Eleventh Five Year Plan

72 Eleventh Five Year Plan• All District Health Action Plans completed by20083.1.50 In the Eleventh Five Year Plan, the emphasisunder NRHM will not be on numerical achievementsonly but also on IPHS and enforcement of guidelinesfor improving the functioning of infrastructure beingstrengthened and created. It has been felt that theMission Directors, both at the Centre and the States,should be officials with public health background,supported by the Civil Service cadres.JANANI SURAKSHA YOJANA (JSY)3.1.51 To change the behaviour of the communitytowards institutional delivery, the GoI, under NRHMin 2005, modified the National Maternity BenefitScheme (NMBS) from that of a nutrition-improvinginitiative to the JSY. The scheme has the dual objectivesof reducing maternal and infant mortalityby promoting institutional deliveries. Though theJSY is implemented in all States and UTs, its focusis on States having low institutional delivery rate. Thescheme is 100% centrally sponsored and integratescash assistance with maternal care. It is fundedthrough the flexi-pool mechanism. Under theNRHM, out of 184.25 lakh institutional deliveriesin the country (as on 1 April 2007), JSY beneficiarieswere 28.74 lakh.3.1.52 While the JSY scheme is meant to promoteinstitutional delivery, it has to take two critical factorsinto account, one being that India does not have theinstitutional capacity (International Institute of PopulationSciences [IIPS], 2003) to receive the 26 millionwomen giving birth each year, and the other being thataround half of all maternal deaths occur outside ofdelivery, during pregnancy, abortions, and postpartumcomplications. If institutions are preoccupied withhandling the huge numbers of normal childbirths,there will be inevitable neglect of life-threatening complicationsfaced by women. They will be compelled tovacate beds in the shortest time. Consequently, complicationsduring pregnancy and after childbirth willnot be given attention. Second, JSY money sometimesdoes not reach hospitals on time, and as a result, poorwomen and their families do not receive the promisedmoney.National Urban Health Mission(NUHM)3.1.53 The NUHM will meet health needs of theurban poor, particularly the slum dwellers by makingavailable to them essential primary health care services.This will be done by investing in high-caliber healthprofessionals, appropriate technology through PPP,and health insurance for urban poor.3.1.54 Recognizing the seriousness of the problem,urban health will be taken up as a thrust area for theEleventh Five Year Plan. NUHM will be launchedwith focus on slums and other urban poor. At theState level, besides the State Health Mission and StateHealth Society and Directorate, there would be aState Urban Health Programme Committee. At thedistrict level, similarly there would be a District UrbanHealth Committee and at the city level, a Health andSanitation Planning Committee. At the ward slumlevel, there will be a Slum Cluster Health and Waterand Sanitation Committee. For promoting publichealth and cleanliness in urban slums, the EleventhFive Year Plan will also encompass experiences of civilsociety organizations (CSO) working in urban slumclusters. It will seek to build a bridge of NGO–GO partnershipand develop community level monitoring ofresources and their rightful use. NUHM would ensurethe following:• Resources for addressing the health problems inurban areas, especially among urban poor.• Need based city specific urban health care systemto meet the diverse health needs of the urban poorand other vulnerable sections.• Partnership with community for a more proactiveinvolvement in planning, implementation, andmonitoring of health activities.• Institutional mechanism and management systemsto meet the health-related challenges of a rapidlygrowing urban population.• Framework for partnerships with NGOs, charitablehospitals, and other stakeholders.• Two-tier system of risk pooling: (i) women’s MahilaArogya Samiti to fulfil urgent hard-cash needs fortreatments; (ii) a Health Insurance Scheme forenabling urban poor to meet medical treatmentneeds.