National Rural Health Mission - India shiv_mathur@hotmail.com Shiv Chandra Mathur Director State Institute of Health and Family Welfare, Rajasthan, Jaipur Shiv Chandra Mathur is a public health specialist working for developing human resources for health. His current assignment involves him consistently in organizing in-service trainings for health professionals. Present paper is a conceptual analysis of the genesis, proposed strategies and outcome expected trough a missionary approach adopted by the largest democratic polity in the world. Viewers/Readers are welcome to share their observations/comments with author at shiv_mathur@hotmail.com. They may go through related ecture from the author in supercourse series on RCH, adolescent health and violence against women in India.

SHIV CHANDRA MATHUR/sihfw Preamble The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP, over the next 5 years. 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. Government of India launced the National Rural Health Mission in April 2005. Political commitment of the missionary approach is reflected in its launch by the Prime Minister of the country. Eighteen of the 35 states of the federal republic of India are following the suit by creating state level missions under the chair of respective Chief Ministers of the states. Geographically these are northern and eastern states of the country which have more challenges on human development front. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

SHIV CHANDRA MATHUR/sihfw Preamble Provision of a health activist in each village ASHA Village health plan prepared through panchayat involvement Strengthening of the rural hospital on IPHS Integration of vertical Health & FW Programme 1/16/2019 SHIV CHANDRA MATHUR/sihfw

SHIV CHANDRA MATHUR/sihfw ASHA The acronym stands for accredited social health activist Accreditation to a female activist volunteering to take up community health work at grassroots will be given after a four phase modular training She will strength primary health care particularly in inaccessible area ASHA is a refined version of community health worker schme which country undertook for a spell of two to five years about 25 yeaars back. The weaknesses and failure encountered in earlier projects have been seriously considered in formulating the current scheme. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

SHIV CHANDRA MATHUR/sihfw Village Health Plan Planning for health to be initiated from village level will transfer the ownership of all health program to the villagers District Annual Plan would generate from village level through a participatory approach. Plan will largely indicate expected level of achievement for each of the health program Since district in India is an administrative units (average population = 1.5 to 2 million), all village health plans would be clubbed at district level. Such a step would facilitate the measurement of change. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Indian Public Health Standards All peripheral health facilities would be rejuvenated on standards developed at the central level by Ministry of Health and Family Welfare. This initiative will take care of rectifying the manpower weaknesses, equipment and appropriate furnishings in health facilities. In a democratic polity, health facilities in public systems are founded enthusiastically to fulfill the demands of the people. But random approach of founding the facilities in periphery leaves behind a consistent challenge of making them productive and viable for ever. NRHM will provide the resources over a period of seven years to the states to fill up the gaps. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Integration of Vertical Health Program All vertical health program like Malaria control, TB control, Leprosy control, Blindness Control, Water and Sanitation and Reproductive and Child Health program would be merged. In India almost one-and-half dozen national health program currently in vogue have a vartical approach. Eventually their implementation have a compartmental approach. The dilemma is that when these program converge at cutting-edge level, there is a competition and success of an individual program depends on program specific intermediary manager who control the program from state headquarters! Missionary approach through NRHM is an expression of not only clubbing the resources but also creating a synergy to elicit better return. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

SHIV CHANDRA MATHUR/sihfw Guiding principles Promote Equity Enhance People orientation and community based approaches Ensure Public Health Focus Recognize value of traditional knowledge base of communities Decentralize and involve local bodies. While health planning at village level is an indication of decentralization, inducting ASHA is recognizing the value of traditional knowledge. Generating a positive culture in favor of public health would spontaneously pave the way for equity. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

SHIV CHANDRA MATHUR/sihfw Goals Reducing IMR and MMR by 50% from existing levels in next 7 years Universalize access to public health services : such as Women’s health, child health, water, sanitation, immunization, Nutrition…. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to Integrated comprehensive primary healthcare Assuring Population stabilization and , gender balance. Promotion of healthy life styles 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Institutional Mechanism - National National Mission Steering Group chaired be co-chaired by Health and Family Welfare Minister with Deputy Chairman Planning Commission. Membership would cover Ministers of Panchayat Raj, RD, HRD. Public health professionals would be nominated by HFM in consultation with PM. Health and Family Welfare Secretary would be its Convener. At lower level an Empowered Programme Committee will be chaired by Secretary HFW. There will also be Standing Mentoring Group for ASHA 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Institutional Mechanism - State State Health Mission (Chaired by Chief Minister; co-chaired by Health Minister; State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc) District Health Mission (under the leadership of Zila Parishad (District Council) with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it) In middle of 2005, process of constituting state and district bodies has started in most of the states. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Institutional Mechanism (cont.) Village Health & Sanitation committee (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers) Autonomous societies for community management of public hospitals 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Role of Peripheral Democratic Bodies ASHAs would be selected by and be accountable to the Village Panchayat. The Village Health Committee would prepare the Village Health Plan, and promote inter-sectoral integration. The untied fund at Sub-centers to be deposited in a Bank Account, jointly operated by ANM and Sarpanch. District Health Mission to be led by the Zila Parishad. The DHM would also guide activities of sanitation. Peripheral democratic bodies at village level in India is known as Panchayat and at district level, they are designated as Zila Parishad. Village head is designated as Sarpanch. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Role of Peripheral Democratic Bodies (PRIs) The DHM will control, guide and manage all public health institutions in the district, Sub-centres, PHCs and CHCs. PRI involvement in autonomous societies for good hospital management. Training to members of PRIs. Making available health related databases to all stakeholders, including Panchayats at all levels. States to indicate in their MoUs their commitment for devolution of funds and programmes to PRIs. PRIs are decentralized democratic bodies known as Panayati Raj Institutions. 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Role of NGOs for the Mission In institutional arrangements Standing Mentoring Group for ASHA Member of Task Forces Provision of Training, BCC and Technical Support for ASHAs/DHM Health Resource Organizations Service delivery for identified population groups on select themes 1/16/2019 SHIV CHANDRA MATHUR/sihfw

Milestones to be achieved Health Provider in each village 2005-2008 Upgrading of Rural Hospitals 2005-2007 Creation of New Hospitals 2005-2008 District Planning operational 2005-2007 Village Health Plans 2006 Merger of Multiple societies into April 2005 District/State Mission Operational PMUs 2005-2006 Technical Support 2005-2007 1/16/2019 SHIV CHANDRA MATHUR/sihfw