Paradigm shift in addressing health issues – Indian experience under National Rural Health Mission (NRHM)

Presenter: Ganga Murthy, Government of India

Abstract

Rationale:
India faces enormous challenges in improving health status of the people. In spite of well designed policies and programmes, the country has failed to provide basic health care to the poor and marginalized in the majority of the states. There is a glaring difference among the Indian states in terms of achievements in health indicators. In order to address the problems of rural health care the Government of India introduced the National Rural Health Mission (NRHM) in the year 2005 to strengthen the public health system across the country by financing substantially through Central Government resources. An assessment of increased availability of Central resources and its influence on health outputs/outcomes as well as the State resources is essential for planning the resource allocation.

Objectives:
This paper has three basic objectives:
•examine the nature and pattern of resource flow under NRHM to different states and assess their absorptive capacity
•assess the influence of additional resources on spending across states on innovations that could have an impact on MDGs
•study the impact of enhanced public spending on health outputs and health outcomes where feasible

Methodology:
The study is based on review of secondary data collected from Central and various state governments since 2005-06. The data pertaining to resources allocated under NRHM and their links with health outcomes will be reviewed for this purpose. This will also examine the organizational and institutional processes adopted and innovations made at the state level to influence the health outcomes. It will explore the link among planning, budgeting and resource needs in the states. Further an attempt will be made to find out whether the level of development (health and economic status) or organizational strengths have influenced the absorptive capacities of the states. In order to find out efficiency in utilization of resources, selected output/outcome indicators will be analyzed across the states to examine the correlation between spending and achieving the targets.

Results :
Efficiency in resource utilization is one of the factors that influence health outcomes. The study would suggest the possible administrative innovations which will improve efficiency of resources. The areas which need further strengthening for effective health sector planning, budgeting and implementation would be identified through this analysis. This study will find out specific links which work towards achieving selected targets of MDGs in many states, particularly the low performing states. Finally this will provide inputs whether the philosophy of additional financing mechanism really helps the low performing states in achieving the health goals.

Conclusions:
Piece meal approach such as additional financing under alternative mechanism may not help achieving broader health outcomes. System strengthening and quality human resources would be the central to sustainable health outcomes.