Rural Health Mission Programme and its Comparison with the Family - - PowerPoint PPT Presentation

Critical Appraisal of India’s National Rural Health Mission Programme and its Comparison with the Family Health Programme in Brazil

Authors: Sahu ML, Bachani D Department of Community Medicine, Lady Hardinge Medical College, New Delhi

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Objectives

• To evaluate the availability and adequacy of

health services under NRHM in India.

• To compare the present status of health

care programmes under NRHM with Family Health Programme in Brazil.

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Material & Methods

• This study is based on analysis of the

secondary data from government and international organizations.

• The

study involves description, interpretation, juxtaposition and comparison.

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National Rural Health Mission

Brief Introduction

• Launched on 12th April, 2005 to provide effective health care to the

rural and disadvantaged population

• To ensure affordable quality health care to the poorest house holds in

remotest areas

• Enabling community ownership
• Strengthening public health systems for efficient service delivery
• Enhancing equity and accountability
• Promoting decentralization
• Special focus on 18 low performing States

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Availability and Adequacy of Health Centres Under NRHM

Health Centers Availability Adequacy Sub Centre (SC)

• 1,48,124 SC
• 62.7% in govt building
• Each SC catering to 5,624

individual (4 villages) against recommended 5,000 individual Primary Health Centre (PHC)

• 23,887 PHC
• 86.7% in Govt. building
• 53.1% function for 24 hr.
• 19.25% have AYUSH practitioner.
• Each PHC catering to 34,876

individuals (27 villages) against recommended 30,000 individual Community Health Care Centre (CHC)

• 4,809 CHC
• 95.3% in Govt. building
• 90.1% have 24 hr delivery services
• 52% designated as FRUs
• Each CHC catering to

1,73,235 individuals (covering 133 Villages) against recommended 1,20,000 individual

Source : MOHFW,GOI,2011

Progress in Number of Health Centres

N U M B E R S An increase of about 43% in number of CHCs, 2.8% in number of PHCs & 1.4% in number of Sub Centres in 2011 as compared to 2005

Source : MOHFW,GOI,2011 I

Health Manpower Under NRHM

Health Manpower Availability & Adequacy Doctors At PHCs

• 26,329 Allopathic Doctors (29% increase)
• 12% short fall & 24.1% sanctioned posts are vacant.
• 7692 AYUSH doctors

At CHCs

• 6,935 Specialists (95% increase)
• Overall 63.9% shortfall of Specialists,
• 75% of Surgeons,
• 65.9% of Obstetricians & Gynaecologists,
• 80.1% of Physicians, and
• 74.4% of Paediatricians

Lab Technician

• 16,208 lab technicians (31.94% increase), Shortfall of 3,525.

Pharmacist

• 24,671 Pharmacists (39.32% increase), Shortfall of 6,444 .

4.6% of PHCs without a doctor, 36.9% without a Lab technician and 24.6% without a Pharmacist

Source : MOHFW,GOI,2011 I

Health Manpower Under NRHM

Human Resources Availability & Adequacy Female Health Workers/ HW(F)/ ANM

• 2,07,868 (56.06% increase)
• 3.8% short fall against requirement
• 5% post vacant against sanctioned post

Male Health Workers

• 64.7% shortfall of HW(M) against the total requirement.
• 42.2% post vacant against sanctioned post

Male Health Assistant

• 43.3% shortfall against requirement
• 35.3% post vacant against sanctioned post

Female Health Assistant

• 38% shortfall against requirement
• 33.9% post vacant against sanctioned post

ASHA

• 8,66,251 workers
• 6,28,527 trained up to 5th module
• 7,85,395 with drug kits

About 3.2% of SCs without a HW(M), 49.1% SCs without a HW(M) & 2% SCs without both.

Source : MOHFW,GOI,2011

Outcomes of NRHM

Indicators Around 2005 2010 Total Fertility Rate (TFR) 2.9 2.5 Maternal Mortality Rate (MMR) 301 (03) 212 (09) Institutional delivery 1,08,40,036 1,62,22,201 Infant Mortality Rate (IMR) 57 (07) 47 Malaria (deaths) 1707 (06) 463 (11) Kala azar (deaths) 187 (06) 80(11) Dengue (deaths) 185 (06) 164(11) Leprosy prevalence rate 1.8 0.68 Cataract operations 50.3 62.9

Source :5th CRM report

Key Issues

• Under funded & inadequate infrastructure with underutilization of existing

infrastructure & funds;  Only 1.45 % of the GDP was used for public health care .  Non utilization of allotted funds- 94% of the allotted funds were utilized in FY 2007-8, whereas it was 94.45 in FY 2008-9.

• Lack of skilled personnel in rural areas.
• Poor plans to deal with the shortfall of health service providers.
• Cadre management of doctors and paramedics are unsatisfactory.
• Difficulty in recruitment and retention of health care service providers.
• Large variation in quality of local care.
• Patchy integration with secondary and tertiary care.

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Brazil-India: the Case for Comparison

• Brazil’s Family Health Programme is probably the most

impressive & innovative example worldwide of a rapidly scaled up, cost effective, comprehensive primary care system.

• India, with over six times the population, has similar challenges

as that of Brazil, namely

• Extreme inequalities (wealth, health, education),
• Growing urban poverty, rich-poor gap widening,
• Rise of middle-class (crushed in-between rich-poor),
• Shortage of health care professional,
• Steady economic growth, increase in per-capita income,
• Working age population and demographic dividend..

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Family Health Programme Brazil

• ‘Programma Saude da Familia’ or Family Health Programme

(FHP) launched in 1994.

• Basic unit of FHP is a multidisciplinary Family Health Team -

comprising a doctor, nurse, nurse auxiliary and 4-6 community health workers(CHW) located in a geographically defined area.

• One CHW for 120 families in a defined area and aims to provide

home visits to every household once a month.

• CHWs are multifunctional, although child and maternal health

forms bulk of their work they also provide curative care, triage and referral into a health unit, health promotions for chronic diseases and promotes community participation.

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Family Health Programme and National Rural Health Mission at a Glance

Family Health Programme (Brazil) National Rural Health Mission(India)

• Emphasis on prevention rather than cure
• Curative and preventive
• Nationwide shift from tertiary centre based

health care to comprehensive primary health care

• Goal is to provide effective healthcare to

rural population throughout the country Decentralization ( Budgetary and political) of management and

• rganization
• f

health services from the federal to the state and, especially, municipal level. Decentralization at village & district level, Generating alternate source of financing.

• Community participation in local budget

setting

• Involvement of PRI’s & local bodies,

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Outcomes of Health Programmes

Indicators Brazil India IMR

43 in I994 reduced to 20.5 in 2011 57 in 2007 reduced to 47 in 2010

MMR

141 in 1994 reduced to 56 in 2010 301 in 2003 reduced to 212 in 2009

TFR

2.2 in 1996 reduced to 2.16 in 2010 2.9 in 2005 reduced to 2.5 in 2010.

Immunization Rate

95%Fully Immunized children ( Highest in the world) 43.50% of Fully Immunized children

Birth Rate

21.16 in 1996 reduced to 17.48 in 2011. 23.8 in 2005 reduced to 22.1 in 2011.

Death Rate

8 in 1995 reduced to 6.38 in 2011 7.6 in 2005 reduced to 7.2 in 2011.

Life Expectancy

67.1 yrs in 1996 increased to 72.79 yrs in 2011 64.72 yrs in 2005 increased to 66.71 yrs in 2011

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Healthcare System of Brazil

Strengths Limitations

• Unified Healthcare
• Right of people to have access to

healthcare

• Vastly improve access to primary

and emergency care

• Reach almost universal coverage
• f vaccination and prenatal care
• Invest heavily in the expansion of

human resources and technology.

• Lack of adequate funds to support higher

level of care

• Limited choice
• State support for the private sector
• Concentration of health services in more

developed regions

• Slow

adoption

• f

Family Health Programmes in large urban centers

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Possible Adoption of Some Key Strategies of Family Health Programme in India’s Healthcare System

• Honour healthcare as a right for every Indian

citizen

• Allow for more governmental funding to provide

for healthcare costs

• Provision for mandatory immunizations
• Inclusion of Mental health, HIV/AIDS &cancers

also in the programme

• Urban poors are also to be addressed.

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Thank You

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