Profile, Components and Strategies

1. Why a National Rural Health Mission?

The National Common Minimum Programme spells out the commitment of the Government to enhance Budgetary Outlays for Public Health and to improve the capacity of the health system to absorb the increased outlay so as to bring all round improvement in public health services. The National Rural Health Mission (NRHM) seeks to provide effective health care to the rural population, especially the disadvantaged groups including women and children, by improving access, enabling community ownership and demand for services, strengthening public health systems for efficient service delivery, enhancing equity and accountability and promoting decentralisation.

2. What is the coverage of the National Rural Health Mission (NRHM)?

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

3. Is NRHM a new programme of the Government of India?

The NRHM is basically a strategy for integrating ongoing vertical programmes of Health & Family Welfare, and addressing issues related to the determinants of Health, like Sanitation, Nutrition and Safe Drinking Water. The National Rural Health Mission seeks to adopt a sector, wide approach and aims at systemic reforms to enable efficiency in health service delivery. NRHM subsumes key national programmes, namely, the Reproductive and Child Health II project (RCH II) the National Disease Control Programmes (NDCP) and the Integrated Disease Surveillance Project (IDSP). NRHM will also enable the mainstreaming of Ayurvedic, Yoga, Unani, Siddha and Homeopathy Systems of Health (AYUSH).

4. What are the strategies of the NRHM?

While providing a broad framework for operationalisation, NRHM lists a set of core and supplementary strategies to meet its goals.

Core strategies of NRHM include: Decentralised village and district level health planning and management, appointment of Accredited Social Health Activist (ASHA) to facilitate access to health services, strengthening the public health service delivery infrastructure, particularly at village, primary and secondary levels, mainstreaming AYUSH, improved management capacity to organize health systems and services in public health, emphasising evidence based planning and implementation through improved capacity and infrastructure, promoting the non-profit sector to increase social participation and community empowerment, promoting healthy behaviours, and improving intersectoral convergence.

Supplementary Strategies include regulation of the private sector to improve equity and reduce out of pocket expenses, foster public private partnerships to meet national public health goals, reorienting medical education, introduction of effective risk pooling mechanisms and social insurance to raise the health security of the poor, and taking full advantage of local health traditions.