national rural health mission (nrhm) - sihfw) rajasthannational rural health mission (nrhm) state...

National Rural Health Mission (NRHM)

National Rural Health Mission (NRHM)(NRHM)(NRHM)

State Institute of Health & Family Welfare, Jaipur

State Institute of Health & Family Welfare, Jaipur

NRHMNRHM

• N…Newer Initiatives.• N…Newer Initiatives.N…Newer Initiatives.• R…Rural Poor Population• H Holistic Health Package

N…Newer Initiatives.• R…Rural Poor Population• H Holistic Health PackageH…Holistic Health Package.• M…Monitoring mechanisms

To cater to the Primary health care needs of

H…Holistic Health Package.• M…Monitoring mechanisms

To cater to the Primary health care needs ofTo cater to the Primary health care needs of vulnerable segment of pop. to bring down IMR and MMR . to attain Pop. Stabilisation.

To cater to the Primary health care needs of vulnerable segment of pop. to bring down IMR and MMR . to attain Pop. Stabilisation.a d to atta op Stab sat oa d to atta op Stab sat o

SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 22

Mission GoalMission Goal

Improve:Access &

Improve:Access &Access & Availability to Health careQuality

Access & Availability to Health careQualityQualityEquity

Simple reiteration of

QualityEquity

Simple reiteration ofSimple reiteration of NHP-1983,HFA-2000,

Simple reiteration of NHP-1983,HFA-2000,HFA 2000, NHP-2002, or a new paradigmHFA 2000, NHP-2002, or a new paradigm

NHP-1983

NRHM-2005


NRHM Paradigm ShiftsNRHM Paradigm Shifts

Decentralized planning Outputs and Outcome basedDecentralized planning Outputs and Outcome basedOutputs and Outcome basedPro-Poor Focus: Equitable systemsQuality of Care and the IPHS norms

Outputs and Outcome basedPro-Poor Focus: Equitable systemsQuality of Care and the IPHS normsQuality of Care and the IPHS normsBringing the public back into public health

At village level :

Quality of Care and the IPHS normsBringing the public back into public health

At village level :At village level : ASHA, VHSC, SHGs, PRIs.At the facility level: RMRS

At village level : ASHA, VHSC, SHGs, PRIs.At the facility level: RMRSAt the facility level: RMRSAt the management level : Health societies

At the facility level: RMRSAt the management level : Health societiessocietiessocieties


NRHM Paradigm ShiftsNRHM Paradigm Shifts

• Governance reformManpower Logistics & Procurement

• Governance reformManpower Logistics & ProcurementManpower, Logistics & Procurement processes.Decision making processes

Manpower, Logistics & Procurement processes.Decision making processesDecision making processesInstitutional design, Accountability framework

Decision making processesInstitutional design, Accountability frameworkframework

• ConvergenceWater and sanitation

framework • Convergence

Water and sanitationWater and sanitationNutritionEducation

Water and sanitationNutritionEducationEducation Education


An Opportunity for Centre-State P t hi

An Opportunity for Centre-State P t hiPartnershipPartnership

Beginning with people and their problemBeginning with people and their problemBeginning with people and their problem.Flexibility to decide and to do. Human resource thrust

Beginning with people and their problem.Flexibility to decide and to do. Human resource thrustHuman resource thrust.Decentralized management of health. Di t t t t t

Human resource thrust.Decentralized management of health. Di t t t t tDistrust to trust. Employment guarantee to service guarantee.A ti th h ll f t

Distrust to trust. Employment guarantee to service guarantee.A ti th h ll f tAccepting the challenge of remoteness. Accepting the challenge of remoteness.


Why NRHMWhy NRHM

Declining Public Health expenditureDeclining Public Health expenditureDeclining Public Health expenditure (1.3 % of GDP in 1990 to 0.9% in 1999)Limited synergism in Vertical and

Declining Public Health expenditure (1.3 % of GDP in 1990 to 0.9% in 1999)Limited synergism in Vertical andLimited synergism in Vertical and Horizontal Health Programs.Lack of community ownership

Limited synergism in Vertical and Horizontal Health Programs.Lack of community ownershipLack of integration of issuesLack of integration of issues


Why NRHMWhy NRHM

Regional inequalitiesPopulation stabilization still not metRegional inequalitiesPopulation stabilization still not metPopulation stabilization still not metCurative services favor richPoor coverage by Health insurance

Population stabilization still not metCurative services favor richPoor coverage by Health insurancePoor coverage by Health insurance (only 10%)Hospitalization eats 58% of annual

Poor coverage by Health insurance (only 10%)Hospitalization eats 58% of annual income, 25 % pop. falls below poverty line following hospitalization expenses.income, 25 % pop. falls below poverty line following hospitalization expenses.


NRHM ?NRHM ?

Program ?Program ?Program ?Scheme ?Project ?

Program ?Scheme ?Project ?Project ?Project ?

A Strategy, for Convergence

A Strategy, for ConvergencePartnershipPartnership


Goals:Goals:Reduction in IMR and MMRUniversal access to public health services such as Women’s health child health water sanitation &

Reduction in IMR and MMRUniversal access to public health services such as Women’s health child health water sanitation &Women s health, child health, water, sanitation & hygiene, immunization, and Nutrition.Prevention and control of CD & NCD, including l ll d i di

Women s health, child health, water, sanitation & hygiene, immunization, and Nutrition.Prevention and control of CD & NCD, including l ll d i dilocally endemic diseasesAccess to integrated comprehensive primary healthcare

locally endemic diseasesAccess to integrated comprehensive primary healthcarehealthcarePopulation stabilization, gender and demographic balance.R it li l l h lth t diti d i t

healthcarePopulation stabilization, gender and demographic balance.R it li l l h lth t diti d i tRevitalize local health traditions and mainstream AYUSHPromotion of healthy life styles

Revitalize local health traditions and mainstream AYUSHPromotion of healthy life stylesPromotion of healthy life stylesPromotion of healthy life styles


National Goals and MDGsNational Goals and MDGs

1990 Current NPP NRHM MDG2010 2012 2015

IMR 80 53 (SRS-2009) <30 <27N M R 53 37 (NFHS III) 20 20N M R 53 37 (NFHS-III) <20 <20

U5M Rate 107 74 3 (NFHS III) <36U5M Rate 107 74.3 (NFHS-III) - <36

ID(%) 45.5 (DLHS-3) 80 80ID(%) 45.5 (DLHS 3) 80 80TFR 2.7 (NFHS-III) 2.1 2.1MMR 254 (SRS-2006) <100 <100( )

SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution1111

Critical AreasCritical Areas

Well functioning health facilitiesWell functioning health facilities

Quality and accountability in thedelivery of health services.Quality and accountability in thedelivery of health services.y

Responsive health system meetingpeople health need

y

Responsive health system meetingpeople health needpeople health need.

Convergence for effectiveness andffi i

people health need.

Convergence for effectiveness andffi iefficiency.efficiency.


NRHM ComponentsNRHM Componentspp

CommunitizeCommunitizeFlexible FinancingImproved management through Flexible FinancingImproved management through g gcapacity buildingMonitor progress against standards

g gcapacity buildingMonitor progress against standardsInnovation in human resource managementInnovation in human resource management


Core StrategiesCore Strategiesgg

Capacity Building of PRIs to own control &Capacity Building of PRIs to own control &Capacity Building of PRIs to own, control &manage public health services.Access to improved healthcare through the

Capacity Building of PRIs to own, control &manage public health services.Access to improved healthcare through theAccess to improved healthcare through the female health activist (ASHA).Village Health Plan through Village HealthC itt

Access to improved healthcare through the female health activist (ASHA).Village Health Plan through Village HealthC ittCommitteeStrengthening sub-centre through an untiedfund to enable local planning and action &

CommitteeStrengthening sub-centre through an untiedfund to enable local planning and action &fund to enable local planning and action &more Multi Purpose Workers (MPWs).fund to enable local planning and action &more Multi Purpose Workers (MPWs).


PHCs and CHCs strengthening, to a normative standard (IPHS -personnel, equipment and management

PHCs and CHCs strengthening, to a normative standard (IPHS -personnel, equipment and managementequipment and management standards).

P ti d I l t ti f

equipment and management standards).

P ti d I l t ti fPreparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health

Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health p p yMission, including drinking water,p p yMission, including drinking water,


Integrating vertical programs at National, State, Block, and District levels

Integrating vertical programs at National, State, Block, and District levelslevels.Technical Support to National, State and District Health Missions, for Public

levels.Technical Support to National, State and District Health Missions, for Publicand District Health Missions, for Public Health Management.Strengthening capacities for

and District Health Missions, for Public Health Management.Strengthening capacities for

data collection, assessment and review for evidence b d l i it i d

data collection, assessment and review for evidence b d l i it i dbased planning, monitoring and supervision.based planning, monitoring and supervision.


Transparent policies for deployment and career development of human

f h lth

Transparent policies for deployment and career development of human

f h lthresources for health.Developing capacities for preventive health care at all levels for promoting

resources for health.Developing capacities for preventive health care at all levels for promotinghealth care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol

health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc.Promoting non-profit sector particularly in under served areas

etc.Promoting non-profit sector particularly in under served areasin under served areas.in under served areas.


Supplementary Strategies:Supplementary Strategies:

Regulation of Private SectorPromotion of PPPRegulation of Private SectorPromotion of PPPPromotion of PPPMainstreaming AYUSHReorienting medical education

Promotion of PPPMainstreaming AYUSHReorienting medical educationReorienting medical education Regulation of medical care and medical ethics.

Reorienting medical education Regulation of medical care and medical ethics.Risk pooling and social health insurance for

A ibl

Risk pooling and social health insurance for

A iblAccessible, Affordable, accountable and Quality hospital care.

Accessible, Affordable, accountable and Quality hospital care.Quality hospital care.Quality hospital care.


NRHM FocusNRHM FocusNRHM FocusNRHM Focus

18 States to start with18 States to start with18 States, to start with Arunachal Pradesh, Assam, Bihar,

Chhattisgarh

18 States, to start with Arunachal Pradesh, Assam, Bihar,

ChhattisgarhChhattisgarh,Himachal Pradesh, Jharkhand, Jammu & Kashmir Manipur Mizoram

Chhattisgarh,Himachal Pradesh, Jharkhand, Jammu & Kashmir Manipur MizoramKashmir, Manipur, Mizoram,Meghalaya, Madhya Pradesh, Nagaland, Orissa Rajasthan Sikkim

Kashmir, Manipur, Mizoram,Meghalaya, Madhya Pradesh, Nagaland, Orissa Rajasthan SikkimOrissa, Rajasthan, Sikkim,Tripura, Uttaranchal and Uttar Pradesh.Orissa, Rajasthan, Sikkim,Tripura, Uttaranchal and Uttar Pradesh.


Where to Strike:Infrastructure Up-gradation

Where to Strike:Infrastructure Up-gradationInfrastructure Up-gradationInfrastructure Up-gradation

Functional Sub CentresAdditional contractual ANMs

Functional Sub CentresAdditional contractual ANMs

24 x 7 PHCsThree staff nurses

24 x 7 PHCsThree staff nurses

ANMsUntied fundsCommunity link worker

ANMsUntied fundsCommunity link worker

Annual maintenance grantUntied funds

Annual maintenance grantUntied fundsCommunity link worker

Village Health Nutrition committees

Community link workerVillage Health Nutrition committees

Untied fundsAYUSH IntegrationRMRS/RKS

Untied fundsAYUSH IntegrationRMRS/RKScommittees

Expanded Medicines supply

committeesExpanded Medicines supply

RMRS/RKSRMRS/RKS


Where to Strike : Infrastructure Up-gradation

Where to Strike : Infrastructure Up-gradationInfrastructure Up gradationInfrastructure Up gradation

CHCs up gradationFirst Referral Units

CHCs up gradationFirst Referral Units

DH up gradationFacility survey

DH up gradationFacility survey

Facility surveyIPHS Facility surveyIPHS

IPHSRMRS/RKSIPHSRMRS/RKS

Untied fundsRMRS/RKSUntied fundsRMRS/RKS


Where to Strike :Where to Strike :

ManpowerFilling up vacant

ManpowerFilling up vacant

Health Sector PlanningHealth Sector PlanningFilling up vacant posts/Creating more postsContractual positions to fill

Filling up vacant posts/Creating more postsContractual positions to fill

Household surveys & Village Health Plans.Integrated Block &District

Household surveys & Village Health Plans.Integrated Block &Districtp

gaps Trainings / expanding training capacity

pgaps Trainings / expanding training capacity

Integrated Block &District Health Action Plans.Annual PIPs / Perspective

Integrated Block &District Health Action Plans.Annual PIPs / Perspective

training capacitySBA/ IMNCI/ HMIS Counseling/

training capacitySBA/ IMNCI/ HMIS Counseling/

Plans.SPMUs/ DPMUs/ Block PMUs

Plans.SPMUs/ DPMUs/ Block PMUsg

Immunization / Planning Rational transfer and posting policy

gImmunization / Planning

Rational transfer and posting policy

PMUsNHSRC/ SHSRCPMUsNHSRC/ SHSRC

posting policyposting policy


Where to Strike :Where to Strike :Improved servicedeliveryImproved servicedelivery

SystemicimprovementsSystemicimprovementsdelivery

Citizen’s charterMonthly Health & Nutrition Day

deliveryCitizen’s charterMonthly Health & Nutrition Day

improvementsImproved logistics.Rational / Optimal

improvementsImproved logistics.Rational / OptimalMonthly Health & Nutrition Day

Outsourcing critical service gapsCatch up rounds of

Monthly Health & Nutrition DayOutsourcing critical service gapsCatch up rounds of

Rational / Optimal positioning of manpowerRational delegation (fi i l &

Rational / Optimal positioning of manpowerRational delegation (fi i l &Immunization

Improved IP & OP utilizationM bilit S t / M bil

Immunization Improved IP & OP utilizationM bilit S t / M bil

(financial & Administrative)Decentralized

(financial & Administrative)DecentralizedMobility Support / Mobile

Medical UnitsMaternity Benefit Schemes

Mobility Support / Mobile Medical UnitsMaternity Benefit Schemes

Decentralized procurementDecentralized procurement

Maternity Benefit SchemesMaternity Benefit Schemes


Where to StrikeWhere to StrikeMonitoring & EvaluationReview meetingsMonitoring & EvaluationReview meetingsgState visits – evaluation teams, RDsIntegrated MIS

gState visits – evaluation teams, RDsIntegrated MISgExternal Surveys

Immunization

gExternal Surveys

ImmunizationImmunization ASHA & JSY External Evaluations

Immunization ASHA & JSY External EvaluationsExternal Evaluations

Community monitoringState level innovations/ Reforms

External EvaluationsCommunity monitoringState level innovations/ ReformsState level innovations/ ReformsState level innovations/ Reforms


DecentralizationDecentralizationProcurementFacility surveyProcurementFacility surveyVillage health plansPlanning at Institutional levelsVillage health plansPlanning at Institutional levels


Operationalizing Functional FRUsOperationalizing Functional FRUs24-hour delivery services including normal and assisted deliveries24-hour delivery services including normal and assisted deliveriesassisted deliveries

Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other

assisted deliveries

Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and otherinterventions like Caesarean Sections(*) and other medical interventionsinterventions like Caesarean Sections(*) and other medical interventions

New-born Care

Emergency Care of sick children

New-born Care

Emergency Care of sick childreng y

Full range of family planning services including Laproscopic Services

g y

Full range of family planning services including Laproscopic ServicesLaproscopic ServicesLaproscopic Services


Operationalizing Functional FRUsOperationalizing Functional FRUsSafe Abortion Services

T t t f STI / RTI

Safe Abortion Services

T t t f STI / RTITreatment of STI / RTI

Blood Storage Facility

Treatment of STI / RTI

Blood Storage Facility

Essential Laboratory Services

Referral (transport) Services

Essential Laboratory Services

Referral (transport) ServicesReferral (transport) Services

24-hour delivery services, both normal and assisted

Referral (transport) Services

24-hour delivery services, both normal and assistedand assisted

Essential newborn care

and assisted

Essential newborn care


Referral for emergenciesReferral for emergenciesReferral for emergencies Ante-natal care and routine immunization

services for children and pregnant women

Referral for emergencies Ante-natal care and routine immunization

services for children and pregnant women p g(besides Fixed day services).

Post-natal care

p g(besides Fixed day services).

Post-natal careEarly and safe abortion services (including MVA)Family planning servicesEarly and safe abortion services (including MVA)Family planning servicesy p gPrevention and management of RTIs/STIsEssential laboratory services

y p gPrevention and management of RTIs/STIsEssential laboratory servicesEssential laboratory servicesEssential laboratory services


Institutional MechanismInstitutional MechanismVillage Health & Sanitation Committee(VHSC)RKS/RMRSVillage Health & Sanitation Committee(VHSC)RKS/RMRSDistrict Health Mission,State Health Mission,District Health Mission,State Health Mission,Integration of Departments of Health and Family Welfare, at National andState level

Integration of Departments of Health and Family Welfare, at National andState levelState levelNational Mission Steering GroupEmpowered Program Committee

State levelNational Mission Steering GroupEmpowered Program CommitteeEmpowered Program CommitteeStanding Mentoring GroupTask Groups for Selected Tasks

Empowered Program CommitteeStanding Mentoring GroupTask Groups for Selected TasksTask Groups for Selected TasksTask Groups for Selected Tasks


Plan of Action-Components:Plan of Action-Components:1. ASHA2. Strengthening of Sub-Centers3 S f C

1. ASHA2. Strengthening of Sub-Centers3 S f C3. Strengthening of PHCs4. Strengthening of CHCs for First referral5 District Health Plan

3. Strengthening of PHCs4. Strengthening of CHCs for First referral5 District Health Plan5. District Health Plan6. Converging Sanitation & Hygiene under NRHM7. Strengthening Disease control program

5. District Health Plan6. Converging Sanitation & Hygiene under NRHM7. Strengthening Disease control program8. Public-private partnership for public Health goals,

including regulation of private sector9. New health financing mechanisms

8. Public-private partnership for public Health goals, including regulation of private sector

9. New health financing mechanisms9. New health financing mechanisms10.Reorienting health/medical education to support rural

health issues

9. New health financing mechanisms10.Reorienting health/medical education to support rural

health issues


Plan of Action Component (A): ASHA

Plan of Action Component (A): ASHAASHAASHA

One per illage chosen b and acco ntable to theOne per illage chosen b and acco ntable to theOne per village chosen by and accountable to the PanchayatVolunteer

One per village chosen by and accountable to the PanchayatVolunteerVolunteer, performance-based compensationf ilit t ti d i l t ti f th

Volunteer, performance-based compensationf ilit t ti d i l t ti f thfacilitate preparation and implementation of the Village Health PlanGOI Cost of training incentives and medical kits

facilitate preparation and implementation of the Village Health PlanGOI Cost of training incentives and medical kitsGOI-Cost of training, incentives and medical kits Drug Kit -generic AYUSH and allopathic formulations

GOI-Cost of training, incentives and medical kits Drug Kit -generic AYUSH and allopathic formulationsformulationsformulations


Plan of Action Component (B): Strengthening SC

Plan of Action Component (B): Strengthening SCStrengthening SCStrengthening SC

Sub-centre -Untied Fund for local action @ Rs. 10 000 per annumSub-centre -Untied Fund for local action @ Rs. 10 000 per annum10,000 per annum.

Joint bank account of the ANM & sarpanchOperated by the ANM, in consultation with

10,000 per annum. Joint bank account of the ANM & sarpanchOperated by the ANM, in consultation with p y ,the village health committee.

Supply of essential drugs (allopathic AYUSH)f

p y ,the village health committee.

Supply of essential drugs (allopathic AYUSH)fIn case of additional outlays,

Multipurpose workers (male)/additional ANMs wherever needed

In case of additional outlays, Multipurpose workers (male)/additional ANMs wherever neededANMs wherever needed, New sub-centers, and upgrading existing sub-centers, including buildings

ANMs wherever needed, New sub-centers, and upgrading existing sub-centers, including buildings


Plan of Action Component (C): Strengthening PHCs

Plan of Action Component (C): Strengthening PHCsStrengthening PHCsStrengthening PHCs

supply of essential drugs and equipmentsupply of essential drugs and equipmentProvision of 24 X 7 in 50% PHCsObservance of SOPsIn case of additional Outlays

Provision of 24 X 7 in 50% PHCsObservance of SOPsIn case of additional OutlaysIn case of additional Outlays,

Program intensification-Comm. Diseasesprograms for control of NCDs,

In case of additional Outlays, Program intensification-Comm. Diseasesprograms for control of NCDs, gup-gradation of 100% PHCs for 24 x 7provision of 2nd doctor at PHC level (I male, 1 female)

gup-gradation of 100% PHCs for 24 x 7provision of 2nd doctor at PHC level (I male, 1 female)))


Plan of Action Component (D): St th i CHC

Plan of Action Component (D): St th i CHCStrengthening CHCsStrengthening CHCs

4276 (March 31, ’09) existing CHCs (30-50 beds) as 24 4276 (March 31, ’09) existing CHCs (30-50 beds) as 24 ( , ) g ( )Hour FRUs, including posting of anesthetists.Codification of new IPHS setting norms for

infrastructure

( , ) g ( )Hour FRUs, including posting of anesthetists.Codification of new IPHS setting norms for

infrastructureinfrastructure, staff, equipment, management

infrastructure, staff, equipment, managementmanagement

Promotion of Stakeholder Committees (RKS/ RMRS) for hospital management.

managementPromotion of Stakeholder Committees (RKS/ RMRS) for hospital management.


Plan of Action Component (D): St th i CHC

Plan of Action Component (D): St th i CHCStrengthening CHCsStrengthening CHCs

Developing standards of services and costs inDeveloping standards of services and costs inDeveloping standards of services and costs in hospital care.Develop, display and ensure compliance to Citi ’ Ch t t CHC/PHC l l

Developing standards of services and costs in hospital care.Develop, display and ensure compliance to Citi ’ Ch t t CHC/PHC l lCitizen’s Charter at CHC/PHC level.In case of additional Outlays,

creation of new Community Health Centres (30-50

Citizen’s Charter at CHC/PHC level.In case of additional Outlays,

creation of new Community Health Centres (30-50creation of new Community Health Centres (30 50 beds) and bearing their recurring costscreation of new Community Health Centres (30 50 beds) and bearing their recurring costs


Amalgamation of field responsesAmalgamation of field responsesAmalgamation of field responses through Village Health Plans, State and National priorities for Health, Water S l S it ti d N t iti

Amalgamation of field responses through Village Health Plans, State and National priorities for Health, Water S l S it ti d N t itiSupply, Sanitation and Nutrition.District -core unit (planning, budgeting & implementation).

Supply, Sanitation and Nutrition.District -core unit (planning, budgeting & implementation).& p e e tat o )Centrally Sponsored Schemes To be modified in consultation with States.All ti l P t i t

& p e e tat o )Centrally Sponsored Schemes To be modified in consultation with States.All ti l P t i tAll vertical Programs to merge into one common “District Health Mission”/ “State Health Mission”

All vertical Programs to merge into one common “District Health Mission”/ “State Health Mission”Provision of DPMUsProvision of DPMUs


District Planning ComponentsDistrict Planning ComponentsPlan Templates, checklists, appraisal criteria, planning toolFacilitation & ConsultationPlan Templates, checklists, appraisal criteria, planning toolFacilitation & ConsultationEnabling EnvironmentFacility, Manpower & Budget - Rationalizing & Role Clarification

Enabling EnvironmentFacility, Manpower & Budget - Rationalizing & Role ClarificationClarificationNGO involvementFocus on Community Needs and Participation

ClarificationNGO involvementFocus on Community Needs and ParticipationFocus on Community Needs and ParticipationResource Materials for Planning & ImplementationOrientation & Training

Focus on Community Needs and ParticipationResource Materials for Planning & ImplementationOrientation & TraininggAccountability, Monitoring & EvaluationInter and intra sectoral Coordination & Communication

gAccountability, Monitoring & EvaluationInter and intra sectoral Coordination & Communication


Plan of Action Component (F): C i S it ti & H i

Plan of Action Component (F): C i S it ti & H iConverging Sanitation & HygieneConverging Sanitation & Hygiene

Total Sanitation campaign(TSC) in allTotal Sanitation campaign(TSC) in allTotal Sanitation campaign(TSC) in all districts in X-FYPTSC through PRIs

Total Sanitation campaign(TSC) in all districts in X-FYPTSC through PRIsTSC through PRIsVHSCs to implementASHA t b i ti i d f TSC

TSC through PRIsVHSCs to implementASHA t b i ti i d f TSCASHA to be incentivized for TSC activitiesIEC

ASHA to be incentivized for TSC activitiesIECIECIEC


Expected Outcomes by 2012Expected Outcomes by 2012

Universal Health care, well functioning health care delivery systemUniversal Health care, well functioning health care delivery systemhealth care delivery system.IMR :30MMR: 100

health care delivery system.IMR :30MMR: 100TFR :2.1Malaria Mortality Reduction – 60% K l A li i d b 2010

TFR :2.1Malaria Mortality Reduction – 60% K l A li i d b 2010Kala Azar eliminated by 2010, Filaria 80 % by 2010 Dengue Mortality reduced by 50%

Kala Azar eliminated by 2010, Filaria 80 % by 2010 Dengue Mortality reduced by 50%Dengue Mortality reduced by 50%TB DOTS series – maintain 85% cure rateResponsive & Functional Health System

Dengue Mortality reduced by 50%TB DOTS series – maintain 85% cure rateResponsive & Functional Health SystemResponsive & Functional Health SystemResponsive & Functional Health System


Accomplished So FarAccomplished So Farpp

State and district mission have been setup.State and district mission have been setup.pHealth and family welfare have been merged.Finalization of State PIPs

pHealth and family welfare have been merged.Finalization of State PIPsFollowing documents shared with the states :

Mission DocumentFollowing documents shared with the states :

Mission DocumentGuidelines on IPHSGuidelines on ASHAGuidelines on IPHSGuidelines on ASHAGuidelines on State Health Mission and Guidelines on District Health MissionGuidelines on State Health Mission and Guidelines on District Health Mission


Accomplished So FarAccomplished So Farcco p s ed So acco p s ed So a

ASHAS: 861548 selected against six lacsASHAS: 861548 selected against six lacsgMgt. support: over 1500 professionals (CA/MBAs) appointed and 521 district level PMU d 2882 bl k l l PMU’ t

gMgt. support: over 1500 professionals (CA/MBAs) appointed and 521 district level PMU d 2882 bl k l l PMU’ tPMU and 2882 block level PMU’s support NRHM.Financial Management: Financial management

PMU and 2882 block level PMU’s support NRHM.Financial Management: Financial managementFinancial Management: Financial management Group set up under NRHM.Mother NGOs: 334 MNGOs appointed for 340

Financial Management: Financial management Group set up under NRHM.Mother NGOs: 334 MNGOs appointed for 340Mother NGOs: 334 MNGOs appointed for 340 districts. Fully involved in ASHA training and other activities.

Mother NGOs: 334 MNGOs appointed for 340 districts. Fully involved in ASHA training and other activities.


Accomplished So FarAccomplished So Farcco p s ed So acco p s ed So a

• Health Action Plan: State PIP received from 31• Health Action Plan: State PIP received from 31Health Action Plan: State PIP received from 31 states during 2006-07 and 35 states/ UTs PIP received during 11-12.

Health Action Plan: State PIP received from 31 states during 2006-07 and 35 states/ UTs PIP received during 11-12. ece ed du g

• PIPs appraised and funds released• Integrated District Health Action Plans have

ece ed du g• PIPs appraised and funds released• Integrated District Health Action Plans have• Integrated District Health Action Plans have

been prepared in 636 districts in various states.Institutional Delivery: 49250358 women

• Integrated District Health Action Plans have been prepared in 636 districts in various states.Institutional Delivery: 49250358 women• Institutional Delivery: 49250358 women benefited since initiation

• Institutional Delivery: 49250358 women benefited since initiation


Source: MoHFW

Infant Mortality Rate (India)Infant Mortality Rate (India)y ( )y ( )

134146

138134 138

110

80

58.547

1951 1961 1971 1981 1991 2001 2011

Source:SRS,2011

4343SIHFW: an ISO9001: 2008 certified institutionSIHFW: an ISO9001: 2008 certified institution

Infant Mortality Rate (Rajasthan)Infant Mortality Rate (Rajasthan)a t o ta ty ate ( ajast a )a t o ta ty ate ( ajast a )

108

79 8179 81

55

1981 1991 2001 2011Source: SRS 4444SIHFW: an ISO9001: 2008 certified institutionSIHFW: an ISO9001: 2008 certified institution

Maternal Mortality RatioMaternal Mortality Ratioate a o ta ty at oate a o ta ty at o

India Rajasthan501

445388

j

327 301254

212

318

212

2001 2003 2006 20092001 2003 2006 2009Source: SRS

4545SIHFW: an ISO9001: 2008 certified institutionSIHFW: an ISO9001: 2008 certified institution

Total Fertility RateTotal Fertility Rate

3 6 3 8India Rajasthan

33.5

4 3.42.9 2.7

3.6 3.83.2

j

22.5

3

0 51

1.5

00.5

NFHS I NFHS II NFHS III


NRHM Rajasthan: AchievementsNRHM Rajasthan: Achievementsjj

12 02 12 0712.79

ID (in lakhs) JSY Beneficiaries (in lakhs)

10.1811.36

12.02 12.07

7 759.17 9.78 9.86 10.1

7.22

3 88

7.75

3.88

2006-07 2007-08 2008-09 2009-10 2010-11 2011-12


Source: www.rajswasthya.nic.in

NRHM: Rajasthan - AchievementsNRHM: Rajasthan - Achievementsjj

• 44858 ASHAs working• 44858 ASHAs working44858 ASHAs working• 40476 VHSC constituted • 1010210 JSY beneficiaries (2011-12)

44858 ASHAs working• 40476 VHSC constituted • 1010210 JSY beneficiaries (2011-12)1010210 JSY beneficiaries (2011-12)• JSY helpline has been initiated • Emergency Health Transport Scheme

1010210 JSY beneficiaries (2011-12)• JSY helpline has been initiated • Emergency Health Transport Scheme• Emergency Health Transport Scheme

successfully implemented through 108 ambulance services

• Emergency Health Transport Scheme successfully implemented through 108 ambulance servicesa bu a ce se cesa bu a ce se ces

Source: www.rajswasthya.nic.in


Thank YouThank YouThank You Thank You

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For more details log on towww sihfwrajasthan comwww.sihfwrajasthan.com

or contact : Director-SIHFW

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contact : Director-SIHFW onon

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national rural health mission (nrhm) - sihfw) rajasthannational rural health mission (nrhm) state...

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