National Rural Health Mission

National Rural Health Mission (NRHM) is an Indian health program for improving health care delivery across rural India. The mission, initially mooted for 7 years (2005-2012), is run by the Ministry of Health. The scheme proposes a number of new mechanism for healthcare delivery including training local residents as Accredited Social Health Activists (ASHA),^[1] and the Janani Surakshay Yojana (motherhood protection program). It also aims at improving hygiene and sanitation infrastructure.^[2] Noted economists Ajay Mahal and Bibek Debroy have called it "the most ambitious rural health initiative ever".^[3]
The mission has a special focus on 18 states Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttarkhand and Uttar Pradesh.
Under the mission, health funding had increased from 27,700 crores in 2004-05 to 39,000 crores in 2005-06 (from 0.95% of GDP to 1.05%).^[4] This has further increased from 14,974 crores in 2007-08 to 34,488 crores in 2012-13. ^[5] As of 2009, economists noted that "the mid-term appraisal of the NRHM has found that there has been a significant improvement in health indicators even in this short period".^[3] However, in many situations, the state level apparatus have not been able to deploy the additional funds, often owing to inadequacies in the Panchayati Raj functioning. Fund utilization in many states is around 70%.^[3]

Structure of the JnNURM program

JnNURM essentially functions incorporating primarily two sub-missions into its program. The two sub-missions are:

• the Sub-Mission for Urban Infrastructure and Governance administered by the Ministry of Urban Development, with a focus on water supply and sanitation, solid waste management, road network, urban transport and redevelopment of old city areas.
• the Sub-Mission for Basic Services to the Urban Poor (BSUP)^[2] administered by the Ministry of Housing and Urban Poverty Alleviation with a focus on integrated development of slums.^[3]

In addition to this, it also has two further components:^[4]

• the Sub-Mission for Urban Infrastructure Development of Small & Medium Towns (UIDSSMT) administered by the Ministry of Urban Development, with a focus on subsuming the schemes of Integrated Development of Small and Medium Towns (IDSMT) and Accelerated Urban Water Supply Programme (AUWSP) which are already in existence and which aim at planned urban infrastructural improvement in towns and cities under its purview.^[5]
• the Sub-Mission for Integrated Housing and Slum Development Programme (IHSDP) administered by Ministry of Housing and Urban Poverty Alleviation (MHUPA) was envisaged and brought into effect in 1993–94 in accordance with providing the entire population with safe and adequate water supply facilities. Program mainly implemented in towns having population less than 20,000 as per 1991 Census.^[6]

Objectives

• Focused attention relating to infrastructural services in the context of integrated development is to be covered under the Mission.
• Make efficient and increase self-sustaining capabilities of cities as per the sector proving infrastructural services by securing the linkages between asset creation and asset management
• Ensure adequate investment of funds to fulfill deficiencies in the urban infrastructural services.
• Planned development of identified cities including peri-urban areas, out growths, urban corridors, so that urbanization takes place in a dispersed manner.
• Scale up delivery of civic amenities and provision of utilities with emphasis on universal access to urban poor.
• To take up urban renewal programme, i.e., re-development of inner (old) cities area to reduce congestion.^[7]

Provisions under NREGA

• Adult members of a rural household, willing to do unskilled manual work, are required to make registration in writing or orally to the local Gram Panchayat
• The Gram Panchayat after due verification will issue a Job Card. The Job Card will bear the photograph of all adult members of the household willing to work under NREGA and is free of cost.
• The Job Card should be issued within 15 days of application.
• A Job Card holder may submit a written application for employment to the Gram Panchayat, stating the time and duration for which work is sought. The minimum days of employment have to be at least fourteen.
• The Gram Panchayat will issue a dated receipt of the written application for employment, against which the guarantee of providing employment within 15 days operates
• Employment will be given within 15 days of application for work, if it is not then daily unemployment allowance as per the Act, has to be paid liability of payment of unemployment allowance is of the States.
• Work should ordinarily be provided within 5 km radius of the village. In case work is provided beyond 5 km, extra wages of 10% are payable to meet additional transportation and living expenses
• Wages are to be paid according to the Minimum Wages Act 1948 for agricultural labourers in the State, unless the Centre notices a wage rate which will not be less than 60 (US$1.10) per day. Equal wages will be provided to both men and women.

Note: The original version of the Act was passed with Rs155/ day as the minimum wage that needs to be paid under NREGA. However, a lot of states in India already have wage regulations with minimum wages set at more than 100 (US$1.80) per day. NREGA's minimum wage has since been changed to 130 (US$2.40) per day.

• Wages are to be paid according to piece rate or daily rate. Disbursement of wages has to be done on weekly basis and not beyond a fortnight in any case.
• At least one-third beneficiaries shall be women who have registered and requested work under the scheme.
• Work site facilities such as crèche, drinking water, shade have to be provided
• The shelf of project for a village will be recommended by the gram sabha and approved by the zilla panchayat.
• At least 50% of works will be allotted to Gram Panchayats for execution
• Permissible works predominantly include water and soil conservation, afforestation and land development works
• A 60:40 wage and material ratio has to be maintained. No contractors and machinery is allowed
• The Central Govt. bears the 100 percent wage cost of unskilled manual labour and 75 percent of the material cost including the wages of skilled and semi skilled workers
• Social Audit has to be done by the Gram Sabha
• Grievance redressal mechanisms have to be put in place for ensuring a responsive implementation process