Ukundululwa kwe- kwelizwe lasemaphandleni, iMission yempilo ephantsi kwegunya lesizwe (NRHM) ngo-2005] kwamela ukuphinda kunyuswelwa okusisiseko kolawulo lukarhulumente wase-Indiya kwimpilo kawonke-wonke. Kangangamashumi eminyaka, uninzi lwasemaphandleni belulungiselelwe ngezixhobo zezempilo ezinganyangekiyo, ezingasebenzi kakuhle, yaye zisoloko zingasebenzi kakuhle. Ngelixesha lamaziko asezidolophini ayeqhayisa izibhedlele eziphezulu, iilali zasemakhaya zazixakeke kakhulu ngokuswe kakhulu kukungabi nankathalo. I-NRHM yayiyilelwe ukumelana nokunzulu kwentloko ephezulu ephezulu, idala ubuchule bokunikezela, ukufikeleleka, nokungena nempilo, kunye neenkonzo zempilo ezifuna ukuzenzela iingingqingqi yelizwe elingu-60666661.

IGenesis Yomsebenzi Wesizwe Wezempilo

Iminyaka yasekuqaleni kowama- 2000 yabonisa ummangaliso ocacileyo kwi-Indiya. Izalathiso zezoqoqosho zakhula, kodwa kwimimandla yasemaphandleni zahlala zimile okanye ziphuculwe ngesantya esithe xhathayo sokudibana namaxhoba esizwe. iMaterinal Mortality Ratiation (MMR) kunye ne-Infant Mortality [ity] [IMR] [[FLTR] yayiphezulu ngokungenakungamkeleki, iqhutywa kakhulu yimizalwa yamakhaya eyayikho ngoncedo lwedasi, ukuswela inkathalo yexesha likaxakeka, nokungondleka okungadliyo. Uwonke uxawulo lwempilo oluthe kratyalwayo olujikelezayo ngaphaya koluphanyazanya oluyi-0.9 ukuya ku 1% ye-GP, ishiya iintsapho eziphakathi ezisebuhlweni eziphakathi ze-ock.

Inkqubo ye-NRHM yasungulwa njengenkqubo yothutho, eyahlukileyo kumacebo ohlobo oluthile lukarhulumente. Yajoliswa kwiziphumo kunokuba ibe ngamagalelo nje, igxininisa ubhetyebhetye ukwenzela iimeko ukuze zilungelelanise neemfuno zasekuhlaleni. Isiseko sasisithi impilo asikokungabikho nje kwezifo kodwa imeko epheleleyo emzimbeni, engqondweni, nakwintlalo entle, kwaye ukufikelela oku kufuna indlela yonyango olunxulumene nempilo, ubugratyazi, nokufumana amanzi.

Izinto Eziyintloko Eziza Kukwenziwa Lo Mbutho

  • Ukuncitshiswa kweMathernal kunye neMwana: eyona njongo ingxamisekileyo yayikukuhlisa iMMR ne-IMR ngendlela ephawulekayo. Oku kwaquka ukwandisa umyinge wokuhambisa nokuqinisekisa ukubakho ngobuchule ngalo lonke ixesha lokuzalwa.
  • I-Access engahambelaniyo kwimpilo yoluntu: Umsebenzi ojolise ekwenzeni ukhathalelo olungundoqo lwempilo luze luphinde luvuselelwe ngothungelwano olukhoyo lweSubCres (SCs), Primary Health Centers (PHCs), kunye neCentrees zezempilo zoluntu (CHC).
  • Ukukhupha kunye noLawulo lwezifo: Iinkqubo zokusulela ngokuthe nkqo zesifo seengcongconi, isifo sephepha, iqhenqa, kunye neHIV/AIDS kumgangatho wesithili nomqobo ukwenzela ukuphendula ngokumanyeneyo.
  • Isivumelwano seCommunity: unike amandla uluntu lwedolophana ukuphatha ucwangciso lonyango lwalo nokuhlola ngekomiti zasekuhlaleni.
  • Ukuqinisa umkhosi wempilo: Ukuqeqesha nokuqeqesha itshati yabasebenzi bempilo yoluntu nokukhuthaza oogqirha ukuba basebenze kwiindawo zasemaphandleni.

Inyathelo Eliphambili Nezindululo Zokwakha

I-NRHM yavelisa isuti yeenkqubo ezidityanisiweyo ezaguqula ngokusisiseko indlela iinkonzo zempilo eziqhutywa ngayo emaphandleni aseIndiya. La manyathelo adlulela ngaphaya kokwakha nje izibonelelo ukuze enze umlinganiselo womntu wokunyamekela idolophana ukuya kwisibhedlele sesithili.

I-Accreated Health Activast (ASHA)

Ukudalwa kwe- kujongwa ngokubanzi njengeyona mpembelelo iphambili ye-NRHM. Isebenza njengebhulorho phakathi koluntu kunye nenkqubo yezempilo esesikweni, i-ASHA lilungu lokuzithandela lezempilo eliqeqeshiweyo elisebenza kubemi abamalunga newaka labantu.

Ngaphezu izigulo ezizizigidi ezili-1 ze-ASH zibekwe kulo lonke elaseIndiya. Zingumsebenzi wokukhuthaza ukunikezelwa kweziko, ukubonelela ngezixhobo zokuthintela ukukhawula, ukulandelela ucwangciso lokugoma, ukunyanga izigulo ezincinane ngezixhobo zeziyobisi, kunye nokulawula izifo eziqhelekileyo. Ngexesha lesifo se-COVID-19, i-ASHA yayingabalwi-majoni aphambili abanoxanduva lokunxibelelana, ukuqwalasela, kunye nokuqonda kwebutho labantu, ngokufuthi bekwingozi enkulu yobuqu. Indima yabo iye yaguqula ukunikezelwa kwezibonelelo zezempilo zokugqibela, izenza ezona zinto zizezona zingundoqo zithembekileyo zempilo kwiidolophana ezingabali.

Janani Suraksha Yojana (JSY) noJanani Shishu Suraksha Karakram

I Janani Suraksha Yoyana iyinkqubo enkulu yeli hlabathi yokudlulisela imali ngemiqathango yempilo kamama. Inika amabhinqa akhulelweyo, ingakumbi akwiZiko lobuhlwempu, enentshukumisa yemali yokudlulisela usana lwawo kwiziko lezempilo likarhulumente. Le njongo yemali yayisisixhobo esinamandla sokususa ukuziphatha okungakhuselekanga kumakhaya.

Ukwakhiwa koku mpumelelo, uJanani Shishu Suraksha Karakram (JSK) wandululwa ukuphelisa iindleko zamabhinqa akhulelweyo kunye nabantwana abagulayo. I-JSK ivumela onke amabhinqa akhulelweyo ukuba akhawuleze ngokukhululekileyo (kuquka iicandelo C), amayeza akhululekileyo, uxilongo lwegazi olukhululekileyo, kunye nezithuthi ezikhululekileyo ezisuka ekhaya ukuya kwisakhiwo esingasemva. Le mfaniso ye-ze-0-expense yaba linyathelo elibalulekileyo ekukhuseleni imali kwimpilo.

Impilo yasedolophaneni, iNcazelo, neeKomiti Zezotya (iiVHSNCs)

I-NRHM yaqonda ukuba iziphumo zempilo zixhomekeke kwizinto ezingaphandle kweendonga zesibhedlele, njengamanzi acocekileyo, ugutyulo, kunye nokutya okunesondlo. Ukuthetha ngale nto, umsebenzi wagunyazisa ukusekwa kwe- Village Health, Santition, kunye ne-Nuttion Committee (VHNCs) kwidolophana nganye. Le komiti, eyilwe ngamalungu oluntu, ASHAM, kunye noPanchati Raj abameli, ifumana imali yokukhulula izicwangciso zempilo yelali. Basebenza njengeqonga lokuhlola uluntu kwaye baqinisekisa ukuba inkqubo yempilo imele abantu iluncedo.

Impembelelo Elinganisiweyo Kwizibonelelo Zempilo

Ugcino-lwazi oluqokelelwe kwiminyaka engamashumi amabini edluleyo lubonisa ukuba i-NRHM ibingumqhubi oyintloko oneziphumo ezintle zempilo eIndiya. Uphuculo kwimilingo yempilo kawonke wonke lubetha luze lubhalwe kakuhle.

Izibonelelo ze-Institugal: Mhlawumbi olona tshintsho luphawulekayo luye lwaba sekuzalweni. Ipesenti yokuzalwa kwezibonelelo zempilo yanyuka isuka ku 40% ngo 2005 ukuya ngaphezulu 88% kwiNational Family Health Survey (NFHS- 15), ngokunempumelelo isusa uninzi lokuzalwa okungakhuselekanga.

  • I-Mortality Rational (MMR): i-MMR ye-Indiya ibone ukuhla kwembali, ukuwa kumashumi amathathu anamashumi amathathu anethoba kukufa ngo-2001 ukuya ku-202] 97 kunyaka ka-2018 . Oku kubeka i-Indiya kwingoma ukufikelela ixhoba le-SDG ka-70. I-NRHM' ijolise ekuzalweni kwabangenisileyo kunye nokukhathalelwa kongxamiselwa kongxamiseko kunxulumene ngqo nokuphumezeka.
  • I-IMR yancipha ukusuka kumashumi asibhozo kunyaka wama-59 kuqikelelo lwakutshanje. Phantsi kokufa oku-55 kuye kwaphinda-phinda, kwaqhutywa yinkqubela kukhathalelo lwabantwana abazalwayo, uqheliso olungcono lokuncancisa ibele, kunye nokugonya-gonya okusasazekileyo.
  • Isantya sokwaleka: Isantya esipheleleyo sefection Riation (TFR) siye sawa ngaphantsi komgangatho wokubuyisela we 2.1 kumaphondo amaninzi, intsingiselo yokuba ulwando lwabemi luzinzile. Oku ngokwenxalenye kubangelwa kunikezelo oluphuculiweyo kucwangciso lwentsapho kunye nothintelo olunikezelwe ngu ASHAA.
  • Ulawulo lwe-Dissease: Inethwekhi ye-NRHM yomeleza ukuhlolwa kunye nezibonelelo zonyango lwezifo ezisuselayo. I-Indiya yafumana unciphiso olubalulekileyo kwiziphumo zesifo seengcongconi kunye nokufa, kwaye inkqubo yonyango oluqwalaselwe ngqo lweTB phantsi kwe-NRHM yaphumelela kwimpumelelo ephezulu yonyango.

La manani asingomanani nje kuphela; amela izigidi zabantu ezisindisiweyo yaye izigidi zeentsapho zasinda kwintlekele yokufa koomama nabantwana abanokuthintelwa.

Ucelomngeni Oluqhubekayo Neminwe Yebhotile

Nangona iziphumo zayo zinkulu, i-NRHM ayiphelelwanga yimiqathango. Ucelomngeni lokufuduka ukusuka kumlinganiselo ukuya kumgangatho lusasoloko lungumxholo ongundoqo kutshintsho lwempilo oluqhubekayo.

Ingxaki Yobuncwane Boluntu Kwimimandla Esemaphandleni

I-Indiya inenye yezona ngxaki zinzima zoogqirha, abongikazi, kunye neengcaphephe ehlabathini. Le ngxaki idityaniswe yi-rral-urdisparence. Ngoxa iikholeji zonyango zikhutshwa amawaka oogqirha nyaka ngamnye, uninzi lutsalela phambili kuqheliselo olunengeniso lwabucala kwizixeko. Ii-CHCC, ezithenjiswa ukubonelela ingcungela (utyando, i-gnecrecology, i-paediaology, isebenza ngaphandle kwengcali enye. Urhulumente uphuhlise icebo elifana "Rral Health Practition" ingcamango enika ingeniso ephambili" kodwa ihleli ingundala.

Ubunjani benkathalo.

I-NRHM yaphumelela ngokulumkileyo ekunyuseni ubuninzi botyelelo lomonde kunye nokuhanjiswa kwemibutho. Noko ke, ubunjani benkathalo kwizakhiwo ezininzi buguquguqukile. Uhlolisiso lubonise ukuba ngoxa amabhinqa amaninzi ethwalisa izibhedlele, ukuphakama konyango lwasemva kwepartum kunye nolawulo lwengxaki yengxaki kusoloko kubuthathaka. Uvavanyo lokuTshabhiswa komdla oqhutywa yiNkonzo yempilo lubalaselele imiba enxulumene nococeko, ukufumaneka kwamayeza, kunye nokuziphatha kwabasebenzi. Ukuphuma kumagalelo okufumana iziphumo kufuna ukugxininisa ukuphucula ubunjani.

Inkxaso-mali yeeNkcukacha kunye neMida

Ngeli xesha ulwabiwo-mali olwenziwayo lwe-NRHM lwandisiwe ukwenzela impilo encomekayo, inkcitho yempilo kawonke-wonke ye-India isenyuka malunga ne-1.5-2% ye-GDP, esezantsi xa ithelekiswa nemigangatho yomhlaba wonke. Oku kuthintela amandla okunyusa izibonelelo, ukugcwalisa iindawo ezingenanto, kunye nokugcina izixhobo. Kwimimandla emininzi ekude, iiPHCs zisaswele amagumbi erejini eejini, amanzi abalekayo, okanye umbane ongaguquguqukiyo. Uxhomekeko kwimali ekhucunyuliweyo yolungiso lusoloko lungqina ukungabikho kolungiso oluphezulu okanye ulungiso oluphezulu.

Umthwalo onyukayo wezifo ezinganyangekiyo (NCD)

I-NRHM yayilwa ekuqaleni ijolise kumama, kwimpilo yomntwana, kunye nezifo ezisulelayo. Noko ke, i-Indiya ngoku ijongene nomthwalo ophindiweyo wezifo, kunye nezingathathi-nxaxheba (NCD)] njenge-ibranting pressix, isifo sentliziyo, isifo sentliziyo, kunye nomhlaza obangela ukuba kufe abantu abangaphezulu kwama-60% abo bonke abafayo. Inkqubo yempilo eyakhiwa ngu-NRHM kwafuneka ilungele ukuqhelanisa ngokukhawuleza nokuxilonga, ukunqanda, nokulawula iimeko zexesha elide, ezifuna uhlobo olwahlukileyo kakhulu lokunikezelwa komsebenzi xa kuthelekiswa ne-iprosodiaccodiase okanye ukukhulelwa.

Imigaqo yexesha elizayo: Ukusuka kwi-NRHM ukuya kuMgaqo-nkqubo wezeMpilo

Lifa le-NRHM likhulu. Ngo-2013, umsebenzi wafakwa kwi-National Health Mission (NHM), eyandisa imigaqo yayo kwimimandla yasedolophini ngeNational Urban Health Mission (NUHM). Namhlanje, utshintsho olwenziwe kwisiseko se-NRHM luqhubela i-Indiya kusukelo lwe-Universal Health Combecage (UHC).

U-Ayushman Bharat nempilo kunye neNkathi yeWellness (HWCs)

Ngokunokwenzeka eyona ndaleko inkulu ye-NRHM yinkqubo ye-Ayushman Bharat. Eli candelo lokuqala libandakanya ukuguqula i-100,000 ekhoyo yeCentres ne-PHCs ibe ISipheko sobuNyaka [HWC] kunye neWellness [HHYCS] . Ezi -HWCs zinikezela ngenkathalo ebanzi engaphaya kwempilo ka-Mayamany-Addys ukuquka ukhuseleko nokuphathwa kwe-NCD, iinkonzo zempilo, kunye nononophelo lwezemali. Oku kuthetha ngqo umsantsa we-NRM. Ilungu lesibini linikela ukhuseleko lwezentengo yemali.

Impilo yamanani kunye noMbutho weBharat adigital (ABDM)

Ikamva elilifa le-NRHM lidibene nobugcisa. [[FLT: 0] I-Ayushman Bharat Digital Mission (ABDM) ijolise ekudaleni imo yempilo yamanani apho abemi bane-ID yezempilo ekhethekileyo kunye neengxelo zabo zempilo ziphathekayo ezihamba phezu kwezinikezeli. E-Indiya yasemaphandleni, apho ufikelelo lomzimba koochwepheshe lulinganiselwe, i-telemedicine ivela njengesixhobo esinamandla. I-e-Sanjevani iqonga elinceda izigidi zengxoxo kwingingqi ye-intanethi, lusukelo olungqalileyo lweNRMM lusuke lufikelele kwizithuba ezikhoyo.

Ukunikela ingqalelo Kwizinto Ezicel ’ Ithemba Entlalweni

I-NRHM ibisoloko ivuma ukuba impilo yenziwa ekhaya, hayi isibhedlele. Iindlela zexesha elizayo kufuneka zomeleze uqhagamshelwano phakathi kwesebe lempilo kunye namanye amasebe emigca njenga [[FLT: 0] Amabhinqa nophuhliso lomntwana (ICD:1], [, UPhuhliso ], , [FLT] [FLT]]], [FLT], [FLT], [FFLT]] ayisaqhubeka i--ardrdolrdrd; [inxathelela ingu, i-Santiza, i-'inqaka, [FTT][5], [inqandati] ne-groulk) elungileyo. [ifuna ingcali ezininzi]

Isiphelo: Isiseko Semfundo Esisiseko Kunyango LwaseIndiya

INational Rural Health Mission yayingaphezulu kakhulu kunenkqubo karhulumente; yayingumbutho wesizwe owenza unikezelo lwezonyango lwedemokrasi. Yadala uthungelwano olukhulu lwabasebenzi bezempilo basekuhlaleni, lwavuselela inkqubo yempilo kawonke-wonke ewohlokayo, lwasindisa izigidi zabantu ngokunciphisa ukufa okungenakuthintelwa. Nangona iingxaki ezibalulekileyo zisekhona, ukusebenza, kunye nenkxaso, i-NRHM yaseka i-NRM [[FLT:] yaseka isakhiwo sokwakha isakhiwo sokwakha i-[ apho iIndiya ilwakhela indlela yayo kumhlaba wonke wempilo epheleleyo. Yafudusa i-paradigm kwicandelo lolwahlulo, umzi ophakathi wesixeko, kunye nenkcuba nempilo, apho ekugqibeleni ummi wasezini wasemaphandleni iqaphele khona kunyango kunye nenkqubo yonikezelo lokuyidlulisa. Izifundo ezifundwe kwi-NMM [ir] apho iqhubekeka khona inkqubo yempilo yamashumi eminyaka e-Indiyane.