Making growth inclusive through

social development

 The war on under nutrition, ill-health

and ignorance has to be waged in a
direct and aggressive manner and
hence….
 National
Click icon to add picture
Rural
Click icon to add picture Health
Mission
(2005-2012)
Reaching affordable,
quality health care to the
poorest households in the
remotest regions
NRHM
 • N…Newer Initiatives.
 • R…Rural Poor Population
 • H…Holistic Health Package.
 • M…Monitoring mechanisms
 To cater to the Primary health care
needs of vulnerable segment of pop. to
bring down IMR and MMR . to attain
Pop. Stabilisation.
NHRM
 The Government of
India made a
commitment to raise
the public expenditure
on health from 1% of
GDP to 2-3% of GDP
over the Mission period
(2005-12).
 Entire
Himachal Country
Pradesh
Jammu
Assam and
Kashmir

Nagaland
Uttar
Pradesh NRHM entire
Meghalaya
Madhya
country, with
Pradesh

Manipur Sikkim special

Arunachal
Pradesh
Tripura
focus on 18
Rajasthan Mizoram
states
Orissa Uttaranchal

Chhattisgar
Jharkhand
Bihar h
 Expected outcomes from the Mission
 IMR reduced to 30/1000 live births by 2012.
 Maternal Mortality reduced to 100/100,000 by 2012.
 TFR reduced to 2.1 by 2012.
 Cataract operations-increasing to 46 lakhs until 2012.
 Leprosy Prevalence Rate –reduce less than 1 per 10,000
thereafter.
 Tuberculosis DOTS series - maintain 85% cure rate
through entire Mission Period.
 Engaging 2,50,000 female Accredited Social Health
Activists (ASHAs) in 10 states.
List of Drugs being provided in
ASHA Kit
 1.DDK for Clean deliveries at home  
2.Tab. Iron Folic Acid (L)  
3.Tab Punarvadu Mandur (ISM
Preparation of Iron)  
4.ORS Packets  
5.Tab. Paracetamol  
6.Tab. Dicyclomine  
7.Povidine Ointment Tube  
8.Thermometers 
 9.Cotton Absorbent Roll  
10.Bandages, 4cm X 4 meters  
11.Tab. Chloroquine  
12.Condoms  13.Oral Pills (In cycles)
IMR reduced to 30/1000 live births by
2012.
 the number per 1,000 children before
one year of age, is 57, which means
over one in 18 infants die before they
are one year old. (2005 – 2006)
 While the figure is a marginal
improvement over the IMR of 68 of
NFHS-2 (1998-99) – about 1 in 14 – this
is unacceptably high.
Infant mortality rate

3
0
 Maternal Health Situation in India:
 About 28 million pregnancies occur every year in
India.
 24 million deliveries
 15% of these are likely to develop complications.
 Complications cannot be predicted.
 Over 67,000 avoidable maternal deaths per year


Maternal Mortality reduced to 100/100,000
by 2012.
 The Maternal Mortality Ratio has
reduced from 301 per 100,000 births in
2001-03 period to 254 in the 2004-06
period
TFR reduced to 2.1 by 2012.

 TFR of 2.7 (SRS 2007)

 Ranks 83 in the world - India 2.72 2008

est.

 Total fertility rate: 2.68 children

born/woman (2009 est.) 
9,000 doctors
60,000 nurses/ANMs
2,00,00,000 women
have availed the facility
Reproductive & Child Health Programme

 MCP (MOTHER &

CHILD PROJECTION
CARD) CARD

 Information right from

the Antenatal test to
growth monitoring of the
newly born baby in
continuation.
 Key Strategies for MH under RCH
 Essential obstetric and new born care for
all .
 Skilled attendance at every birth including
essential new born care.
 Emergency obstetric care for those having
complications and referral services.
 Provision of Safe Abortion Services and
services .
Training
 Training of SNs/LHVs/ANMs as Skilled
Birth Attendant
 Training of MBBS doctors in obstetric
and anesthetic skills.
 Setting up of Blood Storage Centers
(BSC) at First Referral Units.
At Village Level (1000 population):
 Every month at Anganwadi Center a
Village Health and Nutrition Day is being
organized with a focus on ANC, PNC,
Immunization and Counseling on
Nutrition and Family Planning Services.
Monthly Health and Nutrition Days

 Water, sanitation, education, literacy,

nutrition, women’s empowerment have all
been brought together under convergent
community institutions and Health
Missions at various levels.
At the level of Sub- Centre
(3000-5000 population):
 The ANMs at the sub-center are being trained
as Skilled Birth Attendant(SBA).

 50% of the PHCs under NRHM are being

developed as 24X7 PHCs with inputs of 3 or
more SNs/ANMs and one Medical Officer.

 To improve the proficiency, skills and quality of

these SNs/ANMs as skilled provider for delivery,
GOI has launched Skilled Birth Training.
Primary Health Centre
(20,000-30,000 population):
 Funds have been given to the States for
infrastructural development including labour
rooms and equipments as per the laid down
standards under IPHS.

 All CHCs are aimed to be converted as First

Referral Units (FRU) with provision of 1 ObGyn
or a Trained MBBS Doctor for EmOC, 1
Anesthetist or Trained MBBS Doctor proficient
in Anesthetic Skills, Functional OT and a Blood
Storage facility.
Click icon to add picture The scheme focuses
Click icon to add picture on the poor
Janani pregnant woman
with special
Suraksha dispensation for
states having low
Yojana institutional
delivery rate.
key achievement of the NRHM
 One of the key achievement of the
NRHM is a visible growth in the field of
institutional delivery.
 Institutional Delivery:
3.449 M women benefited so far in 06-07
5.135 M in 07-08,
8.378 M in 2008-09 
129 Mobile medical Units are operational.
400 District level MMUs to be positioned by
2008
 National
Click icon to add picture Leprosy
Click icon to add picture
Eradication
Programme
Leprosy
eliminated at
National level
 National
Click icon to add picture Programme
Click icon to add picture for Control
of Blindness
(NPCB)
Rs 125/- for
glasses for
poor children
 STATE
INITIATIVES

27
 Gujarat - Chiranjeevi Yojana
 A Health financing scheme for safe
maternity services to BPL beneficiaries

 More than 7793 BPL mothers, that is

nearly 31 % of BPL pregnant mothers
have safely delivered, under the
scheme.

 not a single death in mothers

has been reported

28
Haryana -Delivery Hut
 Delivery Huts established within villages for
providing services during delivery in institutions
having facilities for normal deliveries and referral
support.

 400 Delivery Huts have been established,

16,500 deliveries conducted, 1756 high-risk referred
of RTI / STI.

29
Madhya Pradesh - Sponsors 500
students
 The state government has come up with
decision to strengthen the nursing cadre
by sponsoring M Sc, B Sc and post basic
B.Sc,nursing students.

 These students have to serve

compulsorily in rural areas for 7 years
after completing the course.
Click icon to add picture Tamil Nadu
Click icon to add picture
Free heart
surgery for
children .

Free spectacles
for children who
are studying .
 Kalaignar
Kappeetu Tittam
BPL family medical insurance scheme

premium will be paid by the

government
 In 2006-07 In 2008-09 In 2009 –10
In 2007-08
Rs. 38 Rs. 1207.17 Rs.2,057
880 Crores
Crores Crores. crores

 Health related indicators would suggest

that significant gains have been made
over the years.
 India fares poorly in most of the
indicators in comparison with developing
countries like China and Sri Lanka. 
 Challenges
 India needs over 6,800 more hospitals in
rural areas to provide basic health
facilities to people.
 There is still a shortage of 4,477 primary
healthcare centre's and 2,337
community healthcare centre's as per
the 2001 population norms,

15196 PHC’s & CHC’s and sub centers are fun

Current Population of India in 2010 -
1,150,000,000 (1.15 billion)

 This means the requirement for

hospitals will be much more if the
population figure in 2010 is taken into
account.
26000 Dr’s : 750 Million pop


we have 30,000 MBBS graduates
coming out of our Colleges every year.
 The entire rural health system for more

than 750 million people never has

more than 26000 doctors.   
Challenges
 The annual survey presented in
parliament said:
 "Almost 29 percent of the existing
health infrastructure is in rented
buildings.
 Poor upkeep and maintenance, and high
absenteeism of manpower in the rural
areas are the main problems in the
health delivery system." 
Solution …
 Transparency
 Monitoring
 Additional weight age of marks that will
be given for service in rural areas.
 Doctors who work in rural areas will be
compensated with extra money
700 consultants (MBA/ CA) have been
appointed
for state/ district level Program
Management Units. Thank you
Deepa
Himanshu
Kapil Billa
Pankaj
Subhangkar
Tony