108 Emergency Responsive Drop back of post natal women to their homes


The Commissioner of Health & Family Welfare in her letter has submitted proposals to Government for issue of administrative sanction for providing the services of drop back of post natal women with 150 number of dedicated vehicles in the initial phase, and also to entrust the above scheme to the existing 108 service provider for operation duly entering into Memorandum of Understanding by taking a view on the cost issue.

2. During the Executive Council meeting for 108 services chaired by Principal Secretary to Government HM&FW department, it was decided to start the dedicated drop back vehicles through GVK EMRI at the identified institutions by converting the replaced 108 ambulances for this purpose. Committee constituted in the Government orders 1st read above was entrusted for validating the drop back vehicles. Committee submitted report duly consisting of operating guidelines, costing, staff, financial guidelines for the dedicated postnatal women drop back services.

3. Government after careful examination of the proposal, here by issue administrative sanction for operation of dedicated drop back services to postnatal women by duly entering an Memorandum of Understanding with the M/s GVKEMRI subject to the following conditions.

i) The capital and operating costs are met from NRHM.

ii) The cost service per vehicle per month shall be renegotiated, as the cost of salaries, vehicle maintenance, communication and administration prima facie appears to be on the higher side.

iii) The service delivery parameters are defined in terms of quality and quantity with a system for close monitoring.

iv) One of the ANMs currently in service shall be trained and placed on the vehicle as the Counselor to ensure greater synergy between with the field staff.

v) The SPHO and the Superintendent of the referral hospital be made responsible for the effective implementation, monitoring and reporting of the activities for and greater ownership of the initiative by the field staff.

vi) The initiative shall be reviewed after six months for mid-year corrections and improvisation. This shall be incorporated in the MOU.

vii) The training of the staff shall be conducted jointly by EMRI and CH&FW.

4. The detailed operational guidelines are appended to this order

5. The Commissioner of Health and Family Welfare is requested to take further necessary action accordingly.

6. This order issues with concurrence of Finance (Exp.M&H.II) Dept., vide their
U.O.Note.No.2098/36/A1/Expr.M&H.II) /2013, dated.05-03-2013

ANNEXURE TO  GO Ms No  66  HM&FW  Department,Dated 16-05-2013

OPERATIONAL GUIDELINES:

1.  Initially programme starts with 150 vehicles.

2.  The 108 ambulances which are replaced with new ambulances shall be converted as drop back vehicles duly refurbished and branded.

3.  The operational indicators for each vehicle are as follows:

(i).     26 days per month, per day 2 trips.

(i)         Each day on an average, 8 post natal women shall be transported to their homes from designated Government Health facility.

(ii)       Average number of kilometres to be covered in a trip is 60 kms.

(iii)      The maximum distance for dropping is 35 kms in case of Hospitals other than Teaching and District Hospitals .For Teaching and District hospitals separate modalities shall be prepared.

(iv)      All  the  vehicles  shall  be  provided  Air  conditioning  and  LCD  while dropping back the post natal women.

(v)      All the vehicles shall be fitted with AVLT (basic model).

(vi)       The plan of deployment of vehicles shall be prepared jointly by both partners. Any changes in the deployment during the implementation of scheme shall be with prior approval of both the parties.

(vii)     The service delivery parameters shall be defined in terms of quality and quantity with a system for close monitoring.

(viii)    Government  of  AP  will  appoint  one  SPOC  from  each  Hospital  as contact person.

•       In case  of CHC  one  Medical  Officer  shall  be designated  as SPOC.

•         In case of Area Hospital/ District hospital the resident Medical officer shall be designated as SPOC.

•       In case of teaching hospital Civil Assistant Surgeon, RMO shall

be designated as SPOC.

COSTINGS

a. Operational Expenditure

SI. No.

Head

Per Vehicle/Per

Month(In Rs)

1 Salaries and Allowances 14,470
2 Travel expenditure

300

3 POL 21,060
4 Vehicle Maintenance 10,083
5 Communication Cost

750

6 Training

120

7 Stationary & Offices Expenses

250

8 Administrative       charges       @5%

towards GVK EMRI.

2,940

 

TOTAL

49,973

The  Commissioner  of Health  and  Family  Welfare  shall  negotiate  a more competitive price than the above cost per vehicle per month before entering into MoU.

The operational expenditure shall be valid for the period from June’2013 to March’2014.  Based  on  the  assumption  section  above,  the  costing  have  been worked out with present prevailing Diesel price of Rs. 54/lt. In case of any fuel cost escalation, the corresponding POL line item will accordingly increase and proportionate budgetary increase and reimbursement will be allowed.

b. Capital Expenditure

SI.No

Item

Estimated Cost
1 Ambulance  conversion  into Drop back vehicle including LCD , AC and Cell Phone . Rs.288.00   lakhs   @   Rs.1.92 lakhs per each vehicle
2 AVLT Rs.12.00  lakhs  @  Rs.8000/- per each vehicle
3 Recruitment Rs.3.00 lakhs
4 Induction Training Rs 29.64 Lakhs
 

Total

Rs.332.64  Lakhs

The expenditure  for branding  of the programme  shall be dealt separately based on the programme  requirement.  Capital Expenditure  @ Rs 332.64 Lakhs and Operational Expenditure @ Rs 49.97 Lakhs for the year 2013-14 is approved and this shall be met from NRHM funds.

STAFF

1, One Pilot for each vehicle.

2.   One of the ANMs Currently in service shall be trained and placed on the vehicle as counsellor.

FINANCIAL GUIDELINES

1.  Operational Expenditure shall be paid @ Rs. 49,973/- per vehicle per month.

2.  Operational expenditure shall be paid quarterly basis in advance Separate bank  account  shall  be  maintained  for  the  dedicated  back  drop  service, separate cash book ledger books   and other financial instruments Shall also maintain for this programme

3.  The  Operational  expenditure,  capital  expenditure,  human  resources  and assets of this drop back scheme are ring fenced to AP operations.

4.  The  savings  accrued  in  the  quarter  shall  be  adjusted  to  next  quarter operational  expenditure.  The savings shall not be diverted to the purpos

other than the drop back of post natal women. Line Item adjustments will be allowed staying within overall annual budget

5.  All the expenditure is subject to audit by resident auditor, statutory auditors appointed by CH&FW, auditors from CAG and NRHM.

6.  Monthly SoE, UC and bank statement shall be submitted on or before 10th of

subsequent month

7.  Any procurement shall be done through procurement committee constituted for 108 services.

8.  The capital expenditure shall be released immediately within 15 days from

the date of signing of MoU. The estimated capital expenditure is based on existing market rates. The expenditure is limited to the actuals. In case of actual is more than estimated, the balance shall be released to GVK EMRI. In case of actual are less than estimated the savings shall be returned to Government.

9.  The financial estimates are for budgetary purposes and release of advance payment. The adjustment of expenses against advance grant will be made on the basis of actual quarterly expenditure for which audited utilization certificate will be provided.

AGREEMENT GUIDELINES:

i.       The validity of the MoU is for a year initially subject to review and extension for the duration of existing 108 MoU.

ii.      Government is the owner for all the physical assets, data, procedures and other   software   applications   developed   for   the   above   scheme   with Government funds.

iii.      in case of expansion of programme above 150 vehicles, the same terms and conditions will be applied.

MONITORING GUIDELINES

a)  The monitoring cell of 108 services shall monitor the implementation of the programme.

b)  Daily, weekly, monthly, quarterly and annual reports of performance shall be submitted by the GVK EMRI to the Monitoring cell of O/o. Commissioner of Health and Family Welfare.

c)  The proforma  for the above reports shall be designed  jointly by both the parties.

d)  The register shall be maintained at the hospital by a nodal officer appointed by GoAP in the prescribed format in which the particulars of all beneficiaries shall be noted every day

e)  At the district level the programme shall be reviewed by District Committees constituted for 108 services.

f)   The nodal officer of this program at a state level will be the nodal officer of 108 programme. The above mentioned 108 nodal officer at a state level will be responsible  for monitoring  the program  and certifying  the performance across the state of Andhra Pradesh.

g)  Hospital SPOC to be appointed by Govt within the base hospital locations will facilitate timely streamlined check out and ensure at least 8 beneficiaries per day for this drop back service. Hospital SPOC to be appointed by Govt to ensure patients is ready for on boarding 15 minutes prior to trip with check out formalities complete. For morning trip, the list of beneficiaries with drop back points will be made available by 6 pm previous day and for after noon trip, the list will be made available by 10 am on the same day with drop off locations.

h)  Service level parameters for the above programme is Number of Post natal women to be drop backed to their home per month per vehicle shall not be less than 208.

I)  this initiative shall be review after six months for midterm corrections  and improvisation and shall be incorporate in the MoU.

G.O.Ms.No. 66 Dated.16-05-2013 Read the following:

1. G.O.Ms.No.1152, HM&FW(K1)Deptt,Dt:17.6.2012
2. Letter from the Commissioner of Health & Family Welfare, Rc.No.4088/G1/2012, dated. 18-12-2012

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