National Rural Health Mission (NRHM)

Overview

The National Rural Health Mission (NRHM) was launched by the Government of India on 12 April 2005 as a major initiative to improve healthcare delivery in rural areas. It is a subprogramme of the National Health Mission (NHM), which later integrated the Urban Health Mission (UHP) in 2013. NRHMs core aim is to provide accessible, affordable, and quality health services to the rural population, particularly the poor, women, and children.

NRHM was conceived in response to chronic underperformance of the public health system in rural India, where a large proportion of the population lacked basic medical facilities, faced high maternal and infant mortality, and struggled with preventable diseases. By mobilising resources, strengthening infrastructure, and empowering local communities, NRHM sought to bridge the gap between urban and rural health outcomes.

Objectives

• Increase the availability of affordable and quality health services in rural areas.
• Reduce maternal, neonatal, and child mortality rates.
• Control communicable and noncommunicable diseases through preventive measures.
• Strengthen the health system by upgrading facilities, human resources, and supply chains.
• Promote community participation and empower local bodies for health governance.
• Ensure equitable access for vulnerable groups, including scheduled castes/tribes, the poor, and women.

Key Components

1. Strengthening Public Health Infrastructure

NRHM focused on expanding and upgrading subcentres, Primary Health Centres (PHCs), Community Health Centres (CHCs) and district hospitals. The mission introduced the concept of hub and spoke models, linking subcentres with PHCs for referral and supervision.

2. Human Resource Augmentation

To address the shortage of doctors, nurses and auxiliary staff, NRHM created new posts such as Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), and Male Health Workers. An intensive recruitment and training programme was launched across states.

3. Community Participation

Through the formation of Village Health and Sanitation Committees (VHSCs) and Rogi Kalyan Samitis (patient welfare committees) at hospitals, NRHM promoted local ownership of health planning and monitoring.

4. Financial Innovations

NRHM introduced the Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) cash assistance schemes encouraging institutional deliveries and providing free drugs, diagnostics, and transport for mothers and newborns.

5. Disease Control Programs

Targeted interventions were rolled out for major public health concerns, including:

• National Vector Borne Disease Control Programme (NVBDCP)
• Revised National Tuberculosis Control Programme (RNTCP)
• Integrated Management of Neonatal and Childhood Illness (IMNCI)

6. Health Information Systems

NRHM laid the foundation for a robust health management information system (HMIS) to collect, analyse, and disseminate data for evidencebased decision making.

Implementation Structure

NRHM is a centrally sponsored scheme, with the Ministry of Health and Family Welfare (MoHFW) providing guidelines, technical assistance and a share of funding. The remaining share is borne by state governments, which adapt the mission to local contexts.

Achievements (20052020)

• Over 150,000 subcentres and 30,000 PHCs upgraded or newly constructed.
• More than 2 million ASHAs recruited, creating a robust grassroots workforce.
• Institutional delivery rate increased from 41% (2005) to 85% (2019).
• Maternal Mortality Ratio (MMR) reduced from 254 per 100,000 live births (200506) to 113 (201618).
• Infant Mortality Rate (IMR) fell from 61 per 1,000 live births (2005) to 32 (2019).
• Coverage of essential immunisation rose above 90% for most vaccines.
• Implementation of the Janani Suraksha Yojana benefitted over 20 million women.

Challenges and Lessons Learned

Despite notable gains, NRHM continues to face several systemic and operational challenges:

• Human resource gaps: Retention of doctors in remote areas remains low; many ASHAs work parttime due to insufficient remuneration.
• Infrastructure inequities: Some districts still lack functional PHCs or reliable electricity and water supply.
• Data quality: Inconsistent reporting hampers realtime decision making.
• Financial management: Delays in fund transfer from the centre to states affect timely execution.
• Social determinants: Poverty, illiteracy and gender bias limit utilisation of available services.

Addressing these issues requires sustained political commitment, innovative financing models, and stronger community empowerment.

Future Directions

With the transition to the broader National Health Mission, the legacy of NRHM informs several priority areas:

• Universal Health Coverage (UHC): Strengthening primary care as the backbone of UHC.
• Digital health: Scaling telemedicine, eprescriptions and mobilebased health education.
• Integrated care: Linking nutrition, sanitation, and mental health interventions with medical services.
• Human resource reforms: Introducing career pathways, incentives, and continuous professional development for rural health workers.
• Communityled monitoring: Expanding participatory platforms using citizen scorecards and social audits.

The continued focus on equity, quality, and accountability will be essential to sustain and enhance the gains achieved under NRHM.