Prinja Shankar, Sharma Atul, Nimesh Ruby, Sharma Vineeta, Madan Gopal K, Badgaiyan Nina, Lakshmi Pvm, Gupta Madhu
Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
NITI Aayog, New Delhi, India.
Int J Health Plann Manage. 2021 Jul;36(4):1143-1152. doi: 10.1002/hpm.3166. Epub 2021 Mar 31.
Government of India introduced National Rural Health Mission in 2005-now transformed into National Health Mission (NHM), to bring about architectural reforms in health sector. In this study, we evaluate the overall impact of NHM on infant mortality at national and state level. Annual data on infant mortality rate (IMR) from 1990 to 2016 were obtained from Sample Registration System bulletins. With reporting year 2009 considered as cut-off point, a two-step segmented time series regression analysis was conducted. Estimates of pre-slope, post-slope and change at the point of intervention were computed by applying auto-regressive integrated moving average (1, 0, 0) while adjusting for trend and auto correlation. We found that while IMR reduced from around 80 to 34 per 1000 live births at the national level from 1990 to 2016, the annual rate of reduction increased from 1.6 per 1000 live births before NHM to 2.2 per 1000 live births after NHM. This is estimated to have averted 248,212 infant deaths in India, between 2005 and 2017. The rate of decline in IMR accelerated in 13 out of 17 larger states, most significantly in Andhra Pradesh, Gujarat, Assam, Haryana, Punjab and Uttar Pradesh. NHM has thus been successful in accelerating the overall rate of reduction in IMR in India. There is still a need to identify the determinants of variations at state level. We recommend strengthening of NHM in terms of funding and implementation.
印度政府于2005年推出了国家农村卫生使命，该使命现已转变为国家卫生使命（NHM），旨在对卫生部门进行结构性改革。在本研究中，我们评估了国家卫生使命在国家和州层面上对婴儿死亡率的总体影响。1990年至2016年的婴儿死亡率年度数据来自抽样登记系统公告。以2009年报告年份为分界点，进行了两步分段时间序列回归分析。在调整趋势和自相关的同时，应用自回归积分滑动平均模型（1, 0, 0）计算干预点前斜率、后斜率和变化的估计值。我们发现，虽然1990年至2016年期间，全国层面每1000例活产婴儿的死亡率从约80例降至34例，但年下降率从国家卫生使命实施前的每1000例活产婴儿1.6例增加到实施后的每1000例活产婴儿2.2例。据估计，这在2005年至2017年期间避免了印度248,212例婴儿死亡。17个较大邦中有13个邦的婴儿死亡率下降速度加快，其中安得拉邦、古吉拉特邦、阿萨姆邦、哈里亚纳邦、旁遮普邦和北方邦最为显著。因此，国家卫生使命成功加快了印度婴儿死亡率的总体下降速度。仍有必要确定州层面差异的决定因素。我们建议在资金和实施方面加强国家卫生使命。
