March 31, 2009

World watching Indian Rural Health Mission: London School of Hygiene and Tropical Health

“The world is keenly watching developments in India following the implementation of the National Rural Health Mission [NRHM], billed as the single-most largest primary health care programmes being run in any country. What happens in India in the primary health care sector will be crucial,” Professor Sir Andrew Haines, Director, London School of Hygiene and Tropical Health, told The Hindu here.

“The programme is getting close attention — its strengths as well as its weaknesses. Of particular interest are its features like recruiting women as Accredited Social Health Activists [ASHAs] and involving the community that would lead to accountability and transparency,” Sir Andrew said. Besides, ASHA would be excellent as an intermediary between the people and the formal health system, he said.

Not willing to comment on the impact the Mission has had on the primary health care system as he was yet to study the outcomes, Sir Andrew, nevertheless, said the bigger challenge before India was to reduce inequalities that existed within the States.

Cost-effectiveness
Sir Andrew, who delivered the Second Public Health Foundation of India Day lecture here on Saturday, said the strengths of any primary health care system were its cost-effectiveness and an increased money absorption capacity.

He also stressed on the need to integrate population issues with the primary health care systems.

“It was in 1978 that representatives from 134 countries gathered in Alma Ata and declared that primary health care was the key to delivering Health for All by the year 2000. Subsequently, however, attention shifted to promoting vertical, disease-specific programmes. These may be efficient in tackling specific disease burden but are inadequate in addressing socio-economic determinants of health, resulting in a still high burden of preventable diseases, particularly in low and middle-income countries,” he said.

Renewed interest
According to Sir Andrew, recent years have seen a renewed interest in primary health care in these countries for various reasons, including inequities in health, inadequate progress towards the millennium development goals, major shortfalls in the human resource in health sectors and the fragmented and weakened state of health system in many countries.

On whether India can achieve the goals set in the NRHM, he said there were variations within the States as some States were making strong progress while others lagged behind.

“I am an optimist and believe a lot can be achieved by way of enhancing absorption capacity, pushing resources, improving the quality of services and establishing an interface between the formal health care at the primary level and workers,” he explained.

The immediate expected outcomes would be a reduction in the child mortality rate while improving maternal mortality rate and chronic disease management would continue to be a challenge for some more time, he said.

Environmental issues
Advocating the need for factoring in environmental issues into public health policies, Professor Haines said India needed to respond to climate change through public health policies.

“A simple thing like reducing the green house gases can reduce the disease burden immensely,” Sir Andrew added.

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