Centre for Health and Social Justice - One Year of NRHM in Orissa : An Overview

You are here:

One Year of NRHM in Orissa : An Overview

JSA and NAWO

The Orissa state level National Rural Health Mission (NRHM) was launched on 17th July 2005. Delivering the key note address, Union health minister Mr A Ramadoss said that 2,000 community health centres in 18 states, including Orissa, will be covered under the National Rural Health Mission Around Rs 200 crore has been allocated for the state in the current financial year. Each block level community health centre will be provided with Rs 1 crore for its upgrade to Indian public health standards by setting up well-equipped operation theatres, labour rooms and wards, Mr Ramdoss said.

Chief Minister Mr Naveen Patnaik said his government had taken steps for the constitution of the state and district rural health missions in the state. Formation of these missions with the involvement of Panchayati Raj institutions, voluntary organisations and eminent experts would contribute a lot for formulation of policy measures and action plans under NRHM. He called upon the district collectors, zilla parishad presidents, chief district medical officers and other functionaries to work with sincerity and dedication for fulfillment of health needs of the rural areas.

Highlighting the measures taken by the state government health minister Mr Bijoyshree Routray said the infant mortality rate in Orissa had come down from 97 in 1999 to 87 in 2002. The leprosy prevalence rate had declined to 2.9 per cent in the state and below 1 per cent in 5 districts. No new polio case had been detected during the last year. However, the shortage of doctors, especially in rural areas, has been a chronic problem and the state has a lot of infrastructural needs, Mr Routray said and added that he expected adequate Central support in this regard.

Union health secretary Mr PK Hota said around Rs 800 crore would be made available to the state in the next 5 years.

A brief overview of the NRHM since its implementation in the state

ASHA selection and training: - The target of appointing ASHA is 34,213 in 5 years. But only 12,730 have been selected, trained and appointed in the current year. The centre had provided 9,36,000.000 for their training purposes. But so far only Rs.2,83,48,000 have been spent in the current year.

Upgrading of PHCs and CHCS:- 30 numbers of PHCs and CHCs at the Block level have been upgraded under the Indian Public Health System (IPHS) model.

Disbursal and utilization of funds from the state to district: - There are complaints that last year the state government has failed to utilize the funds of the centre coming under the head of NRHM. Around 61 crores have not utilized for the said purposes. Specifically a single paisa has not been utilized under different heads like:

providing medicine kits to the village people (Central govt. sanctioned 92 lakhs)
Up gradation of PHCs and CHCs(Central govt. sanctioned 12,00,00,000/-)
Child health programme –II & National Rural Health kit ( Central govt. sanctioned Rs.19,11,00,000)

Under this NRHM programme the centre had sanctioned to Orissa Rs.102,62,85,000/- in the year 2005-06. From this the state government allocated Rs.96,82,87,000 to different districts for the implementation of the programme. But only 41, 63, 00000/- have been spent so far.

Funds allocated by Central govt. Funds spent by State govt.

1) Funds for the Subcentres Rs.5,92,70,000………Rs.4,80,10,000/-only

2) RCH-II programme Rs.40,50,000,00/-…………..Rs.26,89,70,000/-only

3) Immunisation programme Rs.6,97,38,000/- .…..Rs.4,7,30,000/-only

4) Pulse polio Rs.3,25,14,000/-…………………….Rs.2,60,51,000/-only

5) Disease surveillance system Rs.4,58,56,000….Rs.42 lakhs only

Key issues highlighted in the first steering group meet of Orissa Health mission, 10th July 2006

1) Grampanchayats should be entrusted with the job of monitoring primary health centres for better health services in rural areas. The centre would provide Rs.33 crore to the state if it moved in that direction.

2) The centre has relaxed the norms under the mission for providing financial assistance to pregnant women under National Maternity Benefit Scheme (NMBS). It has now decided to extend it for the third child birth and to pregnant woman below 19.

3) The centre will assist the state in improving the standard of 314 CHCs as per Indian Public Health Standard.

4) In view of the shortage of doctors in Rural health centres and specialists in Sub-divisional and district headquarter hospitals, the centre has advised the govt. to enhance the retirement age of specialists and professors to 65 and add more seats Burla Medical College

5) Formation of Paitients development committee in each PHC for the better management of it. The respective MP, MLA, Panchayat Members, Health staffs will be its key members

6) The govt. is going to implement a National Policy for the fresh doctors to go and work in villages compulsorily for one year.

The steering committee meeting was presided by Chief Minister Naveen Pattanaik and attended by the Union Health Secretary Prasanna Hota. Panchayati Raj Minister Raghunath Mohanty, Women and Child Welfare Minister Pramilla Mallick, ST and SC Development Minister Chaitanya Prasad Majhi were also present in this meeting.

(Source- News paper reports)

ORISSA – A Grassroots Review

To understand the present situation of NRHM in Orissa, a study was conducted in five districts – Nuapada, Mayurbhanja, Keonjhar and Ganjam.

Total of 5 ANMs, 5 village heads and PRIs, 5 AWW, 5 Women who have had a sterilization operation in the last three months and 5 women who have had a child birth in the last three months were interviewed.

37% institutionalized delivery.

Important facts coming out of this study are as follows-

About ASHA Scheme

None of the ASHAs mentioned that they were asked for any money for the ASHA forms – they were reluctant to say whether they paid any money for ASHA selection.
All of them were confident in saying that they knew what they are supposed to do. Most of them think that there role is limited to taking care of pregnant mothers, their registration, immunisation and institutionalized deliveries.
All of them received money for attending training programmes, however 3 out of 5 didn’t receive any payment for any other work carried by them except for training.

ANMs interview on ASHA

ANMs have heard about NRHM and ASHA. However they don’t know the details that NRHM incorporates.
Most of them know about JSY and selection and training of ASHA.
However 3 out of 5 do not know about untied funds.
Only 1 is aware of AYUSH.
These ANMs knew about ASHA chosen in their respective villages.
2 ANMs said that ASHA was chosen in the village meeting by village panchayat member. 1 said that ASHA has been chosen by SHGs
Most of the ANMs know what ASHA is supposed to do like- pregnant mothers registration, immunization, make women aware of prenatal and postnatal care.
All ANMs answered that ASHA has received 7 days training at PHCs.

AWW interviews

All 5 AWW interviewed knew about NRHM and ASHA scheme.
Most of them were aware about ASHA’s role.
Nearly all of them said that ASHA got trained for 7 days.

Mother’s interview

4 out of 5 mothers are BPL cardholders
4 out of 5 mothers said that a complete checkup was performed during pregnancy
All mothers said that ASHA did not visit them during pregnancy
Out of 5 mothers, only 1 said that she received the financial support from the government.

PRIs Interview

Out of 5 PRIs only 2 have heard about NRHM and ASHA
Only 2 PRI could tell the names of ASHA chosen from their village.

Maternal Health - Janani Suraksha Yojna

All 5 ANMs are aware of JSY
All 5 ASHAs say that they too are aware of JSY. Most of them are also aware that if a woman holds a BPL card then she is entitled to receive Rs 500.

Untied Funds

All 5 ANMs are aware of the untied funds but not very sure of its use. Most of them think that this fund is meant for maintenance of the sub centre.
2 ANM said that they haven’t used any part of this fund
4 out of 5 PRIs know about untied funds. 3 of them don’t know anything about the usage of this fund.
Only 2 out 5 PRIs said that money from this fund has been utilized.

Target free qualitative family planning

4 out of 5 ANMs are not aware of the Supreme Court guidelines on conducting sterilisation operations.
2 out of 5 ANMs said that they were given Family Planning targets to fulfil.
3 out of 5 ANM said that they know of such women who got pregnant after sterilization operation.

Health Committee

3 PRIs out of 5 say that VHC exists. Out of these 3, only 2 could tell the important issues discussed in the meetings
Only 2 AWW out of 5 know that there exists a village health committee
4 out of 5 ASHA know about the VHC and its role. But majority of them do not know about the issues discussed in these meetings.

Conclusion –

The implementation process of NRHM in Orissa is apparently progressing at a gradual rate with no coordination between ANMs and Gram Pradhan.
ANMs don’t know about ASHA and its role. They assume that they are there to assist them.
Community women are also not very aware of ASHA’s role and what services she would provide.
PRI is an important component in NRHM. Most of them don’t know about NRHM and ASHA.
There is no coordination amongst AWW, ANM, ASHA and PRI.
There is lack of knowledge amongst people about the role of ASHA. Their perception of ASHA’s role is limited to taking care of pregnant mothers and new born babies only.
ASHA have not received money for any other work carried by them except for training.
There is very little information about the usage of untied funds. 2 ANM said that they haven’t used any part of this fund. Guideline to use untied funds not available.
None are aware of the Supreme Court guidelines for female sterilization operations.
None are aware of the Rogi kalyan Samiti
Majority is not aware of AYUSH.
Out of 5 mothers, only 1 said that she received the financial support from the government.

Irregularity in the system - In October 2005, untied fund were distributed but the guidelines came in February 2006.