An evaluation has ranked Tamil Nadu at the top for implementation outcomes of the National Rural Health Mission (NRHM) and described it as a benchmark for other States.
Analysis of data also reveals that in physical infrastructure per 1 lakh population with respect to Primary Health Centres, Community Health Centres, and First Reference Units, Jammu and Kashmir is far ahead of Tamil Nadu and the other States.
One important reason why Tamil Nadu (which also had a much better baseline) was purposively chosen in this sample — surveyed under Evaluation Study of NRHM — was to measure achievement of the high focus States with reference to a benchmark for performance.
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The seven States surveyed are: Tamil Nadu, Madhya Pradesh, Uttar Pradesh, Bihar, Jharkhand, Orissa and Jammu and Kashmir.
For the utilisation of public health facilities for ante-natal care and post-natal care services, Tamil Nadu is the best performing State and Uttar Pradesh, Madhya Pradesh and Assam are the worst.
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On institutional deliveries, Tamil Nadu leads and Jharkhand is at the bottom.
According to the survey done by the Institute of Economic Growth of the University of Delhi, institutional deliveries are reported to be the highest in Tamil Nadu (96.6 per cent), followed by Madhya Pradesh (63.3 per cent), Assam (56.9 per cent), Orissa (52.6 per cent), Jharkhand (46.1 per cent), Uttar Pradesh (45.8 per cent) and Jammu & Kashmir (38 per cent).
The survey found almost all seven States have reported post natal count care by more than 65 per cent of the lactating women except in Jammu & Kashmir, which has only 57 per cent utilisation of this service. Almost similar percentages of lactating women have reported to be Janani Suraksha Yojana (JSY) beneficiaries.
Usage of family planning services, public or private, is maximum in Assam (65.5 per cent) followed by Tamil Nadu (63.3 per cent), Jammu & Kashmir (61.6 per cent), Jharkhand (54.7 per cent), Madhya Pradesh (53.7 per cent), Orissa (53.4 per cent) and Uttar Pradesh (42.3 per cent). The Accredited Social Health Activists (ASHAs) and auxiliary nurse midwives (ANMs) have a major role to play in motivating couples to adopt family planning methods.
As far as utilisation of public vs. private health facilities for chronic disease treatment is concerned, the survey found that majority of the patients were utilising public health facilities in Tamil Nadu (94 per cent), Assam (90.3 per cent), Orissa (86.8 per cent), Jammu & Kashmir (83.5 per cent), Jharkhand (69.8 per cent), Madhya Pradesh (63 per cent) and Uttar Pradesh (44.6 per cent). Overall utilisation being poor in Uttar Pradesh, Madhya Pradesh and Jharkhand reflects that there may be problems of both access and quality of basic health care.
Role of ASHA scheme
Awareness about ASHA scheme was much higher than NRHM per se, and this clearly reflects the role of ASHA as the most linked to the NRHM initiatives as compared with others like Village Health and Sanitation Committees or Village Health and Nutrition Days. Interestingly, source of knowledge about these initiatives are predominantly ASHA/ANM and not print or electronic media.
Also, the study found that most of the ASHAs were reported to be carrying kits and involved in counselling over sanitation and hygienic practices as well as distribution of common medicines. ASHAs’ role was quite important in increasing awareness about the key health care initiatives of NRHM to increase utilisation of obstetric and child care.
Recommending consolidation of ASHAs scheme by mentoring and retraining, the study says inclusion of administering vaccinations, would further enhance antenatal and child care. Thus, more attention is needed for the improvement of existing infrastructure, upgrading health facilities, including drugs, doctors and equipment, in most of the lagging States.
Nevertheless, institutional deliveries have accelerated and safe home deliveries have improved over the period. Most of the public health facilities are getting utilised by more health care seekers. JSY beneficiaries are more than the institutional deliveries in some of the high focus States such as Jharkhand, basically because of home deliveries being covered under JSY. However, despite substantial efforts in mainstreaming AYUSH, only 0.5 per cent of patients with chronic disease had opted for treatment under AYUSH with Ayurveda being more popular than other traditional streams.