NRHM programme fails to live up to expectations

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When the much-hyped National Rural Health Mission (NRHM), one of the most ambitious programmes to revive the healthcare sector in the country, ended its five-year-long term last month, not only were many of its goals for Kerala unfulfilled, but funds were also not utilised effectively.

The project spent only 60 per cent of the allocated state funds. Many innovative projects conceived in geriatric care and adolescent and gender-based categories were not effectively implemented.

There are also widespread allegations of the lack of transparency in fund utilisation both at state and district level. It is also alleged that NRHM, which was conceived to work in convergence with the state health department, remained as a separate entity during the initial years which adversely impacted the implementation.

The NRHM in Kerala received Rs1218 crore from the central and state governments. From 2005 to 2012, the Union government allotted Rs1090.54 crore and the state, Rs127.51 crore. More than 90 per cent of the Centre’s allocation was used, but only 65 per cent of the state funds were used.

More than 5000 employees have been working with NRHM both on contract and permanent basis. The project also employed more than 31,000 ASHA volunteers in rural areas.

When compared with other states in the country, Kerala has specific issues in the healthcare sector. “One of the major limitations is the difficulty in getting qualified doctors in rural areas, especially in districts like Kannur, Wayand, Palakad and Kasargod.

Though there was financial flexibility, funds could not be properly utilised due to procedural and practical difficulties,” said a senior doctor with the NRHM in Kasargod district on condition of anonymity.

The government’s intent in bringing changes to the health care system may be good, but the implementation is ineffective for more than one reason, he added.

Reliable sources in the NRHM say that though it contributed to the infrastructural development of the rural health sector, it could not bring about a qualitative and professional approach to the sector. “The mission lacked a properly conceived plan of action and co-ordinated approach to optimally utilise the resources,” said the sources.

There are allegations that in spite of attaining its goal of raising the level of healthcare service delivery, the project’s emphasis was more on purchasing equipment and attaining standards of infrastructure development.

Every year crores of rupees were spent on quality improvement of government hospitals and a series of health awareness programmes had been conducted at panchayat and corporation levels. While this was good as far as it went, more effort should have been put in to cover urban slums as it was mandated to do, and there was no equivalent plan to set up public health centres, CHCs or sub-centres in urban areas.

Meanwhile, the project has been appreciated for its contribution to the infrastructural development, streamlined drug supply in the state, employing ASHA workers to reach out to the community and the pain and palliative care programme.

“In Ernakulam district, NRHM is a big success and the project could attain most of its goals during the five-year period. When we conducted a thematic audit, it was found that there is a marked improvement in quality, patient service and other indicators. Especially in infant and maternal mortality rate, and child health intervention, the project could bring in a significant change,” said Dr K.V. Beena, district NRHM officer.

Now, the union government in the course of the 12th Plan proposes to convert the NRHM into a National Health Mission (NHM) to provide health care to the urban poor also.