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An army of locally resident Accredited Social Health Activists with strong referral links with the strengthened health system will put even greater pressure on the public sector health system to delivery quality services.

Along with need-based and transparent partnerships with non-governmental providers for public health goals, the strengthened system will have positive consequences for all interventions, whether they are for family welfare, disease surveillance, National Health Programmes, etc. The innovative engagement of human resource as per need and the arrangements for incentives at each level will help craft a new and innovative system of public health delivery. The experience of the last two years gives us the confidence that we are on the right track and that we need to deepen institutional reforms and effective decentralization through a concerted effort at capacity building. The setting up of a National Health System Resource Centre is a step in that direction. States are also in the process of setting up their resource centres. The North Eastern Regional Resource Centre is already playing a critical role in developing need-based programmes in the eight North Eastern States.

The National Rural Health Mission is a bold proposition aimed at changing the way healthcare services are prioritized and delivered in India. But, while it is true that the moribund government healthcare services need bold measures to revitalize them, there is also a sense of déjà vu. Many new health-related programmes have been initiated over the years, and others re-organized, but the results have always lagged far behind the projections. And, the more things change, the more they tend to remain the same. Take, for example, the family welfare programme, the most active health-related initiative in the country. In the last decade, this programme has seen a whole slew of new initiatives, but it seems to be delivered the same way it was a long time ago.

Not so long ago, family planning targets were given to ANMs and anganwadi workers and even the district magistrate's work was judged by the number of cases obtained from his/her district. Then, the target-free approach was announced and there was a general sigh of relief. However, the situation now seems to have reverted to the earlier state. Reports from Uttar Pradesh, Madhya Pradesh and Rajasthan indicate that not only are targets in place once again, but there are inducements like gun-licensees for getting sterilization cases.

Hopefully, the National Rural Health Mission will be different and will deliver on a significant number of its promises. However, there are still many unanswered questions and unresolved issues. The idea of a village health worker is not new. There was an earlier scheme of a Village Health Worker (VHW), who was paid Rs. 50, in the late '70s. The ASHA (the reincarnated VHW) will not be paid a fixed honorarium, and is expected instead to earn a living from performance-linked incentives.

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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.