National Health Mission

UNIT 1 NATIONAL HEALTH MISSION

Structure

1.0 Objectives
1.1 Introduction
1.1.1 Overview of NHM

1.1.2 Milestones of NHM

1.1.3 Vision of NHM

1.2 NUHM Guiding Principles

1.2.1 Goals of NHM

1.3 Components of NHM

1.3.1 Public Health Planning & Financing.

1.3.2 Human Resource strengthening

1.3.3 Health System strengthening.

1.3.4 RMNCH+A services

1.3.5 National Disease Control Programmes (NDCP’S)

1.3.6 Community Processes.

1.4 Organisational structure

1.4.1 National level

1.4.2 District level

1.5 Strategies to achieve targets

1.6 The Primary Care List of Assured Services
1.6.1 Reproductive and Child Health

1.6.2 Emergency and Trauma Care

1.6.3 Communicable Diseases

1.6.4 Non-Communicable Diseases

1.7 Monitoring And Evaluation

1.8 Service Delivery Strategies
1.9 Let Us Sum Up
1.10 Answers to Check Your Progress
1.11 References

1.0 OBJECTIVES
After going through this unit you will be able to:

 Explain the milestones and Vision of NHM

 Describe guiding Principles NUHM/NRHM-NHM

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National Health  Explain Targets of NHM and Components of NHM
Programmes in India-
Role of Nurse  Explain the organisational structure at National and State level

 Discuss about Strategies to achieve targets

1.1 INTRODUCTION
This is the first unit of this block. In the previous block you have gone through
national health problems. Now, we will be covering various strategies under
related national health programmes to prevent and control these problems. The
National Health Mission (NHM) encompasses its two Sub-Missions, the National
Rural Health Mission (NRHM) and the newly launched National Urban Health
Mission (NUHM). In this unit in initial section emphasis is given on vision,
milestones, guiding principles, targets and components of NHM. In next section
on organisational structure is explained at National level and District level. You
will also read about Strategies to achieve targets in a section. The Primary Care
List of Assured Services including Reproductive and Child Health , Emergency
and Trauma Care , Non-Communicable Diseases , Monitoring And Evaluation,
Service Delivery Strategies are also discussed.

1.1.1 Overview of NHM

The NHM was launched by the government of India in 2013 subsuming the
national rural health mission and National urban health mission. It was further
extended in March 2018 to continue until March 2020. The NHM envisages
achievement of universal access to equitable, affordable & quality health care
services that are accountable and responsive to people’s needs.

NHM focuses on decentralized health planning, service delivery, creating

knowledge hubs with district hospitals, strengthening any rural area at district
hospitals, expanding outreach services, improving community processes and BCC.

The main aim is to create a fully functional decentralized and community owned
system with greater intersectoral coordination so that wider social determinants
factors affecting health of people like water sanitation, nutrition gender and
education are also equally addressed.

NHM is headed by mission director and monitored by national Level monitors

appointed by government of India. The main components of the program include
health system strengthening in rural and urban areas, reproductive – maternal –
new-born – child and adolescent health (RMNCH+A) and control of
communicable and non- communicable diseases.

1.1.2 Milestones of NHM

1992 : Child Survival and Safe Motherhood programme (CSSM)

1997 : RCH I : The programme was formally launched on 15th October 1997.
Phase 1 programme incorporated the 4 components-RCH package,
Family planning, Child survival and safe motherhood Client approach
to health care, Prevention and management of RTI/STDs/AIDS.

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2005 : RCH II : began from 1st April 2005,the focus is to reduce maternal National Health Mission
and child mortality and morbidity with emphasis on rural health care.

2005 : National Rural Health Mission (NRHM) : The National Rural Health
Mission (NRHM) was launched by the Prime Minister on 12th April
2005, to provide accessible, affordable and quality health care to the
rural population, especially the vulnerable groups.

2013 : RMNCH +A strategy: India’s Reproductive, Maternal, Newborn,

Child and Adolescent Health (RMNCH+A) Strategy, launched in
2013, was a milestone in the country’s health planning.

2014 : India New-born Action plan (INAP): The India Newborn Action Plan
(INAP) is India’s committed response to the Global Every Newborn
Action Plan (ENAP), launched in June 2014 at the 67th World Health
Assembly, to advance the Global Strategy for Women s and Children’s
Health.

1.1.3 Vision of the NHM:

“Attainment of Universal Access to Equitable, Affordable and Quality health care
services, accountable and responsive to people’s needs, with effective inter-
sectoral convergent action to address the wider social determinants of health”.

Core Values of NHM are

• Safeguard the health of the poor, vulnerable and disadvantaged.

• Strengthen public health systems.

• Build environment of trust between people and providers of health services

• Empower community to become active participants in the process of

attainment of highest possible levels of health.

• Institutionalize transparency and accountability in all processes and

mechanisms.

• Improve efficiency to optimize use of available resources.

1.2 NUHM GUIDING PRINCIPLES

Let us now read the principles for the success of achieving the targets as given
below:

Several principles for the success of achieving the targets set by Government of
India were followed

• Build an integrated network of all primary, secondary and a substantial part of

tertiary care, providing a continuum of care from community level to the
district hospital, with robust referral linkages to tertiary care and a particular
focus on strengthening the Primary Health Care System including outreach
services in both rural areas and urban slums.

• Ensure coordinated inter-sectoral action

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National Health • Ensure prioritization of services that address the health of women and children
Programmes in India- and the prevention and control of communicable and non-communicable
Role of Nurse
diseases, including locally endemic diseases.
• Ensure increased access and utilization of quality health services to minimize
disparity on account of gender, poverty, caste, other forms of social exclusion
and geographical barriers.
• Incentivize good performance of both facilities and providers.
• Address shortages of skilled workers in remote, rural areas, and other under-
served pockets through appropriate monetary and non-monetary incentives.
• Promote partnerships with private, for profit, and not for profit agencies
including civil society organizations to achieve health outcomes.
• Facilitate knowledge networks and create effective public health institutions.
• Encourage and enable the involvement of Panchayati Raj Institutions (PRIs) /
Urban Local Bodies • (ULBs) representatives in the governance and oversight
of health services
• Mainstream AYUSH, so as to enhance choice of services for users and to learn
from and revitalize local health care traditions.
• Expand focus beyond maternal and child survival to ensure quality of life for
women, children and adolescents.

1.2.1 Goals of NHM

• Reduce MMR to 1/1000 live births

• Reduce IMR to 25/1000 live births

• Reduce TFR to 2.1
• Prevention and reduction of anaemia in women aged 15–49 years
• Prevent and reduce mortality & morbidity from communicable, non-
communicable; injuries and emerging diseases
• Reduce household out-of-pocket expenditure on total health care expenditure
• Reduce annual incidence and mortality from Tuberculosis by half
• Reduce prevalence of Leprosy to <1/10000 population and incidence to zero
in all districts
• Annual Malaria Incidence to be <1/1000
• Less than 1 per cent microfilaria prevalence in all districts
• Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

Goals of this phase of NHM will be towards enabling and achieving the stated
vision.

Making the system responsive to the needs of citizens, building a broad based
inclusive partnership for realizing National health goals, focusing on the survival
and well-being of women and children, reducing existing disease burden and
ensuring financial protection for households.

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 Check Your Progress 1 National Health Mission

Q1) What are the milestones of NHM

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Q2) Write five guiding principles of NHM
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1.3 COMPONENTS OF NHM

Let us read the components covered under NHM as given below:

1. Public health Planning & Financing.

2. Human resource strengthening.
3. Health System strengthening.
4. RMNCH+A services
5. National disease control programmes (NDCP’S)
6. Community Processes.

1.3.1 Public health planning & financing

 As pure health indicators facilities & differential planning & made for district
/cities /blocks.
 Planning for full spectrum of health services.
 Emphases on quality assurance in delivery points
 Strengthening of management
 Developing a separate & trained public health cadre of professionals
including Nurses & Doctors.

1.3.2 Human resource strengthening in health;

 Based on Cases arrangement of Health professionals
 HR accountability Performance based incentives & for working in difficult
areas
 Additional incentives to health professionals to serve in rural and remote
areas.
 Speedy recruitment to fill up vacancy, preferable decentralized.
 Amendments in medical colleges norms to ease availability of
heaths professionals
 Capacity building & training of staff at all levels.

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National Health 1.3.3 Health System strengthening.
Programmes in India-
Role of Nurse  Construction of new building & renovation of existing one.
 Improving sanitation & Hygiene in Public facilities: Kavakalp Kayakalp is
new initiative launched in 2015 to increase the hygienic, sanitation, effective
waste management & infections control practices in public health facilities.
 It includes Certificate of commendation & Cash Awards of such public health
care facilities that show good performance & Compliance to protocol.
 Social protection:- Reducing out of pocket expense

A. Drugs:- Free drugs service initiatives.

- Essential drugs as per the defined Essential drugs list are given free of
cost.
- Central procurement of drugs as per various programme EDL & standard
& Guidelines
- Provision of local purchase of drugs & Supplies at lower level.

B. Diagnostics:- free diagnostics service initiative.

- free of cost diagnostic services (radiological & laboratory) are provided to

patients as per level of facilities

C. Diet:- free good quality Diet.

- It’s available to all inpatients including pregnant women

D. Transport:- emergency response system (ERS) / patient transport service /

National Ambulance services.

Based on Janani Suraksha Yojana, & Janani Sishu Suraksha Karyakram (JSSK)
these cashless basic services are provided

Ambulance Services

108 Ambulance 102 Ambulance

- It’s an Emergency response System - It’s basic patient transport System.

- These ambulance work to bring - They are located in govt. hospitals
& post delivery, drop back facility
1. victims of accidents to nearest govt. - They provide
hospital. 1. Facilities to all registered children
& mother from hospital to their
2. to shift patient to district hospital. homes.
3. pickup facilities for pregnant women 2. To bring critically ill neonatal
from their home to health care centre patients from homes to hospital to.
for institutional delivery

• Approximately l ambulance work for 1 lakh population.

Have 3 drivers + 3 paramedical emergency technician + 2 Supervisors for 15
vehicles

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• Outreach Services - Mobile Medical Units: - National Health Mission

- In difficult terrain & remote areas vehicles are appointed to carry health
care to door step of patients & they carry drugs, supplies & laboratory &
diagnostics equipment.

1.3.4 Reproductive, Maternal, Newborn, Child Health &

Adolescent services (RMNCH+A).
- For reducing maternal & child health mortality,
- To improve in access & utilisation of health care services by vulnerable
population

Sub-Component of this scheme are :

A. Reducing maternal mortality rate : Maternal Health.

a) Incentives - Janani Suraksha Yojana.

- Incentives are paid to all pregnant women of both Urban & rural areas
for delivery in public institutions.
- It facilitate public institutional deliveries.

State Incentives under J SY. I

Rural Areas Urban Areas
Pregnant Women Asha Pregnant Women Asha
High performance 700 600 600 400
Status
Low performance 1,400 600 1,000 400
Status
At Home delivery 500 - 500 -

b) Free Patient entitlements: - Janani Sishu Suraksha Karyakram. (JSSK).

- This Scheme ensure the caseless delivery & c-section for pregnant women
& management of sick neonates upto a year to prevent incurring high out
of pocket expenses a exploitation by unwarranted people.

Pregnant women Sick newborn till 30 days of life

 free & Caseless delivery  free treatment

 free c-section  free dung & Consumables
 free dung & Consumables  free diagnostics
 free diagnosis  free provision of blood
 free diet during hospital stay  Exemption from other charges
 free provision of blood  free transport.
 Exemption from user charges
 Free transport – from home to hospital
From hospital to home in 48 hr
Referral to other facility
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National Health c) Strengthening Infrastructure & MCH Services.
Programmes in India-
Role of Nurse - MCH separate wings can be established in District hospitals Sub-District
hospitals / CHC / FRU to overcome the constraints of the Caseloads &
institutional delivery at these facilities.
d) Reorienting Medical Education - Skill Labs
- Establish for competency based training & skill of professionals
e) Capacity building & Daksha Programme.
- for service providers in labour room
f) Promotive health: Mothers absolute Affection
- For promotion of breast feeding.
g) Improve access & Coverage & safe abortion services.
- MTP provided in FRU, 24x 7.
h) Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
- The 9th months of pregnant ladies are provided free health check-up
including BP, Sugar and other blood test etc. & treatment in all health
care facilities. Private sector Gynaecologist are encouraged to voluntary
participate & provide ANC services in these public health facilities.
i) NGO involvement
j) Monitoring & accountability of Services:- Maternal Wealth Review
- Purpose o facility based MDR & Community based MDR is to identify
the causes of maternal death & gap in Service delivery, for taking correct
action.
k) Reducing IMR & child mortality rate :-
i. Newborn care service, programme
Location Services
Newborn Care Corner All delivery points Essential newborn care, 0day
in communication.
Newborn stabilization CHCS/FRUs Stabilization & referral of
sick newborn
Special Newborn care DHs & tertiary care Management of sick newborn
units (SNC Us) hospital
ii. Universal Immunisation Programme (UIP) & Mission Indra Dhanush.
iii. Rashtriya Bal Swasthya Karyakaram (RBSK)
- To improve overall quality of life of children, 0-18 yrs.
- Early detection & intervention 4D’s - Defect at birth.
By management - Deficiency Diseases
Screening
Support -
Through medical referral to - Development delay
Health team /higher centre - Disabilities.
in every block/ in school/ Anganwadi
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iv. IMNCI National Health Mission

v. Nutritional Rehabilitation Centers (NRC’S)

vi. Monitoring : Child health Review

B. Adolescent Health programme.

i. Rashtriya Kishor Swasthya Karya Karam (RKSK)

adolescent friendly health services are provide in District health facilities

to provide counselling on:- sexual & reproductive health substance
abuse, Violence - domestic Violence, Mental health, injury, NCD &
provide iron & folic acid tablets, condoms, pregnancy kits, OCP’S
through counselor.

ii. Reducing Fertility Rate - family planning services - (FPS)

FPS are delivered at district; all PHC’s CHC’s & DH, provides both
temporary & permanent methods

iii. Declining Sex Ratio: Govt. implement the Pre-conception & Pre-natal
Diagnostic Techniques (PCPNDT) Act, 1994

Preventing Communicable & Non Communicable disease: For details

refer Unit 2 and Unit 3 of this block.

1.3.5 National Disease Control Programmes (NDCP’S)

Non Communicable Disease Communicable Disease
Programmes Programmes
- National programme for prevention - - National Vector Borne Disease
& Control of diabetes, CVD- stroke Control Programme (NVBDCP)
- National programs for Prevention & - Revised National Tuberculosis
Control of Blindness. Control Programme (RNTCP)
- National Mental Health programme. - National Leprosy Eradication
programme
- NIDDCP - Integrated Disease surveillance
Programme
- NTCP
- National Oral Health programme.
- National programme for Health Care
of Elderly.

1.3.6 Community Processes

Various community processes are as given below:

Community - Led Action for health.

Community-Led Activities

a) Village Health Sanitation & Nutrition Committee (VHSNC).

b) ASHA

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National Health c) Anganwadi workers
Programmes in India-
Role of Nurse d) Jan Sunwai & Jan Samvad:- Public dialogues / Public
Hearing taking direct feedback from the community members.

- IEC Activities:- Comprehensive communication strategy includes

BCC with IEC strategies to disseminate in villages lowest level.

- Participants and Govt. professionals agencies, Non govt.

agencies Specialized agencies, visible mass medias give efforts in
massive health communication.

1.4 ORGANISATIONAL STRUCTURE

Let us read the Organisational structure at National and District level as given
below:

*INSTITUTIONAL FRAME WORK:

- National Institute of Health & family welfare
1.4.1 National level

Implementation structure - Apex body for training &

Ministry of Health & skill development
family Welfare, Go1

Mission Director . National health system

resource Centre
- for technical support
Programme
Programme Divisions FM headed by Director
(Finance) National Programme
management Unit for
programme management &
State Health Society activities for policy support
Programmes.
 District hospital National ASHA mentoring
 General hospital District health society/City group
 Sub District hospital Health society
 Rogi Kalyan Samitri

Community Health Centre/ Sub Centres Village, Health sanitation

PHC’s of nutrition committee (VHSNC)

Rahikalya Samitri
(RKS)

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1.4.2 District level structure National Health Mission

District Collector

CMO

Medical officer NRHM Nodal officer NVHM

District District District District District District

Programme Account Quality Early Community Urban
Manager Manager Assurance intervention process Health
Officer Centre Manager
Coordinator
Manager
District ASHA
District ASHA Training

1.5 STRATEGIES TO ACHIEVE TARGETS

Following strategies were adopted during NUHM

1. Support and supplement state efforts to undertake sector wide health system
strengthening through the provision of financial and technical assistance.

2. Build state, district and city capacity for decentralized outcome based
planning and implementation

3. Enable integrated facility development planning which would include

infrastructure human resources, drugs and supplies, quality assurance, and
effective Rogi Kalyan Samitis (RKS).

4. Create a District Level Knowledge Centre within each District Hospital

5. Improve delivery of outreach services

6. Strengthen the sub-centre/Urban Primary Health Centre (UPHC) with

additional human resources and supplies

7. Prioritize achievement of universal coverage for Reproductive Maternal,

Newborn, Child Health + Adolescent (RMNCH+A), National Communicable
Disease Control and Non Communicable Diseases programmes.

8. Expand focus from child survival to child development of all children 0-18
years through a mix of Community, Anganwadi, and School based health
services.

9. Achieve the goals of safe motherhood

10. Focus on adolescents and their health needs.

11. Ensure the control of communicable disease

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National Health 12. Use primary health care delivery platforms to address the rising burden of
Programmes in India- Non- Communicable Diseases
Role of Nurse
13. Converge with Ministry of Women & Child Development

14. Empower the ASHA to serve as a facilitator, mobilizer and provider of

community level care.

15. Strengthen people’s organizations such as the Village Health Sanitation and
Nutrition Committees (VHSNC) and Mahila Arogya Samitis (MAS)

16. Create mechanisms to strengthen Behaviour Change Communication

17. Develop effective partnerships with private sector

18. Enhance use of Information & Communication Technology

19. Strengthen Health Management Information Systems

20. Ensure universal registration of births and deaths with adequate information
on cause of death

21. To ensure equitable health care and to bring about sharper improvements in
health outcomes

22. The government has already taken steps towards provision of free maternal,
and child health services, including newborn care, immunization, adolescent
health, and family planning.

23. Free diagnostic and treatment services

24. Focus on strengthening primary health care across the country.

1.6 THE PRIMARY CARE LIST OF ASSURED

SERVICES
Let us now read about the services assured in primary care as given below:

1.6.1 Reproductive and Child Health

a. Care in pregnancy- All care including identification of complications, but
excluding management of complications requiring surgery or blood
transfusion.

b. All aspects of Essential New-born Care.

c. Care for common illnesses of new-born and of children- identify, stabilize and
refer life threatening conditions beyond the approved skill sets of the mid
level care provider.

d. Immunization

e. Universal use of iodized salt.

f. All aspects of prevention and management of malnutrition, excepting those

that requiring institutional care.

g. All family planning services except female sterilization

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h. Provision of safe abortion services - medical and surgical. National Health Mission

i. Identification and management of anaemia, Common sexual and urogenital

problems which can be treated syndromically, or diagnose with point of care
diagnostics, and identification of those which need referral.

j. All health education and individual counselling measures needed for

promotion of desirable health behaviours and health care practices and change
from inappropriate health care practices and behaviours, related to RCH.

k. All activities under the Rashtriya Bal Suraksha Karyakram- at Anganwadi and
school level

l. All laboratory support

m. Patient transport systems that can bring and drop back patients for example
sick infants up to one year of age, institutional delivery, for disability, and
address problems of access due to lack of transport.

1.6.2 Emergency and Trauma Care

a) Prevention and appropriate management for bites and stings- snakes,
scorpions, wild animals.

b) Management of poisoning, including food poisoning.

c) Complete first aid including management of minor injuries

d) Stabilization care in poisoning and major injuries and ensuring referral

through emergency response systems.

1.6.3 Control of Communicable Diseases

a) Screening for leprosy, referral on suspicion, and follow up of cases with
confirmed diagnosis and prescribed treatment.

b) Referral of suspect tuberculosis, family level screening of known patients, and

follow up of cases with confirmed diagnosis and prescribed treatment.

c) HIV testing, appropriate referral and follow up of specialist-initiated

treatment.

d) All measures for the prevention of Vector Borne Diseases; early and prompt
treatment for these diseases, with referral of complicated cases.

e) Control of helminthiasis.

f) Reduction in burden of waterborne disease

g) Reduction of infectious hepatitis B and identification and referral for the

same.

h) Primary care for other infectious diseases

1.6.4 Non-Communicable Diseases

a) Screening for breast and cervical cancers in all women over the age of 30.

b) Screening for mental disorders, counselling, and follow up to specialist

initiated care.
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National Health c) Detection of epilepsy and stroke and follow up to specialist initiated drugs and
Programmes in India- rehabilitative measures.
Role of Nurse
d) Screening for visual impairments, correction of refractive errors and referrals
for the rest.

e) Screening for diabetes and hypertension in all population above 30 annually.

f) Ensuring follow up on doctor initiated drugs in diabetes and hypertension- and

secondary prevention – so that no complications develop.

g) Prevention – primary, secondary and tertiary preventive care in rheumatic

heart disease.

h) Primary and secondary prevention in COPD and bronchial asthma, with

provision of follow up care in patients put on treatment by specialists.

i) Counselling and support to victims of violence.

j) Preventive measures against all harmful addictive substances- tobacco in the

main, but also alcohol and addictive drugs

k) Community based geriatric care support.

l) Preventive and promotive measures to address musculo- skeletal disorders-

mainly osteoporosis, arthritis of different types and referral or follow up as
indicated.

m) Community based rehabilitative and disability care support.

Check Your Progress 2

Q1) What strategies are adopted to achieve the targets of NHM

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Q2) What are the aims of reproductive and child health strategy
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3) List the components of NHM

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1.7 MONITORING AND EVALUATION

For monitoring and evaluation of NHM program several mechanisms were
adopted. The primary aim is to serve as a strong and harmonized M&E component
of the NHS, covering all major disease programmes as well as health system
actions through

 Use of data from large scale population surveys

 Commissioning implementation research or evaluation studies

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 Use of HMIS data and field appraisals and reviews National Health Mission

 Health outcomes, output and process indicators

 Periodic Population Health Surveys and Demographic Information

 The Sample Registration Surveys (SRS)

 Death statistics

 National Sample Survey Organization (NSSO) data on cost of care and

morbidity, DLHS and NFHS.

1.8 SERVICE DELIVERY STRATEGIES

 Reproductive, Maternal, Newborn, Child Health and Adolescent
(RMNCH+A) Services
 Maternal Health – Comprehensive package of RMNCH+A services. – Janani
Suraksha Yojana (JSY) – Janani Shishu Suraksha Karyakram (JSSK)
 Access to safe abortion services
 Prevention and Management of Reproductive Tract Infections (RTI) and
Sexually Transmitted Infections (STI)
 Gender Based Violence
 New-born and Child Health
 Universal Immunization
 Health Screening and Early Intervention Services
 Adolescent Health
 Iron and Folic Acid (IFA) supplementation and Provision of Weekly Iron and
Folic acid Supplementation (WIFS) and National Iron Plus Initiative.
 Facility -based adolescent health services
 Community based health promotion activities
 Information and counseling on sexual and reproductive health (including
menstrual hygiene),
 Substance abuse
 Mental health
 Non-communicable diseases, injuries
 Adolescent Friendly Health Clinics (AFHC)
 Family Planning – Intra-Uterine Contraceptive Devices (IUCD).

Control of Communicable Diseases

 The National Vector Borne Diseases Control Programme (NVBDCP) is an

umbrella programme for prevention and control of vector borne diseases viz.
Malaria, Japanese Encephalitis (JE), Dengue, Chikungunya, Kala-Azar and
Lymphatic Filariasis. Of these, Kala-Azar and Lymphatic Filariasis have been
targeted for elimination by 2015. Please refer details in Unit 2 of this block.
25
National Health  Revised National Tuberculosis Control Programme (RNTCP)
Programmes in India-
Role of Nurse  National Leprosy Control Programme (NLEP)
 Integrated Disease Surveillance Programme (IDSP)
Non Communicable Diseases (NCD)
 National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke (NPCDCS)
 National Programme for the Control of Blindness (NPCB)
 National Mental Health Programme (NMHP)
 National Programme for the Healthcare of the Elderly (NPHCE)
 National Programme for the Prevention and Control of Deafness (NPPCD
 National Tobacco Control Programme (NTCP)
 National Oral Health Programme (NOHP)
 National Programme for Palliative Care (NPPC)
 National Programme for the Prevention and Management of Burn Injuries
(NPPMBI)
 National Programme for Prevention and Control of Fluorosis (NPPCF)

Check Your Progress 3

Q1) Explain Adolescent Health programme.

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Reducing Fertility Rate - family planning services - (FPS)

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Declining Sex Ratio:

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Q2) what are the ways and means of monitoring and evaluation of NHM
services
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Q3) Name three non communicable disease health programmes under

NHH
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 National Health Mission
1.9 LET US SUM UP
In this unit we have discussed The NHM envisages achievement of universal
access to equitable, affordable & quality health care services that are accountable
and responsive to people’s needs.

1.10 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1

1) The milestones of NHM

1992: Child Survival and Safe Motherhood programme (CSSM)

1997: RCH I : The programme was formally launched on 15th October 1997.
Phase 1 programme incorporated the 4 components-RCH package, Family
planning, Child survival and safe motherhood Client approach to health care,
Prevention and management of RTI/STDs/AIDS.

2005: RCH II : began from 1st April 2005,the focus is to reduce maternal and
child mortality and morbidity with emphasis on rural health care.

2005: National Rural Health Mission (NRHM) : The National Rural Health
Mission (NRHM) was launched by the Prime Minister on 12th April 2005, to
provide accessible, affordable and quality health care to the rural population,
especially the vulnerable groups.

2013: RMNCH +A strategy: India’s Reproductive, Maternal, Newborn, Child

and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a
milestone in the country’s health planning.

2014: India New-born Action plan (INAP): The India Newborn Action Plan
(INAP) is India’s committed response to the Global Every Newborn Action
Plan (ENAP), launched in June 2014 at the 67th World Health Assembly, to
advance the Global Strategy for Women s and Children’s Health.

2) Five guiding principles of NHM

1) Build an integrated network of all primary, secondary and a substantial

part of tertiary care, providing a continuum of care from community
level to the district hospital, with robust referral linkages to tertiary care
and a particular focus on strengthening the Primary Health Care System
including outreach services in both rural areas and urban slums.

2) Ensure coordinated inter-sectoral action

3) Ensure prioritization of services that address the health of women and

children and the prevention and control of communicable and non-
communicable diseases, including locally endemic diseases.

4) Ensure increased access and utilization of quality health services to

minimize disparity on account of gender, poverty, caste, other forms of
social exclusion and geographical barriers.

5) Incentivize good performance of both facilities and providers.

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National Health Check Your Progress 2
Programmes in India-
Role of Nurse Q1) Strategies are adopted to achieve the targets of NHM

1. Support and supplement state efforts to undertake sector wide health

system strengthening through the provision of financial and technical
assistance.
2. Build state, district and city capacity for decentralized outcome based
planning and implementation
3. Enable integrated facility development planning which would include
infrastructure human resources, drugs and supplies, quality assurance,
and effective Rogi Kalyan Samitis (RKS).
4. Create a District Level Knowledge Centre within each District
Hospital
5. Improve delivery of outreach services
6. Strengthen the sub-centre/Urban Primary Health Centre (UPHC) with
additional human resources and supplies
7. Prioritize achievement of universal coverage for Reproductive
Maternal, Newborn, Child Health + Adolescent (RMNCH+A),
National Communicable Disease Control and Non Communicable
Diseases programmes.
8. Expand focus from child survival to child development of all children
0-18 years through a mix of Community, Anganwadi, and School
based health services.
9. Achieve the goals of safe motherhood
10. Focus on adolescents and their health needs.
11. Ensure the control of communicable disease
12. Use primary health care delivery platforms to address the rising
burden of Non- Communicable Diseases
13. Converge with Ministry of Women & Child Development
14. Empower the ASHA to serve as a facilitator, mobilizer and provider of
community level care.
15. Strengthen people’s organizations such as the Village Health
Sanitation and Nutrition Committees (VHSNC) and Mahila Arogya
Samitis (MAS)
16. Create mechanisms to strengthen Behaviour Change Communication
17. Develop effective partnerships with private sector
18. Enhance use of Information & Communication Technology
19. Strengthen Health Management Information Systems
20. Ensure universal registration of births and deaths with adequate
information on cause of death

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 21. To ensure equitable health care and to bring about sharper National Health Mission
improvements in health outcomes
22. The government has already taken steps towards provision of free
maternal, and child health services, including newborn care,
immunization, adolescent health, and family planning.
23. Free diagnostic and treatment services
24. Focus on strengthening primary health care across the country.
Q2) The aims of reproductive and child health strategy
- To reduce maternal & child health mortality,
- To improve in access & utilisation of health care services by
vulnerable population
Q3) The components of NHM
The components under NHM are:
 Public health Planning & Financing.
 Human resource strengthening.
 Health System strengthening.
 RMACHTA services
 National disease control programmes (NDCP’S)
 Community Processes.
Check Your Progress 3
1) Adolescent Health programme.
i. Rashtriya Kishor Swasthya Karya Karam (RKSK)
adolescent friendly health services are provide in District
health facilities to provide counselling on:- sexual & reproductive
health substance abuse, Violence - domestic Violence, Mental health,
injury, NCD & provide iron & folic acid tablets, condoms, pregnancy
kits, OCP’S through counselor.
ii. Reducing Fertility Rate - family planning services - (FPS)
FPS are delivered at district; all PHC’s CHC’s & DH, provides both
temporary & permanent methods
iii. Declining Sex Ratio: Govt. implement the Pre-conception & Pre-natal
Diagnostic Techniques (PCPNDT) Act, 1994
2) The ways and means of monitoring and evaluation of NHM services
For monitoring and evaluation of NHM program several mechanisms were
adopted. The primary aim is to serve as a strong and harmonized M&E
component of the NHS, covering all major disease programmes as well as
health system actions through
• Use of data from large scale population surveys
• Commissioning implementation research or evaluation studies

29
National Health • Use of HMIS data and field appraisals and reviews
Programmes in India-
Role of Nurse • Health outcomes, output and process indicators

• Periodic Population Health Surveys and Demographic Information

• The Sample Registration Surveys (SRS)

• Death statistics

• National Sample Survey Organization (NSSO) data on cost of care and

morbidity, DLHS and NFHS.

3) Three non communicable disease health programmes under NHM

• National Programme for Prevention and Control of Cancer, Diabetes,

Cardiovascular Diseases and Stroke (NPCDCS)

• National Programme for the Control of Blindness (NPCB)

• National Mental Health Programme (NMHP)

1.11 REFERENCES
• K.Park; Text Book of Preventive and Social Medicine; Bhanot Banarsidas
Publishers, 22nd Edition 2009

• Keshav Swarnkar, Community Health Nursing; 2nd Edition, Nr Brothers

Publications

• K.K Gulani ‘Community Health Nursing’ Kumar Publishers 1st Edition

• AH Suryakantha, Community Medicine With Recent Advances, 2nd Edition,

New Delhi: Jaypee Publishers, 2010

• www.keralahealht/gov.in

• www.who.in

• http://www.urban.health.resource.centre.in/module

• NRHMbulletin.vol7(4)july-aug2012

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