This document provides an overview of the key elements, achievements, and challenges of the National Health Mission (NHM) in India. It discusses how NHM has strengthened India's public health system and led to important health improvements, but that challenges remain. Key interventions and priorities for the road ahead are also outlined.

1. Key elements of NHM,
Important learnings,
Challenges
Desired Interventions
April 2017

2. STRUCTURE OF THE PRESENTATION
Importance of Health and Why Public
Investment in Health ?
Why NHM?
Key Components and Approaches
Important Achievements/ Learnings
Key Interventions- Road Ahead
Why do we need to discuss Health?

3. WHY IS HEALTH SO IMPORTANT ????
“Sarve bhavantu sukhinah, sarve santu niramaya”
But Health – not only a Goal in itself, but also vital for improved
developmental outcomes
•Better Health Improves productivity
•Reduces Losses due to premature death, prolonged disability &
early retirement
•Out of Pocket Expenditure (OOPE) and catstrophic expenditure
on healthcare reduced
•Health and nutrition directly impact the scholastic
achievements- bearing on productivity and income.
•Huge employment generator- 5th in India

4. WHY PUBLIC INVESTMENT IN HEALTH?
Benefit to cost ratio for key healthcare interventions for India is 10:1
Out Of Pocket Expenditure (OOPE) is over 60% (rank 174/192
countries), catastrophic health care expenditure about 20%, Over 7%
population slip below poverty, 27% of hospitalized patients had to sell
assets or borrow
Creates millions of jobs through the much needed expansion of the
health workforce, health sector biggest employer in developed world,
5th largest employer in India.
Issues of (i) information asymmetry e.g. food/drug regulation, and (ii)
significant externalities e.g. TB, vaccination, (iii) prevention, health
promotion & public health- not addressed by market forces- Will require
government intervention
Reduces inequity of healthcare delivery, markets don’t address equity.
Countries with weak health and education parameters find it
harder to achieve sustained growth.

5. BUT LOW PRIORITY TO PUBLIC SPENDING ON HEALTH
Countries Total
Expenditure
on Health as
% of GDP*
Per capita
total
expenditure on
Health, (USD)
Government
expenditure
on Health as
% of Total
Health
Expenditure
(THE)
Government
expenditure on
Health as % of
Total
Government
Expenditure
Out of Pocket
Expenditure
as a % of
Total Health
Expenditure
India 3.8 58 30.5 4.3 60
Thailand 4.5 247 79.5 16.9 11
China 5.4 322 56 12.5 34
UK 9.3 3595 84 16.2 9
USA 17 8845 47 20 12
•Public Health & Hospitals- state subject- Centre provides only 1/3rd of total government
spend.
•Post NRHM, total Govt. health expenditure has increased from 0.92 to 1.16 % of GDP.

6. Government Health Expenditure (GHE) and Out of Pocket
Expenditure (OOPE) as percentage of Total Health Expenditure (THE)
62.4
45.8
42.1
32.0
25.5
14.1 14.0 13.2 11.9 11.0 9.7
6.3
30
52.2
56.1 55.8
46.0
84 83.6
77 77.8
48.3
83.1
78.2
OOPE as % of THE GHE as % of THE

7. To increase public investments in Health- only 0.9% of
GDP-by Union (20%) & State Governments (80%)=> High
Out of Pocket Expenditure.
To strengthen State’s Health systems- logistics,
infrastructure, human resource, ambulances etc.
To create an architecture for integration of vertical
programmes.
To address Inter- State and rural-urban disparities in health
care availability & health outcomes
Why was the NRHM launched ?

8. Communitize Need Based
Planning &
Financing
N(R)HM - Main Approaches
Monitor
Progress
Health System
Strengthening
Improved
Management
More money
for health
More health for
money

9. NATIONAL HEALTH MISSION - BACKGROUND
• NRHM (NHM) goals largely aligned to the achievement of MDGs
 Thrust was on Reproductive, maternal, child health and major
communicable diseases of TB, vector borne diseases etc
 Effective implementation of programmes envisaged
strengthening of public health system.
 MDG 4 – To reduce Under 5 Mortality
Rate by two thirds by 2015
 MDG 5- To reduce the maternal mortality
ratio by 75 percent from 1990 level by
2015
 MDG 6 – Combat HIV/ AIDS, Malaria
and other diseases such as TB
Millennium Development Goals (MDG)
Adopted
in
2000
3 out of 8
MDGs
related to
Health

10. NATIONAL HEALTH MISSION – SCHEMATIC
COMPONENTS
NRHM-
RCH
Pool
National
Urban Health
Mission
• RMNCH+ A - Reproductive, Maternal,
Neonatal, Child & Adolescent Health
• Universal Immunization Programme-
Routine Immunization & Pulse Polio
Immunization
• Health System Strengthening – ASHAs,
Human Resources including AYUSH,
Infrastructure, Mobile Medical Units,
Ambulances, Drugs, Diagnostics and
Equipment, Quality Assurance & Kayakalp,
IEC etc
• To provide primary care services to urban
population particularly the urban poor and
vulnerable population, operationalised in 2014

11. NATIONAL HEALTH MISSION – SCHEMATIC COMPONENTS
Communicable
Diseases Pool
Infrastructure
Maintenance
• Revised National TB Control Prog (RNTCP)
• National Leprosy Elimination Prog (NLEP)
• National Vector Borne Disease Control Prog
(NVBDCP)
• Integrated Disease Surveillance Project (IDSP)
• Provide salaries of Auxiliary Nurse Midwives
(ANMs) and the Lady Health Visitors (LHVs)
etc
Non
Communicable
Diseases Pool
operationalised
from 2013-14
• National Prog. For Prevention & Control of
Cancer, Diabetes, Cardiovascular Diseases &
Stroke (NPCDCS)
• National Prog. for Control of Blindness (NPCB)
• National Mental Health Prog.(NMHP)
• National Prog. for Health Care of Elderly
(NPHCE)
• National Tobacco Control Prog. (NTCP)

12. Key NHM Interventions

13. About 13.5 lakh
Additional Human
Resources including
ASHAs
Over 31,600
New Constructions
Over 36,200
Renovation/
Upgradations
Over 22000
Ambulances
operational
Around 2700
FRUs
operationalized
Around 9200
Nearly 3 fold
increase over
baseline

14. • 18,300 New Born Care Corners
• 2,300 Newborn Stabilization
Units
• 660 Special Newborn Care
Units
• 965 Nutritional Rehab Centres
• 30000 additional
beds in 495
Maternal & Child
Health Wings
• 200 skills labs
sanctioned

15. 9.45 lakh Accredited Social Health
Activist (ASHA) engaged
5.12 lakh Village Health Sanitation and
Nutrition Committees constituted
(VHSNCs)
28906 Rogi Kalyan Samitis constituted
(Patient Welfare Societies)
VHSNC and RKS empowered with Untied
Grants, decision making powers enhanced
STRENGTHENING COMMUNITY PROCESSES

16. NHM Process of Approvals
• Bottom Up planning- Integrated District Health
Action Plans (DHAPs) through DHS & DPC/ZP
• States prepare their PIPs in light of their
healthcare needs, context and national priorities-
One of the most flexible programmes e.g
specialists salaries vary from Rs 60,000 to
200,000
• The GB and State Health Missions have
representation of all relevant departments/ sectors

17. IMPACT OF NHM

18. Out of total
polio cases
across the
world
India
India accounted for over 50
percent of the polio cases
In 2009…..
In
2014…...
India certified as ‘Polio-free’ by WHO in March 2014 and has
since maintained the status - A Monumental Success
Maternal & Neonatal Tetanus (MNT) and Yaws– ELIMINATED
!!
Polio, Yaws and Maternal & Neonatal Tetanus

19. 91
62
43
126
69
45
40
50
60
70
80
90
100
110
120
130
140
1990 1996 2002 2008 2014
Global India
• In 1990, India carried a 40 % higher burden of child mortality as
compared to global average.
• Rate of decline more than doubled from 3.3% in 1990-2008 to 6.9 % in
2008-2014.
• Total 11.7 lakh deaths have been averted from 2009 to 2014 because
of accelerated decline.
• India likely to achieve the MDG4
India’s Progress on MDG4 - Under 5 Mortality Rate
56
2.92 lakh
lives
saved in
2014
Decline
3.3%
Decline
6.9%

20. • MMR in India declined 59 % faster than the global MMR
• India projected to reach MDG 5.
India’s Progress on MDG 5 – Maternal Mortality Ratio
556
380
1990 2011-13
India
Global
167
216

21. India’s Progress on MDG 6 -to reverse the incidence of
Malaria , TB and HIV/AIDS - Achieved
Tuberculosis
• Incidence reduced from 300/ lakh in
1990 to 217/ lakh in 2015
• Mortality reduced from 76/ lakh in 1990
to 32/ lakh in 2015,
• 2.70 Lakh lives saved annually
Malaria
• 60.12% reduction in the mortality rate
and 35.63% reduction in the incidence of
Malaria in 2015 as against 2005.
HIV/AIDS
• 67 % decline in new infections since 2000
against global average of 35%
• 54 % decline in AIDS related deaths
since 2006-07 against global average of
41%

22. Insights from NSSO – 71st Round (Jan-June, 2014)
Public
Private
Public
Private
IPD OPD
42 58
28
64
32
68
22
73
% Utilization of Public
and Private services -
Rural v/s Urban Areas
Public
Private
Public
Private
IPD OPD
5920
24129
9807
17049
R…
OOPE (in Rs) in Public
and Private sector –
Rural v/s Urban Areas

23. 2004-05 2014
1162 872
4137
8128
Public Private
•Childbirths in public health
facilities increased by 131.63% compared
to 2004
•Reduction in average
medical expenditure in public health
facilities, costs about 1/10th of that in
private sector
Insights from NSSO – 71st Round (Jan-June, 2014)-NHM Impact
Average medical expenditure in
Child Birth in Rural areas
70
%
30
%
Rural Areas
Public
Private
47
%
53
%
Urban Areas
Institutional Deliveries

24. KEY HEALTH INDICATORS:
Despite some impressive progress, Where does India stand
Indicator India China Brazil Sri
Lanka
Thailand
MMR/ 100000 live- births* 167** 27 44 30 20
Under-5 mortality/
1000 live- births
43** 12.7 13.7 9.6 13.1
Immunization coverage
among 1-year-olds (DPT-3) (%)
72 99 95 99 99
Life Expectancy 66 75 75 75 75
OOPE as a % of Total health
expenditure
60 32 25 42 08
44000 plus mothers die every year, more deaths in a week in India
than in a whole year in Europe

25. 8 EAG States & Assam
Contribute…
• 50% of India's
Population
• 58% of Child Births
• 70% of Infant Deaths
• 72% of Under 5
Mortality
• 80% of Maternal
Mortality

26. Moving From MDGs to SDGs

27. Sustainable Development Goals
- 17 Goals, 169 targets & 230 indicators
- 1 Health Goal, 13 targets & 26 indicators 27

28. Target 1.3:
Implement
social
protection
systems for
all
Target 6.1:
achieve universal
& equitable
access to safe and
affordable
drinking water
Target 5.2: end all
forms of violence
against all women and
girls ….
Target 4.2: ensure
access to early
childhood
development, care
and pre-primary
education …
Target 16.1: reduce
all forms of violence
and related death
rates everywhere
Other goals and targets e.g. 10 (inequality), 11 (cities), 13 (climate change)
Health is linked to other SDGs and targets
as contributor and beneficiary
Target 2.2: end
malnutrition, achieve
targets for reductions
child stunting &
wasting
28

29. The National Health Policy- 2017
29
• Strong political commitment
• Goal
‘attainment of highest possible level
of health and wellbeing for all at all
ages, through a preventive and
promotive healthcare orientation in all
developmental policies, and universal
access to good quality health care
services without anyone having to face
financial hardship as a consequence’
Well aligned to SDG3 including
Universal Health Coverage
(UHC)

30. Key Effective Interventions
Neonatal Care (First 28 days) (high institutional deliveries –
major opportunity) - NMR/ U5MR is 25/43.
Labour Room Practices -Quality of Intra partum and Immediate
Post partumcare
Breast feeding (1st vaccine)
Improve access to FRUs i.e. Comprehensive Emergency
Obstetric & Neonatal Care including access to safe blood eg: 80%
shortfall in UP despite NHM flexibility
RMNCH+ A –Continuum of care approach
Improved implementation of Rashtriya Bal Swasthya
Karyakram- Early Screening, referrals to DEIC & intervention
Anemia Management (oral and injectable Iron, diet)
Robust monitoring, active case finding and compliance, ensuring
private sector participation for TB- major threat

31. Key Interventions
Comprehensive Primary Health Care - 12 essential services, universal
health check-up & Screening for NCDs and management, improve usage
of public health facilities
Transform Sub- Health Centres as Health & Wellness Centres with mid-
level providers (Nurses & Ayurveda doctors trained in public health &
primary care through Bridge Course)
Special attention to NPCDCS and Mental Health Programmes
Strengthening DHs as Multi-specialty care and site for trainings
Focus on High Priority Districts/ Blocks-
Strengthen monitoring-Use Data (HMIS/MCTS)-evidence based action
Implement Public Health Interventions across sectors
Partnership with NGOs and Private sector
Use of technology for health transformation, health promotion

32. Key Interventions
Essential Drugs & Diagnostics (Often through PPP) -free of cost
in public health facilities
Patient centric care- safety and with dignity- mera aspatal,
Quality Assurance and Kayakalp
Health Systems integrated approach for human resource
Use NHM flexibility- Align incentives (financial and non-
financial) to service providers to get desired behavior including
quality of care, design good contracts and monitor
Pay maximum importance to quality recruitment

33. YOUR ROLE IN HEALTH?
All of us have very important roles to play in achievement of
SDG targets-mutually interdependent and contributory
Impact of Social determinants- Convergence & coordination
extremely important to improve health outcomes- only 40%
contribution of health sector
Collector/ DM – Chairperson of the District Health Society and
Rogi Kalyan Samities of the District Hospitals- improve service
quality including patient satisfaction- Mera aspatal
Implementation
Huge flexibility under the NHM- DMs oversee the design and
implementation of District Health Action Plans under the NHM,
DPC and Zila Panchayat oversee health care delivery, monitor the
progress under the NHM, RSBY etc
Public investment in Health is decided by people amongst us.
LEADERSHIP MATTERS THE MOST - QUICK RESULTS AND
BIPARTISAN SUPPORT FOR HEALTH IMPROVEMENTS

34. A small body of determined
spirits fired by an
unquenchable faith in their
mission can alter the course
of history. ….
-Mahatma Gandhi

35. FATE OF 1000 NEWBORNS
DEATHS CUMULATIVE &
INDICATOR
First 1 week 22
1- 4 weeks 6 more 28- Neonatal Mortality
Rate
1 – 12 months
(next 48 weeks)
12 more 28+12= 40
Infant Mortality
1- 5 years
(next 48 months)
9 more 40+9= 49
Under 5 Mortality
Still-birth Rate -4
~45% U5MR in first week
~33% of U5 MR In <72 hours
~25% of U5MR in 24 hours
Back to main
presentation

36. FOR WOMEN, STILLBIRTHS, NEWBORNS, THE
TIME OF HIGHEST RISK IS THE SAME
1.2 million intrapartum
stillbirths
>1 million neonatal deaths
~113,000 maternal deaths
75% neonatal
deaths
Birth day
Birth is the time of greatest risk of
death and disability
Source: Lancet Every Newborn series,
paper2
Back to main
presentation

37. Comparison of burden of TB, HIV and
Malaria in India
Size of bubble proportionate to deaths
Tuberculosis
HIV
Malaria
Disease DALY* Deaths
Malaria 287.18 562
HIV 520.21 67,000
TB 1258.37 4,80,000
*per 100,000 population
0
200
400
600
800
1000
1200
1400
1600
DALYsper100,000population
Back to Main Presentation

38. Stunting in early childhood associated with cognitive and educational
deficits in late adolescence, current programmes targeted to
height/weight related consequences of malnutrition, ECCE- stimulation
very critical
Back to Main
Presentation

40. INDIA: RISING NCD BURDENS
2011
(in Millions)
2030
(in Millions)
Diabetes 61 101
Hypertension 130 240
Tobacco Deaths 1+ 2+
PPYLL Due to CVD Deaths
(35-64 Yrs)*
9.2 (2000) 17.9
*Potentially Productive Years of Life Lost (PPYLL) Due To Cardiovascular
Deaths Occurring in The Age Group of 35-64 Years
India stands to lose $4.58 trillion between 2012 and 2030 due to non-
communicable diseases- World Economic Forum
Back to Main presentation

41. What risk factors drive the most death and disability
combined?
GBD, 2015
Back to Main
presentation

42. Top Ten causes of death in India & corresponding shortage of
HR
(* Source: Association of Healthcare Providers (India))
Sl.
No.
Cause Discipline
India – Practising
specialists (Current /
required)
India
PG seats
(Current / required)
1 Diseases of Heart Cardiology 4,000 / 88,000 268 / 3,200
2 Diarrhoeal Disease Paediatric 20,000 / 225,000 1,200 / 10,500
3
Chronic Lower
Respiratory
Disease
Chest Medicine 1,200 / 23,000 329 / 2,000
4 Stroke Neurologist 1,100 / 52,000 171 / 2,800
5
Flu and
Pneumonia
Chest Medicine 1,200 / 23,000 329 / 2,000
6 Tubeculosis Chest Medicine 1,200 / 23,000 329 / 2,000
7 Low birth weight Pediatrics 20,000 / 225,000 1,200 / 10,500
8
Mental disease
leading to suicide
Psychiatry 4,000 / 152,000 417 / 5,250
9 Liver disease Gastroenterology 2,000 / 54,000 102 / 1,800
10 Accidents
Orthopedic Surgeon /
General Surgeon /
Neuro Surgeons
9,000 (77,000) / 18,000
(100,000) / 1,400 (20,600)
978 (3,300) /
2,124 (10,000) /
204 (800)
Back to Main
presentation

43. Functionality of Facilities- Inefficiencies
Jammu & Kashmir
No. of PHCs/ CHCs/excluding CHC-FRUs/DH 508
No. which are delivery points 131 (25 %)
No. of CHCs (FRU & non- FRU)/ excluding
CHC-FRUs/ DH
107
No. conducting C- Sections 53 (49. 53 %)
Madhya Pradesh
No. of PHCs/ CHCs/excluding CHC-
FRUs/DH
1305
No. which are delivery points 538 (41 %)
No. of CHCs (FRU & non- FRU)/ excluding
CHC-FRUs/ DH
149
No. conducting C- Sections 94 (63.09 %)

44. MANIPUR - Data Use-Performance of Public Facilities – OPD Oct –Dec. 2016
Facility Type DH SDH CHC PHC SC
Total no. of
public facilities
7 1 17 87 421
No. reporting nil
performance
0 0 0 2 66
Performance
Max to Min
Ratio
14 1 19 303 517
Maximum
26681
Churachandp
ur District
Hospital
3235
SDH
Moreh
8160
CHC
Nambol
6077
PHC
Oinam
1034
PHSC
Kshetrigao
Minimum
1901
Chandel
District
Hospital
3235
SDH
Moreh
414
CHC
Kamjong
20
PHC
Chingai
2
PHSC
Kullian
No. of
facilities by
performance
(FY 2016-17)
1 to 300 0 0 0 24 347
301 to 1500 0 0 5 44 8
1501 to 3000 2 0 5 11 0
> 3000 5 1 7 6 0

45. Data Use-Performance of Public Facilities – IPD Oct –Dec. 2016
Facility Type DH SDH CHC PHC
Total no. of
public
facilities
7 1 17 87
No. reporting
nil
performance
0 0 0 33
Performance
Max to Min
ratio
8 1 79 220
Maximum
2707
Churachandpur
District Hospital
215
SDH Moreh
476
CHC
Kakching
220
PHC
Khoirom
Minimum
329
Ukhrul District
Hospital
215
SDH Moreh
6
CHC Sugnu
1
PHC
Jessami
No. of
facilities by
performance
1 to 300 0 1 13 54
301 to 1500 6 0 4 0
1501 to 3000 1 0 0 0
> 3000 0 0 0 0

46. HR Status
Position
Require
d
Regular Contractual
Sanctione
d
In-
positio
n
Vacancy
Sanctione
d
In-
positio
n
Vacancy
No. % No. %
ANMs 599 635 542 93 15% 458 444 14 3%
Staff
Nurses
829 605 566 39 6% 275 253 22 8%
Lab
technicians
166 103 91 12 12% 95 75 20
21
%
Pharmacist
s
178 341 279 62 18% 12 12 0 0%
Medical
Officers
233 1722 955 767 45% 28 28 0 0%
Obstetricia
ns/ Gyn
33 27 22 5 19% 4 0 4
100
%
Pediatrician
s
32 26 15 11 42% 5 0 5
100
%
Anesthetist
s
32 25 20 5 20% 2 0 2
100
%
Other
specialists
136 223 56 167 75% 26 0 26
100
%
Back to main
presentation

47. Indicator India
Total Rural Urban % differential
TFR (2013) 2.3 2.5 1.8 39% difference
IMR (2015) 37 41 25 64% difference
Rural Urban Differential
27.1 % (1.83/6.75 Lakh)
hospital beds cater to Rural
population - (CBHI)
About 80 % of Doctors
are in Urban areas–
(KPMG)

48. 235
MMR: 244
IMR: 43
230
66
90
87
Inter
State
Variati
ons-
MMR
and
(IMR)
vary 5-
fold
across
states
IMR:
10
MMR: 221
IMR: 50
MMR: 300
IMR: 47
MMR: 68
IMR: 21
MMR: 208
IMR: 42
MMR: 79
IMR: 19MMR: 61
IMR: 12

49. Inter- District Variation
Indicator Bad
Performing
Good Performing
Three or more
antenatal
check-up
44.3
(Sheopur)
89.4 (Balaghat)
Institutional delivery (%) 49.8
(Dindori)
93.0 (Guna)
Children 12-23 months
fully immunized (%)
40.8
(Umaria)
83.5 (Indore)
Children under 3 years
breastfed within one hour
of birth
46.9
(Neemuch)
84.1 (Guna)
Annual Health Survey – Madhya Pradesh

50. Wealth Category Differentials NFHS-3
Indicator Lowest
Wealth
Quintile
Highest
Wealth
Quintile
% differential
TFR 3.89 1.78 118%
IMR 70.4 29.2 141 %

51. Key Output Indicators
Tribal
Population
Others
Communitie
s (Excluding
SCs & OBCs)
% Deviation
from other
Communties
Infant Mortality Rate (IMR) 62.1 48.9 27%
Under 5 Mortality Rate
(U5MR)
95.7 59.2 62%
% Children Undernourished
(Weight for Age)
54.5 33.7 62%
% women with anaemia 68.5 51.3 34%
% Women with BMI<18.5 46.6 29.4 59%
% Men with BMI<18.5 41.3 28.9 43%
Total Fertility Rate 3.12 2.35 33%
Source: NFHS 3 Back to Main presentationNFHS-3

52. Shortfall of Infrastructure
Public Health
Infrastructure
Required Existing Shortfall
*
%
Shortfall
Community
Health Centres
(CHCs)
7322 5396 2316 30 %
Primary health
Centres (PHCs)
29337 25308 6556 22 %
Sub Centres
(SCs)
179240 153655 35145 20 %
Back to Main
presentation

53. Shortfall of Human Resources
WHO
norm
Current Position in India
Doctors 1:1000 1:1800 (Additionally, there are
7.9 Lakh AYUSH practitioners
registered in the country)
Nurses& mid-
wives
1:300 1:800
Severe human resource constraint
2/3rd of All MBBS seats in 6 States (4 Southern and 2 Western
States of Maharashtra & Gujarat)

54. Top Ten causes of death in India & corresponding shortage of HR
(* Source: Association of Healthcare Providers (India))
Sl.
No.
Cause Discipline
India – Practising
specialists (Current /
required)
India
PG seats
(Current / required)
1 Diseases of Heart Cardiology 4,000 / 88,000 268 / 3,200
2 Diarrhoeal Disease Paediatric 20,000 / 225,000 1,200 / 10,500
3
Chronic Lower
Respiratory
Disease
Chest Medicine 1,200 / 23,000 329 / 2,000
4 Stroke Neurologist 1,100 / 52,000 171 / 2,800
5
Flu and
Pneumonia
Chest Medicine 1,200 / 23,000 329 / 2,000
6 Tubeculosis Chest Medicine 1,200 / 23,000 329 / 2,000
7 Low birth weight Pediatrics 20,000 / 225,000 1,200 / 10,500
8
Mental disease
leading to suicide
Psychiatry 4,000 / 152,000 417 / 5,250
9 Liver disease Gastroenterology 2,000 / 54,000 102 / 1,800
10 Accidents
Orthopedic Surgeon /
General Surgeon /
Neuro Surgeons
9,000 (77,000) / 18,000
(100,000) / 1,400 (20,600)
978 (3,300) /
2,124 (10,000) /
204 (800)
Back to Main presentation

55. Shifting Disease burden trends
(MDG vs SDG era)
Tuberculosis
Lower Respiratory Infection
Ischemic Heart Disease
Diarrheal Disease
COPD
Neonatal Encephalopathy
Neonatal Premature Birth
Asthma
Hemorrhagic Stroke
Other Neonatal
2015Source: Global Burden of Disease, 2015, IHME
55
1990
Top 10 Causes of Premature Deaths India (both sexes, all ages)
Tuberculosis
Lower Respiratory Infection
Ischemic Heart Disease
Diarrheal Disease
COPD
Neonatal Encephalopathy
Neonatal Premature Birth
Cerebrovascular Diseases
Self harm
Road Injuries

56. The key pillars- National Health Policy
Make-In-IndiaforahealthyIndia
Digitalinterventionsforthenation's
health
Betterregulatorymechanismsand
qualitycontrol
lntersectoralconvergencefor
holistichealthcaredelivery
Preventiveandpromotivefocus
withpluralisticchoice
Universal,easilyaccessible,
affordableprimaryhealthcare
FosteringPatient-focus,qualityand
anassurancebasedapproach
Systemstrengtheningandstrategic
engagements
Universal Health Coverage

57. Key Challenges
• Affordability – Nearly 60% of all health care expenditure is Out of Pocket
Expenditure, nearly 3% of population every year goes below poverty line on
account of health care costs.
• Low public financing for health, poor risk pooling through low health insurance
coverage
• Equity -Wide disparities in health outcomes across geographies/states, wide
variation in rural and urban scenario and also among different social and
economic categories, wide intra-state variations also
• Complexity - Many players, private sector –major player but poor regulation on
cost and quality, multiple sectors that impact on health outcomes.
Public health being a state subject, so the wide variations in
states in governance, regulation, socio-economic development,
values are reflected in health scenario across states, limitation in
driving reforms.
• Availability - Shortfall in facilities, inadequate infrastructure, Poor logistics and
supply arrangements to ensure essential drugs and supplies,
• Evidence based policy and programme generally lacking in many states- poor
data quality and utilization – what works and what doesn’t and in what context-
evidence based interventions that give highest returns

58. Key Challenges
• Triple burden of Diseases- Persisting maternal & child health and
communicable diseases challenges, growing burden of lifestyle
diseases - NCDs (60% mortality) and new, emerging & re-emerging
diseases
• Lack of comprehensive Primary Health Care- Disease Prevention
including screening for NCDs and their management, Health
Promotion
• Severe human resource constraints
• Inefficient health service delivery
• Convergence - Social and other determinants- Nutrition, sanitation,
girls education, indoor air pollution, tobacco etc
• Poor Quality in public sector- Poor accountability and community
involvement
• Transformative potential of technology yet to be fully tapped.

59. AYUSH
Finance
WCD
Public
Health
Engineerin
g
Water
and
Sanitatio
n
Planning
&
Program
me
Executio
n
Rural
Developme
nt
Triba
l
Welfa
re
Urban
Affairs
Health
&
Family
Welfare
State
Health
Mission
Source: http://mohfw.nic.in/NRHM%20state%20and%20district%20health%20mission-institutional%20setup.htm
Departments under State Health Mission

60. Findings from NSS 71st Round
ANNUAL AVERAGE
OOPE - All India (In Rs.)
Public Private
OP 9804 17055
IP 5920 24129
Child
birth
1679 16436
HEALTHCARE
UTILIZATION - ALL
INDIA
Public Private
OP 26% 74%
IP 38% 62%
Child
birth
64% 36%
Insurance Coverage
•The coverage provided by Govt. funded insurance schemes
– 13.1% of rural population and 12% urban
• Private insurance provides coverage for 0.3% of the
rural population and 3.5% of the urban population