The challenge now is to honour every household's right to quality healthcare.

As the National Rural Health Mission (NRHM) completes five years on Monday, a mid-term review of the programme claims that it has unleashed a lot of positive synergies and the government should make all efforts to further deepen such processes of community health in a manner that every household is able to seek its entitlement to care.

Vice-President Hamid Ansari will honour the best performing States at a function here.

The 7,00,000 Accredited Social Health Activists (ASHAs) — the first port of call — across the country have demonstrated their ability to link households to facilities. The challenge in the coming years would be to honour the entitlement of every household for quality healthcare that is accessible, accountable and affordable.

The NRHM is very much on the right track and it only needs to further put pressure for better governance and for larger civil society involvement at all levels through public hearings and community monitoring, the review suggests.

The Mission started an excellent community monitoring system in nine States, and the need now is to make it universal before the end of the 11{+t}{+h} Plan so that local communities begin to demand health care in a rights and entitlement framework. This would also call for a behaviour change in the way public system interfaces with poor households and particularly the women.

The challenge before the NRHM is to craft credible public systems, and this would call for new systems of public recruitment which are institution specific and based on service guarantees with complete local level accountability. “The NRHM has promoted this culture of local recruitments and local accountability through contractual appointments. There is a need to develop a new paradigm of public recruitment based on the learning of the last five years,” the report says.

Quoting evidence-based studies, the mid-term review said there was a need to universalise basic protocols of care at all levels, with wide publicity at facilities. There is a lot to learn from the protocols followed by the armed forces hospitals and dispensaries in this regard.

While a lot has moved on delegation of administrative and financial powers, the NRHM needs to further deepen decentralised management and accountability by engaging non-governmental organisations for community monitoring at all levels. The NGO programme of the Ministry needs to be revised in such a manner that presence of quality NGOs for community monitoring and skill development can be crafted from the block to the district to the State levels.

Further, the review says that while resources have reached institutions across the length and breadth of the country under the NRHM, it was time for every facility to develop its detailed institutional plan for utilising the untied resources being made available to it.

Timely utilisation of such resources, their effectiveness and their efficiency ought to be assessed from time to time. Governance reforms and greater supervision in this regard will help, the report says.