Monday, September 29, 2008

Health is not for all

Committed officers are making a difference at the grassroots level. But experts feel the government is chasing quantity, not quality, says GYANENDRA KASHYAP
After more than two and half years of the launch of the National Rural Health Mission (NRHM) to provide accessible, affordable and accountable health services to the poor, the programme is plagued with problems. As I traversed 530 kms to Himachal Pradesh, stopping at various places like Nagrota Bagwan and Gopalpur, I realised that the UPA government’s commitment to hike public spending on health to 2-3% of GDP is hogwash. And the objective of ‘Health For All’ is a distant dream.

But first let me focus on the good news. The drizzle that morning had further dipped the temperatures, but that had not deterred the First Referral Unit (FRU) staff to come on time. As I entered the room of A.R. Raghu (Block Medical Officer, Nagrota Bagwan), what caught my attention was the photographs of national heroes. Before I could quiz him on them, pat came his reply, “I draw my inspiration from them.” As we settled down, Raghu explained how adequate funds and attempts to make the local community a partner in achieving the health goals was the real innovation of the scheme.

At the local level, Raghu said that there had been a major turnaround in the past 6-7 months. The reason, according to him, was that “in the first 11 months or so I was humiliated, and had no administrative powers. But thanks to J. S. Chandel (chief medical officer), who played a pivotal role, things have changed. Had you come a few months ago, you would have been able to see the changes for yourself.” Take the case of the availability of funds. “There is no scarcity of funds; all that we need to do is to spend the amount judiciously,” says a confident J.S. Chandel,. Quite true, as a sum of Rs.53.36 crore was received under NRHM in 2005-06; of this, the state spent Rs.34.54 crore. In the current year, the grants-in-aid released for NRHM up to November 2007 was Rs.18.84 crore. At the national level, Rs.4,75,000 crore was allocated under the Family and Welfare Camp in 2007-08, of which Rs.2,98,000 has been utilised.

Getting into specifics, Chandel revealed that the number of girl children per 1,000 male children went up from 815 in 2006 to 846 in the next year. Similarly, the number of OPDs has more than doubled from 6,051 in the first quarter of 2006 to 12,212 in the same period in 2007. To reduce costs in the future, the administrators are deliberately working on the concept of quality circles; they take suggestions by staff and patients, and necessary actions are taken accordingly. “The awareness of the scheme is slowly catching up,” says Chandel.

I saw evidence of this in Gopalpur, where a board with names of 204 medicines available under the scheme was hung publicly. In the area, the blindness control programme was in full swing. Ansali Devi, a patient, had no attendant, and the CMO ordered for necessary arrangements to be made so that she could get her eyes operated. Neeru Ram, an asthma patient, agreed that he gets free medicine from the unit at Gopalpur. Kamala Devi, another patient, was a bit skeptical: “Aaj to muft mein diya hai, kal bhi denge to yaakin ho jayega (Today, I have got free medicines, if I get them tomorrow, I will believe it).”

Added Munsi Ram, “Pehle bahut mushkil tha, buri halat thi. Dawai bahar se kharidna hota tha. Ab to yahin se mil jaata hai (Earlier, it was difficult and the situation was bad. One had to buy medicines from the market. Now, I get it here).” Roshan Khanna, a local contractor in Nagrota, said: “Prayaas aur Niyat dono hi hain. Alochana ke saath saath sarahna bhi milta hai (There are both efforts and intentions. Along with criticism, the scheme is praised too).”

However, this is just one part of the story. The second one relates to tardy implementation, lack of specialists, and inadequate reach. It’s only those who get free medicines and care who benefit. But there are millions who still have no access to the services. For instance, the number of institutional child deliveries has come down from 0.52 lakh in 2005-06 to 0.49 lakh in the next year. Just over 45% of the children are born in hospitals. Most women prefer to deliver at homes.

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Source :
IIPM Editorial, 2008
An IIPM and Professor Arindam Chaudhuri (Renowned Management Guru and Economist) Initiative

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