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🏥 NATIONAL HEALTH MISSION (NHM)

Goals of NHM

• Reduce MMR to 1/1000 live births
• Reduce IMR to 25/1000 live births
• Reduce TFR to 2.1
• Prevention and reduction of anaemia in women aged 15-49 years
• Prevent and reduce mortality & morbidity from communicable, non-communicable, injuries, and emerging diseases
• Reduce household out-of-pocket health care expenditure
• Reduce annual incidence and mortality from Tuberculosis by half
• Reduce prevalence of Leprosy to <1/10000 population, incidence to zero in all districts
• Annual Malaria Incidence to be <1/1000
• Less than 1% microfilaria prevalence in all districts
• Kala-azar Elimination by 2015 - <1 case per 10000 population in all blocks

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🏘️ NATIONAL RURAL HEALTH MISSION (NRHM)

Core Strategies of NRHM

1. Train and enhance capacity of Panchayati Raj Institutions (PRIs)
2. Promote access to improved healthcare at household level (ASHA recruitment and training)
3. Health Plan for each village through Village Health Committee
4. Strengthening sub-centre through an untied fund
5. Strengthening existing PHCs and CHCs, provision of 30-50 bedded CHC per lakh population (Indian public Health standards: IPHS)
6. Preparation and Implementation of an inter-sectoral District Health Missions
7. Strengthening capacities for data collection, assessment and review for evidence-based planning, monitoring and supervision
8. Formulation of transparent policies for development of human resources
9. Developing capacities for preventive health care at all levels
10. Janani Suraksha Yojana (JSY) - safe motherhood intervention under NRHM; promotes institutional delivery among poor pregnant women
11. Promoting non-profit sector particularly in under-served areas

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Key Strategies of NRHM

1. Village-Level Health Plan (VHP)

• Every village gets a trained female ASHA (Accredited Social Health Activist)
• VHP developed through Village Health Samiti of Panchayat (PHS)
• ASHA + ANM + Aanganwadi Workers + community workers (under PHS leadership) prepare VHPQ

2. Intersectoral District Health Plan (DHPQ)

• Prepared by District Health Mission (DHM)
• Covers: drinking water, sanitation, hygiene, nutrition
• Core unit of planning, budgeting, and implementation = District

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👩‍⚕️ ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA)

Norm: 2 ASHA workers per 1000 population

ASHA Acts As:

Selection Criteria

• Woman resident of local community
• Preferably 25-45 years of age
• Literate with formal education up to VIII class

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Responsibilities of ASHA

1. Create awareness on health and its social determinants; mobilize community towards local health planning
2. Promote good health practices; provide minimum package of curative care; make timely referrals
3. Provide information on determinants of health and existing health services
4. Counsel women on reproductive and child health
5. Mobilise community to access health and health-related services from government
6. Act as depot holder for: ORS, IFA tablets, chloroquine, disposable delivery kits, oral pills & condoms
7. Provide primary medical care and act as DOTS provider
8. Help develop a comprehensive village health plan
9. Arrange escort/accompany pregnant women and children requiring treatment/admission to nearest health facility
10. Be part of JSY and help reduce MMR

Resource person for training of ASHA: ANM and Anganwadi Worker

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Other Roles - Anganwadi Worker (Integrated with ASHA)

• Organisation of Health-day
• IEC activities
• Depot holder and issuing to ASHA
• Update list of eligible couples and children
• Mobilisation for food supplementation

Other Roles - ANM Worker (Integrated with ASHA)

• Organise meetings with ASHA
• Participate and guide for organising Health-day
• Updating eligible couple register
• Motivating pregnant females for antenatal care
• Educating ASHA for danger signals of pregnancy
• Orient ASHA on OCPs

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Indicators for Monitoring & Evaluation of ASHA's Work

Process Indicators

• No. of ASHAs selected
• No. of ASHAs trained
• % ASHAs attending review meeting after 1 year

Outcome Indicators

• % newborns weighed and families counselled
• % deliveries with skilled assistance
• % institutional deliveries
• % JSY claims made to ASHA
• Completed immunized 12-23 months age group
• % unmet need in BPL
• % fever cases received chloroquine within 1 week in endemic area

Impact Indicators

• Infant Mortality Rate (IMR)
• Child malnutrition rates
• No. of cases of TB/Leprosy detected compared to last year

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🎒 ASHA KIT - COMPOSITION

Drug Kit

Equipment Kit

• Digital Wrist Watch
• Thermometer
• Weighing Scale (for newborn)
• Baby Blanket
• Baby Feeding Spoon
• Kit Bag
• Communication Kit
• Mucous Extractor

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🤰 JANANI SURAKSHA YOJANA (JSY)

Salient Features

• 100% centrally sponsored
• Combines benefit of cash assistance with institutional care
• Eligibility for cash assistance:
  • LPS (Low Performing States): All women undergoing institutional deliveries
  • HPS (High Performing States): BPL women aged 19 years and above AND SC/ST pregnant women
• Limitation of cash assistance:
  • LPS: All births in institutions
  • HPS: Up to 2 live births

JSY Package (New Guidelines)

LPS = Low Performing States | HPS = High Performing States

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NRHM - New Initiatives

• Home delivery of contraceptives by ASHA
• District Level Household Survey (DLHS-4) in 26 states/UTs
• Promotion of Menstrual Hygiene in 152 districts
• Differential financial approach

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