National Health Mission: Transforming India’s Public Health System in Rural and Urban India

National Health Mission (NHM): Strengthening Public Health in Rural and Urban India

Access to quality healthcare is a fundamental right, yet millions in India have historically struggled with it—especially in rural and underserved areas. To address this pressing issue, the Government of India launched the National Health Mission (NHM) in 2013, merging two earlier initiatives: the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). NHM is a comprehensive effort to bolster India’s public healthcare infrastructure, improve service delivery, and ensure equitable access to essential health services.

Background: Why NHM Was Needed

Before the NHM, India’s health system was fragmented and overstretched. While urban hospitals received some attention, rural areas faced severe shortages of doctors, medical supplies, and basic infrastructure. Infant mortality, maternal deaths, and communicable diseases were alarmingly high.

Recognizing the need for urgent reform, the government introduced NRHM in 2005, focusing on rural healthcare. Later, NUHM was launched in 2013 to address the growing health needs of urban poor communities. In the same year, both were brought together under one umbrella — the National Health Mission — for unified planning and implementation.

Objectives of NHM

NHM’s core mission is to strengthen health systems, particularly in rural and vulnerable populations. The key objectives include:

·       Reduce infant and maternal mortality rates

·       Improve access to affordable, quality healthcare services

·       Strengthen public health infrastructure and human resources

·       Promote institutional deliveries and immunization

·       Ensure availability of essential drugs and diagnostics for free

·       Decentralize health planning and encourage community participation

Key Components of NHM

1. National Rural Health Mission (NRHM)

Focused on the rural population, especially in 18 high-focus states with poor health indicators. It targets maternal and child health, nutrition, sanitation, and communicable diseases like tuberculosis and malaria.

2. National Urban Health Mission (NUHM)

Addresses health needs of the urban poor, including slum dwellers, migrant workers, street vendors, and homeless populations. NUHM supports setting up urban Primary Health Centres (UPHCs) and outreach through community health workers.

3. Accredited Social Health Activist (ASHA)

Over 1 million ASHAs serve as the link between rural communities and the public health system. These trained female health workers are instrumental in mobilizing mothers for vaccinations, promoting institutional births, and spreading awareness about hygiene and nutrition.

4. Rogi Kalyan Samitis & Village Health Committees

Community-level health committees ensure grassroots participation, allowing locals to supervise health facilities and contribute to planning.

5. Free Drugs and Diagnostics Services Initiative

NHM ensures essential medicines and diagnostic services are available free of cost at government facilities, reducing the financial burden on poor families.

Achievements of NHM

Since its launch, NHM has made significant progress in India’s health landscape, particularly in maternal and child care:

·       Institutional deliveries rose sharply, with more women giving birth in hospitals rather than at home.

·       Infant Mortality Rate (IMR) dropped from 58 per 1,000 live births in 2005 to 28 in 2020.

·       Maternal Mortality Ratio (MMR) declined from 254 in 2004-06 to 97 per 100,000 live births in 2018-20.

·       Over 1.5 lakh health and wellness centres (HWCs) have been operationalized across India.

·       Telemedicine services, especially during the COVID-19 pandemic, saw a boost under NHM infrastructure.

Digital and Technological Integration

NHM has incorporated several digital platforms to improve efficiency:

·       Health Management Information System (HMIS): For real-time tracking of health data.

·       Reproductive Child Health (RCH) portal: Tracks pregnancy care and child immunization.

·       e-Sanjeevani: A telemedicine initiative allowing remote consultations with doctors.

Challenges Facing NHM

Despite its success, NHM still faces hurdles that need urgent attention:

·       Shortage of trained medical staff, especially specialists in rural hospitals.

·       Infrastructure gaps in primary health centres (PHCs) and community health centres (CHCs).

·       Inconsistent quality of care across states due to uneven implementation.

·       Limited community awareness about health entitlements and services.

To overcome these issues, sustained investments in health infrastructure, better training programs, and strong monitoring mechanisms are crucial.

Conclusion

The National Health Mission (NHM) stands as one of India's most ambitious and impactful public health initiatives. By bridging the rural-urban healthcare gap, empowering communities, and making quality care more accessible, NHM is transforming the nation’s health landscape.

Yet, the mission is far from over. Continued focus, innovation, and public participation will be essential in building a resilient, inclusive, and people-centered health system for India’s 1.4 billion citizens.