When was nrhm established

NHP further built on NHP , with an objective of provision of health services to the general public through decentralization, use of private sector and increasing public expenditure on health care overall. Due to the India's federalized system of government, the areas of governance and operations of health system in India have been divided between the union and the state governments. In addition, the Ministry assists states in preventing and controlling the spread of seasonal disease outbreaks and epidemics through technical assistance.

However, areas having wider ramification at the national level, such as family welfare and population control, medical education, prevention of food adulteration, quality control in manufacture of drugs, are governed jointly by the union and the state government.

India has a mixed health-care system, inclusive of public and private health-care service providers. The public health-care infrastructure in rural areas has been developed as a three-tier system based on the population norms and described below.

SCs are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programs. PHCs were envisaged to provide integrated curative and preventive health care to the rural population with emphasis on the preventive and promotive aspects of health care.

As per minimum requirement, a PHC is to be staffed by a medical officer supported by 14 paramedical and other staff. It acts as a referral unit for SCs and has beds for in-patients.

The activities of PHCs involve health-care promotion and curative services. It has 30 beds with an operating theater, X-ray, labor room and laboratory facilities.

It serves as a referral center for PHCs within the block and also provides facilities for obstetric care and specialist consultations.

An existing facility district hospital, sub-divisional hospital, CHC can be declared a fully operational first referral unit FRU only if it is equipped to provide round-the-clock services for emergency obstetric and newborn care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU: i emergency obstetric care including surgical interventions such as caesarean sections; ii care for small and sick newborns; and iii blood storage facility on a h basis.

Schematic diagram of the Indian Public Health Standard IPHS norms, which decides the distribution of health-care infrastructure as well the resources needed at each level of care is shown in Figure 1.

Indian Public Health System. NRHM, launched in , was a watershed for the health sector in India. With its core focus to reduce maternal and child mortality, it aimed at increased public expenditure on health care, decreased inequity, decentralization and community participation in operationalization of health-care facilities based on IPHS norms.

It was also an articulation of the commitment of the government to raise public spending on health from 0. Within the mission there are high-focused and low-focused states and districts based on the status of infant and maternal mortality rates, and these states are provided additional support, both financially and technically.

Gradually it has emerged as a major financing and health sector reform strategy to strengthen the state health systems. Major initiatives have been undertaken under NRHM for architectural correction of the rural health system—in terms of availability of human resources, program management, physical infrastructure, community participation, financing health care and use of information technology. Some of these activities are tabulated below Table 1. The mission emphasized on increasing health-care delivery points as well as facilities available at the health-care delivery points.

It not only focused on increasing the number of physicians, specialists, staff nurses, as well as ANMs, but also gave importance to increasing the production capacity of medical colleges at graduate and post graduate levels.

Physical infrastructure was enhanced by creating more health centers, newborn care units and renovating existing centers, which increased the capacity of health systems to treat more mothers and children. Special efforts were made to strengthen community participation through the formation of health committees at the village level and patient welfare committees at public health-care facilities.

Information technology was used to track delivery of services to the mother and child. And all this has been an outcome of increased financial assistance by the central government and increased rates of utilization. During the period , the total investment by the central government equalled nearly 17 billion USD. In India, major policies and national programs are planned and implemented during the 5-year planning phase.

Despite the fact that no explicit programs on newborn care have been designed in the past, various programs and the 5-year plans in the country had focused on provision of services for mothers and children. Thereafter, newborn care started receiving more attention and resources in the subsequent programs and initiatives. Under NRHM, newborn health received unprecedented attention and resources with the launch of several new initiatives aimed at reducing the burden of maternal and newborn mortality and morbidity.

On the basis of this approach, the central government has taken vital policy decisions to combat major causes of newborn death, providing special attention to sick newborns, babies born too soon premature and too small small for gestational age. The strategy identifies the roles to be played at each level of care and the service provision and health systems requirement in terms of manpower and commodities for each of them.

Only those health facilities are designated as FRUs that have the facilities and manpower to conduct a caesarean section.

Moreover, the strategic document identifies the required capacity building efforts for which NRHM has produced manuals. So far out of capacity building manuals, 10 are dedicated to newborns. The document also has the guidance for reaching remote inaccessible areas to ensure maternal and child Health care. One of the key aspects of the document and one that certainly contributes to its comprehensive nature is the involvement of various stakeholders in its development.

Apart from the core drafting team of the Ministry of Health and Family Welfare, the technical support team is represented by the development partners, academic partners, practitioners, nationally and internationally. This has proved to be an important step for wider adaptation of processes and is crucial for implementation success. India has been focussing on providing comprehensive care to mother and child. It has framed policies that allow the design and implementation of programs on newborn care in an inclusive manner.

However, looking at the pace of achievements of the targets so far and future targets, it needs to focus more on framing of the policies in terms of building capacity of existing human resources, enhancing further allocation of finances dedicated toward newborn care, identifying areas through operational research, which can enhance quantity and quality of care for newborn care in India.

The path is set and we need to operationalize and move forward. Population stabilisation, gender and demographic balance. Promotion of healthy life styles. Goal The goal of NRHM 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.

Vision Provide effective healthcare to rural population throughout the state. Increase public spending on health with increased arrangement for community financing and risk pooling. Undertake architectural correction of the health system to enable it to effectively handle increased allocations and promote policies that strengthen public health management and service delivery in the state. Effectively integrate of health concerns, through decentralised management at district level, with determinants of health like sanitation and hygiene, nutrition, safe drinking water, gender and social concerns.

Address inter-state and inter-district disparities. Set time bound goals and report publicly of progress. Improve access of rural people, especially poor women and children to equitable, affordable, accountable and effective primary health care.