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India is the second most populous country after China. In the 50 years since 1951 the population of the country has increased from 36.11 crore to 102.87 crore (presently about 110 crore).
In the last decade, India added about 18.6 crore to its population that is more than the population of the undivided State of Uttar Pradesh. Although the annual rate of growth of population for the country as a whole declined from 2.14 per cent to 1.93 per cent during the decade 1991-2001, the growth rate of population in demographically backward States has increased during the decade. It is felt that although progress in some States is satisfactory, poor performance in Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, Orissa, Uttranchal, Jharkhand and Chhattisgarh is proving to be a drag on national achievement.
With risk of becoming the most populous country in the world by about 2050, designing of appropriate and effective strategies to address the problem of population growth is an important challenge facing the nation. The growth of population naturally has greater impact on demand for essential items including hospitals, schools, jobs and other public utility services, which will have substantial implication for economy as well as environment.
Under the National Common Minimum Programme of the UPA Government, ‘Health’ has been identified as one of the seven thrust areas to provide integrated health services to people, especially to poor through enhanced allocation for Public Health Sector, increased decentralization to State and District level, involvement of communities and Panchayati Raj Institutions, strengthening Public Health Infrastructure, mainstreaming AYUSH and addressing concerns for nutrition, sanitation and hygiene and and safe drinking water.
Since Independence, a vast public health infrastructure comprising of 1,45,000 Sub-centres, 23,000 Public Health Centres (PHCs) and 3222 Community Health Centres (CHCs) has been created. However, it is estimated that this infrastructure is able to cater only to 20 per cent of the population, whereas 80 per cent of healthcare needs are still being provided by the private sector. Poor access to health leads to avoidable incidence of morbidity, mortality and out-of-pocket expenses, often leading to indebtedness. In rural areas especially, there are pockets of under-served populations where the vicious circle of poverty, malnutrition and poor health reinforce each other.
With the sole objective of meeting the basic requirement of Health for all, the Union Government launched the National Rural Health Mission (NRHM) on April 12, 2005 throughout the country with special focus on 18 States i.e. the States of Himachal Pradesh and Jammu and Kashmir, 8 Empowered Action Group States (Bihar, Jharkhand, M.P., Chhattisgarh, U.P., Uttaranchal, Orissa and Rajasthan) and 8 North-East States (Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura). The Mission aims at provision of comprehensive and integrated primary healthcare to the people, especially to the rural poor, women and children.
The key strategic interventions under the Mission include positioning of 2.5 lakh Accredited Social Health Activists (ASHAs) in 10 high focus States i.e. Assam, Jammu & Kashmir and 8 EAG States and upgrading of CHCs to a new standard of healthcare namely, Indian Public Health Standard (IPHS) so as to ensure 24X7 quality referral hospital care, inter sectoral convergence of programmes related to Health & Family Welfare , Nutrition, Sanitation & Hygiene etc. at village, district and State level and achieving the Goals of National Population Policy & National Health Policy. The ASHA will mobilize community, women and children for the health related services and also escort pregnant women for institutional delivery under the Janani Suraksha Yojana (JSY). The main goals of the NRHM are as follows:provide effective health care to rural population; improve access to health care; enable community ownership and demand for services; strengthening public health system for efficient service delivery; enhance quality and accountability; promote decentralization; mainstream AYUSH and integration with other sectors namely ICDS, nutrition, sanitation & hygiene, drinking water etc.
The NRHM also plans to train and enhance capacity of Panchayati Raj Institutions(PRIs) to own, control and manage public health services. The Mission also envisages the following roles for PRIs: States are required to commit for devolution of funds, functionaries and programmes for health to PRIs; the District Health Mission should be chaired by Zila Parishad. The DHM will control, guide and manage all public health institutions in the districts namely, sub-centres, PHCs and CHCs; ASHA would be selected by and be accountable to the village Panchayat; Village health Committee of the Panchayat would prepare the village Health Plan and promote intersectoral integration; each sub-centre will have an Untied fund for local action @ Rs.10,000 per annum, which will be deposited in a joint Bank Account of the ANM and Sarpanch. This fund will be operated by the ANM in consultation with the Village Health Committee and PRI involvement in Rogi Kalyan Samitis for good hospital management.
Many States even with unfavourable socio-economic indicators have successfully implemented the Population Stabilisation Programmes bringing down fertility levels. The target of achieving the demographic goals of National Population Policy, 2000 largely depends upon effective implementation population stabilization programmes in the States with high population growth. Urgent and focused interventions are required to be undertaken to address the issues of reproductive and child health care in these States for the attainment of the goals set in the NPP, 2000. The new initiatives like NRHM, RCH-II etc. would provide the right impetus for improving the health and family welfare services, which would bring out a significant improvement in demographic scenario in high fertility states.
*Information Officer, PIB, New Delhi
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