title: Addressing the social determinants of health through health system strengthening and inter-sectoral convergence: the case of the Indian National Rural Health Mission.
abstract: BACKGROUND
  At the turn of the 21st century, India was plagued by significant rural-urban, inter-state and inter-district inequities in health. For example, in 2004, the infant mortality rate (IMR) was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself) and to facilitate action on other determinants of health, India launched the National Rural Health Mission (NRHM) in April 2005.
  
  
  METHODS
  Under the NRHM, Rs. 666 billion (US$12.1 billion) was invested in rural areas from April 2005 to March 2012. There was also a substantially higher allocation for 18 high-focus states and 264 high-focus districts, identified on the basis of poor health and demographic indicators. Other determinants of health, especially nutrition and decentralized action, were addressed through mechanisms like State/District Health Missions, Village Health, Sanitation and Nutrition Committees, and Village Health and Nutrition Days.
  
  
  RESULTS
  Consequently, in bigger high-focus states, rural IMR fell by 15.6 points between 2004 and 2011, as compared to 9 points in urban areas. Similarly, the maternal mortality rate in high-focus states declined by 17.9% between 2004-2006 and 2007-2009 compared to 14.6% in other states.
  
  
  CONCLUSIONS
  The article, on the basis of the above approaches employed under NRHM, proposes the NRHM model to 'reduce health inequities and initiate action on SDH'.
authors: Ministry of Health and Family Welfare, Government of India, New Delhi, India.
authors: Amit Mohan
authors: AM
authors: Prasad
authors: Gautam
authors: G
authors: Chakraborty
authors: Sajjan Singh
authors: SS
authors: Yadav
authors: Salima
authors: S
authors: Bhatia
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D054625:Healthcare Disparities; D006801:Humans; D007194:India; D007223:Infant; D007226:Infant Mortality; D008297:Male; D058996:Quality Improvement / Q000458:organization & administration; D012423:Rural Health / Q000592:standards / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D012959:Socioeconomic Factors
keywords: India; National Rural Health Mission; equity; health systems; social determinants of health