Experts fear new rural health plan, consuming Rs 6,713 crore in 2005-2006, will be a fiasco
the much-hyped National Rural Health Mission (nrhm) was launched on April 12, 2005 by prime minister Manmohan Singh with the aim to "deliver healthcare to all". The programme will be operational for seven years (2005-2012). Singh said the event marked the fulfilment of some of the most crucial promises made under his government's National Common Minimum Programme. But experts seriously doubt the chances of the plan's success. They wonder how a "population stabilisation" centric effort will fulfil overall healthcare needs and allege that the government has ignored expert opinion in formulating nrhm. Branding it as too ambitious, they also raise doubts about its implementation and monitoring.
nrhm focuses on rural areas of 18 states. Its key aims include increasing health sector funding, providing a trained female health activist to each village and strengthening rural healthcare centres. It allows states to design their own delivery models and adopts a synergistic approach of linking health to the determinants of good health: nutrition, sanitation, hygiene and safe drinking water. On the face of it, the mission seems overwhelming but a closer scrutiny reveals many loopholes.
But the government is confident. Ghosh asserts: " The programme would, but naturally, be effectively implemented. As for monitoring, the health indices would prove its triumph." Community health experts are not so sure. Thelma Narayan, coordinator of the Community Health Cell, Bangalore, an ngo, points out: "The plan is too ambitious, which also makes it vague. The government wants to have a health plan for each village; this is romantic thinking. It doesn't have the capacity. The nrhm draft has no provisions for implementation." Past experiences also spell caution. The fate of the major initiative to establish primary health centres in all villages, undertaken by various governments since independence, is noteworthy: 85 per cent of India's rural population has no proper healthcare facilities.
Coordinating with state governments will also be a major challenge for nrhm. "Health is a state subject. At present, even if funds are available, the state health departments refuse to use them. How will the Union government ensure that they effectively implement nrhm? The political commitment has to be transferred to the bottom. At present there is no scope of public accountability," points out Narayan. She suggests involving the civil society in implementation and monitoring. But Ghosh is non-committal: "We have not thought about how to involve ngos in the process." "People's ownership of the mission" is what N H Antia, director, Foundation for Research in Community Health (a Pune-based ngo) recommends. He says a mere increase in health outlay won't clear the distortions afflicting the health sector
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