Evaluation of the Health Mission

The National Rural Health Mission (NRHM) was launched in 2005 to ensure effective healthcare for the rural population and had a special focus on 18 states that have poor public health indicators and inadequate infrastructure. In its performance audit of the NRHM for the year ending 2008 the Comptroller and Auditor General (CAG) says that the mission has succeeded in raising expectations from the public health system. While the CAG report does list a number of positive outcomes and “success stories”, it has also pointed out some fundamental inadequacies that have persisted through the first three years of the mission.

The NRHM set national targets for a lower infant mortality rate (IMR), maternal mortality rate (MMR) and total fertility rate (TFR), and also for increasing the cure rate of various endemic diseases. One of the basic requirements of any mission is to set up mechanisms to get regular feedback and data to enable the right kind of intervention at the right time in order to meet targets. But the CAG has found that in 17 states and union territories (UTs) – several of them high focus ones – long-term goals and targets were not prescribed. In some, pre-NRHM data was not available to measure the efficacy of the mission. Half of the states and UTs had not even prepared their long-term perspective plans and worse, at the level of the Ministry of Health and Family Welfare, there was no road map of state-wise long-term goals to achieve the national targets. The national targets, in turn, did not reflect inter-state and intra-state differences that existed before the NRHM was implemented.