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National Rural Health Mission (NRHM)

National Rural Health Mission (NRHM)  

Introduction  

  • The National Rural Health Mission (NRHM) was launched by the Prime Minister on 12th April 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups.
  • A special focus has been given to the Empowered Action Group (EAG) States. The States of North-East, J&K and Himachal Pradesh are also considered.
  • This is to ensure that the necessary attention is delivered wherever needed.

About NRHM

  • NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the vulnerable groups.
  • Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh have been given special focus.
  • The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.
  • NRHM focuses on Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) Services. The emphasis here is on strategies for improving maternal and child health through a continuum of care and the life cycle approach.
  • It recognises the inextricable linkages between adolescent health, family planning, maternal health and child survival.
  • Moreover, the linking of community and facility-based care and strengthening referrals between various levels of health care system to create a continuous care pathway is also to be focussed.

Objectives | National Rural Health Mission (NRHM)

The essence of NRHM is a health delivery system that functions independently, is community-owned and decentralized. The mission also aims to deliver a constant support to those who contribute to the social determinants of health. Basic objectives to implement NRHM are:

  • Reduction in infant mortality rate and maternal mortality rate
  • Prevention and control of communicable and non-communicable diseases
  • Ensuring population stabilization
  • Upgrading AYUSH(Ayurvedic Yoga Unani Siddha and Homoeopathy) for promotion of a healthy lifestyle.

Core Strategies | National Rural Health Mission (NRHM)

  • Health Plan for each village through Village Health Committee of the Panchayat.
  • Train and enhance capacity of Panchayat Raj Institutions (PRIs) to own, control and manage public health services.
  • CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards).
  • Promote access to improved healthcare at household level through the female health activist (ASHA).
  • Strengthening existing PHCs and CHCs, and provision of 30- 50 bedded
  • Strengthening sub – centre through an untied fund to enable local planning and action and more Multi-Purpose Workers (MPWs).
  • Preparation and Implementation of an inter – sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition.
  • Technical Support to National, State and District Health Missions, for Public Health Management.
  • Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels.
  • Formulation of transparent policies for deployment and career development of Human Resources for health.
  • Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision.
  • Promoting non-profit sector particularly in underserved areas.
  • Developing capacities for preventive health care at all levels for promoting healthy lifestyles, reduction in consumption of tobacco and alcohol etc.

Major initiatives under NRHM

  • ASHA:
    • The Accredited Social Health Activists aka ASHAs are the volunteers that engage in this mission that will establish a link between the health system and the targeted community. More than 8.84 lakh of these community health volunteers have contributed to this mission.
    • ASHA is the first port of call for any health-related demands of deprived sections of the population, especially women and children, who find it difficult to access health services in rural areas.
    • This programme is expanding across States and has particularly been successful in bringing people back to the Public Health System. It has also increased the utilization of outpatient services, diagnostic facilities, institutional deliveries and inpatient care.
  • Rogi Kalyan Samiti (Patient Welfare Committee)/Hospital Management Society:
    • It is a registered society that acts as a group of trustees to manage the affairs of the hospitals.
    • A united fund looks after the funding and other financial assistance for these communities that are involved in patient welfare activities.
  • The United Grants to Sub-Centres
    • It has given new confidence to auxiliary nurse midwives (ANMs) in the field who are better equipped now with Blood Pressure measuring equipment, Stethoscope, weighing machine, etc.
    • They can actually undertake proper antenatal care and other health care services.
    • Another important tool of community empowerment is the Village Health Sanitation and Nutrition Committee (VHSNC) which works at the grassroots levels.
  • Health Care Service Delivery
    • Health Care Service Delivery requires intensive human resource inputs. As can be seen from various surveys, there is an enormous shortage of human resources in the public health care sector in the country.     (National Rural Health Mission (NRHM))
    • NRHM has attempted to fill the gaps in human resources by providing nearly 1.7 lakh people for health services to States including 8,871 Doctors, 2025 Specialists, 76,643 ANMs, 41,609 Staff Nurses, etc. on contractual basis.
    • Many unserved areas have been covered through Mobile Medical Units (MMU). So far 2024 MMU are operational in 459 districts across the country.
    • The government also provides free ambulance services in every nook and corner of the country connected with a toll-free number and available within 30 minutes of the call. Over 12,000 basic and emergency patient transport vehicles have been provided under NRHM.
  • Janani Shishu Suraksha Karyakram
    • In order to promote universal healthcare, the government started the Janani Shishu Suraksha Karyakram (JSSK) initiative which provides free to & fro transport, free drugs, free diagnostics, free blood, free diet to pregnant women who come for delivery in public health institutions and sick newborns.

Institutional Mechanisms

  • Village Health & Sanitation Samiti (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers
  • Rogi Kalyan Samiti (or equivalent) for community management of public hospitals
  • District Health Mission, under the leadership of Zila Parishad with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it
  • State Health Mission, Chaired by Chief Minister and co – chaired by Health Minister and with the State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc
  • Integration of Departments of Health and Family Welfare, at National and State level
  • National Mission Steering Group chaired by Union Minister for Health & Family Welfare with Deputy Chairman Planning Commission, Ministers of Panchayat Raj, Rural Development and Human Resource Development and public health professionals as members, to provide policy support and guidance to the Mission
  • Empowered Programme Committee chaired by Secretary HFW, to be the Executive Body of the Mission
  • Standing Mentoring Group shall guide and oversee the implementation of ASHA initiative
  • Task Groups for Selected Tasks (time- bound)

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