国家卫生使命：未来的影响和教训

Impact and Learnings for future A NITI Aayog Study Conducted by Department of Community Medicine & School of Public HealthPostgraduate Institute of Medical Education and Research (PGIMER)Chandigarh TEAM Technical Advisor Dr Rajesh Kumar, Former Dean (Academics), Professor and Head Principal Investigator Dr Madhu Gupta, Professor of Community Medicine Co-Investigators Dr PVM Lakshmi, Professor of Epidemiology Project Staff Dr Ekta Sharma, Project CoordinatorDr Ruby Nimesh, ConsultantDr Ekta Thakur, Project AssociateDr Aarti Goyal, Project Associate ACKNOWLEDGMENTS This study was carried out with the financial support of NITI Aayog, Government of India, and conductedby Department of Community Medicine & School of Public Health Postgraduate Institute of MedicalEducation and Research (PGIMER) Chandigarh. We gratefully acknowledge the contributions made by the NITI Aayog officers, Dr. V.K. Paul (MemberNITI Aayog), Mr. Alok Kumar, Adviser (Health and Nutrition NITI Aayog), Dr. K. Madan Gopal (Sr.Consultant NITI Aayog), Dr. Nina Badgyain (Consultant NITI Aayog) for showing their interest in thestudy and necessary guidance throughout the study. We also acknowledge our gratitude to the senior residents, PGIMER, Chandigarh, including Dr. GarimaSangwan and Dr. Kirtan Raina, who rendered their help during the period of this study. Special thanks to other research staff of PGIMER Chandigarh including Dr. Adarsh Bansal (Projectofficer) for conducting a systematic review on impact of NHM strategies on reproductive and adolescenthealth,Dr. Shivani Aloona (Research Officer) for conducting a systematic review on impact of NHMstrategies on neonatal and infant health, Dr. Atul Sharma (Project officer) for workingon analysis andcomparison of public sector utilization for health services, out-of-pocket expenditures on hospitalizationof under-five children and delivery cases and associated catastrophic rates using NSSO 60thround and71stround data. DISCLAIMER The Organization Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarhhas received the financial assistance under the Research Scheme of NITI Aayog (RSNA-2018) toprepare this report. While due care has been exercised to prepare the report using the data from varioussources, NITI Aayog does not confirm the authenticity of data and accuracy of the methodology toprepare the report. NITI Aayog shall not be held responsible for findings or opinions expressed in thedocument. This responsibility completely rests with thePGIMER, Chandigarh. CONTENTS LIST OF TABLES LIST OF FIGURES LIST OF ABBREVIATIONS Antenatal CareAuxiliary Nurse MidwifeAcute Respiratory InfectionsAdolescent Reproductive Sexual HealthAdolescent Friendly Health ClinicsAccredited Social Health ActivistAYUSHAyurveda Yoga Unani Siddha and HomeopathyBehaviour Change CommunicationContraceptive Prevalence RateDistrict Level Household SurveyEarly Neonatal Mortality RateExclusive Breast FeedingFacility Based Newborn CareFrontline Health WorkersFamily PlanningHBPNCHome based Post Neonatal CareGross Domestic ProductIntegrated Child Development SchemeInfant Mortality RateIntegrated Management of Neonatal and Childhood IllnessJanani Suraksha YojanaJanani Shishu Suraksha KaryakramLow Birth WeightMaternal and Child HealthMid Day MealMenstrual Hygiene SchemeMaternal Mortality Ratio ANCANMARIARSHAFHCsASHABCCCPRDLHSENMREBFFBNCFLWsFPGDPICDSIMRIMNCIJSYJSSKLBWMCHMDMMHSMMR MMUsMobile Medical UnitsMOsMedical OfficersMOHFWMinistry of Health and Family WelfareNFHSNational Family Health SurveyNHMNational Health MissionNSSONational Sample Survey OrganizationNHPNational Health PolicyNMRNeonatal Mortality RateNRCsNutrition Rehabilitation CentresNRHMNational Rural Health MissionNRHMNational Urban Health MissionOOPEOut of Pocket ExpenditurePHCPrimary Health CentrePNCPostnatal CarePNMRPerinatal mortality RateSBRStill Birth RateSDGSustainable Development GoalsSNCUsSick New-born Care UnitsSRSSample Registration SystemRBSKRashtriya Bal Swasthya KaryakramRHSRural Health StatisticsRKSKRashtriya Kishore Swasthya KaryakramRMNCH+AReproductive Maternal New-born Child and Adolescent HealthTFRTotal Fertility RateU5MRUnder Five Mortality RateUNICEFUnited Nations International Children’s Emergency FundVHNDVillage Health Nutrition DayVHSNCsVillage Health, Sanitation and Nutrition Committee WHOWorld Health OrganizationWIFSWeekly Iron Folic Supplementation INTRODUCTION The National Rural Health Mission (NRHM) was launched in 2005 by the Governmentof Indiathroughout the country, with a special focus on 18 states, to improve the accessibility, affordability andavailability of health care especially to those residing in the rural areas, poor and women. The specificgoals were reducing Maternal Mortality Ratio (MMR) to 100 per 1,00,000 births, Infant Mortality Rate(IMR) to 30 per 1000 births, and Total Fertility Rate (TFR) to 2.1 within seven years of its implementationi.e., by the year 2012, which were later extend