National Rural Health Mission is flop: PAC

Centres set up under the government’s flagship National Rural Health Mission (NRHM) are being used for everything but to provide health. Some of them have been turned into warehouses to store food grain, while some have been converted into cattle sheds where there is no place for the already reluctant doctors.

The big “disappointment” has been brought to light by parliament’s public accounts committee (PAC) six years after the ambitious sceheme to universalise healthcare in the country was launched.

PAC also found several other flaws in NRHM. It noted that the health centres were being supplied substandard and expired lifespan medicines and there was a lack of trained health workers and absence of common drugs in many states.

“The committee was distressed to note that a large number of sub-centres, PHCs [public health centres] and CHCs [community health centres] had sub-standard environment and were functioning in unhygienic conditions. Besides, the health centres lacked essentials such as water supply and storage tanks, facilities for disposal of sewage and biomedical waste and separate utilities for men and women,” chairman MM Joshi said.

The committee was “startled” to find that 71 PHCs (11%) in 15 states were functioning without an allopathic doctor. In 518 PHCs (86%) in 28 states/union territories, an AYUSH (ayurveda, yoga, unani, siddha or homeopathy) doctor had never been appointed and 69 PHCs test-checked in audit were functioning without allopathic or AYUSH doctors. “The availability of specialist doctors with respect to CHCs was equally worse and disappointing,” Joshi said.

PAC was surprised that the government did not conduct a performance assessment after the launch of the mission for necessary course correction. Taking note of the glaring deficiencies, infirmities and want of effective monitoring mechanism, it recommended a thorough reappraisal and restructuring of NRHM, so that shortcomings are removed.

PAC also suggested constitution of district and vigilance monitoring committees. It said each state needed to prepare a common formulary of essential drugs for mandatory prescription of generics by hospitals/doctors, so that poor patients are supplied good quality drugs on time and not fleeced. It was also critical of the public expenditure —merely 1.1% of GDP (50% of the target of 2-3% set under the mission) —on health.