National Rural Health Mission

PREETI THAKUR
 12th April 2005
was a historic day in India when our
Honorable Prime Minister,
Dr. Manmohan Singh
lunched
The National Rural Health Mission
With a Budget out lay of Rs.6500 crores for
2005-06 with a commitment to raise public health
expenditure from 0.9% to 2.3%of GDP
 Health is fundamental to national progress in
any sphere.
 In terms of resources for economic development, nothing can be
considered of higher importance than the health of the people.
 For efficiency of the industry, agriculture, other developmental
activities, the health of the people is the most essential
consideration.
The loss caused by morbidity is enormous

To this must be added the expenditure to

the individual and the state in provision of
medical & health care
 Causes of the low state of health are

Lack of awareness about health

Lack of a hygienic environment conducive to healthful living,
 low resistance to infection primarily due to poor nutrition,
lack of safe drinking water,
proper removal of human wastes,
lack of appropriate health care
 Why NRHM ?

Recognizing the importance of Health in the

process of economic and social development and
improving the quality of life of our citizens, the
Government of India has resolved to lunch the
Rural Health Mission (NRHM) to carry our
necessary architectural correction in the basic
health care delivery system
 The National Rural Heath Mission

Seeks to provide effective health care to the rural

population, especially the disadvantaged groups
including women and children
1. by improving access,
2. enabling community ownership and demand for services,
3. strengthening public health system for efficient service
delivery,
4. enhancing equity and accountability and
5. promoting decentralization
 NRHM subsumes (Rules)

A. Activities under RCH-II

B. Initiative under NRHM
C. Action plan for immunization
D. National Disease Control Programme
E. Implementation of inter-sectoral
Scheme under the NRHM
Integrated Disease Surveillance Project
Mainstreaming AYUSH
 The NRHM Focus

Health Health Determinants

RCH-II Nutrition
NDCP
IDSP
Sanitation
General
AYUSH Curative Care
Drinking Water
Immunization Supply
 The Vision

The National Rural Health Mission 2005-2012)

seeks to provide effective healthcare to rural
population throughout the country with specific
focus on 18 states, which have weak public
health indicators and /or weak infra structure
 These 18 states are…..

 Madhyapradesh HimachalPradesh
 Chhatishgarh Jammu& Kasmir
 Bihar Arunachal pradesh
 Jharkhand Assam
 Manipur Meghalaya
 Nagaland Mizoram
 Sikim Tripura
 Orissa Uttaranchal
 Rajasthan Uttar Pradesh
The Mission is an articulation of the commitment of the
Government to raise public spending on health from
0.9% to 2.3% of the GDP.
It 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
 Goals

Reduction of I.M.R. & M.M.R.

Universal access to Public Health Services such as
Women’s Health, Child Health, Water, Sanitation &
hygiene Immunization & Nutrition.
Prevention & Control of Communicable & Non
communicable diseases including locally endemic
Diseases.
 Goals….

Access to integrated, comprehensive Primary

Health Care.
Population stabilization, gender & demographic
balance.
Revitalize local Health traditions & mainstream
AYUSH.
Promotion of Healthy lifestyles.
 Strategies

Health plan for each village through Village Health

Committee of the Panchayat
Train & enhance capacity of P.R.Is. to own, control
and manage PH services.
Promote access to improved Health Care through
ASHA.
Strengthening SC through untied funds to enable local
Planning & action.
 Strategies

Strengthening existing PHCs and CHCs, and

provision of 30-50 bedded CHC per lakh
population for improved curative care to a
normative standard IPHS defining personnel,
equipment and management standards
Preparation and implementation of an inter-
sectoral District plan prepared by the District
Health Mission, including drinking water,
sanitation & hygiene and nutrition.
 Strategies

Integration of vertical Health and Family Welfare

programmes at National, State, District,& Block levels.
Technical support to National, State and District
Health Missions for Public Health Management.
Strengthening capacities for data collection, assessment
and review for evidence based planning, monitoring
and supervision
 Strategies

Formulation of transparent policies for deployment and

carrier development of Human Resources for health.
Developing capacities for preventive health care at all
levels for promoting healthy life style, reduction in
consumption of tobacco and alcohol etc.
Promoting non profit sector particularly in underserved
areas
 Key Components

Provision of Accredited Female Health Activist

(ASHA) in each village/1000 population.
Village Health plan prepared through a local team
headed by Health & sanitation committee of
Panchayat.
Integration of vertical Health & Family Welfare
Programmes & Optimal Utilisation of funds &
infrastructure.
Strengthening Delivery of services in Primary Health
Care .
 Key Components

Revitalize local Health traditions and mainstream

AYUSH into the Public Health systems.
Effective Integration of Health Concerns with
determinants of Health like Sanitation &
hygiene, Safe drinking water & Nutrition
through a District Plan for Health through
District Health Mission.
It shall define time bound goals and report on their
progress.
 Key Components

It seeks to address inter-state and inter-district

disparities, especially among the 18 high focus state,
including unmet needs for public health infrastructure
It shall define time-bound goals and report publicly on
their progress
It seeks to improve access of rural people, especially
poor women and children, to equitable, affordable,
accountable and effective primary health care
 Key Components

Strengthening existing PHCs & CHC- provision of 30-50

bedded CHC per lakh population as per a normative
Indian Public Health Standard (IPHS). for effective
curative care to ensure accountability which can be
measured by the community.
Integration of vertical H&FW programmes at National,
State, Block & District levels.
 Key Components

Strengthening capacities for data collection, monitoring

& super vision
Transparent policies for Deployment & Career
Development of Human Resources for Health.
Developing capacities for Preventive Health Care.
Mainstreaming AYUSH.
 Key Components

Emphasizing evidence based planning and

implementation through improved capacity and
infrastructure
Promoting the non profit sector to increase social
participation and community empowerment,
promoting healthy behavior, and intersectoral
convergence
 Supplementary Strategies

Regulation of the private sector to improve equity and

reduce out of pocket expenses
Foster public private partnership to meet National
Public Health Goal
Re-orientation of Medical Education (ROME)
Introduction of Risk Pooling Mechanisms and social
insurance to raise the health security of the poor taking
full advantage of local health tradition.
Promotion of Public Private Partnership for achieving
public health goals
Mainstreaming AYUSH
 Organization

At National Level
The Mission Steering Group under the
Chairmanship of Union Minister for Health and
Family Welfare will provide policy Guideline and
operational oversight
Ministerial/Secretary level representatives of
Planning Commission, Rural Development,
Panchayati Raj, Human Resource Dev. Health and
Family Welfare Secretary of four states and Public
Health professionals nominated by Prime Minister
shall be the member of the Mission Steering Group
 Organization
State level
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.
District level
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
 Organization

CHC/SDH level
Rogi Kalyan Samiti (or equivalent) for community
management of public hospitals

Village level
Village Health & Sanitation Samiti consisting of
Panchayat Representative/s , ANM/MPW, Anganwadi
worker, teacher, ASHA, community health volunteers
 Technical Support
To be effective the Mission needs a strong component
of Technical Support
This will reorientation into public health management
with existing health resource institutions, like PRC,
RRC, SIHFW also involve NGOs as resource
organisations
Improved Health Information System
Support required at all levels: National, State, District
and sub-district.
Mission would require two distinct support
mechanisms– Program Management Support Centre
and Health Trust of India
 Program Management
Support Centre

For empowering the Management Systems like basic

program management, financial systems,
infrastructure maintenance, procurement & logistics
systems, MIS, non-lapsable health pool etc.
For Improved Governance – decentralization &
empowerment of communities, induction of IT based
systems like e-banking, social audit and right to
information.
 Health Trust of India

Proposed as a knowledge institution, for

Innovative research & documentation, health
information system, planning, monitoring &
evaluation etc.
Establishing Public Accountability Systems – external
evaluations, community based feedback mechanisms,
participation of PRIs /NGOs etc.
 Health Trust of India..

Developing a Framework for pro-poor

Innovations and reviewing Health Legislations.
Encouraging experimentation and action
research.
Inter & intra Sector Networking with National
and International Organizations.
Develop a long-term vision of the Sector & for
building planning capacities of PRIs, Districts etc.
 Role of State GOVT. Under NRHM

States would fund interventions like ASHA,

Programme Management Unit (PMU) and
upgradation of SC/PHC/CHC through Integrated
Financial Envelope.
NRHM provides broad conceptual framework. States
has to project operational modalities in their State
Action Plans, to be decided in consultation with the
Mission Steering Group.
 Role of State GOVT. Under NRHM

Prioritize funding for addressing inter-state and

intra district disparities in terms of health
infrastructure and indicators.
States would sign MoU with Government of India,
indicating their commitment to increase contribution
to Public Health Budget (preferably by 10% each
year), increased devolution to Panchayati Raj
Institutions as per 73rd Constitution (Amendment)
Act, and performance benchmarks for release of
funds
 Role of District Health Mission
Shall control and guide all Public Health Institutions at
the District and Sub-District level.
Prepare and implement integrated district Action Plans
in respect of funds received from funding agencies.
Guide micro planning for selection and Training of
ASHA.
Organize Health Camps at Anganwadi levels for
services related to Immunization and Institutional
Delivery.
 Role of District Health Mission

Mainstreaming AYUSH infrastructure.

Utilization of untied funds at sub-centers and
Strengthening Outreach Services through MHU.
Supplying Drugs,
Upgrading CHCs to IPHS standard
Ensure intersectoral convergence among related
Departments at District and Sub-District level.
 Role of Panchayat Raj Institutions

States to indicate in their MoUs the commitment for

devolution of funds, functionaries and programmes for
health, to PRIs.
The District Health Mission to be led by the Zila
Parishad. The DHM will control, guide and manage all
public health institutions in the district, Sub-centres,
PHCs and CHCs.
 Role of Panchayat Raj Institutions

 ASHAs would be selected by and be

accountable to the Village Panchayat.
 The Village Health Committee of the Panchayat
would prepare the Village Health Plan, and
promote inter sectoral integration.
 PRI involvement in Rogi Kalyan Samitis for
good hospital management.
 Provision of training to members of PRIs.
 Role of Panchayat Raj Institutions

Each sub-centre will have an Untied Fund for local

action @ Rs. 10,000 per annum. This Fund will be
deposited in a joint Bank Account of the ANM &
Sarpanch and operated by the ANM, in
consultation with the Village Health Committee.
Making available health related databases to all
stakeholders, including Panchayats at all levels.
 Role of NGOs in the Mission
Included in institutional arrangement at National,
State and District levels, including Standing
Mentoring Group for ASHA
Member of Task Groups
Provision of Training, BCC and Technical Support
for ASHAs/DHM
Health Resource Organizations
Service delivery for identified population groups on
select themes
For monitoring, evaluation and social audit
 Focus on the North Eastern States
All 8 North East States, including Assam, Arunachal Pradesh,
Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura,
are among the States selected under the Mission, for special
focus.
Empowerment to the Mission would mean greater flexibilities for
the 10% committed Outlay of the Ministry of Health & Family
Welfare, for North East States.
States shall be supported for creation/upgradation of health
infrastructure, increased mobility, contractual engagement, and
technical support under the Mission.
Regional Resource Centre is being supported under NRHM for
the North Eastern States.
Funding would be available to address local health issues in a
comprehensive manner, through State specific schemes and
initiatives.
 Funding Arrangements

The Mission is conceived as an umbrella

programme subsuming the existing programmes
of health and family welfare, including the RCHII,
National Disease Control Programmes & Iodine
Deficiency and Integrated Disease Surveillance
Programme.
The Budget Head For NRHM shall be created in
B.E. 2006-07 at National and State levels. Initially,
the vertical health and family welfare
programmes shall retain their Sub-Budget Head
under the NRHM.
 Funding Arrangements

The Outlay of the NRHM for 2005-06 is in the

range of Rs.6700 crores.
The Mission envisages an additionality of 30%
over existing Annual Budgetary Outlays, every
year, to fulfill the mandate of the National
Common Minimum Programme to raise the
Outlays for Public Health from 0.9% of GDP to 2-
3% of GDP
 Funding Arrangements

The Outlay for NRHM shall accordingly be determined

in the Annual Budgetary exercise.
The States are expected to raise their contributions to
Public Health Budget by minimum 10% p.a. to support
the Mission activities.
Funds shall be released to States through SCOVA,
largely in the form of Financial Envelopes, with
weightage to 18 high focus States
 Time Line (for major components)

Merger of Multiple Societies June 2005

Constitution of District/State Mission
Provision of additional generic drugs December 2005
at SC/PHC/CHC level
Operational Programme Management Units 2005-2006
Preparation of Village Health Plans 2006
ASHA at village level (with Drug Kit) 2005-2008
Upgrading of Rural Hospitals 2005-2007
Operationalizing District Planning 2005-2007
Mobile Medical Unit at district level 2005-08
THANKS