National health mission (NHM)

The National Health Mission (NHM) encompasses
its two Sub-Missions, the National Rural Health
Mission (NRHM) and the National Urban Health
Mission (NUHM). The main programmatic
components include Health system strengthening
in rural and urban areas, ReproductiveMaternal-Neonatal-Child and Adolescent Health
(RMNCH+A) and Communicable and NonCommunicable Diseases. The NHM envisages
achievement of universal access to equitable,
affordable & quality healthcare services that are
accountable and responsive to people’s needs.

1. Dr.Anjalatchi Muthukumaran Vice principal Era college of nursing UNIT-II NATIONA HEALTH MISSION (NHM)

2. Content to be discussed Abbreviation Terminology Introduction NHM component Goal Thurst area NRHM Guidelines NUHM guidelines Questions related to topic Summary Conclusion References

3. Abbreviation Program Implementation Plans (PIPs) National Health Mission (NHM) National Urban Health Mission (NUHM) National Rural Health Mission (NRHM)   Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A),

4. Terminology NHM: The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health system strengthening in rural and urban areas, National Rural Health Mission (NRHM): NRHM seeks to provide quality healthcare to the rural population, especially the vulnerable groups National Urban Health Mission (NUHM): 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.

5. NATIONAL HEALTH MISSION The National Health Mission (NHM) encompasses its two Sub-Missions,  The National Rural Health Mission (NRHM)  and  The National Urban Health Mission (NUHM) . The main programmatic components include Health System Strengthening, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases . The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. Continuation of the National Health Mission - with effect from 1st April 2017 to 31st March 2020 has been approved by Cabinet in its meeting dated 21.03.2018.

6. NHM components RMNCH+A Health systems strengthening Communicable diseases Non communicable diseases Health infrastructure maintenance

7. Six financing components: ( i ) NRHM-RCH Flexipool , (ii) NUHM Flexipool , (iii) Flexible pool for Communicable disease, (iv) Flexible pool for Non-communicable disease including Injury and Trauma, (v) Infrastructure Maintenance and (vi) Family Welfare Central Sector component.

8. National parameter and priorities Within the broad national parameters and priorities, states would have the flexibility to plan and implement state specific action plans. The state PIP would spell out the key strategies, activities undertaken, budgetary requirements and key health outputs and outcomes. The State PIPs would be an aggregate of the district/city health action plans, and include activities to be carried out at the state level.

9. Advantages of PIP The state PIP will also include all the individual district/city plans. This has several advantages: one, -it will strengthen local planning at the district/city level, two,- it would ensure approval of adequate resources for high priority district action plans, and three,- enable communication of approvals to the districts at the same time as to the state.

10. Fund &technical support The fund flow from the Central Government to the states/UTs would be as per the procedure prescribed by the Government of India. The State PIP is approved by the Union Secretary of Health & Family Welfare as Chairman of the EPC, based on appraisal by the National Program Coordination Committee (NPCC), which is chaired by the Mission Director and includes representatives of the state, technical and program divisions of the MoHFW , national technical assistance agencies providing support to the respective states, other departments of the MoHFW and other Ministries as appropriate.

11. Forward Linkages Scheme to NRHM in NE :  With a view to complement & supplement the initiatives under the NRHM for improving the Secondary/Tertiary level and Other health infrastructure in the north eastern region, the Forward Linkage Scheme to NRHM was introduced in the 11th Plan (to be financed form likely saving from other Health schemes). This scheme was also continued in the 12th Plan. The project proposals sent by the NE States are appraised and for the approved projects, funds are released by the Ministry.  Presently the Scheme has been approved by the Government for implementation upto the current Financial Year i.e. 2018-19 for Ongoing projects only. The Forward Linkages Scheme was earlier a 100% Central Sector Scheme. However, the Government has recently revised the sharing pattern of the Scheme to 90:10 ratio between the centre and State during the current year.

12. Goals : Outcomes for NHM in the 12th Plan are synonymous with those of the 11th Plan and are part of the overall vision. Specific goals for the states will be based on existing levels, capacity, and context. State specific innovations would be encouraged. Process and outcome indicators will be developed to reflect equity, quality, efficiency, and responsiveness . Targets for communicable and non-communicable diseases will be set at state level based on local epidemiological patterns and taking into account the financing available for each of these conditions.

13. Continued The endeavor would be to ensure the achievement of indicators in Box 1 as follows : 1. Reduce MMR to 1/1000 live births 2. Reduce IMR to 25/1000 live births 3. Reduce TFR to 2.1 4. Prevention and reduction of anaemia in women aged 15–49 years 5. Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases

14. Continued 6. Reduce household out-of-pocket expenditure on total health care expenditure 7. Reduce annual incidence and mortality from Tuberculosis by half 8. Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts 9. Annual Malaria Incidence to be <1/1000 10. Less than 1 percent microfilaria prevalence in all districts 11. Kala- azar Elimination by 2015, <1 case per 10000 population in all blocks

15. NRHM The National Rural Health Mission (NRHM) was launched by the Hon’ble Prime Minister on 12th April 2005. The Union Cabinet vide its decision dated 1st May 2013, has approved the launch of National Urban Health Mission (NUHM) as a Sub-mission of an over-arching National Health Mission (NHM), with National Rural Health Mission (NRHM) being the other Sub-mission of National Health Mission.

16. INDIAN PUBLIC HEALTH STANDARDS National Rural Health Mission (NHM) was launched in the year 2005 to strengthen the Rural Public Health System and has since met many hopes and expectations. The Mission seeks to provide effective health care to the rural populace throughout the country with special focus on the States and Union Territories (UTs), which have weak public health indicators and/or weak infrastructure. Towards this end, the Indian Public Health Standards (IPHS) for Sub- centres , Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub-District and District Hospitals were published in January/ February, 2007 and have been used as the reference point for public health care infrastructure planning and up-gradation in the States and UTs . IPHS are a set of uniform standards envisaged to improve the quality of health care delivery in the country. The IPHS documents have been revised keeping in view the changing protocols of the existing programmes and introduction of new programmes especially for Non-Communicable Diseases. Flexibility is allowed to suit the diverse needs of the States and regions. These IPHS guidelines will act as the main driver for continuous improvement in quality and serve as the bench mark for assessing the functional status of health facilities. States and UTs should adopt these IPHS guidelines for strengthening the Public Health Care Institutions and put in their best efforts to achieve high quality of health care across the country.

17. Guidelines strengthening the Public Health Care Institutions and put in their best efforts to achieve high quality of health care across the country . IPHS Revised Guidelines 2012   IPHS Facility Survey Formats

18. Goal of NRHM T o provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups.

19. Thrust Area of NRHM The thrust of the mission is on establishing a fully functional, community-owned , decentralized health delivery system with inter- sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health 20 point program such as water, sanitation, education, nutrition, social and gender equality. Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, measured against Indian Public Health Standards for all health facilities.

20. Executive Summary The National Rural Health Mission (NRHM) was launched by the Hon’ble Prime Minister to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The key features in order to achieve the goals of the Mission include making the public health delivery system fully functional and accountable to the community, human resources management, community involvement, decentralization , rigorous monitoring & evaluation against standards, the convergence of health and related program from village level upwards, innovations and flexible financing and also interventions for improving the health indicators.

21. INSTITUTIONAL SETUP UNDER NRHM At the National level, the NHM has a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Program Committee (EPC) headed by the Union Secretary for Health & FW. The EPC will implement the Mission under the overall guidance of the MSG.

22. NHM Criteria for state awards pdf- NRHM_Criteria_Awards_Final.doc

23. Institutional setup under NRHM Composition of SHM & SHS Composition of DHM & DHS

24. NATIONAL URBAN HEALTH MISSION The National Urban Health Mission (NUHM) as a sub-mission of National Health Mission (NHM) has been approved by the Cabinet on 1st May 2013 . NUHM envisages to meet health care needs of the urban population with the focus on urban poor, by making available to them essential primary health care services and reducing their out of pocket expenses for treatment. This will be achieved by strengthening the existing health care service delivery system, targeting the people living in slums and converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education, etc. implemented by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development and Women & Child Development.

25. Content to be discussed National Urban Health Mission Gazette Notification on NUHM Brochure on thematic areas under NUHM Manuals/ Registers NUHM Guidelines Community Processes under NUHM NUHM Contact

26. Goals : i )  Need based city specific urban health care system to meet the diverse health care needs of the urban poor and other vulnerable sections. ii)  Institutional mechanism and management systems to meet the health-related challenges of a rapidly growing urban population. iii)  Partnership with community and local bodies for a more proactive involvement in planning, implementation, and monitoring of health activities. iv)  Availability of resources for providing essential primary health care to urban poor. v)  Partnerships with NGOs, for profit and not for profit health service providers and other stakeholders.

27. GAZETTE NOTIFICATION ON NUHM Gazette Notification on NUHM    (3.49 MB)

28. BROCHURE ON THEMATIC AREAS UNDER NUHM Title Download Inter Sectoral Convergence under NUHM    (2.65 MB ) Strengthening Human Resources for Health Under NUHM     (3.50 MB ) Quality Assurance     (655 KB ) NUHM and Medical Colleges -Collaboration to Strengthen    (2.10 MB) IEC/BCC under NUHM    (505 KB ) Community Process Under NUHM    (665 KB ) NUHM Thrust Areas for States    (125 KB)

29. MANUALS/ REGISTERS Orientation Module for Planners, Implementers and Partners  (1.67 KB ) Presentations for Orientation module for planners, implementers and partners  (4.02 KB ) Technical Resource Group (TRG) on NUHM  (15.1 KB)   NUHM Brand Mannual   (66 MB)  

30. Format of Registers for UPHC DO letter for registers at UPHC   (255 KB ) General Registers   (95 KB ) RCH Register Cover and Profile pages   (310 KB) RCH Register Section-1    (3.85 MB ) RCH Register Section-II  (6.30 MB ) RCH Register Section-III  (61.90 MB ) RCH Register Section-IV back cover  (375 KB)

31. NUHM GUIDELINES Program Safeguard Systems Assessment under the proposed ADB project "Strengthening CPHC in Urban Areas" under PM-ASBY    (560 KB ) Operational Guidelines Extension of Swachh Swasth Sarvatra for Urban Areas    (713 KB ) Framework on Convergence   (7.86 MB ) NUHM Innovation Framework   (1006 KB ) Extension of Kayakalp Guidelines in urban areas    (1.50 MB ) Guidebook for Enhancing the Performance of ANM in urban areas    (810 KB ) Capacity Building Framework for Strengthening Implementation of NUHM    (615 KB)

32. Continued Guidelines & Tools for Vulnerability Mapping and Assessment for Urban Health    (1.35 MB ) NUHM Financial Management Guidelines    (2.00 MB ) Model RFP and SLA to Maintain and Operate UPHC    (200 KB ) Guidelines for Quality Standards UPHC under NUHM    (3.15 MB ) Operational Guidelines for Conducting Outreach Session in Urban Areas    (3.75 MB ) NUHM PIP Guidelines for F.Y. 2016-17    (705 KB ) NUHM PIP Guidelines for F.Y. 2013-14     (244 KB ) Guidelines for Community Process    (2.02 MB)

33. COMMUNITY PROCESSES UNDER NUHM Community Processes under NUHM ASHA/ Mahila Arogya Samiti Training Module

34. Importance of NUHM NUHM would cover all State capitals, district headquarters and cities/towns with a population of more than 50000 . It would primarily focus on slum dwellers and other marginalized groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, construction site workers. The centre-state funding pattern will be 75:25 for all the States except North-Eastern states including Sikkim and other special category states of Jammu & Kashmir, Himachal Pradesh and Uttarakhand , for whom the centre-state funding pattern will be 90:10 . The Program Implementation Plans (PIPs) sent by the by the states are apprised and approved by the Ministry.

35. Executive Summary In order to effectively address the health concerns of the urban poor population, the Ministry proposes to launch a new sub-mission National Urban Health Mission (NUHM). The Mission Steering Group of the NHM will be expanded to work as the apex body for NUHM also. Every Municipal Corporation, Municipality, Notified Area Committee, and Town Panchayat will become a unit of planning with its own approved broad norms for setting up of health facilities. The separate plans for Notified Area Committees, Town Panchayats and Municipalities will be part of the District Health Action Plan drawn up for sub-mission NUHM . The Municipal Corporations will have a separate plan of action as per broad norms for urban areas. The existing structures and mechanisms of governance under NHM will be suitably adapted to fulfill the needs of sub-mission NUHM also.

36. Short answer questions(SAQ) Define NHM? Describe the meaning of NRHM? Describe the meaning of NUHM? What are the components of NHM? Enlist the goal of NRHM? List the six financing components ? enlist the format to be used NUHM?

37. Long answer questions(LAQ) Discuss about NRHM in detail? Describe the NUHM in detail? Explain the NHM and its components ?

38. Summary In order to ensure that enhanced fund allocations to States/UTs and other institutions under the NHM are fully coordinated, managed and utilized, Financial Management Group for NHM (FMG-NHM) has been set up at the State level

39. Conclusion

40. Guidelines National Rural Health Mission Institutional setup under NRHM NRHM - Criteria for Assessment   [70 KB] Indian Public Health Standards View More :  NRHM Framework for Implementation(2005-2012 ) View More:  For More Information on NHM View More:  NHM Framework for Implementation(2012-2017 ) View More:   NUHM Framework for Implementation