National Rural Health Mission: Goals, objectives and achievements

Temjenkaba IA, Medziphema [dropcap]S[/dropcap]ince the launch of the National Rural Health Mission (NRHM) in Nagaland in February 2006, now change the name which is known as National health Mission the state has shown significant improvement in health care delivery both in terms of physical infrastructure and service delivery output. NRHM was launched throughout India on April 12th, 2005 with the aim to provide accessible, affordable and quality health care to the rural population, especially the vulnerable sections. Reducing Maternal Mortality, Infant Mortality and Total Fertility Rates is one top priority under NRHM. The main objective is to Reduction in child and maternal mortality, Universal access to public services for food and nutrition, sanitation and hygiene and universal access to public health care services with emphasis on services addressing women’s and children’s health and universal immunization, Prevention and control of communicable and non-communicable diseases, including locally endemic disease Access to integrated comprehensive primary health care, Population stabilization gender and demographic balance, Revitalize local health traditions and mainstream AYUSH and Promotion of healthy life styles.Under the Nagaland Communalization of Public Institutions and Services Act 2002, all villages in the state had formed Village Health Committees (VHCs). VHCs play an important role in improving the health care system of the village. NRHM seeks to allocate funds, functions and functionaries to local communities and have decentralized planning by empowering Health Centre Management Committees and Hospital Management Committees at the local level. NRHM visualizes a sustained process of capacity development of management of the program through National Health System Resource Centre (NHSRC) and State Health Research Centers (SHRCs). Besides these institutional arrangements district and block level health management systems are being set up, so that program management is more responsive to local management needs and challenges. Facility surveys will setup the benchmarks for the purpose of monitoring achievements of standards. Also, additional preparation of the annual reports by independent agencies will help in publishing these reports at Block, District and State level. Innovation in human resource management is one of the major challenges in making health services effectively available to the rural poor involves innovations in human resources management. NRHM proposes to ensure availability of locally resident health workers, contractual positions, multi-skilling, and integration with AYUSH etc. so as to optimally use human resources. The Accredited Social Health Activist or ASHA are not appointed but are selected by the community or the people themselves. They are not salaried employees, but performance based incentive is given to them. An ASHA must be a primary resident of the village with formal education up to class VIII and preferably in the age group 25-45 years. ASHAs would reinforce community action for universal immunization, safe delivery, newborn care, nutrition, sanitation and prevention of water borne and other communicable diseases. She will also help the villagers promote preventive health by converging activities of nutrition, education, drinking water, sanitation etc and also play a vital role during Village Health & Nutrition Day. Till date 1854 ASHAs have been selected in the State JANANI SURAKSHA YOJANA (JSY) is a safe motherhood intervention under NRHM to reduce maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. JSY is a 100% centrally sponsored scheme and it integrates cash assistance with ante-natal care, delivery and post-natal care. Under JSY, ASHAs receives an incentive of Rs.600 /- for identifying pregnant mothers, bringing them for registrations, ANC and PNC. The mother, who prefers institutional delivery at Urban areas gets Rs.600/- and in rural areas gets Rs.700/- per delivery.The Janani-Shishu Suraksha Karyakram (JSSK), is a National Healthcare initiative launched by the Ministry of Health and Family Welfare, Government of India which places emphasis and elimination of out-of pocket expenses for both pregnant women and sick neonates (up to 30 days after birth) in all Government Health Institutions, both in Rural and Urban areas. Under this initiative, entitlements for pregnant women and sick neonates up to 30 days of birth, would include drugs and consumables,diagnostics, blood (wherever required), diet (during stay at the facility) and referral transport from home to facility, facility to home and between facilities (when required). It will also cover a complete set of quality services desired at the health facilities which includes quality antenatal, intra-natal and post natal services for mothers. In Nagaland JSSK was launched on the 4th of August 2012. Since the launching of NRHM in Nagaland, the State has appointed 969 personnel on contract basis, to fill in critical gaps in health units all over the State (fig. as on Sept. 2013). This includes 9 Specialist, 60 General Duty Medical Officer, 24 Dental Doctors, 47 AYUSH Doctors, 10 Public Health Nurse, 263 Staff Nurses, 333 Second ANMs, 11 District Programme Managers, 11 Media Officers, 11 Data entry Operators and 11 Accountants, 56 Block Programme Manager, 56 Block Accounts Manager and 66 Paramedical Staff. Regular monitoring and timely review of different programmed under NRHM is being carried out. The purpose of regular supervisory visits by the State Programme Officers, DPMs and Nodal officer in charge of the Districts is to assess the performance of the health units and the personnel involved and also to monitor the activities being carried out. NRHM provides untied funds to meet any emergency purpose such as purchase of life-saving drugs, equipment and for other health-related activities. Untied Funds may be used for minor modifications to sub center which can be done at the local level, transport of emergencies to appropriate referral centers, transport of samples during epidemics, payment/reward to ASHA for certain identified activities etc. Maintenance fund is given by the Mission to the DH, CHCs and PHCs for basic maintenance of the health units such as repair and placement of doors, windows, floor, electrification etc. Rogi Kalyan Samiti/Hospital Management Society are a simple yet effective management structure. This committee, a registered society, acts as a group of trustees for the management of Hospitals and Health Centers. It consists of members from NGOs, local elected representatives and officials from the Government sector. NRHM provides RKS funds to various health units for urgent and immediate requirements needed by the health units such as equipment, life-saving drugs, furniture, encouraging community participation in the maintenance and upkeep of the hospital etc. The equitable distribution of health services and access to health services is the right of every individual. Keeping in mind the topography and difficult terrain of Nagaland, the State has already initiated 11 Mobile Medical Units for each district in the state. The following services are provided through the MMUs: • Regular visit to villages through the active participation of Village Health Committees and Community Based Organisations. • To improve health seeking behavior and early health care. • Ante Natal Care, general health checks up with basic investigative facilities, immunization, health education and treatment and referral facilities. Till date, 66 ambulances have been launched in the State for easier access to Health Care by the people at the grass roots. During the current FY, all pregnant women opting for institutional delivery and sick infants requiring hospitalization are getting referral transport assistance of Rs. 500.00 each. Also these ambulances are being fitted with GPS tracking device for effective fleet management. The State Government has undertaken major initiatives in the Public Private Partnerships to tap the much needed resources and technical assistance to ensure adequate health services are available, accessible, affordable and acceptable to all at the right time and right place. Several significant projects have been undertaken under the PPP venture by the state, which are as follows: (a) The setting up of the North East Regional Paramedical Institute at Dimapur wherein the MoU was jointly signed on 22nd September 2010 between the Ministry of DoNER, Government of India and the Nagaland Government and the Christian Institute of Health Sciences and Research (CIHSR) in the presence of the Union Minister of DoNER and Mines, B.K. Handique. (b) Under the CIHSR tripartite Memorandum of Association (MoA), i. CHC Dhansaripar was adopted by CIHSR • For innovative community health programmes • Conducting periodic training programmers to all categories of the staff. • To improve the quality of data collection and its utilization for effective management. • To conduct health education in schools and community. • To assist in the implementation of all the National health programmes. • To use the Health Centre as centre for field work for various training programmed of the CIHSR. (i) To augment the training programmes, the CIHSR Dimapur has been designated as a Training Centre. (ii) Partnership with the Medicines Sans Frontiers (MSF) on the other hand for collaboration to improve access and provision of quality health care services in Mon District through the District Hospital. The MoU was signed between the two on 21st July 2010.The partnership is managed through a Governing Council at the State level and a Hospital Management Committee at the district level in line with the provisions of the Communitisation of Public Institutions and services Act 2002. RHM envisions holding of Village Health and Nutrition Days (VH&NDs) every month in a village so as to provide Health Care Services to the doorstep of the people and also an effective platform for first contact primary health care in the rural areas. Anganwadi centers located at the respective villages have been identified for holding VH&NDs. The main activities carried out on this day are imparting education to the community on various health issues and a host of Health services provided under the Department of Health & Family Welfare (ANC checkups, registration of pregnant women immunization activities etc). Needy patients are also provided along with referral services. Construction and up gradation of Infrastructure taken up for district hospitals, CHCs, PHCs and sub-Centers in all the Districts since the inception of the programmed at the State ,Strengthening of three existing Nursing Schools and construction of one New Nursing School in Dimapur. New Born Care Corners established in 120 Health Units (all delivery points), 16 New Born Stabilisation Units and 1 Sick Newborn Care Unit established. So far since 2006 given below are some of the contributions of NRHM through civil works … • Construction of New District Hospital – 2 • Construction of New Community Health Centre (CHC) – 8 • Construction of New Primary Health Centre (PHC) – 19 • Construction of New Sub Centre – 135 • Construction of New Staff Quarter under CHC – 19. • Construction of New Staff Quarter under PHC – 30 • Construction of New Nursing School – 3. • Construction of New Drug Ware House – 9 • Construction of State Institute of Health & Family Welfare (SIHFW) – 1. • Up-gradation of Nursing School – 2 • Up-gradation of Nursing School – 2 (Source: National Health Mission, a DIPR feature)