1. NATIONAL RURAL HEALTH MISSION (NRHM)
30TH OCTOBER 2008
PRESENTATION ON

2. NATIONAL RURAL HEALTH MISSION
NRHM launched by Hon’ble Prime Minister on 12/4/2005.
Aimed to ensure affordable, quality health care to the poorest house holds in remotest areas.
Special focus on 18 low performing States which have weak public health indicators and weak infrastructure.
Punjab is among the nine high performing States- Punjab, Haryana, Gujarat, Maharashtra, Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, West Bengal.
4/15/2017

3. NRHM OBJECTIVES
Universalized access to quality health care especially to rural poor with focus on women and children.
Reduced infant mortality rate and Maternal Mortality Rate.
Ensuring population stabilization & gender equity.
Prevention and control of communicable and non-communicable diseases.
Access to integrated comprehensive primary health care.
Mainstream AYUSH- Integration of AYUSH with mainstream health institutions .
Promotion of Healthy life style.
Emphasis on potable drinking water, hygiene, sanitation and nutrition.
4/15/2017

4. Accessibility, Approachability and Quality
KEY COMPONENTS OF NRHM
Community Partnership Village level planning ASHA Village Health & Nutrition Days Village Health & Sanitation Committees Increased involvement of PRIs
Improved services
System strengthening
Infrastructure development
Monitoring through computerisation
Improved financial management &
Human Resource
Public Private Partnership
Telemedicine
Mobile units for un reached
Intra & inter sectoral convergence
24-Hour- delivery services
Emergency Obstetric Services
Specialist Services – On call/contract
Immunization strengthening
IMNCI
Adolescent health
Family welfare services
Accessibility, Approachability and Quality

5. NRHM STRATEGIES
Decentralization of the process of health planning and management from Village to District level.
Involvement of PRIs and Village Health & Sanitation Committees.
Up-gradation of existing health institutions from Sub Centres to District Hospitals as per Indian Public Health Standards (IPHS).
Flexible financing- untied funds for filling up the gaps in infrastructure and other related activities.
Manpower requirement- recruitment of doctors, and paramedical staff in relation to Woman & Child Health.
Improved management through capacity building- provision of computers, computer operators, establishment of State, District and Block Programme Management Units (PMUs).
Integration of AYUSH with the mainstream health institutions including recruitment of Ayurvedic/Homeopathy doctors at PHC and CHC level.
Intersectoral Convergence with Nutrition, water and sanitation programmes.
Promotion of Public Private Partnership for achieving public health goals.

6. NRHM – ILLUSTRATIVE STRUCTURE
Health Manager
BLOCK LEVEL HEALTH OFFICE – Accountant
Store Keeper
Accredit private providers for public health goals
100,000 Population
100 Villages
BLOCK
LEVEL
HOSPITAL
Strengthen Ambulance/
transport Services
Increase availability of Nurses
Provide Telephones
Encourage fixed day clinics
Ambulance
Telephone
Obstetric/Surgical Medical
Emergencies 24 X 7
Round the Clock Services;
30-40 Villages
CLUSTER OF GPs – PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;
Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;
Emergencies that can be handled by Nurses – 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
5-6 Villages
GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;
Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic
VILLAGE LEVEL – ASHA, AWW, VH & SC
ASHAs, AWWs in every village; Village Health & Nutrition Day
Drug Kit, Referral chains

7. NRHM FIVE COMPONENTS RCH AND RELATED ACTIVITIES
(PART- A)
RCH AND RELATED ACTIVITIES
(RCH FLEXI POOL)
(PART- B)
INITIATIVES UNDER NRHM OTHER THAN RCH
(MISSION FLEXI POOL)
(PART- C)
IMMUNIZATION STRENGTHENING PROGRAMME
(PART- D)
NATIONAL DISEASE CONTROL PROGRAMMES
(PART- E)
INTER SECTORAL CONVERGENCE SCHEMES

8. INSTITUTIONAL ARRANGEMETS UNDER NRHM
STATE LEVEL
State Health Mission chaired by Hon’ble Chief Minister.
State Health Society chaired by Chief Secretary.
Merger of all vertical societies into State Health Society.
Signing of MoU with GoI.
DISTRICT LEVEL
District Health Mission chaired by Chairman Zila Parishad.
District Health Society chaired by Deputy Commissioner.
Rogi Kalyan Samities in District/Sub Divisional Hospitals.
Merger of all vertical societies into District Health Society.

9. ..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM
BLOCK LEVEL
Block Health Committees at Block PHC.
PHC Management Committee at PHC level.
Rogi Kalyan Samities.
VILLAGE LEVEL
Village Health & Sanitation Committees in each village.
Accredited Social Health Activist (ASHA) for every 1000 population.

10. HEALTH INDICATORS India Punjab Best State Birth Rate Death Rate
(SRS 2006)
23.5
17.8
13.4
14.9
Manipur
Kerala
Death Rate
7.5
6.8
4.5
4.7
Delhi
Life Expectancy at birth
62.15
68.25
73.5
Sex Ratio
(Census 2001)
933
876
1001
1058
Pondicherry
IMR 57 44 11 15
TFR (SRS 2005)
2.9
2.1
1.7
Maternal Mortality Ratio (SRS 2005)
301
178
110
Ante Natal Care (at least 3 checkup) (%) (NFHS III)
50.7
72.5
96.5
T.Nadu
Institution Delivery (%) (NFHS III) 41 53
100
Contraceptive Use (%)
(NFHS III) 56
63.3 73 HP
Vaccine coverage (%) 60 81

11. TARGETS FOR PUNJAB Indicators Total Fertility Rate
At the start of RCH
SRS
Present Status
Target by
Total Fertility Rate
2.5
2.1
1.8
Infant Mortality Rate
(per 1000 live births) 49 44
<30
Maternal Mortality Ratio
(per live births)
199
178
<100
Institutional Deliveries
37.5%
(NFHS II)
52.5
80%
ANC Check-up with 03 contacts
58.4%
72.5
100%

12. HEALTH INSTITUTIONS INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR
MEDICAL COLLEGES 3 5
DISTRICT HOPITALS 20
983
SUB DIVSIONAL HOSPITALS 42
COMMUNITY HEALTH CENTRES
128
PRIMARY LEVEL HEALTH INSTITUTIONS
(PRIMARY HEALTH CENTRES/ CLINICS/ POLY-CLINICS/ DISPENSARIES)
1823
3046
SUB CENTRES AT VILLAGE LEVEL
2858 --
TOTAL =
4858
4034

13. NRHM
OVER THE YEARS
A sum of Rs crore has been received from GoI from to against which a sum of Rs crore has been spent. The plan for the current year is for Rs crore (Rs crore GoI + Rs. 30 crore GoP).

14. Up-gradation of Institutions
District Hospitals – 5 District Hospitals are being upgraded at a cost of Rs crore by adding 230 beds in the current year. The Hospitals are – Gurdaspur ( beds), Ludhiana ( beds), Mohali ( beds), Patiala (MKS) ( beds) & Bathinda.
Construction of Mother and Child Hospital at Fatehgarh Sahib which was lying suspended for 2 years would be resumed at a cost of Rs. 7 crores.
Sub Divisional Hospitals – 4 Sub Divisional Hospitals are being upgraded at a cost of Rs.6.50 crores in the current year. The Hospitals are Batala (50-80 beds), Pathankot ( beds), Nabha ( beds) & Patti (50-80 beds) at a cost of Rs crore.
PHCs at Adampur & Rural Hospial Morinda are being upgraded at a cost of Rs. 1 crore.
CHCs – Community Health Centre at Dhakoli (Zirakpur) will be constructed at a cost of Rs crore.
75 PHCs for 24 hour delivery upgraded during and 26 being upgraded
50 CHCs for Emergency Obstetric care upgraded during and 10 being upgraded
A sum of Rs crore has been earmarked from ACA of for setting up of Urban Healthcare Centres in Municipal Corporation town, Bathinda.

15. Equipment and Furniture
Equipment and Furniture worth Rs. 6.5 crore to be provided to CHCs as per IPHS Norms
Drugs
Drugs and consumable Rs crore provide to CHCs, Rs crore provided to PHCs and Rs crore provided to SHCs. - Total Rs crore
Rogi Kalyan Samities
In the year 07/08 Corpus Grant of Rs. 5 lac for 20 district hospitals, 1 lac each for 42 Sub Divisional Hospitals and Rs. 1 lac each for 100 CHCs was provided.

16. Untied Fund & Maintenance Grant
Rs. 10,000 as Untied Funds to 12300VHSCs–Rs crore has been provided each year.
Rs. 10,000 as Untied Funds to 2858 Sub Centre–Rs crore has been provided each year.
Rs. 25,000 as Untied Funds for 484 PHCs – Total Rs crore has been provided each year.
Rs. 50,000 as Untied Funds to 128 CHCs - Total Rs Lac has been provided in
Rs. 50,000 as Annual Maintenance Grant to 484 PHCs – Total Rs Crore in and to 100 PHCs – Total Rs Lac in
Rs Lac as Annual Maintenance Grant to 112 CHCs – Total Rs crore

17. School Health Programme
Under School Health Campaign health checkup of 32,64,826 students of Primary and Secondary level will be done and minor ailments will be treated and referral will be provided wherever necessary. Report from PGI regarding treatments of Congenital Health Disease and Rheumatic Heart Disease among children has been received and proposal is being finalized. A total outlay of Rs crore has been provided for the programme.
Emergency Response Services
224 Ambulance (56 advance life saving and 168 with basis life saving equipments) equipped with medical facilities and Medical Technicians are to be deployed in the State with Public-Private Partnership total initial cost will be Rs crore. Recurring cost will be Rs crore per annum.

18. Mobile Medical Unit
Mobile Medical Unit (Rs Lac each) equipped with one Male Medical Officer, One Female Medical Officer, Lab Technician, Radiographer and Staff Nurse has been deployed to provide medical services in the rural and remote areas. Total outlay of Rs crore.
Village Health and Sanitation Committees
11319 Village Health and Sanitation Committees constituted and provided Rs. 10,000 each per year.
ASHA
13201 ASHA workers selected in the State. They are not paid given any fixed salary but instead are given cash ncentives on the basis of their performance in child health, family planning and institutional deliveries.

19. Consolidated Salary PM
RECRUITMENT -
STATE PROGRAMME MANAGEMENT UNIT SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
Director Finance
On Deputation 2
State Programme Manager
From State Govt. 3
Maternal Health Specialist
40,000
Services have been terminated 4
Family Welfare Specialist 5
Procurement Manager
25,000
Candidate resigned 6
Manager (HRD)
20,000 7
Manager (F&A) 8
Manager (M&E) 9
State NGO Coordinator
30,000 10
Programme Coordinator (ARSH & Gender)

20. Consolidated Salary PM
…contd… SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 11
Programme Coordinator (BCC) 1
20,000 12
Consultant (Admn) 13
Consultant (M&E) 14
System Analyst
15,000 15
Accounts Officer 2 16
Statistical Assistant 4
10,000 17
Hardware Supervisor 18
Accountant/ Accounts Clerk
Not to recruit 19
Accountant-cum-Cashier

21. Consolidated Salary PM
…contd… SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 20
Computer Assistant 4
8,000
Selection has been done for the vacant position candidate is yet to join 21
Office Assistant 9
7,000
Appointment orders to 4 OAs are being given 22
Graphic Designer 1
10,000
Selection has been done for the vacant position 23
Procurement Assistant 2
Candidates have been adjusted at State HQ from the districts 24
Drivers
5,000
Action is being initiated 25
Class-IV 3
3,000
Total 45 38 7

22. Consolidated Salary PM
RECRUITMENT -
DISTRICT PROGRAMME MANAGEMENT UNITS SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
District Programme Manager 20 17 3
20,000
Selection has been Done. 2
District Accounts Officer
15,000
District Monitoring & Evaluation Officer 18 4
Procurement Officer 16
No further recruitment to be made 5
Maintenance Engineer
12,000 6
Statistical Assistant
8,000 7
Procurement Assistant
No further recruitment to be made. Procurement Assistant have been adjusted as Statistical Assistant or accountant as per their qualification 8
Accountant-cum-Cashier 13 9
BCC Facilitator 11
Total
180
117 63
36 vacancies are not to be filled

23. Consolidated Salary PM
RECRUITMENT -
BLOCK PROGRAMME MANAGEMENT UNITS SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
Block Statistical Assistant
118 93
25*
8,000
*Recruitment in final stage at district level 2
Block Accountant cum Cashier
102
16* 3.
Computer Operator
173 97
76*
5,000
Total
409
292
117

24. Consolidated Salary PM
RECRUITMENT -
EmOCs SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
Obstetricians 60 29
31*
Rs /- +
Rs. 3000/- HRA+ Rs. 1000/ EmOC + Rs. 500/- per delivery conducted + Rs. 200/ MTP
*Appointment letter to 11 Obst. Are being Issued on 2
Paediatricians 21
39*
Rs. 200/- per Emergency Case during off duty hours + Rs. 3000/- HRA
*Appointment letter to 12 Paed are being issued on 3
Anaesthesia 38 22
Rs. 1500/- on call per case + TA Rs. 6/KM upto 50 KM
*Empanelment for 12 CHCs under process 4
Staff Nurses
300
251 59
Rs. 8500/- + Rs. 1500/- (if accommodation is not provided)
*Recruitment Final stage at district level 5
OT Assistant 50 10 40
Rs. 4000/ /- evey Major OT Case + Rs. 1500/- HRA
Not required to recruit

25. Consolidated Salary PM
RECRUITMENT -
PHCs 24x7 & Mini PHCs SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
Female Medical Officer 75 24
51*
Rs PM + Rs. 500 per Delivery+ Rs. 200/ MTP + Rs. 3000/- HRA
*Appointment letter to 13 FMOs are being issued on 2
Staff Nurses
225
168
57*
Rs. 5000/- + Rs. 500/- per delivery conducted + Rs. 100/- per delivery assisted and Rs. 1500/- HRA (if accommodation is not provided)
*Recruitment under process at district level 3.
Medical Officer Mini PHCs 95
Rs. 16,000/- PM
Appointment letter to 61 MOs are being issued on

26. Consolidated Salary PM
RECRUITMENT -
Mobile Medical Unit (MMU) SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
Medical Officer (Male) 20
22,000
Appointed in August 2008 2
Medical Officer (Female) 4
Selection at final stage 3
Nurses 18 2*
8,000
*Recruitment under process at district level
Radiographer * 5
Lab Technician
*Recruitment under process at district level from July 2008 and reports being received 6
Driver
7,000
*Placement agency hired 7
Helper
4,000

27. Consolidated Salary PM
RECRUITMENT -
ANM for Urban Slum Area & Sub-Centres SN
Name of the Post
Sanctioned Post
Filled
Vacant
Consolidated Salary PM
Remarks 1
MPHW (Female) for urban slums
230
114
*116
6,000
*Recruitment under process at district level from July 2008 and reports being received 2
ANM for vacant sub-centres (2211)
514
Advertisement given on recruitment in final stage 3
2nd ANM for 954 sub-centres
954

28. Essential Services to be provided at EmOCs (FRUs)
24-hour delivery services including normal and assisted deliveries
Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other medical interventions
New-born Care(*)
Emergency Care of sick children
Full range of family planning services including Laproscopic Services
Safe Abortion Services
Treatment of STI / RTI
Blood Storage Facility (*)
Essential Laboratory Services
Referral (transport) Services
Janani Suraksha Yojna
(*): Critical determinants of functionality

29. Essential service package to be provided at 24x7 PHC
24-hour delivery services, both normal and assisted (*)
Essential newborn care (*)
Referral for emergencies (*)
Ante-natal care and routine immunisation services for children and pregnant women (besides fixed day services).
Post-natal care
Early and safe abortion services (including MVA)
Family planning services
Prevention and management of RTIs/STIs
Essential laboratory services
Janani Suraksha Yojna
(*): Critical determinants of functionality

30. Services at Mini PHCs Routine OPD
Management of National Health Programmes
RCH Service
Immunization Programmed
National TB Control Programme
National Leprosy Eradication Programme
National Vector Borne Disease Control Programme
Integrated Disease Surveillance Programme
School Health Programme
Supervision of services at Sub-Centre Level

31. THANK YOU