Misgivings persist about implementation
The Union Cabinet gave its approval for the launch of the much-awaited National Urban Health Mission (NUHM) on May 1. The scheme along with the National Rural Health Mission will be part of an over-arching National Health Mission. The goals of NUHM are similar to those of NRHM—reduce Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), extend universal access to reproductive health care and converge all health related interventions.
The scheme will focus on primary health care needs of the urban poor. Under the scheme, the Cabinet approved one urban primary health centre (U-PHC) for every 50,000 to 60,000 population, one urban community health centre (U-CHC) for a cluster of five to six U-PHCs in big cities, one auxiliary nursing midwife (ANM) for each 10,000 population, and one accredited social health activist (ASHA, community link worker) for 200 to 500 households. The mission will be implemented in 779 cities and towns with more than 50,000 population and cover about 77. 5 million people.
The estimated cost of NUHM for five years is Rs 22,507 crore. The Central government's share is estimated at Rs 16,955 crore. Centre-state funding pattern will be in the ratio of 75:25, except for north-eastern states, Jammu and Kashmir, Himachal Pradesh and Uttarakhand--the funding pattern for these states will be in the ratio of 90:10.
However, the commitment of the government is under question in light of the dismal allocation of funds to health, particularly NUM. Amit Sengupta, of the New Delhi-based organisation, Jana Swasthya Abhiyan, said that since its launch, funds released to NRHM have been only one-third of the estimates for the approved framework—about Rs 66,000 crore was released against the estimated Rs175,000 crore. Further, funds released under the 11th Plan are less than half of the original Plan outlay.
“Introducing a scheme is not enough. The government needs to deliver too. The government announced its programme for free medicine one-and-a-half years ago. Till today there is no implementation,” he said.
The government will use existing institutional mechanism and management systems created for the functioning of NRHM to meet the needs of NUHM. Implementation plans in cities will be prepared based on baseline survey and felt need. Urban local bodies will be fully involved.
“They should recruit more people. Right now the authorities are only burdening the existing structures.” said Sengupta.
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