National Rural Health Mission

National Rural Health Mission (NRHM)

National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was initiated by the Government of India to provide quality healthcare services especially to the rural population throughout the country. The Mission was started with a view to bringing improvement in the health system and the health status of the people. NRHM seeks to create a good health system that is an important component of social and economic development. Let us look in detail about the National Rural Health Mission (NRHM) in this article.

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Objectives of NRHM

National Rural Health Mission has the following objectives which are listed below:

  • To reduce the maternal morbidity and child mortality ratio.
  • To provide universal access to quality health care services at affordable costs
  • To prevent and control of the communicable and non-communicable diseases.
  • To provide access to the integrated comprehensive primary health care system.
  • To program population stabilization ensuring the maternal and child health, adolescent health along with the family planning.
  • To recognize the importance of integrating the determinants of the health such as nutrition, water and sanitation with healthcare systems.
  • To improvise the delivery of health care services through standardizing and upgrading health quality.
  • To address the social determinants of the health, paramount among which are women literacy, women’s empowerment and age at marriage.
  • To promote healthy lifestyles among the rural community.

Components of NRHM

The below listed are the key components of NRHM.

  • Involvement and influence of the PRIs for the Health Sector
    Production of a Cadre of the Accredited Social Health Activists (ASHA) in a phased manner.
  • Creation of the village health team and preparation of village health plan—strengthening sub-centres with the united fund of Rs. 10,000 per annum.
  • Codification of Indian Public Health Standards (IPHS)
  • Raising 2,000 plus CHCs to the level of IPH.
  • Mainstreaming AYUSH at any levels of primary health care.
  • Integrating the vertical health and family welfare programmer’s under NRHM at National, State and District level.
  • Strengthening of programme management capacities ai national, state and district level.
  • Institutionalizing district level management of health.
  • Supply of additional generic drugs.
  • Piloting multiple health insurance models.

Key Features of the Mission

The following are the fundamental features of the NRHM that are as follows:

  • The main emphasis of this mission was on services addressing children’s and women’s health universal immunization, etc.
  • The programme aims to improve the overall health system through the concerted policy actions in every sector and expand preventive, curative, palliative and rehabilitative services offered throughout the Public It holds the Health Sector with an ultimate view on the quality services.
  • NRHM makes the health delivery system fully functional and accountable to the community Convergence of the National Health Programme at all levels of the health system.
  • It creates improved management through capacity building.
  • Involvement of community
  • The monitoring progress against the specific standards.
  • Flexible financing process for the optimum fund utilization under the mission
  • Inter-sectoral coordination for the financial enhancement

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Implementation Strategies

Core Strategies

  • Train and improve the capacity of Panchayati Raj Institutions (PRIs) to own, control and manage all the public health services.
  • Promoting access to improved health care services at the household level through the female health activist (ASHA).
  • The health plan for each village through the Village Health Committee of the Panchayat.
  • Strengthening the sub-centre through an untied fund which would enable the local planning and action and more Multi-Purpose Workers (MPW).
  • Strengthening the existing PHCs and CHCs, and provision of 30 to 50 bedded Community Health Centers (CHCs) per lakh population for the improved health care to a normative standard (Indian Public Health Standards defining equipment, personnel, and the management standards).
  • Implementation and Preparation of an inter-sectoral District Health Plan that will be prepared by the District Health Mission, including drinking water, nutrition, sanitation and hygiene
  • Integrating the vertical Health and Family Welfare programmes at the National, State, District and Block levels.
  • Technical Support provided to the National, State and District Health Missions, for the Public Health Management.
  • Strengthening the capacities required for the data collection, assessment and review for the evidence-based monitoring, planning and supervision.
  • Formulation of the transparent policies for the deployment and career development of the Human Resources for health.
  • Developing capacities for preventive health care at primary levels for promoting healthy lifestyles, a decrease in the consumption of tobacco and alcohol etc.
  • Promoting the non-profit sector that is particularly in the underserved areas.

Supplementary Strategies

  • Regulation of the Private Sector including the informal rural practitioners to ensure the availability of quality service to the citizens at the reasonable cost.
  • Promotion of Public-Private Partnerships for achieving public health goals.
  • Mainstreaming the AYUSH – revitalizing the local health traditions.
  • Reorienting the medical education to support all the rural health issues including the management of Medical care and Medical Ethics.
  • Efficient and viable risk pooling and social health insurance to give health security to the poor people by ensuring the accessible, affordable, accountable and good quality hospital care.

Allocation of Funds

The Mission is conceived as an umbrella scheme subsuming the existing missions of health and family welfare, including the RCHII, the National Disease Control Missions for diseases such as Malaria, TB, Kala Azar, Iodine Deficiency, Filaria, Blindness and Integrated Disease Surveillance Programme. The Budget Head for the NRHM would be created at the National and State levels. Initially, the vertical health and family welfare missions would retain the Sub-Budget Head under the programme of NRHM. The Mission envisages an additional fund of 30% over the existing Annual Budgetary Outlays, every year, to fulfil the regulatory of the National Common Minimum Programme to increase the Outlays for the Public Health from 0.9% of Gross domestic product (GDP) to 2-3% of GDP.

The Outlay for the mission would accordingly be determined in the Annual Budgetary exercise. The States are expected to increase their contributions to the Public Health Budget by minimum 10% per annum to cover and support all the Mission activities. The funds would be released to the States through the Standing Committee of Voluntary Agencies (SCOVAs), largely in the form of Financial Envelopes, with the weight to 18 high focus States.

Also read, Universal Health Insurance Scheme (UHIS)

Monitoring and Evaluation

  • The health MIS to be developed up to the CHC level, and web-enabled for the citizen scrutiny.
  • Sub-centres are to report on the performance to the concerned Panchayats, Hospitals to Rogi Kalyan Samitis and District Health Mission to Zila Parishad
  • The District Health Mission monitors the compliance to Citizen’s Charter at the CHC level.
  • The Annual District Reports on the people’s health (to be prepared by the Government/ NGO collaboration)
  • State and national records/ reports on the people’s health to be tabled in Assemblies, Parliament
  • External evaluation and social audit through the professional bodies/ NGOs
  • Mid Course the reviews and appropriate corrections.

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