National Rural Health Mission (NRHM) 2005-2012
National Rural Health Mission is the name of a flagship programme launched by Ministry of Health and Family Welfare in 2005 to provide universal health care through a well functioning health system throughout the country with special focus on eighteen states which have unsatisfactory health indicators and/or weak public health infrastructure. The Mission is to be implemented over a period of seven years (2005-2012). The nodal Ministry for implementation of NRHM is Ministry of Health and Family Welfare.
The NRHM aims to provide accessible, affordable, equitable and qualitative health care to rural population by rejuvenating the health delivery system. The Mission seeks to reduce the Infant Mortality Rate (IMR) to 30 per thousand live births by 2012, Maternal Mortality Rate (MMR) to100 per thousand live births by 2012 and Total Fertility Rate to 2.1 by 2012. It also aims at mainstreaming the Indian systems of medicine to facilitate health care. The Mission envisages raising the public spending on health from 0.9 percent of GDP to 2-3 percent of GDP. It seeks to address the inter-state and inter-district disparities. It provides support to the states for strengthening of the health care system in rural areas by making provisions for physical infrastructure, human resources, equipment, emergency transport, drugs, diagnostics and other support. It covers all programmes in the health sector except HIV/AIDS, Mental Health and cancer.
The Mission adopts a synergistic approach by relating health to determinants of good health viz. nutrition, sanitation, hygiene and safe drinking water. The core strategies of the Mission for achieving its objectives are enhancing the capacity of the Panchayati Raj Institutions (PRI) to own, control and manage public health services; involvement of female health activist to promote access to improved healthcare at household level; strengthening of existing primary health care through better staffing; provision of untied fund to all the health facilities; preparation of health plans at various levels (viz. village, district); and decentralization of planning to district level etc.
One of the key components of the Mission is the female health activist known as Accredited Social Health Activist (ASHA). She is the interface between the community and the health facility and is the first line of assistance for any health related demand. There shall be one ASHA for every village with a population of 1000. Her work includes creating awareness among the community on health and its social determinants, providing primary medical care for minor aliments and first aid for minor injuries, mobilizing the community towards local health planning, motivating women to give birth in hospitals, bringing children for immunization, assisting the Gram Panchayat in preparation of comprehensive village health plan, etc. She is paid on the basis of performance (incentive) for the task she undertakes. The success of NRHM, to a large extent, depends on the performance of ASHA.
In Indian Constitution health is a state subject. The Constitution places ‘public health and sanitation, hospitals and dispensaries’ in the state list and family welfare in the Concurrent list. The Central government can only intervene to assist the state governments through Centrally Sponsored Schemes and policy formulations. However, main responsibility of infrastructure and manpower building rests with the state governments. Thus the outcome of health sector is largely contingent on funding and maintenance of public health system by the states.
The public health care system became dysfunctional mainly due to lack of funding by the states. The lack of proper monitoring of public health delivery was responsible for large scale absenteeism of doctors from PHCs. The shortcomings of public health care system paved way for the growth of private sector health care. The unregulated private health care resulted in increase in cost of medical care thereby making the poor poorer. Further the distribution of health care was skewed, inaccessible and inequitable across region, gender and caste.
The NRHM was launched with the vision to undertake architectural correction of the health system. NRHM marked a paradigm shift as compared with the earlier approach. It emphasized on decentralized planning, output and outcome base approach, pro-poor focus, community participation, dedicated health functionary (ASHA) at the village level for better utilization of health services and integration of health care with other determinants of health like sanitation, nutrition and education, women empowerment and social empowerment of vulnerable groups, etc.
NRHM was for the period 2005-2012. The Union Cabinet vide its decision dated 1 May 2013, approved the continuation of the Scheme as a Sub-mission of an over-arching National Health Mission (NHM) for the period 2012-2017. The National Health Mission (NHM) encompasses two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).Under the National Health Mission (NHM), support is being provided to States/UTs to strengthen their healthcare delivery system including for provision of free/affordable healthcare, free drugs and diagnostics to all those who access public health facilities. The primary healthcare needs of urban population particularly poor and vulnerable population have also been brought under the ambit of NHM with the launch of the National Urban Health Mission as its Sub Mission.
- GoI, NRHM, 2005-12, Mission Document, MoH&FW
- NRHM Website