National Rural Health Mission
The NRHM launched in 2005 aims to improve accessibility to quality health care for the rural population, bridge gaps in health care, facilitate decentralised planning in the health sector and bring about inter-sectoral convergence. The NRHM provided an overarching umbrella to the existing health and family welfare programmes including Reproductive and Child Health (RCH-and various programmes for control of diseases, including tuberculosis, leprosy, vector-borne diseases and blindness. The effort is to integrate all vertical programmes. NRHM has been operationalized throughout the country, with special focus on 18 states, which includes 8 Empowered Action Group States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Orissa and Rajasthan), 8 NE states, Himachal Pradesh and Jammu & Kashmir.
- All the programmes have now been brought under the District Health Society at district level and State Health Society at state level. Under the NRHM, over 1.4 lakh health human resources have been added to the health system across the country (up to September 2011) which include 11,712 doctors/specialists, 10,851 AYUSH doctors, 66,784 auxiliary nurse midwives (ANMs), 32,860 stanurses, and 14,434 paramedics including AYUSH paramedics.
- Accredited Social Health Activists (ASHAs) are engaged in each village /large habitation in the ratio of one per 1000 population. Till September 2011, 8.55 lakh ASHAs have been selected in the entire country out of which 8.07 lakh have been given orientation training and engaged.
- Further, 7.41 lakh ASHAs have been provided with drug kits. So far over 8330 Primary Health Centres (PHCs), accounting for nearly 35 per cent of total PHCs, have been made functional as 24ï¿½7 services across the country. Further, 442 districts in the country are equipped with mobile medical units under the NRHM.
- Under the NRHM, emphasis has been laid on prevention and promotion aspects of health care. At village level, Village Health Sanitation and Nutrition Committees (VHSNCs) have been constituted to create awareness about disease prevention and take preventive measures. Each VHSNC is provided Rs.10,000 every year. So far 496,338 VHSNCs have been constituted.
- Funds are also provided to the states for capacity building and training of VHSNC members. There has been a steady increase in health-care infrastructure available over the plan period. As on March 2010, 147,069 sub-centres, 23,673 PHCs and 4,535 community health centres (CHCs) were functioning in the country.
- Some of the weaknesses identified in the health delivery system in the public sector are poor upkeep and maintenance and high absenteeism of manpower in rural areas. The NRHM seeks to strengthen the public health delivery system at all levels.
Major achievements of the NRHM
A clear deflection of norms and standards for each level of care in terms of services provided, human resources and skills deployed and in infrastructure and support services and systems. Known as the Indian Public Health Standards, a few facilities have been certified as having reached IPHS.
The ASHA programme is one of the most significant achievements. The selection by communities and the training and deployment of women community health volunteers opened the space for community participation and facilitation of services and increased utilization of public facilities.
Human resource addition: e addition of over one lakh skilled workers (other than ASHAs) has served to revitalised the public health system and increase the quantity and variety of services delivered. Of these one lakh workers, almost half are nurses and a third are doctors and specialists.
The NRHM has enabled much greater community participation through the creation of a wide number of platform and activities. The most notable of these are the village health and sanitation committee, village health and nutrition days, public participation in hospital development committee and in district health societies etc.
The upgrading of facilities at all levels in all states has been a major achievement.
Performance of NRHM
Some important achievements as on 31 January 2010 are:
- 49 lakh Accredited Social Health Activists (ASHAs) have been selected though the total number of those who have completed all training modules is low.
- Against the target of 6 lakh fully trained ASHAs by 2008 there are 5.19 lakh ASHAs positioned with drug kits, but their training is still to be completed. Only about 1.99 lakh ASHAs have completed all five modules and 5.65 lakh have completed up to fourth training module.
- 51 lakh Village Health and Sanitation Committees (VHSCs) have been set up against the target of 6 lakh VHSCs by 2008. The operational effectiveness of the VHSCs, however, needs considerable improvement.
- 40,426 Sub-centres (SCs) have been provided two ANMs against the target of 1.05 lakh SCs by 2009. 8,745 SCs are without even a single ANM.
- 8,324 Primary Health Centres (PHCs) are functional on 24ï¿½7 basis and 5,907of them have three Staff Nurses against the target of 18,000 PHCs by 2009.
- 3,966 Community Health Centres (CHCs) are functional on 24ï¿½7 basis. However, information regarding the target of strengthening 3250 CHCs with seven specialists and nine stanurses by 2009 is not available.
- In any case, the number of CHCs/Sub-Divisional Hospitals or equivalent, which have been upgraded to First Referral Unit (FRU) has increased from 750 (as on 31 March 2005) to 1934 (as on 31 December 2009).
- 510 out of total 578 District Hospitals (DHs) have been strengthened to act as FRUs.
- 29,223 Rogi Kalyan Samitis (RKSs)/Hospital Development Committees have been constituted at PHC/CHC/DH levels against the target of 37,100 RKSs by 2009.
- State & District Societies are in place except at the State level in West Bengal. District Programme Managers and District Accounts Managers are in position in 581 and 579 districts respectively.
- 356 Districts have operational Mobile Medical Units (MMUs) against the target of 600 MMUs by 2009 (one for each district). In addition, boat clinics in Assam & West Bengal, emergency transport system in Andhra Pradesh, Gujarat, Karnataka, Goa, Uttarakhand, Assam and Rajasthan, GPS enabled MMUs in Gujarat, Haryana and Tamil Nadu are operational.
Written by princy