National Rural Health Mission

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National Rural Health Mission (NRHM): 

National Rural Health Mission ( NRHM) State Institute of Health & Family Welfare, Jaipur

NRHM: 

NRHM N…Newer Initiatives. R…Rural Poor Population H…Holistic Health Package. M…Monitoring mechanisms To cater to the Primary health care needs of vulnerable segment of pop. to bring down IMR and MMR . to attain Pop. Stabilisation . SIHFW-an ISO 9001:2008 certified Institution 2

Mission Goal: 

Mission Goal Improve : Access & Availability to Health care Quality Equity Simple reiteration of NHP-1983 , HFA-2000 , NHP-2002, or a new paradigm NHP-1983 NRHM-2005 SIHFW-an ISO 9001:2008 certified Institution 3

NRHM Paradigm shifts: 

NRHM Paradigm shifts Decentralized planning Outputs and Outcome based Pro-Poor Focus: Equitable systems Quality of Care and the IPHS norms Bringing the public back into public health At village level : ASHA, VHSC, SHGs, PRIs. At the facility level: RMRS At the management level : Health societies SIHFW-an ISO 9001:2008 certified Institution 4

NRHM Paradigm shifts: 

NRHM Paradigm shifts Governance reform Manpower, Logistics & Procurement processes. Decision making processes Institutional design, Accountability framework Convergence Water and sanitation Nutrition Education SIHFW-an ISO 9001:2008 certified Institution 5

An opportunity for Centre-State partnership: 

An opportunity for Centre-State partnership Beginning with people and their problem. Flexibility to decide and to do. Human resource thrust. Decentralized management of health. Distrust to trust. Employment guarantee to service guarantee. Accepting the challenge of remoteness. SIHFW-an ISO 9001:2008 certified Institution 6

Why NRHM: 

Why NRHM Declining Public Health expenditure (1.3 % of GDP in 1990 to 0.9% in 1999 ) Limited synergism in Vertical and Horizontal Health Programs. Lack of community ownership Lack of integration of issues SIHFW-an ISO 9001:2008 certified Institution 7

Why NRHM: 

Why NRHM Regional inequalities Population stabilization still not met Curative services favor rich Poor coverage by Health insurance (only 10%) Hospitalization eats 58% of annual income, 25 % pop. falls below poverty line following hospitalization expenses. SIHFW-an ISO 9001:2008 certified Institution 8

NRHM ?: 

NRHM ? Program ? Scheme ? Project ? A Strategy, for Convergence Partnership SIHFW-an ISO 9001:2008 certified Institution 9

Goals:: 

Goals : Reduction in IMR and MMR Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of CD & NCD, 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 SIHFW-an ISO 9001:2008 certified Institution 10

National Goals and MDGs: 

National Goals and MDGs 1990 Current NPP 2010 NRHM 2012 MDG 2015 IMR 80 53 (SRS-2009) <30 <27 N M R 53 37 (NFHS-III) <20 <20 U5M Rate 107 74.3 (NFHS-III) - <36 ID(%) 45.5 (DLHS-3) 80 80 TFR 2.7 (NFHS-III) 2.1 2.1 MMR 254 (SRS-2006) <100 <100 SIHFW-an ISO 9001:2008 certified Institution 11

Critical Areas: 

Critical Areas Well functioning health facilities Quality and accountability in the delivery of health services. Responsive health system meeting people health need. Convergence for effectiveness and efficiency. SIHFW-an ISO 9001:2008 certified Institution 12

NRHM components: 

NRHM components Communitize Flexible Financing Improved management through capacity building Monitor progress against standards Innovation in human resource management SIHFW-an ISO 9001:2008 certified Institution 13

Core Strategies: 

Core Strategies Capacity Building of PRIs to own, control & manage public health services. Access to improved healthcare through the female health activist (ASHA). Village Health Plan through Village Health Committee Strengthening sub-centre through an untied fund to enable local planning and action & more Multi Purpose Workers (MPWs). SIHFW-an ISO 9001:2008 certified Institution 14

Slide 15: 

PHCs and CHCs strengthening, to a normative standard ( IPHS -personnel , equipment and management standards ). Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, SIHFW-an ISO 9001:2008 certified Institution 15

Slide 16: 

Integrating vertical programs at National, State, Block, and District levels. Technical Support to National, State and District Health Missions, for Public Health Management. Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. SIHFW-an ISO 9001:2008 certified Institution 16

Slide 17: 

Transparent policies for deployment and career development of human resources for health. Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc. Promoting non-profit sector particularly in under served areas. SIHFW-an ISO 9001:2008 certified Institution 17

Supplementary Strategies: : 

Supplementary Strategies: Regulation of Private Sector Promotion of PPP Mainstreaming AYUSH Reorienting medical education Regulation of medical care and medical ethics. Risk pooling and social health insurance for Accessible, Affordable, accountable and Quality hospital care. SIHFW-an ISO 9001:2008 certified Institution 18

NRHM Focus: 

NRHM Focus 18 States, to start with Arunachal Pradesh , Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan , Sikkim, Tripura, Uttaranchal and Uttar Pradesh. SIHFW-an ISO 9001:2008 certified Institution 19

Where to strike: Infrastructure up gradation : 

Where to strike: Infrastructure up gradation Functional Sub Centres Additional contractual ANMs Untied funds Community link worker Village Health Nutrition committees Expanded Medicines supply 24 x 7 PHCs Three staff nurses Annual maintenance grant Untied funds AYUSH Integration RMRS/RKS SIHFW-an ISO 9001:2008 certified Institution 20

Where to strike : Infrastructure up gradation : 

Where to strike : Infrastructure up gradation CHCs up gradation First Referral Units Facility survey IPHS Untied funds RMRS/RKS DH up gradation Facility survey IPHS RMRS/RKS SIHFW-an ISO 9001:2008 certified Institution 21

Where to strike :: 

Where to strike : Manpower Filling up vacant posts/Creating more posts Contractual positions to fill gaps Trainings / expanding training capacity SBA/ IMNCI/ HMIS Counseling/ Immunization / Planning Rational transfer and posting policy Health sector planning Household surveys & Village Health Plans. Integrated Block &District Health Action Plans. Annual PIPs / Perspective Plans. SPMUs/ DPMUs/ Block PMUs NHSRC/ SHSRC SIHFW-an ISO 9001:2008 certified Institution 22

Where to strike :: 

Where to strike : Improved service delivery Citizen’s charter Monthly Health & Nutrition Day Outsourcing critical service gaps Catch up rounds of Immunization Improved IP & OP utilization Mobility Support / Mobile Medical Units Maternity Benefit Schemes Systemic improvements Improved logistics. Rational / Optimal positioning of manpower Rational delegation (financial & Administrative) Decentralized procurement SIHFW-an ISO 9001:2008 certified Institution 23

Where to strike: 

Where to strike Monitoring & Evaluation Review meetings State visits – evaluation teams, RDs Integrated MIS External Surveys Immunization ASHA & JSY External Evaluations Community monitoring State level innovations/ Reforms SIHFW-an ISO 9001:2008 certified Institution 24

Slide 25: 

Decentralization Procurement Facility survey Village health plans Planning at Institutional levels SIHFW-an ISO 9001:2008 certified Institution 25

Operationalizing Functional FRUs: 

Operationalizing Functional FRUs 24-hour delivery services including normal and assisted deliveries Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other medical interventions New-born Care Emergency Care of sick children Full range of family planning services including Laproscopic Services SIHFW-an ISO 9001:2008 certified Institution 26

Operationalizing Functional FRUs: 

Operationalizing Functional FRUs Safe Abortion Services Treatment of STI / RTI Blood Storage Facility Essential Laboratory Services Referral (transport) Services 24-hour delivery services, both normal and assisted Essential newborn care SIHFW-an ISO 9001:2008 certified Institution 27

Slide 28: 

Referral for emergencies Ante-natal care and routine immunization services for children and pregnant women (besides Fixed day services). Post-natal care Early and safe abortion services (including MVA) Family planning services Prevention and management of RTIs/STIs Essential laboratory services SIHFW-an ISO 9001:2008 certified Institution 28

Institutional Mechanism: 

Institutional Mechanism Village Health & Sanitation Committee(VHSC) RKS/RMRS District Health Mission, State Health Mission, Integration of Departments of Health and Family Welfare, at National and State level National Mission Steering Group Empowered Program Committee Standing Mentoring Group Task Groups for Selected Tasks SIHFW-an ISO 9001:2008 certified Institution 29

Plan of Action-Components:: 

Plan of Action-Components : ASHA Strengthening of Sub-Centers Strengthening of PHCs Strengthening of CHCs for First referral District Health Plan Converging Sanitation & Hygiene under NRHM Strengthening Disease control program Public-private partnership for public Health goals, including regulation of private sector New health financing mechanisms Reorienting health/medical education to support rural health issues SIHFW-an ISO 9001:2008 certified Institution 30

Plan of action Component (A): ASHA : 

Plan of action Component (A): ASHA One per village chosen by and accountable to the Panchayat Volunteer , performance-based compensation facilitate preparation and implementation of the Village Health Plan GOI-Cost of training, incentives and medical kits Drug Kit -generic AYUSH and allopathic formulations SIHFW-an ISO 9001:2008 certified Institution 31

Plan of action Component (B): Strengthening SC: 

Plan of action Component (B): Strengthening SC Sub-centre -Untied Fund for local action @ Rs. 10,000 per annum. Joint bank account of the ANM & sarpanch Operated by the ANM, in consultation with the village health committee. Supply of essential drugs (allopathic AYUSH) In case of additional outlays, Multipurpose workers (male)/additional ANMs wherever needed, New sub-centers, and upgrading existing sub-centers, including buildings SIHFW-an ISO 9001:2008 certified Institution 32

Plan of action Component (C): Strengthening PHCs: 

Plan of action Component (C): Strengthening PHCs supply of essential drugs and equipment Provision of 24 X 7 in 50% PHCs Observance of SOPs In case of additional Outlays, Program intensification-Comm. Diseases programs for control of NCDs, up-gradation of 100% PHCs for 24 x 7 provision of 2nd doctor at PHC level (I male, 1 female ) SIHFW-an ISO 9001:2008 certified Institution 33

Plan of action Component (D): Strengthening CHCs: 

Plan of action Component (D): Strengthening CHCs 4276 (March 31, ’09) existing C HCs (30-50 beds) as 24 Hour FRUs, including posting of anesthetists. Codification of new IPHS setting norms for infrastructure, staff , equipment , management Promotion of Stakeholder Committees (RKS/ RMRS) for hospital management . SIHFW-an ISO 9001:2008 certified Institution 34

Plan of action Component (D): Strengthening CHCs: 

Plan of action Component (D): Strengthening CHCs 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) and bearing their recurring costs SIHFW-an ISO 9001:2008 certified Institution 35

Slide 36: 

Amalgamation of field responses through Village Health Plans, State and National priorities for Health, Water Supply, Sanitation and Nutrition. District -core unit (planning , budgeting & implementation). Centrally Sponsored Schemes To be modified in consultation with States. All vertical Programs to merge into one common “District Health Mission”/ “State Health Mission” Provision of DPMUs SIHFW-an ISO 9001:2008 certified Institution 36

District Planning components: 

District Planning components Plan Templates, checklists, appraisal criteria, planning tool Facilitation & Consultation Enabling Environment Facility, Manpower & Budget - Rationalizing & Role Clarification NGO involvement Focus on Community Needs and Participation Resource Materials for Planning & Implementation Orientation & Training Accountability, Monitoring & Evaluation Inter and intra sectoral Coordination & Communication SIHFW-an ISO 9001:2008 certified Institution 37

Plan of action Component (F): Converging sanitation & Hygiene: 

Plan of action Component (F): Converging sanitation & Hygiene Total Sanitation campaign(TSC) in all districts in X-FYP TSC through PRIs VHSCs to implement ASHA to be incentivized for TSC activities IEC SIHFW-an ISO 9001:2008 certified Institution 38

Expected outcomes by 2012: 

Expected outcomes by 2012 Universal Health care, well functioning health care delivery system. IMR :30 MMR: 100 TFR :2.1 Malaria Mortality Reduction – 60% Kala Azar eliminated by 2010, Filaria 80 % by 2010 Dengue Mortality reduced by 50% TB DOTS series – maintain 85% cure rate Responsive & Functional Health System SIHFW-an ISO 9001:2008 certified Institution 39

Accomplished so far: 

Accomplished so far State and district mission have been setup. Health and family welfare have been merged. Finalization of State PIPs Following documents shared with the states : Mission Document Guidelines on IPHS Guidelines on ASHA Guidelines on State Health Mission and Guidelines on District Health Mission SIHFW-an ISO 9001:2008 certified Institution 40

Accomplished so far: 

Accomplished so far ASHAS: 736198 selected against six lacs Mgt. support: over 1500 professionals (CA/MBAs) appointed and 521 district level PMU and 2882 block level PMU’s support NRHM. Financial Management: Financial management Group set up under NRHM. Mother NGOs: 334 MNGOs appointed for 340 districts. Fully involved in ASHA training and other activities. SIHFW-an ISO 9001:2008 certified Institution 41

Accomplished so far: 

Accomplished so far Health Action Plan: State PIP received from 31 states during 2006-07 and 35 states PIP received during 07-08. PIPs appraised and funds released for 06—07 & 07-08 & 08-09 as well. Integrated District Health Action Plans have been prepared in 540 districts in various states. Institutional Delivery: 3.449 M women benefited so far in 06-07 and 5.135 M in 07-08, 8.378 M in 2008-09 SIHFW-an ISO 9001:2008 certified Institution 42

Infant Mortality Rate : 

Infant Mortality Rate SIHFW-an ISO 9001:2008 certified Institution 43

Maternal Mortality Rate : 

Maternal Mortality Rate SIHFW-an ISO 9001:2008 certified Institution 44

Total Fertility Rate: 

Total Fertility Rate SIHFW-an ISO 9001:2008 certified Institution 45

NRHM Rajasthan: Achievements: 

NRHM Rajasthan: Achievements SIHFW-an ISO 9001:2008 certified Institution 46

NRHM: Rajasthan - Achievements: 

NRHM: Rajasthan - Achievements 46,862 ASHA selected (43742 in place) 40678 VHSC constituted 28.37 lakh JSY beneficiaries (till Dec. ‘09) JSY helpline has been initiated Emergency Health Transport Scheme successfully implemented through EMRI (108) SIHFW-an ISO 9001:2008 certified Institution 47

Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in : 

Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in