health Fans

Iepaatt cf itae
minq (ommunit IHealt. entres I

hed 24 hrt hst relenal nt s tlavel

itast at latie
M.t.tle Mestic al

staff h y tal 0|L000 lve

Fate rehir
edts
oo00 obirtha
tart titlalty talo eduet
la
Maletiial stahty e lta
cate tehac redelon
Idal feiliny h0L by 2010
mwtaity tate
Malaria
iotaltyvate redu
on 00% by 2010 and
Kala atat eunationuntil P0
a1ataniiy
tate (educion 0% by 2010, H0,
ilala hofilarta
ehmnaton by 20T
hy 0 # a l teducion S0% by 2010 and
tate
Abpitol Tengn iinlaltylevel inil 20P
alany atthat
mortality rate edutlo.
Japanee encephaltis hat level until 20p 50%,
Iy 00) and suatalntng at
(ataracl operatlon inereasng to do lakhs per year hy

Leprosv prevalence tate veduce om TN/T0,000 in

herealter
005 to lens than l/10,000
ubeculonin DTS services alntaln NI' cue .
Ihoughentre misslonperlod
Aha

Uparading community health centres lo Indian Publ

ealth Standarda
Iveane utileatton of Frst Reteral Units (rom less than
0O%o75%
Lngagnu 250,000 lemale Accredited Socal Heall,
Ativiats (ASHAR) In 10states.
RATCOMNIUNITYLEVEL
Avalability ol iained communlty level worker at village
level, with a dug lkit lor general ailments
lealth Dav at anganwadi level on a fixed day/month
lor proviskon ot immunization, ante/post-natal check.
s and services related to motherand child healthcare
inchuding utition.
Avalablity of qenerle dugs for common ailments at
ynentatk the jgtamte All wetieal health and Nub cente and hospital level.
n wlare jNINanmex al atisttet level will terte ino one Good hosoital care through assured availability of
t | t ealth Mixxi and at stale level into
doctors, duqs and qualityservices at PHC/CHClevel
-iale alth Mii There wtll e ovixon of a "mobile
beat tixtwt levvl hu impwl outeach services lmproved acess to niversal immunization through
induction of auto disabled syringes, allenate vaccine
Nite aln w ent ot health seveN ae eng delivery and improved mobilization services under the
Ogranme,
nen the jinate v hu ax jat of the Hinitiatives Impoved facilites tor institutional delivery through
Mathue eflthv healtth vate telverv sstem. Thus
provision of reteral, transport, escort and improved
ethe Ai HlNaitne etet, ant enseavalab1litv ot hospital care subsidized under the Janani Suraksha
tie anN cutativ vNn tive and hikt health servives Tojana for the belowpoverty line tamilies.
Availability of assured healthcare at educed financial
le isk through pilots of Community Health Insurance
yetentation of ma Nents ot under the mission.
Povision of household toilets.
June 005
lmproved outreach services through mobile medical
unit at district level.
Selectionof ASHA
atial NS
ASHA must be the resident of the village a woman
(maried widow dvored) preferably in the age group of
 with
CommUnicaion (omalskillsedutabon ) to 407
Atequat representation
(rom the nd
ledershipenhth ass Role nd
disadvantaged
be ensured to
serve
nom of selecion suh qualites inteaation with Anqanwadi (38)
1he
,
qenetal
Iubal, hilly
w oOs belter
will be population
and desel one ASHA
Ahganwadi woker twill guide ASHA in performing
following
month OnActivities day,
(a) Oranizing Health Day onceltwie
ASHA er
t least 40 per cent of
can lbe
tion areasThein thethelarqetnormis fortocouldselect
habilaASHAS l000be hildren fromhealth the womnen adolescent grls and
the villaqe will bo rmobibed for ortentahon on
health related issues uh as importance of nutitios food.
seleled oneand traned first vear Rest of
Atpresent about Dersonal hygiene, core during preqnan. importanre of
hndvea
.eedond
ae being lac uring second and
trained (6) ASHAs have been antenatal chek un an institutional delivery. home renedtes
minor
holeandresponsibility of ASHA already will informailment
Days at
and importance of irmrnunization etc AWWs
ANM to participate and quicde orqanizing the HHealth
ASHA will| be a health anganwadi
resource persons for centre, (b) AWWs and ANMs will acl as
awareness on
health.activistHerin the community who will
the training of ASHA, () IHC activty
through display of posters. folk dances etc on these days
1 ASHA will 1ake steps to
information to the
responsibilities
create
will be as be undertaken to sensitizethe
ISSues beneficiartes on health
can
(d) Anganwadi worker will be depot holder forrelated
druq
onawareness and provide
kits and will be issuing it to
such as
nutrition,community
basic determinandants of health
ASHA The replacenent of the
Consumed drugs can also bedone through Aww, (e)AWW will
practices, healthy
living
information on existing and sanitation hygienic
workingand thecondi
update the list of eligible couples and also the children less
than one year of age in the village with the help of
ASHA, and
health services,
needtions,
timely utilization of () ASHA will support the AWW in
health family mobilizing pregnant and
2 She will counsel womenand
for lactating women and infants for nutrition supplement. She
importance of
safe
on birth welfare services. would also take initiative for brinqing the beneficiaries fron
complementary delivery, preparedness, the village on specific days of immunization. health check-ups/
and prevention feeding,
of breast-contraception
immunization,
reproductive tract common infections including
feeding and health days etc. to anganwadi centres
Role and integration with ANM (38)
infection and care of the
3. ASHA
will
mobilize
the
infectyoungion/child.
sexually transmit ed Auxiliary Nurse Midwife (ANM) will quide ASHA in
performing following activities : (a) She will hold weeklyl
in accessing health and community and facilitate them
at the anganwadi/sub- health related services
fortnightly meeting with ASHA and discuss the activities
available undertaken during the week/fortnight. She will guide her in
has
immunization,
check-up,
-centre/primary
ante natal health centres,
check-up, post natal
case ASHA had encountered any problemn durinq the

supplementary
euices being provided by nutrition, sanitation and other
the government.
performance of her activity: (b) AwWs and ANMs will act as
resource persons for the training of ASHA; (c) ANMs will
She will work with the inform ASHA regarding date and time of the outreach session
the gram village health toand sanitation
4. and will also guide her for bringing the beneficiary to the
committee of
panchayat
comprehensive village health plan. develop a outreach session; (d) ANM will participate and guide in
organizing the Health Days at anganwadi centre; (e) She will
5. She will arrange
d children escort/accompany
requiring
ost pre-identified health
pregnant
treatment/admission towomen
the
take help of ASHA in updating eligible couple register of the
village concerned; (f) She will utilize ASHA in motivating the
facility i.e. primary health pregnant women for coming to sub-centre for initial check
centre/community health centre/First Referral Unit. ups. She will also help ANMs in bringing married couples to
, ASHA will provide primary
medical care for minor sub-centres for adopting family planning: (g) ANM will guide
ailments such as diarrhoea, fevers, and first-aid for ASHAin motivating pregnant women for taking full course of
minor injuries. She will be a provider of iron and folic acid tablets and tetanus toxoid injections etc.
observed treatment short-course (DOTS) under directly
revised
(h) ANMs will orient ASHA on the dose schedule and side
national tuberculosis control programme. effects of oral pills; (i) ANMs will educate ASHA on danger
7 She will also act as a depot holder for essential signs of pregnancy and labour so that she can timely identify
and help beneficiary in getting further treatment; and
provisions being made available to every habitation like (i) ANMs will inform ASHA on date, time and
place for
oral rehydration therapy, iron folic acid tablet, and periodic training schedule. She will also ensureinitialthat
chloroquine, disposable delivery kits, oral pills and during the training ASHA gets the compensation for
condoms etc. Adrug kit will be provided to each ASHA. performance and also TA/DA for attending the training.
Contents of the kit will be based on the
recommendations of the expert/technical advisory Monitoring and evaluation of ASHA's work
group set up by the government of India, and include Government of India has set up following indicators for
both AYUSH and allopathic formulations. monitoring ASHA. (38)
8 Her role as a proider can be enhanced subsequently.
States can explore the possibility of graded training to 1. Process Indicators :
her for providing newborn care and management of a (a) Number of ASHAs selected by due
process;
range of common ailments, particularly childhood
(b) Number of ASHAs trained; and
illnesses.
9 She will inform about the births and deaths in her (c) % of ASHAs attending review meeting after one year.
village and any unusual health problems/disease 2. Outcome Indicators
outbreaks in the community to the sub-centre/primary
health centre. (a) % of newborn who were weighed and families
10.She will promote construction of household toilets counselled;
under total sanitation campaign. (b) % of children with diarrhoea who received ORS,
 405
TABLE 10 NATIONAL RORAL |LAUH MISSION
187(o 2000
pieventabl
theInlasttensifewficattoiona siqniicant
contributed immunization Droqranme
has
in
decline in Inlant Mortality Rateafter
1987 2009 % Decline 1990 as years. Thelodecline is particularly pronounced
28257 741
3.480
97.38 declined bycompared earlier yers.
11 points to 80 per thousand Durinq that year IMR
live births (30)
12952 732
13.780 55,074 b6.38 NATIONAL RURAL HEALTH MISSION
925
247,519 40,840 83.51 Recogni
economic
life of its
z
anding the Idevelopment ofandhealth
social importance to in the process
improve the quality of
of

immunization. government of India

citizens, the
hral iealth Mission" governnment of India
launched "National
of 7 years (NRHM)on Sh Anril 2005 for a period
rOutine
ProQTamme
che2 Sate
o f (a)
Implementation Plan (PIP)
Support for alternate vaccine
(2005-2012).
health care delivery system.The Imission seeks to improve
is operational
rural
in the whole
. :
sub-centre and outre ach Country with special (ocus on 18 statos viz
2S
sessions: Group states 8Empowered Achon
Utar Pradesh,(Bihar, Jharkhand, Madhya Pradesh, Chattisga
to
imanpower to carry out inmmunization
,

states (Assam, Uttaranchal,

.ntird
urbanslums
and underserved areas, where Orissa and Rajasthan).,8 North East
defhcient:
(c) Mobility support to district Arunachal
Mizoram, Nagaland, Sikkim and Pradesh. Manipur, Meghalaya.
as(d)per
state plan for monitoring and
and Jammu and Kashmir. By Trinura) Himachal Pradesn e

Review meeting at the state level making necessary changes i

basic health care delivery system the mission
monthlyintervals; (e) Training of ANM, adopts a synergi
approach by relating health to
handlers,
mid-level managers, refrigerator of nutrition, sanitation, hygienedeterminants
and safe
of good health viz.
Supportfor mobilization of children to brings the Indian system of medicinedrinking water. t ip
n sites by ASHA, women self-help groups
mainstream of health care (6). (AYUSH) to the
immunization cards, monitoring sheet,
of
Printing inventory charts
in
vacCine
etc. The main aim of NRHM is to provide accessible,
- chart government will support in supplies of attordable, accountable, effective and reliable primary health 25
+ central care, and bridging the gap in rural health care througn in
non. syTinges,
downsizing the BCG vial from 20
sable ensurethat BCG vaccine is available in Creation of a cadre of Accredited Social Health Activist 1

dosesto sites. strengthening and maintenance (ASHA). The mission will be instrument to integrate multiple
10 session il
niation.
SUstemin
the states, and supply of vaccines vertical programmes alongwith their funds at the district level.
chain. The programmes to be integrated are existing programmes o1
d
n evan. health and family welfare including RCH Il; national vector
POLIO
IMMUNIZATION PROGRAMME borne disease control programmes against malaria, filaria, ill
Immunization Programme was launched in the kala-azar, dengue fever/DHF and Japanese encephalitis;
Polio 1995 Under this programme children national leprosy eradication programme; revised national ne

inthe
year
are given additional oral polio drops in
tuberculosis control programme; national programme for
of age on fixed days. Since then control of blindness: iodine deficiency disorder control
eyearsJanuaryevery year to
and in the incidence of poliomyelitis. programme, and integrated disease surveillance project (6).
significant decline polio
er de
e success of the eradication programme, the PLAN OF ACTION TO STRENGTHEN INFRASTRUCTURE
cthe elimination are measles and neonatal
diseasesfor page 188 1. Creation of a cadre of Accredited Social Health Activist
C.;
reter to de
details please
Eor (ASHA). ger
HEPATITIS-B VACCINE
CTIONOF 2. Strengthening sub-centres by : (a) Supply of essential ify
introduction of Hepatitis-B vaccine drugs both allopathic and AYUSH to the sub-centre;
projectfor the nd
Immunization Programme was initiated in (b) In case of additional outlay, provision of jal
ational
project Hepatitis-B vaccine is being multipurpose worker (male)/additional ANMs wherever 1at
2 Under this along with the primary doses of DPT needed, sanction of new sub-centres as per 2001 for
eredtto
infants
and 14th week. Additional one dose of population norm and upgrading existing sub-centres;
n6th, 10th for institutionalI deliveries. The project
givenatt birth and (c) Strengthening sub-centres with untied funds of
metropolitan cities as
aonted in 33 districts and 15 Rs. 10,000per annum in all 18 states.
was expanded to all
ert. Later on, the programme
Andhra Pradesh, Himachal 3. Strengthening Primary Health Centres : Mission aims at for
-tof 10states namely
Maharashtra. strengthening PHCs for quality preventive, promotive,
Karnataka, Kerala, Madhya Pradesh, curative, supervisory and outreach services through
amil Nadu, West Bengal and Jammu & Kashmir.
supported by GAVI (3). (a) Adequate and regular supply of essential drugs and
nsion is partially equipment to PHCs (includingsupply of auto-disabled
CTION OF JAPANESE ENCEPHALITIS VACCINE syringes for immunization); (b) Provision of 24 hours
-ogramme was introduced in 2006 to cover 104 service in at least 50 per cent PHCs by including an
districts in phased manner, using SA 14-14-2 AYUSH practitioner; (c) Following standard treatment
ported from China. Single dose of JE vaccine was guidelines; (d) Upgradation of all the PHCs for 24 hours
ilchildren between 1 to 15 years of age through referral service and provision of second doctor at PHC lies
13). The JE vaccine is being integrated into routine level (one male and one female) on the basis of felt
ion in the districts where campaign had already need; strengthening the ongoing communicable disease
ducted to immunize the new cohort of children by control programmes and new programmes for control
gwith single dose at l6-24 months (3). of non-communicable diseases.