Lok Sabha Question No. 2916 (UNSTARRED), answered on 2016-12-02
Subject: National Health Mission
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SHIVKUMAR CHANABASAPPA UDASI

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2916 TO BE ANSWERED ON 2 ND DECEMBER, 2016

## NATIONAL HEALTH MISS ION

## 2916. SHRI SHIVKUMAR UDASI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the salient features and objectives of the National Health Mission (NHM);
- (b) whether the Government has failed to achieve its objectives and targets under NHM a if so, the details thereof and the reasons therefor; and
- (c) whether the Government has conducted evaluation of various programmes running under the NHM and if so, the details thereof, State/UT - wise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

- (a): The  National  Rural  Health  Mission  (NRHM)  was  launched  in  2005  to  improve  the healthcare services, particularly in rural areas. NRHM has since been subsumed as a Sub Mi of  the  overarching  National  Health  Mission  (NHM)  with  the  Nati onal  Urban  Health  Mission (NUHM)  as  the  other  Sub  Mission.  NUHM  aims  at  providing  equitable  and  quality  primary health care services to the urban population with special focus on slum and vulnerable of  the  Society.  Under  NHM,  support  to  States/UTs is  provided  for  five  key  programmatic components:
- (i)Health  Systems  Strengthening  including  infrastructure,  human  resource,  drugs equipment, ambulances, MMUs, ASHAs etc under NRHM and NUHM .
- (ii) Reproductive, Maternal, Newborn, Child and Adolescent Health Serv ices ( RMNCH + A)
- (iii) Communicable Disease Control Programmes .
- (iv) Non - Communicable  Diseases  Control  Programme  interventions  upto  District  Hospital level .
- (v)Infrastructure Maintenance -to support salary of ANMs and LHVs etc .

The objectives of NRHM are as summarised as under:

- i. Reduction in child and maternal mortality
- ii. Prevention and control of communicable and non - communicable diseases, including locally endemic diseases.
- iii. Access to integrated comprehensive primary health care.
- iv. Population stabilisation, ge nder and demographic balance.
- v. Revitalize local health traditions & mainstream AYUSH.
- vi. Universal access to public services for food and nutrition, sanitation and hygie universal access to public health care services with emphasis on services addre ng women's and children's health and universal immunisation.
- vii. Promotion of healthy life styles.
8. (b): NHM did not achieve the 11 th Plan targets of Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR). However, the NHM has been successful in accelerating the rate of decline of Under 5 Mortality Rate (U5MR), MMR IMR and TFR. It h also achieved most of the disease control targets.
9. (c): The implementation of NRHM is reviewed through external surveys such as National Family Health Survey (NFHS), District Level Household Survey (DLHS), Annual Health Survey (AHS) and Sample Registration System (SRS). NFHS - 4 Survey is presently ongoing. Institute of Economic Growth conducted an evaluation of NRHM on behalf of the Planning Com mission. Further,  Common  Review  Missions  (CRMs)  also  undertake  a  review  of  NRHM/NHM  every year. The information is available in public domain as under:

DLHS 4: https://nrhm

- mis.nic.in/SitePages/DLHS - 4.aspx

AHS: http://www.censusindia.gov.in/vital\_statistics/AHS

SRS:http://www.censusindia.gov.in/vital\_statistics/SRS \_Report\_2012/1\_Contents\_2012.pdf

Evaluation of NRHM: Institute of Economic Growth:http://planningcommission.nic.in/report/peoreport/peoevalu/peo 2807.pdf

CRM reports: http://nrhm.gov.in/monitoring/common - review - mission/7th - common - review - mission.html

A summary of observations of the Common Review Missions and the external ev aluation by the Institute of Economic growth is at A nnexure.

## Annexure

- 1) The various Common Review Mission highlighted implementation progress and lacuna for specific states.   CRMs being participatory, multi stakeholder analysis, allowe componen ts  to  be  reviewed  in  depth  monitoring  and  recommendations  were  used  for district  and  state  planning.      The  common  observations  pertain  to  Health  Hum Resource shortages, particularly of specialists, issues of procurement, slow progr SNCU  and  facilit y  based  new - born  care,  out  of  pocket  expenditures  (although  these declined form 2005 levels), Limited progress on PPP, VHSNC and RKS, lack of attentio to areas such as family planning, and adolescent health etc.
- 2) The  Planning  Commission  commissioned  a n  external  evaluation  through  the  IEG  in 2010- 2011 in 37 districts seven states of India - five high focus states and two non - high focus  states.      The  study  reported  that  considerable  progress  was  made  on infrastructure  front  in  all  states  except  Jharkh and.  The  study  also  reported  limited progress on filling HR gaps especially specialists.   Regarding Medical Officers, states were still short of targets.  In most high focus states ANM/GNM schools b functioning around 05 - 06, and it appears that t he position has improved around FY 12 -13.  The findings for ASHA showed that high levels of coordination were reported w ANM and AWW and less so with PRI members.   The report also observes that there i less  movement  of  VHSNC  and  local  planning.    Overa ll  ASHAs  were  found  to  be functional in their roles as facilitator. The study reported poor progr operationalization of First Referral Units (FRUs) and that Rogi Kalyan Samitis ( were established in most states except J&K.  States appear to be o n track with regard to at least  establishing  the  platforms  for  decentralized  management  at  the  district although integration of bank accounts appears to be incomplete.