SUBJECT: COMMUNITY HEALTH NURSING

NURSING

ASSIGNMENT
ON
NRHM

SUBMITTED TO - SUBMITTED BY-

MRS. MALLIKA ROY MR. DEVESHWAR P. DWIVEDI
ASSISTANT PROFESSOR MSC NSG 1 S T YEAR
R.D. MEMORIAL COLLEGE OF R.D. MEMORIAL COLLEGE OF
NURSING, BHOPAL NURSING,BHOPAL
 NATIONAL RURAL HEALTH MISSION (NRHM)
INTRDUCTION:-
The National Rural Health Mission (NRHM) was launched in April 2005,
to provide effective health care to rural population throughout the country. The
mission aims to expedite achievements of policy goals by facilitating enhanced
access and utilization of quality health services, with an emphasis on
addressing equity and gender dimension.
The National Rural Health Mission seeks to adopt a sector wide approach
and subsumes key national programmes, such as: the Reproductive and Child
Health (RCH-II) Programme, the National Disease Control Programmes
(NDCP) and the Integrated Disease Surveillance Project (IDSP). NRHM will
also enable the mainstreaming of Ayurvedic, Yoga, Unani, Siddha and
Homeopathy Systems of Health (AYUSH).
AIMS OF NRHM:-
1. To provide accessible,affordable, accountable, effective and reliable PHC
2. Bridging the gap in rural health care through the creation of a cadre of
accrediated Social Health Activist(ASHA)
GOALS OF NRHM:-
1) Reduction in infant mortality rate (IMR) &Maternal mortality rate
(MMR).
2) Universal access to public health services.
3) Prevention and control of communicable & non-communicable diseases.
4) Access to integrated comprehensive primary health care.
5) Population stabilization, gender and demographic balance.
6) Revitalize local health traditions and mainstream AYUSH.
7) Promotion of health life styles.
The core strategies of the Mission:
1. Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own,
control and manage public health services.
 2. Promote access to improved healthcare at household level through the
female health activist (ASHA).
3. Health Plan for each village through Village Health Committee of the
Panchayat.
4. Strengthening sub-centre through better human resource development,
clear quality action and more Multi Purpose Workers (MPWs).
5. Strengthening existing (PHCs) through better staffing and human resource
development policy, clear quality standards, better community support and
an untied fund to enable the local management committee to achieve these
standards.
6. Provision of 30-50 bedded CHC per lakh population for improved curative
care to a normative standard. (IPHS defining personnel, equipment and
management standards, its decentralized administration by a hospital
management committee and the provision of adequate funds and powers to
enable these committees to reach desired levels)
7. Preparation and implementation of an inter sector District Health Plan
prepared by the District Health Mission, including drinking water,
sanitation, hygiene and nutrition.
8. Integrating vertical health and family welfare programmes at national,
state, block and district levels.
9. Technical support to national, state and district health missions, for public
health management.
10. Strengthening capacities for data collection, assessment and review
for evidence based planning, monitoring and supervision.
11. Formulation of transparent policies for deployment and career
development of human resources for health.
12. Developing capacities for preventive health care at all levels for
promoting healthy life styles, reduction in consumption of tobacco and
alcohol etc.
PLAN OF ACTION:-
ASHA – Accrediated Social Health Activist

The Primary goal of NRHM is to address the health needs of rural

population. ASHA is Community based functionaries. ASHA will be 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.
They will be working as the Community Health volunteers and will look after the
basic health needs of the service seekers at the first place.
To complement the work of ANM, ASHA (the Accredited Social Health
Activist) is selected through a selection process to fill the gaps in the health care
delivery system. She is a volunteer who acts as a bridge between the community
and the available health care system. The ASHA strengthens the link between
health sector and community.
She is working towards catalysingbehavioural change in rural and tribal
areas of the state. ASHA is contributing towards enhancing quality of life with
focus on health nutrition, sanitation, drinking water etc. The village health and
sanitation committee will oversee monitoring and support ASHA.
OBJECTIVES ARE:-

1. Create awareness on health and its social determinants.

2. Mobilize the community towards local health planning.
3. Increase utilization and accountability of the existing health services.
4. Promote good health practices.
5. Provide a minimum package of curative care as appropriate and feasible for
that level.
6. Undertaking timely referrals.
STRATEGIES;-

The ASHA is appointed to take steps to create awareness and provide

information to the community on determinants of health such as nutrition,
basic sanitation & hygiene practices, healthy living condition for working
conditions, information on existing health services and timely utilization 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 RTI/STI and care of young
child.
ASHA will mobilize the community and facilitate them in accessing health
and its related services available at the Anganwadi/Sub-center/primary
health centers.
She will assist the Village health & sanitation committee of the Gram
panchayat to develop a comprehensive village health plan.
She will escort/accompany pregnant women & children requiring treatment
/ admission to the nearest pre-identified health facility i.e. PHC/CHC/FRU.
ASHA will provide primary medical care for minor ailments such as
diarrhoea, fever, and first aid for minor injuries, work as provider of
 DOTS under RNTCP. She will also act AS DEPOT holder for essential
provisions which will be made available to every habitation.
She will inform about the births and deaths in her village and any unusual
health problems/disease outbreaks in the community to the Sub-
Center/Primary Health Centre. Besides, she will also promote construction
of household toilets under Total Sanitation Campaign.

SELECTION

The general norm is ‘One ASHA per 1000 population/Anganwadi

Center’. ASHA’s have been selected phase wise. In the first year 37% of
ASHAs have already been selected; In the last years, 20897 have been
selected. It is proposed to select 3164 new ASHAs for the new Anganwadi
Center set up in the State.

WorkingArrangements:

She will attend the AWC on the day when Immunization / ANC sessions
are being organized. At least once or twice a month, she will organize health
days for health IEC, rudimentary health checkup and advice including
medicine and contraceptive dispensation.

At Home: She will be available at her home, so as to work as depot

holder for distribution of supplies to needy people or for any assistance
required in terms of accompanying a woman to delivery care center/FRU
or RCH camp.
In the Community: She will organize /attend meetings of village women
/ health committees and other group meetings and attend Panchayat
health committees. She will counsel and provide services to the families
as per her defined role and responsibilities.

The supplementary strategies are:-

 Regulation of private sector including the informal rural practitioners to
ensure availability of quality service to citizens at reasonable costs.
 Promotion of PPPs for achieving public health goals.
 Mainstreaming AYUSH – revitalizing local health traditions.
 Reorienting medical education to support rural health issues including
regulation of medical care and medical ethics.
  Effective and viable risk pooling and social health insurance to provide
health security to the poor by ensuring accessible, affordable, accountable
and good quality hospital care.
 Cascade model of training proposed through training of trainers including
contract plus distance learning model.
 Training would require partnership with NGOs/ ICDS training centres and
state health institutes.
PLAN OF ACTION
Components are:-
a. Strengthening the sub-centre
b. Strengthening the primary health centres.
c. Strengthening the community health centres
d. District health plans:- this would be amalgamation of fiald responses
through village health plans, state and national priorities for health, water
supply, sanitation and nutrition.
e. Converging sanitation and hygiene under NRHM.:- total sanitation
compaign (TSC) is presently implemented in 350 districts, and is proposed
to cover all districts in 10 th plan . Also implemented through panchayati
raj institutions and TSC include IEC activities, household toilets, women
sanitary complex, and school sanitary programme, therefore DHM would
guide activities of sanitation at district level and romote joint IEC for
public health, sanitation and hygiene through village health and sanitation
committee.
f. Strengthening disease control programmes
g. PPPs for public health goals including regulation of private sector:- since
almost 75% of hralth services are being currently provided by the private
sector, there is need to refine regulation. Regulation to be transparent and
accountable. Reform of regulation where necessary, need to develop
guidelines for PPPs in health sector.
h. New health financing mechanisms:- progressively the DHM to move
towards paying hospitals for services by way of reimbursement, on the
principle of “money follows the patient”, standardization of services –
outpatient, in-patient, laboratory, surgical interventions- and costs will be
done periodically by a committee of experts in each state., a national
group of experts are there to monitor these standards and give suitable
advice and guidance on protocols and cost comparisions.
 i. Reorienting medical /health education support rural health issues:- while
district and tertiary hospitals are necessarily located in urban centres, they
form an integral part of the referral care chain serving the needs of the
rural people., medical and para medical education facilities need to be
created in states, based on need assessment.
INSTITUTIONAL MECHANISMS:-
1. Village health and sanitation samiti
2. Hospital management committee
3. District health mission, under the leadership of zilaparisad with district
health head as conventor and all relevant departments, NGOs, private
professionals etc are represented on it.
4. Integration of departments of health and family welfare, as national and
state level.
5. National mission steering group chaired by union minister for health and
family welfare with deputy chairman planning commission, minister of
panchayati raj, rural development and human resource development and
public health professionals as members, to provide policy support and
guidance to the mission.
6. Empowered programme committee chaired by secretary, HFW, executive
body of the mission.
7. Standing mentoring group shall guide and oversee the implementation of
ASHA inititive.
8. Task group for selected tasks.

SUMMARY:-
the National Rural Health Mission (2005-2012) seeks to provide
effective healthcare to rural population throughout the country. Its main is to
provide the accessible, affordable, accountable effective and reliable services
to population through PHC and bridging the gap in rural health care through
the creation of ASHA (Accrediated social health activist)worker. The goals
of NRHM is the reduction in infant mortality rate (IMR), maternal mortality
rate, prevention and control of communicable and non- communicable
diseases, revitalize local health tradition and mainstream AYUSH and
promotion of healthy life styles.
 CONCLUSION
At last , we now concluded the primary goal of NRHM is to address
the health needs of rural population and to provide the health services to
rural poor people in an accessible and affordable prices therefore created a
worker called ASHA which will be the first port of cal for any health
related demands of deprived section of the population, especially women
and children, who find difficult to access health services.
 BIBLIOGRAPHY

1. “Basavanthapa B.T”, A text book of “ Community Health Nursing” ,2 nd

Edition Published by Jaypees at NewDelhi. Page no. 195 to 199

2. “Gulani K.K.” , A textbook of “ Community Health Nursing” Principle &

Practice Of nursing, 1 st Edition, published by Kumar Publisher at New
Delhi, Page no. 421-422

3. “Park K”., A textbook of “Preventive and Social Medicine” 19 th Edition

Published by BanarsidasBhanot publisher at Jabalpur, Page no. 364

4. http://www.wikipedia.org/nrhm/