Socio-economic impact of national rural health mission in jammu kashmir
The majority of population of India lives in villages and the poverty is relatively more in rural areas as compared to urban. Health has a cumulative effect on individual's life through human capital formation but unfortunately this vulnerable population is deprived from their basic right of health care that makes India to loss its human assets in the form of high maternal mortality rate, high infant mortality rate and low life expectancy. These rural and poverty ridden population can access their basic right of health care from public sector. This requires sound public health care sector especially in rural areas. With a view to reduce the rural- urban gap in health care, Government of India launched National Rural Health Mission in 2005 which aimed at decentralization of public health care sector, removing horizontal and vertical imbalance in public health care sector. The main aim of this study was to assess the financial performance, human power augmentation and community participation for promoting health care sector in Kashmir division of Jammu and Kashmir State. One non- high focus Srinagar district and one high focus Kupwara district were randomly selected for comparative analysis of public health care sector. Both primary as well as secondary data were collected. Primary data were collected by administering different schedules for Community Health Centre, Primary Health Centre, Sub - Centre, Accredited Social Health Activist, Janani Suraksha Yojana beneficiaries, health manpower, households and Village Health Sanitation and Nutrition Committee. iv The allocation and utilisation of NRHM funds at State level have shown a mixed trend during the years 2005-06 to 2012-13. At the District level, there was relatively higher allocation to high focus district Kupwara as compared to non-high focus Srinagar district while in terms of utilisation there was marginal difference in utilisation between the two selected Districts. The percentage of JSY beneficiaries to total institutional deliveries was relatively higher in high focus District Kupwara (73.59%) while it was only 17.74% in non- high focus Srinagar district during 2008- 2012. The shortfall of health manpower was 8.55% in non- high focus District Srinagar while in high focus District Kupwara, the short fall of health manpower was 21.67%. At Block level, the shortfall of specialists as per Indian Public Health Standard at Community Health Centre Kralpora of high focus District Kupwara was 100% in Physician, Gynaecologist, Pediatrician and Dental surgeon while in Srinagar district all the health specialists were posted except the pediatrician. Further all the four sub centres had inadequate availability of medicine, water supply and electricity except Sub centre Nandpora. The stipulated guidelines were also violated as per NRHM norm of one ASHA per thousand population, marital status of ASHAs (married) and in terms of timely incentives (10th of every month). Also as per NRHM norm, none of the selected Accredited Social Health Activist got their medicine kits restocked during 2012-13. Under NRHM norm, every village Health Sanitation and Nutrition Committee should be allocated Rs10000 per annum. However, it was found that all the four selected Village Health Sanitation and Nutrition committee (VHSNC) from both the Districts received only Rs 5000 per annum. Therefore, the functioning of VHSNC in promoting rural health was not satisfactory in terms of generating awareness about NRHM and also regarding sanitation at the village level. It was also observed that there was a lack of coordination among the officials of NRHM. All in all, this study has highlighted some violations of NRHM guidelines in terms of financial and manpower stipulations. However the launching of NRHM in the State has brought about significant improvement in public health care sector yet it is not up to the Indian Public Health Standard.