Norway India Partnership Initiative...Joint Steering Committee, June 3 3 | Page Executive Summary...

Norway India Partnership Initiative

Joint Steering

Committee

Meeting

June 3

2010 Meeting notes for the 9th meeting of the Joint Steering Committee

Joint Steering Committee, June 3rd 2010

AGENDA

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NIPI Joint Steering Committee, 3rd

June 2010 The Joint Steering Committee (JSC) is the governing body of Norway India Partnership Initiative.

The committee meets at least twice per year and approves proposals as well as provide direction

to the partnership. JSC is assisted by a Program Management Group (PMG) which recommends

technical proposals for JSC’s approval.

Agenda 1. Opening remarks:

• Co-chair, Norway’s Ambassador to India, Ann Ollestad

• Chair, Secretary of Health, Sujatha Rao

2. Adoption of Agenda of the 9th

Joint Steering Committee Meeting

3. Launch of Mobile Payments to ASHAs in Sheikpura District, Bihar

4. Adoption of the minutes of the 8th

JSC meeting (annexure 1)

5. Take note of the minutes from the 9th

PMG (annexure 2)

6. Action taken report after the 8th

JSC meeting (page 9)

7. Specific update on programs from the Focus States (including proposals for 2010)

• Bihar, Madhya Pradesh, Orissa, Rajasthan

8. Update on programs from UNOPS (including new proposals) (proposals from page 5)

9. Update on programs from WHO (including new proposals) (proposals from page 5)

10. Update on programs from UNICEF (including new proposals) (proposals from page 5)

11. Proposal for adopting a new mechanism for Operations Research under NIPI (page 7)

12. Update on new structure for NIPI projects under UNOPS including budget revision and

recruitment of new Director Secretariat (Page 26)

13. No cost extension of NIPI

14. Update from Royal Norwegian Embassy, including presentation of the Mid Term Review report

15. Any other with permission of the chair.

For decision (proposals described on page 5 ff) • Newborn Resource Centre at IPGMER (NIPI Child Health Resource Network, UNOPS).

• Support to Collaborative Centres for Facility Based Newborn Care (UNICEF)

• Strengthening of governance of government contracting in child health PPPs (SHS Bihar/NIPI

Child Health Resource Network, UNOPS)

• NRHM Focus District (State Health Societies/NIPI Child Health Resource Network, UNOPS) • Strengthening of Nursing and Midwifery Pre-Service Education in Bihar (SHS Bihar, NIPI Child

Health Resource Network, UNOPS)

• Capacity building of Child Health Programme managers to review the programme and for effective planning and implementation of child health programme (WHO)

• A new mechanism for handling of OR proposal and a new TOR for the Operations Research Committee is proposed by the NIPI Secretariat on behalf of the RNE for review and comments

• New structure for NIPI projects under UNOPS, incl budget revision. (Page 26)

• No cost extension of NIPI (page 30)

Joint Steering Committee, June 3

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Executive Summary with proposals

Background NIPI was launched in 2007, but due to a slow start, 2010 should be seen as the

During its second year the partnership saw multiple new interventions being rolled out through the

partners. Under NIPI a wide array of interventions for children and mothers are being tested and

evaluated by the state and national gov

implementation of National Rural Health Mission.

In 2009 the NIPI funds have been utilized to support:

• Yashoda (State Health Societies Bihar/Orissa/MP/Rajasthan through UNOPS)

• Home Based Post Natal Care b

• Catalytic support to IMNCI (UNICEF)

• Improved cold chain and vaccine management (UNICEF)

• Technomanagerial support (SHS through UNOPS)

• Special care newborn units, SCNU (UNICEF)

• Sick newborn care units, SNC

Expenditure

The total allocation from Norway

under NIPI to date is 224,7 mill

NOK, equivalent to approximately

USD 38 mill (@5.92) The tot

expenditure under NIPI by end of

2009 is 33,6 mill USD. The largest

part of the allocated funds are

grants to State Health Societies of

Rajasthan, Orissa, Bihar and

Madhya Pradesh, a total of 13,4

mill USD. The actual expenditure

reported from the Focus States is

1,96 mill USD or about 15 % of the

allocated amount. The expenditure

is low due to slow start of several

interventions that are now

running, and expenditure has

increased markedly in the first

months of 2010. The full financia

overviews are given as annexure

from the respective implementers.

Joint Steering Committee, June 3rd

2010

EXECUTIVE SUMMARY

with proposals

NIPI was launched in 2007, but due to a slow start, 2010 should be seen as the



evaluated by the state and national governments, with the aim to increase momentum in the

implementation of National Rural Health Mission.

In 2009 the NIPI funds have been utilized to support:

Yashoda (State Health Societies Bihar/Orissa/MP/Rajasthan through UNOPS)

Home Based Post Natal Care by ASHA (SHS in focus states through UNOPS)

Catalytic support to IMNCI (UNICEF)

Improved cold chain and vaccine management (UNICEF)

Technomanagerial support (SHS through UNOPS)

Special care newborn units, SCNU (UNICEF)

Sick newborn care units, SNCU (SHS through UNOPS)

The total allocation from Norway

is 224,7 mill

approximately

The total

expenditure under NIPI by end of

is 33,6 mill USD. The largest

part of the allocated funds are

grants to State Health Societies of

Rajasthan, Orissa, Bihar and

Madhya Pradesh, a total of 13,4

mill USD. The actual expenditure

reported from the Focus States is

1,96 mill USD or about 15 % of the

allocated amount. The expenditure

rt of several

interventions that are now

running, and expenditure has

increased markedly in the first

The full financial

overviews are given as annexure

from the respective implementers.

EXECUTIVE SUMMARY

NIPI was launched in 2007, but due to a slow start, 2010 should be seen as the 3rd

year of running.



ernments, with the aim to increase momentum in the

Yashoda (State Health Societies Bihar/Orissa/MP/Rajasthan through UNOPS)

y ASHA (SHS in focus states through UNOPS)


2010

EXECUTIVE SUMMARY

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Previous and ongoing activities under NIPI The table below lists activities undertaken within the NIPI Partnership. Some of the activities are

entirely supported by NIPI, while for others the NIPI funds have been clubbed with other funds to

expand activities.

Activities, Headlines

Immunization, Support of Cold Chain and Vaccine Management(UNICEF)

Catalytic support for IMNCI implementation (UNICEF)

Sick Neonate Care Units (UNICEF)

Technical assistance (UNICEF)

Expanding the measles control activities to UP and Bihar (WHO)

Managing Childhood Malnutrition (WHO)

Expanding Pre-Service IMNCI (WHO)

Strengthening of QA for monitoring of Anesthesia, EmOC and SBA trainings (WHO)

Yashoda –Improving Quality Care at Facility (SHS through UNOPS) Enabling Mechanism / Techno+managerial support - Strengthening of SPM/DPMU/BPMU (SHS through UNOPS)

Post Natal Care at Home and in Community (SHS through UNOPS)

Sick Neonate Care Unit (SHS through UNOPS)

Support to Routine Immunization (SHS through UNOPS)

Flexible funds for local initiatives, scaling up etc. (SHS through UNOPS)

Resource support (SHS through UNOPS)

Support to NIHFW - for National Child Health Resource Centre (UNOPS)

Baseline survey (UNOPS)

Further to this list the following activities were approved by the 8th

JSC in November 2009:

• One Stop Shop (1SS) solution for Special Care Newborn Units (UNICEF)

• Operationalization of First Referral Units by JHPIEGO (UNICEF)

• Strengthening of accreditation of RCH providers in NIPI States (WHO)

• Comprehensive Newborn Care in one district of each Focus State (UNOPS/SHS)

• Post Partum IUD insertion in Rajasthan (UNOPS/SHS Rajasthan)

• E-support to routine immunization

While 2007 and 2008 were a “learning period” 2009 became the first year where the NIPI reached its

ambitions of being a strategic and catalytic tool for the partners. In each NIPI Focus State there are

now examples of how this independent, flexible funding has been used to help in the overall process

of implementing NRHM. The new activities submitted to the current JSC meeting reflects this

development, as the activities now are more customized to each states specific need.


2010

EXECUTIVE SUMMARY

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Proposed new activities at a glance Most activities planned for 2010 were approved in the JSC in November 2009 or are ongoing from

earlier JSCs. These will be presented by the respective implementing partners during the meeting.

PMG was requested to review five new proposals as well as one proposal regarding mechanism for

Operations Research funding. The new proposals along with PMGs comments are presented in brief

here, and in full from page 11

Newborn Resource Centre at IPGMER (NIPI Child Health Resource Network, UNOPS).

The strategy of Government of India to expand the number of specialized units for newborn care

(Sick Newborn Care Units) represents a big challenge to the states that are to implement these units.

Learning from the experience of planning and setting up 12 such units (2 currently in function), it is

suggested to Strengthen the Supportive Capacity to the States through strengthening of a Newborn

Resource Centre at Dept of Neonatology at SSKM/IPGMER in Kolkata, West Bengal. This Centre, and

its head, Dr Arun Singh has played a pivotal role in planning the units, and training of the staff, and it

is the wish of the Focus States to continue to receive this support. An important target is to set up

district training centres in selected districts of the Focus States where personnel from other districts

can be trained under conditions similar to that in their own units. To facilitate this, and to ensure

that Indian neonatology can continue to develop and contribute towards the goal of reduced

NMR/IMR, it is suggested that a grant of 1,8 crore rupees are given to this centre over a period of

two years.

Full text proposal and proposed resolution can be found at page 11

PMG Recommendation

PMG recommends the proposal within the financial envelope proposed and sees the importance of

solid and sustainable supervision to the huge effort that is being done by states to set up Special Care

Newborn Units. PMG request the Child Health Resource Network to revisit the budget together with

SSKM/IPGMER to make sure that salary levels that are proposed can be sustainable also after the

initial period of NIPI support. Furthermore the Chair requested a revenue model where the states that

utilize the services of the Resource Centre pay for the services, to make the Centre sustainable

financially.

Support to Collaborative Centres for Facility Based Newborn Care (UNICEF)

Along the same lines, UNICEF proposes to support selected Medical Colleges with well functioning

SNCU at level II or III with grants for supporting new units coming up at district level. The proposal

includes training of staff for district level SNCUs, operational research and supervision through video

conferencing.


PMG Recommendation

PMG agrees that close supervision of new child health interventions is needed, and in particular for

the Special Care Newborn Units that will benefit from consistent and continuous support both in

training and in daily clinical practice. PMG recommends the proposal in principle and requests

UNICEF to submit a concrete proposal to JSC with measurable outputs and budget.


2010

EXECUTIVE SUMMARY

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Strengthening of governance of government contracting in child health PPPs (NIPI Child

Health Resource Network, UNOPS)

In collaboration with the NGO Access Health (an ISB affiliate) and NIHFW, NIPI Child Health Resource

Network supported a workshop on PPP for Child Health in Hyderabad. As a result of this, an

assessment of potential for PPP in child health has been done in Orissa and Bihar. A grant within the

envelope of 60 lakh rupees to Access Health is proposed to assist the States of Bihar and Orissa in

developing proof of concept for a governing model for PPP in Child Health, including contracting

capacity, quality assurance and certification. The final output is a working PPP as pilot in each state.


PMG Recommendation

The PMG recognizes that exploring PPPs for child and maternal health in the Focus States is an

important part of the overall NIPI Strategy and in principle recommends the proposed activity. The

Chair mentioned that it should be clear what the wanted output for the respective state is to be, and

that it should be made sure that the states are really interested in and committed to following up on

this intervention, before commencing the activity. The PMG also request that the budget is revisited,

with regards to the overhead expenses before submitting for JSC.

NRHM Focus District (State Health Societies/NIPI Child Health Resource Network, UNOPS)

The aim of this intervention is to select one district in each Focus State where all interventions

available under NRHM is implemented. The approach will be to stimulate local thinking, learning and

improving Health Systems and Delivery of Health services as a desirable and continuous activity.

Emphasis will be on optimizing existing assets before going for new assets; emphasis will be on

process improvements to reduce wastages and gain more quality and quantity. Except for cost of

some extra manpower to coordinate and monitor the processes, the activities will utilize NRHM

funds already available with the States.


Recommendation The PMG recommends this activity as described in the submitted proposal.

Strengthening of Nursing and Midwifery Pre-service Education in Bihar (SHS Bihar/NIPI

Child Health Resource Netword, UNOPS)

Policies and programs of the Government of India focused on Maternal, Newborn and Child Health

(MNCH), have put an increased emphasis on the role of the basic health worker in the provision of

comprehensive maternal and child health services in the country, especially in rural areas. In

accordance with GoI and Indian Nursing Council guidelines, SHS Bihar and NIPI Child Health Resource

Network, UNOPS proposes a grant to JHPIEGO for TA to the process of setting up a state nodal

centre for ANMTCs, and subsequently support the up-gradation of selected ANMTCs in Bihar.


Recommendation

The PMG recommends this activity as it is in line with the strategy of INC and GoIs strategy.


2010

EXECUTIVE SUMMARY

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Capacity building of Child Health Programme managers to review the programme and for

effective planning and implementation of child health programme (WHO)

WHO tools will be used for developing capacity of the child health programme managers at district

level for conducting short review of the existing child health programme and enhance their techno-

,managerial competencies to plan the annual district child health activities and manage the

implementation in an effective manner. The objective is to build capacity within the system at

district and block levels. The capacity building will be carried out in the selected NIPI focus districts


PMG Recommendation

PMG in principle recommends the proposal to JSC and request for a plan which ensures synergy with

already ongoing activities and with a detailed budget to be worked out for the JSC. It was also

mentioned that this should be followed up with a similar capacity building for the maternal health

activities of the same managers.

Proposal for new mechanism for Operations Research under NIPI 5% of NIPI funds are earmarked for research activities. The aim is to have high quality research to

guide interventions as well as document the impact of such. In order to serve these two purposes,

the mechanism for administering research proposals needs to be flexible and agile. Implementing

partners should play a central role in this, as they would have firsthand experience of where the

knowledge gaps would be. On the other hand, the Government of India and its central research

institutions needs to be represented to ensure convergence with existing GoI policy.

The Mid Term Review strongly advocated for the shifting of the task of organizing OR out of the

Royal Norwegian Embassy and it is proposed that the task of administration of the OR proposals and

subsequent grants is given to NIPI Secretariat. To facilitate this change some changes in the

composition and TOR of the Operations Research Committee (ORC), with the addition of

representatives from the implementing partners and central Indian research institutions are

proposed. The ORC can approve research grants within an financial envelope decided by JSC for each

year.

It is also proposed that for embedded research, that is research which is a vital part of an

intervention, proposals can be approved directly by JSC on recommendation from PMG without

having to go to ORC.


PMG Recommendation

PMG recommends the changes as described in the proposal.

Restructuring of UNOPS Projects under NIPI Based on learning from the first years of NIPI and feedback from the Mid Term Review, a

reorganization of the UNOPS projects under NIPI has been proposed. The main new feature is a

clearer separation between the Secretariat function and the implementation support (LFA/Child

Health Resource Network). This will increase focus on the Secretarial functions, especially

monitoring and documentation of NIPI as a whole, and also make the role of the Secretariat clearer.

It follows from the new structure that the budgets for UNOPS projects under NIPI needs to be


2010

EXECUTIVE SUMMARY

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revised, however it is requested that the new structure can be reflected from 2011 in budgets and

financial reports to simplify financial processes. In addition, UNOPS now have provided expenditure

figures for 2009, and have calculated the forecast for funding for 2010.


Proposed resolution

JSC takes note of the new structure of the NIPI Projects by UNOPS.

JSC approves the new budgets and approves an allocation of NOK 22,3 mill, equivalent to USD

3,542,370 (@6,3).

Recruitment of new Director Secretariat. As shown in the organogram, the NIPI Secretariat will be headed by a Director Secretariat. As the

previous Director, Mr Hota is now Director Emeritus, and the current Officer in Charge, Dy Director

Tomas Alme is ending his contract with UNOPS, the position needs to be filled through an

advertising process.

The Vacancy Announcement has been created and the post will be advertised at P5 level.

Proposed resolution

JSC takes note of this information

No-cost extension of NIPI

Full text proposal can be found at page 30.

Proposed resolution

The JSC approves a No-Cost extension along the suggested lines. The proposed distribution of funds

is noted, however, review of actual expenditure for 2010 and 2011 will give more information and

should be reviewed before a final decision on allocations to the implementers is taken.


2010

ACTION TAKEN REPORT

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Action taken report Resolution Action taken

JSC approved the plan presented by UNICEF, and

grants NOK 26 mill towards this plan for 2010

• Grant support to JHPIEGO for FRU

operationalization is in process.

• TOR for One Stop Shop for SNCU is

developed. Recipient state/district to

be identified before tendering

process will start

JSC approves the plan presented by WHO except for

the proposed INCLEN study which JSC requests

WHO to submit to NIPI Operations Research

Committee that will coordinate research proposals.

Towards the rest of the plan JSC grants USD 500 000

(equivalent to NOK 2 842 [email protected]) and USD 160

000 (equivalent to NOK 910 [email protected]) pending

approval of the OR committee

• Kick-off meeting for Strengthening

SBA in Rajasthan has been

undertaken.

• Research proposal will be submitted

to OR committee.

JSC approves the activity budget for UNOPS LFA as

presented in the JSC notes (NOK 61,3 million)

provided that the request for fresh funds (2010) is

within the limit of NOK 42 mill per year. A request

for funds will be made in February 2010. At that

time, the balance with Focus States (at state, district

and block level) and with UNOPS will be clear.

Regarding budget request of USD 1.3 million

(equivalent to NOK 7 390 500 @5,685) by NIPI

Secretariat, RNE representative requested that a

breakup of general operational expenditure and

additional details may be provided for Co-Chair to

take a decision.

• Budget for Secretariat has been

shared with RNE. However, as a

consequence of the proposed

restructuring of the NIPI projects

under UNOPS, a new budget is

proposed to this JSC

• JHPIEGO has been given a grant for

PPIUD and work has started.

• Fund forecast has been shared with

RNE

• Discussion still going on with NNF

regarding operationalization of

Comprehensive newborn care

•

“JSC approves the allocation of NOK 10 million to

the RNE in addition to the current allocation of 4

million NOK for strengthening the Operations

Research component.”

• Grant for one research proposal has

been disbursed to UiO/PHFI

• Grant for preparatory work has been

given (BPNI/Ammesenteret)

• New review mechanism for

Operations Research proposed to the

current JSC.

“Disbursements: JSC delegates the authority to Co-

Chair to finalize the allocations and release funds

according to the 2010 Budget to the partner

agencies. Towards that it would be critical to have a

clear overview of expenditure and balance available

in the States.

• Allocations for a total of NOK

25.741.068 has been disbursed

during 2009.

• Rajasthan, Orissa and MP has

delivered expenditure reports clearly

indicating remaining funds at state

and district levels. For Bihar, the

expenditure of non-focus states still

are based on estimations.


2010

ACTION TAKEN REPORT

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Strengthening of institutional mechanisms: In order

to strengthen the institutional mechanism, and to

have better coordination between JSC/PMG/SCC,

the GOI and RNE representatives should be invited

to the State coordination committee meetings.

Additionally, it is recommended that the OR

committee considers to invite the partners of NIPI

who operate the various programmes, so that the

Operational Research under implementation as well

as proposals for such research may benefit from the

inputs of the partners.

• GoI was invited to the SCC meeting in

Bihar on May 24TH

• RNE was represented in the same

meeting.

• Operations Research Committee has

not been convened since last

meeting. A new mechanism for the

administration of OR projects is

proposed to this JSC

•

Secretarial functions: The NIPI secretariat will

provide draft resolutions as part of the Agenda for

the JSC meetings. PMG should for the future be

conducted at least three weeks prior to the JSC,

allowing for proper time to prepare JSC materials.

• Draft resolutions is part of these

meeting notes as well as the meeting

notes from the last JSC.

• PMG was held 3 weeks before the

current JSC

Mid term review: The observations and

recommendations of the MTR will be discussed and

deliberated upon presentation of the final report to

the Government of India, Government of Norway

and the NIPI partner agencies.

• MTR report has been shared with all

stakeholders.

• Ongoing discussions between

partners on direction of NIPI

• Several of the recommendations

have already been absorbed

• JSC to discuss MTR report in this

meeting

Regarding UP: Additional Secretary will convene a

meeting in December to get a final response from

UP government keeping in view that NIPI is already

going through the mid term review, and entering

NIPI program at this point or later may have little

benefit. No alternative mechanism will be allowed

where the State government of UP is not involved.”

• No new efforts towards UP has been

registered

Next meeting for JSC proposed in Oslo • As proposed

Joint Steering Committee 3rd

June 2010

PROPOSALS

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Technical proposals for the consideration of the 9th PMG

Newborn Resource Centre (NIPI Child Health Resource Network, UNOPS) Background

• If India is to achieve the MDG 4 Goal, the States have to impact on the Neonatal Mortality

Rate and specifically the early Neonatal Mortality Rate and this is also in line with

Government of India’s view1.

• The four low performing States of Rajasthan, MP, Bihar and Orissa which are also NIPI focus

States have all initiated the establishment of SNCUs across the State and a total of 110

SNCUs are sanctioned so far.

• There is an urgent need for providing continuous, systematic quality technical and

management support to these 4 States with a potential to extend beyond these States

eventually. Hence a resource support approach including capacity building, data monitoring

and trends analysis, customized designing of the units, treatment protocols, equipment

maintenance protocols, Standard Operating manuals besides nurturing these units needs to

be undertaken by a centre of excellence which has both the experience and expertise to

provide this support.

• IPGMER pioneered the first SNCU level II in the country also popularly known as the ‘Purulia

Model’. NIPI also has the experience of working with this group for the past one year where

IPGMER extended its technical assistance to these four States in a limited but strategic

important way.

NIPI Child Health Resource Network, UNOPS therefore proposes to the PMG to support the

establishment of a Newborn Resource Centre for India, based at IPGMER.

Goal of Newborn Resource Center (NBRC):

Having the right information, the right guidance, and right materials at the right moment is

extremely important to support the effort of the four focus states to establish a high number of

highly advanced units. With the right support, the units can become hubs for child health in their

districts, but if set up without the right capacity and support, the units may become harmful to the

newborn.

The Goal of establishing the Newborn Resource Center (NBRC) at the IPGMER is to improve the

quality of facility based newborn care being provided at various health facilities in the 4 NIPI States.

Major Objectives and Processes:

Access to relevant information and specialized guidance is of vital importance, not only in the initial

phase but also during the ongoing routine day to day functioning throughout the working life of

SNCUs.

• The centre will help the district level units reviewing and presenting advances in affordable

technology, diagnostics and treatment modalities.

1 Operational Guidelines on Maternal and Newborn Health (GOI, April 2010)


June 2010

PROPOSALS

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• The NBRC will be a focal point in identification, documentation and dissemination of

knowledge and experiences in newborn care.

• It will support the SNCUs in the NIPI supported states by improving access to information by

developing, collecting and sharing materials that would be useful to the MO, Nurses, policy

makers and managers as well as the community for improving newborn survival.

• The Resource Center in coordination and collaboration with the State SNCU Cell will provide

support and guidance for quality implementation and scaling up of the facility based

neonatal care through SNCU.

• The Center in the IPGMER will coordinate and guide the states in operationalization of

SNCUs; capacity development of different levels of health functionaries; develop teaching

aids for medical officers and nurses; review and perform quality assessment of these units

periodically; support ongoing learning by collaborating with experts in the field and provide

online technical support.

• The NBRC will have an important role in collection and analysis of data from the different

sites and provide easy access to analyzed data.

• NBRC will assist in designing of the SNCU and the provide guidance at the state level in these

states for setting up a mechanism for equipment maintenance. NBRC would also provide

technical support for identifying, designing/modifying physical structure for the setting up of

SNCUs.

• The NBRC would also be responsible for bringing in innovations in the field of newborn care;

one such innovation could be developing a one month certificate course for nurses in

newborn care; others would include developing quality assessment system for the SNCUs.

Outputs

• Standard Operational Procedure (HR, Training, Reporting and data analysis) for establishing

SNCU developed in print ready form.

o Training Manuals for Medical Officers and Nurses

o Treatment protocols for SNCUs.

o Housekeeping protocols for SNCU

o Maintenance Manual for equipment Maintenance

• Quarterly Newsletter (online) consisting of scientific materials, compilation of queries with

respective response etc.

• Communication (AV and printed) materials on newborn feeding and caring practices for care

givers developed.

• Software for patient data analysis.

• Software for MO/Nurses Demonstration Aids.

• All MO and Nurses in the SNCU equipped with knowledge and skills for efficient

management of sick newborns.

• Quarterly Analysis Report on various trends in the 12 SNCUs, e.g. trends of admissions –

inborn Vs outborn, gestation, birth weight, causes, trends in antibiotic sensitivities, causes of

death, equipment down time etc.

• Training and Demonstration Centre in one of SNCUs in each of NIPI supported states

established (where SNCUs are functional).

• Establish Online Technical Helpdesk for queries related to patient care, unit management

etc.

• One month Certificate course for nurses on facility based newborn care developed


June 2010

PROPOSALS

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• Quality Assurance Systems for SNCU developed and bi-annual Quality Assessment

performed for all the 12 SNCUs supported by NIPI with a separate report for each unit.

• Customized design plans for SNCU, SNSU developed.

Budget Heads Annual Costs

1. Manpower Support 40,00,000

1.1 Consulting Manager

1.2 Technical Coordinator (Pediatrician)

1.3 Training Coordinator (Public Health Specialist)

1.4 Deputy Training Coordinator (preferably from Nursing background)

1.5 Engineering and Maintenance Coordinator

1.6 Statistician cum Librarian

1.7 Data cum Management Assistant

1.8 Consultants (Four) @ 5,000 per day X 7 days per month 140,000

2. Development/ Finalization of Training and IEC materials, Protocols, Guidelines

and Teaching Aids (one time)

7,00,000

3. Development of Software for patient data analysis and Demonstration Aids

(one time)

2,00,000

4. Access to Scientific Journals, purchase of books etc. 2,50,000

5. Development and up-dating of Web Page 50,000

6. Office Support

6.1 Communications 1,00,000

6.2 Stationeries and Consumables 60,000

6.3 Computer time 1,00,000

7. Contingency for miscellaneous expenses 60,000

8. Travel support for Monitoring and Supervision ( one travel for 4 days for 5

people @ 5,000 per day per quarter)

3,00,000

9. Travel to States and Districts 5,00,000

10. Bi-annual Quality Assessment of 12 SNCU 4,00,000

Total 68,60,000

11. Institutional Overhead charges (7% of Total) 4,80,000

Grand Total 73,40,000

A budget envelope for two years of 1.4 crores is requested.

PMG Recommendation

PMG recommends the proposal within the financial envelope proposed and sees the importance of

solid and sustainable supervision to the huge effort that is being done by states to set up Special Care

Newborn Units. PMG request the Child Health Resource Network to revisit the budget together with

SSKM/IPGMER to make sure that salary levels that are proposed can be sustainable also after the

initial period of NIPI support. Furthermore the Chair requested a revenue model where the states that


June 2010

PROPOSALS

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utilize the services of the Resource Centre pay for the services, to make the Centre sustainable

financially.

Proposed resolution:

JSC approves the proposal, modified as suggested by PMG, with a budget envelope of INR 1,4 Crores,

equivalent to USD 315,000 for the next two years.

Collaborative Centres for Facility Based Newborn Care (UNICEF)

I. The collaborative centers will be the newborn units or departments of recognized medical colleges

or private hospitals that have:

• A well running level-II or level-III newborn care unit

• Expressed interest in supporting the facility based newborn care in rural India

• Have adequate faculty to support the units, who are willing to travel to the remote districts

about 1-2 weeks per year

• Follow rationale practices of clinical newborn care and of housekeeping

II. The collaborative centers will perform the following functions:

Capacity building

1. Training of SCNU staff:

• Doctors (M.O and Pediatricians)

� Nurses

2. Training in administration/managerial issues

� In-charge M.Os

� Nurse managers

3. To conduct 4-day workshops (separately) in different districts

4. Refresher courses (once every year)

Ongoing support

1. Telemedicine case-discussions: Once every week (two units per week)

2. Follow-up observer-ships to the collaborative center for 1 to 2 weeks (after the induction

training)

3. Mentoring visits to each center by the collaborative team: once per quarter

Operational research:

1. Focused operational research on select issues such as incidence of sepsis, microbial organisms

responsible for sepsis etc

III. Support provided to the units:

• Operational costs of the training programs

• A program or research associate and an administrative assistant

• Operational costs for telemedicine

• Support to research costs based on proposals

• Cost to cover travel and stay for mentoring visits


June 2010

PROPOSALS

15 | P a g e

PMG Recommendation

PMG agrees that close supervision of new child health interventions is needed, and in particular for

the Special Care Newborn Units that will benefit from consistent and continuous support both in

training and in daily clinical practice. PMG recommends the proposal in principle and requests

UNICEF to submit a concrete proposal to JSC with measurable outputs and budget.

Proposed decision:

While JSC in principle agree and approves the activity, it requests UNICEF to submit a more detailed

proposal including budgets and specified expected outputs from the proposed resource centers.

Strengthening of governance of government contracting in child health PPPs (NIPI Child Health Resource Network, UNOPS) In executing a proposal submitted to Norway India Partnership Initiative (NIPI) July 2009, the

National Institute of Health & Family Welfare along with NIPI and the ACCESS Health International

organized a workshop on “Government Contracting for Improved Child Survival in NIPI focus states”.

This was done in collaboration with the Centre for Emerging Markets Solutions at the Indian School

of Business, Hyderabad on November 19, 2009. The outcome of this workshop was captured in a

whitepaper, the first draft of which was submitted to NIPI in January, 2010. NIPI accepted the first

draft of the whitepaper which is to be further improved with materials from interviews and site

visits. To take the recommendations of the whitepaper ahead and initiate two Public Private

Partnership pilots in identified focus states, NIPI requested ACCESS Health International to put

forward a new proposal.

In order to develop the proposal, ACCESS Health International team, during the second phase of the

project visited Bihar and Orissa. The team interacted with key stakeholders in public and private

sector to gauge the policy environment in both the States.

Goal

The goal of the proposed project (Phase-3) is to suggest mechanisms to strengthen the governance

of government contracting and facilitate pilots of Public Private Partnership in Jehanabad, Nalanda

and Shiekhpura districts of Bihar and Angul, Jharsuguda and Sambalpur districts of Orissa, specifically

aimed at reducing child mortality. It is also to document the processes and learning from this

exercise to understand the feasibility of further expansion in the state concerned and also in other

Indian states, where there is a need.

Approach

Based on the assessment undertaken in Bihar and Orissa and in order to strengthen the governance

of government contracting aimed at reducing child mortality following steps are suggested:

Supply side

• Facilitate establishment of an overarching governance body at the state level to facilitate

involvement of private/non government sector and informal workers to reduce child

mortality. This includes development of tools and institutional mechanisms for correct

accounting for liabilities related to PPP projects. This support will be coordinated with

already existing support from agencies in the state.

• Facilitate capacity building of personnel at various levels (State, district and block) in

designing, implementing and monitoring of contracting schemes.


June 2010

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16 | P a g e

• Ensure mechanisms for periodic reviews of specific contractual terms during the life of the

contract

• Ensure performance related reward systems.

• Facilitate establishment of a child care service delivery network (outpatient and inpatient

care), at the district involving child specialists and available private institutions. Including

definition of benefit package and pricing.

• Facilitate establishment of a monitoring and evaluation system.

Demand side

• Strengthen Rogi Kalyan Samitis (Patient Committees established to oversee facility

management. These committees have numerous powers including on deciding whether or

not to levy user charges for services provided by the facility) at District hospital, Community

Health Centre and Primary Health Centre level to facilitate delivery of child care services

• Engage pediatricians in the discussion on household level interventions and community-led

initiatives to improve child survival and well being

• Facilitate capacity building of informal workers and community level workers in child care.

• Facilitate development of referral linkages by involving public practitioners, informal

workers and community level workers (ASHA, AWW etc.).

Budget

Budget Head Amount (INR) Project staff time 2,376,000 Team Leader 720,000 Midline and end line survey 400,000 State level workshops (including some travel a maximum of 8 technical experts)

320,000

Small group technical task force meetings (3 per state)

120,000

Travel of ACCESS Health team to the states – 36 trips ( one trip each to Bihar and Orissa for 18 months)- 3 day stay /visit

864,000

Overhead (administration, legal, office) (10%) 470,000 TOTAL COST 5,270,000

PMG Recommendation

The PMG recognizes that exploring PPPs for child and maternal health in the Focus States is an

important part of the overall NIPI Strategy and in principle recommends the proposed activity. The

Chair mentioned that it should be clear what the wanted output for the respective state is to be, and

that it should be made sure that the states are really interested in and committed to following up on

this intervention, before commencing the activity. The PMG also request that the budget is revisited,

with regards to the overhead expenses before submitting for JSC.


JSC recognizes that exploration of PPP governance is required for the states to be able to utilize

private providers as a resource to reduce child mortality and approves the proposal as modified

according to PMG comments, with an envelope of 53 lakh rupees, equivalent to USD 119,000.


June 2010

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17 | P a g e

NRHM Focused Districts (NIPI Child Health Resource Network, UNOPS) Background

The Hon. Prime Minister of Norway and the Hon. Health Minister of India reviewed NIPI

programme on the 5th February, 2010. One of the strong recommendations that emerged from

the discussions was the need for NIPI to realign efforts to enable convergence of best practices,

processes and resources in selected Districts in each of the 4 NIPI focus States of MP, Rajasthan,

Orissa and Bihar. This recommendation also is echoed in the Government of India’s written input

to the Mid Term Review of NIPI which interalia states “NIPI to focus on ongoing programmes of

Government of India like capacity building for better planning and implementation of NRHM

plan at the district level” (GOI written input to MTR, Feb 2010).

All the NIPI focus States still has a high Infant Mortality Rates and a relatively high Maternal

Mortality Ratio. The States are steadily continuing to improve the health outcome for its

Mothers and Children. It has taken bold measures to make health delivery more efficient.

Successive Common Review Missions of Ministry of Health and Family Welfare, Government of

India have advocated the need for District ownership and thinking for an effective decentralized

planning and implementation for achieving the State and National Goals for Maternal and Child

Health.

What does NFD approach mean?

It is a paradigm shift in thinking and action from the States to the Districts similar to what NRHM

has encouraged in doing so from Centre to the State. The approach will be to stimulate local

thinking, learning and improving Health Systems and Delivery of Health services as a desirable

and continuous activity. Emphasis will be on optimizing existing assets before going for new

assets; emphasis will be on process improvements to reduce wastages and gain more quality

and quantity.

What is the desired outcome?

It is proposed to converge in one District- The NRHM focused District (NFD) the implementation

of a comprehensive set of Medical and Public Health strategies across the RCH domain along

with the process strengthening and reengineering required to enable the optimum delivery of

these strategies resulting in the desired Maternal and Child Health goals set by the State. More

specifically, Outcome will be improved processes, optimization of costs and enabling policies at

the State level for strengthening District and Blocks to develop their capacity for larger tasks/

improved health outcomes

Strategies/What will be done?

I Knowledge Management System:

Continuous system of assessment, gap analysis and reviewing will be established. A District

Consultant for a defined period will be placed to help establish this activity. Bringing the best

practices and adapting it to the District needs.

II Core Package of Interventions:

All RCH interventions, existing and new, decided by GoI and State from time to time across the

continuum of care for children will be facilitated:

• Quality Maternal health interventions

• Facility Based Newborn Care including Sick Newborn Care Unit, Sick Newborn Stabilization

Unit and Newborn Care Corners at the facility level for treating and averting death. (FBNC,

NSSK, SNCUs).


June 2010

PROPOSALS

18 | P a g e

• Focusing on the sick children treating and when needed referring them for facility based

care (IMNCI)

• Home Based Care of all Maternal and Newborns with referrals (HBPNC) will be ensured.

Addition of FP, Nutrition and ARI-Diarrhea control subsequently.

III Enabling Mechanism:

A large number of programs are being implemented at district and block level.

• DPMUs and BPMUs require support for specific attention to child and maternal health.

Districts will have complement of Child (and maternal) Health Managers in their district and

block PMUs.

• Techno-managerial support for Child and Maternal Health with training personnel of

managerial background to manage and coordinate health program will increase utilization of

available resources, increase quality of monitoring and support a bottom-up approach in

planning and implementation, thereby increase relevance and quality of plans.

IV Localization of decision making:

• Establishing Block as key planning and operating nodes.

• A new institutional experiments like Block and below medical human resource pooling;

creation of an integrated Block Chief Medical Officer and empower him as head of a Block

level administrative Committee with delegation of extra powers along with resources

including administrative powers of deployment, redeployment and so on for better service

delivery through rational use of scarce human resources.

• Empowerment of Nurses where action takes place

• Creating and strengthening Block and Village Institutions- expanding the scope and depth of

RKS to establish the Block Health Society, Strengthening VHSC, SHG and PRI links.

V Integrated Referral Transport:

• Providing cashless transportation facility to pregnant women for all maternal emergencies/

At Risk pregnancies covering Antenatal and Post natal period.

• Each beneficiary would be given Vouchers to avail free transport facility at the time of need.

District Training and Resource Centre:

• To build the District Health Resource and Training Centers having specific managerial

element looking after training as part of the DPMU on a continuous basis.

• A District Training Coordinator will work under the DPM and assist the ADMOs and CDMO

and at the State level SIHFW/Directorates for organizing various training courses.

• The District Training Coordinator will be seen both as part of DPMU and act as the Registrar

of any existing facility at District level like ANM Training Centre, Regional Training Centre,

District Training Center.

• State Child Health Resource Centre at SIHFW in the State with its complement of newly

recruited staff will take the lead in providing the intellectual, management and

documentation capacity to the DTCs.

VI Public Private Partnership

Support for PPP arrangement to increase access to facility based services for emergency

maternal and newborn care:

• To increase access to quality maternity services in areas which does not have the

complement of facility based Emergency Medical Obstetric Care and newborn emergency

care.


June 2010

PROPOSALS

19 | P a g e

VII Use of IT and Communication Technology:

Process improvement will be established including

• Delivering health-care payments through branchless banking using mobile phones,

• Improved communication

• Reporting (Mother Baby cohort tracking online).

Operational Steps:

• Situational analysis- of the NRHM interventions, systems and processes- Senior Consultant

to be placed to help with the analysis and assist the BPMU, DPMU and CDMO to review and

monitor the strategies and outputs on a regular basis.

• A draft plan – THE DISTRICT PLAN as the base – preferably through the District Health

Resource and Training Center under the leadership of the CDMO ; and BLOCK PLAN to be

prepared. (District PIP to be a dynamic plan)

• A conclave to be held at District HQ and Blocks for deliberations on the draft plans to be

finalized.

• The DPM and CDMO will ensure integration in to the NRHM system through additional

processes like Review meetings [including focusing on the ‘reform’ issues in the existing

review meetings], Brain-storming sessions around the Annual Plan of Block and District to

see these as ‘live’ documents needing monthly Re-Visits, and Staff Training/Motivation /Role

Clarity Sessions.

• The state PIPs already provide for most of the resources needed.

Inputs Required:

• Senior Consultant to be placed to help with analysis and assisting the BPMU, DPMU and

CDMO to review and monitor the strategies and outputs on a regular basis.

• For establishing the district Training and resource unit and providing support to them

including one District Training Coordinator, a Deputy Training coordinator and a data

assistant.

• Some further funds for process re-alignment- supplementation may be required which may

be available from the large unspent funds available in the State and District.

Recommendation The PMG recommends this activity as described in the submitted proposal.


JSC approves that one Focused NRHM District is taken up in Rajasthan and one in Orissa. Taking into

account that the NRHM funds and flexi pool as well as flexi-funds from NIPI is already available with

SHS Rajasthan and SHS Orissa, the additional cost for this intervention would be 50 lakhs for a two

year period, equivalent to USD 105,000.


June 2010

PROPOSALS

20 | P a g e

Strengthening of Nursing and Midwifery Pre-service Education in Bihar

Policies and programs of the Government of India focused on Maternal, Newborn and Child Health

(MNCH), have put an increased emphasis on the role of the basic health worker in the provision of

comprehensive maternal and child health services in the country, especially in rural areas.

The Auxiliary Nurse Midwife (ANM) is a cornerstone in many of these strategies. Unfortunately both

training capacity as well as quality of training of ANMs is lower than what should be desired in many

of the high focus states. The Indian Nursing Council (INC) has shouldered a comprehensive initiative

to strengthen the foundation of pre-service education for ANMs

A roadmap for improving the pre service education of GNM and ANM by strengthening ANM and

GNM training centers in the high focus States of India has been developed by Nursing Division of GoI

and INC. It includes establishment of a number of Nodal Centres (Upgraded Nursing

Colleges/Training Centres) to lead the process. It is envisioned that these Nodal Centers, besides

serving as model teaching institutions, would serve as pedagogic resource centers for strengthening

pre-service training at the ANMTCs in their region and also provide support in the concurrent

strengthening of these ANMTCs.

JHPIEGO, a Technical Agency specializing in RCH, FP and Pre Service Education for Nursing and

Midwifery cadre, has been entrusted by the INC to help in setting up these nodal centres with 4 such

coming up, currently( Kolkata, Delhi, Ludhiana and Vellore) and subsequent support for

strengthening of ANMTCs in the states of Uttar Pradesh and Jharkhand.

Technical support to this initiative includes capacity building of the existing faculty of the nursing

institutions and strengthening the infrastructure of the teaching facilities and clinical sites. JHPIEGO

is interested and willing to assist Bihar Government in initiating the process of strengthening the 21

ANMTCs in the State and help in setting up a Nodal Centre on same lines elsewhere.

Bihar Government has initiated steps to strengthen the ANMTCs in the State. This follows a

situational analysis study of the ANMTCs done by WHO and INC. Help from UNICEF has been

available to initiate the strengthening of the ANMTCs. Both agencies have used NIPI funds for these

activities.

In a recent State level meeting (28th

April, 2010) under the Chairmanship of Health Secretary, Ravi

Parmar, IAS, the State Government reiterated its resolve to continue the strengthening of the

ANMTCs and follow the INC model of a Nodal Centre approach. The experts in the meeting worked

on a proposal currently estimated to INR 6 crores for strengthening the 21 ANMTCs over 3 years,

based on the calculations arrived at by INC for the Country. Bihar Government will mobilize the

funds from appropriate sources under NRHM.

However, substantial Technical Assistance will be needed to translate this into a solid strengthening

process and availability of such will be a key determinant in the outcome of improved and

strengthened ANMTCs in Bihar. This will essentially focus on Quality improvement by use of

educational standards and strengthening the clinical & training skills of the tutors.

Specifically, the strengthening of the nodal center and the ANM training centers in Bihar is proposed

to be done through the use of simple, measurable performance standards which serve as a guide for

better functioning schools. These performance standards (approved by the INC) provide a structure


June 2010

PROPOSALS

21 | P a g e

for program support and a criterion-based supportive supervision system to provide specific ongoing

technical support for improving the quality of pre service education in the ANMTCs.

The major activities for the proposed support will include:

• Building the capacity of schools to follow a competency and clinic-based training

• Facilitating the updating of faculty in targeted knowledge & clinical skills

• Conducting pedagogic courses for tutors and support the application of modern teaching

principles

• Establishing clinical skills labs, equipped with anatomic models, computers and develop

quality libraries

• Using Standards Based Management approach (SBMR) to strengthen PSE

• Networking schools to compare progress and collectively solve implementation challenges

• Developing a framework and plan for monitoring and evaluation

JHPIEGO interalia will provide technical assistance to Bihar Government in identifying an existing

GNM school as state nodal center and strengthen it using INC programmatic approach. The Nodal

center in turn will facilitate strengthening of the ANMTCs by Capacity building of the ANMTC tutors,

Strengthening pre service education by using educational standards (SBMR), and Network ANMTCs

to compare progress and collectively solve implementation challenges.

The detailed technical proposal is still to be finalized between JHPIEGO and SHS Bihar. However

overall budgets frame for a two year project has been given from JHPIEGO based on preliminary

discussions in Bihar:

(USD) 1st

year 2nd

year Total

Personnel 190654 190654 381308

Program activities 94088 94088 188176

Other direct costs 42711 42711 85422

Indirect costs 58271 58271 116542

Total costs 385724 385724 771448

Recommendation

The PMG recommends this activity as it is in line with the strategy of INC and GoIs strategy.


JSC acknowledges the need for strengthening the nursing cadre in general, and that for Bihar, a

further strengthening of ANM Training Centres, including both infrastructure and faculty is highly

required. JSC in principle agree to the proposed activity, and delegates to the co-chair to approve a

final grant proposal within the financial envelope of USD 772.000.

Capacity building of Child Health Program managers to review the program and for effective planning and implementation of child health programme (WHO) WHO tools will be used for developing capacity of the child health program managers at district level

for conducting short review of the existing child health program and enhance their techno-

,managerial competencies to plan the annual district child health activities and manage the


June 2010

PROPOSALS

22 | P a g e

implementation in an effective manner. The objective is to build capacity within the system at

district and block levels. The capacity building will be carried out in the selected NIPI focus districts

Recommendation

PMG in principle recommends the proposal to JSC and request for a plan which ensures synergy with

already ongoing activities and with a detailed budget to be worked out for the JSC. It was also

mentioned that this should be followed up with a similar capacity building for the maternal health

activities of the same managers..


JSC in principle approves the intervention, as long as synergies with already ongoing activities are

ensured. Before allocating funds to this intervention, a detailed, written proposal, including a

detailed budget should be prepared. JSC delegates to Co-Chair to approve the final proposal.

New Mechanism for Operations Research 5% of NIPI funds are earmarked for research activities. The aim is to have high quality research to

guide interventions as well as document the impact of such. In order to serve these two purposes,

the mechanism for administering research proposals needs to be flexible and agile. Implementing

partners should play a central role in this, as they would have firsthand experience of where the

knowledge gaps would be. On the other hand, the Government of India and its central research

institutions needs to be represented to ensure convergence with existing GoI policy. The Donor has

suggested that the task of handling and administering the research proposals and subsequent grants

is given to NIPI Secretariat, UNOPS.

To facilitate this change and achieve the ambition of increased relevance and agility it is also

proposed to make a some alteration to the TOT and the composition of the Operations Research

Committee (ORC). Also, a clarification of what should be called OR is needed.

Different types of proposals needs different handling Several types of proposals that can be identified as research may be relevant under NIPI. Broadly it

can be divided into two categories:

• Embedded (intramural) research (Directly approved by JSC)

• Extramural research (Through ORC)

Embedded research

Embedded research would typically be assessments done as part of an intervention, it may be a

baseline or an end-line assessment or ongoing assessment to guide the implementation of the

intervention itself. If such proposals are part of the original proposal for the intervention, it is now

proposed that the JSC can, on recommendation from PMG, approve such activity directly. However,

JSC, PMG or NIPI Secretariat may ask ORWG for advice in technical matters if needed.

Extramural research

Extramural research is defined as research done by a organization that is not directly associated with

the implementer, and thus carrying out research independently. Research ideas can and should

however be suggested from the implementing agencies, and these will have opportunity to add

relevance to the proposals for research through the process in the ORC.

It is proposed that the NIPI Secretariat is given the charge of handling the extramural OR proposals

and subsequent grants. The proposals will be reviewed by the ORC consisting of representatives


June 2010

PROPOSALS

23 | P a g e

from the implementing partners, the donor, GoI and central Indian research institutions. The ORC

can approve research grants within a financial envelope decided by JSC for each year.

TOR and composition of ORC A draft TOR including the list of members for the ORC is developed in cooperation between the

implementing partners, and given on the next page.

PMG Recommendation

PMG recommends the changes as described in the proposal.

Proposed decision:

The JSC approves the new mechanism for Operations Research and request the NIPI Secretariat to

immediately call the first meeting to expedite the applications already submitted, where review and

approval is pending.

Terms of Reference for the Operations Research Committee (ORC)

Norway India Partnership Initiative is the result of the vision of the Prime Ministers of India and

Norway to create mechanisms to speed up the reduction in child and maternal mortality in India. To

ensure an evidence base for interventions supported under NIPI, to assist decisions of further up-

scaling of pilot projects reviewing the impact of interventions, 5 % of funds allocated under NIPI is

earmarked for Operations Research.

Under NIPI, OR grants can be given to partners as well as external research institutions for research

related to the interventions funded under NIPI and related subjects.

NIPI Secretariat also serves as secretariat for the ORC and will take care of the administration of

applications as well as issue contracts and disburse grants for research approved by the ORC. The

NIPI Secretariat will compile reports on funds disbursement, budget and expenditure on research for

the ORC.

Mandate:

The ORC is to identify essential Research which can contribute to improved quality of Neonatal and

Child health care services in India in general and in the NIPI supported states. It assesses Proposals

for Studies, Evaluations, Research and Surveys, and provide standards for their implementation

Research can be stand alone or as integral part of NIPI supported projects and programs in the NIPI

supported states.

Program related research-like activities like monitoring, baseline and endline surveys that are

integral parts of interventions approved by JSC can also be taken through PMG and JSC as part of the

project proposal. In such cases the JSC may approve this activity and it does not warrant additional

approval from ORC. In these cases the research activity will be budgeted as part of the project, and

not fall under the 5% Research Component of NIPI. JSC may however ask for the ORCs advice in

cases of doubt.

Meeting frequency:

The ORC will meet at least quarterly of which 2 times will be 14 days before a planned PGM. For

urgent decisions, the Chair of the ORC can circulate proposals etc electronically to the ORC

members, and document the decision through email exchange.


June 2010

PROPOSALS

24 | P a g e

Budget:

NIPI JSC will for each year define the budget envelope for OR under NIPI. Single proposals with value

over USD 200 000, will need JSC approval, alternatively joint approval from Chair and Co-Chair of

JSC.

Research proposal evaluation:

The ORC will evaluate proposals and grade as

1. Recommended for approval as is

2. Recommended for approval, subject to modifications to be made by the responsible PO

3. To be modified and resubmitted

4. Rejected

TOR evaluation criteria:

The ORC will assess the research and its TOR on

• the clarity of its objectives,

• the relevance of the hypothesis and proposed research questions vis-à-vis its objectives

• the soundness of the proposed methodology

• the usefulness of the research

• the timeliness of the research

• the thoroughness of the proposal

• Institution to institution collaboration between India and Norway should be seen as an asset

in the review process, and may justify higher budgets to cover travel expences etc.

Technical Assistance:

The ORC can provide technical assistance when requested to the responsible Research Organisation.

The ORC is also prepared to comment on draft reports so as to provide technical inputs before the

report is finalized.

Use of deliverables and findings of OR:

A draft final report along with a completed Executive Summary by the study supervisor and

electronic copies of any collected data must be submitted to ORC before further dissemination. In

cases where final payment to a Research Organization is dependent on approval of the final report,

the ORWG will review the report and advise NIPI Secretariat on their decisions. Such reviews should

happen without delay, and can be done without a physical meeting of the committee, by email or

letter.

ORC membership:

1. MOHFW

2. IMRC

3. NIHFW

4. NHSRC

5. NIPI Child Health Resource Network (UNOPS)

6. UNICEF

7. WHO

8. RNE


June 2010

PROPOSALS

25 | P a g e

NIPI Secretariat attends and minutes the meetings, but do not vote. Each organization

representation is nominal, and any changes in representation should be intimated the Chair and the

NIPI Secretariat immediately.

Mode of operations:

1. At least four members must be present to comprise quorum. Members cannot comment on

TORs or study proposals from institutions they actually work for.

2. In case of a voting tie, the chair can utilize a double vote.

3. The submitting organization may be called to clarify questions.

4. ORC may call on external assistance (international or national) to advice on technical

questions

5. Based on the decision of the ORC, the NIPI Secretariat will enter into agreement with the

Research Organization and administer contract and disburse grants on behalf of NIPI.

6. Minutes of ORC proceedings will be kept by NIPI Secretariat and made available to all

partners in NIPI and members of PMG within 2 weeks of the meetings held.


, 2010

RESTRUCTURING OF NIPI PROJECTS UNDER UNOPS

26 | P a g e

Restructuring of NIPI Projects under UNOPS UNOPS has been contracted to perform three main tasks under NIPI. In addition to running the NIPI

Secretariat, UNOPS is also responsible for running the Child Health Resource Network and act as

Local Fund Agent for funding to the Focus States.

Initially all these tasks were handled as one project. At the end of 2008 the project was technically

divided into two projects (NIPI Secretariat and NIPI Local Fund Agent), but still run as one unit and

under the same management. However, based on the experience so far, and with the inputs of the

Mid Term Review, it is seen as appropriate to revisit the structure. During the last months of 2009

and the first quarter of 2010, a proposed model for a new structure has been developed and

discussed with stakeholders.

Key properties with the new model

• Implementation support (Enabling Mechanism/Child Health Resource Network) is moved to

the LFA project (project number 64037). The project is managed by the Director Programs

• Secretariat will be headed by a Director Secretariat. The Secretariat Director will be

responsible for liaison with GoI at national level and will be coordinating all the partners

under NIPI.

• While introducing a separation of tasks between projects, the structure will allow for

redundancy of important functions, especially day to day administration and financial

management

Rough division of tasks between the two NIPI projects after re-structuring

Project 00054184 00064037

Tasks Secretariat to JSC including

preparation of meeting notes,

minutes, budgets and plans for

NIPI partnership. Overall

coordination of monitoring of

the NIPI Partnership

In addition, the NIPI Secretariat

is responsible for any

international promotional

activity of NIPI

• Local fund agent for

NIPI

• Technical and project

management support

to states (enabling

mechanism, national

node and state nodes)

The proposed structure takes into account that UNOPS will be establishing an OC in India, and that

HR and Finance Services will be available locally through the OC. The OC will be led by a OC Director

at D1 level. There will also be a Head of internal Services (HR, Finance, Procurement) at P4 level.

The organization map on next page describes the proposed new structure for the two projects under

UNOPS the Secretariat is separated from the LFA and enabling mechanism. The main reason for this

is to increase the emphasis on the Secretariat tasks, including learning and sharing of experiences.

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, 2010


28 | P a g e

Budget revision and funding need for 2010 As a consequence of the proposed restructuring of the NIPI Projects, the budgets for the projects

will have to be changed. However, due to the technical challenges of performing these structural

changes in the middle of a budget year, it is proposed that the formal project structure in the finance

and budgeting systems remains unchanged throughout 2010, and the changes will be reflected in

budgets from 2011.

UNOPS LFA

The table below shows the budget approved for 2010 during JSC 8 in November, with the addition of

expenditure (actual) from the states and indicating new allocations during 2010.

Total Central Bihar MP Orissa Rajasthan UP

Yashoda-incl. kit 2 795,000

1 015,000 260,000 620,000 933,000

HBNC 2 350,000

635,000 515,000 300,000 880,000

Techno-managerial support 1 055,000

360,000 300,000 260,000 130,000

FBNC 1 740,000

800,000 580,000 350,000 345,000

Immunization 280,000

0 25,000 100,000 250,000

Other 2 260,000 1,200,000 230,000 300,000 430,000 100,000

10,918,000 1,200,000 3,040,000 1,980,000 2,060,000 2,638,000

Balance at 31.12.2009 12,792,705 2,673,197 2,824,266* 1,517,846 2,993,013 2,784,383

Estimated balance at 31.12.2010

1,473,197 -215,734 -462,154 933,014 146,383

Requested new allocation from RNE 3,000,000 -999,000 1,333,000 1,333,000

1,333,000

*Estimate

It follows from this that the forecasted funding need for the states can be accommodated by an

allocation of USD 3.000.000 to UNOPS LFA.

NIPI Secretariat – budget revision

The table below shows the budget that was approved by JSC 8 in November 2009 and the funds

request based on remaining balance on 31.12.2009. Due to increase in the cost of hired consultants

(ICA) and increase in budget of USD 90.000 is requested and JSC is requested to approve the revised

budget for NIPI Secretariat.

Budget head 2010 Revised

Human resources $800,000 $890,000

Travel $ 100,000 $ 100,000

General operation expenses $ 400,000 $ 400,000

Grand total 2010 $1 300,000 $1 390,000

Balance on 31.12.2009 $ 847,630 $ 847,630

Funds requested 2010 $ 452,370 $ 542,370


, 2010


29 | P a g e

Proposed resolution

JSC takes note of the new structure of the NIPI Projects by UNOPS.

JSC approves the new budgets and approves an allocation of NOK 22,3 mill, equivalent to USD

3,542,370 (@6,3).

Recruitment of new Director Secretariat. As shown in the organogram, the NIPI Secretariat will be headed by a Director Secretariat. As the

previous Director, Mr Hota is now Director Emeritus, and the current Officer in Charge is ending his

contract with UNOPS, the position needs to be filled through an advertising process.

The Vacancy Announcement has been created and the post will be advertised at P5 level.

Proposed resolution

JSC takes note of this information


, 2010

NO-COST EXTENSION OF NIPI

30 | P a g e

No-cost extension of NIPI

NIPI was launched in 2007, but had a slow start. The interventions to improve the quality of

Maternal and Newborn Care in the NIPI focus States has been rolled out in the last one and half year

and is showing encouraging trends .

However, the full potential of these interventions, the institutionalization of the key processes in

translating these interventions, within the system and dissemination of lessons learnt will take more

time. Besides, due to the delay in initiating these interventions by the States there is savings. So, it is

proposed that a No-Cost Extension till 2013 will be granted to achieve the jointly mandated goals of

the initiative of Government of Norway and Government of India under the NIPI framework.

The table below shows a suggested distribution of allocations, as suggested by RNE.

NIPI actual disbursements 2006 - 2009 and planned 2010 -2013

Partner 2006 2007 2008 2009 2010 2011 2012 2013 TOTAL

WHO

1,400

6,280

13,835

815

5,000

10,000

10,000 10000 57,330

NIPI Secr

7,000

-

8,131

3,751

4,550

5,000

5,000

5,000 38,432

RNE

100

174 274

Unicef

14,600

13,950

25,910

16,754

26,000

26,000

20,000

20,000 163,214

UNOPS-LFA

-

61,000

48,750

-

11,000

35,000

35,000

25,000 215,750

OR

-

-

-

4,373

5,960

6,667

5,000

3,000 25,000

TOTAL

23,100

81,404

96,626

25,693

52,510

82,667

75,000

63,000 500,000

Proposed resolution

The JSC approves a No-Cost extension along the suggested lines. The proposed distribution of funds

is noted, however, review of actual expenditure for 2010 and 2011 will give more information and

should be reviewed before a final decision on allocations to the implementers is taken.

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