National Health Mission (NHM) includes National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM)
National Health Misson has 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.
National Health Mission – Goals
- Reduce MMR to 1/1000 live births
- Reduce Infant Mortality Rate – IMR to 25/1000 live births
- Reduce TFR to 2.1
- Prevention and reduction of anaemia in women aged 15–49 years
- Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases
- Reduce household out-of-pocket expenditure on total health care expenditure
- Reduce annual incidence and mortality from Tuberculosis by half
- Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
- Annual Malaria Incidence to be <1/1000
- Less than 1 per cent microfilaria prevalence in all districts
- Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
National Health Mission Framework for Implementation
National Health Mission (NHM) encompassing two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
Achievement of universal access to health care through strengthening of health systems, institutions and capabilities.
22.214.171.124 Vision of the National Health Mission
Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health”.
126.96.36.199 National Health Mission – Principles
Build an integrated network of all primary, secondary and a substantial part of tertiary care.
Ensure coordinated inter-sectoral action to address issues of food security and nutrition, access to safe drinking water and sanitation, education particularly girls education, occupational and environmental health determinants, women’s rights and empowerment and different forms of marginalization and vulnerability.
Incentivize states and UTs to undertake health sector reforms that lead to greater efficiency and equity in health care delivery.
Ensure prioritization of services that address the health of women and children and the prevention and control of communicable and non-communicable diseases, including locally endemic diseases.
Ensure that all public health care facilities or publicly financed private care facilities provide assured quality of health care services.
Ensure increased access and utilization of quality health services to minimize disparity on account of gender, poverty, caste, other forms of social exclusion and geographical barriers.
188.8.131.52 National Health Mission – Goals, Outcomes and Strategies
- The key goals of this phase of National Health Mission will be towards enabling and achieving the stated vision
- Making the system responsive to the needs of citizens,
- Building a broad based inclusive partnership for realizing National health goals,
- Focusing on the survival and well being of women and children,
- Reducing existing disease burden and ensuring financial protection for households.
- Support and supplement state efforts to undertake sector wide health system strengthening through the provision of financial and technical assistance.
- Build state, district and city capacity for decentralized outcome based planning and implementation,
- Enable integrated facility development planning which would include infrastructure, human resources, drugs and supplies, quality assurance, and effective Rogi Kalyan Samitis (RKS).
- Create a District Level Knowledge Centre within each District Hospital to serve as the hub for a range of tasks
- Improve delivery of outreach services through a mix of static facilities and mobile medical units with a team of health service providers with the skill mix and capacity to address primary health care needs.
- Strengthen the sub-centre/Urban Primary Health Centre (UPHC) with additional human resources and supplies to deliver a much larger range of preventive, promotive and curative care services- so that it becomes the first port of call for each family to access a full range of primary care services.
- Prioritize achievement of universal coverage for Reproductive Maternal, Newborn, Child Health + Adolescent (RMNCH+A), National Communicable Disease Control and Non Communicable Diseases programmes.
- Achieve the goals of safe motherhood and transition to addressing the broader reproductive health needs of women.
- Focus on adolescents and their health needs.
- Ensure the control of communicable disease which includes prompt response to epidemics and effective surveillance.
- Use primary health care delivery platforms to address the rising burden of NonCommunicable Diseases
- Effective prevention and reduction of under-nutrition in children aged 0-3 years and anaemia among children, adolescents and women.
- Strengthen people’s organizations such as the Village Health Sanitation and Nutrition Committees (VHSNC) and Mahila Arogya Samitis (MAS)
- Improve Public Health Management by encouraging states to create public health cadre
- Ehance use of Information & Communication Technology to improve health care and health systems performance.
- Strengthen Health Management Information Systems as an effective instrument for programme planning and monitoring, supplemented by regular district level surveys and a strong disease surveillance system.
- Ensure universal registration of births and deaths with adequate information on cause of death, to assist in health outcome measurements and health planning.
- Establish Accountability Frameworks at all levels for improved oversight of programme implementation and achievement of goals.
- Implement pilots for Universal Health Coverage (UHC) in selected districts in both EAG and non EAG States to test approaches and innovations before scaling up.
184.108.40.206 National Health Mission – Institutional Mechanisms
At the National level, the Mission Steering Group (MSG) and the Empowered Programme Committee (EPC) are in place.
The MSG provides policy direction to the National Health Mission. The Union Minister of Health & Family Welfare chairs the MSG.
The National Health Mission is headed by a Mission Director, of the rank of Additional Secretary, supported by a team of Joint Secretaries.
The National Health Mission handles not just the day-to-day administrative affairs of the Mission but is responsible for planning, implementing and monitoring Mission activities.
Upto 0.5% of National Health Mission Outlay is earmarked for programme management and activities for policy support at the national level through a National Programme Management Unit (NPMU).
The National Health Systems Resource Centre (NHSRC) would continue to serve as the apex body for technical support to the Centre and states
The National Institute of Health and Family Welfare (NIHFW) is the country’s apex body for training. Its main focus is on public health education, development of skills in public health management and all training needs of the health care providers.
The huge need of institutional capacity development across the nation can be met only by coordinated efforts between networks of a large number of public health institutions. Knowledge resources for the National Disease Control Programmes are supported by the National Centre for Communicable Diseases.
Additional knowledge resources can be harnessed from a number of emerging public health institutions, such as the public health divisions of centrally sponsored institutes namely, All India Institutes of Medical Sciences, (AIIMS) and Post Graduate Medical Education and Research, (PGIMER) others, such as, the Public Health Foundation of India, (PHFI) the Indian Institute of Health Management and Research (IIHMR) and other institutes and schools of public health in states.
At the state level, the Mission functions under the overall guidance of the State Health Mission (SHM) headed by the State Chief Minister.
The State Health Society (SHS) would carry the functions under the Mission and would be headed by the Chief Secretary.
The State Program Management Unit (SPMU), State Health System Resource Centres (SHSRC) and the State Institutes of Health and Family Welfare (SIHFW) will continue to play similar roles for the State as do their national counterparts for the Centre. The SPMU acts as the main secretariat of the SHS.
The District Health Mission (DHM)/City Health Mission (CHM) would be headed by the head of the local self-government i.e. Chair Person Zila Parishad/Mayor as decided by the state depending upon whether the district is predominantly rural or urban.
Every district will have a District Health Society (DHS), which will be headed by the District Collector.
At the city level, the Mission or Society may be established based on local context. Existing vertical societies for various national and state health programmes will be merged in the DHS.
The management of NUHM activities may be coordinated by a city level Urban Health Committee headed by the Municipal Commissioner/District Magistrate/Deputy Commissioner/District Collector/ Sub-Divisional Magistrate/Assistant Commissioner based on whether the city is the district headquarter or a sub-divisional headquarter as may be decided by the state.
For the seven mega cities of Delhi, Mumbai, Chennai, Kolkata, Bengaluru, Hyderabad and Ahmedabad, NHM will be implemented by the City Health Mission.
The District Programme Management Unit (DPMU) would be linked to a District Health Knowledge Centre (DHKC) and its partners for the requisite technical assistance.
The District Training Centre (DTC) would be the nodal agency for training requirements of the District Health Society (DHS).