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A billion-plus population and lack of facilities in villages have been the major challenges before the public healthcare delivery system in India
With health assuming greater importance in the agenda of successive governments, it had also become imperative to address this concern of reaching quality healthcare to men, women and children living in villages. Realising this need for immediate action, the first ever National Rural Health Mission (NRHM) of the country was launched this year as a wholesome and long term tool to spruce up the healthcare delivery system.
Ambitious in its outlook and bold enough to deal with some long neglected questions like public-private partnership in the health sector, the NHRM has already become a model mission for all developing countries.
Its lofty goal — to carry out necessary architectural correction in the basic healthcare delivery system — makes it a brilliant mission that brings to fore the various components of nutrition, hygiene and safe drinking water as well.
Increase in Health-Care Budget
The plan of action with a synergistic approach lays emphasis on increase in public expenditure on health, reduction of regional imbalance in health infrastructure, decentralization and upgradation of community health centers into functional hospitals. The entire service is expected to meet Indian Public Health Standards. With the setting up of the Indian Public Health Standards, personnel, management and equipment norms would be specified for the growth of the hospitals, especially in the rural areas.
While the public health expenditure in India had declined from 1.3 per cent of GDP in 1990 to 0.9 per cent of GDP in 1999, the Government has promised to hike this to 2-3 per cent of GDP with the NRHM, spread over 12 years, being one of the thrust areas for this allocation. The budget head for NRHM will be created in 2006-07 at the national and state levels. For the current year, an outlay of Rs 6700 crore has been allocated with an additional 30 per cent over existing annual budgetary outlays envisaged every year.
ASHA -A Change Agent
The mission has begun to take its first fledgling steps with plans to merge multiple societies at the village level and constitution of the district and state level missions. Through this year, the mission would strive to provide additional generic drugs at the sub-centre, primary health centre and community health centre levels as well as identify one female Accreditated Social Health Activist (ASHA) per village chosen by and accountable to the gram panchayats.
This marks a major shift in the governance of public health with the leadership being passed on to Panchayati Raj institutions. The ASHA would work as a ‘Change Agent’ for health and with the help of Anganwadi workers and the Auxiliary Nurse Midwives, develop inter-sectoral plans for the respective villages.
As part of the bigger picture, each of the 1,42,655 sub-centres in the country would be upgraded and strengthened with a corpus of Rs 10,000 per annum for local action. In the 23,109 primary health centres across the country, the long-standing need of adequate and regular supply of essential drugs and equipment would be addressed. The issue of shortage of doctors would be tackled by mainstreaming the manpower and drugs utilised in the Indian systems of medicine under the AYUSH scheme.
One of the key strategies of the mission is to operationalise the 3,222 existing community health centres as 24-hour first referral units and post anaesthetists to provide immediate healthcare to far flung villages.
Private Partnership
The growing role of the private sector in providing healthcare has been acknowledged in the mission as it talks of the need to refine regulations to make them more transparent and accountable. The planners have also called for involvement of the private sector in the district institutional mechanism and to forge need-based thematic and geographic partnerships with the government mechanism.
With a sharp focus on all the eight north-eastern states and a keen eye on creation of new health financing mechanisms including risk pooling for hospital care, the NRHM is all set to create a haven of good health in the countryside.
Networking Health Components
The mission’s visionary appeal lies in its effort to converge the sanitation and hygiene campaigns within its spectrum. By creating platforms for a host of schemes running in parallel, it has not only ensured networking of mutually complimentary health components but also made for one of the most successful model of rejuvenation of rural India.
As the Prime Minister, Dr. Manmohan Singh pointed out, the NRHM seeks to overhaul the delivery of health care. So far inadequate attention was paid to public health issues and social and preventive medicine. Instead the focus was on specified diseases. The NRHM will reorient the approach and address the issue of comprehensive health care.
The results have started showing. Sticking to its set targets, the mission would ensure healthy disease-free villages where infants and mothers do not die of want of services.
*Senior Freelance Writer, Kolkata
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