National Rural Health Mission

All About National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched on 12th April 2005, and inaugurated by the Hon’ble Prime Minister. It aims to ensure accessible, affordable and quality healthcare services to the rural population, especially the vulnerable groups. It is a subsidiary of the overarching National Health Mission (NHM). It has been especially implemented to provide equitable, affordable and quality healthcare to the rural population, especially the vulnerable groups.

NRHM focuses on offering fully functional, community-driven services to the Empowered Action Group (EAG) States as well as the states in the North East, Jammu and Kashmir and Himachal Pradesh. These services include healthcare, effective distribution of water, nutrition, sanitation, education, and social and gender equality. It serves as a boost to the fragmented health sector and drive outcomes, measured against Indian Public Health Standards for all healthcare amenities.

Features of National Rural Health Mission (NRHM)

Below are the key features of National Rural Health Mission, which are a means to achieving its objectives:

  • Making the public health delivery system fully functional and accountable to the community
  • Human resources management
  • Community involvement
  • Decentralization of healthcare services that it specializes in offering
  • Close monitoring and evaluation of services provided against carefully set standards
  • Convergence of health and related programmes from village level upwards
  • Planning and implementing innovations healthcare services and flexible financing
  • Interventions at regular intervals for improving the existing health indictors

Objectives of National Rural Health Mission (NRHM)

Below are the aims and objectives of National Rural Health Mission:

  • Ensures accessible quality, community-driven health services for communicable and non-communicable diseases
  • Organizes awareness campaigns, and plans, implements and monitors initiatives related to health, nutrition, sanitation, solar energy, supply chain management, registering births of children born in the last 6 months, healthcare during pregnancy, etc.
  • Aims to reduce MMR (Measles, Mumps & Rubella) to 1 per 1000 live births
  • Reduce Infant Mortality Rate (IMR) to 25 per 1000 live births
  • Reduce Total Fertility Rate (TFR) to 2.1
  • Prevent and reduce anaemia in women aged between 15 and 49 years
  • Prevent and reduce mortality and morbidity from communicable, non- communicable; injuries and emerging diseases
  • Reduce household out-of-pocket expenditure on total health care expenditure
  • Reduce annual incidence and mortality from tuberculosis by half
  • Control the prevalence of leprosy to less than 1 for every 10000 of the rural population and incidence to zero in all districts
  • Control annual malaria incidence to less than 1 for every 1000 of the rural Indian population
  • Reduce microfilaria to less than 1% of what is currently prevalent in all districts

Initiatives for Community Participation under NRHM

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Below are some of the initiatives undertaken by National Rural Health Mission (NRHM):

  • Community Participation in Health Care, also known as Nagaland Health Project, focuses on community monitoring of healthcare services in 11 districts in Nagaland across 1324 villages through VHSNCs.
  • Nagaland Health Project is supported by World Bank and implemented by the Department of Health and Family Welfare, Government of Nagaland.
  • It has been launched with the objective to encourage ownership and community participation in Nagaland, the state implements its initiatives through two distinct levels – village level and at CHC/PHC level. At the village level, the initiatives are implemented by the Village Health Committee and Common Health Sub-centre Committee. At the CHC/PHC level, Health Centre Managing Committee was especially formed for this purpose. It comprises of the representatives of VHCs and Village Councils of all constituent villages and towns categorized under the respective CHC/ PHC areas.
  • It also aims at stengthening the community involvement in improving access to health care, thereby improving health and nutrition outcomes.
  • It seeks to improve the accessibility and speed of healthcare services by investing in multiple areas.
  • Community healthcare associations, or ASHAs, are an integral part of the program in the distribution of drugs and certain specific equipment like Paracetamol, ORS, condom, weighing scale, thermometer, blanket, etc.
  • After implementation of these healthcare programs, it closely monitors and analyses the reach of its initiatives.
  • NRHM organizes awareness campaigns related to health, nutrition, sanitation and other similar issues. Other areas include water sanitation, solar energy, supply chain management, capacity building, registering births of children born in the last 6 months, registering pregnancies, check-ups during pregnancy, etc.

Achievements of National Rural Health Mission (NRHM)

Below are the achievements against the targets up to the XIth Plan.

Physical Outcomes : Targets & Achievements under NRHM

Targets (2005-12)Achievements (up to 2012)
IMR reduced to 30/1000 live birthsIMR reduced from 58 in 2005 (SRS) to 42 in 2012 (SRS).
Maternal Mortality to reduce to 100/100,000 live birthsMMR reduced from 254 in 2004-06 (SRS) to 178 in 2010-12 (SRS).
TFR reduced to 2.1TFR reduced from 2.9 in 2005 (SRS) to 2.4 in 2012 (SRS).
Malaria Mortality reduction to 60%70% Malaria mortality reduction- (Reduced from 1707 in 2006 to 519 in 2012).
Kala Azar Mortality reduction to 100%85% Kala-azar mortality reduction- (Reduced from 187 in 2006 to 29 in 2012).
Filaria / Microfilaria Reduction Rate to 80%60% Filaria/Microfilaria Reduction (Reduced from 1.02 in 2005 to 0.41 in 2012)
Dengue Mortality reduction by 50%8% reduction- Dengue Mortality has reduced from 184 in 2006 to 169 in 2011.
Cataract operations- increasing to 46 lakhs per yearCataract operations of more than 63.49 lakhs per year have been reported in 2012.
Leprosy Prevalence Rate reduction to less than 1 per 10,000Leprosy Prevalence Rate reduced from 1.34 per 10,000 in 2005 to 0.68 per 10,000 in 2012.
Tuberculosis Control - over 70% case detection & 85% cure rateTuberculosis is having 71% case detection and 88% Cure rate in 2012.

Below are the achievements against the targets during the XIIth Plan.

Physical Outcomes: Targets & Achievements for NHM/12th FY Plan

Targets (2012-17)Achievements
Reduce IMR to 25/1000 live birthsIMR reduced from 42 in 2012 (SRS) to 40 in 2013 (SRS).
Reduce MMR to 1/1000 live birthsMMR has reduced to 167 in 2011-13 (SRS).
Reduce TFR to 2.1TFR has reduced to 2.3 in 2013 (SRS).
Reduce annual incidence and mortality from Tuberculosis by halfTuberculosis is having 171 incidence (per lakh population) and 19 mortality (per lakh population) in 2013.
Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districtsLeprosy Prevalence Rate is less than 1 per 10,000 of the population
Annual Malaria Incidence to be <1/1000Annual Malaria Incidence is less than 1 per 1000
Less than 1% microfilaria prevalence in all districtsOut of 255 districts, 222 have reported mf rate of less than 1%
Kala-azar elimination by 2015, <1 case per 10000 population in all blocksOut of 611 block PHCs, 454 have reported < 1 case per 10000

Conclusion

National Rural Health Mission has been a step in the right direction to make quality health services accessible to the rural Indian population. It is responsible for end-to-end healthcare services, right from planning and implementation to closely monitoring its initiatives. It integrates the rural communities in its core initiatives. Actively involving them enables NRHM to understand the health concerns better and customize the healthcare plans to suit the unique needs of the rural Indian population.

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