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National Rural Health Mission (NRHM) – Vision and Goals

Ministry of Health and Family Welfare, Parul Chopra

Recognising the importance of health in the process of economic and social development and improving the quality of life of our citizens, the Government of India has launched the National Rural Health Mission (2005-12) to carry out necessary architectural correction in the basic health care delivery system. The mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water. It also aims at mainstreaming the Indian systems of medicine to facilitate health care.

The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of organisational structures, optimisation of health manpower, decentralisation and district management of health programmes, community participation and ownership of assets, induction of management and financial personnel into district health system and operationalising community health centres into functional hospitals meeting Indian Public Health Standards in each Block of the Country. The goal of the mission is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.

The Vision

  • The NRHM (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure.
  • These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
  • The Mission is an articulation of the commitment of the Government to raise public spending on health from 0.9% of GDP to 2-3% of GDP.
  • It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country.
  • It has as its key components provision of a female health activist in each village; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); and integration of vertical Health & Family Welfare Programmes and Funds for optimal utilisation of funds and infrastructure and strengthening delivery of primary healthcare.
  • It seeks to revitalise local health traditions and mainstream AYUSH into the public health system.
  • It aims at effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water.
  • It seeks decentralisation of programmes for district management of health.
  • It seeks to address the inter-State and inter-district disparities, especially among the 18 high focus states, including unmet needs for public health infrastructure.
  • It shall define time-bound goals and report publicly on their progress.
  • It seeks to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare.
The Goals 
  • Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR).
  • Universal access to public health services such as women’s health, child health, water, sanitation & hygiene, immunisation and nutrition.
  • Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.
  • Access to integrated comprehensive primary healthcare.
  • Population stabilisation, gender and demographic balance.
  • Revitalise local health traditions and mainstream AYUSH.
  • Promotion of healthy life styles.
The Mission outcomes are expected to follow a phased approach and are at two levels:

A. National Level 
  • Infant Mortality Rate to be reduced to 30/1000 live births.
  • Maternal Mortality Ratio to be reduced to 100/100,000.
  • Total Fertility Rate to be brought to 2.1.
  • Malaria mortality reduction rate –50% upto 2010, additional 10% by 2012.
  • Kala Azar to be eliminated by 2010.
  • Filaria/Microfilaria reduction rate: 70% by 2010, 80% by 2012 and elimination by 2015.
  • Dengue mortality reduction rate: 50% by 2010 and sustaining at that level until 2012.
  • Japanese Encephalitis mortality reduction rate: 50% by 2010 and sustaining at that level until 2012.
  • Cataract Operation: increasing to 46 lakhs per year until 2012.
  • Leprosy prevalence rate: to be brought to less than 1/10,000.
  • Tuberculosis DOTS services: from the current rate of 1.8/10,00, 85% cure rate to be maintained through the entire Mission period.
  • 2000 Community Health Centres to be upgraded to Indian Public Health Standards.
  • Utilisation of First Referral Units to be increased from less than 20% to 75%.
  • 250,000 women to be engaged in 18 states as Accredited Social Health Activists (ASHA).
B. Community Level  
  • Availability of trained community level worker at village level, with a drug kit for generic ailments.
  • Health Day at Anganwadi level on a fixed day/month for provision of immunisation, ante/post natal checkups and services related to mother & child healthcare, including nutrition.
  • Availability of generic drugs for common ailments at Sub-centre and hospital level.
  • Good hospital care through assured availability of doctors, drugs and quality services at PHC/CHC level.
  • Improved access to Universal Immunisation through induction of Auto Disabled Syringes, alternate vaccine delivery and improved mobilisation services under the programme.
  • Improved facilities for institutional delivery through provision of referral, transport, escort and improved hospital care subsidised under the Janani Suraksha Yojana (JSY) for the Below Poverty Line families.
  • Availability of assured healthcare at reduced financial risk through pilots of Community Health Insurance under the Mission.
  • Provision of household toilets.
  • Improved Outreach services through mobile medical unit at district-level.

Monday, 25 May 2009
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