4.1. National Rural Health Mission

With the advent of NRHM, India has made remarkable achievements in providing affordable healthcare facilities to the rural poor and also

♤ Added over 1.56 lakh health human resources to the health system across the country (up to September 2013).

♤ Institutional deliveries in almost all the states show a quantum jump during NRHM period

♤ Majority of the new born children have been immunized in all the states of India

♤ NRHM funds utilization has improved over the period at all levels.

♤ Sub Centers and PHCs have started using untied grants with decentralization under NRHM.

However, there are also some problems as indicated in different studies5 and reports which are as follows:

♤ Physical infrastructure: Since inception of NRHM, a large number of CHCs, PHCs, and SCs have been added to rural health services in India. However, the functioning of CHCs, HCs, and SCs on 24x7 basis is still below the requirement. The infrastructure is also substantially short of Indian Public Health Standards (IPHS) norms.

♤ Human resource: There is a shortage of human resource in public health institutions with shortfalls of even specialists/post-graduate doctors, gynaecologists, staff nurses and anesthetists in almost all the states.

♤ Referral and emergency transport: This system seems to be working quite efficiently in some of the states like Madhya Pradesh, Jharkhand, Assam and Tamil Nadu. However, in most of the districts in Uttar Pradesh, Orissa and J&K, the Mobile Medical Units are not working. Besides inefficient emergency transport system is hampering the outreach of health care services.

♤ Hospital Maintenance: Even peripheral services like cleaning, washing, catering, etc. have not been outsourced in many districts.

♤ Quality of services is seriously affected by shortage of staff nurses at all levels of facilities. Women delivering new born babies also don’t stay for minimum 48 hours after delivery because of lack of basic facilities like cleanliness, electricity potable water, etc.

♤ Capacity building: Although trained ASHA’s are recruited in all the states, in some states they are not trained properly and in some states even the guidelines for the selection of ASHA workers are not followed properly. The existing training infrastructure like medical colleges, nursing training institutes, etc. does not match with the required level of infrastructure. Besides there is no rationalization of posting and transfer policies for medical and health management personnel which affect the credibility and sustainability of health care.