Helps to understand the health care system in India and newer updates related to NRHM and NUHM .

1.  Dr Amitha Marla
A J hospital and research centre
Mangalore
NATIONAL HEALTH MISSION

2. CONTENTS
 Vision and core values
 Goals
 Implementation in country level
 Components of NHM
 NRHM and NUHM
 Achievements and implementation 2014
 New initiatives

3. Vision of the NHM
 “Attainment of Universal Access to Equitable,
Affordable and Quality health care services,
accountable and responsive to people’s needs, with
effective inter-sectoral convergent action to address the
wider social determinants of health”.

4. • Core Values ‹
• Safeguard the health of the poor, vulnerable and disadvantaged, and
move towards a right based approach to health through entitlements and
service guarantees ‹
•
•Strengthen public health systems as a basis for universal access and
social protection against the rising costs of health care.
•‹Build environment of trust between people and providers of health
services. ‹
• Empower community to become active participants in the process of
attainment of highest possible levels of health.
• ‹Institutionalize transparency and accountability in all processes and
mechanisms.
• ‹Improve efficiency to optimize use of available resources.

5. About National Health Mission (NHM)
 The vision of the National Health Mission (which encompasses the
National Rural Health Mission (NRHM) and the National Urban
Health Mission (NUHM) as its two Sub-Missions) is universal
access to equitable, affordable and quality health care services.
 NHM in the 12th Plan are synonymous with those of the 12th Plan, and
are part of the overall vision.
Goals
The endeavor would be to ensure achievement of those indicators
1. Reduce MMR to 1/1000 live births
2. Reduce IMR to 25/1000 live births
3. Reduce TFR to 2.1
4. Prevention and reduction of anaemia in women aged 15–49 years
5. Prevent and reduce mortality & morbidity from communicable,
noncommunicable; injuries and emerging diseases

6. 7. Reduce annual incidence and mortality from Tuberculosis by half
8. Reduce prevalence of Leprosy to <1/10000 population and
incidence to zero in all districts
9. Annual Malaria Incidence to be <1/1000
10. Less than 1 per cent microfilaria prevalence in all districts
11. Kala-azar Elimination by 2015, <1 case per 10000 population in
all blocks

7. Institutional Mechanisms
At the National level,
 The Mission Steering Group (MSG) and the
Empowered Programme Committee (EPC)
 The MSG provides policy direction to the Mission
 Financial proposals brought before the MSG are first
placed before and examined by the EPC
The Union Minister of Health & Family Welfare chairs
the MSG. The convener is the Secretary, Department
of Health & Family Welfare
 EPC headed by the Union Secretary of Health and
Family Welfare.

8. State Health Mission (SHM)
State Health Society (SHS)
State[SIHFW] district DHM/CHM/DPMU/DHS
NHM
Headed by Mission
Director
MSG
CHAIRED BY
MOH&FW
National
Program me
Management Unit
(NPMU)./POLICY
The National
Institute of Health
and Family
Welfare (NIHFW)/
TRAINING
EPG
Chair union secretary
of MOH&FW
The National
Health Systems
Resource NHSRC
Technical support
Cabinet approval of
May 1, 2013

9. STATE AND DISTRICT LEVEL
State level
 At the State level, the Mission functions under the overall guidance of
the State Health Mission (SHM) headed by the State Chief Minister.
 The State Health Society (SHS).
 The State Program Management Unit (SPMU),
 State Health System.Resource Centers (SHSRC) and
 State Institutes of Health and Family Welfare (SIHFW).
District level
 District Health Mission (DHM)/City Health Mission (CHM)
 The District Programme Management Unit (DPMU) would be
linked to District Health Knowledge Center (DHKC) and its
partners for the requisite technical assistance.
 The District Training Center (DTC) would be the nodal agency for
training requirements of the District Health Society (DHS).

10. Components of NHM
 NHM Finance
 NHM- Health Systems Strengthening
 Reproductive, Maternal, Newborn, Child Health and
Adolescent - (RMNCH+A) Services
 National disease control programmes

11. NHM has six financing components:
(i) NRHM-RCH Flexi pool,
(ii) NUHM Flexi pool,
(iii) Flexible pool for Communicable disease,
(iv) Flexible pool for Non communicable disease including
Injury and Trauma,
(v) Infrastructure Maintenance and
(vi) Family Welfare Central Sector component.
The fund flow from the Central Government to the
states/UTs would be as per the procedure prescribed
by the Government of India.
Financial management capabilities for managing the
funds provided to the State Health Societies./PIP
Components of NHM
1 NHM Finance

12. 2 NHM- Health Systems Strengthening
 Adoption of the Indian Public Health Standards and
Quality standards
 Skill gaps and Standard Treatment Protocols
 Quality Improvement Programmes

13. The progress made under health system strengthening
•Infrastructure: strengthen public health delivery system at all levels as
per IPHS
More than 27,400 new construction works have been sanctioned till December
2013, since the inception of the Mission
The numbers of First referral Units (FRUs) has increased significantly from 940
in 2005 to 2653 in 2013-14.
 There are now 8743 PHCs which are working round the clock, compared to
1263 in 2005.
•Human Resources
In 2013,the total number of technical HR supported under NRHM increased to
1.49 lakh, which includes 23079 doctors/ specialists including AYUSH doctors,
35172 Staff Nurses, 20011 para-medics including AYUSH paramedics and 70891
ANMs. 590 District Programme Managers, 601 District Accounts Managers,
4579 Accountants at Block level and 4541 Accountants at PHC level ,ASHA
•Mainstreaming of AYUSH

14. Free drugs; NHM Free Drugs Service Initiative.
Mobile Medical Units (MMUs); All Mobile Medical Units are being
repositioned as “National Mobile Medical Unit Service” with universal
colour and design. As of December, 2014 there were about 1301 operational
MMUs in 368 districts across the country
Emergency response services and patient transport system 28 States
have the facility where people can dial 108 or 102 telephone number for
calling an ambulance
● 108 is emergency response system, primarily designed to attend to patients
of critical care, trauma and accident victims etc.
● 102 services essentially consist of basic patient transport aimed to cater
the needs of pregnant women and children though other categories are
also taking benefit and are not excluded.
102 & 108 ambulances have been repositioned as “National Ambulance
Service” with universal colour and design.

15. Community Participation
To ensure involvement of the communities in over-seeing the provisioning of
health care and to redress the public grievances,
a total of 31358 Rogi Kalyan Samitis (RKS) and 511670 Village Health
Sanitation and Nutrition Committees (VHSNCs) have been created under
NRHM.
Mandatory Disclosures:
To ensure transparency and improve accountability under NHM,
mandatory disclosures of key services by States in public domain have been
prescribed.
These include
• Facility wise deployment of all HR
• Facility wise service delivery data
•Details of services provided by mobile medical units and ambulance services,
procurements, construction of public health facilities.
•Financial Management Group (FMG) initiatives for strengthening of
Financial Management: FMG has undertaken numerous initiatives for
supporting the program in order to make the NRHM/NHM more effective,
transparent and accountable.

16. Increase in Service Utilization 2009 -2013
In terms of service delivery, significant progress has
been made under NRHM.
● Annual OPD in government institutions increased from 54.40 Crores
to 91.31 Crores (68 % increase) between 2009-10 and 2012-13.
● Annual IPD increased from 2.15 Crores to 4.26 Crores (98 %
increase) between 2009-10 and 2012-13.
● Number of General Surgeries performed annually increased from
46.49 lakh to 97.17 lakh (109 % increase) between 2009-10 and
2012-13.
● Number of Caesarean sections performed annually increased from
8.19 lakh to 11.56 lakh (41 % increase) between 2009-10 and 2012-
13

17. 3 Reproductive, Maternal, Newborn, Child Health and
Adolescent - (RMNCH+A) Services
February 2013, India took the lead in articulating
‘A Strategic approach to Reproductive Maternal,
Newborn, Child and Adolescent health (RMNCH+A)’.
 Maternal Health
 Access to safe abortion services
 Prevention and Management of Reproductive Tract Infections
(RTI) and Sexually Transmitted Infections.
 Gender Based Violence
 Newborn and Child Health
 Universal Immunization
 Child Health Screening and Early Intervention Services
 Adolescent Health
 Family Planning
 Addressing the Declining Sex Ratio
 Cross cutting areas

18. Initiatives
Reproductive health
New Strategic focus on Spacing
Methods and other family
planning services
 Safe Abortion Services
Maternal health
 Janani Shishu Suraksha
Karyakram (JSSK) 2011
 State of the art Maternal and Child
Health Wings (MCH wings) for
providing quality obstetric and
neonatal care
 Janani Suraksha Yojana 20
Institutional deliveries in India have
risen sharply from 47% in 2008 to
over 84 % now.
Targets achieved 2014
The Total Fertility Rate has declined
from 3.2 in 2000 to 2.4 in 2012 [2.1]
 Rate of decline of TFR has accelerated
by 52.3% during 2006-2011 as
compared to 2000-2005.
 decline in growth rate, since
independence, from 21.54% in 1990-
2000 to 17.64% in 2001-2011.
 In 2011, MMR in the country has
declined to 178 against a global MMR
of 210.[1/1000]

19. Mother and Child Tracking System (MCTS) &
Mother and Child Tracking Facilitation Centre (MCTFC)
•The facilitation centre has 80 helpdesk agents .
•The facilitation centre will act as a supporting framework to MCTS and help
in validating the data entered in MCTS by making phone calls to pregnant
women and parents of children and health workers.
•Get their feedback on various mother and child care services,
programmes and initiatives like JSSK, JSY, RBSK, NATIONAL IRON
PLUS INITIATIVE (NIPI), contraceptive distribution by ashas etc
•Check with ASHA and ANMS regarding availability of essential drugs and
supplies like ors packets and contraceptives.

21.  Source INAP India guildlines

22. Newborn /Child health- initiatives
Targets achieved 2012 -14 Initiatives have been started to
provide both home based care
and facility based care.[2011]
 Treatment and referral of sick
newborns at health facilities
New born Care Units (SCNU)
in district hospitals
 Newborn Stabilisation Unit
(NBSU), which is 4 bedded unit
providing basic level of sick
newborn care , established at
Community Health Centres/
First Referral Units.
 2012 /India’s child mortality
of 52 per 1000
 Live births is close to the
global average of 48
 Number of child deaths has
been reduced from
approximately 30 lakhs in
1990 to nearly 14 lakhs in
2012. [ 21/1000 live birth]

23. •Newborn Care Corners (NBCC) are established at delivery
points and providers trained in basic newborn care and
resuscitation through Navjaat Shishu Suraksha Karyakram
(NSSK).
•The Home Based Newborn Care Scheme launched in 2011
•National Iron Plus Initiative launched in 2013 to bring about
renewed emphasis on tackling high prevalence of anaemia,
comprehensively, across all age groups.

24. Universal Immunization
 Recommendations of the National Technical Advisory Group on
Immunization (NTAGI).
 Sustaining Pulse polio campaigns
 Improved cold chain management would be ensured with adequate
densities of Ice Lined Refrigerators (ILRs) and deep freezers.
 Integrated with IDSP and name based monitoring of children done
through the MCTS system
 Under the Universal Immunization Programme (UIP) , vaccination is
provided free of cost against seven vaccine preventable diseases i.e.
Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood
Tuberculosis and Hepatitis B.

25.  The first two years of life are considered a “critical
window of opportunity” for prevention of growth
faltering .
• Guidelines for Enhancing Optimal Infant and Young
Child Feeding Practices were launched by the Ministry
of Health & Family Welfare in this respect in 2013.
• policy for Vitamin A supplementation, children
between nine months to five years are given six monthly
doses of Vitamin A.
 In order to reduce the risk of mortality in children with
severe acute malnutrition, Nutritional Rehabilitation
Centres have been established for providing medical and
nutritional care.
 Tribal areas and high focus districts are prioritised for
setting up these units.

26. Integrated Management of Neonatal and Childhood
Illnesses (or IMNCI).2009
The strategy also addresses aspects of nutrition, immunization,
and other important elements of disease prevention and
health promotion.
The strategy includes three main components:
 (i) Improvements in the case-management skills of health
staff
 (ii) Improvements in the overall health system required for
effective management of neonatal and childhood illnesses;
 (Iii) Improvements in family and community health care
practices.

27. Rashtriya Bal Swasthya Karyakram: RBSK/2013
A recent initiative
● Expanding focus from child survival to a more comprehensive approach of
child survival and development and improving the overall quality of life
● RBSK includes provision for Child Health Screening and Early Intervention
Services through early detection and management of 4 Ds i.e Defects at birth,
Diseases, Deficiencies, Development delays including disability.
Universal Immunization Programme
A web enabled National Cold Chain Management Information System
(NCCMIS) has been developed in 2011-13 to track the status of cold chain
equipment. It is aimed at capturing real time data of functionality of cold chain
equipment at all levels across the country.

28.  Family Planning National Family Planning Indemnity Scheme
(NFPIS). The State Quality Assurance Cell would be responsible for
management of claims under the NFPIS scheme.
 Addressing the Declining Sex Ratio
Stricter enforcement of the PCPNDT Act
Providing proactive support for girl children through the ASHA and
Anganwadi system
 Gender Based Violence
 Prevention and Management of Reproductive Tract Infections
(RTI) and Sexually Transmitted Infections (STI):Special focus
would be given on linking up with Integrated Counseling and
Treatment Centers (ICTCs) and establishing appropriate referrals for
HIV testing and RTI/STI management.

31. Adolescent Health
India is home to 253 million adolescents (10-19 years) constituting about
one fourth of the population
Initiatives
•Adolescent Reproductive and Sexual Health (ARSH) Programme
•Scheme for Promotion of Menstrual Hygiene
•Weekly Iron and Folic Acid Supplementation (WIFS) Programme
•National Iron + Initiative
•Rashtriya Kishor Swasthya Karyakram ; Key drivers of the program are
community based interventions like peer educators, facility based
counselling, involvement of parents and the community through a
dedicated adolescent health day;
•Social and Behaviour Change Communication;
•and strengthening of Adolescent Friendly Health Clinics across levels of
care.

32. 4 NDCPS
National disease control programmes
 National Vector Borne Diseases Control Programme (NVBDCP)
 Revised National Tuberculosis Control Programme (RNTCP)
 Integrated Disease Surveillance Programme (IDSP)
 National Programme for Prevention and Control of Cancer,
Diabetes,Cardiovascular Diseases and Stroke (NPCDCS)
 National Programme for the Control of Blindness (NPCB)
 National Mental Health Programme (NMHP)
 National Programme for the Healthcare of the Elderly (NPHCE)
 National programme for the Prevention and Control of Deafness
 (NPPCD)
 National Tobacco Control Programme (NTCP)
 National Oral Health Programme (NOHP):
 National Programme for Palliative Care (NPPC):
 National Programme for the Prevention and Management of Burn
Injuries (NPPMBI):
 National Programme for Prevention and Control of Fluorosis
 (NPPCF)

33. Components of NHM
NHM
FINANCE
STRENGTHING
HEALTH
SERVICES
(RMNCH+A)
Services
NDCPS
NRHM NUHM

34. National Rural Health Mission (NRHM)
 NRHM seeks to provide equitable, affordable and quality health
care to the rural population, especially the vulnerable groups.
 Thrust of the mission is on establishing a fully functional,
community owned, decentralized health delivery system with inter-
sectoral convergence at all levels,
 to ensure simultaneous action on a wide range of determinants of
health such as water, sanitation, education, nutrition, social and
gender equality.
 Initiated in 2005

36. National Urban Health Mission (NUHM) approved by
the cabinet on 1st May 2013
To improve the health status of the urban population
particularly slum dwellers and other vulnerable sections
facilitating their access to quality primary health care.
 NUHM would cover all state capitals, district headquarters and
other cities/towns with a population of 50,000 and above (as
per census 2011) in a phased manner.
 Under NUHM, a provision of Rs 1000 Crores has been made in
2013-14.

37. Framework for Implementation NHM
 Broad principles and strategic directions of the
National Health Mission (NHM) through two Sub-
Missions, National Rural Health Mission (NRHM) and
National Urban Health Mission (NUHM).
 Ensuring the achievement of universal access to health
care through strengthening of health systems, institutions
and capabilities.
 Social Protection Function of Public Health Services
Social protection from the rising cost of health care is a
desirable and critical component of an effective health
system.

38. New initiatives
1 Union ministry of health & family welfare has put in place program guidelines
for implementing the national dialysis program in district hospitals on PPP
mode.
•The swachh bharat abhiyan launched by the prime minister on 2nd october
2014, focuses on promoting cleanliness in public spaces.
•Award to public health facilities/ kayakalpa awards implementing national
.
•Implementing national free essential diagnostics service initiative so as to
ensure the availability of basic diagnostics tests for service users in public health
facilities
•The free essential drugs initiative also expected to ensure a responsive supply
of quality drugs to facilities and promote rational drug use.

39. Programme for Prevention and Control of Cancer,
Diabetes, CVD and Stroke (NPCDCS)
Initiatives under 12th Plan:
1. The programme will cover all 640 districts in the country.
2. From 2013-14, the programme have been subsumed in National Health Mission
and will run under Programme Implementation Plan (PIP) mode.
3. District Hospitals will be strengthened / upgraded. Each district will have a 4-6
bedded Cardiac Care Unit and day care facilities for Chemotherapy component
of Cancer Care.
4. District Hospitals and CHCs will have dedicated NCD Clinics for screening,
counselling, follow up of referred cases, awareness generation and diagnosis and
management of diseases covered under NPCDCS.

40. 5. Screenings of Diabetes and hypertension in urban slums in cities with
population of more than 1 million will get priority.
6. Screening for common cancers (Breast, Oral and Cervical Cancers) will be
undertaken at district level.
7. 20 State Cancer Institutes(SCI) will be set up and 50 Tertiary Care Cancer
Centers (TCCCs) will be set up / strengthened in Government Medical
Colleges for providing

41. In order to achieve the NHM objectives, it is essential
that good quality and safe medicines, diagnostics, and
therapeutic procedures should be accessible, available
and affordable to the beneficiaries
Healthy Village | Healthy People | Healthy Nation
Thank you