|Year : 2007 | Volume
| Issue : 3 | Page : 171-172
Current status of national rural health mission
Suneela Garg, Anita Nath
Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
|Date of Submission||23-Jun-2006|
|Date of Acceptance||19-May-2007|
K-3/53,DLF City 2, Gurgaon, Haryana - 122 002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Garg S, Nath A. Current status of national rural health mission. Indian J Community Med 2007;32:171-2
Health is a fundamental human right, and it is the responsibility of the governments to provide health care to all people in equal proportions. Ever since India's independence in 1947, various national health schemes and programs have been launched with the view to improve the health status of people living in rural areas. It is now almost 2 years since the Government of India launched the National Rural Health Mission (NRHM) on 12 th April 2005. The aim of the NRHM is to bring about dramatic improvement in the health system and the health status of the people, especially those who live in rural areas of the country. The Mission seeks to provide universal access to equitable, affordable and quality health care, as well as to bring about an improvement in the health status of the underprivileged sections of the society, especially women and children. Although NRHM aims to cover all the states of the country, special focus is being given to 18 states - namely, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh. The government has earmarked an outlay of Rs. 8,207 crores for 2006-07 in comparison to Rs. 6,553 crores in the previous year.  The budget for 2007-08 is likely to be increased to Rs. 10,500 crores. 
The present article aims to explore the current status of implementation and progress of activities as envisaged under NRHM in the high-focus states of the country that are under priority, as well as non-priority states. Following actions have been taken under NRHM. ,,
| Institutional framework|| |
The Departments of Health and Family Welfare under the Government of India have been merged in all the states. Mission-steering group and Empowered Program Committee have been constituted. The reports of six Task Groups have been finalized and new task groups on urban health, financial guidelines and medical education have been constituted. Mission document, implementation framework, guidelines on ASHAs' first training module and guidelines for Village Health and Sanitation Committees, PHCs, CHCs and sub-centers have been disseminated. Appraisal of Program Implementation Plan has been prepared by all the states. Constitution of monitoring group for Accredited Social Health Activists (ASHAs) has been done, and the modalities for merger of the various societies under a single state health society have been finalized. The plan of action by inter-sectoral convergence committee has been drawn up as well. A framework for developing health insurance plans for vulnerable groups has been formulated.
| Innovations in health programs|| |
State implementation plans of RCH II have already been adopted as such. The Janani Suraksha Yojana Program was launched all over the country in order to promote safe delivery practices. Cash assistance is integrated with antenatal care during the pregnancy period, institutional care during delivery and immediate postpartum period in a health center by establishing a system of coordinated care by field level health worker. Over the past 1 year, the total number of beneficiaries is 2,216. In the EAG states, Assam, J and K, the incentive for below-the-poverty-line families is Rs. 1,300; while in the other states, it is Rs. 1,000. Auto-disabled syringes for immunization and support for alternative systems of vaccine delivery from PHC to sub-centre have been introduced. JE vaccine was introduced in high-risk states. Sterilization Compensation Scheme has also been launched.
Funds were provided for up-gradation of two CHCs per district according to Indian public health standards. Facility surveys were introduced in Assam, Himachal Pradesh, Manipur, M.P., Sikkim, Tripura and Uttaranchal. The planning process has been strengthened in 50% of districts in EAG states.
As many as 700 consultants (MBA/ CA) have been appointed for state/ district level Program Management Units. Also , an Empowered Procurement Wing is being set up in the ministry. A National Health System Resource Center (NHSRC) is being set up at the national level, while a Regional Resource Center is being set up for northeastern states. Plans for setting up State Resource Centers are underway. A drug testing laboratory of AYUSH and a Government Ayurvedic Pharmacy are proposed to be set up at Kurukshetra with Central assistance. For this purpose, the Central government has already released Rs. 2.50 crores. In order to provide necessary medicines to AYUSH institutes, the Central government had released a sum of about Rs. 1.24 crores during the last financial year. 
The accredited social health activist (ASHA) is a trained female community health worker, provided in each village in the ratio of one per 1,000 population. Her role is to act as a link between the community and health centers. The 18 high-focus states have proposed to select 172,076 ASHAs. A total of 121,444 ASHAs have been selected till March 2006, and a total of 15,798 have been trained during the period.  According to Budget 2006-07 estimates, it is hoped that more than 200,000 ASHAs will be fully functional, and over 1,000 block-level CHCs will provide round the clock services. 
As per IPHS, 2 CHCs per district will be selected to function as first referral units (FRUs). Within 1 year of launch of NRHM, 383 CHCs have been made functional as FRUs. 
| District health action plans|| |
A total of 151 District Health Action Plans have been prepared so far. Micro plans have been prepared in 255 districts. 
As mentioned above, in high-focus priority states, ,, the Departments of Health and Family Welfare have been merged, and State Health Mission and District Health Mission have been constituted. With regard to the northeastern states, state and district level societies have been merged in the four states of Assam, Manipur, Meghalaya and Mizoram. Rogi Kalyan Samitis have been constituted in Assam and Manipur, and 6,520 ASHAs have been selected in Assam. The targets for converting the stipulated number of CHCs into FRUs have not yet been accomplished in the states of Arunachal Pradesh, Bihar, Jharkhand, J and K, Meghalaya, Manipur and Rajasthan. Details for manpower planning for IPHS and State and District Action Plans are yet to be formulated in majority of the states. A total of 720 CHCs were upgraded at the rate of 2 CHCs per district as per IPHS standards.
The status of activities in Uttar Pradesh, the most crucial state under the Mission, is very discouraging. The selection process of ASHAs, the most innovative component of the Mission, has shown rather nonprogressive results. Against 65,000 ASHAs proposed to be selected, only 9,548 ASHAs could be selected, with not even a single ASHA getting trained. Status of NRHM is of equal concern in Jharkhand, Rajasthan and Chhattisgarh, where preparatory exercises have barely started. Out of the total 228,327 ASHAs proposed to be selected, only 145,546 ASHAs have been selected till March, with Rajasthan, Bihar, Orissa and Chhattisgarh almost meeting the target and U.P. and M.P. remaining way behind their target. In the case of northeastern states, H.P., J and K, Mizoram and Assam are the only states that are almost touching the set target; while in respect of other states, selection of ASHAs is not even envisaged.
In non-priority states and Union territories, a total of 426 CHCs were upgraded; and in Andhra Pradesh and Karnataka, the number of CHCs that have been upgraded as FRUs is the maximum. Most of the states/ Union territories have not yet either envisaged or accomplished the preparation of District Action Plans, while efforts aimed at mainstreaming AYUSH are yet to be completed.
It has thus been seen that NRHM activities are displaying varying levels of progress in different states. It is hoped that the objectives of the Mission and expected outcomes are achieved as per the set time frame. The progress could further be enhanced by giving due priority to critical areas and devising strategies and actions to overcome various constraints that may come in the way.
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