NRHM, National HIV Programme

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NRHM, National HIV Programme

NATIONAL RURAL HEALTH MISSION – THE VISION

• The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure.
•  These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
• The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP.
• It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country.
• It has as its key components provision of a female health activist in each village; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); and integration of vertical Health & Family Welfare Programmes and Funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare.
• It seeks to revitalize local health traditions and mainstream AYUSH into the public health system.
• It aims at effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health.
•  It seeks decentralization of programmes for district management of health.
• It seeks to address the inter-State and inter-district disparities, especially among the 18 high focus States, including unmet needs for public health infrastructure.
• It shall define time-bound goals and report publicly on their progress.
• It seeks to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare.

GOALS ·

• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)
• Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition
• Prevention and control of communicable and non-communicable diseases, including locally endemic diseases
• Access to integrated comprehensive primary healthcare
• Population stabilization, gender and demographic balance.
• Revitalize local health traditions and mainstream AYUSH
• Promotion of healthy life styles

STRATEGIES

• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services.
• Promote access to improved healthcare at household level through the female health activist (ASHA).
•  Health Plan for each village through Village Health Committee of the Panchayat.
• Strengthening sub-centre through an untied fund to enable local planning and action and more Multi Purpose Workers (MPWs).
• Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards).
• Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition.
• Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels. Technical Support to National, State and District Health Missions, for Public Health Management.
• Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision.
• Formulation of transparent policies for deployment and career development of Human Resources for health.
• Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc.
• Promoting non-profit sector particularly in under served areas.

PLAN OF ACTION

1. COMPONENT (A): ACCREDITED SOCIAL HEALTH ACTIVISTS
2. COMPONENT (B): STRENGTHENING SUB-CENTRES
3. COMPONENT (C): STRENGTHENING PRIMARY HEALTH CENTRES
4. COMPONENT (D): STRENGTHENING CHCs FOR FIRST REFERRAL CARE
5. COMPONENT (E): DISTRICT HEALTH PLAN
6. COMPONENT (F): CONVERGING SANITATION AND HYGIENE UNDER NRHM
7. COMPONENT (G): STRENGTHENING DISEASE CONTROL PROGRAMMES
8. COMPONENT (H): PUBLIC-PRIVATE PARTNERSHIP FOR PUBLIC HEALTH GOALS, INCLUDING REGULATION OF PRIVATE SECTOR
9. COMPONENT (I): NEW HEALTH FINANCING MECHANISMS
10. COMPONENT (J): REORIENTING HEALTH/MEDICAL EDUCATION TO SUPPORT RURAL HEALTH ISSUES

INSTITUTIONAL MECHANISMS

• Village Health & Sanitation Samiti (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers
• Rogi Kalyan Samiti (or equivalent) for community management of public hospitals
• District Health Mission, under the leadership of Zila Parishad with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it
• State Health Mission, Chaired by Chief Minister and co-chaired by Health Minister and with the State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc
• Integration of Departments of Health and Family Welfare, at National and State level
• National Mission Steering Group chaired by Union Minister for Health & Family Welfare with Deputy Chairman Planning Commission, Ministers of Panchayat Raj, Rural Development and Human Resource Development and public health professionals as members, to provide policy support and guidance to the Mission
• Empowered Programme Committee chaired by Secretary HFW, to be the Executive Body of the Mission
• Standing Mentoring Group shall guide and oversee the implementation of ASHA initiative  
• Task Groups for Selected Tasks (time-bound)

National HIV Programme

• India, the second most populated country in the world, is home to an estimated 2.1 million people living with HIV (PLHIV), the third highest population globally after South Africa and Nigeria.
• The HIV epidemic in India is highly heterogeneous.
• It is concentrated in specific regions of the country and in high-risk groups (HRGs) such as people who inject drugs (PWID), female sex workers (FSW), men who have sex with men (MSM) and transgender people.
• HIV prevalence among all adults (15–49 years) has been declining steadily from 0.38% in 2001 to 0.26% in 2015, while among FSW, MSM and PWID it remains at 2.2%, 4.3%, and 9.9%, respectively.
• Over the period 2000–2015, the annual estimated number of new HIV infections has decreased by 66%, while the number of annual AIDS-related deaths has decreased by 54% since 2007

The National AIDS Control Programme (NACP)

• The National AIDS Control Programme (NACP) has been implemented by Government of India as 100% centrally sponsored scheme through State AIDS Control Societies in the states for prevention and control of HIV/AIDS.
• The first National AIDS Control Programme was launched in 1992, which focused on the national HIV surveillance system, prevention activities among High Risk Groups (HRGs) including information on HIV and the blood safety programme.
• NACP-II launched in 1999 focused on the scale-up of targeted interventions for HRGs, especially prevention, out-reach, HIV testing & counselling and fostered greater involvement of People Living with HIV (PLHIV) and community networks.
• The treatment programme was also launched under NACP II. Institutionalization of decentralized programme management through State AIDS Control Society was a key thrust in phase II.
• NACP-III launched in 2007, showed a rapid expansion of prevention, care, support and treatment efforts across the country with a focus on increasing service access points through institutional scale-up and out-reach.
• Currently, the NACP-IV (2012-2017) is mid-way through implementation. It focuses on consolidating the gains made during NACP-III and aims to accelerate the process of reversal of the HIV epidemic.
• The key strategies under NACP-IV includes intensifying and consolidating prevention services with a focus on HRG and vulnerable population, increasing access and promoting comprehensive care, support and treatment, expanding IEC services for general population and high risk groups with a focus on behaviour change and demand generation, building capacities at national, state and district levels and strengthening the Strategic Information Management System.
• Prevention and Care, Support & Treatment (CST) form the two key pillars of all HIV/AIDS control efforts in India.

The package of services provided under NACP-IV includes:

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