16-04-2013, 04:36 PM
BROAD FRAMEWORK FOR PREPARATION OF DISTRICT HEALTH ACTION PLANS
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BACKGROUND:
The Hon’ble Prime Minister launched the NRHM on 12th April, 2005 throughout the country
with special focus on 18 States, including eight Empowered Action Group (EAG) States, the North-
Eastern States, Jammu & Kashmir and Himachal Pradesh.
The NRHM seeks to provide accessible, affordable and quality health care to the rural
population, especially the vulnerable sections. It also seeks to reduce the Maternal Mortality Rate
(MMR) in the country from 407 to 100 per 1,00,000 live births, Infant Mortality Rate (IMR) from 60 to
30 per 1000 live births and the Total Fertility Rate (TFR) from 3.0 to 2.1 within the 7 year period of
the Mission.
IMPLEMENTATION FRAMEWORK & PLAN OF ACTION FOR NRHM
The key features in order to achieve the goals of the Mission include making the public health
delivery system fully functional and accountable to the community, human resources management,
community involvement, decentralization, rigorous monitoring & evaluation against standards,
convergence of health and related programmes from village level upwards, innovations and flexible
financing and also interventions for improving the health indicators.
IMPROVING THE PUBLIC HEALTH DELIVERY SYSTEM
Given the status of public health infrastructure in the country, particularly in the EAG and the
North Eastern States, it will not be possible to provide the desired services till the infrastructure is
sufficiently upgraded. The Mission seeks to establish functional health facilities in the public domain
through revitalization of the existing infrastructure and fresh construction or renovation wherever
required. The Mission also seeks to improve service delivery by putting in place enabling systems at
all levels. This involves simultaneous corrections in manpower planning as well as infrastructure
strengthening. The Mission would provide priority to both these aspects.
PUBLIC HEALTH INFRASTRUCTURE
The Central Govt. has so far supported only the construction/up gradation of sub-centres.
Because of their difficult financial conditions, the States have usually not provided sufficient funds for
construction / up-gradation of Primary Health Centre [PHC]/Community Health Centre [CHC]/District
Hospitals etc. As a result, health infrastructure is in poor condition in most of the states. NRHM
allows the expenditure for construction subject to the condition that it should not be more than 33%
of the total NRHM outlay in the case of high focus States, and, 25% in the case of non-high focus
States. NRHM also provides for up-gradation of District Hospitals.
In the first Cabinet approval, provision had been made for setting up of Indian Public Health
Standards (IPHS) only for Community Health Centres (CHCs)/PHCs. The Mission now provides for
IPHS at all levels i.e., sub-centres PHC/CHC and district hospitals.
IMPROVING AVAILABILITY OF CRITICAL MANPOWER
The issue of availability of critical manpower in the rural areas is proposed to be addressed
through initiatives like introduction of a trained voluntary community Health Worker (ASHA) in every
village of the 18 high focus states, additional ANM at each sub-centre, three staff nurses at the
Primary Health Centres (PHC) to make them operational round the clock and additional specialists
and paramedical staff at the Community Health Centres (CHC). The condition of local residency is
proposed to ensure that the staffs stay at their place of posting. In the North-east, keeping in view
the difficulty in availing services of doctors and specialists, the emphasis is on recruitment, training
and skill upgradation of locally recruited ANMs/nurses/midwives/ para medics. It is also proposed to
supplement the availability of critical manpower across the States through contractual
appointment/local level engagement of medical and paramedical manpower upgrading and multiskilling
of the existing medical personnel. Innovations in Public private participation for service
provision, franchising of service providers, licensing and training of Rural Medical Practitioners
(RMP), rationalization of existing manpower are few of the innovations/options being explored.
Stringent monitoring at all levels, involvement of the PRIs and monitoring by the Rogi Kalyan Samitis
should ensure presence of doctors & para medicals in the rural areas. Besides compulsory posting of
doctors in the rural areas, better cadre management & personnel policies would also help to improve
manpower availability.
CAPACITY BUILDING
In order to provide managerial support, for tracking funds and monitoring activities under the
Mission, provision has been made for setting up Programme Management Units at the State/District
level. Over 500 professionals have already been recruited. The successful implementation of the
Mission would require health sector reforms and development of human resources. Capacity building
at all levels is a huge challenge under NRHM. In order to provide technical support to the Mission for
achieving this objective, it is proposed to set up National Health System Resource Centre [NHSRC] at
the Central and State levels (SHSRC) with an annual corpus support of Rs. 15 crore and Rs. one
Crore at the Central and State levels respectively. The NRHM also emphasizes the setting up of fully
functional Block and District level Health Management systems, as under NRHM 70% of the
resources would be utilized at Block and below Block levels and 20% at the district level.