national rural health mission mit india reading group meeting 4 oct 07 lavanya marla

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National Rural Health Mission MIT India Reading Group Meeting 4 Oct 07 Lavanya Marla

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National Rural Health Mission

MIT India Reading Group Meeting 4 Oct 07 Lavanya Marla

About NHRM

Inaugurated on April 12, 2005 Increase spending on health from 0.9% of

GDP to 2-3% of GDP Correct the deficiencies of the health

system Focus on 18 states – northern and eastern Goal is good decentralized healthcare Missionary approach by government? Intended for 2005 - 2012

Goals

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

Action Points

Provision of health activist in each village Village health plan prepared through

panchayat involvement Strengthening of rural hospitals Integration of vertical health programs

(leprosy, TB, malarial programs, etc.) and traditional medicine

Integration of plans at different levels New health financing mechanisms

Major Stakeholders

Accredited Social Health Activist (ASHA)

Auxiliary Nurse Midwife and Anganwadi worker

Panchayati Raj Institutions and NGOs District Administration State Governments

Village level

ASHA accredited social health activist Female activist given accreditation after 4

phase training Ownership of health program given to

villagers Village Health Committee prepares

village health Plan

District Level

District health plan generated by combining village health plans

Elements are drinking water, sanitation, hygiene and nutrition

Strengthen PHC (Primary Health Centers) and CHC (Community Health Centers)

Higher levels

Integrate vertical health and family welfare at district, block, state and national levels

Integration of vertical health programs (leprosy, TB, malarial programs, etc.)

All health facilities and infrastructure built based on Indian Public Health Standards (IPHS) standards

Rectify manpower shortage, equipment and other furnishings in health facilities

Strengthen capacities for data collection, processing, evaluation and supervision

Exploit synergies at different levels NGOs and ASHAs work together AYUSH (Ayurvedic, Yogic, Unani, Siddha and

Homoeopathy) - Local health traditions made mainstream

Pass regulations requiring private practitioners to give service at reasonable cost

Public-private partnerships Re-orient medical education (MBBS 6th yr in rural

service?) Social health insurance (how viable?) Health Information System

Milestones

Health provider in each village Upgrading of rural hospitals Build new hospitals District Planning Operational Village Health Plans Merger of multiple societies

into District/State Mission Operational PMUs Technical Support

2005-08 2005-07 2005-08 2005-07 2006 April 05

2005-06 2005-07

Progress of Program

http://mohfw.nic.in/NRHM/Exe_sum_apr07.htm

‘Expected improvement’ statistics missing for many measures

Observations and Questions

Attempt at transparency Data actually available, though not

comprehensive Working on cures is an inherent defect in

Indian health system – Focus seems to be changing towards prevention

Providing ‘standard’ health care in peripheral areas – economically viable?

Is this a missionary approach, or is it sustainable?