National Health Mission (NHM)

The NHM subsumes the NRHM and National Urban Health Mission (NUHM) as sub-missions, initiated in 2013 to expand the primary healthcare service coverage in the country. The NUHM covers slum dwellers and other marginalized groups of all cities/ towns with a population of more than 50,000, as towns below 50,000 population are already covered under the NRHM. Since 2005, the NRHM has led to improvement in healthcare delivery service through better infrastructure, drugs, and equipment and availability of human resources in health facilities at different levels in rural areas.

The gains of the flagship programme of NRHM will be strengthened under the umbrella of NHM which will have universal coverage. The focus on covering rural areas and rural population will continue. A major component of NHM is proposed to be a Scheme for providing primary health care to the urban poor, particularly those residing in slums.

The National Health Mission will incorporate the following core principles.

Universal Coverage

The NHM shall extend all over the country, both in urban and rural areas and promote universal access to a continuum of cashless, health services from primary to tertiary care. There is greater scope for contracting arrangements with the private sector in urban areas, to fill gaps in strengthened public facilities. Area specific NHM plans shall address the challenges unique to their areas such as overcrowding, poor sanitation, pollution, tract injuries, higher rates of crime and risky personal behaviour in urban areas.

Achieving Quality Standards

The IPHS standards will be revised to incorporate standards of care and service to be offered at each level of health care facility. Standards would include the complete range of conditions, covering emergency, RCH, prevention and management of Communicable and Non-Communicable diseases incorporating essential medicines, and Essential and Emergency Surgical Care (EESC). All government and publicly financed private health care facilities would be expected to achieve and maintain these standards. An in-house quality management system will be built into the design of each facility which will regularly measure its quality achievements. The objective would be to achieve a minimum norm of 500 beds per 10 lakh population in an average district. Approximately 300 beds could be at the level of District Hospitals and the remaining distributed judiciously at the CHC level. Where needed, private sector services also may be contracted into supplement the services provided by the public sector.

Continuum of Care

A continuum of care across health facilities helps manage health problems more effectively at the lowest level. For example, if medical colleges, district hospitals, CHCs, PHCs and sub-centres in an area are networked, then the most common disease conditions can be assessed, prevented and managed at appropriate levels. Such linkages would be built in the Twelfth Plan so that all health care facilities in a region are organically linked with each other, with medical colleges providing the broad vision, leadership and opportunities for skill upgradation. The potential offered by tele-medicine for remote diagnostics, monitoring and case management needs to be fully realised.

Decentralised Planning

A key element of the new NHM is that it would provide considerable flexibility to States and Districts to plan for measures to promote health and address the health problems that they face. The NHM guidelines could provide ability to States and districts to plan for results.

Reproductive and Child Health (RCH)

The RCH Programme was launched in 1997-98 Family Welfare Programme and was brought under the ambit of the NRHM during the Eleventh Plan. It has components such as pulse polio immunisation and routine immunisation for protection of children from life threatening conditions that are preventable, such as tuberculosis, diphtheria, pertussis, tetanus, polio, and measles.

Janani Suraksha Yojana (JSY)

The JSY was launched with focus on demand promotion for institutional deliveries in states and regions where these are low. It integrates cash assistance with delivery and post-delivery care. It targets lowering of MMR by ensuring that deliveries are conducted by skilled birth attendants. The JSY scheme has shown rapid growth with the number of beneficiaries increasing to 104.39 lakh in 2014-15. The issues of governance, transparency, and grievance re-addressal mechanisms are now the thrust areas for the JSY.

Janani Shishu Suraksha Karyakram (JSSK)

The JSSK is a new initiative launched on 1 June 2011 to give free entitlements to pregnant women and sick new borns for cashless delivery, C-Section, drugs and consumables, diagnostics, diet during stay in the health institutions, provision of blood, exemption from user charges, transport from home to health institutions, transport between facilities in case of referral, and drop back from institutions to home. In order to reach out to difficult, inaccessible, backward and underserved areas with poor health indicators, 264 high focus districts in 21 states have been identified based on concentration of SC/ST population and presence of lewing extremism for focused attention. A Mother and Child Tracking System has been introduced, which provides complete data of the mothers with their addresses, telephone numbers, etc. for effective monitoring of ante-natal and post-natal check-up of mothers and immunisation services.