## National Health Mission (NHM) Strategy **Key Point:** The National Health Mission (launched in 2013, replacing NRHM) emphasizes decentralization, community participation, and strengthening health systems at grassroots levels rather than centralized control. ### Core Principles of NHM 1. **Decentralization**: Health planning and management devolved to district and sub-district (block) levels 2. **Community Participation**: Involvement of Panchayati Raj Institutions (PRIs) and community health volunteers 3. **Flexibility**: States can adapt programs based on local health needs and epidemiology 4. **Accountability**: District-level accountability for health outcomes ### NHM Pillars | Pillar | Focus Area | |--------|------------| | **Health System Strengthening** | Infrastructure, human resources, supply chain | | **Reproductive, Maternal, Neonatal, Child & Adolescent Health (RMNCH+A)** | Reducing maternal and child mortality | | **Communicable Disease Management** | TB, malaria, dengue, leprosy control | | **Non-Communicable Disease Prevention** | Chronic disease surveillance and management | | **Community Participation** | ASHA, ANM, VHND, health committees | **High-Yield:** NHM operates on the principle of subsidiarity — decisions are made at the lowest competent level (district/block) rather than centrally. This allows contextual adaptation and faster implementation. **Mnemonic:** **DCCF** — Decentralization, Community participation, Contextual flexibility, Flexibility in implementation **Clinical Pearl:** The success of NHM depends on strengthening the public health system from the grassroots (ASHA workers, ANMs) upward, not replacing it with private sector management. [cite:Park 26e Ch 3]
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