The National Rural Health Mission seeks to adopt a sector wide approach and subsumes key National Programmes such as: The Reproductive & Child Health Programme (RCH-II), the National Disease control programmes (NDCP) and the Integrated Disease Surveillance Programme (IDSP). NRHM will also enable the mainstreaming of Ayurvedic, Yoga, Unani, Siddha and homeopathy system of Health (AYUSH). Given that health is so critically linked with nutrition, water and sanitation, NRHM includes strategies for operational convergence to ensure that there is demonstrable synergy between these sectors.. One of the criteria for appraisal of District Health Plan was ensuring that the entire range of wider determinants of health have been taken care of in the approach to convergent action.

The Anganwadi Worker, ASHA and ANM are proposed to form the core of the Village Health Team and all three will work together to draw the village health plan in consultation with dais, other stakeholders and local opinion leaders. The Anganwadi will be the core institution for activities relating to delivery of health, family welfare and nutrition services at the village level. It will also serve as the institutional set up for ASHA at village level.

Govt. of Assam is proposing to develop comprehensive job charts and organograms for different functionaries working at the village level, like ASHA, ANMs, Anganwadi workers, LHVs and Medical Officers and their reporting patterns. These job charts would also specify convergence and co ordination between different functionaries in terms of job functions as well as reporting mechanisms and flow of information. Along with this, the State proposes to specify the accountability and supervisory role of PRI members.

1. INTERDEPARTMENTAL CONVERGENCE:

Past experience indicates that a number of government departments are implementing schemes, which involve non-health interventions that can lead to an improvement in health status of the community. NRHM thus aims at developing a coordinated working system to tackle the inter-departmental issues.

As part of the NRHM, a Village Health & Nutrition Day, as per the GOI guidelines, is proposed to be fixed every month at the AWC to provide antenatal, postnatal family planning and child-health services.

The following areas of convergence between NRHM and ICDS have also been considered:

• Women and Children's Health: Mobilization of women, adolescents, and children and provision of a package of quality health education and services at the village level
  
• Women's empowerment, gender and equity: Involvement of community based women's groups to ensure that social and related determinants of health including gender and equity are addressed. These include prevention of early child marriages, implementation of the PNDT Act, including awareness and action against girl child elimination, leading to distorted sex ratios, domestic violence, and mobilization of resources through collective action for health and other emergencies.
  
• Convergence between the following functions of both departments for nutrition, health and women's empowerment is also necessary. They include:
  * Joint formulation of BCC strategies, materials, and messages,
  *Operational strategies for joint planning at village, block and district levels,

2. CONVERGENCE WITH WATER AND SANITATION

The department of public health engineering(phe) & department of panchayat & rural development implements two mission mode initiatives for improving access, coverage, quality of safe water and sanitation in a sustainable manner- swajaldhara scheme and the total sanitation campaign (tsc). Activities under tsc are: construction of individual household latrines, latrines, community sanitary complexes, anganwadi toilets, iec, school sanitation and hygiene education, and rural sanitary marts and production centers.

• The swajaldhara programme represents the new paradigm for implementing safe drinking water schemes. The scheme is governed by the following guiding principles:
  Adoption of a demand-responsive and adaptable approach based on empowerment of villagers to ensure their full participation in the choice of scheme design, control of finances and management arrangements;
  
• Shifting role of government from direct service delivery to that of planning, policy formulation, monitoring and evaluation and partial financial support.
  
• Partial capital cost sharing either in cash or kind or both and 100 per cent responsibility of o & m by the users.

Swajaldhara, tsc and nrhm rely on community led approaches and are expected to be managed by panchayats. Strong intersectoral convergence is necessary at the district and state levels for improved synergy among these three initiatives. The institutional arrangement for the total sanitation campaign (to be universalized) will be the same at district and village levels. Total sanitation campaign has been proposed in 2008-09 only in tea garden areas of jorhat district.

The village health & sanitation coommitee(vhsc) will be formed in every villages of state as per guidelines of govt. Of india. The vhsc will be responsible for planning, monitoring and implementation of nrhm activities at the village and creating a demand for the services.

3. Involvement of PRIs: Monitoring and supervising the services of health (and related) functionaries providing services to the masses are important and hence involvement of elected representatives is imperative. Under the programme, the PRIs will be involved. PRIs will be sensitized and oriented towards issued relating to women and reproductive health issues, child health issues, family planning and gender.

Panchayati Raj Institutions will be responsible for the selection of ASHA and ASHA will be responsible to the Gram Panchayat. At the village level, the Gram Panchayat will guide the Village Health and Sanitation Committee. Funds for activities for involvement of PRIs have already been budgeted under the head Behaviour Change Communication.

4. Convergence Education Department: Various agencies working on adolescent issues will be converged for improving the knowledge of adolescents in sexual and reproductive health issues. Secondary, Higher and Technical Education dept would be involved in implementing the School Health Programme like formation . They will be involved in ASRH issues. A system of counseling young married adolescents and adults will be worked out through the peer educator and other grass root NGOs, by the health department.

5. Convergence with National Blindness Control Programme:-
The National Blindness Control Programme and NRHM will develop a strategic plan to address the refractory errors and eye related problems of children & adolescents under the School Health Programme.