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1NATIONAL RURALHEALTH MISSIONPRESENTATION BEFORECONFERENCE OF CHIEFSECRETARIES19th July2006Ministry of Health & Family Welfarewww.drjayeshpatidar.blogspot.in
2NRHM GOALS & APPROACHESCOMMUNITYINVOLVEMENTCAPACITYBUILDINGFLEXIBLEFINANCINGHUMANRESOURCEMANAGEMENTMONITORAGAINSTAGREEDMILESTONESUniversal Health CareReducing IMR, MMR,TFRwww.drjayeshpatidar.blogspot.in
3BLOCKLEVELHOSPITAL30-40 VillagesStrengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinicsAmbulanceTelephoneObstetric/Surgical MedicalEmergencies 24 X 7Round the Clock Services;CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE –--------------- AccountantCLUSTER OF GPs – PHC LEVEL3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/ImmunizationClinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses – 24 X 7;Round the Clock Services; Drugs; TB / Malaria etc. testsGRAM PANCHAYAT – SUB HEALTH CENTRE LEVELSkill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic1000Population VILLAGE LEVEL – ASHA, AWW, VH & SC1 ASHA, AWWs in every village; Village Health DayDrug Kit, Referral chains100,000Population100 Villages5-6 VillagesAccredit privateproviders for publichealth goalsHealth ManagerStore KeeperNRHM – ILLUSTRATIVE STRUCTUREwww.drjayeshpatidar.blogspot.in
4NRHM- Institutional framework1Departments of H & FWmerged34 states except UP2State Health MissionsConstituted34 states except Delhi3District Health MissionsConstituted33 states except Haryana, Delhi4Merger ofSocietiesState Level29 States except Jharkhand,Rajasthan, U.P., Tripura, DelhiChandigarh, Karnataka,Pondicherry5MoU with Government ofIndia30 States except U.P., Lakshadweep,Delhi, Tamil Nadu, A&N IslandsHealth is also Economic productivitywww.drjayeshpatidar.blogspot.in
5• Operationalise the State/District/Block health Missions.• Suitable officials - Stable tenures / accountability• Administrative and financial delegations• Review of Acts, Regulations & guidelines fordecentralisation• Health facilities to be planning and budgeting Unitsupto Block level.• Set up procurement/logistics systemHealth is also Women’s empowermentAdministrative Actionswww.drjayeshpatidar.blogspot.in
6Manpower Strengthening•Attend to Shortfall of 84,000 staff nurses, 2 lakh ANMs, 5000 to7000 Specialists in each specialty.•Multi-skilling, incentives for rural posting, Compulsory Rural Posting,Block pooling, Rational cadre policy, Management through PRIs/ RogiKalyan Samitis, Increasing the age of retirement•Appointment on contractual basis and local criterion.•Empower BMO – designate as Chief BMO - to optimally deploydoctors /paramedics in facilities within the block•Strengthen SIHFW, ANM schools, nursing / medical colleges/increase seatsHealth is Women’s rightwww.drjayeshpatidar.blogspot.in
7DECENTRALISATION & CONVERGENCE•Over 20% of the funds to be spent at the District level and 70%below the block level.•Review of Acts, Regulations & guidelines for decentralisation•Health facilities to be planning and budgeting Units upto Block level.•Monitor preparation of Integrated District Plans.•Review health camps in each village by ANM, AWW and ASHA.•Regular meeting of State Committee on Intersectoral Convergence.Healthy family Healthy nationwww.drjayeshpatidar.blogspot.in
8•Operationalisation of Mission structure & managerial support atstate /District / Block levels.•Selection, training and support for ASHA.•Availability & Utilisation of service delivery at facilities.•Immunisation & Institutional deliveries – District wise.•Preparation of District Plans•Interdepartmental Coordination for convergence•Release & Utilisation of funds.•Training/Capacity Building-Health Planning-District training Centre•Delegation of administrative & financial powers to various levels.AGENDA FOR CHIEF SECRETARIESwww.drjayeshpatidar.blogspot.in
9ActivityPhasing and timelineOutcomeMonitoring1Fully trained Accredited Social HealthActivist (ASHA) for every 1000population/large isolated habitations in18 Special Focus States50% by 2007100% by 2008QuarterlyProgressReport2Village Health and SanitationCommittee constituted in over 6 lakhvillages and untied grants provided tothem.30% by 2007100% by 2008QuarterlyProgressReport32 ANM Sub Health Centresstrengthened/established to provideservice guarantees as per IPHS, in1,75000 places.30% by 200760% by 2009100% by 2010Annual FacilitySurveysExternalassessments430,000 PHCsstrengthened/established with 3 StaffNurses to provide service guaranteesas per IPHS.30% by 200760% by 2009100% by 2010Annual FacilitySurveysExternalAssessments56500 CHCs strengthened/established with 7 Specialists and 9 SNurses to provide service guaranteesas per IPHS.30% by 200750% by 2009100% by 2012Annual FacilitySurveysExternalassessments.www.drjayeshpatidar.blogspot.in
1061800 Taluka/ Sub DivisionalHospitals strengthened to providequality health services.30% by 200750% by 2010100% by 2012Annual FacilitySurveysExternalassessments.7600 District Hospitalsstrengthened to provide quality healthservices.30% by 200760% by 2009100% by 2012Annual FacilitySurveysExternalassessments.8Rogi Kalyan Samitis /HospitalDevelopment Committees establishedin all CHCs/Sub Divisional Hospitals/District Hospitals.50% by 2007100% by 2009Annual FacilitySurveysExternalassessments.9District Health Action Plan 2005-2012 prepared by each district of thecountry.50% by 2007100% by 2008Appraisal processExternalassessment.10Untied grants provided to eachVillage Health and SanitationCommittee, Sub Centre, PHC, CHC topromote local health action.50% by 2007100% by 2008IndependentassessmentsQuarterlyProgressreports.www.drjayeshpatidar.blogspot.in
13STATE INITIATIVES• Andhra Pradesh• Woman Health Volunteers in each of the rural and tribal habitations.• Setting up an additional 100 round-the-clock women health centres.• A subsidized Emergency Health Transportation Scheme.• Incentives to women health volunteers, village Panchayats that promoteImmunization Institutional delivery etc.• Arunachal Pradesh• 16 PHCs contracted out to NGOs and Private practitioners.• Link workers at village level.• Outreach camps for service delivery at remote and inaccessible areas.• Assam• RMP Act enacted.• Transfer and Postings of Medical Staff has been decentralized.• Involvement of private sector to render ANC services under PPP.• Infection Control System in all District Hospitals.• Health Insurance Scheme introduced.• 32 FRUs operationalised.www.drjayeshpatidar.blogspot.in
14STATE INITIATIVES• Bihar• Data centre for daily monitoring of OPD output by eachparticipating institutions.• 8000 villages covered with mobile medical units for underserved population.• Telephone connection to all PHCs of the state.• CHhattisgarh• Strengthening the role of the Panchayat and building on thecommunity based link worker.• Promoting emergency referral to public/private facility usingcoupons by Mitanins.• Establishment of State Health Resource Centre.• Delhi• “Basti Sevikas” for Urban Slums as linked worker.www.drjayeshpatidar.blogspot.in
15STATE INITIATIVES• Gujarat• Chiranjivi Yojana – scheme to contract out private providersfor delivery care and management obstetric complications• Block Level Programme Management arrangements.• Haryana• Health link workers in every village.• A couple aged 60 years with only a girl child is being given apension of Rs. 300/- per month and Rs. 500/- per month tothe girl child under “Ladli Scheme”.• Himachal Pradesh• Rs. 30,000 to FRUs as untied fund for emergency transport.• PPP Cell at State and District level.• Involvement of departments like Ayurveda, social justice andwoman empowerment for distribution of contraceptives.www.drjayeshpatidar.blogspot.in
16STATE INITIATIVES• Jammu & Kashmir• Granting autonomy to hospitals• Utilizing the Rehbat-I-Sehat (RIS) teacher’s network forproviding access to health services to tiny villages scattered inthe district.• Karnataka• Incentives to Doctors and Staff Nurses for providing 24x7services.• Health insurance for SC/ST population• Kerela• RCH services at medical colleges• Maternity Security Scheme• Tribal and Coastal Health Plans.• Involvement of ISM and homeopathy system with the healthfacilities.www.drjayeshpatidar.blogspot.in
17STATE INITIATIVESMadhya Pradesh Outsourcing PHCs to NGOs. State Logistics Management Unit at State level “Prasav Hetu Parivahan Yojana”(LY85000 beneficiaries) Incentive to MO’s at PHCs and CHCs for promotion ofinstitutional deliveriesMaharashtra Setting up of PPP cell at state and district level. Incentive to tribal pregnant woman for ANC andinstitutional deliveries under Matrutav Anudan Yojanaof Nav Sanjivini Scheme. Association of Mahila Gram Sabha and Mahila VikasSamitis of “Jan Swarajaya” for implementation of RCH.Mizoram Incentives for doctors serving in remote areaswww.drjayeshpatidar.blogspot.in
18STATE INITIATIVESOrissa Delegation of powers to the ED , State Health society Consideration of key HRD steps such as a differentiated PublicHealth Management cadre, policy / incentives for postings to lessdeveloped districts Health institutions resource mapping on GIS.Pondicherry Family based health cards.Punjab Balika Rakshak Yojana for adopting terminal method ofsterilization after the birth of only one or two girl children @ Rs.500/- and Rs. 700/- respectively. A prize of Rs. 3 lakhs for panchayats achieving CSR of 1000 in ayear and Rs. 2.5 lakhs for panchayats achieving CSR of 951 to 1000in a year. Nutritional supplement for mothers and children belonging to SCsand other reconstruction of the society.www.drjayeshpatidar.blogspot.in
19STATE INITIATIVESRajasthan Panchamrit for catch up rounds for 5 interventions (Immunization,Vitamin A, Neo Natal Care, Family Planning, Safe Motherhood). Considerable emphasis on quality of services through settingstandards, indicators and process protocols Technical resource cell involving NGOs for monitoring andimplementation of PNDT act.Sikkim Link workers at all the villages. Setting up committees at State / District Level for implementationof PNDT act. Link up with AWW and School Health Programme to operationalizeregular de-worming of children. Untied fund at SC to meet transportation cost and accompany linkworkers if it is justifiable by Village Health Committees.www.drjayeshpatidar.blogspot.in
20STATE INITIATIVESTamil Nadu Integration of ISM with primary health care systems Convergence with HIV/ AIDS/TB at PHCs. Efficient logistic and procurement arrangements.Tripura Outsourcing of investigation services including imaging.Uttar Pradesh Involvement of cooperative sector for distribution ofcontraceptives under Family Planning programme. Private lady doctors are being contracted for providing 2 hour dailyOPD services at CHCs and PHCs on fix incentive basis. Yuva Mangal Mela and Adarsh Dampati Samman will be organisedin selected districts. This year 25 Districts selected having poorhealth indicators. Strengthening of MIS by linking District through NIC Networkwww.drjayeshpatidar.blogspot.in
21STATE INITIATIVES Uttaranchal Involvement of community in monitoring andgiving feedback on all the programmes. Documentation of practices on traditionalhealers. West Bengal Piloting of Voucher Scheme for providingservices through private sector. Ranking of blocks as per key health indicators.www.drjayeshpatidar.blogspot.in