Assignment-9 (Blocks 5&6)

Course Code: MHH-103

Assignment Code: MHH-103/AS-9
Maximum Marks: 100
Due Date: October 15, 2023
Answer all the questions

1) Answer the following questions within 1000 words each. (2 20 = 40)

a) Discuss National Rural Health Mission (NRHM) under the following heading
Approaches, Mission, Goals & Objectives

Introduction:
The National Rural Health Mission is a government-aided health insurance scheme that was
launched in 2005 to provide accessible, affordable, and quality health care in the rural areas.
The primary focus of this scheme is on the low-income households in rural areas.
As per the Constitution of India, Article 47 the government must take measures for raising the
level of nutrition and the standard of living of people to improve public health. Thus, the National
Health Mission was launched.
It establishes a community-owned health delivery system through intersectoral convergence with
a special focus on health determinants like water sanitation and nutrition. It established
functional health facilities by renovating and adding new infrastructure, medical equipment,
medicines, and service delivery.

Approaches:
The National Rural Health Mission uses a five-point approach to efficiently deliver the
services by focusing on the following.

1. Communication and awareness

2. Flexible financing

3. Monitoring progress against standards

4. Innovation in human resource management

5. Improvements in the management framework

Mission:

● The thrust of the mission is on establishing a fully functional, community owned,

decentralized health delivery system with inter-sectoral convergence at all levels, to
ensure simultaneous action on a wide range of determinants of health such as water,
sanitation, education, nutrition, social and gender equality.

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 ● focus on Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A)
Services.

Roles and objectives of the National Rural Health Mission

The main goals of NRHM concentrate on the access to inexpensive healthcare

facilities.

Roles

1. To facilitate increased access and utilisation of quality health service in rural

areas.
2. To provide a platform for Panchayati raj and the community to manage
primary health programs and infrastructure.
3. Promoting equality and social justice.
4. To provide preventive health care services in rural areas.

Objectives

1. To reduce MMR (Maternal Mortality Rate) and IMR (Infant Mortality Rate) to
100/1000 and 30/1000 live births, respectively.
2. To minimise anaemia tendencies in women between the ages of 15 and 49.
3. To see a 60% drop in annual malaria fatality.
4. To reduce Leprosy rates to 1/10000 people.
5. To reduce microfilaria prevalence to less than 1%.
6. To decrease disease and injury-related mortality and morbidity.

Eligibility for National Rural Health Mission Scheme

● The targeted beneficiaries are socially backward people that are unable to
access affordable health services in rural areas.
● Any permanent resident of declared rural areas is free to avail of the scheme
benefits. T
● The NRHM aims to serve socially and economically backward states.

Strategies of National Rural Health Mission

● Decentralised village and district-level health planning and management: give more
power and responsibility to the local level so that they can plan and manage their own
healthcare needs. This is done by creating the following:

Village Health and Sanitation Committees (VHS&SCs) and

District Health Management Societies (DHMSs).

Appointment of Accredited Social Health Activist (ASHA)

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 ● Strengthening the public health service delivery infrastructure

This strategy aims to strengthen the public health infrastructure in rural areas. This is done by:

○ building new health facilities,

○ upgrading existing facilities, and
○ providing equipment and supplies.

Grants are provided to states and districts to improve their health infrastructure.

● Mainstreaming AYUSH

AYUSH is a system of traditional Indian medicine. It includes Ayurveda, Yoga, Naturopathy,

Unani, Siddha, and Homeopathy. This strategy aims to integrate AYUSH into the public health
system so that people have access to a wider range of healthcare services.

● Reorienting medical education

This strategy aims to reorient medical education so that it is more relevant to the needs of the
rural population. This is done by introducing new courses and training modules on rural health. It
also involves the provision of scholarships to students from rural areas.

1. Promoting public-private partnerships

This strategy aims to promote public-private partnerships in the health sector. The government
can leverage the resources of the private sector to improve healthcare delivery in rural areas.

Benefits of National Rural Health Mission (NRHM) Scheme

1. provide high-quality medical services and facilities to rural residents.

2. Treatments for both communicable and non-communicable diseases at affordable

rates to the underprivileged people.

3. Health education: Rural residents are more conscious and prioritise addressing
illnesses, hygeine, harmful effects of smoking etc

4. Increased facilities and equipment due to government funding

6. Mobile Medical Units in 459 remote districts that cover medical emergencies in
remote areas.

7. Access to free ambulance services within 30 minutes.

8. Free healthcare for prenatal and postnatal care of pregnant women.

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9. A permanent Accredited Social Health Activist (ASHA) worker resident and
accountable for the village.

10. The efforts of this mission are mainly responsible for the decline in maternal and
newborn mortality.

Important features of National Rural Health Mission Scheme

Following are the important features of the National Rural Health Mission Scheme.

1. Accessible healthcare system

The provision of a high-quality and easily accessible healthcare system for the
underprivileged population living in rural areas is one of the basic services offered by
NRHM.

ANMs (Auxiliary Nurse Midwives), multi-skilled doctors, GDMOs (General Duties

Medical Officers), and staff nurses are among the additional 1.88 lakh health
personnel that have been added.

2. Village Health Sanitation and nutrition committee

It is a committee at village level acting as subcommittee at Gram Panchayat.

Their main objective is to create awareness, survey the nutritional status, nutritional
deficiency (focusing on women and children), and supervise functioning of
Anganwadi centres.

3. Accredited Social Health Activist (ASHA) workers

These workers are trained female community health activists.

These are permanent residents of the village trained to work as interfaces between
public and community health systems.

They are the keystones of this mission, they are the activists who create health
awareness in the rural population.

They counsel the women in prenatal and postnatal care, safe delivery, reproductive
health etc., at the village level.

This mobilises the community and delivers health benefits to the people.

4. Fixed guidelines

The NRHM has set up guidelines and standards of public health at block levels (100
villages), Primary health centre, sub-health centre level, About Accredited Social
Health Activist (ASHA) level.

These indicators will mark the accountability of the scheme and would act as
guidelines for minimum health standards.

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5. Rogi Kalyan Samiti (Patient Welfare Committee)

The committee's members oversee hospital operations and guarantee improved

amenities for the targeted residents covered by NRHM.

To prevent a decline in the standard of patient welfare, the government provides

these committees with financial support.

In contrast, Rogi Kalyan Samitis provides care for locals in all district hospitals, sub-
district hospitals, primary health centres, and community health centres (CHCs).

6. Janani Shishu Suraksha Karyakram

The Janani Suraksha Yojana (JSY) under NRHM seeks to lower maternal mortality
while enticing women to use public facilities for their deliveries. This programme
provides eligible expectant mothers who give birth under the NRHM with financial
aid.

The JSSK (Janani Shishu Suraksha Karyakram) allows qualified women to receive
free deliveries, including those requiring a caesarean section.

They also receive food, blood supplies, and transportation from this programme in
addition to free medications and tests.

7. Health care service delivery

The scheme tried to fill the gaps in human resource requirements in the healthcare
sector by providing healthcare professionals, including doctors, specialists, ANMs,
staff nurses etc., on contract.

Additionally there are Mobile Medical Units (MMU) in 459 districts for emergency
care.

Over 12,000 primary and emergency patient transport vehicles are provided in every
corner of the country within 30 minutes of the call.

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Criticism of the National Rural Health Mission
● adopting a system of Indian public health standards which was the same as being
invested with various limitations.
● largely biased toward reproductive and child health.
● Emphasis was only on purchasing equipment and attaining high standards of
infrastructure development rather than raising the level of overall service provision.

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b) Discuss National Vector Borne Disease Control Programme (NVBDCP) under the
following heading: Goals & Objectives, Strategies and DOTS

Introduction
The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme
launched in 2003-04 to prevent and control vector-borne diseases such as Japanese
Encephalitis (JE), Dengue, Kala-azar, Lymphatic Filariasis, Malaria, and Chikungunya.

○ The NVBDC programme has also been incorporated into the National Rural Health
Mission (NRHM) to improve service availability and access to health care for
people, particularly those living in rural areas, the poor, women, and children.
○ NVBDCP is part of the Technical Division of the Directorate General of Health
Services, Government of India, and is supported by technical experts in public
health, entomology, toxicology, and parasitology of vector-borne diseases.

List of Vector Borne Diseases Control Programme Legislations:

1. National Anti - Malaria programme

2. Kala - Azar Control Programme
3. National Filaria Control Programme
4. Japanese Encephalitis Control Programme
5. Dengue and Dengue Hemorrhagic fever.

Vector-borne diseases (VBDs) are diseases that are transmitted to humans by vectors. Vectors
are living organisms that carry and transmit pathogens. The most common vectors are
mosquitoes, ticks, and fleas, but other vectors include sandflies, lice, and tsetse flies.

○ VBDs are a major public health problem, affecting millions of people worldwide.
VBDs are more common in tropical and subtropical regions. VBDs can be
prevented by avoiding contact with vectors, using insect repellent, and wearing
protective clothing.

These diseases pose major public health problems and hamper socio-economic
development. Generally the rural, tribal and urban slum areas are inhabited mostly by people
of socio-economic groups who are more prone to develop VBDs and are considered as high
risk groups.

Objectives under NVBDCP:

During XI Plan, following objectives were enlisted:

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 ● To prevent mortality due to Vector Borne Diseases namely Malaria, Kala-azar,
Dengue/DHF and Japanese Encephalitis
● To reduce morbidity due to Malaria, Dengue/DHF, Chikungunya and Japanese
Encephalitis Elimination of Kala-azar and Lymphatic Filariasis.
In pursuance to achieve the objectives under NVBDCP, Government of India has taken
various initiatives and set the goal as under
● to reduce the case incidence including morbidity on account of malaria, dengue,
chikungunya and Japanese encephalitis by 50% by 2017,
● to achieve elimination of Kala-azar and lymphatic filariasis by 2015.

general strategies
1. Disease Management (for reducing the load of Morbidity & Mortality)
including early case detection and complete treatment, strengthening of
referral services, epidemic preparedness and rapid response, and preventive
measures like vaccination (for JE) and Annual Mass Drug Administration (for
LF)
2. Integrated Vector Management (For Transmission Risk Reduction) including
Indoor Residual Spraying in selected high risk areas, use of Insecticide
treated bed nets, use of Larvivorous fish, anti larval measures in urban areas
like source reduction and minor environmental engineering
3. Supportive Interventions (for strengthening technical & social inputs)
including Behaviour Change Communication (BCC), Public Private
Partnership, Inter-sectoral convergence, Human Resource Development
through capacity building, Operational research including studies on drug
resistance and insecticide susceptibility, monitoring and evaluation through
periodic reviews/field visits and web based Management Information System

National Anti-Malaria Programme

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Malaria is one of the serious public health problems in India. At the time of independence malaria
was contributing 75 million cases with 0.8 million deaths every year prior to the launching of
National Malaria Control Programme in 1953.
Objective:

● To bring down malaria transmission to a level at which it would cease to be a major

public health problem.

Kala -Azar Control Programme

Kala-azar or visceral leishmaniasis (VL) is a chronic disease caused by an intracellular protozoan
(Leishmania species) and transmitted to man by bite of female phlebotomus sand fly. it is a main
problem in Bihar, Jharkhand, West Bengal and some parts of Uttar Pradesh. In view of the
growing problem planned control measures were initiated to control kala-azar. India is committed
to eliminating Kala Azar from the country by 2023.
Objectives:
The strategy for kala-azar control broadly included three main activities.

● Interruption of transmission by reducing vector population through indoor residual

insecticides.
● Early diagnosis and complete treatment of Kala-azar cases; and
● Health education programme for community awareness.

National Filaria Control Programme

Bancrftian filariasis caused by Wuchereria bancrofti, which is transmitted to man by the bites of
infected mosquitoes - Culex, Anopheles, Mansonia and Aedes. Lymphatia filaria is prevalent in
18 states and union territories. Bancrftian filariasis is widely distributed while brugian filariasis
caused by Brugia malayi is restricted to 6 states - UP, Bihar, Andhra Pradesh, Orissa, Tamil
Nadu, Kerala, and Gujarat.
Objectives:

● Reduction of the problem in un-surveyed areas

● Control in urban areas through recurrent anti-larval and anti-parasitic measures.

Japanese Encephalitis Control Programme

Japanese encephalitis (JE) is a zoonotic disease and caused by an arbovirus, group B
(Flavivirus) and transmitted by Culex mosquitoes. This disease has been reported from 26 states
and UTs since 1978, only 15 states are reporting JE regularly. The case fatality in India is 35%
which can be reduced by early detection, immediate referral to hospital and proper medical and
nursing care. The total population at risk is estimated 160 million. The most disturbing feature of
JE has been the regular occurrence of outbreak in different parts of the country.
Govt. of India has constituted a Task Force at National Level which is in operation and reviews
the JE situations and its control strategies from time to time. Though Directorate of National Anti-
Malaria Programme is monitoring JE situation in the country.
Objectives:
● Strengthening early diagnosis and prompt case management at PHCs, CHCs and
hospitals through training of medical and nursing staff.
● IEC for community awareness to promote early case reporting, personal protection,
isolation of amplifier host, etc.;

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 ● Vector control measures mainly fogging during outbreaks, space spraying in animal
dwellings, and antilarval operation where feasible; and
● Development of a safe and standard indigenous vaccine. Vaccination for high risk
population particularly children below 15 years of age.

Dengue and Dengue Hemorrhagic Fever

One of the most important resurgent tropical infectious diseases is dengue. Dengue Fever and
Dengue Hemorrhagic Fever (DHF) are acute fevers caused by four antigenically related but
distinct dengue virus serotypes (DEN 1,2,3 and 4) transmitted by the infected mosquitoes, Aedes
Aegypti. Dengue outbreaks have been reported from urban areas from all states.
Objectives:

● Surveillance for disease and outbreaks

● Early diagnosis and prompt case management
● Vector control through community participation and social mobilization
● Capacity building

DOTS
Introduction
The National TB Control Programme was started in 1962 with the aim to detect cases earliest
and treat them.
The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly
Observed Treatment, Short Course (DOTS) strategy, began as a pilot project in 1993 and nation-
wide coverage was achieved in 2006.
The Revised National Tuberculosis Control Programme has initiated early and firm steps to its
declared objective of Universal access to early quality diagnosis and quality TB care for all TB

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patients'. RNTCP is being implemented with decentralised services of TB diagnosis through
designated microscopy centres and free treatment across the nation through 4 lakh DOT centres.

WHO announced "DOTS was the biggest health breakthrough of the decade". There
has been a steady global acceptance of DOTS for TB control over subsequent
decades. Since 1995, 41 million people have been successfully treated through this
'Stop TB' strategy.

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2) Write Short notes on the following questions within 500 words each. (10 6 = 60)
a) Empowering Women for Improved Health and Nutrition under National Population
Policy- 2017

b) Flow of Routine Health Information under HMIS

Health Management Information System (HMIS) is a Government to

Government (G2G) web-based Monitoring Information System that has been
put in place by Ministry of Health & Family Welfare (MoHFW), Government of
India to monitor the National Health Mission and other Health programmes
and provide key inputs for policy formulation and appropriate programme
interventions.

HMIS has been utilised in Grading of Health Facilities, identifications of

aspirational districts, review of State Programme Implementation Plan (PIPs),
etc.

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The analytical reports generated through HMIS also provides gap analysis
and evidence based course correction.

HMIS was launched in October 2008. Currently, around 2.25 lakh health
facilities (across all States/UTs) are uploading facility wise service delivery
data on monthly basis, training data on quarterly basis and infrastructure
related data on annual basis on HMIS web portal.

HMIS captures facility-wise information as follows: Service Delivery

(Reproductive, Maternal and Child Health related, Immunisation family
planning, Vector borne disease, Tuberculosis, Morbidity and Mortality,
OPD, IPD Services, Surgeries etc. data) on monthly basis.

Infrastructure (Manpower, Equipment, Cleanliness, Building, Availability of

Medical Services such as Surgery etc., Super Specialties services such as
Cardiology etc., Diagnostics, Para Medical and Clinical Services etc. data)
on monthly basis.

The HMIS Portal facilitates the flow of physical performance from the
Facility level to the Sub-district, District, State and National level using
a web based Health Management Information System (HMIS) interface.

The portal provides periodic reports on the status of the health services
performances and Human Resources and Infrastructure services
facilities available.

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c) Explain the process of Regionalization

The concept of regionalisation of health care follows closely in the footsteps of the regionalisation
process which took place in general administration.
The process of regionalisation of health care helps in assessing the requirements of health care in the
region and then based on that concept a system is evolved, for providing the required health services
considering the available resources..
In the provision of healthcare, the district level is often taken as a region as it is administratively,
functionally, structurally and geographically a distinct entity. As a region, a district provides good
scope for coordination and integration of services not only to health services but to all the allied
services too. It is an established system and delivery of health care s for effective, economical and
successful implementation.

The three-tiered system of the Gram Panchayat, Taluk Panchayat (block level) and the Zilla Parishad
has proved to be the best working system.

ELEMENTS OF REGIONALISATION

The structure of regionalisation consists of three basic components:

i) the demarcation of a region;
ii) presence of a graded hierarchy of services; and
iii) ensuring coordination of services through an integrated authority system.

The process of regionalisation has been introduced to effect better efficiency in the system and with
the intention of a free flow of information and of patients within the region. This includes referral of
patients from the periphery to the centre that is from the PHC to the CHC and then on to the District
Hospital. After the necessary treatment these patients should be able to go back to their villages with
the necessary feedback and follow up of the treatment.

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 a. Coordination within the Region:
For the regionalisation or decentralisation process to be successful, it is necessary that there should be
cooperation between all the levels of the three-tiered system.
The district level is the most crucial in the chain of command of the various departments of the district
which are concerned with the general welfare of the people of the district and the taluks and the
villages. Coordination does not take place spontaneously.
b. Monitoring:
Any system which involves the participation and the cooperation of three different levels of
functionaries and also keeping open channels of communication between all these levels should also
be carefully monitored so that mid-stream corrections can be applied so that the scheme has the right
impact on the people who are to be the beneficiaries, that is the last villager should feel the impact of
the scheme. Monitoring is better done by an agent independent of the functioning of the scheme itself
as otherwise there is a tendency for bias in the interpretation of the results, distribution of resources,
funds etc.
Basis of Regionalisation You also learnt that the district serves very well as the nodal centre for the
regionalisation process. It occupies a central place in the three-tiered system from both sides. It is at
the bottom of the three-tiered system when you consider the three tiers of the Centre, State and
District. It is at the top of the regionalisation three tiers, that is the District, the Taluk and the Village.
This unique feature gives theconcept of regionalisation and has various advantages. Principal among
these is the fact that the ntire governmental administrative machinery too is district based. It is ideal,
therefore, that the health care machinery too follow the same system.

d) Enumerate the Steps involved in monitoring of a health programme.

Monitoring is a routine, continuous inbuilt mechanism to keep track of different activities under
various National Health Programmes. Monitoring helps to detect any deviations from planned
activities in the programmes. Monitoring helps in taking remedial action at the earliest.
many operational factors may affect performance of the programmes and which might not have been
considered during the planning stage of the programmes. Hence monitoring helps to understand these
factors and can accordingly modify the activities to achieve programme goals and objectives.

i) Need for monitoring

ii) Development of monitoring indicator(s)

iii) Choosing numerator and denominator

iv) Goals/objectives

v)

goals and objectives

● Inputs
● Processes and procedures

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 ● Outputs
● Outcomes
● level of efficiency and effectiveness

e) Poshan Abhiyaan (National Nutrition Mission)

POSHAN Abhiyaan, or National Nutrition Mission, is a multi-ministerial convergence mission

that began on March 8, 2018, to improve the nutritional status of children under six, adolescent
girls, pregnant women, and lactating mothers in a time-bound manner using a collaborative and
result-oriented approach.
It is backed by the NITI Aayog’s National Nutrition Strategy, which aims to achieve “Kuposhan
Mukt Bharat,” or malnutrition-free India, by 2022.

The primary goals of POSHAN Abhiyaan are the holistic development and appropriate
nourishment of expectant moms, new mothers, and kids.
The POSHAN Abhiyaan is backed by a National Nutrition Strategy (NNS) prepared by NITI
Aayog in 2017.
Objectives of The POSHAN Abhiyan
Objectives of the POSHAN Abhiyan or National Nutrition Mission are as follows:

○ Address challenges of malnutrition.

○ To contribute to India’s human capital development.
○ Use effective strategies to address nutritional deficiencies.
○ Improving the nutritional & health status of children in India.
○ Encourage nutrition awareness and healthy eating habits for sustainable health
and well-being.
○ Real-time monitoring system powered by ICT.
○ Providing incentives for Anganwadi Workers (AWWs) to use IT-based tools.
○ It focuses on holistic development and adequate nutrition for pregnant women,
lactating mothers, and children.
○ Nutrition counseling is provided to pregnant women and mothers with children up
to the age of two through Integrated Child Development Services (ICDS).

5 Pillars of POSHAN Abhiyaan National Nutrition Mission

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5 Pillars of POSHAN Abhiyaan

Pillar 1 Poshan Abhiyaan ICDS- ○ With the software, the nutritional

status will be monitored.
Common Application Software
○ Workers for AWWs and Supervisors
(CAS) will receive a smart phone.
○ To measure the growth of the infant,
mother, and kid, AWWs and
Supervisors will be given growth
monitoring tools such a
stadiometer, infantometer, and
weighing scales.

Pillar 2 Convergence Action Planning ○ It aims to ensure the convergence

of all MWCD nutrition-related
schemes on the target population.
○ It ensures the convergence of
various programs for all states and
UTs.
○ Setting multiministerial
convergence for specific targets.

Pillar 3 Capacity Building of Poshan ○ Anganwadi workers are

participating in a capacity-building &
Abhiyaan ICDS
learning programs by participating
officials/functionaries through in existing supervisor meetings.
○ The incremental Learning Approach
the Incremental Learning
includes 21 thematic modules for
Approach (ILA) AWWs and Supervisors.

Pillar 4 Jan Andolan (Behaviour Change ○ The Abhiyaan will be managed as a

Jan Andolan with desired public
Communication and Community
involvement.
Mobilisation) ○ A community-based event will be
held once a month to raise
awareness and address issues.

Pillar 5 Performance Incentives ○ Capacity building should be planned

alongside improved service delivery.
○ Front-line workers will be given
incentives for their efforts.
○

Targets of POSHAN Abhiyaan

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The following are the targets of POSHAN Abhiyaan:

Type of Malnutrition and Age Group Annually Reduce

Targets

Stunting in children aged 0 to 6 years: By 2 per-cent

Underweight in children aged 0 to 6 years: By 2 percent

Reduce low birth weight (LBW): By 2 per-cent

Reduce anaemia prevalence among children aged 6 to 59 months: By 3 per-cent

Reduce anaemia prevalence in women and adolescent girls aged 15 By 3 per-cent

to 49 years:

Note: The POSHAN Abhiyaan aims to reduce stunting in children aged 0 to 6 years from 38.4%
to 25% by 2022.

Conclusion
The objective of achieving a malnutrition-free India by 2022 remains unchanged. Continued
proactive measures are required to address India’s long-standing malnutrition and food
insecurity issues through its multi-ministerial convergence mission known as POSHAN
Abhiyaan 2.0 and ensure that its benefits will reach households at the grass-roots level.

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f) Newborn and Childcare Interventions under RMNCH+A Programme

RMNCH+A stands for Reproductive, Maternal, New-born, Child and Adolescent

Health. It is a framework adopted by the Government of India in 2013 to improve the
health and well-being of women and children in the country12.
RMNCH+A was started in 2013 after the Government of India’s “Call to Action (CAT)
Summit” to reduce maternal and child morbidity and mortality1. It also aimed to
address the delays in accessing and utilizing health care services for women and
children23. It integrated adolescent, family planning and nutrition-based
interventions with maternal and child health4.
The RMNCH+A strategy is based on provision of comprehensive care through the five
pillars, or thematic areas, of reproductive, maternal, neonatal, child, and adolescent health,
and is guided by central tenets of equity, universal care, entitlement, and accountability.
The “plus” within the strategy focuses on:
• Including adolescence for the first time as a distinct life stage;
• Linking maternal and child health to reproductive health, family planning, adolescent
health, HIV, gender, and preconception and prenatal diagnostic techniques;
• Linking home- and community-based services to facility-based care; and
• Ensuring linkages, referrals, and counter-referrals between and among health facilities at
primary (primary health centre), secondary (community health centre), and tertiary levels
(district hospital).

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These interventions are selected based on the available scientific evidence
documenting their efficacy and impact on reducing maternal and child,
mortality and morbidity.
The interventions are summarised in the form of ‘RMNCH+A 5×5 Matrix’
specifying five critical interventions in each of the five thematic areas, viz
reproductive health, maternal health, newborn health, child health and
adolescent health.
Additionally, emphasis was also given on five cross-cutting and five HSS
interventions focusing on infrastructure, human resources, supply chain
management and referral transport measures.

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