India Explained
ImplementedINCManmohan Singh, coalition government

National Rural Health Mission (2005)

Launched in April 2005, the Mission funded rural health facilities and created the ASHA worker cadre and cash incentives for facility births; institutional deliveries were 39% in 2005-06 and 89% in 2019-21.

Public health infrastructure

Facts

  • The NRHM was launched in April 2005 'to provide accessible, affordable and quality health care to the rural population' (day of month 12 April is from memory; PRS gives April 2005) [1].
  • Core components reviewed in the first Common Review Mission (2007) included the ASHA community health worker programme, the Janani Suraksha Yojana (JSY) cash incentive for institutional delivery, and untied funds to facilities [2].
  • About 8.6 lakh ASHAs were in place across the country by January 2013, eight years after launch [3].
  • NFHS reports record institutional deliveries at 39% in 2005-06, 79% in 2015-16 and 89% in 2019-21 [4][5].
  • A CAG audit of the Reproductive and Child Health component (2011-12 to 2015-16, tabled 21 July 2017) found a 24%-38% shortfall in sub-centres, PHCs and CHCs in 28 States/UTs, a 77%-87% average shortfall of specialists in selected CHCs in 27 States, and unspent balances with State Health Societies rising from Rs 7,375 crore to Rs 9,509 crore [1].
  • At the time of the audit, India's infant mortality rate was 39 against an MDG target of 27, and the maternal mortality ratio was 167 against a target of 109 [1].

Why

Reasons given by those who did it

  • PRS records the stated aim as accessible, affordable and quality health care for the rural population [1].
  • The first Common Review Mission attributed higher use of public facilities to greater attention and investment in the public health system, filling of vacancies, untied funds, better diagnostics and drug availability, and institutional deliveries following JSY [2].

Criticism of that reasoning

  • The first Common Review Mission itself cautioned that the JSY was 'challenged by the slow rate of growth in infrastructure and personnel to meet the demand' generated by the shift to institutional deliveries, and that the ASHA programme needed more facilitation to be sustainable [2].

Benefits and concerns

Benefits (2)

  • Large rise in births in health facilities.Institutional deliveries 39% (NFHS-3, 2005-06), 79% (NFHS-4, 2015-16), 89% (NFHS-5, 2019-21) [4][5]. The Common Review Mission links part of the rise to JSY [2]; the surveys do not separate the Mission from other factors.
  • Created a community health worker network that the evaluations credit with promoting institutional delivery.About 8.6 lakh ASHAs by January 2013 [3]. In a three-district Karnataka evaluation reported in the same update, about 60% of women who had an institutional delivery named the ASHA as the main motivator; this is a local study, not a national estimate [3].

Concerns (2)

  • Facility and staffing gaps persisted a decade after launch.CAG (2017): shortfall of 24%-38% in sub-centres, PHCs and CHCs in 28 States/UTs, more than 50% in five States (Bihar, Jharkhand, Sikkim, Uttarakhand, West Bengal); average specialist shortfall of 77%-87% in selected CHCs; 1,285 completed works in 20 States not made functional [1].
  • Financial management and outcome targets.Unspent balances of Rs 7,375 crore (2011-12) rose to Rs 9,509 crore (2015-16) in 27 States; transfers from State treasuries were delayed 50 to 271 days; JSY incentives were unpaid or delayed in some cases; IMR 39 vs target 27 and MMR 167 vs target 109 at the time of audit [1].

Evidence points

+10.5
points, mean of two scorers (scale −25 to +25)
+10 to +11
range between the two scorers' totals
Medium confidence
scorers agree within 1 point on every criterion
ReachHow many people did the action materially affect?
Mean +4.5A +5B +4
Outcome evidenceDo official or independent data show the intended result (or its opposite), compared with the era baseline and peers?
Mean +3.0A +3B +3
Cost and sustainabilityIs the fiscal cost proportionate, and is the effect durable?
Mean +1.0A +1B +1
Process and rightsWas it made with debate, consultation and legal soundness, and did it respect rights and court rulings?
Mean +0.5A 0B +1
DeliveryWas it implemented as announced, on time and at scale?
Mean +1.5A +2B +1

Positive meanNegative meanScorer AScorer B

Scorer A. Institutional deliveries rose from 39% to 89%, but CAG found large facility and specialist shortfalls and rising unspent balances.

Scorer B. Institutional deliveries rose from 39% to 89% over fifteen years, but audits found large facility and specialist shortfalls and growing unspent balances.

Context used when scoring

Era baseline
2005-06 (NFHS-3): 39% of births in a health facility; public health spending on rural facilities was low and many sub-centres and PHCs lacked staff and supplies.
Lag before outcomes show
5 years
Shocks considered
covid-2020 (for NFHS-5 period)
Uncertainty
Medium confidence. Scorer totals are +11 and +10. How uncertainty is shown.

In depth

The Mission was a framework for central funding of rural health systems through State health societies, with additional money for facilities, staff and untied funds. Two of its most visible parts were the ASHA, a village-level health worker, and the Janani Suraksha Yojana, which paid a cash incentive to women giving birth in a health facility. The Mission was later combined with an urban component as the National Health Mission.

The clearest change in survey data is in institutional births, which rose from 39% in 2005-06 to 89% in 2019-21. The first Common Review Mission and later reviews associate the early increase with JSY and ASHAs, though the surveys cannot isolate the Mission from other influences such as income growth and State programmes. Maternal and infant mortality fell over the period, but at the 2017 CAG audit they remained above the targets set for 2015.

Audits and review missions describe gaps in facilities, specialist doctors and drug availability, and slow use of funds. The Common Review Mission noted that rising demand for institutional delivery outpaced growth in infrastructure and personnel. The Economic Survey 2025-26 credits the National Health Mission and Ayushman Bharat jointly for improvements in infant and maternal mortality, which means the data do not allow outcomes to be assigned to this Mission alone.

Sources

  2. First Common Review Mission, National Rural Health Mission: Main Report (2007)
    National Health Systems Resource Centre, Ministry of Health and Family WelfarePrimary
  3. Update on the ASHA Programme, January 2013
    National Health Systems Resource Centre, Ministry of Health and Family WelfarePrimary
  4. National Family Health Survey (NFHS-4), India, 2015-16
    International Institute for Population Sciences / Ministry of Health and Family WelfareOfficial data
  5. National Family Health Survey (NFHS-5), India, 2019-21
    International Institute for Population Sciences / Ministry of Health and Family WelfareOfficial data
  6. National Family Health Survey (NFHS-3), India, 2005-06
    International Institute for Population Sciences / Ministry of Health and Family WelfareOfficial data

Last reviewed .Report an error orchallenge a score.

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