UP, J&K worst implementers of health mission

Uttar Pradesh, Assam and Jammu and Kashmir have emerged as the worst-performing states in implementing the UPA...

Uttar Pradesh, Assam and Jammu and Kashmir have emerged as the worst-performing states in implementing the UPA government’s flagship National Rural Health Mission (NRHM). The mission is already suffering from maladies like narrow focus and inadequate availability of drug kits.

According to an internal review of the ambitious programme by the Planning Commission, the NRHM which was conceived at an outlay of Rs 6,713 crore is doing well in north-eastern states like Nagaland and Arunachal Pradesh as well as in Chhattisgarh, but has fared poorly in Bahujan Samaj Party-ruled Uttar Pradesh, Congress-ruled Assam and in Jammu and Kashmir while states like Bihar, Rajasthan and Madhya Pradesh have shown an average performance.

The NRHM, which was conceived with a view to giving the health sector in the rural areas a facelift, lacks adequate support is suffering from major deficiencies as Accredited Social Health Activists (ASHAs) often have to face hostilities from village level functionaries, irregular payment of the workers, biased selection and inadequate training and shortage of adequate drug kits. So the Commission has suggested that the government should begin thinking in terms of offering balance performance incentives with fixed monthly honorarium and enlisting support from the state-level NGOs.

Another key component of the flagship programme called Janani Surakha Yojana (JSY) to suffers from poor quality of care, lack of infrastructure, over reporting of center based deliveries and non-payment of money, problems with the disbursed money, unaccounted attendance in Out Patient Departments, existing critical gaps in human resources, over emphasizing on certain aspects like polio at the cost of other programmes in lack of awareness among rural functionaries about their designated area of activities, the plan panel observed.

The Commission pointed out that though many states have suggested introduction of Public Private Partnership mode in executing the NRHM, yet there are divergent opinions on the same. Bit it definitely favoured creating a PPP framework in the health sector and orienting them as per local conditions. Arguing that there is little effort on replicating and upscaling best practices, the plan panel suggested that there is an express need for comprehensive household surveys and integrated MIS, including all health-related 11th Plan goals along with annual expected outcomes under NRHM and introducing civil society monitoring of the flagship programme.

The Commission is of the unanimous view that there is clear need for putting in place a structured health promotion policy and creating a cadre of health professionals.