National Health Mission

The National Health Mission (NHM) is a centrally sponsored programme of the Ministry of Health and Family Welfare that seeks to provide accessible, affordable, and quality health care to India’s most vulnerable populations, especially in rural and underserved urban areas. Launched on 12 April 2005, NHM integrates the former National Rural Health Mission and the later‑added National Urban Health Mission, creating a unified framework for strengthening primary health infrastructure, expanding preventive services, and reducing maternal and child mortality. Its distinctive feature is the systematic deployment of community health workers and the creation of health‑and‑wellness centres that link the poorest households directly to the public health system.

Origins and Historical Background

The seeds of NHM were sown in the early 2000s when the Government of India recognised that the existing public‑health network could not meet the Millennium Development Goal targets for health. The National Rural Health Mission (NRHM) was inaugurated on 12 April 2005 with an initial outlay of ₹ 30 billion, aiming to bridge the rural‑urban divide in health outcomes. In 2013, the Ministry merged NRHM with the National Urban Health Mission—established in 2010—to form the National Health Mission, thereby extending the same service‑delivery model to slums and other urban pockets.

Institutional Architecture and Mechanism

NHM operates through a three‑tiered governance structure: the National Health Mission Secretariat at the centre, State Health Societies (SHSs) in each state, and District Health Societies (DHSs) at the district level. Funding flows from the Union Budget to the NHM Secretariat, which allocates resources to SHSs based on a formula that incorporates population size, poverty index, and health‑infra gaps. At the grassroots, block‑level health committees supervise the construction of sub‑centres, primary health centres (PHCs), and community health centres (CHCs), while the Accredited Social Health Activist (ASHA) programme mobilises over 900 000 female volunteers to promote immunisation, antenatal care, and sanitation.

Key Programs and Provisions

NHM’s flagship schemes include Janani Suraksha Yojana (JSY), launched in 2005 to incentivise institutional deliveries, and Janani Shishu Suraksha Karyakram (JSSK), introduced in 2011 to provide free delivery kits and post‑natal care. Under JSY, cash assistance of ₹ 1 500 to ₹ 2 500 per delivery has been disbursed to more than 20 million mothers, contributing to the rise in institutional deliveries from 40 % in 2005‑06 to 79 % in 2015‑16. The mission also funds the Integrated Disease Surveillance Programme (IDSP), which monitors outbreaks of malaria, dengue, and COVID‑19 across 734 districts, and the Ayushman Bharat Health‑and‑Wellness Centres (HWCs), of which 150 000 were operational by March 2023, delivering comprehensive primary care services.

Implementation and Current Status

For the fiscal year 2023‑24, the Union Budget earmarked ₹ 64 000 crore for NHM, marking a 12 % increase over the previous year and reflecting the government’s commitment to universal health coverage. As of December 2023, NHM has upgraded 5 000 CHCs, constructed 20 000 new sub‑centres, and equipped 7 000 PHCs with tele‑medicine kiosks under the e‑Sanjeevani platform. State‑level performance is monitored through the National Health Dashboard, which reports a decline in the maternal mortality ratio from 254 per 100 000 live births in 2004‑06 to 113 in 2016‑18, and a reduction in the infant mortality rate from 58 per 1 000 live births in 2005‑06 to 32 in 2019‑21.

Impact and Significance

NHM’s integrated approach has reshaped India’s health landscape by linking community‑level outreach with facility‑based care, thereby narrowing the equity gap between affluent urban centres and remote villages. The ASHA network alone has facilitated over 150 million immunisations and contributed to a 30 % increase in the coverage of the third dose of the diphtheria‑tetanus‑pertussis vaccine between 2005 and 2020. Moreover, the mission’s emphasis on data‑driven planning—exemplified by the IDSP and the Health Dashboard—has enabled rapid response to epidemics, as seen during the COVID‑19 second wave in 2021. By anchoring primary health care within a robust institutional framework, NHM continues to be a cornerstone of India’s pursuit of Sustainable Development Goal 3: ensuring healthy lives and promoting well‑being for all at all ages.