NRHM (National Rural Health Mission)

National Rural Health Mission (NRHM) is an Indian health program for improving health care delivery across rural India. The mission, initially mooted for 7 years (2005-2012), is run by the Ministry of Health. The scheme proposes a number of new mechanisms for healthcare delivery including training local residents asAccredited Social Health Activists (ASHA),^[1] and the Janani Surakshay Yojana (motherhood protection program). It also aims at improving hygiene and sanitationinfrastructure.^[2] Noted economists Ajay Mahal and Bibek Debroy have called it "the most ambitious rural health initiative ever".^[3]

The mission has a special focus on 18 states Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram,Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttarkhand and Uttar Pradesh.

Under the mission, health funding had increased from 27,700 crores in 2004-05 to 39,000 crores in 2005-06 (from 0.95% of GDP to 1.05%).^[4] As of 2009, economists noted that "the mid-term appraisal of the NRHM has found that there has been a significant improvement in health indicators even in this short period".^[3]However, in many situations, the state level apparatus have not been able to deploy the additional funds, often owing to inadequacies in the Panchayati Raj functioning. Fund utilization in many states is around 70%.^[3]

The largest programm under NRHM, covering India's most populous state, Uttar Pradesh, has been clouded by a large-scale corruption scandal in which two apex health officials have been murdered.^[5] The state government headed by Chief Minister Mayawati has been accused of fraud to the tune of Rs. 10,000 crores (USD2 billion).

Health status and problem in India

India is 2nd most populous country in the world having 1,210,193,422 people as of 1 march 2012. It shares almost 18% of the world population and has increased its population by 181 million in a decade. By 2030 India will overtake china in population. Increase in population will have great stress on economy, providing nutrition and will also affect overall health status of the country.^[8]

Life expectancy

Its very notable that their occurs a bridge in overall socioeconomic and health status between urban and rural population of India and even between the states. Healthy life expectancy at birth in India was estimated to be 53.5 in 2002. This was 53.3 for males and 53.6 for females Life expectancy at birth has increased for male and female in India. It is 64.1 years for males and 65.8 years for females (2005). This has revealed the decrease in death rate and the better improvement of quantity and quality health services in India. However, there are inter-state, inter-district and rural-urban differences in life expectancy at birth due to low literacy, differential income levels and socioeconomic conditions and beliefs. In Kerala, a person at birth is expected to live for 73 years while in states like Bihar, Assam, Madhya Pradesh, Uttar Pradesh, etc, the expectancy is in the range of 55–60 years.^[9]

Mortality

A diverse set of factors are thought to be associated with maternal mortality: factors that influence delays in deciding to seek medical care, in reaching a place where care is available, and in receiving appropriate care. The tenth plan document of India has targeted to reduce the IMR to 45 per 1000 live births by 2007 and 28 per 1000 live births by 2012. The main causes of high MMR being socio­economic status of women, inadequate antenatal care, the low proportion of institutional deliveries|birth, and the non-availability of skilled birth attendants in two-thirds of cases. A World Health Report (1999) gives the main causes of death in India as non­communicable diseases (48 percent), communicable diseases (42 percent) and injuries (10 percent). The dominant communicable diseases are infectious and parasitic diseases, respiratory diseases, maternal conditions, perinatal conditions and nutritional deficiencies. Non-communicable diseases are malignant neoplasm, diabetes mellitus, neuropsychiatric disorders, sense organ disorders,cardiovascular diseases, respiratory diseases, digestive diseases, musculo-skeletal diseases, congenital anomalies, oral diseases and other non-communicable diseases^[10]

Morbidity

NFHS-II (National Family Health Survey-II,http://www.nfhsindia.org/) conducted a study on four major diseases prevailing in India, i.e., asthma, tuberculosis, jaundice, malaria. In India around 2,468 persons per 

100,000 populations were reported to be suffering from asthma at the time of survey. The prevalence of asthma is high in rural areas than in urban areas and is slightly higher in males than in females. The overall prevalence of tuberculosis in India is 544 per 100,000 populations. This is 16 percent higher than the survey done by NFHS-I (467 per 100,000). It is more in case of rural areas than in urban areas and more for male than females. It is more in males because of males are in contact with more people who might have TB and smoking is more in men. The prevalence of TB increases with age. Jaundice cases were reported to be 1361 persons per 100,000 populations. This is more prevalent in rural areas than in urban areas. However, it decreases with age. Thus, highest numbers of jaundice patients are in the age of 0-14. 3,697 persons per 100,000 populations were reported to have suffered from malaria. People of rural area suffer twice than that of urban area and it is slightly high for males than for females. All these diseases however vary and differ from state to state depending on the climate and geographical locations of the areas^[10]

Disability

4 to 14 million people are blind, 3.2 million people with hearing impairment, 16 million people are affected by locomotor disabilities and 3 percent of India's children are mentally retarded. The government of India has policies related for the disabled, rehabilitation schemes, grant-­in-aid schemes and schemes run through NGOs.

According to ICMR (Indian council of Medical Research), cataract is the main cause of 55 percent of blindness. The major causes of blindness as seen in the survey conducted by the National Programme for Control of Blindness (NCB), included cataract, refractive errors, corneal opacity, glaucoma, trachoma and vitamin A deficiency.^[10]

Objectives and aims

The overall aim of the Program is to strengthen and improve the whole public health delivery and health of the rural sector. NRHM tries to improve the monitoring and planning process involved within health care. NRHM also aims to bring private sectors to help in the rural health^[3]