NRHM challenges and success

• Purpose: universal access to affordable, equitable and quality healthcare
• successes
• increased health finance
• revived the helaht delivery systems
• traine dhelath care staff
• established institutionals tandards
• facilitated inc entralised procurement of drugs
• village health and hospital committees
• challenges
• health is a state subject
• while center funds NRHM, state implements it

to ensure uniform quality and standard of health care dleivery across country, center needs to play rôle in implementation

SOLUTIOn: bring it under concurrent list

• improve governance
• study of NRHM process inidcators like
• utilisation of funds
• improvement in healthcare delivery
• community participation

it is observed that there is wide variation across states and regions

good performance states have improved while regions which had poor indices continue to remain so despite more funding for poor regions

there is need for overall improvement of governance in poor performance states

• increase funding
• current funding 1% of GDP
• developed nations: 5-10% of GDP
• need to increase to 2-3%
• prevent diversion of funds
• expand focus
• current focus on maternal and child health
• need to expand focus onto general health problems
• urban health
• National urban health mission should be given equal priority as NRHM
• urban health care has glaring deficiencies
• Evaluation criteria
• current assessment based on process indicators
• finance
• infra
• personnel
• shift to indicators of efficient functioning and assess health outcomes
• differential payments for staff serving in remote and difficult terrains
• health information monitoring
• community monitoring and social audits
• empower local communities
• approach
• coordinate with various other schemes
• aim for poverty reduction, social exclusion and gender discrimination
• funding priorities
• why increase fundings?
• better health of people leads to more economic growth
• NRHM should be made integral part of FYPs
• NUHM should get equal funding and work in coordination with NRHM
• improve governance
• develop system to monitor and audit performance