The National Rural Health Mission (NRHM) was launched on April 12, 2005 by the Government of India (headed at the time by the then Prime Minister Manmohan Singh) as a welfare initiative to strengthen the healthcare infrastructure and to boost the failing public health indicators in the rural areas of 18 Indian states. The programme was initially designed to last between 2005 and 2012. By 2013, the considerable success of the mission prompted the Union Cabinet to set up the National Urban Health Mission (NUHM) on May 1, 2013. Both the NRHM and the NUHM currently exist as sub-missions of the National Health Mission (NHM). The NHM, the NRHM and the NUHM are managed by the Ministry for Health and Family Welfare, in close association with the states.
The states initially covered by the NRHM
The 18 states in focus by the NRHM include the Empowered Action Group (EAG) states, the North Eastern states, Jammu and Kashmir, and Himachal Pradesh.
||Jammu & Kashmir
The NRHM now covers all Indian states and Union Territories
Why did India need the NHM?
India's public healthcare situation, particularly in rural regions and villages, had been a major concern since independence. Hunger, malnutrition, and high mortality had plagued the nation for decades. In 2005, India's Infant Mortality Rate (IMR) stood at 58, well above the global average. In 2001-03, the Maternal Mortality Ratio (MMR) estimates were pegged at 301 maternal deaths per 100,000 live births and 2004 & 2006 saw 254 maternal deaths per 100,000 live births. In 2006, when the first Global Hunger Index report was released, India was ranked 96 among 119 hungriest countries in the world. In 2005, about 43.5 percent children in the country were considered underweight. The need for a focused initiative to tackle the health scenario led to the launch of NRHM by the Indian government to improve the widespread malnutrition scenario, to collect and study data relating to public health, and to manage the outbreak of endemics and curb the spread of diseases.
Goals and aims of the NHM
The NHM was launched to "improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women, and children" between the years 2005 to 2012. It aims to provide universally accessible and affordable healthcare facilities both in cities and villages. Prevention, treatment, and control of diseases (both communicable and non-communicable, prevention and management of endemic spread of diseases, prevention of pandemics (such as in the face of the current Ebola scare), and promotion of healthy lifestyles are very important goals of the mission. The mission aims to reduce IMR and MMR in both urban and rural regions. One of India's most important worries is its population explosion. The NHM also looks to control growth of this population and also to bring about a gender balance in the Indian society.
Programmes and components
Reproductive, maternal, newborn, child, and maternal health programme
At the very core of the NHM are women's and children's health programmes. A number of schemes and policies have been initiated to address the concerns in these areas and to match up to India's public health standards. Some of the NHM schemes are - Janani Swasthya Shishu Suraksha Karyakram - Launched in 2011, the scheme aims to bring health benefits to over 12 million pregnant women in the country. Apart from neonatal and postnatal care, the scheme also aims at providing newborn care and infant healthcare for 30 days since birth.
Rashtriya Bal Swasthya Karyakram - The aim of this programme is to provide comprehensive child health care for all Indians from newborns to children under the age of 18. The programme intends to control, manage, and prevent "Diseases, Deficiencies, Disability, and Developmental delays".
Rashtriya Kishore Swasthya Karyakram - Targeted to improve the health of adolescents between the ages of 10 and 19, this scheme not only looks into deficiencies, diseases, and diet but also looks into important aspects of social environment such as substance abuse.
National Disease Control Programmes
These programmes are designed to prevent and contain diseases such as malaria and filarial. While also looking at eradication of preventable diseases such as those caused by iron or iodine deficiency, they also work on a larger scheme of eradicating communicable and potentially lethal diseases such as tuberculosis and leprosy.
The NHM also has comprehensive health and welfare schemes and programmes that work to improve a number of areas such as mental health, family planning, and population control apart from containing endemic spread of diseases..
Measure of success
The NHM has achieved a considerable degree of success in achieving the goals for which it was established. In 2014, India was ranked 55 in the Global Hunger Index ahead of both Pakistan (rank 57) and Bangladesh (57). Our country still trails behind Nepal (44) and Sri Lanka (39). Infant Mortality Rate (IMR) has declined to 40 in 2013 and Maternal Mortality Ratio (MMR) has declined to 178 maternal deaths per 100,000 live births. While there is much more to be done to rid India of the scourge of hunger, malnutrition, and spread of diseases, the achievements must be weighed against India's burgeoning population that stands at 1.2 billion (2013 estimates). Lack of education, awareness, and women's emancipation, particularly in rural regions have been the biggest challenges faced by the mission. India is currently at the threshold of a new phase of growth and development and this can only be achieved when public health is accorded a high level of importance. The NHM's role in realising this aim cannot be undermined.
Targets listed by the NHM
|Achievement of MMR to 1/1000 live births
|Achievement of IMR to 25/1000 live births
|Reduction of Total Fertility Rate to 2.1
|Prevention and control of anaemia in women between the ages of 15 and 49
|Prevention of mortality from communicable & non-communicable diseases
|Control of injuries and newly discovered diseases
|Reduction of household expenditure on health care
|Reduction of mortality and occurrence of tuberculosis by about half each year
|Reduction in occurrence of leprosy to <1 /10000 population
|Reduction in occurrence of malaria to <1 /1000 population
|Reduction in occurrence of microfilaria to < 1 percent population
|Elimination of Kala-azar by 2015
Cost of healthcare
India's healthcare budget (including the money spent towards the NHM) is far below those of other developed nations. Despite the rapid economic growth seen over the past couple of decades, the nation has been unable to eradicate hunger and provide basic healthcare facilities to most of its citizens. The government of India has been spending only about 1 percent of its GDP towards public healthcare. This figure stands out far below in comparison with other nations such as the UK which spends 9.5 percent of its GDP on healthcare, the US which spends about 8.3 percent and India's populous Asian neighbour, China, which spends about 3 percent. In the current fiscal year, India's budgetary allocation towards healthcare has been a mere USD 5 billion. A comprehensive nationwide healthcare plan for India is likely to raise its healthcare spends rather substantially.
Indians are noted for "high out of-pocket" expenditures towards medical facilities, treatments, and healthcare costs. Each year at least 39 million Indians are forced into poverty due to spending on medicines, treatments, and other medical costs (as of 2011). This fact comes in stark contrast to the fact that the nation's medical infrastructure is far from adequate. In India, there are just about hospital beds per 10,000 people despite a population of over 1.2 billion. China, on the other hand, has a population of about 1.3 billion but has 41 hospital beds per 10,000 people.
National Health Assurance Mission
Furthering the ideals of the National Health Mission, the Narendra Modi-led NDA government plans to launch a National Health assurance Mission in 2015. The mission shall be rolled out in phases and aims at providing free healthcare services including diagnostic services and drugs to every Indian. With the implementation of the mission, the government will provide 50 free drugs and 12 diagnostic treatments free of cost for all the citizens.
The financial burden of the implementation of the National Health Assurance Mission is, however, likely to run up a huge bill and has started to attract criticism even at the planning stage. The mission is likely to cost the country Rs1.6 trillion (approximately USD 26 billion) between 2015 and 2019. By 2019, the entire population of the country is to be covered. The mission is likely to cost India about USD 11.4 billion each year. The World Bank and British healthcare agency NICE are collaborating with the Indian government in the planning of the mission. Critics, however, claim that covering the entire population of the country is likely to take over a decade and the costs involved in such a scheme is likely to be much higher than the current estimates.