National rural health mission: Mere tinkering won't do

Similarly, epidemic diseases like plague, TB, cholera, small pox and influenza were taking a heavy toll. Birth rate, death rate and infant mortality was very high. Then there was the problem of anemia.

The villages and small towns had no drinking water facilities. The Government of India, in order to reconstruct society and economy and improve health status of its people launched various development programmes through five years plans. The Bhore Committee’s recommendations guided the health policy and programmes of independent India.

In the process of improving the health status of its people, the Centre among others launched maternal and health programme in India (MCH).The focus of this programme was essentially to  reduce the infant and maternal mortality by improving the health of the pregnant women and nursing mothers. A lady medical officer was appointed at the primary health centre exclusively for MCH programme. It made a small beginning and was progressing well.

Then there was an attempt to integrate MCH with family planning programme. Over-zealous programme managers gave more importance to family planning and as result the entire health programme including MCH programme suffered. And the infant and maternal mortality rate remained very high.

The Centre modified the existing MCH with cosmetic changes and reintroduced the same as Child Survival and Safe Motherhood (CSSM) programme. It suffered from lack of adequate preparation by the planners. There was an attempt to train the traditional village birth attendant to conduct the deliveries. She was given a kit containing essential material to conduct deliveries.

The programme could not sustain because there was no adequate patronage from the programme planners. The birth attendant was promised that she would be paid a nominal sum for each delivered conducted. Even such promises were never honoured by the administrators, with the reason the infant and maternal mortality remaining very high.

The planners were under the illusion that cosmetic changes in the programme strategies would be sufficient to bring down the infant mortality. But unfortunately that was not to be. The persistent high rates must have compelled the programme planners to revise the strategy.

Once again the policy makers made an attempt to tinker with the existing policy as well as change in the nomenclature of the programme. This time it was re-coined as Reproductive and Child Health (RCH). This seems to have been influenced by International conference on Population and Development, convened by the UN at Cairo in 1994.

This was a complete departure from the earlier policies and it aimed at securing the women her reproductive rights. This can be said as a reasonably comprehensive policy. It included among other things provision of safe and high quality contraceptive services, maternal and child health services, treatment of reproductive track infection, sexually transmitted diseases, provision of reproductive health education and services to adolescents, screening of women of menopausal age  for cervical and uterine cancer etc. Thus, RCH programme made a good beginning and was moving in the right direction and went beyond infant and maternal mortality and was considering the women's health in totality.

The UPA government introduced the National Rural Health Mission (NRHM) as a part of common minimum programme in 2005. This programme once again focused on reducing infant and maternal mortality. This programme has ambitious goals and has enough budgetary support but has failed to consider the problem holistically.

 It once again failed to realise that infant mortality will not decline in isolation and assumed that once the programme components are in place then the goals will be realised. The core issues like provision of drinking water, adequate nutrition both for the pregnant women and nursing mothers which are very crucial for the survival for the new born and the nursing mothers do not find a place in the NRHM.

The successive National Family Health surveys have pointed at the poor nutrition, both among nursing mothers and the new born. Perhaps the policy makers are under the impression that Integrated Child Development Scheme will take care of nutrition aspects of the mother and the new born. But it is not so.

Further the mission intends to involve members of the panchayat raj institutions in implementing its programmes. This indeed is a good beginning. But whether the  panchayat members will be able to understand and appreciate the philosophy behind the mission remains to be seen. It is rather difficult considering  the fact that most of them are illiterates and semi literates. So before the programme is implemented, all the members must be adequately oriented with the different facets health programme in general and infant mortality in particular and then they would   probably develop keen interest in the health programmes.

Crores of rupees are being spent on this programme. This ambitious programme should be able to reach its targeted goals. Let us hope that the planners and administrators will take corrective measures once mid term feed back is in their hands.
(The writer specialises in welfare measures)