National Rural Health Mission

Explanation:

Formation of health & family welfare societies [Ref: Park 20/e, p 379-380; National Health programmes of India by J. Kishore 7/e, p 78-92;http://mohfw.nic.in/NRHM/Documents/Mission_Document.pdf%5D

• ASHA is one of the core strategies of NRHM
• Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission being implemented with the objective of reducing maternal & neo-natal mortality by promoting institutional delivery among the poor pregnant women.
• One of the components of plan of action for NRHM is District health plan. Under this plan all vertical Health and Family Welfare Programmes at district & state level merge into one common “District Health Mission” at the district level and the “State Health Mission” at the state level. So under NRHM it is the intergration not .formation of vertical Health &_.family welfare programmes.

NATIONAL RURAL HEALTH MISSION – THE VISION

• The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators .
• These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
• The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP.

Key components:

• provision of a female health activist in each village
• a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat
• strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards(IPHS)
• integration of vertical Health & Family Welfare Programmes
• Funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare. Aim
• Effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health.

GOALS

• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)by 50% from existing levels in 7 years.
• Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition.
• Prevention and control of communicable and non-communicable diseases, including locally endemic diseases
• Access to integrated comprehensive primary healthcare
• Population stabilization, gender and demographic balance.
• Revitalize local health traditions and mainstream AYUSH(Indian system of medicine)
• Promotion of healthy life styles

4. STRATEGIES

(a) Core Strategies:

• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services.
• Promote access to improved healthcare at household level through the _.female health activist (ASHA).
• Health Plan for each village through Village Health Committee of the Panchayat.
• Strengthening sub-centre through an untied fund to enable local planning and action and more Multi Purpose Workers (MPWs).
• Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population
• Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition.
• Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels.
• Technical Support to National, State and District Health Missions, for Public Health Management.
• Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision.
• Formulation of transparent policies.
• Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc.
• Promoting non-profit sector particularly in under served areas.

(b) Supplementary Strategies:

• Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost.
• Promotion of Public Private Partnerships for achieving public health goals.
• Mainstreaming AYUSH – revitalizing local health traditions.
• Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics.
• Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.

PLAN OF ACTION

• Accredited Social HealthActivist(ASHA)
• .Strengthening sub centers
• Strengthening CHC’s for first referral care
• Strengthening PHC for quality preventive, promotive,curative, supervisory and Outreach services
• District Health Plan
• Total Sanitation Campaign (TSC)
• National Disease Control Programmes for Malaria, TB, Kala Azar, Filaria,Blindness & Iodine Deficiency and Integrated Disease SurveillanceProgramme shall be integrated under the Mission
• Public-private partnership for publichealth goals, including regulation of private sector
• New health financing mechanism
• Reorienting health/medical education to support rural health issuers

Details of the above are available on website & book by J. Kishore mentioned in reference

Explanation:

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women.

The success of the scheme would be determined by the increase in institutional delivery among the poor families.

Explanation:

Essential components of Reproductive and, Child Health (RCH) Programme include essential and emergency obstetric services, 24-hour delivery services, medical termination of pregnancy, control of reproductive tract infections (RTI) and sexually transmitted diseases (STD), immunization, drug and equipment kits, essential newborn care, oral rehydration therapy, acute respiratory disease control, and prevention and control of vitamin A deficiency and anaemia in children.

Ref: Park’s Textbook Of Preventive And Social Medicine, By K. Park, 19th Edition, Pages 367-372.

Explanation:

• Creation of cadre of Accredited Social Health Activist (ASHA)
• Strengthening sub-centers
• Strengthening Primary Health Centers
• Strengthening Community Health Centres for First Referral care (e.g., by promotion of Rogi Kalyan Samiti for hospital management)

Explanation:

Ans. is ‘d’ i.e., Tuberculosis 

Integrated management of neonatal and childhood illness (IMNCI)

o IMNCI includes—> Diarrhea, Malaria „Valnutrition, ARI (Pneumonia, Otitis media), Measles.

Explanation:

Ans. is ‘All’ 

o “It aims at mainstreaming the Indian systems ofmedicine to facilitate health care”.

• Supply ofgeneric drugs (both AYUSH & Allopathic) for common ailments at village. SC, PHC/CHC level. o A key strategy of the Mission is : Operational izing 4276 existing Community Health Centres (30-50 beds) as 24 Hour First Referral Units, includingposting of anaesthetists. – Park 21s1/406.
• ‘Initial & periodic training ofparamedics in treatment of minor ailments at PHC” – Park 21 st1842. a 

The revised PHS staff pattern at CI IC  :

a)     Staffnurse& Public health nurse (19+1) (Previously Nurse-midwife: 7+2).

b)      More specialist including Anesthetist, eye surgeon, dental surgeon, AYUSH specialist etc.

Explanation:

Ans. is ‘b’ i.e., Vertical Family welfare and health service 

o District becomes the core unit of planning, budgeting and implementation of the programme. All vertical health and family welfare programmes at district level will merge into one common “District health Mission” and at state level into “State health mission” there will be provision of a “mobile medical tin it” at district level for improved outreach services.

• Since almost 75 percent of health services are being currently provided by the private sector, it is contempolated that involving the private sector as part of the RCH initiatives will provide more effective health care delivery system. Thus settng up of “public private partnership” (PPP) would help to make the RCH II programme better. and ensure availability or preventive and curative reproductive and health services to the community.

o Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission being implemented with the objective of reducing maternal & neo-natal mortality by promoting institutional delivery among the poor pregnant women.

o The schedule of implementation of major components of NRHM are as following (40) :

            Merger of multiple societies and constitution of district/state mission.

            Provision of additional generic drugs at SC/PHC/CHC level.

            Operational programme management units.

            Preparation of village health plans.

              ASHA at village level (with drug kit)

            Upgrading of rural hospital

            Operationalising district planning

            Mobile medical unit at district level

The Goals to be achieved by NRITN I (40)

A. National level

            Infant mortality rate reduced to 30/1,000 live bid hs.

            Maternal mortality ratio reduced to 100/100,000.

            Total fertility rate reduced – 50% by 2010. additional 10% by 2012.

            Malaria mortality rate reduction -50% by 2010 additional 10% by 2012.

            Kala-azar mortality rate reduction – 100% by 2010 and sustaining elimination until 2012.

            Filarial/microfilaria rate reduction 70% by 2010. 80% by 2012 and elimination until 2015.

            Dengue mortality rate reduction – 50% by 2010 and sustaining at that level until 2012.

• Japanese encephalitis mortality rate reduction – 50% by 2010 and sustaining at that level until 2012.

            Cataract operation : increasing to 46 lakhs per year by 2012,

            Leprosy prevalence rate : from 1.8/10,000 in 2005 to less than 1/10,000 thereafter.

• Tuberculosis DOTS services : maintain 85% cure rate through entire mission period.

            Upgrading community health centres to Indian public health standards.

• Increase utilization of first referral units from less than 20% to 75%.

            Engaging 250,000 female accredited social health activists (ASHA) in 10 states.

B. At community level

Availability of trained community level worker at village level, with a drug kit for genera/ ailments.

          Health day at anganwadi level on a fixed thy/month for provision of immunization, ante/post natal checkups and services related to mother and child healthcare, including nutrition.

• Availability of generic drugs for common ailments at subcentre and hospital level.

          Good hospital care through assured availability of doctors, drugs and quality services under the programme.

           Improved facilities for institution deliver through provision of referral, transport, escort and improved hospital care subsidized under the janani suraksha yojana for the below poverty line families.

          Availability of assured healthcare at reduced financial risk through pilots of community health insurance under the mission.

          Provision of household toilets.

improved outreach services through mobile medical unit at district level.

Explanation:

Ans. C: 2005