With a countrywide average of Infant Mortality Rate (IMR) of 39 deaths per 1,000 live births and Maternal Mortality Rate (MMR) of 167 per 1,00,000 live births, the country only “partially achieved” the Millennium Development Goals-2015 under the National Rural Health Mission (NRHM), the CAG has said. The “partial” achievement was far from the targets set under the Framework of Implementation (2012-2017), the Comptroller and Auditor General (CAG) report, laid in Parliament on July 21, said. While MDG for 2015 sets the target of IMR of 27 per 1,000 live births, as per the Sample Registration System, the IMR in 2014 was 39 per 1,000 live births. Similarly, as against the MMR target of 109 per 1,00,000 live births, the countrywide average was at 167 per 1,00,000 live births. But this does not reveal the actual state of affairs as IMR in Madhya Pradesh is 52, Odisha 49, Assam 49, Uttar Pradesh 48, Chhattisgarh 43 and Bihar 42.
Similarly, with regard to MMR, as against the countrywide average of 167 per 1,00,000 live births, the MMR is 300 in Assam, 285 each in Uttar Pradesh and Uttarakhand, Rajasthan 244, Odisha 222, Madhya Pradesh and Chhattisgarh 221 each, and Jharkhand and Bihar 208 each. Framework of Implementation (2012-2015) had set the target of reducing IMR to 25 per 1,000 live births and bringing down the MMR to 100 per 1,00,000 live births.
One of the reasons for this could be the shortfall in the institutional delivery. This shortfall ranges between four per cent to 54 per cent in 14 states, with Arunachal Pradesh recording a shortfall of 54 per cent and Uttarakhand 52 per cent. “The reasons for shortfall in institutional delivery, as gathered during facility survey, were distance of health facilities from villages, lack of public transport and unhygienic surroundings of the Primary Health Centres (PHCs),” the CAG report said.
In a shocking revelation, the CAG in its report said that 161 of the 514 PHCs “did not have the facility for delivery”. It included Kerala where all the 12 selected PHCs did not have the delivery facility and the same was the situation in 50 per cent of the PHCs that were surveyed in Uttar Pradesh, Uttarakhand, Himachal Pradesh, West Bengal, Odisha and Tripura.
Another contributory factor for high IMR and MMR, according to the CAG, is that the test check of type ‘A’ sub-centre of 12 districts of 28 states/UTs revealed that in Assam, Bihar, Chhattisgarh, Jharkhand, Odisha, Punjab, Rajasthan, Sikkim, Tripura and Uttar Pradesh, “50 to 80 per cent of home deliveries were not attended by Skilled Birth Attendants (SBAs)”.
In Haryana, Kerala, West Bengal and Meghalaya, “more than 80 per cent of home deliveries were not attended by SBAs”, said the CAG report. Besides, the report says that there was a shortfall ranging from three to 75 per cent in providing 100 tablets of Iron Folic Acid to each of the expectant mothers.
In Gujarat, Rajasthan, Madhya Pradesh, Maharashtra, Haryana, Karnataka, Andhra Pradesh, Tamil Nadu, Jammu and Kashmir, Andaman and Nicobar Islands and Meghalaya, “more than two per cent of the registered pregnant women were found to have severe anaemia”, the report said. In six states — Punjab, Rajasthan, Himachal Pradesh, West Bengal, Karnataka and Sikkim, 40 per cent expectant mothers did not receive the cash assistance ranging from Rs 500 to Rs 1500.