PRESENTATION ON (NRHM) PROGRAMME

NRHM

SUBMITTED TO:- KRISHNAVNI MAM SUBMITTED BY:-FIROZ QURESHI B.Sc NURSING 4TH YEAR

NRHM LAUNCHED - 12 April 2005

VISION
Effective Healthcare to Rural Population Strengthen Public Health Management and Service Delivery. Revitalize Local Health Traditions & Mainstream AYUSH.

Improve Access to Rural People - Poor Women & Children

Time Bound Goals.

GOAL
Reduction in IMR and Maternal Mortality Ratio Universal access to Public Health Services Women & Child Health, Water Sanitation and Hygiene, Immunization and Nutrition. Prevention and Control - Communicable & NCD.
Access to Integrated Comprehensive Primary Health Care. Population Stabilization, Gender and Demographic Balance

Revitalizing Local Health Tradition and Mainstream AYUSH

Promotion of Healthy Life Styles.

NRHM LAUNCHED - 12 April 2005.

NRHM Undertakes Architectural Correction of Health System

Provision of Female Health Activist each Village Village Health Plan - Prepared by Local Team

Headed by Health & Sanitation Committee of the

Panchayat.
Strengthening of the Rural Hospital for Effective Curative Care and made Measurable and Accountable to the Community through Indian Public Health Standards (IPHS)
Contd..

 Integration of Vertical H & FW Programmes, Funds and Determinants of Heads Like Safe Water, Sanitation, Nutrition etc, through an Effective District Health Plan.

PROVIDE UMBRELLA TO THE EXISTING PROGRAMMES

H & FW Including RCH-II, Malaria, Blindness, Iodine Deficiency, Filaria, Kala Azar, T.B Leprosy Integrated Disease Surveillance Project (IDSP).

 The key features to achieve the goals of NRHM : Public Health Delivery System Fully Functional. Human Resources Management Community Involvement Decentralization Rigorous Monitoring & Evaluation Against Standards

Convergence of Health and Related Programmes from

Village Level Upwards (Bottom to Top approach) Innovations and Flexible Financing and also Interventions for Improving the Health Indicators.

The NRHM seeks to provide : Accessible Affordable Quality Health Care

To the Rural Community Especially to the Vulnerable Sections.

NRHM OUTCOMES EXPECTED

1. National Level IMR MMR TFR MMRR Kala Azar : Reduced to 30/1000 Live Births : Reduced to 100/100,000 : Brought to 2.1 : 50% upto 2010, Addl.10% by 2012 : to be Eliminated by 2010.

Filaria / Microfilaria Reduction Rate : 70% by 2010, 80% by 2012 & Elimination by 2015 Dengue Mortality Reduction Rate : 50% by 2010 and Sustaining at that Level Until 2012
Contd..

 J.E Mortality Reduction Rate Cataract Operation Leprosy Prevalence Rate Tuberculosis DOTS Services 2000 Community Health Centres to be Upgraded

: 50% by 2010 and sustaining at that Level Until 2012 : to 46 lakhs per year Until 2012.

: Brought to < 1 / 10,000. : 85% Cure Rate to be Maintained : Indian Public Health Standard
from < 20% to 75%

Utilization of First Referral Units :

250,000 Women to be Engaged : Accredited Social Health Activists (ASHA).

CORE STRATEGIES
1. Train and Enhance the Capacity of PRIs :
To Own, Control and Manage Public Health Services

2. Promote Access to Improve Health Care :

At House Hold Level 3. Health Plan for each Village through Village Health Committee : At the Panchayat Level 4. Strengthening Sub Centres :

Through Better Human Resource Development, Clear Quality

Standards, Better Community Support and an Untied Fund to Enable Local Planning and Action.
Contd..

5. Strengthening Existing PHCs :

Through Health Staffing and Human Resource Development, Clear Quality Standards, Better Community Support and an Untied Fund to Enable Local Management Committee to

Achieve these Standards.

6. Provision of 30-50 Bedded Community Health Centre (CHC) : 1 / 1,00,000 Lakh Population for Improved Curative Care.

7. Preparation and Impltn of Inter Sector District Health Plan :

Including Drinking Water, Sanitation, Hygiene and Nutrition.

8. Integrating Vertical Health and Family Welfare Programs :

At all Level.

9. Formulation of Transparent Policies :

Development and Career Development of Human Resources for Health.

SUPPLEMENTARY STRATEGIES
Regulation of Private Sector Including the Informal Rural Medical Practitioners (RMP).

Promotion of Public Private Partnership (PPP).

Mainstreaming Ayush Revitalizing Local Health Traditions.

Re-Orienting Medical Education (ROME) to Support

Rural Health Issues

NRHM ORGANISATION SETUP

STATE HEALTH MISSION

Honble Chief Minister

Project Director

Chairman
Mission Director

DISTRICT HEALTH SOCIETY

District Collector Chairman

DDHS (Revenue Dist.) Secretary

PATIENT WELFARE SOCIETY
PHCs District Hospitals Sub District Hospitals

ROLE OF DISTRICT HEALTH MISSION

Planning,

Implementing Monitoring and Evaluating the Progress

Preparation of Annual Work Plan and Budget. Suggesting District Specific Problems & Innovative Approaches. Partnership with SHGs and NGOs. Strengthening Training Institutions. Providing Leadership to Village Level, Block Level Teams. Establishing District Resource Group for Capacity Building.

Contd..

 Operational zing District Hospitals to IPHS. Ensuring Effective Referral System. Ensuring Timely Disbursements of Claims. Establishing Transparent System of Procurement. Setting up of Financial, Progressive and Data Management Teams. Carry Out Health Facility Surveys and Supervise

House Hold Surveys.

Developing District Health Action Plans for Convergent Action.

NRHM A C T I V I T I E S

I. 24 HOURS DELIVERY CARE SERVICES

Round the Clock Availability of :

Basic Emergency Obstetric and New Born Care Services. Improve the Institutional Delivery Performance. Treatment for : 1. Poisoning

2. Snake Bite
3. Scorpion Bite

II. ESTABLISHMENT OF BEmONC CENTRES

3 Staff Nurses 2 ANMs - Round the Clock Delivery Services. Training for ANMs and Staff Nurses to Upgrade the Skills: First Aid in Obstetric and New Born Emergencies, Scorpion Sting, Snake Bite, Poisoning, Drowning etc.,

BEmONC CENTRE SERVICES

Conduct Normal Deliveries. Manual Vacum Aspiration for Termination of Unwanted Pregnancies. Tubectomy Services. Stabilization of Maternal Emergencies and Newborn Complications before Referral. Essential Newborn Care Including the Resuscitation of Newborns, Management of Hypothermia. ISM Clinic for Antenatal Care. Quality Ante Natal Care.

Fetal Monitoring.
Management of Physiological Jaundice of Newborns by using Phototherapy. Management of Premature and Low Birth Weight babies. First aid for Obstetric Complication - PPH, Eclampsia, Puerperal Sepsis. Opportunistic Infection Management of AIDS Case. Integrated Counseling and Testing Services for HIV / AIDS.

INSTITUTIONAL MECHANISMS
Village Health & Sanitation Samiti (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA,community health volunteers
Rogi Kalyan Samiti (or equivalent) for community management of public hospitals District Health Mission, under the leadership of Zila Parishad with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it

State Health Mission, Chaired by Chief Minister and co-chaired by Health Minister and with the State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc Standing Mentoring Group shall guide and oversee the implementation of ASHA initiative
Task Groups for Selected Tasks (time-bound)

TECHNICAL SUPPORT
1. To be effective the Mission needs a strong component of Technical Support 2. This would include reorientation into public health management 3. Reposition existing health resource institutions, like Population Research 4. Centre (PRC), Regional Resource Centre (RRC), State Institute of Health & Family Welfare (SIHFW) 5. Involve NGOs as resource organisations 6. Improved Health Information System 7. Support required at all levels: National, State, District and subdistrict. 8. Mission would require two distinct support mechanisms Program Management Support Centre and Health Trust of India.

Janani Suraksha Yojana scheme

launched on 1st Nov-2005 safe motherhood intervention under NRHM. Under the scheme, Rs.1000/- (Rs.700/- under JSY (GOI) + Rs.300/- under Sukhibhava (State) scheme) is being paid to Rural BPL Woman who delivers in any Govt hospital. Rs.800 Private hospitals From 1st April 2006-BPL urban families-Rs 600

IX.JANANI SURAKSHA YOJANA (JSY)

JSY - Modified form of existing National Maternity Benefit Scheme (NMBS).

JSY Integrates the Cash Assistance with Antenatal Care During the Pregnancy Period, Institutional Care During Delivery and Immediate Post-Partum Period in a Health Centre by Establishing a System of Co-Ordinate Care by Field Level Health Worker.

One of the Accepted Strategies for Reducing Maternal Mortality is to Promote Deliveries at Health Institution by Skilled Personnel Like Doctors and Nurses. Cash Assistance is Provided to Women from Below Poverty Line (BPL) Families, for Enabling them to Deliver in Health Institutions.
THE CASH ASSISTANCE FOR

HOME DELIVERY

: Rs. 500/-

INSTITUTIONAL DELIVERY : Rs.700/(BOTH GOVERNMENT AND PRIVATE INSTITUTION).

JSY Eligible conditions

Rural/Urban BPL family above 19 years at the time of the delivery delivery is of the first child or second or subsequent delivery, with the couple having only one living child or through in the current delivery there are twins, there is only one only living child to that couple

X.MAINSTREAMING OF INDIAN SYSTEM OF MEDICINE (ISM)

One of the priority items of work envisaged under National Rural Health Mission is revitalizing local health traditions and mainstreaming of Indian System of Medicines (ISM) in the Health System. Towards this aim it is proposed to build capacity among the female field health functionaries in the use of Ism drugs. A well designed 13 days training program has already been planned to train the female field health functionaries in the concepts of ISM and ISM drug. On completion of the 13 days training, they were given drug kits consisting of ISM drugs.

PROGRAM MANAGEMENT SUPPORT CENTRE

For Strengthening Management Systems-basic program management,financial systems, infrastructure maintenance, procurement & logistics systems, Monitoring & Information System (MIS), non-lapsable health pool etc. For Developing Manpower Systems recruitment (induction of MBAs/CAs/MCAs), training & curriculum development (revitalization of existing institutions & partnerships with NGO & private sector. Sector institutions), motivation & performance appraisal etc.

ROLE OF STATE GOVERNMENTS UNDER NRHM

1. The Mission covers the entire country. The 18 high
focus States are Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Orissa, Uttaranchal,Jharkhand, Chhattisgarh, Assam, Sikkim, Arunachal Pradesh, Manipur,Meghalaya, Tripura, Nagaland, Mizoram Himachal Pradesh and Jammu & Kashmir. GoI would provide funding for key components in these 18 high focus States. Other States would fund interventions like ASHA,Programme Management Unit (PMU), and upgradation of SC/PHC/CHC through Integrated

Financial Envelope.

CONT.
2.NRHM provides broad conceptual framework. States would project operational modalities in their State Action Plans, to be decided in consultation with the Mission Steering Group. 3.NRHM would prioritize funding for addressing inter-state and intradistrict disparities in terms of health infrastructure and indicators. States would sign Memorandum of Understanding with Government of India, indicating their commitment to increase contribution to Public Health Budget (preferably by 10% each year), increased devolution to Panchayati Raj Institutions as per 73rd Constitution (Amendment) Act, and performance benchmarks for release of funds.

FOCUS ON THE NORTH EASTERN STATES

All 8 North East States, including Assam, Arunachal Pradesh, Manipur,Meghalaya, Mizoram, Nagaland, Sikkim and Tripura, are among the States selected under the Mission, for special focus. Empowerment to the Mission would mean greater flexibilities for the 10% committed Outlay of the Ministry of Health & Family Welfare, for North East States.

CONT.
States shall be supported for creation/upgradation of health infrastructure,increased mobility, contractual engagement, and technical support under the Mission. Regional Resource Centre is being supported under NRHM for the North Eastern States. Funding would be available to address local health issues in a comprehensive manner, through State specific schemes and initiatives.

NRHM 5 MAIN APPROACHES

1.COMMUNITIZE
1. Hospital Management Committee/ PRIs at all Levels 2. Untied Grants to Community/ PRI Bodies 3. Funds, Functions & Functionaries to Local Community Organizations 4. Decentralized Planning, Village Health &Sanitation Committees 2.IMPROVED MANAGEMENT THROUGH CAPACITY 1. Block & District Health Office with Management Skills 2. NGOs in Capacity Building 3. NHSRC / SHSRC / DRG / BRG 4. Continuous Skill Development Support 3.FLEXIBLE FINANCING 1. Untied Grants to Institutions 2. NGO Sector for Public Health Goals 3. NGOs as Implementers 4. Risk Pooling Money Follows Patient 5. More Resources for More Reforms

4.INNOVATION IN HUMAN RESOURCE MANAGEMENT 1. More Nurses Local Resident Criteria 2. 24 X 7 Emergencies by Nurses at PHC. AYUSH 3. 24 x 7 Medical Emergency at CHC 4. Multi Skilling

5.MONITOR,PROGRESS AGAINST STANDARDS

1. Setting IPHS Standards 2. Facility Surveys

3. Independent Monitoring Committees at Block,

District & State levels