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National rural health mission

National rural health mission

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Published by: Lakshya J Basumatary on Jun 20, 2009
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3
National Rural Health Mission(2005-2012)
Appendix
PREAMBLE
Recognizing the importance of Health in the process of economic and social development and improving the qualityof life of our citizens, the Government of India has resolvedto launch the National Rural Health Mission to carry outnecessary architectural correction in the basic health caredelivery system. The Mission adopts a synergistic approachby relating health to determinants of good health viz. segmentsof nutrition, sanitation, hygiene and safe drinking water. Italso aims at mainstreaming the Indian systems of medicineto facilitate health care. The Plan of Action includes increasingpublic expenditure on health, reducing regional imbalance inhealth infrastructure, pooling resources, integration of organizational structures, optimization of health manpower,decentralization and district management of health programes,community participation and ownership of assets, inductionof management and financial personnel into district healthsystem, and operationalizing community health centers intofunctional hospitals meeting Indian Public Health Standardsin each Block of the Country.The Goal of the Mission is to improve the availability of and access to quality health care by people, especially forthose residing in rural areas, the poor, women and children.
STATE OF PUBLIC HEALTH
Public health expenditure in India has declined from 1.3percent of GDP in 1990 to 0.9 percent of GDP in 1999.The Union Budgetary allocation for health is 1.3 percent while the State’s Budgetary allocation is 5.5 percent.Union Government contribution to public healthexpenditure is 15 percent while States contribution about85 percentVertical Health and Family Welfare Programs have limitedsynergization at operational levels.Lack of community ownership of public health programsimpacts levels of efficiency, accountability andeffectiveness.Lack of integration of sanitation, hygiene, nutrition anddrinking water issues.There are striking regional inequalities.Population stabilization is still a challenge, especially inStates with weak demographic indicators.Curative services favour the non-poor: for every Re.1 spenton the poorest 20 percent population, Rs.3 is spent onthe richest quintile.Only 10 percent Indians have some form of healthinsurance, mostly inadequateHospitalized Indians spend on an average 58 percent of their total annual expenditureOver 40 percent of hospitalized Indians borrow heavily orsell assets to cover expensesOver 25 percent of hospitalized Indians fall below povertyline because of hospital expenses
NATIONAL RURAL HEALTH MISSION–  THE VISION
The National Rural Health Mission (2005-12) seeks toprovide effective health care to rural population throughout
 
Appendices9
the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure.These 18 States are Arunachal Pradesh, Assam, Bihar,Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu andKashmir, Manipur, Mizoram, Meghalaya, MadhyaPradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura,Uttaranchal and Uttar Pradesh.The Mission is an articulation of the commitment of theGovernment to raise public spending on Health from 0.9percent of GDP to 2 to 3 percent of GDP.It aims to undertake architectural correction of the healthsystem to enable it to effectively handle increasedallocations as promised under the National CommonMinimum Program and promote policies that strengthenpublic health management and service delivery in thecountry.It has as its key components provision of a female healthactivist in each village; a village health plan preparedthrough a local team headed by the Health and SanitationCommittee of the Panchayat; strengthening of the ruralhospital for effective curative care and made measurableand accountable to the community through Indian PublicHealth Standards (IPHS); and integration of verticalHealth and Family Welfare Programs and Funds foroptimal utilization of funds and infrastructure andstrengthening delivery of primary health care.It seeks to revitalize local health traditions and mainstream AYUSH into the public health system.It aims at effective integration of health concerns withdeterminants of health like sanitation and hygiene,nutrition, and safe drinking water through a District Planfor Health.It seeks decentralization of programs for districtmanagement of health.It seeks to address the inter-state and inter-districtdisparities, especially among the 18 high focus States,including unmet needs for public health infrastructure.It shall define time-bound goals and report publicly ontheir progress.It seeks to improve access of rural people, especially poor women and children, to equitable, affordable, accountableand effective primary health care.
GOALS
Reduction in Infant Mortality Rate (IMR) and MaternalMortality Ratio (MMR).Universal access to public health services such as Women’shealth, child health, water, sanitation and hygiene,immunization, and nutrition.Prevention and control of communicable and non-communicable diseases, including locally-endemicdiseases.Access to integrated comprehensive primary health care.Population stabilization, gender and demographic balance.Revitalize local health traditions and mainstream AYUSHPromotion of healthy life styles.
STRATEGIESCore Strategies
Train and enhance capacity of Panchayati Raj Institutions(PRIs) to own, control and manage public health services.Promote access to improved healthcare at household levelthrough the female health activist (ASHA).Health Plan for each village through Village HealthCommittee of the Panchayat.Strengthening sub-center through an untied fund to enablelocal planning and action and more Multi-purpose Workers(MPWs).Strengthening existing PHCs and CHCs, and provision of 30 to 50 bedded CHC per lakh population for improvedcurative care to a normative standard (Indian Public HealthStandards defining personnel, equipment and managementstandards).Preparation and implementation of an intersectoral DistrictHealth Plan prepared by the District Health Mission,including drinking water, sanitation and hygiene andnutrition.Integrating Vertical Health and Family Welfare programsat National, State, Block, and District levels.Technical Support to National, State and District HealthMissions, for Public Health Management.Strengthening capacities for data collection, assessmentand review for evidence-based planning, monitoring andsupervision.Formulation of transparent policies for deployment andcareer development of Human Resources for health.Developing capacities for preventive health care at all levelsfor promoting healthy life styles, reduction in consumptionof tobacco and alcohol, etc.Promoting non-profit sector particularly in under servedareas.
Supplementary Strategies
Regulation of Private Sector including the informal ruralpractitioners to ensure availability of quality service tocitizens at reasonable cost.Promotion of Public Private Partnerships for achievingpublic health goals.
 
10Practical Approach in Tuberculosis Management
Mainstreaming AYUSH—revitalizing local healthtraditions.Reorienting medical education to support rural healthissues including regulation of Medical care and MedicalEthics.Effective and viable risk pooling and social health insuranceto provide health security to the poor by ensuringaccessible, affordable, accountable and good qualityhospital care.
PLAN OF ACTIONComponent (A): Accredited Social Health Activists
Every village/large habitat will have a female AccreditedSocial Health Activist (ASHA)—chosen by andaccountable to the panchayat—to act as the interfacebetween the community and the public health system.States to choose State specific models.ASHA would act as a bridge between the ANM and the village and be accountable to the Panchayat.She will be an honorary volunteer, receiving performance-based compensation for promoting universalimmunization, referral and escort services for RCH,construction of household toilets, and other health caredelivery programs.She will be trained on a pedagogy of public healthdeveloped and mentored through a Standing MentoringGroup at National level incorporating best practices andimplemented through active involvement of communityhealth resource organizations.She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi worker, ANM,functionaries of other Departments, and Self-Help Groupmembers, under the leadership of the Village HealthCommittee of the Panchayat.She will be promoted all over the country, with specialemphasis on the 18 high focus States. The Governmentof India will bear the cost of training, incentives andmedical kits. The remaining components will be fundedunder Financial Envelope given to the States under theprograme.She will be given a Drug Kit containing generic AYUSHand allopathic formulations for common ailments. Thedrug kit would be replenished from time to time.Induction training of ASHA to be of 23 days in all, spreadover 12 months. On the job training would continuethroughout the year.Prototype training material to be developed at Nationallevel subject to State level modifications.Cascade model of training proposed through Training of Trainers including contract plus distance learning modelTraining would require partnership with NGOs/ICDSTraining Centers and State Health Institutes.
Component (B): Strengthning Sub-centers
Each sub-center will have an Untied Fund for local action@ Rs. 10,000 per annum. This Fund will be deposited ina joint Bank Account of the ANM and Sarpanch andoperated by the ANM, in consultation with the VillageHealth Committee.Supply of essential drugs, both allopathic and AYUSH,to the Sub-centers.In case of additional Outlays, Multipurpose Workers(Male)/Additional ANMs wherever needed, sanction of newSub-centers as per 2001 population norm, and upgradingexisting Sub-centers, including buildings for Sub-centersfunctioning in rented premises will be considered.
Component (C): StrengtheningPrimary Health Centers
Mission aims at Strengthening PHC for quality preventive,promotive, curative, supervisory and Outreach services,through:Adequate and regular supply of essential quality drugsand equipment (including Supply of Auto Disabled Syringesfor immunization) to PHCsProvision of 24 hour service in 50 percent PHCs byaddressing shortage of doctors, especially in high focusStates, through mainstreaming AYUSH manpower.Observance of Standard treatment guidelines andprotocols.In case of additional Outlays, intensification of ongoingcommunicable disease control programes, new programesfor control of noncommunicable diseases, upgradationof 100 percent PHCs for 24 hours referral service, andprovision of 2nd doctor at PHC level (I male, 1 female) would be undertaken on the basis of felt need.
Component (D): Strengthening CHCs forFirst Referral Care
 A key strategy of the Mission is:Operationalizing 3222 existing Community Health Centers(30-50 beds) as 24 Hour First Referral Units, includingposting of anesthetists.Codification of new Indian Public Health Standards,setting norms for infrastructure, staff, equipment,management etc. for CHCs.

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