Azad warns states against health mission slippages

Minister says shoddy work will attract disincentives

Union Health Minister Gulam Nabi Azad warned the state governments that shoddy implementation of the National Rural Health Mission (NRHM) will bring them “disincentives”, reports DHNS from Mamallapuram.

While several interventions under the NRHM have “started to show good results” in the reduction of India’s Under Five Child Mortality Rate (U5MR) in recent years, the Centre’s over Rs 90 billion investments in NRHM alone call for greater accountability, he said.

Inaugurating the three-day “India’s call to action for child survival and development summit” here, Azad said rewarding “good performance” by States has begun this year with the Centre setting up an incentive fund under the NRHM. States would now receive additional funding for sector-wide reforms, through which they can introduce free medicines, create public health cadre and intersectoral convergence initiatives, he noted.

At the same time, if States failed to “make progress” like deployment of human resources and ensuring facilities to both pregnant women and sick newborns, then it would attract “disincentives,” Azad said. He said state health ministers should carry out the NRHM mandate with personal interest and take up initiatives in this regard. Stating that it was “heartening” that India’s U5MR was declining much faster than the global average, Azad said this progress has encouraged the Centre to expand the horizons of child-reach programmes.

The Union Ministry of Health and Family Welfare has organised the summit as a follow-up to the “Global Summit” India had co-convened in Washington last year. The Unicef and USAID have joined hands in this effort.

Azad said “Rashtriya Bal Swasthya Karyakaram,” the new national initiative launched on Wednesday in New Delhi, will help to establish a system of “universal health screening of children and early intervention services”. “We aim to cover over 27 crore children from birth to 18 years of age for early identification of four Ds'- defects at birth, diseases, deficiencies, and developmental delays, including disabilities,” he added.

“In this Summit, a strategic approach to 'Reproductive, Maternal, Neonatal and Child health and for Adolescents (RMNCH+A) will be unveiled,” Azad disclosed. He said the Centre will also come out with a “system of score cards to measure progress” made by states in reducing child mortality rates and other goals set under the NRHM.

Going by the 2015 millennium development goals (MDG) set for countries, the U5MR trend was appreciably going down, but not fast enough, said Dr Robert Black, Professor and Chairman, International Health, John Hopkins School of Public Health, USA. While child mortality still continued to be “very high” in countries of sub-Saharan Africa and South Asia, India accounted for two-thirds of the world's child deaths annually... Nearly 40 per cent of all child deaths globally was in the first month, even as pneumonia, diarrhoea and nutrition issues were the main causative factors, he explained.

Union Health Secretary Keshav Desiraju said reducing India's U5MR to the level of 31 child deaths per 1000 live births, as mandated by MDG 2015 goals, was still a challenging task.

Anuradha Gupta, Additional Secretary in the health ministry, said the rate of decline in child mortality in the last two years, particularly in states like Haryana, Bihar, Maharashtra, Andhra Pradesh, Karnataka and Tamil Nadu has been remarkable. “Yet, inter-district differences within states is often so huge that we need to focus on these high burden districts in child mortality and we would need an average annual decline rate of 7.1 per cent,” she added. US Ambassador to India Nancy Powell assured continued support from her country to India's health sector initiatives and regretted that globally over 6.9 million children die every year before they reach their fifth birthday. However, if India's success in Polio eradication was a pointer, new strategies to address infant mortality could also succeed, she said.