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Corporate Strategy | "National Rural Health Mission: The Tasks Ahead"

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National Rural Health Mission: The Tasks Ahead

- by Dr. Gursharan Singh Kainth *

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Moreover, unless the other levels of the health system, such as PHCs and CHCs, are substantially improved, their services upgraded, and the staff made responsive to people claiming health rights, ASHA would not be able to make much headway in her task of facilitating
people's access to health services. In the absence of major programmatic changes, the likely scenario is that ASHA would be placed in a peripheral 'helper' role related to the health system, but the need for significant compensation to carry out this role might be brushed aside on the pretext that she is an 'activist'!

Principal amount of adequate remuneration for ASHA should be assured and delinked from specific activities, with a small performance linked component, if necessary. The remuneration for regular health activities and village level processes could be routed through the Panchayat or Village Health Committee, if required. Monitoring of ASHA should involve social monitoring by the Gram Sabha and Village Health Committee, and technical monitoring by the public health system. Adequate budgetary provisions must be made to support all the critical elements of the ASHA programme including training and training compensation, cadre of trainers / facilitators, regular replenishment of the drug-kit, remuneration for regular tasks and additional activities done by ASHA, capacity building and support to village health committees, etc.

The role of ASHA is not to substitute elements of the existing health system, but to complement it and promote its better utilization. The ASHA should not be viewed as a replacement for any of the functions to be performed by the ANM, Anganwadi Worker or other public health functionaries. Training of ASHA should be substantial and adequate to equip her for her multiple and reasonably demanding roles, this would require at least about one month of initial training followed by regular (monthly or once in two months) follow-up training. Training needs to be a continuous effort, provided over a period of a few years.

Strengthening of Health Infrastructure

Though there has been a steady increase in health care infrastructure available over the plan period, there is a shortage of 20,903 Sub-Centres (SCs), 4,803 Primary Health Centres (PHCs) and 2,653 Community Health Centres (CHCs) as per 2001 population norm. Further, almost 50 per cent of the existing health infrastructure is in rented buildings. Poor upkeep and maintenance and high absenteeism of manpower in rural areas have also eroded the credibility of the health delivery system in the public sector. NRHM seeks to strengthen the public health delivery system at all levels. In addition to strengthening the health delivery system under NRHM, several other programmes in the area of health are being implemented in the country.

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Dr. Gursharan Singh Kainth started his career as Lecturer at Post Graduate Dept. of Economics, Government College, Gurdaspur, and later at Khalsa College; Amritsar, specializes in Quantitative & Development Economics. Has the distinction of serving Punjab Agricultural Univ, Ludhiana, for more than 2 decades and remained Director-Principal of Saint Soldier Management & Technical Institute, Jalandhar. Currently, heading GAD Institute of Development Studies, Amritsar, a self-financed research institute. Has been honoured with various awards, including Guru Draunacharya Samman, Vijay Rattan Award, etc.
Article posted on December 14, 2008.


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