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8/3/2019 Just Passed - NRHM!
1/17
JUST PASSED!
On Performance of NRHM
SUGGESTIONS TO THE WORKING GROUP FOR THE 12TH FIVE YEAR PLAN
Here, we have considered the Discussion paper as a reference document. Our
comments and suggestions are mentioned under each sub topic as per the
Discussion paper.1
A. Outcomes in Maternal Mortality:
India will be short of MMR Goal of 100
Our comments:
There is a significant decline in maternal mortality in India during the NRHM
2007-10 period, as the data shows, all the limitations notwithstanding.
However, the discussion paper points out the shortfalls in EAG states and
within the southern and other Non EAG ones eg Karnataka and Haryana,
slowing down of MMR decline in Maharashtra, weak correlation between
MM ratio and rates in EAG states are some of the key concerns. All thesetrends indicate that the specific regions and communities in every state may
have specific problems social behaviour, infrastructure including roads,
transportation systems etc.
Main causes of better performances at southern states seem to be
systematically operationalizing forward and backward linkages for safe,
institutional deliveries: incentivizing motivation for institutional deliveries,
EMRI from home to hospital and back home, (Assam, HP, AP, Gujarat, some
NE states) making 24x7 SDH level facilities, improved availability of
medicines, (TN, Manipur) special tribal health care management units (in AP).
Our suggestions
1After each set of suggestions, there is a score out of 10 for the achievement. The rest ofcomments and suggestions are based on the comments circulated by Renu Khanna and Sunil Kaul,
the scoring is entirely by me based on Shyam Ashtekars model. So please send me your comment
on the score, its system and its subjectivity. Dhruv Mankad
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It is therefore suggested that in order to find out gaps in other states, detailed
operational reviews are essential. Except ASHA and to some extent the JSY
programme, none of the other programmes are evaluated in details.
Comparison between MMR as maternal mortality ratio and the maternal
mortality rate.
Our comments:
According to the paper, the reduction in total number of maternal deaths,
lower fertility rates by themselves bring about. Statistically, this may be a
correct interpretation; its relevance to the residual population needs to be
examined. However, the correlation of these two indicators is weak in EAG
states as compared to other regions. (Figure 1) It also mis-indicates that birth
control alone sans controlling any other factors in mothers having low
education status, low decision making role, early marriage, low nutritional
status particularly IDA, low, post natal care, low spacing etc will indeed
reduce the mortality rates! This is particularly true when reducing maternal
morbidity through better postnatal care is still not on agenda.
Our suggestions
Therefore we suggest that emphasis on target free approach for family
planning must be encouraged. Otherwise it may lead to reversal of the
laudable paradigm shift that NRHM has brought in - from family planning to
convergent primary health care. It is clear from the success of strategy of
institutional delivery that improving supply side management will create moredemand and improve its outcome. The same logic should follow in case of
fertility control.
Let us accept that this achievement is despite lack of several components
of an adequate EmOC services and not because of it. The slowing down in
non EAG states is a warning signal.
Our score for reaching this achievement of this goal is 6.
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Figure 1: Comparison of drop in Maternal Mortality Ratio and Rate in states
(2004-06 and 2007-09)
B. Outcomes in Infant and Under 5 mortality:
Our comments:
The national infant mortality rate has declined both in rural and urban areas during
the NRHM. However, at the existing falls, we would well short of the goal.
The decline in under 5 mortality was similar. However, the NRHM has had low
impact on decline of U5MR in rural area and among girl children.
The variations in decline in IMR and U5MR along with rural and gender
differences also indicates that certainly these variations reflect within the states.
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There is a close correlation between state wise drops in maternal mortality ratios
and IMR. Apart from the factors which affect the MMR, other factors like
improved neonatal care, breastfeeding and weaning practices, spacing,
supplementary feeding, economic status of the family and the region etc. also
affect largely the IMR.
Our suggestions
Therefore we suggest detailed operational reviews between and within states
should be carried out to identify gaps in implementing relevant programmes.
Supplementary feeding programmes have been evaluated in the past including
ICDS, Mid-day meal, PDS etc.. However, the role of these programmes in
relations with overall food security at family level and its contribution in reduction
of malnutrition requires to be carried out.
Our score for reaching this achievement of this goal is4.
C. Progress on Population Stabilization:
Our comments:
The Census 2011 (that) the demographic history of the country, as it is
perhaps for the first time, there is a significant fall in growth rate of population
in the EAG states after years of stagnation.
The fact that existing interventions to reduce maternal and child mortality
rates along with availability of family planning services have had an impact
across all the states.
Our suggestions
In fact this achievements during the NRHM underlines that these interventions
to reduce maternal and child mortality rates must be strengthened in quantity
and quality to ensure that gaps in population stabilization would be filled up.
Our suggestion that the paradigm shift that NRHM has brought in must be
maintained, is vindicated.
Our score for reaching this achievement of this goal is6.
D. Outcomes of Clean drinking water for all:
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Our comments:
Figure 2 shows the achievements of this goal. There are still 30% of locations
having adequate coverage for drinking water. However, the continuous back-slipsis a major concern.
Also the data does not give us any information about time of drinking water
availability, distance of its source and its quality.
Our suggestions:
Detailed study about time period of drinking water availability, distance of its
source and its quality is required. Its impact on maternal morbidity also needs to
be explored.
Intersectoral Convergence should emphasize on involvement of DW authorities.
Our score for reaching this achievement of this goal is5.
E. Reducing malnutrition among children of age group 0 to 3 to half its
present level and reducing anemia by 50%
Our comments:
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Although there are no figures available after the NFHS III, there are indicative
studies conducted in various pockets of vulnerable remote areas, in various states
that probable causes of malnutrition: mothers nutritional status, immunization,
drinking water, mothers education, breast feeding practices, ICDS serving 0-2
age group of children still remain to be achieved.
ICDS has been dropped out of inter sectoral convergence as all the PIPs show.
This has been recognized as one of the causes of malnutrition in India.
Our suggestions:
Concurrent evaluation of all nutrition interventions should be made public.
Our score for reaching this achievement of this goal is 3.
F.Raising the sex ratio for age group 0 to 6 to 935 by 2011-12 and 950 by 2016-17
Our comments:
According to your note, the child sex ratio in India has dropped to 914 females against
1,000 males - the lowest since Independence. According to 2011 Census, the child sex
ratio has declined from 927 females against 1,000 males in 2001 to 914 in 2011.
Our suggestions:
First, our suggestion is rigorous enforcement of PCPNDT Act on use of sonography.
Second is to involve State Medical Councils, FOGSCI, Radiological Association and
other Medical Association to bring about professional pressure on colleagues
performing acts which encourages sex selection. Enforce MCI and state councils to
carry out their duties to ensure that the licensed practitioners practice according to the
legal and ethical boundries.
Final suggestion is to encourage behaviour and positive discrimination for girls andtheir parents eg a pension scheme equivalent to a retired government employee for
one of the parents particularly the mother of two daughters.
Our score for reaching this achievement of this goal is -5.
G. Increase in public health expenditure
Our comments:
Although, the public health expenditure has gone up due to the mission, it has reached
nowhere near projected level.
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It has not increased upto the proportion of GDP as public health expenditure (0.9 in
2005-06 to 1 in 2011-12). It has not increased substantially as a proportion of state
budget.
The absorbability of funds from state departments, State society down to the VLHC is
variable. As per all CRMs, the public health services managed largely not being
impartial and professional approaches and politically neutral area are the mainproblems, making this mission functional.
Our suggestions:
Create a National Health Fund where unspent fund remains so that the fiscal
commitment is actual and not notional.
Use additional funds for HR development and for hospital centred services.
The absorbability of funds from state departments, State society down to the VLHC
should be increased by introducing efficient mission management, monitoring and
internal auditing system at state, district and block level Make State health department and health societies down to VLHC trained with proper
accounting and internal auditing system so that men would not be the receivers of
JSY incentives!
Make Tamil Nadu model of drug procurement and distribution become mandatory
with provision for innovative alternatives like the Rajasthan models.
Our score for reaching this achievement of this goal is 4.
.
H. Increase in healthcare infrastructure, human resources and provision of
health services, specifically to women, children and the rural population of the
country
Our comments:
Although there is an increase in the health care infrastructure and in human resources,
it is mainly on a haphazard, arbitrary and knee jerk mode.
Choice of location for PHC, SC is not on the basis of accessibility criteria.
Several states have different models under the Referral Transportation Programmes.
States like AP, Gujarat, Assam, HP etc. have shown successes. However, there are
very few systems which are evaluated concurrently. Maharashtra though the report
says, have a referral transportation system, it is actually only a vehicle made available.
It is not equipped with any capacity to handle any emergency except bringing the
patient to a referral unit from a health station. It does not provide home to hospital
services. There are experiences where BPL patients have paid diesel and chai pani
charges!
There is no overall HR policy as such; contractual appointments have become the
rules rather than as supportive policy: that too is with a collective slavery mode buy
cheap labour. This in addition to rampant selling of posts ensures non-performance
and impossible HR management. There is no induction policy, reward punishment
modes, non-accountability etc.
There is often no congruency in infrastructure and human resources on one hand withthe health care needs due to the location, community it covers, epidemiological
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evidence. Eg PHCs on highway handle cases of road accidents; PHC closer to forest
areas receive cases of wild animal bites, insect bites etc. Even, institutional deliveries
are carried out where there is no institutional or personal competency for BEmOC/
EmOC. Specialists are recruited for MCH programme but there is little use of their
expertise for illnesses other than LSCS and new born care. Counselling and
physiotherapy are not part of a hospital team at CHC level. ASHA is considered as amedical appendage or a helper of the MPWs. Monthly meetings are often conducted
by Lab Technicians! Their payment is inadequate and irregular.
There is no congruency between trained staff and their placement eg BEmOC trained
staff posted at SC which is not a 24x7 SC or EmOC trained medical officer posted at
PHC with no other staff are trained.
The quality of training is far below than required: it is theoretical rather than skill
based, non-participatory. There is no backup system for staff undergoing training.
There are no evaluation studies of the impact of staff retention policies.
Our suggestions:
Overhaul the HR policies and practices following some good practices in other
departments like the Railways, Armed Forces Medical Services, Department of
Forest, Education etc.
Create a cadre of IPHS. Include family needs e.g. child education, family stations v/s
non family stations.
Enforce rules diligently. MO on duty not present at the premise is equal to
absenteeism enforce it.
Tasks of experts necessary at RH/FRU/CHC level should be beyond MCH
programme. Managing a center of this size should be like a medium size hospital withadequate equipment, medicines and facilities essential for the purpose. These facilities
can also help staff retention.
Professionalize the training institutes from district upward level. Environment, posts
(in one institute in Maharashtra a statistician was doing most task as a senior clerk!
This is true even of a counsellor working as a MIS maintainer. !!). Training institutes
must have an HR management work environment with all statutory requirements of
an educational institute. Eg, ethical committee and Vishakha Committee.
Referral Transportation System should go beyond availability of vehicle. A proper
protocol should be ensured and a separate referral transportation system on the line of
a fire station needs to be designed and supported. Products made out of Half-hearted
efforts are often burdens rather than assets.
ASHA payment should be adequate matching the minimum wages act as skilled and
health workers, regular and with convenient approaches like cash vouchers
reimbursable at any nearby bank.
Our score for reaching this achievement of this goal for infrastructure is7and
for HR it is4.
I. Improvements in programme management capabilities:
Our comments:
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There are changes in the district and block level health management structure.
However, often it does not match overall HR, infrastructure and load it needs to be
designed specifically to the needs of every district/block level.
The role of BHO is mainly firefighting one and as an extension of DHO.
DPMU is the only unit created under the NRHM.
RKS have been created under NRHM as a management support unit from districtdownward level. But it mainly consists of government staff who is already
emburdened. It has not served the purpose of including civil society.
Our suggestions:
Additional staff should be allowed at DMPU as per their needs.
Visiting at least two ASHA meetings as AP norms should be part of DPMUs task.
DPMU should be at the premise of DHS.
A separate office with a team of technical and administrative staff should be
considered. RKS was envisaged as a partnership between government and civil society. It has
become more like yet another government committee. A separate office and specific
tasks on the Silvassa model should be encouraged with an independent managers
post.
Our score for reaching this achievement of this goal is 5.
J. Strengthening community processes and community ownership of public health
services: and changes in flexible funding.
Our comments:
Experience from several states indicates that the VHSCs are still being
constituted without going through the due process. Members of VHSCs are many
times not aware that they are indeed members! Elsewhere the VHSC is constituted
with AWWs, Pada workers, ANMs and ASHA thus defeating the purpose of
community process.
The Community participation is not considered as a managerial advantage because of
the holier than thou feelings. In fact, such resistance it results in more problems and
conflicts between the patients and the provider.
Community is not aware of the services available at which level.
There is no communication centre at any place where the community can accessservices whereby particularly women get counselling and information. Often, news
and reports about these are only on paper.
ASHA programme is considered in reality as an escort particularly for pregnant
women. ASHA is not considered a social activist interfacing between the public
health system and the community. She is considered as an extension of the public
health hierarchy. She is not a primary caregiver, often there is no kit distribution or
replenishment process. There is no hand holding processes in the field by the health
professionals. ASHA payment is simply meagre and not in consonance with the legal
bindings under minimum wages act, Provident Fund act, contract labour act and now
domestic workers act. She is NOT a volunteer. This concept is not tenable at all. She
had applied and recruited as a part time worker providing services to the community.
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Community based Monitoring and Planning is an innovative programme where the
community can participate in assessing the primary health care services and its
quality. It has been piloted in 9 states and has promising results in improvement of
availability and accessibility of health care. It has also created a platform where the
grievances are aired and often quick actions are taken. It has also improved the
administrative pitfalls like absenteeism and misbehaviours among staff, or lack ofsecurity to them etc.
Our suggestions:
Community participation processes and their ground realities need to be monitored
more stringently, so that the process laid out is followed and the structures created
become functional.
Health systems personnel need to be sensitised about the benefits of promoting real
community participation many providers are still threatened by active
communities who help as well as challenge.
Effective grievance redressal systems need to be implemented so that peoples
confidence in health systems is increased. Some concrete action to improve grievance
redressal would be to develop, through a participatory and transparent process, a
facility-based or regional system of ombudsmen to receive grievances and pursue
timely redress. This mechanism should be easily accessible to women with little or no
formal education.
Further, early response systems should be developed, including a telephone hotline
for health-related emergencies for women facing especially obstetric emergencies.
Guaranteed health services should be displayed in all health facilities, thus enabling
people to demand these services. This should be accompanied by display of phone
numbers of officials to be contacted in case of grievance, and the grievance redressalmechanism in simple language. Various types of information related to the
performance of health services, maternal and child deaths, usage of RKS / IPHS /
Untied funds at various levels should be displayed and updated on a regular basis in
respective facilities (as per mandatory display under the RTI act mentioned in
IPHS). All such information should be made available to ordinary citizens and civil
society members on request.
Public dissemination of the analysis of HMIS data that is collated both at district and
state level, along with systemic actions taken based on these findings, should be done
to increase transparency. In addition, flow of HMIS data downwards would improve
local ownership of data. Data collected and action taken at every facility could be
proactively disclosed in culturally appropriate formats to local communities, alongwith local participation in decision making.
In all the EAG states and in vulnerable pockets of non EAG states, the focus should
be to provide the ASHA with the skills and support to strengthen her ability to
provide home based new born care and care for the child. In the non EAG, where
programmes for non communicable diseases, mental health, palliative care, eye care,
adolescent health, gender based violence, disability, etc, can be piloted, ASHA should
be trained in counseling for behaviour change, basic screening, referral and home
based primary care.
A complete independent managerial structure for ASHA like the SEWA bank modelof empowering them as professional women volunteers can be considered.
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The CBM and P should be scaled up and incorporated under the tasks of VLHCs with
necessary legal amendments. The NGOs role should be limited as a trainer and as a
watchdog with concurrent monitoring mechanism of CBM in this process to assure
that the VLHC remains an impartial process.
Our score for reaching this achievement of this goal is 4.
K. Improved delivery of Reproductive and Child Health and Nutrition
services.
Our comments:
Complete absence of a professional approach in most of the public health services by
most of the staff. Denials of health care services, provisions of JSY if not from the same
state (despite SCs judgement), asking for money even before admitting a 3 rd parity
mother, asking for money by ambulance driver before referring at risk mother, delay inCS, the list is long. Technically speaking, not following any patient management
protocol but emphasising on administrative procedures.
Referral transport system is not uniformly run. Patient not accompanied by nurse,
leaving to the family to decide with no counselling, no linkage to POL budget and use
of transport vehicles, intrusion of private taxi owners in this business with probably
double charges due to meagre referral charges paid to private taxi owner (Rs 250 as a
flat payment with no relationship with distance and time travelled, in Maharashtra in
contrast with Rs 1000 per day payment in Janani Express scheme in MP)
Institutional delivery has an element of equality and not equity! What is the definition
of ID? If at risk, then it should be at an institution which is competent to tackle the
emergency! And in India almost all pregnant mothers are at risk when considered at
least one the indicator BMI, Hb level, age or parity, etc.
There is no HMIS analysis of MMU. How many patients they are serving, are they
really looking at the children and pregnant mothers? (One small study of a CSR
intervention, it showed that considering the time the clinic is visiting, most of the
patients were elderly women. Lets consider it as a geriatric intervention not equipped
with medicines, instruments, competency to deal with a geriatric OPD.!)
JSY is an incentive which has made the IDs possible and ASHA to be accredited!
However, there is a clear lack of awareness among who really need it. Urban
beneficiaries are swindled than because there is no monitoring system as it exists for
rural health services. Finally, the post natal care services have not improved and there is no mechanism yet
devised for this problem.
Our Suggestions
Staff at all levels, need to undergo sensitisation programmes about responding to
patients needs and observing patient rights, behaving respectfully with patients,
especially adivasi patients including women, and use of common health related terms
in local adivasi language. Sensitisation and Reflection Workshops need to be
conducted as part of an Organisational Development effort. These could address
issues like professional ethics, commitment to duty, sensitivity to the concerns of the
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poor, tribals and women, power relations, Indian Constitution, human rights, and
respect for all individuals.
Equipping Health Facilities and Providing Services. In several states there is still no
rationality in preparing institutions to provide to provide Comprehensive and
Emergency Obstetric Care. Make select facilities fully functional as CEmONC and
BEmONC Centres particularly in the underserved areas. Ensure that CHC/ FRU havestaff, facilities and infrastructure for c-sections, emergency care, and provision of
skilled personnel, equipment and supplies, particularly in underserved areas. Fill
upvacancies of doctors and other related staff as soon as possible. Undertake efforts to
ensure that the District Hospitals are equipped and staffed adequately to discharge
their functions of dealing with critical case load. This will also include efforts to
improve the motivation and morale of the work force. If patients are not accompanied
by suitable donors, blood must be made available to them from the blood bank. If
fresh blood is required or the bank does not have the required group, personnel at the
blood bank should contact suitable donors from a regularly updated donor list that
should be available at the blood bank at all times. Patients in critical need of blood
should also be given blood free of cost if they are not in a position to pay. Ensureprovision and monitoring of safe abortion services in CHCs and PHCs.
Human Resources: Post individuals in weaker districts who are known for their result
orientation, efficiency and integrity, and give them all the support that they need to
turn the situation around in these districts. Deploy available human resources
rationally and ensure through creating an enabling environment that they can
contribute effectively. Develop creative solutions for managing the human resource
shortage, without compromising the quality of care; examples of good practices from
various states will be useful. Undertake urgent skill building, training of all staff
engaged in delivering services, and set up monitoring mechanisms to ensure
supportive supervision post training. Develop a realistic plan to strengthen theprimary health care in tribal districts, including:
Strengthening and monitoring of required numbers of ASHAs.
Strengthening ANMs with SBA training and ensuring that subcentres can handle
quality ANC and normal deliveries. Improve the infrastructure of the subcentres to
ensure that the ANMs can stay and provide quality ANC, Intranatal Care and
Postnatal Care.
Identifying skilled Dais, and building their capacities to handle normal deliveries and
identify complications especially in difficult areas. Ensuring support for Dais,
including access to Emergency Obstetric Care when required. There should also be abetter system of remuneration and incentives/ rewards for Dais.
The cadre of Male Multipurpose Workers needs to be strengthened to address male
sexual health needs. This can be a point of converging the NACP and RCH. And this
will also address Adolescent Boys concerns related to sexuality.
Ensuring Quality of Care. Ensure continuity of care through the antenatal and
postnatal periods, with follow up care in case of complications. Ensure that a regular
schedule for VHNDs is planned, publicly disseminated and implemented. Provide
adequate support to health care staff for travel towards this. Set up monitoring
mechanisms to ensure delivery of a select package of services, including appropriate
antenatal care, nutritional interventions and immunisation.
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Monitor malnutrition closely so as to prevent acute malnutrition, and provide special
nutritional support for malnourished children and women.
Develop systems to make referrals accountable, including provision of ambulances,
and continuity of care during referrals by providing accompanied transfers.
Referrals to a higher centre must automatically include provision of ambulance.
Referrals should be accompanied by the proper referral slip clearly indicatinginvestigation carried out and treatment given, vitals, etc., as well as reason for referral.
Improving Quality through Monitoring. Plan for clinical audits in the District Hospital
and CEmONC and BEmONC Centres. Ensure Maternal Death Reviews take place in
all districts according to National Guidelines including
o Set up and operationalise systems for reporting of maternal deaths both at the
facility and community level.
o Ensure that Maternal Death Reviews are carried out at the facility and
community levels and systemic corrections made based on their findings.
o Ensure that Maternal Death Reviews are institutionalised at the district level in
the monthly Inter Departmental meetings chaired by the District Collector andsystemic actions taken.
District level Maternal Death Reviews are collated at state level and analysed to
initiate systemic changes based on their learnings.
Undertake quarterly reviews against select indicators like maternal deaths, newborn
deaths, referral rates, C-section rates, etc.
Ensure availability of referral transport for problems during post natal care
Our score for reaching this achievement of this goal is 6.
L. Involvement of private sector and strengthening Public PrivatePartnerships.
Our comments:
The key concerns about private sector involved in public health care services are:
non focused and contradiction in a PPP is it strengthening the public health
services or replacing it, supervision and its regulation right from state to grassroot
level, documenting the innovativeness and its sustainability. Very enthusiastic
committed intervention without adequate human, physical and financialinfrastructure can result in disaster costing the public exchequer.
Purpose of a PPP is a. innovative approach b. model building even of good
governance c. for gap filling of services d. implementing for which the public
health services does not have any track record eg social health insurance. The
second key concern is PPP becoming a way of outsourcing or shirking the state
responsibilities
The third major key concern is the legal, ethical bindings of PPP particularly in
areas of clinical and public health research: are there any detailed guidelines for aPPP in various components of health care, are there any legal documents
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equivalent to the contracting out construction work etc.? Which are the regulatory
authorities with what jurisdictions, levels of competency in framing, supervising
and enforcing such agreements, what are the mechanisms in place for accessing
related information?
Our suggestions:
A clear policy document with detailed guidelines for PPP for health care services
and research should be in place.
PPP should be limited to innovative approaches, inaccessible areas, tertiary care
and turnkey models development.
Our score for reaching this achievement of this goal is 3.
M. Improved performance of the disease control programmes and their
integration with the rest of the health sector.
Our comments:
There is a significant reduction in prevalence of communicable diseases like
malaria, filarial, dengue, leprosy and TB.
There are key concerns about persistence of AIDS, MDR TB, sporadic insurgence
of malaria and dengue, pockets of high prevalence of leprosy (in one tribal PHC
area in Nashik, 71 cases were identified prevalence rate being 4.7/1000 very
high than national rate.)
Introduction of Artemisinin Combination Therapy as a part of managing drug
resistant PF malaria is a major concern. The main reason is that the strategy is not
clinically assessed drug resistence but as a public health measure. This can lead to
treating not actually CR PF malaria with protocol limited to CRPF case because
the sensitivity of RDK in not high. Secondly, this will add to a verticality of all
preventive measures of CDs and thirdly, this is the last resort available for DR
malaria.
Final concern is the consistent verticality of illnesses which require
horizontalization with a patient centred approach.
Our suggestions:
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Introduce a post of general physician at the CHC level, integrating the FRU into
a true secondary care hospital.
Include CSOM, RHDs, adult pneumonia, chronic renal diseases in the list of
preventable communicable diseases
Align all secondary preventive measures (early diagnosis and treatment) of
public health with the clinical case management measures.
Carry out epidemiological studies about high prevalence zones of leprosy
Integrate all CDs and NCDs under a single umbrella
Our score for reaching this achievement of this goal is 6.
N. Improved access to drugs and diagnostics.
Our comments:
Although, there is regulatory mechanism in place for drug production, price
control mechanism, rational drugs but it is not functioning in the manner itshould be.
Cross practices are rampant and is so OTC sales
Drug researches and sale through medical professionals is common
Irrational treatment both through monetary gains for the care giver and lack of
awareness or a short cut healing for the receiver
Prescribing drugs at public health services
Our suggestions:
TNMSC model should be mandatory for drug procurement, storage and
distribution
No prescription at ALL public health services center for drugs or diagnostics
All essential drugs and diagnostics should be available free of cost
Drug research should be regulated stringently to ensure that it is conducted
ethically, with no loss to the person volunteering as a subject, the volunteer
should be insured.
Our score for reaching this achievement of this goal is 3.
Here is the NRHM scorecard. It has just passed!
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SCORE CARD
SNo Goals and Objectives
Expected
Achieved
1 Maternal Mortality and RCH services 10 7
2 Child mortality 10 43 Population stabilization 10 7
4 Clean Drinking Water 10 5
5 Malnutrition and Nutrition Services 10 3
6 Sex ratio 10 -5
7 Public Health Expenditure 10 4
8 Human Resources 10 4
9Programme Management Capabilitiesimprovement 10 5
10 Public Health Infrastructure 10 7
11 Public Health Services 10 612 Control of Communicable Diseases 10 6
13 Inter-sectoral Convergence 10 4
14 Community Participation 10 4
15 Drug and diagnostics 10 2
16 Public Private Partnership 10 3
160 66
41%Here is its RADAR! I acknowledge Dr Shyam Ashtekar for usinghis idea of graph design for scoring NRHMs achievement.
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