Malhotra_MNH Financing II JSY India

8/2/2019 Malhotra_MNH Financing II JSY India

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New Initiatives for Maternal and Newborn

Health under NRHM in IndiaDr. Manisha Malhotra,

Asst. Commissioner, Maternal Health,

Ministry of Health and Family Welfare,

Govt. of India

Asia Regional Meeting, Dhaka, 3-6 May 2012


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Total Population: 1.22 Billion

Number of states, UTs: 35

Population of LargestState(UP)- 200 Million

Number of births per annum: 24Million


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National Rural Health Mission- Background

NRHM launched on 12th April 2005

To strengthen the hands of the State Governments

in health care delivery.

To allocate more financial resources for health

To bring sharper focus on rural, particularly

marginalized and vulnerable populations.

Architectural correction through integration ofvertical programmes, decentralization and

communitization.

3


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Overview of Goals

Indicator Goals MDG / NRHM Achievement

Maternal Mortality

Ratio

100 per 100,000 Live

births

Declined from 254 per 100,000 live births (2004-06) live

births to 212 per 100,000 live births (2007-09)

Infant Mortality

Rate30 per 1000 Live births

Reduced from 58 per 1000 (2005) live births to 47

per1000 live births (2010)

Decline in Rural IMR greater than decline in Urban IMR

Total Fertility Rate 2.1 Reduced from 3 (2003) to 2.5 (2010)

Reducing Disease Burden


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NATIONAL

RURAL

HEALTH

MISSION

RCH

Disease

Control

Immunisation

Adolescent

Health

Child

Health

Maternal

Health Family

Planning

Community

Mobilisation :

ASHAs

Health System

Strengthening

Capacity

BuildingInfrastructurestrengthening

Human

Resources

Flexible

financing

NRHM: Sector-wide approach


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6

NRHM - Main Approaches

More money

for health

More health

for money

Innovation In HumanResource Management

1.Additional HR

2.24X7 emergencies at PHC &

CHC3.Multi-skilling & task-shifting

Monitor Progress Against

Standards

1.IPHS Standards

2.Facility Surveys

3. Independent

Monitoring Committeesat all levels

Improved

Management

1.Management support

at State, District and

Block Level

2.NGOs in capacitybuilding

3.NHSRC and SHSRC

4.Continuous skill

development support

Communitize

1.Funds, functions &

functionaries to localcommunity

2.Decentralized planning

3.RKS at all levels

4.Grants to RKS and VHSC

5.Inter-sectoral convergence

Flexible Financing

1.Untied grants

2.Annual MaintenanceGrants

3.Infrastructure

Strengthening

4.More resources for

more reforms


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Under NRHM, focus on Poor Performing States and

Districts: Bring in technical & managerial resources to

states that lag behind

Uttar Pradesh

Bihar

Jharkhand

Chhattisgarh

Madhya Pradesh

Other N-E

states

Assam

Rajasthan

Technical Resources

ManagerialResources

7

Higher resource allocation to 264

backward districts with poor indicators.


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Increased release and expenditure of funds

under NRHMRs. In crores

4433.75

5774.3

8508.879625.09

11470.18

12871.11

3204.17

4518.68

7010.07

10565.1

13216.05

16116.24

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

Release Expenditure

8


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Financial Allocations for NRHM

15 billion USD allocated till now

4 billion USD in current year.

Likely to increase in 12th Five Year Plan.


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Innovations for retention of

Human Resources

10

Financial incentives: Haryana, HimachalPradesh, Karnataka, Chhattisgarh, Odisha,Sikkim and Rajasthan

Regulatory: Compulsory service, Pre-Post Grad.

mandatory rural services, Additional marks forrural residence for PG, - Assam, Haryana, TN.

Workforce Mgmt.: Rotational posting,Recruitment rules, extending retirement age:Karnataka , Maharashtra, Haryana.

Educational: Local Candidates, new courses,Assam, Chhattisgarh, West Bengal.


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Strengthening of Health Facilities

2329 Referral Hospitals have been strengthened to act as

First Referral Units with CEmONC capacity

which meansfunctional OT, laboratory and blood transfusion services,

8250 PHCs are currently functioning as 24x7 PHCs.

9824 Newborn care corners, 340 Special Newborn CareUnits, and 1210 Newborn Stabilization Units are

established under NRHM

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Infrastructure

20251 new constructions

have been sanctioned.

18883 renovations have

been sanctioned.

Significant reduction in

gaps at the level of DH

and CHCs

Increasing number of

states have Institutional

State level mechanismsfor infrastructure

12


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Mobile Medical Units (MMUs) and Emergency

Referral Transport

MMUs

1951 Mobile Medical Units

provided in 442 districts for

delivery of health care to difficult

areas

Emergency and Referral

Transport

7097 Emergency Response

Vehicles

7458 ambulances added for

providing referral transport

services 13


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Strengthening Community Processes Accredited Social Health Activist (ASHA) acts as

interface between community and Health System.

8.61 lakh ASHAs engaged at village level

Village Health Sanitation and Nutrition Committees

(VHSNCs) are constituted at Village/ Gram Panchayat

level with representation from all sections of the

community including the disadvantaged sections.

5.00 lakh VHSNCs constituted

Rogi Kalyan Samitis (Patient Welfare Societies) are

set up at various hospitals to encourage involvement

of the community in the management of Public

Health services. 30,420 RKSs constituted at the health

facilities

VHSNC and RKS empowered with Untied grants.

Community Monitoring programme being

encouraged

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Trends in Maternal Mortality Ratio

35%

38%

33%327

301

254

212

461

438

375

308

206

173

149

127

229

199

174

149

100

150

200

250

300

350

400

450

500

1999-2001 2001-03 2004-06 2007-09

India EAG & Assam States Southern States Other States

Two states: Kerala and

Tamil Nadu have achieved

the MMR goal, whileMaharashtra is close.

Four states are within

striking distance.

35%


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Situation of Child Health in India (SRS 2010)

U5M rate

IMR

Three large states (Kerala, Tamilnadu & Maharashtra ) and 9 others have achievedMDG 4.

IMR is 47 and varies but shows a differential of 51 in rural areas to 31 in urban

areas.

Under-five mortality rate is estimated at 59 and it varies from 66 in rural areas to

38 in urban areas.

Female infants experience a higher mortality than male infants in all States (47TOTAL 46 MALES 49 FEMALES


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3.23.1

3 32.9 2.9

2.8

2.7 2.6 2.62.5

0

0.5

1

1.5

2

2.5

3

3.5

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Trends in TFR: 2000-2010 (SRS)


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Service guarantees

in public healthfacilities

Comprehensive MCHcare, Thrust on neo

natal care

Training, Birthwaiting homes,

Dedicated 100 bedsMCH wing

Adolescent health,School health,

Operational plan forNutrition

Meeting the UnmetNeed for

contraception-postpartum services,

ASHA & NGOsinvolvement

Key thrust areas - RCH

Intensification

and expansion

of UIP

Strengthening

Capacities forImplementation

of PC & PNDT


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JANANI SHISHU SURAKSHA KARYAKRAM

Eliminating out-of-pocket expenses for families of pregnant women and sicknewborns in government health facilities:

Free and cashless delivery including free C-section: Free drugs including

consumables, free diagnostics, free diet, free blood and free referral transport(Home to health institution, between health institutions in case of referral, dropback home )

Reaching the unreached pregnant women (nearly 7.5 million a year who still deliverat home)

JANANI SURAKSHA YOJANA: Phenomenal increase in institutionaldelivery.

Beneficiaries increased from 0.739 million in 2005-06 to 10.8 million in 2010-11

Janani Suraksha Yojana


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Janani Suraksha YojanaA phenomenal increase

20

38258

880

1241

1474

1618324 m

US $

7.34

30.74

73.09

90.8

100.66

113.39

108

120

144 148

162168

0

20

40

60

80

100

120

140

160

180

0

200

400

600

800

1000

1200

1400

1600

1800

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

Expenditure for JSY (Rs.in Crores) JSY Beneficiaries in Lakhs

Institutional Deliveries (in lakhs)

Beneficiaries increased from 0.739 million in 2005-06 to 10.8 million in 2010-11


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The New Strategic Initiatives

Delivery Points to provide comprehensive RMNCHservices (High case load facilities fulfilling benchmarks

Adolescent Health: Strengthening of this pillar, a

weak area till now

Menstrual Hygiene, Weekly Iron and Folic acid

Supplementation (WIFS), School health programme

Home Based Newborn Care : Improving community

newborn care practices through involvement offrontline workers (ASHAs)

Strengthening Nursing and Midwifery Cadre with

focus on midwifery component


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The New Strategic Initiatives Contd

Enhanced focus on spacing methods Ensuring training and follow-up of trained personnel in

IUCD 380A

Introduction of new IUCD Cu IUCD 375

Ensuring Fixed Day service delivery for IUCD at SHC andPHC level

Ensuring focus on Post-partum FP services

Strengthening community based delivery of

contraceptives through ASHAs

233 pilot districts Line listing of severely anemic women

Web enabled MCTS


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Malhotra_MNH Financing II JSY India

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