National Health Mission (NHM)

To ensure that health services are properly distributed to the underprivileged, the Ministry of Health and Family Welfare established the National Health Mission in 2013. The NHM has had a great impact on the health services in the country since its implementation. Read here to know in detail about the mission.

The National Health Mission (NHM) encompasses two Sub-Missions:

• The National Rural Health Mission (NRHM) (2005)
• The National Urban Health Mission (NUHM) (2013)

The main programmatic components include:

1. Health System Strengthening
2. Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A)
3. Communicable and Non-Communicable Diseases.

The NHM envisages the achievement of universal access to equitable, affordable & quality healthcare services that are accountable and responsive to people’s needs.

National Health Mission (NHM)

The goals for NHM have been set specific for states-

• State-specific innovations would be encouraged.
• Process and outcome indicators will be developed to reflect equity, quality, efficiency, and responsiveness.
• Targets for communicable and non-communicable diseases will be set at the state level based on local epidemiological patterns and taking into account the financing available for each of these conditions.

The aim is to achieve the following indicators:

1. Reduce Maternal Mortality Rate to 1/1000 live births
2. Reduce Infant Mortality Rate to 25/1000 live births
3. Reduce Total Fertility Rate to 2.1
4. Prevention and reduction of anemia in women aged 15–49 years
5. Prevent and reduce mortality & morbidity from communicable, and non-communicable; injuries and emerging diseases
6. Reduce household out-of-pocket expenditure on total healthcare expenditure
7. Reduce annual incidence and mortality from Tuberculosis by half
8. Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
9. Annual Malaria Incidence to be <1/1000
10. Less than 1 percent microfilaria prevalence in all districts
11. Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

NHM support is also provided for the provision of a range of free services related to maternal health, child health, adolescent health, family planning, universal immunization program, and for major diseases such as Tuberculosis, vector-borne diseases like Malaria, Dengue and Kala Azar, Leprosy, etc.

National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched in 2005.

It aims to provide accessible, affordable, and quality health care to the rural population, especially vulnerable groups.

Under the NRHM, the Empowered Action Group (EAG) States, as well as the North Eastern States, Jammu, Kashmir, and Himachal Pradesh, have been given special focus.

The thrust of the mission is on establishing a fully functional, community-owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, and social and gender equality.

Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, measured against Indian Public Health Standards for all health facilities.

The key features of the mission:

• making the public health delivery system fully functional and accountable to the community, human resources management
• community involvement, decentralization, rigorous monitoring & evaluation against standards
• the convergence of health and related programs from the village level upwards
• innovations and flexible financing and interventions for improving health indicators.

Mobile Medical Units (MMUs) & Teleconsultation services are also being implemented to improve access to healthcare, particularly in rural areas.

At the National level, the NHM has a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Programme Committee (EPC) headed by the Union Secretary for Health & FW. The EPC will implement the Mission under the overall guidance of the MSG.

National Urban Health Mission (NUHM)

The National Urban Health Mission (NUHM) as a sub-mission of the National Health Mission (NHM) was approved in 2013.

NUHM envisages meeting the healthcare needs of the urban population with a focus on the urban poor, by making available to them essential primary healthcare services and reducing their out-of-pocket expenses for treatment.

This will be achieved by strengthening the:

• existing health care service delivery system
• targeting the people living in slums
• converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education, etc. implemented by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development, and Women & Child Development.

The goals of the NUHM are:

1. Need-based city-specific urban health care system to meet the diverse health care needs of the urban poor and other vulnerable sections.
2. Institutional mechanisms and management systems to meet the health-related challenges of a rapidly growing urban population.
3. Partnership with the community and local bodies for more proactive involvement in the planning, implementation, and monitoring of health activities.
4. Availability of resources for providing essential primary health care to urban poor.
5. Partnerships with NGOs, for-profit and not-for-profit health service providers, and other stakeholders.

NUHM would cover all State capitals, district headquarters, and cities/towns with a population of more than 50000.

It would primarily focus on slum dwellers and other marginalized groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, and construction site workers.

Funding scheme: The center-state funding pattern will be 75:25 for all the States except North-Eastern states including Sikkim and other special category states of Jammu & Kashmir, Himachal Pradesh, and Uttarakhand, for whom the center-state funding pattern will be 90:10.

The Programme Implementation Plans (PIPs) sent the by the states are apprised and approved by the Ministry.

Other initiatives under NHM

• Janani Shishu Suraksha Karyakram (JSSK): Under which free drugs, free diagnostics, free blood and diet, and free transport from home to institution, between facilities in case of a referral and drop back home is provided.
• Rashtriya Bal Swasthya Karyakram (RBSK): It provides newborn and child health screening and early intervention services free of cost for birth defects, diseases, deficiencies, and developmental delays to improve the quality of survival.
• Implementation of Free Drugs and Free Diagnostics Service Initiatives
• PM National Dialysis Programme
• Implementation of National Quality Assurance Framework in all public health facilities including in rural areas.

As part of Ayushman Bharat, the States are supporting the establishment of 1.5 lakh Health and Wellness Centres across the country by December 2022 for the provision of comprehensive primary care that includes preventive healthcare and health promotion at the community level with a continuum of care approach.

Further Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage up to Rs 5 Lakh per family per year to around 1074 crore poor and vulnerable families as per Socio-Economic Caste Census (SECC).

Achievements of NHM

In the years of implementation, the NHM has enabled the achievement of the Millennium Development Goals (MDGs) for health.

It has also led to significant improvements in maternal, new-born, and child health indicators, particularly for maternal mortality ratio, and infant and under-five mortality rates, wherein the rates of decline in India are much higher than the global averages and these declines have accelerated during the period of implementation of NHM.

• Improved core health outcomes and increased access to health services
• Growth in public health facilities
• There was also a sustained focus on the health of tribal populations, those in Left Wing Extremism areas, and the urban poor.
• National Ambulance services for providing “free pick up and drop back” facilities to pregnant women and sick infants.
• Human Resource Augmentation: NHM supports states for engaging service delivery HR such as doctors, nurses, and health workers and also implements the world’s largest community health volunteer program through the ASHAs.
• The National Health Mission enabled the design and implementation of reforms specifically related to Governance and Technology
• Addressing high Out-of-Pocket Expenditure (OOPE)

NHM-supported health system reforms have resulted in the development of resilient health systems, albeit at different stages of maturity.

It has enabled the successful scaling up of existing interventions and the addition of newer reforms given the rapid transitions from rural to urban, gradual demographic transition to aging populations, increasing burden of chronic diseases, and the emergence of newer infectious diseases.

-Article written by Swathi Satish