PIP 2018-19 JS Policy

Orientation MoHFW, GoI

 Why do we need to change the budget
sheet?
 Far too many budget heads/lines (1761)
 Inter change between budget heads not permitted. Detailed
activities reflected in budget sheet under various heads could
not be changed, this rigidity made implementation difficult.
All the heads have now been incorporated under 18 Main
heads, budget sheet has total 68 rows
 FMR codes of later activities too complicated:A.9.3.7.1;
A.9.5.5.2.b
 A.9 Training
 A.9.5 Child Health Training
 A.9.5.5 IMNCI training
 A.9.5.5.2 Other Child Health Training
 A.9.5.5.2.b Observership training for facility based newborn care
 Why do we need to change the budget
sheet?
 Many cases of duplication under different budget heads
(e.g. Drugs for Pregnant women : JSSK in MH, Also in
procurement)
 The system of main heads followed no logical system.
Additions were as per requirement; every effort was made
to keep the earlier budget heads and FMR codes unchanged
which resulted in a mix of program and cross-cutting
heads: MH, CH, FP… but HR, IEC, Procurement…too
 Too much of verticality leading to sub-optimal utilization of
resources
 Lab Technicians under many programs: RCH, NVBDCP,
RNTCP, NIDDCP, AIDS Control etc.
 Pro-program managers but not for implementers
 Changes initiated in 2017-18

 HR, IEC and Procurement : All the components under each of

these heads were brought together
 Very encouraging feedback from the states
 We know total Service delivery HR we have
 We know how much IEC budget we have under various
program heads
 We know the total procurement budget and could procure
all of it together
 As a logical extension of this concept, in 2018-19 all the
existing budget lines are clubbed and aggregated under 18
main budget heads
 New Budget Heads
1 Service Delivery - Facility Based 11 IEC/ BCC
2 Service Delivery - Community 12 Printing
Based 13 Quality Assurance
3 Community Interventions 14 Drug Warehousing &
4 Untied Funds Logistics
5 Infrastructure 15 PPP
6 Procurement 16 Program Mgt and M&E
7 Referral Transport 17 IT initiatives for SD
8 Service Delivery - HR 18 Innovations
9 Training & Capacity Building
10 Review, Research, Surveillance & Surveys
Example of Maharashtra

Total amount approved in RoP 2017-18

= 3118 Crores
 Maharashtra RoP in 18 Heads
Budget Heads Amount (In Cr’)
Facility based Service Delivery 275.5
Community based SD 139.8
Community intervention 200.9
Untied grants 90.1
Infrastructure 182.4
Procurement 613.7
Referral transport 55.2
Human Resource 617.2
Training 36.5
Review, research & surveillance 4.9
IEC-BCC 32.1
Printing 29.5
Quality Assurance 26.8
Drug warehouse & logistic 14.6
PPP 52.6
PM 203.7
IT intervention 5.4
 Maharashtra RoP in 18 Heads
Facility Community based
based annex, 139.8
IT intervention, 5.4 annex,
Infrastructure 275.5 Community
Maintainance, 534.3 intervention, 200.9

Untied grants, 90.1

PM, 203.7

Quality PPP, 52.6 Infrastructure,

Assurance, 26.8 IEC- 182.4
Printing, 29.5 BCC,
32.1
Review, research & Procurment, 613.7
survillance, 4.9 Human Resource,
617.2
Training, 36.5

Referal transport, 55.2

 Maharashtra
IT intervention Community based SD
Facility
0.2% 4%
based
Service
Infrastructure Community intervention
PPP Delivery
Maintenance 6%
2% 9%
17%
Drug warehouse &
logistic PM Untied grants
0.5% 6% 3%
Quality
Assurance Infrastructure
Printing 1% 6%
1% IEC-BCC
1%
Human Resource Procurement
Review, research 20% 20%
& surveillance
0.2%
Training
1% Referral transport
2%
 FEATURES OF
BUDGET SHEET 18-19
Budget Sheet 2018-19

Planning to be done in annexures

Annexure heading: for reference

For ease of reference, Old FMR,

Budget Pool and programme
division have been mentioned

State/ division can compare

previous year activity using the
old FMR codes
 Integration of budget lines across the crosscutting
components

Operational cost including electricity, rent, stationary, consumables etc.

for any facility/ service delivery point have been put under one head
Integration of budget lines across the crosscutting
components

Infrastructure
strengthening/
any budget for
construction
budgeted under
various
programmes last
year have been
put together
 Same Budget line under different Annexure -
Examples
State Task Force, State Technical Advisory
F.1.4.a Committee meeting, District coordination NVBDCP
meeting (Lymphatic Filariasis)
New Old New PIP
Particulars
FMR FMR Sheet
Lymphatic Filariasis: Morbidity SD – Facility
1.1.5.3
Management Level
Printing of forms/registers for Lymphatic
12.11.1 Printing
Filariasis
F.1.4.a
State Task Force, State Technical
Advisory Committee meeting, District Programme
coordination meeting (Lymphatic Management
Filariasis)
Budget Sheet 2018-19

 For Ease of Program Divisions : Abstracts

 Use it for review and implementation
Abstracts – NVBDCP
New FMR Particulars
1 Service Delivery - Facility Based
1.1 Service Delivery
2 Service Delivery - Community Based
2.2 Recurring/ Operational cost
3 Community Interventions
3.1 ASHA Activities
3.2 Other Community Interventions
5 Infrastructure
5.3 Other construction/ Civil works
6 Procurement
6.1 Procurement of Equipment
6.2 Procurement of Drugs and supplies
9 Training
9.5 Trainings
10 Reviews, Research, Surveillance and Surveys
10.2 Research & Surveys
10.3 Surveillance
10.4 Other Recurring cost
11 IEC/BCC
11.11 IEC/BCC activities under NVBDCP
12 Printing
12.11 Printing activities under NVBDCP
14 Drug Warehousing and Logistics
14.2 Other Logistics
Example from Maharashtra: CH Abstract

Referral Transport,
0.0

Training, 328.5

Research, Surveillance
and Surveys, 30.0

IEC/BCC, 390.9

Printing, 706.0
Procurement,
8013.7

SD - Facility Based,
641.9
SD- Community Based,
0.0
Infrastructure, 0.0
Example from Maharashtra: CH Abstract
Referral
Transport
0%
Training
3% Reviews, Research,
Surveillance and
Surveys
IEC/BCC 0%
4%
Printing
Procurement 7%
79% Service Delivery - Facility
Based
7%
Infrastructure
0%
Service Delivery -
Community Based
0%
 Guidance: PIP 2018-19
States/UTs must provide:
 A write up (not exceeding 30-35 pages) summing
up the major problems in health (based on evidence
with source) after a situation analysis and
 Describe the strategies through which it intends to
tackle these problems in 2018-19, along with
outputs expected and expected level of achievement
in process indicators.
 The States/UTs would be required to submit half
yearly progress by 15 November 2018 and yearly
progress by 31st March, 2019
 Guidance: PIP 2018-19
 Budget Sheet is interlinked and locked
 Leverage the flexibility available at planning stage
 By focusing on State issues based on evidence
 By using 40% state share judiciously
 By using 40% against the IM part of state share
 By using the 125% approvals
 Essential and desirable activities
 Priorities for PIP 2018-19
 Operationalization of Health and Wellness Centres (HWCs)
for provision of Comprehensive Primary Healthcare (at
least 5% of funds to be earmarked in 2018-19 for
strengthening SC/PHCs as HWCs)
 Free Essential Drugs
 Free Essential Diagnostics
 Universal Health Checkup/ Screening and management of
NCDs (for 30 years plus) and appropriate referrals for follow
up
 Revised National Tuberculosis Control Program (RNTCP)
including provision for nutrition support to TB patients.
 Applying the Health systems approach to health HR
 Priorities for PIP 2018-19
 Operationalizing FRUs
 Improvement in Quality of Care around child birth e.g.
LaQshya etc.
 Improving coverage under RI.
 District hospital strengthening –addition of specialties and
development as training site for doctors, nurses and allied
health professionals
 Quality certification and Kayakalp
 Patient Centric health centre, Toll free helpline including
doctor on call, and grievance redressal system
 PIP2018-19: Suggested Steps in Planning
 Assess physical and financial progress made so far against last
year’s PIP.
 Identify the challenges and reasons for sub optimal
performance (if any)
 Study new evidence generated including State sheet of Burden
of disease, cost effective interventions, survey reports, HMIS
etc.
 List the major challenges and prioritize the ones that need to be
addressed in 2018-19
 Draft guidance to district/block/facility teams for planning of
DHAPs and City PIPs. Communicate budget envelope to districts
 Conduct planning workshops with district and regions/divisions
to discuss and finalize situation analysis and agree on strategies
 PIP2018-19: Suggested Steps in Planning

 Collate DHAPs including information annexures. DHAPs to

have text as well as budget annexures
 State Program divisions to review the collated DHAPs and
propose revisions (if any) as well as add activities for state
level
 Drafting of final State PIP giving
 Situation analysis using evidence from surveys, studies,
HMIS/MCTS data, CRM observations etc. collated from
District level. State level analysis to be added
 Strategies to address the challenges, Output and process
indicators
 Activities and their prioritization
 Overall Budgeting must be within 150% of the RE
PIP 18-19 Suggested Readings
Published Reports:
 India: Health of Nation’s State Report (State wise
sheet on disease burden)
 Lancet Paper on Disease Control Priorities
 Cost effective Interventions
 Recommendations for Cancer control

(Shared along with PIP guidelines in Annexure-4)

DISCUSSION