The implementation of the Pre Conception, Pre Natal Diagnostic Technique (PCPNDT) Act, which was enacted to stop female foeticide and arrest the declining sex-ratio in the country, is poor in most states, a government report has said. Even where committees have been formed, reasons such as lack of witnesses, insufficient evidence, and out-of-court settlements, were cited as major reasons for low conviction rates, states the 10th Common Review Mission (CRM) report of the National Health Mission (NHM).
According to the report, despite NHM augmentation of human resources in states, shortage of service providers exists in most of the states reviewed. This cuts across all cadres but is especially acute for specialists below the district-level hospital.
Also, vacancies in administrative posts in Andhra Pradesh and Maharashtra and shortage of programme-specific human resources in Bihar and Gujarat were seen as bottlenecks in smooth implementation of national programmes in these states.
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However, the number of health facilities functioning out of rented buildings have reduced significantly. Though significant shortage of health centres were reported from Bihar (41 per cent shortage in student health and counseling services and 51 per cent shortage in Additional Primary Health Centres) and Nagaland (13 per cent shortage in SHCS).
The report highlighted that ‘time to care’ approach is yet to be institutionalised in most hilly states largely due to poor road connectivity and challenges related to inclement weather conditions.
Jammu and Kashmir, Tamil Nadu, Himachal Pradesh, Tripura and Madhya Pradesh have initiated the process of strengthening of District hospitals to develop them as training centers.
However, many other states like Andhra Pradesh, Arunachal Pradesh, Delhi, Gujarat, Jharkhand, Kerala, Maharashtra, and Uttar Pradesh have not reported any progress in this regard, the report says.
Though availability of blood services have seen improvement in most states, there is a concern about the same in six states — Nagaland, Gujarat, Arunachal Pradesh, Uttar Pradesh, Jammu and Kashmir and Bihar — particularly at sub- district level.
These states also reported limited functioning of the Blood Storage Units either due to lack of trained human resources or nonlinkage with a mother blood bank.
All states except Delhi reported utilization of Mobile Medical Units (MMUs) for outreach services. Andhra Pradesh, Gujarat, Jharkhand, Maharashtra, Kerala and Tamil Nadu have reported better utilization of MMUs to provide health care services to tribal and marginalised population.
States like Tamil Nadu, Maharashtra, Chandigarh and Gujarat were found to have relatively better mechanisms of maternal death review, the report said.
Mortality rate in special newborn care units (SNCUs) ranged from as low as 1-3 per cent in Tamil Nadu to as high as 27 per cent in Uttar Pradesh (Gonda District).
Birth asphyxia, pre-maturity and neonatal sepsis have emerged as major reasons for admissions to SNCUs in various states.
States like Arunachal Pradesh, Delhi, Madhya Pradesh, Bihar, Himachal Pradesh, Jharkhand, Kerala (District Idukki), Nagaland and Tripura were found to have shortages of new-born care facilities (particularly NBSUs and SNCUs).
As far as the review of the communicable disease control programmes were concerned, though they continue to be a major public health problem, there has been a consistent decline in malaria incidence with a 40.8 per cent decline in malaria-related deaths.
Similar declining trends have been observed in Kala Azar.
There is progress in the elimination of Lymphatic Filariasis. The country has achieved the goal of elimination of leprosy (less than 1 case per 10,000 population) as a public health problem.
However, chikungunya cases have been reported from 22 states and three UTs. JE continues to be a challenge for the country and the high endemic districts in several states.
In cases of non-communicable diseases, functional NCD clinics with necessary infrastructure, human resources, drugs and diagnostics were seen only in Tamil Nadu and Kerala.