The mission follows the RMNCH+A strategy, which integrates health services across the lifecycle:
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- Reproductive:Maternal care, family planning, and Janani Suraksha Yojana (JSY).
- Maternal:Safe motherhood interventions and institutional delivery incentives.
- Neonatal & Child:Immunization (Mission Indradhanush) and nutrition.
- Adolescent:Weekly Iron and Folic Acid Supplementation (WIFS) and menstrual hygiene.
The Timeline of Evolution
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- 2005: Launch of NRHM to address the dismal health indicators in rural India, specifically in 18 high-focus states.
- 2013: Launch of the National Urban Health Mission (NUHM) as a sub-mission to address the unique challenges of the urban poor.
- 2013 (May): The Union Cabinet approved the launch of the National Health Mission (NHM), which acted as an “umbrella” covering both NRHM and NUHM.
NRHM vs. NUHM
| Feature | NRHM (Rural) | NUHM (Urban) |
|---|---|---|
| Primary Link | ASHA (Accredited Social Health Activist) | USHA (Urban Social Health Activist) |
| Community Unit | Village Health Sanitation & Nutrition Committee | Mahila Arogya Samiti (MAS) |
| Focus Area | Reproductive & Child Health (RCH) | Communicable diseases & Slum-dwellers |
| Infrastructure | PHCs, CHCs, and Sub-Centres | U-PHCs and U-CHCs |
Key Strategic Shifts under NHM
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- Flexible Funding: States were given “Flexi-pools,” allowing them to move money between rural and urban needs based on real-time data.
- Health System Strengthening: The focus moved beyond just “Maternal and Child Health” to strengthening the entire system (infrastructure, HR, and procurement).
- Convergence: NHM mandated convergence with other departments like Water and Sanitation (Jal Jeevan Mission) and Nutrition (POSHAN Abhiyaan).
Key Interventions & Achievements
| Intervention | Purpose / Current Status (2026) |
|---|---|
| ASHA Workers | Over 1 million community health volunteers acting as the first point of contact. |
| Ayushman Arogya Mandir | 1.82 lakh sub-centres/PHCs upgraded to provide 12 packages of CPHC. |
| Institutional Delivery | Over 90% of deliveries are now institutional (up from 18% in 2005). |
| Mission Indradhanush | Full Immunization Coverage (FIC) reached 98.6% in late 2025. |
| TB Mukt Bharat | Aiming for elimination by end of 2025; mortality reduced by 25% since 2015. |
Health Indicators Progress (2026 Trends)
NHM’s success is measured by the rapid decline in critical mortality rates:
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- Maternal Mortality Ratio (MMR): Declined to ~90 per lakh live births (approaching the SDG target of 70).
- Infant Mortality Rate (IMR): Reduced to ~25-27 per 1,000 live births.
- Total Fertility Rate (TFR): Sustained at the replacement level of 1.
Critical Analysis
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- Decentralization: NHM empowers Rogi Kalyan Samitis (Hospital Management Societies) to manage funds locally, promoting bottom-up governance.
- Flexi-Funds: States have the flexibility to plan based on local epidemiological patterns (e.g., focus on Japanese Encephalitis in Gorakhpur or Sickle Cell in tribal belts).
- The “Dual Challenge”: While NHM has mastered communicable diseases and maternal care, it is now pivoting to handle the Non-Communicable Disease (NCD) explosion (Diabetes, Hypertension) through the expanded 12-service package at Ayushman Arogya Mandirs.
