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Health Related National Schemes

NATIONAL RURAL HEALTH MISSION - updated on 02-06-2012

1.    Goals of NRHM

  • Facilitate increased access and utilization of quality health services by all
  • Forge a partnership between the Central, State and the local governments.
  • Set up a platform for involving the Panchayati Raj Institutions and community in the management of primary health care programs and infrastructure.
  • Establish a mechanism to provide flexibility to the States and the community to promote local initiatives.
  • Develop a framework for promoting inter-sectoral convergence for promotive and preventive health care.

2.    Objectives of the Mission

  • Reduction of Infant Mortality Rate, Maternal Mortality Rate, and Total Fertility Rate.
  • Access to integrated comprehensive primary health care.
  • Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.
  • Achieve population stabilization, gender and demographic balance.
  • Revitalize local health traditions and mainstreaming AYUSH
  • Promotion of healthy life styles.

3.  Expected outcomes from the Mission


Indicator

NRHM by 2012

Present status

AP
target

India

AP

IMR (per 1000 live births)

30

57*

53*

30

MMR (per 1,00,000 live births)

100

466**

341**

100

TFR (children per women)

2.1

2.7*

1.8*

1.5

* NFHS-III (2005-06) ** IIHFW Annual report (2002-03)

  • Tuberculosis DOTS services – 85% cure rate by 2012
  • To reduce Leprosy prevalence rate – 0.43 per 10,000 by 2012
  • Cataract operations – increasing to 6 lakhs per annum by 2012 (AP).
  • To reduce Malaria mortality rate – 60% by 2012
To reduce Filaria / Microfilaria rate – 80% by 2012.

NRHM
1.   Maternal Health Care Service :

Maternal Health Care Services are being provided to the pregnant woman by implementing the following schemes / interventions :
i)    Women Health Volunteers (Accredited Social Health Activitist (ASHA):
This scheme is started during the year 2005-06 with an objective of providing the services of the health resource person very nearer to the community in rural areas. It is implemented in 21,916 villages (67561 habitations).
55,400 “Women Health Volunteers” have been identified in all habitations across the state through the Gram Panchayat Health Committees, to act as ‘health-resource persons of first resort.  51,900 WHVs are trained and positioned as on 31.3.2007. They provide services to the pregnant woman, infants and eligible couples.
                       
ii)   FRUs strengthened with CEMONC services (Comprehensive Emergency Obstetric & Neonatal Care):
This scheme is started during the year 2005-06 with an objective of providing the services of life-saving emergency care to mothers and children (caesarian, neonatal care, etc.);
Every CEMONC centre is designed to have 4 obstetricians, 1 pediatrician,           1 anesthetist, blood bank or blood storage center; and additional budget for drugs & consumables per each case of delivery.
148 CEMONC Centers have been set up till now. About 59 obstetricians and 59 MBBS lady medical officers are positioned.
           
iii)  Blood Bank & Blood Storage Centres :
This scheme was started during the year 2005-06 with an objective to provide the blood to the caesarian surgery cases.
16 new blood banks and 89 blood storage centers are to be set up in Comprehensive Emergency Obstetric and Neonatal Care (CEMONC) centres. 40 new blood storage centres are sanctioned during 2006-07.
The Indian Red Cross Society is appointed as the State Level Nodal Agency to set up Blood Banks and Blood Storages Centers. 16 new blood banks and 89 blood storage centers are to be operationalised shortly.
           
iv) 24-hours MCH centre:
This scheme was started during the year 1997-98 with an objective of providing round the clock services for conducting normal deliveries, to identify the high risk pregnancy cases and to refer them to FRUs. 520 PHCs are functioning as 24 MCH Centres.  280 PHCs were converted as 24-hrs MCH centres during 2007-08.  The no.of deliveries conducted during 2006-07 are 70,012.
           
v)  Janani Suraksha Yojana (JSY) :
This scheme was started during the year 2005-06 with an objective to encourage pregnant women for an institutional delivery in Government / Private Institution which contributes for the reduction of Maternal Mortality and Infant Mortality.
Under this scheme Rs.1000/- (Rs.700/- under JSY (GOI) + Rs.300/- under Sukhibhava (State) scheme) is being paid to rural BPL woman who under goes an institutional delivery. From 1st April 2006, JSY has been extended to BPL urban families also.
5,00,000 beneficiaries have been covered under JSY scheme during financial year 2006-07.
vi)  Free Bus Passes :
This scheme was started during the year 2005-06 with an objective to provide free travel facility to the BPL rural pregnant women in APSRTC Buses for antenatal checkups in the nearest Government / Private hospital.
 
8 lakhs bus passes have been distributed to the beneficiaries during 2006-07.
           
vii) Rural Emergency Health Transport Scheme :
This scheme was started during the year 2005-06 with an objective to provide transport to the pregnant women, infants, children and other health emergencies in rural areas to the nearest hospital to provide the emergency health care. One ambulance is provided for a population of about 1.25 to 1.5 lakh in the rural area.
 
 122 ambulances are functioning in 4 districts i.e. Mahabubnagar, Nizamabad, Kurnool, Kadapa and tribal areas of 9 districts. The operationalization of the balance 310 ambulances has been entrusted to M/s Emergency Management and Research Institute which is recognized as a Nodal agency by Government. They have operationalized this scheme in 8 districts so far and complete operationalization in the remaining districts by the end of May 2007. All these ambulances are being utilized to the fullest by the rural population for all medical emergencies at free of cost.

2. Child Health Care Services

Child Health Care Services are being provided to the Infant and Children by implementing the following schemes / interventions :

  • Neo-natal intensive care units
  • New Born Care kits
  • New Born and Neo-natal care campaign

i)   Neonatal Intensive Care Units (NICUs) :
This scheme was started during the year 2006-07 with an objective to provide emergency neonatal care services to new born and neonates to reduce Infant mortality rate and to improve the quality of pediatric care services in remote, interior, tribal areas & urban areas.
It is proposed to establish 160 NICUs in A.P. State (in 13 Teaching Hospitals, 23 Dist. Hospitals, 16 Area Hospitals and 108 CEMONC centers)

  • 12 Pediatricians are positioned against 124 posts sanctioned.
  • Procurement of equipment for NICUs is under process.
  • Two Staff Nurses and two ANMs on contract basis in each unit are being positioned.
  • Proposed to provide Drugs and Consumables to each unit.

           
ii)  New Born Care Kits :
This scheme was started during the year 2006-07 with an objective to prevent deaths from hypothermia and outside infections.  Under this scheme, the kits are being supplied to low birth weight (<2000 grms) new born babies of SC/ST/BPL families, born in all government institutions.

  • The Newborn Care Kit consists of 2 Baby Mattresses; 4 Baby Jacket; 3 Baby Caps; 3 pairs of Gloves; 12 Baby Diaper and 8 Baby Blankets.  The Kit is sterile and would keep the baby warm and prevent death from hypothermia and outside infections.
  • 52,000 new born care kits were procured and distributed to the beneficiaries during 2006-07.
  • It is planned to procure 1,30,000 kits during 2007-08.

iii)   Newborn & Neonatal Care Campaign / Age at Marriage Campaign:
This campaign was conducted with an objective to increase awareness on issues like age at marriage, to identify danger symptoms and signs in new born and neonatal infants. 
The campaign was conducted in 6 districts with high Infant Mortality Rate in 2005-06 and in 21 districts in 2006-07
         

3.  Family Planning Insurance Scheme :

This scheme was started during the year 2005 with an objective to provide insurance to sterilization acceptors.

The details of the scheme are as follows:



Sl.
No.

Issues covered

Limit of indemnity

1

Death due to sterilization operation in Hospital or within 7 days from the date of discharge from the hospital

Rs.2,00,000

2

Death occurring due to sterilization operation between 8 to 30 days from the date of discharge from the hospital

Rs.50,000

3

Failure of sterilization operation (payable once only)

Rs.25,000

4

Expenses for treatment of medical complication due to sterilization operation (within 60 days of operation)

Actual subject to maximum of Rs.25,000

4. Urban Health Services :                                                                                                 

This scheme was started during the year 2000 with an objective to provide preventive, promotive and curative services to the people living in urban slum areas. 192 Urban Health centres are functioning in the state through NGOs with state government funds.  Each urban health centre covers 15,000 population in slum area.
Under RCH-II, 25 UHCs were established during 2005-06 in 9 cities/towns and during 2006-07 21 UHCs were established in another 9 cities/towns.

5.  Tribal Health Services :                                                                                                

The following additional initiatives are taken up to strengthen the health services in the tribal areas

  • 8500 Community Health Volunteers are working in tribal areas.
  • Initiatives under RCH-II from 2005-06 onwards:
    • A package of RCH services have been introduced in the tribal areas (193 tribal PHCs) including shandy level RCH medical camps weekly once at every shandy.
    • 3,500 shandy clinics were conducted during 2005-06 and 7,000 shandy clinics were conducted during 2006-07.  The expenditure under this scheme is Rs.79,26,640/-
    • 43 Emergency Health Transport vehicles are functioning in tribal areas to provide the transport to emergency cases at free of cost.
    • 92 Mobile Medical Units are functioning in all the tribal areas to provide the services at the door step of the tribal people.
    • Birth waiting homes: Tribal area birth waiting homes are being constructed to enable women from distant and interior habitations to reach the delivery care institution a couple of days before the expected date of delivery as to prevent the complications of arrival in late labour.

6.   Preconception and Prenatal Diagnostic Techniques (PC&PNDT) :                  

The Pre-Conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act 1994 and Rules 1996 are being implemented in Andhra Pradesh to prevent the Female foeticide and to improve the female sex ratio in the State. Under this Act - 2751 Medical Facilities (Scanning Centres) are registered in Andhra Pradesh as on 13.9.2006. 19 cases are filed so far in various courts for violation of PC PNDT Act.

7.   Sub-Center Untied Funds                                                                    

The scheme was started during 2005-06.  The Objective of this scheme is to provide funds at Gram Panchayat level to meet the requirements for maintenance of sanitation and public health at village level and to improve the facilities at the sub-centre level.  An amount of Rs.10,000/- is being released to each sub-centre per annum and this amount will be deposited in a joint account to be operated by the Village Sarpanch and the ANM.

8.  Untied funds for Maintenance of PHCs:                                                                   

The scheme was started during 2006-07. The objectives of the scheme are

  • To enable the PHCs to function more effectively
    • By getting minor repairs done,
    • To get the PHC compounds clean on a regular basis.
    • To arrange for scientific bio-medical waste disposal
    • To meet expenses for NRHM review with MPHA (M&F) and ASHAs
    • To provide referral transportation in exceptional situations, etc.

            The budget provision per annum is Rs.90,000/- per PHC.
            The funds released during 2006-07 were Rs.1046.00 lakhs

9.  Untied funds for Maintenance of CHCs:                                                                   

 The scheme was started during 2006-07. The objectives of the scheme are

  • To enable the CHCs to function more effectively
    • By getting minor repairs done,
    • To get the CHC compounds clean on a regular basis.
    • To arrange for scientific bio-medical waste disposal
    • To meet expenses for NRHM review with Fields Staff
    • To provide referral transportation in exceptional situations, etc.

           
10.   Hospital Development Societies (Rogi Kalyana Samithi)                                   

This scheme was started during the year 2006-07.  The broad objectives of RKS are; (i) Improve the institutions/hospitals, upgrade the equipment and modernize the health services; (ii) Ensure discipline in the institutions and supervise the staff; (iii) Undertake construction and expansion in the hospital buildings; (iv) Ensure optimal use of hospital land according to government guidelines; (v) Improve participation of the committees in the running of the institutions / hospitals; (vi) Ensure scientific disposal of hospital waste; (vii) Ensure proper training for doctors and staff; (viii) Ensure subsidized food, medicines and drinking water to the patients and their attendants; (ix) Ensure proper implementation of National Health programmes; and (x) Ensure proper use, timely maintenance and repair of institution / hospital equipment and machinery.
Govt. of India under NRHM is proposed to provide one time Corpus Grant to HDS @ Rs.5.00 lakhs to each District Hospital and Rs.1.00 lakh to each AH/ CHC / PHCs.  1620 HDS’s have been constituted in all the District Hospitals, Area Hospitals, Community Health Centres and Primary Health Centres.

           
11.  Village Level Health and Sanitation Committees                                                 

This scheme was started during the year 2006-07 with an objectives to ensure optimal use of health service in the village; improve participation of the village level health and sanitation committees in maintaining quality health services and sanitation; to prevent occurrence of epidemics in the villages.

The Village Health and Sanitation Committees are formed with Panchayat Sarpanches as chairpersons, and ward members, Anganwadi Workers, ANMs, and Women Health Volunteers as members and MPHAs (M), and MPHAs (F) as member conveners.