NRHM And NUHM

Dr.Praseeda.B.KNRHM And NUHM

NHM

NRHM

NUHM - Plan Of action - Role Of ASHA - Initiatives - Infrastructure

National Health MissionMinistry of health and family welfare

NHM - approved in May 2013

Sub missions NRHM & NUHM

Main programmatic components - RMNCH+A - control of NCDs & Comm. d/sImportant achievement reduction in out of pocket expenses from 72 60%

New initiatives under NHMRashtriya Bal Swasthya Karyakram (RBSK)

Rashtriya Kishor Swasthya karyakram (RKSK)

WIFS(Weekly Iron and Folic Acid Supplimentation Programme)

NRHMLaunched in 5th April 2oo5 for 7 years by GOIRecently extended to 2017Operational in whole country & Special focus on 18 states

STATES FOCUSSED UNDER NRHM

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KEY NATIONAL HEALTH PROGRAMMES

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The Objectives of the Mission

The Objectives of the Mission

PLAN OF ACTION 1)CREATION OF ASHA (ACCREDITED SOCIAL HEALTH ACTIVIST) -health activist in the community -1ASHA= 1000 population -not a paid employee -create awareness about health & its determinants -mobilise community to health care services - counsel women and escort them to PHC/CHC & providing medical care for minor ailments

PLAN OF ACTION..2) STRENGTHENING OF SUB CENTRESSupply of essential medicines and equipments.

Provision of MPW / additional ANM

Provision of funds

3) STRENGTHENING OF PHC24 hr service in at least 50% of PHC incl. AYUSH practitioner

Upgradation for 24hr referral service

Adequate and regular supply of essential drug

Strengthening CD control programme

PLAN OF ACTION.. 4) STRENGTHENING OF CHCS

all operating CHCs should function as first referral unit

Maintain INDIAN PUBLIC HEALTH STANDARDS

Promotion of ROGI KALYAN SAMITIS

Developing standards of services and costs in hospital care.

Major initiatives under NRHM1. Selection of ASHA

ASHA act as the interface between the community and the public health system.

Responsibilities of ASHA1. She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi workerANMfunctionaries of other DepartmentsSelf Help Group members

Responsibilities of ASHA2. will be given a Drug Kit (generic AYUSH and allopathic formulations )for common ailments.

Responsibility of ASHA3. To create awareness among the community regarding nutrition, basic sanitation, hygienic practices, healthy living.

4. Counsel women on birth preparedness, imp of safe delivery, breast feeding, complementary feeding, immunization, contraception, STDs

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Contd.5. Encourage the community to get involved in health related services.

6. Escort/ accompany pregnant women, children requiring treatment and admissions to the nearest PHCs.

7. Primary medical care for minor ailment such as diarrhea, fevers

8. Provider of DOTS.

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Initiatives 2. Rogi Kalyan Samiti(Patient Welfare Committee)

Simple and effective management structure

Registered society whose members act as trustees

31,109 Rogi Kalyan Samitis till march 2014

3. Untied grants to subcenters

4. Villege Health Sanitation and Nutrition Committee(VHSNC)

5.Janani Suraksha Yojna

Janani Suraksha Yojana and ASHA NRHM

JSY

Antenatal Check up

Institutional Care during delivery

Immediate post-partum

(coordinated care)

Institutional Deliveries in BPL families all MMR & IMR Cash assistance

6. Janani Shishu Suraksha Karyakram(JSSK)

Launched on June first 2011

Entitles all pregnant women delivering in public health institutions to absolutely free treatment.

7. National Mobile medical units(NMMUs)

All Mobile medical Units are repositioned as NMMU with universal Color and design.

8. National Ambulance Services

Free service to provide patients transport in every corner of country connected with a toll free number

9. web enabled Mother and Child Tracking System (MCTS)

Name based tracking of pregnant women and children(up to 3 years)

To ensure Timely Antenatal Care Instituitional Delivery post natal care of Mother Immunization

New initiativesHome delivery of contraceptives by ASHA

Conducting District level HH Survey (DLHS)

Modifications in scheme for promotion of menstrual hygiene

Differential financial approach for comprehensive health care

5. Involve ASHA in home based new born care

6. Revision in criterion for allocation of funds to the states under NRHM based on performance of the states.

7. Expansion of Village Health and Sanitation Committee to include Nutrition in its mandate and renaming it as VHSNC.

8. Partial modification of centrally sponsored scheme for development of AYUSH hospitals and dispensaries for mainstreaming of AYUSH under NRHM

9.Rashtreeya Bal Swasthya Karyakram Launched in February 2013For early detection and management of - Defects at birth - Diseases - Deficiencies - Development delays including Disabilities

10. Rashtreeya Kishore Swasthya Karyakram

launched in January 2014Adolascent health programme beyond reproductive and sexual health - life skills - nutrition - injuries - violence - NCD - Mental Health - Substance misuse

11.Mother and child wings( MCH Wings)

12. Free drug and free diagnostic service

13.National Iron + Initiative

Launched in 2013important strategy - WIFS

14. RMNCH+A

15. Delivery points(DPs)Health facilities that have high demand for services and performance above certain bench mark have been identified as DPs

Objective to provide RMNCH+A at this level

16. Universal Health Coverage (UHC)

Achievements As on June 2013

8.89 lakhs ASHAs have been selected in the entire country of which 8.06 lakhs have been trained and provided with drug kit

1.47 lakh sub centres in the country are provided with untied funds of rs. 10,000 each. 40,426 sub centres are functional with a second ANM

31,109 Rogi Kalyan Samithies

4.8,129 doctors and specialists , 70,608 ANMs ,34,605 staff nurses ,13725 paramedics have been appointed.

5.1,691 professionals have been appointed(CA,MBA,MCA)

6.2,127 mobile medical units

7.Emergency transport system in 12 states

8. Accelerated immunization programme for North East States and Empowerde action Groups

9.JSY in all states

10.IMNCI in 310 districts

11. Monthly health and nutrition days every week

12. 5.12 lakh VHSN committees

13. School health programme in 26 states

FUNCTIONS OF NRHM

NUHMTo improve health status of urban population particularly slum dwellers vulnerable section

CoverageAll cities with >50,000 population.

All the district and state headquarters (irrespective of the population size).

Urban areas with < 50,000 population to be covered by NRHM.

So far to ensure that there is no duplication of services.

Seven mega cities ( Mumbai, New Delhi, Chennai, Hyderabad, Kolkatta, Bangaluru & Ahemadabad) will be treated differently their municipal corporations will implement NUHM.

In other cities, District Health Societies will be responsible for NUHM implemetation.

Flexibility- given to states

In the 12th Plan period NUHM and NRHM will be separate programmes

to hand over management of NUHM to cities/towns where sufficient capacity exists with Urban Local Bodies.40

The NUHM would have high focus on:

Urban Poor Population living in listed and unlisted slums

All other vulnerable population such as Homeless, Rag-pickersStreet children Rickshaw pullersConstruction and brick and lime kiln workers Sex workers Other temporary migrants.

Public health thrust on sanitation, clean drinking water, vector control, etc.

Strengthening public health capacity of urban local bodies.

Accredicted Social Health Activist(ASHA)An ASHA will be posted for every 200-500 households (1000-2500 population)

Maintain IPC with the families and the Mahila Arogya Samities (MAS) for which they are earmarked.

The ASHA , preferably be a woman resident of the slum-married/widowed/ divorced

Preferably in the age group of 25 to 45 years.

Should be literate with formal education up to class eight subjected to relaxation.

Chosen through a rigorous community driven process involving ULB Counsellors, community groups, self help groups, Anganwadis, ANMs.

For every2.5 lakh population (5lakh for metros)

12/12/201544U-CHCInpatient facility, 30 -50 bedded(100 bedded in metros)*Only for cities with a population of above 5 lakh

U-PHCMO I/C - 12nd MO (part time) - 1Nurse - 3LHV - 1Pharmacist - 1ANMs - 3-5Public Health Manager/ Mobilization Officer 1Support Staff - 3M & E Unit - 1

For every 50,000population

For every 10,000population

200- 500 HHs(1000-2500 population)

50-100 HHs(250-500 population)

1 ANMOutreach sessions in area of every ANM on weekly basis

Community HealthVolunteer (ASHA/LW)

Mahila Arogya Samiti

Urban Health Delivery System

Mahila Arogya Samitee (MAS)A community based federated group of around 20 to 100 households

Acts as community based peer education group, involves in community monitoring and referral.

Each of the MAS may have 5-20 members with an elected Chairperson and Treasurer, supported by ASHA.

, with flexibility for state level adjustments, 1. , depending upon the size and concentration of the slum population.

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The mobilization of the MAS facilitated by NGO, working along with the ASHA The group focuses on: Health and hygiene behaviour change promotion Facilitating access to identified facilities Community risk pooling.

The MAS will be provide with an annual untied grant of Rs 5000.

Urban Primary Health CenterFunctional for a population of around 50,000 60,000Located preferably within a slum or a half km radius, Catering a population of approximately 20000-30000, With provision for evening OPD also.

Flexibility- One UHC for 75,000 for densely populated areas or. andOne UHC for around 5000-10,000 for isolated slum clusters.

Facilities provided are: Preventive

Promotive

Non-domicilliary curative care including consultation

Basic lab diagnosis and dispensing.

Human Resource at UPHCSl no.Staff CategoryNumber1Medical Officer2* (1 regular and 1part time)2Staff Nurse33Pharmacist 14Lab Technician 15Public Health Manager/ Community Mobilisor16LHV17ANMs3-5** Depending upon population8Support staff39M&E Unit1

Referral unitUrban Community Health Centre (U-CHC) are proposed to be set up as a satellite hospital for every 4-5 U-PHCs. Cater to a population of 2,50,000.

Provide in patient services and a 30-50 bedded facility.

The U-CHCs would be set up in cities with a population of above 5 lakhs, wherever required.

They will be in addition to the existing facilities (SDH/DH) to cater to the urban population in the locality.

For the metro cities, the U-CHCs may be established for every 5 lakh population with 100 beds

The U-CHC would provide medical care, minor surgical facilities and facilities for institutional delivery.

Impact level targets of NUHMReduce IMR by 40% (in urban areas) National Urban IMR down to 20/1000 live birth by 2017 - 40% reduction in U5MR and IMR - achieve Universal Immunization in all urban areas2. Reduce MMR by 50% 100% ANC Coverage

3. Achieve universal access to reproductive health including 100% institutional delivery

4. Achieve replacement level fertility5. Achieve all targets of disease control programme

Urban & Rural health care delivery 50,000 pop

District HospitalBLOCKMunicipalityDISTRICTCENTRESTATE80,000-1.2 lakh popASHASHCANMsPHCUPHCANMUSHA200-500 HH; 1000-2500 popl10,000 poplSlumUCHCCHC/FRU3000-5000 pop1 village=1000 pop 20,000-30,000 pop 2.5 Lakh pop( 5 for metros)12/12/201554

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