NATIONAL RURAL HEALTH MISSION (NRHM)

 

NATIONAL RURAL HEALTH MISSION (NRHM)

 

          National Rural Health Mission is launched by the Government of India on 5^th April, 2005 for a period of 7 years (2005-2012) under the Prime Minister Manmohan Singh and this mission seeks to improve rural health care delivery system.  The prototype developed by AGCA and Ministry of Health and Family Welfare.

 

          The National Rural Health Mission is operation in the whole country with special focus on 18 states such as in Bihar, Jharkhand, Madhya Pradesh, Chattisgarh, Uttar Pradesh, Uttaranchal, Orissa and Assam, Arunachal Pradesh, Manipur, Meghalya, Mizoram, Magaland, Sikkim and Tripura, Himachal Pradesh and Jammu and Kashmir.

 

AIMS:

          The main aim of NRHM is to provide

·        Accessible

·        Affordable

·        Accountable

·        Effective and

·        Reliable Primary health care,

·        Bridging the gap in rural health care through creation of a cadre of ASHA.

 

PLAN OF ACTION TO STRENGTHEN INFRASTRUCTURE

1.          Creation of a cadre of Accredited Social Health Activist (ASHA).

2.          Strengthening sub centres by

a.     Supply of essential drugs both allopathic and AYUSH to the sub centre.

b.    Provision of multipurpose worker (male ) / additional ANMs where ever needed, sanction of new sub-centres as per 2001 population norm and upgrading existing subcentres and

c.     Strengthening sub-centres with united funds of Rs.10,000 per annum in all 18 states.

3.          Strengthening Primary Health Centres:

a.     Adequate and Regular supply of essential drugs and equipment to PHCs.

b.    Provision of 24 hours service in at least 50% PHCs by including and AYUSH practitioner.

c.     Following standard treatment guidelines.

d.    Upgradation of all the PHCs for 24 hours referral service and provision of second doctor at PHC level (One male and 1 female); strengthening the ongoing communicable disease control programmes and new programmes for control of non – communicable diseases.

4.          Strengthening community Health Centres for First referral care by

a.     Operating all 3222 existing CHCs (3035 beds) as 24 hours first referral units, including posting of an anaesthetist.

b.    Codification of new “Indian Public Health Standards” by setting up norms for infrastructure,  equipment, management etc, for CHCs,

c.     Promotion of ‘Rogi Kalyan Samiti” for hospital management.

d.    Developing standards of services and costs in hospital care.

 

          District becomes the core unit of planning, budgeting and implementation of the program.  All vertical health and family welfare programmes at district level will merge intone common “District Health Mission” and at state level into “State Health Mission” and also they are having the provision of a “Mobile Medical Unit” at district level for improved out reach services.

 

GOALS

A. NATIONAL LEVEL

·        Infant mortality rate reduced to 30/1,000 live births.

·        Maternal mortality ratio reduced to 100/100,000.

·        Total Fertility rate reduced to 2%.

·        Malaria mortality rate REDUCTION-50% BY 2010, ADDITIONAL 10% BY 2012.

·        Kala-agar mortality rate reduction-100% by 2010 and sustaining elimination until 2015.

·        Falarial microfilaria rate reduction 70% by 2010, 80% by 2012 and elimination by 2015.

·        Dengue mortality rate reduction 50% by 2010 and sustaining at that level until 2012.

·        Japanese encephalitis mortality rate reduction 50% by 2010 and sustaining at that level until 2012.

·        Cataract operation increasing to 46 lacks per year by 2012.

·        Leprosy prevalence rate: reduce from 1.8/10,000 in 2005 to less than 1/10,000 thereafter.

·        Tuberculosis DOTS services: maintain 85% are rate through entire mission period.

·        Upgrading community health centres to Indian Public health standards.

·        Increase utilization of first referral units from less than 20% to 75%.

·        Engaging 250,000 female accredited social health activities (ASHAS) in 10 states.

 

B.AT COMMUNITY LEVEL

·        Availability of trained community level worker at village level, with a drug kit for general ailments.

·        Health day at Anganwadi level on a fixed day / month for provision of immunization ante/post natal checkups and services related to mother and child health care, including nutrition.

·        Availability of generic drugs for common ailments at sub-centre and hospital level.

·        Good hospital care through assured availability of doctors, drugs and quality services at PHC / CHC level.

·        Improved access to universal immunization through induction of auto disabled syringes, alternate vaccine delivery and improved mobilization services under the programme.

·        Improved facilities for institutional delivery through provision of referral, transport, escort and improved hospital care subsidized under the Janani Suraksha Yojana for the below poverty line families.

·        Availability of assured health care at reduced financial risk through pilots of community health insurance under the mission.

·        Provision of house hold toilets.

·        Improved outreach services through mobile medical unit at district level.

 

SELECTION OF ASHA

          ASHA must be the resident of the village a woman (married / widow / divorced) preferably in the age group of 25 to 45 years with formal education of upto VIIIth Class, having communication skills and leadership qualities.

 

          The general normal of selection will be one ASHA for 1000 population.  In tribal, hilly and desert areas the norm could be relaxed to one ASHA per habitation.  At present about one lac ASHA’s have been already selected and are being trained.

 

ROLE AND RESPONSIBILITY OF ASHA

        ASHA will be a health activist in the community who will create awareness on health.  Her responsibilities will be as follows:-

1.     ASHA will take steps to create awareness and provide information to the community on determinants of health.

2.     She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization, contraception and prevention of common infections including reproductive tract infection / sexually transmitted infection and care of the young child.

3.     Asha will mobilize the community and facilitate them in accessing health and health related services.

4.     She will work with the village health and sanitation committee of the gram panchayat to develop a comprehensive village health plan.

5.     She will arrange escorts / accompany pregnant woman and children requiring treatment / admission to the nearest pre-identified health facility.

6.     ASHA will provide primary medical care for minor ailments.

7.     She will also act as a depot holder for essential provisions being made available to every habitation.

8.     Her role as a provider can be enhanced subsequently.

9.     She will inform about the births and deaths in her village and any unusual health problems / disease out breaks in the community to the sub-centre / primary health centre.

10.                       She will promote construction of household toilets under total sanitation campaign.

CONCLUSION

 

          National rural health mission is one of the project of Prime Minister, is to improve the health of the rural people, and other determinants are like water, sanitation, education, nutrition, social and gender equality.

 

          Thus it is a narrowly defined schemes, the NRHM shifting focus to a functional health system at all levels, from village to district.

BIBLIOGRAPHY

 

A text of “Community Health Nursing”

By K.Park

Edition : 19^th Edition

Page No.328-330.