1. National Rural Health Mission
Meeting people’s health
needs in rural areas

2.  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

3.  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.

4. 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.

5. 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.

6. Expected Outcomes at community
level
 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.

7. Institutional Framework
National Steering Group
Mission Steering Group
Empowered Programme Committee
Mission Directorate
State Health Mission
District Health Mission ------------Rogi Kalyan Samitis
Panchayat
Village Health Village Health Village Health
Committee Committee Committee

8. COMPONENTS OF NRHM
 PART A- RCH PROGRAMME
 PART B – NRHM ADDITIONALITIES
 PART C- IMMUNIZATION
 PART-D- NATIONAL DISEASE CONTROL
PROGRAMME
 PART E- CONVERGENCE

9.  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.

10. 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.

11. 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.

12. Village Health & Sanitation
Committees
• 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.

13. 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

14. 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

15. 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

16. 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)

17. 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

18. 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.

19. 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

20. DISTRICT HOSPITAL
• All four DHs targeted to be operationalised
as FRU
• DH Gyalshing & Namchi functioning as FRU
• DH Mangan & Singtam planned FRU by
2012.

21. 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.

22. 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

23. 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

24. 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

25. 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

26. 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.

27. 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

28. 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

29. 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

30. 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.

31. HEALTH MELA
• Rs. 5 lakhs/district
• Health Mela once in a Year in 4
Districts

32. 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

33. Rural Dental Health
 5 Dental Surgeon in position
 1 to be recruited
 Equipment for 2 dental units approved &
under process

34. OTHER SERVICES
 GPS Vehicle tracker Rs.9.36 lakhs
 Maintenance of Generators : Rs.2.4 laks

35. Thank You