District Health Mission and the District Health Society
On the lines of the State Health Mission, every district will have a District Health Mission headed by the Chairperson, Zila Parishad. It will have the District Collector as the Co-Chair and Chief Medical Officer as the Mission Director.
To support the District Health Mission, every district will have an integrated District Health Society (DHS) and all the existing societies as vertical support structures for different national and state health programmes will be merged in the DHS. The DHS will be responsible for planning and managing all health and family welfare programmes in the district, both in the rural as well as urban areas. There are two important implications of this requirement. Firstly, DHSs planning will have to take note of both treasury and non-treasury sources of funds, even though it may not be handling all sources directly. Secondly, its geographical jurisdiction will be greater than those of the Zilla Parishad and /or Urban Local Bodies (ULBs) in the district
Ensuring Inter-sectoral convergence and integrated planning should be a specific task for the Governing Body of the DHS. However, the DHS is not meant to take over the executive functions of the ZP / ULBs and/or the district health administration. On the contrary, DHS is meant to provide the platform where the three arms of governance ZP, ULBs and district health administration and district programme managers of NHM sectors get together to decide on health issues of the district and delineate their mutual roles and responsibilities.
The DHS may also be viewed as an addition to the district administrations capacity, particularly for planning, budgeting and budget analysis, development of operational policy proposals, and financial management etc. Because it is a legal entity, the DHS can set up its own office which has adequate contingent of staff and experts and can evolve its own rules and procedures for hiring the staff and experts both from the open market as well as on deputation from the Government.
In other words, the DHS is not an implementing agency; it is a facilitating mechanism for the district health administration as also the mechanism for joint planning by NHM related sectors.
|Governance Structure of DHM|
|Chairperson||:||Chairman, Zilla Parishad|
|Vice Chair||:||CEO Zila Parishad|
|Convener*||:||Chief Medical Officer/CDMO/CMHO/Civil Surgeon|
|Members||:||MPs, MLAs, MLCs from the district, Chair-persons of the Standing Committees of the Zilla Parishad, Project Officer (DRDA), Chair-persons of the Panchayat Samitis and Hospital Management Societies, District Programme Managers for health, PHED, ICDS, AYUSH, education, social welfare, Panchayati Raj, State representative, representatives of MNGO/SNGO, etc.|
The overall governance structure of the Society may be as depicted in Diagram-1 below.
Governance Structure of the DHS
|A. Governing Body|
|Chair||:||District Collector/DM/CEO Zilla Parishad|
|Co-Chair||:||DDC cum CEO, Zilla Parishad|
|Chief Executive Officer||:||Chief Medical Officer/CDMO/Civil Surgeon|
|Members||:||Project Officer (DRDA), District Programme Managers for Health, AYUSH, Water and Sanitation [under Total Sanitation Campaign (TSC)], DPMSU, PHED, ICDS, education, social welfare, Panchayati Raj, a State representative, Sub-Divisional Officer, CHC In-charge; representatives of Medical Association/MNGO/SNGO and Development Partners|
|Chair||:||DDC cum CEO Zilla Parishad (CMO in case no Post of DDC/CEO Zilla Parishad is notified in the district|
|Chief Executive Officer and Convener||:||District Programme Manager/District RCH Officer|
|Members||:||Superintendent-District Hospital, All District Programme Managers for health, ICDS, PHED, Water and Sanitation, Education, Panchayati Raj etc.|
Diagram-1 : Governance Structure of the DHS
Role of the District Programme Manager, DHS Secretariat
She is seen as the key player not only in setting up and operationalising the DHS secretariat, but also in arranging managerial and supportive assistance to the district health administration, including general management and logistic support. It is because of the twin responsibility that s/he is been made the Convenor of both the Governing Body as well as the Executive Committee. In the Programme Committees, however, s/he will be a simple member.
B: Planning, Monitoring and Evaluation
C: Inventory management, Procurement & Logistics
Initially, the Society Secretariat will have a core team of 3 full time persons, consisting of the following:
Once the Society Secretariat is operationalised (i.e., the above core staff is in place and the office is set up), the district programme officer posts sponsored under the Centrally Sponsored Schemes and the contractual staff/consultants under the various Health Programmes and bilateral/multi-lateral funding programmes may be brought under the District Health Secretariat.
Procedure for recruitment and appointment of contractual staff
Recruitment can be facilitated by the State Society as this would allow economies of scale and save time.
Process of merger of existing societies into integrated District Health Society
After the District Health Society has been registered, a special meeting of the Governing Body of existing district societies in the health sector has to be convened to adopt the following resolutions:
Appendices to facilitate creation and functioning of Integrated District Societie
|1.||Name of the Society||The Name of the Society shall be District Health Society, District..or DHS (district name).|
|2.||Area of operation||The area of operation of the Society shall be whole of district . (district name)|
|3.||Location||The Society shall have its office at the office of Chief Medical Officer/ Civil Surgeon / Chief Medical and Health Officer / Chief District Health Officer, district, situated at .. (postal address)|
|4.||Objectives||The Society shall assist district health administration in the implementation of various health programmes and projects in the district, with special emphasis on priority sectors like reproductive and child health, population control, control of malaria, TB and leprosy and prevention of blindness and malnutrition etc.|
|5.||Scope of functions||To achieve the above objectives, the Society shall direct its resources towards performance of the following key tasks:
|6.||First members of the Governing Body||The names, addresses, occupations and designations of the First Members of the Governing Body of the Society to whom by the rules and regulations of the Society, the management of the affairs of the Society is entrusted as required under section 2 of the Societies Registration Act, 1860 (No. XXI of 1860) are as follows:-
|A copy of the rules of the Society certified to be a correct copy by three members of the Governing Body is filed along with this Memorandum of Association.|
|7.||Declaration||We, the several persons whose names and addresses are given below having associated ourselves for the purpose described in this Memorandum of Association do hereby subscribe our names to this Memorandum of Association and set our several and respective hands hereunto and form ourselves into a Society under the Societies Registration Act, 1860 (Act, No.XXI of 1860): this.day of 2005 at ..|
|Sl. No.||Name||Occupation and address||Status in Society||Signature||Attested by|
|1.1||These Rules and Regulations shall be called The Rules and Regulations of the District Health Society (District ..), 2005.|
|1.2||These Rules shall come into force with effect from the date of registration of the Society by the Registrar of Societies.|
|2.1||In the interpretation of these Rules and Regulations, the following expressions shall have the following unless inconsistent with subject or context :|
|3.1||Registered office of the Society shall be situated at the Office of the Civil Surgeon / Chief Medical Officer / Chief Medical and Health Officer, .. District having its office at ..|
|3.2||The jurisdiction of the Society shall be the whole of .. (district name)|
|4.1||The following shall be the members of the Society :|
|4.2||The membership of an ex-officio member of the Society and of the Governing Body shall stand terminated when he/she ceases to hold the office by virtue of which he/she was member and his/her successor to the office shall become such member.|
|4.3||The Society shall maintain a roll of members at its registered office and every member shall sign the roll and state therein his/her rank or occupation and address. No member shall be entitled to exercise rights and privileges of a member unless he/she has signed the roll as aforesaid.|
|4.4||All members of the Governing Body shall cease to be members if they resign, become of unsound mind, become insolvent or be convicted of a criminal offence involving moral turpitude or removal from the post by virtue of which s/he was holding the membership.|
|4.5||Resignation of membership shall be tendered to the Governing Body in person to its Executive Secretary and shall not take effect until it has been accepted on behalf of the Governing Body by the Chairperson.|
|4.6||If a member of the Society changes his/her address he/she shall notify his/her new address to the Executive Secretary who shall thereupon enter his/her new address in the roll of member. But if a member fails to notify his/her new address the address in the roll of members shall be deemed to be his/her address.|
|4.7||Any vacancy in the Society or in the Governing Body shall be filled by the authority entitled to make such appointment. No act or proceedings of the Society or of the Governing Body shall be invalid merely by reason of the existence of any vacancy therein or of any defect in appointment of any of its members.|
|4.8||No member of the Governing Body, except the Executive Secretary to be appointed as per these Rules, shall be entitled to any remuneration.|
|5.1||The following shall be the bodies and authorities of the Society :|
|5.2.1||All members of the Society as set out in para 4.1 shall constitute the Governing Body of the Society.|
|5.2.2||The first members of the Governing Body of the Society shall be those mentioned in Clause 6 of the Memorandum of Association. They shall hold office until a new Governing Body is appointed according to these Rules.|
|5.2.3||The management of the affairs of the Society shall be entrusted to Governing Body and the property of the Society shall be vested in the Governing Body.|
|5.2.4||The Society may sue or be sued in the name of the Executive Secretary of the Society or of such other members as shall, in reference to the matter concerned, be appointed by the Governing Body for the occasion.|
|5.3||Proceedings of the Governing Body|
|5.3.1||The meetings of the Governing Body shall be held at least twice a year and at such time and place as the Chair-person shall decide. If the Chair-person receives a requisition for calling a meeting signed by one-third members of the Governing Body, the Chair-person shall call such a meeting as soon as may be reasonably possible and at such place as s/he may deem fit.|
|5.3.2||Following minimum business shall be brought forward and disposed off in every meeting of the Governing Body:
|5.3.3||Every notice calling meeting of the Governing Body shall state the date, time and place at which such meeting will be held and shall be served upon every member of the Governing Body not less than twenty one clear days before the date appointed for the meeting. Such notice shall be issued by the Executive Secretary of the Society and shall be accompanied by an agenda of the business to be placed before the meeting provided that accidental omission to give such notice to any member shall not invalidate any resolution passed at such meeting. In the event of any urgent business the Chair-person may call the meeting of the Governing Body at clear ten days notice.|
|5.3.4||The Chair-person shall Chair the meetings of the Governing Body. In his/her absence, the Governing Body shall elect one from among the members present as Chair-person of the meeting.|
|5.3.5||One third of the members of the Governing Body, including the substitutes nominated under Rule 5.3.7 present in person, shall form a quorum at every meeting of the Governing Body.|
|5.3.6||All disputed questions at the meeting of the Governing Body shall be determined by votes. Each member of the Governing Body shall have one vote and in case of a tie, the Chair-person shall have a casting vote.|
|5.3.7||Should any official members be prevented for any reason whatsoever from attending a meeting of the Governing Body, the Chair-person of the Society shall be at liberty to nominate a substitute to take his place at the meeting of the Governing Body. Such, substitute shall have all the rights and privileges of a member of the Governing Body for that meeting only.|
|5.3.8||Any member desirous of moving any resolution at a meeting of the Governing Body shall give notice there of in writing to the Executive Secretary of not less than ten clear days before the day of such meetings.|
|5.3.9||Any business which it may become necessary for the Governing Body to perform, except the agenda prescribed for the full meeting as set out in para 5.3.2 above, may be carried out by circulation among all its members and any resolution so circulated and approved by majority of the members signing shall be as effectual and binding as if such resolution had been passed at a meeting of the Governing Body provided that at least one third members of the Governing Body have recorded their consent of such resolution.|
|5.3.10||In the event of any urgent business, the Chair-person of the Society may take a decision on behalf of the Governing Body. Such a decision shall be reported to the Governing Body at its next meeting for ratification.|
|5.3.11||A copy of the minutes of the proceedings of each meeting shall be furnished to the Governing Body members within 2 weeks after completion of the meeting.|
|5.4||Powers of the Governing Body|
|5.4.1||The Governing Body will have full control of the affairs of the Society and will have authority to exercise and perform all the powers, acts and deeds of the Society consistent with the aims and objects of the Society.|
|5.4.2||In particular and without prejudice to the generality of foregoing provision, the Governing Body may:
|5.5||Powers and Functions of the Chairperson of the Governing Body|
|5.5.1||The Chair-person shall have the powers to call for and preside over all meetings of the Governing Body.|
|5.5.2||The Chair-person may himself/herself call, or by a requisition in writing signed by him/her, may require the Executive Secretary to call, a meeting of the Governing Body at any time and on the receipt of such requisition, the Executive Secretary shall forthwith call such a meeting.|
|5.5.3||The Chair-person shall enjoy such powers as may be delegated to him by the Society and the Governing Body.|
|5.5.4||The Chair-person shall have the authority to review periodically the work and progress of the Society and to order inquiries into the affairs of the Society and to pass orders on the recommendations of the reviewing or inquiry Committee.|
|5.5.5||Nothing in these Rules shall prevent the Chair-person from exercising any or all the powers of the Governing Body in case of emergencies in furtherance of the objects of the Society. However, the action taken by the Chair-person on such occasions shall be reported to the Governing Body subsequently for ratification.|
|5.6||Executive Committiee and its Sub-Committees (Programme Committees)|
|5.6.1||The Governing Body will constitute an Executive Committee which will be responsible for acting for and doing all deeds on behalf of the Governing Body and for taking all decisions and exercising all the powers, vested in the Governing Body except those which the Governing Body may specifically specify to be excluded from the jurisdiction of by the Executive Committee.|
|5.6.2||The composition of the Executive Committee shall be as follows :|
The Executive Committee may co-opt additional members and/or invite subject experts to its meetings from time to time.
|5.6.4||Meetings of the Executive Committee shall be convened by the Member Secretary by giving clear seven days notice in writing along with the Agenda specifying the business to be transacted, the date, time and venue of the meeting.|
|5.6.5||Meetings of the Executive Committee shall be held at least once every month or more frequently as necessary.|
|5.6.6||The minutes of the Executive Committee meetings will be placed before the Governing Body at its next meeting.|
|5.6.7||The Executive Committee may appoint one or more programme-committees for the purpose of day-to-day execution of the various programmes.|
|5.6.8||The programme committees will submit a monthly performance / progress report to the Executive Committee which shall incorporate these into the consolidated progress reports to be placed before the Governing Body.|
|5.7||Society Secretariat and Executive Secretary|
|5.7.1||Governing Body, with the assistance of the Executive Secretary, will establish a Secretariat of the Society consisting of technical, financial and management professionals to serve as the District Programme Management Support Unit (DPMSU) to assist the district health administration.|
|5.7.2||The Secretariat shall consist of such technical / management units as set out in the Operational Manual prescribed by the State Government.|
|5.7.3||The district level officers appointed under on-going projects sponsored by development partners, if any, shall be physically co-located in the Society Secretariat office.|
|5.8||Powers and Functions of the Secretariat|
|5.8.1||The Secretariat of the Society shall consist of the Executive Secretary and Staff of the Society.|
|5.8.2||The Secretariat will be responsible for day-to-day management of the Societys activities. In particular, it will be responsible for performing all functions of the Society as set out in article 5 of the MoA.|
|5.8.3||The Secretariat will provide Technical Support to the District Health Mission. It will also be responsible for financial management of funds of the Society.|
|5.8.4||The funds sanctioned by the Governing Body/Executive Committee shall be released by the two authorized signatories and a copy of the sanction order marked to the DPMSU for financial management of the same.|
|6.1||The funds of the Society shall consist of the following :|
|7.1||The Society shall cause regular accounts to be kept of all its monies and properties in respect of the affairs of the Society.|
|7.2||The Executive Committee may cause separate Bank Accounts in respect of each scheme or separate ledgers for each scheme under one account. In such an event, the Governing Body shall prescribe written instructions relating to submission of Statement of Expenditure (SoE) for each scheme. The separate Accounts of different Programmes could be audited by different auditors, and submitted to Programme Units separately. However, the DPMSU will ensure one integrated audit of the District Health Society.|
|7.3||The accounts of the Society shall be audited annually by a Chartered Accountant firm included in the panel of Comptroller and Auditor General of India or any qualified person appointed by the Government of India/State Government and any expenditure incurred in connection with such audit shall be payable by the Society to the Auditors. The Office of the Accountant General of State may also, at its discretion, audit the accounts of the society.|
|7.4||The Chartered Accountant or any qualified person appointed by the Govt. of India/State Government in connection with the audit of the accounts of the Society shall have the same rights, privileges and authority in connection with such audit as the Auditor General of the State has in connection with the audit of Government accounts and in particular shall have the right to demand the production of books, accounts, connected vouchers and other necessary documents and papers.|
|7.5||The report of such audit shall be communicated by the auditor to the Society, which shall submit a copy of the Audit Report along with its observation to the State Government.|
|7.6||The Auditor shall also forward a copy of the report to the following:
|8.1||The account of the Society shall be opened in a nationalised bank approved by the Executive Committee or in a scheduled commercial bank as may be specified by the MoHFW, Government of India. All funds shall be paid into the Societys account with the appointed bank and shall not be withdrawn except through a cheque, bill note, other negotiable instruments or through electronic banking (e-banking) procedures signed/electronically authorised by such authorities of the Society Secretariat as may be determined by the Executive Committee.|
|8.2||The Society shall switch over to e-banking procedures as and when the MoHFW, Government of India directs the Society to do so as the principal donor to the Society.|
|9.1||A draft annual report and the yearly accounts of the Society shall be placed before the Governing Body at next meeting for consideration and approval. A copy of the annual report and audited statement of accounts as finally approved by the Governing Body shall be forwarded within six months of the closure of a financial year to the following :|
|10.1||The Society may sue or be sued in the name of Society through its Executive Secretary.|
|10.2||No suit or proceedings shall abate by the reason of any vacancy or change in the holder of the office of the Chairperson or Executive Secretary or any office bearer authorised in this behalf.|
|10.3||Every decree or order against the Society in any suit or proceedings shall be executable against the property of the Society and not against the person or the property of the Chairperson, Executive Secretary or any office bearer of the Society.|
|10.4||Nothing in sub-rule 10.3 above shall exempt the Chairperson, Executive Secretary or office bearer of the Society from any criminal liability or entitle him/her to claim any contribution from the property of the Society in respect of any fine to be paid by him/her on conviction by a criminal court.|
|11.1||The Society may amend these Rules provided that such changes shall not alter the nature and /or the objectives and/or the purposes for which it has been set up. The proposals for any amendments shall be carried out only through the following process :|
|11.2||Proposals for amendments have been circulated to all members of the Governing Body and have been duly included in the written agenda of the ensuing meeting of the Governing Body or a special meeting of the Governing Body;|
|11.3||The Governing Body has endorsed the proposal at least 3/5th of the members of the Governing Body; and|
|11.4||The State Government has communicated, in writing, its endorsements to the Governing Body resolution for the amendment.|
|12.1||The Governing Body may resolve to dissolve the Society by bringing a proposal to that effect in a special meeting to be convened for the purpose, provided that the proposal for dissolution has been duly approved /endorsed through the process prescribed for amendment as set out in para 11.1 of these Rules.|
|12.2||The dissolution proceedings shall be made in accordance with the provisions of the Act as amended from time to time in its application in the State.|
|12.3||Upon the dissolution of the Society, all assets of the Society, after the settlement of all its debts and liabilities, shall stand reverted to the State Government for such purposes as it may deem fit.|
|13.1.||All contracts and other instruments for and on behalf of the Society shall be subject to the provisions of the Act, be expressed to be made in the name of the Society and shall be executed by the persons authorised by the Governing Body.|
|13.2||No contracts for the sale, purchase or supply of any goods and material shall be made for and on behalf of the Society with any member of the Society or his/her relative or firm in which such member or his/her relative is a partner or shareholder or any other partner or shareholder of a firm or a private company in which the said member is a partner or director.|
|13.2.1||The Society shall have a common seal of such make and design as the Governing Body may approve.|
Government Power to Review
|13.4.1||Notwithstanding anything to the contrary contained in these Rules, the State Government and/or Ministry of Health & Family Welfare may appoint one or more persons to review the work and progress of the Society and hold enquiries into the affairs thereof and report thereon. The Central Government may also cause the accounts of the Society to be audited by the internal audit parties of the Chief Controller of Accounts, MoHFW, GOI or do Management Audit through the Financial Management Group, and issue directions, as deemed appropriate, to the Society.|
|13.4.2||The Chair-person of the Governing Body shall have the right to nominate one or more persons to be part of the review / enquiries.|
|13.4.3||The progress review reports and / or enquiry reports shall be included in the written agenda of the ensuing meeting of the Governing Body.|
We, the undersigned being three of the members of the first Governing Body of the District Health Society, certify that the above is a correct copy of the Rules and Regulations of the said Society.
|Sl. No.||Name and address||Signature|
Dated : _________________________
Procurement of goods and services will be organized as per the procedures recommended by the State Society. Commitments made to multilateral/bilateral donor agencies with regard to Procurement Procedures under different Projects would be honoured.
Funds would be ordinarily released from State Health Society to District Health Society in two tranches. The Society funds shall be drawn through cheques and/or bank drafts or through e-banking mechanism as and when the same is introduced.
All cheques shall be signed by two authorized signatories comprising of Accounts Manager and Member-Secretary of the concerned programme committee.
All releases will be made on the basis of a written authorization from the Member-Secretary of the concerned programme committee.
Wherever releases are decided to be made through bank drafts and/or through e-banking, the authorization letter to the bank shall be signed by the concerned authorized signatories.
Note: Wherever, under e-banking procedures, releases are to be made through electronic authorization to the bank to issue cheque/draft/account transfer on behalf of the Society, the electronic authorization will be executed by the same two authorized functionaries of the Society secretariat who have been authorized to sign cheques on the basis of a written authorization from the concerned programme manager and/or consultant and/or Head of concerned Programme Division and/or Executive Secretary and/or Chief Medical Officer.
|Type of expenditure||Authority||Extent of power|
|A : Release of funds to Hospitals/ hospital societies, block Medical Officers and other implementing agencies as per State Government approved norms and/or proposals approved by State Government.||District Programme Manager (DHS)/ Member-Secretary of the concerned Programme Committee||Full powers.|
|B : Release of funds for implementation of plans / allocations approved by Governing Body / Executive Committee, as approved by the Executive Committee.|
|C : Expenditure proposals not covered under categories A and/or B|
|C-1: Procurement of goods
C-2: Repairs and minor civil works
C-3: Procurement of services for specific tasks including outsourcing of support services.
|Chair-person, Governing Body||More than Rs 2.00 lakh and upto Rs. 5.00 lakh per case.|
|Chair-person, Executive Committee||Upto Rs. 2.00 lakh per case.|
|C-4: Miscellaneous items not mentioned above such as hiring of taxis, hiring of auditors, meetings and workshops, training, purchase of training material/ books and magazines, payment of TA/DA allowances for contractual staff and/or non-official invitees to DHS meetings and/or officials deputed to meetings outside the district.||Chair-person, Governing Body||Upto Rs. 1.00 lakh at a time subject to a maximum of Rs. 10 lakh per annum.|
|Chair-person, Executive Committee||Upto Rs 50,000 at a time, subject to a maximum of Rs. 5.00 lakh per annaum.|
|Member-Secretaries of the Programme Committees||Upto Rs 5,000/- at a time subject to a maximum of Rs. 1.00 lakh per annum.|
D-1 : Recruitment and Appointment
Recruitment would be through either of the following two routes:
Recruitment may either be made by the State Society [ e.g. recruitment of Executive Secretary from the open market or recruitment of District Programme Managers on deputation basis] OR by the DHS [e.g. recruitment of support staff for the District Programme Manager] OR a combination of both a may be determined by the State Society.
All appointments would be temporary and would be made for the contract / deputation period as may be determined by the State Government.
D-2 : Terms of appointment (applicable to Society staff and Consultants)
The terms of appointment of the staff of the Society shall be regulated in terms of the guidelines that may be provided by the State Government.
D-3 : Compliance of Statutory Requirements :
The Society shall register itself with relevant government agencies for the purpose of complying with the statutory requirements including regulations governing deduction of tax at source relating to the staff, consultants and experts employed by it and/or consultancies / contracts awarded by it in the course of performance of its tasks.
 E.g. State Health Society, Haryana (SHSH), State Health Society, Bihar (SHSB) etc.
 The 74th Amendment provides for creation of a District Planning Committee to consolidate the plans prepared by Panchayats and Municipalities in the district and to prepare a draft development plan for the district as a whole. However, the DPCs role is limited to planning only and does not include management functions.
 At the district level, operational policy will relate to decisions about procedures, priorities etc. which set the precedent about what management actions are to be followed by the programme managers. For example, the DHS may be authorised to relocate all or some categories of staff within the district. The DHS will be required to evolve and approve a procedure to be followed by the programme managers in this regard.
* The State may decide to designate Convenor of the District Health Mission as Mission Director in respect of the District Health Mission
 This provision is being made to ensure that the DHSs in other districts also benefit from avenues of improvements identified in a district.
 In districts having District Hospital (Male) and District Hospital (Female), Superintendents of both should be included as members of the Executive Committee.
 These include NPSP Medical Officers (WHO), District Programme Managers of the Border District Cluster Scheme (UNICEF) and District Programme Manager for the nutrition projects of the CARE etc.