Topic: National Rural Health Mission (NRHM) (2005-2012)

Question: Discuss in brief the National Rural Health Mission (NRHM) .

Answer : National Rural Health Mission (NRHM) (2005-2012) : Health is an important determinant of economic and social development. Recognising the significance of health, to improve the quality of life of citizens, government of India has launches the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health care delivery system. The goal of the mission is to improve the availability of and access to quality health care by people, especially those residing in rural areas, the poor, women and children.

State of Public Health

The public health expenditure has declined from 1.3% of GDP in 1990 to 0.9% of GDP in 1999. The union govt. contribution to public health expenditure is 15% while state contribution is 85%. There is lack of community ownership of public health programme. Health care services have striking regional inequalities. The curative services favour the non-poor: for every Rs. 1 spent on the poorest 20% population, Rs. 3 is spent on richest quintile. Only 10% of Indians have some form of health insurance which is mostly inadequate. Hospitalised Indians spend on an average 58% of their total annual expenditure. Over 40% of hospitalised Indians borrow heavily or sell assets to cover expenses. Over 25% of hospitalised Indians fall below poverty line because of hospital expanses.

NRHM — The Vision

• NRHM seeks to provide effective health care to rural population throughout country with special focus on 18 states which have weak public health indicators/ or weak infrastructure.

• The mission is an articulation of the government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP.

• It aims to undertake architectural correction in health care to enable it to effectively handle increased allocations and promote policies that strengthen public health management and service delivery in the country.

• It aims at effective integration of health concerns with determinants of health like sanitation and hygiene, nutrition and safe drinking water through a district plan for health.

Goals

1. Reduction in IMR and MMR.

2. Universal, access to public health services such as women’s health, child health, water, sanitation and hygiene, immunisation and nutrition.

3. Access to Integrated Comprehensive Primary Health Care.

4. Population stabilisation, gender and demographic balance.

Strategies

(a) ‘Core strategies’

1. Train and enhance capacity of Panchayat Raj Institution (PRIs) to own, control 7 manage public health services.

2. Promote access to improve health care at household level through female health activist (ASHA).

3. Health plan for each village Health committee of the Panchayat.

4. Preparation and implementation of an inter-sectoral District health plan prepared by District Health Mission, including drinking water, sanitation and hygiene and nutrition.

5. Integrating vertical health and Family welfare programmes at National, state, block and district levels.

6. Technical support to National, state and District Health Missions, for public health management.

(b) Supplementary Strategies:

1. Regulation of private sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost.

2. Promotion of Public private partnerships for achieving public health goals. Mainstreaming AYUSH — revitalising local health traditions.

Plan of Action

1. Accredited Social Health Activist (ASHA): Every village will have a female Accredited Social Health Activist (ASHA) chosen by and accountable to the panchayat. ASHA would be a bridge between ANM and the village. She will be a honorary volunteer, receiving performance-based compen-sation for promoting universal immuniza-tion, referral and escort services for RCH, construction of household toilet and other healthcare delivery programmes. She will be promoted all over the country with special emphasis on 18 high focus states. The GOI will bear the cost of training incentives and medical kits.

2. Sub-Centres shall be strengthened by providing on Untied fund for local action © Rs. 10,000 per annum.

3. PHC’s shall be strengthened by adequate and regular supply of essential quality drugs and equipments, provision of 24 hrs. service in 50% PHC’s by addressing shortage of doctors.

4. Community Health Centres shall be strengthened as 24 hour first referral units including posting of anaesthetists.

5. A District Health Plan would be prepared; it shall be an amalgamation of field responses through village health plans, state and National priorities for Health, water supply, sanitation and Nutrition.

6. Total sanitation campaign aimed to improve sanitation shall be converged with district Health mission which was promoting hygiene.

7. National disease control programmes for Malaria, TB, filariasis, Kalazar, Blindness shall be integrated under the mission for improved programme delivery.

8. The mission seeks to enhance public-private partnership for public health goals by identifying areas of partnership which are need-based, thematic and geographic.

9. A task force has been formed to examine new health financing mechanism.

Other Features of NRHM

1. NRHM proposes to establish Health trust of India, which shall be a knowledge institution, and a repository of innova-tion research and documentation, health information system, planning, monito-ring and evaluation etc.

2. The mission shall lay special focus on North Eastern states and support these states for creation/upgradation of health infrastructure, increased inability contractual engagement and, technical support under the Mission.

3. The mission envisage an important role for PRI’s and seeks to involve NGO’s ii institutional arrangement at National, state and district levels.

4. The mission seeks to revitalize local health traditions and mainstream AYUSH Infrastructure, including man-power and drugs to strengthen public health system at all levels.

Outcome

(a) National level

1. IMR reduced to 30/1 000 live births.

2. MMR reduced to 100/100,000

3. TRR reduced to 2.1

4. Engaging 250,000 ASHAS

5. Increasing utilization of first referral units from loss than 20% to 75%.

6. Upgrading CHCs to Indian public health standards

(b) Community level

1. Availability of trained community level worker at village level, with a drug kit for generic.

2. Health day at Anganwadi Level on a fixed day for provision of immunization, ante/post natal check ups and services related to mother and child health care, through assured availability of doctors, drugs and quality services at PHC/CHC level.

3. Good health care through assured availability of doctors, drugs and quality services at PHC/CHC level.

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