National Rural Health Mission

Recognizing the importance of Health in the process of economic and social development and improving the quality of life of our citizen, the Government of India has launch the National Rural Health Mission to carry out necessary architectural correction in the basic health care delivery system. The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water. It also aims at mainstreaming the Indian systems of medicine to facilitate health care. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of organization structures, optimization of health manpower, decentralization and district management of health programmes, community participation and ownership of assets, induction of management and financial personal into district health system, and operationalizing community health centers into functional hospitals meeting Indian Public Standards.

GOALS

Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition.Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.Access to integrated comprehensive primary healthcare.Population stabilization, gender and demographic balance.Revitalize local health traditions and mainstream AYUSH.Promotion of healthy life styles.

Strategic Approaches

The NRHM seeks to address the underlying causes of stagnant health indicators, through intregration of all health and family welfare programmes.It also seeks to bring about fundamental changes in operation of the public health sector through increased community owernership and decentralized implementation through Panchayati Raj institutions. In the process it seeks to promote accessible, equitable and high quality health care in rural areas, particulary to poor women and children.

COMPONENT

  • Accredited Social Health Activists (ASHA).

  • Strengthening Sub-Centres.

  • Strengthening Primary Health Centres.

  • Strengthening CHCs for First Referral Care.

  • Public-Private Part.

  • Strengthening District Health Plan.

  • Converging Sanitation and Hygiene under NRHM.

  • Strengthening Disease Control Programmes.

  • New Health Financing Mechanisms.

National Rural Health Mission in Sikkim

Since its launch in 2005 the Government of Sikkim has been implementing NRHM in the right earnest. Over the past 5 years the State has made significant gains in the health sector with the opportunities presented under NRHM.

Institutional Set Up:

National Steering Group

Mission Steering Group

Empowered Programme Committee

Mission Directorate

State Health Mission

District Health Mission ————Rogi Kalyan Samitis

Panchayat

Village Health SanitationCommittee

ASHA/ LINK WORKERS

The NRHM will support an Accredited Social Health Activist in every village to serve as the interface between the community and the health system, selected and accountable to the panchayat.In Sikkim 641 ASHA and 25 link worker planned and in place, actively working in the village in close coordination with Sub Center Health Worker and trained upto 6th& 7thModule (1stround). All ASHA/Link workers are provided with drug kits and aprons. Provision of ASHA Ghar at made DH (Rs 3000/-) and PHC (Rs1500/-).ASHA Mentoring Group: State and District level ASHA Mentoring Committee formed & notified to support ASHA.

Strengthening Sub-Centres.

As part of the National Rural Health Mission to strengthening sub-centre all 147 sub centres are provided Rs.10,000/- as an untied fund as well as Rs. 10,000/- as Annual Maintenance Grant to 139 (running in Govt. building) to facilitate meeting urgent activities like minor modifications/repairs of sub centre, lighting, cleanliness maintenance at sub-centre, buying small quantity of approved drugs etc. Strengthening of Sub Centre is also being done by placing 2ANM, 56 PHSCs have been brought to IPHS with recruitment of 2ndANM.In2011-12 Construction of 4 new subcentre buildings approved namely Phamtam,Kamling, Legship & Karjee .Four (4) PHSCs of previous year carried over are Naya bazaar, Gangyap, Majitar and Basilakha. Work near completion in Basilaka and work under process in Phamtam and Karjee. In rest of the PHSCs work could not be started due to land problem. Further, rewiring of 10 PHSCs completed and 4 under process.

Strengthening Primary Health Centres

To strengthen PHCs as facilities available for 24 hour delivery is the core strategy to increase proportion of institutional deliveries. At present 24 PHCs are providing basic 24×7 services and the process of upgrading them to IPHS is on.Two PHSCs upgradated to PHCs: One in North & one in South and two existing PHCs under process of upgradation to CHCs. Hence, total number of PHC will remain at 24. Augmentation work in 16 PHCs approved and in progress, total of22 PHCs will be completed. To strengthening PHCs, all 24 PHC are provided with Untied Fund @ Rs 25,000, AMG @Rs 50,000 and corpus grant @ Rs 100000.

Strengthening CHCs
At the beginning of NRHM there were no CHCs in Sikkim, District Hospital designated as DH cum CHC. During 2008-09 three PHCs identified for upgradation to CHCs, civil works in two PHCs completed.

District Hospital

All four DHs targeted to be operationalised as FRU, DH Gyalshing & Namchi functioning as FRU, DH Mangan & Singtam planned FRU by 2012. Corpus grant @Rs.500000 provided. In 2011-12 Augmentation of Bld storage unit at Gyalshing and renovation/ addition of 3 phase wiring for Singtam Hosptial approved and under process. Last years equipment for Mangan Hospital delivered.Public-Private Part (PPP)The MNGO programme was carried out in all the four district of the State. All the MNGOs were trained by VHAI RRC. The MNGOs and FNGOs would provide RCH services in the un-served and under-served areas of the state. The key service delivery areas would be maternal and child health, family planning, adolescent reproductive health, prevention and management ofRTI etc. Further, impact assessment was proposed and approved, RRC NE are requested for conducting studies.

Mobile Medical Units (MMU)

All the 4 Districts are having fully functional MMU. This MMU Scheme under NRHM will ensure the availability of health care service to the people of remote areas at certain interval (well-advertised dates). In this scheme each district provided with 2 Diagnostic Bus equipped with x-ray, USG, Laboratory, audio-visual system and 1programme vehicle. Human resources like 2MO, 1staff nurse, 1pharmacist, 2 technician and 3Driver were provided. The MMU is providing curative and RCH services with specialized facilities like X-ray, ECG, USG and Laboratory investigations. Now, MMU is also been utilized in CATCH programmes.

MMU Report for the year 2011-12

Sl. No Name of District Total Camp Held No. of PatientsExamine No. of USG done No. of x-ray done No. of Lab test done
1. East
2. West 101 12471 nil 365 7968
3 North
4 South 141 31325 315 53 13218
5 Total

Health Melas

Health Melas have become an important activity for the State in respect of generating awareness on Health and providing services. Health Melas organized at all 4 District to avail the facilities provided under NRHM including Health checkup by specialists and to disseminate the health messages.

Mainstream AYUSH

With the aim to provide alternative choice of services to public AYUSH Clinics have been established at all four District Hospitals including infrastructure manpower and drugs. At present 8(eight) Medical Officer AYUSH and 6(six) Paramedics are in position.

Manpower under NRHM

Efforts are also being made to ensure the availability of qualified manpower at all levels. Manpower in various categories ranging from specialist, Medical Officer, GNM,ANM, Lab Technicians, X-ray technicians, pharmacist and Store Keepers have been recruited under contract to fill gaps in manpower.