National Rural Health Mission
NRHM is a government initiative inaugurated in April 2005 to increase health expenditure from 0.9 % GDP to 2-3 % GDP with the aim of good decentralized healthcare. The focus is on 18 states and correction of deficiencies in the health system, withan implementation timeline is 2005-2012. The goals are fairly broad, ranging from infant and women’s health to promotion of healthy lifestyles, involving integration of healthcare from local to government level. Other aspects include sanitation, immunization, traditional medicine, nutrition, etc. Action points include providing a health activist in each village, village health plan, integration of specialized health programs (e.g. malaria), and new health financing mechanism for integration. The hierarchy is health activist, auxiliary nurse, Panchayat and NGOs, district administration, and state governments. The health activist (ASHA worker) takes care of the people, and is a woman 25-45 years old with a minimum 8th grade education and some basic training. She can refer people to the nurse or a doctor at the district level. At the state and higher level, the focus is on integrating different programs. Some examples are NGOs, AYUSH (ayurvedic, yogic, unani, siddha, and homeopathy), regulations requiring practitioners to provide healthcare at reasonable cost, re-orientation of MBBS, social health insurance, health information system, public-private partnerships, etc. The milestones are to provide an ASHA worker in each village till 2008, upgrading rural hospitals, village health plans, etc. The progress report is available on a website, but there seems to be a lack of specific targets to be achieved. Even then, there is some attempt at transparency, and the focus seems to be shifting from curing disease to prevention. This scheme seems to be good, but raises a number of questions- What are these public-private partnerships? Is it sustainable? Is it economically viable? How will unification of the different health system help public health?What happens if the government changes? How are NGOs integrated into the scheme? Etc.