National Health Mission

National Health Mission
Name	National Health Mission
Abbreviation	NHM
Formed	12 April 2013
Preceding	National Rural Health Mission; National Urban Health Mission
Jurisdiction	India
Headquarters	New Delhi
Minister1 name	Ministry of Health and Family Welfare (India)

National Health Mission The National Health Mission (NHM) is a major public health initiative launched in India to strengthen healthcare delivery across rural and urban areas through integrated service provision, infrastructure development, and community engagement. It consolidated flagship programs to address maternal and child health, communicable and non-communicable diseases, and health systems capacity building, aligning with commitments made at Alma-Ata Declaration and targets in the Sustainable Development Goals. The mission operates under the policy framework of the Ministry of Health and Family Welfare (India) and coordinates with state and municipal agencies such as the National Institution for Transforming India and various state health missions.

Background and Objectives

The NHM emerged from the merger of the National Rural Health Mission and the National Urban Health Mission to respond to persistent indicators highlighted in the National Family Health Survey, Sample Registration System, and reports by the World Health Organization and the United Nations Children's Fund. Primary objectives include reducing the Maternal mortality ratio and Infant mortality rate, expanding access to Reproductive health and Child health services, controlling tuberculosis, malaria, and HIV/AIDS through linkages with agencies like the National AIDS Control Organisation and strengthening public health surveillance via collaboration with the Indian Council of Medical Research and National Centre for Disease Control. The mission also seeks to improve health infrastructure in line with standards set by the Indian Public Health Standards and to support human resources in health, referencing recommendations from the Bhore Committee and the High Level Expert Group on Universal Health Coverage (India).

Organizational Structure and Governance

NHM governance is multi-tiered, involving the Ministry of Health and Family Welfare (India), state health departments such as the Department of Health and Family Welfare (Tamil Nadu), municipal bodies like the Bruhat Bengaluru Mahanagara Palike, and autonomous institutions including the National Health Systems Resource Centre and the National Health Mission, Uttar Pradesh. The mission uses contractual cadres such as Accredited Social Health Activists linked to the National Rural Health Mission legacy, and coordinates with professional councils like the Medical Council of India (now National Medical Commission), the Nursing Council of India, and the Indian Nursing Council. Financing and oversight draw on mechanisms associated with the National Bank for Agriculture and Rural Development for rural infrastructure and audit by the Comptroller and Auditor General of India. Policy inputs have been informed by commissions including the Rangarajan Committee and the Yashpal Committee.

Programs and Components

NHM comprises programmatic components such as the Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, and initiatives addressing non-communicable diseases that are linked to the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Maternal and child services integrate with the Integrated Child Development Services and immunisation drives coordinated with the Universal Immunisation Programme and partners like the Gavi, the Vaccine Alliance. Communicable disease control aligns with the Revised National Tuberculosis Control Programme and the National Vector Borne Disease Control Programme. Health systems strengthening includes infrastructure upgrades to Primary Health Centres, Community Health Centres, and integration with tertiary institutions such as the All India Institute of Medical Sciences. Digital health components reference frameworks from the National Health Stack and the Ayushman Bharat Digital Mission.

Implementation and Funding

Implementation follows a federal model with funding shared between the Government of India and state governments, leveraging schemes such as the Mahatma Gandhi National Rural Employment Guarantee Act for allied workforce support and convergence with the Pradhan Mantri Jan Dhan Yojana in beneficiary identification. Financial flows are administered through state health societies and district health societies, with audit and compliance reviewed by agencies like the Central Bureau of Health Intelligence and the Economic Survey of India used for macro-level assessment. Donor collaboration has involved organisations such as the World Bank, the Bill & Melinda Gates Foundation, and bilateral partners including United States Agency for International Development, while procurement systems draw on the Central Government Health Scheme and national drug policies influenced by the National Pharmaceutical Pricing Authority.

Impact and Outcomes

NHM interventions contributed to measurable declines in Maternal mortality ratio and Infant mortality rate as recorded in successive rounds of the National Family Health Survey and the Sample Registration System. Immunisation coverage increases were documented through the Universal Immunisation Programme and partnership reports from UNICEF and WHO. Strengthening of primary care was reflected in upgraded Primary Health Centre infrastructure and workforce deployment, with evaluations by the NITI Aayog and studies published in journals associated with the Indian Council of Medical Research reporting mixed gains in service quality, equity, and financial protection compared with benchmarks set by the High Level Expert Group on Universal Health Coverage (India).

Criticisms and Challenges

Critiques of NHM cite uneven state-level outcomes highlighted in analyses by the NITI Aayog, fiscal sustainability concerns in the Economic Survey of India, and human resource deficits flagged by the Bhore Committee historic comparisons and contemporary assessments by the Medical Council of India/National Medical Commission. Challenges include procurement and supply-chain inefficiencies documented in audits by the Comptroller and Auditor General of India, variable convergence with urban bodies like the Municipal Corporation of Delhi, and difficulties in reaching marginalised populations noted in reports by Oxfam India and the Centre for Policy Research. Disease-specific programs report gaps in integration with initiatives by the National AIDS Control Organisation and the Revised National Tuberculosis Control Programme.

Future Directions and Reforms

Proposed reforms emphasize integration with the Ayushman Bharat ecosystem, expansion of digital platforms consistent with the National Digital Health Blueprint, strengthening public financing in line with recommendations from the High Level Expert Group on Universal Health Coverage (India), and deeper engagement with multilateral partners such as the World Bank and WHO. Policy debates involve legislative options referenced to the National Health Policy, 2017 and institutional changes recommended by the NITI Aayog and panels like the Rangarajan Committee, aiming to address equity gaps, workforce shortages, and resilient systems capable of responding to events such as the COVID-19 pandemic and future public health emergencies.

Category:Health programmes in India