V.SRINIVAS
The National Health Mission is India’s flagship health sector programme to revitalize rural and urban health sectors by providing flexible finances to State Governments. The National Health Mission comprises of 4 components namely the National Rural Health Mission, the National Urban Health Mission, Tertiary Care Programmes and Human Resources for Health and Medical Education.
The National Health Mission represents India’s endeavor to expand the focus of health services beyond Reproductive and Child Health, so as to address the double burden of Communicable and Non-Communicable diseases as also improve the infrastructure facilities at District and Sub-District Levels. The National Health Mission has synergized learning from the National Rural Health Mission for better implementation of the National Urban Health Mission. The National Health Mission has an allocation of Rs. 26,690 crores for 2017-18 and is one of the largest centrally sponsored schemes of the Government of India.
The National Health Mission (NHM) brought together at National level the two Departments of Health and Family Welfare. The integration resulted in significant synergy in programme implementation and enhancement in Health Sector allocations for revitalizing India’s rural health systems. A similar integration was witnessed at State levels too. Further the NHM brought in revolutionary changes in devolution of central finances to State Health Societies outside the purview of the State Finance Departments. The second major change was the integration of the disease control programmes into the NHM framework.
The NHM brought in considerable innovations into the implementation of Health Sector Programmes in India. These included flexible financing, monitoring of Institutions against Indian Public Health Standards, Capacity Building at the State, District and Panchayat Samiti levels by induction of management specialists into the Programme Management Units and simplified HR management practices for timely recruitment through the State Institutes of Health and Family Welfare. Another significant innovation is the establishment of the National Health Systems Resource Center (NHSRC) to help design and formulate various initiatives. State Health Systems Resource Centers have also been established in some States.
The Ministry of Health and Family Welfare approves Programme Implementation Plans of the State Health Societies on an annual basis with specific resource allocations under the major heads of RCH Flexi Pool, the NRHM Flexi Pool, the Flexi Pool for Communicable Diseases and the Flexi Pool for Non Communicable Diseases as also for Infrastructure strengthening. There are significant resource allocations for training programmes and capacity building. The State Health Societies have considerable autonomy to re-appropriate resources within the major heads and devolution to District Hospitals, Community Health Centers and Primary Health Centers.
The priority focus of NHM is Reproductive and Child Health services. The successful implementation of Janani Suraksha Yojana (JSY) and Accredited Social Health Activist (ASHA) programmes had a significant impact in behavioral changes and brought pregnant women in large numbers to public health institutions. The NRHM flexi pool resources were utilized to create adequate infrastructure at public health institutions to cope with the heavy rush of maternity cases. Ambulance services were introduced for transportation of maternity cases to public health institutions and for emergency care. The success story of the 108 ambulance services has been well documented across many States.
The increase in institutional deliveries in High Focus States of NHM had a significant impact on Maternal Mortality Ratio (MMR) and Under Five Mortality Rate (U5MR). On the Millennium Development Goals (MDGs) 4 and 5, the country made substantial progress. In the case of MDG 6, the country was able to meet the target and reverse the prevalence of Tuberculosis, Malaria and HIV. NHM has also performed well by adopting a continuum of care or life cycle approach as demonstrated by improvements in key health indicators.
The Ministry of Health and Family Welfare added two new programmes to its basket of activities under the National Health Mission. The first is Mission Indradhanush, which has demonstrated good progress in improving immunization coverage by over 5% in the just one year. The second is the Kayakalp initiative launched in 2016 under the NHM to inculcate the practice of hygiene, sanitation, effective waste management and infection control in public health facilities. The competition for awards introduced under Kayakalp has been well received by all the States and significant improvements in sanitation standards are being witnessed.
The NHM created a peoples’ movement for health care. India has deployed nearly 10 lac Accredited Social Health Care (ASHA) workers representing transformational change agents. The ASHA workers act as mobilizers for institutional deliveries, focus on integrated management of neonatal and childhood illness and advise on home based neo-natal care. The NHM has also empowered people through Village Health and Sanitation Committees to formulate village health plans and exercise supervisory oversight of ASHA workers. At the Primary Health Centre (PHC) and Community Health Centre (CHC) level Rogi Kalyan Samitis have been activated to establish systems of oversight over the public health facilities for creating a patient friendly institution. Besides rural areas, the urban slums are now receiving attention with the launch of the National Urban Health Mission.