A simplified guide to the National Rural Health Mission

• The National Rural Health Mission is a social welfare scheme which aims to provide quality healthcare facilities to the rural population.
• The NRHM scheme was launched in 2005 by Dr. Manmohan Singh, who was the Prime Minister of India at the time.
• The scheme focuses on better healthcare services for women and children to reduce maternal and infant mortality rates.
• ASHA workers, Village Health Sanitation and Nutrition Committee, mobile medical and ambulance units have been deployed under the scheme.

Medical illnesses or injuries can affect anyone and require relevant treatment. However, affording them is difficult with the rising cost of medical treatments, especially for the rural population. With most of India's population living in rural areas, the government felt the need for a suitable healthcare program. This gave birth to the National Rural Health Mission.

The NRHM full form, National Rural Health Mission (NRHM) is a government-sponsored health scheme that offers free and low-cost medical facilities to eligible individuals living in rural areas. The main focus of the scheme is on Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) medical services.The NRHM scheme promotes maternal health and childcare among the rural population. Besides healthcare facilities, the scheme also aims to promote inter-sectoral convergence of major health determinants, including nutrition, education, sanitation, social equality, water, etc.

Origin of the NRHM scheme

In 2005, under the leadership of the then Prime Minister, Dr. Manmohan Singh, the NRHM was launched in India. Till today, the scheme benefits crores of individuals belonging to the lower income groups.

The NRHM scheme is helmed by different individuals at different levels. Let's explore this institutional framework:

National level

At the national level, the NRHM programme is helmed by the Mission Steering Group (MSG) and the Empowered Program Committee (EPC). While the MSG is headed by the Union Minister for Health and Family Welfare, the EPC is headed by the Union Secretary for Health and Family Welfare. The EPC is tasked to implement the scheme following the guidelines set by the MSG.

State level

The State Health Commission, which is headed by the State's Chief Minister, guides the implementation of the scheme. The scheme is implemented and administered through the State Health and Family Welfare Society.

Some of the main objectives of NRHM are as follows:

• Allowing citizens at all income levels access to quality healthcare services
• Reduction of the Maternal Mortality Rate in villages to 100/1000
• Reduction in the Infant Mortality Rate to 30/1000 live births
• Decreasing the Total Fertility Rate (TFR) to 2.1
• Eliminating anaemia and anaemic tendencies among women aged between 15 and 49 years
• Reducing the annual malaria mortality rate to 60%
• Decreasing leprosy among the rural population to achieve a level of 1/10000
• Reducing the prevalence of microfilaria to less than 1%
• Reducing the mortality and morbidity rates of diseases and injuries
• Preventing and controlling communicable and non-communicable diseases and local endemics
• Having a cure rate of 85% for tuberculosis
• Reducing the dengue and malaria mortality rates by half
• Providing universal access to public services, including healthcare services
• Attaining a balance in gender and demography
• Revamping mainstream AYUSH (Ayurveda, Unani, Siddha and Homeopathy) and local traditions of treating illnesses

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The main features of the National Rural Health Mission are listed in the following points:

• General Duties Medical Officers (GDMOs)
• Medical specialists
• Paramedics
• Staff nurses
• Auxillary Nurse Midwives (ANM)
• Public Health Managers
• Programme Management Staff, among others

• Delivery of healthcare services in rural areas The basic objective of the NRHM programme is to provide accessible and good-quality healthcare facilities to the low-income population living in rural areas. To this extent, the NRHM scheme has appointed lakhs of medical specialists across India, which include:
• Focused operational areas The NRHM scheme focuses mainly on the Empowered Action Group (EAG) States, rural regions of Jammu & Kashmir, Himachal Pradesh and the North Eastern States.
• Free drugs and diagnostics The scheme offers Free Drug Services, which provide free medicine to individuals. Qualifying Indian States/Union Territories can utilise the NHM-Free Drug Service Initiative.
  Moreover, under the NHM-Free Diagnostics Service Initiative, free diagnostic tests are offered to eligible states. Under this initiative, you can access high-cost, low-frequency diagnostics, lab technicians and equipment, radiologists, etc.
• Accredited Social Health Activists (ASHAs) In the case of medical care, the rural population will first approach ASHAs, who, in turn, will facilitate the relevant healthcare facilities.
• Rogi Kalyan Samiti/Hospital Management Society The committee manages the hospital's affairs to provide better facilities to the beneficiaries. These committees receive financial assistance from the Government to maintain high delivery standards.
  Rogi Kalyan Samitis tend to the community members in Community Health Centres (CHCs), District Hospitals (DHs), Primary Health Centres (PHCs) and Sub-District Hospitals (SDHs).
• Village Health Sanitation and Nutrition Committee (VHSNC) To promote basic sanitation, the VHSNC empowers the rural population. Individuals representing the Panchayati Raj, ASHA and other frontline workers are the main members of VHSNC. An annual grant of ₹10,000 is offered by the government to maintain the sanitation and nutritional requirements of NRHM beneficiaries.
• Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JJSK) NRHM's Janani Suraksha Yojana (JSY) works with the motto to reduce the Maternal Mortality Rate (MMR) through government-offered healthcare services during childbirth. Under the scheme, eligible pregnant women can get financial assistance after delivery.The Janani Shishu Suraksha Karyakram (JJSK) enables free deliveries among pregnant women through normal or Caesarean deliveries. Expecting and new mothers get free medicines, diagnostics, suitable diet, blood, and transportation
• National Mobile Medical Units (NMMUs) and National Ambulance Services (NAS) 333 out of 672 districts have NMMU to increase awareness among people. These units increase the visibility of NRHM and educate the rural population about the importance of getting quality healthcare facilities.The National Ambulance Service (NAS) provides a much-needed emergency ambulance facility during medical crises. People can dial 102 or 108 and book an ambulance for hospital transportation.
• Standardised health protocols The scheme has established standardised health guidelines at block levels, where each block comprises 100 villages. There are three service levels - primary health service level, sub-health centre level and ASHAs. This will bring uniformity in medical services throughout the country.

The functions of NRHM are carried out through core and supplementary strategies, which are discussed below:

Core strategies

• Training and improving the capacity of village Panchayati Raj Institutions (PRIs) to own, manage, and controlhealth services.
• Promoting improved health care services in every household through a female health activist (ASHA).
• Providing health plans through the Village Health Committee of each village's Panchayat.
• Strengthening the sub-centre through optimal funding for local planning, action and enhanced Multi-Purpose Workers (MPW).
• Strengthening PHCs and CHCs.
• Implementing and preparing an inter-sectoral District Health Plan prepared by the District Health Mission, which will include clean drinking water, sanitation, nutrition, and hygiene.
• Integrating the vertical Health and Family Welfare programmes at alllevels.
• Providing the required technical supporttoNational, State and District Health Missions for effective public health management.
• Strengthening data collection, assessment and review for effective monitoring, planning and supervision.
• Formulating transparent policies for deploying and developing the career of health professionals.
• Promoting preventive healthcare through healthy lifestyles, reduced consumption of tobacco, alcohol, etc.
• Promoting the non-profit sectors operating in underserved areas.

Supplementary strategies

• Regulatingtheprivate sector and informal medical practitioners in the rural areas to offer quality service at reasonable costs.
• Promoting Public-Private Partnerships for public health goals.
• Reorientingmedical education for supporting rural health issues.
• Feasible risk pooling and health insurance for providing financial security to the poor through good quality hospital care.

The NRHM primarily provides healthcare facilities to eight economically backward states, which are as follows:

• Bihar
• Chhattisgarh
• Madhya Pradesh
• Rajasthan
• Jharkhand
• Uttar Pradesh
• Odisha
• Uttarakhand

The rural areas of Northeastern India, Himachal Pradesh, and Jammu and Kashmir are also covered under the scheme's scope.People living permanently in the rural areas of these states are eligible to enjoy the benefits of the National Rural Health Mission.

Benefits of the National Rural Health Mission

Some of the main benefits of the National Rural Health Mission are as follows:

• People belonging to low-income groups can get access to quality healthcare facilities without burning a hole in their pockets.
• Treatments for both communicable and non-communicable diseases can be availed under the scheme.
• The NRHM has increased the rural population's awareness of the need for proper medical treatments.
• With continued efforts to raise awareness, the scheme has highlighted the dangers of smoking and tobacco consumption. This has brought down the rate of tobacco users in villages.
• With the help of government funding, the scheme has provided individuals with high-quality medical services.
• The different initiatives offered by the NRHM scheme have also resulted in the generation of employment opportunities.

There is no specified application process for enrolling under the NRHM. If you are a permanent resident of an identified village, you can access healthcare facilities under the scheme.The workers under the NRHM scheme provide door-to-door services and awareness campaigns for new residents. You can contact the nearest ASHA worker at the Aanganwadi centre to access healthcare benefits under the NRHM programme.

The National Rural Health Mission is on a mission to provide basic and quality healthcare facilities to individuals who cannot afford them otherwise. Ever since its inception, it has delivered required medical assistance through its mechanism and continues to work towards social welfare.That being said, the primary goal of NRHM is to target the rural population. A health insurance plan will be a good choice for those ineligible for the scheme. The health insurance plan facilitates access to quality medical treatments by covering medical expenses. So, understand what is NRHM and buy a suitable health insurance scheme for your medical needs, and secure your finances. Also Read: Tips to Choose the Health Insurance Plan in India