National Rural Health Mission:A revolution in the health sector Subodh S Gupta Dr. Sushila Nayar School of Public Health MGIMS, Sewagram
The Challenges in health sector • Under funded public health system • High and prohibitive out of pocket expenditure • Poor distribution of skilled manpower • Poor quality services in public health system • Poor community participation • People’s needs different from what system offers • Large unregulated private sector • Unwillingness to look for structural change and governance reform
Priorities for health under Common Minimum Program • Raise public spending on health to 2-3% of GDP • A national scheme for health insurance for poor families • Responsibility for development schemes to village women • Special attention to poorer sections in matters of health care. • Food and nutrition security • Life saving drugs at reasonable prices
Introduction • National Rural Health Mission was launched by our Hon’ble Prime Minister launched in 12 th April, 2005 with an objective to provide effective health care to the rural population, by • Improving access • Enhancing equity and accountability • Promoting decentralization
Coverage • The NRHM covers the entire country, with special focus on 18 states where the challenge of strengthening poor public health systems is the greatest. • These are Uttar Pradesh, Uttaranchal, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Orissa, Rajasthan, Himachal Pradesh, Jammu and Kashmir, Assam, Arunachal Pradesh, Manipur, Meghalaya, Nagaland, Mizoram, Sikkim and Tripura.
NRHM Main Approaches • Communitization • Village Health & Sanitation Committee • ASHA • Panchayati Raj Institutions • RogiKalyanSamiti • Monitor progress against standard • IPHS Standard • Facility Surveys • Independent Monitoring Committee • Flexible Financing • Untied grants • NGOs as implementers • Risk Pooling • Money follows patient • More resources for more reforms • Innovations in Health Management • Additional manpower • Emergency services • Multi-skilling • Improved management through capacity • DPMU/ BPMU/ FMG • NGOs for capacity building • NHRC/ SHRC/ DRG • Continuous skill development
NOW 20% public expenditure (0.9% GDP), often inefficient and ineffective. 80% private expenditure, mostly out of pocket 15-20% MoHFW expenditure – rest by States By 2012 40% public expenditure with improved accountability and efficiency ( 2-3% GDP) Private expenditure by risk pooling/insurance 40% GoI expenditure – rest by States Health Financing
Supplementary Strategies • Regulation of Private Sector: To ensure quality of service to citizen (includes the informal rural practitioners). • Promotion of Public Private Partnerships: For achieving public health goals. • Mainstreaming AYUSH. • Reorienting medical education: To support rural health issues including regulation of Medical care and Medical Ethics. • Effective and viable risk pooling: To provide health security to the poor by ensuring accessible, accountable and good quality hospital care.
NRHM: The concerns • Village Health and Sanitation Committees • ASHA • Lack of skilled manpower • Lack of technical as well as management capacity • IPHS standards and strengthening of public health care delivery system