Performance appraisal of NRHM suggests Gujarat's inertia in health care

By Rajiv Shah 
A recent analysis of the way different state governments have been handling rural health suggests that Gujarat is one of the three major states in India which have slowed down their expenditure on various programmes being implemented under the National Rural Health Mission (NRHM), the Government of India’s largest public health programme. Launched in 2005, a breakup of expenditure for two consecutive years, financial year (FY) 2010-11 and 2011-12, suggests wide gap between states in implementing it.
The analysis, carried out by a high-profile NGO, Accountability Initiative, notes “wide variations in expenditure patterns across states”, adding, “Chhattisgarh increased expenditure from 58 percent in FY 2010-11 to 65 per cent in FY 2011-12. On the other hand, expenditure in Gujarat, Madhya Pradesh, and Rajasthan slowed down from near 100 percent in FY 2010-11 to an average of 82 percent in FY 2011-12.”
Figures analyzed in the report, titled, “Budget Briefs-National Rural Health Mission 2013-14”, show that Gujarat, which spent 98 per cent of the funds made available to it under the NRHM in 2010-11, brought down its expenditure under the mission to 85 per cent of the Central allocations in the very next year, as against Tamil Nadu’s 87 per cent, Maharashtra’s 92 per cent, and Punjab’s 86 per cent.
The report notes that despite whatever expenditure it made, Gujarat, alongside several other states, failed to build their health infrastructure. The Primary Health Centre (PHC) is the first point of contact with a qualified doctor for people in rural areas. According to the Government of India (GoI) norms, there should be 1 PHC for 30,000 people in plain areas and 1 for 20,000 people in hilly, tribal or difficult areas.

Calculating the shortfall, the report says, it is to the tune of 12 per cent in Gujarat, which is better than the national average of 18 per cent, though worse than several states including Odisha (6 per cent shortfall) and Chhattisgarh (5 per cent shortfall). And though in terms of setting up PHCs Gujarat showed a better performance, it failed to provide doctors for them – there is a 31 per cent shortfall in physicians needed in Gujarat for running the PHCs as against the national average of 12 per cent.
As for the Central Health Clinics (CHCs), which provide specialized medical treatment at the block level, the shortfall in doctors is the highest in India – to the tune of 94 per cent, as against the national average of 64 per cent. The report underlines, ”Gujarat had a 94 percent shortfall in required posts and 78 percent vacancy rate, while Haryana had an 89 percent shortfall in required posts and an 82 percent vacancy rate.”
It adds, “The availability of specialists at CHCs (surgeons, paediatricians, physicians, obstetricians and gynaecologists), is much worse. Data up to March 2011 reveals that across India, only 36 percent of the required specialist positions were sanctioned. In addition, 29 percent of sanctioned posts for specialists were vacant. Only 13 percent of CHCs had all the 4 required specialists.
The result of the lack of doctors at PHCs and CHCs has led to a situation where mother-and-child care has suffered, the report suggests. Thus, in Gujarat, 28 per cent of mothers failed to get complete antenatal care (ANC), which is a must for the health a pregnant woman. Exactly the same percentage of mothers failed to get postnatal care (PNC) as well in Gujarat, the report points out.