Strategies of national rural health mission dr.d.shankar reddy: Strategies of national rural health mission dr.d.shankar reddy Slide 2: National Rural Health Mission (2005-12) Effective healthcare to rural population 18 States EAG & N.E Raise public spending on Health from 0.9% of GDP to 2-3% of GDP. NRHM Strategy: NRHM Strategy Core Strategies Supplementary Strategies Core Strategies : Core Strategies 1)Appointment of Accredited Social Health Activist (ASHA) to facilitate access to health services . Can states continue to implement existing community health workers programmes? Flexibility, continue to engage with those already selected primarily a woman resident of the village, age group of 25 to 45 years, Married/ Widow/ Divorced with formal education up to Eighth Class. Slide 5: Is ASHA to be selected on a population-based norm? States are free to select ASHA Is ASHA a paid employee? How will ASHA be selected? Village Health & Sanitation Committee. Will the ASHA get a formal letter of appointment? Slide 6: Who is ASHA accountable to? Accountable to the community through the Gram Panchayat. Primary roles and responsibilities? Creates awareness on health and its social determinants and mobilize the community towards local health planning ,increased utilization and accountability of the existing health services. Slide 7: Village health guides-1977 Mahila swastya sangh-1990-91 Jan mangal couple-rajastan-1995 Community worker- Gadchirowli , Maharastra-1995 TBA-180 dt,2001 Mittanin-chattisgarh-2002 Sanjeevini-haryana-5 dt,-2003 Slide 8: Last Tuesday of every month being observed as ASHA day for effective monitoring and ensuring timely payment of incentives. NHD every month. Janani Suraksha Yojana scheme: Janani Suraksha Yojana scheme launched on 1st Nov-2005 safe motherhood intervention under NRHM. Under the scheme, Rs.1000/- (Rs.700/- under JSY (GOI) + Rs.300/- under Sukhibhava (State) scheme) is being paid to Rural BPL Woman who delivers in any Govt hospital. Rs.800 –Private hospitals From 1st April 2006-BPL urban families-Rs 600 JSY – Eligible conditions: JSY – Eligible conditions Rural/Urban BPL family above 19 years at the time of the delivery delivery is of the first child or second or subsequent delivery, with the couple having only one living child or through in the current delivery there are twins, there is only one only living child to that couple Slide 11: 2) Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own , control and manage public health services. Panchayats have been assigned 29 rural development activities, including several, which are related to health and population stabilization. The XI schedule includes Family Welfare, Health and Sanitation, (including hospitals, primary health centers , and dispensaries,) and The XII schedule includes Public Health. Role of PRIs: : Role of PRI s : Critical to the planning, implementation, and monitoring of the NRHM The NRHM is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. Slide 13: District Health Mission to be led by the Zila Parishad Implementation of the NRHM in achieving its outcomes is significantly dependent on well functioning gram, block and district level panchayats . Slide 14: 3) Health Plan for each village through Village Health Committee of the Panchayat. Planning for health to be initiated from village level will transfer the ownership of all health program to the villagers. District Annual Plan would generate from village level through a participatory approach. Plan will largely indicate expected level of achievement for each of the health program Slide 15: VHC will form the link between the Gram Panchayat and the community. The VHC would be responsible for working with the Gram Panchayat to ensure that the health plan is in harmony with the overall local plan. Slide 16: Effective health care is not within the realm of the health department alone. At the village level convergence is required with agencies providing nutrition, sanitation, education, livelihood/poverty alleviation and empowerment schemes at the very least. Slide 17: 4) Strengthening S/C through an untied fund to enable local planning & action &more Multi Purpose Workers (MPWs). 2 nd ANM Untied fund Village sanitation committee Slide 18: 5) Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC / lakh population for improved curative care to a normative standard(IPHS) Set of standards envisaged to improve the quality of health care delivery in the country under the National Rural Health Mission. Slide 19: Need for IPHS? Quality of services is not uniform Non availability of manpower Problems of access Acceptability Slide 20: Standards are being applied only to CHC As a first step, requirements for a Minimum Functional Grade of a CHC are being prescribed. Further up gradation will be proposed after these minimum requirements have been met. Subsequently, standards for PHC and SC shall also be developed. Slide 21: CHCs are First Referral Units as far as curative care is concerned and are also the link between primary care and tertiary care. With the availability of specialist care in these centres, it was felt that these would be the right breaking ground. Slide 22: Recommendations under IPHS? Improvement in the availability of specialist services in the CHCs by ensuring availability of all the sanctioned specialists. Additional sanction of the post of Anaesthetist and Public Health Manager is also envisaged. Slide 23: Strengthening support staff, by recommending a PHN and an ANM in all these Centres Norms for infrastructure, equipment, laboratory, Blood storage facilities, and drugs have been formulated Slide 24: Guidelines for management of routine and emergency cases under National Health programmes are being provided to all CHCs, to maintain uniformity, and also optimum standardized treatment. Rs 20,00,000 -CHCs Rogi Kalyan Samitis: : Rogi Kalyan Samitis : Improve the institutions / hospitals, upgrade the equipment and modernize the health services. Undertake construction and expansion in the hospital buildings. Ensure subsidized food, medicines and drinking water to the patients and their attendants Ensure proper use, timely maintenance and repair of institution / hospital equipment and machinery. Slide 26: 6) Preparation and Implementation of an inter- sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. Responsible for planning, implementing, monitoring and evaluating progress of Mission. Preparation of Annual and Perspective Plans for the district. Suggesting district specific interventions. Slide 27: Partnerships with NGOs, Panchayats for effective action. Strengthening training institutions for ANMs / Nurses, etc. Provide leadership to village, Gram Panchayat, Cluster & Block level teams Aggregation and consolidation of the Village and the Block Health Plan Slide 28: The Zila Parishad Adhyaksha , the District Medical Officer, the District Magistrate would be key functionaries of the District Team . Slide 29: 7) Integrating vertical Health and Family Welfare programmes at National,State , Block, and District levels. TB, vector-borne diseases, Blindness,leprosy , Iodine Deficiency and IDSP. New Initiatives would be launched for control of Non Communicable Diseases. Eleventh Five Year Plan will not allow any vertical structures to be created below district level under different programmes. Slide 30: 8) Promoting non-profit sector particularly in under served areas. As per the NFHS data, less than 10% of rural women report that they are visited by the ANMs during a year. Eleventh Five Year Plan-delivery of non-clinical methods of contraception and referring the clinical cases to the PHCs or FRUs. Ex: Janani , in Bihar An NGO, Janani , set up a network of more than 21000 Titli (Butterfly) centres and more than 500 Surya (Sun) clinics in the States of Bihar, Jharkhand, and MP. Slide 31: Surya clinics are referral clinics run in towns by formally qualified,State -registered doctors. Titli centres are situated in villages and run by RHPs who have been trained to provide family planning counselling and sell non-clinical contraceptives. MNGO:MCH, FP,immunization,institutional delivery FNGO:1-2 S/C SNGO: Birth attendent training,MTP Slide 32: 9)Technical Support to National, State and District Health Missions, for Public Health Management. Reorientation into public health management Involve NGOs as resource organisations Improved Health Information System Mission would require two distinct support mechanisms – Program Management Support Centre and Health Trust of India. Slide 33: (A) PROGRAM MANAGEMENT SUPPORT CENTRE For Strengthening Management For Developing Manpower Systems – recruitment (induction of MBAs/CAs/MCAs), training & curriculum development , partnerships with NGO & private sector For Improved Governance – decentralization & empowerment of communities, induction of IT based systems like e-banking, social audit and right to information. Slide 34: HEALTH TRUST OF INDIA Proposed as a knowledge institution, to be the repository of innovation –research & documentation, health information system, planning, monitoring & evaluation For establishing Public Accountability Systems – external evaluations, community based feedback mechanisms, participation of PRIs /NGOs etc For inter & intra Sector Networking with National and International Organizations. Think Tank for developing a long-term vision of the Sector & for building planning capacities of PRIs, Districts etc Slide 35: 10)Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision Monitoring and Surveillance of all drinking water sources in the country by the community. Decentralization of water quality monitoring and surveillance of all rural drinking water sources in the country. Slide 36: 11) Formulation of transparent policies for deployment and career development of Human Resources for health. Slide 37: 12) Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc Supplementary Strategies:: Supplementary Strategies: 1) Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. Slide 39: 2)Promotion of Public Private Partnerships for achieving public health goals AP- Arogya Raksha Scheme in collaboration with the new India Assurance Company and with private clinics. It is an insurance scheme fully funded by the Govt. It provides hospitalization benefits and personal accident benefits to citizens ,BPL who undergo sterilization for family planning from government health institutions. The government paid an insurance premium of Rs. 75 per family to the insurance company, with the expected enrollment of 200,000 acceptors in the first year. Slide 40: 108,104 National Blindness Control Programme : Government, non-government and private sectors. The NGOs have been involved for providing a package of services National AIDS Control Programme has involved both the voluntary and private sector for outreaching the target population through Targeted Interventions The RNTCP has involved the private practitioners and the NGOs for the rapid expansion of the DOTS strategy. The non-inclusion of the private providers had been one of the main reasons for the failure of the earlier program. The private medical practitioners serve as the first point of contact for more than two-thirds of TB symptomatics . Slide 41: 3) Mainstreaming AYUSH – revitalizing local health traditions. PHCs/CHCs would be provided AYUSH facilities under the same roof. relocation of AYUSH doctors from existing dispensaries or from contractual hiring of AYUSH doctors under NRHM funds. Reorientation Training program of AYUSH Personnel Slide 42: 4) Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics. Slide 43: 5)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 .