thCOMMON REVIEW 6 MISSION REPORT 2 0 1 2 This report has been synthesised and published on behalf of the National Rural 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 NRHM 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, they are : Ð Christian Medical Association of India, CMAI, New Delhi Ð Department of Community Medicine, MSR Medical College Ð Department for International Development (DFID) UK, New Delhi Ð Delhites’ National Initiative in Palliative Care (DNip Care), Delhi Ð Health Sector Technical Support Team, Bill and Melinda Gates Foundation (BMGF), New Delhi Ð Health Sector Technical Support Team, Delegation of the European Union to India, New Delhi Ð Health Sector Technical Support Team, United States Agency for International Development (USAID), New Delhi Ð Health Sector Technical Support Team, World Bank, New Delhi Ð Institute for Public Health (IPH), Bengaluru, Karnataka Ð Karuna Trust, Karnataka Ð Micronutrient Initiative, Gandhi Nagar, Gujrat Ð Ministry of Health and Family Welfare, Government of India, New Delhi • Child Health Division • Department of AYUSH • Department of Health & Family Welfare • FMG/NRHM • Immunization Division • Maternal Health Division • National Vector Borne Disease Control Program (NVBDCP) Division • RCH Division • Training Division Ð National Health Systems Resource Center (NHSRC), Delhi Ð National Institute of Health and Family Welfare (NIHFW), New Delhi Ð National Institute of Public Cooperation and Child Development (NIPCCD), Regional Centre Guwahati, Assam Ð Norway India Partnership Initiative (NIPI) UNOPS, New Delhi Ð Planning Commission, Government of India, New Delhi Ð Plan India, Delhi Ð Population Foundation of India (PFI), New Delhi Ð Prayas, Rajasthan Ð Public Health Foundation of India (PHFI), New Delhi Ð SAATHI, Tamil Nadu Ð Technical and Management Support Agency (TMSA), New Delhi Ð United Nation’s Child Emergency Fund (UNICEF), India Ð United Nation’s Fund for Population Activities (UNFPA), Delhi Ð Women and Child Development Department, Ministry of Women & Child Development, Government of India, New Delhi 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 978-81-908725-9-1 Cover Photo: An old family member is be taken to health centre in Churachandpur, Manipur, facilitated by an ASHA. Designed & Printed by: Royal Press # +91 93101 32888 www. royal-press.com LokLF; ,oa ifjokj dY;k.k ea=h Hkkjr ljdkj fuekZ.k Hkou] ubZ fnYyh & 110108 Minister for Health & Family Welfare xqyke uch vktkn+ Government of India Nirman Bhavan, New Delhi - 110108 GHULAM NABI AZAD Message I am happy to learn that efforts put in by NRHM for bringing health closer to people and enhancement of services has led to steady improvements in the health status and health service delivery in the country. This report of Sixth Common Review Mission has brought out both the improvement and the gaps in service delivery. I note that flexible financing under the Mission has also fostered several innovations across the country. I read with some satisfaction that availability of infrastructure and health human resources in the remote areas has increased substantially and the areas that are difficult to reach are being reached through mobile medical units. In the second phase of NHRM we look forward to consolidating the efforts made so far and make universal primary health care a reality for the people. JSSK has shown us the way in expanding free services by providing free delivery and newborn care including drugs, diagnostics and transport. Our focus is going to be on strengthening and expanding accessibility of free public health care services for both communicable and non- communicable diseases and for emergency and trauma care. States should take note of the observations and recommendations of this report and I am sure that this will further the improvement process. This annual review process has become an assessment of our performance and a source of guidance for future. I thank all the experts who were part of this exercise for their valuable inputs. P.K. PRADHAN Hkkjr ljdkj Secretary LokLF; ,oa ifjokj dY;k.k ea=ky; Department of Health & FW Tel. : 23061863, Fax : 23061252 fuekZ.k Hkou] ubZ fnYyh & 110108 e-mail : [email protected] GOVERNMENT OF INDIA MINISTRY OF HEALTH & FAMILY WELFARE NIRMAN BHAVAN, NEW DELHI - 110108 Message This year is an important milestone for the National Rural Health Mission- this being the first year of 12th Five Year Plan. Expectations from the Mission have greatly increased. The 12th Plan promises a three fold hike in allocation for health as compared to the 11th Plan. Further, the National Urban Health Mission (NUHM) is also proposed to be launched with focus on addressing primary health care needs of urban poor. Thus, The 12th Plan period period provides a great opportunity to the States to accelerate progress towards improving health outcomes and quality health care for entire population by adopting appropriate strategies and addressing critical gaps in governance using the Common Review Mission (CRM) findings. The Common Review Missions have served as an important mechanism for monitoring the progress of the programmes and in taking timely corrective actions. The findings of the Mission point to various shortcomings that we take note of. The recommendations from this review mission have emphasized the need for increased availability of drugs and diagnostics, planned development of infrastructure, HR policy reforms, skill development of available 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 State Implementation. Plans for the coming year. On behalf of the National Rural 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 in the context of the Twelfth Five Year Plan. I would also thank all those who have worked tirelessly for the success of the National Rural Health Mission. 28/12/2012 (P.K. Pradhan) National Rural Health Mission Hkkjr ljdkj LokLF; ,oa ifjokj dY;k.k ea=ky; fuekZ.k Hkou] ubZ fnYyh & 110108 Government of India Anuradha Gupta, IAS Ministry of Health & Family Welfare Additional Secretary & Nirman Bhavan, New Delhi - 110108 Mission Director, NRHM Tel. : 23062157 E-mail : [email protected] Message The Rural Health Mission in its first phase has laid the foundation for re-vitalisation of primary health care in the nation. The last seven years have seen a renewed commitment to strengthen public health systems at all levels - from the sub center to the tertiary care facility. Not all of this is directly under the Mission. The remarkable increase in nursing, paramedical and medical institutions in the public sector and even the private sector in the last seven years is not a direct objective of the Mission. However the Mission’s policy articulations and its readiness to match this by investing in strengthening public health facilities and building partnerships with the private sector has created a conducive environment that has contributed to this increase. The additions of over a lakh to the public health workforce, reversing a trend where almost no additions had taken place over the previous year had been fundamental to such a change. Similarly the Mission has made a major contribution to strengthening health care infrastructure at all levels - from the sub-center to district hospital. Other major areas have been an emphasis on community processes to strengthen the demand side, making all health care services for pregnant women and newborns completely free of costs, and a push towards governance reforms. I am happy to read from this report that there is a marked increase in the out–patients, admissions, institutional delivery and major surgeries across the country in the public health institutions. There has been also 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 Mission has confirmed to dramatic increase in emergency transport services and in facility based care for the sick child. However, I also note that there are many areas where the progress has been unacceptably inadequate- especially in some of the states which face the greatest challenges. It is clear that we will need to pay much greater central attention – both in the from of monitoring and support to these areas of poor progress. We also need to develop a much better and inclusive strategy for capacity building where we leverage partnerships with medical colleges and schools of public health and health NGOs for achieving the institutional capacity that is required at state and district levels. I wish to assure all stakeholders and participants in this process, that the Mission takes the follow up to the CRM very seriously and rigorously. The state specific reports are shared with each state, and it is expected that states provide a response and a follow up action commitment. Based on this the national leadership for the Mission also draws up a schedule to monitor such follow up action – and more important direct support to those areas - geographic and thematic – where support is most needed.