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PE17.1 | National Health Mission Programs — SDL Guide (Part 3)
Impact, Achievements and Current Gaps
India's MCH indicators have improved substantially since the launch of NRHM/NHM, though the progress is uneven and several targets remain unmet. A balanced assessment of NHM's achievements and limitations is essential for any MBBS graduate who will practise within this system.
Achievements:
The most dramatic gain has been in institutional delivery: the proportion of births occurring in government facilities increased from approximately 40% (NFHS-3, 2005-06) to approximately 79% (NFHS-5, 2019-21) nationally, and over 90% in several southern states. This shift is directly attributable to Janani Suraksha Yojana (JSY) conditional cash transfer for institutional delivery and JSSK free-services guarantees — together removing the financial and geographic barriers that had historically kept rural women from facility delivery. Institutional delivery, in turn, reduced intrapartum mortality and early neonatal deaths substantially.
Full immunisation coverage improved from approximately 44% (NFHS-3) to approximately 76% (NFHS-5), with Mission Indradhanush contributing the majority of the catch-up in high-focus districts. The elimination of polio in 2014 (India was declared polio-free) and progress toward measles-rubella elimination are landmark NHM achievements.
Under-5 mortality fell from approximately 91 per 1,000 live births in 2000 to approximately 32 per 1,000 live births in 2020, and the MMR declined from approximately 300 per 100,000 live births in 2001 to approximately 97 in 2018-20 — on track toward but not yet at the SDG target of <70 per 100,000 LB by 2030.
Persistent gaps and challenges:
• Immunisation plateau: despite Mission Indradhanush, approximately 24% of children remain incompletely immunised (NFHS-5). Hard-to-reach populations — tribal, nomadic, urban slum dwellers — remain systematically uncovered.
• Anaemia: NFHS-5 found that 67% of children 6–59 months and 57% of women 15–49 years were anaemic — a worsening trend compared to NFHS-4, despite WIFS and iron supplementation programmes.
• RBSK DEIC utilisation: many DEICs in high-focus states are under-resourced or non-functional; children detected by RBSK MHTs are not always completing the referral pathway.
• Inter-state disparity: the gap between high-performing states (Kerala, Tamil Nadu, Goa) and high-focus EAG states (Bihar, UP, Rajasthan) in MCH indicators remains large, despite NHM's differential resource allocation.
• Last-mile reach: ASHAs and AWWs, the backbone of community delivery, face workload, capacity, and compensation challenges that affect programme quality.
SELF-CHECK
Under JSSK, which of the following entitlements is available to a sick neonate born in a government facility?
A. Free treatment and drugs up to 1 year of age at any government facility
B. Free treatment, drugs, diagnostics, blood transfusion, and referral transport up to 30 days after birth at government facilities
C. Free drugs only — diagnostics and transport must be paid for by the family
D. Free treatment at the birthing facility only — if transfer to another facility is needed, transport costs are borne by the family
Reveal Answer
Answer: B. Free treatment, drugs, diagnostics, blood transfusion, and referral transport up to 30 days after birth at government facilities
JSSK entitlements for sick neonates include: free treatment, free drugs and consumables, free diagnostics, free blood transfusion if required, free diet for the accompanying mother, and free referral transport — all up to 30 days after birth at government facilities. The 30-day limit corresponds to the neonatal period. Beyond 30 days, other NHM mechanisms (RBSK, RMNCH+A child health component) cover care. JSSK does NOT limit sick neonate care to the birthing facility — referral transport to a higher facility is explicitly included as a JSSK entitlement, which is critical for reaching SNCUs at district hospitals.
Self-Assessment
The following questions are designed to test your ability to recall, distinguish, and apply knowledge of NHM programmes at the level required for NMC exit examinations and for practical functioning as a PHC medical officer. PE17.1 is a knowledge-level competency (KH — able to describe and explain), and the examination standard reflects this: you should be able to name the programmes under NHM that pertain to maternal and child health, describe the target population and key components of each, and contextualise them within India's MCH burden. The questions below progress from identification to application — from naming a programme to explaining why it was needed and what it does. Working through them helps consolidate the large volume of programme names, abbreviations, and targets that this SDL covers, and also demonstrates the connections between the programmes — RMNCH+A → JSSK → HBNC → IMNCI form a single continuum of care, not separate silos.
- List the six NHM programmes described in this SDL (NHM/RMNCH+A, RBSK, RKSK, JSSK, Mission Indradhanush, ICDS) and for each, state: (a) the target population, and (b) one key specific intervention or entitlement.
- Explain the RBSK 4Ds with one example of a condition from each category. What happens after a child is found with a condition at an Anganwadi screening visit?
- What is the RKSK's Weekly Iron and Folic Acid Supplementation (WIFS) regimen for adolescent girls, and what is the public health rationale for targeting anaemia in adolescent girls specifically?
- A PHC medical officer finds that only 55% of children under 2 years in her catchment area are fully immunised despite regular UIP sessions. Which NHM programme should she activate to address this gap, and what specifically does it entail?
- Describe the three major achievements of NHM/NRHM in reducing maternal and child mortality, and identify one persistent challenge that has not yet been adequately addressed.