The document discusses India's National Health Mission (NHM) and National Urban Health Mission (NUHM). Some key points: - NHM was approved in 2013 and focuses on health system strengthening, reproductive/maternal/newborn/child health, and communicable/non-communicable diseases. - NUHM was launched to improve health access for urban slum dwellers and other vulnerable groups in cities/towns with populations over 50,000. - Both missions aim to reduce infant/maternal mortality rates and focus on interventions like institutional deliveries, antenatal/postnatal care, immunization, and addressing malnutrition.

1. NHM AND NUHM

2. National Health Mission
• Approved in May 2013
• Main programmatic components include health
system strengthening in rural and urban areas
• Reproductive Maternal- Newborn -Child and
Adolescent Health and control of communicable
diseases and non communicable diseases.

3. Health programmes for maternal and
newborn health
• 1992- CSSM
• 1997- RCH I
• 2005- RCH II
• 2005- National rural health mission
• 2013- RMNCH + A Strategy
• 2013- National Health Mission
• 2014- India Newborn Action Plan ( INAP)

4. List of interventions currently
implemented under NHM
• Promotion of institutional deliveries through JSY
• Capacity building of health care providers in basic and
comprehensive obstetric care
• Operationalization of sub centers, primary health centers,
community health centers and district hospitals for providing
24 * 7 basic and comprehensive obstetric care services.
• Tracking of pregnant women to ensure antenatal, intranatal and
postnatal care.
• Mother and child protection card to monitor service delivery
for mothers and children

5. • Iron and folic acid supplementation to pregnant and lactating mothers
• Village health and nutrition days in rural areas
• Health and nutrition education
• JSSK entitles for pregnant women delivering public health institutions
• Emphasis on facility based Newborn care
• Capacity building of health care providers
• Indian Newborn action plan launched
• Newer interventions to reduce newborn mortality
• Home based Newborn care

6. • Intensified diarrhea control fortnight
• Integrated action plan for Pneumonia and Diarrhea
• Management of malnutrition
• Appropriate infant and young child feeding practices
• UIP
• Mission Indradhanush has been launched
• MCTS
• RBSK
• NIPS

7. The targets and achievements of National
Health Mission
Targets (2012-17) Achievements
Reduce IMR to 25/1000 live births IMR reduced from 42 in 2012 to 34 in 2016
Reduce MMR to 1/1000 live births MMR has reduced to 1.30 in 2014-16
Reduce TFR to 2.1 TFR has reduced to 2.3 in 2015
Reduce annual incidence and mortality from
tuberculosis by half
Tuberculosis incidence is at 204 per lakh population
and mortality at 31 per lakh population in 2017
Annual malaria incidence to be <1/1000 Annual malaria incidence is <1/1000
Less than 1% microfilaria prevalence in all districts Out of 225 endemic districts, 222 have reported mf
rate of less than 1%
Reduce prevalence of leprosy to <1/10,000 population
and incidence to zero in all districts
Leprosy prevalence rate is <1/10,000 population
Kala azar elimination by 2015, <1 case per 10,000
population in all blocks
Out of 633 block PHCs, 539 have reported < 1 case per
10,000

8. National Urban Health Mission
• To improve the health status of the urban population particularly
slum dwellers and other vulnerable section by facilitating their access
to quality health care
• Covers all state capitals, district head quarters and 779 other cities/
towns with a population of 50,000 and above
• Cities and towns below 50,000 population will be covered by NRHM.

9. The main focus of NUHM
• Urban poor population living in listed and unlisted slums
• All other vulnerable population such as homeless, rag pickers, street
children, rickshaw pullers, construction and brick workers, sex
workers and temporary migrants
• Public health thrust on sanitation, clean drinking water, vector control
etc.
• Strengthening public health capacity of urban local bodies.

10. • Outreach services provided through FHW
• ANMs will report at U PHC regarding services provided on designated
days
• Conduct immunization and ANC clinics etc. at U PHC level
• NUHM encourage effective community participation in planning and
management of health care services
• It would promote a community health volunteer ASHA or LW
• NUHM provide annual grant for them

11. Essential services provided by ASHA worker
• Active promoter of good health practices
• Facilitate awareness on essential RCH services
• Facilitate assess to health related services
• Formation and promotion of Mahila Arogya Samites
• Arrange / accompany pregnant women and children to nearest Health
centers
• Reinforcement of community action for immunization, prevention of
water borne and other communicable diseases
• Carrying out preventive and promotive health activities
• Maintenance of necessary information and records

12. Assignment
• List down services, facilities provided in Ambalappuzha UHTC
• Staffing pattern of Urban health care

13. NRHM
• Launched on 5th April 2005 for a period of 7 years ( 2005-2012)
• Extended up to year 2017
• To improve rural health care delivery system
• More focus on North east states of India
• Introduce AYUSH to the mainstream of health care

14. Aim
• To provide accessible, affordable, accountable, effective and
reliable primary health care
• Bridging gap in rural health care by creation of ASHA
• Integration of certain health programs – RCH, NVBCP, NLEP,
RNTCP, NPCB, IDDCP and disease surveillance project

15. Plan of action to strengthen infrastructure
• Creation of ASHA
• Strengthening subcenters, PHC, CHC

16. Infrastructure of NRHM

18. Major initiatives under NRHM
• Selection of ASHA
• Rogi kalyan samitti
• United grants to subcenters
• Village health sanitation and Nutrition committee
• JSY
• JSSK
• NMMU
• National Ambulance service
• MCTS

19. NEW INITIATIVES
• Home delivery of Contraceptives
• Conducting District Level Household Survey (DLHS)
• Promotion of menstrual hygiene
• Differential financial approaches
• Involving ASHA in home based New born care
• Expansion of village health and sanitation committee
• Development of AYUSH hospitals
• RBSK , RKSK

20. • Free drugs and diagnostic services
• NIPP
• RMNCH + A
• Delivery points
• Universal health coverage
• Comprehensive primary health care
• Kilkari
• Nationwide anti TB drug resistance survey
• Kala azar elimination plan- UP, Bihar, Jharkhand and West
Bengal

21. IMNCI
• The Ministry of Health and Family Welfare is implementing
the Integrated Management of Neonatal and Childhood
Illness (IMNCI) as a key child health strategy within the
National Reproductive Child Health Programme II and the
National Rural Health Mission.

22. Objectives
The objectives of the IMNCI strategy are:
• to reduce mortality and morbidity associated with the
major causes of disease in children less than five years of
age
• to contribute to the healthy growth and development of
children.

23. The IMNCI guidelines are based on the following
principles:
• All sick children must be checked for ‘general danger signs’ which
indicate the need for immediate referral or admission to a higher
health facility level.
• All sick children must be routinely assessed for major symptoms:
cough, fever, diarrhoea, ear problems.
• Children should also be assessed for nutritional and immunization
status, feeding problems and other problems.

24. The 3 Components of the IMNCI Strategy
• The strategy actually includes three main components:
1. Improvements in the case-management skills of health staff
through the guidelines on Integrated Management of Neonatal and
Childhood illness
2. Improvements in the overall health system required for effective
management of childhood illness;
3. Improvements in family and community health care practices and
involving them in health care process

27. Assess and classify sick young children of age
upto 2 month

32. Pre- service IMNCI
• It is being included in the curriculum of medical colleges of the country.
• This will help in providing the much needed trained IMNCI manpower in
the public and private sector.
Facility based IMNCI (F – IMNCI)
• The F-IMNCI training would provide the optimum skills needed by the
Medical officers and Staff Nurses at the FRU’s (First Referral Unit)
• Thereby helps to address the acute shortage of Pediatricians at facilities
• It focusses on providing appropriate inpatient management of the major
causes of neonatal and childhood mortality such as asphyxia, sepsis, low
birth weight, pneumonia, diarrhea, malaria, meningitis and severe
malnutrition in children at the FRU
• The master trainers at state and district level are pediatricians from
tertiary hospitals and medical colleges.