The National Health Mission (NHM) is a flagship initiative of the Government of India, designed to address the healthcare needs of the country, particularly in rural and urban areas. This mission aims to achieve universal access to equitable, affordable, and quality healthcare services. This article provides a detailed overview of the NHM, its objectives, strategies, institutional mechanisms, and various components.
About the National Health Mission (NHM):
The National Health Mission (NHM) is an overarching mission that encompasses two sub-missions:
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National Rural Health Mission (NRHM): Focuses on providing equitable, affordable, and quality healthcare to the rural population, especially vulnerable groups.
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National Urban Health Mission (NUHM): Seeks to improve the health status of the urban population, particularly slum dwellers and other vulnerable sections, by facilitating their access to quality primary healthcare.
The NHM was launched with the goal of achieving the targets set out in the 12th Five-Year Plan, and its outcomes are aligned with the overall vision of improving health indicators across the country. The mission emphasizes state-specific goals based on existing levels, capacity, and context, encouraging state-specific innovations.
Key Objectives of the NHM:
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Reduce Maternal Mortality Rate (MMR) to 1/1000 live births.
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Reduce Infant Mortality Rate (IMR) to 25/1000 live births.
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Reduce Total Fertility Rate (TFR) to 2.1.
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Prevent and reduce anemia in women aged 15-49 years.
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Prevent and reduce mortality and morbidity from communicable and non-communicable diseases, injuries, and emerging diseases.
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Reduce household out-of-pocket expenditure on total healthcare.
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Reduce the annual incidence and mortality from Tuberculosis by half.
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Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts.
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Reduce the annual malaria incidence to <1/1000.
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Reduce microfilaria prevalence to less than 1% in all districts.
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Eliminate Kala-azar by 2015 to <1 case per 10000 population in all blocks.
Institutional Mechanisms:
The NHM operates through various institutional mechanisms at the national and state levels:
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National Level:
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Mission Steering Group (MSG): Provides policy direction to the Mission, chaired by the Union Minister of Health & Family Welfare.
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Empowered Programme Committee (EPC): Examines financial proposals and is headed by the Union Secretary of Health and Family Welfare.
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Mission Director: The Mission is headed by a Mission Director of the rank of Additional Secretary, supported by a team of Joint Secretaries.
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National Programme Management Unit (NPMU): Earmarked for program management and policy support activities.
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National Health Systems Resource Center (NHSRC): Serves as the apex body for technical support to the center and states, focusing on problem identification, analysis, and capacity building.
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National Institute of Health and Family Welfare (NIHFW): The country’s apex body for training, focusing on public health education and skill development.
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State Level:
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State Health Mission (SHM): Functions under the overall guidance of the State Chief Minister.
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State Health Society (SHS): Carries out the functions under the Mission, headed by the Chief Secretary.
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District Health Mission (DHM)/City Health Mission (CHM): Headed by the head of the local self-government (Chairperson Zila Parishad/Mayor).
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State Program Management Unit (SPMU): Acts as the main secretariat of the SHS.
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State Health System Resource Centers (SHSRC): Provide technical support to the state.
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State Institutes of Health and Family Welfare (SIHFW): Focus on training and skill development.
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District Programme Management Unit (DPMU): Linked to a District Health Knowledge Center (DHKC).
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District Training Center (DTC): Nodal agency for training requirements of the District Health Society (DHS).
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Financing Components of NHM:
The NHM has six financing components:
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NRHM-RCH Flexipool
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NUHM Flexipool
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Flexible pool for Communicable Diseases
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Flexible pool for Non-Communicable Diseases, including Injury and Trauma
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Infrastructure Maintenance
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Family Welfare Central Sector component
States have the flexibility to plan and implement state-specific action plans within the broad national parameters.
National Rural Health Mission (NRHM):
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Focus: To provide equitable, affordable, and quality healthcare to the rural population, especially vulnerable groups.
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Empowered Action Group (EAG) States: Special focus is given to EAG states, North Eastern States, Jammu and Kashmir, and Himachal Pradesh.
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Community-Owned System: The mission aims to establish a fully functional, community-owned, decentralized health delivery system.
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Inter-sectoral Convergence: It seeks to ensure simultaneous action on determinants of health, such as water, sanitation, education, nutrition, social and gender equality.
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Institutional Integration: It promotes integration within the fragmented health sector, focusing on outcomes measured against Indian Public Health Standards.
NRHM – Health Systems Strengthening:
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Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Services:
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Integrates all schemes and programs of RCH-II into the NHM.
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Emphasizes a continuum of care approach, recognizing the linkages between adolescent health, family planning, maternal health, and child survival.
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Focuses on increasing knowledge and access to reproductive health services and addressing nutritional anemia.
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Links community and facility-based care, strengthening referrals, and creating a continuous care pathway.
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Maternal Health:
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Improves access to skilled obstetric care through facility development.
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Increases coverage and quality of antenatal and postnatal care.
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Ensures basic and comprehensive emergency obstetric care.
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Strengthens health facilities as “delivery points.”
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Modifies the Janani Suraksha Yojana (JSY) to synergize with new Food Security legislation.
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Moves towards Universal Health Coverage (UHC) through free and cashless services for pregnant women and sick infants.
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Strengthens emergency response and patient transport systems.
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Improves monitoring of care in pregnancy through name-based information systems.
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Emphasizes comprehensive women’s health, including care for non-communicable diseases and screening for common cancers.
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Access to Safe Abortion Services:
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Improves access to comprehensive abortion care, including post-abortion contraception.
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Expands the network of facilities providing MTP services.
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Prevention and Management of Reproductive Tract Infections (RTI) and Sexually Transmitted Infections (STI):
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Includes prevention of RTI/STI in community health education and adolescent health education.
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Provides diagnosis and treatment services at health facilities.
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Emphasizes syndromic management and laboratory services.
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Links up with Integrated Counseling and Treatment Centers (ICTCs) for HIV testing and RTI/STI management.
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Gender-Based Violence:
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Addresses the consequences of gender-based violence, including physical injuries, reproductive health problems, and mental health.
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Sensitizes and trains frontline workers and clinical service providers to identify and manage GBV.
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Develops effective referral mechanisms and creates follow-up mechanisms with government departments and NGOs.
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Newborn and Child Health:
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Provides a continuum of care from the community to the facility level.
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Includes home-based newborn and child care through ASHAs and ANMs.
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Provides community-level care for acute respiratory infections, diarrhea, and fevers.
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Ensures essential newborn care and resuscitation at delivery points.
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Provides facility-based care for sick newborns.
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Universal Immunization:
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Sustains Pulse Polio campaigns and achieves over 80% routine immunization.
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Considers the introduction of new and underutilized vaccines.
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Improves cold chain management and logistics.
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Child Health Screening and Early Intervention Services:
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Improves the quality of life of children 0-18 years through early detection of birth defects, diseases, deficiencies, developmental delays, and disabilities.
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Provides comprehensive care at appropriate levels of health facilities through the Rashtriya Bal Swasthya Karyakram (RBSK).
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Adolescent Health:
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Provides Iron and Folic Acid (IFA) supplementation.
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Offers facility-based adolescent health services.
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Conducts community-based health promotion activities.
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Provides information and counseling on sexual and reproductive health, substance abuse, mental health, non-communicable diseases, injuries, and violence.
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National Urban Health Mission (NUHM):
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Focus: To improve the health status of the urban population, particularly slum dwellers and other vulnerable sections.
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Coverage: To cover all state capitals, district headquarters, and other cities/towns with a population of 50,000 and above, in a phased manner.
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Implementation: Implemented by the City Health Mission in mega cities.
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Urban Health Committees: The management of NUHM activities is coordinated by city-level Urban Health Committees.
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Integration: Existing vertical societies are merged into the DHS.
Flexible Pool for Control of Communicable Diseases:
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The NHM continues to focus on communicable disease control and disease surveillance.
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Strategies and interventions are adapted to meet the challenges of urban settings.
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The Flexible Pool facilitates states in preparing state, district, and city-specific plans.
National Vector Borne Diseases Control Programme (NVBDCP):
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An umbrella program for prevention and control of vector-borne diseases.
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Provides policy guidance, technical assistance, and funding to states.
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Emphasizes early case detection, prompt treatment, integrated vector management, and use of Long Lasting Insecticidal Nets (LLIN).
Revised National Tuberculosis Control Programme (RNTCP):
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Aims to reduce mortality and morbidity due to TB and reduce transmission of infection.
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Focuses on achieving a cure rate of at least 85% among new sputum-positive patients and case detection of at least 70% of estimated cases.
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Ensures universal access to quality TB diagnosis and treatment.
National Leprosy Control Programme (NLEP):
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Provides diagnosis and treatment of leprosy through primary health centers and government dispensaries.
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Uses Multi-Drug Therapy (MDT) and involves ASHAs in case finding and treatment completion.
Integrated Disease Surveillance Programme (IDSP):
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Implements surveillance of disease outbreaks in all states.
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Collects data on epidemic diseases through reporting units.
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Analyzes data for disease trends and investigates outbreaks.
National Programme for the Healthcare of the Elderly (NPHCE):
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Provides comprehensive healthcare to senior citizens through all levels of the healthcare system.
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Focuses on outreach services, geriatric clinics, and rehabilitation services.
National Programme for the Prevention and Control of Deafness (NPPCD):
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Aims to prevent avoidable hearing loss, promote early identification and diagnosis, and provide rehabilitation.
Community Processes, Behavior Change Communication, and Addressing Social Determinants:
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ASHAs: The ASHA program is strengthened, emphasizing voluntarism, local residency, and community-based selection.
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BCC: Behavior Change Communication is a key component, focusing on identifying and addressing behaviors detrimental to health.
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Social Determinants: Action on social determinants occurs at multiple levels, including integration into district plans, shaping the VHSNC, and inter-sectoral coordination.
Human Resource Development:
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NHM supports the creation and strengthening of institutions for capacity building.
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States develop strong HR management systems with improved practices for recruitment and postings.
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In-service programs are provided for skill development.
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Bridge courses are developed for ASHAs to become ANMs/GNMs and for ANMs to become nurses.
Public Health Management:
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Managerial expertise is infused into public health services.
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A specialized Public Health Cadre is developed.
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The Directorate of Health Services is strengthened, and synergy is promoted at the leadership level.
Governance and Accountability Framework:
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The Mission Steering Group oversees the program at the national level.
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State Health Missions and Governing Bodies hold program executives accountable at the state level.
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Regular meetings, transparency, and multi-stakeholder participation are essential.
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Statutory audit reports are placed before the Governing Body.
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Rogi Kalyan Samitis (RKS) play a role in improving accountability at the facility level.
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Periodic concurrent audits and annual audits are conducted.
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Community monitoring of facilities and innovative systems of community oversight are encouraged.
Conclusion:
The National Health Mission (NHM) is a comprehensive and ambitious program that aims to transform the healthcare landscape in India. By addressing both primary and secondary healthcare needs, focusing on preventive and curative services, and promoting community participation, the NHM strives to achieve universal health coverage and improve the health and well-being of all citizens.