Under the
National Common Minimum Programme (NCMP) of UPA Government, health care is one
of the seven thrust areas. The NCMP mandates an increase in expenditure in health
sector, with main focus on Primary Health Care from current level of 0.9% of
GDP to 2-3% of GDP over the next five years.
The National Rural Health Mission (NRHM) which is the main vehicle for
giving effect to the above mandate was launched on 12.4.05 by the Prime
Minister of India. It is being operationalized throughout the country, with
special focus on 18 states which includes 8 Empowered Action Group States
(Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttaranchal,
Orissa and Rajasthan), 8 NE States, Himachal Pradesh and Jammu & Kashmir.
The main
aim of NRHM is to provide accessible, affordable, accountable, effective and
reliable primary health care facilities, especially, to the poor and vulnerable
sections of the population. It also
aims at bridging the gap in Rural Health care services through creation of a
cadre of Accredited Social Health Activists (ASHA) and improved hospital care,
decentralization of programme to district level to improve intra and
inter-sectoral convergence and effective utilization of resources. The NRHM further aims to provide overarching
umbrella to the existing programmes of Health and Family Welfare including
RCH-II, Malaria, Blindness, Iodine deficiency, Filaria, Kala Azar, T.B.,
Leprosy and Integrated Disease Surveillance.
Further, it addresses the issue of health in the context of sector-wide
approach addressing sanitation and hygiene, nutrition and safe drinking water
as basic determinants of good health in order to have greater convergence among
the related social sector Departments i.e. AYUSH, Women & Child
Development, Sanitation, Elementary Education, Panchayati Raj and Rural
Development.
The
expected outcome of the Mission include reduction of IMR to 30 per 1000 live
births, MMR to 100 per 100,000 live births & TFR to 2.1 by 2012. Further
the Mission envisages guaranteed service delivery at all health facilities and
quantifiable deliverables for all national disease Control Programmes.
The
Mission further seeks to build greater ownership of the programme among the
community through involvement of Panchayati Raj Institutions, NGOs and other
stake holders at National, State, District and Sub-District levels to achieve
the goals of National Population Policy 2000 and National Health Policy.
The detailed Framework
for Implementation of NRHM was finalised after discussions with various stakeholders
including State Governments, Public Health experts, Civil Society representatives,
other departments of the Government and multilateral donor agencies. The framework
received formal approval during the year 2006-07. The Framework, articulates
the goals, major strategies and the time lines for various activities under
NRHM. It elucidates the overarching umbrella status of the Mission and provides
a road map as well as inclusive norms for additional activities to be undertaken
as part of the NRHM.
Community Link Worker
Under the
detailed Framework of Implementation, Accredited Social Health Activists (ASHA)
have been extended to all 18 High Focus states and to tribal and under served
areas of other states. ASHA is envisaged to be a primary resident of the
village with formal education upto Class VIII and preferably in the age group
25-45. She would be selected by the Gram Sabha following an intense community
mobilization process and would be fully accountable to Panchayat.
Till December
2006, 2.38 lakh ASHAs have been selected in 18 High Focus states out of which
1.50 lakh have been trained. A detailed framework for mentoring of ASHAs has
been disseminated to the states, This framework utilizes the Rs. 10,000 per
ASHA devolution envisaged under the approved Framework for Implementation.
The mentoring set up includes an ASHA resource Centre at State level, Strengthening
of Programme Management Unit (PMU) with additional manpower at District level,
designation of Block Medical Officer as a nodal officer supported by facilitators and
optimum office support at block level and funding support at PHC level. A detailed normative budgeting of this set
up has also been communicated to the states and funds for the same released.
Norway
– India Partnership
ASHA is also
envisaged to be imparted training for Home based Neonatal care under the Norway
India Partnership Initiative (NIPI), Modules for the same are being prepared
and shall be disseminated to the states shortly.
Improving Service Delivery
NRHM seeks
to Strengthen the Public Health delivery system at all levels. The Sub-centre
and PHCs are proposed to be revitalized through better human resource
management, clear quality standards, better community support and an untied
fund to enable local planning and action. The Indian Public Health Standards
define structural, personnel, equipment and management standards and have been finalized
for CHCs, PHCs and SCs. Till December 2006 states have identified 2045 CHCs for
upgradation to IPHS and facility surveys have been completed in 1452 CHCs.
All the facilities
are also being provided through untied funds to enable the local management
committee to carry out locally relevant initiaties for better service
delivery. At the level of the Sub Centre, untied funds are to be managed in
the Joint account of ANM and the Gram Pradhan. States have reported operationalisation
of over 68,000 joint accounts at the Sub Centre level till December 2006.
The Hospital Management Committees (Rogi Kalyan Samitis) at various levels
are being set up as registered societies with Panchayati Raj Institutions
representation. Till December 2006, states have reported operationalisation
of over 8000 RKSs at various levels and funds are being released as part of
state PIPs.
Decentralised Planning
Flexible,
Decentralized Planning is the pivot on which the entire concept of the Mission
revolves. Till December 2006, states have reported finalization of Integrated
District Health Action Plans in129 Districts. This activity is in final stages
in other districts. The states have
also been requested to finalise the Perspective State Action Plan under NRHM
so as to lay a road map for action under the Mission upto the year 2012. The
state PIPs under NRHM have been received from 33 states/UTs which have been
appraised by NPCC and funds of approved amounts released to the states.
Community Ownership
The NRHM
seeks to strengthen service delivery by ensuring community ownership of the
health facilities. The Sub centres are envisaged to be under the management
of the local Panchayat. The Pradhan shall be operating the Joint account with
the ANM for utilisation of the Untied Funds. Similarly the PHCs and CHCs are
also proposed to be transferred to the local elected Panchayati Raj Institutions
for management. The management committee of the health facilities, which would
have the representation of the local SHGs and NGOs, elected representatives of the Panchayati Raj along with the MO of the facility shall be authorized to undertake
local action for ensuring that the agreed service guarantees for the respective
facility are fulfilled. A detailed process of Community Monitoring has been
envisaged in the Framework for Implementation and the Advisory Group on Community
Action (which is a standing committee under NRHM) has been working towards developing a tool
kit for the same.
Mother NGOs
During the
year 2006-07, 134 more Mother NGOs have
been selected in various states and at present, in all, 299 NGOs are operational covering 410
Districts in the country. Each of these
MNGOs is a vehicle for release of funds to the extent of Rs. 15 lakh per annum
per district for health related initiatives under NRHM through three to four
Field NGOs per District.
The
states have operationalised 228 Mobile Medical Units and during 2006-07 funds
have been released as part of the PIPs for this initiative also.
Role of AYUSH
The mainstreaming
of AYUSH is one of the important strategies under NRHM. As part of this initiative,
states have reported AYUSH practitioners have been collocated in over 3400
PHCs, 900 CHCs and 170 DHs. The states have reported posting of over 2500
AYUSH practitioners on contract in various health facilities. Most states
have already included AYUSH representative as member of the State health Mission
and Society and in the Rogi Kalyan Samitis. (PIB Features)
*Inputs from Department of
Health & Family Welfare
SV/AB/RTS/VN
SS-08/SF-08/10.01.2007
(Release ID :23952)