Introduction
The National Health Mission (NHM) is India’s flagship initiative aimed at achieving universal access to equitable, affordable, and quality healthcare services. Launched in 2013, NHM is an umbrella initiative that subsumes the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), targeting both rural and urban populations.
With India’s demographic transition and epidemiological shift, NHM has become central to achieving the goals of the National Health Policy 2017, Sustainable Development Goals (SDG-3), and the broader vision of Ayushman Bharat.
Evolution of NHM
| Year | Milestone |
|---|---|
| 2005 | Launch of NRHM for improving rural health indicators |
| 2013 | Integration of NRHM and NUHM into a unified National Health Mission |
| 2017 | NHM aligned with National Health Policy 2017 and Ayushman Bharat |
| 2020 onward | Greater emphasis on Health and Wellness Centres (HWCs), NCDs, and pandemic resilience |
Objectives of NHM
- Reduce maternal and infant mortality
- Ensure population stabilization and reproductive health
- Control communicable and non-communicable diseases
- Provide universal access to public health services
- Strengthen health systems at all levels
- Empower communities through ASHA workers and local governance mechanisms
Constitutional and Legal Framework
- Article 21: Right to life includes right to health
- Article 47: Directive Principle for improving public health
- Right to Health Bill: Adopted in Rajasthan (2023), indicates future national trend
- SDG-3: Ensure healthy lives and promote well-being for all at all ages
Institutional Framework
NHM operates on a decentralized, flexible, and participatory model:
| Level | Institution/Body |
|---|---|
| Central | Ministry of Health and Family Welfare, Mission Steering Group |
| State | State Health Society, State Health Mission |
| District | District Health Society |
| Community | Village Health, Sanitation, and Nutrition Committees (VHSNCs) |
Components of NHM
1. National Rural Health Mission (NRHM)
- Targets low-performing rural states
- Enhances access to maternal and child healthcare
- Deploys Accredited Social Health Activists (ASHAs)
2. National Urban Health Mission (NUHM)
- Focuses on the urban poor, especially migrants and slum dwellers
- Establishes Urban Primary Health Centres (UPHCs)
- Promotes community-based interventions for urban health
Major Programme Interventions under NHM
RMNCH+A (Reproductive, Maternal, Neonatal, Child & Adolescent Health)
- Janani Suraksha Yojana (JSY)
- Janani Shishu Suraksha Karyakram (JSSK)
- Mission Indradhanush (Immunization drive)
- Rashtriya Kishor Swasthya Karyakram (RKSK)
Communicable Disease Control
- National Tuberculosis Elimination Programme (NTEP)
- National Vector Borne Disease Control Programme (NVBDCP)
Non-Communicable Disease (NCD) Management
- NPCDCS:
- National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
- Mental Health Programme
- Oral and Eye Health Programmes
Health System Strengthening
- Construction and upgradation of Sub-Centres (SCs), Primary Health Centres (PHCs), Community Health Centres (CHCs)
- Implementation of Health Management Information Systems (HMIS)
- Training and recruitment of human resources
Role of ASHA Workers
ASHAs are the backbone of NHM, bridging the gap between the healthcare system and the community:
- Over 10 lakh ASHAs deployed
- Incentivized through performance-based payments
- Provide maternal care, immunization support, health education, and act as COVID-19 warriors during the pandemic
Digital Health and Innovation
NHM is progressively integrating e-Governance and digital health tools:
- eSanjeevani (Telemedicine portal)
- mHealth apps like Kilkari, RCH App
- e-Hospital portal
- Use of Aadhaar-linked health IDs under Ayushman Bharat Digital Mission (ABDM)
Achievements of NHM (As of 2024)
| Indicator | Achievement |
|---|---|
| IMR | Declined from 58 (2005) to 28 (2022) |
| MMR | Reduced from 254 (2004-06) to 97 (2018-20) |
| Institutional Deliveries | >89% nationally |
| Full Immunization | ~85% (Mission Indradhanush) |
| TB Cure Rate | >85% (NTEP data) |
| Urban PHCs | Over 5,000 operational |
| Health & Wellness Centres | ~1.5 lakh functional |
Budgetary Allocations
- Approx. ₹37,000 crore allocated to NHM
- Major focus areas:
- NCD control
- Infrastructure strengthening
- AYUSH integration
- Digital health expansion
Challenges in NHM Implementation
- Inadequate Health Infrastructure
- Shortage of Sub-Centres (SCs), PHCs, and CHCs.
- Lack of modern equipment, beds, and facilities.
- Human Resource Deficit
- High vacancy rates for doctors, nurses, lab technicians.
- Difficulty in attracting and retaining healthcare professionals in rural areas.
- Underfunding
- Public health expenditure still below 2% of GDP.
- Delays in fund release and under-utilization of allocated budgets.
- Urban Health Neglect
- NUHM rollout is weak in many states.
- Urban slums and migrant populations remain underserved.
- Weak Monitoring and Evaluation
- Poor quality of data in Health Management Information Systems (HMIS).
- Lack of real-time audits and performance reviews.
- Overburdened ASHA Workers
- Heavy workload with inadequate remuneration.
- No job security, social protection, or fixed salary.
- Fragmented Service Delivery
- Lack of convergence across health and nutrition schemes.
- Duplication of efforts and inefficiencies.
- Slow Digital Integration
- Limited use of digital tools in rural areas.
- Inconsistent training for frontline workers in ICT.
- Regional Disparities
- Poorer states (BIMARU) lag behind in implementation and outcomes.
- Inequitable access to services across regions.
- Rising NCD Burden
- NHM was originally designed for communicable diseases.
- Not fully adapted to address rising Non-Communicable Diseases (NCDs).
| Challenge | Description |
|---|---|
| Inadequate Infrastructure | Shortage of PHCs and medical equipment |
| Human Resource Deficit | Vacant posts and poor rural retention |
| Urban Health Neglect | NUHM not fully rolled out |
| Poor Quality Monitoring | Weak data collection and analysis |
| Low Health Spending | Public expenditure <2.5% of GDP |
| Overburdened ASHA Workers | Lack of fixed income or social protection |
Reforms and Way Forward
- To strengthen the National Health Mission (NHM), India must enhance public health spending to at least 2.5–3% of GDP and prioritize upgrading rural and urban health infrastructure.
- Addressing human resource gaps by recruiting and retaining doctors, nurses, and empowering ASHA workers with better pay and digital tools is crucial.
- Strengthening the National Urban Health Mission (NUHM), promoting digital health solutions like telemedicine, and ensuring real-time monitoring through HMIS will improve efficiency.
- Focus should also shift towards preventive care via Health and Wellness Centres (HWCs), alongside boosting community participation and ensuring convergence with schemes like Ayushman Bharat, POSHAN Abhiyaan, and Swachh Bharat.
- Increase Health Expenditure to ≥3% of GDP
- Strengthen NUHM, especially in Tier 2 & Tier 3 cities
- Upskill ASHA and ANMs to handle NCDs and digital tools
- Boost Public-Private Partnerships for efficiency
- Local Health Governance through empowered VHSNCs
- Integrated Health Planning across schemes
- Robust Digital Ecosystem under ABDM
- Climate-Resilient Healthcare Infrastructure
- Focus on Preventive and Promotive Health
- Transparent Monitoring & Social Audits
Conclusion
The National Health Mission is not just a health scheme—it’s a transformational movement. It symbolizes India’s commitment to healthcare equity, grassroots empowerment, and inclusive development. Yet, NHM’s success is contingent on robust governance, adequate funding, human resource investment, and technological integration.
