The findings of the second Common Review Mission, the biggest independent review exercise of its kind in any flagship programme of the government, has clearly confirmed that the National Rural Health Mission has made a difference everywhere.
Outpatient cases, institutional deliveries, impatient cases, diagnostic services, emergency transport services have all registered an improvement in a majority of the States.
Over 50,000 Nurses and ANMs have been added on contract under the National Rural Health Mission besides nearly 15,000 Specialists, MBBS Doctors and Ayush Doctors. Such large-scale addition of human resources has translated into improved availability of health care services for people in rural areas.
13 States were visited by six member teams as part of the Second Common Review Mission of the National Rural Health Mission in November-December 2008. Public Health experts, NGO representatives, development partners, senior public servants etc. were part of these independent teams that spent ten days in two districts of the selected States. Assam and Mizoram in North Eastern region, Bihar, Uttar Pradesh, Madhya Pradesh, Orissa, Jharkhand, Chhattisgarh and Rajasthan from among the high focus States, four States namely, Karnataka, Maharahstra, Kerala and Tamil Nadu among the non-high focus States were covered in the current Common Review Mission.
There is a large-scale evidence of poor people coming to government facilities on much larger scale than before. Shortages of human resources, physical infrastructure, equipments etc. is being attempted under the National Rural Health Mission as per the Indian Public Health Standards. The fast expansion of medical and nursing education is required in high focus States for provision of adequate number of health human resources. Similarly, more efforts at building capacities among community leaders in the management of health programmes and in seeking inter-sectoral convergence with other determinants of health like Water, Sanitation, Education, Nutrition etc. is required. National Rural Health Mission has established the institutions and encouraged the activities that bring about communitization of health care with flexible financing and innovations in human resource engagement. The development of the last two years have created hope that India may also be able to achieve the Millennium Development Goals by a faster reduction of mortality and morbidity.
The Mission found that states with better baseline like Kerala, Tamil Nadu and Maharashtra have been in a position to make quicker use of untied funds. The Mission has felt the need for more flexibility in funding along with better management for enabling the areas of infrastructure, human resources and supplies to catch up with the achievements in institutional deliveries. In the field of public-private-partnership, most of the states have NGO and private sector collaboration. A need was felt to deepen such partnerships in the states like Kerala, Madhya Pradesh and Uttar Pradesh. NRHM has definitely given a boost to community participation in the health sector. For example, Village Health and Sanitation Committees haven formed in 82 per cent villages in Maharashtra and 92 per cent villages in Chhatisgarh. ASHA remains the flagship of community participation. The Assam Report states “ the ASHA programme has created a groundswell for NRHM in the state, they are the face of NRHM and have a visible and audible presence”.Chhatisgarh, Orissa, Assam Rajasthan, Madhya Pradesh have all completed their 4th module of training for ASHAs (total of 15 to 19 days of training. Uttar Prades Bihar and Mizoram lag behind with only 7 days training. Drug kits for ASHAs have been procured and distributed in all states except in UP and Bihar.
National Rural Health Mission has also put in place an elaborate system of decentralized management of health with the involvement of Panchayati Raj Institutions, Rogi Kalyan Samitis and Village Health and Sanitation Committees. These institutions are utilized untied financial resources for improving the health facilities and for involving local communities in the organization of Village Health and Nutrition Days and other outreach services.
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