Articles from General Knowledge Today

National Rural Health Mission

The National Rural Health Mission was

launched in 2005, to provide accessible, affordable and accountable quality health services to the poorest households in the remotest rural regions. The thrust of the Mission is on establishing a fully functional, community owned, decentralized health delivery system with inter sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health like water, sanitation, education, nutrition, social and gender equality. Important Notes: The NRHM is about increasing public expenditure on healthcare from the current 0.9% of the GDP to 2 to 3% of the GDP. The scheme proposes a number of new mechanism for healthcare delivery including training local residents as Accredited Social Health Activists (ASHA), and the Janani Suraksha Yojana. It also aims at improving hygiene and sanitation infrastructure. The mission is in whole country but has 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. Five Pillars of NRHM

NRHM is organized around five pillars, each of which is made up of a number of overlapping core strategies. Increasing Participation and Ownership by the Community: Through an increased role for PRIs, the ASHA programme, the village health and sanitation committee, increased public participation and NGO participation. Improved Management Capacity: Professionalising management by building up management and public health skills in the existing workforce, supplemented by inculcation of skilled management personnel into the system. Flexible Financing: Provision of united funds to every village health and sanitation committee, to the sub-center, to the PHC, to the CHC including district hospital. Innovations in human resources development for the health sector: Contractual appointment route to immediately fill gaps as well as ensure local residency, incentive and innovation to find staff to work in hitherto underserved areas and the use of multiskilled and multi-tasking options. Setting of standards and norms with monitoring: The prescription of the Indian Public Health Standards (IPHS) norms marks one of the most important core strategies of the mission. This has been followed up by a facility survey to identify gaps and funding is directed to close the gaps so identified. Accredited Social Health Activists (ASHA) One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist called ASHA or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Notable points about ASHA are as follows: ASHA must primarily be a woman resident of the village married/ widowed/

divorced, preferably in the age group of 25 to 45 years. She should be a literate woman with formal education up to class eight. This may be relaxed only if no suitable person with this qualification is available. ASHA will be chosen through a rigorous process of selection involving various community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer, District Nodal officer, the village Health Committee and the Gram Sabha. Capacity building of ASHA is being seen as a continuous process. ASHA will have to undergo series of training episodes to acquire the necessary knowledge, skills and confidence for performing her spelled out roles. The ASHAs will receive performance-based incentives for promoting universal immunization, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes, and construction of household toilets. Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is expected to be a fountainhead of community participation in public health programmes in her village. ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services. ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services. She would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals. ASHA will provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilisation of health & family welfare services. She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs) and care of the young child. ASHA will mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers, such as immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition, sanitation and other services being provided by the government. She will act as a depot older for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc. At the village level it is recognised that ASHA cannot function without adequate institutional support. Women's committees (like self-help groups or women's health committees), village Health & Sanitation Committee of the Gram

Panchayat, peripheral health workers especially ANMs and Anganwadi workers, and the trainers of ASHA and in-service periodic training would be a major source of support to ASHA. There will be one ASHA per 1000 population. More than 7.49 lakh Accredited Social Health Activists (ASHAs) are connecting households to health facilities. The presence of community volunteers on this unprecedented scale has resulted in people's growing pressure on utilization of services from the public sector health system. Auxiliary Nurse Midwife and Anganwadi Worker (ANM)
Auxiliary Nurse Midwife (ANM)

The roles of Auxiliary Nurse Midwife (ANM) and ASHA have been integrated in various ways. The ANM will hold weekly/fortnightly meeting with ASHA, and provide on-job raining by discussing the activities undertaken during the week/fortnight and provide guidance in case ASHA encounters any problem. ANMs will also act as resource persons for the initial and periodic training and also ensure that during the training ASHA gets the compensation for performance and also TA/DA for attending the training schedule. She will also guide ASHA in bringing the beneficiary to the outreach session. She will utilize ASHA in motivating the pregnant women for coming to the Sub-Centre for initial check-ups and also take ASHAs help in bringing married couples to sub centres and motivating pregnant women for taking full course of Iron and Folic Acid (IFA).
Anganwadi Worker (AWW)

The responsibilities of Anganwadi Worker (AWW) will guide ASHA in performing on health and integrated with the role of ASHA. AWW will guide ASHA in performing activities such as organising Health Day once/twice a month at Anganwadi Centre and orientating women on health related issues such as importance of nutritious food, personal hygiene, care during pregnancy, importance of immunisation etc. anganwadi worker will be depot holder for drug kits and will be issuing it to ASHA. The replacement of the consumed drugs can also be done trough AWW. ASHA will support the AWW in mobilizing pregnant and lactating women and infants for nutrition supplement. She would also take initiative for bringing the beneficiaries from the village on specific days of immunisation, health check-ups/health days etc. to Anganwadi Centres.