We have been hammering at this. Sometimes we get tired, but we hope that someday it will click. The Commission can only advise and suggest the ministries what they need to do, Syeda Hameed, Planning Commission member (health) told FE .
The Commission has been suggesting a three-pronged approach to improve rural health to health ministry mandarins, which hasnt been implemented yet. The approach is simpleuse the four lakh rural medical practitioners to make up for the shortfall of doctors in remote areas; train the traditional midwives to ensure safe deliveries at home and introduce low-cost diagnostic equipments and technologies to check the growing incidence of lifestyle diseases in Indias villages.
It is not possible to have institutional deliveries in most of the rural areas given the geographical location and the capacity constraints. Therefore, we told the health ministry to further train the dais (mid-wives) who have been doing the job for ages, and give them the stipend. Do not insist on institutional deliveries so long as the dais are able to ensure safe and hygienic deliveries at home, she said.
To deal with the human resources problem at the practitioner level, the Commission has been pointing out that it would be impossible to produce over 4 lakh MBBS graduates by 2009 and alternatives must be considered. However, the health ministry led by Ambumani Ramadoss has been pursuing its own controversial solution posting medical graduates in rural areas compulsorily for a year. The Commissions advice has been largely in cold storage.
Nobody wants to go to far flung areas. We have suggested the use of available human resource which is readymade in the form of RMPs. There are about 4 lakh of them who are there in every village and talukas. They are not MBBS but properly trained and ready to work for the NRHM. We have been suggesting this to the health ministry time and again, Hameed said .
Lifestyle diseases are all over the place. Diabetes, hypertension are no more just urban health problems. But people in rural areas cannot afford the kind of diagnostic equipments required. Therefore we have suggested the use of indigenously built, low priced diagnostic equipments she added.
With just few months left (in the UPAs tenure), we have to look for improvement. We have set some process in motion. One very outstanding example of this is if we are told that malnutrition has gone down, which actually takes very long, we should at least be able to see some trends in that direction. Towards the end of our term, we would like to set some processes rolling so that whoever comes in next carry on with these best practices, she said.
Seeking a bigger role for the non-government organisations (NGOs) for successful implementation of flagship programmes, Hameed said greater involvement of NGOs, particularly to monitor the functioning of primary health centres and sub-centres under the Mission is pertinent. Monitoring is best done by NGOs. These NGOs should be from the neighbourhood, maybe from the same village so that concurrent monitoring goes on. This will ensure a very local, day-to-day monitoring, the member said.
She also emphasised the need for engaging NGOs in the operation of the Integrated Child Development Scheme (ICDS) scheme so that they can overlook the cooking of meals and providing proper supplementary nutrition to the children under the scheme.
Most of the times things do not happen because nobody is watching or supervising. The figures that are generated and the charts that are filled and tables that are prepared regarding the performance of the programme are never filtered upwards as we do not have any physical monitoring, she pointed out.