NRHM bungled in J&K; rules flouted, norms violated

Mohammed Musa

Inadequate utilization of funds, lack of facility surveys and deficient maintenance of records are few of many imperfections in the implementation of National Rural Health Mission (NRHM) in the state singled out by Controller and Auditor General of India (CAG).

Aimed to provide accessible, affordable, and accountable health facilities in rural areas of the entire country, especially to the poor and vulnerable sections of population coupled with the decentralization of healthcare, NRHM was implemented in Jammu and Kashmir in April 12, 2005.

Nevertheless, REPORT in its report has pointed flaws in the implementation of the Mission in the state. Quoting the report, in Jammu and Kashmir for planning and monitoring, governing and executive bodies of the district health society (DHS) were not constituted separately. The District Health Action Plan (DHAP), which is an annual plan for implementation of NRHM, was to be prepared by the DHS and approved by District Health Mission (DHM).

A DHS was to be constituted in each district by amalgamating all existing districts level societies engaged in implementing national level health and family welfare programmes. The governing and executive bodies of the DHS were to meet at least twice a year and once a month respectively. Under the Mission, annual DHAP were to be prepared on the basis of preparatory studies, mapping of services, household and facility surveys conducted at village, block and district level, which would act as the baseline for the Mission against which the progress would be measured.

The Mission targeted to complete 50 percent of household and facility surveys by 2007 and 100 percent by 2008. These surveys, the report states, were not conducted. During 2005-2008, the DHAP was prepared by all district only in three states and union territories(UTs) (Chhattisgarh, Chandigarh and Pondicherry) while the annual district plan was not prepared by any district in nine states /UTs including J&K, the report reveals.

As for outsourcing the task of planning, the NRHM laid down in its guidelines that district and lower level plans were to be prepared annually by planning team to be performed at each level under the leadership of Panchayat Raj institutions. However, REPORT points, in 11 states, which include Jammu and Kashmir, the State Health Society (SHS) outsourced the task of district planning to private agencies, which meant that the growth of in house capacity in decentralized planning was not fostered. Nor was work quality and output standardized.

In Jammu and Kashmir, where the task of facility survey and district planning was outsourced to a private agency, the agency did not actually visit health centers but instead called health centre functionaries to the block level for filling up the facility survey forms. The reports further reads, reports of Computerization and MIS (Management Information System) were being collected by health centers and submitted to DHS and SHS without any analysis of data collected.

Further, the government body and executive body of the Rogi Kalyan Samiti (a hospital managements society), were required to hold meeting on a quarterly and monthly basis respectively for reviewing the functioning of health care facilities. The Rogi Kalyan Samiti (RKS) was to submit a monthly report to DHS and give recommendations for improvement for health care system.

However, in Jammu and Kashmir, Jharkhand and Kerala (RKS not registered) and Tamil Nadu, the report says, the governing body and executive body were not formed separately under RKS. Additional, monthly reports and hence recommendations for improvement of health care system were not sent by the RKS in most states.

In regard to  levying of the charges by the  RKS, the reports states the RKS was to prescribe user charges for non-BPL patients for various types of services rendered by the healthcare centre. The only condition for release of central grants to the states for the RKS was that the Samiti would levy the charges and retain the money received on account of those charges for using them as local needs. In Andaman and Nicobar Islands, Andhra Pradesh, J&K, Pondicherry, Punjab, Sikkim, Arunachal  Pradesh, Tamil Nadu and Jharkhand, no user charges were collected from non-BPL patients.

Further reads the report, the state/UT governments of Andaman and Nicobar Islands, Andhra Pradesh, Arunachal Pradesh, Haryana, Jammu and Kashmir, Maharashtra, Mizoram, Punjab, Jharkhand, Orissa, Tamil Nadu, Lakshadweep and Sikkim had neither made their contributions nor had RKS been able to generate resources to maintain the prescribed ratio of sources of RKS funds.

The flaw in utilization of funds in sample districts has also been mentioned in reports. It states that in Jammu and Kashmir 136(RKS) Rs 1.53 crore were released amongst which 67 lakh were utilized, and 85 lakh utilized which means 55.80 percent of funds remained unutilized.

REPORT report also picks errors in the maintenance of records. It says in Assam, Chhattisgarh, Jammu and Kashmir, Madhya Pradesh, Uttar Pradesh, Uttarakhand, and Jharkhand, the books of accounts and subsidiary records like cash book, vouchers, ledgers etc, were either not maintained or not maintained as per the government accounting rules of the states. Discrepancies in expenditure by the RKS were also noticed in 13 states and union territories.



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