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Editorial From the Hindu

Editorial From the Hindu

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Published by monuaryan
Editorial From the Hindu
Editorial From the Hindu

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Published by: monuaryan on Jun 09, 2011
Copyright:Attribution Non-commercial


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NRHM: addressing the challenges
K.S. Jacob
 NRHM needs to revitalise systems, monitor their unctional performance and investigate their impact onthe indices of health.
The National Rural Health Mission (NRHM) waslaunched in 2005 to bring about a dramaticimprovement in the health system and health status of  people in rural India. It seeks to provide universalaccess to health care, which is affordable, equitable,and of good quality. It aims at making architecturalcorrections to basic health care systems, reduceregional imbalances, pool resources, integrateorganisational structures, optimise human resource,decentralise the management of district health programmes and integrate many vertical health programmes. It also aims at facilitating community participation, partnership and ownership of health andhealth care delivery.
itious progra
The NRHM has been described as one of the largestand most ambitious programmes to revive health careand has many achievements to its credit. It hasreiterated the focus on health and re-prioritised ruralhealth and health care. It has increased health finance,and improved infrastructure for health delivery. It has
established standards and trained health care staff. Ithas also set benchmarks for health institutions andimproved and streamlined health care deliverystructures. It has coordinated technical support fromhealth resource institutions and non-governmentalorganisations. It has improved health care delivery inmany regions. It has facilitated financial management,assisted in computerisation of health data, suggestedcentralised procurement of drugs, hospital equipmentand supplies, and mandated the formation of villagehealth and hospital committees and communitmonitoring of services. It has revived and revitalised aneglected public health care delivery system.The NRHM has injected new hope in the health caredelivery system. However, it continues to face diversechallenges, which need to be addressed if its goals areto be achieved in the near future.Regional variation: A comparison of data betweenStates and within regions and social groups suggestsmarked variations in the NRHM process indicators,utilisation of funds, improvement in health caredelivery, health indices and in community participation.Regions with good health indices have shown markedimprovements, while those with prior poor indices haverecorded a much lesser change.This is true, despite a greater NRHM focus on andinputs to poor-performing States. Improvinggovernance and stewardship within the NRHM programmes mandates general improvement in theoverall governance of States and regions. It calls for redoubling of efforts to improve the governance of 
States and regions in general and NRHM programmesin particular.Convergence of different programmes: Many programmes of the government, the Integrated ChildDevelopment Services (ICDS), the Mahatma Gandhi National Rural Employment Guarantee Scheme(MGNREGS) and the NRHM focus on the rural poor.In principle, these programmes are meant to becomplementary and synergistic. However, many issuesneed to be resolved. For example, the NRHM's VillageHealth and Nutrition Days compete with the ICDS'swell-established Anganwadi programme. This results ina lack of synergy between the workers employed by thetwo programmes. Similarly, coordination between theMGNREGS and the NRHM, which could help the mostvulnerable sections, is non-existent. The goal of healthfor all requires cooperative teamwork among the manyschemes and departments of the government.Parallel health systems: The NRHM is intended tostrengthen and support the existing State health systemsand services. However, its status as a project makes itscomplete integration problematic. The idea that theStates will take over its financing after 2012 does notgenerate enthusiasm for long-term commitment fromstaff at the State and district levels. In addition, theadministrative machinery of the NRHM and healthservices at the national, State and district levels remainsseparate without complete integration, making the programme less effective and the services less thanoptimal. Independent and vertical disease control programmes also continue to operate with separatesocieties and line management. Despite calls for 

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