All About the National Health Mission

The National Health Mission (NHM) was launched by the government of India in the year 2013 with the purpose of strengthening the health systems in urban and rural areas of the country. It carries the vision of attaining universal access to equitable, quality and affordable healthcare services, which is both accountable and responsive to the needs of people.

NHM encompasses two sub-missions – the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). In March 2018, the NHM was extended by the government to continue until March 2020. Let us discuss the two – NRHM and NUHM – in detail.

NRHM/National Rural Health Mission

NRHM was launched in the year 2005 with the aim of providing quality healthcare facilities to the rural population, especially the vulnerable groups. Under this scheme, special focus has been given to the Empowered Action Group (EAG) States along with North Eastern States, Himachal Pradesh and Jammu & Kashmir. The mission is about developing a fully functional health delivery system, that is owned by the community and is decentralized. It further aims to ensure taking action on several health determinants, such as sanitation, nutrition, water, and social and gender equality.    

NUHM/National Urban Health Mission

Launched in 2013, the NUHM aims to facilitate the urban poor and vulnerable sections’ access to quality primary healthcare. It covers all state capitals along with district headquarters and cities/towns with 50,000 or more population (as per census 2011). Those below 50,000 will be covered under the NRHM.

Components of NHM

• Public Health Planning and Financing
• Human Resource Strengthening in Health; Deployment and Development
• Health Systems Strengthening
• RMNCH-A
• Preventing Communicable and Non-communicable Diseases: National Disease Control Programmes
• Community Processes: Institutionalizing Community-led Action for Health

Let us discuss some of these in detail.

Health Systems Strengthening

Its various sub-components are:

• Construction of new buildings; renovation of existing ones.
• Improving sanitation and hygiene in public facilities: Kayakalp
• Social protection: Reduction in Out-of-pocket expenses
• Outreach services: Mobile medical units

(RMNCH-A) Reproductive, Maternal, Newborn, Child Health and Adolescent Services

This programme of NHM was launched in 2013 to manage increasing maternal and child health mortality. Its sub-components include reducing fertility rate, adolescent health programme, declining sex ratio, reducing infant and child mortality rate and reducing maternal mortality rate.  

Preventing Communicable and Non-communicable Diseases: National Disease Control Programmes

The government has started several programmes to prevent and control non-communicable diseases, which are one of the leading causes of mortality and morbidity, and to limit instances of communicable diseases.

Initiatives Under NHM

There are a number of initiatives started by the government under NHM for the achievement of its objectives. Some of them are:  

• Accredited Social Health Activist (ASHA)
• Rogi Kalyan Samiti or Hospital Management Society
• The United Grants to Sub-Centres (SCs)
• The Village Health Sanitation and Nutrition Committee (VHSNC)
• Healthcare service delivery
• Janani Suraksha Yojana (JSY)
• Janani Shishu Suraksha Karyakram (JSSK)
• Facility-Based Newborn Care
• National Mobile Medical Units (NMMUs)
• National Ambulance Services (NAS)
• Mainstreaming of AYUSH
• Launch of National Quality Assurance Framework for Health Facilities
• Launch of Kayakalp: An Initiative for Awards to Public Health Facilities
• Free Drugs Service Initiative
• Free Diagnostics Service Initiative
• Bio-Medical Equipment Maintenance
• Comprehensive Primary Healthcare
• Kilkari
• Mobile Academy
• Launch of Nationwide Anti-TB Drug Resistance Survey
• Kala Azar Elimination Plan
• Revision of criteria for incentives to States

Talking of the ASHA initiative, there are more than 9.15 lakh activists in the country, who are serving as facilitators, mobilizers and providers of community-level care.

Rogi Kalyan Samiti is responsible for upkeeping the facilities and ensuring provision for better facilities to all patients in the hospital. There are around 31,763 such societies already established.

JSY aims to encourage pregnant women to deliver in government health facilities and reduce maternal mortality. Cash assistance is also given to those eligible. Already around 8.55 crore women have benefited from this scheme.

Objectives of NHM

National Health Missions aims to:

• Bring down MMR (maternal mortality ratio) to 1/1000 live births
• Bring down IMR (infant mortality rate) to 25/1000 live births
• Bring down TFR (total fertility rate) to 2.1
• Prevent and reduce anemia in women of ages 15 to 49 years
• Bring down household out-of-pocket expenses on one’s overall healthcare expenditure
• Prevent as well as reduce mortality and morbidity from communicable and non-communicable diseases, injuries and emergency diseases
• Lower the annual incidences and mortality from tuberculosis by half
• Lower the prevalence of leprosy to <1/1000 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 1000 population in all blocks

Achievements of NHM

• The country has shown a reduction in out-of-pocket expenditures, MMR, IMR, TFR, incidence of tuberculosis, malaria cases/deaths, prevalence rate of leprosy, and prevalence of blindness. The National Health Mission has brought down the use of tobacco by 6 per cent and tobacco users by around 81 lakhs. This has been done with the help of text messaging via mobile phones.
• The number of people seeking care from public health facilities has gone up.
• NHM has helped increase institutional capacities for service delivery.
• There has been a sustained focus on the health of the tribal population too.
• National Ambulance Services have also seen tremendous growth.
• The NHM has helped reduce inequality in health spending across states and also added funds to the health pyramid’s lower tiers.

Conclusion

The NHM has shown visible progress in many states in terms of healthcare facilities as well as individuals’ health post the implementation of its various initiatives.