The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health system strengthening in rural and urban areas, ReproductiveMaternal-Neonatal-Child and Adolescent Health (RMNCH+A) and Communicable and NonCommunicable Diseases. The NHM envisages achievement of universal access to equitable, affordable & quality healthcare services that are accountable and responsive to people’s needs.

1. Dr.Anjalatchi Muthukumaran
Vice principal
Era college of nursing
UNIT-II
NATIONA HEALTH MISSION
(NHM)

2. Content to be discussed
 Abbreviation
 Terminology
 Introduction
 NHM component
 Goal
 Thurst area
 NRHM Guidelines
 NUHM guidelines
 Questions related to topic
 Summary
 Conclusion
 References

3. Abbreviation
 Program Implementation Plans (PIPs)
 National Health Mission (NHM)
 National Urban Health Mission (NUHM)
 National Rural Health Mission (NRHM)
 Reproductive-Maternal- Neonatal-Child and
Adolescent Health (RMNCH+A),

4. Terminology
 NHM: The National Health Mission (NHM)
encompasses its two Sub-Missions, the National
Rural Health Mission (NRHM) and the National Urban
Health Mission (NUHM). The main programmatic
components include Health system strengthening in
rural and urban areas,
 National Rural Health Mission (NRHM): NRHM
seeks to provide quality healthcare to the rural
population, especially the vulnerable groups
 National Urban Health Mission (NUHM): NUHM
seeks to improve the health status of the urban
population particularly urban poor and other
vulnerable sections by facilitating their access to
quality primary healthcare.

5. NATIONAL HEALTH MISSION
 The National Health Mission (NHM) encompasses its
two Sub-Missions, The National Rural Health
Mission (NRHM) and The National Urban Health
Mission (NUHM).
 The main programmatic components include Health
System Strengthening, Reproductive-Maternal-
Neonatal-Child and Adolescent Health (RMNCH+A),
and Communicable and Non-Communicable
Diseases.
 The NHM envisages achievement of universal
access to equitable, affordable & quality health care
services that are accountable and responsive to
people’s needs.
 Continuation of the National Health Mission - with
effect from 1st April 2017 to 31st March 2020 has
been approved by Cabinet in its meeting dated
21.03.2018.

6. NHM components
 RMNCH+A
 Health systems strengthening
 Communicable diseases
 Non communicable diseases
 Health infrastructure maintenance

7. Six financing components:
 (i) NRHM-RCH Flexipool,
 (ii) NUHM Flexipool,
 (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.

8. National parameter and priorities
 Within the broad national parameters and
priorities, states would have the flexibility to plan
and implement state specific action plans.
 The state PIP would spell out the key strategies,
activities undertaken, budgetary requirements
and key health outputs and outcomes.
 The State PIPs would be an aggregate of the
district/city health action plans, and include
activities to be carried out at the state level.

9. Advantages of PIP
 The state PIP will also include all the individual
district/city plans.
 This has several advantages:
 one, -it will strengthen local planning at the
district/city level,
 two,- it would ensure approval of adequate
resources for high priority district action plans,
and
 three,- enable communication of approvals to the
districts at the same time as to the state.

10. Fund &technical support
 The fund flow from the Central Government to the
states/UTs would be as per the procedure prescribed
by the Government of India.
 The State PIP is approved by the Union Secretary of
Health & Family Welfare as Chairman of the EPC,
based on appraisal by the National Program
Coordination Committee (NPCC),
 which is chaired by the Mission Director and includes
representatives of the state, technical and program
divisions of the MoHFW,
 national technical assistance agencies providing
support to the respective states, other departments of
the MoHFW and other Ministries as appropriate.

11. Forward Linkages Scheme to
NRHM in NE :
 With a view to complement & supplement the initiatives
under the NRHM for improving the Secondary/Tertiary
level and Other health infrastructure in the north eastern
region,
 the Forward Linkage Scheme to NRHM was introduced in
the 11th Plan (to be financed form likely saving from other
Health schemes). This scheme was also continued in the
12th Plan.
 The project proposals sent by the NE States are appraised
and for the approved projects, funds are released by the
Ministry.
 Presently the Scheme has been approved by the
Government for implementation upto the current Financial
Year i.e. 2018-19 for Ongoing projects only.
 The Forward Linkages Scheme was earlier a 100%
Central Sector Scheme. However, the Government has
recently revised the sharing pattern of the Scheme to
90:10 ratio between the centre and State during the
current year.

12. Goals :
 Outcomes for NHM in the 12th Plan are
synonymous with those of the 11th Plan and are
part of the overall vision.
 Specific goals for the states will be based on
existing levels, capacity, and context. State
specific innovations would be encouraged.
Process and outcome indicators will be
developed to reflect equity, quality, efficiency, and
responsiveness.
 Targets for communicable and non-
communicable diseases will be set at state level
based on local epidemiological patterns and
taking into account the financing available for
each of these conditions.

13. Continued
 The endeavor would be to ensure the
achievement of indicators in Box 1 as follows :
 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, non- communicable; injuries and
emerging diseases

14. Continued
 6. Reduce household out-of-pocket expenditure
on total health care expenditure
 7. Reduce annual incidence and mortality from
Tuberculosis by half
 8. Reduce the 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 percent microfilaria prevalence in
all districts
 11. Kala-azar Elimination by 2015, <1 case per
10000 population in all blocks

15. NRHM
 The National Rural Health Mission (NRHM) was
launched by the Hon’ble Prime Minister on 12th
April 2005.
 The Union Cabinet vide its decision dated 1st
May 2013, has approved the launch of National
Urban Health Mission (NUHM) as a Sub-mission
of an over-arching National Health Mission
(NHM), with National Rural Health Mission
(NRHM) being the other Sub-mission of National
Health Mission.

16. INDIAN PUBLIC HEALTH
STANDARDS
 National Rural Health Mission (NHM) was launched in the year 2005 to strengthen
the Rural Public Health System and has since met many hopes and expectations.
 The Mission seeks to provide effective health care to the rural populace throughout
the country with special focus on the States and Union Territories (UTs), which have
weak public health indicators and/or weak infrastructure.
 Towards this end, the Indian Public Health Standards (IPHS) for Sub-centres,
Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub-District
and District Hospitals were published in January/ February, 2007 and have been
used as the reference point for public health care infrastructure planning and up-
gradation in the States and UTs.
 IPHS are a set of uniform standards envisaged to improve the quality of health care
delivery in the country. The IPHS documents have been revised keeping in view the
changing protocols of the existing programmes and introduction of new programmes
especially for Non-Communicable Diseases. Flexibility is allowed to suit the diverse
needs of the States and regions.
 These IPHS guidelines will act as the main driver for continuous improvement in
quality and serve as the bench mark for assessing the functional status of health
facilities.
 States and UTs should adopt these IPHS guidelines for strengthening the Public
Health Care Institutions and put in their best efforts to achieve high quality of health
care across the country.

17. Guidelines
 strengthening the Public Health Care Institutions
and put in their best efforts to achieve high quality
of health care across the country.
 IPHS Revised Guidelines 2012
 IPHS Facility Survey Formats

18. Goal of NRHM
 To provide accessible, affordable and quality
health care to the rural population, especially the
vulnerable groups.

19. Thrust Area of NRHM
 The 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
 20 point program such as water, sanitation,
education, nutrition, social and gender equality.
 Institutional integration within the fragmented
health sector was expected to provide a focus on
outcomes, measured against Indian Public Health
Standards for all health facilities.

20. Executive Summary
 The National Rural Health Mission (NRHM) was launched by the
Hon’ble Prime Minister to provide accessible, affordable and
quality health care to the rural population, especially the
vulnerable groups.
 The key features in order to achieve the goals of the Mission
include making the
 public health delivery system fully functional and accountable to
the community,
 human resources management,
 community involvement,
 decentralization,
 rigorous monitoring & evaluation against standards,
 the convergence of health and related program from village level
upwards, innovations and
 flexible financing and also interventions for improving the health
indicators.

21. INSTITUTIONAL SETUP UNDER
NRHM
At the National level, the NHM has a Mission
Steering Group (MSG) headed by the Union
Minister for Health & Family Welfare and an
Empowered Program Committee (EPC) headed
by the Union Secretary for Health & FW.
The EPC will implement the Mission under the
overall guidance of the MSG.

22. NHM
 Criteria for state awards pdf-
NRHM_Criteria_Awards_Final.doc

23. Institutional setup under NRHM
 Composition of SHM & SHS
 Composition of DHM & DHS

24. NATIONAL URBAN HEALTH
MISSION
The National Urban Health Mission (NUHM) as a sub-
mission of National Health Mission (NHM) has been
approved by the Cabinet on 1st May 2013.
NUHM envisages to meet health care needs of the
urban population with the focus on urban poor, by
making available to them essential primary health
care services and reducing their out of pocket
expenses for treatment.
This will be achieved by strengthening the existing
health care service delivery system, targeting the
people living in slums and converging with various
schemes relating to wider determinants of health like
drinking water, sanitation, school education, etc.
implemented by the Ministries of Urban Development,
Housing & Urban Poverty Alleviation, Human
Resource Development and Women & Child
Development.

25. Content to be discussed
 National Urban Health Mission
 Gazette Notification on NUHM
 Brochure on thematic areas under NUHM
 Manuals/ Registers
 NUHM Guidelines
 Community Processes under NUHM
 NUHM Contact

26. Goals :
 i) Need based city specific urban health care system
to meet the diverse health care needs of the urban
poor and other vulnerable sections.
 ii) Institutional mechanism and management systems
to meet the health-related challenges of a rapidly
growing urban population.
 iii) Partnership with community and local bodies for a
more proactive involvement in planning,
implementation, and monitoring of health activities.
 iv) Availability of resources for providing essential
primary health care to urban poor.
 v) Partnerships with NGOs, for profit and not for profit
health service providers and other stakeholders.


27. GAZETTE NOTIFICATION ON
NUHM
Gazette Notification on NUHM (3.49 MB)

28. BROCHURE ON THEMATIC AREAS
UNDER NUHM
 Title Download Inter Sectoral Convergence under
NUHM (2.65 MB)
 Strengthening Human Resources for Health
Under NUHM (3.50 MB)
 Quality Assurance (655 KB)
 NUHM and Medical Colleges -Collaboration to
Strengthen (2.10 MB)IEC/BCC under
NUHM (505 KB)
 Community Process Under NUHM (665 KB)
 NUHM Thrust Areas for States (125 KB)

29. MANUALS/ REGISTERS
Orientation Module for Planners, Implementers and
Partners (1.67 KB)
Presentations for Orientation module for planners,
implementers and partners (4.02 KB)
Technical Resource Group (TRG) on NUHM (15.1
KB)
NUHM Brand Mannual (66 MB)

30. Format of Registers for UPHC
 DO letter for registers at UPHC (255 KB)
 General Registers (95 KB)
 RCH Register Cover and Profile pages (310
KB)RCH Register Section-1 (3.85 MB)
 RCH Register Section-II (6.30 MB)
 RCH Register Section-III (61.90 MB)
 RCH Register Section-IV back cover (375 KB)

31. NUHM GUIDELINES
 Program Safeguard Systems Assessment under
the proposed ADB project "Strengthening CPHC
in Urban Areas" under PM-ASBY (560 KB)
 Operational Guidelines Extension of Swachh
Swasth Sarvatra for Urban Areas (713 KB)
 Framework on Convergence (7.86 MB)
 NUHM Innovation Framework (1006 KB)
 Extension of Kayakalp Guidelines in urban
areas (1.50 MB)
 Guidebook for Enhancing the Performance of
ANM in urban areas (810 KB)
 Capacity Building Framework for Strengthening
Implementation of NUHM (615 KB)

32. Continued
 Guidelines & Tools for Vulnerability Mapping and
Assessment for Urban Health (1.35 MB)
 NUHM Financial Management Guidelines (2.00 MB)
 Model RFP and SLA to Maintain and Operate
UPHC (200 KB)
 Guidelines for Quality Standards UPHC under
NUHM (3.15 MB)
 Operational Guidelines for Conducting Outreach
Session in Urban Areas (3.75 MB)
 NUHM PIP Guidelines for F.Y. 2016-17 (705 KB)
 NUHM PIP Guidelines for F.Y. 2013-14
(244 KB)
 Guidelines for Community Process (2.02 MB)

33. COMMUNITY PROCESSES UNDER
NUHM
 Community Processes under NUHM
 ASHA/Mahila Arogya Samiti Training Module

34. Importance of NUHM
 NUHM would cover all State capitals, district
headquarters and cities/towns with a population of
more than 50000.
 It would primarily focus on slum dwellers and other
marginalized groups like rickshaw pullers, street
vendors, railway and bus station coolies, homeless
people, street children, construction site workers.
 The centre-state funding pattern will be 75:25 for all
the States except North-Eastern states including
Sikkim and other special category states of Jammu &
Kashmir, Himachal Pradesh and Uttarakhand, for
whom the centre-state funding pattern will be 90:10.
 The Program Implementation Plans (PIPs) sent by the
by the states are apprised and approved by the
Ministry.

35. Executive Summary
 In order to effectively address the health concerns of the
urban poor population, the Ministry proposes to launch a
new sub-mission National Urban Health Mission (NUHM).
 The Mission Steering Group of the NHM will be expanded
to work as the apex body for NUHM also.
 Every Municipal Corporation, Municipality, Notified Area
Committee, and Town Panchayat will become a unit of
planning with its own approved broad norms for setting up
of health facilities.
 The separate plans for Notified Area Committees, Town
Panchayats and Municipalities will be part of the District
Health Action Plan drawn up for sub-mission NUHM.
 The Municipal Corporations will have a separate plan of
action as per broad norms for urban areas.
 The existing structures and mechanisms of governance
under NHM will be suitably adapted to fulfill the needs of
sub-mission NUHM also.

36. Short answer questions(SAQ)
 Define NHM?
 Describe the meaning of NRHM?
 Describe the meaning of NUHM?
 What are the components of NHM?
 Enlist the goal of NRHM?
 List the six financing components ?
 enlist the format to be used NUHM?

37. Long answer questions(LAQ)
 Discuss about NRHM in detail?
 Describe the NUHM in detail?
 Explain the NHM and its components ?

38. Summary
 In order to ensure that enhanced fund allocations
to States/UTs and other institutions under the
NHM are fully coordinated, managed and utilized,
Financial Management Group for NHM (FMG-
NHM) has been set up at the State level

39. Conclusion

40. Guidelines
 National Rural Health Mission Institutional setup
under NRHM
 NRHM - Criteria for Assessment [70 KB]
 Indian Public Health Standards
 View More : NRHM Framework for
Implementation(2005-2012)
 View More: For More Information on NHM
 View More: NHM Framework for
Implementation(2012-2017)
 View More: NUHM Framework for
Implementation