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NRHM LAUNCHED - 12 April 2005
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VISIONEffective Healthcare to Rural Population
Strengthen Public Health Management and Service Delivery.
Revitalize Local Health Traditions & Mainstream AYUSH.
Improve Access to Rural People - Poor Women & Children
Time Bound Goals.
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Reduction in IMR and Maternal Mortality Ratio
Universal access to Public Health Services Women & Child Health,
Water Sanitation and Hygiene,
Immunization and Nutrition.
Prevention and Control - Communicable & NCD.
Access to Integrated Comprehensive Primary Health Care.
Population Stabilization, Gender and Demographic Balance
Revitalizing Local Health Tradition and Mainstream AYUSH
Promotion of Healthy Life Styles.
GOAL
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NRHM LAUNCHED - 12 April 2005.
NRHM Undertakes
Architectural Correction of Health System
Provision of Female Health Activist each Village
Village Health Plan - Prepared by Local Team
Headed by Health & Sanitation Committee of the
Panchayat.
Contd..
Strengthening of the Rural Hospital for Effective Curative
Care and made Measurable and Accountable to the
Community throughIndian Public Health Standards (IPHS)
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Integration of Vertical H & FW Programmes, Funds and
Determinants of Heads Like Safe Water, Sanitation,
Nutrition etc, through an Effective District Health Plan.
PROVIDE UMBRELLA TO THE EXISTING PROGRAMMES
H & FW Including RCH-II,
Malaria, Blindness,
Iodine Deficiency,
Filaria,
Kala Azar,
T.B
Leprosy
Integrated Disease Surveillance Project (IDSP).
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The key features to achieve the goals of NRHM :
Public Health Delivery System Fully Functional.
Human Resources Management
Community Involvement
Decentralization
Rigorous Monitoring & Evaluation Against Standards
Convergence of Health and Related Programmes from
Village Level Upwards (Bottom to Top approach)
Innovations and Flexible Financing and also
Interventions for Improving the Health Indicators.
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The NRHM seeks to provide :
Accessible
Affordable
Quality Health Care
To the Rural CommunityEspecially to the Vulnerable Sections.
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NRHM OUTCOMES EXPECTED1. National Level
IMR : Reduced to 30/1000 Live Births
MMR : Reduced to 100/100,000
TFR : Brought to 2.1
MMRR :50% upto 2010, Addl.10% by 2012
Kala Azar : to be Eliminated by 2010.
Filaria / Microfilaria
Reduction Rate : 70% by 2010, 80% by 2012 &
Elimination by 2015
Dengue Mortality
Reduction Rate : 50% by 2010 and Sustaining atthat Level Until 2012
Contd..
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J.E Mortality Reduction Rate : 50% by 2010 and sustaining
at that Level Until 2012
Cataract Operation : to 46 lakhsper year Until 2012.
Leprosy Prevalence Rate : Brought to < 1 / 10,000.
Tuberculosis DOTS Services : 85% Cure Rate to beMaintained
2000 Community Health
Centres to be Upgraded : Indian Public Health Standard
Utilization of First Referral Units : from < 20% to 75%
250,000 Women to be Engaged : Accredited Social Health
Activists (ASHA).
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CORE STRATEGIES
1. Train and Enhance the Capacity of PRIs :
To Own, Control and Manage Public Health Services
2. Promote Access to Improve Health Care :
At House Hold Level
3. Health Plan for each Village through Village Health Committee :
At the Panchayat Level
4. Strengthening Sub Centres :Through Better Human Resource Development, Clear Quality
Standards, Better Community Support and an Untied Fund to
Enable Local Planning and Action.
Contd..
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5. Strengthening Existing PHCs :
Through Health Staffing and Human Resource Development,
Clear Quality Standards, Better Community Support and anUntied Fund to Enable Local Management Committee to
Achieve these Standards.
6. Provision of 30-50 Bedded Community Health Centre (CHC) :
1 / 1,00,000 Lakh Population for Improved Curative Care.
7. Preparation and Impltn of Inter Sector District Health Plan :
Including Drinking Water, Sanitation, Hygiene and Nutrition.
8. Integrating Vertical Health and Family Welfare Programs :
At all Level.
9. Formulation of Transparent Policies :
Development and Career Development of Human Resources for Health.
SUPPLEMENTARY STRATEGIES
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SUPPLEMENTARY STRATEGIES
Regulation of Private SectorIncluding the Informal Rural
Medical Practitioners (RMP).
Promotion ofPublic Private Partnership (PPP).
Mainstreaming Ayush Revitalizing Local Health Traditions.
Re-Orienting Medical Education (ROME) to Support
Rural Health Issues
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STATE HEALTH MISSION
Honble Chief Minister Chairman
Project Director Mission Director
DISTRICT HEALTH SOCIETY
District Collector Chairman
DDHS (Revenue Dist.) Secretary
PATIENT WELFARE SOCIETY
PHCs
District Hospitals
Sub District Hospitals
NRHM ORGANISATION SETUP
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ROLE OF DISTRICT HEALTH MISSION
Planning, Implementing Monitoring and Evaluating the Progress
Preparation of Annual Work Plan and Budget.
Suggesting District Specific Problems & Innovative Approaches.
Partnership with SHGs and NGOs.
Strengthening Training Institutions.
Providing Leadership to Village Level, Block Level Teams.
Establishing District Resource Group for Capacity Building.
Contd..
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Operational zing District Hospitals to IPHS.
Ensuring Effective Referral System.
Ensuring Timely Disbursements of Claims.
Establishing Transparent System of Procurement.
Setting up of Financial, Progressive and Data
Management Teams.
Carry Out Health Facility Surveys and Supervise
House Hold Surveys.
Developing District Health Action Plans for Convergent Action.
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NRHM
A
C
T
IV
I
T
I
E
S
I 24 HOURS DELIVERY CARE SERVICES
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Round the Clock Availability of :
Basic Emergency Obstetric and New Born Care Services.
Improve the Institutional Delivery Performance.
Treatment for :
1. Poisoning
2. Snake Bite
3. Scorpion Bite
I. 24 HOURS DELIVERY CARE SERVICES
II ESTABLISHMENT OF BEmONC CENTRES
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3 Staff Nurses
2 ANMs - Round the Clock Delivery Services.
Training for ANMs and Staff Nurses to Upgrade the Skills:
First Aid in Obstetric and New Born Emergencies,
Scorpion Sting, Snake Bite, Poisoning, Drowning etc.,
II. ESTABLISHMENT OF BEmONC CENTRES
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BEmONC CENTRE SERVICES
Conduct Normal Deliveries.
Manual Vacum Aspiration for Termination of Unwanted Pregnancies.
Tubectomy Services.
Stabilization of Maternal Emergencies and Newborn Complications before
Referral.
Essential Newborn Care Including the Resuscitation of Newborns,
Management of Hypothermia.
ISM Clinic for Antenatal Care.
Quality Ante Natal Care.
Fetal Monitoring.
Management of Physiological Jaundice of Newborns by using Phototherapy.
Management of Premature and Low Birth Weight babies.
First aid for Obstetric Complication - PPH, Eclampsia, Puerperal Sepsis.
Opportunistic Infection Management of AIDS Case.
Integrated Counseling and Testing Services for HIV / AIDS.
INSTITUTIONAL MECHANISMS
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INSTITUTIONAL MECHANISMS
Village Health & Sanitation Samiti (at village level consisting of
Panchayat Representative/s, ANM/MPW, Anganwadi worker,
teacher, ASHA,community health volunteers
Rogi Kalyan Samiti (or equivalent) for community management
of public hospitals
District Health Mission, under the leadership of Zila Parishad
with District Health Head as Convener and all relevant
departments, NGOs, private professionals etc represented on it
State Health Mission, Chaired by Chief Minister and co-chaired
by Health Minister and with the State Health Secretary as
Convener- representation of related departments, NGOs, private
professionals etc
Standing Mentoring Group shall guide and oversee the
implementation of ASHA initiative
Task Groups for Selected Tasks (time-bound)
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1. To be effective the Mission needs a strong component of
Technical Support
2. This would include reorientation into public health management
3. Reposition existing health resource institutions, like Population
Research
4. Centre (PRC), Regional Resource Centre (RRC), State Institute of
Health & Family Welfare (SIHFW)
5. Involve NGOs as resource organisations
6. Improved Health Information System
7. Support required at all levels: National, State, District and sub-
district.
8. Mission would require two distinct support mechanisms
Program Management Support Centre and Health Trust of India.
TECHNICAL SUPPORT
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Janani Suraksha Yojana
scheme launched on 1st Nov-2005
safe motherhood intervention under NRHM.
Under the scheme, Rs.1000/- (Rs.700/- under JSY (GOI) +
Rs.300/- under Sukhibhava (State) scheme) is being paid to
Rural BPL Woman who delivers in any Govt hospital.
Rs.800 Private hospitals
From 1st April 2006-BPL urban families-Rs 600
IX JANANI SURAKSHA YOJANA (JSY)
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IX.JANANI SURAKSHA YOJANA (JSY)
JSY - Modified form of existing National Maternity Benefit Scheme (NMBS).
JSY Integrates the Cash Assistance with Antenatal Care During the Pregnancy
Period, Institutional Care During Delivery and Immediate Post-Partum Period in a
Health Centre by Establishing a System of Co-Ordinate Care by Field Level HealthWorker.
One of the Accepted Strategies forReducing Maternal Mortality is to Promote
Deliveries at Health Institution by Skilled Personnel Like Doctors and Nurses.
Cash Assistance is Provided to Women from Below Poverty Line (BPL)
Families, for Enabling them to Deliver in Health Institutions.
THE CASH ASSISTANCE FOR
HOME DELIVERY : Rs. 500/-
INSTITUTIONAL DELIVERY : Rs.700/-
(BOTH GOVERNMENT AND PRIVATE INSTITUTION).
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JSY Eligible conditions
Rural/Urban BPL family
above 19 years at the time of the delivery
delivery is of the first child or second or
subsequent delivery, with the couple having onlyone living child or
through in the current delivery there are twins,
there is only one only living child to that couple
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X.MAINSTREAMING OF INDIAN SYSTEM OF MEDICINE (ISM)
One of the priority items of work envisaged under National
Rural Health Mission is revitalizing local health traditionsand mainstreaming of Indian System of Medicines (ISM)
in the Health System.
Towards this aim it is proposed to build capacity amongthe female field health functionaries in the use of Ism
drugs.
A well designed 13 days training program has already
been planned to train the female field health functionaries
in the concepts of ISM and ISM drug.
On completion of the 13 days training, they were given
drug kits consisting of ISM drugs.
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PROGRAM MANAGEMENT SUPPORT
CENTRE
For Strengthening Management Systems-basicprogram management,financial systems, infrastructure
maintenance, procurement & logistics systems,
Monitoring & Information System (MIS), non-lapsable
health pool etc.
For Developing Manpower Systems recruitment
(induction of MBAs/CAs/MCAs), training & curriculum
development (revitalization of existing institutions &
partnerships with NGO & private sector. Sectorinstitutions), motivation & performance appraisal etc.
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ROLE OF STATE GOVERNMENTS
UNDER NRHM
1. The Mission covers the entire country. The 18 highfocus States are Uttar Pradesh, Bihar, Rajasthan,
Madhya Pradesh, Orissa, Uttaranchal,Jharkhand,
Chhattisgarh, Assam, Sikkim, Arunachal Pradesh,
Manipur,Meghalaya, Tripura, Nagaland, MizoramHimachal Pradesh and Jammu & Kashmir. GoI would
provide funding for key components in these 18 high
focus States. Other States would fund interventions like
ASHA,Programme Management Unit (PMU), andupgradation of SC/PHC/CHCthrough Integrated
Financial Envelope.
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CONT.
2.NRHM provides broad conceptual framework. States would project
operational modalities in their State Action Plans, to be decided in
consultation with the Mission Steering Group.
3.NRHM would prioritize funding for addressing inter-state and
intradistrict disparities in terms of health infrastructure and indicators.
States would sign Memorandum of Understanding with Government of
India, indicating their commitment to increase contribution to Public
Health Budget (preferably by 10% each year), increased devolution to
Panchayati Raj Institutions as per 73rd Constitution (Amendment) Act,
andperformance benchmarks for release of funds.
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FOCUS ON THE NORTH EASTERN
STATES
All 8 North East States, including Assam,
Arunachal Pradesh, Manipur,Meghalaya,
Mizoram, Nagaland, Sikkim and Tripura, are
among the States selected under the Mission,for special focus.
Empowerment to the Mission would mean
greater flexibilities for the 10% committed Outlay
of the Ministry of Health & Family Welfare, forNorth East States.
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CONT.
States shall be supported for
creation/upgradation of health
infrastructure,increased mobility, contractual
engagement, and technical support under theMission.
Regional Resource Centre is being supported
under NRHM for the North Eastern States.
Funding would be available to address local
health issues in a comprehensive manner,
through State specific schemes and initiatives.
NRHM 5 MAIN APPROACHES
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NRHM5 MAIN APPROACHES1.COMMUNITIZE
1. Hospital Management Committee/ PRIs at all Levels
2. Untied Grants to Community/ PRI Bodies
3. Funds, Functions & Functionaries to Local Community Organizations
4. Decentralized Planning, Village Health &Sanitation Committees
2.IMPROVED MANAGEMENT THROUGH CAPACITY
1. Block & District Health Office with Management Skills
2. NGOs in Capacity Building
3. NHSRC / SHSRC / DRG / BRG
4. Continuous Skill Development Support
3.FLEXIBLE FINANCING
1. Untied Grants to Institutions
2. NGO Sector for Public Health Goals
3. NGOs as Implementers
4. Risk PoolingMoney Follows Patient
5. More Resources for More Reforms
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4.INNOVATION IN HUMAN RESOURCE MANAGEMENT
1. More Nurses
Local Resident Criteria2. 24 X 7 Emergencies by Nurses at PHC. AYUSH
3. 24 x 7 Medical Emergency at CHC
4. Multi Skilling
5.MONITOR,PROGRESS AGAINST STANDARDS
1. Setting IPHS Standards
2. Facility Surveys3. Independent Monitoring Committees at Block,
District & State levels
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