CAG finds serious lapses in NRHM implementation

Creation of a parallel fund flow route through a set of societies at the state and the district level had not resulted in faster disbursement of funds,the report alleged.

“There were delays in release of funds from the SHSs to the districts and consequently to the health centres,which led to delay in implementation of the mission,” it said.

The report further goes on to say that the releases and the disbursements under the NRHM at all levels,from the Ministry to the SHSs and below were equated with expenditure,“regardless of whether these had actually been utilised”,adding “the actual expenditure on the mission could not be ascertained”.

Blaming the planning of NRHM for its non-effectiveness,it said the programme initiated decentralised bottom-up planning. This,however,was hindered by non-completion of household and facility surveys and state-specific perspective plans.

The data available with the ministry remained inadequate as implementation of a computerised MIS was delayed by almost three years due to delay in development of a reporting format and user guidelines,the report claimed.

On the positive side,the mission has created a cadre of about 6.16 lakh female community health workers and set up an Empowered Procurement Wing (EPW) which had developed a comprehensive procurement manual.

The increased patient inflow at Primary Health centres and Community Health Centres and improved institutional deliveries and immunisation efforts are indicators of the Mission’s impact on health care delivery,the CAG report said.

The percentage of women receiving post natal care has also gone up in eight states.

On the other hand,the induction of ASHA workers was incomplete in most of the states and Union Territories,the report claimed.

While contract workers have been engaged to fill vacancies,there are “still shortages” of specialist doctors at CHCs,adequate staff nurses at CHCs and PHCs and nurses and mid-wives.

“In seven states,more than 50 per cent and in nine states,20 to 50 per cent of pregnant women did not receive the full dose of iron and folic acid tablets due to delays and shortfalls as high as 62 per cent in coverage,” the report said.