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					National Rural Health
Mission

    MIT India Reading Group Meeting
    4 Oct 07
    Lavanya Marla
About NHRM

   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

   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 non-
    communicable 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

   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

   Accredited Social Health Activist (ASHA)
   Auxiliary Nurse Midwife and Anganwadi worker
   Panchayati Raj Institutions and NGOs
   District Administration
   State Governments
Village level

   ASHA
       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

   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

   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

   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

   Health provider in each village        2005-08
   Upgrading of rural hospitals           2005-07
   Build new hospitals                    2005-08
   District Planning Operational          2005-07
   Village Health Plans                   2006
   Merger of multiple societies into      April 05
    District/State Mission
   Operational PMUs                       2005-06
   Technical Support                      2005-07
Progress of Program

   http://mohfw.nic.in/NRHM/Exe_sum_apr07.htm
   ‘Expected improvement’ statistics missing for many
    measures
Observations and Questions

   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?

				
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