New Delhi, March 24
A large number of primary health centres under the ambitious National Rural Health Mission (NRHM) are serving as storehouses for foodgrains, community halls and tehsil offices. Many such centres are located close to garbage dumps, cattle sheds and stagnant water bodies, forcing patients away and defeating the purpose of accessible and affordable healthcare for which the NRHM was launched in 2005.

Belying the government’s claims on the NRHM, the Public Accounts Committee of the Parliament today showed that none of the professed objectives of the scheme had been achieved. The government had, under the programme, promised to raise the proportion of public expenditure on health from 0.9 per cent of the GDP in 2004 to 2 to 3 per cent over 2005 to 2012.

Today, this proportion is just 1.1 per cent of the GDP - less than 50 per cent of the target. Worse still, the per capita allocation by the Centre under the NRHM has increased by just 15 per cent annually against the target of 40 per cent a year from 2009.

“India spends just $7 per capita per year on health as against $30 spent by Sri Lanka. The NRHM is a miserable state and needs a total reappraisal for the 12th Plan,” PAC chairperson Murali Manohar Joshi said.

A major deficiency the audit points out relates to the absence of manpower - ANMs, nurses, allopathic doctors and specialists - in several test checked health centres in many states. The NRHM had aimed

to ensure two ANMs at 60 per cent sub-centres by 2008. It said every primary health centre (PHC) would have a medical officer, one AYUSH

doctor and three staff nurses, while every community health centre would have seven specialists and nine staff nurses.

The audit shows that 116 sub-centres (9 per cent) in 20 states have no ANM; 992 sub-centres (77 per cent) in 29 states don’t have the required two ANMs. Over 11 per cent PHCs in 15 states are working without an allopathic doctor; 518 PHCs (86 per cent) in 28 states never had any AYUSH doctor while 69 PHCs in the test checked districts had no allopathic or AYUSH doctor.

Another startling finding is the administration of expired medicines to patients in some centres. In Orissa, West Bengal and Jharkhand, the authorities were purchasing medicines without quality checks.

In Orissa’s Bolangir and Sunderharh districts, in 14 cases, expired medicines worth Rs 3.02 lakh were given to patients. In Bihar, the mechanism for checking essential drugs was non-existent.

If that was less - 13 states (Assam, Delhi, Haryana, J&K, Punjab, and Jharkhand) had not cared to prepare the common formulary of essential drugs that should be available at a health centre.

Further, the NRHM provision of two month medicine stock at a health centre was not being adhered to in most places.

It further picks holes in the NRHM’s Janani Suraksha Yojana scheme under which expecting mothers were to be issued health cards for tracking to achieve the goal of 100 per cent institutional deliveries by 2010.