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Introduction to NRHM

Introduction to NRHM. Objectives. 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.

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Introduction to NRHM

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  1. Introduction to NRHM

  2. Objectives • 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

  3. Important Core Strategies • Capacity building of PRIs to own and govern public health services. • Promote access to improved healthcare at household level through ASHAs. • Community based, inter-sectoral bottom up planning for health beginning from health plans for each village, integrated at each up to the state and national level • Preparation and implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition • Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels. • Strengthening sub-centres and providing infrastructure in existing PHCs and CHC based on IPHS recommendations.

  4. Important expected outcomes National Level • IMR reduced to 30/1000 live births • MMR reduced to 100/100,000 • TFR reduced to 2.1 • Upgrading CHCs to Indian Public Health Standards • Increase utilization of FRUs from less than 20% to 75%

  5. Important expected outcomes Availability of ASHA at village level, (with a drug kit for generic ailments) Regular Health Days at Anganwadi level for provision of immunization, ante/post natal checkups and services related to mother & child healthcare, including nutrition. Availability of generic drugs for common ailments at Sub-centre and hospital level Good hospital care through assured availability of doctors, drugs and quality services at PHC/CHC level Improved access to Universal Immunization Community Level

  6. Important expected outcomes Improved facilities for institutional delivery through provision of referral, trans port, escort and improved hospital care subsidized under the Janani Suraksha Yojana (JSY) for the Below Poverty Line families. Provision of household toilets Improved Outreach services through mobile medical unit at district levels Community Level

  7. Implementation approach • Communities involved in: • Planning • Implementation • Monitoring • (VHSCs, ARS, PMC etc) HMIS, Community Monitoring Resource envelope provided. States have the flexibility to plan with the available funds, and can integrate other available funds Options of need based contractual staffing HMIS: Health Management Information System VHSC/VHSNC: Village Health Sanitation and Nutrition Committee, ARS: Arogya Raksha Samiti, PMC: Planning and Monitoring Committee

  8. Implementation approach

  9. Role of States • Health is a state subject. However, through NRHM, Centre takes a more active and hands-on approach in public health governance • Activities under the mission to be planned and carried out under the leadership of the states, under the broad framework proposed by NRHM. • Funds: Centre: 85%, State: 15% • State Commitments: • increase yearly public health budget by at 10%, • increased devolution to PRIs • adherence to the stipulated national performance benchmarks

  10. Planning in NRHM Planning process envisioned to be Bottom up Decentralized Participatory Responsive to local needs Need based • Resource Allocation approaches proposed • Equal distribution • Equity based distribution, based on socio-demographic indicators • Need based distribution

  11. Contents of District Health Action Plan • Background and Planning Process • Priorities as per the background and planning process • Annual Plan for each of the Health Institutions • Community Action Plan • Financing of Health Care • Management Structure to deliver the programme • Partnerships for convergent action • Capacity Building Plan • Human Resource Plan • Procurement and Logistics Plan • Non-governmental Partnerships • Community Monitoring Framework • Action Plan for Demand generation • Sector specific plan for maternal health, child health, adolescent health, disease control, disease surveillance, family welfare etc. The DHAP also has to have inter-sectoral convergence on issues like nutrition, sanitation and drinking water

  12. Fund Flow in NRHM • Funds are released from the Centre through two routes : • Treasury and State Health Society • Funds released under following components through the society route • RCH Flexipool (RCH, Family Planning, JSY, PA, HR) • Mission Flexipool (Infrastructure, maintenance grants, untied funds, innovations, HR) • Routine Immunization • National Disease Control Programmes

  13. GoI NRHM Managed by Financial Management Group (FMG) State Govt State Govt. Share (15%) Managed by FMG and State Health Mission (SHM) State Level Expenses State Health Society Managed by FMG and District Health Mission (DHM) District Level Expenses District Health Society Block, CHC, PHC, SC Regular/United/Maintenance Grants

  14. A. RCH B. NRHM C. RI D. NDCP NRHM RCH and Mission Flexipool constitute the largest share and as such expected to have the largest impact SHM & SHS DHM & DHS NRHM NRHM RI Malaria TB Leprosy Blindness RCH

  15. Thank you

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