Nurses in implementation of National

Rural Health Mission

Dr. Pratima Mittra

Sr. Consultant,
RCH – II / NRHM
NIHFW
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 INTRODUCTION
Launched on 12th
April 2005 by the
Prime Minister .
Identified 18 States
with week PH
Indicators/Health Care
Infrastructure
The initial Outlay for
NRHM for 2005-06
was over Rs.6700
Crore.
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 Why NRHM ?
Declining Public Health Expenditure
Limited synergy in vertical and horizontal health
Programs
Lack of community ownership
Regional inequalities
Population stabilization is far from our reach
Curative services favor rich
Poor coverage by Health insurance (only 10%)
Hospitalization eats 58% of annual income,25%
population falls below poverty line following
hospitalization expenses
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 NRHM
N…..Newer Initiatives
R…..Rural Poor Population
H…..Holistic Health Package
M….Monitoring mechanisms

To cater to the primary health care needs

of vulnerable segment of population to
bring down IMR and MMR to attain
populations Stabilization

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 THE VISION
 Architectural correction in health care delivery
 Special focus on 18 states with weak
indicators.
 Improve availability of quality health care in
rural areas
 Synergy between health and determinants of
good health
 Mainstream the Indian Systems of Medicine.

 Capacity Building.

 Involve the community in the planning process

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 GOAL

The Mission seeks to provide universal

access to equitable, affordable and quality
health care which is accountable at the
same time responsive to the needs of the
people, reduction of child and maternal
deaths as well as population stabilization,
gender and demographic balance.

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 OBJECTIVES
 Reduction in child and maternal mortality
 Universal access to PH services for food and nutrition,
sanitation and hygiene with focus on women and
children health
 Prevention and control of communicable and non
communicable diseases including locally and endemic
diseases
 Population stabilization, attaining gender and
demographic balance
 Revitalize local health traditions and mainstream
AYUSH
 Promotion of healthy life styles
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The expected outcomes from the Mission
as reflected in statistical data are:

 IMR reduced to 30/1000 live births by

2012.
 Maternal Mortality reduced to
100/100,000 live births by 2012.
 TFR reduced to 2.1 by 2012.

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Current Status-Indicators

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 Action Points
Provision of health activist in each village
(ASHA)
Village health plan prepared through
Panchayats involvement
Strengthening of rural hospitals
Integration of vertical health programs
(leprosy, TB, malarial programs, etc.) and
traditional medicine
Integration of plans at different levels
New health financing mechanisms
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 NRHM focuses on
 making the public health delivery system fully
functional and accountable to the community,
 human resource management,
 community involvement,
 decentralization,
 rigorous monitoring and evaluation against
standards,
 convergence of health and related programmes
from village level upwards,
 innovations and flexible financing.

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 Core Strategies
1. Train and enhance capacity of Panchayat Raj
institutions to own, control and manage public
health services.
2. Promote access to improved health care at
household level through the female health activist.
3. Health plan for each village through village health
committee of the Panchayats.
4. Strengthening sub center through an untied fund
to enable local planning and action and more
MPW’s.
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 Core Strategies Contd…

5. Strengthening existing PHCs and CHCs.

6. Preparation and implementation of an intersect
district health plan prepared by the district
health mission .
7. Strengthening capacities for data collection,
assessment and review for evidence based
planning, monitoring and supervision.
8. Developing capacities for preventive health
care at all levels by promoting healthy life styles,
reduction in tobacco consumption, alcohol etc.

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 Components
 Accredited social health activists
 Strengthening sub-centers
 Strengthening primary health centers (24X7 PHCs)
 Strengthening CHCs for first referral unit
 District health plan under NRHM
 Strengthening disease control program
 Public-private partnership for public health goals,
including regulation of private sector
 New health financing mechanisms
 Reorienting health/medical education to support
rural health issues

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 Initiatives under NRHM
Initiatives under Maternal Health
Janani Suraksha Yojana (JSY)
Integrated RCH Camps
Village Health & Nutrition Days-Once in a
month at AWWC (anganwadi work center)
Initiatives for referral transport
EMRI services-108 ambulances-
JSSK (janani suraksha & shishu kalyan)-with
drop back facility, free medication, free diet

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Beneficiaries under JSY receive
Categ Rural Area Urban Area
ory of
Assista Packag Total Assista Packa Total
States
nce e for nce ge for
Packag the Packa the
e to Accredit ge to Accred
Mother ed Mother ited
Worker Worker

LPS 700 600 1300 600 200 800

HPS 700 Nil 700

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 Initiatives under Child Health
 Strengthening of routine immunization,
 Promotion of early and exclusive breast feeding
practices
 Establishment of neo-natal care units,
 Establishment of ORT corners and child care units up to
CHC level.
 Establishment of Neonatal Stabilization Units (NBSUs) &
New born care corners at LR
 IMNCI and F-IMNCI trainings (facility based management
of Neonatal Childhood Illness)
 Facility based new born care training to Medical Officers
& Staff Nurses to counter the shortage of Paediatricians
in District Hospital and FRU’s(1st referral unit)
 SNCUs(sick newborn care unit) at DH/SDH
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 Initiatives Contd….

Initiatives under Family Planning

 Fixed day approach
 The compensation for –
 Male Sterilization Rs 1400
 Female Sterilization Rs 1000
 Initiatives under ARSH
 Convergence with School Health Teams
 Menstrual Hygiene Program
 Career Counselling and Skill Enhancement
 Adolescent Friendly Clinic and Counselling
Centre(AFCs)

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 Role of Nurses
The nurses, the ANMs and the Staff Nurses play an important role
in:
 promotion of safe and institutional deliveries, conduction of
normal deliveries at SC/PHC/CHC/DH
 early detection of high risks pregnant mothers and difficulties
for having normal deliveries
 Provide newborn care
 Management of sick newborn
 early detection of complications of mothers and newborns
during post-natal period.
 The Community Health Nurse Specialists, as a leader can
provide support, guidance and contribute in strengthening the
competency of the service providers at community set up.
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 Training included for nurses
under NRHM
For ANM:
MH-SBA, RTI/STI, Infection Management and Environment
Protection (IMEP), MCTS
CH-NSSK, Integrated Management of Neonatal and Child
Illness (IMNCI), Infant and Young Child Feeding (IYCF),
Immunization
FP-IUD, Contraceptive update
For Staff Nurses:
MH-SBA, RTI/STI, IMEP, MTP team,
CH- IMNCI, SNCU, FBNC, Immunization
FP-IUCD and PP-IUCD, Minilap team, Contraceptive
update
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 Additional Nursing
Persons under NRHM

Staff Nurses:

4 at 24X7 PHCs (5/each), CHCs (15/CHC)

ANMs

Second ANM at Sub center

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NGO’S working in the health field
 Several agencies & institutions are working in the field of
health to extend medical facilities and to eradicate health
problems. These agencies & institutions are working at
local, state, national & international levels. These
institution Can be classified in to 2 groups.
1. Government organizations
2. Non governmental org. (NGO’S) or voluntary health
association.
The NGO’S pay more attention to area like improvement
of health status, health education, legislation regarding
health & research.

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 voluntary health
International health agencies
agencies
INDIAN RED CROSS
WHO SOCIETY
UNICEF KASTURBA
FAO MEMORIAL FUND
WORLD BANK BHARAT SEVAK
CARE SAMAJ
INTERNATIONAL CMAI
REDCROSS  world vision
Leprosy mission
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 Role of NGO’S
In India Panchayat’s are an old institution for
govt. at village level. Panchayat Raj
institution (PRI) were strengthened with clear
areas of jurisdiction, authority and funds.
PRI’s have been assigned several
development activities including health &
population stabilization.
The gram sabha act as a community level
accountability function to ensure that the
functions of the PRI respond to people’s
need.
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 Cont….
The state would involves PRI in the
implementation of health & family welfare
prog. By progressive transfer of funds,
manage & supervise the functioning of
health care infrastructure
To coordinate the activities of works of
different dept. such as HFW & social
welfare & education at the village & block
level.

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 Cont….
To support & facilitate PRI in the success
of NRHM.
Empowerment of panchayat through and
assured availability of adequate funds,
clear articulation of function.
Enlist NGO’s support in building capacity
among PRI’s members to effectively
handle development related functions

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 Cont….
NGO’s could be involved in PRI
strengthening in a variety of ways
including raising provision of technical
advice, support in participation in planning
,monitoring process such as community
and social audit to improve accountability.

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Role of Panchayati Raj Institutions
The Mission envisages the following roles for
PRIs:
• States to indicate in their MoUs the commitment
for devolution of funds, functionaries and
programmes for health, to PRIs.
• The District Health Mission to be led by the Zila
Parishad. The DHM will control, guide and
manage all public health institutions in the
district, Sub-centers, PHCs and CHCs.
• ASHAs would be selected by and be
accountable to the Village Panchayat.

Dr. KANUPRIYA LOGO

CHATURVEDI
 contd.
· The Village Health Committee of the
Panchayat would prepare the Village Health
Plan, and promote inter sectoral integration
· Each sub-centre will have an Untied Fund for
local action @ Rs. 10,000 per annum. This
Fund will be deposited in a joint Bank Account
of the ANM & Sarpanch and operated by the
ANM, in consultation with the Village Health
Committee.
· PRI involvement in Rogi Kalyan Samitis for
good hospital management.
· Provision of training to members of PRIs.
Dr. KANUPRIYA LOGO
CHATURVEDI
 Monitoring and
Evaluation
· Health MIS to be developed upto CHC level, and web-
enabled for citizen scrutiny
· Sub-centres to report on performance to Panchayats,
Hospitals to Rogi Kalyan Samitis and District Health Mission
to Zila Parishad
· The District Health Mission to monitor compliance to Citizen’s
Charter at CHC level
· Annual District Reports on People’s Health (to be prepared
by Govt/NGO collaboration)
· State and National Reports on People’s Health to be tabled in
Assemblies, Parliament
· External evaluation/social audit through professional
bodies/NGOs
· Mid Course reviews and appropriate correction
Dr. KANUPRIYA LOGO
CHATURVEDI
 Reference
www.bibalex.org/supercourse/supercourse
PPT/40011-41001/40361

Dr. KANUPRIYA LOGO

CHATURVEDI
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