For better health

The Union cabinet’s approval for the launch of a national urban health mission (NUHM) is welcome for its aim of providing basic health services to the poor and disadvantaged sections in cities and towns.

The Rs 22,500 crore programme plans to cover 7.75 crore people living in 779 urban clusters and is mainly targeted at the poor people living in slums. The national rural health mission (NRHM) was launched in 2005 and it has taken about eight years to design a similar programme for city-dwellers.

Both missions will be part of the bigger national health mission. The launch of a populist programme intended to benefit large numbers of people months before elections may have a political angle. But that should not detract from the value of the programme if it is implemented efficiently.

Provision of public health facilities to the poor and needy is the responsibility of the state. All the health indicators in the country are much below par. The poor cannot afford even meagre expenses on health and so the government has to provide the infrastructure and personnel to them.

The scheme at present intends to provide one health centre for 10,000 people and nursing midwives and health activists for specified numbers of people and households.  Seventy-five per cent of the funding will be met by the Centre in most states. As different from the NRHM, the programme seeks to involve non-government bodies also in the NURM as these are active in many urban areas. A decentralised system of implementation involving state, district and ward level bodies is envisaged so that the programme can reach the lowest levels.

The aims, design and methods of the programme may be good but its success will depend on how well it is administered. The NRHM has suffered in many places from corrupt practices like leakage and misutilisation of funds and failure to create necessary health infrastructure and to reach out to the needy people. The lessons should guide the implementation of the NURM.

However the strategies will have to be different for rural and urban areas. In the NURM there is a proposal to reimburse private practitioners  for their services at government rates. The accent should be on providing necessary infrastructure and services by the government. It will also have to be supported by schemes for sanitation, clean drinking water and other basic conditions for good health.

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