Competitive Exams: Current Affairs 2011: NHRM

National Rural Health Mission (NHRM)

  • The National Rural Health Mission (NRHM) was launched in 2005 to bring about a dramatic improvement in the health system and health status of people in rural India.

  • It seeks to provide universal access to health care, which is affordable, equitable, and of good quality. It aims at making architectural corrections to basic health care systems, reduce regional imbalances, pool resources, integrate organisational structures, optimise human resource, decentralise the management of district health programmes and integrate many vertical health programmes. It also aims at facilitating community participation, partnership and ownership of health and health care delivery.

  • The NRHM has been described as one of the largest and most ambitious programmes to revive health care and has many achievements to its credit.

  • It has reiterated the focus on health and re-prioritised rural health and health care.

  • It has increased health finance, and improved infrastructure for health delivery.

  • It has established standards and trained health care staff.

  • It has also set benchmarks for health institutions and improved and streamlined health care delivery structures.

  • It has coordinated technical support from health resource institutions and nongovernmental organisations.

  • It has improved health care delivery in many regions.

  • It has facilitated financial management, assisted in computerisation of health data, suggested centralised procurement of drugs, hospital equipment and supplies, and mandated the formation of village health and hospital committees and community monitoring of services.

  • It has revived and revitalised a neglected public health care delivery system.

  • The NRHM has injected new hope in the health care delivery system. However, it continues to face diverse challenges, which need to be addressed if its goals are to be achieved in the near future.

  • Non-convergence of different programmes: Many programmes of the government, the Integrated Child Development Services (ICDS), the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) and the NRHM focus on the rural poor. In principle, these programmes are meant to be complementary and synergistic. However, many issues need to be resolved. For example, the NRHM's Village Health and Nutrition Days compete with the ICDS's well-established Anganwadi programme. This results in a lack of synergy between the workers employed by the two programmes. Similarly, coordination between the MGNREGS and the NRHM, which could help the most vulnerable sections, is non-existent. The goal of health for all requires cooperative teamwork among the many schemes and departments of the government.

  • Parallel health systems: The NRHM is intended to strengthen and support the existing State health systems and services. However, its status as a project makes its complete integration problematic. The idea that the States will take over its financing after 2012 does not generate enthusiasm for long-term commitment from staff at the State and district levels. In addition, the administrative machinery of the NRHM and health services at the national, State and district levels remains separate without complete integration, making the programme less effective and the services less than optimal.

  • Process and outcome indicators: The NRHM currently employs process indicators to measure its implementation. The measures used are mainly related to infrastructure and personnel. There is need to shift to indicators of efficient functioning. In the final analysis, the NRHM's impact will have to be assessed against hard data on health outcomes. The initial high rates of mortality tend to reduce rapidly with early inputs but require fully functional, efficient and effective systems for sustained results.

  • Social determinants of health: The NRHM's goals clearly state the need to impact on the social determinants of health by coordinating efforts to provide clean water, sanitation, and nutrition. It should be in conjunction with MGNREGS work towards the reduction of poverty. Social exclusion and gender discrimination are two major areas of concern as they have a significant impact on health. The NRHM should not only focus on treating diseases in these sub-populations but also work towards implementing policies, which will bring about health and social justice for all.

  • The NRHM has made a significant impact on health care delivery. However, the need for constant monitoring of its impact for course corrections should be built into the system for optimal results and for achieving the goal of Health for all.

Courtesy: The Hindu and Times of India