PLANNING, IMPLEMENTATION AND MONITORING STRUCTURE
The management structure holds the key to the success of any program and efforts to develop appropriate arrangements for effective delivery of services. The success of decentralized experiment would depend on the strength of the pillars supporting the structure. It is imperative that good management structure must be developed at each level of program. To develop good management structure, NRHM has provided management costs up to 6% of the total annual plan approved for state.
NRHM expects strong management structure at State and District level. At state level all the policy decisions will be made, guidelines to the district will be issued and regular monitoring of programs will be carried out. At district level, the mission will support and insist on developing health management capacities and introducing the policies in systematic manner so that over time all district program officers and their leaderships are professionally qualified public health managers. In addition, strong managerial capacity will also be established at block level as blocks are link between villages and districts.
Institutional mechanism and program management
In Maharashtra, State Health Mission is established at Mumbai and District Health Missions are also established at all the Districts. These missions approve the PIP, support the society for coordination with other departments and take policy decisions.
State Health society is established at Mumbai and 34 District Health Societies are established at all the districts. There are two districts in Mumbai City Corporation. Therefore there is one society for Greater Mumbai two districts. Because of this, although Maharashtra has 35 districts, society is established in 34 districts only.
Utilisation of RKS funds
RKS is provided RKS, AMG, Untied fund and IPHS funds for improving the functioning of the health facility. Total funds are provided to RKS and are only utilized after formal approval of RKS. Records of approval of RKS are kept at health facility level.
Chairman of RKS of PHC is local Zilla Parishad Member. All the plans and decisions regarding improvement of health facility are taken by this person. President of Zilla Parishad is head of the mission. PIP of the district is approved by the District Mission. Thus, there is complete involvement of PRI members in NRHM implementation.
PRI Members are involved in all the NRHM activities. At village level, Sarpanch is Chairman of Village Health, Sanitation, Water Supply and Nutrition Committee. Similarly, Sub-Center committee is also headed by Sarpanch. Sarpanch at both the places is one of the signatories of bank account of the village and Sub-Center.
Block Health Missions are established at all block level. Policy decisions, approval of PIP and coordination issues are dealt at this level.
Program Management System
District Program Management Unit is established at all the districts. This unit consists of District Program Manager, District Account Manager, District M & E Officer, District IPHS Officer and coordinators for programs like ASHA, Sickle Cell, School Health, etc. Adequate Program Assistants and Accountants are provided to these districts.
Block Program Management Unit is established at all 353 the blocks. Taluka Health Officer (THO) is head of the unit. He is regular Medical Officer from Public Health Department. THO is supported by Junior Clerk, Health Assistant and MPW from regular employees and Data Entry Operator and Accountant on contract.
Program management structure of NRHM is as follows