F/O Architecture & Ekistics, Jamia Millia Islamia

HEALTHCARE PLANNING- 1
Write in brief the policies and goals set for infrastructural
development in National Health Policy and Programmes
Assignment, M Arch
(17th February-2021)

1. Name of Student DANISH RAIS

…………………………………………………
2. Roll number
………………
…………………………………………………
3. Enrolment No.
………………

Teacher:
Ar. Noor E Alam Choudhary
Q. Write in brief the policies and goals set for
infrastructural development in National Health Policy
and Programmes

Ans.
The National Rural Health Mission (2005-12) encompasses its two Sub-
Missions, the National Rural Health Mission (NRHM) and the National
Urban Health Mission (NUHM). The main programmatic components
include Health system strengthening in rural and urban areas,
Reproductive Maternal-Neonatal-Child and Adolescent Health
(RMNCH+A) and Communicable and Non Communicable Diseases. The
NHM envisages achievement of universal access to equitable, affordable &
quality healthcare services that are accountable and responsive to people’s
needs.

National Rural Health Mission (NRHM):

NRHM seeks to provide quality healthcare to the rural population,

especially the vulnerable groups. Under the NRHM, the Empowered Action
Group (EAG) States as well as 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, social and gender equality.
Objectives of NRHM:

Improve rural healthcare delivery system. Other goals are as

following:

a) Child & maternal mortality rate

b) Universal access to public health services for food ,nutrition,
sanitation and public health services addressing maternal and child
health.
c) Prevention and control of CD’s and NCD’s
d) Access to primary health care
e) Mainstreaming of AYUSH
f) Promotion of healthy life style

 NRHM aims to undertake architectural correction of the health

system to enable it to effectively handle increased allocations as
promised under the National Common Minimum Programme and
promote policies that strengthen public health management and
service delivery in the country.

 It has as its key components provision of a female health activist in

each village; a village health plan prepared through a local team headed
by the Health & Sanitation Committee of the Panchayat; strengthening
of the rural hospital for effective curative care and made measurable
and accountable to the community through Indian Public Health
Standards (IPHS); integration of vertical Health & Family Welfare
Programmes, optimal utilization of funds & infrastructure, and
strengthening delivery of primary healthcare.
 Under National Health Mission (NHM), Financial support is provided
to States to strengthen the public health system including upgradation
of existing or construction of new infrastructure.
  Upto 33% of NHM funds in High Focus States can be used for
infrastructure development. Details of new construction and
renovation/ upgradation works undertaken across the country under
NHM are as follows:

Facility New Construction Renovation/Upgradation

Sanctioned Completed Sanctioned Completed

SC 26116 16051 17475 12992

PHC 2148 1362 9280 8196

CHC 637 356 3536 2480

SDH 101 50 671 613

DH 102 69 947 730

Other* 1646 762 938 690

TOTAL 30750 18650 32847 25701

Plan of action of NHM/NRHM

1) CREATION OF ASHA (ACCREDITED SOCIAL HEALTH ACTIVIST)

Health activist in the community is not a paid employee which creates

awareness about health & its determinants. Counsel women and escort
them to PHC/CHC & providing medical care for minor ailments
1ASHA= 1000 population
2) STRENGTHENING OF SUB CENTRES
o Supply of essential medicines
o Provision of MPW / additional ANM
o Provision of funds
3) STRENGTHENING OF PHC
o 24 hr service in at least 50% of PHC incl. AYUSH practitioner
o Upgradation for 24hr referral service
o Adequate and regular supply of essential drug
o Strengthening CD control programme

4) STRENGTHENING OF CHC’S
o 3222 CHCs should function as first referral unit
o Maintain ‘INDIAN PUBLIC HEALTH STANDARDS ‘
o Promotion of ‘ROGI KALYAN SAMITIS’

• The population Norms for setting up of public health facilities are as under:

o Sub Centre: 1 per 5,000 population in general areas and 1 per 3,000
population in difficult/tribal and hilly areas
o Primary Health Centre: 1 per 30,000 population in general areas and 1
per 20,000 population in difficult/tribal and hilly areas
o Community Health Centre: 1 per 1,20,000 population in general areas
and 1 per 80,000 population in difficult/tribal and hilly areas.

• A new norm has also been adopted for setting up a SHC based on ‘time to
care’ within 30 minutes by walk from a habitation has been adopted for
selected district of hilly and Desert areas.

• It has also been decided to strengthen Sub-Health Centres based on 'time

to care' within minutes by walk from habitations has been adopted in
selected districts of hilly States and desert areas.

• As per the Rural Health Statistics (RHS) 2019, as on 31.3.2019 the status of
public health facilities function in the Country is as under:

o 1,57,411 Sub Centres (SCs),

o 24,855 Primary Health Centres (PHCs),
 o 5,335 Community Health Centres (CHCs),
o 1234 Sub-divisional Hospitals (SDHs) & 756 Districts Hospitals (DH)
in the country

• There is a shortfall of 43736 SCs (23%), 8764 PHCs (28%) and 2865 CHCs
(37%) across the country as per the Rural Health Statistics (RHS) 2019.

• First Referral Units (FRU) provides comprehensive obstetric care services

including like caesarean section, new-born care, emergency care of sick
children, full range of family planning services, safe abortion services
treatment of STI/RTI availability of blood storage unit and referral transport
services. Number of FRUs has increased significantly from 940 in 2005 to
2953 in 2020 (up to 30.06.2020).

Table gives statistics which clearly show that standards of health are more a
function of the accurate targeting of expenditure on the decentralised
primary sector (as observed in China and Sri Lan Sri Lanka), than a function
of the aggregate health expenditure.

Indicator % Infant %healtth % public

population mortality expenditure expenditure
with rate/1000 to GDP on health to
income od total health
<$1 day expenditure
India 44.2 70 5.2 17.3
China 18.5 31 2.7 24.9
Srilanka 6.6 16 3 45.4
UK 6 5.8 96.9
USA 7 13.7 44.1
Therefore, the Policy, while committing additional aggregate financial
resources, places great reliance on the strengthening of the primary health
structure for the attaining of improved public health outcomes on an
equitable basis. Further, it also recognizes the practical need for levying
reasonable user charges for certain secondary and tertiary public health care
services, for those who can afford to pay.

National Urban Health Mission (NUHM):

NUHM seeks to improve the health status of the urban population

particularly urban poor and other vulnerable sections by facilitating their
access to quality primary healthcare. NUHM covers all State capitals,
district headquarters and other cities/ towns with a population of 50,000
and above (as per census 2011) in a phased manner. Cities and towns with
population below 50,000 will continue be covered under NRHM.

Objective of NUHM:

Improve health status of urban population - particularly slum dwellers and

other vulnerable section by facilitating their access to quality health care.

References, Online Links and Websites

1) (n.d.). Retrieved from

https://main.mohfw.gov.in/sites/default/files/56987532145632566578.
pdf

2) (n.d) Retrieved from-

https://www.youtube.com/watch?v=BKmnkBng9os

3) (n.d) Retrieved from- https://www.nmcnagpur.gov.in/national-urban-

health-mission