NATIONAL RURAL HEALTH MISSION AS STRATEGIC INTERVENTION
- SIKKIM PERSPECTIVE
TERM PAPER SUBMITTED BY
Ms. Punam Lama Rapgyal PGDM (11-13) (M 201125)
I acknowledge my gratitude to Dr. Vinti Agarwal, for providing me valuable guidance and necessary support throughout the project. I also express my immense gratitude and thanks to Mr. Sonam Wangchuk Barfungpa, Addl Director (Accounts), Govt. of Sikkim for providing me all the necessary information, data and valuable inputs towards this project. I am thankful to my friends who helped me make this study successful.
Mrs. Punam Lama Rapgyal
HEALTH FOR ALL : NATIONAL RURAL HEALTH MISSION AS STRATEGIC INTERVENTION
Chapter I Introduction
1.1 Background 1.2 Objectives of NRHM 1.3 Approaches in implementing NRHM 1.4 Strategies adopted for implementation 1.5 Programme coverage
4 6 7 7 8
Implementation Of NRHM in Sikkim 2.1 The Planning Process 2.2 Organisational Structure 2.3 Budget Allocation 2.4 Implementation & Outcome of Programmes 9 10 11 11 15
Conclusion & Recommendations
CHAPTER I INTRODUCTION
India has registered significant progress in improving life expectancy at birth, reducing mortality due to Malaria, as well as reducing infant and maternal mortality over the last few decades. In spite of the progress made, a high proportion of the population, especially in rural areas, continues to suffer and die from preventable diseases, pregnancy and child birth related complications as well as malnutrition. In addition to old unresolved problems, the health system in the country is facing emerging threats and challenges. The rural public health care system in many States and regions is in an unsatisfactory state leading to pauperization of poor households due to expensive private sector health care. India is in the midst of an epidemiological and demographic transition – with the attendant problems of increased chronic disease burden and a decline in mortality and fertility rates leading to an ageing of the population. An estimated 5 million people in the country are living with HIV/AIDS, a threat which has the potential to undermine the health and developmental gains India has made since its independence. Non-communicable diseases such as cardio-vascular diseases, cancer, blindness, mental illness and tobacco use related illnesses have imposed the chronic diseases burden on the already overstretched health care system in the country. Premature morbidity and mortality from chronic diseases can be a major economic and human resource loss for India. The large disparity across India places the burden of these conditions mostly on the poor and on women, scheduled castes and tribes especially those who live in the rural areas of the country. The inequity is also reflected in the skewed availability of public resources between the advanced and less developed states.
Public spending on preventive health services has a low priority over curative health in the country as a whole. Indian public spending on health is amongst the lowest in the world, whereas its proportion of private spending on health is one of the highest. More than Rs. 100,000 crores is being spent annually as household expenditure on health, which is
more than three times the public expenditure on health. The private sector health care is unregulated pushing the cost of health care up and making it unaffordable for the rural poor. It is clear that maintaining the health system in its present form will become untenable in India. Persistent malnutrition, high levels of anaemia amongst children and women, low age of marriage and at first child birth, inadequate safe drinking water round the year in many villages, over-crowding of dwelling units, unsatisfactory state of sanitation and disposal of wastes...