Evaluation Study of NationalRural Health Mission(NRHM) In 7 States

Programme Evaluation Organisation Planning Commission Government of India New Delhi-110001 February 2011

-Presented By Dr. Swati SharmaBDS (Pt.B.D Sharma Uni., Rohtak)

PGDPHM(student)(NIHFW)

NRHM

(NATIONAL RURAL HEALTH MISSION)

INTRODUCTION

12th April 2005. The National Rural Health Mission (NRHM) was launched by the Hon’ble Prime Minister

DECENTRALISATION

COMMUNICATIONORGANISATIONAL

BEHAVOIUR

INTER-SECTORIALCONVERGENCE

PUBLIC PRIVATE PARTNERSHIP

Launched on 12th April 2005 by the Prime Minister

Identified 18 States with weak PH Indicators/Health Care Infrastructure

The initial Outlay for NRHM for 2005-06 was over Rs.67000 Million and outlay for 2012-13 is Rs.208220 Million

Mainstreaming of AYUSH

Why NRHM ?

STATE OF PUBLIC HEALTH IN INDIA BEFORE NRHMHealth gap at rural level

Multiple health crisis ( malnutrition, maternal and infant deaths, inadequate water supply etc..

Systemic Deficiencies in health Sector

OBJECTIVES

Reduction in child and maternal mortality

Universal access to PH services for food and nutrition, sanitation and hygiene with focus on women and children health

Prevention and control of communicable and non communicable diseases including locally and endemic diseases

Population stabilization, attaining gender and demographic balance

Revitalize local health traditions and mainstream AYUSH

Promotion of healthy life styles

EVALUATION(Concurrent evaluation)

Evaluation Design:(Intervention – Post only)

PROCESS IN ACTION PLAN

Supervision &Monitoring

(Output &Efficiency)

Situation Analysis

Objective Setting

Implementation

- Inputs

- Activities- Outputs

-Outcomes

Goals- Impact

EFFECTIVENESS

EVALUATION

131.66

44.33

20.95

31.28

23.22

7.62

34.92

0

20

40

60

80

100

120

140

UP MP Jharkhand Orissa Assam J & K Tamil Nadu

Rural population(2001) in million .

neo-natal mortality

component of IMR for India in 2008

was 37

the total fertility rate (TFR) is around 2.7

Health Infrastructure

Approaches:

Routine:Reporting and feedback system with help of structured scheduled reports

SRS AHS

DLHS

TOOLS

Community interviews(internal/external)

Tracking program implementation:

Supervisory field visitsusing checklists

Community monitoring with special tools

Fixed monthly meetings with subordinate staff

Implementation plan

1. Hiring or recruitment 2. Hiring of office space 3. Fund for activity and Monitoring &

evaluation support4. Basic survey of all the Government

facilities, private facilities, private practitioners,

1. Categorization of population on high risk, low risk and migration

2. Identify the causes.3. Ensure availability of interventions.4. Ensure the availability of service

provider.

Inputs

Process

1.Capacity building of all stakeholders.2.Capacity building of health workers.3.Local NGOs and private practitioner can be involved.4.Capacity building of private practitioner.5.Ensure outgoing patient to be registered.6.IEC activities in community.

Activity

1. Training of stake holders.2. Training of ASHA planed and held3. No. of health centers have increased.4. No. of health providers have increased.5. Pt. registration & diagnosis, treatment.

Output

Outcome

EXPECTED

Reduce IMR to 30/1000 by 2012

Reduce MMR to 100/100000 by 2012

TFR to 2.1 by 2012.

OUTCOME

39/1000,

167/100000 by 2013

2.3,by 2013

Malaria mortality reduce by 50% by 2010,Additional by 2012.

Kala Azar 100% by 2010, sustain elimination until 2012.

Filaria/microfileria reduction – 70% by 2012, 80% by 2012 & elimination by 2015.

Dengue mort. Reduction by 50% by 2010, & sustain until 2012

Cataract operation increasing by 46 lkhs by 2012.

Leprosy prevalence rate below 1/10000 Below 1

45% by 2012

45% by 2012

0.29% by 2012

9 death reported in 2014

6304177 operated, 2012

TB DOTS maintain 85% cure rate., sustain case detection.

Upgrading health establishment acc. To IPHS.

Increase utilization of FRU bed occupancy from 20% to over 75%

67.3

Not upto IPHS standars

2514

*Prevalence and incidence not improved upto the expectations.

*Awareness in the district will increase in the district

Impact

Where it is lacking. !!

Not adequate number of ASHA .

Failing family planning services.

No Job security and high attrition rate.

Low motivation level among staff.

OVERALL RECOMMENDATIONS TO UPGRADE PUBLIC HEALTH FACILITIE

filling of vacant positions

provisioning of cold chains would facilitate improvements in outreach of the health services in rural areas.

emergency care for sick children, and treatment of emergency cases for the chronic diseases at FRUs.

Provisioning of ambulances at FRUs and referral transport at PHCs and SCs would be more cost effective.

ASHA’s mentoring and retraining for updating skills

Utilization of untied funds