National Rural Health Mission Milestones

National Health
Mission
Dr.S.Sujatha M.D.,D.P.H.,
Assistant Professor
Department Of Community Medicine
Chengalpattu Medical College.

Milestones
1992 – Child Survival and Safe Motherhood
(CSSM)
1997- RCH I phase
2005 – RCH II phase
(2005-2012) - National Rural Health Mission
 Feb 2013 – RMNCH+ A Strategy
May 2013 – National Health Mission
June 2014 – India Newborn Action Plan (INAP)
4/29/2018 2Chengalpattu Medical College

NATIONAL RURAL HEALTH MISSION
(2005-2012)

NRHM
National Rural Health Mission (NRHM) was
launched at the National Level in April
2005 for a period of seven years (2005-
2012) .

Plan of Action-Components
 1)ASHA
 2)Strengthening of Sub-Centers
 3)Strengthening of PHCs
 4)Strengthening of CHCs for First referral
 5)District Health Plan
 6)Converging Sanitation & Hygiene under NRHM
 7)Strengthening Disease control program
 8)Public-private partnership for public Health goals,
including regulation of private sector
 9)New health financing mechanisms
 10)Reorienting health/medical education to support rural
health issues

Component A: ASHA
• Accredited social
health activists

Component A: ASHA
Accredited social health activists
 Every village will have a female ASHA
 Chosen by and accountable to the panchayat

ASHA – Accredited Social Health
Activist
 ASHA must be primarily a woman resident of the village
‘Married/ Widow/ Divorced” and preferably in the age
group of 25 to 45 yrs.
 ASHA should have effective communication skills,
leadership qualities and be able to reach out to the
community.
 She should be a woman with formal education up to
Eighth Class.
 Adequate representation from disadvantaged population
groups should be ensured to serve such groups better.

Training
Prototype training material for ASHA to
be developed at National level subject to
State level modifications.

ROLE AND RESPONSIBILITY OF
ASHA
 ASHA will be the health activist in the community who
will create awareness on health
 She will take steps to create awareness and provide
information to the community
 She will counsel women on birth preparedness,
importance of safe delivery, breast feeding and
complementary feeding, immunization, contraception
and prevention of common infections including
reproductive tract infection / sexually transmitted
infection and care of the young child.

Role of ASHA
 She will mobilize the community and facilitate them in
accessing health and health related services available at
the anganwadi / sub centre / primary health centres
 She will work with the village health and sanitation
committee of the gram Panchayat to develop a
comprehensive village health plan
 She will arrange escort/ accompany pregnant women
and children requiring treatment/ admission to the
nearest pre-identified health facility i.e., primary health
centre / community health centre/ first referral unit.

Role of ASHA
 She will provide primary medical care for minor ailments
such as diarrhoea, fevers, and first aid for minor injuries.
 She will be a provider of directly observed treatment
short – course (DOTS) under revised national
tuberculosis control programme.
 She will also act as a depot holder for essential
provisions being made available to every habitation.
 A drug kit will be provided to each ASHA.

Role of ASHA
 Her role as a provider can be enhanced subsequently.
 She will inform about the births and deaths in her village
and any unusual health problems/disease outbreaks in
the community to the Sub-centres/ Primary Health
Centre.
 She will promote construction of household toilets under
Total Sanitation Campaign.

Role of ASHA and integration with
Anganwadi
 Organizing Health Day once/twice a month.
 On health day, the women, adolescent girls and children
from the village will be mobilized for orientation on
health related issues
 AWW to participate and guide organizing the Health
Days at Anganwadi Centre (AWC).
 AWW and ANMs will act as resource persons for the
training of ASHA.

Role of ASHA and integration with
Anganwadi
 IEC activity through display of posters, folk dances etc.
 Anganwadi worker will be depot holder for drug kits and
will be issuing it to ASHA.
 AWW will update the list of eligible couples and also the
children less than one year of age in the village with the
help of ASHA.
 ASHA will support the AWW in mobilizing pregnant and
lactating women and infants for nutrition supplement.

Role and integration with ANM
 She will hold weekly / fortnightly meeting with ASHA and discuss
the activities undertaken during the week/ fortnight.
 She will guide her in case ASHA had encountered any problem
during the performance of her activity.
 AWWs and ANMs will act as resource persons for the training of
ASHA
 ANMs will inform ASHA regarding date and time of the outreach
session and will also guide her for bringing the beneficiary to the
outreach session.
 ANM will participate and guide in organizing the health days at
anganwadi centres
 She will take help of ASHA in updating eligible couple register of the
village concerned.

 She will utilize ASHA in motivating the pregnant women
for coming to sub centre for initial check-ups.
 She will also help ANMs in bringing married couples to
sub centres for adopting family planning.
 ANM will guide ASHA in motivating pregnant women for
taking full course of Iron and folic acid tablets and
tetanus toxoid injections etc.
 ANMs will orient ASHA on the dose schedule and side
effects of oral pills
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 ANMs will educate ASHA on danger signs of pregnancy
and labour so that she can timely identify and help
beneficiary in getting further treatment.
 ANMs will inform ASHA on date, time and place for initial
and periodic training schedule.
 She will also ensure that during the training ASHA gets
the compensation for performance and also TA/DA for
attending the training

1)ASHA
2)Strengthening of Sub-Centers

STRENGTHENING
SUB-CENTRES
Each sub-centre will have an
Untied Fund for local action
@ Rs. 10,000 per annum.

Essential drugs to subcentres
Supply of essential
drugs to the Sub-
centres.

1)ASHA
3)Strengthening of PHCs

STRENGTHENING
PRIMARY HEALTH CENTRES
 Adequate and regular supply of essential
quality drugs and equipment to PHCs
 Provision of 24 hour service in PHCs
 Intensification of ongoing communicable
disease control programmes, new
programmes for control of non-
communicable diseases and provision of
2nd doctor at PHC level (1 male, 1
female)

1)ASHA
4)Strengthening of CHCs for First referral

STRENGTHENING CHCs FOR
FIRST REFERRAL UNITS
 Existing CHC (30-50 beds) as 24 Hour FRU,
including posting of anaesthetists
 Codification of new Indian Public Health
Standards, setting norms for
 Infrastructure
 Staff
 Equipment
 Management
 Promotion of Rogi Kalyan Samitis for
hospital management.

1)ASHA
5)District Health Plan

DISTRICT HEALTH PLAN
• District becomes core unit of
planning, budgeting and
implementation

At district level:
Health
Programmes
Family
Welfare
Programmes
District
Health
Mission”

1)ASHA
6)Converging Sanitation &
Hygiene under NRHM

CONVERGING SANITATION AND
HYGIENE UNDER NRHM
Total Sanitation Campaign (TSC) in all
districts

Sanitary toilet
ASHA would be incentivized for promoting
household toilets by the Mission.

1)ASHA
6)Converging Sanitation & Hygiene under NRHM
7)Strengthening Disease control
program

STRENGTHENING DISEASE
CONTROL PROGRAMMES

Contd..
 Disease surveillance system at village
level would be strengthened.
 Supply of generic drugs (both AYUSH &
Allopathic).
Provision of a mobile medical unit at District
level for improved Outreach services.

1)ASHA
6)Converging Sanitation & Hygiene under
NRHM
7)Strengthening Disease control program
8)Public-private partnership for public
Health goals, including regulation of
private sector

9. NEW HEALTH FINANCING
MECHANISMS
Village - VHWSC- Rs.10,000 per year.
HSC - Untied funds – Rs.10,000 per year.
AMG – Rs.10,000 per year.
PHC - Untied funds – Rs.25,000 per year.
- AMG – Rs.50,000 per year
- PWS – Rs.1,00,000 per year

FLEXIBLE FINANCING LE
FINANCING
CHC - Untied funds Rs.50,000 per year.
AMG – Rs.50,000 per year.
RKS (PWS) – Rs.1,00,000 per year.
Districts - DH&SDH – RKS – Rs.5,00,000 per year.
Medical College – Rs.10,00,000 per year.
Health Melas – Rs.8,00,000 per year. per
constituency

1)ASHA
6)Converging Sanitation & Hygiene under NRHM
7)Strengthening Disease control program
8)Public-private partnership for public Health goals,
including regulation of private sector
9)New health financing mechanisms
10)Reorienting health/medical education to support
rural health issues4/29/2018 38Chengalpattu Medical College

REORIENTING HEALTH/MEDICAL EDUCATION
TO SUPPORT RURAL HEALTH ISSUES
 While district and tertiary
hospitals they form an integral part
of the referral care chain serving the
needs of the rural people.
 Medical and para-medical education
facilities need to be created in states,
based on need assessment.

NRHM – 5 MAIN APPROACHES
COMMUNITIZE
Hospital management
committees
United grants to community
Funds, functions to local
community organizations
Decentralized planning, village
health and sanitation
committees
FLEXIBLE FINANCING
Partnership of state and
community resources
United grants to institutions
NGO sector for public health
goals
More resources for more
reforms
MONITOR, PROGESS
AGAINST STANDARDS
Setting IPHS standards
Facility surveys
Independent monitoring
committees at block, district
and state levels
IMPROVED
PROGRAMME
MANAGEMENT
THROUGH CAPACITY
Block and district health
office with management
skills
NGOs in capacity building
Continuous skill
development support
INNOVATION IN
HUMAN RESOURCE
MANAGEMENT
Nurse managers
More nurses local resident
criteria
24X7 emergency medical
services at PHC/CHC
Multi skilling

NRHM ACHIEVEMENTS IN TAMIL NADU
EMRI
 Emergency Referral Services (Toll free no 108) introduced in all the
districts.
Chengalpattu Medical College4/29/2018 41

Chengalpattu Medical College
NICU MODEL
4/29/2018 42

Health Mela
Health Mela conducted

INFRASTRUCTURE UPGRADATION
• 148 First Referral Units and CEmONC centers provided with
essential equipments for maternal and child care including central
oxygen supply .
• 513 PHCs taken up for Infrastructure upgradation, extensions,
renovations and repair works in 2009-10 to cope up with
additional service demands.

Facelift of PHC
Omandur PHC, Villupuram Dist.
Before After

Chengalpattu Medical College
Mechanized laundry services in all the HUDs
4/29/2018 46

PHC Siruvanthadu
AfterBefore

Healthy Environment
Morappur PHC, Dharmapuri Dist.

Healthy Environment for Patient
Kaveripakkam PHC
Healthy Environment
Kaveripakkam PHC, Vellore Dist.

Healthy Environment
Kaveripakkam PHC, Vellore Dist

Healthy Environment
Ladavaram PHC, Vellore Dist.

Garden – Nandhivaram PHC, Saidapet HUD

Waiting Hall for Relatives
and Children

Baby Warmer

New Born Corner – Radiant warmer, other necessary
equipment and trained staff.
Thirupoondi PHC,
Nagappattinam Dist.
New Born Corner

Solar Water Heater in PHC

Scan Facility at PHC

Inverter Facility at PHC

Safe Drinking Water

Generator for Operation Theaters

Blood storage facility
Banavaram PHC, Vellore Dist.

Caesarean operation
Banavaram PHC, Vellore Dist.

Computer Facility in PHC

VBD - Control Activities

Integrated vector
control measures

MONITORING AND EVALUATION
Process indicators :
(a) Numbers of ASHA seleted by due process
(b) Number of ASHA trained
(c) % of ASHA attending review meeting after one year.
Outcome indicators :
(a) % of newborn who were weighed and families
counselled
(b) % of children with diarrhoea who received ORS
(c) % of institutional deliveries

(d) % of JSY claims made to ASHA
(e) % completely immunized in 12-23 months age group
(f) % of unmet need for spacing contraception among BPL
(g) % of fever cases who received chloroquine within first
week in an malaria endemic area;
Impact indicators :
(a) IMR
(b) child malnutrition
(c) number of case of TB/ leprosy cases detected as
compared to previous year.

Why NUHM?
 Urban population is estimated to increase from 35.7
crores in 2011 to 43.2 crores in 2021
 Rapid increase in the urban population can lead to
increase in the number of slums
 Slum population is growing at the rate of 7% annually
 Poor health status of the urban slums
 Inadequacy of the health care delivery to the slum
population

Challenges of urban health care
 Poor households not knowing where to go to meet
health need
 Weak and dysfunctional public system of outreach
 Contaminated water, poor sanitation
 Poor environmental health, poor housing
 Unregistered practitioners first point of contact – use of
irrational and unethical medical practice
 Community organizations helpless in health matters

 Weak public health planning capacity in urban local
bodies
 Large private sector but poor cannot access them
 Problems of targeting the poor on the basis of BPL card
 No convergence among wider determinants of health
 No system of counselling and care for adolescents
 No concerted campaigns for behaviour change
 Problems of unauthorized settlements

 Over congested secondary and tertiary facilities and
underutilized primary care facilities.
 Problem of drug abuse and alcoholism
 Many slums not having primary health care facility
 High incidence of domestic violence
 Multiplicity of urban local bodies, State government, etc.
management of health needs of urban people
 No norms for urban health facilities

Access to health care
 Inadequate public health care delivery system
 Severely restricted health care access (for urban poor)
 lack of standards for urban health delivery system
makes the urban poor more vulnerable
 Poor environmental conditions – overcrowding, poor
housing, poor water and electricity availability result in
high incidence of communicable diseases, asthma etc.
 Higher rates of traffic accidents, domestic violence,
mental health cases, drugs, tobacco and alcohol abuse

National Urban Health Mission
The NUHM would focus on:
– Urban Poor living in listed and unlisted slums
– Vulnerable population such as homeless, rag-pickers,
street children, rickshaw pullers, construction and
brick and lime kiln workers, sex workers, and other
temporary migrants.
– Public health thrust on sanitation, clean drinking
water, vector control, etc.
– Strengthening public health capacity of urban local
bodies.

UrbanHealth
CareDelivery
Model

Urban Health Care Facilities

Urban Health Care Delivery
 Health services delivered under the urban health
delivery system through the Urban-PHCs and Urban-
CHCs will be universal in nature
 Outreach services will be targeted to specific groups
(slum dwellers and other vulnerable groups)
 1 FHW (ANM) for 10,000 population; Outreach sessions
in area of every ANM on weekly basis
 FHW to be stationed at PHC; Mobility support for
outreach activities
 School Health Programmes

Urban CHC
 For 2,50,000 population (5,00,000 for metros)
 Inpatient facility, 30 -50 bedded
(100 bedded in metros)
Only for cities with a population of above 5 lakhs
 Renovation of existing referral facility or up-gradation of
facility shall essentially be the first choice
 Support for local contractual arrangements for part time
Specialist/ Medical Officer.

 Promote role of urban local bodies in the planning and
management of urban health care
 One USHA for 1000-2500 population
 States to have flexibility of motivating Mahila Arogya
Samiti (MAS) for getting the work done
 One MAS for 50-100 households
 Annual grant of Rs. 5000 to the MAS
 NGOs may also be given this responsibility

 IPHS/ Revised IPHS for Urban areas etc
 Quality of the services provided will be constantly
monitored for improvement
 Strengthen IDSP
 Convergence with AYUSH practitioners

Roles & responsibilities of ASHA
 Identify target beneficiaries and support ANM in
conducting outreach sessions
 Promote formation of Women’s Health Groups
 Provide information to the community
 Facilitate access to health and related services
 Accompany pregnant women and children requiring
treatment/ admission
 Facilitate development of a comprehensive health plan
 Facilitate construction of community/ household toilets
 Act as depot holder
 Maintain necessary information and records.

Women’s Health Committee
• Process of promotion of Women’s Health
Committee
Women’s Health
Committee
15 members
for about
250-350
families
encouraged
to work
collectively
on
community
issues
potential
community
leaders and
target
women

Roles of the Mahila Arogya Samiti
 Support ASHA in tracking and monitoring coverage of
key interventions
 Facilitate group counseling sessions
 Support outreach camps by ensuring presence of target
group
 The conveners or other designated representatives of
the group along with the respective Link Volunteer will
attend meetings held at the UHC and provide feedback
on service delivery.
 Collect, manage and utilize a Community Health Fund for
meeting health emergencies in the slum and for
sustaining health promotion efforts.
 Maintain BCC and IEC materials at a safe and easily
accessible place in the community.4/29/2018 84Chengalpattu Medical College

Functions of UPHC
• Medical care – OPD services 4 hours in the
morning and 2 hours in the evening
• RCH II services
• National health programmes
• Collection and reporting of vital events
• IDSP
• Referral services
• Basic laboratory services
• Counselling services

Services provided under NUHM
Community / outreach services
Services at UPHC
Services at UCHC

Main services
Maternal health
 Registration, ANC, identification of danger signs, referral for
institutional delivery, follow up counselling and behaviour
promotion
 ANC, PNC, initial management of complicated delivery cases and
referral, management of regular maternal health conditions,
referral of complicated cases
 Delivery, management of complicated gynae/ maternal health
conditions, hospitalization and surgical interventions including
blood transfusion.
Family welfare
 Counselling, distribution of OCP/CC, referral for sterilization,
follow up of contraceptive related complications
 IUD insertion, management of contraceptive related
complications
 Sterilization operations, fertility treatment

Main services
Child health and nutrition
immunization, identification of danger signs, referral,
follow –up, distribution of ORS, paediatric cotrimoxazole,
post natal visits, counselling for new born care
diagnosis and treatment of childhood illness, referral of
acute/chronic cases, identification and referral of neonatal
sickness
management of complicated paediatric / neo-natal cases,
hospitalization, surgical intervention, blood transfusion

Main services
Cancer
 Symptomatic search and referral, follow up of under treatment patients
 Identification and referral, follow up of under treatment patients
 Diagnosis, treatment and hospitalization
Trauma care (burns and injuries)
 First aid and referral
 First aid/ emergency resuscitation, documentation for medico-legal case
and referral
 Case management and hospitalization, physiotherapy and rehabiltiation
Other surgical interventions
 Identification and referral
 Hospitalization and surgical intervnetion
Other support services like IEC, BCC, counselling and personal and social
hygiene.

Essential Health Care Services under NUHM
Community Level Primary Health Care Level Referral Centre
(U-CHC)
Maternal Health • Registration
• Ante-natal Care
• Identification of danger signs
• Referral for institutional delivery
• Follow-up
• Counseling and Behavior
• Ante-natal and Post-natal
care
• Management of
complicated delivery
cases and referral
• Management of regular
maternal conditions
• Referral of complicated
cases
• Delivery (normal and
complicated)
• Management of
complicated
Gynae/maternal health
condition
• Hospitalization and surgical
interventions including
blood transfusion
Child Health and
Nutrition
• Immunization
• Identification of danger signs
• Referral services
• Follow-up
• Distribution of ORS
• Post-natal visits/counseling for
new-born care
• Diagnosis and treatment
of childhood illnesses
• Referral of acute
cases/chronic illness
• Identification and referral
of neo-natal sickness
• Management of
complicated
pediatric/neonatal cases
• Hospitalization
• Surgical interventions
• Blood transfusion
Nutrition
Deficiency
Disorders
• Height/weight measurement
• Distribution of IFA tablet
• Promotion of iodized salt
• Nutrition supplements to identified
children and pregnant/lactating
mothers
• Promotion of breastfeeding
• Complementary feeding prevention
of under-nutrition
• Diagnosis and referral of
acute deficiency cases
• Management of acute
deficiency cases
• Hospitalization
• Treatment and
rehabilitation of sever
under-nutrition

Monitoring and evaluation
City level indicators (process and input indicators of NUHM)
Community process
 Number of mahila Arogya Samiti (MAS) formed
 Number of MAS members trained
 Number of ASHA selected and trained
Health systems
 Number of ANMs recruited
 Number of special outreach health camps organized in slum /
HFas
 Number of UHNDs organized in the slums aand vulnerable areas
 Number of UPHCs made operational
 Number of UCHCs made operational
 Number of RKS created at UPHC and UCHC
 OPD attendance in UPHCs
 Number of deliveries conducted in public health facilities

NATIONAL HEALTH MISSION
The National health mission was approved in May 2013.
The main programmatic components include health
system strengthening in rural and urban areas,
reproductive – maternal – new-born – child and
adolescent health (RMNCH+A) and control of
communicable and non-communicable diseases.

Vision of the NHM
“Attainment of Universal Access to Equitable,
Affordable and Quality health care services,
accountable and responsive to people’s needs,
with effective inter-sectoral convergent action to
address the wider social determinants of health”.

SERVICE DELIVERY STRATEGIES
 Reproductive, Maternal, Newborn, Child Health and
Adolescent (RMNCH+A) Services
 Maternal Health
– Comprehensive package of RMNCH+A services.
– Janani Suraksha Yojana (JSY)
– Janani Shishu Suraksha Karyakram (JSSK)
 Access to safe abortion services
 SNCU(Special Newborn are Units),NBSU(Newborn stabilization
Units),NBCC(NewBorn Care Corners),FBNC(Facility Based
Newborn Care),IYCF(Infant and Young Child Feeding
practices),HBNC(Home Based Newborn Care)
 NSSK(Navjaat Sishu Suraksha Karyakram)
 NRCs(Nutritional Rehabilitation Centres)
 IDCF (Intencified Diarrhoea Control Fortnight)

 MCTS (Maternal and Child Tracking System)-PICME
 Prevention and Management of Reproductive Tract
Infections (RTI) and Sexually Transmitted Infections
(STI)
 Gender Based Violence
 New-born and Child Health
 Universal Immunization
 Health Screening and Early Intervention Services
 Adolescent Health
 Iron and Folic Acid (IFA) supplementation
 Facility -based adolescent health services

 Community based health promotion activities
 Information and counseling on sexual and reproductive health
(including menstrual hygiene),
 Substance abuse
 Mental health
 Non-communicable diseases, injuries
 Adolescent Friendly Health Clinics (AFHC)
 Provision of Weekly Iron and Folic acid Supplementation (WIFS)
 National Iron Plus Initiative.
 Universal use of iodized salt
 Family Planning
Intra-Uterine Contraceptive Devices (IUCD).

Control of Communicable Diseases
1. The National Vector Borne Diseases Control Programme
(NVBDCP) is an umbrella programme for prevention
and control of vector borne diseases viz. Malaria,
Japanese Encephalitis (JE), Dengue, Chikungunya,
Kala-Azar and Lymphatic Filariasis. Of these, Kala-Azar
and Lymphatic Filariasis have been targeted for
elimination by 2015.
2. Revised National Tuberculosis Control Programme
(RNTCP)
3. National Leprosy Control Programme (NLEP)
4. Integrated Disease Surveillance Programme (IDSP)

Non Communicable Diseases (NCD)
1. National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)
2. National Programme for the Control of Blindness (NPCB)
3. National Mental Health Programme (NMHP)
4. National Programme for the Healthcare of the Elderly (NPHCE)
5. National Programme for the Prevention and Control of Deafness
(NPPCD
6. National Tobacco Control Programme (NTCP)
7. National Oral Health Programme (NOHP)
8. National Programme for Palliative Care (NPPC)
9. National Programme for the Prevention and Management of
Burn Injuries (NPPMBI)
10. National Programme for Prevention and Control of Fluorosis
(NPPCF)

 Use of data from large scale population surveys
 Commissioning implementation research or evaluation
studies
 use of HMIS data and field appraisals and reviews
 Health outcomes, output and process indicators
 Periodic Population Health Surveys and Demographic
Information
 The Sample Registration Surveys (SRS)
 Death statistics
 National Sample Survey Organization (NSSO) data on
cost of care and morbidity, DLHS and NFHS.

RMNCH+A

What does RMNCH+A stands for
1. Reproductive,
2. Maternal,
3. New-born,
4. Child health
5. Adolescent care
Plus denotes
• Inclusion of adolescence as a distinct ‘life
stage’ in the overall strategy
• Links maternal and child survival to other
components (family planning , adolescent
health, gender & PC & PNDT)
• Links home and community based services
to facility based care
• Ensuring linkages , referrals and counter
referrals between various levels of health
care system
Adolescent
Health Package
Reproductive
Health package
Antenatal &
Intrapartum care
package
Newborn care
package
Post partum
family
planning,spacin
g methods
Under five
child health
pacakge

RBSK( Rashtriya Bal Swasthya
Karyakram) –Feb 2013

RKSK (Rashtriya Kishor
Swasthiya Karyakram) Jan 2014
Beyond ARSH - focuses on
Life skills
Nutrition
Gender based injuries and violence
Non-communicable diseases
Mental health
Substance misuse

WIFS –Weekly Iron Folic acid
Supplementation

WIFS - Advantages
 Improved concentration in school, and school
performance
 Feeling stronger and less tired,
 Increased energy levels and output in day to day work,
 Increased appetite,
 Improved overall capacity to work and earn
 Better sleep
 Improved skin appearance,
 Regularization of menstruation
 Building pre-pregnancy health

Key activities
 Both boys and girls to be given IFA and Albendazole
Tablets
 6th to 12th class students to be covered
 Weekly Fixed day approach
 Supervised consumption of weekly IFA tablet to be
ensured
 IFA tablet to be given after meals ( Mid-Day Meal or
Lunch)
 Screen students for pallor and refer
 Bi-annual ( six months apart) distribution of Albendazole
tablets
 HE sessions to be conducted regularly
 Filling of Individual compliance cards

Iron plus Initiative

PUDHU YUGAM SCHEME
The programme will be focused in rural areas with
the following objectives:
To increase awareness among adolescent girls on
menstrual hygiene,
 build self-esteem, and
empower girls for greater socialisation
To increase access to and use of high quality
sanitary napkins by adolescent girls in rural areas
To ensure safe disposal of sanitary napkins in an
environment friendly manner
.

4/29/2018
Chengalpattu Medical
College
115

4/29/2018
Chengalpattu Medical
College
116

4/29/2018 117 Chengalpattu Medical College

CONCLUSION
The NHM envisages achievement of
universal access to equitable, affordable &
quality health care services that are
accountable and responsive to people's
needs.

Thank You

National Rural Health Mission Milestones

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