Law · Public Policy

Role of National Rural Health Mission in refining the Health care system in India

National Rural Health Mission was introduced as a flagship scheme of Government in 2005-06 to address the Healthcare needs of the rural population of India. It is a holistic and mission mode intervention in the field of health sector by the state. The main objective of this mission is to provide accessible, affordable and quality health care to rural population of the country by improving the household health status. In addition to that, it also emphasizes on community participation through the involvement of Panchayati Raj Institutions(PRI). NRHM has been extended till 2017, looking at the crucial needs of improving general health conditions specifically IMR (Infant mortality rate) and MMR (Maternal Mortality Rate). The main reason behind the idea of NRHM was a range of systemic deficiencies in the health system of the country, these  deficiencies include lack of holistic approach, shortage of infrastructure and human resources, lack of community ownership and accountability, non-integration of vertical disease control programs, non-responsiveness and lack of financial resources. Available literature suggests that the Mission has been successful in some areas, but a few concerns persist.

Importance of Health care

The Alama-Ata Declaration of 1978 emphasized that Health is the Fundamental Right of all individuals.  The Alma Ata Declaration of health has become an important avocation for most of the countries, with a growing concern towards health. The governments of various countries are taking effective steps in the direction of providing primary health care to the citizens. Health sector is very important in the developing countries because the health status, in such countries, is especially very low and population growth rates are high. All the reports of United Nations Development programme (UNDP) have especially emphasized on the improvement in the health status of the population as one of the most important goals for development. (Mahadevia, 2012)[1].

Current Scenario of Health care

According to the reports of Ministry of Health and Family Welfare , the current scenario of Healthcare in India is improving and there have been  substantial improvements in the Health Sector. The implementation of NRHM and NHM has made  universal access of  Healthcare equitable, affordable  and the  healthcare services have become accountable and responsive to people’s need.

The main programmatic components of NRHM  and NHM  include Health System Strengthening in rural and urban areas, Reproductive- Maternal- Newborn- Child and Adolescent Health (RMNCH+A) (RMNCHA+A) – Reproductive, Maternal, Neonatal and Child Health + Adolescent Health and control of Communicable and Non-Communicable Diseases.

The 7th Common Review Mission (CRM) under NHM, was conducted  in 14 States/UTs, namely Bihar, Jharkhand, Odisha, Uttar Pradesh, Jammu & Kashmir, Himachal Pradesh, Arunachal Pradesh, Meghalaya, Nagaland, Andhra Pradesh, Haryana, Karnataka, Maharashtra and Gujarat. The CRM observed increased child survival, population stabilization and utilization of health services, though the progress across States was not analogous. The Infant Mortality Rate (IMR), the deaths of children before age 1 per 1000 live-births, has fallen steadily every year, with an all India average of 42. The Maternal Mortality Ratio (MMR), which measures the number of women of reproductive age (15 to 49) dying due to maternal causes per 1,00,000 live births, has come down to 178, though this is far short of the 12th Five Year Plan target of 100. Availability of drugs has improved at all levels and the robust logistic arrangements for procurement and storage of these drugs are being put in place. An important achievement of NHM has been a considerable reduction in out of pocket expenses from 72% to 60%.[2]

Situations after the launch of NRHM

Outcomes in Maternal Mortality:

In the four southern states, Kerala, Tamil Nadu, Karnataka and Gujarat  fall in the category of Non-High Focus States and Tamil Nadu11 has already achieved the goal of an MMR of 100/100000 live births but, within the group, Karnataka11 lags significantly behind with an MMR of 178/100000 live births. (MOHFW, 2012)

Outcomes in Infant and Under 5 Mortality Rate:

The national infant mortality rate has declined from 57 /1000 live births in the year 2006 to 50 /1000 live births in the year 2009. Of this, the decline in rural areas was more (from 62 /1000 live births to 55/1000 live births). In urban areas, the decline in IMR was from 39/1000 live births to 34/1000 live births. The rate of decline across the sexes, in both urban and rural areas, was the same. At the all India level, in 2012 it  reached an IMR of 44/1000 live births, well short of the goal. (MOHFW, Report of the Working group on NRHM for Twelfth Five Years Plan 2012-2017, 2011)

Outcomes in Total Fertility Rate:

The national TFR[3] was 2.6 in the year 2008. By 2012, it reached  2.4. Nineteen states and five union territories have reached the population stabilization goals of a TFR below 2.1 and/or a crude birth rate below 21 per 1000 population by 2012. Three states are on way for achieving it- Haryana, Gujarat and Assam. Three large viz, Bihar, Uttar Pradesh, Assam, Madhya Pradesh have a TFR above 3.0, which is a matter of concern, but even these three states have shown steady improvements.  (MOHFW, 2012)

To Conclude:

With the advent of NRHM, India has made remarkable achievements in providing affordable healthcare facilities to the rural poor and also added 1.56 lakh health human resources to the health system across the country (up to September 2013). Institutional deliveries in almost all the states show a quantum jump during NRHM period and a majority of the newborn children have been immunized in all the states of India and many more achievements  but there are also some problems and challenges like lack of trained personnel, Participation of Local self-Governing bodies, Utilization of United funds, Public Private partnership, etc. In spite of all these challenges and problems, NRHM has been effective in delivering health care services in rural areas.


  • Mahadevia, D. (2012). Health for all ? is it achivable . Economic and Political weekely .194-204
  • Ministry of Health and Family walfare, (2014). Annual Report. New Delhi: Government of India.
  • MOHFW. (2011). Report of the Working group on NRHM for Twelfth Five year Plan( 2012-2017). New Delhi: Department of Health and Family Walfare, Government of India.
  • MOHFW. (2012). Report of the Working group on NRHM for Twelfth Five year Plan( 2012-2017). New Delhi: Ministry of health and family walfare.

[1] Darshani Mahadevia, Health for all is it achievable ?, Economic and Political Weekly, P-194-204

[2] Annual Report, Ministry of Health and Family Welfare, Government of India, 2014

[3] TFR: Total Fertility Rate

According to the CIA world fact book, the TFR can be defined as “…..the average number of children that would be born per woman, if all the women lived to the end of their child bearing years and bore children according to the given fertility rate at each age.

Formula for calculating TFR= (The sum of the age specific fertility Rates * Number of years in each Age group)/1000

About the Author 


 Sunny is currently pursuing his Masters at Center for Studies in Social Management, Central University of Gujarat. He has done extensive field work in tribal areas of Gujarat on the issues of FRA and MGNREGA. He has also worked on issues of Women Empowerment and Local Governance. Lately, his research interest has spilled over in the issues of Role of PRI (Panchayati Raj Institutions) in health care delivery services in rural areas of Gujarat. Besides that, his papers have been published in National and International Journalsand has presented papers in National and International Conferences. In the past, he was a Columnist in the leading daily- Pakistan Observer. Currently, he is interning with the Model Governance Foundation and Gujarat Environment Management Institute (GEMI), Government of Gujarat.

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