The Union Cabinet, chaired by Prime Minister, Shri Narendra Modi, was apprised about the progress under NHM during FY 2020-21 including accelerated decline in MMR, IMR, U5MR and TFR. It also noted the progress in respect of various diseases programmes like TB, Malaria, Kala-Azar, Dengue, Tuberculosis, Leprosy, Viral Hepatitis etc.

Expenditure involved: Rs. 27,989.00 Cr (Central Share)

No. of 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.

Point-wise details:

The Cabinet noted the role of NHM as implementing agency for the Emergency Response and Health Systems Preparedness Package (ECRP) Phase-I to accelerate health system preparedness for immediate responsiveness for early prevention, detection and management of COVID-19. ECRP-I is a 100% centrally supported intervention and an amount of Rs. 8,147.28 crores were allocated to States/UTs for the period upto 31.03.2021.

The interventions in this package were implemented using National Health Mission framework, supplementing the available resources for health systems strengthening. The objective of the package was to slow down the spread of COVID-19 and to support & strengthen National and State Health System for prevention and preparedness for future.

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 to States / 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 under NHM by 2025:

• Reduce MMR to 90 from 113
• Reduce IMR to 23 from 32
• Reduce U5MR to 23 from 36
• Sustain TFR to 2.1
• Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
• Annual Malaria Incidence to be <1/1000
• 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.

Major impact, including Employment Generation Potential:

• The implementation of NHM in 2020-21 lead to engagement of 2.71 lakh additional Human Resources which includes GDMOs, Specialists, ANMs, Staff Nurses, AYUSH Doctors, Paramedics, AYUSH Paramedics, Programme Management Staff and Public Health Mangers on contractual basis.
• The implementation of NHM during 2020-21 has led to further strengthening of Public Health system which also enabled effective and coordinated COVID-19 response by way of introducing India COVID 19 Emergency Response and Health Systems Preparedness Package (ECRP).
• U5MR in India has declined from 49 in 2013 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.  As per SRS 2020, U5MR has further reduced to 32.
• 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 (SRS) to 113 in 2016-18 (SRS). As per SRS 2017-19, MMR has further reduced to 103.
• IMR 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 SRS 2020, IMR has further reduced to 28.
• 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 -2018 has been observed as 0.89%. Currently 28 States/ UTs out of 36 have achieved desired replacement level of fertility (2.1). As per SRS 2020, SRS has further reduced to 2.0.
• In the year 2020, malaria cases and deaths have declined by 46.28% and 18.18%, respectively.
• 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 (KA) endemic blocks, achieving the elimination target of < 1 KA case per 10000 population, increased from 74.2% in 2014 to 97.5% in 2020-21. 
• The National target of sustaining Case Fatality Rate (CFR) to less than 1 percent was achieved. In 2020, the case fatality rate on account of Dengue has been sustained at 0.01% as it was in 2019.

Details & progress of scheme:

Progress under NHM during 2020-21 is as under:

• The approvals of 1,05,147 Ayushman Bharat-Health & Wellness Centres were accorded till 31^st March 2021. As reported by the States/UTs on the Ayushman Bharat - Health & Wellness Centres Portal, 1,17,440 Health & Wellness Centres were operationalized against the cumulative target of 1,10,000 till 31^st March, 2022.
• A total of 5,34,771 ASHAs, 1,24,732 Multi-Purpose Workers (MPWs-F) / Auxiliary Nurse Midwife (ANMs), 26,033 Staff Nurses and 26,633 Primary Health Center (PHC) Medical Officers were trained on Non-Communicable Diseases (NCDs) by the end of 31^st March, 2021.
• 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.
• Intensified Mission Indradhanush 3.0 was conducted from February 2021 to March 2021, a total of 250 districts were identified across 29 states/UTs.
• Around 6.58 crore doses of Rotavirus vaccine were administered in all States/UTs.
• Around 204.06 lakh doses of Pneumococcal Conjugated Vaccine (PCV) were administered in 6 states Bihar, Himachal Pradesh, Madhya Pradesh, Rajasthan, Uttar Pradesh & Haryana. As per Budget Announcement 2021-22, PCV has been scaled up nationwide under Universal Immunization Programme (UIP).
• Around 3.5 crore adults have been vaccinated with adult Japanese Encephalitis Vaccine which has been carried out in 35 endemic Districts of 3 States viz. Assam, Uttar Pradesh and West Bengal.
• 31.49 Lakh ANC check-ups had been conducted at over 18,400 health facilities across all State/UTs under Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA).
• LaQshya: 202 Labour Rooms & 141 Maternity Operation Theatres are State LaQshya certified and 64 Labour Rooms & 47 Maternity Operation Theatres are National LaQshya certified.
• To strengthen the Cold Chain system in the country, Cold Chain equipment i.e. ILR (large)- 1041, ILR (small)- 5185, DF (large)- 1532, Cold Box (large)- 2674, Cold Box (Small) - 3700, Vaccine Carrier – 66,584 and Ice packs – 31,003 had been supplied to the States/UTs.
• A total of 13,066 ASHAs were selected during 2020-21 making the total pool ASHAs 10.69 lakhs across the country upto 31^st March, 2021.
• National Ambulance Services (NAS): As on March 2021, 35 States / UTs have the facility where people can Dial 108 or 102 for calling an ambulance. 735 additional Emergency Response Service vehicles were added in 2020-21.
• During 2020-21, 30 additional Mobile Medical Units (MMUs) were added.
• 24x7 Services and First Referral facilities: During 2020-21, 1140 facilities were added as FRUs operationalization.
• Kayakalp: 10,717 public health facilities received Kayakalp awards under this scheme in 2020-21.
• Malaria: The total number of malaria cases and deaths reported in 2020 were 1,81,831 and 63 respectively in comparison to 11,02,205 cases and 561 deaths reported in 2014, indicating a decline of 83.50% malaria cases and 88.77% deaths in comparison to the corresponding period of 2014.
• Kala-Azar: The percentage of Kala Azar (KA) endemic blocks, achieving the elimination target of < 1 KA case per 10,000 population, increased from 74.2% in 2014 to 97.5% in 2020-21. 
• Lymphatic Filariasis: In 2020-21, among 272 LF endemic districts, 98 districts have successfully cleared 1 Transmission Assessment Survey (TAS-1) and stopped MDA and these districts are under Post MDA surveillance.
• 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 2020, it has been sustained at 0.1% as it was in 2019.
• National Tuberculosis Elimination Programme (NTEP): A total of 1,285 Cartridge Based Nucleic Acid Amplification Test (CBNAAT) machines and 2,206 Truenat machines are operational at district level across the country. In 2020, 29.85 lakh molecular tests have been performed. This is 4 times increase as compared to 7.48 lakh during 2017. Shorter MDR-TB regimen and Bedaquiline/Delamanid (newer drugs) based regimen rolled out in all State/UTs. In 2020, 30,605 MDR/RR-TB patients have been initiated on shorter MDR-TB regimen, 10,489 DR-TB patients have been initiated on newer drug containing regimen (Bedaquiline-10,140 and Delamanid-349) throughout country.
• 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 2020-21, PMNDP has been implemented in 35 States/UT in 505 Districts in 910 Dialysis Centres by deploying 5781 machines. During 2020-21, total 3.59 lakh patient availed dialysis services and 35.82 Lakhs Hemo-dialysis Sessions held.

Background:

The National Rural Health Mission was launched in 2005 with the objective of building public health systems to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups, up to the District Hospitals (DH) level. In 2012, the National Urban Health Mission (NUHM) was conceptualized and the NRHM was rechristened as the National Health Mission (NHM) with the two Sub Missions viz. the NRHM and the NUHM.

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

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

The Ministry of Finance, Department of Expenditure vide its OM No. 01(01)/PFC-I/2022 dated 01st February, 2022 has further accorded the approval for continuation of National Health Mission from 01.04.2021 to 31.03.2026 or till further review, whichever is earlier, subject to the adherence to Expenditure Finance Committee’s (EFC) recommendations and the financial ceilings etc.

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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