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.
Text of NRHM in context with MCH
NRHM IN CONTEXT WITH MATERNAL & CHILD HEALTH DR PRADIP AWATE, ASSISTANT DIRECTOR OF HEALTH SERVICES, MAHARASHTRA
National Health Mission (NHM) NRHM NUHM From 1 May 2013
Scheme of Presentation Backdrop of NRHM Advent of NRHM Why & What for ? Vision of NRHM Core Strategies Plan of Action MCH Services Achievements Way ahead !
Public Health Status 1. Poor Public health expenditure in India - Public health expenditure has declined from 1.3% of GDP in 1990 to 0.9% of GDP in 1999. 2. Vertical Health and Family Welfare Programmes have limited synergisation at operational levels. 3. Lack of community ownership of public health programmes impacts levels of efficiency, accountability and effectiveness. 4. Lack of integration of sanitation, hygiene, nutrition and drinking water issues.
5. There are striking regional inequalities. 6. Population Stabilization 7. Curative services favor the non-poor: for every Re.1 spent on the poorest 20% population, Rs.3 is spent on the richest quintile. 8. Only 10% Indians have some form of health insurance, mostly inadequate 9. Out of Pocket Expenses -Hospitalized Indians spend on an average 58% of their total annual expenditure Over 40% of hospitalized Indians borrow heavily or sell assets to cover expenses. Over 25% of hospitalized Indians fall below poverty line because of hospital expenses
Vision Of NRHM 1 1. To provide effective health care to rural health population. (Special focus on 18 states) 2. To raise public spending on Health from 0.9% of GDP to 2-3% of GDP. 3. To undertake architectural correction of the health system to strengthen public health management and service delivery in the country.
Vision Of NRHM 2 4. Female health activist (ASHA)in every village. 5. A village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat. 6. Strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards(IPHS)
Vision Of NRHM 3 7. Integration of vertical Health & Family Welfare Programmes. 8. It seeks to revitalize local health traditions and mainstream AYUSH into the public health system. 9. effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health.
Vision Of NRHM 4 10. Address inter state , inter district disparities. 11.Define time-bound goals and report publicly on their progress. 12.To improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare.
NRHM - GOALS 1. Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) 2. Universal access to public health services such as Womens health, child health, water, sanitation & hygiene, immunization, and Nutrition. 3. Prevention and control of communicable and non- communicable diseases, including locally endemic diseases. 4. Access to integrated comprehensive primary healthcare 5. Population stabilization, gender and demographic balance. 6. Revitalize local health traditions and mainstream AYUSH 7. Promotion of healthy life styles
Core Strategies 1. Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services. 2. Promote access to improved healthcare at household level through the female health activist (ASHA). 3. Health Plan for each village through Village Health Committee 4. Strengthening sub-centre through an untied fund to enable local planning and action and more Multi Purpose Workers . 5. Strengthening existing PHCs and CHCs, and provision of 30- 50 bedded CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards).
Core Strategies 6. Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. 7. Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels. 8. Technical Support to National, State and District Health Missions, for Public Health Management. 9. Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. 10. Formulation of transparent policies for deployment and career development of Human Resources for health. 11. Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc. 12. Promoting non-profit sector particularly in under served areas.
Supplementary Strategies 1. Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. 2. Promotion of Public Private Partnerships for achieving public health goals. 3. Mainstreaming AYUSH revitalizing local health traditions. 4. Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics. 5. Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.
Plan Of Action A] ASHA Honorary volunteer Chosen by & accountable to Panchayat. Bridge between ANM & Village. Will be imparted necessary training. Provision of Medicine kit Will facilitate preparation of Village Health Plan
B] Sub center Strengthening Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This Fund will be deposited in a joint Bank Account of the ANM & Sarpanch and operated by the ANM, in consultation with the Village Health Committee. Supply of essential drugs, both allopathic and AYUSH, to the Sub-centres. In case of additional Outlays, Multipurpose Workers (Male)/Additional ANMs wherever needed, sanction of new Sub-centres as per 2001 population norm, and Upgrading existing Sub-centres, including buildings for Sub- centres functioning in rented premises will be considered.
C] STRENGTHENING PRIMARY HEALTH CENTRES Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto Disabled Syringes for immunization) to PHCs Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially in high focus States, through mainstreaming AYUSH manpower. Observance of Standard treatment guidelines & protocols. In case of additional Outlays, intensification of ongoing communicable disease control programmes, new programmes for control of non communicable diseases, up gradation of 100% PHCs for 24 hours referral service, and provision of 2nd doctor at PHC level (I male, 1 female) would be undertaken on the basis of felt need.
D] STRENGTHENING CHCs FOR FIRST REFERRAL CARE Operationalizing 3222 existing Community Health Centres (30-50 beds) as 24 Hour First Referral Units, including posting of anaesthetists. Codification of new Indian Public Health Standards, setting norms for infrastructure, staff, equipment, management etc. for CHCs. Promotion of Stakeholder Committees (Rogi Kalyan Samitis) for hospital management. Developing standards of services and costs in hospital care. Develop, display and ensure compliance to Citizens Charter at CHC/PHC level. Creation of new Community Health Centres (30-50 beds) to meet the population norm.
Other Aspects District Health Plan District Health Plan Converging sanitation & hygiene Strengthening of Disease Control Programmes PPP & Pvt Sector Regulation New Health Financing New Health Financing Flexibility Money follows the patient Standardization of services Program Management Support Non lapsable health Pool ( Management System ) Developing Manpower Improved Governance o E banking o Social audit
Communitize Flexible Financing Monitor Progress against standards Improved Management Through Capacity Innovations in HR Management
Reproductive Maternal Newborn Child Health And Adolescent RMNCH+A Services
Maternal Health Services Janani Suraksha Yojana Janani Shishu Suraksha Karyakram - In this programme following free entitlements are provided to pregnant mothers and sick infants. I. Free transport services from home to institute, institute to other institute & institute to home. II. Free diet services to mothers (3 days for normal deliveries and 7 days for C section) III. Ze