For the first time since the inception of National Rural Health Mission,a substantial part of the allocations under it to states will be linked to the performance of the latter. Though nobody is talking about the multi-crore NRHM scam in UP,the changes in the funding pattern aim to ensure better monitoring/linking of expenditure and outcomes,with the mission directorate having set state-specific targets,instead of a blanket countrywide goal.
States stand to gain by up to 30 per cent of the allocation as incentives if they undertake a slew of reforms,including institution of a public health cadre and supply of free generic medicines at state health facilities.
The Ministry of Health,in a recent review meeting chaired by Pulok Chatterji,Principal Secretary to the PM,had been asked to step up pressure on both initiatives.
On the other hand,states could lose the same amount if they do not rationally deploy available manpower or do not have a facility-wise audit. The NRHM support for a second auxiliary nurse and midwife (ANM) could be withdrawn if the implementation of the Mother-and-Child Tracking System (MCTS) is not found to be satisfactory. For the financial year 2012-13,the ministry has been given Rs 20,541 crore under NRHM.
The move has been made as per the recommendations of the Mission Steering Group,which had reasoned that while the fact that health being a state subject precluded any binding directive from the Centre on governance measures for the mission,after seven years,the programme has finally reached a stage when the structures would need to be put in place through a system of incentives and disincentives that are linked to payment.
For the first time this year,the mission directorate has also set state-specific targets in terms of health indicators like infant mortality rate,maternal mortality rate,fertility rates etc to ensure that the present situation,when some states are striving to achieve the impossible while others are way past the targets already,is rationalised.