PE17.1 | National Health Mission Programs — Summary & Reflection

KEY TAKEAWAYS

The National Health Mission (NHM, 2013) integrates NRHM (rural, 2005) and NUHM (urban, 2013) under a single umbrella to reduce maternal and child mortality and improve essential health services across India. The RMNCH+A strategic framework organises interventions along a life-course continuum across five areas: reproductive health, maternal health (JSSK entitlements), newborn care (HBNC, SNCUs), child health (IMNCI, RBSK, immunisation), and adolescent health (RKSK). RBSK screens all children 0–18 years for the 4Ds (Birth Defects, Diseases, Deficiencies, Developmental Delays) via Mobile Health Teams, with referral to District Early Intervention Centres (DEIC). RKSK targets adolescents 10–19 years through Adolescent Friendly Health Clinics (AFHCs), WIFS (weekly iron-folic acid for anaemia prevention), peer educators, and ASHA Facilitators. JSSK provides free delivery, drugs, diagnostics, blood, transport, and diet for all pregnant women and sick neonates (to 30 days) at government facilities. Mission Indradhanush (2014) is an intensified catch-up immunisation campaign targeting children <2 years and pregnant women with missed vaccines, aiming for ≥90% full immunisation coverage — progress includes rising from ~44% (NFHS-3) to ~76% (NFHS-5). ICDS (1975, now under NHM) delivers nutrition, immunisation, health checks, and preschool education through over 14 lakh Anganwadi Centres. Achievements include IMR decline from 66 to 28/1,000 LB, MMR decline from ~300 to ~97/100,000 LB, and polio elimination (2014). Persistent gaps include anaemia (67% of children 6–59 months in NFHS-5), incomplete immunisation (~24%), RBSK DEIC utilisation gaps, and EAG state disparities.

REFLECT

Return to the hook scenario: the 23-year-old tribal woman at 28 weeks with anaemia, hypertension, and two previous neonatal deaths, who received no ANC visits. Under NHM, her entitlements are clearly defined: JSSK covers her delivery; RMNCH+A mandates four ANC contacts; ASHA should have made antenatal home visits; MCP card should document her pregnancy. None of this happened. Reflect on which specific failure in the NHM delivery chain led to this outcome — was it ASHA capacity, facility distance, social barriers to care-seeking, or programme knowledge gaps at the PHC level? Now consider: if this woman's next child is born alive and requires HBNC visits, who is responsible for those visits, what do they cover, and how do they connect to the IMNCI risk stratification framework you learned in this cluster? Finally, if the child is detected at 18 months to have developmental delay during an RBSK Anganwadi visit, what is the specific referral pathway and what free services are available? Trace the full NHM care pathway from this mother's antenatal period to her child's developmental screening, naming the specific programme, worker, and entitlement at each step.