National Rural Health Mission
The National Health Mission (NHM) encompasses its two Sub-Missions, The National Rural Health Mission (NRHM) and The National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases. The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. Continuation of the National Health Mission – with effect from 1st April 2017 to 31st March 2020 has been approved by Cabinet in its meeting dated 21.03.2018.
Six financing components:
(i) NRHM-RCH Flexipool,
(ii) NUHM Flexipool,
(iii) Flexible pool for Communicable disease,
(iv) Flexible pool for Non-communicable disease including Injury and Trauma,
(v) Infrastructure Maintenance and
(vi) Family Welfare Central Sector component.
Within the broad national parameters and priorities, states would have the flexibility to plan and implement state specific action plans. The state PIP would spell out the key strategies, activities undertaken, budgetary requirements and key health outputs and outcomes.
The State PIPs would be an aggregate of the district/city health action plans, and include activities to be carried out at the state level. The state PIP will also include all the individual district/city plans. This has several advantages: one, it will strengthen local planning at the district/city level, two, it would ensure approval of adequate resources for high priority district action plans, and three, enable communication of approvals to the districts at the same time as to the state.
The fund flow from the Central Government to the states/UTs would be as per the procedure prescribed by the Government of India.
The State PIP is approved by the Union Secretary of Health & Family Welfare as Chairman of the EPC, based on appraisal by the National Programme Coordination Committee (NPCC), which is chaired by the Mission Director and includes representatives of the state, technical and programme divisions of the MoHFW, national technical assistance agencies providing support to the respective states, other departments of the MoHFW and other Ministries as appropriate.
Forward Linkages Scheme to NRHM in NE : With a view to complement & supplement the initiatives under the NRHM for improving the Secondary/Tertiary level and Other health infrastructure in the north eastern region, the Forward Linkage Scheme to NRHM was introduced in the 11th Plan (to be financed form likely saving from other Health schemes). This scheme was also continued in the 12th Plan. The project proposals sent by the NE States are appraised and for the approved projects, funds are released by the Ministry.
Presently the Scheme has been approved by the Government for implementation upto the current Financial Year i.e. 2018-19 for Ongoing projects only. The Forward Linkages Scheme was earlier a 100% Central Sector Scheme. However, the Government has recently revised the sharing pattern of the Scheme to 90:10 ratio between the centre and State during the current year.
Outcomes for NHM in the 12th Plan are synonymous with those of the 11th Plan and are part of the overall vision. Specific goals for the states will be based on existing levels, capacity, and context. State specific innovations would be encouraged. Process and outcome indicators will be developed to reflect equity, quality, efficiency, and responsiveness. Targets for communicable and non-communicable diseases will be set at state level based on local epidemiological patterns and taking into account the financing available for each of these conditions.
The endeavor would be to ensure the achievement of indicators in Box 1 as follows :
1. Reduce MMR to 1/1000 live births
2. Reduce IMR to 25/1000 live births
3. Reduce TFR to 2.1
4. Prevention and reduction of anaemia in women aged 15–49 years
5. Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases
6. Reduce household out-of-pocket expenditure on total health care expenditure
7. Reduce annual incidence and mortality from Tuberculosis by half
8. Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
9. Annual Malaria Incidence to be <1/1000
10. Less than 1 percent microfilaria prevalence in all districts
11. Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks