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National Health Mission (NHM)

Overview

• NRHM - National Rural Health Mission (launched 5 April 2005)
• NUHM - National Urban Health Mission (launched 2013)

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Main Programmatic Components

1. Health System Strengthening (rural and urban)
2. RMNCH+A - Reproductive, Maternal, Newborn, Child and Adolescent Health
3. Communicable Disease Control
4. Non-Communicable Disease Control

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Six Financing (Flexipool) Components

1. NRHM-RCH Flexipool
2. NUHM Flexipool
3. Flexible pool for Communicable Diseases
4. Flexible pool for Non-Communicable Diseases (including Injury and Trauma)
5. Infrastructure Maintenance
6. Family Welfare Central Sector component

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Historical Milestones (Health Programme Evolution)

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Targets of NHM (12th Five Year Plan)

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National Rural Health Mission (NRHM)

Special Focus States (18 total):

• 8 Empowered Action Group (EAG) States: Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Odisha, Rajasthan
• 8 North-East States: Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura
• Himachal Pradesh and Jammu & Kashmir

Main Aim of NRHM

Programmes Integrated under NRHM

• RCH II
• National Vector Borne Disease Control Programme (malaria, filaria, kala-azar, dengue, Japanese encephalitis)
• National Leprosy Eradication Programme (NLEP)
• Revised National TB Control Programme (RNTCP)
• National Programme for Control of Blindness
• Iodine Deficiency Disorder Control Programme
• Integrated Disease Surveillance Project (IDSP)

Plan of Action - Infrastructure Strengthening

1. ASHA creation - Accredited Social Health Activist (1 per 1000 population in rural areas)
2. Sub-Centres strengthened - Essential drugs (allopathic + AYUSH), untied funds of Rs. 10,000/year
3. PHCs strengthened - 24-hour services in at least 50% PHCs, AYUSH practitioners, standard treatment guidelines, 2nd doctor provision
4. CHCs upgraded - All CHCs (30-50 beds) as 24-hour First Referral Units (FRUs)

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National Urban Health Mission (NUHM)

Focus Groups

1. Urban poor in listed and unlisted slums
2. Vulnerable groups - homeless, rag-pickers, street children, rickshaw pullers, construction/kiln workers, sex workers, temporary migrants
3. Public health - sanitation, clean drinking water, vector control
4. Strengthening urban local bodies' health capacity

7 Metropolitan Cities (Special Treatment)

Urban Community Structures

• ASHA/Link Worker (LW): 1 per 1000-2500 urban poor (200-500 households)
• Mahila Arogya Samiti (MAS): Per 50-100 households; receives annual grant of Rs. 5,000
• Rogi Kalyan Samitis

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Key NHM Interventions to Reduce IMR and MMR

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ASHA (Accredited Social Health Activist) - Key Figure of NRHM

• Rural: 1 ASHA per 1000 population
• Urban: 1 ASHA per 1000-2500 urban poor population
• Acts as a link between community and health system
• Promotes good health practices, RCH services, contraception, gender equality, maternal and child care

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Recent Initiatives Under NHM (2024-2026)

• Ayushman Bharat - PM-JAY (health insurance component)
• National Sickle Cell Anaemia Elimination Mission
• National TB Elimination Programme (NTEP)
• PM-ABHIM (Pradhan Mantri Ayushman Bharat Health Infrastructure Mission)
• Revised Mobile Medical Units (MMU) Guidelines 2026
• Revised CEmONC Curriculum 2024

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NATIONAL HEALTH MISSION (NHM)

Park's Textbook of PSM - Structured Notes

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1. INTRODUCTION

• Ministry of Health & Family Welfare launched NHM by merging all health programmes under one umbrella
• Approved: May 2013
• Two Sub-Missions:
  • National Rural Health Mission (NRHM)
  • National Urban Health Mission (NUHM)
• Key Achievement: Reduction in out-of-pocket expenses from 72% → 60%

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2. HISTORICAL MILESTONES (Parks)

1992 → Child Survival and Safe Motherhood Programme (CSSM)
       ↓
1997 → RCH I
       ↓
2005 → RCH II + NRHM (launched 5 April 2005)
       ↓
2013 → RMNCH+A Strategy + NHM (approved May 2013)
       ↓
2014 → India Newborn Action Plan (INAP)
       ↓
2018 → Ayushman Bharat Programme

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3. NHM - OVERALL STRUCTURE (FLOWCHART)

                    ┌─────────────────────────────┐
                    │   NATIONAL HEALTH MISSION    │
                    │     (Approved May 2013)       │
                    └─────────────┬───────────────┘
                                  │
              ┌───────────────────┴────────────────┐
              ↓                                     ↓
  ┌───────────────────────┐           ┌─────────────────────────┐
  │  NRHM                 │           │  NUHM                    │
  │  National Rural       │           │  National Urban          │
  │  Health Mission       │           │  Health Mission          │
  │  (Launched 5 Apr 2005)│           │  (Launched 2013)         │
  └───────────────────────┘           └─────────────────────────┘

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4. PROGRAMMATIC COMPONENTS (3 Main)

NHM COMPONENTS
     │
     ├─── 1. Health System Strengthening (Rural + Urban)
     │
     ├─── 2. RMNCH+A
     │         (Reproductive - Maternal - Newborn - Child - Adolescent Health)
     │
     └─── 3. Disease Control
               ├── Communicable Diseases
               └── Non-Communicable Diseases

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5. SIX FINANCING (FLEXIPOOL) COMPONENTS

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6. NHM TARGETS (12th Five Year Plan)

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7. NATIONAL RURAL HEALTH MISSION (NRHM) - DETAILED

A. Basic Facts

• Launched: 5th April 2005 (for 7 years; extended to 2017)
• Operational: Whole country with special focus on 18 states

B. 18 Special Focus States

18 Special Focus States
    │
    ├── 8 EAG (Empowered Action Group) States
    │       Bihar, Jharkhand, MP, Chhattisgarh,
    │       UP, Uttarakhand, Odisha, Rajasthan
    │
    ├── 8 North-East States
    │       Assam, Arunachal Pradesh, Manipur, Meghalaya,
    │       Mizoram, Nagaland, Sikkim, Tripura
    │
    └── 2 Others: Himachal Pradesh + Jammu & Kashmir

C. Main Aim (5 A's - Park's)

Provide Accessible, Affordable, Accountable, Effective and Reliable primary health care

D. Programmes Integrated under NRHM

1. RCH II
2. National Vector Borne Disease Control Programme (malaria, filaria, kala-azar, dengue, Japanese encephalitis)
3. National Leprosy Eradication Programme (NLEP)
4. Revised National TB Control Programme (RNTCP)
5. National Programme for Control of Blindness
6. Iodine Deficiency Disorder Control Programme
7. Integrated Disease Surveillance Project (IDSP)

E. Synergic Approach (Park's)

• AYUSH integrated into mainstream healthcare
• Health related to determinants: nutrition, sanitation, hygiene, safe drinking water

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8. NRHM INFRASTRUCTURE (Pyramid - Park's Fig. 11)

LEVEL              POPULATION  FACILITY              KEY PERSONNEL/SERVICES
─────────────────────────────────────────────────────────────────────────────
Block Level        1,00,000    Block Level           Chief Block Health Officer
                   100 villages Hospital (CHC)       + Health Manager + Accountant
                               (24×7 FRU)            Ambulance, OBS/Surgical/Medical
                                                      Emergencies Round the Clock

PHC Level          30-40       Cluster of GPs -       3 Staff Nurses, 1 LHV,
                   villages    PHC                    MO-i/c, AYUSH Doctor,
                                                       24×7 Emergency care,
                                                       MCH/Immunization Clinics

Sub-Centre Level   5-6         Gram Panchayat -       2 ANMs + 1 Male MPW,
                   villages    Sub Health Centre       MCH/Immunization Days,
                                                       Drugs, MCH Clinic

Village Level      1,000       Village                ASHA + AWW + VHSNC
                   population  (ASHA, AWW,             Drug Kit, Referral Chain,
                               VHSNC)                  Village Health Day
─────────────────────────────────────────────────────────────────────────────

• District = Core unit of planning, budgeting, and implementation
• All vertical programmes merged into District Health Mission (district level) and State Health Mission (state level)
• Mobile Medical Unit at district level for outreach

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9. PLAN OF ACTION - INFRASTRUCTURE STRENGTHENING (Park's)

1. ASHA Creation
        ↓
2. Sub-Centre Strengthening
   - Essential drugs (Allopathic + AYUSH)
   - Untied funds: Rs. 10,000/year (18 states)
   - Additional ANMs / MPW
        ↓
3. PHC Strengthening
   - 24-hr service in ≥50% PHCs
   - AYUSH practitioner included
   - Standard Treatment Guidelines
   - 2nd doctor (1M + 1F)
        ↓
4. CHC Strengthening (First Referral Care)
   - All CHCs (30-50 beds) as 24-hr FRUs
   - Anaesthetist posting
   - Indian Public Health Standards (IPHS)
   - Rogi Kalyan Samiti (RKS)
   - Standards of services and costs

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10. MAJOR INITIATIVES UNDER NRHM

A. ASHA (Accredited Social Health Activist)

• Selection: Woman (married/widow/divorced), age 25-45 years, education ≥ Class 8
• Norm: 1 ASHA per 1000 population (relaxed to 1 per habitation in tribal/hilly/desert areas)
• Acts as link between community and health system

B. Rogi Kalyan Samiti (RKS) - Patient Welfare Committee

• Registered society; members act as trustees
• Manages hospital affairs, patient welfare
• Receives untied funds
• 32,005 RKS set up in DH, SDH, CHC, PHC (as of March 2015)

C. Untied Grants to Sub-Centres

• Sub-centres equipped with BP instruments, Hb testing kits
• Untied funds for local health needs

D. Village Health & Sanitation Committee → renamed VHSNC (Village Health, Sanitation & Nutrition Committee)

E. Indian Public Health Standards (IPHS)

• Norms for infrastructure, staff, equipment, management at all levels

F. National Ambulance Services

• Dial 108 - Emergency Response (critical care, trauma, accidents)
• Dial 102 - Basic patient transport (focus: pregnant women and children; JSSK entitlements)
• Dial 104 - Mobile health services
• 8680 (Dial-108) + 8718 (Dial-102) + 603 (Dial-104) vehicles operational

G. Web-enabled Mother and Child Tracking System (MCTS)

• Name-based tracking of every pregnant woman and child up to 3 years
• Tracks: ANC, institutional delivery, PNC, immunization
• Linked with AADHAR for subsidy tracking

H. Public-Private Partnership (PPP)

• 75% health services provided by private sector; PPP ensures RCH services reach community

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11. NEW INITIATIVES UNDER NRHM (from 2011 onwards)

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12. KEY SCHEMES UNDER NHM (Flowchart)

NHM KEY SCHEMES
        │
        ├── JSY (Janani Suraksha Yojana)
        │     └─ Cash incentive for institutional delivery (BPL women)
        │
        ├── JSSK (Janani Shishu Suraksha Karyakram)
        │     └─ FREE: Delivery + C-section + Drugs + Diagnostics
        │            + Blood + Diet + Transport (home → facility → home)
        │            + Same for sick infants
        │
        ├── ASHA Home Delivery of Contraceptives
        │
        ├── RBSK (4 Ds: Defects, Diseases, Deficiencies, Developmental delays)
        │
        ├── RKSK (Adolescent health)
        │
        ├── National Iron+ Initiative (WIFS)
        │
        ├── MCTS (Mother & Child Tracking System)
        │
        ├── Dial 108 / 102 / 104 (Ambulance Services)
        │
        └── Kilkari (IVR mobile health messages)

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13. NATIONAL URBAN HEALTH MISSION (NUHM)

Coverage

• All state capitals + district HQs + ~779 cities/towns with population ≥ 50,000 (Census 2011)
• Cities < 50,000 covered under NRHM

Focus Groups

1. Urban poor in listed and unlisted slums
2. Vulnerable groups - homeless, rag-pickers, street children, rickshaw pullers, construction/kiln workers, sex workers, temporary migrants
3. Sanitation, clean water, vector control
4. Urban Local Bodies capacity building

7 Metro Cities (Special Treatment via Municipal Corporations)

Community Structures under NUHM

NUHM Community Structures
        │
        ├── ASHA / Link Worker (LW)
        │     └─ 1 per 1,000-2,500 urban poor (200-500 households)
        │
        ├── Mahila Arogya Samiti (MAS)
        │     └─ 1 per 50-100 households
        │         Annual grant: Rs. 5,000/-
        │         (States can route ASHA incentives to MAS)
        │
        └── Rogi Kalyan Samiti

Service Delivery under NUHM

• Urban PHCs + Urban CHCs → Universal services
• Outreach → Targeted to slum dwellers/vulnerable groups
• Female Health Workers (FHWs/ANMs) - placed at Urban PHCs with 3-6 months induction training

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14. NHM GOVERNANCE STRUCTURE

National Level
    Ministry of Health & Family Welfare
    Mission Steering Group
            ↓
State Level
    State Health Mission
    State Health Society
            ↓
District Level (Core Unit)
    District Health Mission
    District Health Society
    (All vertical programmes merged here)
            ↓
Block Level
    Block Health Unit / CHC
            ↓
Village Level
    ASHA + AWW + VHSNC

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QUICK MEMORY AIDS

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