NRHM in Assam

NRHM Assam, Initiative and Innovations

1. National Rural Health Mission Department Of Community Medicine Gauhati Medical College Dr . Ramkesh Prasad Dr. Ashok Jyoti Deka

2. Goals Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH Promotion of healthy life styles

3. Expected outcomes of the Mission IMR reduced to 30/1000 live births Material Mortality reduced to 100/100,000 TFR reduced to 2.1 by 2012. Malaria Mortality Reduction Rate - 50% up to 2010, additional 10% by 2012. Kala Azar Mortality Reduction Rate - 100% by 2010, sustaining elimination until 2012. Filaria /Microfilaria Reduction Rate - 70% by 2010, 80% by 2012 and elimination by 2015. Dengue Mortality Reduction Rate - 50% by 2010 and sustaining at that level until 2012. Cataract operations - increasing to 46 lakhs until 2012. Leprosy Prevalence Rate –reduce less than 1 per 10,000 thereafter. Tuberculosis DOTS series - maintain 85% cure rate through entire Mission Period. Upgrading Community Health Centers to Indian Public Health Standards. Increase utilization of First Referral Units from less than 20% to 75%.

4. Components of NRHM 1. RCH – II 2. NRHM Additionalities 3. Immunization 4. National Programmes 5. Mainstreaming of AYUSH

5. Major Stakeholders Accredited Social Health Activist (ASHA) Anganwadi worker (AWW) Auxiliary Nurse Midwife / Health Worker (female) Panchayati Raj Institutions and NGOs District Administration State Governments

6. Plan of Action Accredited Social Health Activists Strengthening Sub- Centres Strengthening Primary Health Centres Strengthening CHCs for First Referral Care District Health Plan Converging Sanitation and Hygiene under NRHM Strengthening Disease Control Programmes Public-Private Partnership for public health goals, including regulation of private sector New health financing mechanisms Reorienting health/medical education to support rural health issues

7. Village level ASHA Accredited S ocial H ealth A ctivist Female activist given accreditation after 4 phase training ASHA would act as a bridge between the ANM and the village and be accountable to the Panchayat . Ownership of health program given to villagers Village Health Committee prepares Village H ealth Plan

8. District Level District health plan generated by combining village health plans Elements are drinking water, sanitation, hygiene and nutrition Strengthening Sub Centers, Primary Health Centers and Community Health Centers

9. Monitoring and Evaluation Health MIS to be developed up to CHC level, and web-enabled for citizen scrutiny ( October, 2008 ) Sub- centres to report on performance to Panchayats , Hospitals to Rogi Kalyan Samitis and District Health Mission to Zila Parishad The District Health Mission to monitor compliance to Citizen’s Charter at CHC level Annual District Reports on People’s Health (to be prepared by Govt./NGO collaboration) State and National Reports on People’s Health to be tabled in Assemblies, Parliament External evaluation/social audit through professional bodies/NGOs Mid Course reviews and appropriate correction

10. NRHM – What is the Impact * SRS # NFHS Infant Mortality Rate * 60 (2003) 53 (2008) Maternal Mortality Ratio # 301 (2001-03) 254 (2004-06) Total Fertility Rate # 2.9 (2005) 2.7 (2007) Institutional Delivery Fully Immunized Children Unmet needs of Family Planning

11. Janani Suraksha Yojana Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Yojana , launched on 12th April 2005 is being implemented in all states and UTs. The Yojana is being implemented in all states and Union Territories. JSY is a 100% centrally sponsored scheme. The Yojana has identified ASHA, the Accredited Social Health Activist as an effective link between the Government and the poor pregnant women in 10 low performing states, namely the 8 (EAG) - Empowered Action Group (EAG) states and Assam and J&K and the remaining NE States. Her main role is to facilitate pregnant women to avail Services of maternal care and arrange referral transport. The scheme focuses on the poor pregnant woman with special dispensation for states having low institutional delivery rate. Besides the maternal care, the scheme provides cash assistance to all eligible mothers for delivery care .

12. NRHM – Other Improvements Key findings in DLHS – III (2007-08) 53.1% PHC working 24 hours basis 90.1% CHC have 24 hours normal delivery services 90.6% Sub Centres with ANM 19.2% PHCs with AYUSH doctors 90.7% villages have JSY beneficiaries Full immunisation up to 54.1% Institutional Delivery up to 47%

13. Improvements in No. of Institutional Deliveries DLHS-2 (2002-04) 23.20 % DLHS-3 (2007-08) 35.30% * Concurrent Evaluation Survey, 2009, Regional Resource Center-NE, Ministry of Health & Family Welfare, Govt. of India = 66.30%

14. Innovations Boat Clinic – Ship of Hope Launched on 11 th November ’07 Operational in 27 districts Equiped with Microscope, SemiAuto Analyser , Generator, Medical Officers, Nurses, Technicians,

15. Boat Clinic - For the marginalized million Launched on 25 th May 2005 on National Immunisation Day – Pulse Polio Immunisation in Bogibeel , Dibrugarh MoU signed between NRHM and Centre for North East Studies and Policy Research (C-NES) in 2008 Operational in Dibrugarh , Tinsukia , Morigaon , Dhemaji , Dhubri , Nalbari , Barpeta , Jorhat , Sonitpur , and Lakhimpur Services offered: OPD services, ANC, Immunisation, Family planning, Minor operative procedures, Basic Laboratory Services INNOVATION – Assam

16. Mobile Medical Unit Hospital on Wheels Launched on 11 th November ’07 Operational in 27 districts Equipped with Microscope, SemiAuto Analyser , Portable X-ray, USG, ECG, Generator 2 MO, Nurses, Technicians… INNOVATION – Assam

17. ASHA Radio Updating the ASHAs with new development and also informing them about the mission for upgrading the standard of life of the rural people in respect to health and hygiene and particularly promoting the healthy environment for mother and child Feedback Mechanism : Pre paid post cards with printed address of office of the AIR, Each ASHA will be given 12 postcards INNOVATION – Assam

18. ANM Mobile Can report any suspected cases to the PHC to take immediate action before it results to outbreak. Can also facilitate for the referral transport so that people can avail the facility as there are villages where public transportation facility is not available. INNOVATION – Assam

19. Compulsory Rural posting of Doctors in Assam 768 doctors were given appointment across the State at different MPHCs/ SDs / SHCs / in few BPHCs & CHCs having less or no doctors INNOVATION – Assam

20. Rural Health Practitioners by Assam Rural Health Regulatory Act in 2004 The main objectives behind introducing this act are: To increase trained manpower for rural areas and in the health sector. To bridge the gap between doctors working in the PHC and the outreach section of people of rural community. To ease implementation of Govt. health programme efficiently. To fill up the vacant posts of proper health personnel in rural areas. Regularization of trained manpower will minimize the practice of village quacks and self-made doctors in those areas spreading unscientific knowledge of health . The first batch of 92 RHP has been posted in the PHC/MPHC/SD/SHC located in the remotest areas of the INNOVATION – Assam

21. Initiative in Assam Mamoni Majoni Marom

22. Majoni - Assistance to Girl Child An initiative under Assam Bikas Yojna (ABY) The birth of the girl child must be Institutional The birth will have to be registered Families conforming to the Govt. Policy of Two Children only will be eligible. The FD will be issued by the designated bank. Girl child and the date of maturity will be the eighteenth birthday of the girl (i.e. after completion of 18years). The Girl should not be married before attaining 18 years. INITIATIVE – Assam

23. Mamoni - Nutritional Supplement for Pregnant Women An initiative under Assam Bikas Yojna (ABY) Every pregnant woman gets Rs. 1000/ for taking nutritious food. During the registration the pregnant women receives Mamoni Booklet comprising information on the care and management of pregnancy and the new born. During her 1stANC,the pregnant woman receives an A/C payee cheque of Rs. 500/- During her 3rd ANC, she gets another cheque of Rs. 500/- along with a voucher for the referral transport . INITIATIVE – Assam

24. Evening Out Patient Department An initiative by Government of Assam to provide round-the-clock medical services to the people of the state. Launched on 6 th May, 2008 to make the govt. health care facilities accessible and available to the rural people beyond routine OPD hours as the timing of the OPD is as per the convenient of the community (i.e. 5 pm to 8 pm). INITIATIVE – Assam

25. Emergency Management & Referral Transport Looking at the demand for comprehensive emergency system Govt. of Assam has entered into a MoU with the EMRI, Hyderabad on 8th July, 2008. The 108 Mrityunjoy Emergency Response Services was formally inaugurated on 6th November, 2008 at Guwahati . The objective of the partnership to improve access of the general public to services like Medical, Police and Fire. There are in Total 280 Advance Life Saving (ALS) ambulances covering all 27 districts. The 108 Mrityunjoy Emergency Response Services is 24 x 7 functional with dedicated team members. Dialing ‘108’ the toll free emergency number, the emergency call lands at Emergency Response Centre (ERC). INITIATIVE – Assam

26. PPP with Tea Garden Hospitals Objectives To provide health care services to the tea garden worker s& non-workers; To strengthen existing infrastructure in the TE hospitals based on facility survey; To purchase medical equipment pertaining to service delivery mentioned in the MoU ; To standardize the existing Labour Room; To provide baby care rooms and other facility to meet emergencies of newborn; To appoint Doctors, Nurses and paramedical staff, if required; Services Provided Mother & Child Care Provision of normal delivery Routine Ante- Natal & Post – Natal care to all women. Facility for New born Care such as neonatal resuscitation & management of neonatal hypothermia/ jaundice Immunization of the children INITIATIVE – Assam