National Rural Health Mission (NRHM)
National Rural Health Mission (NRHM)(NRHM)(NRHM)
State Institute of Health & Family Welfare, Jaipur
State Institute of Health & Family Welfare, Jaipur
NRHMNRHM
• N…Newer Initiatives.• N…Newer Initiatives.N…Newer Initiatives.• R…Rural Poor Population• H Holistic Health Package
N…Newer Initiatives.• R…Rural Poor Population• H Holistic Health PackageH…Holistic Health Package.• M…Monitoring mechanisms
To cater to the Primary health care needs of
H…Holistic Health Package.• M…Monitoring mechanisms
To cater to the Primary health care needs ofTo cater to the Primary health care needs of vulnerable segment of pop. to bring down IMR and MMR . to attain Pop. Stabilisation.
To cater to the Primary health care needs of vulnerable segment of pop. to bring down IMR and MMR . to attain Pop. Stabilisation.a d to atta op Stab sat oa d to atta op Stab sat o
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 22
Mission GoalMission Goal
Improve:Access &
Improve:Access &Access & Availability to Health careQuality
Access & Availability to Health careQualityQualityEquity
Simple reiteration of
QualityEquity
Simple reiteration ofSimple reiteration of NHP-1983,HFA-2000,
Simple reiteration of NHP-1983,HFA-2000,HFA 2000, NHP-2002, or a new paradigmHFA 2000, NHP-2002, or a new paradigm
NHP-1983
NRHM-2005
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 33
NRHM Paradigm ShiftsNRHM Paradigm Shifts
Decentralized planning Outputs and Outcome basedDecentralized planning Outputs and Outcome basedOutputs and Outcome basedPro-Poor Focus: Equitable systemsQuality of Care and the IPHS norms
Outputs and Outcome basedPro-Poor Focus: Equitable systemsQuality of Care and the IPHS normsQuality of Care and the IPHS normsBringing the public back into public health
At village level :
Quality of Care and the IPHS normsBringing the public back into public health
At village level :At village level : ASHA, VHSC, SHGs, PRIs.At the facility level: RMRS
At village level : ASHA, VHSC, SHGs, PRIs.At the facility level: RMRSAt the facility level: RMRSAt the management level : Health societies
At the facility level: RMRSAt the management level : Health societiessocietiessocieties
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 44
NRHM Paradigm ShiftsNRHM Paradigm Shifts
• Governance reformManpower Logistics & Procurement
• Governance reformManpower Logistics & ProcurementManpower, Logistics & Procurement processes.Decision making processes
Manpower, Logistics & Procurement processes.Decision making processesDecision making processesInstitutional design, Accountability framework
Decision making processesInstitutional design, Accountability frameworkframework
• ConvergenceWater and sanitation
framework • Convergence
Water and sanitationWater and sanitationNutritionEducation
Water and sanitationNutritionEducationEducation Education
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 55
An Opportunity for Centre-State P t hi
An Opportunity for Centre-State P t hiPartnershipPartnership
Beginning with people and their problemBeginning with people and their problemBeginning with people and their problem.Flexibility to decide and to do. Human resource thrust
Beginning with people and their problem.Flexibility to decide and to do. Human resource thrustHuman resource thrust.Decentralized management of health. Di t t t t t
Human resource thrust.Decentralized management of health. Di t t t t tDistrust to trust. Employment guarantee to service guarantee.A ti th h ll f t
Distrust to trust. Employment guarantee to service guarantee.A ti th h ll f tAccepting the challenge of remoteness. Accepting the challenge of remoteness.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 66
Why NRHMWhy NRHM
Declining Public Health expenditureDeclining Public Health expenditureDeclining Public Health expenditure (1.3 % of GDP in 1990 to 0.9% in 1999)Limited synergism in Vertical and
Declining Public Health expenditure (1.3 % of GDP in 1990 to 0.9% in 1999)Limited synergism in Vertical andLimited synergism in Vertical and Horizontal Health Programs.Lack of community ownership
Limited synergism in Vertical and Horizontal Health Programs.Lack of community ownershipLack of integration of issuesLack of integration of issues
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 77
Why NRHMWhy NRHM
Regional inequalitiesPopulation stabilization still not metRegional inequalitiesPopulation stabilization still not metPopulation stabilization still not metCurative services favor richPoor coverage by Health insurance
Population stabilization still not metCurative services favor richPoor coverage by Health insurancePoor coverage by Health insurance (only 10%)Hospitalization eats 58% of annual
Poor coverage by Health insurance (only 10%)Hospitalization eats 58% of annual income, 25 % pop. falls below poverty line following hospitalization expenses.income, 25 % pop. falls below poverty line following hospitalization expenses.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 88
NRHM ?NRHM ?
Program ?Program ?Program ?Scheme ?Project ?
Program ?Scheme ?Project ?Project ?Project ?
A Strategy, for Convergence
A Strategy, for ConvergencePartnershipPartnership
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 99
Goals:Goals:Reduction in IMR and MMRUniversal access to public health services such as Women’s health child health water sanitation &
Reduction in IMR and MMRUniversal access to public health services such as Women’s health child health water sanitation &Women s health, child health, water, sanitation & hygiene, immunization, and Nutrition.Prevention and control of CD & NCD, including l ll d i di
Women s health, child health, water, sanitation & hygiene, immunization, and Nutrition.Prevention and control of CD & NCD, including l ll d i dilocally endemic diseasesAccess to integrated comprehensive primary healthcare
locally endemic diseasesAccess to integrated comprehensive primary healthcarehealthcarePopulation stabilization, gender and demographic balance.R it li l l h lth t diti d i t
healthcarePopulation stabilization, gender and demographic balance.R it li l l h lth t diti d i tRevitalize local health traditions and mainstream AYUSHPromotion of healthy life styles
Revitalize local health traditions and mainstream AYUSHPromotion of healthy life stylesPromotion of healthy life stylesPromotion of healthy life styles
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1010
National Goals and MDGsNational Goals and MDGs
1990 Current NPP NRHM MDG2010 2012 2015
IMR 80 53 (SRS-2009) <30 <27N M R 53 37 (NFHS III) 20 20N M R 53 37 (NFHS-III) <20 <20
U5M Rate 107 74 3 (NFHS III) <36U5M Rate 107 74.3 (NFHS-III) - <36
ID(%) 45.5 (DLHS-3) 80 80ID(%) 45.5 (DLHS 3) 80 80TFR 2.7 (NFHS-III) 2.1 2.1MMR 254 (SRS-2006) <100 <100( )
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution1111
Critical AreasCritical Areas
Well functioning health facilitiesWell functioning health facilities
Quality and accountability in thedelivery of health services.Quality and accountability in thedelivery of health services.y
Responsive health system meetingpeople health need
y
Responsive health system meetingpeople health needpeople health need.
Convergence for effectiveness andffi i
people health need.
Convergence for effectiveness andffi iefficiency.efficiency.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1212
NRHM ComponentsNRHM Componentspp
CommunitizeCommunitizeFlexible FinancingImproved management through Flexible FinancingImproved management through g gcapacity buildingMonitor progress against standards
g gcapacity buildingMonitor progress against standardsInnovation in human resource managementInnovation in human resource management
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1313
Core StrategiesCore Strategiesgg
Capacity Building of PRIs to own control &Capacity Building of PRIs to own control &Capacity Building of PRIs to own, control &manage public health services.Access to improved healthcare through the
Capacity Building of PRIs to own, control &manage public health services.Access to improved healthcare through theAccess to improved healthcare through the female health activist (ASHA).Village Health Plan through Village HealthC itt
Access to improved healthcare through the female health activist (ASHA).Village Health Plan through Village HealthC ittCommitteeStrengthening sub-centre through an untiedfund to enable local planning and action &
CommitteeStrengthening sub-centre through an untiedfund to enable local planning and action &fund to enable local planning and action &more Multi Purpose Workers (MPWs).fund to enable local planning and action &more Multi Purpose Workers (MPWs).
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1414
PHCs and CHCs strengthening, to a normative standard (IPHS -personnel, equipment and management
PHCs and CHCs strengthening, to a normative standard (IPHS -personnel, equipment and managementequipment and management standards).
P ti d I l t ti f
equipment and management standards).
P ti d I l t ti fPreparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health
Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health p p yMission, including drinking water,p p yMission, including drinking water,
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1515
Integrating vertical programs at National, State, Block, and District levels
Integrating vertical programs at National, State, Block, and District levelslevels.Technical Support to National, State and District Health Missions, for Public
levels.Technical Support to National, State and District Health Missions, for Publicand District Health Missions, for Public Health Management.Strengthening capacities for
and District Health Missions, for Public Health Management.Strengthening capacities for
data collection, assessment and review for evidence b d l i it i d
data collection, assessment and review for evidence b d l i it i dbased planning, monitoring and supervision.based planning, monitoring and supervision.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1616
Transparent policies for deployment and career development of human
f h lth
Transparent policies for deployment and career development of human
f h lthresources for health.Developing capacities for preventive health care at all levels for promoting
resources for health.Developing capacities for preventive health care at all levels for promotinghealth care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol
health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc.Promoting non-profit sector particularly in under served areas
etc.Promoting non-profit sector particularly in under served areasin under served areas.in under served areas.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1717
Supplementary Strategies:Supplementary Strategies:
Regulation of Private SectorPromotion of PPPRegulation of Private SectorPromotion of PPPPromotion of PPPMainstreaming AYUSHReorienting medical education
Promotion of PPPMainstreaming AYUSHReorienting medical educationReorienting medical education Regulation of medical care and medical ethics.
Reorienting medical education Regulation of medical care and medical ethics.Risk pooling and social health insurance for
A ibl
Risk pooling and social health insurance for
A iblAccessible, Affordable, accountable and Quality hospital care.
Accessible, Affordable, accountable and Quality hospital care.Quality hospital care.Quality hospital care.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1818
NRHM FocusNRHM FocusNRHM FocusNRHM Focus
18 States to start with18 States to start with18 States, to start with Arunachal Pradesh, Assam, Bihar,
Chhattisgarh
18 States, to start with Arunachal Pradesh, Assam, Bihar,
ChhattisgarhChhattisgarh,Himachal Pradesh, Jharkhand, Jammu & Kashmir Manipur Mizoram
Chhattisgarh,Himachal Pradesh, Jharkhand, Jammu & Kashmir Manipur MizoramKashmir, Manipur, Mizoram,Meghalaya, Madhya Pradesh, Nagaland, Orissa Rajasthan Sikkim
Kashmir, Manipur, Mizoram,Meghalaya, Madhya Pradesh, Nagaland, Orissa Rajasthan SikkimOrissa, Rajasthan, Sikkim,Tripura, Uttaranchal and Uttar Pradesh.Orissa, Rajasthan, Sikkim,Tripura, Uttaranchal and Uttar Pradesh.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 1919
Where to Strike:Infrastructure Up-gradation
Where to Strike:Infrastructure Up-gradationInfrastructure Up-gradationInfrastructure Up-gradation
Functional Sub CentresAdditional contractual ANMs
Functional Sub CentresAdditional contractual ANMs
24 x 7 PHCsThree staff nurses
24 x 7 PHCsThree staff nurses
ANMsUntied fundsCommunity link worker
ANMsUntied fundsCommunity link worker
Annual maintenance grantUntied funds
Annual maintenance grantUntied fundsCommunity link worker
Village Health Nutrition committees
Community link workerVillage Health Nutrition committees
Untied fundsAYUSH IntegrationRMRS/RKS
Untied fundsAYUSH IntegrationRMRS/RKScommittees
Expanded Medicines supply
committeesExpanded Medicines supply
RMRS/RKSRMRS/RKS
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2020
Where to Strike : Infrastructure Up-gradation
Where to Strike : Infrastructure Up-gradationInfrastructure Up gradationInfrastructure Up gradation
CHCs up gradationFirst Referral Units
CHCs up gradationFirst Referral Units
DH up gradationFacility survey
DH up gradationFacility survey
Facility surveyIPHS Facility surveyIPHS
IPHSRMRS/RKSIPHSRMRS/RKS
Untied fundsRMRS/RKSUntied fundsRMRS/RKS
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2121
Where to Strike :Where to Strike :
ManpowerFilling up vacant
ManpowerFilling up vacant
Health Sector PlanningHealth Sector PlanningFilling up vacant posts/Creating more postsContractual positions to fill
Filling up vacant posts/Creating more postsContractual positions to fill
Household surveys & Village Health Plans.Integrated Block &District
Household surveys & Village Health Plans.Integrated Block &Districtp
gaps Trainings / expanding training capacity
pgaps Trainings / expanding training capacity
Integrated Block &District Health Action Plans.Annual PIPs / Perspective
Integrated Block &District Health Action Plans.Annual PIPs / Perspective
training capacitySBA/ IMNCI/ HMIS Counseling/
training capacitySBA/ IMNCI/ HMIS Counseling/
Plans.SPMUs/ DPMUs/ Block PMUs
Plans.SPMUs/ DPMUs/ Block PMUsg
Immunization / Planning Rational transfer and posting policy
gImmunization / Planning
Rational transfer and posting policy
PMUsNHSRC/ SHSRCPMUsNHSRC/ SHSRC
posting policyposting policy
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2222
Where to Strike :Where to Strike :Improved servicedeliveryImproved servicedelivery
SystemicimprovementsSystemicimprovementsdelivery
Citizen’s charterMonthly Health & Nutrition Day
deliveryCitizen’s charterMonthly Health & Nutrition Day
improvementsImproved logistics.Rational / Optimal
improvementsImproved logistics.Rational / OptimalMonthly Health & Nutrition Day
Outsourcing critical service gapsCatch up rounds of
Monthly Health & Nutrition DayOutsourcing critical service gapsCatch up rounds of
Rational / Optimal positioning of manpowerRational delegation (fi i l &
Rational / Optimal positioning of manpowerRational delegation (fi i l &Immunization
Improved IP & OP utilizationM bilit S t / M bil
Immunization Improved IP & OP utilizationM bilit S t / M bil
(financial & Administrative)Decentralized
(financial & Administrative)DecentralizedMobility Support / Mobile
Medical UnitsMaternity Benefit Schemes
Mobility Support / Mobile Medical UnitsMaternity Benefit Schemes
Decentralized procurementDecentralized procurement
Maternity Benefit SchemesMaternity Benefit Schemes
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2323
Where to StrikeWhere to StrikeMonitoring & EvaluationReview meetingsMonitoring & EvaluationReview meetingsgState visits – evaluation teams, RDsIntegrated MIS
gState visits – evaluation teams, RDsIntegrated MISgExternal Surveys
Immunization
gExternal Surveys
ImmunizationImmunization ASHA & JSY External Evaluations
Immunization ASHA & JSY External EvaluationsExternal Evaluations
Community monitoringState level innovations/ Reforms
External EvaluationsCommunity monitoringState level innovations/ ReformsState level innovations/ ReformsState level innovations/ Reforms
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2424
DecentralizationDecentralizationProcurementFacility surveyProcurementFacility surveyVillage health plansPlanning at Institutional levelsVillage health plansPlanning at Institutional levels
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2525
Operationalizing Functional FRUsOperationalizing Functional FRUs24-hour delivery services including normal and assisted deliveries24-hour delivery services including normal and assisted deliveriesassisted deliveries
Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other
assisted deliveries
Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and otherinterventions like Caesarean Sections(*) and other medical interventionsinterventions like Caesarean Sections(*) and other medical interventions
New-born Care
Emergency Care of sick children
New-born Care
Emergency Care of sick childreng y
Full range of family planning services including Laproscopic Services
g y
Full range of family planning services including Laproscopic ServicesLaproscopic ServicesLaproscopic Services
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2626
Operationalizing Functional FRUsOperationalizing Functional FRUsSafe Abortion Services
T t t f STI / RTI
Safe Abortion Services
T t t f STI / RTITreatment of STI / RTI
Blood Storage Facility
Treatment of STI / RTI
Blood Storage Facility
Essential Laboratory Services
Referral (transport) Services
Essential Laboratory Services
Referral (transport) ServicesReferral (transport) Services
24-hour delivery services, both normal and assisted
Referral (transport) Services
24-hour delivery services, both normal and assistedand assisted
Essential newborn care
and assisted
Essential newborn care
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2727
Referral for emergenciesReferral for emergenciesReferral for emergencies Ante-natal care and routine immunization
services for children and pregnant women
Referral for emergencies Ante-natal care and routine immunization
services for children and pregnant women p g(besides Fixed day services).
Post-natal care
p g(besides Fixed day services).
Post-natal careEarly and safe abortion services (including MVA)Family planning servicesEarly and safe abortion services (including MVA)Family planning servicesy p gPrevention and management of RTIs/STIsEssential laboratory services
y p gPrevention and management of RTIs/STIsEssential laboratory servicesEssential laboratory servicesEssential laboratory services
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2828
Institutional MechanismInstitutional MechanismVillage Health & Sanitation Committee(VHSC)RKS/RMRSVillage Health & Sanitation Committee(VHSC)RKS/RMRSDistrict Health Mission,State Health Mission,District Health Mission,State Health Mission,Integration of Departments of Health and Family Welfare, at National andState level
Integration of Departments of Health and Family Welfare, at National andState levelState levelNational Mission Steering GroupEmpowered Program Committee
State levelNational Mission Steering GroupEmpowered Program CommitteeEmpowered Program CommitteeStanding Mentoring GroupTask Groups for Selected Tasks
Empowered Program CommitteeStanding Mentoring GroupTask Groups for Selected TasksTask Groups for Selected TasksTask Groups for Selected Tasks
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 2929
Plan of Action-Components:Plan of Action-Components:1. ASHA2. Strengthening of Sub-Centers3 S f C
1. ASHA2. Strengthening of Sub-Centers3 S f C3. Strengthening of PHCs4. Strengthening of CHCs for First referral5 District Health Plan
3. Strengthening of PHCs4. Strengthening of CHCs for First referral5 District Health Plan5. District Health Plan6. Converging Sanitation & Hygiene under NRHM7. Strengthening Disease control program
5. District Health Plan6. Converging Sanitation & Hygiene under NRHM7. Strengthening Disease control program8. Public-private partnership for public Health goals,
including regulation of private sector9. New health financing mechanisms
8. Public-private partnership for public Health goals, including regulation of private sector
9. New health financing mechanisms9. New health financing mechanisms10.Reorienting health/medical education to support rural
health issues
9. New health financing mechanisms10.Reorienting health/medical education to support rural
health issues
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3030
Plan of Action Component (A): ASHA
Plan of Action Component (A): ASHAASHAASHA
One per illage chosen b and acco ntable to theOne per illage chosen b and acco ntable to theOne per village chosen by and accountable to the PanchayatVolunteer
One per village chosen by and accountable to the PanchayatVolunteerVolunteer, performance-based compensationf ilit t ti d i l t ti f th
Volunteer, performance-based compensationf ilit t ti d i l t ti f thfacilitate preparation and implementation of the Village Health PlanGOI Cost of training incentives and medical kits
facilitate preparation and implementation of the Village Health PlanGOI Cost of training incentives and medical kitsGOI-Cost of training, incentives and medical kits Drug Kit -generic AYUSH and allopathic formulations
GOI-Cost of training, incentives and medical kits Drug Kit -generic AYUSH and allopathic formulationsformulationsformulations
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3131
Plan of Action Component (B): Strengthening SC
Plan of Action Component (B): Strengthening SCStrengthening SCStrengthening SC
Sub-centre -Untied Fund for local action @ Rs. 10 000 per annumSub-centre -Untied Fund for local action @ Rs. 10 000 per annum10,000 per annum.
Joint bank account of the ANM & sarpanchOperated by the ANM, in consultation with
10,000 per annum. Joint bank account of the ANM & sarpanchOperated by the ANM, in consultation with p y ,the village health committee.
Supply of essential drugs (allopathic AYUSH)f
p y ,the village health committee.
Supply of essential drugs (allopathic AYUSH)fIn case of additional outlays,
Multipurpose workers (male)/additional ANMs wherever needed
In case of additional outlays, Multipurpose workers (male)/additional ANMs wherever neededANMs wherever needed, New sub-centers, and upgrading existing sub-centers, including buildings
ANMs wherever needed, New sub-centers, and upgrading existing sub-centers, including buildings
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3232
Plan of Action Component (C): Strengthening PHCs
Plan of Action Component (C): Strengthening PHCsStrengthening PHCsStrengthening PHCs
supply of essential drugs and equipmentsupply of essential drugs and equipmentProvision of 24 X 7 in 50% PHCsObservance of SOPsIn case of additional Outlays
Provision of 24 X 7 in 50% PHCsObservance of SOPsIn case of additional OutlaysIn case of additional Outlays,
Program intensification-Comm. Diseasesprograms for control of NCDs,
In case of additional Outlays, Program intensification-Comm. Diseasesprograms for control of NCDs, gup-gradation of 100% PHCs for 24 x 7provision of 2nd doctor at PHC level (I male, 1 female)
gup-gradation of 100% PHCs for 24 x 7provision of 2nd doctor at PHC level (I male, 1 female)))
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3333
Plan of Action Component (D): St th i CHC
Plan of Action Component (D): St th i CHCStrengthening CHCsStrengthening CHCs
4276 (March 31, ’09) existing CHCs (30-50 beds) as 24 4276 (March 31, ’09) existing CHCs (30-50 beds) as 24 ( , ) g ( )Hour FRUs, including posting of anesthetists.Codification of new IPHS setting norms for
infrastructure
( , ) g ( )Hour FRUs, including posting of anesthetists.Codification of new IPHS setting norms for
infrastructureinfrastructure, staff, equipment, management
infrastructure, staff, equipment, managementmanagement
Promotion of Stakeholder Committees (RKS/ RMRS) for hospital management.
managementPromotion of Stakeholder Committees (RKS/ RMRS) for hospital management.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3434
Plan of Action Component (D): St th i CHC
Plan of Action Component (D): St th i CHCStrengthening CHCsStrengthening CHCs
Developing standards of services and costs inDeveloping standards of services and costs inDeveloping standards of services and costs in hospital care.Develop, display and ensure compliance to Citi ’ Ch t t CHC/PHC l l
Developing standards of services and costs in hospital care.Develop, display and ensure compliance to Citi ’ Ch t t CHC/PHC l lCitizen’s Charter at CHC/PHC level.In case of additional Outlays,
creation of new Community Health Centres (30-50
Citizen’s Charter at CHC/PHC level.In case of additional Outlays,
creation of new Community Health Centres (30-50creation of new Community Health Centres (30 50 beds) and bearing their recurring costscreation of new Community Health Centres (30 50 beds) and bearing their recurring costs
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3535
Amalgamation of field responsesAmalgamation of field responsesAmalgamation of field responses through Village Health Plans, State and National priorities for Health, Water S l S it ti d N t iti
Amalgamation of field responses through Village Health Plans, State and National priorities for Health, Water S l S it ti d N t itiSupply, Sanitation and Nutrition.District -core unit (planning, budgeting & implementation).
Supply, Sanitation and Nutrition.District -core unit (planning, budgeting & implementation).& p e e tat o )Centrally Sponsored Schemes To be modified in consultation with States.All ti l P t i t
& p e e tat o )Centrally Sponsored Schemes To be modified in consultation with States.All ti l P t i tAll vertical Programs to merge into one common “District Health Mission”/ “State Health Mission”
All vertical Programs to merge into one common “District Health Mission”/ “State Health Mission”Provision of DPMUsProvision of DPMUs
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3636
District Planning ComponentsDistrict Planning ComponentsPlan Templates, checklists, appraisal criteria, planning toolFacilitation & ConsultationPlan Templates, checklists, appraisal criteria, planning toolFacilitation & ConsultationEnabling EnvironmentFacility, Manpower & Budget - Rationalizing & Role Clarification
Enabling EnvironmentFacility, Manpower & Budget - Rationalizing & Role ClarificationClarificationNGO involvementFocus on Community Needs and Participation
ClarificationNGO involvementFocus on Community Needs and ParticipationFocus on Community Needs and ParticipationResource Materials for Planning & ImplementationOrientation & Training
Focus on Community Needs and ParticipationResource Materials for Planning & ImplementationOrientation & TraininggAccountability, Monitoring & EvaluationInter and intra sectoral Coordination & Communication
gAccountability, Monitoring & EvaluationInter and intra sectoral Coordination & Communication
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3737
Plan of Action Component (F): C i S it ti & H i
Plan of Action Component (F): C i S it ti & H iConverging Sanitation & HygieneConverging Sanitation & Hygiene
Total Sanitation campaign(TSC) in allTotal Sanitation campaign(TSC) in allTotal Sanitation campaign(TSC) in all districts in X-FYPTSC through PRIs
Total Sanitation campaign(TSC) in all districts in X-FYPTSC through PRIsTSC through PRIsVHSCs to implementASHA t b i ti i d f TSC
TSC through PRIsVHSCs to implementASHA t b i ti i d f TSCASHA to be incentivized for TSC activitiesIEC
ASHA to be incentivized for TSC activitiesIECIECIEC
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3838
Expected Outcomes by 2012Expected Outcomes by 2012
Universal Health care, well functioning health care delivery systemUniversal Health care, well functioning health care delivery systemhealth care delivery system.IMR :30MMR: 100
health care delivery system.IMR :30MMR: 100TFR :2.1Malaria Mortality Reduction – 60% K l A li i d b 2010
TFR :2.1Malaria Mortality Reduction – 60% K l A li i d b 2010Kala Azar eliminated by 2010, Filaria 80 % by 2010 Dengue Mortality reduced by 50%
Kala Azar eliminated by 2010, Filaria 80 % by 2010 Dengue Mortality reduced by 50%Dengue Mortality reduced by 50%TB DOTS series – maintain 85% cure rateResponsive & Functional Health System
Dengue Mortality reduced by 50%TB DOTS series – maintain 85% cure rateResponsive & Functional Health SystemResponsive & Functional Health SystemResponsive & Functional Health System
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 3939
Accomplished So FarAccomplished So Farpp
State and district mission have been setup.State and district mission have been setup.pHealth and family welfare have been merged.Finalization of State PIPs
pHealth and family welfare have been merged.Finalization of State PIPsFollowing documents shared with the states :
Mission DocumentFollowing documents shared with the states :
Mission DocumentGuidelines on IPHSGuidelines on ASHAGuidelines on IPHSGuidelines on ASHAGuidelines on State Health Mission and Guidelines on District Health MissionGuidelines on State Health Mission and Guidelines on District Health Mission
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 4040
Accomplished So FarAccomplished So Farcco p s ed So acco p s ed So a
ASHAS: 861548 selected against six lacsASHAS: 861548 selected against six lacsgMgt. support: over 1500 professionals (CA/MBAs) appointed and 521 district level PMU d 2882 bl k l l PMU’ t
gMgt. support: over 1500 professionals (CA/MBAs) appointed and 521 district level PMU d 2882 bl k l l PMU’ tPMU and 2882 block level PMU’s support NRHM.Financial Management: Financial management
PMU and 2882 block level PMU’s support NRHM.Financial Management: Financial managementFinancial Management: Financial management Group set up under NRHM.Mother NGOs: 334 MNGOs appointed for 340
Financial Management: Financial management Group set up under NRHM.Mother NGOs: 334 MNGOs appointed for 340Mother NGOs: 334 MNGOs appointed for 340 districts. Fully involved in ASHA training and other activities.
Mother NGOs: 334 MNGOs appointed for 340 districts. Fully involved in ASHA training and other activities.
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 4141
Accomplished So FarAccomplished So Farcco p s ed So acco p s ed So a
• Health Action Plan: State PIP received from 31• Health Action Plan: State PIP received from 31Health Action Plan: State PIP received from 31 states during 2006-07 and 35 states/ UTs PIP received during 11-12.
Health Action Plan: State PIP received from 31 states during 2006-07 and 35 states/ UTs PIP received during 11-12. ece ed du g
• PIPs appraised and funds released• Integrated District Health Action Plans have
ece ed du g• PIPs appraised and funds released• Integrated District Health Action Plans have• Integrated District Health Action Plans have
been prepared in 636 districts in various states.Institutional Delivery: 49250358 women
• Integrated District Health Action Plans have been prepared in 636 districts in various states.Institutional Delivery: 49250358 women• Institutional Delivery: 49250358 women benefited since initiation
• Institutional Delivery: 49250358 women benefited since initiation
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 4242
Source: MoHFW
Infant Mortality Rate (India)Infant Mortality Rate (India)y ( )y ( )
134146
138134 138
110
80
58.547
1951 1961 1971 1981 1991 2001 2011
Source:SRS,2011
4343SIHFW: an ISO9001: 2008 certified institutionSIHFW: an ISO9001: 2008 certified institution
Infant Mortality Rate (Rajasthan)Infant Mortality Rate (Rajasthan)a t o ta ty ate ( ajast a )a t o ta ty ate ( ajast a )
108
79 8179 81
55
1981 1991 2001 2011Source: SRS 4444SIHFW: an ISO9001: 2008 certified institutionSIHFW: an ISO9001: 2008 certified institution
Maternal Mortality RatioMaternal Mortality Ratioate a o ta ty at oate a o ta ty at o
India Rajasthan501
445388
j
327 301254
212
318
212
2001 2003 2006 20092001 2003 2006 2009Source: SRS
4545SIHFW: an ISO9001: 2008 certified institutionSIHFW: an ISO9001: 2008 certified institution
Total Fertility RateTotal Fertility Rate
3 6 3 8India Rajasthan
33.5
4 3.42.9 2.7
3.6 3.83.2
j
22.5
3
0 51
1.5
00.5
NFHS I NFHS II NFHS III
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 4646
NRHM Rajasthan: AchievementsNRHM Rajasthan: Achievementsjj
12 02 12 0712.79
ID (in lakhs) JSY Beneficiaries (in lakhs)
10.1811.36
12.02 12.07
7 759.17 9.78 9.86 10.1
7.22
3 88
7.75
3.88
2006-07 2007-08 2008-09 2009-10 2010-11 2011-12
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 4747
Source: www.rajswasthya.nic.in
NRHM: Rajasthan - AchievementsNRHM: Rajasthan - Achievementsjj
• 44858 ASHAs working• 44858 ASHAs working44858 ASHAs working• 40476 VHSC constituted • 1010210 JSY beneficiaries (2011-12)
44858 ASHAs working• 40476 VHSC constituted • 1010210 JSY beneficiaries (2011-12)1010210 JSY beneficiaries (2011-12)• JSY helpline has been initiated • Emergency Health Transport Scheme
1010210 JSY beneficiaries (2011-12)• JSY helpline has been initiated • Emergency Health Transport Scheme• Emergency Health Transport Scheme
successfully implemented through 108 ambulance services
• Emergency Health Transport Scheme successfully implemented through 108 ambulance servicesa bu a ce se cesa bu a ce se ces
Source: www.rajswasthya.nic.in
SIHFW-an ISO 9001:2008 certified InstitutionSIHFW-an ISO 9001:2008 certified Institution 4848
Thank YouThank YouThank You Thank You
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or contact : Director-SIHFW
on
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on