Mission steering group for NRHM holds 7th meeting

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ASHAS to home deliver contraceptives
Menstrual hygiene scheme to be taken up in 152 districts
Expanded mandate to VHSC for nutritional issues


The Union Minister of Health and Family Welfare Shri Ghulam Nabi Azad today chaired the seventh meeting of the Mission Steering Group (MSG) of the National Rural Health Mission (NRHM). The MSG is the highest decision making body of NRHM that takes decisions on the policies and programs under the Mission. Sh Vilasrao Deshmukh, Minister of Rural Development and Panchayati Raj, Shri Kapil Sibal, Minister of Human Resource Development and Telecom, Mrs. Sayeeda Hameed, Member, Planning Commission, Secretaries of various Departments of Government of India, Health Secretaries of State Governments and eminent public health professionals attended the meeting.

Addressing the meeting Shri Azad noted that NRHM has completed six years and has been instrumental in revitalizing a health system across the country. Upgradation of health infrastructure, additional manpower at health facilities, improved skills of health care providers, better availability of drugs and diagnostics and service delivery through the participation of community have been the hallmark of National Rural Health Mission. “As we prepare for the 12th Five Year Plan, it is time to take stock of the progress made and to review the strength and weaknesses” he added. He informed that during the year 2010-11, the number of beneficiaries under Janani Suraksha Yojana has reached 11.3 million as against 7,40,000 in 2005-06. Talking about new initiatives, the Minister particularly mentioned that the Mother and Child name based tracking system have also picked up in different States. The data base for more than 43 lakh mothers and 17 lakh children has already been created.

The following important decisions were taken in the meeting:

Population stabilization was one of the thrust areas discussed by the MSG. It was decided to utilize ASHAs for delivery of contraceptives at the homes of the beneficiaries and ASHAs are to be allowed to charge Rs. 1.00 for a pack of 3 condoms, Re 1.00 for an Oral Contraceptive Pill (OCP) cycle and Rs. 2.00 for an Emergency Contraceptive Pill (ECP) from the beneficiaries.

Global evidence indicates that home visits for neonatal care by community health workers are associated with reduced neonatal mortality. To make an impact on the Infant Mortality Rate, MSG decided to provide performance linked incentive of Rs. 250/- to ASHAs. The proposed schedule of home visit for institutional delivery is 6 home visits on days 3, 7, 14, 21, 28, and 42 in order to assess newborn as well as to ensure post partum care of mother. In the case of home delivery, a total of 7 home visits will be required as ASHA should be present at the birth or visit the mother and baby as soon as possible within the first 24 hours and on days 3, 7, 14, 21, 28 and 42.

It was decided to further improve and streamline the scheme to promote menstrual hygiene amongst the adolescent girls in rural areas. For this the MSG decided to revise the existing scheme with following modification: The scheme would be taken up in 152 districts instead of 150; A price of Rs. 7.50 per pack of 6 sanitary napkins was fixed for procurement for which assistance will be provided by the Government of India. Any amount for procurement over and above this norm will be provided through the State budget; A uniform selling price of Rs. 6 per pack was fixed for all the adolescent girls to be covered under the scheme.

The criteria for financial allocation to the States were discussed in detail. It was decided that an Expert Group be set up to look into the existing weightage formula to bridge the gap in health systems between the States. The MSG also decided that 10% of the total allocation under flexible pools of NRHM be kept apart at the national level which can be released to different States for specific activities based on their performance against the monitorable targets and implementation of specific reform agenda in the health sector.

Under NRHM, funds are placed at the disposal of health facilities across the country to meet the immediate needs in the form of Untied Funds and Rogi Kalyan Samiti Grants. So far the funds are provided to the health facilities on normative basis without taking into consideration the case load. MSG decided to revise the norms for Untied Funds and RKS grants to health facilities based on differential case load and requirement. It has also given power to District Health Society to reallocate upto 15% of the admissible Untied Funds and RKS grants to ensure better and proper utilization of funds.

Malnutrition is one of the important contributors to Infant, child and maternal mortality. It is estimated that 23% of children are born with low birth weight, 42.5% of children under 5 are underweight and 70% suffer from anemia. 55.3% women suffer from Anaemia and 35.6% have a low body mass index. To provide greater focus to the nutritional issues in rural areas, the MSG decided to expand the mandate of Village Health and Sanitation Committee to create awareness about nutritional issues; carry out surveys on nutritional status, inclusion of Nutritional needs in the Village Health Plan, monitoring and supervision of Village Health and Nutrition Day and supervise the functioning of Anganwadi Centre (AWC). In addition the committee will facilitate early detection and ensure referrals of malnourished children to the nearest Nutritional Rehabilitation Centres and act as a grievance redressal forum to the community. The MSG also decided to rename the committee as Village Health, Sanitation and Nutrition Committee (VHSNC).

MSG also considered the proposal of AYUSH department for Partial modification of the Centrally Sponsored Scheme for development of AYUSH Hospitals and Dispensaries for mainstreaming of AYUSH under NRHM and approved the following: For the 3 NE States (Mizoram, Manipur and Tripura) and 3 Hilly States (Himachal Pradesh, Uttarakhand and Jammu & Kashmir) a onetime assistance towards non-recurring expenditure up to Rs 45 Crores (i.e. Rs 7.5 crore/state) and Rs. 9 Crores (i.e Rs. 1.50 crore/state) towards recurring expenditure was approved for setting up of AYUSH hospitals shared by the Center and the State on a 85:15 basis; For the remaining 5 NE States(Assam, Arunachal Pradesh, Nagaland, Sikkim and Meghalaya), a onetime assistance upto Rs. 12.70 crores (i.e Rs 2.54 crore/state) and recurring assistance of Rs. 2.35 Crores (i.e Rs. 0.47 crore/state) for setting up of 10 bedded integrated AYUSH Hospital on 85:15 centre: state share basis was approved; It was further decided that the funds allocated under Centrally Sponsored Scheme for Development of AYUSH Hospitals and Dispensaries will be utilized for financing the said additional components.

The MSG also approved conduction of District Level Household Survey (DLHS) – 4 in those States where Annual Health Survey (AHS) is presently not being done. IIPS, Mumbai was designated as the Nodal Agency. IIPS will also do the required pooling of data from AHS and DLHS-4 household survey to arrive at National Estimates and prepare the National Report. Further, the Facility Survey will also be conducted in all States.

The MSG while reviewing action taken on its earlier decisions noted that though it had sanctioned Rs. 100 crores to Jammu and Kashmir for setting up 200-bedded maternity hospitals at Jammu and Srinagar respectively, there has not been much progress. Therefore, MSG decided that the Government of India will now get these two hospitals constructed, for which a provision of Rs. 124 crores will be kept during this financial year.


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