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National Health Mission

1. National Health Mission An Over View Moderator :- Dr Rohul Jabeen Shah SR Incharge :- Dr Beenish Mushtaq Presenter :- Dr Rabia Ahmad

2. From then to now…

3. 4 TFR Prevalence of Leprosy Incidence of Malaria Incidence of TB

4. NEWER INITIATIVES UNDER NHM Namma Samudaya Mahila swasthya clinic E-Manas/ Namma Kannu Namma Doddabalapura CEmONC BEmONC BASIC TOTAL 1109 2619 4140 7868 CEmONC BEmONC BASIC TOTAL 763 1271 3473 5507 SUMAN Identified facilities SUMAN Notified facilities

5. ALLOCATION UNDER DIFFERENT POOLS OF NHM: FY 2021-22 S. No Name of the Flexible Pools Allocation (Rs. in crore) % of Allocation A NRHM – RCH Flexible Pool 20,691.59 67% 1 RCH Flexible pool including RI, PPI, NIDDCP 6,273.32 2 Health System Strengthening under NRHM including AB-HWC, ABP 14,418.27 B National Urban Health Mission-Flexible Pool 1,000.00 3% C Flexible Pool for Communicable Diseases 2,178.00 7% D Flexible Pool for Non-Communicable Diseases, Injury & Trauma 717.00 2% E Infrastructure Maintenance 6,343.41 20% F Others including Pilot Projects, NPMU 170.00 1% Grand Total 31,100.00

6. Organizational structure UPHC Bannimantap UPHC N.H Palya UPHC Saraswathipuram Subcentres- Alaganchi & Belavadi NQAS Certified in Mysuru

7. LIST OF DRUGS BEING PROVIDED IN ASHA KIT Content of Drug kit DDK for Clean deliveries at home Tab. Paracetamol Paracetamol syrup Tab. Iron Folic Acid (L) Tab. Punarvadu Mandur (ISM Preparation of Iron) Tab. Dicyclomine Tetracycline ointment Zinc Tablets Povidine Ointment Tube G.V. Paint Cotrimoxazole syrup Paediatric Cotrimoxazole tablets ORS Packets Condoms Oral pills (In cycles) Spirit Soap Sterilized Cotton Bandages, 4cm X 4 meters Nischay Kit Rapid Diagnostic Kit Slides for Malaria & Lancets Emergency Contraceptive Pill Sanitary napkins (to promote Menstrual Hygiene amongst adolescent girls) List of Items in ASHA Equipment Kit Digital Wrist Watch Thermometer Weighing Scale (for newborn) Baby Blanket Baby Feeding spoon Kit Bag Communication Kit Mucous Extractor

8. CERTIFICATION & ACCREDITATION for NQAS Visit to facility by Empanelled assessors & NHSRC team for assessment On-Site assessment of & Certification by SQAC SQAC recommends to Director NRHM for National Accreditation DQAC recommends to SQAU for State Level Certification If score is more than 70% NHSRC recommends Director NRHM for Accreditation Director NRHM issues the accreditation Sustenance & Incentives Facilitation and recognition of achievement, Financial incentives, Surveillance every year, Recertification after three years

9. Process of award. . .

10. KAYAKALP Swachh Bharat Abhiyan in October 2014 → Kayakalp in May 2015 → Extended to urban areas in 2017 – 18 → Extended to subcentres in 2019 – 20 → Swachh swasth sarvatra

11. NATIONAL QUALITY ASSURANCE FRAMEWORK 2013 onwards 2008 - 2012 2007 2005 Quality assurance committees in all states for Family Planning Sterilization Procedure set up as per directions of Supreme Court Various Quality models followed in country Viz. ISO 9001:2008, FFHI, KASH, NABH etc. India Public Health Standards developed for District Hospitals, Community Health Centers, Primary Health Centers and Sub Centers Launch of Operational Guidelines for Quality Assurance in public Healthcare facilities and National Quality Assurance Programme

12. NATIONAL QUALITY ASSURANCE FRAMEWORK Quality assurance committees in all states for Family Planning Sterilization Procedure set up as per directions of Hon’ble Supreme Court India Public Health Standards developed for District Hospitals, Community Health Centers, Primary Health Centers and Sub Centers. Various Quality models followed in country Viz. ISO 9001:2008, FFHI, KASH, NABH etc. Launch of Operational Guidelines for Quality Assurance in public Healthcare facilities and National Quality Assurance Programme 2005 2007 2008-12 2013 onwards

13. Organizational structure UPHC Bannimantap UPHC N.H Palya UPHC Saraswathipuram Subcentres- Alaganchi & Belavadi NQAS Certified in Mysuru

14. Challenges in health sector Underfunded public health system. High and prohibitive out of pocket expenditure. Poor distribution of skilled manpower. Poor quality services in public health system. Poor community participation. People’s needs different from what system offers. Large unregulated private sector. Unwillingness to look for structural change and governance reform.

15. Major Milestones so far 1992 – Child survival and Safe Motherhood Programme(CSSM). 1997 – RCH1. 2005 – RCH2. 2005 – National Rural Health Mission. 2013 – RMNCH+A Strategy. 2013 – National Health Mission. 2015 – India Newborn Action Plan .

16. CSSM was further enhanced by launching of RCH1 in 1997

17. Government felt the need to integrate all ongoing health programme into one programme and consolidate the work being done by other departments under NRHM NRHM encompasses – RCH – II including immunization All individual disease control programme Flexi-pool as per requirement of the State Convergence with other departments like AYUSH, Water Supply and Sanitation, Nutrition, Woman and Child Development, Rural Development and Panchayats

18. NRHM Inaugurated on 12 April , 2005 Increase spending on health from 0.9% of GDP to 2-3% of GDP Correct the deficiencies of the health system Focus on 18 states – northern and eastern Goal is good decentralized healthcare Missionary approach by government. Intended for 2005 – 2012 but due to its remarkable achievement and remaining work it has been extended to 31 st March 2017.

19. Goals of the NRHM Mission 22 • Universal Health care, well functioning health system. • Reduce IMR to 30/1000 live births by 2012 • Reduce MMR to 100/100,000 live births by 2012 • TFR reduced to 2.1 by 2012 • Reduce & sustain Malaria Mortality to 60% by 2012 • Kala Azar eliminated by 2010, • Filaria reduced by 80 % by 2010 • Dengue Mortality reduced by 50% by 2012 • TB DOTS maintain over 70 % case detection & 85% cure rate • 46 lakh cataract operations annually by 2012. • Upgrading all health facilities to IPHS. • Increase utilization of FRUs from 20% bed occupancy to 75%

20. Coverage The NRHM covers the entire country, with special focus on 18 states where the challenge of strengthening poor public health systems is the greatest. These are Uttar Pradesh, Uttarakhand , Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Odhisha , Rajasthan, Himachal Pradesh, Jammu and Kashmir, Assam, Arunachal Pradesh, Manipur, Meghalaya, Nagaland, Mizoram, Sikkim and Tripura.

21. BLOCK LEVEL HOSPITAL 30-40 Villages Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; BLOCK LEVEL HEALTH OFFICE –--------------- Accountant CLUSTER OF GPs – PHC LEVEL 3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c ; Ayush Doctor; Emergencies that can be handled by Nurses – 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic VILLAGE LEVEL – ASHA, AWW, VH & SC ASHAs, AWWs in every village; Village Health & Nutrition Day Drug Kit, Referral chains 100,000 Population 100 Villages 5-6 Villages Accredit private providers for public health goals Health Manager Store Keeper NRHM – ILLUSTRATIVE STRUCTURE

22. Challenges of urban health care Poor households not knowing where to go to meet health need Weak and dysfunctional public system of outreach Contaminated water, poor sanitation Poor environmental health, poor housing Unregistered practitioners first point of contact – use of irrational and unethical medical practice Community organizations helpless in health matters Weak public health planning capacity in urban local bodies Large private sector but poor cannot access them Problems of targeting the poor on the basis of BPL card

23. continue No convergence among wider determinants of health No system of counselling and care for adolescents Problems of unauthorized settlements Over congested secondary and tertiary facilities and under utilized primary care facilities. Problem of drug abuse and alcoholism Many slums not having primary health care facility High incidence of domestic violence No norms for urban health facilities

24. NUHM So After success of NRHM , the government expanded the scope of health service in towns On 1st May 2013, The Union Cabinet vide its decision and has approved the launch of National Urban Health Mission (NUHM),

25. Main Aims of NUHM Urban poor population living in listed and unlisted slums. Other vulnerable population. Public health thrust on sanitation ,clean drinking water ,vector born disease control. Strengthen the public health capacity of urban bodies Seven Metropolitan cities-municipal cooperation-NUHM Urban health delivery system-U PHC, UCHC Out reach services- ANM ,Female Health Worker Effective participation of community in planning and management through ASHA and link workers through creation of community based institution like MAHILA AROGYA SAMITI (MAG)

26. National Health Mission NRHM and NUHM were combined under overall umbrella of National Health Mission NHM envisages “Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people’s needs, with effective inter- sectoral convergent action to address the wider social determinants of health

27. Goals of the NRHM GOALS OF NHM 1. Universal Health care, well functioning health system. Reduce IMR to 30/1000 live births by 2012 3. Reduce MMR to 100/100,000 live births by 2012 4. TFR reduced to 2.1 by 2012 5. Reduce & sustain Malaria Mortality to 60% by 2012 6. Kala Azar eliminated by 2010, Filaria reduced by 80 % by 2010 7. Dengue Mortality reduced by 50% by 2012 8. TB DOTS maintain over 70% case detection & 85% cure rate 9. 46 lakh cataract operations annually by 2012. 10. Upgrading all health facilities to IPHS. 11. Increase utilization of FRUs from 20% bed occupancy to 75%

28. KEY FEATURES OF NHM

29. 1. Range and delivery of services Prioritize achievement of universal coverage for Reproductive Maternal, Newborn, Child Health and Adolescents (RMNCH+A) services, National Disease Control and Non Communicable Diseases programmes in rural and urban areas. Go beyond maternal and child survival to ensuring quality of life for women and children. Expand focus from child survival to development of all children 0-18 years through a mix of Community, Anganwadi and School based health services. Build an integrated network of all primary, secondary and a substantial part of tertiary care, providing a continuum from community level to the district hospital, with robust referral linkages to tertiary care strengthening the Primary Health Care System including outreach services in urban slums.

30. Converge with Ministry of Women & Child Development and other related Ministries for effective prevention and reduction of under-nutrition in children aged 0-3 years and anemia among children, adolescents and women • and provision of safe drinking water and sanitation

31. 2.Equity Plan for differential financial investments and technical support to states, districts and cities, with focus on higher proportions of vulnerable population. Ensure increased access and utilization of quality health services to minimize disparity on account of gender, poverty, caste, other forms of social exclusion and geographical barriers.

32. Address shortages of skilled workers in remote, rural areas, urban slums, and other under-served pockets through appropriate monetary and non-monetary incentives. Reduce out of pocket expenditure on health care, eliminate catastrophic health expenditures . provide social protection to the poor against the rising costs of health care through cashless services delivered by public health care facilities, supplemented by contracted-in private sector facilities where-ever necessary.

33. 3.Health system strengthening Support and supplement state efforts to undertake sector wide health system strengthening through the provision of financial and technical assistance; incentivize States to undertake health sector reforms that lead to greater efficiency and equity in health care delivery . Improve Public Health Management by encouraging states to create public health cadre, strengthening/ creating effective institutions for programme management providing incentives for improved performance and • building high quality research and knowledge management structures.

34. Empower the ASHA to serve as a facilitator, mobilizer of community level care. Ensure Quality Assurance for improved credibility of public health services. Strengthen Health Management Information Systems (HIMS) as an effective instrument for programme planning and monitoring, supplemented by annual district level surveys and a strong disease surveillance system. Ensure universal registration of births and deaths with adequate information on cause of death, so to assist health outcome measurements and health planning.

35. Create mechanisms to strengthen Behaviour Change Communication efforts for preventive and promotive health functions and social determinants. Mainstream AYUSH, to enhance choice of services for users using local health care traditions. Develop effective partnerships with not-for-profit, Non Governmental Organizations in all aspects of health care and with the for-profit, private sector to bring in additional capacity where needed to close gaps or improve quality of services.

36. 4.Program management 1. Improve Program management structures at state, district, city, block and facility levels. 2. Involvement of Panchayati Raj Institutions (PRIs) /Urban Local Bodies (ULBs) 3. People’s organizations such as the Village Health Sanitation and Nutrition Committees (VHSNC) and Mahila Arogya Samitis (MAS) for convergent inter- sectoral planning and monitoring. Build state, district and city capacity for decentralized outcome based planning and implementation, based on varying diseases burden scenarios, and using a differential financing approach. There will be a focus on results and performance based funding

37. Enable integrated facility development planning which would include infrastructure, human resources, drug supplies, quality assurance, and effective Rogi Kalyan Samitis (RKS). Incentivize good performance of both facilities and providers. Create a District Level Knowledge Center within each District Hospital to serve as the hub for a range of tasks that includes, provision of secondary and selected elements of tertiary care, being the site for skill based training for all cadres of health workers, collecting and analyzing data and coordinating district planning.

38. NHM Main Approaches

39. Key components of nhm

40. Community Partnership V ill age level planning ASHA Village Health & Nutrition Days Village Health & Sanitation Committees Increased involvement of PRIs System strengthening Infrastructure development Monitoring through computerisation Improved financial management & Human Resource Public Private Partnership Telemedicine Mobile Medical Units Intra & inter sectoral convergence 24-Hour- delivery services Emergency Obstetric Services Specialist Services – On call/contract Immunization strengthening IMNCI Adolescent health Family welfare services RMNCH A+ Improved services Accessibility, Approachability and Quality

41. Major initiatives under NHM:

42. ASHA More than 8.96 lakh Accredited Social Health Activists (ASHAs) are in place across the country and serve as facilitators, mobilizers and providers of community level care. ASHA is the first port of call in the community. ASHA has been a key figure in contributing to the positive outcomes of increases in institutional delivery, immunization, active role in disease control programmes and improved breastfeeding and nutrition practices.

43. Rogi Kalyan Samiti Patient Welfare Committee / Hospital Management Society is a simple yet effective management structure. This committee is a registered society whose members act as trustees to manage the affairs of the hospital and is responsible for upkeep of the facilities and ensure provision of better facilities to the patients in the hospital. Financial assistance is provided to these Committees through untied fund . 30,338 Rogi Kalyan Samitis (RKS) have been set up involving the community members in almost all (DHs), (SDHs) (CHCs) and(PHCs) till date.

44. The Untied Grants to Sub- Centres The SCs are far better equipped now with Blood Pressure measuring equipment, Hemoglobin ( Hb ) measuring equipment, stethoscope, weighing machine etc. This has facilitated provision of quality antenatal care and other healthcare services.

45. Village Health Sanitation and Nutrition Committee (VHSNC) is an important tool of community empowerment and participation at the grassroots level to address issues of environmental and social determinants. VHSNC membership includes panchayati raj representatives, ASHA & other frontline workers, and also representatives of the marginalized communities. Capacity building of the VHSNC members with regards to their roles and responsibilities including public service monitoring and planning .

46. Janani Suraksha Yojana (JSY) Mother Security Scheme Launched on 12 April 2005 aims to reduce maternal mortality among pregnant women by encouraging them to deliver in government health facilities. cash assistance is provided to eligible pregnant women for giving birth in a government health facility.

47. Janani Shishu Suraksha Karyakarm (JSSK) Launched on 1st June, 2011 entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery, including caesarean section. The free entitlements include free drugs and consumables, free diagnostics, free diet during stay in the health institutions, free provision of blood, free transport from home to health institution, between health institutions in case of referrals and drop back home and exemption from all kinds of user charges. Similar entitlements are available for all sick infants ( upto 1 year of age) accessing public health institutions.

48. Facility Based Newborn Care Newborn care components ensuring that every newborn receives essential care right from the time of birth and first 48 hours at the health facility and then at home during the first 42 days of life. Newborn Care Corners (NBCCs) are established at every delivery points to provide essential newborn care at birth, Special Newborn Care Units (SNCUs) at District Hospital/Medical College and Newborn Stabilization Units (NBSUs) at FRUs provide care for sick newborns.

49. Universal Immunization Programme (UIP) Immunization Programme in India was introduced in 1978 as Expanded Programme of Immunization (EPI). The programme gained momentum in 1985 and was expanded as Universal Immunization Programme (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90. UIP become a part of Child Survival and Safe Motherhood Programme in 1992. Since, 1997, immunization activities have been an important component of National Reproductive and Child Health Programme and is currently one of the key areas under National Rural Health Mission (NHM) since 2005. It targets to vaccinate 2.7 crore new born and 3 crore pregnant mothers annually Under the Universal Immunization Programme , Government of India is providing vaccination to prevent eight vaccine preventable diseases nationally, i.e. Diphtheria, Pertussis , Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B and meningitis & pneumonia caused by Haemophilus influenza type B, and against Japanese Encephalitis in selected districts.

50. this programme is placed under the Ministry Of Health and Family Welfare,. provides all the technical assistance required to undertake the activities under UIP. reviews the state Program implementation plans and facilitates in its approval process as per norms and guidelines The key roles of this division include activities related to Routine Immunization, Campaigns (SIAs) such as Polio Monitoring Adverse Events Following Immunization (AEFI), Vaccine and Cold Chain Logistics, Strategic communication related to immunization program and trainings related to Immunization Program. t facilitates the National Technical Advisory Group on Immunization (NTAGI) to review and ecommend its views on various technical and programmatic issues related to mmunization such as new vaccine introduction etc

51. National Mobile Medical Units (NMMUs) To increase visibility, awareness and accountability, all Mobile Medical Units have been repositioned as “National Mobile Medical Unit Service” with universal colour and design.

52. National Ambulance Services (NAS) People can dial 108 or 102 telephone number for calling an ambulance. 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. JSSK entitlements e.g. free transport from home to facility, inter facility transfer in case of referral and drop back as mother and children are the key focus of 102 service. This service can be accessed through a toll free call to a Call Centre.

53. Mainstreaming of AYUSH: Mainstreaming of AYUSH has been taken up by allocating AYUSH facilities in PHCs, CHCs, DHs, health facilities above SC .

54. Mother and Child Tracking System It is a name based tracking system, launched by Ministry of Health & Family Welfare, as an innovative application of information technology directed towards improving the healthcare service delivery system and strengthening the monitoring mechanism. MCTS is designed to capture information on and track all women and children (0-5 Years) so that they receive ‘full’ maternal and child health services and thereby contributes to the reduction in maternal, infant and child morbidity and mortality. MCTS relies heavily on information technology tools and techniques and promotes its usage by grass roots level health service providers. MCTS is a centralized web based application, which facilitates in real time entry of the information related to pregnant women and children and subsequent healthcare services provided to them.

55. NEW INITIATIVES

56. India Newborn Action Plan (INAP) Was launched by Hon’ble Union Minister of Health and Family Welfare, on 18th September, 2014 in New Delhi. It outlines a targeted strategy for accelerating the reduction of preventable newborn deaths and stillbirths in the country. INAP defines the latest evidence on effective interventions which will not only help in reducing the burden of stillbirths and neonatal mortality, but also maternal deaths. it is expected that all stakeholders working towards improving newborn health in India will work towards attainment of the goals of “Single Digit NMR by 2030” and “Single Digit SBR by 2030. The INAP will be implemented within the existing RMNCH+A framework and guided by the principles of Integration, Equity, Gender, Quality of Care, Convergence, Accountability and Partnerships.

57. Mission Indradhanush Launched on 25th December, 2014, this seeks to drive towards 90% full immunization coverage of India and sustain the same by year 2020. The objective of Mission Indradhanush is to fully immunize more than 89 lakh children who are either unvaccinated or partially vaccinated those that have not been covered during the rounds of routine immunization for various reasons Vaccination will be provided against seven vaccine preventable diseases, i.e. diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis-B. In addition, vaccination against Japanese Encephalitis and Haemophilus influenza type b were provided in selected districts/states of the country. Pregnant women were also be immunised against tetanus. Four special vaccination campaigns, of more than a week, from April to July 2015 were conducted, starting from 7th of each month, with intensive planning and monitoring of these campaigns. As per the data available, during the four rounds of Mission Indradhanush , 9.4 lakh sessions were held, during which 1.89 crore vaccines were administered to the children and pregnant women.

58. Intensified Diarrhoea Control Fortnight (IDCF) Was launched by Hon’ble Union Minister of Health and Family Welfare, on 28 th July, 2014 in New Delhi. IDCF comprised of a set of activities implemented in an intensified manner from 28th July to 8th August 2014 to prevent deaths due to childhood diarrhoea across all districts of all States & UTs. These activities mainly include- Intensification of advocacy activities, Awareness generation activities, Diarrhoea management service provision, establishing ORS-Zinc Corners, ORS distribution by ASHA, Detection of undernourished children and their treatment and promotion of Infant and Young Child Feeding activities.

59. Rashtriya Bal Swasthya Karyakram (RBSK) This initiative was launched in February, 2013 and provides for Child Health Screening and Early Intervention Services through early detection and management of 4 Ds i.e Defects at birth, Diseases, Deficiencies, Development delays including disability. RBSK Mobile Health Teams and Districts Early Intervention Centre have been approved.

60. Rashtriya Kishor Swasthya Karyakram (RKSK): This initiative was launched in January, 2014 to reach out to 253 million adolescents in the country in their own spaces and introduces peer-led interventions at the community level, supported by augmentation of facility based services. This initiative broadens the focus of the adolescent health programme beyond reproductive and sexual health and brings in focus on life skills, nutrition,injuries and violence (including gender based violence), non-communicable diseases, mental health and substance misuse.

61. Mother and Child Health Wings (MCH Wings) 100/50/30 bedded Maternal and Child Health (MCH) Wings have been sanctioned in public health facilities with high bed occupancy to cater to the increased demand for service.

62. Free Drugs and Free Diagnostic Service Extremely high Out of Pocket expenditure on healthcare due to high cost of drugs and diagnostics have proved to be a deterrent in provision of accessible and affordable healthcare for all. So Ministry of India introduced an incentive to the extent of 5% of the state’s Resource Envelope under NHM for those states that implemented free essential drugs scheme for all patients accessing public health facilities For Free Drug and Free Diagnostics Service Initiative, substantial funding is being provided to these states . National Iron+ Initiative is another new initiative to prevent, control and treats iron deficiency Anemia comprehensively across all life stages, a grave public health challenge in India. Besides pregnant women and lactating mothers , IFA supplementation is provided to children, adolescents and women in reproductive age group. Albendazole tablets for dewormings is also provided to children.

63. Reproductive, Maternal, Newborn, Child and Adolescent Health services A continuum of care approach has now been adopted under NHM with the articulation of strategic approach to Reproductive Maternal, Newborn, Child and Adolescent health(RMNCH + A) in India. This approach brings focus on adolescents as a critical life stage and linkages between child survival, maternal health and family planning efforts. It aims to strengthen the referral linkages between community and facility based health services and between the various levels of health system itself.

64. Delivery Points (DPs): Health facilities that have a high demand for services and performance above a certain benchmark have been identified as “Delivery Points” with the objective of providing comprehensive reproductive, maternal, newborn, child and adolescent health services (RMNCH+A) services at these facilities. Funds have been allocated to strengthen these DPs in terms of infrastructure, human resource, drugs, equipments etc.

65. “ Pradhan Mantri Surakshit Matritva Abhiyan ” as we know that main aim and objective of NHM is to reduce maternal mortility . India has made considerable progress on this front over last 10 yrs with implementation schemes like JSSK ,JSY Institutional deliveries has increased to 78.7%( RSOC) inspite of this there are still only 61.8%s pregnant female who receive Ist ANC and only 19.7% receive full ANC coverage So to provide quality ANC to every pregnant woman Government of India has launched the (PMSMA), a fixed day ANC s given on 9 th of every month across the country. This is given in addition of the routine ANC at the health facility

66. Pradhan mantri surakshit maitritva abhiyan

67. Universal Health Coverage (UHC) UHC is a key goal of the 12th Plan. The National Health Mission is the primary vehicle for quality assurance The road map for QA envisages development of a robust institutional mechanism within the states to make States self- sufficient and to have more sustainable system than are existing in systems. 8 major areas of concerns- Service provision, Patient right, Inputs, Support Services, Clinical Services, Infection Control, Quality Management and Outcome have been identified. Standards have been developed for each area of concern and detailed checklist has been laid down to ensure conformance to these standards. All Public Health Facilities would be assessed, and Quality score is given . Besides clinical care, due weightage has been given to issues of patients, right, confidentiality, privacy, compliance to National Health Programme Guidelines, cleanliness at health facilities, etc. The facilities having a credible system of quality assurance (verified through district & state assessment) would be assessed for National Level Certification. These facilities would be given incentives and QA certification.

68. HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) It was launched in October 2008 It is a web-based Monitoring system that has been put in place by the Ministry to monitor its health programmes and provide key inputs for policy formulation and interventions. To make HMIS more robust, effective and in order to facilitate local level monitoring, all States/UTs were requested to shift to “facility based reporting” from April, 2011. At present, 633 districts are reporting facility wise data. The data is being made available to various stakeholders in the form of standard & customized reports, factsheets, scorecards etc. HMIS data is widely used by the Central/State Government officials for monitoring and supervision purposes. Ministry of Health & Family Welfare ( MoHFW ) is also conducting periodic review Meetings, Workshops, Training etc. to discuss Data Quality.

69. NGO Guidelines The new guidelines envisage greater state ownership for NGO led programmes and are intended to provide a broad framework to the States to partner with NGOs and facilitate their participation in capacity building, support for community processes service delivery, develop innovations through researchs and documentation advocacy and for supplementing capacities in key areas of the public health system to improve healthcare service delivery.

70. Other Programmes under NHM National Vector Borne Diseases Control Programme (NVBDCP) Revised National Tuberculosis Control Programme (RNTCP) National Leprosy Control Programme (NLEP) Integrated Disease Surveillance Programme (IDSP) National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) National Programme for the Control of Blindness (NPCB) National Mental Health Programme (NMHP) National Programme for the Healthcare of the Elderly (NPHCE) National Tobacco Control Programme (NTCP) National Oral Health Programme (NOHP) National Programme for Palliative Care (NPPC) National Programme for the Prevention and Management of Burn Injuries (NPPMBI) National Programme for Prevention and Control of Fluorosis (NPPCF):

71. FUNDING UNDER NATIONAL HEALTH MISSION (NHM) NHM is a major instrument of financing and support to the states to strengthen public health systems and healthcare delivery. This financing to the states are based on the State’s Programme Implementation Plan (PIP).

72. Six financing components NRHM-RCH Flexipool , NUHM Flexipool Flexible pool for Communicable disease Flexible pool for Non communicable Infrastructure Maintenance Family welfare Central sector component

73. Financial Management Personnel

74. The Budgetary outlays & Expenditure of NHM for the Financial Years 2013-14 and 2014-15

75. INSTITUTIONAL ARRANGEMENTS

76. NHM HEALTH INFRASTRUCTURE AND INSTITUTIONS OF GOVERNANCE

77. OBJECTIVES Reduce MMR to 1/1000 live births Reduce IMR to 25/1000 live births Reduce TFR to 2.1 Prevention and reduction of anaemia in women aged 15-49 years Prevent and reduce mortality & morbidity from communicable, noncommunicable; injuries and emerging diseases Reduce household out-of-pocket expenditure on total health care expenditure Reduce annual incidence and mortality from Tuberculosis by half Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts Annual Malaria Incidence to be <1/1000 Less than 1 per cent microfilaria prevalence in all districts Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks STRATEGIES RMNCH+A, JSK, e-PMSMA JSSK, RBSK, Facility based newborn care, IMNCI Mahila Arogya Samiti Anemia Mukt Bharath National Deworming Day, Larva survey National Ambulance Scheme, National Mobile Medical Units Anti TB drug resistance survey NLEP NVBDCP