The government will expand the scope of the NRHM to all towns and cities, by converting it into a National Health Mission (NHM), Prime Minister Manmohan Singh announced on Wednesday.

In his Independence Day speech from the ramparts of the Red Fort here, he said the government was also formulating a new scheme for distribution of free medicines through public hospitals and health centres.

The NHM would be launched in a couple of years by merging the National Rural Health Mission and the National Urban Health Mission (NUHM), which is likely to be put into place early next year.

“After the success of the NRHM, we now want to expand the scope of health services in our towns also. The National Rural Health Mission will be converted into a National Health Mission which would cover all villages and towns.”

The NRHM, a flagship scheme of the Congress-led UPA government, was launched in 2005 to provide better health services in remote and rural areas.

“Today this Mission is being implemented with the help of 10 lakh health personnel, including 8.5 lakh ASHA workers,” Dr. Singh said. The Accredited Social Health Activists are local women trained to act as health educators and facilitators in the community.

The then President, Pratibha Patil, made these announcements earlier, in her address to the joint session of Parliament in March. She said the government would endeavour to increase both Plan and Non-Plan public expenditure at the Centre and in the States taken together to 2.5 per cent of the Gross Domestic Product (GDP), by the end of the 12th Plan period.

The government credits the NRHM with a number of successes and made a strong case for launching the NUHM to cover towns and cities with a large slum population. Since 2005, the infant mortality rate had declined from 58 per thousand live births in 2005 to 47 in 2010 and maternal mortality from 254 per one lakh deliveries in 2004-2006 to 212 in 2007-2009. The Janani Suraksha Yojana registered impressive gains with 1.13 crore women benefiting during 2010-11.

Thrust on urban areas

In its proposals to the Planning Commission, the Ministry of Health and Family Welfare said the NUHM would be taken up as a thrust area under the 12th Plan and launched as a separate mission for urban areas with the focus on slums and the urban poor. It will cover 779 cities and towns with a population of more than 50,000 each, including the megacities of Mumbai, New Delhi, Kolkata, Chennai, Bangalore, Hyderabad and Ahmedabad.

The budget allocation for the mission is envisaged at Rs. 30,000 crore which will be invested in recruitment of health professionals, creation and upgrade of infrastructure and strengthening of the health care service delivery system.

The NUHM will cover the entire urban areas (including the general population, and listed and unlisted slums), but outreach services will be targeted at slum or slum-like areas and other homeless people, street vendors, railway and bus station workers, street children, and construction site workers. Inter-sectoral convergence will be planned among the Jawaharlal Nehru National Urban Renewal Mission, the Rajiv Awas Yojana and the NUHM, according to the proposal.

Primary care

At the primary care level, one Urban Primary Health Centre will be established for every 50,000-60,000 people.

At the community level, outreach services will be provided to urban poor slums with the help of Urban Social Health Activists (USHA) — one for every 200-500 households — and activists from the Mahila Arogya Samiti (one for every 50-100 households). No sub-centres are proposed but communisation will be made possible through the Mahila Arogya Samiti and the Rogi Kalyan Samiti, while secondary and tertiary level services will be provided through public or empanelled private providers.

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