National health mission

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The National Rural Health Mission will be converted into a National Health Mission (NHM) which would cover all villages and towns in the country. While the focus on covering rural areas and rural population will continue, a major component will be to provide Primary Health Care to the urban poor, particularly to those residing in slums.

NHM would give the states greater flexibility to make multi-year plans for strengthening of their health systems.

The roles and responsibilities of the Centre and States in the health sector would be made operational through instruments such as state specific and Sector-wide Memoranda of Understanding (MoU).

The MoU mechanism would allow a lot of flexibility to the states to develop their own strategies and plans for delivery of services, while committing the states to quantitative, verifiable and mutually agreed upon outputs and outcomes. The targets in the MoU would be finalised through a consultative process so that there is a consensus. The MoU will cover the entire health sector, be subject to rigorous monitoring, and linked to a performance based appraisal and incentive system.

  The MoU would include important policy reforms, which may not necessarily have budgetary implications such as regulation, HR policies, inter-sectoral convergence, use of generic medicines. The MoU can have a set of obligatory parameters, state specific optional parameters and reform parameters.

For objective evaluation, in addition to the Common Review Mission, a methodology of external concurrent evaluation would be finalised and put in place to assess the progress in MoU goals. All major programme components would be evaluated as part of operational research and programme evaluation.

Core Principles

Universal Coverage: The NHM shall cover the entire country, both in urban and rural areas and promote universal access to a continuum of cashless, health services from primary to tertiary care.

To meet the needs of indoor care, the objective would be to achieve a minimum norm of 500 beds per 10 lakh population in an average district. ApproxĂ­mately 300 beds could be at the level of District Hospitals and the remaining distributed judiciously at the CHC level. Where needed, private sector services also may be contracted in to supplement the services provided by the public sector.

States would be encouraged to put in place systems for Emergency Medical Referral to bridge the gaps in access to health facilities and need for transport in the event of an emergency. Standards for these services will specify the time taken to transport patients from the location to designated health facilities. For ensuring access to health care among under-served populations the existing Mobile Medical units would be expanded to have a presence in each CHC. Mobile Medical Units may also be dedicated to certain areas, which have moving populations.

Achieving Quality Standards: The IPHS standards will be revised to incorporate standards of care and service to be offered at each level of health care facility. Standards would include the complete range of conditions, covering emergency, RCH, prevention and management of Communicable and Non-Communicable diseases incorporating essential medicines, and Essential and Emergency Surgical Care. All government and publicly financed private health care facilities would be expected to achieve and maintain these standards. An in-house quality management system will be built into the design of each facility, which will regularly achievements. Facilities will be provided with an incentive, which they measure its quality can share with their teams to achieve and improve their quality rating. The service and quality standards shall be defined made consistent with requirements under the Clinical Establishments Act, and performance of each registered facility made public, and periodically ranked. The work of quality monitoring will be suitably institutionalised.

Continuum of Care: There will be networking of health facilities from sub-centre level to PHC, CHC, district and medical college level for management of conditions at appropriate levels Decentralised Planning: A key element of the new NHM is that it would provide considerable flexibility to states and districts to plan for health services. New health facilities would not be set rigid, population based norm, but would aim to be accessible to populations in remote given time. As for staffing, the healthcare facilities should have a basic up on a locations and within a staff, with provisions for additional staff in response to an increase in case load, or the range of services provided. Indian Public Health Standards (IPHS) would be revised accordingly. Individual states would be allowed to choose from a range of staffing options.

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