Social Welfare Policies – Health: National Health Mission (NHM)

Health: National Health Mission (NHM)

The National Health Mission (NHM) is one of India’s largest health-focused social welfare programs aimed at improving the healthcare system in the country, especially for underserved populations. Launched by the Government of India in 2013, the NHM integrates two key health initiatives—the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM)—to strengthen public healthcare across rural and urban areas. The mission seeks to provide universal access to equitable, affordable, and quality healthcare.

Key Objectives of the National Health Mission (NHM)

1. Reduction in Maternal and Infant Mortality:
   • One of the NHM’s primary goals is to reduce maternal mortality (MMR) and infant mortality rates (IMR) by improving healthcare services for women and children.
   • It emphasizes safe motherhood, skilled birth attendance, and access to antenatal care and postnatal care.
2. Universal Access to Healthcare:
   • NHM aims to ensure that every individual, regardless of their socio-economic background, has access to essential healthcare services.
   • Special focus is given to marginalized groups, including women, children, rural populations, and urban poor.
3. Strengthening Health Infrastructure:
   • The mission emphasizes improving the healthcare infrastructure in rural and urban areas by upgrading existing facilities, building new healthcare centers, and providing necessary medical equipment.
4. Focus on Communicable and Non-Communicable Diseases:
   • NHM addresses both communicable diseases (like tuberculosis, malaria, and HIV/AIDS) and non-communicable diseases (like diabetes, hypertension, and cancer) through preventive and curative services.
5. Affordable and Quality Healthcare:
   • The mission seeks to provide affordable healthcare by strengthening public hospitals, reducing out-of-pocket expenses, and providing free or low-cost healthcare services.
   • It focuses on improving the quality of care through better training of healthcare workers and ensuring access to essential medicines and diagnostic services.
6. Human Resource Development:
   • NHM works on building human resources by training and deploying healthcare workers, especially in rural and underserved areas, and enhancing their skills through capacity-building programs.
7. Community Participation and Health Awareness:
   • The mission promotes community participation in health programs through village health committees, ASHA (Accredited Social Health Activists) workers, and other community-based initiatives.
   • It emphasizes health education and awareness campaigns to improve health-seeking behaviors among the population.

Components of the National Health Mission

1. National Rural Health Mission (NRHM)

Launched in 2005 and later merged under NHM, the National Rural Health Mission (NRHM) focuses on improving healthcare delivery in rural areas, where the majority of India’s population resides but faces a shortage of healthcare facilities and professionals.

• Key Initiatives under NRHM:
  • Janani Suraksha Yojana (JSY): Aimed at reducing maternal and neonatal mortality by promoting institutional deliveries through financial incentives.
  • ASHA Workers: Community health workers who act as a bridge between rural communities and the public healthcare system. They help in delivering basic health services, such as maternal and child healthcare, immunization, and health education.
  • National Mobile Medical Units (MMUs): Provide medical services to remote and underserved areas where access to healthcare is limited.
  • Infrastructure Development: Strengthening of Primary Health Centers (PHCs), Community Health Centers (CHCs), and Sub-Centers in rural areas.

2. National Urban Health Mission (NUHM)

Launched in 2013 as part of NHM, the National Urban Health Mission (NUHM) focuses on improving healthcare services in urban areas, particularly for the urban poor and slum dwellers who often face inadequate access to health services.

• Key Initiatives under NUHM:
  • Establishment of Urban Primary Health Centers (UPHCs) and Urban Community Health Centers (UCHCs) to cater to the health needs of urban populations.
  • Deployment of Mobile Medical Units (MMUs) in urban slums and underserved areas.
  • Focus on preventive care, maternal and child health, and control of communicable diseases in urban areas.

3. Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A)

This initiative under NHM focuses on the continuum of care approach, addressing healthcare needs at different life stages—from reproductive health to maternal, newborn, child, and adolescent care. It covers aspects like family planning, immunization, safe delivery, and nutrition.

Key Programs Under National Health Mission

1. Janani Suraksha Yojana (JSY):
   • Promotes institutional deliveries to reduce maternal and infant mortality by providing cash incentives to pregnant women, particularly those from low-income households.
2. Rashtriya Bal Swasthya Karyakram (RBSK):
   • Aims at early identification and treatment of diseases and disabilities in children up to 18 years of age.
   • Children are screened for deficiencies, diseases, disabilities, and developmental delays, and provided free treatment if needed.
3. National Ambulance Services (NAS):
   • Provides free ambulance services (through the 102 and 108 helplines) to pregnant women, infants, and other emergency cases.
   • Ensures emergency care and timely transportation to healthcare facilities.
4. Mission Indradhanush:
   • Focuses on improving immunization coverage by providing vaccines to children and pregnant women who are left out of routine immunization programs.
   • The mission aims for 90% immunization coverage by targeting unvaccinated and partially vaccinated children.
5. Kayakalp Awards:
   • Aims to promote cleanliness, hygiene, and infection control in public healthcare facilities through incentives and recognition.
6. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):
   • A program that provides free antenatal check-ups to pregnant women on the 9th of every month in government health centers and hospitals.

Impact of the National Health Mission

1. Improved Health Indicators:
   • The NHM has significantly contributed to improvements in maternal and child health indicators, including reductions in the maternal mortality ratio (MMR) and infant mortality rate (IMR).
   • Enhanced immunization coverage and access to institutional deliveries have further improved the overall health outcomes of vulnerable populations.
2. Expansion of Healthcare Infrastructure:
   • NHM has played a crucial role in strengthening primary healthcare infrastructure by establishing new Primary Health Centers (PHCs) and Community Health Centers (CHCs), particularly in rural areas.
3. Increased Access to Healthcare:
   • Through initiatives like the ASHA worker program and mobile medical units, NHM has made healthcare more accessible, especially in remote and underserved areas.
   • The 102 and 108 ambulance services have provided emergency care to millions of people, reducing delays in accessing urgent medical attention.
4. Promotion of Community Participation:
   • NHM has encouraged community participation in healthcare through initiatives like Village Health and Sanitation Committees and the engagement of ASHA workers. This has created greater awareness and responsibility for health at the local level.
5. Health System Strengthening:
   • The mission has contributed to strengthening the health workforce, improving supply chains for essential medicines, and enhancing monitoring and evaluation of health services.

Challenges and Criticisms

1. Human Resource Shortages:
   • There remains a shortage of healthcare professionals, particularly in rural areas, including doctors, nurses, and paramedical staff. This has led to gaps in service delivery.
2. Funding Constraints:
   • The NHM relies heavily on government funding, and periodic financial constraints can affect the sustainability and quality of healthcare programs, particularly in states with limited resources.
3. Quality of Care:
   • While access to healthcare has improved, quality continues to be a concern. Issues such as overcrowding, inadequate infrastructure, and lack of skilled staff persist in many government hospitals and health centers.
4. Urban Healthcare Gaps:
   • Despite the National Urban Health Mission, healthcare challenges in urban slums and densely populated areas remain significant due to poor infrastructure and inadequate service delivery.
5. State-wise Disparities:
   • The implementation and success of NHM vary across states, with some states showing better health outcomes than others. Inter-state disparities in healthcare access and infrastructure are still a challenge.

Conclusion

The National Health Mission (NHM) is a comprehensive social welfare policy designed to improve healthcare access, affordability, and quality, particularly for marginalized populations. It has made significant progress in reducing maternal and child mortality, strengthening primary healthcare infrastructure, and improving public health outcomes. However, challenges like human resource shortages, quality of care, and state-level disparities need to be addressed to fully realize