NATIONAL RURAL HEALTH MISSION (NRHM)
NATIONAL
RURAL HEALTH
National
Rural Health Mission is launched by the Government of India on 5th
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
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 : 19th Edition
Page No.328-330.
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