NRHM 10 yrs on: Short of centres by 20-30%, of doctors by 70-80%

Former Union health secretary Sujatha Rao links the problem to poor spending. “In all these years we have spent Rs 6,000-7,000 crore on physical infrastructure in NRHM while the gap is of Rs 70,000 crore. Our total health spending has never been more than 1% of the GDP; the US spends 18-20% and the UK 9-12%,” she says. “Seventy per cent of the disease burden and bad health indicators are in 250 districts. The central government has to fund healthcare there.”

Former Union health secretary Sujatha Rao links the problem to poor spending. “In all these years we have spent Rs 6,000-7,000 crore on physical infrastructure in NRHM while the gap is of Rs 70,000 crore. Our total health spending has never been more than 1% of the GDP; the US spends 18-20% and the UK 9-12%,” she says. “Seventy per cent of the disease burden and bad health indicators are in 250 districts. The central government has to fund healthcare there.”

Inevitably, the shortfall puts severe pressure also on existing infrastructure. A rural sub-centre is supposed to cater to a population of 3,000-5,000. In India the 1,52,326 such centres would be responsible for 5,473 people each, going by the 2011 population census. A PHC is supposed to cover 20,000-30,000 but the average coverage of the 25,020 PHCs in 2014 stood at 33,323. A CHC is supposed to cover 80,000-1,20,000; India’s 5,363 provide services to an average 1,55,463.

During the entire 12th Plan, 3,960 new SCs, 971 PHCs and 530 CHCs came up. The current shortfall is 36,346, 6,700 and 2,350. The CHCs are 70-80% short of trained physicians and surgeons.

Since it was launched in April 2005 with the purpose of improving rural health infrastructure and services, NRHM has been renamed National Health Mission in the hope of extending the model to urban areas. It has, however, not been able to start even one of the basic requirements of a universal healthcare model — a free generic drugs programme. Some states are worse off than others. Bihar, for example of 91% short of CHCs and 48% short of sub-centres while UP is 40%, 33% and 34% short respectively, according to Rural Health Statistics 2014. Tamil Nadu, Uttarakhand, Himachal Pradesh and Kerala, on the other hand, have a surplus of rural health infrastructure.

The data, according to Dr Mohan Rao, professor at the Centre for Social Medicine and Community Health at Jawaharlal Nehru University, shows how health has been a victim of …continued »