National Health Mission

In May 2013, the UPA government had launched National Urban Health Mission, which was later integrated into National Rural Health Mission and a new National Health Mission was created from 2014-15. Both NUHM and NRHM are now two of six components of NHM. The six components of National Health Mission as follows:

1. National Rural Health Mission (now called NRHM-RCH Flexipool
2. National Urban Health Mission Flexipool for population above 50000
3. Flexible pool for Communicable disease
4. Flexible pool for Non communicable disease including Injury and Trauma
5. Infrastructure Maintenance
6. Family Welfare Central Sector component.

National Rural Health Mission

The major functions under this sub-mission is to provide Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) Services to the rural deprived people through its network of ASHA, ANMs and AWWs. NRHM, also called NRHM-RCH Flexipool is one of the components of NHM and is for all towns and villages below population of 50,000.

Under this mission, government seeks to provide accessible, affordable and quality healthcare to rural population. Thrust of this mission is to provide a fully functional, community owned, decentralised health delivery system in rural areas.

National Urban Health Mission

National Urban Health Mission (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.

Flexible Pool for Control of Communicable Diseases

Under National Health Mission, the Flexible Pool for Control of Communicable Diseases has been created to combine and integrate all the ongoing schemes related to communicable diseases. These include

• National Vector Borne Diseases Control Programme (NVBDCP): Covers Malaria, Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya.
• Revised National Tuberculosis Control Programme (RNTCP)
• National Leprosy Control Programme (NLEP)
• Integrated Disease Surveillance Programme (IDSP)

Flexible Pool for control of Non Communicable Diseases (NCD)

The Flexible Pool for Control of Non-communicable Diseases has been created to combine and integrate all the ongoing schemes related to non communicable diseases. These include:

• 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)

Broad Objectives of National Health Mission

National Health Mission is basically a conglomerate of all existing health schemes of the country. The broad measurable objectives of this mission in totality are as follows:

• Reducing MMR to 1/1000 live births
• Reducing IMR to 25/1000 live births
• Reducing TFR (Total Fertility Rate) to 2.1
• Prevention 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

Various Initiatives under National Health Mission

Accredited Social Health Activists (ASHA)

At present, there are around 8.96 lakh Accredited Social Health Activists in India to serve as facilitators, mobilizers and providers of community level care. An ASHA is the first port of call in the community especially for marginalized sections of the population, with a focus on women and children.

Rogi Kalyan Samiti

A Rogi Kalyan Samiti is a registered society whose members act as trustees to manage the affairs of the hospital and is responsible for upkeep of the facilities and ensure provision of better facilities to the patients in the hospital. The Government provides financial assistance to these committees. Currently, there are more than 30,000 Rogi Kalyan Samitis (RKS) in India.

Janani Suraksha Yojana

Janani Suraksha Yojana (JSY) was launched with objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. This scheme is currently being implemented in all states. Under the scheme, cash assistance is provided to eligible pregnant women for giving institutional birth in a Government health facility. Since the inception of NRHM, 7.33 crore women have been benefited under this scheme.

Janani Shishu Suraksha Karyakram (JSSK)

This scheme was launched in 2011 and entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery, including caesarean section. This scheme marks entitlement based approach in health schemes includes free drugs and consumables, free diagnostics, free diet during stay in the health institutions, free provision of blood, free transport from home to health institution, between health institutions in case of referrals and drop back home and exemption from all kinds of user charges. Similar entitlements are available for all sick infants (upto 1 year of age) accessing public health institutions. All states and union territories are implementing this scheme.

National Ambulance Services

This initiative includes ambulance services by dialling 108 or 102 telephone numbers. Dial 108 is a emergency response system to attend to patients of critical care, trauma and accident victims etc. Dial 102 services are for basic patient transport aimed to cater the needs of pregnant women and children though other categories are also taking benefit and are not excluded.

India Newborn Action Plan

The current NDA Government had launched India Newborn Action Plan (INAP) in September 2014 as a response to the Global Every Newborn Action Plan (ENAP), which was launched in June 2014 at 67th World Health Assembly.

This action plan focuses on preventable newborn deaths and stillbirths. The objective is to achieve Single Digit NMR by 2030 and Single Digit SBR by 2030. Implementation has to be done under RMNCH+A framework. {Details}

Rashtriya Bal Swasthya Karyakram (RBSK)

This initiative was launched in February, 2013 and provides for Child Health Screening and Early Intervention Services through early detection and management of the four Ds i.e Defects at birth, Diseases, Deficiencies, Development delays including disability.

Rashtriya Kishore Swasthya Karyakram

This initiative was launched in January, 2014 to reach out to 253 million adolescents with focus on the adolescent health programme beyond reproductive and sexual health and brings in focus on life skills, nutrition, injuries and violence (including gender based violence), non-communicable diseases, mental health and substance misuse.

Child Death Review

Child Death Review (CDR) is a strategy to understand the geographical variation in causes of child deaths and thereby initiating specific child health interventions. Analysis of child deaths provides information about the medical causes of death, helps to identify the gaps in health service delivery and social factors that contribute to child deaths. This information can be used to adopt corrective measures and fill the gaps in community and facility level service delivery. With uniform CDR process and formats across the states, information can be compared over a period of time and common factors identified and addressed through the national programme. This contributes to overall improvement in quality of care and reducing child mortality.