Page 1 of 7
European Journal of Business &
Social Sciences
Available at https://ejbss.org/
ISSN: 2235-767X
Volume 07 Issue 01
January 2019
Available online: https://ejbss.org/ P a g e | 396
National Rural Health Mission: Issues and Challenges
PANKAJ ROHILLA
7988159263
jaigodsir@gmail.com
ABSTRACT The National Rural Health Mission aims at providing accessible, affordable, effective,
accountable, and reliable healthcare to all citizens and in particular to the poorer and vulnerable
sections of the population; consistent with the outcomes envisioned in the Millennium Development
Goals and general principles laid down in the National and state health policies. This programme has
put rural public health care firmly on the agenda, and is on the right track with the institutional
changes it has wrought within the health system. The present paper seeks to evaluate the performance
of service delivery in rural public health facilities under National Rural Health Mission. The concept
and working of NRHM has been discussed in brief. The historical development of health services in
Indian context has been explained. The problems and challenges being faced in the implementation
of this programme are highlighted.
______________________________________________________________________________
INTRODUCTION
India was one of the pioneers in health service planning with a focus on primary health care. In 1946,
the Health Survey and Development Committee, headed by Sir Joseph Bhose recommended
establishment of a well structured and comprehensive health service with a sound primary health care
infrastructure. In 1952 as a consequence of the Bhore Committees recommendation, Primary Health
Care Centers were established to promote, prevent, curate and rehabilitate the services to entire rural
population, as an integral component of wider Community Development Programme. The convulsive
political changes that took place in the 1970s impelled the Central Government to implement the
vision of Sokhey Committee of having one Community Health Worker for every 1000 people to
entrust ‘people health on people's hand'. India has come quite close to Alma Ata Declaration on
Primary Health Care made by all countries of the world in 1978. The Declaration included
commitment of governments to consider health as fundamental right; giving primacy to expressed
health needs of people; community health reliance and community involvement; Intersectoral action
in health; integration of health services; coverage of entire population; choice of appropriate
technology; effective use of traditional system of medicine; and use of only essential drugs. National
Health Policy was formed in 1982 to make architectural corrections in health care system. National
Health Policy gave a general exposition of the policies which require recommendation in the
circumstances then prevailing in health sector. The Universal Immunization Programme (UIP) was
launched in 1985 to provide universal coverage of infants and pregnant women with immunization
against identified vaccine preventable diseases. In 1997, Reproductive and Child Health (RCH- Phase1) programme was launched which incorporated child health, maternal health, family planning,
treatment and control of reproductive tract infections and adolescent health. RCH Phase-2 (2005-
2010) aims at sector wide, outcome oriented programme based approach with emphasis on
decentralization, monitoring and supervision which brings about a comprehensive integration of
family planning into safe motherhood and child health.
Page 2 of 7
European Journal of Business &
Social Sciences
Available at https://ejbss.org/
ISSN: 2235-767X
Volume 07 Issue 01
January 2019
Available online: https://ejbss.org/ P a g e | 397
CONCEPT OF NRHM Rural India is suffering from a long-standing healthcare problem. Studies
have shown that only one trained healthcare provider including a doctor with any degree is available
per sixteen villages. Although more than 70 per cent of its population lives in the village, only 20 per
cent of India’s hospital beds are located in rural areas. Most of the health problems that people suffer
from in the rural community and in urban slums are preventable and easily treatable. In view of the
above issues, the National Rural Health Mission (NRHM) was launched by the Government of India
in April 2005. The duration of NHRM will be from 2005 to 2012. The total allocation for the
Departments of Health and Family Welfare has been hiked from Rs 8420 crore to Rs 10,820 crore in
the budget proposals for the year 2005–2006. NRHM is a flagship scheme of central government to
improve the provision of basic healthcare facilities in rural India by undertaking an architectural
correction in the existing healthcare delivery system and by promoting good health through
improvements in nutrition, sanitation, hygiene and safe drinking water. It also seeks to revitalize
Indian health traditions of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH), and
mainstream them in to the healthcare system. NRHM is an umbrella programme subsuming existing
health and family welfare programmes, such as the second phase of the Reproductive and Child
Health programme (RCH II), National Disease Control Programmes for Malaria, TB, Kala Azar,
Filaria, Blindness, Iodine Deficiency (NDCP), and the Integrated Disease Surveillance Programme
(IDSP). By integrating these vertical health programmes, This programme seeks to optimise
utilisation of funds and infrastructure, thereby strengthening delivery of public healthcare. A task
force has been constituted to recommend strategies for expanding the programme to include the
urban poor
GOALS & STATEGIES OF NRHM National Rural Health Mission seeks to provide effective
healthcare to the rural population throughout the country with special focus on eighteen states, which
have weak public health indicators and weak infrastructure. These states are Arunachal Pradesh,
Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram,
Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal, and Uttar
Pradesh. In the beginning Government of India was to provide funding for key components in these
eighteen high focus states. This programme has to cover all the villages in these eighteen states
through approximately 2.5 lakh village-based ‘Accredited Social Health Activists’ (ASHA) who has
to act as a link between the health centres and the villagers. One ASHA will be raised from every
village, or cluster of villages, across these eighteen states. The ASHA will be trained to advise village
populations about sanitation, hygiene, contraception, and immunization to provide primary medical
care for diarrhoea, minor injuries, and fevers; and to escort patients to medical centers. They would
also be expected to deliver direct observed short course therapy for tuberculosis and oral dehydration,
to give folic acid tablets and chloroquine to patients, and to alert authorities of unusual outbreaks of
disease. The goals of the NRHM were as given below:
1. Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR);
2. Universal access to integrated comprehensive public health services;
3. Child health, Water, Sanitation and Hygiene;
4. Prevention and control of communicable and non-communicable diseases, including locally
endemic diseases;
5. Population stabilization, gender, and demographic balance;
6. Revitalization of local health traditions and main-stream Ayurvedic, Yoga, Unani, Siddha, and
Homeopathy Systems of Health (AYUSH);
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Page 3 of 7
European Journal of Business &
Social Sciences
Available at https://ejbss.org/
ISSN: 2235-767X
Volume 07 Issue 01
January 2019
Available online: https://ejbss.org/ P a g e | 398
7. Promotion of healthy lifestyles. The strategies to achieve the goals include:
1. Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage
public health services;
2. Health plan for each village through Village Health Committee of the Panchayat;
3. Strengthening sub-centre through an untied fund of Rs.10000 for local action and planning. This
Fund will be deposited in a joint Bank Account of the ANM and Sarpanch and operated by the ANM,
in consultation with the Village Health Committee, and more Multi Purpose Workers (MPWs);
4. Provision of 24 hour service in 50 per cent PHCs by addressing shortage of doctors, especially in
high focus states, through mainstreaming AYUSH manpower;
5. Preparation and implementation of an intersectoral District Health Plan prepared by the District
Health Mission, including drinking water, sanitation, and hygiene and nutrition;
6. Integrating vertical Health and Family Welfare programs at National, State, Block, & District
levels.
WORKING OF NRHM
Health is listed as a state subject in the Indian Constitution while family welfare is in the concurrent
list. Primary healthcare is a subject of local self governments. Therefore, public expenditure is
restricted by resources available at the state and sub-state levels. NRHM envisages a significant role
for communities in the delivery and monitoring of primary healthcare. One of the scheme’s core
strategies is to build the capacity of Panchayati Raj Institutions (PRIs) to control and manage public
health services. NRHM has a provision for professional bodies and non-governmental organizations
(NGOs) to conduct monitoring and evaluation. It also relies on communities to monitor the delivery
system and the provision of health services. Preparation of annual district health report involves
government line departments and NGOs, and state and national reports are tabled in State Legislative
Assemblies and the Parliament. At the national level, NRHM is a joint Mission Steering Group,
headed by the Union Minister of Health and Family Welfare, and an Empowered Programme
Committee, headed by the Union Secretary for Health and Family Welfare. A Mission Directorate
has been created for planning, implementation and monitoring day-to-day administration. At the state
level, the State Health Mission headed by the Chief Minister, carries out the activities through State
Health Societies.At the sub-state level, The District Health Mission shall be led by the Chairman of
the Zilla Parishad, and be convened by the District Head of the Health Department. It shall have
representation from all relevant Departments, NGOs and private professionals. District Health
Societies are responsible for preparing perspective plans for the entire period (2005-12), annual plans
of all NRHM components and for integrating public health plans with those for water, sanitation,
hygiene and nutrition. Block level health plans on the basis of district plans are formulated to
integrate the village plans. Rogi Kalyan Samitis (RKS) at the block level are responsible for the day- to-day management of hospitals. In each village, a Village Health and Sanitation Samiti is
accountable to the panchayat and is comprised of a female Accredited Social Health Activist
(ASHA) who is the bridge for the village, an ANM, a teacher, a panchayat representative, and
community health volunteers. Primary Health Centres are staffed by a medical officer and fourteen
paramedical staff, and provide integrated curative and preventive care. PHCs are the first point of
contact with a medical officer. At the block level, CHCs, serving as referral units for four PHCs, are
manned by four medical specialists (surgeon, physician, gynaecologist and paediatrician) and provide
obstetric care and specialist consultations. NRHM seeks to bring CHCs and PHCs on par with Indian
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