1. National Rural Health Mission:A revolution in the health sector Subodh S Gupta Dr. Sushila Nayar School of Public Health MGIMS, Sewagram

2. The Challenges in health sector • 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

3. Priorities for health under Common Minimum Program • 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

4. Introduction • 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 • Improving access • Enhancing equity and accountability • Promoting decentralization

5. Coverage • 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.

6. NRHM Main Approaches • Communitization • Village Health & Sanitation Committee • ASHA • Panchayati Raj Institutions • RogiKalyanSamiti • Monitor progress against standard • IPHS Standard • Facility Surveys • Independent Monitoring Committee • Flexible Financing • Untied grants • NGOs as implementers • Risk Pooling • Money follows patient • More resources for more reforms • Innovations in Health Management • Additional manpower • Emergency services • Multi-skilling • Improved management through capacity • DPMU/ BPMU/ FMG • NGOs for capacity building • NHRC/ SHRC/ DRG • Continuous skill development

8. NOW 20% public expenditure (0.9% GDP), often inefficient and ineffective. 80% private expenditure, mostly out of pocket 15-20% MoHFW expenditure – rest by States 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 Health Financing

9. Supplementary Strategies • 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.

10. NRHM: The concerns • 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