1. Dr. Ranadip Chowdhury
2nd year PGT
Dept. of Community Medicine
R.G.Kar Medical College

2.  Launched in 12th April, 2005
 Key objective is “architectural correction” of health
sector
 Seeks to improve access of rural people to affordable,
effective, accountable and RELIABLE health care
 Address the issue of gross intra-state and inter-district
disparities in demographic indicators
 Integration of key determinants of health like
sanitation, safe water, hygiene, nutrition
 Focus on 18 high focus states including 8 EAG states

3.  Reduction in IMR and MMR.
 Universal access to public health services such as women’s
health, child health, water, sanitation and
hygiene, immunization and nutrition.
 Prevention and control of communicable and non-
communicable diseases, including locally endemic diseases.
 Access to integrated comprehensive primary health care.
 Population stabilization, gender and demographic balance.
 Revitalize local health traditions and mainstream AYUSH.
 Promotion of healthy life styles.

4.  IMR reduced to 30 per 1000 live births by 2012.
 Maternal Mortality reduced to 100/100,000 live births by 2012.
 TFR reduced to 2.1 by 2012.
 Reduction in mortality due to malaria, dengue, Kalazar,JE; Filaria
elimination 2015.
 85% cure rate under TB DOTs.
 46 lakh cataract operations by 2012.
 Leprosy prevalence rate- reduction from 1.8 per 10000 in 2005 to
<1/10000 thereafter.
 Upgrading CHCs to IPHS.
 Increase utilization of FRUs from 20% to 75%;

5.  Availability of trained community level worker at village level, with a drug
kit for generic ailments.
 Health Day at Aanganwadi level on a fixed day/month for provision of
immunization, ante/post natal check ups and services related to mother and
child care, including nutrition.
 Availability of generic drugs for common ailments at sub centre/hospital
level.
 Good hospital care through assured availability of doctors, drugs and
quality services at PHC/CHC level.
 Improved access to universal immunization.
 Improved facilities for institutional deliveries.
 Availability of assured health care at reduced financial risk through pilots
of Community Health Insurance.
 Provision of household toilets.
 Improve outreach services through mobile medical unit at district level.

6.  Trust communities and forge partnerships.
 Innovation and autonomy.
 Role for community organizations /PRIs.
 Habitation level health workers in referral chains.
 Service delivery and outcome focus.
 Service guarantees-a rights based approach.
 Recognition of need for management skills.
 Public health through convergent action.
 Giving authority to those with the motivation…

8. NRHM – 5 MAIN APPROACHES
COMMUNITIZE
IMPROVED
MANAGEMENT
THROUGH
CAPACITY
BUILDING
FLEXIBLE
FINANCING
MONITOR, PRO
GRESS AGAINST
STANDARDS
INNOVATION IN
HUMAN
RESOURCE
MANAGEMENT

10.  Decline in MMR estimates in 2007-09 over 2004-06:
– For India: 212 from 254 (a fall of about 17%)
• States realizing MDG target of 109 have gone up to 3
with TamilNadu & Maharashtra (new entrants)
joining Kerala
• Andhra Pradesh, West Bengal, Gujarat and Haryana
are in closer proximity to achieving the MDG target
.

11. 139
140
141
142
143
144
145
2004-06 2007-09
MMR 141 145
AxisTitle
MMR

12.  Every 6th death in the country pertains to an infant.
 IMR in India has registered a 3 points decline to 50
from 53 in 2008
 Maximum IMR in Madhya Pradesh (67) and
minimum IMR in Kerala (12)
 Kerala (12) & Tamil Nadu (28) have achieved the
MDG target (28 by 2015)
 Delhi (33), Maharashtra (31) and West Bengal (33)
are in close proximity

13. 0
10
20
30
40
50
60
70
2005 2009
Chart Title
total male female

14.  TFR for the country remained stationery at 2.6
during 2008 to 2009
 Bihar reported the highest TFR (3.9) while Kerala
and Tamil Nadu, the lowest (1.7)
 Replacement level TFR, viz 2.1, has been attained by
Andhra Pradesh (1.9), Delhi (1.9), Himachal Pradesh
(1.9), Karnataka (2.0), Kerala (1.7), Maharashtra
(1.9), Punjab (1.9), Tamil Nadu (1.7) & West Bengal
(1.9).

15. 2007 2008 2009 2010 2011(oct)
mortality 0.46% 0.45% 0.38% 0.36% 0.24%
0.00%
0.05%
0.10%
0.15%
0.20%
0.25%
0.30%
0.35%
0.40%
0.45%
0.50%
AxisTitle
mortality

16. 2007 2008 2009 2010 2011(oct)
mortality 0.49% 0.24% 0.00% 0.27% 0.00%
0.00%
0.10%
0.20%
0.30%
0.40%
0.50%
0.60%
AxisTitle
mortality

17.  Kala-azar fatality rate reduction in 2010 was 21.74%
from 2007 in India.
 Till Oct’11 Kala-azar fatality rate reduction was
33.33% compare to 2010 in India.
 Kala-azar fatality rate reduction in 2010 was 44.9%
from 2007 in West Bengal.
 In 2011 till October no death due to kala-azar in West
Bengal.

18. 1 2 3 4 5 6
microfilaria rate% 1.02 0.98 0.64 0.53 0.65 0.37
0
0.2
0.4
0.6
0.8
1
1.2
AxisTitle
microfilaria rate%

19. 1 2 3 4 5 6
microfilaria rate% 4.1 2.72 2.83 0.89 0.48 0.44
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
AxisTitle
microfilaria rate%

20.  Microfilaria reduction rate was 63.73%.
 In West Bengal microfilaria reduction rate was
89.27%.

21. 2007 2008 2009 2010 2011(Nov)
dengue fatality rate 1.24% 0.64% 0.62% 0.39% 0.66%
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
1.40%
AxisTitle
dengue fatality rate

22. 2007 2008 2009 2010 2011(Nov)
dengue fatality rate 4.20% 0.67% 0% 0.12% 0.00%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
4.50%
AxisTitle
dengue fatality rate

23.  Dengue case fatality rate reduction was 68.55% from
2007 (1.24%) to 2010 (.39%).
 But rate of dengue case fatality rate has been
increased by 69.23% in Nov’11 from 2010.
 In west Bengal Dengue case fatality rate reduction
was 97.15%.
 There is no death due to dengue in West Bengal till
Nov’2011.

24. 2005 2006 2007 2008 2009 2010 2011(oct)
malaria mortality 0.05% 0.10% 0.09% 0.07% 0.07% 0.06% 0.03%
0.00%
0.01%
0.02%
0.03%
0.04%
0.05%
0.06%
0.07%
0.08%
0.09%
0.10%
AxisTitle
malaria mortality

25. 2007 2008 2009 2010 2011(oct)
malaria mortality 0.11% 0.12% 0.05% 0.04% 0.02%
0.00%
0.02%
0.04%
0.06%
0.08%
0.10%
0.12%
0.14%
AxisTitle
malaria mortality

26.  Malaria case fatality rate had been increased by 20%
from 2005 (.05%) to 2010 (.06%) in India.
 But in 2011 till October (.03%) malaria case fatality
rate had been decreased by 50% compared to 2010 in
India.
 Malaria case fatality rate had been decreased 63.63%
from 2007 (.11%) to 2010 (.04%) in West Bengal.
 Till Oct’11 malaria case fatality rate reduction rate
was 50% compared to 2010.

27. 2007 2008 2009 2010 2011(Dec)
case fatality 24.21% 17.82% 17.27% 13.14% 14.51%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
AxisTitle
case fatality

28. 2007 2008 2009 2010 2011(Dec)
case fatality 12.50% 0 0 0 5.60%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
AxisTitle
case fatality

29.  Japanese Encephalitis case fatality reduction by 40%
from 2007 to2011 in India.
 Japanese Encephalitis case fatality reduction by
55.2% from 2007 to2011 in West Bengal.

30.  Kala-azar mortality reduction by 21.93% in
2006-08.
 Malaria mortality reduction by 45.23% in
2006-08.
 Microfilaria reduction rate from 2006-2008
was 26.74%.
 Dengue mortality reduction rate in 2006-2008
was 56.52%.

31.  Goal: Cataract operations-increasing to 46 lakhs until 2012.
5700000
5750000
5800000
5850000
5900000
5950000
6000000
6050000
2008-09 2009-10 2010-11
cataract surgery 5810336 5906016 6023173
AxisTitle
cataract surgery

32.  The year 2010-11 started with 0.87 lakh
leprosy cases on hand as on 1st April
2010, with PR 0.72/10,000.
 Till then 32 States/ UTs had attained the level
of leprosy elimination. A total of 510 districts
(80.6%) out of total 633 districts also achieved
elimination by March 2010.

33. 2005 2006 2007 2008 2009 2010
2011(31st
march)
leprosy PR 2.3 0.84 0.72 0.74 0.72 0.72 0.69
0
0.5
1
1.5
2
2.5
AxisTitle
leprosy PR

34.  87% cure rate of TB has been maintained over the
last 5 years.
 Case detection rate has moved from 70% to 71%.

35. 0
20
40
60
80
100
120
Bihar Chhatti
sgarh
HP J & K Jharkha
nd
MP Orissa Rajasth
an
UP Uttarak
hand
WB
Series1 47 61 102 76 77 65 74 85 83 75 72
AxisTitle
Chart Title

36. 82
83
84
85
86
87
88
89
90
91
Bihar Chhatti
sgarh
HP J & K Jharkha
nd
MP Orissa Rajasth
an
UP Uttarak
hand
WB
Series1 89 87 89 91 90 88 87 89 89 85 85
AxisTitle
Chart Title

37. 1 2 3 4 5 6 7 8 9 10 11
Total sputum-positive case
notification
54% 61% 65% 66% 69% 65% 67% 70% 71% 71% 71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
AxisTitle
Total sputum-positive case notification

38. 82.5
83
83.5
84
84.5
85
85.5
86
86.5
87
87.5
2000 2001 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
success rate of new smear positive patients(%)
success rate of new smear positive
patients(%)

39.  Physical infrastructure up-gradation, human resource
augmentation, equipment provision taken up in
nearly all community health Centres.
 DLHS-III found 90.1% CHCs with normal delivery
service.
 Since the IPHS provides for a higher Standard, it will
take some time before augmentation is as per IPHS.

40. INFRASTRUCTUR
E/HUMAN
RESOURCE
2005 2010 Comment
No. of Health
Sub-centres(SC)
146026 147069 .7% increase
Health SCs in
Govt. Buildings
63901 84957 32.95% increase
ANMs at Health
SC
139798 200010 43.07% increase
PHCs in Govt.
Buildings
23236 23673 1.88% increase
No. of CHCs 3346 4535 35.53% increase
Specialist at
CHCs
3550 6781 91% increase
GDMOs other
doctors at CHCs
NA 9432
Nurse midwife at
PHC/CHC
28930 93935 3.25 times more
Paramedical staff 12284 21740 1.75 times more

41.  461 Districts Equipped with Medical Mobile unit under
NRHM
 1787 Mobile Medical Units Operational in the State/UT
Under NRHM
 4764 ERS Vehicles Operational in the State/UT Under
NRHM
 8826 Ambulances functioning in the State/UTs (At
PHC/CHC/SDH/DH)

45.  No separate data on utilizationss levels in FRUs.
 The CRM reported much higher utilization of in-
patients facilities due to increased institutional
deliveries.
 Total 2891 First Referral Unit is operationing (31st
March 2011).
 883 FRUs in 10 high focus non NE states.
 120 FRUs in 8 high focus NE states.
 1842 FRUs in Non high focus states-large.
 46 FRUs in Non high focus states –small & UTs.

46.  Total 128 FRUs operationing till 31st March 2011.
 In Last 5 years of NRHM no more District Hospital had
been upgraded to FRUs.
 27 more sub divisional hospitals have been up graded to
FRUs.
 In 2005 in WB there was no CHCs was functioning as
FRUs, but as per 2010 SEVEN CHCs are functioning as
FRUs.

48.  8.25 lakh ASHAs selected.(2010) with 690221 having drug
kits.
 46,690 ANMs appointed on contract.
 8624 MBBS doctors appointed on contract.
 2460 specialists appointed on contract.
 7692 AYUSH doctors appointed on contract.
 14490 paramedic staff appointed on contract.

50.  42003 ASHA selected & 32123 ASHA with drugs kit.
 51 paramedical staff appointed.
 Specialists appointed 1253.
 No data on appointment on staff nurse.
 19 AYUSH doctors & paramedical staffs.

51.  NRHM has brought the thrust on human resources at
centre stage.
 Performance based payment system.
 Failure of The World Bank funded Health Systems
projects on account of lack of attention to human
resource.

52.  Boat Clinics in Assam to partnerships with tea-gardens.
 Partnerships for diagnostics in Bihar & West Bengal.
 Emergency transport system in Haryana, AP, Gujarat,
Rajasthan.
 Rural medical assistants in Chhattisgarh.
 Rural Health Practitioners in Assam.
 Orissa recruited AYUSH doctors to provide services at PHC
where no MBBS doctor.

54.  By end 2010, the total number of ASHAs had risen to
825,000.
 Except for Himachal Pradesh all other 17 high focus state opt
for the ASHA programme.
 In January 2009, responding favourably to a very positive
political and administrative feedback from the states, a
decision was taken to extend the programme within even the
non high focus states to cover the entire state. Except in
Tamilnadu, which kept the programme limited to tribal areas,
all other states opted for this expansion.

55. At the national level, the guidelines lay out three roles
for ASHA:
 facilitator of health services
 service provider
 activist.

56.  At the time of the study only Assam had set up the full support structure as
per national guidelines.
 Orissa had a structure in state and district and block level, but not yet at the
sub-block level.
 Orissa had the most functional review process in place, with a clear
schedule of meetings and some mechanisms of recording and measuring
progress.
 Rajasthan had all structures in place, but these require more content, depth
and skills to be effective.
 At the time of the evaluation Bihar had no support structures in
place, although plans were underway to establish these.
 Jharkhand only state and district structures were in place.
 In contrast Andhra, Kerala and West Bengal had no full time support
structures in place at any level and were managed by ad hoc appointments
of nodal officers who oversaw this work in addition to many other tasks

57.  Andhra had a more motivated District Public Health and
Nutrition officer, though despite this, it was perhaps the most
weakly monitored and supported ASHA of the eight states
studied.
 Kerala had a regular schedule of meetings and the ANM
(called JPHN) was much more available for playing this role-
as her work had either shifted up to the PHC or been shifted
down to the ASHA- making her a supervisor of an ASHA with
little work outputs of her own.
 In West Bengal, panchayat and field functionaries formed a
viable administrative support team, though this is of little use
in providing clinical support.
 All states except Kerala have involved NGOs in the
programme.

58.  In Assam and Orissa stable leadership at state level
and a dedicated technical agency have served the
programme well.
 In West Bengal, Kerala, and Andhra Pradesh while
there is commitment to the ASHA programme this is
not reflected in the management or support or
realised in terms of outcomes.
 In Rajasthan Bihar and Jharkhand, frequent
leadership changes have hampered programme
progress.

59.  In most states, minimum levels of training have been achieved, but the pace of
training fell far short of what was required.
 In West Bengal, 90% had received 23 days of training.
 In Orissa about 86% received more than 16 days training of which nearly 54% had
received more than the targeted 23 days of training.
 In Assam 77% received more than 16 days, of which 26% had received more than
23 days.
 In Kerala, 52% had received over 16 days- all had completed module 4.
 The poorest performance was Bihar, where about 97% of ASHA had received less
than 16 days, and 87% had received less than ten days of training over a four year
period! In effect for 87% of the ASHAs in Bihar only Module 1 had been covered.
 In Jharkhand 46% had received between 11 and15 days of training and 50%
received less than ten days.
 In Rajasthan 31% of ASHA had received less than 16 days of training, with the
remaining 69% getting more than 16 days.

60.  Except in Orissa and Assam, states adapted the modules for
local context and need.
 Jharkhand and West Bengal substantially strengthened the
message content. Jharkhand even revised the modules entirely,
made it more pictorial and richer in key information.
 Rajasthan, Uttar Pradesh and Angul in Orissa supplemented
these modules with child and newborn health modules of their
own and Kerala included messages on non communicable
disease.
 Andhra Pradesh did not use these modules at all.

61.  Across the states, most ASHAs are receiving Rs. 500 to Rs.
1000 per month with the highest being in Orissa followed by
Assam.
 In West Bengal ASHA’s receive a fixed sum of Rs. 800 per
month. West Bengal has a fixed amount system which is well
implemented.
 Rajasthan, a fixed sum of Rs. 950 of which at least Rs. 500 is
delivered in an assured manner. Rajasthan has a fixed plus
performance based payment system but with weak
implementation
 In Angul (Orissa) newborn visits are also incentivised and
accounts for the ASHA receiving the highest amounts.

62.  Assam, Orissa and Kerala have robust mechanisms of
accounting and timely payment, but net receipts in Kerala
are lower since payment is linked to RCH activities.
 Andhra, Bihar and Jharkhand have performance based
payments which are poorly implemented - clearly co-relating
with the lack of a management-support structure in these three
states.
 In Andhra Pradesh and Kerala, the problem is compounded by
JSY being a poor yield opportunity as only BPL women get
the JSY package and anyway fertility rates are much lower.
 Mode of payment in Orissa, was the bank transfer, in
Assam and Rajasthan a mix of all three- bank transfer,
cheque and cash; in Jharkhand and AP it was a mix of
cash and cheque and it was cash predominantly in West
Bengal, Kerala, Bihar.

64.  The highest expenditure of all eight states is in Assam amounting to Rs. 12,546.
 Orissa reports the second highest expenditures with about Rs. 10,689 per ASHA
 Kerala expanded its programme late, but still reports an expenditure of Rs. 10,689
per ASHA.
 Rajasthan’s estimate of Rs. 7529 over three years may be a serious under-estimate-
as the state government spends almost Rs. 500 per month per ASHA on fixed
honorarium.
 West Bengal’s Rs. 8300 represents the slower pace of training and the lack of
investment in support structures.
 Jharkhand has expenditure at Rs. 7348 per ASHA.
 Bihar’s expenditures of Rs. 3373 per ASHA is the lowest amongst the 8 states
examined and it correlates with the weakest programme- where training is still to
take off beyond the first round, and where there is no support structure in place.

65. All states have spent much less than allocated, reasons
are….
 Inability or unwillingness to invest in management
and support structures at state, district and block
levels.
 Poor pace of training and no doubt impacts the
quality of training.
 Quality of political and administrative support the
programme.

66.  VHSC have been formed in Rajasthan, Jharkhand, Assam, Andhra Pradesh
and Orissa (referred to as Gaon Kalyan Samiti).
 In West Bengal, Kerala and Bihar the existing health and sanitation
committees of the Gram Panchayats have been designated as the VHSC
with differing nomenclature and modifications in membership.
 Except in Kerala, Assam and Orissa, and to a limited extent in West Bengal
there is little systematic training of the VHSC members.
 The ASHA is a member of this committee and is expected to attend the
meetings, mobilise community and raise issues relating to health in the
village. Where established it is generally supportive of the ASHA and
usually the ASHA has an important role in this.
 But in West Bengal such a relationship is established only in 48% of cases
and in Jharkhand this is about 66%.
 The process has taken place in only about one fifth of the villages of West
Bengal and half the villages of Andhra Pradesh.

67.  ASHA’s activities
 Optimising outcomes for time spent
 Areas for skill building
 Reaching the unreached
 Advocacy for health outcomes
 Advocacy for activism
 Role of ASHA Mentoring Groups
 Support to ASHAs
 Drug Kits
 Incentives
 Monitoring the ASHA programme
 Support, training and on the job monitoring
 Role, clarity and synergy
 Involvement of NGOs
 VHSC
 Building convergence and co-operation

68.  Till 2005 central funding to states was on normative
basis.
 During financial year 2005-06 basic PROGRAMME
IMPLEMENTATION PLANS (PIPs) prepared.
 Financial management group operationalised
 To oversee the release of funds.
 Monitoring of utilisation certificates & audit reports.

71.  Latest version of Tally ERP.9 for NRHM
accounting.
 Implemented concurrent audit system through
C.A firms.
 Open tender system.
 Ensuring timely submission of all FMRs on
quarterly basis.
 Implementation of e-Banking.

75. 2005-06 2006-07 2007-08 2008-09
% incraese in central transfers under
NRHM
26.24% 19.50% 26.05% 19.12%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
AxisTitle
% incraese in central transfers under NRHM

76. 2005-06 2006-07 2007-08 2008-09
% increase under state expenditure 23.41% 19.12% 13.37% 19.94%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
AxisTitle
% increase under state expenditure

77. 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
public expenditure on health as
percentage of GDP
1.16% 1.23% 1.22% 1.23% 1.37% 1.45%
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
1.40%
1.60%
AxisTitle
public expenditure on health as percentage of GDP

78. 2005-2006 2006-2007 2007-2008 2008-2009
2009-2010(till
31st Jan
expenditure % 84.74% 83.18% 94.67% 94.38% 71.27%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
AxisTitle
expenditure %

79. 0
20000000
40000000
60000000
80000000
1E+09
1.2E+09
1.4E+09
1.6E+09
2005-06 2006-07 2007-08 2008-09
PUBLIC EXPENDITURE 344461722 406788591 486852110 586813788
PRIVATE EXPENDITURE 1150005214 1278405733 1426902392 1573935382
EXTERNAL FLOW 21488597 22402612 26538964 37015853
AxisTitle
Chart Title

80. 2005-2006 2006-2007 2007-2008 2008-2009
PUBLIC EXPENDITURE IN TOTAL
HEALTH EXPENDITURE
22.72% 23.82% 25.09% 26.70%
20.00%
21.00%
22.00%
23.00%
24.00%
25.00%
26.00%
27.00%
AxisTitle PUBLIC EXPENDITURE IN TOTAL HEALTH EXPENDITURE

81.  619 Integrated District Health Action Plans in 2009-10.
 Achievements of District Health Action Plans:
◦ Institutional structures.
◦ Provision of untied resources for local action.
◦ Identified areas for focused attention through facility and
household surveys.
◦ Convergence with wide determinants.
BASIS FOR DECENTRALIZED PLANNING…………

82.  Initial journey of NRHM-
underfunded, underperforming, public health system.
 Positive programmatic approach-
◦ Provision of resources
◦ Expansion of public health infrastucture
◦ Additional human resources
◦ Creation of community structures
◦ Decentralized
◦ Non-verticalized framework

83.  State to send resource envelope to Districts-October 2009
 District plans based on village/gram panchayats/ block
panchayat samiti plans-December2009
 First Draft PIP before State Health Mission- First week
Jan 2010
 Pre-appraisal meetings in Jan up to 15th 2010
 Final NPCC meetings between Feb and 15th March 2010

84.  Clear action plan for backward districts as part of the
PIP.
 Clear action plan for streamlining of procurement and
logistics.
 Clear action plan for operationalising HMIS up to
facility level.
 Capacity development of all institutions crafted under
NRHM.
 Higher utilisation of financial resourses under NRHM
 Clear plan for human resources for health
 Clear action plan on training and skill developement

85.  Neo-natal Mortality
 Population stabilisation
 Malaria
 MDR-TB
 Making facilities family friendly-water, electricity, clean
toilets, lights ,security
 Vibrant VHSCs and RKSs
 NABH/ISO certification of government facilities

86.  Total 147069 SCs.
• 84957 in SCs in Govt. Buildings.
• 140942 SCs with one ANMs.
• 6127 without ANMs.
• 59068 SCs with 2nd ANMs.
 18348 APHCs, PHCs, CHCs & other Sub District
facilities functional as 24X7 basis
 Total 23673 PHCs
 Total 4535 CHCs

87. 0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
2005 2010 2011(31st march)
No. of PHCs 24*7 hrs service 1263 8409 9107
AxisTitle
No. of PHCs 24*7 hrs service

88. 0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2005 2010 2011(31st march)
No. of CHCs 24*7 hrs service 980 3829 4531
AxisTitle
No. of CHCs 24*7 hrs service

89. 0
1000
2000
3000
4000
5000
6000
PHYSICAL INFRASTRUCTURE
TAKEN UNDER COMPLETED

90.  Total 10356 SCs.
• 4684 in SCs in Govt. Buildings.
• 10205 SCs with one ANMs.
• 151 without ANMs.
• 7715 SCs with 2nd ANMs.
 622 APHCs, PHCs, CHCs & other Sub District facilities functional as
24X7 basis
 Total 909 PHCs
 Total 348 CHCs
 348 CHCs functional as 24X7 basis compared to ZERO at the start of
NRHM.
 Of the 93 CHCs just 8 CHCs completed physical up-gradation according to
IPHS.

91. 0
20
40
60
80
100
120
140
160
180
2005 2011(31st March)
PHCs functioning as 24*7 hrs basis 86 179
AxisTitle
PHCs functioning as 24*7 hrs basis

92.  4.51 lakh village health and sanitation committees constituted.
 1.87 cr village health and nutrition days organised.
 8,25,000 ASHAs selected.
 4.43 lakh joint account operationalised.
 16687 PHCs have Rogi Kalyan Samiti out of total 23673 PHCs.
 Nearly all CHC, Sub Divisional and District hospitals have the Rogi
Kalyan Samiti facility.
 District Health Mission under the Chairman Zila parishad/ District Tribal
Council and District Health Society under the District magistrate have been
constituted nearly all the states/UTs.
 State health Mission under the Chief Minister and the state Health Society
under the Chief Secretary have been constituted and meet regularly in
nearly all the states.
 Mission Steering Group under the Minister Health and Family Welfare at
the national level has been meeting regularly to take all decisions regarding
NRHM.

93.  SRS
 DLHS-III
 IAP study (Rajasthan, UP,MP)
 Kaveri Gill’s study (AP, UP, Rajasthan, Bihar)
 PRC study (31districts)
 Citizen’s report
 Community Monitoring reports
 External Evaluation of JSY in 7 states.
 Performance audit of NRHM by CAG

94.  90.7% of villages have beneficiary under Janani
Surakhsa Yojana (JSY).
 72.6% of villages have sub-centres within 3 kms.
 90.6% sub-centres with ANM.
 57.8% of ANM living in quarter where available.
 53.1% PHCs functioning on 24 hrs basis.
 19.2% PHCs having AYUSH medical officer.
 52% CHCs designated as FRU.
 90.1% CHCs having 24hrs normal delivery service.
 9.2% FRUs having blood storage facility.

95.  45.6% of ANM living in quarter where
available.
 25.9% PHCs functioning on 24 hrs basis.
 17.9% CHCs designated as FRU.
 10% FRUs having blood storage facility.

96.  Positive contribution of ASHA but more training is
necessary.
 Facility improvement on an unprecedented scale.
 Slow pace of utilization of untied fund.
 Management structure needs further strengthening.
 HR challenges.
 Pleads for higher financial allocation.

97.  Decentralized management to be faster.
 JSY putting pressure on public system.
 System preparedness in adequate.
 Question ability of PRI to hold system accountable.
 More effforts at building capacity.
 Invest in ability and confidence.

98. INITIATIVES UNDER NRHM

99.  Popularity of the scheme.
 Increase in institutional deliveries.
 Quality issue at facilities.
 Low 48 hrs stay.
 Large case loads.
 Changing health seeking behaviuor.
 Timeliness of payments.
 Role of ASHA.

100. 0
20
40
60
80
100
120
140
160
180
2006-07 2007-08 2008-09 2009-10 2010-11
Institutional deliveries(lakh) 119 143 148 162 168
AxisTitle
Institutional deliveries(lakh)

101. 0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11
Institutional deliveries(lakh) 7.31 8.33 8.85 9.40 9.80 9.51
AxisTitle
Institutional deliveries(lakh)

102.  Institutional deliveries increased from 47% (DLHS-
III, 2007-08) to 72.9% (CES, 2009).
 Number of Pvt. institutions accredited under JSY
12645 in India, 6691in High Focus- Non NE (10) , 53
in High Focus- NE (8), 5841 in Non High Focus-
Large (10) , 60 in Non High Focus- Small & UT(7).
 66 Pvt. institute in WB accredited under JSY.

103. 0.00
20.00
40.00
60.00
80.00
100.00
120.00
05-06 06-07 07- 08 08- 09 09-10 10-11
No. of beneficiaries of JSY (in lakh) 7.03 28.49 67.36 83.32 93.42 108.04
AxisTitle
No. of beneficiaries of JSY (in lakh)

104. 0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
05-06 06-07 07- 08 08- 09 09-10 10-11
No. of beneficiaries of JSY (in lakh) 0.31 2.25 5.73 7.48 7.24 5.35
AxisTitle
No. of beneficiaries of JSY (in lakh)

107.  263 Sick New Born Care unit (SNCU) established
under NRHM till 31ST March 2011.
 1120 New Born Stabilisation Unit.
 6403 New Born Care Corner (NBCC) .
In West Bengal
 6 Sick New Born Care unit (SNCU) established
under NRHM till 31ST March 2011.
 100 New Born Stabilisation Unit.
 105 New Born Care Corner (NBCC) .

108.  No. of districts implementing IMNCI
–current(10) and planned(remaining eight).
–No. of districts where training is saturated-One district
(Purulia)
 Plan for HBNC, including incentives to ASHAs Visit of New
born (during PNC ) incorporated in revised ASHA
comprehensive incentive package.
 6th& 7thmodule training initiated in 2 districts.

109.  The new initiative of JSSK would provide completely
free and cashless services to pregnant women
including normal deliveries and caesarean operations
and sick new born (up to 30 days after birth) in
Government health institutions in both rural and
urban areas. The new JSSK initiative is estimated to
benefit more than one crore pregnant women &
newborns who access public health institutions every
year in both urban & rural areas.

110.  Free and Cashless Delivery.
 Free C-Section.
 Free treatment of sick-new-born up to 30 days.
 Exemption from User Charges.
 Free Drugs and Consumables.
 Free Diagnostics.
 Free Diet during stay in the health institutions – 3days in case
of normal delivery and 7 days in case of caesarean section.
 Free Provision of Blood.
 Free Transport from Home to Health Institutions.
 Free Transport between facilities in case of referral as also
Drop Back from Institutions to home after 48hrs stay.

111.  Financial management
 Programme management
 Data management
 Development of standards
 IPHS
 ISO 9001
 NABH
 Capacity development for public health
 Accountability system

113.  Universal HIV screening included as an integrated component of ANC
check up.
 VHNDs may be utilized for rapid blood test.
 Counselors at ICTCs also counsel the non-HIV pregnant women on
nutrition, STI & birth spacing.
 Link workers & out reach workers to under take line listing of all pregnant
women and prepare birth plan for non HIV women as well.
 ASHAs to be trained on the module “ Shaping our lives” by NACO.
 ASHAs to provide ANC & STI counselling, referral, pre and post natal
care for mother and new born,
 All 24*7 health facilities to be strengthened by ICTC service & PPTCT
service.
 Appropriate incentives to the service providers conducting deliveries in
24*7 facilities.

114.  FP counselors may be trained on STI, PPTCT, ANC and
nutrition.
 Infrastructure up-gradation .
 All HIV patients to be screened for TB and vice versa.
 SACS to take care of condom promotion in the high
prevalence states.
 PD SACS & MD NRHM should meet quarterly.

115.  Macro Health Indicators-30 marks
 IMR-15 MARKS
 CBR-5 MARKS
 CDR-5 MARKS
 TFR-5 MARKS
 Physical capacity and delivery outcomes of rural services
centre-40 marks
 24*7 PHCs as a % of total no of PHCs-5 marks
 FRUs as % all CHCs, SDHs and DHs-5 marks
 Institutional deliveries-10 marks
 OPD/IPD-4 marks
 ABER-2 marks
 % of new smear positive patients registered-2 marks
 Sterilization performance-2 marks
 Physical infrastructure development-10 marks

116.  Outcomes in enhancements of human resources in
the health systems-20 marks
 ASHA programme-8 marks
 ANM, Nurses-4 marks
 Doctors,Specialists, AYUSH doctors-3 marks
 % utilisation of untied funds under the NRHM Mission flexible
pool-5 marks
 Outcomes in the area of Goverence-10 marks
 Institutional framework and decentralisation-4 marks
 Financial performance and state contribution-3 marks
 Innovation-3 marks

117.  Home based care component in the training programme of
ASHA training.
 Basic provision for neo-natal at all facilities.
 Strengthening VHSC.
 Public Health specialist at all level; every state must have a
public health cadre.
 Indian Public Health Service.
 Universalization of basic protocols of care at all levels.
 NRHM needs further deepen decentralized management and
accountability by engaging NGOs for community monitoring.


118.  Every facility to develop its detailed institutional plan.
 Establishment of medical & nursing institutions in
deficient states.
 Urban Health Mission.
 National Health Bill.
 Supervisory structures and job descriptions of every
workers should well be established.
 Speed up the Village Health Registers.
 RSBY
 Malaria, TB & IDSP further intergraded into the NRHM.
 Speed up the accreditation process.

119. 1. Kishore J. National Health Programs Of India
2. WHO. Meeting people’s health needs in rural areas- The progress so far the way
ahead
3. Maternal & Child Mortality and Total Fertility Rates Sample Registration System
(SRS). Office of Registrar General, India 7th July 2011
4. National Vector Borne Disease Control programme
5. National Programme For Control Of Blindness
6. National Leprosy Elimination Programme
7. RNTCP-2011 report
8. National Rural Health Mission. Meeting people’s health needs in partnership
with states, The journey so far (2005-2010).MOHFW.Govt. of India
9. National Rural Health Mission State Wise Progress
10. Programme Implementation Plan 2011-12. West Bengal State Health and Family
Welfare samiti.
11. ASHA –Which way forward…? Excecutive Summary-Evaluation of ASHA
Programme. NHSRC
12. National Health Account
13. Guidelines for Janani-Shishu Suraksha Karyakram. MOHFW. Govt. of India
14. NRHM & NACP convergence. MOHFW. Govt. of India