The Union Cabinet, chaired by the Prime Minister Shri Narendra Modi, was apprised of the Progress under the National Health Mission (NHM) during the years 2021-22, 2022-23 and 2023-24. Cabinet was also apprised of accelerated decline in Maternal Mortality Rate, Infant Mortality Rate, under 5Mortality Rate and Total Fertility Rate and the progress in respect of various diseases programmes like TB, Malaria, Kala-Azar, Dengue, Tuberculosis, Leprosy, Viral Hepatitis etc. and new initiatives undertaken such as National Sickle Cell Anaemia Elimination Mission.

The National Health Mission (NHM) has significantly contributed to improving India's public health outcomes through its relentless efforts in expanding human resources, addressing critical health issues, and fostering an integrated response to health emergencies. Over the last three years, the NHM has driven substantial progress in multiple areas, including maternal and child health, disease elimination, and healthcare infrastructure. The mission’s efforts have been integral to India's health improvements, particularly during the COVID-19 pandemic, and have played a vital role in ensuring more accessible and quality healthcare services across the country.

A key achievement of NHM has been the significant increase in human resources within the healthcare sector. In FY 2021-22, NHM facilitated the engagement of 2.69 lakh additional healthcare workers, including General Duty Medical Officers (GDMOs), specialists, staff nurses, ANMs, AYUSH doctors, allied healthcare workers, and public health managers. Additionally, 90,740 Community Health Officers (CHOs) were engaged. This number grew in subsequent years, with 4.21 lakh additional healthcare professionals engaged in FY 2022-23, including 1.29 lakh CHOs, and 5.23 lakh workers engaged in FY 2023-24, which included 1.38 lakh CHOs. These efforts have contributed significantly to improving healthcare delivery, especially at the grassroots level.

The NHM framework has also played a crucial role in strengthening the public health system, especially in response to the COVID-19 pandemic. By utilizing the existing network of healthcare facilities and workers, NHM was pivotal in administering over 220 crore COVID-19 vaccine doses between January 2021 and March 2024. Additionally, the India COVID-19 Emergency Response and Health Systems Preparedness Package (ECRP), implemented under NHM in two phases, helped further bolster the healthcare system to effectively manage the pandemic.

India has also made impressive progress in key health indicators under NHM. The Maternal Mortality Ratio (MMR) has declined significantly from 130 per lakh live births in 2014-16 to 97 per lakh in 2018-20, marking a 25% reduction. It has declined by 83% since 1990, which is higher than the global decline of 45%. Similarly, the Under-5 Mortality Rate (U5MR) has decreased from 45 per 1,000 live births in 2014 to 32 in 2020 which demonstrates a higher decline of 75% in the reduction of mortality in comparison to the global reduction of 60% since 1990. The Infant Mortality Rate (IMR) has fallen from 39 per 1,000 live births in 2014 to 28 in 2020. Furthermore, the Total Fertility Rate (TFR) decreased from 2.3 in 2015 to 2.0 in 2020, according to the National Family Health Survey (NFHS-5). These improvements indicate that India is on track to meet its SDG targets for maternal, child, and infant mortality well ahead of 2030.

NHM has also been instrumental in the elimination and control of various diseases. For instance, under the National Tuberculosis Elimination Programme (NTEP), the incidence of tuberculosis (TB) has reduced from 237 per 1,00,000 population in 2015 to 195 in 2023, and the mortality rate has decreased from 28 to 22 in the same period. In terms of Malaria, In the year 2021, Malaria cases and deaths have declined by 13.28% and 3.22% respectively as compared to 2020. In the year 2022, malaria surveillance and cases have increased by 32.92% and 9.13% respectively whereas malaria deaths have decreased by 7.77% as compared to 2021. In the year 2023, malaria surveillance and cases have increased by 8.34% and 28.91% respectively as compared to 2022. Additionally, Kala-azar elimination efforts have been successful, with 100% of endemic blocks achieving the target of less than one case per 10,000 population by the end of 2023. The Measles-Rubella Elimination Campaign, under the Intensified Mission Indradhanush (IMI) 5.0, vaccinated over 34.77 crore children, achieving a 97.98% coverage.

In terms of specialized health initiatives, the Pradhan Mantri TB Mukt Bharat Abhiyaan, launched in September 2022, has seen the registration of 1,56,572 lakh Ni-kshay Mitra volunteers who are supporting over 9.40 lakh TB patients. The Pradhan Mantri National Dialysis Programme (PMNDP) has also been expanded, with over 62.35 lakh hemodialysis sessions provided in FY 2023-24, benefiting over 4.53 lakh dialysis patients. Furthermore, the National Sickle Cell Anemia Elimination Mission, launched in 2023, has screened over 2.61 crore individuals in tribal areas, working toward the goal of eliminating sickle cell disease by 2047.

Digital health initiatives have been a major focus as well. The launch of the U-WIN platform in January 2023 ensures the timely administration of vaccines to pregnant women, infants, and children across India. By the end of FY 2023-24, the platform had expanded to 65 districts across 36 States/UTs, ensuring real-time vaccination tracking and improving immunization coverage.

The NHM has also focused on strengthening healthcare infrastructure, including the certification of public health facilities under the National Quality Assurance Standards (NQAS). As of March 2024, 7,998 public health facilities have been certified, with over 4,200 of them receiving national certification. Additionally, the number of operational Ayushman Arogya Mandir (AAM) centers, which provide a range of healthcare services, has increased to 1,72,148 by the end of FY 2023-24, with 1,34,650 of these centers offering 12 key healthcare services.

The NHM’s efforts have extended to improving emergency services, with the establishment of 24x7 Primary Health Centres (PHCs) and First Referral Units (FRUs). By March 2024, 12,348 PHCs had been converted to 24x7 services, and 3,133 FRUs were operational across the country. Additionally, the fleet of mobile medical units (MMUs) has expanded, with 1,424 MMUs now operating to ensure healthcare access in remote and underserved areas. The introduction of the MMU Portal in 2023 further strengthened monitoring and data collection on health indicators for vulnerable tribal groups.

NHM has also addressed pressing public health concerns such as tobacco use and snakebite envenoming. Through sustained public awareness campaigns and enforcement of tobacco control laws, NHM has contributed to a 17.3% reduction in tobacco use over the past decade. Furthermore, in FY 2022-23, the National Action Plan for Snakebite Envenoming (NAPSE) was launched, with efforts focused on prevention, education, and management of snakebites

The ongoing efforts of NHM have successfully led to a dramatic transformation in India's healthcare landscape. By expanding human resources, improving health outcomes, and addressing critical health issues, NHM continues to enhance the quality and accessibility of healthcare services across the nation. With significant progress towards achieving the Sustainable Development Goals (SDGs), India is on track to meet its health targets well ahead of the 2030 deadline.

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 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 Ministry of Finance, Department of Expenditure vide its OM No. 01(01)/PFC-I/2022 dated 01^st 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.

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.

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MJPS/SKS