My Presentation Nrhm

7/27/2019 My Presentation Nrhm

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NRHM LAUNCHED - 12 April 2005


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VISIONEffective 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.


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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.

GOAL


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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.

Contd..

Strengthening of the Rural Hospital for Effective Curative

Care and made Measurable and Accountable to the

Community throughIndian Public Health Standards (IPHS)


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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).


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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.


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The NRHM seeks to provide :

Accessible

Affordable

Quality Health Care

To the Rural CommunityEspecially to the Vulnerable Sections.


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NRHM OUTCOMES EXPECTED1. National Level

IMR : Reduced to 30/1000 Live Births

MMR : Reduced to 100/100,000

TFR : Brought to 2.1

MMRR :50% upto 2010, Addl.10% by 2012

Kala Azar : 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 atthat Level Until 2012

Contd..


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J.E Mortality Reduction Rate : 50% by 2010 and sustaining

at that Level Until 2012

Cataract Operation : to 46 lakhsper year Until 2012.

Leprosy Prevalence Rate : Brought to < 1 / 10,000.

Tuberculosis DOTS Services : 85% Cure Rate to beMaintained

2000 Community Health

Centres to be Upgraded : Indian Public Health Standard

Utilization of First Referral Units : from < 20% to 75%

250,000 Women to be Engaged : Accredited Social Health

Activists (ASHA).


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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..


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5. Strengthening Existing PHCs :

Through Health Staffing and Human Resource Development,

Clear Quality Standards, Better Community Support and anUntied 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


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SUPPLEMENTARY STRATEGIES

Regulation of Private SectorIncluding the Informal Rural

Medical Practitioners (RMP).

Promotion ofPublic Private Partnership (PPP).

Mainstreaming Ayush Revitalizing Local Health Traditions.

Re-Orienting Medical Education (ROME) to Support

Rural Health Issues


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STATE HEALTH MISSION

Honble Chief Minister Chairman

Project Director Mission Director

DISTRICT HEALTH SOCIETY

District Collector Chairman

DDHS (Revenue Dist.) Secretary

PATIENT WELFARE SOCIETY

PHCs

District Hospitals

Sub District Hospitals

NRHM ORGANISATION SETUP


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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..


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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.


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NRHM

A

C

T

IV

I

T

I

E

S

I 24 HOURS DELIVERY CARE SERVICES


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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

I. 24 HOURS DELIVERY CARE SERVICES

II ESTABLISHMENT OF BEmONC CENTRES


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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.,

II. ESTABLISHMENT OF BEmONC CENTRES


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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


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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)


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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 sub-

district.

8. Mission would require two distinct support mechanisms

Program Management Support Centre and Health Trust of India.

TECHNICAL SUPPORT


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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)


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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 HealthWorker.

One of the Accepted Strategies forReducing 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).


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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 onlyone living child or

through in the current delivery there are twins,

there is only one only living child to that couple


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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 traditionsand mainstreaming of Indian System of Medicines (ISM)

in the Health System.

Towards this aim it is proposed to build capacity amongthe 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.


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PROGRAM MANAGEMENT SUPPORT

CENTRE

For Strengthening Management Systems-basicprogram 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. Sectorinstitutions), motivation & performance appraisal etc.


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ROLE OF STATE GOVERNMENTS

UNDER NRHM

1. The Mission covers the entire country. The 18 highfocus States are Uttar Pradesh, Bihar, Rajasthan,

Madhya Pradesh, Orissa, Uttaranchal,Jharkhand,

Chhattisgarh, Assam, Sikkim, Arunachal Pradesh,

Manipur,Meghalaya, Tripura, Nagaland, MizoramHimachal 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), andupgradation of SC/PHC/CHCthrough Integrated

Financial Envelope.


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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,

andperformance benchmarks for release of funds.


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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, forNorth East States.


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CONT.

States shall be supported for

creation/upgradation of health

infrastructure,increased mobility, contractual

engagement, and technical support under theMission.

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


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NRHM5 MAIN APPROACHES1.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 PoolingMoney Follows Patient

5. More Resources for More Reforms


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4.INNOVATION IN HUMAN RESOURCE MANAGEMENT

1. More Nurses

Local Resident Criteria2. 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 Surveys3. Independent Monitoring Committees at Block,

District & State levels


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My Presentation Nrhm