PM launches "National Rural Health Mission"
Speaker: Dr.Manmohan Singh
Date: April 12, 2005 New Delhi

PM launches "National Rural Health Mission" Hindi Version The Prime Minister, Dr. Manmohan Singh, has said that the motto of people's health in people's hand is the root to getting rid of chronic diseases, malnutrition and other social ills that plague the country. Launching the National Rural Health Mission, here today, the Prime Minister said, "we have grievously erred in the design of many of our health programmes.  We have created a delivery model that fragments resources and dissipates energies.   Most importantly we have paid inadequate attention to the public health issues and the possibilities of social and preventive medicine."  The Mission would radically overhaul the manner of delivery of healthcare services in the country, he added. Dr. Singh said "the monitoring systems have to become outward towards the community and not upward towards the bureaucracy.  For example, so far the health information we have in our country through the National Family Health Services Reports are seen at State and Central levels and hardly ever at district and below district levels.  If information is to lead to action, it should be available and used at the local level."  The information system must be re-oriented to support an accountability-structure by developing  district health reports, state health reports and so on, he added. Following is the text of the Prime Minister's address: "I am extremely happy to be here today to launch the National Rural Health Mission.  This is truly an important day for our Government and a very special day for me. We are today fulfilling one of the most important promises of the UPA Government to the people of our country. The slow improvement in the health status of our people has been a matter of great concern. There is no denying the fact that we have not paid adequate attention to this dimension of development thus far. I am, therefore, particularly delighted to launch this new Mission of our Government. We need to act quickly to bridge the income gap, the education gap and the health gap of our people.  They are interconnected in their causes and their solutions are mutually reinforcing. Jawaharlal Nehru had referred to this solemn commitment as our unfinished agenda and he said that the struggle against poverty, disease, ignorance and the inequality of opportunity have to be the foremost instruments of closing these various gaps.  Over the years, Governments have been addressing this issue with some success.  However, the experience of our country has been somewhat uneven. Some States have recorded impressive achievements on the healthcare front. Indeed, there is much that we can learn from the experience of some of our States. I commend to the less developed States the experience of our southern and western States in dealing with the challenge of affordable healthcares. However, what has been a fatal flaw in our approach is that we have gradually abandoned comprehensive health care and a public health perspective for focussed attention on selective diseases. The Indian Health System is perhaps guilty of many sins of omissions and commissions.  But it is now self-evident, and I need not stress this before this audience of Health Ministers and health professionals, that we have grievously erred in the design of  many of our health programmes.  We have created a delivery model that fragments resources and dissipates energies.   Most importantly we have paid inadequate attention to the public health issues and the possibilities of social and preventive medicine.  What is especially gratifying is that the Mission is seeking to radically overhaul the manner of delivery of healthcare services in our country. To my mind, that is a critical issue. Many villages in India today do not have even a rudimentary healthcare provider.  This is because the lowest unit of healthcare delivery of the Sub-Health Centre has been planned for a population norm and not a habitation norm.  The person in charge of it called the ANM (Auxiliary Nurse and Midwife) works to a duty chart from above and so fails to respond to local felt health needs. The nearest hospital of the Primary Healthcare Centre is perhaps the most serious example of a design flaw, it is a halfway house between in-patient care and outreach activity unable to do either well.  Its hospital beds are very often unutilized.  The next unit of the Community Health Centre is something close to a full-fledged hospital but often has vacancies and needs to improve.  Finally in not having moved to District-based planning, the health sector has not been able to leverage action in the critical determinants of health in a holistic integrated manner, integrating action on safe water, sanitation and nutrition and building them into the design of good workable healthcare system. After all, health is a cumulative output of a set of conditions.  The doctor can only cure disease.  To be healthy a citizen needs more than just medical care. A decentralized district-based management can  provide an operational platform to harmonise all services as well as mobilise collective action on health goals through opportunities provided by the Panchayati Raj Institutions. I sincerely hope that the architectural correction that this Mission proposes by empowering district-level institutions in the health sector will offer a new way out for an effective rural healthcare system. We are already seeing encouraging results in the primary education sector as a result of the decentralised district-based approaches and I am confident that the health sector too will benefit from this type of  approach. The key component of the Mission of creating an Accredited Social Health Activist (ASHA) in each village will help all those villages which are today unserved by the health professionals.  The fact that this person is going to be a woman who is trained and also incentivised by the Government should effectively establish her as a change agent for health in our villages.  The Bhore Committee on health, which reported even before India became Independent and it was a pioneer in health policy planning in our country, had recommended that we see this health activist "as fingers of the community moving up and not as fingers of the Government going down".  This Health Activist working together with the Anganwadi workers, the ANM and the Panchayat leadership can develop an effective inter-sectoral plan for health in our villages.  I am also happy to know that professionals in the Community Health field who have demonstrated these practices in selected parts of India will monitor the entire experiment. The component for strengthening the nearest unit of the sub-health centre with an  'untied fund' is again an important step forward.  It is important to ensure that the ANM is given some autonomy in her local space to flexibly respond to local health needs. The  strengthening of the Primary or Community Health Centre  would be the key step for strengthening public health infrastructure.  Words like "strengthening", "improving", etc. do not have much meaning in Government except as additional outlays.  But what is significant in this Mission, is the setting of Indian Public Health Standards which will specify personnel norms, equipment norms and management norms including norms for community control to which these hospitals would need to be built up.  This will help us give all rural citizens good, functioning round the clock public hospitals. All these components are to be implemented through the District Health Plan and the District Health Fund.  The District Health Plan is expected to contain both health action and inter-sectoral action in sectors like safe water, sanitation and nutrition.  I am given to understand that this year, the vertical programmes of the Health Ministry would get pooled under a common Health Society at the District level and the State level and that the Government should be able to move to district level planning for health from the year 2006.  As in the case of Sarva Shiksha Abhiyan, districts should be able to field their health plans and seek funds. There are improvements in the system of delivery, but without these systemic improvements, mere additional funding would be of no avail.  The Government is committed under the National Common Minimum Programme to raise health spending from 0.9 per cent of GDP at present to 2 per cent in the course of the next few years.  A beginning has been made in this year's Budget by increasing it by over Rs. 2000 crore.  The Government would adhere to this commitment of increasing resources and would call upon the State Governments to ensure their timely utilization after architectural corrections are immediately effected. With an accelerated effort through improving health services, we can, I believe, move towards population stabilization as well.  Of equal importance is the adverse sex ratio in several of our Indian states.  In fact including some relatively prosperous States.  I am happy to know that the Mission proposes to make it a part of its goals to correct the gender imbalance and the gender bias. It must be appreciated that Indian Health scenario is not uniform across States.  There are several States in India which are relatively advanced in the delivery of health care.  We must have differentiated responses for such States.  It is time that as a principle we accept the reality that there is no "All-India solution" to the problems in any sector, but as is true with everything else in India, there will have to be multiple models that co-exist.  The Mission should provide space for this type of  diversity. The success of this mission, in my opinion depends on enlarging it to become a truly societal mission enlisting the cooperation and enthusiastic support of  people at the grassroot level.  The institutional structures will have to open up to welcome participation from elected representatives, professionals, community leaders and so on.  The monitoring systems have to become outward towards the community and not upward towards the bureaucracy.  For example, so far the health information we have in our country through the National Family Health Services Reports are seen at State and Central levels and hardly ever at district and below district levels.  If information is to lead to action, it should be available and used at the local level.   We must reorient the information system to support an accountability-structure by developing  district health reports, state health reports and so on. We must understand that the biggest opportunity that we have in our country to make this mission successful is that large numbers of community leaders in our panchayat institutions and health professionals working in the Government and outside would be willing to contribute to it.  The mission will be successful to the extent that it is able to engage their creative energies and build a movement from below for colletive public health improvement. Therefore, I look forward to the National Rural Health Mission delivering the goals that it has set for the country. We will all watch anxiously its progress. I hope it really becomes a mass movement giving people a chance to improve their health through their collective effort. People's health in People's hand; that is the root to getting rid of chronic diseases, malnutrition and other social ills that plague our country."