National Rural Health Mission – An Overview

Journey to NRHM Family Planning Programme(1952) Education and Target oriented approach( ) Under PHC-PPP and MTP Act( ) FP FW( ) National Health Policy-I(1983) Strengthening of MCH (1983) CSSM(1992) ICPD(1994) Review of CSSM(1996) RCH(1997) NRHM(2005)

National Rural Health Mission launched in April, Rejuvenate the Health delivery System Universal Health Care Affordability Access Equity Quality Reduce IMR, MMR,TFR Improve Disease control

Goals of the Mission 4 Universal Health care, well functioning health system Reduce IMR to 30/1000 live births by 2012 Reduce MMR to 100/100,000 live births by 2012 TFR reduced to 2.1 by 2012 Reduce & sustain Malaria Mortality to 60% by 2012

Goals of the Mission Kala Azar eliminated by 2010, Filaria reduced by 80 % by 2010 Dengue Mortality reduced by 50% by 2012 TB DOTS maintain over 70 % case detection & 85% cure rate 46 lakh cataract operations annually by Upgrading all health facilities to IPHS. Increase utilization of FRUs from 20% bed occupancy to 75%

The Paradigm Shift 7 Decentralised planning Outputs and Outcome based Pro-Poor Focus: Equitable systems Quality of Care and the IPHS norms Rights based service delivery Pre stated entitlements at all levels Inputs computed as function of the entitlements and estimated patient load Judicious mix of dedicated budget lines - untied funds Monitor quality Community Participation at all levels

RCH-II NVBDCP RNTCP NLEP NPCB IDSP IDDCP N.R.H.M.

The Paradigm Shift 9 Bringing the public back into public health At hamlet level : ASHA, VHSC, SHGs, Panchayats At the facility level: RKS At the management level : Health Societies Governance reform Manpower, Logistics & Procurement processes Decision making processes Institutional design, Accountability framework Convergence Water and sanitation Nutrition Education

Institutional Set up Mission Steering Group Rogi Kalyan Samities RKS, PHC Village Health Community State Health Mission District Health Mission District Health Society Block Committee Programme Committee

Health Financing % public expenditure (0.9% GDP), often inefficient and ineffective. 80% private expenditure, mostly out of pocket 15-20% MoHFW expenditure – rest by States By % public expenditure with improved accountability and efficiency ( 2-3% GDP) Private expenditure by risk pooling/insurance – less duress and distress 40% GoI expenditure – rest by States

Expected Outcomes at community level Availability of trained community level worker at village level, with a drug kit for generic ailments. Health Day at AWlevel on a fixed day/month for provision of immunization, ante/post natal check ups and services related to mother and child care, including nutrition. Availability of generic drugs for common ailments at sub centre/hospital level. Good hospital care through assured availability of doctors, drugs and quality services at PHC/CHC level.

Expected Outcomes at community level Improved access to universal immunization. Improved facilities for institutional deliveries. Availability of assured health care at reduced financial risk through pilots of Community Health Insurance. Improve outreach services through mobile medical unit at district level.

Community Empowerment 16

OBJECTIVES 17 Create forums for community ownership  VHSC, RKS,DHM,SHM Collect systematic info about community needs provide feedback according to  locally developed yardsticks  key indicators Validate sector wide data from other sources Triangulation

Tools of Community Monitoring 18 Village Level  Village Health Register - Records of ANM - Public dialogue  Village Health Calendar- Infant and maternal death audit PHC level  Charter of Citizens Rights – IPHS - PHC Health Plan Block level  IPHS - Charter of Citizens Rights - Block Health Plan District level  Report from the PHC Health committees  Report of the District Mission committee  Public Dialogue (Jan Samvad) State level  Reports of the District Health committees  Periodic assessment reports by taskforces / State level committees about the progress made in formulating policies according to IPHS etc.

VILLAGE HEALTH & SANITATION COMMITTEE 19 Gram Panchayat members from the village ASHA, Anganwadi Sevika, ANM SHG leader, village representative of any Community based organisation working in the village, user group representative  Chairperson : Sarpanch  Convenor would be ASHA / AWW/ANM ( State specific) Formed at level of revenue village (more than one such village may come under single Gram Panchayat)

PHC Level Committee (RKS) 20 30% members : representatives of Panchayati Raj Institutions (Panchayat Samiti member from the area; two or more sarpanchs) 20% members - non-official representatives from VHSCs with annual rotation to enable representation from all the villages 20% members representatives from NGOs / CBOs in the area 30% members representatives of providers, MO, ANM  Chairperson be one of the Panchayat representatives  Secretary Medical officer I/c of PHC

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