The effect of the National Rural Health Mission on health services and outcomes for childbirth in India: a retrospective analysis of survey data

Abstract

BackgroundPublic health in India is the responsibility of provincial governments. In 2005, the Indian Government launched the National Rural Health Mission (NRHM) to focus on bottom-up planning and flexible funding to address the local needs. We assessed the effect of interventions introduced under the NRHM on childbirth health services and outcomes in states with poor health indicators. MethodsWe extracted data for infant mortality rate and total fertility rate from sample registration surveys done in 2001, 2005, and 2011. We also extracted data for institutional deliveries and availability of infrastructure and human resources from the National Family Health Survey III (2005–06), the Annual Health Survey (2010–11), and Rural Health Statistics (2012). We assessed changes in these data before and after the introduction of the NRHM in eight Empowered Action Group states—ie, states with poor health indicators. FindingsMedian infant mortality rate fell by 14·6% in 2001–06, compared with 20·9% in 2006–11. Likewise, median total fertility rate fell by 10·3% in 2001–06 compared with 14·3% in 2006–11 (appendix). Although the availability of public health facilities changed little (78 305 in 2005, 81 058 in 2012), the availability of nursing staff increased from 10 633 in 2005, to 16 079 in 2012. The availability of auxiliary nurse midwives also rose, from 50 837 in 2005, to 66 001 in 2012. The proportion of institutional deliveries increased from 23% in 2005–06, to 49% in 2010–11. InterpretationThe NRHM provides a model to efficiently provide health care to people in low-resource settings. FundingNone.