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We are looking for strategic partners so that we can effectively monitor the scheme

The newly-appointed mission director of NRHM scheme Dr Rakesh Gupta in Haryana has announced that in order to make the rural health scheme effective in the state he is looking for strategic partnerships In an exclusive chat with R M he said rn We will have strategic partnerships so that we get independent feedback while we actually run the program or do the various modules and this will help us in making online corrections Because ultimately after the end of one year or two years if we realise that nothing has happened then that is of no use

Dr. Rakesh Gupta
Mission Director, NRHM Scheme
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The National Rural Health Mission was initiated by the Government of India as a flagship healthcare programme to provide affordable, accessible and accountable healthcare services to the rural poor, however, it is known mostly for corruption. Does the mission fulfill its objectives? How is the state of Haryana performing?

Actually, I have joined this position in this month only, just a couple of days back. The name of NRHM got its bad name because of Uttar Pradesh. As far as my knowledge goes and Haryana state is concerned, I don’t think that is an issue.
Here, the issue is of performance, in the sense that Haryana has to do a lot to be closer to states like Kerala and Tamil Nadu. Haryana’s infant mortality rate (IMR) is quite high. The MMR is also stagnating for last several years. So, as far is the objective of NRHM is concerned, these two key indicators are very important. We need to do a lot so that these outlays transform into processes and ultimately we able to bring these indicators down. So a lot needs to be done. We are not worried about the issues that are not taking place like what all are happening in Uttar Pradesh.

Does your department have any mechanism to have a check on the implementation of rural health schemes in the state? If yes, what are the modules you apply and what would be your suggestion for the other states to follow?

Let me first start with the performance of the NRHM in the state of Haryana as we are worried about not having Haryana amongst the first five states of the country as far as MMR and IMR are concerned.

So recently we have devised a tool which we are calling as Supportive Supervision. We have already launched it for the performance of the sub-centre level. Here the idea is to ensure that all the inputs, processes, outputs, all the things which are required to be there or existing or be happening at the sub-centres. Those are actually happening. So, what we are asking is that the senior medical officers, medical officers, deputy civil surgeons, civil and surgeons of the respective districts will do inspections. They will sit with the staffs of sub-centres for the whole day and will ensure that all this is happening.

In fact, we are also looking for independent feedbacks. We are sending people from the headquarters to do a similar kind of exercise. We are also consulting the residents from PGI Rohtak. They are already in the field and already filling these forms. They are talking to ENMs whether the inputs are present at the sub-centres level or not. We have started with sub-centres, but ultimately we’ll do it for primary health centres, community health centres and the district hospitals also. This is one thing. Another thing, we want to do is to monitor the outcome very closely, that is, the maternal deaths or the infant deaths or the still births that are happening in Haryana. For that we are devising a surveillance system for maternal deaths, infant deaths and still deaths.

So ultimately we need to track where these are happening, why these are happening, and what could be done to prevent deaths or still births.
As far as financial angle is concerned, last year, we had hired the services of senior and veteran accountants of a government institute. They are going to different districts, supporting the staff to follow the due procedures as far as instructions are concerned. This year also we have involved chartered accountants at district level so that we have close supervision regarding the expenditure made in these facilities.

There is a set phenomenon in the country about lack of doctors in the public health centres belonging to rural areas, the doctors deployed at PHCs are often found absent and they run their own private clinics at some other place. What would you like to say on this and how would you tackle this?

As we are using the module of Supportive Supervision System to ensure that the doctors are actually, physically present in their respective CHCs and PHCs. We can assess the whole situation once we get feedback and then we’ll make a thorough evaluation.

What are the other challenges in front of you in the implementation of the scheme in the state?

I think accountability is one big issue. In the sense, that lot is happening the state of Haryana in the last 7 years or so. But, still we are not getting suggestions as MMR of the state is going down. Similarly, as IMR is concerned, we are at par with Bihar. In fact, we are the worst in comparison to India’s overall average. So these are something of big concern for us and we are trying to find out reasons for the dismal performance for the state.
So, I would say that the ground realities are very different from the way we perceive at the Headquarter. We got these checked up and found that certain things are not happening. For example, we often talk about the quality anti-natal care, so we checked various sub-centres and facilities and found that the quality anti-natal check-up is not happening at many places.

For example, the haemoglobin meters are not being used by ONMs (Observatory Nurse Midwifes). Similarly, many times, blood pressure is not measured. Many of the ONMs are not using the urosticks, which is very necessary for checking the parameters of pregnant women. So these are important things, which are not happening. Similarly, in post natal care, a lot needs to be done.

There is a module for the care of new natal and infants called Integrated Management of New Natal and Childhood Illness (IMNCI).
So, I get a feeling that a lot of training has been given to various service providers, but, a lot needs to be done. At many places, we have found out that this particular component IMNCI has not really taken off. This is observed that even after imparting training and providing material, books and booklets these people are not doing what they are supposed to do. So, using supportive supervision and modules will ensure that all these are done. So that Haryana registers rapid decline in infant mortality rate and under-five mortality rate.

With the current allotment of Rs. 20,822 Crore to the NRHM nationally, what is the share of Haryana government? How are you implementing the scheme? Are you engaging private companies also in the publicity campaign?

I think, our module, which has been recently approved is around Rs. 400 Crore. So that is a small proportion as far as the total outlay of NRHM for the entire country is concerned. I would like to highlight that we are looking for strategic partnerships. One, I already told you about PGI Rohtak, which is sending their residents to cross check what is exactly happening at the ground level. Second, we are trying to rope in PGI Chandigarh also. They will provide us with external monitors to ensure that what we need to do and intend to do is happening at the ground level.

Similarly, we are going to talk to other research institutes with which we will collaborate so that we get independent feedback while we run the program or do the various modules, it will help us in doing online corrections. Because ultimately after the end of one year or two years, we realise nothing has happened. That is of no use. So we are trying to involve various institutes and looking for strategic partners, so that we get all the information which we require at the state headquarter level to monitors the scheme.

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