Fourth Common Review Mission (CRM) Report 2010

The Fourth Common Review Mission (CRM) Report 2010 of the National Rural Health Mission was presented here today. Speaking on the occasion, Secretary Health and Family Welfare Shri K Chandramouli noted that NRHM in its sixth year has showcased commendable progress where as on September, 2010, nearly 8lakh Accredited Social Health Activists (ASHAs) have been engaged; 1572 specialists, 8284 MBBS doctors, 26,734 staff nurses, 53,552 auxiliary nurse midwives (ANMs), 18,272 Paramedics employed on contract basis and a total of 16,338 Primary Health Centres (PHCs), Community Health Centres (CHCs), and other Sub District facilities have been made functional on 24 x 7 basis. Shri Chandramouli however pointed out that it is important to increase the absorption capacity for funds and address the challenge of entire gamut of infectious and chronic diseases. Secretary also emphasized upon need for training and convergence of inter sectoral issues with greater vigour. He said while palpable progress in public health systems is evident, the efforts need to be accelerated.

The Fourth Common Review Mission Report notes that there is appreciable improvement in Integrated Disease Surveillance Project infrastructure and flow of information through Health Management Information Systems particularly in Orissa and Chattisgarh as also in Punjab and Chandigarh. There have been substantial improvements in the process of accounting- with the addition of staff, with improved leadership arrangements, with the use of customized software and with the electronic transfer of funds upto district level in almost all states.

The CRM teams visiting Maharashtra, Assam and Kerala have reported a number of innovations like evening OPD, scaled up boat clinics from Kerala and Assam as also the innovation in palliative care in Kerala. Sustained increase in institutional delivery reflecting the continuing gains of Reproductive and Child Health programme; assured referral transport and emergency response system especially in Assam, Tamil Nadu, Uttarakhand; improved availability of essential drugs; increased incidence of Male sterilization in States like Assam, Punjab, Maharashtra are some of the main findings of CRM Report. Nutrition Rehabilitation Centres are now functional in States of Assam, Madhya Pradesh, Rajasthan, Jharkhand, Maharashtra, Chattisgarh and Uttar Pradesh. Most states have reported good coordination between the Auxiliary Nurse Midwife, Anganwadi Workers and the Accredited Social Health Activist. In maternal health there had been considerable progress with almost 76 health facilities with C-section capabilities being functional in the 30 districts visited and a network of PHCs and CHCs providing institutional care for the pregnant women. The facility based care for the sick newborn and child would also be similarly scaled up in the coming year. Other major positive findings include the expansion in nursing education.

To rapidly build on achievements of NRHM, CRM recommends that Infrastructure development units should be provided with a basic training package by a suitable hospital management institution to understand the specific aspects of safety and efficiency in hospital construction. Technical Guidelines on these should be prepared and made widely available. Prioritization of health facilities for infrastructure development needs to be based on mapping of village by village utilization patterns of health facilities; dialogue with each state on the quantum of human resource required; ensuring geographically balanced development of professional education; Scaling-up of multi-skilling programme for emergency obstetric care, are some of the other recommendations. The Report also talks of advocacy and prioritization of policies to promote rational drug prescription and hospital pharmacy-based prescription with free drugs in every public health facility; procurement and supply of Generic drugs at reasonable rates with assured quality for social protection of the poor against the rising costs of health care, especially the rising costs of essential drugs. There is also need for deepening and expanding community monitoring in states where it is already implemented and to initiate in states where they have not been started yet. CRM Report also emphasizes on continuation of contractual service providers and technical and management support staff into the next plan period to promote long term planning of services.

Responding to the presentation of the findings, the Special Secretary and Mission Director, NRHM Shri P K Pradhan called for accelerating efforts to achieve the Plan targets in the last year of the XIth plan. He informed the participants that with a bit of sustained efforts all but six of the large states with over one crore population viz Madhya Pradesh, Rajasthan, Bihar, Uttar Pradesh, Jharkhand and Chattisgarh would have achieved population stabilization in this plan period. The bulk of the maternal and child deaths are also from these six States and there would be redoubled efforts with a central push in the coming year to address the problem in these States.

The 4th Common Review Mission was held from 15th to 23rd December, 2010. A total of 14 states – Arunachal Pradesh, Assam, Chattisgarh, Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Nagaland, Orissa, Punjab, Rajasthan, Tamil Nadu, Uttarakhand and Uttar Pradesh and one union territory – Chandigarh was reviewed by 15 teams. These teams comprised of 125 public health experts from NGOs and Civil Society Organisations, donor partners in additions to the State and Central Government officials. The Common Review Mission is one of the most important monitoring mechanisms to assess the progress of NRHM as also an opportunity to share best practices across States. CRM has been an annual exercise since 2007.