The Union Minister of Health and Family Welfare Shri Ghulam Nabi Azad chaired the eighth meeting of the Mission Steering Group (MSG) of the National Rural Health Mission (NRHM) last evening. Minister of Human Resource Development Shri Kapil Sibal; Minister for Rural Development Shri Jairam Ramesh;  Minister of Women & Child Development Smt. Krishna Tirath;  Member Planning Commission Ms. Syeda Saiyidain Hameed; Minister of State for Health & Family Welfare Shri S Gandhiselvan were among the members who attended the meeting.  Secretary Health & Family Welfare  Shri P.K. Pradhan;  Secretary  AYUSH Shri Anil Kumar; Principal Secretary (Health), Govt. of Jharkhand; Commissioner cum Secretary (Healthcare, Human Services & Family Welfare), Govt. of Sikkim  apart from senior officials from Ministries of Finance, Panchayati Raj, H &FW Government of India as also State Government Officials were present in the meeting. Public Health Professionals namely Shri A.K. Shiva Kumar, Member, UNICEF; Shri T.V. Antony, former Chief Secretary, Govt. of Tamil Nadu; Dr. K.S. Jacob, Professor of Psychiatry, Christian Medical College, Vellore; Dr. Devi Shetty, Chairman & Senior Consultant Cardiac Surgeon, Narayan Hridayalaya, Bangalore, Dr. Abhay Bang, SEARCH, Maharashtra; Dr. V.R. Muraleedharan, Professor of Humanities & Social Sciences, IIT Chennai and Dr. K. Srinath Reddy, President, Public Health Foundation of  India   also attended the meeting.   The MSG is the highest decision making body of NRHM that takes decisions on the policies and programs under the Mission. 

Addressing the meeting Shri Azad noted that during the 11^th Plan, substantial progress has been made under the National Rural Health Mission.  He said that several new initiatives have been taken, particularly during the last 3 years to provide better health care services to the people and improve overall health outcomes.  “We are greatly encouraged by the success that we have achieved in Polio Eradication.  India has not seen a single wild polio virus case for the last more than 15 months now”, the Minister added. 

Shri Azad said Maternal and Child Health has been a key focus under NRHM.  It is a matter of satisfaction that both MMR and IMR have started showing consistent and steady decline.  The fact that the decline is sharper in rural areas and also that Empowered Action Group states have by and large shown better than National performance,  points to the success of several interventions made under NRHM, he added.  The Minister also added that NRHM has made a remarkable beginning and started to address the issues of physical infrastructure, human resources, ambulances and other logistics.  “However, substantial investments would be required to complete the task.  The assurance that health would receive priority and increased funding in the 12^th Plan is reassuring”, Shri Azad pointed out.  He hoped that increase in funding in the  12^th Plan would help roll out the much needed interventions to strengthen the primary health care and ensure that there is universal health coverage.   

Addressing social determinants of health particularly sanitation, drinking water, nutrition and education would be critical for a quantum jump in health gains, Shri Azad said.   Good governance, institutional reforms, innovations and focus on overall human development on the part of the states are a pre-requisite to optimal gains under NRHM, he emphasized. 

Smt. Anuradha Gupta, AS & MD NRHM made a detailed presentation highlighting progress made under NRHM. She highlighted that NRHM had brought significant higher decline of IMR (rural). The Progress made by EAG States has been much better. Similarly, TFR recorded a greater decline in highly populous States. The MSG highlighted the need for process indicators. She also mentioned that a number of new initiatives were initiated in the last seven years, most notable of them are the Programme for promoting menstrual hygiene in adolescent girls, the Janani Shishu Suraksha Karyakram and Mother and Child Tracking system in which a database of more than 3.5 Crore pregnant women has been already created. Simultaneously, newborn and neonatal care has been prioritized through NRHM and all the states have initiated development of infrastructure and capacities for the same.

Proposals forwarded by the Empowered Programme Committee were discussed at length at the MSG meeting. The following major decisions were taken:

After acknowledging the significance of Haemophilus influenzae b (Hib) vaccination, a decision was taken to continue inclusion of Haemophilus influenzae b (Hib) vaccines in Universal Immunization Program as liquid pentavalent vaccine (DPT+ Hep B+ Hib) in Kerala and Tamil Nadu. Further, introduction of Haemophilus influenzae b (Hib) vaccines in Universal Immunization Program as liquid pentavalent vaccine (DPT+ Hep B+ Hib) in six States, namely, Gujarat, Haryana, Karnataka, Goa, Jammu & Kashmir, Puducherry from October 2012 to December 2014 with an outlay of Rs. 332.70 Crores toward cost of the vaccine was also approved. An additional requirement of Rs. 4.75 Crores (from domestic budget) for research as well as strengthening supervision for introduction of pentavalent vaccines was also considered and approved.

Polio Eradication strategy was introduced for discussion and was approved with an outlay of Rs. 4249.04 Crores. Since the initiative to eradicate polio from India started in 1995, significant success has been achieved in reducing the number of polio cases in the country. Most parts of India are polio free for several years. India has been taken off the list of WHO endemic countries. Sustained efforts are needed to achieve eradication of polio. Based on the current needs of the programme and increase in cost associated with various activities, revised norms for the Immunization programme were calculated and placed before the MSG. These were discussed in detail and approved.

Proposal for modifying the Hospitals and dispensaries scheme of AYUSH was also placed in front of the MSG. Important decisions were made to remove the ceiling of remuneration for various contractual manpower employed under the different components of the Scheme, and to strengthen the Programme Management Unit at Centre level with deployment of the additional manpower. For a more meaningful mainstreaming, it was decided to direct the States to create Institutional Mechanisms for mainstreaming of AYUSH in the States/ District Level and include AYUSH Mainstreaming in the MIS monitoring and evaluation cell under NRHM at district/ State level. The guidelines for the modified scheme were placed in front of the MSG and were approved.

As a part of the communitization strategy of NRHM, it was proposed to involve ASHAs in convening the VHSNC meeting at the village level. For this, an incentive of Rs.  Rs 150/- to ASHAs for facilitating the monthly meeting of VHSNC followed by the meeting of women and adolescent girls was decided. Guidelines in this regard will also be issued to the States as recommended by the MSG. An honorarium for performance based community level testing and creating awareness about use of iodated salt through

Salt Testing Kits @ Rs 25/month to each ASHA on testing of, at least, 50 salt samples per month for 303 endemic districts in the country was also approved. 

Reaching out to the unreached is of utmost importance to ensure that health care services are easily accessible. Presently NRHM supports only one MMU per district in a State. A proposal for relaxing this norm and providing up to 5 MMUs per district was proposed and approved. Increase in the recurring expenditure cost of North-Eastern states, J&K and Himachal Pradesh for diagnostic van from Rs. 23.71 lakhs to Rs. 28.00 lakhs was also approved. For other states the recurring cost would be revised from Rs.19.87 lakhs to Rs 24.00 lakhs as approved by MSG. To provide a national identity, a universal name “Rashtriya Mobile Medical Unit” was approved for all MMUs funded under NRHM. Also uniform color with emblem of NRHM, Government of India and State government would be used on all the MMUs.

Emergency Medical Transport System has been successfully developed and are being implemented almost all the States of the country. It was decided to extend the financial support for the same beyond three years. Thus, 20 % operational expenditure incurred by states on Emergency Medical transport System (EMTS) would be supported by NRHM beyond 3^rd years under NRHM with the cap of Rs 3 lakh per year per ambulance.

It has been proved by various studies that spacing between children have a positive impact on reducing maternal deaths; if spacing between two children is 27-32 months (2-2½ yrs), maternal mortality would decline by 61% (from 9.5 deaths per 10,000 women to 3.7 deaths per 10,000 women). Further spacing also indirectly helps in reducing infant mortality. It was therefore considered that services of the ASHA should be used for counseling eligible couples for ensuring healthy spacing between births. For this, incentives to ASHAs are to be introduced as decided by MSG.

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