NATIONAL RURAL HEALTH MISSION

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NATIONAL RURAL HEALTH MISSION

• PRESENTATION BEFORE
• CONFERENCE OF CHIEF SECRETARIES
• 20th April 2007
• Ministry of Health Family Welfare

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NATIONAL GOALS MDG
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Key Indicators

• IMR (SRS 2005) (India 58)
• Kerala -14, Manipur -13, Nagaland -18,Goa -16
• Rajasthan - 68, UP - 73, MP -76, Orissa 78
• MMR (SRS 2001-03) (India 407 to 301)
• UP - 707 to 517, Rajasthan - 670 to 445, MP - 498
  to 379, Bihar - 452 to 371
• Wide interstate intrastate variations in key
  health indicators

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Progress of Key RCH interventions

• Infant Mortality
• Seven states achieved Infant Mortality Rate goals
  set for 2007 (accounting for 34.3 population)
• Over one million Monthly Village Health and
  Nutrition days held at Anganwadi Centres across
  the country
• Maternal Mortality
• Eight states achieved Maternal Mortality Ratio
  goal set for 2007. (43 of Indias population)
• JSY - beneficiaries gone up by over 3 times
• Around 26 lakh pregnant women have benefited from
  JSY scheme, upto December 2006

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Strengths of the Health System

• Extensive framework and reach even in many
  difficult areas
• Established procedures in State Health
  Directorates
• Presence of active Non Governmental service
  providers
• Recent Achievements
• Leprosy eliminated at National level
• Neonatal Tetanus eliminated from 9 States
• TB cure rate sustained at more than global target
  of 85
• Efficient response to Avian flu
• Medical Tourism

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Issues Challenges

• Health is often not a core Governance issue
• Acute Shortage of manpower/vacancies/absenteeism
• Insufficient training infrastructure and faculty
• Weak health delivery Infrastructure
• Weak capacity for fund utilisation
• Lack of management support
• Poor nutritional status of population
• Poor sanitation, drinking water availability

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Launched on 12th April, 2005January-March 2005
Preparatory PhaseOperationalization from April
2005Framework for implementation - July 2006
NRHM is designed to provide Universal Health
Care Access Affordability Equity Quality Red
uce IMR, MMR,TFR Improve Disease control
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• 18 High Focus states which include
• 8 Empowered Action Group States
• Bihar, Jharkhand, Madhya Pradesh,
• Chhattisgarh, Uttar Pradesh,
• Uttarakhand, Orissa and Rajasthan
• 8 NE States
• Himachal Pradesh and Jammu Kashmir.
• High Focus states are entitled to
• Funds allocation with weightage of 1.3 (for NE
  states 3.2)
• support for all ASHAs
• 33 of allocation may be deployed for civil
  construction
• Other than High Focus states are entitled to
• Funds allocation with weightage of 1
• Support for ASHAs in tribal and underserved areas
• Support for Link workers under RCH II
• 25 allocation may be deployed for civil
  construction

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• Progress and
• Key deliverables

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Institutional Framework of NRHM

• Mission Steering Group
• Empowered Programme Committee
• State Health Missions
• District Health Missions
• Rogi Kalyan Samitis
• Village Health Sanitation Committees
• ASHA Mentoring Group
• Advisory Group on Community Action
• National / State Health System resource Centre

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Subcentres made functional

• All Sub Centres to be functional with at least 1
  ANM and operational joint accounts by March 2008
• Additional contractual ANMs to be positioned in
  30 SCs by March 2008. Positioned in 7847 SCs
• By 2008, all SC level joint accounts for untied
  funds to be operational. Made operational in
  91,135 SCs
• All ASHAs to be selected 3 lakh ASHAs given
  drug kits by 2008. 3.65 lakh ASHAs selected (2.55
  lakhs trained)
• 30 Village Health and Sanitation Committees
  (VHSCs) to be set up by 2008. 14,129 VHSCs
  constituted

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PHC, CHC DH strengthening

• IPHS made for all levels
• At least 5000 PHCs to be operational 24 x 7 by
  2008. Till date 3 staff nurses positioned in 2294
  PHCs
• At least over 20,000 PHC/CHC level and all DH
  level Rogi Kalyan Samitis (RKS) to be operational
  by 2008. RKS have been set up in 10345 PHCs, 2733
  CHCs and 421 DHs
• At least 1000 CHCs to be upgraded to FRUs by
  March 2008. 896 CHCs upgraded till date
• All facility surveys to be completed by 2008.
  2032 CHC level facility survey completed
• Untied funds annual maintenance grant at all
  levels

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Manpower augmentation

• 4455 doctors, 1374 specialists, 8397 staff nurses
  1561 paramedics on contract. Process to be
  accelerated
• Need to fill up critical vacant posts /create
  more posts
• Need to expand training capacity Proposals for
  new / upgradation of ANMTCs, Medical Nursing
  colleges
• Need to create district cadres of nurses
• Rationalisation of manpower policies required

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Health sector planning

• All SPMUs and 60 DPMUs to be operational by
  2008. 27 SPMUs, 467 DPMUs 1750 Block level PMUs
  are operational
• NHSRC has been set up. SHSRC proposals awaited
• Expedite Household surveys Village Health Plans
• All Integrated District Health Action Plans
  (IDHAPs) to be prepared annually. 147 IDHAPs
  prepared
• Annual PIPs / perspective Plans for the entire
  Mission period to be prepared

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Other initiatives

• Monthly Village Health Nutrition Day (over 10
  lakhs organised)
• 129 Mobile medical Units are operational. 400
  District level MMUs to be positioned by 2008
• AYUSH Integration at all facilities to be ensured
• Health Melas to take place in at least 15
  parliamentary constituencies during FY 2007-08
• NRHM Fund allocation for FY 2007-08 communicated
  to all states
• E moding of funds operationalised
• All states sending Financial Monitoring Reports.
  Ensure timely submission

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Monitoring Evaluation

• Review meetings at various levels
• State visits GoI evaluation teams
• Integrated MIS timely and quality reporting
• External Surveys
• Immunisation - UNICEF
• ASHA JSY UNICEF, UNFPA, GTZ
• Financial protocols- Institute of Public Auditors
• External Evaluations
• Community monitoring

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National Health Programmes

• TB, Malaria, Blindness Control, Filaria, Kala
  Azar, as part of the NRHM Framework
• Need for integration at all levels
• Functional public health system at village,
  SHC/PHC/CHC/District Hospital level to facilitate
  better programme delivery.
• Strong linkages in preventive and public health
  measures for vector control, early disease
  surveillance, and preparedness for epidemics.

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Public Health and Surveillance

• IDSP also a part of NRHM.
• Need for integration with Primary Health care
  system ASHA, ANM, PHC, CHC, Sub District and
  District Hospitals.
• Untied funds at village, Sub Centre, PHC, CHC
  levels for community action for public health.
• IPH Standards for all health facilities designed
  for all health sector interventions, including
  disease control and surveillance.

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NRHM - Inter Sectoral Convergence

• ICDS and Aanganwadi Worker
• Total Sanitation Campaigns, drinking water,
  sanitation committees.
• School Health Programme
• Decentralization and Panchayati Raj Institutions
• Womens empowerment and literacy
• AYUSH integration
• Partnerships for urban poor

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• Leadership by
• Chief Secretary

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Issues for follow up by Chief Secretary
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Issues for follow up by Chief Secretary
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Critical Issues - follow up by Chief Secretary
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Population Stabilisationarea of concern

• Performance going down in all states both in
  terminal and spacing methods
• Marginal decline in unmet need from 16 in NFHS 2
  to 13 in NFHS 3 (over 7 years). Still 12.88
  million couples have unmet need. Between 1998-99
  and 2004-05 unmet need of only 2.53 million
  couples could be met through contraception
• Sterilization compensation amount revised upwards
  by GoI. Introduced National Family Planning
  Insurance Scheme which also includes accredited
  private practitioners
• Need for close monitoring at the highest level

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• Major State Innovations

• Many states have undertaken effective
  innovations. These include
• Institutional Delivery and GIS Interventions in
  Health in Orissa
• Chiranjeevi Yojana Gujarat
• Delivery Huts-Haryana
• Infrastructure Strengthening Swasthya Chetana
  Yatra Rajasthan
• School Health Programme Tamil Nadu
• Drug Procurement/Emergency Medical Services/
  Vitamin A Supplementation - Bihar
• Partnerships with NGOs-West Bengal

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• THANK YOU

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Orissa

• Management of PHC through NGOs. District Bhadrak
  by SHEPHERD Districts Dhenkanal and Jajpur by
  Nysasdri
• GIS Intervention in Health
• Geographical mapping of existing health
  facilities incidence of diseases- allocation of
  more resources to endemic areas, focused IEC.
• Mapping coverage of services - helped in
  allocating additional resources to unserved
  villages
• Development of GIS based Health MIS
• IMR Reduction from 82 (NFHS-2) to 65 (NFHS-3)
• IMR reduced from 90 (2001-SRS) to 77 (2003-SRS) .
  
• IMR mission activities - Referral Transport.
• Nabajyoti Scheme-Dai Training Home visits
• Strengthening Routine Immunisation.
• Implementation of RCH programme

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Gujarat

• Chiranjeevi Yojana- A Health financing scheme for
  safe maternity services to BPL beneficiaries .
• To begin with the scheme was made operational in
  five most underserved tribal, desert and border
  districts namely Kutch, Banaskanta, Sarbarkanta,
  Panchamahal and Dahod.
• The scheme has been operational from December
  2005.
• So far 163 doctors (76 private OG specialists )
  have entered into an MOU with the state
  government for carrying out deliveries in the
  five pilot districts
• More than 7793 BPL mothers, that is nearly 31
  of BPL pregnant mothers have safely delivered,
  under the scheme.
• So far, not a single death in mothers has been
  reported

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Haryana

• Delivery Hut (launched in August 2005-06 )
• Delivery Huts established within villages for
  providing services during delivery in
  institutions having facilities for normal
  deliveries and referral support.
• Additional ANM helper hired to strengthen anc
  etc
• So far, 400 Delivery Huts have been established,
  16,500 deliveries conducted, 1756 high-risk cases
  referred
• In the first year of the launch of the scheme,
  the scheme has been strengthened the
  institutional deliveries and increased it from
  23 (2004-05) to 48 (2005-06) (Source Chief
  Registrar Birth Death, Haryana)