Abstract
Background: At the turn of the 21st century, India was plagued by significant rural–urban, inter-state and inter-district inequities in health. For example, in 2004, the infant mortality rate (IMR) was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself) and to facilitate action on other determinants of health, India launched the National Rural Health Mission (NRHM) in April 2005.Methods: Under the NRHM, Rs. 666 billion (US$12.1 billion) was invested in rural areas from April 2005 to March 2012. There was also a substantially higher allocation for 18 high-focus states11States with weak public health indicators and/or weak health infrastructure. and 264 high-focus districts, identified on the basis of poor health and demographic indicators. Other determinants of health, especially nutrition and decentralized action, were addressed through mechanisms like State/District Health Missions, Village Health, Sanitation and Nutrition Committees, and Village Health and Nutrition Days.Results: Consequently, in bigger high-focus states, rural IMR fell by 15.6 points between 2004 and 2011, as compared to 9 points in urban areas. Similarly, the maternal mortality rate in high-focus states declined by 17.9% between 2004–2006 and 2007–2009 compared to 14.6% in other states.Conclusion: The article, on the basis of the above approaches employed under NRHM, proposes the NRHM model to ‘reduce health inequities and initiate action on SDH’.
Highlights
At the turn of the 21st century, India was plagued by significant ruralÁurban, inter-state and inter-district inequities in health
Results and discussion: impact of the National Rural Health Mission The strategies employed under NRHM have led to an improvement in availability of health services/health system strengthening, improvement in health service delivery, and have had a significant impact on health outcomes in the rural areas, the high-focus states, and the high-focus districts in the country
To conclude, it may be said that the NRHM has followed the following model to reduce health inequities and initiate action on social determinants of health (SDH) (Fig. 2): (1) The first step for initiation of action on SDH has been the identification of weak states/districts based on available health indicators
Summary
At the turn of the 21st century, India was plagued by significant ruralÁurban, inter-state and inter-district inequities in health. In 2004, the infant mortality rate (IMR) was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself) and to facilitate action on other determinants of health, India launched the National Rural Health Mission (NRHM) in April 2005. Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited These included differences in the availability of health resources (input), health service delivery, and health outcome indicators. In 2004, the infant mortality rate (IMR) in India was 24 points higher in rural areas (64/1,000 live births) as compared to urban areas (40/1,000 live births) (1). (1) Sample Registration System (SRS) bulletins released by the Registrar General of India (2) Reports of the Coverage Evaluation Surveys (CES) by UNICEF (3) Bulletins on Rural Health Statistics (RHS), StateWise Progress reports, and Common Review Mission reports released by the Ministry of Health and Family Welfare
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