WORKSHOP ON NATIONAL HEALTH MISSION: ACHIEVEMENTS AND CHALLENGES SEPTEMBER 08-12, 2014 INSTITUTE OF ECONOMIC GROWTH, DELHI Background The millennium marks a paradigm shift in the field of developmental policies and programmes in India. The turn of the century also coincides with a good economic performance of India, though the social and human development indicators of the country leave much to be desired. Given such intricacies, the reciprocity between health and development has now traversed the domain of simple interpretations and has emerged as a fundamental challenge to sustain economic growth and development in India. In fact, it is this recognition of “Health in the process of economic and social development … [that] the Government of India has resolved to launch the National Rural Health Mission [NRHM] to carry out necessary architectural correction in the basic health care delivery system” (NRHM Mission Document 2005-12). The preamble of the NRHM mission document emphasizes on a synergistic approach by relating health to determinants such as nutrition, sanitation, hygiene and safe drinking water. The Mission also aims to revamp the health system (including Indian systems of medicine) by increasing public health expenditure, strengthening health infrastructure, augmenting human resources (medical, technical and managerial), decentralizing action planning, and greater participation of community members in programme activities. Overall, it is expected that such unprecedented efforts could help achieve the goal of improved “availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children” (ibid). The Mission has completed its first phase from 2005-12 and with the inception of the 12th Plan period (2012-17) further strengthening of strategies and approaches is evident. While phase-1 of NRHM has performed well to achieve some of the desired objectives, yet there remains a large unfinished agenda before the Mission. From a policy perspective it is also critical to focus on equity concerns. As such, the health concerns marginalized sections of the population both in rural and urban areas are remarkably similar. This, in part, led to conception of the National Urban Health Mission (NUHM), which along with NRHM is now referred to as the National Health Mission (NHM) of India. NHM initiates with the vision to provide accessible, affordable and quality universal health care, both preventive and curative, which would be accountable and at the same time responding to the needs of the inhabiting population especially vulnerable social segment of the country. In particular, the key objectives include in NHM are as follows: 1 • • • • • • Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as women’s health, child health, drinking water, sanitation and hygiene, nutrition and universal immunization. Prevention and control of communicable and non-communicable diseases. Population stabilization, gender & demographic balance. Access to integrated comprehensive primary health care. Promotion of healthy lifestyles. With the encouraging performance of NRHM, Government of India launches the NUHM covering all state capitals, district headquarters and other cities/towns with a population of 50,000 and above in a phased manner (cities and towns with a population below 50,000 will be covered under NRHM). NUHM envisages to meet health care needs of the urban population with the focus on urban poor, by making available to them essential primary health care services and reducing their out of pocket expenses for treatment. This will be achieved by strengthening the existing health care service delivery system, targeting the people living in slums and converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education etc. The NUHM is emerging as an urgent need to improve health status of urban poor by serving quality health services. Since, according to Census of India 2011, the urban population is 377 million compared to 286 million in 2001. This increase is mainly led by migration, natural increase and inclusion of new areas under urban. The percentage decadal change from 2001 to 2011 of urban population is 34 percent, which is higher than the overall decadal change of population of India (18.3 percent). With increasing urban population, the proportion of poor in urban areas has also increased many folds consequently many of them live in slum areas. With ongoing demographic and epidemiological transition, urban health concerns are received increased research and policy attention. In fact, urban areas are also severely affected by problems associated with maternal and child health. Particularly, the poor households from slum areas are among the unprivileged group as they have fewer resources to allocate for health care services. Several of the public health challenges between poor urban and rural people are common and includes, among others: • • • • Incomplete information and lack of awareness regarding health and health care services Weak public health system to provide primary health care services as several households across slums is deprived of basic health care facilities. Poor housing, sanitation and water management adversely affects the living environment Poor outreach of the private sector Despite, the similar health situation faced by urban poor the policies and health programmes in India have remained more or less rural centric consequently the urban poor remained neglected from better health services. The NRHM launched in 2005 has a key focus on providing the equity health care needs in rural areas and, therefore, the poor section of urban slums dwellers have remained in the periphery of the mission. Thus in the recent past, health care needs of the urban population has received increasing policy attention, especially to improve health and health care utilization by urban poor and other disadvantaged sections by facilitating equitable access to quality health care. 2 Against this backdrop, the aim of this workshop is to assess the performance of the Mission so far and to review the challenges ahead for the NHM. While reviewing aspects of rural and urban health, the workshop will specifically aim to elicit the key concerns that deserve sustained policy focus and concerted engagement within the public health systems and at all levels. CALL FOR PAPERS Institute of Economic Growth (IEG) invites original research papers from researchers and policy practitioners across India for the five-day workshop on National Health Mission (NHM): Achievements and Challenges. The Workshop aims to elicit prominent health concerns and its distributional pattern across Indian states with an emphasis on aspects of urban health. The papers are expected to compare rural-urban disparities and also focus on health concerns across urban slums. The broad thematic areas identified are as follows: • • • • • • • • Mortality and Causes of Death Infant and Child Mortality Epidemiological and Disease Dynamics Nutritional Health and Obesity Maternal and Child Health Child Health and Immunization Adolescent Health Health inequalities and gender gap • • • • • • • • Contraception and Fertility Decline Mental Health Elderly Health and Health Care Urbanization, Migration and Health Water, sanitation facility and Health Environment and Health Review of Health Policies Other Aspects of Urban Health Extended abstracts or draft full papers on the thematic areas, including a title and author’s affiliation, should be submitted by email to [email protected] by 31 July, 2014. IEG will provide 3rd AC return railway fare and local hospitality to the participants during the workshop. We aim to publish selected papers in an edited peer-reviewed volume. Important dates: Deadline for submission of abstracts : 31 July, 2014 Notification for the acceptance: 10 August, 2014 Deadline for submission of full papers: 31 August, 2014 Days of Workshop: 08 – 12 September, 2014 Workshop coordinator: William Joe ([email protected]) Institute of Economic Growth, University of Delhi Enclave, North Campus Delhi 110007 3