National Health Mission (NHM): Providing Universal Health Care

This flagship mission was started on 12 April 2005 by the Government of India with the name National Rural Health Mission (NRHM) in 18 states. In 2013 Government of India announced National Urban Health Mission (NUHM) and combined it with NRHM to form National Health Mission (NHM).Spending on health to be increased from 0.9% of GDP to 2-3% of GDP.

Q 1) What does NHM basically means and what are the programmes covered under this?
Ans. The NHM is basically a strategy for integrating ongoing vertical programmes of Health & Family Welfare and addressing issues related to the determinants of Health like Sanitation, Nutrition and Safe Drinking Water.

Q 2) What are the main objectives of NHM?
Ans. The core objectives of NHM include:

  • Decentralized village and district level health planning and management.
  • Appointment of Accredited Social Health Activist (ASHA) to facilitate access to health services.
  • Strengthening the public health service delivery infrastructure, particularly at village, primary and secondary levels.
  • Mainstreaming AYUSH(Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) in public health care.
  • Promoting the non-profit sector to increase social participation and community empowerment.
  • Promoting healthy behaviours and improving intersectional convergence.

Q 3) What is basic approach of NHM towards fulfilling above objectives?
Ans. The NHM employed five main approaches namely communitization, flexible financing,improved management through capacity building, monitoring progress against standards, and innovations in human resource management. What helped immensely in communitizing the healthcare was the ongoing process of decentralization with concomitant convergence. In the process of communitization, the role of Non-governmental Organizations(NGOs) is critical for the success of NHM. Their partnership is being utilized under the disease control programs, reproductive and child health, routine immunization and special immunization activities (SIAs).

Q 4) What are the some key initiatives of NHM?
Ans.Some of the major initiatives under (NHM) are as follows:
1.  Accredited Social Health Activists: Community Health volunteers called Accredited Social Health Activists (ASHAs) have been engaged under the mission for establishing a link between the community and the health system. ASHA will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.

2.  Rogi Kalyan Samiti (Patient Welfare Committee): It is a management structure that acts as a group of trustees for the hospitals to manage the affairs of the hospital. Its members would be selected from local MLA/MPs, Health officials (including an Ayush doctor), Representatives of the IMA, Panchayati Raj representative and Leading donors for health care.

3.  Village Health Sanitation and Nutrition Committees (VHSNC): VHSNC have used untied grants to increase their involvement in their local communities to address the needs of poor households and children.

4.  Janani Suraksha Yojana (JSY): JSY aims to reduce maternal mortality among pregnant women by encouraging them to deliver in government health facilities. Under the scheme cash assistance is provided to eligible pregnant women for giving birth in a government health facility. The number of beneficiaries under JSY had increased from 7 lakhs in 2005-2006 to over 86 lakhs in 2008-2009.

5.  National Mobile Medical Units (NMMUs): Free ambulance services are provided in every nook and corner of the country connected with a toll-free number and reaches within 30 minutes of the call.

6.  Janani Shishu Suraksha Karyakarm (JSSK): It was introduced to provide free to and fro transport, free drugs, free diagnostic, free blood, and free diet to pregnant women who come for delivery in public health institutions and sick infants up to one year.

7.  Free Drugs and Free Diagnostic Service: A new initiative is launched under the National Health Mission to provide Free Drugs Service and Free Diagnostic Service with a motive to lower the out-of-pocket expenditure on health.

8.  District Hospital and Knowledge Centre (DHKC): District Hospitals are being strengthened to provide Multi-specialty health care. These hospitals would act as the knowledge support for clinical care in other facilities also.

9.  National Iron+ Initiative: The National Iron+ Initiative is an attempt to look at Iron Deficiency Anaemia in which beneficiaries will receive iron and folic acid supplementation irrespective of their Iron/Hb status.

Q 5) Does NHM include private sector regulation?
Ans. Almost 75% of health services in India are being currently provided by the private sector, so there is a need to refine regulations. The supplementary strategies of NHM include following aspects with respect to private sector:
1.   District Institutional Mechanism for Mission must have representation of private sector.
2.   Develop guidelines for Public-Private Partnership (PPP) in health sector.
3.   Public sector to play the lead role in defining the framework and sustaining the partnership.
4.   Management plan for PPP initiatives to be done at District/State and National levels.
5.   Regulation of the private sector to improve equity and reduce out-of-pocket expenses.
6.   Foster public-private partnerships to meet national public health goals and reoriented medical education.
7.   Introduction of effective risk pooling mechanisms and social insurance to raise the health security of the poor and taking full advantage of local health traditions.

Q 6) How Successful NHM has been?
Ans. One of the success stories being attributed to NHM is a huge increase in institutional deliveries. ASHAs (around 7.5 lakh in number) at grass root level have done a phenomenal job in mobilizing women from valuable community to come to institutions.There definitely have been gains as shown by statistics – infant mortality rate has come down to 53/1000 live births, maternal mortality rate has come down to 254/1000 live births and total fertility rate is now 2.7.

Q 7) What the future holds for NHM?
Ans. The inherent problems of public-private partnership might continue to examine the pro-people character of NHM for a very long period. The other major obstacles for NHM might be:
1.   Use of multidimensional strategy at district, block and village levels.
2.   Cross-linkages with the issues of poverty, illiteracy, and social acceptance.
3.   Governance issues, including ongoing empowerment of PRIs (Panchayati Raj Institutes).
4.   Making VHSC (Village Health and Sanitation Committee) vibrant.
5.   Impediments in release of funds and assured availability of incremental outlays for mission is also big challenge.
There is also a need to explore linkages with the ongoing programs like MNREGA, added with the deployment of rich repository of human resource of elderly men and women, who could be used for community mobilization.

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