By Nidhi Mardi

Edited by Michelle Cherian, Associate Editor, The Indian Economist

1.1 BACKGROUND

The National Rural Health Mission, launched in 2005 is a flagship scheme of the UPA government with the primary motive of improving the basic healthcare infrastructure in India. It is considered to be the largest healthcare programme run in the world and dwells on the Government of India’s commitment to spend atleast 2-3% of the country’s GDP on development and upgradation of the health infrastructure of the country. It is operational in the entire country, but has a special focus on eighteen states that have weak public health indicators and/or weak infrastructure. These include eight Empowered Action Group (EAG) states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Orissa, Uttarakhand, Jharkhand, Chhattisgarh, and eight North Eastern states of Assam, Sikkim, Arunachal Pradesh, Manipur, Mizoram, Nagaland, Meghalaya, Tripura as well as Himachal Pradesh and Kashmir.

1.1.1 STRENGTHENING HEALTHCARE AND DELIVARY SYSTEM

The primary aim of the scheme is improvement of rural healthcare schemes, improving healthcare delivery schemes as well as adopting a synergistic approach by relating Health to determinants of good health i.e nutrition, sanitation, hygiene and safe drinking water. The Mission strategizes decentralization in administration and management of the public health care delivery system to effectively meet the health and family welfare needs of the people in diverse social, economic and cultural settings. The Mission also addresses the issue of empowerment of the community to own, manage and control the public health care delivery system.

1.1.2 PROPAGATION OF INDIAN HEALTHCARE TRADITIONS

It helps to propagate Indian healthcare traditions of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) to facilitate comprehensive and integrated health care to rural population. NRHM primarily works by integrating the pre-existing health and family welfare programmes with the aim of better utilization of funds and infrastructure. For instance NRHM is integrated with the second phase of Reproductive and Child Health programme (RCH 2), National Disease Control Programmes for Malaria, TB, Kala Azar, Filaria, Blindness, Iodine Deficiency (NDCP), as well as Integrated Disease Surveillance Programmes. However, National AIDS and Cancer programs were not integrated to the NRHM scheme. The scheme primarily focused on catering to the healthcare needs of the vulnerable and underserved population in rural areas. The need for NRHM came in response to a growing healthcare crisis in India.

1.1.3 ACHIEVEMENT OF PRESET BENCHMARKS

Thirdly the mission, as per 12th five year plan, aims to achieve an Infant Mortality Rate (IMR) of 25 per 1000 live births, maternal mortality rate of 1 in 1000 live births and total fertility rate of 2.1. The Mission is pillared on some core strategies including enhancing Budgetary Outlays for Public Health, decentralized village and district level health planning and management, appointment of Accredited Social Health Activist (ASHA) to facilitate access to healthcare services, as well as promoting non-profit sector to increase social participation, and community empowerment, inter-sectoral convergence, upgradation of the public health facilities to Indian Public Health Standards (IPHS), reduction of infant and maternal mortality through Janani Suraksha Yojana (JSY) etc. (NRHM, 2005: MoHFW, 2007). The detailed action plan to achieve the objective comprised primarily of an increase in the public spending on health and family welfare from 0.9 percent to 2-3 percent of the Gross-Domestic Product during 2005-12.

1.1.4 DECENTRALIZED PLANNING AND COMMUNITIZATION

Decentralized Planning and Communitisation also includes capacity building in terms of training and sensitization of ASHA’s, Village Health and Sanitation Committee (VHSC) and Rogi Kalyan Samiti (RKS) members about their roles and responsibilities towards proper utilization of Grants and Funds to the best interest of users. The financial management also includes evaluation of utilization of untied funds to VHSC, SC, PHC and CHC. One of the scheme’s core strategies is to build the capacity of Panchayati Raj Institutions (PRI’s) to control and manage public health services. NRHM has a provision for professional bodies and non-governmental organizations (NGO’s) to conduct monitoring and evaluation. It primarily relies on communities to monitor the delivery system and provision of healthcare services. This process necessitates the involvement of Gram Panchayat and district associations in the management of VHSC’s, hospital development committees and district health societies.

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Figure 1.1: Five main approaches of NRHM

Ministry Ministry of Health and Family Welfare
Sector Healthcare
Goal
  • Strengthening healthcare and delivery system with a special focus on developing health infrastructure of the country.
  • Propagation of Indian healthcare traditions (AYUSH)
  • Achieving preset benchmarks in improving various health indicators like IMR, MMR, etc. Promoting social and community participation in achievement of the same.
  • Decentralized healthcare planning and communitization.
Output/ Scheme Indicator*
  • Reduce MMR to 1/1000 live births
  • Reduce 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 and 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 1000 population in all blocks
Funding Shared by centre and states in the ratio 85:15
Year of Inception 2005

* As per twelfth Five Year Plan: Prospective healthcare goals

HAVE THE TARGETS BEEN ACHIEVED?

There is little doubt that the mission has conferred some benefits on rural areas. Major health indicators in the focus states have shown some improvement. For instance, at the national level, there was a decline in the infant mortality rate from 58 per thousand live births in 2005 to 53 in 2008 (all India) after implementation of NRHM. The IMR in focus states like Bihar fell from 61 to 56, in Chhattisgarh from 63 to 57, in Madhya Pradesh from 76 to 70, in Uttar Pradesh from 73 to 67, in Rajasthan from 68 to 63 and in Assam from 68 to 64. These figures are, however, still dismal even when compared to the target IMR rate of 30 under NRHM. The NRHM has had an impact but a rather limited one.

It seems the Government had its heart in the right place when it brought out this Mission, but that’s not enough, it’s never enough. What is now required of the incumbent Modi Government is to improve upon these reforms and their implementation, while keeping within their allocated healthcare budget cap (less than 3%), so as to achieve the dream of accessible and affordable healthcare, for those Indians for whom this dream still remains a distant reality.

Nidhi is currently pursuing Economics in Lady Shri Ram College, Delhi University. She has a keen interest in global economic affairs. An avid reader, she loves writing on various topical issues in economics, politics and international affairs. She loves travelling and considers herself much of a movie buff.

Posted by The Indian Economist | For the Curious Mind