NATIONAL RURAL HEALTH MISSION

PRESENTATION BEFORE

CONFERENCE OF CHIEF SECRETARIES

19th July2006

Ministry of Health & Family Welfare

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NRHM GOALS & APPROACHES Universal Health Care

Reducing IMR, MMR,TFR

COMMUNITY INVOLVEMENT

MONITOR AGAINST AGREED MILESTONES

FLEXIBLE FINANCING
CAPACITY BUILDING
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HUMAN RESOURCE
MANAGEMENT
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NRHM ILLUSTRATIVE STRUCTURE CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE
Accredit private providers for public health goals 100,000 Population 100 Villages ---------------

Health Manager Accountant Store Keeper

BLOCK LEVEL HOSPITAL

Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; 30-40 Villages

Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics

CLUSTER OF GPs PHC LEVEL

3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests 5-6 Villages

GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL

Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic

1000 Popu lation

VILLAGE LEVEL ASHA, AWW, VH & SC

1 ASHA, AWWs in every village; Village Health Day www.drjayeshpatidar.blogspot.in Drug Kit, Referral chains

NRHM- Institutional framework

1 2 3 Departments of H & FW merged State Health Missions Constituted District Health Missions Constituted Merger of Societies 34 states except UP 34 states except Delhi 33 states except Haryana, Delhi

State Level

29 States except Jharkhand, Rajasthan, U.P., Tripura, Delhi Chandigarh, Karnataka, Pondicherry
30 States except U.P., Lakshadweep, Delhi, Tamil Nadu, A&N Islands

MoU with Government of India

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 Operationalise the State/District/Block health Missions.

Suitable officials - Stable tenures / accountability

Administrative Actions

Administrative and financial delegations

Review of Acts, decentralisation Regulations & guidelines for

Health facilities to be planning and budgeting Units upto Block level. Set up procurement/logistics system
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Manpower Strengthening
Attend to Shortfall of 84,000 staff nurses, 2 lakh ANMs, 5000 to 7000 Specialists in each specialty. Multi-skilling, incentives for rural posting, Compulsory Rural Posting, Block pooling, Rational cadre policy, Management through PRIs/ Rogi Kalyan Samitis, Increasing the age of retirement Appointment on contractual basis and local criterion.

Empower BMO designate as Chief BMO - to optimally deploy

doctors /paramedics in facilities within the block

Strengthen SIHFW, ANM schools, nursing / medical colleges/

increase seats

www.drjayeshpatidar.blogspot.in right Health is Womens

DECENTRALISATION & CONVERGENCE

Over 20% of the funds to be spent at the District level and 70%
below the block level.

Review of Acts, Regulations & guidelines for decentralisation Health facilities to be planning and budgeting Units upto Block level. Monitor preparation of Integrated District Plans. Review health camps in each village by ANM, AWW and ASHA. Regular meeting of State Committee on Intersectoral Convergence.
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AGENDA FOR CHIEF SECRETARIES

Operationalisation of Mission structure & managerial support at
state /District / Block levels.

Selection, training and support for ASHA.

Availability & Utilisation of service delivery at facilities. Immunisation & Institutional deliveries District wise. Preparation of District Plans Interdepartmental Coordination for convergence Release & Utilisation of funds. Training/Capacity Building-Health Planning-District training Centre
www.drjayeshpatidar.blogspot.in Delegation of administrative & financial powers to various levels.8

Activity

Phasing and time line

Outcome Monitoring

Fully trained Accredited Social Health Activist (ASHA) for every 1000 population/large isolated habitations in 18 Special Focus States
Village Health and Sanitation Committee constituted in over 6 lakh villages and untied grants provided to them. strengthened/established to provide service guarantees as per IPHS, in 1,75000 places. 30,000 PHCs strengthened/established with 3 Staff Nurses to provide service guarantees as per IPHS.

50% by 2007
100% by 2008

Quarterly Progress Report Quarterly Progress Report Annual Facility Surveys External assessments Annual Facility Surveys External Assessments Annual Facility Surveys External 9 assessments.

30% by 2007
100% by 2008

2 ANM Sub Health Centres

30% by 2007
60% by 2009 100% by 2010

30% by 2007
60% by 2009 100% by 2010

6500 CHCs strengthened 30% by 2007 /established with 7 Specialists and 9 S 50% by 2009 Nurses to provide service guarantees www.drjayeshpatidar.blogspot.in 100% by 2012 as per IPHS.

1800 Taluka/ Sub Divisional Hospitals strengthened to provide quality health services. 600 District Hospitals strengthened to provide quality health services. Rogi Kalyan Samitis /Hospital Development Committees established in all CHCs/Sub Divisional Hospitals/ District Hospitals. District Health Action Plan 20052012 prepared by each district of the country.

30% by 2007 50% by 2010 100% by 2012 30% by 2007 60% by 2009 100% by 2012

Annual Facility Surveys External assessments.

Annual Facility Surveys External assessments.

Annual Facility Surveys External assessments. Appraisal process External assessment. Independent assessments Quarterly Progress reports.
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50% by 2007 100% by 2009

50% by 2007 100% by 2008

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Untied grants provided to each 50% by 2007 Village Health and Sanitation Committee, Sub Centre, PHC, CHC to 100% by 2008 promote local health action. www.drjayeshpatidar.blogspot.in

THANK YOU

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STATE INITIATIVES

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STATE INITIATIVES
Andhra Pradesh Woman Health Volunteers in each of the rural and tribal habitations. Setting up an additional 100 round-the-clock women health centres. A subsidized Emergency Health Transportation Scheme. Incentives to women health volunteers, village Panchayats that promote
Immunization Institutional delivery etc.

Arunachal Pradesh 16 PHCs contracted out to NGOs and Private practitioners. Link workers at village level. Outreach camps for service delivery at remote and inaccessible areas. Assam RMP Act enacted. Transfer and Postings of Medical Staff has been decentralized. Involvement of private sector to render ANC services under PPP. Infection Control System in all District Hospitals. Health Insurance Scheme introduced. 32 FRUs operationalised. www.drjayeshpatidar.blogspot.in

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STATE INITIATIVES
Bihar Data centre for daily monitoring of OPD output by each

participating institutions. 8000 villages covered with mobile medical units for under served population. Telephone connection to all PHCs of the state.

CHhattisgarh Strengthening the role of the Panchayat and building on the

community based link worker. Promoting emergency referral to public/private facility using coupons by Mitanins. Establishment of State Health Resource Centre.

Delhi Basti Sevikas for Urban Slums as linked worker. www.drjayeshpatidar.blogspot.in

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STATE INITIATIVES
Gujarat Chiranjivi Yojana scheme to contract out private providers
for delivery care and management obstetric complications Block Level Programme Management arrangements.

Haryana

Health link workers in every village. A couple aged 60 years with only a girl child is being given a
pension of Rs. 300/- per month and Rs. 500/- per month to the girl child under Ladli Scheme.

Himachal Pradesh
Rs. 30,000 to FRUs as untied fund for emergency transport. PPP Cell at State and District level. Involvement of departments like Ayurveda, social justice and
woman empowerment for distribution of contraceptives. www.drjayeshpatidar.blogspot.in 15

STATE INITIATIVES

Jammu & Kashmir Granting autonomy to hospitals Utilizing the Rehbat-I-Sehat (RIS) teachers network for
providing access to health services to tiny villages scattered in the district.

Karnataka Incentives to Doctors and Staff Nurses for providing 24x7

services. Health insurance for SC/ST population

Kerela RCH services at medical colleges Maternity Security Scheme Tribal and Coastal Health Plans. Involvement of ISM and homeopathy system with the health
facilities.
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STATE INITIATIVES
Madhya Pradesh Outsourcing PHCs to NGOs. State Logistics Management Unit at State level Prasav Hetu Parivahan Yojana(LY85000 beneficiaries) Incentive to MOs at PHCs and CHCs for promotion of institutional deliveries

Maharashtra Setting up of PPP cell at state and district level. Incentive to tribal pregnant woman for ANC and institutional deliveries under Matrutav Anudan Yojana of Nav Sanjivini Scheme. Association of Mahila Gram Sabha and Mahila Vikas Samitis of Jan Swarajaya for implementation of RCH.
Mizoram www.drjayeshpatidar.blogspot.in Incentives for doctors serving in remote areas
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STATE INITIATIVES
Orissa Delegation of powers to the ED , State Health society Consideration of key HRD steps such as a differentiated Public Health Management cadre, policy / incentives for postings to less developed districts Health institutions resource mapping on GIS. Pondicherry Family based health cards. Punjab Balika Rakshak Yojana for adopting terminal method of sterilization after the birth of only one or two girl children @ Rs. 500/- and Rs. 700/- respectively. A prize of Rs. 3 lakhs for panchayats achieving CSR of 1000 in a year and Rs. 2.5 lakhs for panchayats achieving CSR of 951 to 1000 in a year. Nutritional supplement for mothers and children belonging to SCs and other reconstruction of the society.
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STATE INITIATIVES
Rajasthan

Panchamrit for catch up rounds for 5 interventions (Immunization, Vitamin A, Neo Natal Care, Family Planning, Safe Motherhood). Considerable emphasis on quality of services through setting standards, indicators and process protocols Technical resource cell involving NGOs for monitoring and implementation of PNDT act.

Sikkim

Link workers at all the villages. Setting up committees at State / District Level for implementation of PNDT act. Link up with AWW and School Health Programme to operationalize regular de-worming of children. Untied fund at SC to meet transportation cost and accompany link workers if it is justifiable by Village Health Committees.
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STATE INITIATIVES
Tamil Nadu

Integration of ISM with primary health care systems Convergence with HIV/ AIDS/TB at PHCs. Efficient logistic and procurement arrangements.

Tripura

Outsourcing of investigation services including imaging.

Uttar Pradesh

Involvement of cooperative sector for distribution of contraceptives under Family Planning programme. Private lady doctors are being contracted for providing 2 hour daily OPD services at CHCs and PHCs on fix incentive basis. Yuva Mangal Mela and Adarsh Dampati Samman will be organised in selected districts. This year 25 Districts selected having poor health indicators. www.drjayeshpatidar.blogspot.in Strengthening of MIS by linking District through NIC Network 20

STATE INITIATIVES

Uttaranchal

Involvement of community in monitoring and giving feedback on all the programmes. Documentation of practices on traditional healers.
West Bengal

Piloting of Voucher Scheme for providing services through private sector. Ranking of blocks as per key health indicators.
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