NATIONAL RURAL HEALTH MISSION AND NATIONAL URBAN HEALTH MISSION

1. NATIONAL RURAL HEALTH
MISSION & NATIONAL URBAN
HEALTH MISSION
PRAMOD KUMAR

2. HEALTH
Health is defined as "a state
of complete physical,
mental, and social well-
being and not merely the
absence of disease or
infirmity."

3. NATIONAL RURAL HEALTH MISSION-
• The National Rural Health Mission (NRHM)
was launched on 12th April 2005, to provide
accessible, affordable and accountable quality
health services to the poorest households in the
remotest rural regions. Under the NRHM,
difficult areas with unsatisfactory health
indicators were classified as special focus States
to ensure greatest attention where needed.

4. CHALLENGES OF PUBLIC HEALTH IN
RURAL AREA
 Integration of sanitation, hygiene, nutrition and
drinking water issues needed in the overall sectoral
approach for health.
 Striking regional inequalities.
 The challenge of population stabilization especially in
States with weak demographic indicators.
 Undue importance of curative services that favor non-
poor.
 For every Rs.1 spent on poorest 20% population, Rs.3
spent on the richest quintile.
 About 10% Indians had some form of health insurance,
mostly inadequate.

5. PRINCIPLES
 Promote equity, efficiency, quality and
accountability in Public Health Systems.
 Enhance people orientation band community- based
approaches.
 Ensure Public health focus.
 Recognize value of traditional knowledge base of
communities.
 Promote new innovations, methods and process
development.
 Decentralize and involve local bodies.

6. GOALS
 Reduction in Infant Mortality Rate (IMR) and Maternal
Mortality Ratio (MMR)
 Universal access to public health services such as Women’s
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.

7. 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.
• Revitalise local health traditions and mainstream
AYUSH into the public health system.

8. cont..
• Effectively integrate of health concerns, through
decentralized management at district level, with
determinants of health like sanitation and
hygiene, nutrition, safe drinking water, gender
and social concerns.
• 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.

9. OBJECTIVES
• ASHA: Provision of trained and supported Village
Health Activist in underserved areas as per need
(Accredited Social Health Activists, ASHA)-
Ensuring quality and close supervision of ASHA.
• Health Action Plan: Preparation of health action
plans by panchayat as mechanism for involving
community in health.
• IPHS: Strengthening SC/PHC/CHC by developing
Indian Public Health Standards.

10. cont..
• FRU: Increase utilization of First Referral Units from
less than 20% (2002) to more than 75% by 2010.
• District: Institutionalizing and substantially
strengthening District level Management of Health
(all districts).
• AYUSH: Strengthening sound local health traditions
and local resource based practices related to PHC
and public health.

11. EXPECTED OUTCOMES FROM THE
MISSION
• IMR reduced to 30/1000 live births by 2010.
• MMR reduced to 100/100.000 live births by 2012.
• TFR reduced to 2.1 by 2012.
• Malaria mortality reduction rate-50% by 2010,
additional 10% by 2012.
• Kala-Azar mortality reduction rate-100% by 2010
and sustaining elimination until 2012.
• Filarial reduction rate-70% by 2010, 80% by 2012
and elimination by 2015.

12. cont..
• Dengue mortality reduction rate-50% by 2010 and
sustaining it at that level till 2012.
• Japanese encephalitis mortality reduction rate-50% by
2010 and sustaining it at that the level till 2012.
• Cataract operations increasing to 46 lakh per annum
until 2012.
• Leprosy prevalence rate- reduce from 1.8 per 10,000 in
2005 to less than one per 10000 thereafter.
• TB DOTS series- maintain 85% cure rate through entire
mission period.
• Upgrading all CHCs to Indian Public Health Standards.

13. PLAN OF ACTION
Consists of 10 components
COMPONENT-1: ASHA (ACCREDITED SOCIAL HEALTH
ACTIVISTS)
• Selection: every village/large habitat (1000 population) will
have a female community health activist-chosen by and
accountable to the panchayat -to act as the interface
between the community and the public healthcare system.
ASHA must be primarily a woman resident of the village-
married/widow/ divorced and preferably in the age group
of 25-45 yrs. She should be a literate woman with formal
education upto the 8th class with communication and
leadership qualities.
• ASHA would act as a bridge between the ANM and the
village and be accountable to the panchayat.
• ASHA will be honorary volunteer.

14. cont..
Responsibilities
 Awareness: Regarding nutrition, basic sanitation and hygienic
practices, healthy living and working conditions, information on
existing health services and need for utilization of health & family
welfare services.
• Counseling: On birth preparedness, importance of safe delivery,
breast feeding, and complementary feeding, immunization,
contraception and prevention of common infections including
RTIs/STIs and care of the young child.
• Mobilization: to mobilize the community and facilitate them in
accessing health and health related services available at the
Anganwadi/subcentres/PHCs.
• Escort: to arrange escort/accompany pregnant women and
children requiring treatment/ admission to the nearest pre-
identified health facility.

15. cont..
• Medical care: to provide primary medical care for
minor ailments such as diarrhea, fever, and first aid.
She will be a provider of DOTS also.
• Drug Depot: to act as depot holder for essential
provisions being made available to every habitation
like ORS, iron & folic acid tablets, Disposable
Delivery Kit, Oral pills, condoms etc.
• Birth & death registration: to inform sub-
centre/PHC about birth and death and

16. cont..
COMPONENT 2: STRENGTHENING SUB-CENTRES
• Each sub- centre will have an untied fund for local
action @ Rs. 10,000 per annum. This fund will be held
in joint account of ANM and Panchayat Sarpanch.
• Supply of essential drugs (allopathic and AYUSH) to the
sub-centres.
• In case of additional outlays, MPWs (Male)/additional
ANMs wherever needed, sanction of new sub-centers
as per 2001 population norm, and upgrading existing
subcentres, including buildings for subcentres
functioning in rented premises will be considered.

17. cont..
COMPONENT 3: STRENGTHENING PRIMARY HEALTH
CENTRES
• Strengthening of PHC for quality preventive,
promotive, curative, supervisory and outreach
services. Adequate and regular supply of essential
quality drugs and equipment to PHCs.
• Provision of 24 hours services in 50% PHCs by
addressing shortage of doctors, especially in high
focus states, through mainstreaming AYUSH
manpower.
• Standard treatment guidelines & protocols.

18. cont..
• Supply of Auto Disabled (AD) Syringes for
immunization.
• In case of additional outlays, intensification of
ongoing communicable disease control
programmes, new progress for control of non-
communicable diseases, upgradation of 100% PHCs,
and provision of 2nd doctor at PHC level (1 male, 1
female) would be undertaken on the basis of felt
need.

19. cont..
COMPONENT 4: STRENGTHENING OF CHCS FOR
FIRST REFERRAL CARE
• Operationalsing existing community Health centres
(30-50 beds) as 24 hours First Referral Units,
including posting of anesthetists.
• Codification of new Indian Public Health Standards
(IPHS), setting norms for infrastructures, staff,
equipment, management etc. for SC/PHC/CHC.
• Promotion of stakeholders’ committees (Rogi Kalyan
Samities) for hospital management.

20. cont..
• Developing standards of services and costs in
hospital care.
• Develop, display and ensure compliance to Citizen’s
Charter at CHC/PHC level.
• In case of additional Outlays, creation of new
Community Health Centres (30-50 beds) to meet
the population norm as per Census 2001, and
bearing their recurring costs for the Mission period
could be considered.

21. cont..
• COMPONENT 5: DISTRICT HEALTH PLAN
• District Health Plan would be an amalgamation of
field responses through Village Health Plans, State
and National priorities for Health, Water Supply,
Sanitation and Nutrition.
• Health Plans would form the core unit of action
proposed in areas like water supply, sanitation,
hygiene and nutrition. Implementing Departments
would integrate into District Health Mission for
monitoring.

22. cont..
• District becomes core unit of planning, budgeting
and implementation.
• Centrally Sponsored Schemes could be
rationalized/modified accordingly in consultation
with States.
• Concept of “funneling” funds to district for effective
integration of programmes

23. cont..
• All vertical Health and Family Welfare Programmes
at District and state level merge into one common
“District Health Mission” at the District level and
the “State Health Mission” at the state level
• Provision of Project Management Unit for all
districts, through contractual engagement of MBA,
Inter Charter/Inter Cost and Data Entry Operator.

24. cont..
• COMPONENT 6: CONVERGING SANITATION AND
HYGIENE UNDER NRHM
• Total Sanitation Campaign (TSC) is presently
implemented in 350 districts, and is proposed to cover
all districts in 10th Plan. Components of TSC include IEC
activities, rural sanitary marts, individual household
toilets, women sanitary complex, and School Sanitation
Programme.
• Similar to the DHM, the TSC is also implemented
through Panchayati Raj Institutions (PRIs).
• The District Health Mission would guide activities of
sanitation at district level ASHA would be incentivized
for promoting household toilets by the Mission.

25. cont..
• COMPONENT 7: STRENGTHENING DISEASE
CONTROL PROGRAMMES
• National Disease Control Programmes for Malaria a,
TB, Kala Azar, Filaria, Blindness & Iodine Deficiency
and Integrated Disease Surveillance Programme
shall be integrated under the Mission, for improved
programme delivery.
• New Initiatives would be launched for control of
Non Communicable Diseases.

26. cont..
• Disease surveillance system at village level would be
strengthened.
• Supply of generic drugs (both AYUSH & Allopathic)
for common ailments at village, SC, PHC/CHC level.
• Provision of a mobile medical unit at District level
for improved Outreach services.

27. cont..
• COMPONENT 8: PUBLIC-PRIVATE PARTNERSHIP
FOR PUBLIC HEALTH GOALS, INCLUDING
REGULATION OF PRIVATE SECTOR
• Since almost 75% of health services are being
currently provided by the private sector, there is a
need to refine regulation
• District Institutional Mechanism for Mission must
have representation of private sector

28. cont..
• Need to develop guidelines for Public-Private
Partnership (PPP) in health sector. Public sector
to play the lead role in defining the framework
and sustaining the partnership
• Management plan for PPP initiatives: at
District/State and National levels

29. cont..
• COMPONENT 9: NEW HEALTH FINANCING
MECHANISMS
A Task Group to examine new health financing
mechanisms, including Risk Pooling for Hospital Care as
follows:
• District Health Missions to move towards paying
hospitals for services by way of reimbursement, on the
principle of “money follows the patient.”
• Standardization of services and National Expert Group
to monitor these standards and give suitable advice
and guidance on protocols and cost comparisons.

30. cont..
• COMPONENT 10: REORIENTING HEALTH/MEDICAL
EDUCATION TO SUPPORT RURAL HEALTH ISSUES
• Medical and Para-medical education facilities need
to be created in states, based on need assessment.
• Suggestion for Commission for Excellence in Health
Care (Medical Grants Commission), National
Institution for Public Health Management etc.
• Task Group to improve guidelines/details.

31. NATIONAL RURAL HEALTH MISSION -
INSTITUTIONAL MECHANISM
• Village Health & Sanitation Samiti.
• Rogi Kalyan Samiti (or equivalent) for community
management of public hospitals.
• District Health Mission, under the leadership of Zila
Parishad with District Health Head as Convener and
all relevant departments, NGOs, private
professionals etc represented on it

32. cont..
• State Health Mission, Chaired by Chief Minister and
co-chaired by Health Minister and with the State
Health Secretary as Convener- representation of
related departments, NGOs, private professionals
etc.
• Integration of Departments of Health and Family
Welfare, at National and State level.
• National Mission Steering Group to provide policy
support and guidance to the Mission.

33. cont..
• Empowered Programme Committee
• Standing Mentoring Group shall guide and
oversee the implementation of ASHA
initiative.

34. ROLE OF STATE GOVERNMENTS
UNDER NRHM
The Mission covers the entire country. The 18 high focus
States are Uttar Pradesh, Bihar, Rajasthan, Madhya
Pradesh, Orissa, Uttaranchal, Jharkhand, Chhattisgarh,
Assam, Sikkim, Arunachal Pradesh, Manipur, Meghalaya,
Tripura, Nagaland, Mizoram Himachal Pradesh and
Jammu & Kashmir. Govt would provide funding for key
components in these 18 high focus States.
• NRHM provides broad conceptual framework. States
would project operational modalities in their State
Action Plans, to be decided in consultation with the
Mission Steering Group.

35. cont..
• NRHM would prioritize funding for addressing inter-
state and intra district disparities in terms of health
infrastructure and indicators.
• States would sign Memorandum of Understanding
with Government of India, indicating their
commitment to increase contribution to Public
Health Budget (preferably by 10% each year),
increased devolution to Panchayati Raj Institutions.

36. NATIONAL URBAN HEALTH MISSION
GOAL
• To improve the health status of the urban
population but particularly of the poor and
other disadvantaged sections, by facilitating
equitable access to quality health care through
a revamped public health system. capacity of
urban local bodies.

37. Mission’s High Focus
•Urban Poor Population living in listed and unlisted
slums
•All other vulnerable population such as homeless,
rag-pickers, street children, rickshaw pullers,
construction and brick and lime kiln workers, sex
workers, and other temporary migrants
•Public health thrust on sanitation, clean drinking
water, vector control, etc.
•
Strengthening public health

38. cont..
• All existing CHCs to have wage component paid on
monthly basis. Other recurrent costs may be
reimbursed for services rendered from District
Health Fund. Over the Mission period, the CHC may
move towards all costs, including wages reimbursed
for services rendered.
• A district health accounting system, and an
ombudsman to be created to monitor the District
Health Fund Management, and take corrective
action.

39. cont..
• Adequate technical managerial and accounting
support to be provided to DHM in managing risk-
pooling and health security.
• The Central government will provide subsidies to
cover a part of the premiums for the poor, and
monitor the schemes.
• The IRDA will be approached to promote such
CBHIs, which will be periodically evaluated for
effective delivery.

40. CORE STRATEGIES
• Improving the efficiency of public health system in
the cities by strengthening, revamping and
rationalizing existing government primary urban
health structure and designated referral facilities
• Promotion of access to improved health care at
household level through community based groups :
Mahila Arogya Samitis

41. cont..
• Strengthening public health through innovative
preventive and promotive action
• Increased access to health care through creation
of revolving fund
• IT enabled services (ITES) and e- governance for
improving access improved surveillance.

42. cont..
• Capacity building of stakeholders
• Prioritizing the most vulnerable amongst the
poor
• Ensuring quality health care services

43. OUTCOMES- IMPACT LEVEL
• Reduce IMR by 40 % (in urban areas) – National
Urban IMR down to 20 per 1000 live births by 2017
• Mternal mortality reduced to 100/10,000 live births
by 2012.
• TFR reduced to 2.1 by 2012
• Malaria Mortality reduction rate- 50% by 2010,
assitional 10% by 2012.
• Kala-Azar mortality reduction rate 100% by 2010
and sustaining elimination thereafter.

44. cont..
• Filarial reduction rate 70% by 2010, 80 % by 2012
and elimination by 2015. Dengue mortality
reduction rate 50% by 2010 and sustaining it at
that level till 2012
• Japanese encephalitis mortality reduction rates
50% by 2010 and sustaining it at the level till 2012.
• Chikungunya: reduction in number of outbreaks
and morbidity due to chikungunya by prevention
and control strategy.

45. cont..
• Leprosy prevalence rate reduced from 1.8 per
10,000 in 2005 to less than 1 per 10,000 thereafter.
• Tuberculosis DOTS series- maintain 85% cure rate
through the entire mission period and also sustain
planned case detection rate.
• Reduce the prevalence of deafness by the 25% by
2012.

46. Measurable indicators of improved health of the urban poor at the
city level are also proposed to be assessed annually through e-
enabled HIMS and surveys. Some of the measurable indicators are
given below:
• Cities/population where mission has been mapped
• Number cities/population where mission has been
initiated.
• Increase in OPD attendance
• Increase in BPL referrals from UHCs.
• Increase in BPL referral availed at referral units.
• Number of slum/cluster level health and sanitation day.
• Number of USHA receiving full honorarium.
• Number of MAS formed.
• Number of UHCs with program manager.
• Increase in ANC check-up of pregnant. Women.

47. cont..
• Increased tetanus toxoid coverage among pregnant
women.
• Increase in institutional deliveries as percentage of
total deliveries.
• Increase in complete immunization among children <12
months.
• Increase in case detection for malaria through blood
examination.
• Increase in case detection of TB through identification
of chest symptomatic.
• Increase in referral for sputum microscopy examination
for TB.
• Increase in number of cases screened and treated for
dental ailments.

48. cont..
• Increase in number of cases screened for diabetes.
• Increase in number of cases referred and operated
for heart related ailments.
• Increased in first aid and referral of burns and injury
cases.
• Increase in number of mental health services at
primary health care level in urban health setting.
• Increase in the awareness of community about
tobacco products/alcohol and substance abuse.

49. URBAN HEALTH CARE DELIVERY
MODEL
• The urban health delivery model would basically
comprise of an Urban Primary Health Centre for
provision of primary health care with outreach and
referral linkages.

50. 1. URBAN- COMMUNITY HEALTH
CENTRE (U-CHC)
Population Norms and Location
• May act as a satellite hospital for every 4-5 U-PHCs
• The U-CHC would cater to a population of 2,50,000
Services
• It would provide in patient services and would be a
30-50 bedded facility
• It would provide medical care, minor surgical
facilities and facilities for institutional delivery.

51. cont..
Support Staff
• Two doctors (one regular and one on a part time
basis)
• There will be 2 multi skilled paramedics (lab
technician and pharmacist)
• 2 multi-skilled nurse, 1 LHV, 4-5 ANMs (depending
upon the population covered)
• Clerical and support staff and one Programme
Manager for supporting community mobilization,
behavior change communication, capacity building
efforts and strengthening referrals

52. 2. URBAN PRIMARY HEALTH CENTRE
(U-PHC)
Population Norms and Location
• Functional for a population of around
approximately 50,000-60,000
• It may be located preferably within a slum or near a
slum within half a kilometer radius catering to a
slum population of approximately 25,000-30,000,
with provision for OPD from 12 noon to 8 pm in the
evening
• The cities based upon the local situation may
establish a U-PHC for 75,000 for areas with very
high density

53. cont..
Services
• OPD (consultation); Basic lab diagnosis, drug
/contraceptive dispensing; Distribution of health
education; Material and counseling for all
communicable and non communicable diseases
• It will not include in-patient care

54. cont..
Support Staff
• Two doctors (one regular and one on a part time
basis)
• There will be 2 multi skilled paramedics (lab
technician and pharmacist)
• 2 multi-skilled nurse, 1 LHV, 4-5 ANMs (depending
upon the population covered)
• Clerical and support staff and one Programme
Manager for supporting community mobilization,
behavior change communication, capacity building
efforts and strengthening referrals

55. 3. COMMUNITY LEVEL
A. Urban Social Health Activist (USHA)
• A Frontline community worker for each
slum/community similar to USHA under NRHM
• The USHA would be a woman resident of the slum,
preferably in the age group of 25 to 45 years
• She would be covering about 1000 - 2500
community level beneficiaries.
• She would be covering between 200-500
households based on spatial consideration
preferably co-located at the Anganwadi Centre
functional at the slum level the door steps

56. cont..
• She would serve as an effective demand–generating
link between the health facility (Urban Primary Health
Centre) and the urban slum populations
• She would maintain interpersonal communication with
the beneficiary families and individuals to promote the
desired health seeking behavior
• She would help the ANM in delivering outreach
services in the vicinity of the doorsteps of the
beneficiaries
• She will be responsible to the Mahila Arogya Samitis
(community groups) for which they are designated

57. cont..
Selection Process
• The USHA will be selected through a community driven
process led by the Urban Local Body
• To facilitate the selection process the District/ City level
Mission would constitute a City Level USHA Selection
Committee headed by the member of the urban local
body. The CMO/CDMO; DPOICDS; and PO of JnNURM;
DUDA; SJSRY would be the members
• The District/ City level health mission can also decide to
induct more members from the NGO/ Civil society
based on the local need.

58. cont..
Mentoring System
• Involving dedicated community level
volunteers/professionals preferably through the
local NGO at the U-PHC level for supporting and
coordinating the activities of the USHA
• The states may also consider the option of 1
Community Organizer for 10 USHAs for more
effective coordination and mentoring.

59. cont..
Essential services to be rendered by the USHA
• Active promoter of good health practices and enjoying
community support
• Facilitate awareness on essential RCH services, sexuality,
gender equality, age at marriage/pregnancy; motivation on
contraception adoption, medical termination of pregnancy,
sterilization, spacing methods
• Early registration of pregnancies, pregnancy care, clean and
safe delivery, nutritional care during pregnancy, identification
of danger signs during pregnancy; counseling on
immunization, ANC, PNC etc. act as a depot holder for
essential provisions like Oral Re-hydration Therapy (ORS), Iron
Folic Acid Tablet (IFA), chloroquine, Oral Pills & Condoms, etc.

60. cont..
• Facilitate access to health related services available
at the Anganwadi/Primary Urban Health
Centres/ULBs, and other services being provided by
the ULB/State/ Central Government
• Formation and promotion of Mahila Arogya Samitis
in her community
• Arrange escort/accompany pregnant women and
children requiring treatment to the nearest Urban
Primary Health Centre, secondary/tertiary level
health care facility

61. cont..
• Reinforcement of community action for immunization,
prevention of water borne and other communicable
diseases like TB (DOTS), Malaria, Chikungunya and
Japanese Encephalitis
• Carrying out preventive and promotive health activities
with AWW/ Mahila Arogya Samiti.
• Maintenance of necessary information and records
about births & deaths, immunization, antenatal
services in her assigned locality as also about any
unusual health problem or disease outbreak in the
slum and share it with the ANM in charge of the area.

62. B. MAHILA AROGYA SAMITI (MAS)
• It acts as community group involved in community
awareness, interpersonal communication,
community based monitoring and linkages with the
services and referral
• The MAS may cover around 50- 100 households
(HHs) with an elected Chairperson and a Treasurer
supported by an USHA Link worker

63. cont..
Activity
• Preventive and promotive health care
• Facilitating access to identified facilities
• Management of revolving fund
Constitution of Mahila Arogya Samiti
• ASHA
• Group of socially committed females from the
community itself
• Women’s/ SHG groups

64. C. AUXILIARY NURSE MID-WIFE:
OUTREACH SESSION
• Each ANM will organize a minimum of one outreach
session in the area of the MAS every month
• Outreach Medical Camps – Once in a week the
ANMs would organize one Outreach Medical Camp
in partnership with other health professionals
(doctors/pharmacist/technicians/nurses –
government or private.

65. cont..
• 4-5 ANMs will be posted in each U-PHC depending
upon the population
• Outreach sessions will be planned to focus special
attention for reaching out to the vulnerable
sections like slum population, rag pickers, sex
workers, brick kiln workers, street children and
rickshaw pullers
•

66. REFERRAL LINKAGES:
Existing hospitals including maternity homes, state
government hospitals and medical colleges.
Referral
Linkages
Different
health
care
services
ULBs
Maternity
Homes
State
Govt.
Hospitals
Existing
Hospitals/
private
hopitals
Medical
Colleges
Public
Health
Laborotie
s

67. COORDINATION AND CONVERGENCE
FOR EFFECTIVE IMPLEMENTATION
1. JAWAHARLAL NEHRU URBAN RENEWAL MISSION
(JNNURM)
Sub- Mission 1- Basic Services to the Urban Poor
(BSUP)
• City will be the unit of planning for health and allied
activities
• The City Health plan would also be shared for
prioritization of actions at the City level

68. cont..
• GIS based physical mapping of the slums is being
undertaken
• The community level institutions such as MAS may
also be utilized by the implementation mechanism
of JnNURM
Sub- Mission 2- Integrated Housing and Slum
Development
• The community centers being created under IHSDP
will be used as sites for conducting fixed outreach
session

69. cont..
2. RAJIV AWAS YOJANA
• The City Health Plans under NUHM can be
incorporated into the slum free city and state plans
of action under RAY
• GIS based physical mapping of the slums and the
spatial representation of the socio-economic
profile of slums (Slum MIS) is being undertaken
under RAY. This will also be useful for development
of city health plans

70. cont..
3. SWARN-JAYANTI SHEHRI ROJGAR YOJNA
• The community level structures being proposed
under NUHM can be strengthened by effectively
aligning them with the SJSRY structures.
• Community organizer for about 2000 identified
families under SJSRY can be co-opted as ASHA

71. cont..
• Neighborhood Groups which are informal
associations of woman living in mohalla or slum or
neighborhood representing 10 to 40 urban poor or
slum families and Development of Women and
Children in Urban Areas (DWCUA) Groups under
SJSRY may be federated into Mahila Arogya Samitis
(MAS)
• Neighborhood Committee (NHC) is a more formal
association of women from slum or mohalla.
Representatives from other sectoral programmes in
the community like ICDS supervisor, school teacher,
ANM etc. are also its members

72. cont..
4. MINISTRY OF WOMEN AND CHILD DEVELOPMENT
• MAS/ASHA in coordination with the ANM to
organize Community Health and Nutrition day in
close coordination with the Anganwadi worker
(AWW) on lines of NRHM
• MAS/ ASHA to support AWW/ANM in updating the
cluster/ slum level health register

73. cont..
• Outreach session also to be organized in the
Anganwadi centers located in slums or nearby
• Organization level health education activities at the
AW Centre
• AWW and MAS to work as a team for promoting
health and nutrition related activities.

74. cont..
5. SCHOOL HEALTH PROGRAMME (MINISTRY OF
HUMAN RESOURCE DEVELOPMENT)
• It cover Government or private schools located in
slums (U-PHC catchment) or government schools
near slums which slum children attend
• It would focus on school health services, school
environment and health education

75. cont..
6. ADOLESCENT REPRODUCTIVE AND SEXUAL
HEALTH
• Once a week adolescent clinic will be organized at
the Urban PHC
• During this teen clinic health education and
counseling will be provided to the adolescent girls
for promoting menstrual hygiene, prevention of
anemia, prevention of RTIs/STIs, counseling for
sexual problems etc.

76. cont..
• 7. Member of Parliament/Legislative Assembly/
Municipal Local Area Development Fund
• 8. Corporate Social Responsibility (CSR)
• 9. North Eastern Region Urban Development
Programme
• 10. Multi Sectoral Development Programme
(MsDP)- in 90 minority districts in the country

77. ESSENTIAL HEALTH CARE SERVICES
UNDER NUHM
Community Level Primary Health Care
Level
Referral Centre
(U-CHC)
Maternal
Health
- Registration
• Ante-natal Care
• Identification of danger
signs
• Referral for institutional
delivery
• Follow-up
• Counseling and Behavior
• Ante-natal and
Post-natal care
• Management of
complicated
delivery cases
and referral
• Management of
regular maternal
conditions
• Referral of
complicated
cases
• Delivery
(normal and
complicated)
• Management of
complicated
Gynae/materna
l health
condition
• Hospitalization
and surgical
interventions
including blood
transfusion

79. Difference between NRHM and NUHM
NRHM NUHM
National rural health mission National urban health
mission
Improves rural health
delivery system
Separate mission for urban
areas and focus on slums &
other urban poor families.
Launched on 12 th April, 2005 Approved on 1st May 2013
Creation of ASHA (Accredited
Social Health Activist)
Creation of USHA (Urban
Social Health Activist)

81. RESEARCH ARTICLE
Impact of National Rural Health Mission on Perinatal
Mortality in Rural India
• The aim of present study was to find whether
increase in hospital deliveries is associated with
decline in perinatal mortality in rural areas of India
after the launch of NRHM.

82. METHODS
Institutional deliveries (in government and private
hospitals) and perinatal mortality rate reported by the
sample registration system (SRS) operated by the
Registrar General of India on a representative sample
from 2005-2008 was used for this study . The relative
change in PNMR and hospital deliveries was calculated for
rural areas in each of the major states of India from year
2005 to 2008, and correlation between relative change in
PNMR and hospital deliveries was examined using SPSS
version 17. The study had 80% power at 5% significance
level for finding a correction co-efficient of 0.54 or higher.

83. RESULTS
In most of the Indian states, hospital deliveries in
rural areas have increased during 2005 to 2008.
However,
• PNMR has declined only marginally during this
period; it has even increased in few states .
• At the national level, relative increase in hospital
deliveries was 57% and elative decline in PNMR
was only 2.5% in the rural areas of Indian states.

84. DISCUSSION
• NRHM is a novel initiative by the Government of
India to provide health care to people living in the
rural areas of relatively poorer states of India. It is
evident from the present study that post NRHM
there have been a significant rise in hospital
deliveries in rural areas. It was expected that the
rise in the institutional delivery will lead to decline
in PNMR.