NRHM.pptx

CONTENTS

Introduction
NHM
NRHM
Components of NRHM
NUHM
Components of NRHM
Difference between NRHM and NUHM
Future goals
Conclusion
References

INTRO:
National Health Mission
Ministry of health and family welfare
NHM - approved in May 2013
Sub missions – NRHM & NUHM
It aims at improving and correcting the deficiencies in the health care delivery system with a focus on integrating all thee available healthcare facilities like Ayush along with ongoing vertical programme.
Main programmatic components
- RMNCH+A
- control of NCDs & Comm. d/s

NRHM:
Launched in 5th April 2005 for 7 years by GOI
Intended for 2005 - 2012
Recently extended to 2017
Operational in whole country & Special focus on 18 states
Correct the deficiencies of health system
The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

Objective of the mission:

Reduction in child and maternal mortality.
Universal access to public health services.
Prevention and control of communicable and noncommunicable diseases, endemic diseases
Stabilization and demographic balance.
Revitalizeimunisation programme
Access to integrated phc.
Revitalize local local health tradition.(Ayush)
Promotion of healthy life style

COMPONENTS UNDER NRHM:
Comprehensive Primary Health Care (CPHC) through Ayushman Bharat Health and Wellness Centers (HWCs)
National Ambulance Services (NAS)
National Mobile Medical Units (NMMUs)
Free Drugs Service Initiative
Free Diagnostics Service Initiative
Community Participation
a)Accredited Social Health Workers (ASHA)
b)Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Society
c)VHSNCs
Mera Aspataal
Kayakalp
SUMAN (Surakshit Matritva Aashwasan)
Mission Indradhanush
TB Harega Desh Jeetega Campaign
Eat Right India Movement, with ‘Sahi Bhojan Behtar Jeevan’

AYUSHMAN BHARATH HWCS:
Ayushman Bharath is an attempt to move from a selectiv approach to health care to deliver range of services like preventive,promotive,curative,rehabilitative,and palliative care
It has 2 components
1) Health and wellness centre(HWCs) 1,50,000
2)Pradhan mantri jan Arogya yojan (PM-JAY)
Health insurance cover 5 lakh / year – 10 crore poor ppl

The first Health and Wellness Centre was inaugurated by Hon’ble Prime Minister on 14th April 2018 in Bijapur district of Chhattisgarh.
So far, 51,484 HWC are formed
Objectives:
upgrading the Sub Health Centers (SHCs) and Primary Health Centers (PHCs) in rural and urban area
provide Comprehensive Primary Health Care
common NCDs such as Hypertension, Diabetes and 3 common cancers of Oral, Breast and Cervix.
primary healthcare services for Mental health, ENT, Ophthalmology, Oral health, Geriatric and Palliative health care and Trauma care as well as Health promotion and wellness activities like Yoga.

1. National rural health mission and its components Presenter : Dr Soumya P Final year PG Scholar Department of Kayachikitsa

2. Contents Introduction NHM NRHM Components of NRHM NUHM Components of NRHM Difference between NRHM and NUHM Future goals Conclusion References

3. NHM National Health Mission Ministry of health and family welfare NHM - approved in May 2013 Sub missions – NRHM & NUHM It aims at improving and correcting the deficiencies in the health care delivery system with a focus on integrating all thee available healthcare facilities like Ayush along with ongoing vertical programme. Main programmatic components - RMNCH+A - control of NCDs & Comm. d/s

4. NRHM Launched in 5th April 2005 for 7 years by GOI Intended for 2005 - 2012 Recently extended to 2017 Operational in whole country & Special focus on 18 states Correct the deficiencies of health system The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

5. Why NRHM was launched? Only 20% population coverage by govt sector , 80% by private sector Stat -Rural India – long standing healthcare problems Rural health problems/ mortality – preventable and easily treatable . Characteristics Urban rural Infant mortality rate 39% 62% Government beds 68.1% 31.9% Beds per 1000 population 1.1 beds 0.2 beds Graduate doctor distribution 74% 28%

6. States focused under NRHM

7. Objectives of the mission Reduction in child and maternal mortality. Universal access to public health services. Prevention and control of communicable and noncommunicable diseases, endemic diseases Stabilization and demographic balance. Revitalizeimunisation programme Access to integrated phc. Revitalize local local health tradition.(Ayush) Promotion of healthy life style

8. Components under NRHM Comprehensive Primary Health Care (CPHC) through Ayushman Bharat Health and Wellness Centers (HWCs) National Ambulance Services (NAS) National Mobile Medical Units (NMMUs) Free Drugs Service Initiative Free Diagnostics Service Initiative Community Participation a)Accredited Social Health Workers (ASHA) b)Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Society c)VHSNCs

9. Cont.. Mera Aspataal Kayakalp SUMAN (Surakshit Matritva Aashwasan) Mission Indradhanush TB Harega Desh Jeetega Campaign Eat Right India Movement, with ‘Sahi Bhojan Behtar Jeevan’

10. Ayushman Bharat Health and Wellness Centers (HWCs) Ayushman Bharath is an attempt to move from a selectiv approach to health care to deliver range of services like preventive,promotive,curative,rehabilitative,and palliative care It has 2 components 1) Health and wellness centre(HWCs) 1,50,000 2)Pradhan mantri jan Arogya yojan (PM-JAY) Health insurance cover 5 lakh / year – 10 crore poor ppl

11. Health and Wellness Centre (HWC) The first Health and Wellness Centre was inaugurated by Hon’ble Prime Minister on 14th April 2018 in Bijapur district of Chhattisgarh. So far, 51,484 HWC are formed Objectives: upgrading the Sub Health Centers (SHCs) and Primary Health Centers (PHCs) in rural and urban area provide Comprehensive Primary Health Care common NCDs such as Hypertension, Diabetes and 3 common cancers of Oral, Breast and Cervix. primary healthcare services for Mental health, ENT, Ophthalmology, Oral health, Geriatric and Palliative health care and Trauma care as well as Health promotion and wellness activities like Yoga.

12. Ayush intervention Upgrading existing Ayush dispensaries and sub health centers . Sub health centers headed by Ayush doctors 10% of total HWC are for Ayush HWC Total of 12,500 Ayush HWC Objective – “self care” Focus on preventive and promotive interventions Services- outreach opd, health mela,home visits, school and anganavadi visits. Include Ayush wellness package- 1) self care 2) common ailments 3) medicinal palnts and home remedies 4) prakriti assessment 5) yoga classes

13. Health calendar S. No. Month and Date Day 1. 12 th January National Youth Day 2. 31 st January Anti-Leprosy Day 3. 4 th February World Cancer Day 4. 11 th February International Epilepsy Day 5. 8 th March International Women’s Day 6. 24 th March World Tuberculosis Day 7. 7 th April World Health Day 8. 14 th April Ayushman Bharat-Health and Wellness Centre Day 9. 12 th May International Nurses Day 10. 31 st May Anti-Tobacco Day 11. 14 th June World Blood Donor Day 12. 21 st June International YOGA Day 13. 1 st July Doctors Day 14. 11 th July World Population Day 15. 01-07 August World Breast Feeding Day/ Week 16. 15 th August Independence Day 17. 01-07 Sept. National Nutrition Week 18. 29 th Sept. World Heart Day 19. 1 st October World Elderly Day 20. 11 th October World Mental Health Day 21. 10 th Nov. World Immunization Day 22. 14 th Nov. Children’s Day 23. 1 st December World AIDS Day 24. 20 th Dec. Food Safety Day

14. National ambulance service It is a patient transport service launched by NHM Now 35 states/UTs has the service Dial 108/102 Dial 108- Emergency response system( critical care , trauma , accident victims) Dial 102 – basic patient transport - cater needs of pregnant women and children 10599 – under 108 9875 – under 102 Other vehicles to transport pregnant women and children- Janani express, mamta vahan,kushiyo ki sawaari etcx…

15. NMMU To increase visibility, awareness and accountability, all Mobile Medical Units have been positioned as “National Mobile Medical Unit Service” with universal colour and design. 426 districts are provided with service providing Primary Health Care Services at the door step of communities living in difficult to reach, hilly areas which were unserved or underserved Each MMU was covering 8-12 villages on fixed days and had service points in the said villages.

16. OBJECTIVES: 1 To provide quality Primary Health Care and selected Secondary Care Services, including referral services as per objectives of NRHM and GOK. 2 To contribute to the achievement of improvements in CBR, CDR, IMR, MMR and TFR and other health goals in the area by reducing the Infant and Maternal Mortality and communicable diseases like malaria, T.B, AIDS, pneumonia, diarrhea and dysentery. 3 To provide essential health care services for chronic illness such as such as Diabetes Mellitus, Hypertension, Epilepsy, Chronic Bronchitis, Chronic Bronchial Asthma, Chronic Arthritis, Acid Peptic Disease (Gastritis) etc. 4 To provide minimum Laboratory Investigation such as Urine for Albumin & Sugar, Pregnancy test, Blood Sugar level estimation, Hemoglobin estimation etc. 5 To create awareness regarding communicable and non-communicable diseases and their prevention through IEC activities. 6 To Provide Family Planning Services, mainly Spacing Methods

17. SERVICES PROVIDED BY MMU: 1 . Curative Services for common illnesses and chronic illness. 2. First Aid. 3. Referral Services. 4. Family Planning Services. 5. Antenatal and Postnatal Care Services. 6. Immunization services. 7. Counselling on all matters, in particular HIV/AIDS. 8. Implementation of National Health Programs. 9. Health Education Activities and Environmental Sanitation. 10. Minimum routine laboratory investigations. 11. Management of Bio Medical Waste (collection, storage and disposal). 12. Extensive health related IEC activities and other services. 13. Samples collection for special investigation like sputum examination for AFB, Blood smear for Malaria Parasite & Elisa test, etc. 14. Screening and regular follow up treatment of all chronic illnesses like diabetes mellitus, hypertension, chronic respiratory diseases, epilepsy, chronic arthritis and acid peptic diseases and others, free of cost.

18. Free drug delivery system It is an Free Drugs Service Initiative by NHM . Launched on 2nd July, 2015. substantial funding is being given to States for provision of free drugs and setting up of systems for drug procurement, quality assurance, IT based supply chain management system, training and grievance redressal etc. Drugs procurement, quality system and distribution has been streamlined through IT based Drug Distribution Management Systems in 29 States,

19. Free Diagnostics Service Initiative: The NHM- Free Diagnostics Service Initiative was launched in 2013 to provide free essential diagnostic services at public health facilities This initiative was launched to address the high out of pocket expenditure on diagnostics and improve quality of healthcare services. Objectives: Strengthening of the existing systems in public health facilities such as Lab infrastructure, provision of Lab Technician, equipment, etc.; Out Sourcing of High Cost -low frequency diagnostic services and Contracting in of services of essential Human Resources (e.g. Radiologist, Lab Technician) on a need basis. 7 to 14 tests at Sub Centre/ Health & Wellness Centre level 19 tests to 63 tests at PHC level, 39 tests to 97 tests at CHC level and 56 tests to 134 tests at District Hospital level. The tests encompass hematology, serology, bio-chemistry, clinical pathology, microbiology, radiology, and cardiology

20. ASHA(Accredited Social Health Workers) 10.42 lakh ASHAs across the country - rural / urban Health activist in the community Resident of the village, a woman (M/W/D) between 25-45 years, with formal education upto 8th class, having communication skills and leadership qualities. One ASHA per 1000 population. Trained for period of 23 days(induction) over one year and periodic re-training. Chosen by the panchayat to act as thee interface between the community and the public health system. - Bridge between the ANM and thee village. - Honorary volunteer, receiving performance based compensation.

21. Responsibilities of ASHA To create awareness among the community regarding nutrition, basic sanitation, hygienic practices, healthy living. Counsel women on birth preparedness, imp of safe delivery, breast feeding, complementary feeding, immunization, contraception, STDs counsel women and escort them to PHC/CHC & providing medical care for minor ailments Encourage thee community to get involved in health related services. Drug depot: depot holder like ORS, iron and folic acid, oral pills, condoms etc.. Primary medical care for minor ailment Provider of DOTS.

22. Integration of AYUSH with ASHA • Training module for ASHA and ANMs have to be updated • Training & capacity building to be undertaken • Drug kit that will be provided to ASHA will contain one AYUSH preparation Deliver Ayush Pushti biscuits to Anganavadi IEC material for certain diseases by Ayush . Home remedies material for minor ailments.

23. Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Society It is a simple yet effective management structure. This committee is a registered society that acts as a group of trustees for the hospitals to manage the affairs of the hospital. 33,378 Rogi Kalyan Samitis (RKS) have been set up involving the community members in almost all District Hospitals, Sub- divisional Hospitals, Community Health Centers and PHCs till date. It consists of members from local Panchayati Raj Institutions (PRIs), NGOs, local elected representatives and officials from Government sector who are responsible for proper functioning and management of the hospital / Community Health Centre / FRUs.

24. VHSNCs 5.49 lakh Village Health Sanitation and Nutrition Committees (VHSNCs) have been constituted at village level across the country to facilitate village level healthcare planning. 11.19 crore Village Health & Nutrition Days (VHNDs) were held so far during the Mission period. It is a platform for improving health awareness and access of community for health services, address specific local needs and serve as a mechanism for community based planning and monitoring. nutritional deficiencies early detection of malnourished children in the community; grievances redressal forum on health and nutrition issues.

25. Ayush interventions Ongoing One Ayush doctors at phc 24/7 PHC Screening of anaemia/ nutritional status Scope Ayush camps on nutrition and health Healthy eating campaigns

26. MeraAspataal: This initiative launched in September 2016 with a mandate to integrate with Central Government Hospitals and District Hospitals is currently functioning in 17 States and 5 UTs. In 2018-19, 1698 facilities were integrated into Mera Aspataal . Inititative to capture patient feedback for the services received from public. It works through - SMS - OBD ( outbound dialing ) - mobile application and web portal Analysed data il be used to improve quality of services in healthcare facilities.

27. Kayakalp an initiative for Award to Public Health facilities. Kayakalp initiative has been launched to promote cleanliness,hygiene and infection control practices in public health facilities. Action : - PHC meeting standards of protocols of cleanliness, hygiene and infection control will receive awards and commendation As part of contribution towards the Swachh Bharat Abhiyaan launched by the Prime Minister on 2nd October 2014, the Ministry launched “Kayakalp - Award to Public Health Facilities. As on 1st Oct 2019, 9 Central Government, 395 DHs, 1,140, CHCs/SDHs, 2,723 PHCs, 556 UPHCs,6 Urban Community Health Centers (UCHCs) have scored more thean 70%. 4829 facilities have been awarded under this scheme in FY 2018-19.

28. Suman Union government has launched surakshith matritva aashvasan (SUMAN) to provide quality heathcare at zero cost to pregnant women , new mothers and newborn . Launched on October 10 ,2019. Aims : -to provide dignified and quality health care at no cost to every woman and newborn visiting to public health facility. upto 6 months, free health services - 4 antenatal check ups , 6 homebased newborn care visit. Zero expense delivery and c-section facility . Transport of pregnant women . Significance : -bring down maternal and infant mortality rate . - provide stress free birth experience .

29. Mission indradhanush It is a health mission of govt of india to boost rotine immunization coverage. Launched on 25 December 2014. Aims too drive 90% of full immunisation coverage . Vaccination against – diptheria , whoophing cough,tetanus , polio,measles,childhood tb , hepatitis b , meningitis,pneumonia , influenza , rotavirus, Japanese encephalitis. Goals: Full available vaccination upto 2 years of age foe children At 201 high focus districts acroos country.

30. Sahi bhojan behetar Jeevan (EAT RIGHT INDIA MOVEEMNT) It is a programme launched by union health ministry under food safety standards authority of india (FSSAI). It is the new healthy eating approach which places citizens at the centre of health revolution through food and fitness. It is aligned with … Actions: Eat right quiz Eat right camps School camps

31. Nuhm National urban health mission To improve health status of urban population particularly slum dwellers vulnerable section. Launched National Health Mission (NHM) on 1 st May, 2013 .

32. Coverage All cities with >50,000 population. All the district and state headquarters (irrespective of the population size). Urban areas with < 50,000 population to be covered by NRHM. So far to ensure that there is no duplication of services. Seven mega cities ( Mumbai, New Delhi, Chennai, Hyderabad, Kolkatta, Bengaluru & Ahmedabad) will be treated differently their municipal corporations will implement NUHM. In other cities, District Health Societies will be responsible for NUHM implementation. Flexibility- given to states In the 12th Plan period NUHM and NRHM will be separate programmes……

33. High focus on : Urban Poor Population living in listed and unlisted slums All other vulnerable population such as Homeless, Rag-pickers Street children Rickshaw pullers Construction and brick and lime kiln workers Sex workers Other temporary migrants

34. Objectives: Public health thrust on sanitation, clean drinking water, vector control, etc. Strengthening public health capacity of urban ocal bodies.

35. RAJIV AWAS YOJANA ( slum free india ) •it was launched in June 2011 this initiative aims at providing hosing facilities to slum dwellers through a new scheme. Implementation : Preparation of slum free city plan Preparation of project for selected slum. • This will also be useful for development of city health plans. Housing , basic civic infrastructure in slums Community halls Childcare centres Rental housing

36. SWARN-JAYANTI SHEHRI ROJGAR YOJNA • government have introduced an effective self employment programme SGSY. Launched on April 1, 1999 It aims at poor families living below poverty line in rural areas for taking up self employment. They make take up the activity either individually or in groups called self help groups. Goal : 1) Anti poverty programme, empowerment 2) Self employment , income generation Role of scheme : Identification of poor Training Infrastructural support Marketing support Engaging youths

37. Difference between NRHM and NUHM NRHM NUHM National rural health mission National urban health mission Improves rural health delivery system Separate mission for urban areas and focus on slums & other urban poor families. Launched on 12 the April, 2005 Approved on 1st May 2013 Creation of ASHA (Accredited Social Health Activist) Creation of USHA (Urban Social Health Activist) 1 Asha = 1000 population 1 Usha = 1000- 2500 population JSY, RKS, RSBY NRY, MAS , UPSB , SJSRY

38. Areas of priority : 1. Education –standards upgradation 2. Drug standardization 3. Setting up of vanaspati van (Herbarium) 4. Expansion Ayush treatment facility 5. Research & development 6. Intellectual property Rights

39. Conclusion The grossly deficient health workforces in rural India are hugely replenished by AYUSH doctors and paramedics. • Many of the therapeutics are being used in different forms for the management of community health problems which are safe and effective. Future of integrated medicine- Bright and promising. effective implementation of mainstreaming of AYUSH and revitalization of local health tradition in a more homogenous manner throughout the nation. universal recruitment policy, provision of drugs and necessary equipments and infrastructural correction. Ayush has a great role in rural health and is successful in combating health care facilities. Nationalisation of aysuh work forces is in need of hour.

40. references AYUSH official website http://india.gov.in & http://mohfw.nic.in National health mission official website nhm.gov.in Ayushman Bharath official website ab-hwc.nhp.gov.in