NATIONAL RURAL HEALTH MISSION

” Meeting peoples health needs in rural areas”

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 State of Public Health in India
Public health expenditure dropped
from 1.3% of GDP to 0.9% in 1999. Lack of community
Union budgetary allocation = 1.3% ownership of public Vertical Health and Family
State budgetary allocation = 5.5% health programmes Welfare Programmes

Union government expenditure to

Over 40% of hospitalized
public health = 15%
Indians borrow heavily or sell
State government expenditure to
public health = 85% assets to cover expenses

Hospitalized Indians spend on

Striking regional inequalities. an average 58% of their total
annual expenditure

Population Stabilization is still Curative services favor Only 10% Indians have some
a challenge the non-poor: form of health insurance
3
• Launched on 5th April 2005 for a period of 7 years (2005-2012) and extended upto year
2017
 National Rural Health Mission

Mission steering group (MSG) Empowered Program Committee (EPC)

State Project Management Unit State Health Mission State Health Society

District Project District Health Mission District Health Society

Management Unit

Block level committee CHC

PHC

Village Health & Untied

Sub Centre
Sanitation committee Fund

ASHA AW
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SELECTION OF ASHA
State Health Society

6. Good leadership
District Health Society
1. Female qualities

2. Resident of the District Nodal Officer

7. Age group of 25 to
same village 45 yrs.

3. Acceptable to the Block Nodal Officer 8. Adequate

community representation from
disadvantaged
Facilitator
4. Education up to population
VIIIth Standard
Gram Sabha
5. One per 1000
8.35 Lakh ASHAs Selected
population
ASHA Training for 23 days 13
 Honorarium to ASHA
One time honorarium Amount (Rs)

Monthly meeting 100

Social mobilization for Health and Nutrition Day 150

Organizing monthly VHSC meetings 100

Meeting of Adolescent girls (Bi- monthly) 100

Honorarium by PHC 500

JSY- 400 + 100+100 600

Sterilization 200,150

DOTS 250

Cataract 175

Toilet Construction 60

RT for Malaria cases 50

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MAJOR INITIATIVES UNDER NRHM
1. Selection of ASHA

2. Rogi Kalyan Samiti (Patient welfare Committee/Hospital Management Society)

3. The Untied grants to sub-centres (SCs)

4. The Village Health Sanitation and Nutrition Committee (VHSNC)

5. Janani Suraksha Yojana (JSY)

6. Janani Shishu Suraksha Karyakarm (JSSK)

7. National Mobile Medical Units (NMMUs)

8. National Ambulance Services

9. Web enabled Mother and Child Tracking system

NEW INITIATIVES
• Home delivery of contraceptives by ASHA

• Conducting DLHS -4 in 26 states where Annual Health Survey is not done

• Scheme for promoting menstrual hygiene

• Untied funds and Rogi Kalyan Samiti grants will be made based on case load and services

• Involving ASHA in Home Based Newborn Care

• Revision in criteria for allocation of funds under NRHM based on performance of States

• Rashtriya Bal Swasthya Karyakram (RBSK)

• Rashtriya Kishor Swasthya Karyakram (RKSK)

• Mother and Child Health Wings

• National Iron Initiative plus

• Free drugs and free diagnostic services

• RMNCH+A

• Delivery Points (DPs)

• Universal Health Coverage

• Comprehensive Primary Health care

• Kilkari – Interactive Voice Response Based Mobile service delivering time sensitive voice messages

• Launch of Nationwide anti-TB drug resistance survey

• Kala-Azar elimination plan

NATIONAL URBAN HEALTH MISSION
CITY LEVEL INDICATORS: PROCESS AND INPUT INDICATORS IN NUHM
NATIONAL HEALTH MISSION
The National Health Mission (NHM) encompasses its two Sub-Missions:
• National Rural Health Mission (NRHM) , and
• National Urban Health Mission (NUHM)

• The main programmatic components include

- Health Systems Strengthening in rural and urban areas,
- Reproductive-Maternal-Neonatal Child and Adolescent Health (RMNCH+A), and
- Communicable and Non-Communicable Diseases.
 Under NHM, health interventions/ initiatives are regularly designed and
implemented to address the healthcare needs of the country.

The steps taken by the Government under the National Health Mission (NHM) to
accelerate the pace of reduction in maternal mortality and infant mortality:-

• Promotion of institutional deliveries through Janani Suraksha Yojana.

• Capacity building of health care providers in basic and comprehensive obstetric care.

• Operationalization of Sub-Centres, Primary Health Centres, Community Health Centres

& District Hospitals for providing 24x7 basic and comprehensive obstetric care services.
• Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal
and postnatal care.

• Mother and Child Protection Card in collaboration with the Ministry of Women and Child
Development to monitor service delivery for mothers and children.

• Antenatal, Intranatal and Postnatal care including Iron and Folic Acid supplementation
to pregnant & lactating women for prevention and treatment of anaemia.

• Village Health and Nutrition Days in rural areas as an outreach activity, for provision of
maternal and child health services.
• Health and nutrition education to promote dietary diversification, inclusion of iron and
foliate rich food as well as food items that promote iron absorption.

• Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in public
health institutions to absolutely free and no expense delivery including Caesarean section.

• 184 High Priority Districts (HPDs) have been prioritized for RMNCH+A interventions for
achieving improved maternal and child health outcomes
• Emphasis on facility based newborn care at different levels to reduce child morbidity and
mortality:
Setting up of facilities for care of sick newborn such as Special New Born Care Units (SNCUs),
Newborn Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) at different levels is a
thrust area under NHM.

• Capacity building of health care providers:

Various trainings are being conducted under NHM to train doctors, nurses and ANMs for
essential newborn care, early diagnosis and case management of common ailments of children.
These trainings are on Navjaat Shishu, Suraksha Karyakram (NSSK), Integrated Management of
Neonatal and Childhood Illnesses (IMNCI), Facility Based Newborn Care (FBNC), Infant and
Young Child Feeding practices (IYCF), etc.
• India Newborn Action Plan (INAP) has been launched with an aim to reduce neonatal
mortality and stillbirths.

• Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal

corticosteroids for preterm labour, kangaroo mother care and injection gentamicin to young
infants in cases of suspected sepsis.

• Home Based New Born Care (HBNC): Home based newborn care through ASHAs has been
initiated to improve new born practices at the community level and early detection and
referral of sick new born babies.
• Intensified Diarrhoea Control Fortnight (IDCF) to be observed in July-August 2015 focusing
on ORS and Zinc distribution for management of diarrhoea and feeding practices.

• Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with
highest infant mortality (UP,MP, Bihar and Rajasthan).

• Management of Malnutrition: Nutritional Rehabilitation Centres (NRCs) have been

established for management of severe acute malnutrition in children.

• Appropriate Infant and Young Child Feeding practices are being promoted in
convergence with Ministry of Woman and Child Development.
• Universal Immunization Program (UIP)

• Mission Indradhanush has been launched in 201 high focus districts to fully immunize more
than 89 lakh children who are either unvaccinated or partially vaccinated; those that have
not been covered during the rounds of routine immunization for various reasons.

• Mother and Child Tracking System (MCTS):

A name based Mother and Child Tracking System has been put in place which is web based to
ensure registration and tracking of all pregnant women and new born babies so that provision
of regular and complete services to them can be ensured.
• Rashtriya Bal Swasthya Karyakram (RBSK):
Health screening and early intervention services has been launched to provide comprehensive
care to all the children in the age group of 0-18 years in the community.
The purpose of these services is to improve the overall quality of life of children through early
detection of birth defects, diseases, deficiencies, development delays including disability.

• Under National Iron Plus Initiative (NIPI), through life cycle approach, age and dose specific IFA
supplementation programme is being implemented for the prevention of anaemia among the
vulnerable age groups like under-5 children, children of 6 – 10 years of age group, adolescents,
pregnant & lactating women and women in reproductive age along with treatment of anaemic
children and pregnant mothers at health facilities