want to know about indian public health standards ?

our country framing the standards for its public health system popularly called as indian public health standards. the standards are periodically upgraded to improve the quality. for the year 2012, the guide lines were released..if you have interest please click the below given link. 

http://www.mohfw.nic.in/NRHM/iphs.htm

Clinical establishment act — Presentation Transcript

• 1. Dr.Rajive Kumar Dikshit,MD,FCCM,MPH
• 2. What Is Clinical establishmentAct? This bill makes it mandatory for each and every clinical establishment including every individual clinic, consulting chamber, laboratory or any other investigative or treatment place without indoor beds, nursing homes, hospital etc. by whatever name it may be called to register and follow minimum standards of infrastructure i.e. of space / equipment and qualified para medical staff.
• 3.  It provides for mandatory registration of all clinical establishments, including diagnostic centers and single-doctor clinics across all recognized systems of medicine both in the public and private sector except those run by the Defense forces
• 4. As-is-where-is Initially, provisional registration would be granted within 10 days of application on ‘as- is-where-is basis upon receiving the application filed with supporting documents. Once standards have been notified, permanent registration would be provided to all those conforming to the notified standards.
• 5. To stabilize the emergencypatient  (with its grammatical variations and cognate expressions) means, with respect to an emergency medical condition specified in clause (f), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from one clinical establishment to other.
• 6. The registering authoritycan impose fines for non-compliance and if aclinical establishmentfails to pay the same, itwould be recovered as anarrear of land revenue.
• 7. Penalties for non registrationThere are stringent and huge monitory penalties for non registration by any professional, which are more than many criminal penalties of IPC.For First Offence, 10,00 FOR SECOND 50,000,subsequent offenses Rs.5 Lakhs.
• 8. Any person serving in non registered establishment 25,000/-Disobeying any direction or obstruction to inspection Rs. 5 Lakhs.
• 9. Rajasthan and UttarPradesh have alreadyadopted the Act.
• 10.  The state government is making an all out effort to crack the whip on private clinics and hospitals with an Act which would require them to declare the amount of fees they charge, the number of services they offer and get registration from the medical authorities to set up a health facility.
• 11.  clinics and private hospitals will have to mention on a display board about the services they are providing and the fees they are charging for that.
• 12. The proposed Act envisages to have district level committees, which would include district collector, chief medical health officer and superintendent of police.
• 13.  Act would also prescribe minimum quality standards of services at the private clinical establishments. A medical department official said under the Act, no one can open clinics and hospitals without applying for registration. For the first two years, the department would issue temporary registration and after two years, permanent registration would be provided.
• 14. IMA view point This bill unleashes a license Raj. Draconian powers have been vested with authorities at all levels with little provision for appeal. Are doctors doing some illegal work to be harassed like this??
• 15. What IMA proposes - Single Doctor establishment and clinics to be considered for minimum registration only without applying strict rules, these provisions should be prospective in implementing ( old clinics, establishments should be excluded).
• 16. IMA wants that only thoseestablishments with indoorfacilities should be included forregistration under this act. Tilldate existing establishmentsshould be exempted from theprovisions of this act.)
• 17. What IMA proposes That every clinical establishment shall try to provide every possible care for emergency cases so as to stabilize the condition of the patient to best of its ability and refer it to appropriate clinical establishment. This is already a part of ethical conduct. Ethics and rules are different and should not be mixed.
• 18.  There are many more such objectionable and highly detrimental provisions Govt. has included in this Clinical Establishment Act. IMA has given their suggestions in writing to everybody concerned including Union Health Minister and the Parliamentary Standing Committee. But nobody cared and Parliament had passed the Clinical Establishment Bill without discussion.
• 19. NATIONAL COMMISSSION FOR HUMAN RESOURCES IN HEALTH BILL 2011 (NCHRH)
• 20.  Decentralization is a slogan of the Union Government for better organization and achievements. But it is unfortunate to learn that the benign Government is proposing for centralization of powers by forming National Commission and by taking away the autonomy of all the concerned Board, Councils and other wings of the Union Government for health.
• 21.  The Bill in introduction – States to supervise and regulate professional councils in various disciplines of health sector. Page (1) However, subsequently it dissolves all the existing Councils and takes away all their duties and fund.
• 22.  The Medical Council of India, constituted by Indian Medical Council Act 1956, has been an autonomous body regulating medical education in the country. As the majority of the members were elected and represented different states, they were able to give unbiased opinion regarding medical institutions and medical courses.
• 23.  This new Commission is constituted by Central Government appointed members. They will act like a department of union Ministry of health and family welfare and will not be able to give unbiased opinion.
• 24.  As per the clause 105(1) & (2), the Commission, the Board, committee or the National Council will be bound by the directions of the central government. In other words, the Commission, the Committee and the Council will execute the orders given by the central government.
• 25.  9) No elected members from Professional Associations in National Commission 1) National Commission the proposed supreme body with vested powers will have no elected members and State representatives to represent their needs and demands 2) Professionals from other discipline of Management technology and law are given place in this Commission will pave way for dilution and nepotism 3) It is unfortunate in a democratic country elected representative Council is brought under appointed non democratic body
• 26.  There is no provision for the representation from the professional organizations, like Indian Medical Association or Health Universities in the Commission, Board or Council, shunning the voice of the health care providers.
• 27. In the circumstances, it will not be possible for the Commission, Board, committee or Council to provide fair assessment of the medical education or health care delivery.
• 28.  Sec. 100 which bars challenging of removal of name from state register should be deleted. It is unconstitutional and is against the fundamental principles of constitution. No law can bar the citizen of India from seeking a judicial recourse for getting relief against the decision of a regulatory body. Further a single body can’t be investigating, prosecuting, judging and then final super punishing authority whose decision is un- challengeable in the court of Law. It is against natural justice.
• 29. Is the bill is above the existing laws?Clause 100 & 101 (Page 34) says the decisions of the Commission cannot be questioned in the court of law and the agreed persons cannot seek legal remedies.
• 30.  Modern medicine is not defined properly it is defined only as medicine. Health professionals are not properly defined to discharge their duties. Without defining properly the objectives of the bill will not be accomplished.
• 31. Similarly the words" medical practitioner" in section 2(t), should be replaced with the words "modern medical practitioner"
• 32. Doctor doing any other occupationis misconduct? The seventh schedule in continuation of section 68 in Part I (10) (page 50) says engage in any business (or) occupation other than health profession is a misconduct. This prohibits all career opportunities for health professionals.
• 33.  The statement of object andreason for the bill section (2)page 53 says “……. to reduceshortage, standardize qualityand bridge the unevendistribution of existing workforce in the health sector”.
• 34.  With No roadmap. How is the Government going to reduce the shortage of manpower by forming this Commission?
• 35.  Use of attractive words will not solve the problem.- There is no need to dissolve the existing health Councils to achieve this purpose.- Health is a State subject and resources cannot be redistributed by the Central Government.
• 36.  For example - “There is acute shortage of water & electricity in various parts of the country. Will the Central Government constitute the Commission to make even distribution?”·
• 37. Audit and Accounting Clause 77 says even the accounts of State Councils will be audited only by the CAG of Central Government. State will have no role on this
• 38. The Indian Medical Association totally rejects the proposed “National Commission for Human Resources for Health Bill 2011 for the following reasons:-
• 39. BRMS / BRHC Course The Government of India has decided to introduce a Short 3 years course of Modern Medicine, called BRHC (Bachelor of Rural Health & Care) exclusively to serve the Rural population (villages). Decision was taken under the pretext that doctors are not available for rural population. It is understood that for this purpose Medical Schools will be started in District Hospitals.
• 40.  The recruitment of the students will be from rural areas and on completion of the course they will be obliged to serve in their native rural area compulsorily for 5 years. Such graduates will also be given an option to undergo bridge course so as to enable them to obtain MBBS degree. IMA opposes substandard, short BRHC Course.
• 41.  Hon’ble Prime Minister of India said “India needs more Family physicians and efforts will be taken to increase the importance of Family physician. Contradicting to this the bill says 4(c) page 53 “….to ensure uniform augmentation of trained specialist and super specialist” as its priority.·
• 42.  National Commission, the proposed supreme body with vested powers will not have elected members and State representatives to represent their needs and demands.
• 43.  Professionals from other discipline of Management technology and law are given place in this Commission which will pave way for dilution and nepotism. It is unfortunate that in a democratic country elected representative Council is brought under power of non democratic body.
• 44.  Health is a State subject.- Independent Councils is the need of Medical Professions.- NCHRH will do more harm to health education and health care of India.
• 45.  In short NCHRH is of the Government by the Government and for the Government and not for health care and medical education.
• 46.  With No roadmap. How is the Governmentgoing to reduce theshortage of manpower byforming thisCommission?
• 47. Pay scales for Doctors & stipend for Junior Doctors.Salaries of sate govt. doctors should be at par with central govt. scales. Stipend of the junior doctors should be at par with those of central govt. medical institutions.
• 48.  Amend the CPA act. Medical profession should be exempted from the present CPA act, which is crippling the medical fraternity and forcing the doctors to do defensive medical practice resulting in denying of proper medical aid to needy patients.
• 49. Mandatory rural service Indian Medical Association – positively responds to the Govt.’s newly proposed compulsory rural service after internship for MBBS graduates, provided the ‘provisional doctors’ shall get salary and other perks as of regular service personnel along with weight age in PG entrance exam.
• 50.  IMA stresses that this mandatory rural service shall be implied to those students studying in Govt. colleges only. IMA recommends to Govt. of India, that this ‘rural service clause’ shall be optional to those students studying in private medical colleges. IMA would also advise the Hon. Health Minister and BOG of MCI to discuss the matter with all India Junior doctors association and other stake holders in medical education, before finalizing the decision. Likewise there are so many issues relating to health care bothering the medical practitioners at local and state level also.
• 51.  Doctors not going to rural areas is the problem of governance. Adequate allowances and facilities like rural service allowances, proper free accommodation, education allowances for children, vehicle or vehicle allowances, appropriate reservation for education and employment for their children,·
• 52.  sabbatical leave for academic enhancement of Doctors, allowances for attending academic conferences for updating their knowledge, f acility for interest free personal loans should be provided to doctors serving in rural areas. This will attract doctors to rural areas.
• 53.  Enhance budgetary allotment for health care from present meager 2% to at least 12% of GDP. Pay good salaries; make sure the Government PHCs have adequate supply of medicine. All PHCs should be fully equipped with required para - medical staff and nursing staff to help the doctors.
• 54. Mandatory rural service Indian Medical Association – positively responds to the Govt.’s newly proposed compulsory rural service after internship for MBBS graduates, provided the ‘provisional doctors’ shall get salary and other perks as of regular service personnel along with weight age in PG entrance exam. IMA stresses that this mandatory rural service shall be implied to those students studying in Govt. colleges only.
• 55.  IMA recommends to Govt. of India, that this ‘rural service clause’ shall be optional to those students studying in private medical colleges. IMA would also advise the Hon. Health Minister and BOG of MCI to discuss the matter with all India Junior doctors association and other stake holders in medical education, before finalizing the decision. Likewise there are so many issues relating to health care bothering the medical practitioners at local and state level also.

To the society in general !!!!!

To the society in general !!!!!
We have a few questions,
1. Does a doctor get any special discount on MRP of consumer goods?
2. Does any school waives its fees for a doctor's kid?
3. Does a doctor get any special tax rebate?
4. Does the govt. give permanent jobs to doctors in village?
5. Does the courts convict the people who attack doctors on duty?
6. Does a doctor get any discount on railway,airplane ticket or petrol?
7. Is the doctor responsible for poor health infrastructure or the politicians whom you elect on the basis of caste,religion or quotas?
8. Does Amir Khan treat you when you are ill?
9. Why should a doctor not be paid well for saving your life? Or is it that your life is worthless?
10. Is Amir Khan promoting good health by doing ads for coca-cola and earning millions?
11. Why should a doctor sacrifice his life and happiness for you? What have you done to deserve it?
I am a doctor because I am capable and not because of charity.....I am qualified on my own merit and not because you elected me....So Mr. Amir Khan until you have the answers of the above questions,SHUT YOUR BLOODY TRAP and do what you do best-dancing for money. And yes next time do a show on the plight of children of divorced parents..You can start the research from your own kids..!

वे डॉक्टर नहीं रहना चाहते !!!!!!

ठीक है कि वे डॉक्टर नहीं रहना चाहते
योजना आयोग के मुताबिक, देशमें छह लाखडॉक्टरों, दस लाखनर्सों और दो लाखडेंटल सर्जनों की कमी है। पिछले एक साल में एक दर्जन वरिष्ठ प्रोफेसर एम्स छोड़ चुके हैं और अनेक वरिष्ठ प्रोफेसर रिटायर होने वाले हैं।
इस साल की सिविल सर्विसेज परीक्षा में एम्स से डॉक्टरी की पढ़ाई कर चुकीं शीना अग्रवाल अव्वल आई हैं। कश्मीर घाटी से सफल हुए छह उम्मीदवारों में से पांच डॉक्टरी की पढ़ाई पूरी कर आए हैं। डॉक्टर आखिर आईएएस क्यों बनना चाहते हैं? कुछ साल पहले सफल हुए केरल के डॉ. समीरन ने डॉक्टर की सरकारी नौकरी के दौरान महसूस किया कि स्वास्थ्य के मुद्दे वास्तविक तौर पर सिर्फ स्वास्थ्य के मुद्दों तक ही सिमटे नहीं होते। इसी को ध्यान में रखकर उन्होंने चिकित्सा के बजाय प्रशासन का रास्ता पकड़ा।
बात 1982 की है, जब इंदिरा गांधी से मिलने नवनियुक्त आईएएस अधिकारी आए हुए थे। एक एक अधिकारी का परिचय प्राप्त करते हुए जब वह आगे बढ़ रही थीं, तो एक मेडिकल डॉक्टर आईएएस की बात सुनकर उन्होंने पूछा, आपको इस सर्विस में आने की क्या जरूरत पड़ी? युवा डॉक्टर आईएएस ने जवाब दिया कि एक सरकारी मेडिकल अफसर से सिविल सर्जन बनने में मुझे बीस साल लगेंगे और फिर भी डिस्ट्रिक्ट कलक्टर को रिपोर्ट करना होगा। आईएएस बनकर मैं महज चार साल में डिस्ट्रिक्ट कलक्टर बन जाऊंगा।
एम्स के वरिष्ठ प्रोफेसर डॉ. शक्ति गुप्ता ने कुछ साल पहले एक अध्ययन प्रकाशित किया था कि एम्स में साढ़े पांच साल की एमबीबीएस की पढ़ाई पूरी करवाने में प्रति छात्र लगभग एक करोड़ सत्तर लाख रुपये खर्च होते हैं। तब यह तथ्य भी सामने आया कि औसतन तिरेपन फीसदी छात्र एम्स की पढ़ाई के बाद उच्च अध्ययन या ज्यादा पैसा कमाने के लिए दूसरे देशों में चले जाते हैं। यही हाल आईआईटी का है। लंबे समय तक मद्रास, आईआईटी के निदेशक रहे डॉ. इंदिरेशन ने अपने एक लेख में हिसाब लगाया था कि आईआईटी से एक विद्यार्थी को पढ़ाई कराने में बीस से तीस लाख रुपये का कैपिटल खर्च आता है और उस समय के हिसाब से दो लाख रुपये का रनिंग खर्च।
करीब दस साल पहले प्रणब मुखर्जी की अध्यक्षता में एक संसदीय समिति बनी थी, जिसने सुझाव दिया था कि सिविल सेवा परीक्षाओं में सम्मिलित होने से इंजीनियरों और डाक्टरों को वंचित किया जाना चाहिए, क्योंकि वे प्रचुर सबसिडी प्राप्त विशेषज्ञ शिक्षा प्राप्त करते हैं, पर देश को उनकी विशेषज्ञता का कोई लाभ नहीं मिलता। लेकिन इस सिफारिश को कूड़े के ढेर पर फेंक दिया गया। गौरतलब है कि जापान और फ्रांस जैसे देशों ने अपने यहां नौकरशाही में प्रोफेशनल डिग्रीधारियों को प्रतिबंधित कर रखा है।
योजना आयोग के मुताबिक, भारत में छह लाख डॉक्टरों, दस लाख नर्सों और दो लाख डेंटल सर्जनों की कमी है। इस रिपोर्ट के अनुसार बिहार में अभी एक करोड़ पंद्रह लाख, उत्तर प्रदेश में पंचानबे लाख, मध्य प्रदेश में तिहत्तर लाख और राजस्थान में अड़सठ लाख की आबादी पर एक मेडिकल कॉलेज है, जबकि केरल में सिर्फ पंद्रह लाख, कर्नाटक में सोलह लाख और तमिलनाडु में उन्नीस लाख की आबादी पर एक मेडिकल कॉलेज कार्यरत है। एम्स की आम लोगों और मेडिकल विशेषज्ञों के बीच जो भी प्रतिष्ठा हो, सरकारी नीतियों और राजनेताओं और नौकरशाहों के अत्यधिक हस्तक्षेप ने इसकी चमक फीकी करने में कोई कसर नहीं छोड़ी। स्वास्थ्य संबंधी ढुलमुल नीतियों ने भी एम्स से डॉक्टरों के पलायन का मार्ग प्रशस्त किया। पिछले एक साल में एक दर्जन वरिष्ठ प्रोफेसरों ने एम्स को अलविदा कह दिया और अगले तीन वर्षों में करीब चार दर्जन वरिष्ठ प्रोफेसर रिटायर होने जा रहे हैं। यानी चिकित्सा के क्षेत्र में हमारी राष्ट्रीय चुनौतियां अभी थमने वाली नहीं हैं।

What are the cases that should be regarded as medico legal?

The following cases must be labeled as medicolegal by the treating doctor and medicolegal report should be prepared for further legal investigation
All injury/hurt cases, circumstances of which suggest commission of offence by someone
All traffic vehicular, railways, aeroplane, ship, boat, factory, construction site or other unnatural accidents
Self–inflicted injuries/attempted suicide
Cases of criminal abortion
Accidents where there is likelihood of death or grievous hurt
All cases of suspected or evident poisoning
Suspected or evident homicide, suicide including attempted
All burn injuries, whatever the cause of burn
All suspected or evident sexual assaults
All suspected or evident criminal abortion
Unconscious cases where the cause is not natural or not clear
Cases referred by Courts for age estimation
Cases brought dead with improper medical history
Dead on arrival cases or patients who die shortly after being brought to the hospital before a definite diagnosis can be made
Patients dying suddenly after parenteral administration of a drug or medication
Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital
Death on the operation table
Unexplained death after surgery or interventional procedure
Unexplained ICU death
Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.
Relatives of the patient assault the treating doctor or other staff of the hospital.
Any other case not falling under the above mentioned category but has legal implications like medical examination of arrested accused without consent of person.
In case of death of a medicolegal case, the treating doctor has to only handover the body to the concerned police officer with written recommendation for medicolegal (Forensic) autopsy in final death summary/discharge report and a receipt must be obtained for record.

Financial Management, Internal Control & Accounting System at State/District Health Societies & Blocks /RCH Societies

                     GUIDING PRINCIPLES OF FINANCIAL MANAGEMENT

5.1     The overall internal control framework of the NRHM programme is governed by the provisions of this manual read together with procurement manual and prescribed financial limits/norms issued by various pogrammes of Ministry of Health & Family Welfare and various programme guidelines such as Janani Suraksha Yojana, MNGO guidelines and ASHA guidelines etc.

5.2     Any officer of a State Health Society or of a District Health Society, who is authorized to incur expenditure or draws money out of the RCH-II funds (Bank A/c) for disbursement, should treat himself as a trustee of the funds of such society or District Unit and would therefore, manage all types of financial affairs in the capacity of a sincere Executive trustee.

5.3     The officer, who is authorized to draw and incur expenditure out of a State Health Society or a District Health Societyfund, is expected to exercise same vigilance, which a man of ordinary prudence exercises while incurring his own money. He should keep in mind that:-

i)                   Funds should not be drawn if they are not required for immediate   disbursement.

ii)                Funds should not be utilized directly or indirectly on himself or on any family member or relative of the officers who operate the funds of the society or a unit for the time being.

iii)              The Mission Director at State Health Society and District Programme officer(s) at District Health Society level will ensure, with the help and assistance of State Finance Manager, State Accounts Manager respectively, that an efficient system of internal financial control is introduced, for which they should visit District Health Society & Programme implementing Agencies frequently & make instant inspections/examinations of Cash Book, Bank Pass Book, Ledgers & some vouchers of more than Rs.5,000/- value and satisfy themselves that all of these are being maintained properly. Similarly, District officials (including DPMU staff) should make regular visits to the sub-district levels to ensure that efficient and sound financial system is in place. During the visit, they may verify the implementation status of various programmes as per the checklist. RNTCP and IDSP already have a checklist for the verification purpose on the field visits. 

iv)              Officers authorized to incur expenditure must ensure that financial order and strict economy are enforced at every step and see that all-relevant financial rules, orders, directions and instructions are observed.

v)                It should be seen that not only the total expenditure is kept within the limits of the budget provision but also that the funds allotted/transferred, are spent strictly in the interest and service of the programme and upon the objects for which provisions have been sanctioned.

vi)              He will also see that items of expenditure are of obvious necessity and are at fair and reasonable rates, sanction of the competent authority obtained and calculations are correct.

vii)           In order to exercise proper financial control, he should keep himself closely acquainted with the progress of receipts, expenditure, commitments or liabilities incurred but not paid.

CHECKS TO BE EXERCISED BEFORE WITHDRAWAL & DISBURSEMENT OF FUNDS

5.4     Before authenticating a cheque for any payment/disbursement, the cheque drawing officer, in this regard, shall ensure that:

i)             There is a proper and formal statement of claim (Bill) or invoice through which payments have been demanded by the concerned person or party or firm.

ii)          Invoice must be marked “Passed for Payment” on its face by competent authority. In case of advance adjustments, it should be marked “Passed for Adjustments”.

iii)        That the purchases made or services received are according to the approved plan and the claimant is entitled to get it.

iv)        That the particulars of the claim i.e. rates, calculations, net payable amount etc. have been examined/checked by the Accountant or by an authorized accounts person and have also been entered in appropriate stock/store register wherever necessary and certification on this account has been made on the bill/claim itself by an authorized officer.

v)          A competent sanction to incur expenditure is attached with the claim.

vi)        ADVANCES:

§  In case of advances payments, it must be ensured that all earlier advances to the same person/party and for the same purpose have been settled/adjusted. No advances should be made to a person/party if an advance is already pending for settlement for the same purpose.

§  All the advances should be settled within a maximum period of 90 days. All the advances should be entered in Advance Register as per APPENDIX 10. Settlement of advances should be tracked as per Advance Tracking Register as per Appendix 11). Age wise analysis of unsettled advances should be prepared and periodically be reviewed by Programme Officers.

§  For settlement of long pending advances lying with various institutions/organizations, special drive may be undertaken by forming special teams and deputing them to these institutions.

vi) AUTHORIZATIONS & PAYMENTS FOR CONTRACTS/AGREEMENTS:

§  Payments to be made in accordance with the terms and conditions of the contract/agreement including compliance with the conditions relating to performance guarantee and bank guarantee.

§  Goods receiving officers to certify the quality and quantity of the goods received.

§  Evidence to show the delivery of goods and services at the agreed time and place of delivery should be obtained.

5.5     POST PAYMENTS INTERNAL CONTROLS:

§  Paid invoice and supporting documents must be defaced with the seal of “Paid & Cancelled”. The reference of cheque vide which the payment made is to be recorded on invoice.

§  All the paid vouchers must be serially numbered and maintained box file.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

5.6     PROCEDURE FOR UTILISATION OF FUNDS

i)                   The Society funds shall be drawn through cheques and/or bank drafts. All payments to the maximum extent possible should be made by cheques only. Cash payment should be discouraged at all levels.

ii)                Any payment above Rs 5000/- must necessarily be made through crossed Account payee cheques only.

iii)              All cheques shall be signed by at least two signatories as authorized by the Governing/Executive body of the Society in line with defined guidelines . Similar control mechanisms should be ensured in case of electronic transfer of funds.

           

5.7     PREPARATION OF CHEQUES

i)                   All the cheques shall be entered in the Cheque issue register before they are submitted for signatures, indicating its number, amount, name of the person or party, purpose  and date of issue, etc.

ii)                Cheque books, new or used or under used shall be kept in the personal custody of one of the officer who are authorized to put their signature on the cheques.

iii)              Acknowledgement of a cheque shall be obtained from the payee (receiver) in the prescribed format.

iv)              CASH WITHDRWAL: Signatures with date shall be obtained in the cheque issue Register from the Cashier/Accountant for each cheque, which is endorsed in his favour or handed over to him for obtaining cash payment from the bank.

v)                All persons handling cash and keeping valuable stores should be required to provide Fidelity Insurance in favour of the State Health Society of not less than Rs.1,00,000/- from a Nationalized Insurance Company or Bank against which monthly security allowance will be paid on the basis of 1% of the ‘Fidelity Insurance’ value per month.

5.8     WRITING OF CASH BOOK

i)                   All payments which are received in the State Health Society or in a District Health Society and at Block CHC/PHC, either in cash or through cheques/bank drafts/money orders/bankers cheque etc. shall be first entered in the prescribed register and then entries in the cash book shall be made, on the same day. Likewise all payments/disbursements shall be entered in the cash book on the day of the payment.

ii)                Receipts shall be issued, for the cash/bank Drafts/Banker cheque and money orders on its entry in the prescribed register, signed either by one of the fund operator or by an authorized officer.

iii)              Cash book shall be written on daily basis and closed on the same day and put up for checking & authentication to one of the cheque signing officer as decided by the chairperson of the Executive Committee of a State/District Health Society.

iv)              Cash book should be closed daily and if no transactions have taken place in a day/s the entry "No Transaction" has to be noted in the cash book on that day/s in red ink and balances are to be carried over to next day.

v)                Cash balance, more than Rs.10,000/-, should be avoided to be kept in office, as far as possible.

vi)              Escort should be provided to the cashier when he is required to carry the amount more than Rs.10,000/- from the bank at a time. Cashier should be provided vehicle to obtain heavy cash form the Bank.

vii)           The Cash book is the principal record of all money transactions taken place every day and all other registers are subsidiary. It should be maintained on the basis of double entry system as per format appended with the manual.

viii)         Each entry of receipt and expenditure should be descriptive but brief in nature. Each voucher should be assigned a serial number and Ledger Folio number, which should be noted against each entry in the cash book.

ix)              All cash/cheques/Demand Drafts etc. received should be deposited into bank as far as possible on the same day itself, otherwise on the next working day positively. If any cash remains in office on any day it should be kept in the cash chest/vault which should have double lock system. The cash kept in the chest should be deposited in the bank account on the next day and the entry in the cash book should be verified physically by the authorized officer.

x)                Over writings should be avoided and corrections, if any, should be attested by the authorized officer under his dated initials.

xi)              While making payments through cheque, its number should invariably be noted in the cash book for cross checking.

xii)           Format of Cash Book to be maintained at State Health Society and District Health Societies and Block Units .

VERIFICATION OF CASH BALANCE

         

5.9     The contents of the cash chest/cash box should be verified by the SFM/SAM at State level, by DAM at District Level and Block Accountant at Block level and Programme Officer at Health Society level at least once in a month at the close of the month or on the first day (immediately after opening of Office) of the next month and the amount will be compared with the cash book balance shown in the Cash Book.

         

5.10   The result of verification should be recorded in the cash book each time as under: “Certified that Cash Balance checked and found correct”. In case the cash balance is found to be less or in excess then the balance shown in the cash book, the fact should be recorded in the cash book and a formal report should also be submitted to the next higher authority for further necessary action. 

5.11   A cash balance certificate shall be obtained at the end of each year as per the format provided in appendix.

MAINTAINING BOOKS OF ACCOUNT

         

5.12   Complete and correct accounts in respect of each monetary transaction occurring at State Health Societys or at District RCH Societies shall be maintained through prescribed Books of Account including Registers as indicated below:

(a)        Cash book with cash & Bank columns.

(b)       Petty cash book

(c)        Cheque issue register

(d)       Register of Bank drafts and Cheques received

(e)        Bank Pass Book/Bank Statement

(f)         Register of Bank drafts/Cheques dispatched.

(g)        Ledger (in line with the Chart of Accounts of various programmes)

(h)       Journal

(i)          Registers for Temporary advances as below

·        Advance to the staff (Control Account)

·        Advances to the Contractors/suppliers/CHCs/PHCs. (Control Account)

·        TA/DA advance (Control Account)

(j)          Salary Register

(k) Fixed Asset Register:

§  Machinery & Equipment's

§  Civil Works,

§  Mobile Medical Units, ambulances etc.

(l)          Stock Registers for: -

·        Furniture & other non-consumable articles.

·        Register for drugs & medicines.

·        Register of consumable articles

(m)     Register of advances to NGOs and other Voluntary Agencies implementing NRHM.

(n)       Dispatch Register

N.B.  Any other book of accounts and resisters, which may be considered necessary for the day-to-day work of the State/District Health Society, the same may be maintained.

5.13   The State Health Society and its District Health Society shall maintain Dead Stock Registers, separately for machinery & equipment's and other non-consumable articles and  shall also arrange for physical verification of stores articles of permanent or long duration nature, at least once a year in the month of April. If any item of permanent nature is purchased at CHC/PHC level, entry in the concerned Register of District RCH Society shall be made on the basis of the voucher or bill etc.

         

5.14   All functionaries should ensure that only actual expenditure incurred is treated as expenditure and not the normative costs in accounting. Therefore, fund released by the State Health Society to District Health Societies or to any other implementing agency by the District Health Society such as CHC/PHC etc. shall, initially be classified as Advance and the same is indicated as such in the books of accounts. The advances shall be adjusted based on the expenditure statement/utilization certificate received from the Advancee.  Advance, if not actually spent or if spent but accounts not settled should be shown as advance and not as expenditure and all such outstanding/unsettled advances should be shown in the SoEs separately.

5.15   The audit will verify the status of settlement of all advances.

MIS-CLASSIFICATION OF EXPENDITURE

5.16   If any item of receipt or payment (cheque), belongs to one head of account has been wrongly classified under different head, the error can be corrected by making an adjustment entry in the journal and posting of the same in the related ledger account heads. It should be noted that such corrections in the cash book or ledgers can be made before the accounts of a financial year are closed to prepare annual accounts for audit purposes.

JOURNAL

5.17   Journal is one of the important account book but its use is restricted to recording adjustment entries only other than cash transactions. Vouchers shall support each adjustment entry passed through a Journal. Brief narration of each entry shall be given in the voucher and it should be signed by the Cheque drawing officer. The Finance/Accounts Manager at Health Society will check each such entry of the Journal with the Journal voucher and other subsidiary vouchers and put dated initials against the entries checked.

LEDGER

5.18   The ledger is also an important register in which all transactions recorded in the cash book or journals are classified under different heads of accounts.

5.19   The ledger should be kept in the standard form. Separate pages are to be opened for each item of expenditure. The ledger accounts shall be arranged and grouped in such a manner that the desired information is promptly secured.

5.20   Every ledger account is divided into two sides, the left-hand side being the "debit side" and the right hand side the "credit side". All items of debits and credits of the cash book and journal shall, invariably be posted on the same day in respective ledger accounts. Daily totals should be made, shown in the inner column and the progressive totals shown, wherever necessary in the outer (balance) column.

5.21   All the ledger accounts shall be closed at the end of the month. Totals would also be made in the classified abstract. Monthly totals of various ledger accounts shall then be tallied with the totals of classified abstract and discrepancy, if any, will be rectified and reconciled.

5.22   Bank account shall be posted from the daily totals of cheques issued and challans/remittances (deposited) made into the Bank.

RECEIPT AND PAYMENT STATEMENT

5.23   Monthly account of receipts and payments shall be prepared immediately after closing of the accounts for the month but not later then 5^th of the next month.

BANK RECONCILIATION STATEMENT

5.24   Bank reconciliation statement will be prepared on monthly basis by reconciling the cash book and Bank Pass Book/Bank Statement by 10^th day of the following month.  Bank Pass Book will be sent to the bank on weekly basis for making up-to-date entries of credits and debits in the month.  Any discrepancy will be rectified and difference explained in the bank reconciliation statement as per the format provided .

         

ADVANCE REGISTER

5.25   All advances sanctioned to an officer of State Health Society or to the District Programme Management Unit or to the In-charge Medical Officer of a CHC or PHC or to any other official of the above institutions and also to any non-government organization, shall be entered in the Advance Register (format given in  immediately after the advance amount/ cheque is given to the advancee. Any advance remaining unadjusted at the year end may be adjusted in the SoE for the last quarter of the year. However, the procedure for adjustment/settlement/refund of advances and their depiction in the Advance Register may continue as prescribed. The audit by Chartered Accountant would ensure the compliance and also highlight the advances pending adjustment for long period.  For the purpose of facilitating proper tracking of advances and their settlement, an Advance Tracking Register should be maintained, at all the levels from where the advances are given, in the Format given.

REGISTER OF FIXED ASSETS

5.26   Each State/District Society shall maintain Stock Registers for the articles or item of permanent or of non-consumable nature indicating the details of such assets e.g. furniture, fixtures, equipment's, machinery, instruments, vehicles, computer systems etc. purchased during the programme period. Such register is also called as Register of permanent (nature) articles or Dead Stock register. Annual physical verification shall be carried out in the month of April every year. This register shall be maintained in the format given.

5.27   Only those articles, as mentioned in the above para, will be treated as assets of the society which are procured, used and installed in the Office of the Society and will form part of the core asset of the society. Formal tracking as per the requirements of the Asset Register for the entire life of the asset will be done by the society.    

5.28   All other assets which are purchased by the society and subsequently handed over to the Office of Health & Family Welfare/Family Welfare Stores/CMOs/PHCs/CHCs, etc. will be shown as transferred to such entities in the Asset Register and no further tracking about the life of the asset will be required. However, a certificate from the receiving entity will be required to be kept in the asset register with contra- entry in the ‘Location/Under custody’ column of the Asset Register .

RE-APPROPRIATION OF FUNDS

5.29     Any changes in the approved PIP/AWP may be discussed during the quarterly and annual reviews and implemented by mutual consent. The States/UTs may amend their approved AWP within 10% of any of the sub item(s) so as to have flexibility in inter-component use of funds without affecting the overall outlay approved for the State/UT for the year. Activity-wise performance evaluation will then be synchronized with the revised work plan. In all such cases FMG, GOI will necessarily be informed of this revision.

COMPUTERISATION OF ACCOUNTS

 

5.30   It is desirable that maintenance of accounts at the State/UT Health Societies as well as at District Health Societies is computerized so that the account statements can be prepared accurately and promptly with least efforts and time. State should maintain accounts in Tally software as the trained personnel in this software are widely available. 

5.31   Even if the accounts are maintained in computerized form in Tally, at least the Cash Book should be maintained manually as well.  The print out of daily, weekly or monthly statements may also be serially kept in file.