National Health Mission (NHM)

• The National Health Mission (NHM) was officially launched by the Government of India in 2013 by subsuming two major existing health missions.
• It integrated the National Rural Health Mission (NRHM), which was initially launched in 2005, and the National Urban Health Mission (NUHM), which was launched in 2013.
• The scheme operates as a Centrally Sponsored Scheme under the direct administrative control of the Ministry of Health and Family Welfare (MoHFW).
• The mission was extended in March 2018 to continue its operations till March 2020, and it continues to receive budgetary extensions aligned with the Finance Commission cycles to achieve the goals set by the National Health Policy 2017.

Core Vision and Objectives

• NHM aims to achieve universal access to equitable, affordable, and quality healthcare services that are accountable and responsive to the specific needs of the population.
• The mission directly targets the reduction of out-of-pocket expenditure (OOPE) on healthcare, which is a major cause of impoverishment in India.
• It emphasizes a decentralized, community-owned approach to health planning and delivery, bridging the gap between rural and urban public health infrastructures.
• The mission operates on a life-cycle approach to healthcare, encompassing maternal, neonatal, infant, child, and adolescent health.

Key Sub-Missions of NHM

National Rural Health Mission (NRHM)

• Launched in 2005, NRHM focuses on providing accessible, affordable, and quality healthcare to the rural population, especially focusing on vulnerable groups.
• The mission established a special focus on 18 states that possessed weak public health indicators and infrastructure.
• These focus states include eight Empowered Action Group (EAG) States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Orissa, and Rajasthan), eight North-Eastern States, alongside Himachal Pradesh and Jammu & Kashmir.

National Urban Health Mission (NUHM)

• Approved by the Cabinet in May 2013, NUHM specifically targets the healthcare needs of the urban population with a distinct focus on the urban poor and slum dwellers.
• It covers all state capitals, district headquarters, and cities or towns with a population of more than 50,000 (as per the 2011 census).
• Cities with a population below 50,000 are covered under the NRHM framework to ensure no jurisdiction is left without intervention.
• NUHM operates through Urban Primary Health Centres (U-PHCs), Urban Community Health Centres (U-CHCs), and Mahila Arogya Samitis (MAS) formed at the community level.

Major Initiatives and Interventions under NHM

Maternal and Child Health Programmes

• Janani Suraksha Yojana (JSY): A safe motherhood intervention aimed at reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women, functioning as a conditional cash transfer scheme.
• Janani Shishu Suraksha Karyakaram (JSSK): Launched in 2011, it guarantees completely free and cashless services to pregnant women, including normal deliveries and caesarean operations, along with free treatment for sick newborns (up to 1 year of age) in all public health institutions.
• Rashtriya Bal Swasthya Karyakram (RBSK): Focuses on early identification and early intervention for children from birth to 18 years to cover the “4 Ds”: Defects at birth, Deficiencies, Diseases, and Development delays including disability.
• Rashtriya Kishor Swasthya Karyakram (RKSK): Targets the holistic health needs of adolescents (10-19 years), shifting the focus from a strictly curative approach to a preventive and promotive one, addressing nutrition, sexual and reproductive health, mental health, and substance misuse.

Community and Infrastructure Development

• Accredited Social Health Activist (ASHA): Deploys a trained female community health worker in every village (one per 1,000 population) who acts as the primary interface between the community and the public health system.
• Rogi Kalyan Samitis (RKS): Registered societies acting as a group of trustees for hospitals to manage affairs and utilize untied hospital funds for infrastructure maintenance and patient welfare.
• National Ambulance Services (NAS): Provides an integrated emergency response mechanism across the country under toll-free numbers 108 (emergency response) and 102 (basic patient transport, primarily for pregnant women and children).
• National Mobile Medical Units (NMMUs): Deployed to provide basic curative, promotive, and preventive services in highly unserved and hard-to-reach geographical areas.

Quality Assurance and Disease Control

• Kayakalp Initiative: An award scheme instituted to promote cleanliness, hygiene, and infection control practices within public healthcare facilities.
• LaQshya (Labour Room Quality Improvement Initiative): Aims to improve the quality of care in labor rooms and maternity operation theatres to prevent adverse outcomes associated with childbirth.
• Pradhan Mantri National Dialysis Programme (PMNDP): Rolled out in 2016 to provide free dialysis services to Below Poverty Line (BPL) patients at district hospitals in a public-private partnership (PPP) mode.
• Free Drugs and Diagnostics Service Initiatives: Mandates the provision of essential drugs and core diagnostics free of cost to all patients visiting public health facilities.

Institutional Framework and Governance

National and State Level Administration

• The Mission Steering Group (MSG), headed by the Union Minister of Health & Family Welfare, acts as the highest policy-making and steering institution for NHM at the national level.
• The Empowered Programme Committee (EPC), headed by the Secretary, MoHFW, executes the policies and manages the operational implementation.
• At the state level, the State Health Mission is headed by the Chief Minister, ensuring high-level political ownership, while the State Health Society, headed by the Chief Secretary, executes the programs.
• The District Health Mission, headed by the Zila Parishad Chairperson, and the District Health Society, headed by the District Collector, manage decentralized planning and local implementation.

Funding Pattern and Financial Mechanisms

Financial Nuances

• Funds are released to the states through the State Consolidated Fund, and specific outlays are detailed in the State Programme Implementation Plans (PIPs) which are appraised by the central ministry.
• The mission provides flexible “Untied Funds” to sub-centers, PHCs, CHCs, and Village Health Sanitation and Nutrition Committees (VHSNCs) to enable local planning and immediate contextual actions.

Targeted Outcomes and Goals (Aligned with NHP 2017)

Demographic and Mortality Targets

• Reduce the Maternal Mortality Ratio (MMR) to 1 per 1,000 live births.
• Reduce the Infant Mortality Rate (IMR) to 25 per 1,000 live births.
• Reduce the Total Fertility Rate (TFR) to 2.1 (Replacement level fertility).
• Prevent and reduce the prevalence of anaemia in women aged 15 to 49 years.

Communicable Disease Elimination Targets

• Reduce annual incidence and mortality from Tuberculosis (TB) by half compared to the baseline.
• Reduce the prevalence of Leprosy to less than 1 per 10,000 population and bring the incidence to zero in all districts.
• Maintain the Annual Malaria Incidence at less than 1 per 1,000 population.
• Ensure less than 1% microfilaria prevalence in all districts to combat Lymphatic Filariasis.
• Maintain Kala-azar elimination status (less than 1 case per 10,000 population in all blocks).