The document provides an overview of the National Rural Health Mission (NRHM) and its components in India. Some key points: - NRHM was launched in 2005 to address deficiencies in rural healthcare and aims to provide accessible, affordable healthcare across the country. - Its main components include expanding primary healthcare centers, establishing ambulance services, mobile medical units, and initiatives for free drugs and diagnostics. - It works to reduce maternal and child mortality and improve access to services through community health workers like ASHAs and various committees.

1. NATIONAL RURAL HEALTH
MISSION AND ITS COMPONENTS
Presenter : Dr Soumya P
Final year PG Scholar
Department of Kayachikitsa

2. CONTENTS
• Introduction
• NHM
• NRHM
• Components of NRHM
• NUHM
• Components of NRHM
• Difference between NRHM and NUHM
• Future goals
• Conclusion
• References

3. NHM
• National Health Mission
• Ministry of health and family welfare
• NHM - approved in May 2013
• Sub missions – NRHM & NUHM
• It aims at improving and correcting the deficiencies in the health care delivery system with a focus
on integrating all thee available healthcare facilities like Ayush along with ongoing vertical
programme.
• Main programmatic components
- RMNCH+A
- control of NCDs & Comm. d/s

4. NRHM
• Launched in 5th April 2005 for 7 years by GOI
• Intended for 2005 - 2012
• Recently extended to 2017
• Operational in whole country & Special focus on 18 states
• Correct the deficiencies of health system
• The Mission adopts a synergistic approach by relating health to determinants of
good health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

5. WHY NRHM WAS LAUNCHED?
• Only 20% population coverage by govt sector , 80% by private sector
• Stat -Rural India – long standing healthcare problems
• Rural health problems/ mortality – preventable and easily treatable .
Characteristics Urban rural
Infant mortality rate 39% 62%
Government beds 68.1% 31.9%
Beds per 1000 population 1.1 beds 0.2 beds
Graduate doctor distribution 74% 28%

6. STATES FOCUSED UNDER NRHM
1.Arunachal
Pradesh
2.Assam
3.Bihar
4.Orissa
5.UP
6.MP
• 7.Rajasthan
• 8.Uttaranchal
• 9.Mizoram
• 10.Manipur
• 11.Meghalaya
• 12.Chattisgar
h
13.Tripura
•14.Nagalan
d
•15.Gujarat
•16.J & K
•17.HP
•18.Sikkim

7. OBJECTIVES OF THE MISSION
• Reduction in child and maternal mortality.
• Universal access to public health services.
• Prevention and control of communicable and noncommunicable diseases, endemic
diseases
• Stabilization and demographic balance.
• Revitalizeimunisation programme
• Access to integrated phc.
• Revitalize local local health tradition.(Ayush)
• Promotion of healthy life style

8. COMPONENTS UNDER NRHM
• Comprehensive Primary Health Care (CPHC) through Ayushman Bharat Health
and Wellness Centers (HWCs)
• National Ambulance Services (NAS)
• National Mobile Medical Units (NMMUs)
• Free Drugs Service Initiative
• Free Diagnostics Service Initiative
• Community Participation
a)Accredited Social Health Workers (ASHA)
b)Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management
Society
c)VHSNCs

9. CONT..
• Mera Aspataal
• Kayakalp
• SUMAN (Surakshit Matritva Aashwasan)
• Mission Indradhanush
• TB Harega Desh Jeetega Campaign
• Eat Right India Movement, with ‘Sahi Bhojan Behtar Jeevan’

10. AYUSHMAN BHARAT HEALTH AND
WELLNESS CENTERS (HWCS)
• Ayushman Bharath is an attempt to move from a selectiv approach to health care to
deliver range of services like preventive,promotive,curative,rehabilitative,and
palliative care
• It has 2 components
1) Health and wellness centre(HWCs) 1,50,000
2)Pradhan mantri jan Arogya yojan (PM-JAY)
• Health insurance cover 5 lakh / year – 10 crore poor ppl
•

11. HEALTH AND WELLNESS CENTRE (HWC)
• The first Health and Wellness Centre was inaugurated by Hon’ble Prime Minister on
14th April 2018 in Bijapur district of Chhattisgarh.
• So far, 51,484 HWC are formed
Objectives:
• upgrading the Sub Health Centers (SHCs) and Primary Health Centers (PHCs) in
rural and urban area
• provide Comprehensive Primary Health Care
• common NCDs such as Hypertension, Diabetes and 3 common cancers of Oral, Breast
and Cervix.
• primary healthcare services for Mental health, ENT, Ophthalmology, Oral health,
Geriatric and Palliative health care and Trauma care as well as Health promotion and
wellness activities like Yoga.

12. AYUSH INTERVENTION
• Upgrading existing Ayush dispensaries and sub health centers .
• Sub health centers headed by Ayush doctors
• 10% of total HWC are for Ayush HWC
• Total of 12,500 Ayush HWC
• Objective – “self care”
• Focus on preventive and promotive interventions
• Services- outreach opd, health mela,home visits, school and anganavadi visits.
• Include Ayush wellness package-
1) self care
2) common ailments
3) medicinal palnts and home remedies
4) prakriti assessment
5) yoga classes

13. HEALTH CALENDAR
S.
No.
Month and Date Day
1. 12th January National Youth Day
2. 31st January Anti-Leprosy Day
3. 4th February World Cancer Day
4. 11th February International Epilepsy Day
5. 8th March International Women’s Day
6. 24th March World Tuberculosis Day
7. 7th April World Health Day
8. 14th April Ayushman Bharat-Health and Wellness
Centre Day
9. 12th May International Nurses Day
10. 31st May Anti-Tobacco Day
11. 14th June World Blood Donor Day
12. 21st June International YOGA Day
13. 1st July Doctors Day
14. 11th July World Population Day
15. 01-07
August
World Breast Feeding Day/
Week
16. 15th August Independence Day
17. 01-07 Sept. National Nutrition Week
18. 29th Sept. World Heart Day
19. 1st October World Elderly Day
20. 11th October World Mental Health Day
21. 10th Nov. World Immunization Day
22. 14th Nov. Children’s Day
23. 1st December World AIDS Day
24. 20th Dec. Food Safety Day

14. NATIONAL AMBULANCE SERVICE
• It is a patient transport service launched by NHM
• Now 35 states/UTs has the service
• Dial 108/102
Dial 108- Emergency response system( critical care , trauma , accident victims)
Dial 102 – basic patient transport
- cater needs of pregnant women and children
• 10599 – under 108
• 9875 – under 102
• Other vehicles to transport pregnant women and children- Janani express, mamta
vahan,kushiyo ki sawaari etcx…

15. NMMU
• To increase visibility, awareness and accountability, all Mobile Medical Units have been
positioned as “National Mobile Medical Unit Service” with universal colour and design.
• 426 districts are provided with service
• providing Primary Health Care Services at the door step of communities living in
difficult to reach, hilly areas which were unserved or underserved
• Each MMU was covering 8-12 villages on fixed days and had service points in the said
villages.

16. OBJECTIVES:
• 1 To provide quality Primary Health Care and selected Secondary Care Services, including referral services as per
objectives of NRHM and GOK.
• 2 To contribute to the achievement of improvements in CBR, CDR, IMR, MMR and TFR and other health goals in the
area by reducing the Infant and Maternal Mortality and communicable diseases like malaria, T.B, AIDS, pneumonia,
diarrhea and dysentery.
• 3 To provide essential health care services for chronic illness such as such as Diabetes Mellitus, Hypertension, Epilepsy,
Chronic Bronchitis, Chronic Bronchial Asthma, Chronic Arthritis, Acid Peptic Disease (Gastritis) etc.
• 4 To provide minimum Laboratory Investigation such as Urine for Albumin & Sugar, Pregnancy test, Blood Sugar level
estimation, Hemoglobin estimation etc.
• 5 To create awareness regarding communicable and non-communicable diseases and their prevention through IEC
activities.
• 6 To Provide Family Planning Services, mainly Spacing Methods

17. SERVICES PROVIDED BY MMU:
1. Curative Services for common illnesses and chronic
illness.
2. First Aid.
3. Referral Services.
4. Family Planning Services.
5. Antenatal and Postnatal Care Services.
6. Immunization services.
7. Counselling on all matters, in particular HIV/AIDS.
8. Implementation of National Health Programs.
9. Health Education Activities and Environmental
Sanitation.
• 10. Minimum routine laboratory investigations.
• 11. Management of Bio Medical Waste (collection,
storage and disposal).
• 12. Extensive health related IEC activities and
other services.
• 13. Samples collection for special investigation
like sputum examination for AFB, Blood smear
for Malaria Parasite & Elisa test, etc.
• 14. Screening and regular follow up treatment of
all chronic illnesses like diabetes mellitus,
hypertension, chronic respiratory diseases,
epilepsy, chronic arthritis and acid peptic
diseases and others, free of cost.

18. FREE DRUG DELIVERY SYSTEM
• It is an Free Drugs Service Initiative by NHM .
• Launched on 2nd July, 2015.
• substantial funding is being given to States for provision of free drugs and setting up of
systems for drug procurement, quality assurance, IT based supply chain management
system, training and grievance redressal etc.
• Drugs procurement, quality system and distribution has been streamlined through IT
based Drug Distribution Management Systems in 29 States,

19. FREE DIAGNOSTICS SERVICE INITIATIVE:
• The NHM- Free Diagnostics Service Initiative was launched in 2013 to provide free essential
diagnostic services at public health facilities
• This initiative was launched to address the high out of pocket expenditure on diagnostics
and improve quality of healthcare services.
• Objectives:
 Strengthening of the existing systems in public health facilities such as Lab infrastructure,
provision of Lab Technician, equipment, etc.;
 Out Sourcing of High Cost -low frequency diagnostic services and
 Contracting in of services of essential Human Resources (e.g. Radiologist, Lab Technician) on a
need basis.
 7 to 14 tests at Sub Centre/ Health & Wellness Centre level
 19 tests to 63 tests at PHC level,
 39 tests to 97 tests at CHC level and
 56 tests to 134 tests at District Hospital level.
 The tests encompass hematology, serology, bio-chemistry, clinical pathology, microbiology,
radiology, and cardiology

20. ASHA(ACCREDITED SOCIAL HEALTH
WORKERS)
• 10.42 lakh ASHAs across the country - rural / urban
• Health activist in the community
• Resident of the village, a woman (M/W/D) between 25-45 years, with formal education upto 8th
class, having communication skills and leadership qualities.
• One ASHA per 1000 population.
• Trained for period of 23 days(induction) over one year and periodic re-training.
• Chosen by the panchayat to act as thee interface between the community and the public health
system.
- Bridge between the ANM and thee village.
- Honorary volunteer, receiving performance based compensation.

21. RESPONSIBILITIES OF ASHA
• To create awareness among the community regarding nutrition, basic sanitation, hygienic
practices, healthy living.
• Counsel women on birth preparedness, imp of safe delivery, breast feeding, complementary
feeding, immunization, contraception, STDs
• counsel women and escort them to PHC/CHC & providing medical care for minor ailments
• Encourage thee community to get involved in health related services.
• Drug depot: depot holder like ORS, iron and folic acid, oral pills, condoms etc..
• Primary medical care for minor ailment
• Provider of DOTS.

22. INTEGRATION OF AYUSH WITH ASHA
• Training module for ASHA and ANMs have to be updated
• Training & capacity building to be undertaken
• Drug kit that will be provided to ASHA will contain one AYUSH preparation
• Deliver Ayush Pushti biscuits to Anganavadi
• IEC material for certain diseases by Ayush .
• Home remedies material for minor ailments.

23. ROGI KALYAN SAMITI (PATIENT WELFARE
COMMITTEE) / HOSPITAL MANAGEMENT
SOCIETY
• It is a simple yet effective management structure. This committee is a registered
society that acts as a group of trustees for the hospitals to manage the affairs of the
hospital. 33,378 Rogi Kalyan Samitis (RKS) have been set up involving the
community members in almost all District Hospitals, Sub- divisional Hospitals,
Community Health Centers and PHCs till date.
• It consists of members from local Panchayati Raj Institutions (PRIs), NGOs, local
elected representatives and officials from Government sector who are responsible for
proper functioning and management of the hospital / Community Health Centre /
FRUs.

24. VHSNCS
• 5.49 lakh Village Health Sanitation and Nutrition Committees (VHSNCs) have been
constituted at village level across the country to facilitate village level healthcare
planning.
• 11.19 crore Village Health & Nutrition Days (VHNDs) were held so far during the
Mission period.
• It is a platform for improving health awareness and access of community for health
services, address specific local needs and serve as a mechanism for community based
planning and monitoring.
• nutritional deficiencies
• early detection of malnourished children in the community;
• grievances redressal forum on health and nutrition issues.

25. Monthly
meetings
Accounting
village fund
Management of
funds
Record
maintanenece
Acess to
essential public
services
Health
promotion
Service delivery
in village
Monitoring
health care
facilities
Village health
planning

26. AYUSH INTERVENTIONS
Ongoing
• One Ayush doctors at phc
• 24/7 PHC
• Screening of anaemia/ nutritional
status
Scope
• Ayush camps on nutrition and health
• Healthy eating campaigns

27. MERAASPATAAL:
• This initiative launched in September 2016 with a mandate to integrate with Central Government
Hospitals and District Hospitals is currently functioning in 17 States and 5 UTs. In 2018-19, 1698
facilities were integrated into Mera Aspataal.
• Inititative to capture patient feedback for the services received from public.
• It works through
- SMS
- OBD ( outbound dialing )
- mobile application and web portal
• Analysed data il be used to improve quality of services in healthcare facilities.
•

28. KAYAKALP
• an initiative for Award to Public Health facilities.
• Kayakalp initiative has been launched to promote cleanliness,hygiene and infection control practices
in public health facilities.
• Action :
- PHC meeting standards of protocols of cleanliness, hygiene and infection control will receive
awards and commendation
• As part of contribution towards the Swachh Bharat Abhiyaan launched by the Prime Minister on
2nd October 2014, the Ministry launched “Kayakalp - Award to Public Health Facilities. As on 1st
Oct 2019, 9 Central Government, 395 DHs, 1,140, CHCs/SDHs, 2,723 PHCs, 556 UPHCs,6 Urban
Community Health Centers (UCHCs) have scored more thean 70%. 4829 facilities have been
awarded under this scheme in FY 2018-19.

29. SUMAN
• Union government has launched surakshith matritva aashvasan (SUMAN) to provide
quality heathcare at zero cost to pregnant women , new mothers and newborn.
• Launched on October 10 ,2019.
• Aims :
-to provide dignified and quality health care at no cost to every woman and newborn visiting to
public health facility.
- upto 6 months, free health services - 4 antenatal check ups , 6 homebased newborn care visit.
- Zero expense delivery and c-section facility .
- Transport of pregnant women .
• Significance :
-bring down maternal and infant mortality rate .
- provide stress free birth experience .

30. MISSION INDRADHANUSH
• It is a health mission of govt of india to boost rotine immunization coverage.
• Launched on 25 December 2014.
• Aims too drive 90% of full immunisation coverage .
• Vaccination against –diptheria, whoophing cough,tetanus, polio,measles,childhood
tb , hepatitis b ,meningitis,pneumonia, influenza , rotavirus, Japanese encephalitis.
• Goals:
• Full available vaccination upto 2 years of age foe children
• At 201 high focus districts acroos country.

31. SAHI BHOJAN BEHETAR JEEVAN
(EAT RIGHT INDIA MOVEEMNT)
• It is a programme launched by union health ministry under food safety standards
authority of india (FSSAI).
• It is the new healthy eating approach which places citizens at the centre of health
revolution through food and fitness.
• It is aligned with …
• Actions:
• Eat right quiz
• Eat right camps
• School camps

32. NUHM
• National urban health mission
• To improve health status of urban population particularly slum dwellers vulnerable
section.
• Launched National Health Mission (NHM) on 1 st May, 2013 .

33. COVERAGE
• All cities with >50,000 population.
• All the district and state headquarters (irrespective of the population size).
• Urban areas with < 50,000 population to be covered by NRHM.
• So far to ensure that there is no duplication of services.
• Seven mega cities ( Mumbai, New Delhi, Chennai, Hyderabad, Kolkatta, Bengaluru & Ahmedabad)
will be treated differently their municipal corporations will implement NUHM.
• In other cities, District Health Societies will be responsible for NUHM implementation.
• Flexibility- given to states
• In the 12th Plan period NUHM and NRHM will be separate programmes……

34. HIGH FOCUS ON :
• Urban Poor Population living in listed and unlisted slums
• All other vulnerable population such as
• Homeless,
• Rag-pickers
• Street children
• Rickshaw pullers
• Construction and brick and lime kiln workers
• Sex workers
• Other temporary migrants

35. OBJECTIVES:
• Public health thrust on sanitation, clean drinking water, vector control, etc.
• Strengthening public health capacity of urban ocal bodies.

36. RAJIV AWAS YOJANA ( SLUM FREE INDIA )
•it was launched in June 2011
• this initiative aims at providing hosing facilities to slum dwellers through a new scheme.
Implementation :
• Preparation of slum free city plan
• Preparation of project for selected slum.
• This will also be useful for development of city health plans.
Housing , basic civic infrastructure in slums
Community halls
Childcare centres
Rental housing

37. SWARN-JAYANTI SHEHRI ROJGAR YOJNA
• government have introduced an effective self employment programme SGSY.
• Launched on April 1, 1999
• It aims at poor families living below poverty line in rural areas for taking up self employment.
• They make take up the activity either individually or in groups called self help groups.
• Goal :
1) Anti poverty programme, empowerment
2) Self employment , income generation
Role of scheme :
 Identification of poor
 Training
 Infrastructural support
 Marketing support
 Engaging youths

38. DIFFERENCE BETWEEN NRHM AND NUHM
NRHM NUHM
National rural health mission National urban health mission
Improves rural health
delivery system
Separate mission for urban
areas and focus on slums &
other urban poor families.
Launched on 12 the April, 2005 Approved on 1st May 2013
Creation of ASHA (Accredited
Social Health Activist)
Creation of USHA (Urban
Social Health Activist)
1 Asha = 1000 population 1 Usha = 1000- 2500 population
JSY, RKS, RSBY NRY, MAS , UPSB , SJSRY

39. AREAS OF PRIORITY :
1. Education –standards upgradation
2. Drug standardization
3. Setting up of vanaspati van (Herbarium)
4. Expansion Ayush treatment facility
5. Research & development
6. Intellectual property Rights

40. CONCLUSION
• The grossly deficient health workforces in rural India are hugely replenished by AYUSH
doctors and paramedics.
• • Many of the therapeutics are being used in different forms for the management of
community health problems which are safe and effective.
• Future of integrated medicine- Bright and promising.
• effective implementation of mainstreaming of AYUSH and revitalization of local health
tradition in a more homogenous manner throughout the nation.
• universal recruitment policy, provision of drugs and necessary equipments and
infrastructural correction.
• Ayush has a great role in rural health and is successful in combating health care
facilities.
• Nationalisation of aysuh work forces is in need of hour.

41. REFERENCES
• AYUSH official website http://india.gov.in & http://mohfw.nic.in
• National health mission official website nhm.gov.in
• Ayushman Bharath official website ab-hwc.nhp.gov.in