC profile per block Recommendations for incentivizing Service providers Vulnerability Status Sl. No. 1 2 3 4 On the basis of total score, Institutions will be categorized as follows: Score Less than 20 marks 20 to 50 marks >50 to 60 marks More than 60 marks Vulnerability Assessment Less vulnerable Moderate vulnerability High Vulnerability Extremely vulnerability Category V-1 V-2 V-3 V-4

OUTCOMES OF THE VULNERABILITY SCORING DISTRICT HIGH FOCUSED DISTRICTS OTHER DISTRICTS GRAND TOTAL TOTAL VI 629 2291 2920 TOTAL V2 2977 1742 4719 TOTAL V3 546 12 558 TOTAL V4 177 11 188

STATE POLICY HARDSHIP ALLOWANCE Paramedics serving in V3 and V4 areas will be provided with hardship allowances. Those serving in V4 areas will be privileged to get double the amount of incentives than the employees serving in V3 areas. Monetary and non monetary benefits will be awarded to those engaged in V3 and V4 areas.

SPECIAL INCENTIVES FOR WORKING IN V3 AND V4 AREAS FOR STRENGTHENING COMMUNITY BASED INITIATIVES Each habitation needs to have one ASHA. ASHAs serving in V3 and V4 areas will be rewarded with 50 % and 100% extra benefits respectively in addition to their incentive. Allowances on completion of 1 year term in MHU services

PERFORANCE INCENTIVES Case based incentives for conducting institutional deliveries will be provided in V3 and V4 areas, if they are labelled as L1 and L2 All staff engaged in specialized institutions like ICU, SNCU, NRCs will be provided a daily allowance as per the mandated slabs confirming to their positions in the hierarchy Regular clinical staff would receive a retainership allowance of 10% annually on completion of one year as a special incentive.

SPECIAL ALLOWANCES FOR LWE AFFECTED AREAS Insurance coverage for all employees.

HARDSHIP ALLOWANCES FOR SERVING IN V3 AND V4 AREAS (Details of V3, V4 areas at Annexure-A) Strategies Facility Specific Incentive Schemes Hardship allowance to paramedics : Output Increased attendance to health care needs at facility level Time Frame

Scope: Service providers in V3 and V4 facilities will be awarded with incentives under this scheme. An incentive amount for Rs 1000 and Rs 2000 will be given to V3 and V4 facilities respectively. Eligibility Criteria : The following conditions will be admissible for incentives of paramedics for all categories : 1 Resides at head quarters of selected V3/V4 facilities For Sub Centres that do not have its own building but HW (F) who reside at any of its targeted village are also eligible to get the incentive 2 Incentive can also be provided if one avails CL or goes for on job training or any other official duty. It is not applicable, if one proceeds for on maternity leave or El for more than 10 days. Payment Modalities : Following documents have to be provided by the eligible Service providers for getting the incentive: Head Quarter staying certificate Signed by : 1 Self 2 Chairperson, Gaon Kalyan Samiti of head quarter village /chairperson , GB , RKS , whichever is applicable to that facility . 3 Sector , MO /MO (i/c) , whichever is applicable to that particular facility Incentive will be paid on a monthly basis along with their salary /remuneration Non Financial Incentives : Non financial incentives streamlined Provision to be made under NRHM PIP Distance Education course with duty leave to attend contact sessions House rent allowances to retain rented quarters at previous place of non difficult posting. District level Awards Competition will be organized amongst service providers working in these areas.
SPECIAL INCENTIVES FOR WORKING IN V3 AND V4 AREAS FOR STRENGTHENING COMMUNITY BASED INITIATIVES

ASHA Incentive Monthly ASHA Incentive for serving at most difficult blocks :Plus (+)100% of total incentive earned during the month Monthly ASHA Incentive for serving at difficult block: Plus (+) 50% of total incentive earned during the month

Increase in motivation to serve in difficult areas and reduction in resistance to serve in difficult areas by service providers

Recognition for completing 1 year term in MHU services Annual incentive package- Doctor Rs.12000/-,Pharmacist / ANM- Rs.6000/Attendant /Driver- Rs.2500/-

Increase in motivation and consensus to serve and remain in difficult areas thus reducing the resistance to serve in these areas by service providers.

INCENTIVE FOR WORKING IN SPECIALIZED CARE UNITS Incentive to Service Providers (Doctors/Staff Nurse/LT/ANM) providing specialised Improved quality of health care services due services in SNCU-II,NRC ,ICU to high levels of Incentives to be provided on the basis of daily motivation. allowances. For doctors it is Rs. 100/ per day, For paramedics, Rs. 75/ per day and other support staff get Rs. 50/ per day.

SPECIAL ALLOWANCES FOR LWE AFFECTED AREAS Sustained motivation for retention of Employees in life 87* blocks in 15 districts threatening conditions Insurance coverage with money back policy. *as per reports of the Planning Commission, naxalism is insurgent movement has become a force to reckon with in the districts like Malkangiri , Rayagada ,Gajapati , Deogarh and Sambalpur . However , district reports received by the Health Department have shown that the movement has affected 87 blocks in 15 districts inclusive of 37 blocks in five districts mentioned above .This is based on the consistent occurrence/threats of naxal violence in the last five years. Retainership Allowance for paramedic staff Regular clinical staff will receive a retainership allowance of 10% annually on completion of one year as a special incentive. Insurance coverage will be done in all the 87 blocks by the service providers.

Lower incidence of staff turnover and increased retention in one place of posting

Budget in B.17 (NRHM Initiatives)