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1
NATIONAL RURAL HEALTH MISSION
PRESENTATION BEFORE
CONFERENCE OF CHIEF SECRETARIES
19th July2006
Ministry of Health & Family Welfare
www.drjayeshpatidar.blogspot.in
2
NRHM GOALS & APPROACHES
COMMUNITY
INVOLVEMENT
CAPACITY
BUILDING
FLEXIBLE
FINANCINGHUMAN
RESOURCEMANAGEMENT
MONITOR
AGAINST
AGREED
MILESTONES
Universal Health CareReducing IMR, MMR,TFR
www.drjayeshpatidar.blogspot.in
3
BLOCK
LEVEL
HOSPITAL
30-40 Villages
Strengthen Ambulance/
transport Services
Increase availability of Nurses
Provide Telephones
Encourage fixed day clinics
Ambulance
Telephone
Obstetric/Surgical Medical
Emergencies 24 X 7
Round the Clock Services;
CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE –--------------- Accountant
CLUSTER OF GPs – PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;
Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;
Emergencies that can be handled by Nurses – 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;
Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic1000
Popu
lation VILLAGE LEVEL – ASHA, AWW, VH & SC
1 ASHA, AWWs in every village; Village Health Day
Drug Kit, Referral chains
100,000
Population
100 Villages
5-6 Villages
Accredit private
providers for public
health goals
Health Manager
Store Keeper
NRHM – ILLUSTRATIVE STRUCTURE
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NRHM- Institutional framework
1Departments of H & FW
merged34 states except UP
2State Health Missions
Constituted34 states except Delhi
3District Health Missions
Constituted33 states except Haryana, Delhi
4Merger of
SocietiesState Level
29 States except Jharkhand, Rajasthan, U.P., Tripura, Delhi
Chandigarh, Karnataka, Pondicherry
5MoU with Government of
India30 States except U.P., Lakshadweep,
Delhi, Tamil Nadu, A&N Islands
Health is also Economic productivitywww.drjayeshpatidar.blogspot.in
5
• Operationalise the State/District/Block health Missions.
• Suitable officials - Stable tenures / accountability
• Administrative and financial delegations
• Review of Acts, Regulations & guidelines fordecentralisation
• Health facilities to be planning and budgeting Units upto Block level.
• Set up procurement/logistics system
Health is also Women’s empowerment
Administrative Actions
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Manpower Strengthening•Attend to Shortfall of 84,000 staff nurses, 2 lakh ANMs, 5000 to 7000 Specialists in each specialty.
•Multi-skilling, incentives for rural posting, Compulsory Rural Posting,Block pooling, Rational cadre policy, Management through PRIs/ RogiKalyan Samitis, Increasing the age of retirement
•Appointment on contractual basis and local criterion.
•Empower BMO – designate as Chief BMO - to optimally deploydoctors /paramedics in facilities within the block
•Strengthen SIHFW, ANM schools, nursing / medical colleges/increase seats
Health is Women’s rightwww.drjayeshpatidar.blogspot.in
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DECENTRALISATION & CONVERGENCE
•Over 20% of the funds to be spent at the District level and 70% below the block level.
•Review of Acts, Regulations & guidelines for decentralisation
•Health facilities to be planning and budgeting Units upto Block level.
•Monitor preparation of Integrated District Plans.
•Review health camps in each village by ANM, AWW and ASHA.
•Regular meeting of State Committee on Intersectoral Convergence.
Healthy family Healthy nationwww.drjayeshpatidar.blogspot.in
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•Operationalisation of Mission structure & managerial support at state /District / Block levels.
•Selection, training and support for ASHA.
•Availability & Utilisation of service delivery at facilities.
•Immunisation & Institutional deliveries – District wise.
•Preparation of District Plans
•Interdepartmental Coordination for convergence
•Release & Utilisation of funds.
•Training/Capacity Building-Health Planning-District training Centre
•Delegation of administrative & financial powers to various levels.
AGENDA FOR CHIEF SECRETARIES
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ActivityPhasing and time
lineOutcome
Monitoring
1
Fully trained Accredited Social Health
Activist (ASHA) for every 1000
population/large isolated habitations in 18 Special Focus States
50% by 2007100% by 2008
Quarterly Progress
Report
2
Village Health and Sanitation Committee constituted in over 6 lakh villages and untied grants provided to
them.
30% by 2007100% by 2008
Quarterly Progress
Report
3
2 ANM Sub Health Centresstrengthened/established to provide service guarantees as per IPHS, in
1,75000 places.
30% by 200760% by 2009
100% by 2010
Annual FacilitySurveysExternal
assessments
4
30,000 PHCsstrengthened/established with 3 Staff Nurses to provide service guarantees
as per IPHS.
30% by 200760% by 2009
100% by 2010
Annual FacilitySurveys
ExternalAssessments
5
6500 CHCs strengthened/established with 7 Specialists and 9 S Nurses to provide service guarantees
as per IPHS.
30% by 200750% by 2009
100% by 2012
Annual FacilitySurveys
Externalassessments.
www.drjayeshpatidar.blogspot.in
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61800 Taluka/ Sub Divisional
Hospitals strengthened to provide quality health services.
30% by 200750% by 2010
100% by 2012
Annual FacilitySurveysExternal
assessments.
7600 District Hospitals
strengthened to provide quality health services.
30% by 200760% by 2009
100% by 2012
Annual FacilitySurveys
Externalassessments.
8
Rogi Kalyan Samitis /Hospital Development Committees established in all CHCs/Sub Divisional Hospitals/
District Hospitals.
50% by 2007
100% by 2009
Annual FacilitySurveys
Externalassessments.
9District Health Action Plan 2005-
2012 prepared by each district of the country.
50% by 2007
100% by 2008
Appraisal process
Externalassessment.
10
Untied grants provided to each Village Health and Sanitation
Committee, Sub Centre, PHC, CHC to promote local health action.
50% by 2007
100% by 2008
Independentassessments
Quarterly Progress
reports.www.drjayeshpatidar.blogspot.in
11
THANK YOU
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STATE
INITIATIVES
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STATE INITIATIVES• Andhra Pradesh
• Woman Health Volunteers in each of the rural and tribal habitations.• Setting up an additional 100 round-the-clock women health centres.• A subsidized Emergency Health Transportation Scheme.• Incentives to women health volunteers, village Panchayats that promote
Immunization Institutional delivery etc.
• Arunachal Pradesh• 16 PHCs contracted out to NGOs and Private practitioners.• Link workers at village level.• Outreach camps for service delivery at remote and inaccessible areas.
• Assam• RMP Act enacted.• Transfer and Postings of Medical Staff has been decentralized. • Involvement of private sector to render ANC services under PPP.• Infection Control System in all District Hospitals.• Health Insurance Scheme introduced.• 32 FRUs operationalised.www.drjayeshpatidar.blogspot.in
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STATE INITIATIVES• Bihar
• Data centre for daily monitoring of OPD output by each participating institutions.
• 8000 villages covered with mobile medical units for under served population.
• Telephone connection to all PHCs of the state.
• CHhattisgarh
• Strengthening the role of the Panchayat and building on the community based link worker.
• Promoting emergency referral to public/private facility using coupons by Mitanins.
• Establishment of State Health Resource Centre.
• Delhi
• “Basti Sevikas” for Urban Slums as linked worker.www.drjayeshpatidar.blogspot.in
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STATE INITIATIVES• Gujarat
• Chiranjivi Yojana – scheme to contract out private providers for delivery care and management obstetric complications
• Block Level Programme Management arrangements.
• Haryana
• Health link workers in every village.• A couple aged 60 years with only a girl child is being given a
pension of Rs. 300/- per month and Rs. 500/- per month to the girl child under “Ladli Scheme”.
• Himachal Pradesh
• Rs. 30,000 to FRUs as untied fund for emergency transport.• PPP Cell at State and District level.• Involvement of departments like Ayurveda, social justice and
woman empowerment for distribution of contraceptives.www.drjayeshpatidar.blogspot.in
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STATE INITIATIVES
• Jammu & Kashmir• Granting autonomy to hospitals• Utilizing the Rehbat-I-Sehat (RIS) teacher’s network for
providing access to health services to tiny villages scattered in the district.
• Karnataka• Incentives to Doctors and Staff Nurses for providing 24x7
services.• Health insurance for SC/ST population
• Kerela• RCH services at medical colleges• Maternity Security Scheme• Tribal and Coastal Health Plans.• Involvement of ISM and homeopathy system with the health
facilities.
www.drjayeshpatidar.blogspot.in
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STATE INITIATIVES
Madhya Pradesh Outsourcing PHCs to NGOs. State Logistics Management Unit at State level “Prasav Hetu Parivahan Yojana”(LY85000 beneficiaries) Incentive to MO’s at PHCs and CHCs for promotion of
institutional deliveries
Maharashtra Setting up of PPP cell at state and district level. Incentive to tribal pregnant woman for ANC and
institutional deliveries under Matrutav Anudan Yojanaof Nav Sanjivini Scheme.
Association of Mahila Gram Sabha and Mahila VikasSamitis of “Jan Swarajaya” for implementation of RCH.
Mizoram Incentives for doctors serving in remote areas
www.drjayeshpatidar.blogspot.in
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STATE INITIATIVESOrissa Delegation of powers to the ED , State Health society Consideration of key HRD steps such as a differentiated Public
Health Management cadre, policy / incentives for postings to lessdeveloped districts
Health institutions resource mapping on GIS.
Pondicherry Family based health cards.
Punjab Balika Rakshak Yojana for adopting terminal method of
sterilization after the birth of only one or two girl children @ Rs.500/- and Rs. 700/- respectively.
A prize of Rs. 3 lakhs for panchayats achieving CSR of 1000 in ayear and Rs. 2.5 lakhs for panchayats achieving CSR of 951 to 1000in a year.
Nutritional supplement for mothers and children belonging to SCsand other reconstruction of the society.
www.drjayeshpatidar.blogspot.in
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STATE INITIATIVES
Rajasthan Panchamrit for catch up rounds for 5 interventions (Immunization,
Vitamin A, Neo Natal Care, Family Planning, Safe Motherhood).
Considerable emphasis on quality of services through setting standards, indicators and process protocols
Technical resource cell involving NGOs for monitoring and implementation of PNDT act.
Sikkim Link workers at all the villages.
Setting up committees at State / District Level for implementation of PNDT act.
Link up with AWW and School Health Programme to operationalize regular de-worming of children.
Untied fund at SC to meet transportation cost and accompany link workers if it is justifiable by Village Health Committees.
www.drjayeshpatidar.blogspot.in
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STATE INITIATIVES
Tamil Nadu Integration of ISM with primary health care systems Convergence with HIV/ AIDS/TB at PHCs.
Efficient logistic and procurement arrangements.
Tripura Outsourcing of investigation services including imaging.
Uttar Pradesh Involvement of cooperative sector for distribution of
contraceptives under Family Planning programme. Private lady doctors are being contracted for providing 2 hour daily
OPD services at CHCs and PHCs on fix incentive basis. Yuva Mangal Mela and Adarsh Dampati Samman will be organised
in selected districts. This year 25 Districts selected having poor health indicators.
Strengthening of MIS by linking District through NIC Networkwww.drjayeshpatidar.blogspot.in
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STATE INITIATIVES
Uttaranchal
Involvement of community in monitoring and giving feedback on all the programmes.
Documentation of practices on traditional healers.
West Bengal
Piloting of Voucher Scheme for providing services through private sector.
Ranking of blocks as per key health indicators.www.drjayeshpatidar.blogspot.in