New Delhi, February 26
Punjab may well be the first state to close all gaps in the public health infrastructure by the end of this year, reveals the latest annual review of the National Rural Health Mission (NRHM).

The 130-page report of the fourth Common Review Mission (CRM) of the UPA’s flagship programme, made public today, hails Punjab’s progress on health facilities and recommends for India a body like the Punjab Health Services Corporation (PHSC), which pools resources for on-schedule completion of health facilities.

“An autonomous body like the PHSC is the minimum that should be insisted upon in all states where construction is well behind schedule,” says the 2010 review. On health infrastructure, Punjab, Kerala and Maharashtra are nearing zero gaps; Orissa, Madhya Pradesh, Chandigarh, Assam, Arunachal Pradesh and Uttarakhand are progressing well but Uttar Pradesh, Jharkhand and Rajasthan are trailing.

The report, while lauding Punjab for infrastructure gains, warns it against persistently acute shortage of human resources: the state is short of 363 MBBS doctors (15 per cent); 249 specialists (22.35 per cent); 2369 staff nurses (41 per cent shortage). It needs 6555 auxiliary nurses and midwives and is short of 2050 (31 per cent shortage). All state dispensaries have one medical officer each except Muktsar, where 30 posts out of 40 are lying vacant.

“District and civil hospitals have severe nursing shortage considerably below norms,” the review finds.

Another major concern for Punjab is a constantly high rate of home-based deliveries when institutional delivery rates across India are rising and are as high as 95 per cent for Tamil Nadu and Kerala. The report points out unacceptably high private sector load in Jalandhar where availability of blood for transfusion is a huge bottleneck if cesarean sections are to be performed.

Strangely, both Punjab and Chandigarh have reported poor progress on maternal and child health indicators in the 2010 review. In Chandigarh, the institutional delivery rate has gone up by just 3.6 per cent between 2008 and 2010 and there has been a 39 per cent increase in still-born babies. The review found neonatal units at Chandigarh’s 22 Community Health Centres dysfunctional.

The saddest finding from Chandigarh and Punjab pertains to poor implementation of Janani Suraksha Yojana, which is meant to be a cash transfer scheme to promote institutional deliveries. In Chandigarh, only in 0.91 per cent deliveries conducted in public hospitals, JSY payments were made.

In Punjab, the review finds: “JSY payments are being delayed at primary health centre-level as powers of disbursement are at block level.”