UPSC MainsMEDICAL-SCIENCE-PAPER-II201120 Marks
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Q22.

Write briefly about key strategies of National Rural Health Mission. Describe the roles and responsibilities of an Accredited Social Health Activist.

How to Approach

This question requires a two-part answer. First, outline the key strategies of the National Rural Health Mission (NRHM), focusing on its objectives and programmatic components. Second, detail the roles and responsibilities of Accredited Social Health Activists (ASHAs), highlighting their importance in bridging the gap between the community and the healthcare system. Structure the answer by first introducing NRHM, then detailing its strategies, followed by a comprehensive description of ASHA’s role. Use examples to illustrate the impact of both.

Model Answer

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Introduction

The National Rural Health Mission (NRHM), launched in 2005 as a part of the overarching National Health Policy, aimed to address the health disparities prevalent in rural India. It was a significant step towards achieving universal access to quality healthcare services, particularly for the most vulnerable populations. NRHM adopted a multi-pronged approach, focusing on improving maternal and child health, strengthening public health infrastructure, and promoting community participation. A crucial component of NRHM’s success was the deployment of Accredited Social Health Activists (ASHAs), community health workers who serve as the first point of contact for healthcare needs at the grassroots level.

Key Strategies of the National Rural Health Mission

NRHM was built upon several key strategies designed to improve rural healthcare. These can be broadly categorized as follows:

  • Strengthening Public Health Infrastructure: This involved upgrading Primary Health Centres (PHCs), Community Health Centres (CHCs), and sub-centres, ensuring adequate staffing, and providing essential equipment and medicines.
  • Improving Maternal and Child Health: Key interventions included Janani Suraksha Yojana (JSY) to promote institutional deliveries, and the Integrated Child Development Services (ICDS) scheme to address malnutrition and early childhood development.
  • Communicable Disease Control: NRHM focused on controlling major communicable diseases like tuberculosis, malaria, and HIV/AIDS through targeted interventions and awareness campaigns. The Revised National Tuberculosis Control Programme (RNTCP) was a key component.
  • Non-Communicable Disease Control: Recognizing the rising burden of non-communicable diseases, NRHM initiated programs for early detection and management of conditions like diabetes, hypertension, and cardiovascular diseases.
  • Human Resources for Health: Addressing the shortage of healthcare professionals in rural areas was a priority. NRHM focused on increasing the number of doctors, nurses, and paramedical staff through training and incentives.
  • Decentralized Planning and Community Participation: NRHM emphasized decentralized planning, empowering local communities to identify their health needs and participate in the planning and implementation of healthcare programs.
  • Accredited Social Health Activist (ASHA) Program: The cornerstone of community-level healthcare delivery, ASHAs were instrumental in bridging the gap between the healthcare system and the community.

Roles and Responsibilities of an Accredited Social Health Activist (ASHA)

ASHAs are community health workers, typically women, selected from and trained within the communities they serve. Their roles and responsibilities are extensive and crucial for the success of NRHM:

  • Facilitating Access to Healthcare Services: ASHAs facilitate access to healthcare services by accompanying pregnant women to antenatal care, ensuring immunization of children, and assisting in referrals to hospitals.
  • Health Awareness and Education: They conduct health awareness sessions on topics like maternal and child health, sanitation, hygiene, and disease prevention.
  • Early Detection and Reporting: ASHAs are trained to identify early signs of illness and report them to the PHC, enabling timely intervention.
  • Distribution of Medicines and Supplies: They distribute essential medicines like oral rehydration solution (ORS) and iron folic acid (IFA) tablets.
  • Maintaining Records: ASHAs maintain records of births, deaths, and disease prevalence in their assigned areas.
  • Anganwadi Coordination: They work closely with Anganwadi workers to ensure the effective implementation of ICDS programs.
  • Community Mobilization: ASHAs mobilize communities to participate in health programs and adopt healthy behaviors.

ASHA Compensation: ASHAs receive a task-based incentive structure, meaning they are compensated for each service they provide. This incentivizes them to actively engage with the community and deliver healthcare services.

Role Responsibility
Community Mobilizer Encouraging community participation in health programs.
Health Educator Conducting health awareness sessions.
Service Facilitator Accompanying patients to health facilities.
Data Collector Maintaining health records at the village level.

Conclusion

The National Rural Health Mission, with ASHAs at its core, has significantly improved healthcare access and outcomes in rural India. While challenges remain, such as ensuring consistent ASHA motivation and addressing infrastructure gaps, the mission’s strategies have laid a strong foundation for achieving universal health coverage. Continued investment in strengthening the public health system, empowering communities, and supporting ASHAs is crucial for building a healthier India. The success of NRHM demonstrates the importance of a holistic, community-based approach to healthcare delivery.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

Additional Resources

Key Definitions

Universal Health Coverage (UHC)
Universal Health Coverage means that all people have access to the health services they need, when and where they need them, without facing financial hardship.
Institutional Delivery
Refers to childbirth taking place in a healthcare facility, such as a hospital or a primary health centre, rather than at home.

Key Statistics

According to the National Family Health Survey-5 (2019-21), institutional delivery rates in India have increased from 41% in 2005-06 to 88.7% in 2019-21, largely attributed to JSY and ASHA’s efforts.

Source: NFHS-5 (2019-21)

As of 2023, there are over 1.04 million ASHAs across India, making it one of the largest community health workforces globally.

Source: National Health Mission Website (as of knowledge cutoff)

Examples

Kerala’s Public Health Model

Kerala’s success in achieving high health indicators, such as high literacy rates and low infant mortality rates, serves as an example of the positive impact of investing in public health infrastructure and community participation, principles aligned with NRHM.

Frequently Asked Questions

What are the challenges faced by ASHAs?

ASHAs often face challenges such as low remuneration, lack of adequate training and support, and difficulties in balancing their healthcare duties with their personal responsibilities. Ensuring their well-being and providing them with adequate resources is crucial for their effectiveness.

Topics Covered

Public HealthSocial MedicineRural HealthNational Health ProgramsASHA Workers