Funds Allocation for Strengthening Health Care System Under National Health Mission

Public Health is a State subject. Under the National Health Mission (NHM) which encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) as its two sub-missions, support is provided to States/UTs for strengthening their health care systems based on requirements posed by the States/UTs in their Programme Implementation Plans (PIPs).Approvals against the PIPs received have been provided to all States/UTs based on appraisal and resource availability. AStatement showing State wise Allocation under NHM in 2014-15 is given below:-

Statement Showing State wise Allocation(B.E.) under NHM for 2014-15
Rs. in crore
Sl. No.	States		Allocation
1	Andaman & Nicobar Islands		28.29
2	Andhra Pradesh		712.94
3	Arunachal Pradesh		184.09
4	Assam		1086.52
5	Bihar		1300.32
6	Chandigarh		19.48
7	Chhattisgarh		559.01
8	Dadra & Nagar Haveli		14.04
9	Daman & Diu		9.72
10	Delhi		193.60
11	Goa		27.73
12	Gujarat		863.19
13	Haryana		319.29
14	Himachal Pradesh		233.45
15	Jammu & Kashmir		438.23
16	Jharkhand		567.23
17	Karnataka		838.78
18	Kerala		375.60
19	Lakshadweep		5.89
20	Madhya Pradesh		1258.27
21	Maharashtra		1545.73
22	Manipur		143.99
23	Meghalaya		159.19
24	Mizoram		116.00
25	Nagaland		130.54
26	Orissa		734.49
27	Puducherry		25.54
28	Punjab		353.87
29	Rajasthan		1246.07
30	Sikkim		51.17
31	Tamil Nadu		973.38
32	Tripura		160.68
33	Uttar Pradesh		2666.81
34	Uttarakhand		310.05
35	West Bengal		1059.29
36	Telangana		507.49
Sub  Total		19219.96
Others		1211.51
Total		20431.47

The key goals of the National Rural Health Mission (NRHM) at the time of its launch and achievements are as below:

Key Goals	Achievements
Reduce Infant Mortality Rate (IMR) to 30/1000 live births by 2012	The IMR for the country  is 42/1000 live births as per SRS 2012
Reduce Maternal Mortality Ratio (MMR) to 100/100000 live births by 2012	The MMR for the country is 178/100000 live births as per SRS 2010-2012
Reduce TFR to 2.1 by 2012	The TFR for the country is   2.4 as per SRS 2012
Bring down Malaria Mortality Rate by 50% upto 2010 and additional 10% by 2012	The achievement is 46%.
Tuberculosis - maintain 85% cure rate through the entire Mission period and also sustain planned detection rate	The treatment success rate which is a sum of Cured and Treatment completed is 88%.
Engage 4,00,000 female Accredited Social Health Activist (ASHAs)	8.66  lakhs ASHAs were  engaged as on 31 March,2012

Although goal of IMR, MMR and TFR were not achieved, the Infant Mortality Rate (IMR), Maternal Mortality Ratio (MMR) and Total Fertility Rate (TFR) have shown accelerated decline post launch of NRHM. The percentage annual compound rate of decline in IMR during 2005-2013 rose to 4.5% from 2.1% observed during 1990-2005. The percentage annual compound rate of decline in MMR during 2005 to 2011 accelerated to 5.8% from 5.1% observed during 1990 to 2005. The percentage annual compound rate of decline in TFR during 2005-2012 has risen to 2.7% from 1.8% observed during 1990-2005. The achievements on many key indicators have not been as per the goals mainly on account of inadequate funding and governance challenges in certain States.

As far as NUHM is concerned, the implementation of the activities has started only from the last quarter of 2013 -14.

The implementation of NRHM is reviewed through external surveys such as National Family Health Survey(NFHS), District Level Household Survey (DLHS), Annual Health Survey (AHS) and Sample Registration System (SRS). NFHS-4 Survey is presently ongoing. Institute of Economic Growth conducted an evaluation of NRHM on behalf of the Planning Commission. Further, Common Review Missions (CRMs) also undertake a review of NRHM/NHM every year. The information is available in public domain as under:

DLHS 4: https://nrhm-mis.nic.in/SitePages/DLHS-4.aspx

AHS:http://www.censusindia.gov.in/vital_statistics/AHS

SRS:http://www.censusindia.gov.in/vital_statistics/SRS_Report_2012/1_Contents_2012.pdf

Evaluation of NRHM: Institute of Economic Growth:http://planningcommission.nic.in/report/peoreport/peoevalu/peo 2807.pdf

CRM reports: http://nrhm.gov.in/monitoring/common-review-mission/7th-common-review-mission.html

A summary of observations of the Common Review Missions and the external evaluation by the Institute of Economic growth is given below:-

1)     The various Common Review Mission highlighted implementation progress and lacuna for specific states.   CRMs being participatory, multi stakeholder analysis, allowed for all components to be reviewed in depth monitoring and recommendations were used for district and state planning.   The common observations pertain to Health Human Resource shortages, particularly of specialists, issues of procurement, slow progress on SNCU and facility based new-born care, out of pocket expenditures (although these declined form 2005 levels), Limited progress on PPP, VHSNC and RKS, lack of attention to areas such as family planning, and adolescent health etc.   

2)     The Planning Commission commissioned an external evaluation through the IEG in 2010-2011 in 37 districts seven states of India- five high focus states and two non-high focus states.   The study reported that considerable progress was made on the infrastructure front in all states except Jharkhand. The study also reported limited progress on filling HR gaps especially specialists.   Regarding Medical Officers, many states were still short of targets.  In most high focus states ANM/GNM schools began functioning around 05-06, and it appears that the position has improved around FY 12-13.  The findings for ASHA showed that high levels of coordination were reported with ANM and AWW and less so with PRI members.   The report also observes that there is less movement of VHSNC and local planning.  Overall ASHAs were found to be functional in their roles as facilitator.  The study reported poor progress on operationalization of First Referral Units (FRUs) and that RogiKalyanSamitis (RKS) were established in most states except J&K.  States appear to be on track with regard to at least establishing the platforms for decentralized management at the district levels, although integration of bank accounts appears to be incomplete.

The CRM teams consist of public health experts, civil society representatives, development partners, besides Officials from Health and other related Ministries. Regular interactions are held with State Government Officials for seeking their inputs.

The Health Minister, Shri J P Nadda stated this in a written reply in the LokSabha here today.

 Courtesy: pib.nic.in