Mission Possible

The union health ministry which kick-started the Rs 7000 crore National Rural Health Mission (NRHM) in April, is a welcome but belated move that should have happened long time ago. Even as it comes in hastily to appease to the pro-poor policy decisions taken in the common minimum programme of the last general elections, this programme should honestly be seen and implemented in a manner that will deliver the goods to the grass-root level. At a time, when the health inequalities have been widening and a pro-private healthcare delivery is being encouraged by the centre and the states, a timely introduction of the NRHM should quickly resurrect the abysmal state of our PHCs and sub-centres, practically on the verge of collapse. This must have prompted the prime minister, suggesting a slowing down on privatisation of healthcare if it is going to be detrimental to the need and availability of those lower in the economic order. He is right with his observations that we have paid little attention to public health issues including social and preventive medicine. The NRHM to be driven through the panchayat system will inevitably have political influences and the first thing is to see that political parties are not allowed to use the panchayats to distribute political patronage. The PMO must get rid of all sorts of machinations that could thwart a radical overhaul in the delivery of healthcare services at the rural level.

Of the six priority areas to reform the health sector, the idea of a public-private partnership model for PHCs is an important one and no time should be lost in completely revamping this. All the thriving ills of a corrupt society can be seen in the present set-up. NGOs as partners and the infusion of private doctors will help in a better delivery. A thorough overhaul of the Human Resources in the entire spectrum of healthcare delivery is also a priority and employing multi-skilled personnel must become mandatory and the unipurpose staff stuck in bureaucrasies must be eased out. It should be clear to all that the ‘architectural correction’ the PM refered to, must be incorporated if the mission has to show a new way out for an effective rural healthcare system. It may not suffice to bring in a centralised drug procurement system alone, but there is also an urgent need to change the system radically from the ‘tender system’ of drugs procurement where corruption and low quality drugs are the order of the day. This is a fertile ground for spurious drugs and the government which is serious about this mess must make amends now. Talking of rural healthcare where even today a majority prefer traditional medicines, integrating the Indian System of Medicine in the delivery mechanism is essential. It would be better if a majority of ASHA (accredited social health activists) are women and the stringent qualifying norms for it including minimum education should not be rigid but recruit persons with a missionary zeal to improve the health of their respective villages. Apart from sanitation, hygiene, safe drinking water and nutrition, even if in the next three years, NRHM is able to play a significant role in containing scourges like malaria and TB together with improving child and mother health, the government’s lofty pronouncements would not go in vain.

—nvramamurthy@expressindia.com