National Rural Health Mission (NRHM) | General Awareness for SSC CGL PDF Download

Introduction

The National Rural Health Mission (NRHM), launched on April 12, 2005, by the Government of India, is a flagship initiative aimed at providing accessible, affordable, and quality healthcare to rural populations, with a special focus on underserved and marginalized communities. Administered by the Ministry of Health and Family Welfare, NRHM was integrated into the National Health Mission (NHM) in 2013, alongside the National Urban Health Mission (NUHM). The mission seeks to strengthen healthcare infrastructure, improve service delivery, and address health challenges like maternal and child mortality, communicable diseases, and malnutrition. It aligns with Sustainable Development Goal (SDG) 3 (Good Health and Well-being).

Objectives of NRHM

1. Improve Healthcare Access: Ensure equitable and quality healthcare services in rural areas.
2. Reduce Maternal and Child Mortality: Lower Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR) through targeted interventions.
3. Strengthen Health Infrastructure: Enhance rural health facilities, including Primary Health Centres (PHCs) and Community Health Centres (CHCs).
4. Promote Community Participation: Engage communities through health workers and village committees for better health outcomes.
5. Address Communicable and Non-Communicable Diseases: Prevent and manage diseases like tuberculosis, malaria, and diabetes.
6. Enhance Health Equity: Prioritize vulnerable groups, including women, children, SC/ST, and tribal populations.
7. Improve Health System Efficiency: Strengthen human resources, financing, and monitoring for effective service delivery.

Key Features of NRHM

Health Infrastructure Development:

• Upgradation of Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs).
• Establishment of District Hospitals and Mobile Medical Units (MMUs) for remote areas.
• Over 1.5 lakh Sub-Centres, 25,000 PHCs, and 5,000 CHCs operational as of 2023.

Accredited Social Health Activists (ASHAs):

• Community-based ASHA workers act as a link between rural communities and health systems.
• Over 10 lakh ASHAs trained to promote immunization, maternal care, and health awareness.

Janani Suraksha Yojana (JSY):

• Cash incentive scheme to promote institutional deliveries among pregnant women.
• Provides ₹1,400 (rural) and ₹1,000 (urban) for institutional deliveries in low-performing states.
• Benefited over 10 crore women since inception.

Janani Shishu Suraksha Karyakram (JSSK):

• Free delivery, cesarean, neonatal care, and transport for pregnant women and infants.
• Covers drugs, diagnostics, and hospital stay for up to 30 days post-delivery.

Immunization Programs:

• Universal Immunization Programme (UIP) for vaccines against diseases like polio, measles, and hepatitis B.
• Mission Indradhanush and Intensified Mission Indradhanush to achieve 90% immunization coverage.

Reproductive and Child Health (RCH):

• Focus on maternal health, child health, and family planning services.
• Programs like LaQshya for quality labor rooms and Rashtriya Bal Swasthya Karyakram (RBSK) for child health screening.

Financial Support:

• Flexible funding through Rogi Kalyan Samitis (RKS) for PHCs and CHCs.
• Shared funding between Central and State Governments (60:40 for general states; 90:10 for North-Eastern and Himalayan states).
• Budget of over ₹30,000 crore annually under NHM.

Community Participation:

• Village Health Sanitation and Nutrition Committees (VHSNCs) promote local health planning.
• Over 5 lakh VHSNCs operational, involving Gram Panchayats and community leaders.

Technology Integration:

• Health Management Information System (HMIS) for real-time monitoring of health indicators.
• Mobile apps like ANMOL for ASHA workers to track maternal and child health.
• Telemedicine and e-Hospital platforms for remote consultations.

Convergence with Other Schemes:

• Integration with Ayushman Bharat for health insurance and wellness centers.
• Collaboration with ICDS, Poshan Abhiyaan, and Jal Jeevan Mission for nutrition and water access.
• Linkages with Swachh Bharat Mission for sanitation and hygiene.

Implementation Structure

Central Level:

• Ministry of Health and Family Welfare oversees NRHM under the National Health Mission.
• National Health Mission Directorate coordinates policy, funding, and monitoring.
• Technical support from NITI Aayog, WHO, and UNICEF.

State Level:

• State Health Missions, led by Chief Secretaries, develop state-specific plans.
• Coordinate with districts for infrastructure and service delivery.

District Level:

• District Health Missions, led by District Collectors, implement programs and monitor progress.
• Manage PHCs, CHCs, and district hospitals.

Village/Community Level:

• ASHAs, ANMs (Auxiliary Nurse Midwives), and VHSNCs deliver services and promote awareness.
• Gram Panchayats ensure community participation.

Private Sector and NGOs:

• Partnerships for healthcare delivery, training, and infrastructure.
• CSR contributions for MMUs and health camps.

Key Achievements of NRHM

Health Outcome Improvements:

• Maternal Mortality Ratio (MMR) reduced from 254 (2004-06) to 97 (2018-20) per lakh live births.
• Infant Mortality Rate (IMR) decreased from 58 (2005) to 28 (2020) per 1,000 live births.
• Institutional deliveries increased from 40% (2005) to 89% (NFHS-5, 2019-21).

Infrastructure Expansion:

• Over 1.5 lakh Sub-Centres, 25,000 PHCs, and 5,000 CHCs upgraded or established.
• Over 1,000 Mobile Medical Units deployed in remote areas.

Immunization Coverage:

• Achieved 90% full immunization coverage for children under 5 (NFHS-5).
• Polio eradicated, and significant reductions in measles and diphtheria cases.

ASHA Workforce:

• Over 10 lakh ASHAs trained, serving as a critical link in rural healthcare.
• Improved maternal and child health outcomes through ASHA interventions.

Janani Suraksha Yojana:

• Benefited over 10 crore women, boosting institutional deliveries.
• Reduced neonatal and maternal mortality in high-focus states.

Disease Control:

• Significant reduction in communicable diseases like TB (25% decline) and malaria (50% decline).
• Non-communicable disease screening scaled up through Health and Wellness Centres.

Challenges of NRHM

Infrastructure Gaps:

• Shortage of functional PHCs and CHCs in remote and tribal areas.
• Inadequate equipment and facilities in some health centers.

Human Resource Shortages:

• Lack of doctors, nurses, and specialists in rural health facilities.
• High vacancy rates in PHCs and CHCs in certain states.

Service Delivery Issues:

• Irregular supply of drugs and diagnostics in rural areas.
• Limited access to emergency services in remote regions.

Awareness and Utilization:

• Low awareness of health schemes among rural populations.
• Cultural barriers affecting uptake of institutional deliveries and immunization.

Funding Constraints:

• Delays in fund disbursal from states affecting program implementation.
• Insufficient budgets for maintenance of health infrastructure.

Regional Disparities:

• Uneven progress in high-focus states like Bihar, Uttar Pradesh, and North-Eastern regions.
• Challenges in tribal and hilly areas due to logistical issues.

Recent Developments and Initiatives

Integration with Ayushman Bharat:

• NRHM merged into NHM, supporting 1.5 lakh Health and Wellness Centres under Ayushman Bharat.
• PMJAY integration for free hospital care to over 50 crore beneficiaries.

Mission Indradhanush:

• Intensified Mission Indradhanush 4.0 (2022) to vaccinate missed children and pregnant women.
• Covered over 5 crore children and women since 2014.

Digital Health Push:

• Expansion of e-Sanjeevani telemedicine for rural consultations (over 10 crore teleconsultations by 2023).
• HMIS and ANMOL apps upgraded for real-time health tracking.

Focus on Non-Communicable Diseases:

• Screening and management of diabetes, hypertension, and cancer scaled up in rural areas.
• Over 5 crore screenings conducted annually via Health and Wellness Centres.

Maternal and Child Health:

• Launch of SUMAN (Surakshit Matritva Aashwasan) for zero-cost maternal and neonatal care.
• LaQshya initiative improved 2,000+ labor rooms for quality delivery services.

Convergence with Other Schemes:

• Integration with Poshan Abhiyaan for nutrition support.
• Collaboration with Jal Jeevan Mission for clean water to reduce waterborne diseases.

Impact of NRHM

Health Impact:

• Significant reduction in MMR, IMR, and neonatal mortality.
• Improved immunization coverage and disease control.

Social Impact:

• Empowered women through JSY and JSSK, increasing institutional deliveries.
• Enhanced community participation via ASHAs and VHSNCs.

Economic Impact:

• Reduced healthcare costs through free services and insurance under Ayushman Bharat.
• Created jobs for over 10 lakh ASHAs and health workers.

Equity Impact:

• Improved healthcare access for SC/ST, tribal, and rural populations.
• Narrowed urban-rural health disparities.

Policy Impact:

• Strengthened India’s commitment to SDG 3.
• Set a global model for community-based rural healthcare.

Monitoring and Evaluation

Health Management Information System (HMIS):

• Tracks health indicators, service delivery, and infrastructure status.
• Monitors state and district-level progress.

Third-Party Audits:

• Evaluations by NITI Aayog, WHO, and independent agencies.
• National Family Health Surveys (NFHS) to measure health outcomes.

Community Monitoring:

• VHSNCs and Rogi Kalyan Samitis conduct social audits.
• Feedback through ASHA workers and community meetings.

Grievance Redressal:

• NHM helplines and online portals for complaints.
• District-level committees for quick resolution.

Conclusion

The National Rural Health Mission has been a transformative initiative in strengthening India’s rural healthcare system, significantly improving maternal and child health, immunization, and disease control. By upgrading health infrastructure, deploying ASHAs, and integrating with schemes like Ayushman Bharat, NRHM has reached millions of rural beneficiaries. Despite challenges like human resource shortages and regional disparities, recent advancements in digital health and convergence are enhancing its impact. NRHM continues to drive India’s vision of universal healthcare, ensuring equitable access and better health outcomes for rural communities.