Subsequently, it is planned to have Urban Health Mission (UHM) to cater to the NRHM ahd Role of NGOs

health needs of urban population. Accordingly, the Urban Health Mission (UHM) is to
be implemented in 450 towns and cities across the country covering 5 crore people.
~ i k health
e workers known as Accredited Social Health Activists (ASHAs) in
NRHM, UHM will have Urban Social Health Activists (USHAs). 7-10% of the
UHM budget will be invested for street and homeless children. Under the proposed
UHM, government would pay premium for slum dwellers and the urban local bodies
would be given jurisdiction to monitor implementation of the programme. There will
be a provision of USHA for every 200 populations and a Urban Health Centre for
every 50,000 population. Self-help groups of women, Mahila Arogya Samitis would be
"
formed for every 100 households to monitor health issues at the grassroot level. The
government will be ensured that under the programme ambulances will be made
available within 7- 15 minutes of a telephone call anywhere in the country by 201 0. An
emergency and trauma programme has been envisioned with effort to make highway
safety with ambulances at every 50-km stretch on the highways, trauma centres on a
distance of every 100 km, speciality centres at every 150 km and a telephone facility
at every 5 km. C

As the Urban Health Mission is yet to be formalized, this Unit will focus on the
Maternal and Child Health components of the National Rural Health Mission.
a

2.2 FEATURES
The main features of the National Rural Health Mission are:
I) The National Rural Health Missioil aims to undertake architectural correction of
the health system to enable it to effectively handle increased allocations as
promised under the National Common Minimum Programme, and promote
policies that strengthen public health management and service delivery in the
country.
2) The key components of the National Rural Health Mission are:
a) Provision of a fernale health activist in each village;
b) A village health plan prepared through a local team headed by the Health &
Sanitation Committee of the Panchayat;
c) Strengthening of the rural hospital for effective curative care and made
measurable and accountable to the community through Indian Public Health
Standards (IPHS); and
d) Integration of vertical Health and Family Welfare Programmes and Funds
for optimal i~tilizationof funds and infrastructur4and strengthening delivery
of primary health care.
The National Rural Health Mission (NRHM) seeks to revitalize local health traditions
and nlainstream AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and
Homoeopathy) into the public health system.
It aims effective integration of health concerms with determinants of health like
sanitation and hygiene, nutrition, and safe drinking water through a District Plan for
Health.
It seeks decentralization of programmes for district management of health.
It seeks to address the inter-state and inter-district disparities, especially among the
18 high focus states, including unrnet needs for public health infrastructure.
It seeks to improve access of rural people, especially poorhornen and children, to
equitable, affordable, acco~~ntable and effective primary health care.
, . ..Primary Health
, Care Management 2.3 GOALS AND OUTCOMES
-
The gc~ a l and
s expe :comes of the National Rural Health Mission are dealt with
in this section.

Goals
The goals of tlieNational Rural Health Mission are:
Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR);
Universal access to public health services S L I Cas
~ women's health, child health,
'
water, sanitation & hygiene,-i~nmunization,and nutrition;
Prevention and control ofcommunicable and non-com~nunicablediseases,
including locally endemic diseases;
Access to integrated comprehensive primary health care;
Population stabilization, gender and demographic balance;
Revitalize focal health traditions and mainstream AYUSH;
Pro~notionof health life-styles.

Outcomes
1) National Level 1

Infant Mortality Rate reduced to 3011000 live births by 20 12; 4

Maternal Mortality Ratio reduced to 1001100,000 live births by 20 12;

Total Fertility Rate reduced to 2.1 by 2012.
Upgrading Co~n~nunity
Health Centres to Indian Public Health Standards.
Increase utilization of First Referral Units from less than 20% to 75%.
i
Engaging 250,000 female Accredited Social Health Activists (ASHAs) in
10 states.
Malaria Mortality Reduction Rate - 50% upto 20 10, additional 10% by 20 12.
Kala Azar Mortality Reduction Rate: 100% by 20 10 and sustaining
elimination until 201 2.
FilariaIMicrofilaria Reduction Rate: 70% by 2010,80% by 20 12 and
elimination by 2015.
Dengue Mortality Reduction Rate: 50% by 201 0 and sustaining at that level
until 20 12.
Japanese Encepl~alitisMortality Reduction Rate: 50% by 2010 and
sustaining at that level until 201 2.
Cataract Operations: increasing to 46 lakhs per year until 2012.
Leprosy Prevalence Rate: reduce from 1.8110,000 in 2005 to less than 11
10,000 thereafter. :
Tuberculosis DOTS Services: maintain 85% cure rate through entire
Mission period.
2) Community Level
Availability oftrained community level worker at village level, with a drug
kit for generic ailments.
Health Day at Ah.ganwadi level on a fixed daylmonth for provision of
immunization, antehostr - - natal checku~s
I
and services related to mother a3n'd
child health care, including nutrition.
 Availability of generic drugs for common ailments at sub-centre and hospital +
NRflM and Role of NGOs
level.
Good hospital care through assured availability ofdoctors, drugs and quality
services at PHCICHC level.
Improved access to Universal Immunization through induction of Auto-
Disabled Syringes, alternate vaccine delivery and improved mobilization
services under the programme. .
Improved facilities for institutional delivery through provision of referral,
transport, escort and improved hospital care subsidized under the Janani
Siiraksha Yojana (JSY) for the Below Poverty Line families.
Availability of assured health care at 'reduced financial risk through pilots of
Community Health Insurance under the Mission.
Provision of household toilets.
Inlproved outreach services through mobile medical unit at district level.

2.4 ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA)

ASHA yill be a health activist in the community 'who will create awareness on health
and its social determinants. She will mobilize the community towards local health
planning and increased utilization and accountability of the existing health services.
She would be a promoter of good health practices. She will also provide a minimum
package of curative care as appropriate and feasible for that level and make timely
referrals.
Roles and Responsibilities
Her roles and responsibilities would be as follows:
ASHA will take steps to create awareness and provide information to the
co~n~nunity on determinants of health such as nutrition, basic sanitation and
hygienic practices, health living and working conditions, existing health services
and the need for timely utilization ofhealth and family welfare services.
She will counsel women on birth preparedness, importance of safe delivery,
breast-feeding and complementary feeding, immunization, contraception and
prevention of cornmon infections including Reproductive Travel Itifectionsl
Sexually Transmitted
-. Infection (RTIsISTIs) and care ofthe young child.
ASHA will mobilize the community and facilitate them in accessing health and
health related services available at the Anganwadilsub-centrelprimary health
centers, such as immunization, antenatal clieck-ups, postnatal check-up,
supplementary nutrition, sanitation and other services being provided by the
government.

i She will work with the Village Health and Sanitation Committee ofthe Gram
Panchayat to develop a comprehensive village health plan.
She will arrange escort/accompany pregnant worn& and children requiring
i treatmentladm ission to the nearest pre-identified health facility, i.e., Primary

j Health CentreIConimunity Health CentreIFirst Referral Unit (PHC/CHC/

FRU).
ASHA will provide primary medical care for minor ailments such as diarrhoea,
I
fevers, and first aid for mi~iorinjuries. She will be aprovider ofDirectly
Observed Treatment Short-course (DOTS) under Revised National Tuberculosis
Control Programme.
i
I
P r i m a r y Health She will inform about tlie births and deaths in lier village and any unusual liealth

I
C a r e Management problernsldisease outbreaks in tlie co~iimi~nity to the Sub-centre1Prilnary Health
Centre.
She will act as a depot holder for essential provisions being made available to
every habitation like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet
(IFA), chloroqi~ine,Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.
A Drug Kit will be provided to each ASHA. Contents ofthe kit will include both
AYUSH and allopatl~iqformulations.
Her role as a urovider can be enhanced subseai~entlv.Statis can explore the
possibility of graded training to ller forprovidiag newborn care and manageement
I
ofa range ofcolnmon ailments particularly c11iIdhood illnesses.
She will constructio~iofl~ouseholdtoilets under Total Sanitation 1
Ca~npaign.
Fulfilment ofall these roles by ASHA is envisaged through continuous training
and up-gradation of her skills, spread over tivo years or more.

Selection of ASHA 1
She would be chosen by and accountable to the pancliayat. She will act an interface
between the cornmunitv and the public health.
The general norm will be 'One ASHA per 1000 population'. In tribal, hilly,
desert areas, the norm could be relaxed to one ASHA per habitation, dependent
on workload, etc.
ASHA must be primarily a woman resident d t h e village- 'MarriedfWidowI
Divorced' and preferably in the age group of 25 to 45 years.
ASHA sliould have effective com~n~~nication skills, leadership qualities and be
able to reach out to the community. She should be a literate woman with formal
education up to eighth class. This may be relaxed only if no suitable person with
this qi~alificationis available.
Adequate representation from disadvantaged population groups shoi~ldbe
ensured to serve such groups better.
State Governments may modify these guidelines except that no change may be done
in the basic criteria of ASHA being- a woman volunteer with minimum education LIPto
eighth class and that she would be a resident of the village. I n case any of the .
selection criteria or guidelines is modified, these should be widely disseininated in
local languages.

Training
Capacity building of ASHA is critical in enhancing lier effectiveness. It lias been
envisaged that training will help to equip her with necessary knowledge and skills
resulting in achievement of scheme's objectives. Capacity building of ASHAhas
been seen as a continuous process.
After selection, ASHA will have to undergo a series of training episodes to acquire
the necessary knowledge, skills and confidence for perfor~nirigher defined roles.
Considering the range of functions and tasks to be performed, induction training may
be completed in 23 days spread over a periqd of 12 months. The first round may be

days to complete induction training.

-
of sever1 days, to be folldwed by another four r o ~ z d of
s training, each lasting for four

After the ii~ductioi~

training, periodic re-training will be held for about two days, once
in every alternate month at an appropriate level for all ASHAs. During this training, NRHM and Role of NGOs
interactive sessions will be held to help refresh and upgrade their knowledge and
skills, trouble-shoot problems they are facing, monitor their work and also for keeping
up motivation and interest. The opportunity will also be used for replenishments of
supplies and payment of performance linked i~~c~ritives. ASHAs will be compensated
\
for attending these meetings.

Work Schedule
ASHA will have her work organized in following manner. She will have a flexible
work schedule and her work load would be limited to putting in only abouttwo-three
hours per day, on about four days per week, except during some mobilization events
and training programmes. L

Compensation to ASHA
ASHA would be an honorary volunteer and would not receive any salary or
honorarium. Her work would be so tailored that it does not interfere with her normal
livelihood.
However, ASHA could be compensated for her time in the following situations:
a For the duration of her tra'ining both in terms of TA and DA. (so that her loss of
livelil~oodfor those days is partly compensated).
a For participating in the monthlylbi-monthly training, as the case may be.
(For these two situations, payment will be made at the venue of the training
when ASHAs come for regular training sessions and meetings).
a Wherever compensation has been provided for under different national
prograinmes for ~~ndertaking specific health or other social sector programmes
with measurable outputs, such tasks should be assigned to ASHAs on priority
(i.e., before it is offered to other villag'e volunteers) wherever they are in
position. In such cases, disbursement ofcompensation to ASHAs will be made
as per the specific payment mecha~iismbuilt into individual programmes.
a Other than the above specific programmes, a number of key health-related
activities and service outcomes are aimed within a village (for example, all
eligible children immunized, all newborns weighed, all pregnant women attended
an antenatal clinic, etc.). The Untied Fund of Rs. 10,0001- at the Sub-centre
level (to be jointly operated by the ANM and the Sarpanch) could be used as
~nonetaryco~npensationto ASHA for achieving these key processes. The exact
package of processes that form the package would be determined at the state
level depending on the supply-side constraints and what is feasible to achieSe
within the specified time period. In such cases, the payment to ASHAs will be
made at Panchayats.
a Group recognitionlawards may also be considered.
a Non-monetary incentive, e.g., exposure visits, annual conventions, etc. can be
considered.
a A drug kit containing basic drugs should be given.

2.5 VILLAGE HEALTH NUTRITION DAY

The Village Health Nutrition Day (VHND) is to be organized once every month
(preferably on Wednesdays, and for those villages that have been left out, on any
other day of the same month) at the Anganwadi Centre (AWC) in the village. The
Anganwadi Centre is identified as the hub for service provision in the RCH-11,
NRHM, and also as a platform for inter-sectoral convergence.
. Primary Health On the appointed day, ASHAs, Anganwadi Workers (AWWs), and others will
. Care Management
mobilize the villagers, especially women and children, to assemble at the nearest
Anganwadi Centre. The Auxiliary Nurse Midwife (ANM) and other health personnel
should be present on time; otherwise the villagers will be reluctant to attend the
following rnonthly Village Health Nutrition Day. On the VHND, the villagers can
interact freely with the health personnel and obtain basic services and information.
They can also learn about the preventive and promotive aspects of health care, which
will encourage them to seek health care at proper facilities. Since the VHND will be
held at a sitevery close to their habitation, the villagers will not have to spend money
or time on travel. Health services will be provided at their doorstep. The Village
Health and Sanitation Committee (VHSC) comprising of ASHA, the Anganwadi
Worker fAWW), the ANM, and the Pancliayati Raj Institution (PRI) representatives,
if fully involved in organizing the event, can bring about dramatic changes in the way
people perceive health and health care services.

Services to be provided
All pregnant wolnen are to be registered.
Registered pregnant women are to be given Antenatal Care.
Dropout pregnant women eligible for Antenatal Care are to be tracked and
services are to be provided to them.
A11 eligible children below one year are to be given vaccines against six vaccine
preventable diseases.
All dropout children who do not receive vaccines as per the sclieduled doses are
to be vaccinated.
Vitamin A solution is to be administered to cliildre~i.
All children are to be weighed, with the weight being plotted on a card, and
managed appropriately in order to combat malnutrition.
Anti-TB drugs are to be given to patients of tuberculosis.
All eligible couples are to be given condo~nsand oral co~itraceptivepills as per
tlieir choice and referrals are to be made for other co~itraceptiveservices.
Supplementary nutrition is to be provided to underweight cliildren.

Issues to be discussed with the community

Danger signs during pregnancy.
importance of institutional delivery and where to go for delivery.
Importance of seeking post-natal care.
Counselling on Essential Newbor~iCare (ENBC).
Registration for Janani Suraksha Yojana (JSY).
Counselling for better nutrition.
Exclusive breastfeeding.
Weaning and complementary feeding.
Care during diarrhoea and home management.
Care during acute respiratory infections.
Prevention of malaria, tuberculosis, and other communicable diseases.
Prevention of HIV/AIDS.
Prevention of Sexually Transmitted Infections (STIs).
Importance of safe drinking water.
 Personal hygiene. NRHM and Role of NCOs
, Household sanitation.
Education of children.
Dangers of sex selection.
Age at marriage.
Infor~iiationon Reproductive Tract Infections, STIs, HIV and AIDS.
Disease outbreak.
Disaster management.
Identification of cases that need special attention
ldelitify children with disabilities.
Identify cliildren with Grade I11 and Grade IV malnutrition for referral.
Ideiitify severe eases of anaemia.
Identify pregnant women who need hospitalization.
Identify cases of malaria, tuberculosis, leprosy and kala azar.
Identify problems ofthe old and the destitute.
Pay special attention to the SC, ST, minorities, and the weaker sections of
society.
Collection of data
a
Compile data on the number of children with special needs, particularly girl
children with disabilities.
Report outbreaks of disease.
Reportlaudit deaths of children and women.
Compile data pertaining to the SCs, the STs, the minorities, and weaker sections
of society that need services.
Outcomes
The organization of the Village Health Nutrition Day on a regular basis as per the
guidelineswill result in the achievement ofthe following outcomes:
Hundred per cent coverage with preventive and promotive interventions,
especially for pregnant women, children and adolescents.
, Preventive and promotive coverage for the National Disease Control
Programmes.
Increased awareness about the determinants of health such as nutrition,
sanitation, timely care, etc.
Improve knowledge about the services offered under the various Nutritional
Health Programmes.
Greater emphasis on the commbnity's role in making the health system
responsive to the health needs of the community and in demanding and ensuring
accountability.

Activity 1
1 ) List the key colnpoiients of National Rural Health Mission.
...................................................................................................................
...................................................................................................................
....................................................................................................................
...................................................................................................................
P d m a r y Health
C a r e Management 2) List the expected outcolnes of NRHM.
.................................................................................................................

3) List the basic criteria for selection of Accredited Social Health Activist
(ASHA).

4) List the services that are to be provided to children in Village Health

Nutrition Day.

--
2.6 JANANI SURAKSHA YOJNA
Janani Suraksha Yojna (JSY) is a safe motherhood intervention under the National
Rural Health Mission being i~npleinentedwith the objective of reducing maternal and
ne~o-natalmortality by promoting institutional delivery among the poor pregnant
women. The Yojna, launched on 12th April, 2005 by the Hon'ble Prime Minister, is
being implemented in all States and Union Territories with special focus on low
peirfor~ning states.
Janani Suraksha Yojana integrates cash assistance with antenatal care during tips
pregnancy period, institutional care during delivery and immediate post-partum period
in a health centre by establishing a system of coordinated care by field level health
worker. The JSY is a 100% centrally sponsored scheme.

Vision
T o reduce over all maternal mortality ratio and infant mortality rate, and
To increase institutional deliveries in below poverty line (BPL) families.

Target Group
a All pregnant women belonging to the below poverty line (BPL) households, and
a Up to two live births.

Strategy
The main strategy to achieve the .uision mentioned above is to fink the cash assistance
under Janani Surakslla Yojana to institutional delivery. This entails carrying out the
following:
a Early registration ofthe beneficiaries with the help ofthe village level health
workers like ASHA or an equivalent worker;
 Early identification of complicated cases;
Providing at least three antenatal care, and Oost delivery visits;
Organizing appropriate referral and provide referral transport to the pregnant
women;
Convergence with Integrated Child Development Services (ICDS) worker by
way of involving Anganwadi Worker (AWW) intensively;
Devising as well as ensuring transparent and timely disbursement of tlie cash
assistance to the mother and the incentive to the Accredited Social Health
Activist (ASHA) or an equivalent worker with fund available with ANM.
The strategy also involves the following:
Operationalization of2417 delivery services at PHC level to provide basic
obstetric care;
Operationalization of First Referral Units (FRUs) to provide emergency
- obstetric care;
P
Building partnerships through a process of recog~~itio~i/accreditation with doctors,
I~ospitals/uu:sing horneslcli~iicsfrom the private sector specially in the rural
areas to provide obstetric services to the beneficiaries of Janani Suraksha
Y ojana.

Features
Some features of the Janani SurakshaYojana are as follows:
StatesIUTs have been classified into two categories based on the institutional
delivery rate. The 10 states, namely, the eight Empowered Action Group
(EAG) states (Madhya Pradesh, Chliattisgarh, Bihar, Jharkhand,
Uttar Pradesh, Uttarakhand, Rajasthan and Orissa) and the states of
Assan1 and Jammu & Kaslimir constitute Low Performing States and the rest
High Performing States.
Cash assista~lcelinked to institutional delivery. The benefifs under the scheme
would be linked to availing of antenatal check ups by tlie pregnant women and
getting the delivery conducted in health centers/hospitals. While the beneficiaries
will be encouraged to register themselves with tlie health workers at the sub-
centre/Anganwadi/Primary Health Centres for availing of at least three
antenatal check-ups, post-natal care and neo-natal care, the disbursement of
enhanced benefits under tlie scheme will be linked to institutional delivery.
Theeligibility for cash assistance for institutional delivery is as follows:
Low Performing States: All,pregnant women delivering in Government healtli
centres like sub-centre, P H C / C H C / F R U / ~ wards
~ ~ ~ ~of~ District
I and State
Hospitals or accredited private institution.
High Performing States: BPL pregnant women, aged 19 and above.
Low Performing States and High Performing States: A I ~ S and C ST women
delivering in a govern~nenthealth centre like sub-centre, PHC/CHC/FRU/generaI
wards of District and State Hospitals or accredited private institution.
Cash assistance. One of the accepted strategies for reducing ~ n a t e r ~ mortality
~al
is to promote deliveries at healtli institutions by skilled personnel like doctors and
nurses. Accordingly, cash assistance is to be provided to women from Below
Poverty Line (BPL) fdrnilies, for enabling them to deliver in health institutions.
The assistance will be available as per the following rates:
 (in Rs.)

N o t ~ :1 he package for ASHA or an equivalent worker provided in the scheme includes:

7 i ~ creferral transport assistance for ASHA and the expectant mother to go to ,

t i w nearest health centre;

e I);(- compensation for ASHA or an equivalent worker if she stays wit11 the
pregnant woman in the health centre for delivery; .
1ncl:ntive to tlie AStIA or an equivalent worker. ASHA or an c q l ~ ~ \ a l eworker
nt
should be working as a basic health provider in the village. Such \\orkers
functioning in the rural and urban areas would get an incentive in nII the low
performing States for providing certain essential support services. ,
Note: It must however he ensured that the cash incentive to the ASHA should not be
less than Rs. 2001- per delivery case facilitated by her. This is essential to keep her
sustaine~lin tlle system.
Thc Assistance package to the ASHA or an equivalent worker is available only if she
works and assists the pregnant women. If any pregnant woman does not take
assistan.:: of any accredited worker, may be because no ASHA is in position, she
be paid tlie sum total of' both the packages.
sl~~lilld
Asriistance for Caesarean Section. First Referral UnitsICommunity Health
Centres would provide emergency obstetric services. Where Government
specialists are not available in a health institution, assistance upto Rs. 1500 per
case will be provided for hiring services of private experts to carry out the ,

sargery either in aGover1;ment medical facility or in private hospital, nursing

ho~ne,etc.

Role of Registered Accredited WorkerIASHA in Janani Suraksha Yojna

Each village of 1000 population is expected to have one ASHA or an equivalent
wotker registered with the sub-centre and the PHC of the concerned village. She
. *
would b: working under the supervision oftlie ANM and in tandem with the
Anpanwadi Worker (AWW). Under Janani Suraksha Yojana (JSY), ASHA or an
eqrrivalent worker would have the following role:
Identify pregnant women from BPL families as beneficiaries of tlie scheme;
Ke3ort to the ANM and bring thePwomento the sub-centre1PHC for
registration;
Assist the women to obtain BPL certification if BPL card is not available;
Provide andlor help the women to receive at least three ANC visits;
Counsel for institutional delivery and fix before 7th month of pregnarrCy, the
place of delivery, in close consultation with the ANM and the PHC and inform
the beneficiary;
 Assist in receiving two tetanus toxoid injections; NRHhl :ind Role of NGBs

When the pregnant woman is in labour or faces complications, escort the

women to the pre-determined health centre and stay wit11 her till the delivery is
complete and woman is discharged; a

Arrange to immi~nizethe newborn till the age of 10 weeks;

Register birth or death of the child or mother;
Post natal visits within 7 days of pregnancy and track mother's Iicalth:
Counsel for initiation ofbreast feeding within one hourofdeli\e~-yand its
continuance till 3-6 months; .
Motivate for family planning services.

2.7 INDIAN PUBLIC HEALTH STANDARDS

The health care'syste~nin India has eapanded considerably over tlie last few
decades. However, tlie quality of services is not uniform due to various reasons like
non-availability of manpower, proble~; ofaccess, acceptability, lack ofcommunity
involvement, etc. Hence, Indian P u b l l ~I lealth Staudards (IPHS) are being introduced
in the country. 'These are a set of standards envisaged to improve tlie quality of health
care delivery i~ndertIieNationa1 Rural Health Mission.
The National Rural Idealtli Mission aims at strengthening hospital care for riiral areas.
At present, these standards are being applied only to tlie Community Health Centrcs
(CI-ICs). As a first step, requirements for a Minimum Functional Grade of a
C'omniu~~ity Ilealth Centre are being 1,rcscribecl. Further ilpgradatio~iwill be proposed
atier tliesc mininlum r e q u ~ ~ e m e nhave
t \ been met. Standards for Primary I-Iealth
C'cntl-c and Sub-centres arc also being de\/eloped.
.1.lic follo\ving test deals with Indian Public Health Standards for Community Healtli
Centres.

Objectives of the Indian Public Health Standards (IPHS) for CHCs

'1'0 provide optimal expert care to tlie co~~itni~nity;
To achieve and maintain an acceptable, standard of quality of care;
To make these services more responsive and sensitive to the needs of tlie
community.

Service Delivery
All "Assured Services" as envisaged in tlie CliC should be available, which
incli~deroutine and emergency care in Surgery. Medicine. Obstetrics and
Gynaecology and P:wdiatrics in addition to all the National Health Programmes.
Appropriate guidelines for each National Program~nefor management of routine
atid emergency cases are bcing provided to the CI IC.
All the support services to fillfill the above ob.jectn cc will be strengthened at t l ~ e
CI4C level.

M i ~ i i ~ i i ~ nreqoirement
tn for tlelivery of the above-meationetl-services
The following reqliirements are being projected based on the assumption that there
will be average bed occupancy of 60%. The strcngtli may be l i ~ r t l i eincreased
~ if thc
occupancy increases. \vith subsequent upgradation. As regards Inanpower. two
y , ~ c i a l ~ s namely,
ts Annesthesist and Public Health Programme Manager, M ill be
provicled on contractual basis in addition to tlie available specialists, namely, Surger! ,
Meclicinc. Obstetrics and Gynaecology. and Pacdiatrics.
 I'he si~pport~nanpowerwill include a Publi: HealthNurse and ANM in addition to
tlie existing staff. An Ophthalmic Assistant bill also need to be provided in centres
where currently there is none. One OpI~tha1~~io1ogist (MS-Ophthal.) for every
5 CHCs is recommended in addition to ex~stingbiovisions. One Dental Surgeon.
6 GDMOs, one AYUSH specialist, and one AYUSW general doctor are also
recommended. 1
Facilities
The eq~~ipment provided under the Child Survival and 2afe Motherhood Programme is
deemed adequate. Physical infrastructure will be re~nodeledor rearranged to ~iialie
best possible use for optimal utilization. New constructions will follow the
specificatio~isprovided in the India11Public Health Standards. Space requirements for
different functional areas have been listed out.
Drugs will be as per the list included in the Indian Public Health Standards. AYUSH
drugs are also being included. All tlie support services like laboratory, blood storage,
etc. will be strengthened.

Human Resource Management and Accountability

Capacity building will be ensured at all levels by periodic training of all cadres.
It is mandatory for every CHC to have a "Rogi Kalyan Sa~niti"to ensure
accountability. Every CHC shall have the Charter of Patients' Rights displayed
prominently at the entrance. A grievance redressal mechanism i~nderthe overall
supervision of Rogi Kalyan Samiti would also be set up.

Quality of Services
Every CHC shall also have tlie Standard Operating Procedures and Standard
Treatment Protocols for coininon ailments and the National Health Programmes.
Social audit by involvement ofthe co~nmunitythrough Rogi Kalyan Samitis is being
recommended. 7:0 maintain quality of services, external monitoring thro~~gll
.ti Raj Ins1 ion! ~di~ )nit:oriyg at apprc
A. Guiideli are ing for manage:ment
cases under the Natioilal Health Programmes so as to maintain uniformity in
management in tune with theNational Policy.

IList the measures recommended for ensuring accountability at the level of

Co~nmunityHealth Centre, as per the Indian Public Health standards.

2.8 SUMMARY
In this Unit, you have learnt about the main features of the National Rural Health
Mission (2005-20 12). The Mission has been launched in the entire country, with
special focus on 18 states. Goals and expected outcolnes have been specified.
 You Iia\ e come to know that the key components of the Mission are provision of a NRHRI a r 1 ~ - \1
li.m;llc health activist (Accredited Social Health Activist [ASHA]) in each village,
preparation of\'illa&re Health Plans, establishment of Indian Public Health Standards
h r effective curative care at rural health centres, and integration of various vertical
Health and Family Welfare Programmes fill optimal utilization of funds and
I infrastructure.
AS1 1.4. the woman volunteer. is envisaged as a change agent on health in a villag,e.
She will create health awareness, promote good health practices, mobilize tlie
co~nmunityand provide a rninimi~~n package of curative care. The importa~iceand
I organization of a \'illage Health Ni:trition Day has been described.
You have learnt about tlie Janani SuraksIiaYojna (JSY), which is being implemented
all o\er the country, with special focus on states with institutional delivery rates. The
primary objective ot'tliis Yojna is to reduce ~naternaland neo-natal mortality by
pro~noti~ig institutional delivery among the poor pregnant women. Cash assistance is
linked to institutional delivery.
I n this [!nit, a description oftlie Indian Public Health Standardsfor Community
I lealtli C'cntres ha\ heen included. Adherence to these standards is expected
to result in improvetl cluality of Iiealth care semices under theNational
Raral I Iealtli 1 1ission.

2 SELF-ASSESSMENT QUESTIONS
I. S t ~ ~ the
d y other activities of NHRM and list the objectives ofthe mission with
special refsrence to HIVIAI Ds.
2. What measures NHRM plans to take to Control HIVIAIDs?

2.1 0 FURTHER READINGS

.Innall I ' \ 111 hsha Yojana. Guidc1irre.s ,for Ir)ipZenientution.National Rural Health
I\.l~\,ionhlinistry of Health and Family Welfare, Government of India.
National Rural 14ealth Mission. Freclricntly Asked Qzrc.vtiovrs.Ministry of ITealth and
I'amily Welfare. Government of Indin.
AC.C.I'C~IILY/
,Yoci(rl lletrlth Ac/ivi.st (Aa91/.,Ij(;riit/eline\. National Rural Health
bTis\ion. Ministry of l lealth and Family Welfare, Govern~nentof India.
Natio~lalIlural Hcnltli Misbion (1005-2012). iMissiotr L)oc~inic~~~/.
Ministry of Health
and I:nrniI~,Weitire. Ciovernn~cntof India.
I~idian1'11blic I~leal~l, (1PtIS) for Community Health Centres (Revised).
Sl:~~lclards
I Direclo~.nte(iencral 01' I Icalth Services. lvational Rural Health IMission. Freytrcnt!~
. I.\kctl <_)rie.s/iou.s.
Ministry 01'1 Iealth and 1:arnily Welfare, Government of India.
Fchruar\-2007.
I Nat ioo:~l Ilul.a l 'I leal tli M ission. :Meeri~rgr"c~o,,le
l:~.a~llc\\ork
'.v IIeulth h1ec.ds in Rzn.01 Arecrs.
ii)r lniplcmentatio~r2005-2012. National Rural Health Mission. Ministry
01.1-leallh and Family Welfare, C;overnment of India.
. - I I I I I I I ( I / I\'c,j~o~./
2000-0-. Mi~iistryof tlealth and Family Welfare, Gover~l~nent
of
It~cli~~.

I
hIo111111y\'illage tienlth Nutrition Day. G~~idelines ji)1..4ms/ASHAs/Ah'AIs/PRL~Y
K ; ~ t i o ~K~ra~lr n lI-lcalth Mission. Mi~;istryofHealtli and Family Welfare, Government
01. I11dia.I:cI>I.II~I.~ 2007.