PHRN seeks to identify like-minded, motivated individuals and organisations through existing state level resource support agencies, NGO networks and state health societies, and reach out to them in order to accelerate and consolidate the potential gains from the NRHM that can truly change the health scenario of disadvantaged people. PHRN has been active since 2005 in the states of Chhattisgarh, Jharkhand, Bihar, and Orissa. It has also supported similar action in many other states, such as Rajasthan, Haryana, Uttarakhand and the North Eastern states. PHRN has refined its objectives and strategies in accordance with its experience as well as circumstances of its work.
National Rural Health Mission (NRHM) [Click to read]
The National Rural Health Mission (NRHM) was announced in April 2005 as a part of the Common Minimum Programme of the Government of India with the stated goal “to promote equity, efficiency, quality and accountability of public health services through community driven approaches, decentralisation and improving local governance”. The duration of the Mission is seven years (2005-2012) and its focus is on 18 states where the challenge of strengthening the weak public health system and improving key health indicators is the greatest. Taking a ‘comprehensive approach’ by integrating existing vertical health programmes, the NRHM seeks to provide effective health care to the rural population, especially the disadvantaged groups including women and children, by improving access, enabling community ownership and demand for services, strengthening public health systems for efficient service delivery, enhancing equity and accountability and promoting decentralisation.
ASPECTS OF THE NATIONAL RURAL HEALTH MISSION: THE KEY COMPONENTS
The key components of the NRHM to achieve these objectives include the following:
- Improved Community Participation: The plan for placing a community based women health activist called the Accredited Social Health Activist (ASHA) at the village level, to affect community-owned processes for behavioural change and to facilitate sustainable access to health is one key process that addresses this objective. The primary role of the ASHA is to create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services. She would be a promoter of desired health practices and will also provide a minimum package of curative care as appropriate and feasible for that level as well as make timely referrals. In addition to ASHA, the space for community participation has also increased with the thrust to form village health and sanitation committees, district health societies, hospital development committees and with support for programmes like community monitoring of health care and partnerships with civil society for a variety of health care initiatives.
- Strengthening Public Health Infrastructure: The NRHM recognises that strong public health systems are imperative to achieving improved health outcomes. It has laid down the Indian Public Health Standards for different levels of care and provides support to facilities and to districts for reaching these levels in a time bound manner. This would be accompanied by improved management capacity to organise health systems and services in public health by emphasising evidence based planning and implementation. This also requires very effective human resource policies and expansion of capacities and infrastructure at every level.
- Decentralisation of Health Planning: One of the core strategies of the NRHM is to empower local governments to manage, control and be accountable for public health services. This decentralised approach is evident in the plans for State Health Missions led by the state Departments of Health and Family Welfare, the District Health Missions to be led by the Zila Parishad as well as the District Health Plan to be finalised by the District Health Society and the Village Health Plan to be formulated by the Gram Panchayat. The NRHM has created structures at each of these levels for the planning and implementation of the initiatives to be undertaken within the Mission.
RATIONALE: Most existing Health Sector Reform plans envisage programmes for building health management capacity. However the requirements for such capacity building are large, and given available resources it would take over a decade to complete the minimum levels of such capacity building. Capacity building is also needed in civil society - for members who are active in forums like District Health Societies, district planning teams, in hospital management committees, in the implementation of ASHA programmes etc. Currently the programmes addressing this need are very limited. The formal process organised by governments would reach out to senior officers, determined largely by seniority and current placement. However, both within the government and the non-government sector there are many dedicated individuals and organisations who are willing to voluntarily contribute to strengthening pro-poor health systems, because they personally feel the urgency to do so or because it is part of their organisational mandate to do so. This programme is meant to build the skills of such individuals and organisations through existing state level resource support agencies, NGO networks and state health societies, and reach out to them.
Public Health Resource Society (PHRS)
Whereas PHRN is a voluntary network of many hundred concerned public health practitioners who are willing to intervene towards 'Health for All' by creating capacities and engaging with the public health system, the Public Health Resource Society (PHRS) is the core group that has initiated the network. It comprises of a small group of members and full timers that provides leadership to the network as well as functions as its secretariat. [Click here for governing board members]