NHM NRHM NUHM Plan Of action Role Of

�NHM �NRHM �NUHM - Plan Of action - Role Of ASHA - Initiatives - Infrastructure

National Health Mission �Ministry of health and family welfare �NHM - approved in May 2013 �Sub missions – NRHM & NUHM �Main programmatic components - RMNCH+A - control of NCDs & Comm. d/s Important achievement – reduction in out of pocket expenses from 72 – 60%

New initiatives under NHM �Rashtriya Bal Swasthya Karyakram (RBSK) �Rashtriya Kishor Swasthya karyakram (RKSK) �WIFS(Weekly Iron and Folic Acid Supplimentation Programme)

NRHM �Launched in 5 th April 2 oo 5 for 7 years by GOI �Recently extended to 2017 �Operational in whole country & Special focus on 18 states

1. Arunachal Pradesh 2. Assam 3. Bihar 4. Orissa 5. UP 6. MP 7. Rajasthan 8. Uttaranchal 9. Mizoram 10. Manipur 11. Meghalaya 12. Chattisgarh 13. Tripura 14. Nagaland 15. Gujarat 16. J & K 17. HP 18. Sikkim

Reproductive and Child Health II(RCH II) National Programme for Control of Blindness (NPCB) Integrated Disease Surveillance Project(IDSP) RNTCP National Leprosy Eradication Programme National Iodine Defficiency Disorder Control Programme NVBDCP (malaria, filaria, kala azar, dengue, JE)

The Objectives of the Mission Reduction in Child & Maternal mortality Universal access to public health services Universal Access to Immunization Programme

The Objectives of the Mission Prevention & Control of Communica ble & Noncomm. Diseases Access to Integrated Primary Health Care Population Stabilization & demographic Balance Revitalize local health Tradition (AYUSH)

PLAN OF ACTION 1)CREATION OF ASHA (ACCREDITED SOCIAL HEALTH ACTIVIST) -health activist in the community -1 ASHA= 1000 population -not a paid employee -create awareness about health & its determinants -mobilise community to health care services - counsel women and escort them to PHC/CHC & providing medical care for minor ailments

PLAN OF ACTION. . 2) STRENGTHENING OF SUB CENTRES �Supply of essential medicines and equipments. �Provision of MPW / additional ANM �Provision of funds

3) STRENGTHENING OF PHC � 24 hr service in at least 50% of PHC incl. AYUSH practitioner �Upgradation for 24 hr referral service �Adequate and regular supply of essential drug �Strengthening CD control programme

PLAN OF ACTION. . 4) STRENGTHENING OF CHC’S � all operating CHCs should function as first referral unit �Maintain ‘INDIAN PUBLIC HEALTH STANDARDS‘ �Promotion of ‘ROGI KALYAN SAMITIS’ �Developing standards of services and costs in hospital care.

Major initiatives under NRHM 1. Selection of ASHA

ASHA act as the interface between the community and the public health system.

Responsibilities of ASHA 1. She will facilitate preparation and implementation of the Village Health Plan along with �Anganwadi worker �ANM �functionaries of other Departments �Self Help Group members

Responsibilities of ASHA 2. will be given a Drug Kit (generic AYUSH and allopathic formulations )for common ailments.

Responsibility of ASHA 3. To create awareness among the community regarding nutrition, basic sanitation, hygienic practices, healthy living. 4. Counsel women on birth preparedness, imp of safe delivery, breast feeding, complementary feeding, immunization, contraception, STDs

5. Encourage the community to get involved in health related services. 6. Escort/ accompany pregnant women, children requiring treatment and admissions to the nearest PHC’s. 7. Primary medical care for minor ailment such as diarrhea, fevers 8. Provider of DOTS.

Initiatives 2. Rogi Kalyan Samiti(Patient Welfare Committee) Simple and effective management structure Registered society whose members act as trustees 31, 109 Rogi Kalyan Samitis till march 2014

3. Untied grants to subcenters 4. Villege Health Sanitation and Nutrition Committee(VHSNC) 5. Janani Suraksha Yojna

Janani Suraksha Yojana and ASHA NRHM ↓↓ all MMR & IMR Antenatal Check up Institutional Care during delivery Immediate post-partum (coordinated care) ↑↑Institutiona l Deliveries in BPL families Cash assistance JSY

6. Janani Shishu Suraksha Karyakram(JSSK) Launched on June first 2011 Entitles all pregnant women delivering in public health institutions to absolutely free treatment. 7. National Mobile medical units(NMMUs) All Mobile medical Units are repositioned as NMMU with universal Color and design.

8. National Ambulance Services Free service to provide patients transport in every corner of country connected with a toll free number

9. web enabled Mother and Child Tracking System (MCTS) Name based tracking of pregnant women and children(up to 3 years) To ensure – Timely Antenatal Care Instituitional Delivery post natal care of Mother Immunization

New initiatives 1. Home delivery of contraceptives by ASHA 2. Conducting District level HH Survey (DLHS) 3. Modifications in scheme for promotion of menstrual hygiene 4. Differential financial approach for comprehensive health care

5. Involve ASHA in home based new born care 6. Revision in criterion for allocation of funds to the states under NRHM based on performance of the states. 7. Expansion of Village Health and Sanitation Committee to include Nutrition in its mandate and renaming it as VHSNC.

8. Partial modification of centrally sponsored scheme for development of AYUSH hospitals and dispensaries for mainstreaming of AYUSH under NRHM 9. Rashtreeya Bal Swasthya Karyakram Launched in February 2013 For early detection and management of - Defects at birth - Diseases - Deficiencies - Development delays including Disabilities

10. Rashtreeya Kishore Swasthya Karyakram launched in January 2014 Adolascent health programme beyond reproductive and sexual health - life skills - nutrition - injuries - violence - NCD - Mental Health - Substance misuse

11. Mother and child wings( MCH Wings) 12. Free drug and free diagnostic service 13. National Iron + Initiative Launched in 2013 important strategy - WIFS

14. RMNCH+A 15. Delivery points(DPs) Health facilities that have high demand for services and performance above certain bench mark have been identified as DPs Objective – to provide RMNCH+A at this level 16. Universal Health Coverage (UHC)

Achievements �As on June 2013 1. 8. 89 lakhs ASHAs have been selected in the entire country of which 8. 06 lakhs have been trained and provided with drug kit 2. 1. 47 lakh sub centres in the country are provided with untied funds of rs. 10, 000 each. 40, 426 sub centres are functional with a second ANM 3. 31, 109 Rogi Kalyan Samithies

4. 8, 129 doctors and specialists , 70, 608 ANMs , 34, 605 staff nurses , 13725 paramedics have been appointed. 5. 1, 691 professionals have been appointed(CA, MBA, MCA) 6. 2, 127 mobile medical units 7. Emergency transport system in 12 states

8. Accelerated immunization programme for North East States and Empowerde action Groups 9. JSY in all states 10. IMNCI in 310 districts 11. Monthly health and nutrition days every week

12. 5. 12 lakh VHSN committees 13. School health programme in 26 states

NUHM �To improve health status of urban population particularly slum dwellers vulnerable section

Coverage All cities with >50, 000 population. All the district and state headquarters (irrespective of the population size). Urban areas with < 50, 000 to be covered by NRHM. So population far to ensure that there is no duplication of services.

Seven mega cities ( Mumbai, New Delhi, Chennai, Hyderabad, Kolkatta, Bangaluru & Ahemadabad) will be treated differently — their municipal corporations will implement NUHM. In other cities, District Health Societies will be responsible for NUHM implemetation. Flexibility- given to states In the 12 th Plan period NUHM and NRHM will be separate programmes……

The NUHM would have high focus on: Urban All Poor Population living in listed and unlisted slums other vulnerable population such as Homeless, Rag-pickers Street children Rickshaw pullers Construction and brick and lime kiln workers Sex workers Other temporary migrants.

Public health thrust on sanitation, clean drinking water, vector control, etc. Strengthening public health capacity of urban local bodies.

Accredicted Social Health Activist(ASHA) An ASHA will be posted for every 200 -500 households (1000 -2500 population) Maintain IPC with the families and the Mahila Arogya Samities (MAS) for which they are earmarked. The ASHA , preferably be a woman resident of the slum- married/widowed/ divorced Preferably in the age group of 25 to 45 years. Should be literate with formal education up to class eight subjected to relaxation. Chosen through a rigorous community driven process involving ULB Counsellors, community groups, self help groups, Anganwadis, ANMs.

For every 2. 5 lakh population (5 lakh for metros) For every 50, 000 population For every 10, 000 population 200 - 500 HHs (1000 -2500 population) 5404 -100 HHs (250 -500 population) U-CHC Inpatient facility, 30 -50 bedded (100 bedded in metros) *Only for cities with a population of above 5 lakh U-PHC MO I/C - 1 2 nd MO (part time) - 1 Nurse - 3 LHV - 1 Pharmacist - 1 ANMs - 3 -5 Public Health Manager/ Mobilization Officer – 1 Support Staff - 3 M & E Unit - 1 1 ANM Outreach sessions in area of every ANM on weekly basis Community Health Volunteer (ASHA/LW) Mahila Arogya Samiti 3/6/2017

Urban Health Delivery System

Mahila Arogya Samitee (MAS) A community based federated group of around 20 to 100 households Acts as community based peer education group, involves in community monitoring and referral. Each of the MAS may have 5 -20 members with an elected Chairperson and Treasurer, supported by ASHA.

The mobilization of the MAS facilitated by NGO, working along with the ASHA The group focuses on: Health and hygiene behaviour change promotion Facilitating access to identified facilities Community risk pooling. The MAS will be provide with an annual untied grant of Rs 5000.

Urban Primary Health Center Functional for a population of around 50, 000 – 60, 000 Located preferably within a slum or a half km radius, Catering a population of approximately 20000 -30000, With provision for evening OPD also. Flexibility One UHC for 75, 000 for densely populated areas or…. and One UHC for around 5000 -10, 000 for isolated slum clusters.

Facilities provided are: Preventive Promotive Non-domicilliary curative care including consultation Basic lab diagnosis and dispensing.

Human Resource at UPHC Sl no. Staff Category Number 1 Medical Officer 2* (1 regular and 1 part time) 2 Staff Nurse 3 3 Pharmacist 1 4 Lab Technician 1 5 Public Health Manager/ Community Mobilisor 1 6 LHV 1 7 ANMs 3 -5** Depending upon population 8 Support staff 3 9 M&E Unit 1

Referral unit Urban Community Health Centre (U-CHC) are proposed to be set up as a satellite hospital for every 4 -5 U-PHCs. Cater to a population of 2, 50, 000. Provide in patient services and a 30 -50 bedded facility. The U-CHCs would be set up in cities with a population of above 5 lakhs, wherever required.

They will be in addition to the existing facilities (SDH/DH) to cater to the urban population in the locality. For the metro cities, the U-CHCs may be established for every 5 lakh population with 100 beds The U-CHC would provide medical care, minor surgical facilities and facilities for institutional delivery.

Impact level targets of NUHM Reduce IMR by 40% (in urban areas) – National Urban IMR down to 20/1000 live birth by 2017 - 40% reduction in U 5 MR and IMR - achieve Universal Immunization in all urban areas 2. Reduce MMR by 50% 100% ANC Coverage 1. 3. Achieve universal access to reproductive health including 100% institutional delivery 4. Achieve replacement level fertility 5. Achieve all targets of disease control programme

Urban & Rural health care delivery CENTRE STATE DISTRICT District Hospital Municipality BLOCK 80, 000 -1. 2 lakh pop 20, 000 -30, 000 pop 3000 -5000 pop CHC/ FRU UCHC PHC SHC ANMs UPHC ANM 2. 5 Lakh pop( 5 for metros) 50, 000 pop 10, 000 popl Slum 1 village=1000 pop 54 ASHA USHA 200 -500 HH; 1000 -2500 popl 3/6/2017