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8Th CRM Main Report.Pdf ISBN: 93-82655-14-X This report has been synthesised and published on behalf of the National Health Mission by its technical support institution; National Health Systems Resource Centre (NHSRC) located at NIHFW campus, Baba Gangnath Marg, New Delhi-110 067. We gratefully acknowledge the contributions made by consultants and officers in the NHM Division of the MoHFW. We also place on record our deep appreciation and gratitude to participants from other Ministries, Public Health Institutions, Civil Society and Development Partners who have all contributed to this Common Review Mission Report. ©2014 Ministry of Health and Family Welfare Government of India, Nirman Bhawan New Delhi-110 011 Reproduction of any excerpts from this documents does not require permission from the publisher so long it is verbatim, is meant for free distribution and the source is acknowledged. ISBN: 978-93-82655-14-5 Designed by: Macro Graphics Pvt. Ltd. www.macrographics.com Message Message I am happyThe to learnCommon from theReview report Mission of the Eighth(CRM) Commonis an important Review Missionreview (CRM)and monitoring that the inputsmechanism provided to by assess National the progressHealth Missionof NHM. (NHM) CRM toreports bring providehealth services insights closer on the to progresspeople hasmade resulted as well in steady as critical improvement gaps yet into the be statusplugged of health and emerging and access needs. to health These care reports services also evenreflect in the that remote people's parts expectations of the Country. from Though the Mission NHM hashave ledincreased. to an increase The Common in OPD, ReviewIPD andMission number findings of Institutional also provide Deliveries, an opportunity there is tomore the to States be done to adoptfor increasing appropriate both strategies — reach and quality of health care. This report of Eighth Common Review Mission has brought out and address critical gaps in governance. the improvement as well as gaps in service delivery. I note that flexible financing under the Mission hasAlong also fosteredwith the several progress innovations made on theacross infrastructure, the Country. service delivery, increased patient load and institutional deliveries, the findings of the Mission points to various 2. I read with satisfaction that availability of infrastructure and health human resources deficiencies that we all need to take note of and work upon. The recommendations in remote areas has increased substantially and areas that are difficult to reach are being from this review mission have emphasized the need for increased availability of human reached through mobile medical units. resources, enhancing quality of health care delivery, strengthening community support 3. and accountabilityIt is also interesting mechanisms to note andthat increased large number convergence of innovations with the are related taking departments. place across StatesI am to sure improve that Stateshealth willcare incorporate service delivery these and suggestions are thus helping into theirin improved State Implementation health status. Plans. 4. At this stage of NHM, we look forward to consolidating the efforts made so far and make primary healthOn behalf care aof reality the National for the people.Health Mission, The newer I convey challenges my thanks like Non-Communicable and appreciation to Diseasesall the and team rapid members urbanisation who travelled are the tonew 15 frontiers States and that prepared need to thisbe focusedreport thuson and offering dealt with.a learning experience for us all. The observations provided in this report will help us take the mission forward. I also thank all those who have worked tirelessly for the success of 5. This Annual Review of NHM has become a process of comprehensive assessment of the National Health Mission. our performance and a source of guidance for further improvement in future. I thank all the experts who were part of this exercise for their valuable inputs. I see this as an occasion to rededicate ourselves to the goals of NHM. (BP Sharma) New Delhi (Jagat Prakash Nadda) 28th October, 2015 Message The Common Review Mission (CRM) is an important review and monitoring mechanism to assess the progress of NHM. CRM reports provide insights on the progress made as well as critical gaps yet to be plugged and emerging needs. These reports also reflect that people's expectations from the Mission have increased. The Common Review Mission findings also provide an opportunity to the States to adopt appropriate strategies and address critical gaps in governance. Along with the progress made on the infrastructure, service delivery, increased patient load and institutional deliveries, the findings of the Mission points to various deficiencies that we all need to take note of and work upon. The recommendations from this review mission have emphasized the need for increased availability of human resources, enhancing quality of health care delivery, strengthening community support and accountability mechanisms and increased convergence with the related departments. I am sure that States will incorporate these suggestions into their State Implementation Plans. On behalf of the National Health Mission, I convey my thanks and appreciation to all the team members who travelled to 15 States and prepared this report thus offering a learning experience for us all. The observations provided in this report will help us take the mission forward. I also thank all those who have worked tirelessly for the success of the National Health Mission. (BP Sharma) New Delhi 28th October, 2015 MESSAGE The National Rural Health Mission, in its first phase laid the foundation for re-vitalization of primary health care in the nation. The second phase, named National Health Mission - which also included the Urban Health Mission, has seen a renewed commitment to strengthening of public health systems at all levels - from sub-centers to tertiary care facilities. The remarkable increase in utilization of public health care services reassures of the confidence that NHM has given to people across the nation. The Mission has made a major contribution in strengthening health-care infrastructure at all levels - from the sub-center to district hospital. The other major areas strengthened under NHM have been - community processes and participation to strengthen the demand side, making all health care services for pregnant women and newborns completely free of cost and a push towards governance reforms. I am happy to read from this report that there is a marked increase in number of out- patients, admissions, institutional deliveries and major surgeries across the country in public health institutions. There has also been considerable increase in the range and quality of services being provided. In particular, district hospitals and block level PHCs have been strengthened and are delivering a wide range of services. Cold chain gaps in immunization are more or less completely attended to and delivery of immunization services has been streamlined. I also note that the CRM has confirmed substantial increase in utilisation of emergency transport services as well as in-facility-based-care for the sick children. Mobile Medical Units are also deployed in most of the difficult-to-reach areas. However, I also note that there are many areas where the progress has been inadequate- especially in some of the States which face the greatest challenges. Now, we will need to focus attention on these areas - both in the form of providing additional support and monitoring. We also need to develop better and more inclusive strategy for building institutional capacity by leveraging partnerships with medical colleges, schools of public health and civil society. I wish to thank and assure all stakeholders and participants in this review process, that the Mission takes observations as well as recommendations of CRM very seriously and uses it to draw a meticulous schedule for monitoring follow up actions - particularly for those geographic and thematic areas, where support is most needed. I thank all the participants of the 8th CRM for their time and effort, and invite them to remain partners in the process of follow up and implementation of the recommendations. (CK Mishra) New Delhi 28th October, 2015 Contents Executive Summary 1 Mandate and Methodology of the 8th CRM 27 TOR 1-11 31 State Positives and Challenges 161 Abbreviations AGCA Advisory Group on Community Action DOTS Direct Observation Therapy - Short- AMTSL Active Management of Third Stage of course Labour DPM District Programme Manager ANC Ante-Natal Care DPMU District Programme Manager Unit ANM Auxiliary Nurse Midwife DTC District Training Centre ANMTC Auxiliary Nurse Midwife Training Centre DWCD Department Women & Child APHC Additional Primary Health Centre Development API Annual Parasite Index EDL Essential Drug List ARC ASHA Resource Centre EmONC Emergency Obstetric & Neonatal Care ART Anti retroviral Treatment EMRI Emergency Management and Research Institute ASHA Accredited Social Health Activist FMG Financial Management Group AWC Anganwadi Centre FP Family Planning AWW Anganwadi Worker FRU First Referral Unit AYUSH Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homeopathy GNM General Nursing Midwife BCC Behaviour Change Communication HMIS Health Management Information System BEmONC Basic Emergency Obstetric & Neonatal HMRI Health Management & Research Institute Care HR Human Resource BMO Block Medical Officer HRD Human Resource Development BMWM Bio-Medical Waste
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