The document discusses the National Rural Health Mission in India and provides details on its goals, approaches, institutional framework, and state-level initiatives. The NRHM aims to provide universal access to equitable, affordable and quality health care through community involvement, capacity building, flexible financing, and human resource management. It outlines the proposed structure from village to block to district levels. It also summarizes administrative actions and strategies to strengthen manpower and decentralize implementation across various Indian states.

1. 1
NATIONAL RURAL
HEALTH MISSION
PRESENTATION BEFORE
CONFERENCE OF CHIEF
SECRETARIES
19th July2006
Ministry of Health & Family Welfare
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2. 2
NRHM GOALS & APPROACHES
COMMUNITY
INVOLVEMENT
CAPACITY
BUILDING
FLEXIBLE
FINANCING
HUMAN
RESOURCE
MANAGEMENT
MONITOR
AGAINST
AGREED
MILESTONES
Universal Health Care
Reducing IMR, MMR,TFR
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3. 3
BLOCK
LEVEL
HOSPITAL
30-40 Villages
Strengthen Ambulance/
transport Services
Increase availability of Nurses
Provide Telephones
Encourage fixed day clinics
Ambulance
Telephone
Obstetric/Surgical Medical
Emergencies 24 X 7
Round the Clock Services;
CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE –--------------- Accountant
CLUSTER OF GPs – PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;
Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;
Emergencies that can be handled by Nurses – 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;
Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic1000
Popu
lation VILLAGE LEVEL – ASHA, AWW, VH & SC
1 ASHA, AWWs in every village; Village Health Day
Drug Kit, Referral chains
100,000
Population
100 Villages
5-6 Villages
Accredit private
providers for public
health goals
Health Manager
Store Keeper
NRHM – ILLUSTRATIVE STRUCTURE
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4. 4
NRHM- Institutional framework
1
Departments of H & FW
merged
34 states except UP
2
State Health Missions
Constituted
34 states except Delhi
3
District Health Missions
Constituted
33 states except Haryana, Delhi
4
Merger of
Societies
State Level
29 States except Jharkhand,
Rajasthan, U.P., Tripura, Delhi
Chandigarh, Karnataka,
Pondicherry
5
MoU with Government of
India
30 States except U.P., Lakshadweep,
Delhi, Tamil Nadu, A&N Islands
Health is also Economic productivitywww.drjayeshpatidar.blogspot.in

5. 5
• Operationalise the State/District/Block health Missions.
• Suitable officials - Stable tenures / accountability
• Administrative and financial delegations
• Review of Acts, Regulations & guidelines for
decentralisation
• Health facilities to be planning and budgeting Units
upto Block level.
• Set up procurement/logistics system
Health is also Women’s empowerment
Administrative Actions
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6. 6
Manpower Strengthening
•Attend to Shortfall of 84,000 staff nurses, 2 lakh ANMs, 5000 to
7000 Specialists in each specialty.
•Multi-skilling, incentives for rural posting, Compulsory Rural Posting,
Block pooling, Rational cadre policy, Management through PRIs/ Rogi
Kalyan Samitis, Increasing the age of retirement
•Appointment on contractual basis and local criterion.
•Empower BMO – designate as Chief BMO - to optimally deploy
doctors /paramedics in facilities within the block
•Strengthen SIHFW, ANM schools, nursing / medical colleges/
increase seats
Health is Women’s rightwww.drjayeshpatidar.blogspot.in

7. 7
DECENTRALISATION & CONVERGENCE
•Over 20% of the funds to be spent at the District level and 70%
below the block level.
•Review of Acts, Regulations & guidelines for decentralisation
•Health facilities to be planning and budgeting Units upto Block level.
•Monitor preparation of Integrated District Plans.
•Review health camps in each village by ANM, AWW and ASHA.
•Regular meeting of State Committee on Intersectoral Convergence.
Healthy family Healthy nationwww.drjayeshpatidar.blogspot.in

8. 8
•Operationalisation of Mission structure & managerial support at
state /District / Block levels.
•Selection, training and support for ASHA.
•Availability & Utilisation of service delivery at facilities.
•Immunisation & Institutional deliveries – District wise.
•Preparation of District Plans
•Interdepartmental Coordination for convergence
•Release & Utilisation of funds.
•Training/Capacity Building-Health Planning-District training Centre
•Delegation of administrative & financial powers to various levels.
AGENDA FOR CHIEF SECRETARIES
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9. 9
Activity
Phasing and time
line
Outcome
Monitoring
1
Fully trained Accredited Social Health
Activist (ASHA) for every 1000
population/large isolated habitations in
18 Special Focus States
50% by 2007
100% by 2008
Quarterly
Progress
Report
2
Village Health and Sanitation
Committee constituted in over 6 lakh
villages and untied grants provided to
them.
30% by 2007
100% by 2008
Quarterly
Progress
Report
3
2 ANM Sub Health Centres
strengthened/established to provide
service guarantees as per IPHS, in
1,75000 places.
30% by 2007
60% by 2009
100% by 2010
Annual Facility
Surveys
External
assessments
4
30,000 PHCs
strengthened/established with 3 Staff
Nurses to provide service guarantees
as per IPHS.
30% by 2007
60% by 2009
100% by 2010
Annual Facility
Surveys
External
Assessments
5
6500 CHCs strengthened
/established with 7 Specialists and 9 S
Nurses to provide service guarantees
as per IPHS.
30% by 2007
50% by 2009
100% by 2012
Annual Facility
Surveys
External
assessments.
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10. 10
6
1800 Taluka/ Sub Divisional
Hospitals strengthened to provide
quality health services.
30% by 2007
50% by 2010
100% by 2012
Annual Facility
Surveys
External
assessments.
7
600 District Hospitals
strengthened to provide quality health
services.
30% by 2007
60% by 2009
100% by 2012
Annual Facility
Surveys
External
assessments.
8
Rogi Kalyan Samitis /Hospital
Development Committees established
in all CHCs/Sub Divisional Hospitals/
District Hospitals.
50% by 2007
100% by 2009
Annual Facility
Surveys
External
assessments.
9
District Health Action Plan 2005-
2012 prepared by each district of the
country.
50% by 2007
100% by 2008
Appraisal process
External
assessment.
10
Untied grants provided to each
Village Health and Sanitation
Committee, Sub Centre, PHC, CHC to
promote local health action.
50% by 2007
100% by 2008
Independent
assessments
Quarterly
Progress
reports.
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11. 11
THANK YOU
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12. 12
STATE
INITIATIVES
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13. 13
STATE INITIATIVES
• Andhra Pradesh
• Woman Health Volunteers in each of the rural and tribal habitations.
• Setting up an additional 100 round-the-clock women health centres.
• A subsidized Emergency Health Transportation Scheme.
• Incentives to women health volunteers, village Panchayats that promote
Immunization Institutional delivery etc.
• Arunachal Pradesh
• 16 PHCs contracted out to NGOs and Private practitioners.
• Link workers at village level.
• Outreach camps for service delivery at remote and inaccessible areas.
• Assam
• RMP Act enacted.
• Transfer and Postings of Medical Staff has been decentralized.
• Involvement of private sector to render ANC services under PPP.
• Infection Control System in all District Hospitals.
• Health Insurance Scheme introduced.
• 32 FRUs operationalised.www.drjayeshpatidar.blogspot.in

14. 14
STATE INITIATIVES
• Bihar
• Data centre for daily monitoring of OPD output by each
participating institutions.
• 8000 villages covered with mobile medical units for under
served population.
• Telephone connection to all PHCs of the state.
• CHhattisgarh
• Strengthening the role of the Panchayat and building on the
community based link worker.
• Promoting emergency referral to public/private facility using
coupons by Mitanins.
• Establishment of State Health Resource Centre.
• Delhi
• “Basti Sevikas” for Urban Slums as linked worker.www.drjayeshpatidar.blogspot.in

15. 15
STATE INITIATIVES
• Gujarat
• Chiranjivi Yojana – scheme to contract out private providers
for delivery care and management obstetric complications
• Block Level Programme Management arrangements.
• Haryana
• Health link workers in every village.
• A couple aged 60 years with only a girl child is being given a
pension of Rs. 300/- per month and Rs. 500/- per month to
the girl child under “Ladli Scheme”.
• Himachal Pradesh
• Rs. 30,000 to FRUs as untied fund for emergency transport.
• PPP Cell at State and District level.
• Involvement of departments like Ayurveda, social justice and
woman empowerment for distribution of contraceptives.www.drjayeshpatidar.blogspot.in

16. 16
STATE INITIATIVES
• Jammu & Kashmir
• Granting autonomy to hospitals
• Utilizing the Rehbat-I-Sehat (RIS) teacher’s network for
providing access to health services to tiny villages scattered in
the district.
• Karnataka
• Incentives to Doctors and Staff Nurses for providing 24x7
services.
• Health insurance for SC/ST population
• Kerela
• RCH services at medical colleges
• Maternity Security Scheme
• Tribal and Coastal Health Plans.
• Involvement of ISM and homeopathy system with the health
facilities.
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17. 17
STATE INITIATIVES
Madhya Pradesh
 Outsourcing PHCs to NGOs.
 State Logistics Management Unit at State level
 “Prasav Hetu Parivahan Yojana”(LY85000 beneficiaries)
 Incentive to MO’s at PHCs and CHCs for promotion of
institutional deliveries
Maharashtra
 Setting up of PPP cell at state and district level.
 Incentive to tribal pregnant woman for ANC and
institutional deliveries under Matrutav Anudan Yojana
of Nav Sanjivini Scheme.
 Association of Mahila Gram Sabha and Mahila Vikas
Samitis of “Jan Swarajaya” for implementation of RCH.
Mizoram
 Incentives for doctors serving in remote areas
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18. 18
STATE INITIATIVES
Orissa
 Delegation of powers to the ED , State Health society
 Consideration of key HRD steps such as a differentiated Public
Health Management cadre, policy / incentives for postings to less
developed districts
 Health institutions resource mapping on GIS.
Pondicherry
 Family based health cards.
Punjab
 Balika Rakshak Yojana for adopting terminal method of
sterilization after the birth of only one or two girl children @ Rs.
500/- and Rs. 700/- respectively.
 A prize of Rs. 3 lakhs for panchayats achieving CSR of 1000 in a
year and Rs. 2.5 lakhs for panchayats achieving CSR of 951 to 1000
in a year.
 Nutritional supplement for mothers and children belonging to SCs
and other reconstruction of the society.
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19. 19
STATE INITIATIVES
Rajasthan
 Panchamrit for catch up rounds for 5 interventions (Immunization,
Vitamin A, Neo Natal Care, Family Planning, Safe Motherhood).
 Considerable emphasis on quality of services through setting
standards, indicators and process protocols
 Technical resource cell involving NGOs for monitoring and
implementation of PNDT act.
Sikkim
 Link workers at all the villages.
 Setting up committees at State / District Level for implementation
of PNDT act.
 Link up with AWW and School Health Programme to operationalize
regular de-worming of children.
 Untied fund at SC to meet transportation cost and accompany link
workers if it is justifiable by Village Health Committees.
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20. 20
STATE INITIATIVES
Tamil Nadu
 Integration of ISM with primary health care systems
 Convergence with HIV/ AIDS/TB at PHCs.
 Efficient logistic and procurement arrangements.
Tripura
 Outsourcing of investigation services including imaging.
Uttar Pradesh
 Involvement of cooperative sector for distribution of
contraceptives under Family Planning programme.
 Private lady doctors are being contracted for providing 2 hour daily
OPD services at CHCs and PHCs on fix incentive basis.
 Yuva Mangal Mela and Adarsh Dampati Samman will be organised
in selected districts. This year 25 Districts selected having poor
health indicators.
 Strengthening of MIS by linking District through NIC Networkwww.drjayeshpatidar.blogspot.in

21. 21
STATE INITIATIVES
 Uttaranchal
 Involvement of community in monitoring and
giving feedback on all the programmes.
 Documentation of practices on traditional
healers.
 West Bengal
 Piloting of Voucher Scheme for providing
services through private sector.
 Ranking of blocks as per key health indicators.
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