Ensuring equitable healthcare for all is crucial for fostering a healthy and flourishing society. A nation free from the financial strain of healthcare expenses and committed to proactive preventive care not only enhances public health but also cultivates a stable population. Providing accessible and fair healthcare is an essential responsibility of government to promote the well-being of its citizens.
The Government of India launched the National Health Mission (NHM) in 2013, encompassing its two sub-missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The NHM envisages achievement of universal access to equitable, affordable & quality healthcare services that are accountable and responsive to people’s needs by supporting States and Union Territories in strengthening their healthcare systems. The main programmatic components include reducing maternal and child mortality, preventing and controlling communicable and non-communicable diseases, and strengthening healthcare infrastructure at both rural and urban levels.
National Rural Health Mission (NRHM)
The National Rural Health Mission (NRHM) is dedicated to delivering quality healthcare to rural populations, with a special focus on vulnerable groups and states such as the Empowered Action Group (EAG) States, North-eastern States, Jammu & Kashmir, and Himachal Pradesh. The mission emphasizes the establishment of a community-owned, decentralized health delivery system, addressing various health determinants like water, sanitation, education, nutrition, and gender equality. The mission aims to bridge rural healthcare gaps through improved infrastructure, increased human resources, enhanced service delivery, and decentralized programs at the district level for tailored, context-specific interventions and resource utilization. The NRHM was launched with a view to shift the focus of public health in the country from a vertical, disease focussed, and programmatic approach towards one that recognises the complex adaptive nature of the health system.
National Urban Health Mission (NUHM)
The National Urban Health Mission (NUHM) aims to enhance the health of the urban population, especially the urban poor and vulnerable sections, by providing access to quality primary healthcare. It covers state capitals, district headquarters, and cities/towns with a population of 50,000 and above (according to the 2011 census) in a phased manner. NUHM focuses on meeting the healthcare needs of the urban poor by reducing their out-of-pocket expenses. This involves strengthening the existing healthcare delivery system, targeting slum dwellers, and aligning with schemes related to broader health determinants like water supply, sanitation, education, etc., led by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development, and Women & Child Development.
Enhanced Focus on Community Well-Being
Government health initiatives play a critical role in fostering public wellness by implementing policies and programs that focus on creating awareness, preventive healthcare, improving access to services, and addressing maternal and child health. NHM support is provided for provision of a range of free services related to maternal, child, and adolescent health, family planning, universal immunization programme, and for major diseases such as Tuberculosis, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy etc., contributing to a healthier population through a comprehensive and multifaceted approach. Some of the key government initiatives under NHM are:
- Ayushman Bharat: The first component involves establishing 1,50,000 Health and Wellness Centres in both urban and rural areas to provide comprehensive primary health care. This includes enhancing existing reproductive & child health and communicable diseases services, as well as incorporating services for common non-communicable diseases such as Hypertension, Diabetes, Oral, Breast, and Cervix cancers. The second component involves Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana (AB PM-JAY), the world's largest publicly funded health assurance scheme, offering INR 5 Lakh per family per year for secondary and tertiary care hospitalization. As of December 20, 2023, around 28.45 Cr Ayushman Cards have been created, with approximately 9.38 Cr added in Jan-Dec 2023.
- ASHAs: A key aspect of the NRHM is the deployment of Accredited Social Health Activists (ASHAs) in every village. These female health activists are selected from the village itself and serve as a vital link between the community and the public health system. ASHAs provide essential counselling to women on birth preparedness, safe delivery, breastfeeding, contraception, and prevention of infections. They mobilize the community to access health services at various centres covering areas like immunization, ante natal check-up, postnatal check-ups, supplementary nutrition, and sanitation. Recognizing the need for institutional support, ASHA relies on women's committees, village Health & Sanitation Committee, peripheral health workers, and trainers for effective functioning. Empowered with knowledge and a drug-kit, ASHAs play a crucial role in community participation, raising awareness on health and its determinants, and facilitating access to health services, acting as a depot for essential provisions.
- Janani Shishu Suraksha Karyakram (JSSK): It ensures that all pregnant women delivering in public health institutions receive completely free delivery, including caesarean sections. This represents a shift towards an entitlement-based approach, providing free drugs, consumables, diagnostics, diet during the stay, blood provision, and transport from home to the health institution. The entitlements extend to sick infants up to one year of age accessing public health institutions. This scheme is uniformly implemented across all States and Union Territories, emphasizing the commitment to providing essential maternal and infant healthcare without financial burden.
- Rashtriya Bal Swasthya Karyakram (RBSK): A Child Health Screening and Early Intervention Services has been launched in February 2013 to screen diseases specific to childhood, developmental delays, disabilities, birth defects and deficiencies. The initiative will cover about 27 Cr children between 0–18 years of age and also provide free treatment including surgery for health problems diagnosed under this initiative.
- National Digital Health Mission: On 15th August 2020, National Digital Health Mission or Ayushman Bharat Digital Mission was announced. The mission issues a Health ID to every Indian, incorporating details such as test results, medical history, doctor visits, prescribed medications, and diagnoses. This portable and easily accessible health account ensures continuity of care, even when patients relocate or consult new doctors. The holistic, voluntary program integrates doctors, hospitals, pharmacies, and insurance companies, establishing a comprehensive digital health infrastructure. As of 22nd December 2023, 50 Cr individuals have Ayushman Bharat Health Account (ABHA) number as their unique health identity, over 1.5 Cr patients have used ABHA-based instant OPD registration service and more than 50 Lakh people are using the ABHA app to manage their health records digitally.
Other major initiatives include implementation of Free Drugs and Free Diagnostics Service Initiatives, PM National Dialysis Programme, Tribal TB Eradication Project, Mobile Medical Units, and more.
Impact and Findings
The NHM has had a significant impact on the health system, enhancing care quality, financial allocation, responsiveness, and accountability. This mission, geared towards increased public health spending, reduced inequity, decentralization, and community involvement, reflects the government's commitment to elevate healthcare. The budget allocation for the National Health Mission increased from INR 28,974.29 Cr in 2022-23 to INR 29,085.26 Cr in 2023-24. Major initiatives under NRHM have brought about substantial improvements in rural health systems, including human resources, program management, infrastructure, community engagement, healthcare financing, and information technology utilization, thereby bolstering the health system's capacity to address maternal and child health, with a focus on reducing infant and maternal mortality rates.
As per the latest report of Special Bulletin on Maternal Mortality released by RGI, Maternal Mortality Ratio (MMR) of India reduced from 103 per 100,000 live births in 2017-19 to 97 per 100,000 live births in 2018-20. India has committed to the UN target for Sustainable Development Goal (SDG) for MMR at 70 per 1,00,000 live births by 2030 and NHP (National Health Policy) 2017 target for MMR less than 100 per 1,00,000 live births by 2020. India has already accomplished the National Health Policy (NHP) target for MMR. Similarly, the Infant Mortality Rae (IMR) has also seen a decline of 6.66% in 2019-20, being 28 per 1000 live births at national level for the year 2019.
The formation of health committees at the village level and patient welfare committees at healthcare facilities, along with the use of information technology such as Health Management Information System and Mother and Child Tracking System, has strengthened community participation and service delivery tracking.
In India, as well as globally, the pursuit of inclusive medical services has become imperative for fostering a healthier society. In the Indian context, initiatives like the National Health Mission (NHM) have played a pivotal role in expanding healthcare accessibility and reducing disparities. The emphasis on inclusive services addresses the unique challenges faced by diverse socioeconomic groups, ensuring that essential medical care reaches all segments of the population. This inclusivity extends to rural areas, where programs like Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana strive to provide financial protection and comprehensive healthcare coverage. Globally, the call for inclusive medical services aligns with the United Nations Sustainable Development Goals, particularly Goal 3 on ensuring healthy lives and promoting well-being for all at all ages. Inclusivity in healthcare involves addressing global health disparities, strengthening health systems, and ensuring that marginalized populations receive adequate medical attention. By exploring and implementing inclusive medical services, both India and the global community aim to create a healthier and more equitable future for all.