National Rural Health Mission – An Overview

Journey to NRHM

Family Planning Programme(1952)Education and Target oriented approach(1961-66)

Under PHC-PPP and MTP Act(1969-74)

FP FW(1975-80)National Health Policy-I(1983)

Strengthening of MCH (1983)CSSM(1992)

ICPD(1994)Review of CSSM(1996)

RCH(1997)

NRHM(2005)

National Rural Health Mission launched in April, 2005

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Rejuvenate the Health delivery System

Universal Health Care

• Affordability• Access• Equity • Quality• Reduce IMR, MMR,TFR• Improve Disease control

Goals of the Mission4

• Universal Health care, well functioning health system

• Reduce IMR to 30/1000 live births by 2012

• Reduce MMR to 100/100,000 live births by 2012

• TFR reduced to 2.1 by 2012

• Reduce & sustain Malaria Mortality to 60% by 2012

Goals of the Mission

• Kala Azar eliminated by 2010, Filaria reduced by 80 % by 2010

• Dengue Mortality reduced by 50% by 2012

• TB DOTS maintain over 70 % case detection & 85% cure rate

• 46 lakh cataract operations annually by 2012.

• Upgrading all health facilities to IPHS.

• Increase utilization of FRUs from 20% bed occupancy to 75%

The Paradigm Shift7

Decentralised planningOutputs and Outcome basedPro-Poor Focus: Equitable systemsQuality of Care and the IPHS norms

• Rights based service delivery• Pre stated entitlements at all levels• Inputs computed as function of the entitlements and

estimated patient load• Judicious mix of dedicated budget lines - untied funds• Monitor quality

Community Participation at all levels

RCH-II NVBDCP

RNTCP NLEP

NPCB IDSP

IDDCP

N.R.H.M.

The Paradigm Shift9

Bringing the public back into public health• At hamlet level : ASHA, VHSC, SHGs, Panchayats• At the facility level: RKS• At the management level : Health Societies

Governance reform• Manpower, Logistics & Procurement processes• Decision making processes• Institutional design, Accountability framework

Convergence• Water and sanitation• Nutrition• Education

Institutional Set upInstitutional Set up

Mission Steering Group

Rogi Kalyan Samities

RKS, PHC

Village Health Community

Village Health Community

Village Health

Community

State Health Mission

District Health Mission

District Health Society

Block Committee

Programme Committee

Health Financing

2005-2006

20% public expenditure (0.9% GDP), often inefficient and ineffective.

80% private expenditure, mostly out of pocket

15-20% MoHFW expenditure – rest by States

By 2012

40% public expenditure with improved accountability and efficiency ( 2-3% GDP)

Private expenditure by risk pooling/insurance – less duress and distress

40% GoI expenditure – rest by States

Expected Outcomes at community level

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

Health Day at AWlevel on a fixed day/month for provision of immunization, ante/post natal check ups and services related to mother and child care, including nutrition.

Availability of generic drugs for common ailments at sub centre/hospital level.

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

Expected Outcomes at community level

Improved access to universal immunization.

Improved facilities for institutional deliveries.

Availability of assured health care at reduced financial risk through pilots of Community Health Insurance.

Improve outreach services through mobile medical unit at district level.

Community Empowerment

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OBJECTIVES17

Create forums for community ownership VHSC, RKS,DHM,SHM

Collect systematic info about community needs

provide feedback according to locally developed yardsticks key indicators

Validate sector wide data from other sources

Triangulation

Tools of Community Monitoring18

Village Level Village Health Register - Records of ANM - Public dialogue Village Health Calendar- Infant and maternal death audit

PHC level Charter of Citizens Rights – IPHS - PHC Health Plan

Block level IPHS - Charter of Citizens Rights - Block Health Plan

District level Report from the PHC Health committees Report of the District Mission committee Public Dialogue (Jan Samvad)

State level Reports of the District Health committees Periodic assessment reports by taskforces / State level committees

about the progress made in formulating policies according to IPHS etc.

VILLAGE HEALTH & SANITATION COMMITTEE

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Gram Panchayat members from the village

ASHA, Anganwadi Sevika, ANM

SHG leader, village representative of any Community based organisation working in the village, user group representative Chairperson : Sarpanch Convenor would be ASHA / AWW/ANM ( State specific)

Formed at level of revenue village (more than one such village may come under single

Gram Panchayat)

PHC Level Committee (RKS) 20

30% members : representatives of Panchayati Raj Institutions(Panchayat Samiti member from the area; two or more sarpanchs)

20% members - non-official representatives from VHSCs with annual rotation to enable representation from all the villages

20% members representatives from NGOs / CBOs in the area

30% members representatives of providers, MO, ANM Chairperson be one of the Panchayat representatives Secretary Medical officer I/c of PHC

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