‘NRHM short on equipment, manpower’

FM Bureau | 12-November-2012

In an interview with Education Insider, Dr Zakir Husain, Associate Professor, Population Research Centre, Institute of Economic Growth, Delhi, gives an expert opinion on the operational aspects of the National Rural Health Mission (NRHM). A PhD holder in Economics from Calcutta University, Dr Husain works in the field of development econometrics and public health

How successful has been the National Rural Health Mission (NRHM) in streamlining and improving the health system?

Targets have not been fulfilled in most cases. States need to focus more effectively. But given the complexity and magnitude of the task, NRHM has been a success in terms of keeping health to the forefront of policy-making.

The government intends to upgrade NRHM as the National Health Mission (NHM). What are the specific problem areas that the government should attend to before such upgradation?

The Health Management Information System needs to be more effective. It is crucial for monitoring and evaluation and has tremendous potential. Statistics Division, Ministry of Health and Family Welfare, is working on this along with Population Research Centres.
Finding manpower requirement in rural areas remains an important challenge.
Given the economic crisis, frustration with corruption and red tapism, and shift of attention of donors to Africa, funds may become a major issue as scale of NRHM is enhanced to NHM.
Planning needs to be more responsive to the local needs and concerns. Unrealistic targets are leading to falsifying of figures.

Do you have any recommendations for strengthening the network of sub centres/primary health centres/community health centres?

Physical location of health centres is fine. Equipment remains a worry. Manpower shortage is an even greater constraint. Allocating existing manpower in keeping with the incidence of morbidity and epidemiological profile and existence of equipment/other staff is another challenge.

Is there an alarming level of shortage of medical equipment and medicines in the rural health establishments? How can we overcome this, considering India’s huge population?

Yes, there is a shortage. But we also have to focus on leakages. Repeat economist and social activist Reetika Khera’s study, which had showed that 50% of PDS subsidy leaked away, to find out the true deficit.

In addition to the problem of absenteeism, the rural health system is in acute need of more qualified doctors and paramedical staff. How do we attract more professionals, especially in the light of opposition from a section of the medical community to the proposal of compulsory rural service?

“Barefoot doctors” may be a step forward. Address two concerns of rural doctors: education of children and need to lobby for transfer back to urban area. We should adopt a mixed policy in which a doctor spends four days in a rural posting and two days at the nearest urban centre.

How effectively has NRHM empowered the backward states?

Look at Uttar Pradesh! The state has been forced to invest in health in a big way. Some improvements have occurred.
How can the ASHA scheme be enhanced further since it is one of the areas where NRHM has been successful?
Re-training can augment their medical knowledge, and their functions should be increased in accordance with experience.

Is there a way to give better insurance entitlements to the rural population?
The Rashtriya Swasthya Bima Yojana has been a failure. Local community-based insurance schemes may be an option. Let us learn from experience of other countries.

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