Rural Ill Health

It is good that you have drawn attention (“Evaluation of the Health Mission”, 23 January 2010) to an account of the early operation (May 2005-December 2008) of the National Rural Health Mission (NRHM) in the performance audit conducted by the Comptroller and Auditor General of India.

It is unfortunate that even the limited performance audit confirms the worst fears I had expressed soon after the publication of the mission document (“Politics of Rural Health”, EPW, 23 July 2005). I had regretted that the NRHM was based on questionable premises. The key officers of the union ministry of health and family welfare and their advisors seemed to doggedly refuse to learn from the many experiences of the past, both from sincere efforts to d evelop endogenous mechanisms to o ffer access to health for the people as well as the devastating impact of the imposition of prefabricated, illconceived, badly designed, technocentric vertical programmes.