2. BACKGROUND
The evaluation of the NRHM was conducted by Programme Evaluation
Organization Planning Commission Government of India, New Delhi in 2011.
NRHM was launched by Prime Minister on 12th April 2005.
The architectural correction enshrined in the preamble of NRHM document
comprised of:
Decentralization, communitization and organizational structural reform in health sector.
Inter-sectoral convergence.
Public Private partnership in health sector.
Mainstreaming Indian system of medicines under Ayurveda, Yoga, Unani, Siddha
& Homeopathy(AYUSH).
Induction of management and financial personnel into health care and management
delivery system.
3. CONTENT
• Needs Assessment
• Programme Theory / Theory of Change
• Programme Procedure Evaluation
• Impact Evaluation
• Impact Processes
• Does evaluation suggest modification of progamme design?
• Cost Effectiveness and/ Cost-Benefit Analysis
4. NEEDS ASSESSMENT
1996 – Target Free Approach
Cairo Conference in 1994
Non coverage of rural population under NHM
a) No direct contact between Health institution and
population
b) Absence of health Infrastructure
i) Improper diagnosis
ii) No clinical testing
iii) Vaccination problem
5. Lack of Integrated approach
1) Choice of quality contraception
2) Safe and satisfying sexlife
3) Treatment of infertility
4) Pre-natal, natal and post-natal care of women
5) Adolescent education
6. PROGRAMME THEORY/ THEORY
OF CHANGE
Targeted
Group
In
program
Rural
People
Health
Infrastructure
Facility
Up gradation
Enhance awareness
&
Faith In govt.
institution
Mamta Vahan/
Vaccination/ASHA
/
ANM
Coverage of
rural people
&
Utilization of
Health facility
And Services
7. Document:-
Health Committee Report, Monthly monitoring of
Infrastructure, District Health Plan. The programme
evaluation does not specify documents used at different
health facility.
Stakeholders:-
Government of India, State Head Quarters, District
Head Quarters, NRHM Health Societies, District Program
Management Units, Chief Medical Officer/Office, Medical
Superintended Office and Rural People.
9. PROGRAMME PROCEDURE
EVALUATION
Data analysis method
-Multinomial logit regression model
Data collection method
-Household survey (7400 HH)
-Facility survey (37 District of 7 state)
10. Programme Procedure Indicators
(Quant…..)
-Antinatal care from public private health facility done
through adjusted probability.
-People behavior in delivery care
(Qualt…….)
-61% women use public institution for postnatal, 2% goes
to private institution.
-Vaccination by SCs (68%) and PHCs (9%)
11. Critique of PPE
Fix the gap between District and Block level health facility.
Co-ordination between functionaries (ASHAs, ANM etc.) and
Involvement of VHSC can bring effective change in nutrition,
sanitation and quality health services.
Provisioning of ambulances at FRUs.
Innovative incentives are required and mainstreaming for AYUSH
programme.
13. Internal Validity Threat
History
- Health facility and service was week, Higher MMR
Instrumentation
- No health personnel and institutions in rural areas.
Maturation
- Education and awareness
Mortality
- No political administrative arrangement for habitats of
the rural people for demanding health facility and
services.
14. Result of Impact Evaluation
State PNC (%) Institution
Delivery (%)
Family plan
(%)
Use of Health
Facility (%)
UP >65 45.8 42.3 44.6
MP >65 63.3 53.7 63
TN >65 96.6 63.3 94
J&k 57 38 61.6 83.5
Orissa >65 52.6 53.4 86.8
Assam >65 56.9 65.5 90.3
Jharkhand >65 46.1 54.7 69.8
15. Does evaluation suggest modification of programme design?
The evaluation done by planning commission programme
evaluation department does not specify any modification. Instead
it recommends certain procedural change and redistribution of
health services and facility.
16. Cost Effectiveness and/ Cost-Benefit
Analysis
• No cost benefit analysis done by Planning Commission Programme
Evaluation Department.
• It gives information about increase in public spending on health and family
welfare from 0.9 percent to 2-3 percent of Gross Domestic Product (GDP)
during 2005-12.
