National Health MissionMaharashtra

Historical Background

The Government of India has launched NRHM on 12th April 2005 with ob-jective to provide integrated com-prehensive and effective primary health care to the under privileged and vulnerable sections of the society especially women and children by improving access, availability and quality of public health services.

The key strategies of the mission include: ensure intra and intersect oral convergence, strengthening public health infrastructure, increasing community participation, creating a village level health cader of health workers fostering public private partnerships, emphasizing quality services and enhanced Programme management inputs.

India has registered significant progress in improving life expectancy at birth, reducing mortality due to Malaria, as well as reducing infant and material mortality over the last few decades. In spite of the progress made, a high proportion of the population, especially in rural areas, continues to suffer and die from preventable diseases, pregnancy and child birth related complications as well as malnutrition. In addition to old unresolved problems, the health system in the country is facing emerging threats and challenges like, an estimated 5 million people in the country are living with HIV/AIDS, non-communicable diseases such as cardio-vascular diseases, cancer, blindness, mental illness and tobacco use related illnesses etc have imposed the chronic diseases burden on the already over- stretched health care system in the country. India is in the midst of an epidemiological and demographic transition – with the attendant problems of increased chronic disease burden and a decline in mortality and fertility rates leading to an ageing of the population. Premature morbidity and mortality from chronic diseases can be a major economic and human resource loss for India.

Public spending on preventive health services has a low priority over curative health in the country as a whole. Indian public spending on health is amongst the lowest in the world, whereas its proportion of private spending on health is one of the highest. More than Rs. 100,000 crores is being spent annually as household expenditure on health, which is more than three times the public expenditure on health. The private sector health care is unregulated pushing the cost of health care up and making it unaffordable for the rural poor.

Thus, the country has to deal with multiple health crises, rising costs of health care and mounting expectations of the people. The challenge of quality health services in remote rural regions has to be met with a sense of urgency. Given the scope and magnitude of the problem, it is no longer enough to focus on narrowly defined projects. The urgent need is to transform the public health system into an accountable, accessible and affordable system of quality services. This understanding has led to the development of health mission in the country.

The Vision of the Mission is to...
  • 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.
  • 18 special focus states are Arunachal Pradesh, Assam, Bihar, Chattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa , Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
  • To raise public spending on health from 0.9 percentage GDP to 2-3 percentage of GDP, with improved arrangement for community financing and risk pooling.
  • To undertake architectural correction of the health system to enable it to effectively handle increased allocations and promote policies that strengthen public health management and service delivery in the country.
  • To revitalize local health traditions and mainstream AYUSH into the public health system.
  • Effective integration of health concerns through decentralized management at district, with determinants of health like sanitation and hygiene, nutrition, safe drinking water, gender and social concerns.
  • Address inter State and inter district disparities.
  • Time bound goals and report publicly on progress.
  • To improve access to rural people, especially poor women and children to equitable, affordable, accountable and effective primary health care.

The NRHM is an effort to strengthen the hands of States to carry out the required reforms. The Mission would also provide additional resources to the States to enable them to meet the diverse health needs of the citizens. While recognizing the leadership role of the states in this regard, it is proposed to provide necessary flexibility to the States to take care of the local needs and socio-cultural variations. In turn, States will decentralize planning and implementation arrangements to ensure that need based and community owned District Health Action Plans become the basis for interventions in the health sector. The States would be urged to take up innovative schemes to deal with local issues. Keeping in view the decentralization envisaged under the NRHM, the States would be required to devolve sufficient administrative / financial powers to the PRIs. At the same time, the States are also required to take action to increase their expenditure on health sector by at least 10% every year over the Mission period. The States would also be supported in their endeavour to build capacity for handling the complex health issues. The States would also be expected to adhere to mutually agreed milestones which would be reflected in a MOU to be signed with each State.

Maharashtra State - Administrative

Maharashtra is considered to be one of the better-developed states of India. However, in absolute terms there is still a large gap in health status of Maharashtra as compared to some other States. There are considerable variations across districts, necessitating setting up of district specific targets. Mission has provided the opportunity to address these issues. As per the order from Government of India, State Health Mission has been constituted under the chairmanship of the Hon Chief Minister vide Govt. Resolution dated 15th October 2005.

Thereafter, the Maharashtra state cabinet has approved the Memorandum of Understanding with the Central Government with some modifications and the MOU has been submitted to the Central Government on 16-1-2006.

Thereafter, the Maharashtra state cabinet has approved the Memorandum of Understanding with the Central Government with some modifications and the MOU has been submitted to the Central Government on 16-1-2006.

HEALTH INFRASTRUCTURE

The State Health Society has been constituted under the Chairmanship of the Chief Secretary; GOM as per the Govt. Resolution dated 24th October 2005. Guidelines have been issued to all concerned vide Government Circular dated 5-12-2005 and 22-12-2005 for constitution of the District Health Mission and District Health Societies. Accordingly, District Health Missions and District Health Societies have been constituted in all districts. All the vertical societies at state and district level have been merged into the State Health Society and District Health Societies respectively.

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