Understanding the Dynamics of Implementation of NRHM and its Effectiveness

“Health for All” has become now unwritten, or at times, written target of all nations of the World, as envisaged by World Health Organization (WHO). But what does this it mean? “The goal of real healthcare reform must be high-quality, universal coverage in a cost-effective way.”-Bernie Sanders. In order to provide, accessible, affordable and quality healthcare services to the poorest of the poor, the Government of India in 2005 launched its most ambitious flagship programme National Rural Health Mission, integrating all its vertical health and family welfare programmes at National, State, Block, and District levels to carry out architectural correction in the basic health care delivery system. India under NRHM has been able to improve its public healthcare delivery system, despite the constraints and limitations of a diverse country like India, evident from improvement in a variety of basic health indicators and the expansion of health infrastructure (both physical as well as manpower) over the years. But the problem is, how far this improvement of public health in overall India is reflected in its State/Uts? Being a diverse country, all the State/Uts of India are different, be it geographical, political, economical or social. Accordingly, the status of the public health is also different in different state/Uts. There are States like Tamil Nadu with TFR as low as 1.7, whereas there are States like Bihar with TFR as high as 3.7. In the case of Infant mortality, the highest IMR is visible in Madhya Pradesh (56 per 1000 live births) and lowest (10 per 1000 live births) in Goa and Manipur. While looking at the basic health indicators like IMR, TFR, CBR etc, it was realised that Himachal Pradesh(HP) is doing better in all indicators as compared with other State/Uts as well as all India average. It is pertinent to mention that HP is one of the “high focus” State of NRHM, indicating weak public health indicators and weak health infrastructure at the time of the launch of the mission. The research attempts to understand the dynamics of the implementation of NRHM in HP, how it has been able to achieve its targets while many other State/Uts are still lagging behind. The study has revealed that HP has been able to implement the concept of community participation. It was in fact the first state to introduce to start a community financial management programme. However, the State is using its existing Anganwadi workers to play the key role of implementation of NRHM at grass root level, i.e ASHA. The state is also being successful in integrating AYUSH in the mainstream. It has also been found that the State is implementing a number of other schemes like Parivar Kalayan Salahakar Samiti (PARIKAS), Matri Sewa Yojana(MSY), Pre-Conception (PC) and Pre-Natal Diagnostic Techniques (PNDT) act, ‘Beti Hai Anmol’, ‘Balika Smridhi Yojana’ and ‘Kishori Shakti Yojana’ to improve its public health system. In HP, main problem in health care lies in the unavailability of skilled human resources. Another problem the State faces is that the programmes for family planning are very less effective here, as it includes camps for sterilization which are held only once in a year.