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NRHM: Time to Take Stock

NRHM: Time to Take Stock. Sharma AK. National rural health mission: Time to take stock. Indian J Community Med 2009 Dec ;34:175-82. Introduction:. The poor performance of the Indian Public Health System is widely acknowledged.

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NRHM: Time to Take Stock

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  1. NRHM: Time to Take Stock Sharma AK. National rural health mission: Time to take stock. Indian J Community Med 2009 Dec ;34:175-82.

  2. Introduction: • The poor performance of the Indian Public Health System is widely acknowledged. • By the end of 2008, NRHM has lived half of its life. It is the right time to take stock . • Core objective - To create fully functional health facilities within the public health system.

  3. Five principles of structural correction • Setting norms and standards and achieving service guarantees, • Innovations in the human resource development for the health sector • Increasing participation and ownership by the community, • Improving the management capacity and • Flexible financing.

  4. 1. Infrastructure and Preparedness of Health Facilities • 24 x 7 health facilities - at 12166 units (include SHCs, PHCs, CHCs): 58% of these are in the non high focus large and small states. • Last 3 years , the no. of PHCs with 24 x 7 facilities -1263 to 6397 (506%)and CHCS- 980 to 2469 (251%)and the high focus non NE states have recorded 500% growth. Mobile medical units (MMUs) - 243 of the 623 districts(39%).

  5. Case load handling by the health system.

  6. Quality of services: • Quantitative improvement in services having been achieved in a majority of the states, the quality needs scrutiny. • Episiotomy is performed by AYUSH doctors who are not trained in surgical skills.

  7. 4. Diagnostics and Drugs: • Basic drugs have been made available up to the SHC and PHC level in most places. However, AYUSH doctors are not provided with AYUSH medicines. 5. Human Resource Planning : • Acute shortage of all categories of staff in health sectors across the length and breadth of the nation. • Lack of specialist doctors, laboratory technicians, and male health workers. • Multi-skilling and multitasking is being talked about, but could not be seen.

  8. ASHA: The ASHA quarterly newsletter, ASHA sammelan, and annual ASHA awards are the highlights of the ASHA-related activities in Uttar Pradesh.The ASHA support system and ASHA mentoring group is being formulated.

  9. 7. Community Processes Including Community Participation: • Rogi kalyansamitis : DH-565, CHCs-3912, PHC-16628, others-1995. In large states like Uttar Pradesh the participation of the Panchayati Raj Institutions (PRIs) is not very encouraging. • Lack of political will and an attitude of indifference prevails. Meetings of VHSC are not held regularly and the RKS are also not very proactive in participating in the activities of the health institutions. • Lack of awareness and motivation has led to minimal community participation. • It appears to be an uphill task to initiate a social audit at the village level.

  10. 8. Difficult Areas and Vulnerable Groups: • Mobile medical units and 'difficult area allowance‘ Monetary incentives and faster promotions . • In Maharashtra, an additional stipend of Rs. 1000 per month is given for working in tribal areas, and an additional payment of Rs. 1500 is given to ANMs, for working in insurgency affected areas of the Nagpur division. • 9. Information Systems and Record Maintenance • Integrated Disease Surveillance Project (IDSP) and Health Management Information System (HMIS) were aimed at documentation and flow of data. Tamil Nadu and Maharashtra have good computerized HMIS systems.

  11. Innovations in Implementation JananiSurakshaVahini (KA) Mamta Friendly Hospital Initiative (DL) Safe motherhood Birth waiting rooms (AP) Saubhagyawati scheme (UP) Ayushmati and VandeMataram scheme (WB) Chiranjeeviyojana (GJ) Janani Express Yojana (MP)

  12. BalshaktiYojana 10.3. Adolescent reproductive and sexual healthSaathiya Youth Friendly Project in Uttar Pradesh strengthens provider knowledge and skills on contraception and sexual health for out-of-school girls at youth information centers. Kano parbona Immunization Panchamritcampain Ankur Project

  13. 10.4 Behavior change communication Goliki hamjoli-7 states in north BodhanaNauka in Kerala Bindassbol – 9 states Saathibachapanke-Ors AadarshDampatiSamman in UP

  14. 10.5. Gender mainstreaming • In Karnataka ,special provisions in the budget for needs of adolescent girls, pregnant, and lactating women in tribal districts. • TheBhagyaLakshmi scheme in Karnataka and Ladli scheme in Delhi gift Rs. 10000 in the form of fixed deposit. 10.6. Service delivery for RCH • Services in the difficult-to-reach areas : Mobile Health Clinics in seven states, mobile boat clinics in Assam, Mobile Helicopter services for remote inaccessible areas in Tripura, and floating dispensaries in the Narmada basin of Maharashtra. • Social franchising networks : Distribution of contraceptives in Karnataka, Uttar Pradesh, Jharkhand, and Uttarakhand.

  15. 10.7. Program management : • Decentralized clinical training and post training supervision of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) trained personnel by (NGOs); community and panchayat involvement. • Improvements of procurement and finance systems e.g. Tamil Nadu and Kerala Medical Services Corporation as a drug management and supply system, e-banking for fund management in Kerala and Debit cards for ASHAs.

  16. Conclusion: • NRHM in its endeavor to improve healthcare delivery system in rural India may be considered as a paradigm shift in the way healthcare delivery is to be executed. • In spite of the supply of computers and availability of internet links, data management and information flow to and from the peripheral levels is still very poor. • The future of the mission appears promising as a political will, hard work, and professional managerial approach will help cross the hurdles and accomplish the mission.

  17. Innovative schemes under NRHM in Wardha District: • CUG scheme: • The central server is installed at DHO office and is receiving SMS from the field staff & the HRIS updated. • Inventory control: Install an Application Software for Inventory Control and Stock Management at District Warehouse and 27 PHCs in 8 (eight) blocks of Wardha district. • ArogyaUdyan in Wardha district • Human resource development: - ASHA- 967, AYUSH -10 • School health check up program: - out of 153026 student and 133153 were examined (87%).

  18. VHNSC : -formed in the 870 villages out of 967 villages. • JananiSurakshaYojana : - beneficiaries- 3621 • CDC: In 17 PHCs CDC were established, 202 grade III ,IV & (-3) sd. malnourished children were admitted in CDC for 21 days. The change in gradation of these malnourished children were 204 (88%). While in the second term 193 (76 %) children improved in the camp taken in Nov. & Dec. 08. • ARSH: 65000 adolescent girls - sanitary Napkins provided to the adolescent girls for the period of two months totally free of cost and thereafter at minimal price through these depots.

  19. Thanks…....

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