OVERVIEW OF
NATIONAL RURAL
HEALTH MISSION
NATIONAL RURAL HEALTH MISSION
National Rural Health Mission (NRHM)
was launched on 12th April 2005 in India. It
is one of the biggest–ever integrated health
initiatives in the health sector in the last 50
years. NRHM is not a project but an over
arching umbrella integrating the on going
vertical programmes and addressing issues
related to the determinants of health like
sanitation, Nutrition, and safe drinking
water.
Cont…
The National Rural Health Mission seeks to
adopt a sector wide approach and aims at
systematic reforms to enable efficiency in health
services delivery. NRHM subsumes key national
programmes namely the RCH II, General
Curative Care, National disease control
programmes and the integrated disease
surveillance project. NRHM will also enable the
mainstreaming of Ayurvedic, Yoga, Unani,
Siddha and Homeopathy system of medicine
(AYUSH).
Cont…
The Goal of Mission is to improve the
availability of and access to quality health care
by people especially for those residing in rural
areas, the poor, women and children. Mission
adopt a synergistic approach by relating Health
to determinants of good health viz. of
-
nutrition,
sanitation,
hygiene and
safe drinking water
Cont…
THE NRHM VISION
The National Rural Health Mission (2005-12)
seeks to provide effective healthcare to rural
population throughout the country with
special focus on 18 states, which have weak
public health indicators and/or weak
infrastructure.
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.
EXPECTED OUTCOMES AT NATIONAL LEVEL
FInfant Mortality Rate (IMR) reduced to 30/1000
live births by 2012.
F Maternal Mortality Ratio (MMR) reduced to
100/100,000 by 2012.
FTotal Fertility Rate (TFR) reduced to 2.1 by 2010.
F Malaria Mortality Reduction Rate : 50% upto
2010, additional 10% by 2012.
F Leprosy Prevalence Rate : Reduce from
1.8/10,000 in 2005 to less than 1/10,000
thereafter.
EXPECTED OUTCOMES AT NATIONAL LEVEL
F Tuberculosis DOTS Services : Maintain 85% cure
rate through entire Mission period.
F Increase Utilisation of first Referral Units from
less than 20 to 75%.
F Upgrading Community Health Centres to Indian
Public Health Standards.
FJapanese Encephalitis Mortality Reduction Rate
: 50% by 2010 and sustaining at the level until
2012.
FCataract Operation : Increasing to 46 lakhs per
NRHM – 5 COMPONENTS
NRHM Initiatives
ASHA ,GKS, Untied Funds
RKS , MHUs,
School Health Programs ,
Other NRHM additionalities
RCH-II
Maternal/Child Health
Family Planning/Tribal RCH/BCC
Adoloscent Health/
Training/
Institutional
strengthening
INTER SECTORAL
CONVERGENCE
PPP Initiatives,
Departmental
Coordination
for programs
Like VHND,
Pustikar Diwas
DISEASE CONTROL
PROGRAMME
RNTCP,NLEP,
Blindness Control ,
National Iodine Deficiency
Disaster Control
Programe
IMMUNISATION
Routine Immunization
Pulse Polio Campaign
Special Immunization
COMPENSATION PACKAGE
1. Institutional Delivery
Rural Areas
Mother’s ASHA’s
Package Package
1400
600
Total
Rs.
2000
Motivation for Vasectomy
Tubectomy
• Immunization
• DOTs Provider
Urban Area
Total
Mother’s ASHA’s Rs.
Package Package
1000
200
1200
@ Rs.
@ Rs.
@ Rs.
@ Rs.
200
100
150
250
(Per case)
(Per case)
(Per session)
(on completion of
ASHA
• Every one thousand population there will be a
ASHA
• ASHA act as a bridge between the ANM and the
village and be accountable to the Panchayat.
• She will be an honorary volunteer, receiving
performance-based compensation.
• She will promote institutional delivery, universal
immunization, referral, escort services for RCH
and other health care delivery programmes.
• She will facilitate in preparation of village health
plan along with ANM/AWW under leadership of
village health & sanitation committee.
Untied fund at Sub Centre level
Rs.10000/- per SubCentre per annum to be kept in joint
account of Sarpanch and ANM. To be spent on:– Minor repair of Sub Centre.
– Payments for cleaning after child birth.
– Transport during emergency to appropriate referral centre.
• Transport of samples during
epidemics.
• Payment of wages for
environmental sanitation.
• Payment/Reward to ASHA for
certain specific activities.
• Should not be used for Salary,
Vehicle purchase & expenses of
Gram Panchayat.
Upgrading CHCs as per Indian Public Health
Standard.
Provision quality service round the clock referral
care at CHC level is an important strategic
intervention under NRHM. In order to ensure
quality of services, the Indian Public Health
Standards are being set up for CHCs so as to set
up a yard stick to measure the services being
provided. The Programme includes provision of :
•
OT/ Labour room/ X-Ray etc.
•
Blood transfusion facilities.
•LSAS doctors at each L-3 institutions
Rogi Kalyan Samiti
– RKS at every District, Sub-Division and Block
Level Hospital.
– RKS is a registered society for better
management of hospitals with people’s
participation.
– Corpus Fund from Govt. of India
–Rs. Five Lakhs per District Headquarters
Hospital
–Rs. One Lakh per Sub-Divisional
Hospital and CHCs/ PHCs.
Mobile Medical Units
–
Under NRHM Mobile Medical Unit to be functional in
each tribal blocks to supplement existing system in
remote inaccessible areas.
– Each Mobile Medical Unit will have Specialist
services
Mainstreaming AYUSH
 Seeks to revitalize local health traditions and
mainstream AYUSH infrastructure, manpower and
drugs.
 Space shall be provided for AYUSH practitioner and
pharmacist in CHCs/ PHCs.
 PHC(N) shall be upgraded to include two Doctors by
inducting AYUSH practitioner.
Ayurveda
Homoeopathy
Unani
Siddha
Yoga and Naturopathy
Intersectoral Convergence
NRHM envisage that determinants of
health, like sanitation, nutrition and
safe drinking water influences general
health to a large extent. Therefore it is
considered necessary to forge linkages
with department of Women & Child
Development,
Rural
Development
Department, Education, Panchayat Raj,
Rural Water Supply & Sanitation
Department.
Cont…
Stakeholders
Ongoing Programmes :
1.Reproductive & Child Health (RCH) Programme - II.
Reproductive and Child Health (RCH) Programme-II
is an ongoing programme under NRHM, with the
objective of improving the Reproductive Health of
men and women and the health of children from
2005-12
The focus of the programme is to reduce the
Maternal and Child Mortality and Morbidity with
emphasis on rural health care. Adolescent Health
and Gender, Urban Health, Tribal Health and Public
Health and Public Private Partnership are the other
supporting focus areas in RCH-II.
Components of RCH II
Maternal Health
• Quality ANC, PNC – VHND, Anemia prophylaxis,
TT, early diagnosis of complication, Birth planning
• Institutional Delivery –Infrastructure strengthening,
Incentives, referral system
• SBA
• Provision of BEmONC & CEmONC services
• Availability of FP services for limiting/Spacing
• Safe Abortion
• Janani Express at each health institutions
Components of RCH II
Child Health
•
•
•
•
•
•
Institutional delivery with 48 hrs stay
SNCU I & II
NSSK
Immunization strengthening
Pustikar Diwas, VHND
IMNCI
Components of RCH II
Family Planning
• Expanding facilities & choices
– Fixed day centers
– Limiting methods
• Minilap
• Laparoscopic
• NSV
– Spacing methods
• IUCD
– Skill enhancement
– RTI/STI treatment at PHC level
• OP/CC – ASHA is a depot holder
• QAC – To provide quality services
VILLAGE HEALTH& NUTRITION DAYS…MAMATA DIVAS
 Village level interventions
for addressing Maternal &
Child Health issues.
 Organised
monthly
at
Anganwadi
Centres
through the coordinated
efforts of ANM, ASHA,
AWWs.
23
PUSTIKAR DIWAS
To effectively combat the problems of malnutrition and to reduce
malnutrition rate in Orissa (from 44% to 35% by 2012 NRHM Goal) Pushtikar
Divas has been devised. This activity is one of the strategic interventions by
Health & Family Welfare and Women & Child Development departments to
address malnutrition. This is to be organized once on the 15th of every
month, in the Block PHC/CHC. Children in the Grade - II, III, IV or moderate to
severely malnourished shall be referred by the AWW/ANM to the Block
PHC/CHC for management & treatment. The Medical Officers shall
undertake the treatment as per the defined treatment protocol.
At the block, PHC/CHC Medical Officers are required to undertake detailed
examination, possible investigation, diagnosis and treatment of referred
children, as per the treatment protocol.
School Health Programme
• Address holistically the health and nutrition needs of
children in a manner which fulfils the needs of today's
lifestyle
• For preventive, promotive and curative services to the
school children
• Around 2848 schools will be covered
• Around 2,80,000 children will be screened
• It will be an inter-sectoral effort
Components of SHP
 Screening, health care and referral
 Immunization (TT-10)
 De-worming
 School-based activities promoting good health
 Monitoring & Evaluation
GKS Formation Processes
• Revenue village is the unit of
GKS formation
• Ward
member
is
the
chairperson,
Anganwadi Worker is the
convener,
ASHA supports the functioning
of GKS
Rs. 10,000/- untied fund per
annum
Immunization :
Immunization is one of the foremost Public Health
Programme in the country. It is the need of the
hour to reach every child and mother and deliver
health services. This is an emerging process and
the goal is to 100% immunization status by 2010
in the district. Immunization is a key intervention
under NRHM and major activities include
•Routine immunisation
• Intensified Pulse Polio immunization.
• Maintenance of Cold Chain Procedure
National Disease Control Programme :
National
Vector
Borne
Programme (Malaria)
Disease
Control
The goal of the NVBDCP programme is to reduce
Malaria death by 50% by 2012. Vector control
activities are parasite index and in areas with
resistance to synthetic Parathyroid. Larvivorous
fish and treated bed nets have been distributed.
Besides BCC activities have been undertaken in
the community by creating awareness.
National Programme
Blindness
for
control
of
The goal of the programme is to reduce
the prevalence of blindness to 0.8% by 2012. To
realize the goal, cataract surgery, screening of
students for refractive errors & correction, eye
collection & training of workers & teaches ect
are being conducted in the state.
Revised
National
Programme (RNTCP)
Tuberculosis
Control
RNTCP is uniformly operational across the state
through the strategy is directly observed
treatment short course(DOTs). The chest
symptomatic
are
subjected
to
sputum
examination & patients positive for acid fast
bacilli are provided full course of treatment
under the direct supervision of DOTs provider.
Success rate of new smear positive case is 85%,
case detection is 54% & seamer conversion is
86%.
National Leprosy Elimination Programme
(NLEP)
The objective of the programme is to
eliminate leprosy by bringing all the cases
of leprosy under Multi Drug Therapy (MDT).
As of now 20 districts have achieved
leprosy elimination status. This has been
possible, as a result of intense BCC
activities, training integrated of vertical
infrastructure of leprosy into general health.
Areas of the Project
Area of operation
• 13 Blocks of this district
• 286 GPs of this district
• 2060 villages of this district
HEALTH INSTITUTIONS OF KEONJHAR DISTRICT
District Head Quarter Hospital
Sub-Divisional Hospital
Community Health Centre
Single Doctor PHC (PHC New)
Sub-center
Total
: 01
: 02
: 17
: 66
: 351
:437
Scope for private participation
• Handing of PHC (N)/SC to Corporate houses
/NGOs
for management purposes where
health service providers are not available
• Collaboration with the corporate houses
organising different health camps and Mega
Swasthya Mela.
• Vulnerable
group
sensitisation
and
mobilisation.
• Adoption of different wards in DHH/SDH for
management purposes and beautification of
hospitals
Strengthening the local government (PRIs
& Communities)
• Through GKS capacity building the PRIs and
the communities can be sensitised and
ownership can be developed for health
seeking behaviour.
• Capacity building of RKS members
Practical problem/issues
• Delay in constructional activities
• Vacancy of Medical Officers and other
paramedical staff in rural health institutions.
• Delay in referral by the community.
• Fill up the paramedical persons immediately in
the drive mode.
• Promotion of 2nd referral system in all the
Block CHC by providing hired ambulances
Specific problem
Banspal:
1. Posting of Doctors (5 Nos), staff nurses (6 Nos) , HW(F) &
Addl. HW(F), HW(M) in all the health institution of Banspal
Block
2. Ambulance provision at CHC
3. Adoption of few institutions under PPP mode by
NGO/NYK/Corporate houses where the service providers are
not available (4-5 sub-centers)
4. Sensitisation among the service providers about the service
delivery system
5. Infrastructure development at PHC (N),SC- 1 No. SC constru.
6. IEC/BCC activities at community and service providers level
7. Incentive packages for HW(F) and ASHA for service delivery
Telkoi
1. Posting of Doctors, staff nurses (6 Nos.) , HW(F) (5Nos)&
Addl. HW(F), HW(M)
2. Adoption of few institutions under PPP mode where the
service providers are not available 5 PHC(N) ( Kaliahata,
Raisuan, Krushnapur, Jagamohanpur, Sirigida) & SC-5
(Talapada, L.N.. Pur, Kaliahata, Raisuan, Karadangi)
3. Sensitisation among the service providers about the service
delivery system
4. Infrastructure development at PHC (N),SC
5. IEC/BCC activities at community and service providers
6. Incentive packages for HW(F) and ASHA for service delivery
Harichandanpur
1. Posting of Doctors, staff nurses , HW(F) & Addl. HW(F),
HW(M)
2. Adoption of few institutions under PPP mode where the
service providers are not available 2 PHC(N) ( Kalapata,
Rebenapalaspal,
3. Posting doctors and other paramedical staff at Bhagamunda
4. Sensitisation among the service providers about the service
delivery system
5. Infrastructure development at PHC (N),SC- 6 Nos.
6. IEC/BCC activities at community and service providers
7. Incentive packages for HW(F) and ASHA for service delivery
Basudevpur
1. Posting of Doctors, staff nurses , HW(F) & Addl. HW(F),
HW(M)
2. Adoption of few institutions under PPP mode where the
service providers are not available 2 PHC(N) ( Kalimati, Guali)
to corporate houses
3. Sensitisation among the service providers about the service
delivery system
4. Infrastructure development at PHC (N),SC- 15 Nos.
5. IEC/BCC activities at community and service providers
6. Incentive packages for HW(F) and ASHA for service delivery