At the District level all existing Societies have been merged into the District Health Society, the Apex body. It executes the activities of the Mission. NRHM envisages financial autonomy and delegation of powers at the district level, to the District Health Mission led by the Zilla Panchayat. The DHM will control, guide, and mange all public health institutions in the District. The NRHM will assist in setting up the full time secretariat of the DHS.
The Secretariat of the District Health Society Should have a small but dedicated unit for inter-sectoral co-ordination, which will directly report to the CEO, Zilla Panchayat with regard to.
- District Health Planning, implementation and monitoring.
- Coordination across relevant Departments.
- Management of each flows.
- Financial accounting/Administration.
GOI in 12 national surveys conducted in the decade of 90s established certain facts relating to health sector which needed correction and in short an overhaul of the existing health system. The facts brought out in the survey where
- The Govt. spending on public health had actually come down from 1.33% of the GDP to 0.99% of GDP in one decade.
- The public expectation from the existing health system had increased during the same period
- The rural population had difficulty in accessing the Health care establishments.
- Majority of curative Services were concentrated in urban areas.
- A Medical event in a rural poor family threw it into debt. And some time’s was a cataphrope for the family.
- NRHM was born as a corrective, of which, the following is a part.
- The National Rural Health Mission (2005-2012) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak Public Health Indicators and weak infrastructure.
- The Mission is an articulation of the commitment of the government to raise public spending on health from 0.9% of GDP to 2-3% of GDP
- It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations and promote policies that strengthen public health management and service in the country.
- It has as its key components, (1) Provision of female health activist in each village (ASHA). (2) A village health plan prepared through a local team headed by the health & sanitation Committee of the zilla panchayath. (3)Strengthening of the rural hospital for effective curative care and be made measurable and accountable to the community through Indian public health standards (IPHS). and integration of vertical health & Family Welfare programmes and Funds for optimal utilization of funds and infrastructure and strengthening of quality and delivery of primary healthcare.
- It seeks to define time-bound goals and report publicly on their progress.
- It seeks to improve access of rural people, especially poor woman and children, to equitable, affordable, accountable, quality and effective primary healthcare.
- Train and enhance capacity of Panchayath raj institutions (PRIs) to own, control and mange public health services.
- Promote access to improved health care at household level through the female health activist (ASHA)
- Health plan for each village through village health Committees of the Panchayaths.
- Strengthening sub-centre through an untied fund to enable local planning and action.
- Strengthening existing PHCs and CHCs and provision of 30-50 bedded CHC per lakh population, for improved curative care to a normative standard (Indian Public Health standards defining personnel, equipment and management standards)
- Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition.
- Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision.
- Formulation of transparent policies for deployment and career development of human resources for health.
- Promoting non – profit sector particularly in underserved areas. (PPP)
- Reduction in Infant Mortality Rate (IMR) and Maternal Mortality rate (MMR).
- Universal access to public health services such as child health, adolescent health, women’s health, safe drinking 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.