The National Health Mission is India’s flagship health sector programme
to revitalize rural and urban health sectors by providing flexible finances to
State Governments. The National Health Mission comprises of 4 components namely
the National Rural Health Mission, the National Urban Health Mission, Tertiary
Care Programmes and Human Resources for Health and Medical Education.
The
National Health Mission represents India’s endeavor to
expand the focus of health services beyond
Reproductive and
Child Health, so as to address the double burden
of Communicable and Non-Communicable diseases as also improve the infrastructure facilities at
District and Sub-District Levels. The
National Health Mission has synergized learning from the National Rural Health Mission for
better implementation of the National Urban Health Mission. The
National Health Mission has an allocation of Rs. 26,690 crores for 2017-18 and
is one of the largest centrally sponsored schemes of the Government of India.
The National Health Mission (NHM) brought together at National
level the two Departments of Health and Family Welfare. The integration
resulted in significant synergy in programme implementation and enhancement in
Health Sector allocations for revitalizing India’s rural health systems. A
similar integration was witnessed at State levels too. Further the NHM brought
in revolutionary changes in devolution of central finances to State Health
Societies outside the purview of the State Finance Departments. The second
major change was the integration of the disease control programmes into the NHM
framework.
The NHM brought in considerable innovations into the
implementation of Health Sector Programmes in India. These included flexible
financing, monitoring of Institutions against Indian Public Health Standards,
Capacity Building at the State, District and Panchayat Samiti levels by
induction of management specialists into the Programme Management Units and
simplified HR management practices for timely recruitment through the State
Institutes of Health and Family Welfare. Another significant innovation is the
establishment of the National Health Systems Resource Center (NHSRC) to help
design and formulate various initiatives. State Health Systems Resource Centers
have also been established in some States.
The Ministry of Health and Family Welfare approves Programme
Implementation Plans of the State Health Societies on an annual basis with
specific resource allocations under the major heads of RCH Flexi Pool, the NRHM
Flexi Pool, the Flexi Pool for Communicable Diseases and the Flexi Pool for Non
Communicable Diseases as also for Infrastructure strengthening. There are
significant resource allocations for training programmes and capacity building.
The State Health Societies have considerable autonomy to re-appropriate
resources within the major heads and devolution to District Hospitals,
Community Health Centers and Primary Health Centers.
The priority focus of NHM is Reproductive and Child Health
services. The successful implementation of Janani Suraksha Yojana (JSY) and Accredited
Social Health Activist (ASHA) programmes had a significant impact in behavioral
changes and brought pregnant women in large numbers to public health
institutions. The NRHM flexi pool resources were utilized to create adequate
infrastructure at public health institutions to cope with the heavy rush of
maternity cases. Ambulance services were introduced for transportation of
maternity cases to public health institutions and for emergency care. The
success story of the 108 ambulance services has been well documented across
many States.
The increase in institutional deliveries in High Focus States of
NHM had a significant impact on Maternal Mortality Ratio (MMR) and Under Five
Mortality Rate (U5MR). On the Millennium Development Goals (MDGs) 4 and 5, the country made substantial progress. In the case of MDG 6, the country was
able to meet the target and reverse the prevalence of Tuberculosis, Malaria and HIV. NHM has also performed
well by adopting a continuum of care or life cycle approach as demonstrated by improvements in key health indicators.
The Ministry of Health and Family Welfare added two new programmes
to its basket of activities under the National Health Mission. The first is Mission Indradhanush, which
has demonstrated
good progress in improving immunization coverage by over 5% in the just one year. The second is the Kayakalp initiative launched in 2016 under the NHM to
inculcate the
practice of
hygiene,
sanitation,
effective waste management and infection control in public health facilities. The competition for
awards introduced
under Kayakalp has been well received by all the States and significant improvements in
sanitation standards are being witnessed.
The NHM created a peoples’ movement for health care. India has
deployed nearly 10 lac Accredited Social Health Care (ASHA) workers
representing transformational change agents. The ASHA workers act as mobilizers
for institutional deliveries, focus on integrated management of neonatal and
childhood illness and advise on home based neo-natal care. The NHM has also
empowered people through Village Health and Sanitation Committees to formulate
village health plans and exercise supervisory oversight of ASHA workers. At the
Primary Health Centre (PHC) and Community Health Centre (CHC) level Rogi Kalyan
Samitis have been activated to establish systems of oversight over the public
health facilities for creating a patient friendly institution. Besides rural
areas, the urban slums are now receiving attention with the launch of the National Urban Health
Mission.
The National Health Mission represents India’s flagship health
sector programme making the Health For All vision a reality. In its innate
success lies the future of a healthy India
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