National Health Rural Mission

Contains about NHM and NRHM

1. NATIONAL RURAL HEALTH MISSION Presented by- Dr.Payal Dash Post Graduate Trainee

2. CONTENTS B ackground and History Terminologies NRHM- Why NRHM? Illustrative Structure G oals and Objectives Strategies- Core and Supplimentary Approaches Outcomes Critical Areas for Concerted Action Finances Health Monitoring and Planning Committee under NRHM PHC level Block level State level District level Concrete Service Guarantees Coverage

3. CONTENTS Communisation- VILLAGE HEALTH SANITATION & NUTRITION COMMITTEE ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA) VILLAGE HEALTH NUTRITION DAY ROGI KALYAN SAMITIES Components Of NHM- RMNCH+A Health Systems Strengthening Non-Communicable Disease Control Programmes Communicable Disease Control Programme Infrastructure Maintenance NHUM Summary Conclusion References PART 2

4. BACKGROUND Adopted in 2000 3 out of 8 related to Health MDG 4-: Reduce child mortality MDG 5-Improve maternal health MDG 6- Combat HIV/AIDS, malaria and other diseases MILLENIUM DEVELOPMENT GOALS NRHM (NHM) Goals are largely aligned to the acheivement of MDGs.

5. BACKGROUND- NATIONAL HEALTH MISSION 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.

6. The National Rural Health Mission (NRHM), now under National Health Mission Launched - 12 April 2005 by Manmohan Singh To address the health needs of 18 states - Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh , referred to as the Empowered Action Group (EAG) states HISTORY

7. As per the 12th Plan (2012-2017) document of the Planning Commission, the flagship programme of NRHM will be strengthened under the umbrella of National Health Mission. The focus to include non-communicable diseases and expanding health coverage to urban areas. L aunched by the government of India in 2013 subsuming the NRHM and NHUM F urther extended in March 2018 , to continue until March 2020 .

8. TERMINOLOGIES Infant mortality rate : Infant mortality rate is the ratio of deaths under 1 year of age in a given year to the total number of live births in the same year usually expressed as a rate per 1000 live births . universally accepted indicators of health status for whole population Maternal (puerperal) mortality rate : greatest proportion of deaths among women of reproductive age in most of the developing world. number of maternal deaths during a given time period per 100,000 live births during the same time period

9. NATIONAL RURAL HEALTH MISSION LAUNCHED- 5th April, 2005 for a period of 7 years (2005-2012) and recently extended upto year 2017. adopts a synergic approach by relating health to determinants of good health viz.of nutrition, sanitation , hygiene and safe drinking water. It also brings the Indian system of medicine (AYUSH) to mainstream.

10. NRHM-Illustrative Structure

11. STATE HEALTH MISSION STATE HEALTH SOCIETY Chairperson Chief Minister Chief Secretary/Development Commissioner Co-Chairperson Minister of Health and Family Welfare, State Government Development Commissioner Convener Principal Secretary/Secretary (Family Welfare) Officer designated as Mission Director of State Health Mission Frequency of Meetings At least once in every six months At least once in every six month Ordinary Business Providing health system oversight, consideration of policy matters related with health sector (including determinants of good health), review of progress in implementation of NHM; inter-sectoral coordination, advocacy measures required to promote NHM visibility. Approval / endorsement of Annual State Action Plan for the NHM. Consideration of proposals for institutional reforms in the H&FW sector. Review of implementation of the Annual Action Plan. Inter-sectoral co-ordination: all NHM related sectors and beyond (e.g. administrative reforms across the State). Status of follow up action on decisions of the State Health Mission. Co-ordination with NGOs/Donors/other agencies/organisations.

12. DISTICT HEALTH MISSION DISTRICT HEALTH SOCIETY Chairperson Chairman, Zilla Parishad District Collector/DM/CEO Zilla Parishad Co-Chairperson District Collector/DM CEO, Zilla Parishad Convener Chief Medical Officer/CDMO/CMHO/Civil Surgeon Chief Medical Officer/CDMO/Civil Surgeon Members MPs, MLAs, MLCs from the district, Chair-persons of the Standing Committees of the Zilla Parishad, Project Officer (DRDA), Chair-persons of the Panchayat Samitis and Hospital Management Societies, District Programme Managers for health, PHED, ICDS, AYUSH, education, social welfare, Panchayati Raj, State representative, representatives of MNGO/SNGO, etc. Project Officer (DRDA), District Programme Managers for Health, AYUSH, Water and Sanitation [under Total Sanitation Campaign (TSC)], DPMSU, PHED, ICDS, education, social welfare, Panchayati Raj, a State representative, Sub-Divisional Officer, CHC In-charge; representatives of Medical Association/MNGO/SNGO and Development Partners

13. AIMS & OBJECTIVES Reduction in child and maternal mortality Universal access to food and nutrition, sanitation , hygiene and public health care services Prevention and control of communicable and non-communicable diseases ,endemic disease Access to integrated comprehensive primary health care. Population stabilization, gender and demographic balance. Revitalize local health traditions & mainstream AYUSH. Promotion of healthy life styles. to provide accessible, affordable, accountable, effective and reliable primary health care, and bridging the gap in rural health care through creation of a cadre of Accredited Social Health Activist (ASHA).

14. APPROACHES OF NRHM Communitize Innovation in Human Resource Management Improved management through capacity Flexible Financing Monitor,Progress against standards

15. SUPPLIMENTARY STRATEGIES

16. INITIATIVES UNDER NRHM

17. New Initiatives under NRHM 1. Home delivery of contraceptives (condoms, oral contraceptive pills, emergency contraceptive pills) by ASHA SCHEME:- I mplemented across all districts of the country. ASHA would do home delivery of the contraceptives at the doorstep The free supply of contraceptives at PHC and Sub-Centre level would stand withdrawn The free supply of contraceptives at CHCs, Sub-Divisional and District level hospitals shall continue as before. State - 25% and District -10% of the total stock of contraceptives as buffer ASHA shall collect the consignment/ replenish her stock every month No transport cost “Government of India supply,” “For home delivery by ASHA,” “Re 1/- for a pack of 3 condoms” “Re 1/- for a cycle of OCP” “Re 2/- for a pack of one tablet of ECP”

18. STATE: D esignate a nodal person to manage and monitor the scheme. O rient the CMOs of the districts CMOs of the pilot districts would further orient MOs Develop c ommunication material ( banners, posters and leaflets etc. ) PHC I/C /ANM : MO I/C of PHC : Certify ANMs, list of eligible couples and make corrections, if necessary. Ensure all ASHAs collect supply from designated place. Verify ASHAs’ performance on a monthly basis. Screen the couples for eligibility for OCPs ASHA would: Inform / counsel all the eligible couples in her area regarding availability of variou s contraceptive choices. Get the clients screened by the MO/ ANM before selling OCPs to them. Prepare and update list of eligible couples in her village and d eliver contraceptives at door step of the beneficiaries. Regularly collect stock from Block/ CHC/ PH C and c harge the beneficiary at the approved rate, as an incentive for her efforts.

19. 2. Conducting District Level Household Survey SCHEME:- initiated in 1997 DLHS-1 - 1998-99 and DLHS-2 in 2002-04.

20. Health Monitoring and Planning Committee under NRHM PHC level Block level State level District level

21. PHC Health Monitoring and Planning Committee Role and Responsibilities of the Committee Consolidation of the village health plans and charting out the annual health action plan in order of priority. Presentation of the progress made at the village level, achievements, actions taken and difficulties faced followed by discussion

22. access to health facilities in the area of that particular PHC. The discussion could include: o Sharing of reports of Village Health Committees o Reports from ANM about the coverage of health facilities o Any efforts done at the village level to improve the access to health care services o Record and analysis of neonatal and maternal deaths. o Any epidemic occurring in the area and preventive actions taken.

23. Block Health Monitoring and Planning Committee Role and Responsibilities: Consolidation of the PHC level health plans and charting out of the annual health action plan for the block. Review of the progress made at the PHC levels, difficulties faced, actions taken and achievements made, followed by discussion Analysis of records on neonatal and maternal deaths; and the status of other indicators . Monitoring of the physical resources Coordinate with local CBOs and NGOs to improve the health services in the block

24. District Health Monitoring and Planning Committee Role and Responsibility • Discussion on the reports of the PHC health committees • Financial reporting and solving blockages in flow of resources if any • Infrastructure, medicine and health personnel related information and necessary steps required to correct the discrepancies. Progress report of the PHCs emphasising the information on referrals utilisation of the services, quality of care etc. Contribute to development of the District Health Plan Ensuring proper functioning of the Hospital Management Committees.

25. State Health Monitoring and Planning Committee Role and Responsibilities T o discuss the programmatic and policy issues related to access to health care and to suggest necessary changes. This committee will review and contribute to the development of the State health plan . Key issues arising from various District health committees . Institute a health rights redressal mechanism Operationalising and assessing the progress made in implementing the recommendations of the NHRC .

26. Concrete Service Guarantees that NRHM will provide: Skilled attendance at all Births Emergency Obstetric care Basic neonatal care for new born Full coverage of services related to childhood diseases / health conditions Full coverage of services related to maternal diseases / health conditions Full coverage of services related to low vision and blindness due to refractive errors and cataract. Full coverage for curative and restorative services related to leprosy Full coverage of diagnostic and treatment services for tuberculosis Full coverage of preventive, diagnostic and treatment services for vector borne diseases

27. Coverage The Mission has the following coverage: Population coverage - 740 million Households - 148 million (approx.) Birth Rate in Rural Areas - 26.6, nearly 20 million births Sub Health Centres - 1,75,000 ( on population, distance and work load norm) P H Cs - 27,000 (single MO, 2 MO, 1 AYUSH) C H Cs - 7,000 (every Block) Sub Divisional/Taluk Hospitals - 1,800 District Hospital - 600 ANMs - 3.50 lakhs Staff Nurses at PHC - 81,000

28. FINANCE P ublic health expenditure -1 % of the GDP The above target however cannot be achieved unless the states also step up major burden of the additional expenditure - Central Government It would be the aim of the NRHM to increase the share of central and State Governments on health care from the current 20 – 80 to 40 – 60 sharing in the long run. X Plan-100 % to states XI Plan- Central-85% States -15% XII Plan-Central -75% States -25%

29. Financial Resource Assessment -by National Commission on Macro Economics and Health Non-recurring investment of Rs. 33811 crores Recurring investment of Rs. 41006 crores 5-7 Years

30. COMPONENTS OF NHM 1. Reproductive, Maternal, Newborn, Child and Adolescent Health Ministry of Health & Family Welfare launched (RMNCH+A) to influence the key interventions for reducing maternal and child morbidity and mortality.

31. Rashtriya Kishor Swasthya Karyakram (RKSK) In order to ensure holistic development of adolescent population, the Ministry of Health and Family Welfare launched Rashtriya Kishor Swasthya Karyakram (RKSK) on 7th January 2014 to reach out to 253 million adolescents - male and female, rural and urban, married and unmarried, in and out-of-school adolescents with special focus on marginalized and undeserved groups .

32. ADOLESCENT FRIENDLY HEALTH CLINICS (AFHCS) This approach was initiated in 2006 The key ‘friendly’ component of AFHC mandates facility-based clinical and counselling services for adolescents, which are: Equitable —services are provided to all adolescents who need them. Accessible —ready accessibility to AFHCs by adolescents Acceptable —health providers meet the expectation of adolescents who use the services. Appropriate —the required care is provided and any unnecessary and harmful practices are avoided. Effective —healthcare produces positive change in the status of the adolescents; services are efficient and have high quality.

33. WEEKLY IRON FOLIC ACID SUPPLEMENTATION (WIFS) i. Objective To reduce the prevalence and severity of anaemia in adolescent population (10-19 years). ii. T arget groups School going adolescent girls and boys in 6th to 12th class enrolled in government/government aided/municipal schools. Out of school adolescent girls. iii. Intervention Administration of supervised Weekly Iron-folic Acid Supplements of 100mg elemental iron and 500ug Folic acid using a fixed day approach. Screening of target groups for moderate/severe anaemia and referring these cases to an appropriate health facility. Biannual de-worming (Albendazole 400mg), six months apart, for control of helminthic infestation. Information and counselling for improving dietary intake and for taking actions for prevention of intestinal worm infestation. iv. Current Status: The programme has been rolled out in all States/UTs. The programme covers 11.2 crore beneficiaries including 8.4 crore in-school and 2.8 crore out of school beneficiaries.

34. MENSTRUAL HYGIENE SCHEME The major objectives of the scheme are: To increase awareness among adolescent girls on Menstrual Hygiene To increase access to and use of high quality sanitary napkins to adolescent girls in rural areas. To ensure safe disposal of Sanitary Napkins in an environmentally friendly manner. 2011 - 107 selected districts in 17 States wherein a pack of six sanitary napkins called “Freedays” was provided to rural adolescent girls for Rs. 6. 2014 onwards, funds are now being provided to States/UTs under National Health Mission for decentralized procurement of sanitary napkins packs for provision to rural adolescent girls at a subsidized rate of Rs 6 for a pack of 6 napkins. The ASHA will continue to be responsible for distribution, receiving an incentive @ Rs 1 per pack sold and a free pack of napkins every month for her own personal use. IEC material has been developed around MHS, using a 360 degree approach

35. CHILD HEALTH:- 1.NATIONAL DEWORMING DAY

36. 2.R ASHTRIYA BAL SWASTHYA KARYAKRAM(RBSK) According to March of Dimes (2006), out of every 100 babies born in this country annually, 6 to 7 have a birth defect. This would translate to around 17 lakhs birth defects annually in the country and accounts for 9.6% of all the newborn deaths cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability.

37. JANANI SURAKSHA YOJANA Janani Suraksha Yojana (JSY) is a safe motherhood intervention objective - reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. L aunched on 12th April 2005, JSY is a 100 % centrally sponsored scheme and it integrates cash assistancewith delivery and post-delivery care.

38. DAKSHATA IMPLEMENTATION PROGRAM

39. PRADHAN MANTRI SURAKSHIT MATRITVA ABHIYAN Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched to provide fixed-day assured, comprehensive and quality antenatal care universally to all pregnant women (in 2nd and 3rd trimester) on the 9th of every month.

40. 1. Outline the implementation approach for operationalizing PMSMA. 2. Outline the contours for private sector engagement for PMSMA

41. LABOUR ROOM & QUALITY IMPROVEMENT INITIATIVE LaQshyaon 11th December 2017 with following objectives: Reduce maternal and newborn morbidity and mortality Improve quality of care during delivery and immediate post-partum period Enhance satisfaction of beneficiaries, positive birthing experience and provide Respectful Maternity Care (RMC) to all pregnant women attending public health facilities. . Following facilities are being taken under LaQshya initiative on priority: All Government Medical College hospitals. All District Hospitals & equivalent healthy facilities. All designated high case load CHCs with over 100 deliveries/60 (per month) in hills and desert areas.

42. 2. HEALTH SYSTEMS STRENGTHENING A. Adoption of the Indian Public Health Standards minimum inputs required to ensure quality of care, in terms of infrastructure, equipment, skilled human resources, and supplies. A ssurance to the states of financing the gaps between available levels of these inputs and the levels needed to achieve the IPHS norms. B. Quality standards clinical protocols, administrative and management processes and for support services.

43. C. Skill gaps and Standard Treatment Protocols - Skilled Birth Attendance (SBA) "an accredited health professional - such as midwife, doctor or nurse - who has been educated and trained to achieve proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and immediate postnatal period and in the identification, management and referral of complications in women and newborns." Navjat Shishu Suraksha Karyakram (NSSK) Training Program To reduce perinatal asphyxia (1/5th of all neonatal deaths)

44. IMNCI packages for ANMs - Implementation of Integrated Management of Neonatal and Childhood Illness Keeping the child warm. o Initiation of breastfeeding immediately after birth and counseling for exclusive breastfeeding and non-use of pre lacteal feeds. o Cord, skin and eye care. o Recognition of illness in newborn and management and/or referral). o Immunization o Home visits in the postnatal period Care of Newborns and Young Infants (infants under 2 months) Care of Infants (2 months to 5 years) Management of diarrhoea, acute respiratory infections (pneumonia) malaria, measles, acute ear infection, malnutrition and anemia. o Recognition of illness and at risk conditions and management/referral) o Prevention and management of Iron and Vitamin A deficiency. o Counseling on feeding for all children below 2 years o Counseling on feeding for malnourished children between 2 to 5 years. o Immunization

45. Home Based Newborn Care (HBNC) for ASHAs

46. D. Hospital Management Societies (RKS) and untied funds T he mandatory creation of a hospital management society (Rogi Kalyan Samiti) and empowering this body with untied funds has allowed public participation also contributed to improved quality of care. E. Quality Improvement Programmes S upports initiatives for building quality management systems. Till date, 82 facilities have been certified by ISO, nine facilities have been certified by NABH and 446 facilities are under process of certification.

47. National Ambulance Service (NAS) One of the achievement of NHM is the patient transport ambulances operating under Dial 108/102 ambulance services. Now 35 States/UTs have the facility Dial 108 is predominantly an emergency response system, primarily designed to attend to patients of critical care, trauma and accident victims etc. Dial 102 services essentially consist of basic patient transport aimed to cater the needs of pregnant women and children though other categories are also taking benefit and are not excluded.

48. Implementation of National Ambulance Service (NAS) guidelines has been made mandatory for all the ambulances whose Operational Cost is supported under NHM. 10993 ambulances are being supported under 108 emergency transport systems including new. 9955 ambulances are operating as 102 patient transport including new ambulances. 5126 empanelled vehicles are also being used in some States to provide transport to pregnant women and children e.g. Janani express in MP, Odisha, Mamta Vahan in Jharkhand, Nishchay Yan Prakalpa in West Bengal and Khushiyo ki Sawari in Uttarakhand.

49. NON COMMUNICABLE DISEASE CONRTROLPROGRAMME

50. NATIONAL ORAL HEALTH PROGRAM Objectives:- To improve the determinants of oral health To reduce morbidity from oral diseases To integrate oral health promotion and preventive services with general health care system To encourage Promotion of Public Private Partnerships (PPP) model for achieving better oral health.

51. National Tobacco Control Programme launched 2007-08 during the 11th Five-Year-Plan, with the aim to (i) create awareness about the harmful effects of tobacco consumption, (ii) reduce the production and supply of tobacco products, (iii) ensure effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA) (iv) help the people quit tobacco use (v) facilitate implementation of strategies for prevention and control of tobacco advocated by WHO Framework Convention of Tobacco Control .

52. COMMUNICABLE DISEASE CONTROL PROGRAMME

53. Components Of Village Health Sanitation and Nutrition Committee

54. 2. ASHA Anganwadi Workers (AWWs) under the Integrated Child Development Scheme (ICDS) are engaged in organizing supplementary nutrition programmes and other supportive activities. The very nature of her job responsibilities (with emphasis on supplementary feeding and pre school education) does not allow her to take up the responsibility of a change agent on health in a village. Thus a new band of community based functionaries, named as Accredited Social Health Activist (ASHA) is proposed to fill this void. first port of call for any health related demands of deprived sections

55. Roles and Responsibilties Create Awareness Counsel women mobilize the community and facilitate them in accessing health work with the Village Health & Sanitation Committee of the Gram Panchayat escort/accompany pregnant women provide primary medical care for minor ailments such as diarrhoea, fevers,and first aid for minor injuries. inform about the births and deaths She will promote construction of household toilets under Total Sanitation Campaign.

56. SELECTION OF ASHA The general norm will be ‘ One ASHA per 1000 population ’. In tribal, hilly, desert areas the norm could be relaxed to one ASHA per habitation, dependant on workload etc. The States will also need to work out the district and block-wise coverage/phasing for selection of ASHAs. Criteria for Selection ASHA must be primarily a woman resident of the village - ‘Married/Widow/Divorced’ and preferably in the age group of 25 to 45 yrs. ASHA should have effective communication skills, leadership qualities and be able to reach out to the community. She should be a literate woman with formal education upto Eighth Class.

57. ROLE AND INTEGRATION WITH ANGANWADI Anganwadi Worker (AWW) will Guide ASHA in performing following activities: • Organizing Health Day once/twice a month. • AWWs and ANMs will act as a resource persons for the training of ASHA. • IEC activity through display of posters, folk dances etc. on these days can be undertaken to sensitize the beneficiaries on health related issues. • Anganwadi worker will be depot holder for drug kits and will be issuing it to ASHA. • AWW will update the list of eligible couples and also the children less than one year of age in the village with the help of ASHA. ASHA will support the AWW in mobilizing pregnant and lactating women and infants for nutrition supplement. She would also take initiative for bringing the beneficiaries from the village on specific days of immunization, health checkups / health days etc. to Anganwadi Centres.

58. ROLE AND INTEGRATION WITH ANM Auxiliary Nurse Midwife (ANM) will Guide ASHA in performing following activities: • She will hold weekly / fortnightly meeting with ASHA and discuss the activities undertaken during the week / fortnight. • AWWs and ANMs will act as a resource person for the training of ASHA. • ANMs will inform ASHA regarding date and time of the outreach session and will also guide her for bringing the beneficiary to the outreach session. • ANM will participate & guide in organizing the Health Days at AWC. ANMs will orient ASHA on the dose schedule and side affects of oral pills. • ANMs will educate ASHA on danger signs of pregnancy and labour • ANMs will inform ASHA on date, time and place for initial and periodic training schedule.

59. FUND-FLOW MECHANISM FOR ASHA It is proposed that funds for making the payments to ASHA may flow from Centre to States through SCOVA mechanism and from State SCOVAs to District Health Societies. Standing Committee of Voluntary Agencies (SCOVA) in 1986. SCOVA functions to promote the following objectives:- To provide a feedback on implementation of process/programmes of the Department of Pension & Pensioners’ Welfare To discuss and critically examine the policy initiatives and To mobilize voluntary efforts to supplement the Government action

60. (a) The compensation to ASHA based on measurable outputs would be given under the overall supervision and control by Panchayat. For this purpose a revolving fund would be kept at Panchayat. The guidelines for such compensation would be provided by the District Health Mission, led by the Zila Parishad. (b) For the compensation money under the various national programmes / Schemes, the programmes have in-built provisions for the payment of compensation. These compensations will be made in accordance with the programme guidelines. (c) ASHA would be entitled for DA for attending training programmes. She would be given the amount at the venue itself.

61. BUDGET & FINANCIAL MECHANISMS FOR TRAINING ASHAs

62. 4.ROGI KALYAN SAMITTI Rogi Kalyan Samities (RKSs) / Hospital Management Committees 2005 under the National Rural Health Mission (NRHM) as a forum to improve the functioning and service provision in public health facilities, increase participation and enhance accountability. 31,763 Rogi Kalyan Samities (RKS) hav e been set up

63. OBJECTIVES OF RKS

64. Source of RKS Funds 1. Each RKS will be provided with Untied funds under NHM by State Health Society/District Health Society based on the level of facility, its case load, fund utilization capacity and availability of previous year funds. 2. User fees as determined by RKS for hospital services E.g. X-ray, Ultrasound scanning, laboratory services, private wards etc.Levying of user charges will depend on localcircumstances and decided by the GB, and implemented by the EC. 3. Funds can also be raised from donations, grants from government and loans fromfinancial institutions (with permission of State Government).

65. MAINSTREAMING AYUSH-Ayurveda Yoga & Naturopathy, Unani, Siddha and Homoeopathy STRATEGIES Integrate in health care delivery system including National Programmes. Encourage and facilitate in setting up of specialty centres and ISM clinics. Facilitate and Strengthen Quality Control Laboratory. Strengthening the Drug Standardization and Research a ctivities on AYUSH. Develop Advocacy for AYUSH. Establish Sectoral linkages for AYUSH activities

66. AYUSH services in 314 CHC / Block PHC - contractual AYUSH Doctors. Appointment of 200 paramedics and Data assistant Strengthening of AYUSH Dispensaries Making provision for AYUSH Drugs at all levels. Establishment of specialized therapy centers in District Head Quarter Hospitals & 3 Medical Colleges. AYUSH doctors to be involved in all National Health Care programmes, Training of AYUSH doctors in Primary Health Care and NDCP. Yoga Therapy Centre will be opened in district Headquarters Hospitals to provide Yogic therapy Block level School Health Programmes to be conducted twice in a year

67. Integration of AYUSH with ASHA. Update Training module for ASHA and ANMs Training & capacity building - Director, SIHFW, Bhubaneswar Drug kit - one AYUSH preparation in the form of iron supplement. O ther drugs - treatment of common diseases,communicable diseases , maternal and child health as well as improving quality of life could be included subsequently. Drug Management: Priority will be given to manufacture drugs in Govt. Sector Pharmacies as per their capacity. In case of any surplus funds, drugs will be procured from the market observing all financial formalities of the Govt. Provision of Rs. 25,000/- to supply drugs per AYUSH dispensary has been projected as per NRHM norm. Provisions of medicines for District AYUSH wings and Specialty Therapy Centres proposed to be operated in the State.

68. Strengthening the Quality Control Laboratory D rug regulation and enforcement unit has to be established in the state. The drug regulatory mechanism to be strengthened at the state level The existing State DrugTesting and Research Laboratory (ISM) at Bhubaneswar shall also be modernised and strengthened for the purpose. Strengthening the Drug Standardisation and Research Activities on AYUSH: T to evaluate the chemical, pharmacological and clinical efficacy of the plant drugs. The pharmacologically viable drugs will be screened clinically under WHO guideline to establish the therapeutic activity

69. Development of Herbariums and crude drug museums: Herbarium will be developed in collaboration with the Forest Dept. in 15 selected Districts of the State. The existing Herbal gardens strengthened with necessary infrastructure. One State Herbarium at DTL, Bhubaneswar shall be developed. Strengthening of the State and District Management System of AYUSH: It is proposed to create necessary Managerial post in the State and District level for effective supervision and implementation of different activities. Necessary vehicles with supporting manpower has also been proposed to strengthen the supervisory

70. Kilkari: Interactive Voice Response (IVR) based mobile service that delivers time- sensitive audio messages (voice call) about pregnancy and child health directly to the mobile phones of pregnant women, mothers of young children and their families. The service covers the critical time period- where the most maternal/ infant deaths occur from the 4th month of pregnancy until the child is one year old. Families which subscribe to the service receive one pre-recorded system generated call per week. Launch of Nationwide anti-TB drug resistance survey: Drug resistance survey for 13 anti- tuberculosis drugs was launched to estimate the burden of MOR-TB within the community.

71. Kala- azar elimination plan The National Health Policy-2002 set the goal of Kala-azar elimination in India by the year 2010 which was revised to 2015. Objective - To reduce the annual incidence of Kala-azar to less than one per 10 000 population at block PHC level by the end of 2015 by: reducing Kala-azar in the vulnerable, poor and unreached populations in endemic areas; reducing case-fatality rates from Kala-azar to negligible level; reducing cases of PKDL to interrupt transmission of Kala-azar; and preventing the emergence of Kala-azar and HIV/TB co-infections in endemic areas.

72. S.no Targets 1 Reduce IMR to 30 /1000 live births by 2012 2 Reduce MMR to 100/1,00,000 live births by 2012 3 Reduce TFR to 2.1 4 Reduce annual prevalence and mortality from Tuberculosis by half 5 Reduce prevalence rate of Leprosy to <1/10000 population in all districts. 6 Annual Malaria Incidence to be <1/1000 7 Less than 1 per cent microfilaria prevalence in all districts 8 Kala-Azar Elimination by 2015, <1 case per 10000 population in all blocks TARGETS OF NRHM

73. https://timesofindia.indiatimes.com/india/india-improves-infant-mortality-rate-but-gains-slowing-down/articleshow/87266537.cms

74. Maternal Mortality Ratio (MMR) of India has reduced from 130 per 100,000 live births in SRS 2014-16 to 122 in SRS 2015-17 and to 113 per 100,000 live births in SRS 2016-18.

75. West Bengal, Maharashtra were found to have the lowest Total Fertility Rate in India https://www.indiatoday.in/india/story/india-fertilitaty-rate-declines-replacement-level-meaning-nfhs-survey-1880894-2021-11-25

76. The countries that contributed most to the global drop between 2019 and 2020 were India (41%), Indonesia(14%), the Philippines (12%) and China (8%); these and 12 other countries accounted for 93% of the total global drop of 1.3 million https://www.who.int/publications/i/item/9789240037021

77. https://www.nhp.gov.in/world-leprosy-day-2021_pg

78. The eastern state of Odisha, which carried more than 40% of the country’s malaria burden, reported a 90% decline in malaria cases and 89% decline in malaria deaths in 2020 as compared to 2015. The malaria-endemic North-Eastern region and the states of Jharkhand, Chhattisgarh, and Madhya Pradesh also registered similar reductions in cases and deaths. The WHO’s World Malaria Report 2020 highlighted India’s gains in the path to elimination. India recorded impressive 60% reduction in reported cases compared with 2017, and a 46% reduction in cases compared with 2018, which built momentum to reach the goal of zero indigenous malaria cases by 2027.

79. https://theprint.in/health/poor-campaign-aversion-to-medicines-why-india-is-unlikely-to-eradicate-filariasis-by-2021/542340/

80. The disease incidence has been declining steadily, from 13869 in 2013 to 3145 in 2019. Of the cases reported in 2019, nearly 60 per cent cases were from four States alone. These included Bihar with maximum number (2416 cases), followed by Jharkhand (541), Uttar Pradesh (97) and West Bengal (87)7. In addition, 821 cases of post-kala-azar dermal leishmaniasis (PKDL) were reported and these were considered as the main cause of transmission in the community Thakur CP, Thakur M. Accelerating kala-azar elimination in India. Indian J Med Res. 2020;152(6):538-540.

81. REFERENCES https://www.nhm.gov.in/WriteReadData/l892s/nrhm-framework-latest.pdf https://nhm.gov.in/images/pdf/communitisation/task-group-reports/guidelines-on-asha.pdf https://www.nhm.gov.in/New_Updates_2018/communization/RKS/Guidelines_for_Rogi_Kalyan_Samities_in_Public_Health_Facilities.pdf http://nhm.gov.in/images/pdf/programmes/RKSK/RKSK_Implementation_Guideline_05.03.2015.pdf http://www.nhm.gov.in/MAA/Operational_Guidelines.pdf https://www.ayush.gov.in/docs/ayurved-guidlines.pdf