National Rural Health Mission Meeting people’s health needs in rural areas
The National Rural Health Mission (NRHM) was launched in April,2005. by Hon’ble Prime Minister of India. The NRHM (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure
The Mission is an articulation of the commitment of the Govt. to raise public spending on health from 0.9% to 2-3% of GDP. The NRHM intends to ensure better delivery of services by undertaking “architectural correction of the health system” to enable it to effectively handle the increased allocation for public health.
Goals of the Mission Reduction in IMR and MMR. Universal access to public health services such as women’s health, child health, water, sanitation and hygiene, immunization and nutrition. Prevention and control of communicable and non- communicable diseases, including locally endemic diseases. Access to integrated comprehensive primary health care. Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH. Promotion of healthy life styles.
Expected Outcomes from the Mission IMR reduced to 30 per live births by 2012. Maternal Mortality reduced to 100/100,000 by 2012. TFR reduced to 2.1 by 2012. Reduction in mortality due to malaria, dengue and Kalazar; Filaria elimination 2015. 85% cure rate under TB DOTs. 46 lakh cataract operations by 2012. Upgrading CHCs to IPHS; Increase utilization of FRUs from 20% to 75%; Engaging 2,50,000 ASHAs in 10 States.
Expected Outcomes at communitylevel Availability of trained community level worker at village level, with a drug kit for generic ailments. Health Day at Aanganwadi level on a fixed day/month for provision of immunization, ante/post natal check ups and services related to mother and child care, including nutrition. Availability of generic drugs for common ailments at sub centre/hospital level. Good hospital care through assured availability of doctors, drugs and quality services at PHC/CHC level. Improved access to universal immunization. Improved facilities for institutional deliveries. Availability of assured health care at reduced financial risk through pilots of Community Health Insurance. Provision of household toilets. Improve outreach services through mobile medical unit at district level.
Institutional Framework National Steering Group Mission Steering Group Empowered Programme Committee Mission Directorate State Health MissionDistrict Health Mission ------------Rogi Kalyan Samitis Panchayat Village Health Village Health Village Health Committee Committee Committee
COMPONENTS OF NRHM PART A- RCH PROGRAMME PART B – NRHM ADDITIONALITIES PART C- IMMUNIZATION PART-D- NATIONAL DISEASE CONTROL PROGRAMME PART E- CONVERGENCE
Government of Sikkim has been implementing NRHM in the right earnest. Over the past 5 years the state has made significant gains in the health sector with the opportunities presented under NRHM. The state is working towards ensuring quality service delivery, efficient utilization of scarce resources, and most of all, to ensuring service guarantees to local households.
INSTITUTIONAL FRAMEWORK The State Health Mission The SHM has been providing management oversight & policy support for implementation of NRHM in the State. The District Health Missions Meet regularly in all four districts indicating that the institutional framework at the district is functional.
Societies The different societies at state & district level have been merged. One State Health Society and 4 District Health Societies Integration in terms of their structure and function has also taken place. Rogi Kalyan Samitis: registered in all 4 district & all 24 PHCs Capacity building efforts being carried out.
Village Health & SanitationCommittees• 641 VHSC constituted & operational• Joint accounts opened for all VHSC• Untied funds @ Rs. 10000 per VHSC annually have been disbursed to all the 641 Members of VHSCs have been imparted orientation training on NRHM and participatory methods.
ASHA/ LINK WORKERS• No. of ASHA planned & in place – 641 / 641.• 25 Link Workers selected for Urban Gangtok under RCH- trained & in position• Trainings upto 5th Module.completed• Drug kits to ASHA – all ASHAs provided• Two aprons• Mobile vouchers
2011-12 Training – up to 6th -7th module under completion. ASHA Ghar provision made at DH (Rs.3000) & PHC (Rs.1500) State & District Mentoring groups: Meetings and monitoring
UPGRADATION OF PHSC TO IPHS• All 147 PHSCs targeted for upgradation in phased manner.• All PHSCs have atleast one ANM• 56 PHSCs brought to IPHS with recruitment of second ANMs.• 139 PHSCs functional from Government Buildings• Equipment and Furniture for all PHSCs - .• Untied fund of RS 10000• Annual maintenance grant of Rs 10000
2011-12 Untied fund of RS 10000 Annual maintenance grant of Rs 10000 Construction of 4 new subcentre buildings Phamtam,Kamling, Legship & Karjee) 4 PHSCs of previous year carried over: Naya bazaar, Gangyap (under process), Majitar, Basilakha (work commenced) Provision of rewiring carried over from 2010-11 ( 10 completed 4 under process)
UPGRADATION of PHCs • All 24 PHCs functional as 24 X 7 • Upgradation to IPHS planned in phased manner. • Recruitment of Lady MOs done where no Lady MO • Staff Nurse yet to be recruited • Untied fund of Rs 25000 • AMG Rs 50000 • Corpus grant : Rs.100000 • Augmentation works in progress • Equipment and furniture in place
2011-12 Two PHSCs upgradated to PHCs: One in North & one in South Two existing PHCs proposed for upgradation to CHCs by the end of 2012. Total number of PHCs will remain at 24. Augmentation work in 16 PHCs approved & in progress. Total 22 PHCs will be completed.
CHCs• At the beginning of NRHM: No CHCs in Sikkim• Dist Hospitals designated as DH cum CHC• During 2008-09 three PHCs identified for upgradation to CHCs• Civil Works in two PHCs completed• 2 CHCs will be operational end 2012
DISTRICT HOSPITAL• All four DHs targeted to be operationalised as FRU• DH Gyalshing & Namchi functioning as FRU• DH Mangan & Singtam planned FRU by 2012.
2011-12 Corpus grant Rs.500000 Augmentation of Bld storage unit at Gyalshing Renovation and addition of 3 phase wiring for Singtam Hosptial. Extension of IRL at STNM also approved. Last years equipment for Mangan Hospital delivered.
AVAILABILITY OF CONSUMABLES RCH kits being provided in kind from GoI Essential drugs to District Hospitals provided through NRHM State ensures adequate and quality drugs through the CHSO CHCs, PHCs, DHs & SCs have atleast 2 months supply Vaccines stored at PHCs & CHCs only for a month
Procurement 2011-12 Essential drugs for DH&PHC Rs.500000/district Procurement of equipment under MH Rs.10 lakhs Equipment for NBSU 2.5 lakhs/district-under process Medicines for school health Rs.6 lakhs Hb colour scale : Rs.3 lakhs, disbursed Establishment of State & District ProMIS TOT Training Completed, additional manpower (logistic manager )to be recruited
Monitoring & Evaluation (M&E) Sensitization of 666 ASHA/link worker on MCTS completed. Workshop and training on M&E Review meeting of MCTS activities (going on) USB Modem: fund released to districts Development of website : under process Printing of HMIS register : under process
IMEP 2011-12 Construction of PITs for sharps at STNM, Mangan and Singtam: completed Colour coded charts: disbursed Trainings :completed Salary for staff : 5 incinerator operators
AVAILABILITY OF MANPOWER Specialists doctors like G&O sp, Paedriatician & Anesthetists could not be contracted State pool specialists are being posted subject to availability. Medical Officers (32), ANMs (89),GNMs (52), Lab Technicicans, X ray Techs,pharmacists and store keepers have been taken on contract to fill gaps in manpower.
Programme Management Support Unit State and All the four districts have PMSU At the state : SPM,FC,SAM, SDM & suppoting staff All the PMUs at district level have three professionals namely accountant, manager & MIS person Block Programme Management Units in place at all PHCs with one BPM & one Data person
Capacity Building Training of VHSC members: going on Management Training for MO/DPMU &BPMU Staff: completed Training of MO in Public Health CME for MOs one at each District: one completed CME for Paramedics and Nursing Staff at each District: 2 completed
MOBILE MEDICAL UNIT• All the 4 Districts are having fully functional MMU• Each district provided with 2 Buses equipped with x-ray, USG, Laboratory, audio-visual system and 1programme vehicle.• Human resources like 2MO, 1staff nurse, 1pharmacist, 2 technician and 3Drivers have been provided.• The MMU vehicles have been operationalised.• MMU are visiting the remote areas within the District jurisdiction on pre- announced date.• Total approval is of Rs.94.84 lakhs
AYUSH• Civil works for AYUSH ward & clinic for 4 Districts completed• AYUSH Drugs available• Present position : 8 AYUSH Doctors with 6 parameds on contract under NRHM.
HEALTH MELA• Rs. 5 lakhs/district• Health Mela once in a Year in 4 Districts
Research studies Impact studies under RCH II, 1 , Anemia among PWs Anemia among adolescents Impact Study of NGO Programme Assessment of NRHM and its various Component
Rural Dental Health 5 Dental Surgeon in position 1 to be recruited Equipment for 2 dental units approved & under process
OTHER SERVICES GPS Vehicle tracker Rs.9.36 lakhs Maintenance of Generators : Rs.2.4 laks