The Union Cabinet chaired by the Prime Minister, Shri Narendra Modi was apprised on the progress under National Health Mission (NHM)during FY 2019-20 includingaccelerated decline in Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR), Under Five Mortality Rate (U5MR)  and Total Fertility Rate (TFR). It also noted the progress in respect of various diseases programmes like TB, Malaria, Kala-Azar, Dengue, Tuberculosis, Leprosy, Viral Hepatitis etc.

Details:

The Cabinet noted that NHM has envisaged new Initiatives in 2019-20 as:

• Social Awareness and Actions to Neutralize Pneumonia Successfully (SAANS) initiative was launched to accelerate action to reduce deaths due to childhood pneumonia.
• SurakshitMatritvaAashwasan (SUMAN) initiative was launched to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services and all existing Schemes for maternal and neonatal health have been brought under one umbrella.
• Midwifery Services Initiative aims to create a cadre of Nurse Practitioners in Midwifery who are skilled in accordance to competencies prescribed by the International Confederation of Midwives (ICM) and are knowledgeable and capable of providing compassionate women-centered, reproductive, maternal and newborn health care services.
• School Health and Wellness Ambassadors Initiative has been launched under the AB-HWCs Programme in partnership with Ministry of Education to promote health and well-being through an active lifestyle amongst school children.

Implementation strategy and targets:

Implementation strategy:

The implementation strategy of Ministry of Health and Family Welfare under NHM is to provide financial and technical support toStates / Union Territories (UTs) enabling them to provide accessible, affordable, accountable, and effective healthcare upto District Hospitals (DHs), especially to the poor and vulnerable sections of the population. It has also aimed to bridge the gap in rural healthcare services through improved health infrastructure, augmentation of human resource and improved service delivery in rural areas and has envisaged decentralization of programme to district level to facilitate need-based interventions, improve intra and inter-sectoral convergence and effective utilization of resources.

Targets:

• Reduce MMR to 1/1000 live births
• Reduce IMR to 25/1000 live births
• Reduce TFR to 2.1
• Reduce prevalence of Leprosy to < 1 /10000 population and incidence to zero in all districts
• Annual Malaria Incidence to be <I/1000
• Prevent and reduce mortality &morbidity from communicable, non-communicable; injuries and emerging diseases
• Reduce household out-of-pocket expenditure on total health care expenditure
• Ending the TB epidemic by 2025 from the country.

Impact including Employment Generation Potential:

• The implementation of NHM in 2019-20 lead to engagement of 18,779 additional Human Resources which includes GDMOs, Specialists, ANMs, Staff Nurses, AYUSH Doctors, Paramedics, AYUSH Paramedics, ProgrammeManagement Staff and Public Health Mangers on contractual basis.
• The implementation of NHM during 2019-20 has led to further strengthening of Public Health system which also enabled effective and coordinated Covid-19 response.
• U5MR in India has declined from 52 in 2012 to 36 in 2018 and the percentage annual rate of decline in U5MR during 2013-2018 has accelerated to 6.0 % from 3.9 % observed during 1990-2012.
• Maternal Mortality Ratio (MMR) of India has declined by 443 points from 556 per one lakh live births in 1990 to 113 in 2016-18. A decline of 80% has been achieved in MMR since 1990, which is higher than the global decline of 45%. In last five years, Maternal Mortality Ratio (MMR) has declined from 167 in 2011-13 Sample Registration System (SRS) to 113 in 2016-18 (SRS).
• MR has declined from 80 in 1990 to 32 in the year 2018. Percentage annual compound rate of decline in IMR during past five years, i.e. during 2013 to 2018, has accelerated to 4.4% from 2.9% observed during 1990-2012.
• As per Sample Registration System (SRS), TFR in India declined from 2.3 in 2013 to 2.2 in the year 2018. The National Family Health Survey-4 (NFHS-4, 2015-16) also recorded a TFR of 2.2. The percentage annual compound rate of decline in TFR during 2013-2018has been observed as 0.89%.
• In the year 2019, malaria cases and deaths declined by 21.27% and 20% respectively as compared to 2018.
• The incidence of TB per 1,00,000 population has been reduced from 234 in 2012 to 193 in 2019. The mortality due to TB per 1,00,000 populations for India reduced from 42 in 2012 to 33 in 2019.
• The percentage of Kala-Azar endemic blocks, achieving the elimination target of < 1 KA case per 10000 population, increased from 74.2% in 2014 to 94% in 2019-20.
• The National target of sustaining case fatality rate (CFR) to less than 1 percent was achieved. The case fatality rate on account of Dengue in 2019 was 0.1%.

Expenditure: Rs 27,989.00 Cr (Central Share)

Beneficiaries:

NHM is implemented for universal benefit - i.e. entire population; services are offered to everyone visiting the public healthcare facilities with a special focus to vulnerable section of the society.

Details & progress under NHM during 2019-20 is as under:

• Approvals of 63,761 Ayushman Bharat-Health & Wellness Centreswere accorded till 31st March 2020, 38,595 Health & Wellness Centres were operationalized against the target of 40,000 till 31st March, 2020. A total of 3,08,410 health workers which includes ASHAs, Multi-Purpose Workers (MPWs-F) / Auxiliary Nurse Midwife (ANMs), Staff Nurses and Primary Health Center (PHC) Medical Officers by the end of 31st March 2020.
• There has been acceleration in decline of Maternal Mortality Ratio (MMR), Under Five Mortality Rate (U5MR) and the IMR since the launch of the NRHM/NHM. At the current rate of decline, India should able to reach its SDG target (MMR-70, U5MR-25) much before the due year i.e. 2030.
• In 2019-20, Intensified Mission Indradhanush2.0 was conducted to reach the unreached and partially vaccinated children in 381 Districts across 29 States/UTs.
• During 2019-20, around 529.98 lakh doses of Rota virus vaccine and 463.88 lakh doses of Measles-Rubella vaccine were administered in all states/UTs.
• During 2019-20, around 164.18 lakh doses of Pneumococcal Conjugated Vaccine were administered in 6 states Bihar, Himachal Pradesh, Madhya Pradesh, Rajasthan, Uttar Pradesh & Haryana.
• During 2019-20, 25.27 lakhs adults were administered with adult Japanese Encephalitis Vaccine (25 JE endemic Blocks of 9 Districts of West Bengal).
• During 2019-20, 45.45 Lakh ANC check-ups had been conducted at over 16,900 health facilities across all State/UTs under Pradhan MantriSurakshitMatritvaAbhiyan (PMSMA) program.
• LaQshya: Till 31st March 2020, 543 Labour Rooms and 491 Maternity Operation Theatres are State LaQshya certified and 220 Labour Rooms &190 Maternity Operation Theatres are National LaQshya certified.
• In 2019-20, to strengthen the cold chain system in the country, cold chain equipment i.e., ILR- 283, DF- 187, Cold Box(large)- 13,609, Cold Box (Small)-11,010, Vaccine Carrier - 270,230 and Ice packs - 10,94,650 had been supplied to the States/UTs.
• Approvals of 63,761 Ayushman Bharat-Health & Wellness Centreswere accorded till 31st March 2020, 38,595 Health & Wellness Centres were operationalized against the target of 40,000 till 31st March, 2020. A total of 3,08,410 health workers which includes ASHAs, Multi-Purpose Workers (MPWs-F) / Auxiliary Nurse Midwife (ANMs), Staff Nurses and Primary Health Center (PHC) Medical Officers by the end of 31st March 2020.
• During 2019-20, a total of 16,795 ASHAs were selected making the total pool ASHAs 10.56 lakhs across the country by March, 2020.
• National Ambulance Services (NAS): As on March 2020, 33 States / UTs have the facility where people can Dial 108 or 102 for calling an ambulance. 1096, additional Emergency Response Service vehicles were added in 2019-20.
• During 2019-20, 187 additional Mobile Medical Units (MMUs) were added.
• 24x7 Services and First Referral facilities: During 2019-20, additional 53 facilities were operationalized as FRUs.
• Kayakalp: 25 States & UTs, 293 DHs, 1,201 CHCs/SDHs, 2,802 PHCs, 668 UHCs, and 305 HWCs have scored more than 70% in 2019-20. 5,269 public health facilities have been awarded under this scheme in 2019-20.
• Malaria: The total number of malaria cases and deaths reported in 2018 were 4,29,928 and 96 in comparison to 11,02,205 cases and 561 deathsreported in 2014, indicating a decline of 61% malaria cases and 83% deaths in comparison to the corresponding period of 2014.
• Kala-Azar: At the end of December 2019, 94% Kala-azar endemic blocks have achieved the elimination target of <1 KA case per 10,000 population at block level.
• Lymphatic Filariasis: In 2019, among 257 LF endemic districts, 98 districts have achieved microfilaria rate <1% and verified by Transmission Assessment Survey (TAS-1) and stopped Mass Drug Administration (MDA).
• In relation to Dengue, the National target was to sustain case fatality rate (CFR)< 1 percent. The target was achieved as case fatality rate in 2014 was 0.3% and during 2015 to 2018, CFR has been sustained at 0.2%. Further in 2019, it has been reduced to 0.1%.
• National Tuberculosis Elimination Programme (NTEP): A total of 1,264 Cartridge Based Nucleic Acid Amplification Test (CBNAAT) machines and 2,206 Truenat machines are operational at district level across the country. In 2019, 35.30 lakh molecular tests have been performed. This is 5 times increase as compared to 7.48 lakh during 2017. In 2019, 22,03,895 TB patients received Daily Regimen for treatment of Drug Sensitive TB compared to 19,71,685 in 2018. Introduction of newer anti-TB drugs: Shorter drug regimen and Bedaquiline based regimen rolled out in all State/UTs. In 2019, 40,397 MDR/RR-TB patients have been initiated on shorter regimen.
• Pradhan Mantri National Dialysis Programme(PMNDP) was Launched in 2016 to support dialysis facilities in all district hospitals in the PPP mode under NHM. During FY 2019-20 PMNDP has been implemented in 3 States/UT in 52 Districts in 105 Centres deploying 885 machines.

Background:

The National Rural Health Mission (NRHM) was launched by the Hon'ble Prime Minister on 12^th April 2005, for accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The Union Cabinet vide in its meeting held on 1^st May 2013, approved the National Urban Health Mission (NUHM) as a Sub-mission of an over-arching National Health Mission (NHM), with National Rural Health Mission (NRHM) being the other Sub-mission of National Health Mission.

Continuation of the National Health Mission-with effect from 1^st April 2017 to 31^st March 2020 was approved by Cabinet in its meeting held on 21^st March 2018.

The Ministry of Finance, Department of Expenditure vide its Office Memorandum No. 42(02/PF-II.2014) dated 10^th January 2020 has also accorded interim extension of National Health Mission for a period up to 31^st March 2021 or till the date the recommendation of 15^th Finance Commissions come into effect, whichever is earlier.

The Cabinet approval for NHM Framework further stipulates that exercise of these delegated powers would be subject to the condition that a progress report regarding N(R)HM, along with deviation in financial norms, modifications in ongoing schemes and details of new schemes be placed before the Cabinet for information on an annual basis.

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DS