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National Rural Health Mission

National Rural Health Mission. MIT India Reading Group Meeting 4 Oct 07 Lavanya Marla. About NHRM. Inaugurated on April 12, 2005 Increase spending on health from 0.9% of GDP to 2-3% of GDP Correct the deficiencies of the health system Focus on 18 states – northern and eastern

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National Rural Health Mission

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  1. National Rural Health Mission MIT India Reading Group Meeting 4 Oct 07 Lavanya Marla

  2. About NHRM • Inaugurated on April 12, 2005 • Increase spending on health from 0.9% of GDP to 2-3% of GDP • Correct the deficiencies of the health system • Focus on 18 states – northern and eastern • Goal is good decentralized healthcare • Missionary approach by government? • Intended for 2005 - 2012

  3. Goals • Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) • Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition. • Prevention and control of communicable and non-communicable diseases, including locally endemic diseases • Access to integrated comprehensive primary healthcare • Population stabilization, gender and demographic balance. • Revitalize local health traditions and mainstream AYUSH • Promotion of healthy life styles

  4. Action Points • Provision of health activist in each village • Village health plan prepared through panchayat involvement • Strengthening of rural hospitals • Integration of vertical health programs (leprosy, TB, malarial programs, etc.) and traditional medicine • Integration of plans at different levels • New health financing mechanisms

  5. Major Stakeholders • Accredited Social Health Activist (ASHA) • Auxiliary Nurse Midwife and Anganwadi worker • Panchayati Raj Institutions and NGOs • District Administration • State Governments

  6. Village level • ASHA • accredited social health activist • Female activist given accreditation after 4 phase training • Ownership of health program given to villagers • Village Health Committee prepares village health Plan

  7. District Level • District health plan generated by combining village health plans • Elements are drinking water, sanitation, hygiene and nutrition • Strengthen PHC (Primary Health Centers) and CHC (Community Health Centers)

  8. Higher levels • Integrate vertical health and family welfare at district, block, state and national levels • Integration of vertical health programs (leprosy, TB, malarial programs, etc.) • All health facilities and infrastructure built based on Indian Public Health Standards (IPHS) standards • Rectify manpower shortage, equipment and other furnishings in health facilities • Strengthen capacities for data collection, processing, evaluation and supervision

  9. Exploit synergies at different levels • NGOs and ASHAs work together • AYUSH (Ayurvedic, Yogic, Unani, Siddha and Homoeopathy) - Local health traditions made mainstream • Pass regulations requiring private practitioners to give service at reasonable cost • Public-private partnerships • Re-orient medical education (MBBS 6th yr in rural service?) • Social health insurance (how viable?) • Health Information System

  10. Health provider in each village Upgrading of rural hospitals Build new hospitals District Planning Operational Village Health Plans Merger of multiple societies into District/State Mission Operational PMUs Technical Support 2005-08 2005-07 2005-08 2005-07 2006 April 05 2005-06 2005-07 Milestones

  11. Progress of Program • http://mohfw.nic.in/NRHM/Exe_sum_apr07.htm • ‘Expected improvement’ statistics missing for many measures

  12. Observations and Questions • Attempt at transparency • Data actually available, though not comprehensive • Working on cures is an inherent defect in Indian health system – Focus seems to be changing towards prevention • Providing ‘standard’ health care in peripheral areas – economically viable? • Is this a missionary approach, or is it sustainable?

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