components of nrhm 1

8/3/2019 Components of Nrhm 1

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COMPONENTS OFCOMPONENTS OF

NRHMNRHM

COMPONENTS OFCOMPONENTS OF

NRHMNRHMGuided By, __ Presented By,Guided By, __ Presented By,Prof. Juliet M.Sc(N), PhD Mrs. RajeswariProf. Juliet M.Sc(N), PhD Mrs. Rajeswari

HOD, CHN II yr M.Sc(N)HOD, CHN II yr M.Sc(N)SHNC SHNC.SHNC SHNC.


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Accredited social health activists

Strengthening sub-centres Strengthening PHCs

Strengthening CHCs

District health plan Converging sanitation and hygiene underNRHM

Strengthening disease control programs.


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PPP For public health goals, includingregulation of private sector

New health Financing mechanisms

Reorienting health/medical education tosupport rural health issues.


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ASHA


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ASHA - chosen by and accountable tothe panchayat- to act as the interfacebetween the community and the publichealth system.

ASHA would act as a bridge between theANM and the village.

She will be an honorary volunteer,receiving performance-basedcompensation for promoting universalimmunization, referral and escort

services for RCH, construction ofhousehold toilets, and other healthcaredelivery program.


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Cont She will facilitate preparation and

implementation of the Village Health Planalong with Anganwadi worker, ANM,functionaries of other Departments, andSelf Help Group members, under the

leadership of the Village Health Committeeof the Panchayat.

She will be given a Drug Kit containing

generic AYUSH and allopathic formulationsfor common ailments.


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She will be promoted all over the country,with special emphasis on the 18 high focusStates. The Government of India will bearthe cost of training, incentives and

medical kits. Induction training of ASHA to be of 23days in all, spread over 12 months.


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STRENGTHENINGSUB-CENTRES


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Each sub-centre will have an Untied Fundfor local action @ Rs. 10,000 per annum.

Supply of essential drugs.

In case of additional Outlays, MPW(Male)/Additional ANMs wherever needed,sanction of new SCs as per 2001

population norm, and upgrading existingSCs including building.


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STRENGTHENINGPHCs


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Adequate and regular supply of essentialquality drugs and equipment (including

Supply of ADS for immunization) to PHCs.

Provision of 24 hour service in 50% PHCs

by addressing shortage of doctors,especially in high focus States, throughmainstreaming AYUSH manpower.


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Observance of Standard treatment

guidelines & protocols.

In case of additional Outlays,

intensification of ongoing CDCPs, newprograms for control of NCDs, upgradation of 100% PHCs for 24 hoursreferral service, and provision of 2nddoctor at PHC level.


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STRENGTHENINGCHCs


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Operationalzing 3222 existing CHCs (30-50 beds) as 24 Hour FRU, includingposting of anesthetists.

Codification of new Indian Public Health

Standards, setting norms forinfrastructure, staff, equipment,management etc. for CHCs.

Promotion of Stakeholder Committees(Rogi Kalyan Samitis) for hospitalmanagement


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In case of additional Outlays, creation ofnew CHCs, to meet the population norm asper Census 2001, and bearing theirrecurring costs for the Mission periodcould be considered.


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DISTRICT

HEALTH PLAN


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Health Plans would form the core unit ofaction proposed in areas like water supply,

sanitation, hygiene and nutrition.Implementing Departments would integrateinto District Health Mission formonitoring.

District becomes core unit of planning,budgeting and implementation.


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Centrally Sponsored Schemes could berationalized/modified accordingly inconsultation with States.

Concept of funneling funds to districtfor effective integration of programs.


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All vertical Health and Family WelfarePrograms at District and state level

merge into one common District HealthMission at the District level and theState Health Mission at the state level.

Provision of Project Management Unit forall districts, through contractualengagement of MBA, Inter Charter/InterCost and Data Entry Operator, for

improved program management.


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CONVERGINGSANITATION &

HYGIENE UNDERNRHM


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Total Sanitation Campaign (TSC) ispresently implemented in 350 districts.

Components of TSC include IEC activities,rural sanitary marts, individual householdtoilets, women sanitary complex, and

School Sanitation Program. Similar to the DHM, the TSC is alsoimplemented through PRIs.


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The District Health Mission wouldtherefore guide activities of sanitation atdistrict level, and promote joint IEC forpublic health, sanitation and hygiene,

through Village Health & SanitationCommittee, and promote household toiletsand School Sanitation Program. ASHAwould be incentivized for promotinghousehold toilets by the Mission.


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STRENGTHENINGDISEASE CONTROL

PROGRAMMES


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National Disease Control Programmes for

Malaria, TB, Kala- Azar, Filaria, Blindness& Iodine Deficiency and IntegratedDisease Surveillance Program shall beintegrated under the Mission, for improvedprogram delivery.

New Initiatives would be launched forcontrol of NCDs.


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Disease surveillance system at village level

would be strengthened. Supply of generic drugs (both AYUSH &Allopathic) for common ailments at village,

SC, PHC/CHC level. Provision of a mobile medical unit atDistrict level for improved Outreachservices.


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PPP FOR PUBLIC

HEALTH GOALS,INCLUDING

REGULATION OFPRIVATE SECTOR


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Since almost 75% of health services arebeing currently provided by the private

sector, there is a need to refineregulation.

Reform of regulatory bodies/creationwhere necessary.

District Institutional Mechanism forMission must have representation ofprivate sector.


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Need to develop guidelines for PPP in

health sector.

Public sector to play the lead role in

defining the framework and sustaining thepartnership.

Management plan for PPP initiatives: atDistrict/State and National levels.


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NEW HEALTH

FINANCING

MECHANISMS


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Progressively the District Health Missionsto move towards paying hospitals for

services by way of reimbursement, on theprinciple of money follows the patient.

Standardization of services outpatient,

in-patient, laboratory, surgicalinterventions- and costs will be doneperiodically by a committee of experts ineach state.


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A National Expert Group to monitor thesestandards and give suitable advice andguidance on protocols and costcomparisons.

All existing CHCs to have wage componentpaid on monthly basis. Other recurrentcosts may be reimbursed for services

rendered from District Health Fund. Overthe Mission period, the CHC may movetowards all costs, including wagesreimbursed for services rendered.


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A district health accounting system, andan ombudsman to be created to monitor

the District Health Fund Management ,and take corrective action.

Adequate technical managerial andaccounting support to be provided to DHMin managing risk-pooling and healthsecurity.

Where credible Community Based Health

Insurance Schemes (CBHI) exist/arelaunched, they will be encouraged as partof the Mission.


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The Central government will provide

subsidies to cover a part of thepremiums for the poor, and monitor theschemes.

The IRDA will be approached topromote such CBHIs, which will beperiodically evaluated for effectivedelivery.


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REORIENTINGHEALTH/MEDICAL

EDUCATIONTO SUPPORT RURAL

HEALTH ISSUES


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While district and tertiary hospitals arenecessarily located in urban centres, they forman integral part of the referral care chain

serving the needs of the rural people. Medical and para-medical education facilities

need to be created in states, based on needassessment.

Suggestion for Commission for Excellence inHealth Care (Medical Grants Commission),National Institution for Public Health

Management etc. Task Group to improve guidelines/details.


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THANK YOU

components of nrhm 1

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