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 1

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. 2

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. 3

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 4

Availability and Adequacy of Health Centres Under NRHM Health Availability Adequacy Centers • 1,48,124 SC • Each SC catering to 5,624 • 62.7% in govt building Sub Centre individual (4 villages) against (SC) recommended 5,000 individual • 23,887 PHC • Each PHC catering to 34,876 • 86.7% in Govt. building Primary individuals (27 villages) against • 53.1% function for 24 hr. Health Centre recommended 30,000 • 19.25% have AYUSH practitioner. (PHC) individual • 4,809 CHC • Each CHC catering to • 95.3% in Govt. building Community 1,73,235 individuals (covering • 90.1% have 24 hr delivery services Health Care 133 Villages) against • 52% designated as FRUs Centre (CHC) recommended 1,20,000 individual Source : MOHFW,GOI,2011

Progress in Number of Health Centres N U An increase of about 43% in number of CHCs , M 2.8% in number of PHCs & 1.4% in number of Sub B Centres in 2011 as compared to 2005 E R S Source : MOHFW,GOI,2011 I

Health Manpower Under NRHM Health Manpower Availability & Adequacy At PHCs • 26,329 Allopathic Doctors ( 29% increase ) • 12% short fall & 24.1% sanctioned posts are vacant. • 7692 AYUSH doctors Doctors At CHCs 4.6% of PHCs without a doctor, 36.9% without a Lab • 6,935 Specialists ( 95% increase ) • Overall 63.9% shortfall of Specialists, technician and 24.6% without a Pharmacist  75% of Surgeons,  65.9% of Obstetricians & Gynaecologists,  80.1% of Physicians, and  74.4% of Paediatricians • 16,208 lab technicians ( 31.94% increase), Shortfall of 3,525. Lab Technician • 24,671 Pharmacists ( 39.32 % increase), Shortfall of 6,444 . Pharmacist Source : MOHFW,GOI,2011 I

Health Manpower Under NRHM Human Resources Availability & Adequacy • 2,07,868 (56.06% increase) Female Health Workers/ • 3.8% short fall against requirement HW(F)/ ANM • 5% post vacant against sanctioned post • 64.7% shortfall of HW(M) against the total requirement. Male Health Workers • 42.2% post vacant against sanctioned post About 3.2% of SCs without a HW(M) , 49.1% SCs • 43.3% shortfall against requirement without a HW(M ) & 2% SCs without both . Male Health Assistant • 35.3% post vacant against sanctioned post • 38% shortfall against requirement Female Health Assistant • 33.9 % post vacant against sanctioned post • 8,66,251 workers ASHA • 6,28,527 trained up to 5 th module • 7,85,395 with drug kits 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 :5 th 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. 10

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 o Extreme inequalities (wealth, health, education), o Growing urban poverty, rich-poor gap widening, o Rise of middle-class (crushed in-between rich-poor), o Shortage of health care professional , o Steady economic growth, increase in per-capita income, o Working age population and demographic dividend. . 11

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 . • CHW s 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 . 12

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 • Goal is to provide effective healthcare to health care to comprehensive primary health rural population throughout the country care Decentralization ( Budgetary and political) of Decentralization at village & district level, management and organization of health Generating alternate source of financing. services from the federal to the state and, especially, municipal level. • Community participation in local budget • Involvement of PRI’s & local bodies, setting 13

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 95%Fully Immunized children 43.50% of Fully Immunized children ( Highest in the world) Rate 21.16 in 1996 reduced to 17.48 in 2011. 23.8 in 2005 reduced to 22.1 in 2011. Birth Rate 8 in 1995 reduced to 6.38 in 2011 7.6 in 2005 reduced to 7.2 in 2011. Death Rate 64.72 yrs in 2005 increased to 66.71 67.1 yrs in 1996 increased to 72.79 yrs Life yrs in 2011 in 2011 Expectancy 14

Healthcare System of Brazil Strengths Limitations • Unified Healthcare • Lack of adequate funds to support higher level of care • Right of people to have access to • Limited choice healthcare • Vastly improve access to primary • State support for the private sector and emergency care • Concentration of health services in more • Reach almost universal coverage developed regions of vaccination and prenatal care • Slow adoption of Family Health • Invest heavily in the expansion of Programmes in large urban centers human resources and technology. 15

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. 16

Thank You 17