Dissection of National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched by the Hon’ble Prime Minister on 12th April 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The Union Cabinet vide its decision dated 1st May 2013, has approved the launch of National Urban Health Mission (NUHM) as a Sub-mission of an over-arching National Health Mission (NHM), with National Rural Health Mission (NRHM) being the other Sub-mission of National Health Mission.

NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the vulnerable groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh have been given special focus. 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 such as water, sanitation, education, nutrition, social and gender equality. Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, measured against Indian Public Health Standards for all health facilities.

Facility Based Newborn and Child Care :

Neonatal mortality is one of the major contributors (2/3) to the Infant Mortality. To address the issues of higher neonatal and early neonatal mortality, facility based newborn care services at health facilities have been emphasized. Setting up of facilities for care of Sick Newborn such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs) at different levels is a thrust area under NHM.

Special Newborn Care Units 

(SNCU)States have been asked to set up at least one SNCU in each district. SNCU is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for round the clock services.Newborn Stabilization units (NBSUs)NBSUs are established at community health centres /FRUs. These are 4 bedded units with trained doctors and nurses for stabilization of sick newborns.New Born Care Corners (NBCCs)These are 1 bedded facility attached to the labour room and Operation Theatre (OT) for provision of essential newborn care. NBCC at each facility where deliveries are taking place should be established.

A comprehensive “Facility Based Newborn Care Operational Guide- 2011, a guideline for planning and Implementation” have been published and disseminated in 2011 by Child Health Division, MoHFW, GOI to act as reference tool for the states to take necessary steps in implementation of same.

Janani Shishu Suraksha Karyakram (JSSK)Facility Based Integrated Management of Neonatal and Childhood Illness (F- IMNCI)

F-IMNCI is the integration of the Facility based Care package with the IMNCI package, to empower the Health personnel with the skills to manage new born and childhood illness at the community level as well as at the facility. Facility based IMNCI focuses on providing appropriate skills for inpatient management of major causes of Neonatal and Childhood mortality such as asphyxia, sepsis, low birth weight and pneumonia, diarrhea, malaria, meningitis, severe malnutrition in children. This training is being imparted to Medical officers, Staff nurses and ANMs at CHC/FRUs and 24×7 PHCs where deliveries are taking place. The training is for 11 days.

Integrated Management of Neonatal & Childhood Illnesses (IMNCI)

which includes Pre-service and In-service training of providers, improving health systems (e.g. facility up-gradation, availability of logistics, referral systems), Community and Family level care.

Home Based New Born Care (HBNC):

A new scheme has been launched to incentivize ASHA for providing Home Based Newborn Care. ASHA will make visits to all newborns according to specified schedule up to 42 days of life. The proposed incentive is Rs. 50 per home visit of around one hour duration, amounting to a total of Rs. 250 for five visits. This would be paid at one time after 45 days of delivery, subject to the following :

recording of weight of the newborn in MCP cardensuring BCG , 1st dose of OPV and DPT vaccinationboth the mother and the newborn are safe till 42 days of the delivery, andregistration of birth has been done

A comprehensive “Home Based Newborn Care Operational Guideline- 2011” has been developed, published and disseminated in 2011 by Child Health Division, MoHFW, GOI to provide framework and guidance to enable a coherent home based new born care strategy and act a reference tool for the states to plan necessary interventions.

Navjat Shishu Suraksha Karyakram(NSSK)

NSSK is a programme aimed to train health personnel in basic newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this new initiative is to have a trained health personal in Basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.

Infant and Young Child Feeding :

Infant and Young Child Feeding is the single most preventive intervention for child survival. It advocates the following:-

Early initiation (within one hour of birth) and exclusive breast feeding till 6 months.Timely complementary feeding after 6 months with continued breast feeding till the age of 2 yrs.Comparison of indicators of child feeding practices :IndicatorsCES (2009)DLHS-3 (2007-08)NFHS-3 (2005-06)Children under three years breastfed within an hour of birth33.5%40.2%24.5%Children 0-5 months exclusively breastfed56.8%46.4%46.3%Children age 6-35 months breastfed for at least 6 months- 24.9%

Nutritional Rehabilitation Centres (NRC)

(treat severe acute malnutrition amongst children)

Severe Acute Malnutrition is an important contributing factor for most deaths amongst children suffering from common childhood illness, such as diarrhoea and pneumonia. Deaths amongst SAM children are preventable, provided timely and appropriate actions are taken.

Nutritional Rehabilitation Centres (NRCs) are being set up in the health facilities for inpatient management of severely malnourished children, with counselling of mothers for proper feeding and once they are on the road to recovery, they are sent back home with regular follow up.

An “Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition-2011” has been published and disseminated in 2011 by Child Health Division, MoHFW,

Reduction in morbidity and mortality due to Acute Respiratory Infections (ARI) and Diarrhoeal Diseases :

Promotion of zinc and ORS supplies is ensured.

Childhood Diarrhoea

In order to control Diarrrhoeal diseases Government of India has adopted the WHO guidelines on Diarrhoea management.

India introduced the low osmolarity Oral Rehydration Solution (ORS), as recommended by WHO for the management of diarrhea.Zinc has been approved as an adjunct to ORS for the management of diarrhea. Addition of Zinc would result in reduction of the number and severity of episodes and the duration of diarrhoea.New guidelines on management of diarrhoea have been modified based on the latest available scientific evidence.Acute Respiratory InfectionsAcute Respiratory Infections forms 19 % of all under five mortalities in India (WHO 2007 report) and along with Diarrhoea are two major killers of under five children.India leads the world in the number of pneumonia cases with nearly 44, 00, 000 cases yearly. Early diagnosis and appropriate case management by rational use of antibiotics remains one of the most effective interventions to prevent deaths due to pneumonia. The ARI guidelines are being revised with the inclusion of the latest available global evidence.

Role of ASHA (Accredited Social Health Activists)

Community Health volunteers called Accredited Social Health Activists (ASHAs) have been engaged under the mission for establishing a link between the community and the health system. ASHA is 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 in rural areas. ASHA Programme is expanding across States and has particularly been successful in bringing people back to Public Health System and has increased the utilization of outpatient services, diagnostic facilities, institutional deliveries and inpatient care

Regularization of NHM Employees 

The demand for regularisation by NRHM employees is justified and genuine. If the Rehbar-i-Zerat employees were regularised, why is the government’s approach towards the NRHM employees is so step motherly? 

I agree that NRHM employees fall under the jurisdiction of the Central Government but if our Government was genuinely concerned about their welfare, they should have absorbed all the NRHM employees in various Family Welfare Schemes. 

Our state has thousands of job posts lying vacant. Yet, the Government instead of employing people against these vacant posts is only working to increase the hardships of the general public. NRHM is the backbone of healthcare. The main motive of NRHM is to develop healthcare in India (something our state is in dire need of). 

NRHM employees are working in rural areas as well as in urban areas. They work 24 hours a day and have contributed significantly to the healthcare sector of our country. India is Polio free only because of the tireless work of various NRHM employees. Govt should provide risk allowances to technical staff as well.The Government really needs to ponder over this issue and come up with a viable solution.



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