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National Rural Health
Mission
MIT India Reading Group Meeting
4 Oct 07
Lavanya Marla
About NHRM
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Inaugurated on April 12, 2005
Increase spending on health from 0.9% of GDP to
2-3% of GDP
Correct the deficiencies of the health system
Focus on 18 states – northern and eastern
Goal is good decentralized healthcare
Missionary approach by government?
Intended for 2005 - 2012
Goals
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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, immunization,
and Nutrition.
Prevention and control of communicable and noncommunicable diseases, including locally endemic diseases
Access to integrated comprehensive primary healthcare
Population stabilization, gender and demographic balance.
Revitalize local health traditions and mainstream AYUSH
Promotion of healthy life styles
Action Points
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Provision of health activist in each village
Village health plan prepared through panchayat
involvement
Strengthening of rural hospitals
Integration of vertical health programs (leprosy,
TB, malarial programs, etc.) and traditional
medicine
Integration of plans at different levels
New health financing mechanisms
Major Stakeholders
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Accredited Social Health Activist (ASHA)
Auxiliary Nurse Midwife and Anganwadi worker
Panchayati Raj Institutions and NGOs
District Administration
State Governments
Village level
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ASHA
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accredited social health activist
Female activist given accreditation after 4 phase training
Ownership of health program given to villagers
Village Health Committee prepares village health
Plan
District Level
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District health plan generated by combining village
health plans
Elements are drinking water, sanitation, hygiene and
nutrition
Strengthen PHC (Primary Health Centers) and
CHC (Community Health Centers)
Higher levels
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Integrate vertical health and family welfare at district, block,
state and national levels
Integration of vertical health programs (leprosy, TB,
malarial programs, etc.)
All health facilities and infrastructure built based on Indian
Public Health Standards (IPHS) standards
Rectify manpower shortage, equipment and other
furnishings in health facilities
Strengthen capacities for data collection, processing,
evaluation and supervision
Exploit synergies at different levels
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NGOs and ASHAs work together
AYUSH (Ayurvedic, Yogic, Unani, Siddha and
Homoeopathy) - Local health traditions made mainstream
Pass regulations requiring private practitioners to give
service at reasonable cost
Public-private partnerships
Re-orient medical education (MBBS 6th yr in rural service?)
Social health insurance (how viable?)
Health Information System
Milestones
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Health provider in each village
Upgrading of rural hospitals
Build new hospitals
District Planning Operational
Village Health Plans
Merger of multiple societies into
District/State Mission
Operational PMUs
Technical Support
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2005-08
2005-07
2005-08
2005-07
2006
April 05
2005-06
2005-07
Progress of Program
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http://mohfw.nic.in/NRHM/Exe_sum_apr07.htm
‘Expected improvement’ statistics missing for many
measures
Observations and Questions
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Attempt at transparency
Data actually available, though not comprehensive
Working on cures is an inherent defect in Indian
health system – Focus seems to be changing
towards prevention
Providing ‘standard’ health care in peripheral areas
– economically viable?
Is this a missionary approach, or is it sustainable?