Public Health being a State subject, the primary responsibility to provide health care facilities lies with the State Governments. To address the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was launched in 2005 to supplement the efforts of the State/UT governments to provide accessible, affordable and quality healthcare. The National Rural Health Mission (NRHM) has now been subsumed under the National Health Mission (NHM) as its Sub-Mission, along with National Urban Health Mission (NUHM) as the other Sub-Mission. Under NHM, support is being provided to States/ UTs for strengthening of their healthcare systems including support for setting up and or renovation/up-gradation of public health facilities including on basis of “Time to care norm” in hilly and desert areas, Human Resources etc. based on requirements posed by the States in their Programme Implementation Plans. Under NHM, so far support has been given for 2.89 lakhs additional HR, 30805 new construction and 32856 renovation/upgradation works and 1106 Mobile Medical units for taking healthcare to the doorsteps of the population in rural and hard to reach areas.
To improve the availability of critical manpower to provide services in public health facilities in rural areas, financial support is provided to States under NHM, inter-alia for giving hard area allowance to doctors for serving in rural and remote areas and for their residential quarters, so that doctors find it attractive to join public health facilities in such areas. In order to encourage the doctors to work in remote and difficult areas, the Post Graduate Medical Education Regulations, 2000 has also been amended to provide:
(i) 50% reservation in Post Graduate Diploma Courses for Medical Officers in the Government service who have served for at least three years in remote and difficult areas; and,
(ii) Incentive at the rate of 10% of the marks obtained for each year in service in remote or difficult areas up to the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.
To remove financial barriers to improve access healthcare, States are being supported to provide large number of services fee of cost to those who access public health facilities. Some key services included are as follows:
- Maternal Health services,
- The Universal Immunization Programme (UIP) that provides immunization against 7 vaccine preventable diseases and free TT vaccination,
- Pulse Polio Immunization [PPI],
- Family Planning supplies and services,
- Child Health services that include both Home Based and facility based New born Care,
- Communicable diseases services:
- Investigation and treatment for Malaria, Kala azar, Filaria, Dengue, JE and Chikungunya,
- Detection and treatment for Tuberculosis
- Detection and treatment for Leprosy,
Besides the above, under the national initiative of “Janani Shishu Suraksha Karyakram” (JSSK), every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions. The entitlements includes free drugs and consumables, free diagnostics, free diet, free blood wherever required, free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements are in place for sick infants up to one year of age and cases of ante natal and post natal complications as well.
Under the national initiative of Rashtriya Bal Swasthya Karyakram (RBSK), support is being provided to States/UTs for Child Health Screening and Early Intervention Services through early detection and early management of common health conditions classified into 4 Ds i.e Defects at birth, Diseases, Deficiencies, Development delays including disability. Treatment including surgeries at tertiary level is free of cost under this initiative.
Support under NHM is also provided to States to provide free essential drugs and free essential diagnostics in public health facilities under the NHM – Free Drugs Service and NHM – Free Diagnostic Service.
Under the Rastriya Swasthya Bima Yojana (RSBY) free hospital care upto Rs 30,000 is provided to poor and vulnerable families.