NRHM

1. Presented by
Metsivi Iralu
MBBS Intern

2. BACKGROUND
STATE OF PUBLIC HEALTH IN INDIA BEFORE
NRHM
Health gap at rural level
Multiple health crisis ( malnutrition, maternal and
infant deaths, inadequate water supply etc..)

3. AIM
To provide accessible, affordable,
accountable, effective and reliable primary
health care and bridging the gap in rural
health care through creation of ASHA.
(ACCREDITED SOCIAL HEALTH
ACTIVIST).

4. NRHM
Launched on 5th
April 2oo5 for 7 years by GoI.
It has been recently extended upto 2017.
Special focus on 18 states.
8 NORTH EASTERN STATES (ASSAM, AP,
MANIPUR, MEGHALAYA, MIZORAM, NAGALAND,
SIKKIM, TRIPURA).
8 EMPOWERED ACTION GROUP STATES
( BIHAR, JHARKHAND, MP, CHATTISGARH,UP,
UTTARANCHAL, ORISSA, RAJASTAN)
HP & JK

5. Objectives of the mission
-improve rural health care delivery system by
 Child & maternal mortality rate
Universal access to public health services for food,
nutrition, sanitation and public health services
addressing maternal and child health.
Prevention and control of CD’s and NCD’s
Access to primary health care
Mainstreaming of AYUSH
Promotion of healthy life style

6. Core Strategies
1. Train and enhance capacity of Panchayat Raj
institutions to own, control and manage public
health services.
2. Promote access to improved health care at
household level through the female health activist.
3. Health plan for each village through village health
committee of the panchayat.

7. 4.Strengthening sub center through an untied fund to
enable local planning and action and more MPW’s.
5. Strengthening existing PHC’s and CHC’c.
6. Preparation and implementation of an intersect
district health plan prepared by the district health
mission .
7. Strengthening capacities for data collection,
assessment and review for evidence based planning,
monitoring and supervision.
8. Developing capacities for preventive health care at all
levels by promoting healthy life styles, reduction in
tobacco consumption, alcohol etc.

8. Supplementary strategies
1. Regulation of private sector to ensure availability of
quality service to citizens at reasonable cost.
2. Mainstreaming AYUSH – revitalizing local health
traditions.
3. Reorienting medical education to support rural
health issues including regulation of Medical care
and Medical Ethics.
4. Effective and viable risk pooling and social health
insurance to provide health security to the poor by
ensuring accessible, affordable, accountable and
good quality hospital care.

9. GOALS TO BE ACHIEVED
AT NATIONAL LEVEL
 IMR : Reduce to 30/1000
 MMR : Reduce to 100/100,000
 TFR : Reduce to 2.1
 MALARIA MORTALITY RATE REDUCTION:
50% by 2010 , addtl 10% by 2012
 FILARIA RATE REDUCTION :
70%(2010), 80%(2012), elimn by 2015
 DENGUE MORTALITY RATE REDUCTION:
50%(2010)
 KALA AZAR MORTALITY RATE REDUCTION:
100%(2010)
 JE MORTALITY RATE REDUCTION:
50%(2010)
 CATARACT OPERATION: increase to 46 lakhs/year 2012

10. National level….
LEPROSY PREVALENCE RATE : reduce from
1.8/10,000 in 2005 to less than 1/10,000
TB DOTS SERVICES : 85% Cure rate
Upgrading CHC to Indian Public Health
Standards
Increase utilisation of FIRST REFERRAL UNITS
from <20% to 75%
Engaging 250,000 female ASHA in 10 states

11. At community level
 PHC/CHC should provide good hospital care.
 Generic drugs at subcentre level
 Access to UIP
 Facilities for institutional deliveries
 Trained community level worker at village level
 Health day at ANGANWADI
-immunisation
- antenatal/postnatal check ups
 Provision of house hold toilets
 Improved outreach services through MOBILE MEDICAL
UNIT at district level
 Community health insurance

12. PLAN OF ACTION
1.CREATION OF ASHA (ACCREDITED SOCIAL
HEALTH ACTIVIST)
-health activist in the community
-1ASHA= 1000 population
-not a paid employee
-Female M/W/D between 25-45 yrs of age
- formal education up to 8 class
-Resident of the village with good communication
skills and leadership qualities

13. Responsibility of ASHA
- To create awareness among the community regarding
nutrition, basic sanitation, hygienic practices, healthy
living.
- Counsel women on birth preparedness, imp of safe
delivery, breast feeding, complementary feeding,
immunization, contraception, STDs
- Inform about births and deaths in her village & also
any unusual health problems to subcentre/phc.
- Work with village health and sanitation committee to
develop a comprehensive village health plan

14. Contd.
- Encourage the community to get involved in health
related services.
- Escort/ accompany pregnant women, children
requiring treatment and admissions to the nearest
PHC’s.
- Primary medical care for minor ailment such as
diarrhea, fevers
- Provider of DOTS.

15. 2.STRENGTHENING SUB-CENTRES
 Each sub-centre will have an Untied Fund for local
action @ Rs. 10,000 per annum. This Fund will be
deposited in a joint Bank Account of the ANM &
Sarpanch and operated by the ANM, in consultation
with the Village Health Committee.
Supply of essential drugs, both allopathic and
AYUSH, to the Sub-centers.
In case of additional Outlays, Multipurpose Workers
(Male)/Additional ANMs wherever needed, sanction
of new Sub-centers as per 2001 population norm, and
upgrading existing Sub-centers, including buildings
for Sub-centers functioning in rented premises will be
considered

16. 3.STRENGTHENING PRIMARY HEALTH CENTRES
Mission aims at Strengthening PHC for quality preventive,
promotive, curative, supervisory and outreach services,
through:
 Adequate and regular supply of essential quality drugs
and equipment including Supply of Auto Disabled
Syringes for immunization) to PHCs
Provision of 24 hour service in 50% PHCs by addressing
shortage of doctors, especially in high focus States
Observance of Standard treatment guidelines & protocols.
Intensification of ongoing communicable disease control
programs, new programs for control of non
communicable diseases, up gradation of 100% PHCs for 24
hours referral service, and provision of 2nd doctor at PHC
level (I male, 1 female) would be undertaken on the basis
of felt need.

17. 4.STRENGTHENING CHCs FOR FIRST
REFERRAL CARE
Operationalizing 3222 existing Community Health Centers
(30-50 beds) as 24 Hour First Referral Units, including
posting of anesthetists.
Codification of new Indian Public Health Standards, setting
norms for infrastructure, staff, equipment, management etc.
for CHCs.
Promotion of Stakeholder Committees (Rogi Kalyan Samitis)
for hospital management.
Developing standards of services and costs in hospital care
Develop, display and ensure compliance to Citizen’s Charter
at CHC/PHC level
In case of additional Outlays, creation of new Community
Health Centres(30-50 beds) to meet the population norm as
per Census 2001, and bearing their recurring costs for the
Mission period could be considered

18. INSTITUTIONAL SET UP OF NRHM
AT NATIONAL LEVEL: MISSION STEERING GROUP
,
-chairman is union minister of health and family
welfare
AT STATE LEVEL : STATE HEALTH MISSION
- led by CM
AT DISTRICT LEVEL : DISTRICT HEALTH MISSION
- Led by chairman of ZILA PARISHAD

19. DISTRICT HEALTH MISSION
Core unit in planning, budgeting and implementation
of the programme.
FUNCTIONS
Selection and training of ASHA
Organising health camps at ANGANWADI
Mainstreaming AYUSH
Upgrading CHCs to IPHS
Outreach services through mobile medical units

20. ACHIEVEMENTS AS ON 30 JUNE
2013
8.89 lacs ASHAs have been selected of which 8.06 have
been trained and provided with drug kits
1.47 lacs subcentres provided with untied funds of Rs.
10,000 each & 40426 subcentres are functional with second
ANM
31,109 Rogi Kalyan Samitis have been registered at
different level of facilities
8129 docs, 70,608 ANMs, 34,605 staff nurses, 13,725
paramedics have been appointed on contract
1619 professionals have been appointed as support staff
2127 mobile medical units are operational under NRHM
Emergency transport system operational in 12 states

21. Accelerated immunization programme taken up in north
eastern states and EAG. India declared polio free
country;neonatal tetanus declared eliminated in 7 states;JE
vaccination completed in 11 districts of 4 states
JSY operational in all the states. 106.57 lac women
benefitted in the year 2012-13
Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) started in 310 districts
Monthly health and nutrition days organized at village
level in various states
5.12 lac Village Health Sanitation and Nutrition
Committees have been constituted in the states
School health programme have been initiated in over 26
states

22. Monitoring and evaluation
Baseline survey at district level & household level
Community monitoring at village level
Eventual monitoring of the outcomes is done by
planning commission of India

23. Thank you..