NATIONAL RURAL HEALTH MISSION

PREAMBLE- Recognizing the importance of Health in the process of economic and social

Development and improving the quality of life of our citizens, the Government of India has

resolved to launch the National Rural Health Mission to carry out necessary architectural

correction in the basic health care delivery system.  The Mission adopts a synergistic

Approach by relating health to determinants of good health viz. segments of  nutrition,

sanitation, hygiene and safe drinking water. It also aims at mainstreaming the Indian

systems of medicine to facilitate health care. The Plan of Action includes increasing public

expenditure on health, reducing regional imbalance in health infrastructure, pooling

resources, integration of organizational structures, optimization of health manpower,

decentralization and district management of health programmes, community participation

and ownership of assets, induction of management and financial personnel into district

health system and operationalizing community health centers into functional hospitals

meeting Indian Public Health Standards in each Block of the Country. 

The Goal of the Mission is to improve the availability of and access to  quality

health care by people, especially for those residing in rural areas, the poor, women and

children

National Rural Health Missionis one of the largest and the most ambitious programmes to revive healthcare in the world.

Launched in 2005,this mission has many achievements to its credit. It seeks to provide universal access to healthcare, which is affordable, equitable and of good quality. It has revived and revitalized a neglected health care delivery system.

NRHM seeks to provide effective healthcare to urban and rural population throughout the state with special focus on the backward districts with weak human development and health indicators especially among the poor and marginalized groups like women and vulnerable sections of the society.

18 states have special focus in this scheme. These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram,

Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim,

Tripura, Uttaranchal and Uttar Pradesh. 

The Mission is an articulation of the commitment of the Government to

raise public spending on Health from 0.9% of GDP to 2-3% of GDP.

-It has as its key components provision of a female health activist in each

village;

 a village health plan prepared through a local team headed by the

Health & Sanitation Committee of the Panchayat;

strengthening of the rural hospital for effective curative care and made measurable and

accountable to the community through Indian Public Health Standards

(IPHS);

and integration of vertical Health & Family Welfare Programmes

and Funds for  optimal utilization of funds and infrastructure and

strengthening delivery of primary healthcare

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 

It has facilitated financial management, assisted in computerization of health data, suggested centralized procurement of drugs, equipment and supplies, mandated the formation of village health and hospital committees and community monitoring of services.

CHALLENGES

NRHM has injected new hope into the healthcare delivery system in India. However it faces new and diverse challenges which need to be addressed in order to achieve its future goals.

·         Health  is a state subject and NRHM seeks to build a partnership with states to ensure meaningful reforms with more resources. The NRHM is currently functioning under the Govt. of India is due to end in 2012. Its significant contribution to improving healthcare infrastructure and service delivery across the country will be frittered away if its funding ceases with the 11^th FYP. This mission should not only be included in the 12^th FYP, and should be incorporated with more innovative ideas to ensure it as a permanent solution to the healthcare problem in India.

·         Another challenge is to craft credible public systems and this would also call for new systems of public recruitments which are institution specific and based on service guarantees with complete local level accountability.

·         In spite of its achievements, its impact on reinventing and reinvigorating systems seems to be limited. There is a need for a more coordinated approach which optimally utilizes resources.

SOLUTIONS

The government must move from the population and contraceptive tech agenda which was a focus of the earliest version of this mission to a truly comprehensive primary health care orientation that stresses empowerment and rights based approach to health care.

The mission must build systems and institutional mechanisms at the peripheral level if its community based and community oriented goals are to be met. Unless it addresses the realities of the lives of the poor and the marginalized in the rural, tribal abd poor urban communities, it will remain yet another populist exercise on paper.

Promoting decentralization of healthcare and encouraging a truly inter sectoral approach is a basic requirement and a challenge.

The mission must become part of a bold padagrim shift,from providing services through ‘top down planning” to building capacity and empowering communities to manage their own healthcare needs.