The Goal of the Mission is to improve the availability of and access to quality health care by people, especially for

those residing in rural areas, the poor, women and children.

Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Womens 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 Promotion of healthy life styles

NRHM components

Part A Part B Part C Part D Part E

RCH Phase II Additionalities Strengthening Immunization National Disease Control Programs Convergence Action

PART A RCH II Health and Family Welfare programme is being implemented in the state to sustain the achievement of the previous years and to reach new goals. NRHM is working in a task mode to achieve goals set-in for the state and effectively deal with the challenges. NRHM has set the strategic direction that encompasses year wise objectives, technical strategies; interventions include program and services for improving maternal health, child health, family planning, adolescents' health etc. RCH II has been bifurcated into core programmatic strategies and cross cutting program strategies for taking effective actions. The institutional and other strategies have impact on all the components of RCH viz. maternal health, child health, family planning,

adolescent health and sex selection etc whereas specific core program strategies have wider impact on the specific program component. It has been built that all these strategies would converge and go hand in hand to achieve the program outcome. The state considers that strengthening institutional mechanisms, infrastructural development, adequately trained human resources etc. are fundamental requirements for getting better RCH outcomes. Accordingly, the Programme Implementation Plan is presented with backward linkages from core programme strategies to institutional framework. RCH II in Kerala is focused to achieve health parameters in close proximity to that of the developed countries. The State has to improve on its health accomplishment to reach those levels. Women and Children constitute to 71% of the population, whose health and socio-economic condition needs improvement. Maternal Mortality Rate of 95 per 1 lakh deliveries needs to be brought down to below 65. As per NFHS 3 Infant Mortality Rate is 15 but it is 12 as per SRS 2008. Still IMR in Kerala is high when compared to the Developed countries. However the IMR continues reduction compared with the previous two NFHS survey. This has to be brought down to at least 10. Perinatal Mortality

Though Kerala has the lowest perinatal mortality rate than any other state in India, when compared to developed countries this rate is high and needs to be brought down. Infant Mortality in Kerala is lowest in the country 15 per thousand populations (NFHS3) and 12 as per SRS 2008. In NRHM further reduction of IMR is aimed. Infant Mortality Rate of 15 (NFHS 2006) has been reduced to 12 (SRS 2008) which is still high when compared to the Developed countries. This has to be brought down to 10 by March 2009 and to single digit of 9 by 2011-12. Maternal Mortality Ratio of 110 per 1 lakh deliveries as per SRS 2003 has been brought down to below 75 and the target for 2009-10 is to bring it below 50. As pert the Special Bulleting on MMR in India 2004-06 published by Sample Registration System MMR is 95. The perspective plan is that by 2012, MMR should be less than 30. RCH PROGRAMME IS IMPLEMENTED TO ACHIEVE ALL THESE

Maternal Health activities Maternal Health

Janani Suraksha Yojana FRUs to be operationalized 24 X 7 services in 135 PHCs Providing specialists Ward Health & Nutrition Day RCH Camps Telephone call allowance for JPHN through WHSC

ASHA/Link Worker Implementing activities through ASHA, providing Drug Kits, Training for ASHA

Child Health

Routine immunization Hepatitis B Recombinant DNA vaccine Pulse polio Acute Flaccid Paralysis surveillance RIMS (Routine Immunization Monitoring System)

PART

Additionalities

Major components under NRHM addtionalities include:

Ward Health & Sanitation Committee (WHSC) Annual Maintenance Grant (AMG) Untied Funds Hospital Management Societies (RKS) ASHA / Link Worker including ASHA drug kits Pain & Palliative Care / Comprehensive Mental Health Program Upgradation of hospitals including insurance pool Strengthening Nursing Education Strengthening Training Schools Setting up of State Health Systems Resource Centre Setting up of Emergency Management Response System

PART C Strengthening Immunisation Universal Immunization Programme was introduced in the State with all determination and vigour along with National launching of the scheme and could achieve set goals ahead of other States in the country. The state population is distributed in 14 districts having 63 Taluks, 152 development blocks, 978 Panchayats, 1452 revenue villages, 5 municipal corporations and 59 municipalities. Population density of the state as per census 2001 is 819 persons per sq.km.with district Alapuzha having the highest density of 1496 and Idukki the lowest population density of 252 per sq.km. Scheduled castes and Scheduled tribe population forms 3.92 percent and 1.10 respectively of the total population. The state recorded the lowest population growth rate, 9.42, in the country during the decade 1991-2001 as per 2001 census. The decadal growth rate has recorded substantial decline over the previous census, from 14.32 (1981-91) to 9.42 (1991-2001). As per the result of sample registration survey 2007, state of Kerala has recorded the lowest birth rate (14.7) and Infant

Mortality Rate (13) far below the National average of 23.1and 55 respectively. Death rate in the State is 6.8 against National rate of 7.4 during the year. As per the results of NFHS-3 Kerala has achieved the target of hundred percent institutional deliveries there by reducing Maternal Mortality to considerable levels. Sex ratio as per census 2001 is 1058 female per thousand men. Child Sex ratio (age 0-6) is 960 females per thousand male children. Female literacy rate is (86.87%) is also the highest in the country. National Family Health Survey 2005-06 has recorded the total fertility rate as 1.9, which is below the replacement level of fertility. SRS 2007 has recorded a further reduction in TFR to 1.7 which is the lowest in the country. However the results of NFHS 3 show that the state has gone down in vaccination coverage due to many reasons. Various action plans have been mooted to sustain the achievements already recorded and improve performance wherever required. As a result the latest Coverage Evaluation Survey shows that 87.9 % (CES 2008) of children are fully immunized though the percentage of full immunization by age 12 months is 82.9. Further the recently concluded DLHS III shows 79.5% coverage for full immunization. Various initiatives to bridge the gaps are taken. Immunisation camps without the presence of Medical Officers, increased number of outreach sessions to cover floating population, local specific IEC/BCC, awards to best performing JPHNs are all planned to improve immunisation coverage. The state has decided to observe October as Immunization Month every year. PART D National Disease Control Programmes

PART E Convergence Action Arogyakeralam seeks convergence with other departments/institutions like Local Self Government, Social welfare, Education, Sanitation Mission etc towards comprehensive delivery of health services. Upgradation of Health institutions, School Health, Palliative care, ASHA, Strengthening Immunisation, Vector Control Programmes are run in convergence with related departEssence

of NRHM implementation in

the state

o o o o o o o o o

o o o

Establishing referral system of protocol Strengthening the 3rd tier and activating the 2nd tier Promoting preventive and promotive aspects of Primary Health care in the community Strengthening Training program and Capacity Building Establishing Health Management Information System Strengthening Nursing Education Department Improving & sustaining Health Indicators Putting up a system of referral transport Launching special programs for NCDs linked with ASHA Piloting remedial measures for 2nd Generation problems like Pain & Palliation. Malignancies. Geriatric Suicides. Mental Health Problems Tackling Re-emergence of Infectious Diseases Combined Behaviour Change Communication strategy Optimizing use of all systems of medicine

Convergence of activities of Health Determinantsments

Institutional Framework

As per the Government Order G.O.(P)No.204/06/H&FWD. Dated, Thiruvananthapuram,22.09.06 National Rural Health Mission is being implemented in the state constituting State Health Mission District Health Missions, State Health Society and District Health Societies Kerala State Rural Health Mission District Health Mission and the District Health & Family Welfare Society Kerala State Rural Health Mission Composition Kerala State Health and Family Welfare Society

Chair person

Chief Minister

Minister of H&FW, State Govt. CoChairperson Convener Members Principal Secretary/Secretary(Health and Family Welfare)

Ministers in charge of departments relevant to NRHM such as AYUSH, Woman and Child development, Medical Education, Public Health Engineering (In Kerala Minister Health and Social Welfare already included as Co-chair person), Minister (Irrigation, Water and Sanitation), Minister (Local Self Govt), Minister (Planning and Economic Affairs, in Kerala, Chief Minister, already included as Chairperson), Minister (Social Welfare, in Kerala, Minister of H&FW, already included as Co-chairperson, Minister (SC/ST Welfare) and Minisiter (Finance) Nominated Public Representatives (5 to 10 members) such as MPs, MLAs, President District Panchayat, Urban Local Bodies (Women should be adequately represented) Official representatives-Chief Secretary, Principal Secretaries/Secretaries Finance, Water Resources, Rural Development, Planning and Economic Affairs and Social Welfare, Woman and Chaild development, Public Health Engineering, Kudumbashree Panchayathi Raj, Rurlal Development/SC/ST Welfare, Urban Development Affairs, Finance, Planning and representative, MOGFW, Govt. of India Director (Health Services)/Director Medical Education, Director (ISM, Director Ayurveda Medical Education, Director Homoeo, State Mission Director, National Rural Health Mission. Nominate Non Official member (5~8 members) such as Health experts, representatives of Medical Associations NGOs etc. One representative each of the District Panchayat Presidents, Block Panchayt Presidents, Grama Panchayat Presidents, Municipal Chairperson and Mayors of Municipal Corporations are to be added, preferably President/Secretary of their respective Associations/Chambe` Representatives of Development Partner

Frequency of Meetings: At least once in every six months Ordinary Business: Providing Health systems over sight, consideration of Policy matters related with Health Sector (including determinants of Good Health), review of progress in

implementation of NRHM; inepter sectoral co-ordination, advocacy measures required to promote NRHM visibility. Kerala State Health and Family Welfare Society

Kerala State Health and Family Welfare Society, named as AROGYAKERALAM at the State level and District Health and Family Welfare Societies, named as AROGYAKERALAM (indicate name of district) in all the District Headquarters are registered societies under the Travancore Cochin Literary Scientific and Charitable Societies Registration Act 1955. A. Governing Body Chair person Minister, Health & Family Welfare

Principal Secretary H&FW CoChairperson Vice Chair Governor Members Secretary H&FW Officer Designated as Mission Director of State Health Mission

Secretaries of the NRHM related Departments: Health and Family Welfare, Finance, Woman and Child Development, Water and Sanitation, Panchayathi Raj, Rural Development, Tribal/SC Welfare, KWA, KSEB, Urban Affairs and Planning and Programme implementation, Executive Director, Kudumbashree. DHS, Director of Medical Education, Directors of ISM, Ayurveda Medical Education, Director of Homoeo and Principal & Controller Homoeo Medical Education GOI representative(S), MOHFW nominee Representative of development partners supporting the NRHM in the state Nominated Non-official members 4-6members (Public Health Professionals, MNGO representative/representatives of Medical Associations) Regional Directors

Frequency

of

meetings:

At

least

once

in

six

months

Ordinary Business of the Governing Body meeting: Approval/endorsement of Annual State Action Plan for the NRHM Consideration of proposals for institutional reforms in the H&FW sector review of implementation of the Annual Action. Plan Amendment and approval of bye laws of Kerala State Health Society Inter sectoral Co-ordination: All NRHM related sectors and beyond (eg: Administrative reforms across the State) Status of follow up action on decisions of the State Health Mission Co-ordination with NGOs/Donors/other Agencies/Organizations. B. Executive Committee

Chairperson Principal Secretary H&FW Co-chair(s) Secretary, H&FW (in case of separate Secretaries in the State)

Convener

Executive Director/Mission Director (to be an IAS Officer of JAG/selection Gr.) State Programme Managers/Project Directors of National disease control Programme. Director of Health Services, Directors of Health Services (Public Health, Family Welfare and Medical)-3 non-official members in the governing body are also to be included in the executive committee Director ISM, Director Ayurveda Medical Education, Director Homoeo, Principal Homoeo Medical Education Secretaries/Technical officers from NRHM related sectors, Project Director State Aids Control Society. MOHFW, GOI representatives Regional Directors

Members

Frequency of Meetings: At least once in three month Ordinary Business:

Detailed Expenditure and Implementation review Approval of proposals and other Districts and implementation agencies/District Action Plans. Execution of the approved State Action Plan, including release of funds of Programmes at State level as per annual Action Plan. Release of funds to the District Health Socieities. Finalization of working arrangements for intra sectoral and inter sectoral co-ordination. Follow up action on decision of the Governing Body. Issuing of Bye-laws, of Kerala State Health and Family Welfare Society and District Health and Family Welfare Society. Health Mission and the District Health & Family Welfare Society

District

On the lines of the State Health Mission, every district will have a District Health Mission comprising of the District Panchayath President as chair person and the District Collector as the Co-Chair person and District Medical Officer (H) as the Convenor & Member Secretary. To support the District Health Mission, there is the integrated District Health & Family Welfare Society. All the existing societies (except AIDS and Cancer) as vertical support structures for

different national and state health programmes were merged in the District Health & Family Welfare Society. The District Health & Family Welfare Society is responsible for planning and managing all health and family welfare programmes in the district, both in the rural as well as urban areas. The District Health & Family Welfare Society may also be viewed as an addition to the district administrations capacity, particularly for planning, budgeting, budget analysis, development of operational policy proposals, and financial management etc. Because it is a legal entity, the District Health & Family Welfare Society can set up its own office, which has adequate contingent of staff and experts and can evolve its own rules and procedures for hiring staff and experts both from the open market as well as on deputation from the Government. In other words, the District Health & Family Welfare Society is not an implementing agency; it is a facilitating mechanism for the district health administration as also the mechanism for joint planning by NRHM related secto` Governance structure Chairperson District Panchayath President Co-Chair & District Collector Executive Director Convener& Member Secretary District Medical Officer (H)

Members

MPs, MLAs, from the district, Chair-persons of the Standing Committees of the District Panchayath, Project Officer (DRDA), Chair-persons & Convenors of the District, General & W & C Hospital Development Societies, District Programme Officers for health programmes PHED, ICDS, AYUSH, Education, Social welfare, panchayati Raj, representative of State Mission Director Representative OF MNGO etc. District Health & Family Welfare Society

Governance

Structure

of

the

District

Health

&

Family

Welfare

Society

Governing Body Chair District Panchayat President

Co-Chair & District Collector Executive Director

Convener Members

District Medical Officer.

District Programme Manager (NRHM), Project Officer (DRDA), District Programme Managers for Health, AYUSH, Water and Sanitation [under Total Sanitation Campaign (TSC)], DPMSU, PHED, ICDS, Education, Social Welfare, Panchayati Raj, A representative of State Mission Director, Representatives of Medical Association/MNGO and Development Partners

Executive Committee Chair Co-Chair Vice-chair Convener Members District Collector DMO(H) District RCH Officer District Programme Manager District Superintendent of Police, Superintendents - General, W & C and District Hospitals, All District Programme Managers for health, ICDS, PHED, Water and Sanitation, Education, Panchayati Raj RDOs/ Sub Collectors, CHC In-charge, Project Officer (DRDA), District Programme Managers for AYUSH.

Contacts
Contact Details for Arogyakeralam #Name 1Sri. V.S. Sivakumar Shri. E. K. Bharat Bhushan IAS 3Dr. K. Ellangovan IAS 4Smt. Dr. M. Beena IAS 2 5Dr. N Sreedhar 6Dr K V Beena 7P. K. Harikrishnan 8K. Udayasimhan 9Sri. Jayasankar.S Position Minister for Health and Social Welfare and Chair Person Governing Body Chief Secretary to Govt of Kerala & Co-Chairperson, Governing Body Principal Secretary to Govt. (Health & Family Welfare) State Mission Director Addl. DHS (FW), State Programme Manager (NRHM) & Appellate Authority (RTI) NRHM State Programme Manager (RCH) State Administration Manager Senior administrative Assistant/Public Information Officer Chief Engineer

Sri. V Arunagiriswara Iyer 11V. V. Ramachandran 12Smt. P.C. Rajalakshmi 13Dr. Bipin K Gopal 14Dr. Amar Fetle 15Resmi C P 16Suneel Kumar Chvv 17Premjith P. 18Anishakumari M. C 19Dr. K.R. Rani 20Seena K.M. 21Rajeev Sekhar 22Abhilash R 23Awsathy L. 24Ajith Kumar.S 25G. Muraleedharan 10

Director {FInance and Accounts} Senior Consultant {DCP} Senior Administrative Asst. Assistant & Public Information Officer State Nodal Officer NCD State Nodal Officer {ARSH} State Data Officer & Demographer Senior Consultant (IT) Senior Consultant (BCC) Senior Consultant {Accounts} Consultant ( School Health & ARSH) Consultant (Social Development) Co ordinator KEMP Assistant System Adminstrator Assistant Bio Medical Officer Regional Quality Assurance Officers Jr. Consultant (NBITS)

The mission which is envisaged as another phase of the National Rural Health Mission, aims at improving healthcare facilities at hospitals in urban areas. The new mission will be implemented in five corporations and 10 municipalities in the first phase. The scheme will benefit around 33 lakh people from Thiruvananthapuram, Kollam, Ernakulam, Thrissur and Kozhikode corporations and municipalities of Neyyattinkara, Alappuzha, Kottayam, Palakkad, Manjeri, Kannur, Thodupuzha, Pathanamthitta, Kalpetta and Kasaragod. In the second phase, the mission will be extended to 22 more municipalities. It has been planned to begin the mission in towns with a population of over 50,000. It has been planned to set up 54 new healthcare centres in 15 towns in the first phas Health Minister V S Sivakumar M Beena, director of NRHM, Kerala