National Rural Health Mission: An Unfinished Agenda

This book provides a fresh perspective on review of the NRHM and its performance during the first phase 2005-12. The contributions here focus on different aspects of the Mission and draw lessons from state level experiences on issues including population stabilization, infant mortality and child health outcomes, front the health workers, community participation and decentralization. While reviewing aspects of rural health, the chapters specifically aim to elicit the key concerns that deserve sustained policy focus and concerted engagement within the public health systems at all levels. However, without undertaking anything in the nature of a summary of its contents, this introductory chapter aims to reiterate some of the specific concerns from the NRHM implementation as well as policy strategies.

This book is divided into three sections: First, we briefly review the progress made during NRHM phase-1 in terms of key indicators of maternal and child health, viz. maternal mortality, infant mortality, antenatal care visits, institutional delivery, and immunisation. Second, we draw upon our field experience based on the NRHM monitoring and interactions with health officials, beneficiaries as well as our observations during our visits. We highlight the specific concerns in programme implementation. In our view, these concerns are common to several other states of the country and are corroborated by findings of the various chapters on performance of the NRHM across states. Finally, we document some of the broader strategic concerns that deserve policy attention. Notable among this is the need to focus on population stabilization and strengthening of primary health care system. Besides, the role of community participation (including the private sector) appears to be rather discrete and therefore, attention is drawn towards such intricacies. The case of heavy internal migration and exclusive understanding of migrant health is highlighted as an area for policy attention. In conclusion, we draw attention on the importance of good governance as a cross cutting theme and suggest for effective management at all levels. (jacket)