BACKGROUND

STATE OF PUBLIC HEALTH IN INDIA BEFORE NRHM

Health gap at rural level

Multiple health crisis ( malnutrition, maternal and infant deaths, inadequate water supply etc..

Improve rural health delivery system -Accessible -Affordable -Accountable -Equitable

NRHMLaunched in 5th April 2oo5 for 7 years by GoISpecial focus on 18 states8 NORTH EASTERN STATES (ASSAM, AP,

MANIPUR, MEGHALAYA, MIZORAM, NAGALAND, SIKKIM, TRIPURA)

8 EMPOWERED ACTION GROUP STATES ( BIHAR, JHARKHAND, MP,

CHATTISGARH,UP, UTTARANCHAL, ORISSA, RAJASTAN)

HP & JK

Objectives of the mission -improve rural health care delivery system

Child & maternal mortality rateUniversal access to public health services for

food ,nutrition, sanitation and public health services addressing maternal and child health.

Prevention and control of CD’s and NCD’sAccess to primary health careMainstreaming of AYUSHPromotion of healthy life style

Core strategies of nrhmDecentralization of village and district level

health planning and managementAppointing ASHA for facilitating the access to

health servicesStrengthen public health delivery services at

primary and secondary levelMainstreaming AYUSHImprove management capacity to organize

health systems and servicesImprove intersectorial coordination

Supplementary strategies..Private partnership to meet national public

health goals-’public pvt. Partnership’ (ppp)Social insurance to raise the health security

of poor

GOALS TO BE ACHIEVED BY NRHM AT NATIONAL LEVEL IMR : Reduce to 30/1000 MMR : Reduce to 100/100,000 TFR : Reduce to 2.1 MALARIA MORTALITY RATE REDUCTION: 50% by 2010 , addle 10% by 2012 FILARIA RATE REDUCTION : 70%(2010), 80%(2012), elimn by 2015 DENGUE MORTALITY RATE REDUCTION: 50%(2010) KALA AZAR MORTALITY RATE REDUCTION: 100%(2010) JE MORTALITY RATE REDUCTION: 50%(2010) CATARACT OPERATION: increase to 46 lakhs/year 2012

National level….LEPROSY PREVALENCE RATE : reduce

from 1.8/10,000 in 2005 to less than 1/10,000TB DOTS SERVICES : 85% Cure rateUpgrading CHC to Indian Public Health

StandardsIncrease utilization of FIRST REFERRAL

UNITS from <20% to 75%Engaging 250,000 female ASHA in 10 states

At community level PHC/CHC should provide good hospital care. Generic drugs at subcentre level Access to UIP Facilities for institutional deliveries Trained community level worker at village level Health day at ANGANWADI -immunisation - antenatal/postnatal check ups Provision of house hold toilets Improved outreach services through MOBILE

MEDICAL UNIT at district level Community health insurance

PLAN OF ACTION 1)CREATION OF ASHA (ACCREDITED SOCIAL

HEALTH ACTIVIST) -health activist in the community -1ASHA= 1000 population -not a paid employee -create awareness about health & its

determinants -mobilise community to health care services - counsel women and escort them to PHC/CHC

& providing medical care for minor ailments

PLAN OF ACTION..2) STRENGTHENING OF SUB CENTRESSupply of essential medicinesProvision of MPW / additional ANMProvision of funds3) STRENGTHENING OF PHC24 hr service in at least 50% of PHC incl.

AYUSH practitionerUpgradation for 24hr referral serviceAdequate and regular supply of essential drugStrengthening CD control programme

PLAN OF ACTION.. 4) STRENGTHENING OF CHC’S

3222 CHCs should function as first referral unit

Maintain ‘INDIAN PUBLIC HEALTH STANDARDS‘

Promotion of ‘ROGI KALYAN SAMITIS’

INSTITUTIONAL SET UP OF NRHMAT NATIONAL LEVEL: MISSION STEERING

GROUP , -chairman is union minister of health and family

welfare

AT STATE LEVEL : STATE HEALTH MISSION - led by CM

AT DISTRICT LEVEL : DISTRICT HEALTH MISSION

- Led by chairman of ZILA PARISHAD

DISTRICT HEALTH MISSIONCore unit in planning, budgeting and

implementation of the programme. FUNCTIONSSelection and training of ASHAOrganising health camps at ANGANWADIMainstreaming AYUSHUpgrading CHCs to IPHSOutreach services through mobile medical units

Monitoring and evaluationBaseline survey at district level & household

levelCommunity monitoring at village levelEventual monitoring of the outcomes is done

by planning commission of India

Thank you..

The National Rural Health Mission (NRHM) proposed the decentralization of health planning so that the state health plan represents the needs and priorities of respective blocks and districts in the state. In Bihar, the State Programmed Implementation Plan (SPIP) for the year 2010-2011 has been framed on the basis of strategies and activities, which worked in the last four years. State has identified major bottlenecks and attempted to overcome them through alternative strategies.