Saturday, May 5, 2012

Indian Health Care On Move Under NRHM

After the eight meeting of the Mission Steering Group (MSG) of the National Rural Health Mission (NRHM) was held on 16th April, 2012, chaired by the Union Minister of Health and Family Welfare, Ghulam Nabi Azad, the press release issued made significant revelations.

The MSG is the highest decision making body of NRHM that takes decisions on the policies and programs under the Mission. Among  the members who had attended the meeting, according to the release, included: Minister of Human Resource Development, Kapil Sibal; Minister for Rural Development, Jairam Ramesh; Minister of Women & Child Development, Krishna Tirath; Member Planning Commission, Syeda Saiyidain Hameed; Minister of State for Health & Family Welfare, S. Gandhiselvan.

Secretary Health & Family Welfare, P.K. Pradhan; Secretary AYUSH, Anil Kumar; Principal Secretary (Health), Govt. of Jharkhand; Commissioner cum Secretary (Healthcare, Human Services& Family Welfare), Govt. of Sikkim apart from senior officials from Ministries of Finance, Panchayati Raj, H &FW Government of India as also State Government Officials were present in the meeting.

Among the Public Health Professionals, A.K. Shiva Kumar, Member, UNICEF; T.V. Antony, former Chief Secretary, Govt. of Tamil Nadu; Dr. K.S. Jacob, Professor of Psychiatry, Christian Medical College, Vellore; Dr. Devi Shetty, Chairman & Senior Consultant Cardiac Surgeon, Narayan Hridayalaya, Bangalore, Dr. Abhay Bang, SEARCH, Maharashtra; Dr. V.R. Muraleedharan, Professor of Humanities & Social Sciences, IIT Chennai and Dr. K. Srinath Reddy, President, Public Health Foundation of India also attended the meeting.

Addressing the meeting Azad noted that during the 11th Plan, substantial progress had been made under the NHRM. He added that several new initiatives have been taken, particularly during the last 3 years to provide better health care services to the people and improve overall health outcomes. Among the achievements made  he added, “we are greatly encouraged by the success that we have achieved in Polio Eradication. India has not seen a single wild polio virus case for the last more than 15 months now”.

The NHRM key focus is on maternal and child health, he said  It is a matter of satisfaction that both MMR and IMR have started showing consistent and steady decline. The fact that the decline is sharper in rural areas and also that Empowered Action Group states have by and large shown better than National performance, points to the success of several interventions made under NRHM, he added.

The Minister also added that NRHM has made a remarkable beginning, and has started  addressing the issues of physical infrastructure, human resources, ambulances and other logistics. “However, substantial investments would be required to complete the task. The assurance that health would receive priority and increased funding in the 12th Plan is reassuring”, Azad pointed out. He hoped that increase in funding in the 12th Plan would help roll out the much needed interventions to strengthen the primary health care and ensure that there is universal health coverage.

Addressing social determinants of health particularly sanitation, drinking water, nutrition and education would be critical for a quantum jump in health gains, Azad said. Good governance, institutional reforms, innovations and focus on overall human development on the part of the states are a pre-requisite to optimal gains under NRHM, he emphasized.

 Anuradha Gupta, AS & MD, NRHM, made a detailed presentation highlighting progress made under NRHM. She highlighted that NRHM had brought significant higher decline of IMR (rural). The Progress made by EAG States has been much better. Similarly, TFR recorded a greater decline in highly populous States. The MSG highlighted the need for process indicators.

She also mentioned that a number of new initiatives were initiated in the last seven years, most notable of them are the Programme for promoting menstrual hygiene in adolescent girls, the Janani Shishu Suraksha Karyakram and Mother and Child Tracking system in which a database of more than 3.5 Crore pregnant women has been already created. Simultaneously, newborn and neonatal care has been prioritized through NRHM and all the states have initiated development of infrastructure, and capacity building for the same.

Proposals forwarded by the Empowered Programme Committee were discussed at length at the MSG meeting, and the major decisions taken were:

  • Keeping in view the significance of Haemophilus influenzae b (Hib) vaccination, a decision was taken to continue inclusion of Haemophilus influenzae b (Hib) vaccines in Universal Immunization Program as liquid pentavalent vaccine (DPT+ Hep B+ Hib) in Kerala and Tamil Nadu. Further, introduction of Haemophilus influenzae b (Hib) vaccines in Universal Immunization Program as liquid pentavalent vaccine (DPT+ Hep B+ Hib) in six States, namely, Gujarat, Haryana, Karnataka, Goa, Jammu & Kashmir, Puducherry from October 2012 to December 2014 with an outlay of Rs. 332.70 Crores toward cost of the vaccine was approved. An additional requirement of Rs. 4.75 Crores (from domestic budget) for research as well as strengthening supervision for introduction of pentavalent vaccines was also considered and approved.
  • Polio eradication strategy introduced for discussion, was approved with an outlay of Rs. 4249.04 Crores. Since the initiative to eradicate polio from India started in 1995, significant success has been achieved in reducing the number of polio cases in the country. Most parts of India are polio free for several years. India has been taken off the list of WHO endemic countries. Sustained efforts are needed to achieve eradication of polio. Based on the current needs of the programme and increase in cost associated with various activities, revised norms for the Immunization programme were calculated and placed before the MSG. These were discussed in detail and approved.
  • Proposal for modifying the Hospitals and dispensaries scheme of AYUSH was also placed in front of the MSG. Decisions were made to remove the ceiling of remuneration for various contractual manpower employed under the different components of the Scheme, and to strengthen the Programme Management Unit at Centre level with deployment of the additional manpower. For a more meaningful mainstreaming, it was decided to direct the States to create Institutional Mechanisms for mainstreaming of AYUSH in the States/ District Level and include AYUSH Mainstreaming in the MIS monitoring and evaluation cell under NRHM at district/ State level. The guidelines for the modified scheme were placed in front of the MSG and were approved.
  • For communitization of NRHM, it was proposed to involve ASHAs in convening the VHSNC meeting at the village level. For this, an incentive of Rs. Rs 150/- to ASHAs for facilitating the monthly meeting of VHSNC followed by the meeting of women and adolescent girls was decided. Guidelines in this regard will also be issued to the States as recommended by the MSG. An honorarium for performance based community level testing and creating awareness about use of iodated salt through Salt Testing Kits @ Rs 25/month to each ASHA on testing of, at least, 50 salt samples per month for 303 endemic districts in the country was approved.
  • It has been recognised that reaching the unreached is of utmost importance to ensure access to health care services. Presently NRHM supports only one Medical Mobile Unit (MMU) per district in a State. A proposal for expanding this norm  to 5 MMUs per district was approved. Increase in the recurring expenditure cost of North-Eastern states, J&K and Himachal Pradesh for diagnostic van from Rs. 23.71 lakhs to Rs. 28.00 lakhs was also approved. For other states the recurring cost was revised from Rs.19.87 lakhs to Rs 24.00 lakhs, as approved by MSG. To provide a national identity, a universal name “Rashtriya Mobile Medical Unit” was approved for all MMUs funded under NRHM. Also uniform color with emblem of NRHM, Government of India and State government would be used on all the MMUs.
  • Emergency Medical Transport System has been successfully developed and are being implemented in almost all the States of the country. It was decided to extend the financial support for the same beyond three years. Thus, 20 % operational expenditure incurred by states on Emergency Medical Transport System (EMTS) would be supported by NRHM beyond 3rdyears under NRHM with the cap of Rs 3 lakh per year per ambulance.
  • It has been proved by various studies that spacing between children have a positive impact on reducing maternal deaths: If spacing between two children is 27-32 months (2-2½ yrs), maternal mortality by 61% (from 9.5 deaths per 10,000 women to 3.7 deaths per 10,000 women). Further spacing also indirectly helps in reducing infant mortality. It was therefore considered that services of the ASHA should be used for counseling eligible couples for ensuring healthy spacing between births. For this, incentives to ASHAs are to be introduced as decided by MSG.
Blogger's note:

With the above developments taking place in the health sector in India, it is clear the country is heading for better times by meeting one of the most important needs of the people, the health. Reachng health to the unreached by a national network of mobile units under the banner, 'Rashtriya Mobile Medical Unit' is a valuable move in achieving universal health care. 

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