Annexure

Guidelines for the Operational cost towards the Comprehensive Obstetric Care Services of
the Medical College Hospitals, District Head Quarters and Sub District Hospitals

1. FORMATION OF THE COMMITTEE WITH A NODAL OFFICER FOR EACH

OF THESE INSTITUTIONS DELIVERING OBSTETRIC SERVICES:
A Committee shall be formed with a Nodal Officer ( preferably one who is not in the
verge of either immediate transfer /promotion) at each of the above mentioned
Institutions to operationalise and monitor the functioning of the CEmONC services of
the Medical College Hospitals/District Head Quarters /Sub District Hospital.
The Composition shall be as follows:

S. CEmOC centre at CEmOC centre at CEmOC centre at

Composition
No MCH DH SDH
1 The Medical The Medical
Chairman The Dean(Ex-officio) Superintendent /
Superintendent
CMO
2 HOD of Obstetrics and
Vice Chairman NIL NIL
Gynecology
3 Convener and Senior Obstetrician Senior Obstetrician
Executive Nodal officer
Secretary i/c. of CEmONC i/c. of CEmONC
1.Obstetrician 1.Obstetrician 1.Obstetrician
2.Prof.of Anaesthesia 2.Anesthetist 2.Anesthetist
3. HOD .of Paediatrics 3.Peadiatrican 3.Paediatrician
3.Chief Lab 3.Chief Lab
4. Member 3.Chief Lab Technician
Technician Technician
4.Medical stores
4.Chief Pharmacist 4.Chief Pharmacist
Officer
AO/ JAO /
5.AO AO/ JAO
Superintendent
ROLES AND RESPOSIBILITIES OF THE COMMITTEE:

− The Committee formed at the institution will be responsible for operationalisation of

CEmONC Centres of the Medical College Hospitals/District Head Quarters/District
Hospitals and will monitor day to day functioning of the same
− The Committee will meet at least once in 15 days on fixed days and review with
respect to the performance, staff & drug position of the CEmONC Centres of the
Medical College Hospitals/District Head Quarters/District Hospitals and plan for
following 2 weeks.
− The Committee will approve the placement of indent for special drugs through
TNMSC or through local purchase whenever the drug is reported to be not available
in TNMSC and also ratify any emergency purchase of drugs done in between.
− The Committee may hire the services of Experts-Super specialists for Expert Opinion
for the CEmONC Centre of the Medical College Hospital only if that particular
Superspeciality post/ personnel is not available in that institution.
− The Committee will develop the empanelled list of Super specialists (both
government and private-when there is no such post/personnel in their respective
institution) based on the existing need and modify it as and when necessary and
prescribe the mode of implementation of hired super- specialist care including the
mode of payment for hired services with modifications as and when required.
− The Committee will decide, identify and prepare empanelled list of private providers
of diagnostic and lab services which are not available 24 x 7 or during specified times
in their institutions.
− The Committee will decide the rate of user fees and the mode of payment for lab
investigation/ diagnostic services.
− The Committee is empowered to negotiate as and when necessary with the lab and
Diagnostic service providers for a reasonable user fee.
− The Committee will take up fortnightly Audit of all Maternal Deaths occurred at the
institution and ensure that preventable causes are addressed satisfactorily.
 − The Committee will address and resolve any management issues affecting the
successful operationalisation of CEmONC Centres of the Medical College Hospitals/
District Head Quarters/ Sub District Hospitals.
− The Committee will ensure to send prescribed information to the State Maternal
Health Quality Assurance Cell at State Health Society, Chennai periodically before
7th of every month.

2. Drugs and Clinical accessories :

a. The Chief Pharmacist / the MSO of CEmONC Centre of the Medical College
Hospitals, the District and Sub District Hospitals should get a “No objection
Certificate” or not available certificate from the Regional warehouse of the TNMSC
of the concerned district for the drugs and clinical accessories included in the EDL
but that are not available at present in TNMSC before making the local purchase.
b. The Clinical accessories available in the CPC list may also be purchased as per the
need from the funds allotted as and when decided by the Committee.

3. Expert Opinion
i. The Hiring charges for expert opinion will be admissible only when they are not
available in the institution.
ii. Hiring charges will be considered to the Hired Super specialists when called for
giving opinion any time of the day.
iii. The Clinical cases of the Department of Obstetrics and Gynecology requiring
expert opinion( not available in the institution) may be pooled together and the
hiring charges has to be given for each visit and not to be based on the number of
cases seen during each visit.
iv. The Obstetrician / EmOC trained doctor on duty may call for the expert opinion.
v. A register should be maintained at the CEmONC Centres of the Medical College
Hospitals/ District Head Quarters/ Sub District Hospitals giving the following
details: 1) Name of the patient 2) Diagnosis 3) Date and Time of Call for the
Expert Opinion 4) Date and Time seen by the Expert 5) Name of the Expert and
their speciality 6) Amount paid 7) Date of Payment 8) outcome particulars.

4. User fees for Diagnostic / Lab services / Lab reagents

i. Investigations which are not available at the Government institution 24 x 7 may
be hired from Private lab by the duty Obstetrician /Trained EmOC doctor of
 CEmONC Centres of the Medical College Hospitals/District Head
Quarters/District Hospitals.
ii. The special investigations which may not be routinely available in the
Government institution eg. Coagulation profile etc may also be considered as
and when the need arises.
iii. The user charges towards the diagnostic services like Blood gas analysis etc when
not available (24 x 7 or after specified time) at the institution concerned may also
be met from the funds provided under this head.
iv. The user fees for the CT and MRI of the Government Facilities for the maternity
cases (collected towards maintenance and consumables) shall be paid from this
amount.
v. A register should be maintained at the CEmONC Centres of the Medical College
Hospitals/District Head Quarters/District Hospitals for documentation of
diagnostic/lab services etc.

5. Institutional Death Review :

a. An institutional Review of all Maternal Deaths must be undertaken every month on a

fixed day with the following objective .

• To identify causes that had led to the death of the mother either in the
Antepartum/ Intrapartum/ Postpartum period for planning appropriate
interventions.
• To identify gaps in the services provided
• To study the Health seeking behavior in the community.

b. The allotted funds may be utilized for incidental expenses towards institutional death
review.

c. Monthly reports on or before of 10th of every succeeding month have to be sent to the
State Maternal Health Quality Assurance Cell, State Health Society, Chennai.

6. Consumables :
The contingencies /consumables/ minor repairs of essential equipments / procurement of
accessories for the CEmONC Centres of the Medical College Hospitals/District Head
Quarters/District Hospitals may be utilized from this fund.
 a. Xeroxing of death case sheets at CEmONC Centres of the Medical College
Hospitals/District Head Quarters/District Hospitals for sending them to State
Maternal Health Quality assurance cell.
b. The contingencies like soap, cleaning /mopping agents etc may be purchased locally.
c. The fuel requirement for running the generators may be met from this head when
allotment (regular/additional amount under Revised Estimate / DMS or DME
allotment / Hospital Maintenance funds) are exhausted.

7. AMC / CMC charges & Repair of Equipments

The Annual and Continuous Maintenance Contractual Services, and Rectification of Major
and Minor Repair of the Equipments at CEmONC Centres of the Medical College Hospitals/
District Head Quarters/ Sub District Hospitals may be done with the concurrence of State
Maternal Health Quality Assurance cell with the allotted funds.

8. Hiring of Private Specialists and Honorarium towards Additional Services for

Government Specialists and Honorarium to EmOC and LSAS trained doctors:
(Applicable only for secondary care facilities)
The Guidelines enclosed in Annexure- 5 (already issued form SHS and is in force
already).
9. Utilization Certificate / Statement of Expenditure and further Release- on the basis
of utilization of released fund, next release will be made. As soon as 50% amount is
utilized, next 50% amount will be released.

10. Maintenance of Accounts:

This separated account to be operated jointly by OG Head of Department and one
nodal officer in Medical Colleges and Hospital Superintendent /CMO with Senior
Obstetrician/Gynaecologist i/c. of CEmONC in District Hospital / Sub District
Hospitals.
 Annexure-3

Statement of Monthly Expenditure

Name Name of the CEmONC Centre of the

of the Medical College Hospitals/District Head
District Quarters/District Hospitals
Name of Scheme: Operational Cost of the CEmONC Centres of the Medical College
Hospitals/District Head Quarters/District Hospitals
Expenditure statement for the month of

Opening Receipt Closing

Expenditure
S.NO Details Balance during Total Refund balance
during the month
as on the year as on

Drugs and
Clinical
1 accessories
.Expert
2 Opinion
User fees for
Diagnostic /
Lab services /
3 Lab reagents
Institutional
4 Death Review
5 Consumables
AMC / CMC
charges &
Repair of
6 Equipments

Others
7
Total

* Interest accrued to be shown separately

 Annexure - 4

Form No. GFR-19A

Name of the office:
District -
Utilization Certificate for the year:
Dated:

Sanction letter no. and

Purpose Amount
date

Certified that out of Rs. (……….-) of grants-in-aids sanctioned during the financial
year 201 - 20 in favour of the
…………………………………………………………………………..by the……………… as
per orders noted above and Rs…….. /- (Rs………………………………………………………)
on account of unspent balance of the previous years (201 - 20 ), a sum of Rs………/-(Rs.
……………………………………………………………) has been utilized towards the
……………………………………..for which it as sanctioned and that the balance of Rs………..
/- remained as unutilized at the end of the year, will be adjusted towards the grants-in-aid
payable during the next year.

Further certified that I have satisfied myself that the conditions, on which the grants-in-
aid was sanctioned, have been duly fulfilled and that I have exercised the following checks to see
that the money was actually utilized for the purpose for which it was sanctioned.
Checks exercised:
Examining of
a. Cash Book/Bank Pass book
b. Monthly & Quarterly statements of expenditure
c. Ledgers

Signature

Note: (1) Unspent balance/Unutilized amount of previous year plus released of

funds during the year under audit are the "total funds available."(2) Closing
balance of the year means "amount remained un-utilized or not spent."
 Annexure- 5

GUIDELINES FOR HIRING OF SPECIALISTS FOR MCH CARE

1. G.O (3D) No.46, H & FW (EAP 3) Dept dated 15.09.2000
2. Lr. No 4466/ EAP 6/ 2001-02 of H& FW Dept dated 13.03.2002
3. Lr. No. 823/ EAP 3 / 2005-1 of H & FW Dept dated 2.02.2005
4. G.O (D) No 1118 H & FW (EAP(1) Dept dated 20.12.2005
5. Minutes of 4th E.C. Meeting of State Health Society dated 10.6.2008
6. Lr. No.2009 /P/ SHS/ 08 dated 15.07.2008.
7. Minutes of the 5thE.C.Meeting of State Health Society dated
8. Minutes of 9thE.C.Meeting dated 25.08.2009
9. G.O (3D) No.15, H & FW (EAP-II (2) ) Dept dated 5.07.2010
10. PIP 2012-13
11. F. No. 10(11)/NRHM-I/ 2012 dated 14.7.2012 of GoI, Nirman Bhavan, New Delhi
12. Minutes of the 20th E.C dated 01.08.2012

With a view to reduce IMR & MMR , a scheme for hiring the services of private
Anaesthetists & Obstetricians for providing Emergency Obstetric Care services on payment of
Honorarium of Rs. 500 per surgery was introduced during the RCH- phase-I of TamilNaduin 75
identified First Referral Units (Ref.No.1 ) where the services of Government Anaesthetists &
Obstetricians are not available. In addition, Rs.500 /day visit for 5 FW surgeries with Rs. 100
for each additional case for each of the specialist and a transport allowance of Rs.100 per visit
when Government Vehicle was not provided, was given.

Based on the success of the scheme it was extended to all the FRUs and
PHCs.(Ref.No.2) and to all the urban Health Posts functioning under local bodies covering six
corporations and other Municipalities.(ref.No.3)

FRUs improved their EmOC services with referrals to higher Institutions considerably
reduced and improved FW surgery performances in primary & secondary care Institutions.

Under RCH-II, Govt accorded sanction for the continuance of the scheme. (Ref.
No.4).The Honorarium to Anaesthetist was increased to Rs.1000 from Rs.500 and that of
Obstetrician to Rs.800 as allowed by GoI.

4th E.C of State Health Society approved Rs.1000/ case for obstetrician also on par with
anaesthetist (Ref.No 5) and the Proceedings were issued (Ref.No.6) by the Mission Director,
SHS.

9th E.C of SHS approved Rs.1000/ session for the first 5 FW cases and Rs. 150 as
additional remuneration for each case after the 5th case. (Ref.No.8)

To bridge the gap in specialist services especially in Emergency Obstetric Care in remote
areas of the State and to utilize all the health facilities provided with theatre facilities optimally,
multi-skilling of MBBS qualified Government Medical Officers in LSAS and EmOC services is
being implemented successfully in the State as recommended by GoI.
 These trained medical officers have been provided with a monetary incentive of Rs. 200
per LSCS surgery or Emergency Obstetric procedure or Family Welfare session attended by
them in addition to eligible TA & DA.(Ref.No.9)

Details of Honorarium being provided to the Private Obstetrician & Anaesthetist and the
monetary incentive given to the trained M.Os at present are stated below.

S.No Details Family Welfare LSCS Obstetric

Services Emergencies
1 Hiring Rs.1000 per session for a Rs.1000 for each Rs.1000 per case
Charges to minimum of 5 cases. If case (It is assumed of obstetric
Pvt. less than 5 cases then that there can be emergency like
Obstetrician proportionate amount of only one cervical tear and
Rs.200 per case may be emergency case of vacuum
paid LSCS at a time extraction
however there is no
limitation)
2 Additional Rs.150 per case as - -
cases (Pvt. additional remuneration
Obstetrician) for every case after the
fifth
3 Hiring Rs.1000 per session for a Rs.1000 for each -
charges to minimum of 5 cases. If case (If is assumed
Pvt., less than 5 cases, the that there can be
Anesthetist proportionate amount of only one
Rs.200 per case may be emergency case of
paid LSCS at a time
however there is no
limitation)
4 Additional Rs.150 per case as - -
cases Pvt. additional remuneration
Anesthetist for every case after the
fifth
5 Hiring Rs.1000 for each -
charges to case(It is assumed
Pvt. that there can be
Pediatrician only one
emergency case of
LSCS at a time
however there is no
limitation
6 Transport Rs.150 to each specialist, if Government vehicle is not provided
(Except Chennai Corporation)

Guidelines for Trained Medical Officers of Govt. Institutions

S.No Details Family Welfare LSCS Obstetric
Services Emergencies
1 TA/DA for Govt. As per TNTA rules As per TNTA rules As per TNTA
 Specialists rules
2 LSAS trained Rs.200 per family Rs.200 per LSCS + -
doctors planning session + TA / DA as per
TA / DA as per TNTA rules
TNTA rules
3 EmOC trained Rs.200 per family Rs.200 per LSCS + Rs.200 per
doctors planning session + TA / DA as per Emergency
TA / DA as per TNTA rules procedure + TA
TNTA rules /DA as per
TNTA rules

During the review meetings and field visits , the District health officials have shared the
reluctance of even the service minded private health specialists to attend the Government Health
Institutions especially for provision of EmOC as the Honorarium is relatively meager and the
time spent on travel specifically during nights is huge with additional risks involving safety &
security.
Based on their representations, a proposal to increase the Honorarium and monetary
incentives to the private specialists and trained Government M.Os along with expansion of the
scheme to include Govt. specialists on certain terms and conditions was included in PIP 2012-
13(Ref.No.10).
The same has been approved by NPCC vide Ref. No 11 and also approved by the 20th
E.C. meeting (Ref. No.12).
The revised guidelines as approved by the Executive Committee of State Health Society,
for provision of
(A) Honorarium for hired private specialists
(B) Incentives for trained Medical Officers and
(C) Incentives for Government Specialists
are as follows.
 (A) GUIDELINES FOR HIRING PRIVATE ANAESTHETISTS, OBSTETRICIANS
& PAEDIATRICIANS
Obs. Emerg
(repair of cervical FW procedures (PS /TAT/
S.No Details LSCS tear) LS / MTP with TAT)
7 AM - 7 PM
Rs. 1000 per session of 5
cases (irrespective of the
Hiring of Pvt. Rs. 1500 per number of cases if less than
1 Obstetrician case Rs. 1500 per case or equal to 5).
Rs. 150 per case as
Additional cases additional renumeration for
2 ( pvt.obstetrician) every case after the fifth.
Rs. 1000 per session of 5
cases (irrespective of the
Hiring of private Rs. 1000 per Rs.1000 per case number of cases if less than
3 Anaesthetist case (based on need) or equal to 5).

Rs. 150 per case as

Additional cases additional renumeration for
4 ( pvt.Anesthetist) every case after the fifth.
Hiring of Rs. 250 per
5 pvt.Paediatrician case Not applicable Not applicable
7 PM -7 AM
Hiring of Pvt. Rs. 2000 per
1 Obstetrician case Rs. 2000 per case Not applicable
Hiring of private Rs.1250 per Rs.1250 per case
2 Anaesthetist case (based on need) Not applicable
Hiring of Rs.500 per
3 pvt.Paediatrician case Not applicable Not applicable

• Hiring may be done for Emergency MCH care for repair of cervical tears.
• Hiring of private specialists for performing LSCS shall be done in CEmONC facilities of
secondary level care.
• Hiring of private specialists for obstetric emergencies (repair of cervical tear) shall be done
in all facilities conducting deliveries if the specialist is not available at the time of
emergency (on leave/ Post duty off/ court duty/ week off/ on duty at camps, training)
• Hiring of private specialists for conducting Family Welfare Procedures shall be done in
DMS Institutions if the specialist is not available.
 (B) GUIDELINES FOR INCENTIVES FOR LSAS & EmOC TRAINED
MEDICAL OFFICERS
FW procedures (PS
Obs. Emerg (repair of /TAT/ LS/ MTP with
S.No Details LSCS cervical tear) TAT)
IN THE SAME FACILITY
7 AM - 7 PM
EmOC
trained Rs. 200 per Family
1 M.Os Rs. 250 per case Rs. 250 per case Planning session
LSAS
trained Rs. 250 per case (as per Rs. 200 per Family
2 M.Os Rs. 250 per case need) Planning session
7 PM - 7 AM
EmOC Rs.250 per case
trained + Rs. 500 as Rs.250 per case + Rs.
1 M.Os mobility support 500 as mobility support Not applicable

LSAS Rs. 250 per case Rs.250 per case (as per
trained + Rs. 500 as need) + Rs. 500 as
2 M.Os mobility support mobility support Not applicable
IN OTHER GOVERNMENT INSTITUTIONS
7 AM - 7 PM
EmOC Rs. 250 per case Rs. 200 per Family
trained + Rs. 500 as Rs. 250 per case +Rs. Planning session + Rs.
1 M.Os mobility support 500 as mobility support 500 as mobility support

LSAS Rs. 250 per case Rs. 250 per case (as per Rs. 200 per Family
trained + Rs. 500 as need) +Rs. 500 as Planning session + Rs.
2 M.Os mobility support mobility support 500 as mobility support
7 PM - 7 AM
EmOC Rs. 250 per case
trained + Rs. 500 as Rs. 250 per case +Rs.
1 M.Os mobility support 500 as mobility support Not applicable

LSAS Rs. 250 per case Rs. 250 per case (as per
trained + Rs. 500 as need) +Rs. 500 as
2 M.Os mobility support mobility support Not applicable
Incentives will be provided for Government Specialists for the additional services (non-duty
hours / weekly off etc) rendered by them when no specialist is available on duty . The details
are as follows.

(C)GUIDELINES FOR INCENTIVES FOR GOVERNMENT SPECIALISTS

FW procedures (PS
Obs. Emerg (repair of /TAT/ LS/ MTP
S.No Details LSCS cervical tear) with TAT)
IN THE SAME FACILITY
7 PM - 7 AM
Rs. 500 per case +Rs.
Govt. 500 as mobility Rs. 500 per case + Rs.
1 Obstetrician support 500 as mobility support Nil.
Rs. 250 per case +Rs. Rs.250 per case (as per
Govt. 500 as mobility need) + Rs. 500 as
2 Anaesthetist support mobility support Nil.
Govt.
Paediatrician Rs. 250 per case +Rs.
(LSCS/ 500 as mobility
3 normal) support Not applicable Nil.
IN OTHER FACILITIES
7AM - 7 PM
Rs.200 per Family
Planning session +
Govt. Rs. 500 as Mobility Rs. 500 as Mobility Rs. 500 as Mobility
1 Obstetrician support support support
Rs.200 per Family
Planning session +
Govt. Rs. 500 as Mobility Rs. 500 as Mobility Rs. 500 as Mobility
2 Anaesthetist support support ( as per need) support
Govt. Rs. 500 as Mobility
3 Paediatrician support Not applicable Nil.
7 PM - 7 AM
Rs. 500 per case +Rs.
Govt. 500 as mobility Rs. 500 per case+ Rs.500
1 Obstetrician support as mobility support Not applicable
Rs. 250 per case +Rs. Rs.250 per case (as per
Govt. 500 as mobility need) + Rs. 500 as
2 Anaesthetist support mobility support Not applicable
Rs. 250 per case +Rs.
Govt. 500 as mobility
3 Paediatrician support Not applicable Not applicable