National Rural Health Mission: Convergence with ICDS

1. National Rural Health Mission: Convergence with ICDS

2. National Rural Health Mission • The Prime Minister launched a National Rural Health Mission on 12th April 2005. • The Mission is for a period of 7 years (2005-12). • The Outlay for NRHM for 2005-06 is over Rs.6700 crore. • High focus on 18 States (8 EAG, 8 North East, Jammu & Kashmir and Himachal Pradesh) • Reproductive and Child Health Programme (RCH-II) is an important component of NRHM

3. Reproductive Child Health Programme RCH-II is the Flagship programme under NRHM. Its strategies include: • Maternal Health – Institutional deliveries EmOC, BCC, Mobilization Strategies, improved coverage and quality of ANC, skilled care to Pregnant women, Post -partum care at Community level. • Child health - UIP, IMNCI • Population Stabilization – contraceptive choice, private sector intervention, stimulating demand for FP services • Urban and tribal health – similar initiatives with special focus disadvantages

4. NRHM Goals • To provide effective health care to rural population (especially for Women & Children). • Improve access to health care. • Enable community ownership and demand for services. • Strengthen public health system for efficient service delivery. • Enhance equity and accountability. • Promote decentralization. • Mainstream AYUSH. • Integration with other sectors (ICDS, Sanitation, Drinking water ) • Focus to change from Outlays to Outcomes.

5. NRHM – The Concept Health Health Determinants RCH-II NDCP Sanitation & Hygiene Nutrition Drinking Water Supply General Curative Care AYUSH

6. Institutional Framework National Steering Group Mission Steering Group Empowered Programme Committee Mission Directorate State Health Mission District Health Mission ------------Rogi Kalyan Samitis Panchayat Village Health Committee Village Health Committee Village Health Committee

7. Core Strategies • Train and enhance capacity of PRIs to own, control and manage public health services. • Promote access to healthcare to household through the female Accredited Social Health Activist (ASHA). • Health Plan for each village. • Untied fund for Sub-centre. • Upgrading all CHCs to Indian Public Health Standards. • Integrating relevant vertical Health and Family Welfare programmes at National, State and District levels. • Mainstreaming AYUSH. – revitalizing local health traditions.

8. Intersectoral Convergence under NRHM • Mission Steering Group chaired by Union Minister for Health and Family Welfare. Dy. Chairman, Planning Commission, Minster for HRD, PR & Rural Development members. • Empowered Programme Committee has representatives from cognate Ministries - DWCD,PR, RD, NE and AYUSH • Committee on Intersectoral Convergence constituted under Mission Director. • Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. • Theme Papers on Convergence shared with DWCD, PRI TSC, NACO • In-principle agreement on NRHM framework • Common strategy being evolved for IEC & Training among DWCD, DoHFW & PR

9. ASHA under NRHM • Community based functionary - a change agent of health in a village. • First port of call for any health related demand. • Create awareness and provide information to the community. • Counsel women on birth, safe delivery, breast feeding etc.

10. ASHA under NRHM (II) • Mobilize the community and facilitate health related services. • Work with the village health and sanitation committee of Gram Panchayat. • Arrange escort / accompany pregnant women and children requiring any health services. • Provide primary medical care. • Will be equipped with Drug Kit • Promote construction of household toilets under Total Sanitation Campaign.

11. Village Level Convergence under NRHM • Anganwari to be hub of mother and child care activity at village level • Village Health Team: ANM, AWW, ASHA, SHG etc. under Village Health & Sanitation Committee of the Gram Panchayati • Monthly Health Camp at Anganwari to promote ANC, PNC, Universal Immunisation, Nutrition, Micronutrient supplementation – ASHA to support AWW in mobilising pregnant women and infants. • AWW to be the Mentor for ASHA • AWW will be the depot holder for drug kits and will be issuing them to ASHAs.

12. Micronutrient Deficiency • Micronutrients of Public Health significance: Iron, Iodine, Vitamin A & Zinc • Three strategies for correcting micronutrient deficiencies are: * Supplementation * Fortification * Dietary diversification 3) Convergence between ICDS & Health and Family Welfare important for strategies on dietary diversification and supplementation.

13. Government Programmes for Nutrition Intervention • Integrated Child Development Scheme (ICDS) • Mid Day Meal Programme (MDMP) • Wheat Based Programme (WBP) • Reproductive and Child Health Programme for Iron Folic Acid and Vitamin ‘A’ supplementation. • National Iodine Deficiency Disorders Control Programme (NIDDCP) • Pilot Programme against Micronutrient Malnutrition for School children, adolescents etc introduced in 1995 - to assess levels of Iron, Vitamin A and Zinc deficiency. • Notification to ban sale of non-iodated salt issued on 27.5.2005

14. Micronutrient Programmes and Convergence under RCH & ICDS • Vitamin ‘A’ Deficiency • The AWW / ASHA to bring children to Anganwadi Centres or health Sub-centres for supplementation of Vitamin ‘A’ by ANM. • ANM, ASHA and AWW to create awareness about vitamin ‘A’ deficiency.

15. IRON DEFICIENCY ANAEMIA • AWW / ASHA & ANM to distribute iron folic acid tablets to pregnant and lactating mothers. • Educate the consequences of anaemia. • Awareness about regular consumption of fruits and vegetables. • Promote good food habits.

16. IODINE DEFICIENCY DISORDERS • AWW, ASHA / ANM to educate public about various iodine deficiency disorders. • Promote regular consumption of iodated salt. • Demonstrate qualitative testing of house hold salt.

17. OPPORTUNITIES OF CONVERGENCE WITH DWCD AND MOH&FW • Mutual Institutional support by both the Ministries for Women and Child programme • Capacity building of functionaries of both departments. • Identification and training of village level community workers. • Joint training of health and ICDS functionaries and usage of common facilities. • Fixed health and nutrition days block level resource mapping organised jointly by AWW/ANM/ASHA • Village Health Plan to include ICDS/Health components • Community based monitoring system for ICDS and health programmes.

18. Immediate Action Points • Expression of general support for NRHM particularly the ASHA to be mentored by the Anganwari system. • State level meeting between Secretary HFW and DWCD and issuance of Guidelines on common goals for NRHM and National ICDS program • Guidelines for Common Training Program • Setting up of State Level Task Force for Common IEC Strategy. • Setting up Convergence Mechanism between Institutes of Training of DWCD and HFW for development of common training material, programme, curriculum etc. • Discussion about financial compensation to AWW for mentoring role. • Physical infrastructure at Anganwari by Health Sector • Preparation of District Plan for Health and Nutrition • Quarterly Joint Review Mechanism to monitor progress at all levels – Block, District, State and National

19. Medium Term Plan • Health Data System including e-moding to be made available to ICDS • Convergence of management of Stores, Training Institutions and Physical Infrastructure including residential colonies, fund flow, logistics and supplies for better efficiencies.

20. THANK YOU