Download NRHM - Introduction

National Rural Health Mission:
A revolution in the health sector
Subodh S Gupta
Dr. Sushila Nayar School of Public Health
MGIMS, Sewagram
The Challenges in health sector
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Under funded public health system
High and prohibitive out of pocket expenditure
Poor distribution of skilled manpower
Poor quality services in public health system
Poor community participation
People’s needs different from what system offers
Large unregulated private sector
Unwillingness to look for structural change and
governance reform
Priorities for health under
Common Minimum Program
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Raise public spending on health to 2-3% of
GDP
A national scheme for health insurance for
poor families
Responsibility for development schemes to
village women
Special attention to poorer sections in
matters of health care.
Food and nutrition security
Life saving drugs at reasonable prices
Introduction
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National Rural Health Mission was launched by
our Hon’ble Prime Minister launched in 12 th
April, 2005 with an objective to provide
effective health care to the rural population,
by
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Improving access
Enhancing equity and accountability
Promoting decentralization
Coverage
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The NRHM covers the entire country, with special
focus on 18 states where the challenge of
strengthening poor public health systems is the
greatest.
These are Uttar Pradesh, Uttaranchal, Madhya
Pradesh, Chhattisgarh, Bihar, Jharkhand, Orissa,
Rajasthan, Himachal Pradesh, Jammu and Kashmir,
Assam, Arunachal Pradesh, Manipur, Meghalaya,
Nagaland, Mizoram, Sikkim and Tripura.
Communitization
NRHM
Main Approaches
•Village Health &
Sanitation Committee
• ASHA
• Panchayati Raj
Institutions
• Rogi Kalyan Samiti
Improved
management
through capacity
•DPMU/ BPMU/ FMG
• NGOs for capacity
building
• NHRC/ SHRC/
DRG
• Continuous skill
development
Flexible Financing
• Untied grants
• NGOs as
implementers
• Risk Pooling
• Money follows patient
• More resources for
more reforms
Monitor progress
against standard
•IPHS Standard
• Facility Surveys
• Independent
Monitoring
Committee
Innovations in
Health Management
• Additional manpower
• Emergency services
• Multi-skilling
Health Financing
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NOW
20% public expenditure
(0.9% GDP), often
inefficient and ineffective.
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80% private expenditure,
mostly out of pocket
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15-20% MoHFW
expenditure – rest by
States
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By 2012
40% public expenditure
with improved
accountability and
efficiency ( 2-3% GDP)
Private expenditure by risk
pooling/insurance
40% GoI expenditure – rest
by States
Supplementary Strategies
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Regulation of Private Sector: To ensure quality of
service to citizen (includes the informal rural
practitioners).
Promotion of Public Private Partnerships: For
achieving public health goals.
Mainstreaming AYUSH.
Reorienting medical education: To support rural
health issues including regulation of Medical care and
Medical Ethics.
Effective and viable risk pooling: To provide health
security to the poor by ensuring accessible,
accountable and good quality hospital care.
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NRHM: The concerns
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Village Health and Sanitation Committees
ASHA
Lack of skilled manpower
Lack of technical as well as management
capacity
IPHS standards and strengthening of public
health care delivery system