about national health mission india

2. CONTENTS
 Vision and core values
Goals
 Implementation in country level
 Components of NHM
NRHM and NUHM
 Achievements and implementation 2014
New initiatives OF NHM
AT THE END YOU WILL BE ABLE TO UNDERSTAND
About objectives of NHM
CORE COMPONENTS OF NHM
PROGRAMMES IN NHM

3. HISTORY
• Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu
and Kashmir and Himachal Pradesh have been given special focus. 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 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. As per the 12th Plan
document of the Planning Commission, the flagship programme of NRHM will be strengthened under
the umbrella of National Health Mission. The focus on covering rural areas and rural population will
continue along with up scaling of NRHM to include non-communicable diseases and expanding health
coverage to urban areas. Accordingly, the Union Cabinet, in May 2013, has approved the launch of
National Urban Health Mission (NUHM) as a sub-mission of an overarching National Health Mission
(NHM), with National Rural Health Mission (NRHM) being the other sub-mission of the National Health
Mission.It was further extended in March 2018, to continue till March 2020.

4. Vision of the NHM
“Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and
responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social
determinants of health”.
Core Values ‹
Safeguard the health of the poor, vulnerable and disadvantaged, and move towards a right
based approach to health through entitlements and service guarantees ‹
 Strengthen public health systems as a basis for universal access and social protection against
the rising costs of health care.
‹Build environment of trust between people and providers of health services. ‹
 Empower community to become active participants in the process of attainment of highest
possible levels of health. • ‹Institutionalize transparency and accountability in all processes and
mechanisms
. Improve efficiency to optimize use of available resources.

5. . Goals The endeavor would be to ensure achievement of those indicators
 Reduce MMR to 1/1000 live births
. Reduce IMR to 25/1000 live births
 . Reduce TFR to 2.1 4. Prevention and reduction of anaemia in women aged 15–49 years
 Prevent and reduce mortality & morbidity from communicable, noncommunicable; injuries and
emerging diseases
The National Rural Health Mission (NRHM), now under National Health Mission[1] is an initiative
undertaken by the government of India to address the health needs of under-served rural areas.
Launched on 12 April 2005 by then Indian Prime Minister Manmohan Singh, the NRHM was initially
tasked with addressing the health needs of 18 states that had been identified as having weak public
health indicators.

6.  Reduce annual incidence and mortality from Tuberculosis by half
 Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
 Annual Malaria Incidence to be <1/1000
 . Less than 1 per cent microfilaria prevalence in all districts
 Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
Institutional Mechanisms
At the National level,
 The Mission Steering Group (MSG) and the Empowered Programme Committee
(EPC)
 The MSG provides policy direction to the Mission
Financial proposals brought before the MSG are first placed before and examined
by the EPC The Union Minister of Health & Family Welfare chairs the MSG. The
convener is the Secretary, Department of Health & Family Welfare
 EPC headed by the Union Secretary of Health and Family Welfare.

7. State level
At the State level, the Mission functions under the overall guidance of the State Health Mission
(SHM) headed by the State Chief Minister.
 The State Health Society (SHS).
 The State Program Management Unit (SPMU),
State Health System.Resource Centers (SHSRC) and State Institutes of Health and Family
Welfare (SIHFW).
District level
 District Health Mission (DHM)/City Health Mission (CHM)
The District Programme Management Unit (DPMU) would be linked to District Health Knowledge
Center (DHKC) and its partners for the requisite technical assistance.
The District Training Center (DTC) would be the nodal agency for training requirements of the
District Health Society (DHS).

8. INITIATIVES OF NHM
• FREE DRUGS AND FREE DIAGNOSTIC SERVICE
• A NEW INITIATIVE IS LAUNCHED UNDER THE NATIONAL HEALTH MISSION TO PROVIDE FREE DRUGS SERVICE AND FREE DIAGNOSTIC SERVICE
WITH A MOTIVE TO LOWER THE OUT OF POCKET EXPENDITURE ON HEALTH.
• DISTRICT HOSPITAL AND KNOWLEDGE CENTER (DHKC)
• AS A NEW INITIATIVE DISTRICT HOSPITALS ARE BEING STRENGTHENED TO PROVIDE MULTI-SPECIALTY HEALTH CARE INCLUDING DIALYSIS
CARE, INTENSIVE CARDIAC CARE, CANCER TREATMENT, MENTAL ILLNESS, EMERGENCY MEDICAL AND TRAUMA CARE ETC. THESE
HOSPITALS WOULD ACT AS THE KNOWLEDGE SUPPORT FOR CLINICAL CARE IN FACILITIES BELOW IT THROUGH A TELE-MEDICINE CENTER
LOCATED IN THE DISTRICT HEADQUARTERS AND ALSO DEVELOPED AS CENTERS FOR TRAINING OF PARAMEDICS AND NURSES.
• NATIONAL IRON+ INITIATIVE
• THE NATIONAL IRON+ INITIATIVE IS AN ATTEMPT TO LOOK AT IRON DEFICIENCY ANAEMIA IN WHICH BENEFICIARIES WILL RECEIVE IRON AND
FOLIC ACID SUPPLEMENTATION IRRESPECTIVE OF THEIR IRON/HB STATUS. THIS INITIATIVE WILL BRING TOGETHER EXISTING PROGRAMMES
(IFA SUPPLEMENTATION FOR: PREGNANT AND LACTATING WOMEN AND; CHILDREN IN THE AGE GROUP OF 6–60 MONTHS) AND INTRODUCE
NEW AGE GROUPS.
• TRIBAL TB ERADICATION PROJECT
• THIS PROJECT IS LAUNCHED BY MOS HEALTH SHRI FAGGAN SINGH KULASTE AT MANDLA ON 20 JANUARY 2017.

9. Components of NHM
NHM Finance
NHM- Health Systems Strengthening
Reproductive, Maternal, Newborn, Child Health and
Adolescent - (RMNCH+A) Services
National disease control programmes

10. The progress made under health system strengthening •Infrastructure: strengthen public health delivery system
at all levels as per IPHS
More than 27,400 new construction works have been sanctioned till December 2013, since
the inception of the Mission
The numbers of First referral Units (FRUs) has increased significantly from 940 in 2005 to
2653 in 2013-14.
 There are now 8743 PHCs which are working round the clock, compared to 1263 in 2005.
Human Resources
 In 2013,the total number of technical HR supported under NRHM increased to 1.49 lakh,
which includes 23079 doctors/ specialists including AYUSH doctors, 35172 Staff Nurses, 20011
para-medics including AYUSH paramedics and 70891 ANMs. 590 District Programme
Managers, 601 District Accounts Managers, 4579 Accountants at Block level and 4541
Accountants at PHC level ,
ASHA
Mainstreaming of AYUSH

11. Free drugs;
 NHM Free Drugs Service Initiative. Mobile Medical Units (MMUs); All Mobile Medical Units
are being repositioned as “National Mobile Medical Unit Service” with universal colour and
design. As of December, 2014 there were about 1301 operational MMUs in 368 districts across
the country Emergency response services and patient transport system 28 States have the
facility where people can dial 108 or 102 telephone number for calling an ambulance
 108 is emergency response system, primarily designed to attend to patients of critical care,
trauma and accident victims etc.
 102 services essentially consist of basic patient transport aimed to cater the needs of
pregnant women and children though other categories are also taking benefit and are not
excluded. 102 & 108 ambulances have been repositioned as “National Ambulance Service” with
universal colour and design.

12. Community Participation To ensure involvement of the communities in over-seeing the
provisioning of health care and to redress the public grievances,
a total of 31358 Rogi Kalyan Samitis (RKS) and 511670 Village Health Sanitation and Nutrition
Committees (VHSNCs) have been created under NRHM. Mandatory Disclosures:
 To ensure transparency and improve accountability under NHM, mandatory disclosures of key
services by States in public domain have been prescribed. These include
 Facility wise deployment of all HR
 Facility wise service delivery data
 Details of services provided by mobile medical units and ambulance services, procurements,
construction of public health facilities.
•Financial Management Group (FMG) initiatives for strengthening of Financial Management:
FMG has undertaken numerous initiatives for supporting the program in order to make the
NRHM/NHM more effective, transparent and accountable.

13. Reproductive, Maternal, Newborn, Child Health and Adolescent - (RMNCH+A) Services February
2013, India took the lead in articulating ‘A Strategic approach to Reproductive Maternal, Newborn,
Child and Adolescent health (RMNCH+A)’. Maternal Health
Access to safe abortion services
 Prevention and Management of Reproductive Tract Infections (RTI) and Sexually Transmitted
Infections.
 Gender Based Violence
Newborn and Child Health
Universal Immunization
Child Health Screening and Early Intervention Services
 Adolescent Health
Family Planning
 Addressing the Declining Sex Ratio
Cross cutting areas

14. Initiatives Reproductive health New Strategic focus on Spacing Methods and other
family planning services
Safe Abortion Services Maternal health
 Janani Shishu Suraksha Karyakram (JSSK) 2011
 State of the art Maternal and Child Health Wings (MCH wings) for providing quality obstetric and
neonatal care
 Janani Suraksha Yojana 20 Institutional deliveries in India have risen sharply from 47% in 2008 to
over 84 % now. Targets achieved 2014 The Total Fertility Rate has declined from 3.2 in 2000 to 2.4 in
2012 [2.1]
Rate of decline of TFR has accelerated by 52.3% during 2006-2011 as compared to 2000-2005.
decline in growth rate, since independence, from 21.54% in 1990- 2000 to 17.64% in 2001-2011.
 In 2011, MMR in the country has declined to 178 against a global MMR of 210 at present 38/1000 in
India

15. Mother and Child Tracking System (MCTS) & Mother and Child Tracking
Facilitation Centre (MCTFC) •The facilitation centre has 80 helpdesk agents
.
 The facilitation centre will act as a supporting framework to MCTS and help in validating the
data entered in MCTS by making phone calls to pregnant women and parents of children and
health workers.
 Get their feedback on various mother and child care services, programmes and initiatives
like JSSK, JSY, RBSK, NATIONAL IRON PLUS INITIATIVE (NIPI), contraceptive distribution
by ashas etc
 Check with ASHA and ANMS regarding availability of essential drugs and supplies like ors
packets and contraceptives.

16. Newborn /Child health- initiatives Targets achieved 2012 -14
 Initiatives have been started to provide both home based care and facility based care.[2011]
 Treatment and referral of sick newborns at health facilities New born Care Units (SCNU) in district
hospitals
 Newborn Stabilisation Unit (NBSU), which is 4 bedded unit providing basic level of sick newborn
care , established at Community Health Centres/ First Referral Units.
 2012 /India’s child mortality of 52 per 1000
 Live births is close to the global average of 48
 Number of child deaths has been reduced from approximately 30 lakhs in 1990 to nearly 14 lakhs
in 2012. [ 21/1000 live birth in 2019]
Newborn Care Corners (
NBCC) are established at delivery points and providers trained in basic newborn care and
resuscitation through Navjaat Shishu Suraksha Karyakram (NSSK).
The Home Based Newborn Care Scheme launched in 2011
National Iron Plus Initiative launched in 2013 to bring about renewed emphasis on tackling high
prevalence of anaemia, comprehensively, across all age groups

17. The first two years of life are considered a “critical window of opportunity” for
prevention of growth faltering .
 Guidelines for Enhancing Optimal Infant and Young Child Feeding Practices
were launched by the Ministry of Health & Family Welfare in this respect in 2013.
policy for Vitamin A supplementation, children between nine months to five
years are given six monthly doses of Vitamin A.
 In order to reduce the risk of mortality in children with severe acute malnutrition,
Nutritional Rehabilitation Centres have been established for providing medical
and nutritional care.
 Tribal areas and high focus districts are prioritised for setting up these units.

18. Universal Immunization Recommendations of the National Technical Advisory Group on
Immunization (NTAGI).
 Sustaining Pulse polio campaigns
 Improved cold chain management would be ensured with adequate densities of Ice Lined
Refrigerators (ILRs) and deep freezers.
 Integrated with IDSP and name based monitoring of children done through the MCTS
system
 Under the Universal Immunization Programme (UIP) , vaccination is provided free of cost
against seven vaccine preventable diseases i.e. Diphtheria, Pertussis, Tetanus, Polio,
Measles, severe form of Childhood Tuberculosis and Hepatitis B.

19. NDCPS National disease control programmes
 National Vector Borne Diseases Control Programme (NVBDCP)
Revised National Tuberculosis Control Programme (RNTCP)
 Integrated Disease Surveillance Programme (IDSP)
 National Programme for Prevention and Control of Cancer, Diabetes,Cardiovascular Diseases and
Stroke (NPCDCS)
National Programme for the Control of Blindness (NPCB)
 National Mental Health Programme (NMHP)
National Programme for the Healthcare of the Elderly (NPHCE)
National programme for the Prevention and Control of Deafness (NPPCD)
 National Tobacco Control Programme (NTCP)
 National Oral Health Programme (NOHP):
 National Programme for Palliative Care (NPPC):
National Programme for the Prevention and Management of Burn Injuries (NPPMBI):
 National Programme for Prevention and Control of Fluorosis (NPPCF)


20. Adolescent Health India is home to 253 million adolescents (10-19 years)
constituting about one fourth of the population Initiatives
Adolescent Reproductive and Sexual Health (ARSH) Programme
•Scheme for Promotion of Menstrual Hygiene
•Weekly Iron and Folic Acid Supplementation (WIFS) Programme
•National Iron + Initiative
•Rashtriya Kishor Swasthya Karyakram ; Key drivers of the program are community based
interventions like peer educators, facility based counselling, involvement of parents and the
community through a dedicated adolescent health day; •Social and Behaviour Change
Communication; •and strengthening of Adolescent Friendly Health Clinics across levels of
care.

21. . National Rural Health Mission (NRHM)
 NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the
vulnerable groups.
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 such as water, sanitation,
education, nutrition, social and gender equality.
Initiated in 2005
National Urban Health Mission (NUHM) approved by the cabinet on 1st May 2013
To improve the health status of the urban population particularly slum dwellers and other vulnerable sections
facilitating their access to quality primary health care.
 NUHM would cover all state capitals, district headquarters and other cities/towns with a population of 50,000
and above (as per census 2011) in a phased manner.
 Under NUHM, a provision of Rs 1000 Crores has been made in 2013-14.

22. Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)
Initiatives under 12th Plan:
1. The programme covered all 640 districts in the country.
2. From 2013-14, the programme have been subsumed in National Health Mission and is running under
Programme Implementation Plan (PIP) mode.
3. District Hospitals were strengthened / upgraded. Each district will have a 4-6 bedded Cardiac Care Unit and
day care facilities for Chemotherapy component of Cancer Care.
4. District Hospitals and CHCs will have dedicated NCD Clinics for screening, counselling, follow up of referred
cases, awareness generation and diagnosis and management of diseases covered under NPCDCS.
5. Screenings of Diabetes and hypertension in urban slums in cities with population of more than 1 million will
get priority.
6. Screening for common cancers (Breast, Oral and Cervical Cancers) was undertaken at district level.
7. 20 State Cancer Institutes(SCI) were supposed to be set up and 50 Tertiary Care Cancer Centers (TCCCs)
will be set up / strengthened in Government Medical Colleges for providing

23. New initiatives
Union ministry of health & family welfare has put in place program guidelines for implementing the
national dialysis program in district hospitals on PPP mode
. The swachh bharat abhiyan launched by the prime minister on 2nd october 2014, focuses on
promoting cleanliness in public spaces.
 Award to public health facilities/ kayakalpa awards implementing national .
Implementing national free essential diagnostics service initiative so as to ensure the availability of
basic diagnostics tests for service users in public health facilities
The free essential drugs initiative also expected to ensure a responsive supply of quality drugs to
facilities and promote rational drug use.

24. In order to achieve the NHM objectives, it is essential that good quality and safe medicines, diagnostics,
and therapeutic procedures should be accessible, available and affordable to the beneficiaries Healthy
Village | Healthy People | Healthy Nation.
So here are some questions for you
Que I What are the objectives of National Health Mission ?
Que 2. Discuss the new initiatves of NHM?
Que 3 . What are the initiatives of Janani Suraksha Yojna?
Que 4. Which components are included in Maternal Health?

25. SELECTED BIBLIOGRAPHY
•https://en.wikipedia.org/wiki/National_Health_Mission
•"Cabinet okays National Health Mission till March 2020", Business Standard, 21 March 2018
•Mukherjee, S; Singh, A (5 February 2018). "Has the Janani Suraksha Yojana (a conditional maternity benefit
transfer scheme) succeeded in reducing the economic burden of maternity in rural India? Evidence from the
Varanasi district of Uttar Pradesh". Journal of public health research. 7 (1):
957. doi:10.4081/jphr.2018.957. PMID 29780760.
•Modugu, Hanimi Reddy; Kumar, Manish; Kumar, Ashok; Millett, Christopher (5 December 2012). "State and
socio-demographic group variation in out-of-pocket expenditure, borrowings and Janani Suraksha Yojana (JSY)
programme use for birth deliveries in India". BMC Public Health. 12 (1). doi:10.1186/1471-2458-12-1048.

26. THANK YOU ……