The document discusses the National Rural Health Mission (NRHM) of India. It was launched in 2005 to provide healthcare to rural areas. Key aspects include:
1. The mission aims to reduce maternal and child mortality and make healthcare accessible through community health workers like ASHAs.
2. It focuses on strengthening primary healthcare and aims to upgrade all subcenters, PHCs, and CHCs.
3. Key components include ASHA workers, improving rural health infrastructure, disease control programs, and expanding health insurance.
The goal is to universally improve access to healthcare and reduce inequities between urban and rural populations.
This ppt gives you the details about the NRHM scheme. The SWOT analysis has been done which helps you to know the strength and weakness part of the NRHM program.
BY: Dr.Pavithra R (M.H.A)
This ppt gives you the details about the NRHM scheme. The SWOT analysis has been done which helps you to know the strength and weakness part of the NRHM program.
BY: Dr.Pavithra R (M.H.A)
The orderly process defining national Health problems, identifying the unmeet needs, surveying the resources to meet them, and establishing the priority goals to accomplish the purpose of proposed Programme.
The orderly process defining national Health problems, identifying the unmeet needs, surveying the resources to meet them, and establishing the priority goals to accomplish the purpose of proposed Programme.
AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner
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.
This presentation deals with advent of NRHM, backdrop of public health scenario prior to NRHM & discusses in details vision & core strategy of NRHM. It focuses on different schemes related to maternal & child health under NRHM with special reference to Maharashtra.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. THE CONTENTS
National Rural Health Mission
States focussed
Illustrative structure
Main approaches
Objectives
Functions of NRHM
Core strategies
Supplementary strategies
Components
RCH – II
Janani Suraksha Yojna
NRHM expected outcome
Innovations
Achievements of NRHM
Health Financing
Paradigm shift due to NRHM
Outcome indicators by NRHM
References
2
3. 3
NATIONAL RURAL HEALTH MISSION
National Health Mission(NHM) is an umbrella mission
launched on 1st May 2013, having two components :
National Rural Health Mission(NHRM) and National Urban
Health Mission(NHUM)
National Rural Health Mission was launched for a period of
7 years (2005-12).
NRHM initially had high focus on 18 States (8 EAG, 8 North
East, Jammu & Kashmir and Himachal Pradesh), but now
all the states are included.
RCH-II was an important component of NRHM.
5. NRHM – ILLUSTRATIVE STRUCTURE
Block
Level
Hospital
Clusters of GPs –
PHC level
Gram Panchayat –
Sub health centre level
Village level –
ASHA, AWW, VH, SC
5
6. Dept. of
family welfare
Dept. of
women and
child
National mission steering
State health mission
District health mission
Block coordination
VHCGram
ASHA
AWMANM
CLIENTS
Gram panchayat
The Institutional Structure
Service provider
6
7. INSTITUTIONAL ARRANGEMETS UNDER
NRHM
STATE LEVEL
• State Health Mission chaired by Hon’ble Chief Minister.
• State Health Society chaired by Chief Secretary.
• Merger of all vertical societies into State Health Society.
• State Level Planning and Monitoring Committee headed by
Hon’ble Health Minister
DISTRICT LEVEL
District Health Mission chaired by Chairman Zila Parishad.
District Health Society chaired by Deputy Commissioner.
District Planning and Monitoring Committee headed by Zila
Parishad Chairman. 7
8. CONTD..
BLOCK LEVEL
Block Planning and Monitoring Committees at Block PHC.
PHC Planning and Monitoring Committees at PHC level.
Rogi Kalyan Samities for CHCs
VILLAGE LEVEL
Village Health & Sanitation Committees in each village.
Accredited Social Health Activist (ASHA) for every 1000
population.
8
9. NRHM
MAIN APPROACHESCommunitization
•Village Health &
Sanitation Committee
• ASHA
• Panchayati Raj
Institazutions
• Rogi Kalyan Samiti
Improved
management
through capacity
•DPMU/ BPMU
• NGOs for capacity
building
• NHRC/ SHRC
•Continuous skill
development
Flexible Financing
• Untied grants
• NGOs as
implementers
• Risk Pooling
• Money follows patient
• More resources for
more reforms
Monitor progress
against standard
•IPHS Standard
• Facility Surveys
• Independent
Monitoring
Committee
Innovations in
Health Management
• Additional manpower
• Emergency services
• Multi-skilling
9
10. OBJECTIVES OF THE MISSION
Reduction
in Child &
Maternal
mortality
Universal
access to
public
health
services
Universal
Access to
Immunization
Programme
10
11. OBJECTIVES OF THE MISSION
Prevention &
Control of
Communica
ble
& Non-
comm.
Diseases
Access to
Integrated
Primary
Health
Care
Revitalize
Local
Health
Tradition
(AYUSH)
Population
Stabilization
&
Demographi
c
Balance
11
15. 3.Strengthening Sub-Centre through
better human resource development,
untied fund to enable local planning and
action and more Multi Purpose Workers
(MPWS).
4. Promote access to improve
healthcare at household level through
the female health activist (Asha-
Accredited Social Health Activist)
15
20. Regulation for Private sector
including the informal Rural
Medical Practitioners (RMP) to
ensure availability of quality
service to citizens at
reasonable cost.
Promotion of public private
partnerships for achieving
public health goals.
Mainstreaming AYUSH
(Ayurveda, Yoga, Unani, Siddi,
Homeopathy)
20
21. Reorienting medical
education to support
rural health issues
including regulation of
medical care and
medical ethics.
Social health insurance
to provide health
security to the poor by
ensuring accessible,
affordable, accountable
and good quality
hospital care.
21
22. PLAN OF ACTION - COMPONENTS
ASHA
Strengthening of Sub-Centers
Strengthening of PHCs
Strengthening of CHCs for First referral
District Health Plan
Converging Sanitation & Hygiene under NRHM
Strengthening Disease control program
Public-private partnership for public Health goals,
including regulation of private sector
New health financing mechanisms
Reorienting health/medical education to support rural
health issues
22
23. COMPONENT A: ASHA
Every village will have a female ASHA
Chosen by and accountable to the panchayat .
Prototype training material for ASHA to be developed at
National level subject to State level modifications
23
24. ASHA act as the interface between the
community and the public health
system.
She will facilitate preparation and
implementation of the Village Health Plan
along with
Anganwadi worker
ANM
functionaries of other Departments Self
Help Group members.
She will be given a Drug Kit (generic
AYUSH and allopathic formulations )for
common ailments 24
25. RESPONSIBILITY OF ASHA
To create awareness among the community regarding
nutrition, basic sanitation, hygienic practices, healthy
living.
Counsel women on birth preparedness, importance of
safe delivery, breast feeding, complementary feeding,
immunization, contraception, STDs.
Encourage the community to get involved in health
related services.
25
26. CONTD…
Escort/ accompany pregnant women, children requiring
treatment and admissions to the nearest PHC’s.
Primary medical care for minor ailment such as
diarrhea, fevers.
Provider of DOTS.
ASHA would be incentivized for promoting household
toilets by the Mission.
26
27. COMPONENT (B): STRENGTHENING SUB-
CENTRES
Each sub-centre will have an Untied
Fund for local action @ Rs. 10,000
per annum.
Supply of essential drugs, both
allopathic and AYUSH, to the Sub-
centres.
27
28. COMPONENT (C): STRENGTHENING PRIMARY
HEALTH CENTRES
Adequate and regular supply of essential
quality drugs and equipment to PHCs.
Provision of 24 hour service in 50%
PHCs.
Intensification of ongoing communicable
disease control programmes, new
programmes for control of non-
communicable diseases and provision of
2nd doctor at PHC level (I male, 1
female).
28
29. COMPONENT (D): STRENGTHENING CHCS FOR
FIRST REFERRAL UNITS
Existing CHC (30-50 beds) as 24 Hour FRU, including
posting of anaesthetists
Codification of new Indian Public Health Standards,
setting norms for
Infrastructure
Staff
Equipment
Management
Promotion of Rogi Kalyan Samitis for hospital
management.
29
30. COMPONENT (E): DISTRICT HEALTH PLAN
District becomes core unit of
planning, budgeting and
implementation
Health
Program
mes
Family
Welfare
Program
mes
“District
Health
Mission”
30
31. COMPONENT (F): CONVERGING SANITATION
AND HYGIENE UNDER NRHM
Total Sanitation Campaign (TSC) is
presently implemented in 350 districts, and is
proposed to cover all districts in 10th Plan.
Components of TSC include rural sanitary
marts, individual household toilets, women
sanitary complex, and School Sanitation
Programme
31
33. CONT…
Disease surveillance system at village level
would be strengthened.
Supply of generic drugs (both AYUSH &
Allopathic).
Provision of a mobile medical unit at District
level for improved Outreach services.
33
34. COMPONENT(H) PUBLIC-PRIVATE PARTNERSHIP FOR
PUBLIC HEALTH GOALS, INCLUDING REGULATION OF
PRIVATE SECTOR
75% of health services are provided by the
private sector.
Identifying areas of partnership, which are
need based, thematic and geographic.
Public sector to play the lead role in defining the
framework and sustaining the partnership.
34
35. COMPONENT (I): NEW HEALTH FINANCING
MECHANISMS
Progressively the District Health Missions to
move towards paying hospitals for services .
Standardization of services – outpatient, in-
patient, laboratory, surgical interventions- and
costs will be done periodically by a committee of
experts in each state.
An ombudsman to be created to monitor the
District Health Fund Management , and take
corrective action.
The Central government will provide subsidies to
cover a part of the premiums for the poor, and
monitor the schemes.
35
36. COMPONENT (J): REORIENTING HEALTH/MEDICAL
EDUCATION TO SUPPORT RURAL HEALTH ISSUES
While district and tertiary hospitals are
necessarily located in urban centers, they form an
integral part of the referral care chain serving the
needs of the rural people.
Medical and Para-medical education facilities
need to be created in states, based on need
assessment.
36
37. 37
REPRODUCTIVE CHILD HEALTH PROGRAMME
RCH-II is the Flagship programme under NRHM.
RCH-II started in 2005 and will continue till 2010 and beyond.
RCH is principal vehicle and major component of NRHM aimed at reducing
Maternal Mortality Ratio to 100/1,00,000, infant mortality to 30/1000 live
birth and total fertility to 2.1 by year 2010.
Components of RCH II :
• Maternal health, MTP and JSY .
• Child Health.
• Family Planning.
• Adolescent Reproductive and Sexual Health.
• Urban RCH
• Trial RCH
• Vulnerable Groups
• Institutional Strengthening.
• Infection Management and Environment Plan at health facilities.
38. STRATEGIES :
Maternal Health – Institutional deliveries, BCC, Mobilization
Strategies, improved coverage and quality of ANC, skilled
care to Pregnant women, Post -partum care at Community
level.
Child health - UIP, IMNCI.
Population Stabilization – contraceptive choice, private
sector intervention.
Urban and tribal health – similar initiatives with special
focus disadvantages.
38
39. JANANI SURAKSHA YOJANA
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the
NRHM being implemented with the objective of reducing maternal and neo-
natal mortality by promoting institutional delivery among the poor pregnant
women.
The Yojana, launched on 12th April 2005 is being implemented in all states
and UTs. JSY is a 100% centrally sponsored scheme.
The Yojana has identified ASHA, as an effective link between the Government
and the poor pregnant women.
The scheme focuses on the poor pregnant woman with special dispensation
for states having low institutional delivery rate. Besides the maternal care, the
scheme provides cash assistance to all eligible mothers for delivery care.
39
40. JANANI SURAKSHA YOJANA AND ASHA
NRHM JSY
Antenatal Check up
Institutional Care during delivery
Immediate post-partum
(coordinated care)
↑↑Institutional
Deliveries
in BPL families
↓↓ all MMR
& IMR
Cash assistance
40
41. To reduce Maternal and Neonatal Mortality by promoting
institutional delivery among beneficiaries from BPL, SC and ST
family in rural and urban area.
Incentives for Institutional Delivery
The eligible beneficiary is from Below Poverty Line and if she
delivered at home in this case Rs. 500/-is paid . In case of
L.S.C.S, Rs 1500/-is to be given to beneficiary
41
RUR
AL
UR
BAN
Mothe
r
ASHA Total Mothe
r
ASHA Total
LPS 1400 600 2000 1000 200 1200
HPS 700 200 900 600 200 800
HPS(n
otified
tribal
area)
600
42. NRHM OUTCOMES EXPECTED
1. National Level
IMR : Reduced to 30/1000 Live Births
MMR : Reduced to 100/100,000
TFR : Brought to 2.1
MMRR : –50% upto 2010, Addl.10% by 2012
Kala Azar : to be Eliminated by 2010.
Filaria / Microfilaria
Reduction Rate : 70% by 2010, by 2012 80%
Elimination by 2015
Dengue Mortality
Reduction Rate : 50% by 2010 and Sustaining at
that Level Until 2012
Contd.. 42
43. J.E Mortality Reduction Rate : 50% by 2010 and sustaining
at that Level Until 2012.
Cataract Operation : Increase to 46 lakhs
per year Until 2012.
Leprosy Prevalence Rate : Brought to < 1 / 10,000.
Tuberculosis DOTS Services : 85% Cure Rate to be
Maintained.
2000 Community Health
Centres to be Upgraded : Indian Public Health Standard.
Utilization of First Referral Units : Increase from < 20% to 75% .
250,000 Women to be Engaged : Accredited Social Health
Activists (ASHA).
43
44. 2. COMMUNITY LEVEL
Availability of trained community level workers at village level, with a drug
kit.
Health Day at Anganwadi level on a fixed day/month.
Availability of generic drugs for common ailments at subcentre and hospital
level.
Good hospital care.
Improved access to Universal Immunisation.
Improved facilities for institutional delivery.
Provision of household toilets.
44
45. INNOVATIONS
Boat Clinic – Ship of Hope
Launched on 25th May 2005
Services offered: OPD services, ANC, Immunization, Family
planning, Minor operative procedures, Basic Laboratory
Services
45
46. MOBILE MEDICAL UNIT
HOSPITAL ON WHEELS
•Launched on 11th November ’07
•Operational in 27 districts
•Equipped with Microscope, Semi Auto Analyzer, Portable X-ray, USG,
ECG, Generator
•2 MO, Nurses, Technicians…
46
47. ASHA RADIO
•Updating the ASHAs with new development and also informing them
about the mission for upgrading the standard of life of the rural people
in respect to health and hygiene and particularly promoting the healthy
environment for mother and child.
•Feedback Mechanism : Pre paid post cards with printed address of
office of the AIR, Each ASHA will be given 12 postcards.
47
48. ANM MOBILE
•Can report any suspected cases to the PHC to take
immediate action before it results to outbreak.
• Can also facilitate for the referral transport so that people
can avail the facility as there are villages where public
transportation facility is not available.
48
49. ACHIEVEMENTS OF NRHM
More than 8.3 lakh ASHAs are connecting households to health facilities.
NRHM has provided an opportunity to provide cashless hospitalized service
to the poor through Rogi Kalyan Samiti resources.
Over 5 lakh village – health nutrition and sanitation committees have been
constituted.
Subcentres have been strengthened by way of providing untied money of
Rs. 10,000 per annum and second ANM at Subcentre.
NRHM has benefited below poverty line women for safe delivery.
Delivery huts have been constructed to promote safe delivery at village
level.
49
50. CONT.....
PHCs and CHCs have been strengthened by provision of untied fund of
Rs.25,000 per annum per PHC and Rs.50,000 per annum per CHC.
District level plans have been formulated by 636 districts.
District programme management units have been set up.
Upgrading of CHCs, PHCs and SCs as per Indian public health standards
(IPHS).
District, state, national health mission constituted.
Public – private partnership with NGOs and private partnership has begun.
Indigenous system of medicine: AYUSH has been promoted and services
set – up at district level.
First referral units (FRUs) for 24 – hour referral services and PHCs for 24 –
hour referral services are progressing. 50
51. HEALTH FINANCING
NOW
• 20% public expenditure
(0.9% GDP), often
inefficient and ineffective.
• 80% private expenditure,
mostly out of pocket.
• 15-20% MoHFW
expenditure – rest by
States.
By 2012
• 40% public expenditure
with improved
accountability and
efficiency ( 2-3% GDP).
• Private expenditure by risk
pooling/insurance.
• 40% GoI expenditure – rest
by States.
51
52. PARADIGM SHIFT DUE TO NRHM
Moves From
1. Current public
expenditure on health
0.9% of GDP.
2. Inflexible Financing
3. Dysfunctional health
infrastructure.
4. No standards prescribed
for quality.
5. Central Govt. Financing
Confined to select
Programmes or
Programme disease
centric.
TO
1. Increase Public
expenditure 2-3% of
GDP by 2012.
2. Flexible financing
3. Fully Functional Health
Facilities
4. IPHS for physical
infrastructure, human
resources, equipment,
drugs
5. Financing now is
directed to Development
of state health system.
52
53. CONT....
6. Time consuming
recruitment system
and inadequate
provision of human
resources.
7. Low level community
participation.
8. Poor management
capacity.
9. Lack of coverage
10 Centralized planning
and evaluation.
6. Contractual
appointments, local
residency and additional
human resources.
7. Increasing community
participation.
8. Improved management
capacity.
9. Integrating vertical
health and Family
Welfare programme
10. Decentralized district
health action plans.
53
54. OUTCOME INDICATORS BY 2017
Reduce infant mortality rate to 25.
Reduce maternal mortality rate to 100.
Reduction of total fertility rate to 2.1.
Reduce prevalence of under nutrition in children
under 3 years to 27%.
Reduction of anaemia among women (15-49
years) to 28%.
Raise child sex ratio from 914 to 950.
Prevention and reduction of burden of
communicable disease , non-communicable
disease and injuries.
54
55. REFRENCES
Park’s textbook of Preventive and Social
Medicine
Textbook of Community Medicine – Sunder
Lal, Adarsh, Pankaj
www.nrhm.gov.in
www.upnrhm.gov.in
pglibrary-publichealth.wikispaces.com/file
www.nhm.gov.in
55