1. National Rural Health Mission - India
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.
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2. 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 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.
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3. 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
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4. 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.
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5. 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.
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6. 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.
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7. 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.
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8. 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.
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9. 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
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10. 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
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11. 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.
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12. 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
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13. 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.
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14. 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.
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15. 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
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16. Milestones to be achieved
Health Provider in each village
Upgrading of Rural Hospitals
Creation of New Hospitals
District Planning operational
Village Health Plans
Merger of Multiple societies into April 2005
District/State Mission
Operational PMUs
Technical Support
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