The National Rural Health Mission (NRHM) was launched in 2005 to address deficiencies in India's rural health sector by improving access to quality health care, especially for poor women and children. It aims to reduce maternal and child mortality, provide universal access to public health services, and control communicable and non-communicable diseases. The evaluation assessed NRHM's implementation in 7 states and found improvements in health infrastructure and outcomes, but some gaps remain, such as inadequate numbers of community health workers. Recommendations include filling staff vacancies, improving emergency care and transportation, and retraining community health volunteers.

1. Evaluation Study of National
Rural Health Mission
(NRHM) In 7 States
Programme Evaluation
Organisation Planning
Commission Government of India
New Delhi-110001 February
2011
-Presented By
Dr. Swati Sharma
BDS (Pt.B.D Sharma Uni.,
Rohtak)
PGDPHM(student)
(NIHFW)

2. NRHM
(NATIONAL RURAL HEALTH MISSION)
INTRODUCTION
12th April 2005. The National Rural Health Mission (NRHM) was launched by the Hon’ble
Prime Minister
DECENTRALISATION
COMMUNICATION
ORGANISATIONAL
BEHAVOIUR
INTER-SECTORIAL
CONVERGENCE
PUBLIC PRIVATE
PARTNERSHIP

3. Launched on 12th April 2005 by the Prime Minister
Identified 18 States with weak PH Indicators/Health Care
Infrastructure
The initial Outlay for NRHM for 2005-06 was over Rs.67000 Million and
outlay for 2012-13 is Rs.208220 Million

4. Mainstreaming of AYUSH

5. Why NRHM ?
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..
Systemic Deficiencies in health Sector

6. OBJECTIVES
 Reduction in child and maternal mortality
 Universal access to PH services for food and nutrition, sanitation and
hygiene with focus on women and children health
 Prevention and control of communicable and non communicable
diseases including locally and endemic diseases
 Population stabilization, attaining gender and demographic balance
 Revitalize local health traditions and mainstream AYUSH
 Promotion of healthy life styles

7. EVALUATION
(Concurrent evaluation)
Evaluation Design:
(Intervention – Post only)

8. PROCESS IN ACTION PLAN
Supervision
&Monitoring
(Output
&Efficiency)
Situation Analysis
Objective Setting
Implementation
- Inputs
- Activities
- Outputs
-Outcomes
Goals
- Impact
E
F
F
E
C
T
I
V
E
N
E
S
S
E
V
A
L
U
A
T
I
O
N

9. 131.66
44.33
20.95
31.28
23.22
7.62
34.92
0
20
40
60
80
100
120
140
UP MP Jharkhand Orissa Assam J & K Tamil Nadu
Rural population(2001) in million.

11. neo-natal
mortality
component of IMR
for India in 2008
was 37

13. the total fertility rate
(TFR) is around 2.7

14. Health Infrastructure

21. Approaches:
Routine:
Reporting and feedback system with help
of structured scheduled reports
SRS AHS
DLHS
TOOLS

22. Community
interviews
(internal/external)
Tracking program implementation:
Supervisory field
visits
using checklists
Community
monitoring
with special tools
Fixed monthly
meetings
with subordinate
staff

23. Implementation plan
1. Hiring or recruitment
2. Hiring of office space
3. Fund for activity and Monitoring &
evaluation support
4. Basic survey of all the Government
facilities, private facilities, private
practitioners,
1. Categorization of population on high
risk, low risk and migration
2. Identify the causes.
3. Ensure availability of interventions.
4. Ensure the availability of service
provider.
Inputs
Process

24. 1.Capacity building of all stakeholders.
2.Capacity building of health workers.
3.Local NGOs and private practitioner can
be involved.
4.Capacity building of private practitioner.
5.Ensure outgoing patient to be registered.
6.IEC activities in community.
Activity
1. Training of stake holders.
2. Training of ASHA planed and held
3. No. of health centers have increased.
4. No. of health providers have increased.
5. Pt. registration & diagnosis, treatment.
Output

25. Outcome
EXPECTED
Reduce IMR to 30/1000 by 2012
Reduce MMR to 100/100000 by 2012
TFR to 2.1 by 2012.
OUTCOME
39/1000,
167/100000 by 2013
2.3,by 2013

26. Malaria mortality reduce by 50% by 2010,
Additional by 2012.
Kala Azar 100% by 2010, sustain elimination
until 2012.
Filaria/microfileria reduction – 70% by 2012,
80% by 2012 & elimination by 2015.
Dengue mort. Reduction by 50% by 2010, &
sustain until 2012
Cataract operation increasing by 46 lkhs by
2012.
Leprosy prevalence rate below 1/10000 Below 1
45% by 2012
45% by 2012
0.29% by 2012
9 death reported in 2014
6304177 operated, 2012

27. TB DOTS maintain 85% cure rate., sustain
case detection.
Upgrading health establishment acc. To
IPHS.
Increase utilization of FRU bed
occupancy from 20% to over 75%
67.3
Not upto IPHS standars
2514

28. *Prevalence and incidence not
improved upto the expectations.
*Awareness in the district will increase
in the district
Impact

29. Where it is lacking. !!
Not adequate number of ASHA .
Failing family planning services.
No Job security and high attrition rate.
Low motivation level among staff.

30. OVERALL RECOMMENDATIONS TO UPGRADE PUBLIC HEALTH FACILITIE
filling of vacant positions
provisioning of cold chains would facilitate improvements in outreach of the health
services in rural areas.
emergency care for sick children, and treatment of emergency cases for the chronic
diseases at FRUs.
Provisioning of ambulances at FRUs and referral transport at PHCs and SCs would be
more cost effective.
ASHA’s mentoring and retraining for updating skills
Utilization of untied funds