The Comptroller and Auditor General (CAG) has criticised the National Rural Health Mission (NRHM) for “hampering” the smooth implementation of the Janani Suraksha Yojana – maternity benefit scheme — by delays and irregularities in the payment of incentives.
In its latest report, the CAG pointed out that a majority of the registered pregnant women did not use the health centres for institutional deliveries.
This was particularly so in the States lagging on health and development parameters due to lack of planning in micro birth plan entrusted to the Accredited Social Health Activist (ASHA) and the Auxiliary Nurse Midwives (ANMs). Facilities were inadequate facilities and there was a shortage of supporting staff and doctors at the health centres.
Even though the District Level Household and Facility Survey-III (2007-08) indicated that the percentage of institutional deliveries was 47, the Mission seeks to achieve a target of 100 per cent institutional deliveries by 2012.
The national targets for progress in human development goals and health indicators such as Infant Mortality and Maternal Mortality Rates were fixed by the Ministry of Health and Family Welfare but there was no attempt to ensure that individual State targets matched national targets or that these were achievable.
Long term targets and outcomes for performance indicators were not even prescribed by 17 States, the report said.
More than 50 per cent of pregnant women in seven States 20 to 50 per cent and in 9 States did not receive the full dose of iron and folic acid tablets due to delays and shortfalls in supply.
The State Health Society did not prescribe year-wise targets for various terminal methods of family planning in 15 States and Union Territories, and there were shortfalls as high as 62 per cent in coverage in another 11 States.
The targets for immunisation were fixed on an ad hoc basis in 15 States and UTs and despite higher rates of immunisation, the incidence of infant and child disease increased in 9 States, according to the CAG report.
Despite major immunisation drives, 1640 new polio cases were detected in 17 States/UTs during 2005-2008.
The report recommended that the monitoring and reporting mechanism under the JSY should be strengthened so as to ensure availability of reliable information with the State and District Health Societies.
This would help mitigate the risk of fraud and irregularities in grant of cash compensation under the scheme.
Keywords: Comptroller and Auditor General, National Rural Health Mission, Janani Suraksha Yojana, Accredited Social Health Activist, Auxiliary Nurse Midwives, Infant Mortality Rates, Maternal Mortality Rates