National Rural Health Mission - India

1. National Rural Health Mission - India shiv_mathur@hotmail.com Shiv Chandra Mathur Director State Institute of Health and Family Welfare, Rajasthan, Jaipur

2. Preamble • 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, over the next 5 years. • It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme. SHIV CHANDRA MATHUR/sihfw

3. Preamble • Provision of a health activist in each village ASHA • Village health plan prepared through panchayat involvement • Strengthening of the rural hospital on IPHS • Integration of vertical Health & FW Programme SHIV CHANDRA MATHUR/sihfw

4. ASHA • The acronym stands for accredited social health activist • Accreditation to a female activist volunteering to take up community health work at grassroots will be given after a four phase modular training • She will strength primary health care particularly in inaccessible area SHIV CHANDRA MATHUR/sihfw

5. Village Health Plan • Planning for health to be initiated from village level will transfer the ownership of all health program to the villagers • District Annual Plan would generate from village level through a participatory approach. • Plan will largely indicate expected level of achievement for each of the health program SHIV CHANDRA MATHUR/sihfw

6. Indian Public Health Standards • All peripheral health facilities would be rejuvenated on standards developed at the central level by Ministry of Health and Family Welfare. • This initiative will take care of rectifying the manpower weaknesses, equipment and appropriate furnishings in health facilities. SHIV CHANDRA MATHUR/sihfw

7. Integration of Vertical Health Program • All vertical health program like Malaria control, TB control, Leprosy control, Blindness Control, Water and Sanitation and Reproductive and Child Health program would be merged. SHIV CHANDRA MATHUR/sihfw

8. Guiding principles • Promote Equity • Enhance People orientation and community based approaches • Ensure Public Health Focus • Recognize value of traditional knowledge base of communities • Decentralize and involve local bodies. SHIV CHANDRA MATHUR/sihfw

9. Goals • Reducing IMR and MMR by 50% from existing levels in next 7 years • Universalize access to public health services : such as Women’s health, child health, water, sanitation, immunization, Nutrition…. • Prevention and control of communicable and non-communicable diseases, including locally endemic diseases • Access to Integrated comprehensive primary healthcare • Assuring Population stabilization and , gender balance. • Promotion of healthy life styles SHIV CHANDRA MATHUR/sihfw

10. Institutional Mechanism - National • National Mission Steering Group chaired be co-chaired by Health and Family Welfare Minister with Deputy Chairman Planning Commission. Membership would cover Ministers of Panchayat Raj, RD, HRD. Public health professionals would be nominated by HFM in consultation with PM. Health and Family Welfare Secretary would be its Convener. • At lower level an Empowered Programme Committee will be chaired by Secretary HFW. There will also be Standing Mentoring Group for ASHA SHIV CHANDRA MATHUR/sihfw

11. Institutional Mechanism - State • State Health Mission (Chaired by Chief Minister; co-chaired by Health Minister; State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc) • District Health Mission (under the leadership of Zila Parishad (District Council) with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it) SHIV CHANDRA MATHUR/sihfw

12. Institutional Mechanism (cont.) • Village Health & Sanitation committee (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers) • Autonomous societies for community management of public hospitals SHIV CHANDRA MATHUR/sihfw

13. Role of Peripheral Democratic Bodies • ASHAs would be selected by and be accountable to the Village Panchayat. • The Village Health Committee would prepare the Village Health Plan, and promote inter-sectoral integration. • The untied fund at Sub-centers to be deposited in a Bank Account, jointly operated by ANM and Sarpanch. • District Health Mission to be led by the Zila Parishad. The DHM would also guide activities of sanitation. SHIV CHANDRA MATHUR/sihfw

14. Role of Peripheral Democratic Bodies(PRIs) • The DHM will control, guide and manage all public health institutions in the district, Sub-centres, PHCs and CHCs. • PRI involvement in autonomous societies for good hospital management. • Training to members of PRIs. • Making available health related databases to all stakeholders, including Panchayats at all levels. • States to indicate in their MoUs their commitment for devolution of funds and programmes to PRIs. SHIV CHANDRA MATHUR/sihfw

15. Role of NGOs for the Mission • In institutional arrangements • Standing Mentoring Group for ASHA • Member of Task Forces • Provision of Training, BCC and Technical Support for ASHAs/DHM • Health Resource Organizations • Service delivery for identified population groups on select themes SHIV CHANDRA MATHUR/sihfw

16. Milestones to be achieved Health Provider in each village 2005-2008 Upgrading of Rural Hospitals 2005-2007 Creation of New Hospitals 2005-2008 District Planning operational 2005-2007 Village Health Plans 2006 Merger of Multiple societies into April 2005 District/State Mission Operational PMUs 2005-2006 Technical Support 2005-2007 SHIV CHANDRA MATHUR/sihfw