1. Introduction

The National Health Mission (NHM), launched in 2013, is India’s flagship health initiative aimed at ensuring accessible, affordable, and quality healthcare services, particularly for vulnerable populations. A 2021-24 assessment report highlights key achievements, particularly in human resource expansion, disease control, infrastructure development, and vaccination campaigns.

2. Key Achievements (2021-24)

A. Human Resource Expansion

• Over 12 lakh additional healthcare workers (including medical officers, nurses, specialists, community health officers, and AYUSH doctors) were engaged.
• Pradhan Mantri TB Mukt Bharat Abhiyan enlisted 1.56 lakh Ni-kshay Mitra volunteers, supporting 9.4 lakh TB patients in rural areas.

Impact:

• Strengthened primary healthcare services, particularly in rural and underserved areas.
• Improved TB care and management through community engagement.

B. Reduction in Mortality Rates

• Maternal Mortality Ratio (MMR) reduced by 83% since 1990, exceeding the global decline of 45%.
• Under-5 Mortality Rate (U5MR) fell by 75%, outperforming the global reduction of 60%.
• Infant Mortality Rate (IMR) dropped from 39 (2014) to 28 (2020).
• Total Fertility Rate (TFR) declined from 2.3 (2015) to 2.0 (2020).

Impact:

• Reflects effective maternal and child health programs, such as Janani Shishu Suraksha Karyakram (JSSK).
• India is on track to meet Sustainable Development Goals (SDGs) related to child and maternal health.

C. Disease Control and Elimination

1.   Tuberculosis (TB)

o    Incidence reduced by 17.7% (2015-2023).

o    Mortality declined by 21.4% under the National Tuberculosis Elimination Programme (NTEP).

2.   Malaria

o    Cases declined by 13.28% in 2021, but rose by 9.13% in 2022 and 28.91% in 2023.

o    Malaria deaths declined despite case surges, indicating better treatment access.

3.   Kala-azar

o    100% elimination achieved in endemic blocks (cases below 1 per 10,000 population by 2023).

Impact:

• India is progressing toward TB elimination by 2025, aligning with WHO’s End TB Strategy.
• Fluctuations in malaria cases highlight the need for sustained interventions despite decreasing fatalities.
• Kala-azar elimination is a major milestone in controlling neglected tropical diseases.

D. Vaccination & Immunization Campaigns

• Measles-Rubella Campaign (IMI 5.0): 97.98% coverage, vaccinating 34.77 crore children.
• Covid-19 Response:
• 220 crore vaccine doses administered (Jan 2021 – Mar 2024).
• India Covid-19 Emergency Response and Health Systems Preparedness Package (ECRP) strengthened pandemic response.
• U-WIN Platform (Jan 2023):
• Tracked vaccination events in real-time across 65 districts.

Impact:

• India’s Covid-19 vaccination drive was one of the largest globally.
• U-WIN platform ensures efficient tracking of immunization efforts.

E. Healthcare Infrastructure Expansion

• 7,998 public health facilities certified under National Quality Assurance Standards (NQAS).
• Ayushman Arogya Mandirs operational centers increased to 1.72 lakh, enhancing rural healthcare.

Impact:

• Infrastructure growth has improved service delivery, patient satisfaction, and quality benchmarks.

F. Specialized Health Initiatives

1.   Pradhan Mantri National Dialysis Programme (PMNDP)

o    62.35 lakh hemodialysis sessions in FY 2023-24, benefiting 4.53 lakh patients.

2.   National Sickle Cell Anemia Elimination Mission (NSCAEM)

o    2.61 crore individuals screened, focusing on tribal populations.

o    Target: Eliminate Sickle Cell Anemia by 2047.

Impact:

• Affordable dialysis services have benefitted kidney disease patients, particularly the economically weaker sections.
• Targeted screening in tribal regions addresses genetic disease prevalence.

3. Challenges and Gaps in NHM Implementation

1.   Rural-Urban Healthcare Divide

o    Despite Ayushman Arogya Mandirs, access to specialized care remains limited in remote areas.

2.   Healthcare Worker Shortages

o    Although 12 lakh workers were recruited, doctor-patient ratios still fall below WHO recommendations.

3.   Fluctuations in Disease Prevalence

o    Malaria cases increased (2022-23) despite earlier decline, showing the need for consistent interventions.

4.   Digital Divide in Health Services

o    U-WIN platform covers only 65 districts; digital tracking must expand to all states.

4. Way Forward

1.   Strengthening Last-Mile Healthcare Delivery

o    Enhance telemedicine services in underserved areas.

o    Expand health infrastructure & mobile healthcare units.

2.   Bridging Human Resource Gaps

o    Incentivize rural postings for doctors & specialists.

o    Expand Community Health Officer (CHO) programs.

3.   Sustaining Disease Control Efforts

o    TB & Malaria interventions need continuous monitoring.

o    Implement vector control programs to prevent malaria resurgence.

4.   Enhancing Immunization & Digital Health Integration

o    U-WIN should be scaled nationally for real-time vaccination tracking.

o    Ayushman Bharat Digital Mission (ABDM) must integrate NHM services seamlessly.

5. Conclusion

The National Health Mission (NHM) 2021-24 has made significant strides in maternal & child health, disease elimination, vaccination, and healthcare accessibility. However, challenges like rural healthcare gaps, fluctuating disease prevalence, and digital inclusivity need to be addressed for sustained impact. Strengthening last-mile connectivity, human resources, and data-driven health interventions will be crucial for achieving Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) by 2030.

1. What is the primary objective of the National Health Mission (NHM)?

A. To provide free health insurance to all Indian citizens
B. To ensure accessible, affordable, and quality healthcare, focusing on vulnerable populations
C. To privatize the healthcare sector for better efficiency
D. To provide specialized healthcare services only in urban areas

Answer: B. To ensure accessible, affordable, and quality healthcare, focusing on vulnerable populations

2. Which of the following disease control programs under NHM achieved 100% elimination in endemic blocks by 2023?

A. Tuberculosis (TB)
B. Malaria
C. Kala-azar
D. Sickle Cell Anemia

Answer: C. Kala-azar

3. What was the percentage reduction in the Maternal Mortality Ratio (MMR) in India since 1990, as highlighted in the NHM 2021-24 report?

A. 45%
B. 60%
C. 75%
D. 83%

Answer: D. 83%

4. Which of the following initiatives is associated with real-time vaccination tracking under NHM?

A. PM-JAY
B. U-WIN platform
C. Swayam Prabha
D. DIKSHA Portal

Answer: B. U-WIN platform

5. Which of the following statements about the Pradhan Mantri National Dialysis Programme (PMNDP) is correct?

A. It provides free dialysis services only in metropolitan cities.
B. It delivered over 62.35 lakh hemodialysis sessions in FY 2023-24.
C. It is a private sector initiative for kidney care.
D. It primarily focuses on treating tuberculosis patients.

Answer: B. It delivered over 62.35 lakh hemodialysis sessions in FY 2023-24.