About NHM (NUHM & NRHM)

1. NATIONAL HEALTH
MISSION
BY
DR. Anup Kr Gupta
MD (CHA)
NIHFW

2. INTRODUCTION
 The National Health Mission (NHM)
encompasses its two Sub-Missions, the
National Rural Health Mission (NRHM)
and the National Urban Health Mission
(NUHM). The National Health Mission
was approved in May 2013.
 The NHM envisages achievement of
universal access to equitable, affordable &
quality healthcare services that are
accountable and responsive to people’s
needs.

3. OBJECTIVES
• Brief presentation on the national health
mission
• Discuss about the National Rural Health
Mission & National Urban Health Mission

4. Problem statement
• Multiple burden of communicable & non –
communicable diseases.
• High infant and maternal mortality
• High TFR in many states
• 50% under nourished and anemic women
and children – very little improvement
• Water and sanitation problems are still a big
challenge
• Malaria, dengue, chikunguniya on the rise
• Public health regulation – poor monitoring

5. COMPONENT OF NHM
 NHM Finance
 Health system strengthening
 RMNCH+A
 National disease & control programs

6. Goals & Achievements

1. Reduce MMR to 1/1000 live births
(1.30/1000 in 2016)
 2. Reduce IMR to 25/1000 live births
(34/1000 as in year 2016 )
 3. Reduce TFR to 2.1( 2.3 in year 2016)
 4. Prevention and reduction of anaemia in
women aged 15–49 years
 5. Prevent and reduce mortality & morbidity
from communicable, non- communicable;
injuries and emerging diseases
 6. Reduce household out-of-pocket
expenditure on total health care
expenditure(reduction from 72% to 60%
achieved)

7. GOALS Continue
 7. Reduce annual incidence and mortality
from Tuberculosis by half (in 2015, incidence
is 167 per lakh & mortality17 per 2015.)
 8. Reduce prevalence of Leprosy to <1/10000
population and incidence to zero in all
districts ( achieved)
 9. Annual Malaria Incidence to be <1/1000 (
achieved)
 10. Less than 1 per cent microfilaria
prevalence in all districts( Achieved in 222
districts out of 225)
 11. Kala-azar Elimination by 2015, <1 case
per 10000 population in all blocks ( 454
blocks out of 611 blocks achieved )

8. NRHM
 Launched in 2005
 Focus of the mission is on establishing a fully
functional, community owned, decentralized
health delivery system with inter-sectoral
convergence at all levels.
 Under the NRHM, special focus have been
given on 18 states including the 8
Empowered Action Group(EAG) States as
well as 8 North Eastern States, Jammu &
Kashmir and Himachal Pradesh.
 There is a shortfall of 35110 SCs (20%),
6572 PHCs (22%) and 2220 CHCs (30%)
across the country as per the Rural Health
Statistics (RHS) 2016.

9. CONTINUE..
AIMS OF NRHM
 Universal access to equitable,
affordable and quality health care.
 Bridging the gap in rural health care
through creation of a cadre of
Accredited Social Health
Activist(ASHA)
 Reduction of child and maternal
mortality
 Population Stabilization including
gender and demographic balance

10. Components of NRHM
 1. ASHA - Resident of the village, a
woman (M/W/D) between 25-45 years,
with formal education up to 8th class,
having communication skills and
leadership qualities. - One ASHA per
1000 population. - Around 9.4 lakhs
ASHA’s are already selected.
 ASHA is chosen by the Panchayat to act
as the interface between the community
and the public health system. - Bridge
between the ANM and the village. -
Honorary volunteer, receiving
performance based compensation .

11. Responsibility of ASHA
 To create awareness among the community
regarding nutrition, basic sanitation, hygienic
practices, healthy living.
 Counsel women on birth preparedness,
importance of safe delivery, breast feeding,
complementary feeding, immunization,
 Encourage the community to get involved in
health related services. - Escort/ accompany
pregnant women, children requiring treatment
and admissions to the nearest PHC’s.
 Primary medical care for minor ailment such
as diarrhea, fevers - Provider of DOTS.

12. STRENGTHENING Primary Health
Centres :
 Mission aims at Strengthening PHC for quality
preventive, promotive, curative, supervisory and
outreach services, through 25,354 Primary Health
Centres: –
 Adequate and regular supply of essential quality
drugs and equipment including Supply of Auto
Disabled Syringes for immunization to PHCs
 Provision of 24 hour service in 50% PHCs by
addressing shortage of doctors, especially in high
focus States.
 Intensification of ongoing communicable disease
control programs, new programs for control of non
communicable diseases, up gradation of 100%
PHCs for 24 hours referral service, and provision of
2nd doctor at PHC level (I male, 1 female) would
be considered if required.

13. For Sub-Centres
 The Untied Grants of Rs. 10,000 per annum to
Sub-Centres (SCs) has given a new confidence
to our ANMs in the field. . This Fund will be
deposited in a joint Bank Account of the ANM &
Sarpanch and operated by the ANM. The SCs
are far better equipped now with blood pressure
measuring equipment, haemoglobin (Hb)
measuring equipment, stethoscope, weighing
machine etc.
 Supply of essential drugs, both allopathic and
AYUSH, to the 1.5 lakhs Sub Centres (SCs).
 In case wherever needed, sanction of new Sub-
centers, and upgrading existing Sub-centers,
including buildings for Sub-centers functioning in
rented premises will be considered.

14. Rogi Kalyan Samiti/Hospital Management Society is
a simple yet effective management structure. This
committee is a registered society whose members
act as trustees to manage the affairs of the hospital
and is responsible for upkeep of the facilities and
ensure provision of better facilities to the patients in
the hospital.
Healthcare service delivery requires intensive
human resource inputs. NHM has attempted to fill
the gaps in human resources by providing nearly
1.88 lakh additional health human resources to
States including 7,263 GDMOs, 3,355 Specialists,
73,154 ANMs, 40,847 Staff Nurses on contractual

15. The Village Health Sanitation and Nutrition Committee
(VHSNC) is an important tool of community empowerment
and participation at the grassroots level to address issues
of environmental and social determinants. Untied grants
of Rs. 10,000 are provided annually to each VHSNC. Till
date, 5.01 lakh VHSNCs have been set up across the
country.
Janani Suraksha Yojana (JSY, 100% centre funded) aims
to reduce maternal mortality among pregnant women by
encouraging them to deliver in government health
facilities. Under the scheme, cash assistance is provided
to eligible pregnant women for giving birth in a
government health facility/ accredited private hospital.
Since the inception of NRHM, 8.55 crore women have
benefited under this scheme.

16.  Janani Shishu Suraksha Karyakram(JSSK):
Launched on 1st June, 2011. JSSK entitles all
pregnant women delivering in public health
institutions to absolutely free and no expense
delivery, including caesarean section.
 Facility Based Newborn Care: As on June
2015, a total of 14,441Newborn Care Corners
(NBCCs), 2,020 Newborn Stabilization
Units(NBSUs) and 575 Special Newborn Care
Units (SNCUs) have been made operational
across the country.
 National Mobile Medical Units(NMMUs):
Support has been provided in 333 out of 672
districts for 1107 Mobile Medical Units (MMUs)
under NHM in the country

17.  National Ambulance Services (NAS): As on
date, 31 States/UTs have the facility where
presently, 7358 Dial-108, 400 Dial-104 and 7836
Dial-102 Emergency Response Service Vehicles
are operational under NHM, besides 6290
empaneled vehicles for transportation of patients,
particularly pregnant women and sick infants from
home to public health facilities and back.
 Mainstreaming of AYUSH: Mainstreaming of
AYUSH has been taken up by allocating AYUSH
facilities in 10042 PHCs, 2732 CHCs, 501 DHs,
5714 health facilities above SC but below block
level and 421 health facilities other than CHC at or
above block level but below district level.

18. National Quality Assurance Framework for Health
facilities: To improve quality of healthcare in over 31000
public facilities and provide a clear roadmap to States,
Quality Standards for District Hospitals (DHs), CHCs and
PHCs under National Quality Assurance Framework were
rolled out in November, 2014.
Launch of Kayakalp - An initiative for Award to Public
Health facilities: Kayakalpinitiative has been launched to
promote cleanliness, hygiene and infection control
practices in public health facilities.
Free Drugs Service Initiative:Under the NHM-Free Drug
Service Initiative, substantial funding is available to States
for provision of free drugs subject to States/UTs meeting
certain specified conditions.

19.  Free Diagnostics Service Initiative:
The NHM- Free Diagnostics Service
Initiative was launched in 2013 to
provide free essential diagnostic services
at public health facilities under which
substantial funding was provided to
States.
 Bio Medical Equipment Maintenance:
States have been asked to plan
interventions for comprehensive
equipment maintenance for all functional
medical equipment/machinery.

20.  Comprehensive Primary Healthcare: In
December 2014, the Ministry of Health and
Family Welfare constituted a Task Force to
identify current challenges like rolling out
comprehensive primary health care, finalizing
components of service delivery, clarifying the
institutional structures and service
organizations, developing guidelines.
 Kilkari: To create proper awareness among
pregnant women, parents of children and field
workers about the importance of Ante-Natal
Care (ANC), Institutional Delivery, Post-Natal
Care (PNC) and Immunization, it was decided to
implement the Kilkari and Mobile Academy
services across India in phased manner.

21.  Mobile Academy is an anytime, anywhere
audio training course on interpersonal
communication skills that the ASHA can
access from her mobile phone.
 Launch of Nationwide Anti-TB drug
resistance survey: Drug resistance survey
for 13 anti TB drugs was launched to provide
a better estimate on the burden of Multi-Drug
Resistant Tuberculosis within the community.
This is the biggest ever such survey in the
world with a sample size of 5214 patients.
 Kala-Azar Elimination Plan: To reduce the
annual incidence of Kala-azar to less than
one per 10,000 population at block PHC level
by the end of 2015.

22. NATIONAL URBAN HEALTH
MISSION(NUHM)
 Launched on 1st May 2013.
 for providing equitable and quality primary
healthcare services to the urban population
with special focus on slum and vulnerable
sections of the society.
 The Centre-State funding pattern is 60:40 for
all the States except the North-Eastern
States and other hilly States viz. Jammu &
Kashmir, Himachal Pradesh and
Uttarakhand, for which the Centre-State
funding pattern is 90:10.
 In the case of UTs the entire NUHM
programme is fully funded by Central
Government.

23.  Nuhm has high focus on urban poor
population living in listed & unlisted
slum areas.
 All others vulnerable population are
rikshaw pullers, homeless, street
children, sex workers, beggers.
 Public health thrust on sanitation,
clean water, vector controls.
 Strengthening public health capacity
of urban local bodies.

24. Problem statement
 There has been a considerable rise of
urbanization in the country over the last
decade.
 Census 2011 data showed, for the first time
since Independence, the absolute increase in
population was more in urban areas that in
rural areas.
 As per Census 2001, 28.6 crore people live in
urban areas. The urban population has
increased to 37.7 crore in 2011.
 Of the 370 million urban dwellers, over 100
million are estimated to live in slums and face
multiple health challenges on the fronts of
Sanitation, Communicable and Non
communicable diseases.

25. Slums

28. Goal of NUHM
 The NUHM aims to address the health
concerns of the urban poor
Facilitating equitable access to available
health facilities
Strengthening of the existing capacity of
health delivery
The existing gaps to be filled up through
partnership with NGOs.
Planning process to undertake large
scale community level insurance
mechanism.
Active involvement of the urban local bodies

29. Service Delivery Infrastructure
of NUHM
 Urban–Primary Health Centre (U-PHC): New U-PHCs
are established as per gap analysis, as per norm of one
U-PHC for approximately 50,000 urban populations.
 Urban-Community Health Centre (U-CHC) and
Referral Hospitals: 30- 50 bedded U-CHCs are
established for providing inpatient care. U-CHCs are set
up in cities with a population of above 5 lakhs. Urban
Community Health Centre (U-CHC) are proposed to be
set up as a satellite hospital for every 4-5 U-PHCs.
 Outreach services: NUHM also support engagement
of ANMs for conducting outreach services for targeted
groups particularly slum dwellers and the vulnerable
population. All the services delivered under the mission
will be based on identification of the target groups
through distribution of Family/ Individual Health
Suraksha Cards

30. Urban Social Health
Activist(USHA)
 An USHA will be posted for every 200-500 households
Maintain IPC with the families and the Mahila Arogya
Samities (MAS) for which they are earmarked.
 The USHA , preferably be a woman resident of the
slummarried/widowed/ divorced & preferably in the age
group of 25 to 45 years, should be literate with formal
education up to class eight subjected to
relaxation.Approx 33000 USHA has been selected.
 Chosen through a rigorous community driven process
involving ULB Counsellors, community groups, self
help groups, Anganwadis, ANMs.

31. Functions of USHA
• To promote good health services in her area
• To facilitate awareness on RCH services
• To motivate all types of family planning
methods
• To register all pregnant mothers and to
motivate them for antenatal care
• To act as a depot folder for essential
provisions like ORS packets, IFA tablets,
Chloroquine tablets, oral pills, condoms.
 Contn…

32. • To support ANM/MAS in conducting monthly
 outreach session regularly
• To form and promote MAS
• To escort the patients requiring health services
• To encourage the community participation in
health activities
• To maintain the records of vital events in her area
• To treat minor ailments with the drug kit provided

33. Community Process
 Mahila Arogya Samiti (MAS): One Mahila
Arogya Samiti will covers 250-1,000
beneficiaries and between 50-100
households and act as community based
peer education group in slums. So far 40132
MAS have been formed
 ASHA/Link Workers: ASHA serves as an
effective and demand–generating link
between the health facility and the urban
slum population. Each link worker/ASHA will
have a well-defined service area of about
1000-2,500 beneficiaries/between 200-500
households. So far 31899 ASHAs have been
identified.

34. HEALTH MANAGEMENT
INFORMATION SYSTEM
(HMIS)
 It is a web-based monitoring system that has
been put in place by the Ministry to monitor
health programmes under National Health
Mission.
 It was launched in October 2008 with district
wise data uploading on HMIS portal. At
present, 672 districts are reporting facility
wise data while Brihan Mumbai and Kolkata
are uploading district consolidated figure on
the HMIS web portal.
 HMIS data is widely used by the
Central/State Government officials for
monitoring and supervision purposes

35. SURVEYS AND EVALUATION
ACTIVITIES
 Periodically surveys to assess the
level and impact of health
interventions that include National
Family Health Survey (NFHS), District
Level Household Survey (DLHS),
Annual Health Survey (AHS).

36. NATIONAL HEALTH SYSTEM
RESOURCE CENTRE (NHSRC)
 The National Health System Resource
Centre (NHSRC) was set up in 2007, as
a technical support and knowledge
management agency for the National
Rural Health Mission (NRHM).
 SUPPORT TO NGO: the Central
Government will support the NGOs only
as per the proposals of States through
their Programme Implementation Plans
(PIPs).

37. Serial
No.
Parameter 1951 1981 1991 2001 2016
1 Crude Birth Rate(
Per 1000
population)
40.8 33.9 29.5 25.4 20.4
2 Crude death rate
( Per 1000
population)
25.1 12.5 9.8 8.4 6.4
3 Total fertility rate 6.0 4.5 3.6 3.1 2.3
4 Maternal
Mortality rate
(per lakh live
birth)
NA NA 437 301 130
5 Infant Mortality
Rate (per 1000
live birth)
146 110 80 66 34
6 Expectation of
life at birth
55.4 59.4 63.4 67.9
(2010-14)