Historical Background/Periodical Development
National Rural Health Mission
Under the mandate of National Common Minimum Programme (NCMP) of United Progress Alliance government, health care is one of the seven trust areas of NCMP, wherein, it is proposed to increase the expenditure in health sector from current 0.9% Gross Domestic Product (GDP) to 2–3% of GDP over the next five years, with main focus on Primary Health Care. The National Rural Health Mission (NRHM) has been conceptualized and the same is being operationalized from April,2005 throughout the country, with special focus on 18 state which includes 8 Empowered Action Group Stastes.
The main aim of NRHM is to provide accessible, affordable, accountable, effective and reliable primary health care, especially, to the poor and vulnerable sections of the population. It also aims at bridging the gap in Rural Health Care through creation of a cadre of Accredited Social Health Activists (ASHA), improved hospital care measured through Indian Public Health Standards (IPHS), decentralization of programme to district level to improve intra and inter–sectoral convergence and effective utilization of resources. The NRHM further aims to provide overarching umbrella to the existing programmes of Health and Family Welfare including Reproductive & Child Health–II (RCH), Malaria, Blindness, Iodine deficiency, Filaria, Kala Azar, T.B., Leprosy and Integrated Disease Surveillance. Further, it addresses the issue of Health in the context of sector–wise approach addressing sanitation and hygiene, nutrition and safe drinking water as basic determinants of good health in order to have greater convergence among the related social sector Departments i.e. Ayush, Women & Child Development, Sanitation, Elementary Education, Panchayati Raj and Rural Development.
The Mission further seeks to build grater ownership of the programme among the community through involvement of Panchayati Raj institutions, Non Govermental Organisations (NGOs )and other stake holders at National, State, District and Sub – District levels to achieve the goals of National Population Policy 2000 and National Health Policy.
RCH – II
India was the first country to launch Family Planning Programme during 1952. The programme was initiated in Maharashtra State during 1956. Initially the programme envisaged hospital based interventions and Local Information Education & Communication (IEC) activities for promotion of Contraceptive Methods. The programme achieved a boost during the third five–year plan, wherein infrastructural inputs were provided. Supportive programmes like All India Post Partum programme (1971), Control of Diarrhoeal Diseases, Community Health Guide (CHG )scheme, Multipurpose Worker (MPW) scheme etc. were introduced during after years.
The programme passed through various phases of expansion or modification. Universal Immunisation Programme (UIP) (1985–86) introduced a programme with systematic delivery of services even at remote places. Child Survival & Safe Motherhood (CSSM) (1992–93) encompassed crucial Maternal and Child Health interventions along with immunization services. International Conference on Population and Development (ICPD) (1994) led towards consideration of holistic and integrated services based on life cycle approach with special emphasis on Reproductive Health.
The concept of RCH is to provide to the beneficiaries need based, client centred, demand driven, high quality & integrated RCH Services. The RCH Programme is a composite Programme incorporating the inputs of Govt. of India as well as funding support from external donor agencies including World Bank & the European Commission. From April 2005, the RCH II Programme implementation started in the State.
Reproductive and Child Health Programme initiated during 1997 intended to provide need based demand driven, integrated and quality services, based on decentralized and participatory planning with the whole hearted involvement of the community. The RCH I did not covered the important aspects of life cycle like adolescent health, 40 plus care, Sexually Transmitted Infections/ Reproductive Tract Infections (STI/RTI). Additional inputs were provided for capacity building, infrastructure development, strengthening supervision and monitoring, strengthening of out reach services and neonatal care as well as involvement of NGOs and Panchayat Raj Institutions (PRI) along with implementation of certain innovative schemes.
The indicator wise status and Goals are as given below
Indicator–wise status and Goals
|MMR||149(MMR in India 1997 –2003 by RG)||100|
|IMR||35(SRS – 2006)||27|
|NMR||24(SRS – 2004)||27|
- Indian Institute of Health and Family Welfare, Hyderabad. There is a large difference between the SRS and IIHFW figure for MMR. This may lead to change in Goals.
- IIHFW – Indian Institute of Health and Family Welfare, MMR–Maternal Mortality Rate.
IMR – Infant Mortality Rate.
NMR – Neonatal Mortality Rate.
TFR – Total Fertility Rate.
SRS – Sample Registration System.
The Components of RCH Programme
- Safe Motherhood Services.
- Child Survival Services.
- Adolescent Health.
- Family Planning.
- 40 + Services.
- Implementation of Preconception & Prenatal Diagnostic Techniques (PNDT) Act.
- Maharashtra State.
Demographic and Administrative Profile
Maharashtra is situated in the western part of India between 15 0 45’ to 22 00 North latitude and 720 45’ to 800 45’ east longitude. The state is rich in its social and cultural heritage. In the 2001 Census, population wise Maharashtra was the second largest state in India after Uttar Pradesh having 9.42% population of the nation, i.e. 9.6752 crores. With an area of 3.08 lakh Sq. Km, the state also ranks second in area after Uttar Pradesh. The state has the highest percentage of urban population i.e. 43.3%, but has very meager public health infrastructure.
According to 1991 census, spread over 15 districts, 9% of the state population is tribal. The districts of Gadchiroli and Nandurbar have highest tribal population at 39% and 41% respectively. The population below poverty line decreased to 25% in 1999–2000 from 36.9% in 1993–94 and 53.2% in 1973–74. Maharashtra is considered as one of the most economically developed states in India. The per capita income of the state increased from Rs.7,612 in 1990–91 to Rs.24,248 in 2001–02 third highest in the country after Punjab & Haryana.
As far as the two key indicators of social development – Literacy and Infant Mortality – are concerned, Maharashtra occupies the second position among the major states, next to Kerala. During the period 1961–2001, the literacy rate for males increased from 49% to 86% and amongst female the rate increased more than three times from 20% to 68% during the same period. In 1999 the IMR for Maharashtra was 48, whereas for Kerala it was 14 (as per National Family Health Survey 2(NFHS).
Demographic indicators of Maharashtra as per census 2001
|Proportion of State Area to Total Area||9.5||100|
|Percentage of state Population to total Population||9.42||100|
|Population Density per Sq.Km.||314||324|
|Sex Ratio 0–6 Years||913||927|
|Female Literacy Percentage||67.51||54.16|
Sex ratio is considered a sensitive indicator of development. Data indicates a decline in sex ratio from 934 in 1991 to 922 in 2001 census. This is a very alarming situation especially since the sex ratio of the country increased from 927 in 1991census to 933 in 2001. The sex ratio of 0 to 6 years age groups has declined from 946 in 1991 census to 913 in 2001 census, indicating a gender bias and poor status of women.
The 35 districts –33 rural and 2 fully urban districts (of Mumbai) are divided into 6 revenue divisions.
There are 41095 villages and 27247 gram panchayats spread over 353 blocks.
There are 22 municipal corporations and 222 municipal councils along with 7 Cantonment boards, which have no organized health infrastructure as per need.
Manpower available at district level
|Maharashtra Medical Health Services (MMHS) Class I||1177|
|MMHS Class II||5075|
|General Staff Services (GSS) Class I||57|
|GSS Class II||384|
|Health Assistant (M)||4642|
|Health Assistant (F)||3586|
|Health Assistant (M)||12646|
|Health Assistant (F)||11915|
|Village Health Guide||44050|
|Trained Traditional Birth Attendant||45681|
Health Infrastructure and facilities
The state has well developed health infrastructure in public sector
- No. of Medical College hospitals – 8.
- No. of District hospitals – 23.
- No. of Rural Hospitals(CHC)/Cottage Hospital– 365.
- No. of Primary Health centers – 1816.
- No. of Sub centers – 10579.
- No. of Primary Health Units – 172.
- No. of Mobile Health Units – 61.
- Urban Health Posts – 285.
- Urban Family Welfare Centers – 81.