1. National Rural Health Mission MIT India Reading Group Meeting 4 Oct 07 Lavanya Marla

2. About NHRM Inaugurated on April 12, 2005 Increase spending on health from 0.9% of GDP to 2-3% of GDP Correct the deficiencies of the health system Focus on 18 states – northern and eastern Goal is good decentralized healthcare Missionary approach by government? Intended for 2005 - 2012

3. Goals Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non- communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH Promotion of healthy life styles

4. Action Points Provision of health activist in each village Village health plan prepared through panchayat involvement Strengthening of rural hospitals Integration of vertical health programs (leprosy, TB, malarial programs, etc.) and traditional medicine Integration of plans at different levels New health financing mechanisms

5. Major Stakeholders Accredited Social Health Activist (ASHA) Auxiliary Nurse Midwife and Anganwadi worker Panchayati Raj Institutions and NGOs District Administration State Governments

6. Village level ASHA  accredited social health activist  Female activist given accreditation after 4 phase training Ownership of health program given to villagers Village Health Committee prepares village health Plan

8. District Level District health plan generated by combining village health plans Elements are drinking water, sanitation, hygiene and nutrition Strengthen PHC (Primary Health Centers) and CHC (Community Health Centers)

9. Higher levels Integrate vertical health and family welfare at district, block, state and national levels Integration of vertical health programs (leprosy, TB, malarial programs, etc.) All health facilities and infrastructure built based on Indian Public Health Standards (IPHS) standards Rectify manpower shortage, equipment and other furnishings in health facilities Strengthen capacities for data collection, processing, evaluation and supervision

10. Exploit synergies at different levels NGOs and ASHAs work together AYUSH (Ayurvedic, Yogic, Unani, Siddha and Homoeopathy) - Local health traditions made mainstream Pass regulations requiring private practitioners to give service at reasonable cost Public-private partnerships Re-orient medical education (MBBS 6 th yr in rural service?) Social health insurance (how viable?) Health Information System

11. Milestones Health provider in each village Upgrading of rural hospitals Build new hospitals District Planning Operational Village Health Plans Merger of multiple societies into District/State Mission Operational PMUs Technical Support 2005-08 2005-07 2005-08 2005-07 2006 April 05 2005-06 2005-07

12. Progress of Program http://mohfw.nic.in/NRHM/Exe_sum_apr07.htm ‘Expected improvement’ statistics missing for many measures

13. Observations and Questions Attempt at transparency Data actually available, though not comprehensive Working on cures is an inherent defect in Indian health system – Focus seems to be changing towards prevention Providing ‘standard’ health care in peripheral areas – economically viable? Is this a missionary approach, or is it sustainable?