The common review mission on the National Rural Health Mission (NRHM) has found that there existed gap in supply of drugs and Rapid Diagnostic Kits (RDK) to peripheral workers and the lack of local specific action for very high endemic pockets.

The sixth review mission, the report of which was presented recently, also called for a clear policy for the supply of free drugs, diagnostics and diet in public hospitals must be articulated by each state. While commenting on the positive outcomes, the mission said availability of drugs had increased at all levels.

“The distribution of case load is skewed towards the DH and CHCs rendering low utilization of services at Primary Health Centres (PHCs) & Sub Health Centres (SHCs). Specialist and nurse vacancies are significant in many states particularly in remote, difficult and tribal areas. The deployment of HR across the health facilities is more in the facilities located in and around urban areas. Complementary specialists are also needed at many locations to provide services such as Caesarean Section. Grievance redressed mechanisms in the States are still not fully developed,” the report said on the flip side of the NRHM.

On the positive side, the review said there had been accelerated progress in achievement of key health outcomes-notably in child survival and population stabilization. There is considerable increase in outpatient attendance and in-patient admissions. The package of health care services, especially in non-high focus states, has expanded and includes a wider range of communicable and non-communicable diseases. There is a significant improvement in the institutional deliveries. Implementation of Janani Shishu Suraksha Karyakram (JSSK) has resulted not only in withdrawal of user fees but also in significant reduction in out of pocket expenditure, the review said.

The Review called for a responsive and transparent grievance redressal system meeting minimum standards defined by state should be in every facility. Infection control needs immediate attention in all four dimensions – infrastructure design, infection control practices, sterile supplies and specific technical monitoring, it said.

“There should be clear policy articulation that mandates a move towards an adequately staffed sub-centre acting as the first port of entry into the district health care system. The impact of mobile medical unit services on the underserved should be assessed for appropriate design modifications. States need to develop a comprehensive human resource policy with a clear plan of action to meet public health workforce requirements. Strategies for attraction and retention of skilled workforce in rural and remote areas should go beyond limited incentivisation and could include well planned non-financial incentives,” it said among its recommendations.