Approach:

Introduction: Introduce the national health mission and its rural component.

Body: Mention the three-tiered structure of the rural system. Highlight issues and challenges in achieving outcomes of this program followed by giving some achievements.

Conclusion: Suggest further solutions to realise Sustainable Development Goal 3.

Answer:

National Health Mission (NHM) is launched in 2005 to improve access to quality healthcare services for underserved communities, particularly in rural areas, later its scope was expanded to urban areas in 2013.

It has several components such as Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A), a Universal immunisation program, a program for vector-borne disease control, tobacco control, a national mental health program and a general health promotion and disease prevention program.

Focus on rural healthcare was particularly ensured to minimise the urban-rural healthcare gap in India.

 A three-tiered structure of healthcare centres was envisaged:

• Sub centres: Most basic level for providing primary services such as vaccination. These are staffed by trained healthcare workers known as Auxiliary Nurse midwives (ANM) or Male Multipurpose Health Workers (MMPHW).
• Primary Health Centres ( PHCs): Providing more comprehensive primary health services are staffed by a team of healthcare workers including doctors. They provide basic services along with diagnostic ones.
• Community Health Centres (CHCs): Provide secondary and tertiary services including specialised ones such as surgery, obstetrics etc. These require a team of professionals.

Due to the following issues and challenges to the NHM, the outcomes are not substantial:

• Shortage of professionals: a recent health ministry report highlighted a shortfall of 80% of specialist doctors in CHCs overburdening the system.
  1. Doctors don’t prefer to serve in rural areas due to the rise of commercialism, profit-driven motives and to extract returns of heavy investments ( donations ) made for medical education.
• Infrastructure and equipment shortage: a study by the Centre for Policy Research highlighted lack of basic facilities such as running water. Bed density in India is 1.0 compared to the world average of 2.7 per cent as per NITI Aayog’s study in June 2021.
• Inadequate budgetary resources: Funds allocated under NHM are inadequate leading to the inability to provide medicines, services etc. This was also supported by the Journal of Family Medicine and Primary Care.
• Socioeconomic and geographical factors like difficult terrain, remoteness, poverty and lack of awareness inhibit access to healthcare among people.
• Lack of data collection, management and analysis inhibiting the development of region-specific solutions.
• Corruption in government facilities with the mindset of treating larger masses with disrespect such as in labour rooms, thus LaQshya program has been introduced to improve quality in labour rooms.
• Limited focus on preventive healthcare in the overall mission.

However, there have been certain achievements of NHM:

• Increased access to basic services such as essential medicines has also been supported by a World Health Organisation study.
• Improved maternal and child health outcomes in India since the rollout of NHM such as reduced Maternal mortality rate from 167 in 2011-12 to 130 in 2014-16 as per sample registration system data.
• Increased points of delivery from 2,243 in 2005 to 15,494 (a rise of 591 per cent) in 2020.
• New facilities have started such as more than 5 lakh Ayushman Bharat Health and Wellness Centres have been built. Preventive healthcare is also part of these centres.
• Reduction in out-of-pocket expenditures as claimed by the Health Ministry that the proportion of those seeking care from public health facilities increased from 3% to 32.5% in rural areas from 2014 to 2017.

There is a long way to go to achieve Health for All in rural India. This requires -

• an increase of public health to 2.5-3 per cent of GDP as was supported by the economic survey 2020-21.
• Dedicated efforts towards promoting innovations such as utilising private sector expertise ( as mentioned by health policy in 2017),
• increasing the use of technology through efforts like the National Digital Health mission and the use of telemedicine,
• focussing on preventive healthcare supplementing them with traditional medicine like AYUSH.

We should ensure a change in paradigm to create a healthy India alongside fulfilling our Sustainable Development Goal (SDG 3) commitments.