National Rural Health Mission (NRHM)

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Impact of National Rural Health Mission on Reproductive and Child Health in Assam (2011-2016)
(CAG of India, 15-09-2017) CAG of India
Reproductive and Child Health (RCH) is the most important programme under NRHM for improvement of Maternal and Child Health care. Considering the substantial expenditure (Rs 4,461.92 crore) incurred by the State Government of Assam under the programme during 2011-16 and with a view to assess the impact of NRHM on RCH, the Performance Audit (PA) of the programme was taken up. In the PA, efforts of the State Health Mission (SHM) on improving RCH in terms of availability of infrastructure, health care personnel, the quality of health care provided, achievement relating to Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) and Total Fertility Rate (TFR) and related health information and management system under the programme were reviewed highlighting the areas of concern which need to be addressed for achieving the intended goals. It was noticed in audit that 98.13 per cent children up to one year of age were immunised and 98.57 per cent of the target for pulse polio administration was achieved under the programme which was high but 100 per cent immunisation to eradicate Polio from the State was yet to be achieved. Increase in institutional deliveries and providing Post Natal Care facility was also seen. The percentage of Pregnant Women (PW) who received 3rd Ante Natal Care (ANC) in the 28 to 32 weeks of pregnancy increased from 71 to 87 per cent during 2012-16. The rate of still birth had also reduced simultaneously and came down from 2.55 to 2.05 per cent. There were, however, areas of concern like shortfall in infrastructure and health care professionals, 85 per cent of home deliveries remained unattended by Skilled Birth Attendant (SBA), PW/mothers had to spend their own money for conducting deliveries in government health centres against the norm of free and no expense delivery, non-achievement of target of reduction in MMR, IMR and TFR and some other related issues which would require action on the part of the NRHM, Assam on priority basis.
Performance Audit of National Rural Health Mission (NRHM)
(CAG of India, 2009) CAG of India
This Report of the Comptroller and Auditor General of India for the year ended March 2008 contains the results of the Performance Audit of the implementation of the National Rural Health Mission. The Performance Audit was conducted between April 2008 and December 2008 through test check of records of the Ministry of Health and Family Welfare, State and District Health Societies and health centres covering the period 2005-06 to 2007-08. The purpose of undertaking the performance audit of the implementation of activities under the Mission is to highlight the positive trends and developments, while simultaneously pointing out possible areas of weakness or shortcomings in field-level operations that could hinder progress towards achievement of the Mission’s overall goals. The performance audit concluded that NRHM’s attempt to rejuvenate the healthcare delivery system has succeeded in raising hopes and consequently, demands from the public health system. A focused prioritisation of interventions and adaptability based on feedback from States are necessary to help the Mission deliver on its goals.
Performance Audit of National Rural Health Mission (NRHM) in Arunachal Pradesh
(CAG of India, 2008) CAG of India
National Rural Health Mission (NRHM) was launched in April 2005 throughout the country with special focus on 18 States including Arunachal Pradesh to provide healthcare to all in an equitable manner through increased outlays, horizontal integration of existing healthcare schemes with special emphasis on primary healthcare to 9.74 lakh rural people in the State. There are some noteworthy achievements of the Mission and the State Government in implementation of NRHM. Arunachal Pradesh has been declared as the first State in the country to eradicate the polio menace. Moreover, there is no incidence of death due to vector borne diseases like kala azar, filaria, Japanese encephalitis and dengue in the State. However, there were deficiencies in planning, implementation and monitoring of the scheme; shortage of medical staff, inadequate infrastructure facilities and lack of public awareness about the facilities provided under the scheme nullified some of the interventions of the scheme. The overall performance of the Mission was not very satisfactory, as the delivery of rural healthcare services in the State was only partial. The review highlights glaring gaps in planning and programme implementation. The State Mission failed to conduct household / facility survey, which constitutes the most crucial element of the planning process upon which the very basis of the Mission success depends. The credibility and the basis on which the State PIP was formulated is questionable. The major shortcoming experienced by the Mission till date is largely attributable to the manpower shortage and the absence of appropriate functionaries at all tiers of the implementation structure. Inadequate health infrastructure, compounded by the delay in upgradation of the existing health infrastructure adversely affected the delivery of healthcare services among the rural population. Shortfall in selection/training of ASHAs and shortfall/ delay in constitution of RKS, contributed to poor awareness among the targeted groups. Monitoring system was inadequate at all levels in the State.
Performance Audit of National Rural Health Mission (NRHM) in Assam
(CAG of India, 2008) CAG of India
The National Rural Health Mission (NRHM) was launched in April 2005 throughout the country to provide accessible, affordable and reliable healthcare to the rural population, especially the vulnerable sections of the society. The programme envisaged convergence of various existing standalone health programmes, decentralization of the planning process with special emphasis on bottom-up approach in decision making and creating better linkages and cooperation among various social sector departments. A mid-term review of the implementation of the programme in the third year of the Mission period (2005-2012) in Assam is aimed at reviewing the initiatives taken by the State Government to bridge the gaps in healthcare facilities provided in the earlier programmes and highlight the areas and issues of concern, which need to be addressed for successful achievement of the objectives of the Mission by the target date. The performance review brought out several positives relating to maternal and child care services like increase in institutional deliveries as envisaged in the programme guidelines. Diseases like polio were contained and there were no cases of kala azar during 2005-07. There was a significant improvement in the cure rate of tuberculosis and the overall achievement of primary immunization of children in the targeted age group was quite high. There were, however, many areas of concern which require the attention of the State Government on priority basis. Foremost among these is the planning process. Community owned, decentralized planning as envisaged by the Mission, was not achieved as yet in the State. Household survey was not completed at all the levels – village, block and district and time bound action plans were not drawn up to achieve the objectives of the programme. Community based monitoring committees were also not formed at various levels. The State Government increased its outlay on healthcare during the review period in keeping with the programme guidelines. However, it failed to utilize the available funds optimally to strengthen the healthcare infrastructure and delivery at the grass root level. Fund management was quite poor and the State had not released its share of funds for implementation of the programme. Funds were released to the health centres in excess of the prescribed norms and in certain cases, funds were shown to have been released to non-existent dispensaries and subsidiary health centres. Basic accounting records were not maintained at both the State and the district level, leaving scope for fraud and misappropriation. Infrastructure, both physical and human, is an area where the State fared badly in achieving the targets set by the Mission. The number of health centres, especially in the tribal areas, was woefully inadequate resulting in non-achievement of the primary objective of the programme to provide accessible health facilities to the rural population. There was a delay in completing the construction of health centres and the basic facilities and diagnostic services were not available in a number of health centres that were sampled during audit, affecting the quality and reliability of health services in rural areas. There was a shortage of medical and support staff at the health centres, impeding the goal of providing quality healthcare. Procurement of medicines and medical equipments in the State was ad-hoc and the quality of drugs procured remained questionable. Considering that drug management is a critical input, delays, shortages or poor quality of drugs are likely to jeopardize the implementation of the programme. Information, Education and Communication (IEC) activities are meant to promote behavioural changes, increase the awareness of the public about their rights and available health facilities. The State could not achieve this objective of spreading awareness and dissemination of information regarding availability of and access to healthcare facilities for the rural population owing to lack of planning and implementation strategy in this regard. As regards maternal health, while there was a considerable improvement in the registration of pregnant women, they were not administered the prescribed dosage of medicines, due, apparently, to their non availability in sufficient numbers. The overall achievement in terms of maternal health was far from satisfactory and registration of pregnant women for systematic ante-natal check up and tracking was not in place. Scrutiny revealed that essential obstetrics care facilities were lacking in almost all the health centres. Reproductive healthcare was not accorded adequate attention and the complete details in this regard were not available with the district health authorities. There was a wide variation among the districts with regard to achievement of targets for immunization and the overall achievement, especially with regard to secondary immunization, was quite poor.
Performance Audit of National Rural Health Mission (NRHM) in Bihar (2005-2009)
(CAG of India, 2009) CAG of India
The National Rural Health Mission was launched by the Government of India in April 2005 for strengthening rural health care institutions by providing adequate infrastructure facilities and funds. The Mission sought to provide universal access to equitable, affordable and quality health care facilities in rural areas. This performance review of the implementation of the National Rural Health Mission in Bihar revealed improvement in flow of funds to rural health institutions and better health awareness among rural population. However, the objectives of the Mission were not achieved due to inadequate surveys, non-preparation of Perspective Plan, ineffective financial management, inappropriate community participation, lack of basic infrastructure facilities, inadequate equipment and human resources. Accredited Social Health Activists selected were not imparted training in four out of five prescribed modules. Delivery of services under different disease control programmes also suffered due to improper planning, poor quality of services, non-achievement of targets etc. Functioning of Rogi Kalyan Samities was not effective and Village Health and Sanitation Committees were not formed.
Performance Audit of National Rural Health Mission (NRHM) in Bihar (2010-2015)
(CAG of India, 18-03-2016) CAG of India
Following are the main audit findings of this performance review of National Rural Health Mission in Bihar covering the period 2010-2015: 1. The financial statements of State Health Society, Bihar did not represent the true status of NRHM in the State as different figures were indicated in different financial statements as opening balances, funds received and expenditure for the same components. 2. Action plans were not decentralised with a bottom-up approach resulting in scant community participation in the Mission. 3. Despite completion of Mission period of 2005-12, nearly half of the pregnant women in the State failed to register in the first trimester of pregnancy. This resulted in inadequate antenatal care which along with deliveries at home in nearly half of the cases due to insufficient healthcare facilities caused the Mission to miss the targeted Maternal and Infant mortality rates. 4. Despite shortage of physical infrastructure and availability of funds, construction of buildings for health care units and trauma centres were not completed. 5. Procurement system of drugs was not efficient as liquidated damages and undue advances were not recovered from agencies. Quality of biological drugs were not ensured in the State; 6. AYUSH set up was not provided in each RH/PHC and regular supply of AYUSH drugs were not ensured. 7. The Kala-azar Elimination Programme was marred with shortage of manpower and delayed spray of DDT etc. and missed the target date; 8. National Programme for Control of Blindness Suffered due to inadequate infrastructure and shortage of manpower. National Leprosy Eradication Programme missed the goal of leprosy elimination due to shortage of specialised medical staff. 9. Fifty seven per cent posts of Medical/Specialist Medical Officers was lying vacant while there was shortage of 29 to 72 per cent of para-medical staff in the State. 10. Monitoring and evaluation was deficient due to non- constitution of Health Monitoring Committees at various levels.
Performance Audit of National Rural Health Mission (NRHM) in Chhattisgarh
(CAG of India, 2010) CAG of India
The National Rural Health Mission was launched in April 2005 with the aim of providing accessible, affordable, accountable, effective and reliable health care facilities in rural areas. The State Government spent Rs 634.55 crore from the inception of the scheme till March 2009. There were savings of Rs 250.96 crore (28 per cent). There were instances of irregular expenditure, stage-wise planning was not done and the availability of health care infrastructure, doctors and supporting staff remained inadequate. While there were significant achievements in some interventions and the health indicators accordingly showed improvements, there were shortfalls in administration of iron-folic acid tablets, gender imbalance in sterilisation, low institutional deliveries, low detection of sputum positive cases and nonachievement of the norms of annual parasitic incidence. The indicators of maternal and infant mortality remained short of interim targets.
Performance Audit of National Rural Health Mission (NRHM) in Goa
(CAG of India, 17-03-2011) CAG of India
The State achieved targets in respect of Infant Mortality Rate, Maternal Mortality Rate and Total Fertility Rate. The State Health Society did not prepare annual village, block and district level Action Plans nor the Perspective Plans for the Mission period. Out of E 25.26 crore received by the State Health Society, E 10.30 crore was unutilised till March 2010. There was a shortage of specialists in Community Health Centres as per NRHM norms and the supporting staff in Primary Health Centres were in excess by 240 per cent. The absence of a State Health Monitoring Committee and unsatisfactory functioning of Mother NGOs resulted in poor monitoring and evaluation.
Performance Audit of National Rural Health Mission (NRHM) in Gujarat
(CAG of India, 2009) CAG of India
The National Rural Health Mission was launched in April, 2005 in the country to bridge gaps in healthcare facilities, facilitate decentralized planning in the health sector, provide an overarching umbrella to the existing programmes of Health and Family Welfare including Reproductive & Child Health, Vector Borne Disease Control Programme, Tuberculosis, Leprosy, Blindness Control Programmes and Integrated Disease Surveillance Project and also to address the sector wise health issues like sanitation and hygiene, nutrition etc, and advocate its convergence with related social sector departments. A performance review on NRHM in the State of Gujarat revealed that Annual Action Plans for 2005-06 and 2006-07 were prepared based on annual household survey conducted at Sub-Centre level without conducting facility survey. Facility survey was not carried out for any Sub Centre in the State till March 2009. District Health Action Plan was not prepared by consolidating Block level Action Plans in any of the four years 2005-06 to 2008-09 in any district as Block level plans were not prepared. Delay in submission of State Programme Implementation Plans for 2007-08 and 2008-09 to GOI was to the extent of 91 and 95 days respectively. As of 31 March 2009, funds of Rs.103.77 crore remained unutilized. Untied Fund and Maintenance Grant were not released to any Rogi Kalyan Samities at Community Health Centres during 2005-07 and 2005-09 respectively. Infrastructure provided at health centres was inadequate and critical equipments were found wanting in CHCs and PHCs test checked. Vacancies in cadres of medical and para-medical staff in the State ranged between 12 and 100 per cent. Medicines worth Rs.1.45 crore were purchased from two de-registered companies. Printing work of booklets, stickers, cards etc. for Rs.1.44 crore was got done by three black listed parties. Percentage of registered pregnant women who received antenatal check-ups ranged between 69 and 73 during the years 2005-06 to 2008-09. Annual targets for pulse polio immunisation was achieved during the period 2005-09. Percentage of vasectomy to the total sterilization was a meagre 2.92 per cent.
Performance Audit of National Rural Health Mission (NRHM) in Haryana
(CAG of India, 2009) CAG of India
The National Rural Health Mission was launched in April 2005 with the main objective to bring about improvement in health status of the people, who live in rural areas. Performance audit of the Mission activities in Haryana during the period 2005-06 to 2008-09 brought out deficiencies in completion of household and facility survey, non-preparation of perspective and annual plans and lack of planning as well as monitoring. Against the targets of construction of nine Community Health Centres (CHC), 79 Primary Health Centres (PHC) and 44 Sub Centres, no health centre was constructed during 2005-09. The services at CHCs and PHCs suffered for want of doctors, para-medical staff and other basic medical facilities. A large number of pregnant women did not show up for antenatal check ups. While there was shortfall of 17 percent in targets of sterlisation, the shortfall in Vitamin A solution administration ranged between 17 and 67 per cent. Against detection of 36,487 cases of refractive errors, only 6,937 students were provided free spectacles in test checked districts. Annual Parasitic Incidence was higher than the stipulated rate of 0.5 per thousand. The achievement of targets, set for 2010 for infant mortality rate, maternal mortality rate, total fertility rate, sex ratio, etc. were far from satisfactory.
Performance Audit of National Rural Health Mission (NRHM) in Himachal Pradesh
(CAG of India, 2010) CAG of India
The National Rural Health Mission was launched in Himachal Pradesh in April 2005 to provide accessible, affordable and reliable healthcare to the rural population, especially the vulnerable sections of the society. The programme envisaged convergence of various existing stand alone healthcare programs, decentralisation of the planning process, with special emphasis on bottom up approach in decision making and creating better linkages and cooperation amongst various social sector departments. A mid term review of the implementation of the program in the fourth year of mission period (2005-2012), highlights the areas of concern and issues which needs to be addressed for successful achievement of the objectives set out for the Mission. The review underlines glaring gaps in planning, implementation and monitoring activities. Absence of household survey, and prospective plan and lack of inputs from the community at the grass roots level in the annual plans rendered the planning process an exercise in futility. While the number of health centres exceeded the norm, these could not ensure reliable and accessible healthcare to the targeted beneficiaries due to inadequate infrastructure and insufficient manpower. Some of the key initiatives of the NRHM like ASHA and village health and sanitation committees have not received the required attention. Public spending on health sector also remained constant during the last four years.
Performance Audit of National Rural Health Mission (NRHM) in Jammu and Kashmir
(CAG of India, 2009) CAG of India
Government of India launched (April 2005) the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health-care delivery system. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, decentralization and district management of health programmes, community participation and operationalising community health centres into functional hospitals. The performance audit review of implementation of NRHM in Jammu and Kashmir showed that the status of health profile of the State has been quite encouraging vis-à-vis the performance indicators available for the country. These can be further improved if there is proper fund management/utilisation and various sectors involved are covered in conformity with the guidelines issued for implementation of the Programme. There are large gaps in planning as well as implementation of the Mission activities in the State even after four years of launching the programme. This is evidenced by the findings that no new health centre was put in place, essential services and amenities were not available in many centres and there was critical shortage of technical manpower. Maternal and child health programmes have not made much headway. Planning, implementation and monitoring of the programme through participation of NGOs and community-based organisations was nonexistent.
Performance Audit of National Rural Health Mission (NRHM) in Jharkhand
(CAG of India, 13-08-2010) CAG of India
The National Rural Health Mission (NRHM) was launched by the Government of India in April 2005. It aimed at strengthening rural health care institutions by provision of infrastructure facilities and funds. A review of the implementation of the National Rural Health Mission in the State revealed improvement in flow of funds to rural health institutions and better health awareness among the rural population. However, the objectives of NRHM were not achieved due to lack of surveys, effective community participation, basic infrastructure, sufficient medicines and other equipment and adequate human resources. The programmes of various societies at the State and district levels were not integrated. Reproductive health care services were at a nascent stage. Targets under the different National Disease Control Programmes were partially achieved due to incomplete coverage. The department did not have an internal audit wing or a vigilance wing. There was no mechanism for redressal of grievances and evaluation of deficiencies.
Performance Audit of National Rural Health Mission (NRHM) in Karnataka
(CAG of India, 2010) CAG of India
The performance audit of the National Rural Health Mission in Karnataka noted gaps in community participation in preparation of village and block plans for project implementation, defeating the objectives of decentralised planning. The Arogya Raksha Samithis were not effective in management of healthcare centres. There was delay in taking up the upgradation and construction of healthcare centres resulting in huge amount of the funds remaining unspent even at the end of fourth year of project implementation. There was shortage of medical and paramedical staff and lack of essential equipment and buildings for the healthcare centres. Evaluation of health indicators indicated poor achievement in reducing maternal mortality and registering higher cure rate of endemic diseases. Computerisation of health centres up to block level and networking was yet to be achieved.
Performance Audit of National Rural Health Mission (NRHM) in Kerala
(CAG of India, 2009) CAG of India
The National Rural Health Mission was launched by Government of India in April 2005 for strengthening rural health care institutions by providing adequate infrastructure facilities and funds. In Kerala, the State Health Mission was set up in September 2006. A review of the implementation of the National Rural Health Mission in Kerala for the period 2005-06 to 2008-09 revealed improvements in the flow of funds to rural health institutions, upgradation of infrastructure in some health institutions and better health awareness among the rural population. Although sample household surveys were carried out in the three test-checked districts, facility surveys required to identify health care needs of rural areas were conducted only in Community Health Centres though the guidelines stipulated that these were also to be carried out in Primary Health Centres and Sub Centres. The Perspective Plan for the Mission period was not prepared. During 2007-08 and 2008-09, National Rural Health Mission funds of Rs 1.48 crore were spent on activities not approved by Government of India in the annual Programme Implementation Plans and Rs 51.86 lakh was diverted without their approval. Accredited Social Health Activists selected during 2007-08 and 2008-09 were not imparted training in three out of five prescribed modules. Availability of manpower, infrastructure and equipment in Community Health Centres and Primary Health Centres did not meet the Indian Public Health Standards. Guidelines for procurement of medicines prescribed by Government of India were not followed. Penalty of Rs 3.18 crore for delayed supplies of medicines was not levied. An effective Health Management Information System was not set up even though hardware and software valuing Rs 4.70 crore were procured for this purpose. Under the 'Integrated Disease Surveillance Project', hardware and accessories procured for Rs 54.82 lakh for video-conferencing units at the district level were lying idle as the State level video-conferencing unit had not been set up due to non provision of space by the Director of Health Services.
Performance Audit of National Rural Health Mission (NRHM) in Madhya Pradesh
(CAG of India, 28-07-2010) CAG of India
The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India to bring about significant improvements in the health status of the rural population. The Mission sought to provide universal access to equitable, affordable and quality health care facilities in rural areas. A performance audit of implementation of NRHM revealed that baseline surveys were not completed, Perspective Plans for the Mission and Annual Plans for districts, blocks and villages were not prepared regularly. The objective of the Mission to bring all health care activities under one umbrella was not achieved. The State Government did not contribute its share of 15 per cent funds during 2007-08. Funds amounting to Rs 2.12 crore were diverted from NRHM’s funds to a State scheme during 2007-08. Funds remained unspent at the State Health Society/ District Health Societies level, thus defeating the goal of improving public spending in the health sector. None of the health care centres in the State were upgraded as per the Indian Public Health Standards. Despite provision of contractual appointments, there was a shortage of medical and para-medical staff. In 10 out of 12 test-checked districts, 101 Primary Health Centres were functioning without doctors. The fifth module training was not imparted to any of the Accredited Social Health Activists in the State. In the test-checked districts, 49 to 58 per cent of pregnant women were not registered in health centres during their first trimester. Targets set for spacing and terminal methods for family planning were not achieved. The current status of maternal mortality rate and infant mortality rate in the State remained high. Spectacles were not supplied to 30,715 out of 57,191 children suffering from refractive errors during 2005-09 in the test-checked districts. Due to non-formation of monitoring and planning committees, appraisal and evaluation of activities could not be ensured.
Performance Audit of National Rural Health Mission (NRHM) in Maharashtra
(CAG of India, 2010) CAG of India
This performance audit reveals that even after four years of its launch in April 2005 and a mammoth spending of Rs 1130 crore, the Government of India sponsored National Rural Health Mission programme in Maharashtra has still not been able to come out of its initial hurdles, such as lack of reliable beneficiary database, improper planning etc. The performance audit noted serious gaps in the delivery of mission objectives. Although the mission made considerable progress in achieving Revised National Tuberculosis Control Programme, Infant Mortality Rate and Total Fertility Ratio targets, these were overshadowed by suboptimal use of the available health care infrastructure such as mobile medical units. The Mission needs to seriously introspect into the functioning of the Rugna Kalyan Samitis besides upgrading the standards of PHCs and Sub-centres to the level of Indian Public Health Standards.
Performance Audit of National Rural Health Mission (NRHM) in Manipur
(CAG of India, 24-03-2011) CAG of India
The National Rural Health Mission was launched in the Manipur in November 2005. The review revealed that the Department did not achieve the goal set for the health indicators i.e. Infant Mortality Rate, Maternal Mortality Rate and Total Fertility Rate by March 2010. Planning process was inadequate as it was prepared without baseline survey inputs. As of March 2010, the State was yet to carry out a comprehensive household and facility survey to identify the gaps in health care facilities. Up-gradation of Community Health Centres, Primary Health Centres and Sub-Centres to the level of Indian Public Health Standards had not been achieved. While the percentage of fully immunized infants ranged between 69 and 81 per cent during 2005-06 and 2007-10, it exceeded the target during 2006-07. There was an absence of monitoring and evaluation mechanism. As of December 2010 all the vertical diseases control programmes had not been merged with the Mission.
Performance Audit of National Rural Health Mission (NRHM) in Meghalaya
(CAG of India, 24-03-2017) CAG of India
Performance audit of National Rural Health Mission in Meghalaya for the period 2011-2016 disclosed shortages in availability of required healthcare facilities such as Public Health Centres and Sub Centres, unavailability of essential drugs, lack of infrastructure in the health facilities, equipment lying unutilised etc. Required infrastructural facilities viz. operation theatres, blood bank facility, water supply, telephone connections, etc. were not found available in selected healthcare facilities. In other cases, infrastructure was created but were lying unutilised for want of required personnel to operate them. Shortages in availability of required manpower, especially medical specialists was a serious impediment in the proper delivery of healthcare services. A large number of pregnant women did not show up for antenatal care while a number of them did not receive the full dose of Iron Folic Acid tablets. 47 per cent to 51 per cent of registered pregnant women preferred delivery at home rather than at health facilities. There was shortfall in achievement of immunisation as well as sterilisations. There was shortfall in payment of Janani Suraksha Yojana incentive despite availability of funds. All these indicated that the State Government had failed to connect the scheme with the people who are the stakeholders. The Quality Assurance Committees at various levels did not meet at the prescribed intervals to assess the quality of the services being delivered. Mismatch of data as per Health Management Information System and data as per original records maintained at the healthcare facilities was noticed. Monitoring of the Mission by State Health Mission headed by the Chief Minister was absent while monitoring by State Health Society headed by the Chief Secretary was minimal thus indicating that adequate priority was not being accorded to the health sector in the State. Considering that there is a strong correlation between facilities created and health outcomes (infant mortality rate, maternal mortality ratio and total fertility rate), the deficiencies were responsible in preventing the State from achieving the targets set by GoI.
Performance Audit of National Rural Health Mission (NRHM) in Mizoram (2005-2008)
(CAG of India, 2008) CAG of India
The National Rural Health Mission (NRHM) was launched by the GOI in April 2005. A mid-term review of the implementation of the programme in the third year of the Mission period (2005-12) in Mizoram is an attempt to highlight areas of concern, which need to be addressed by the State Government for successful implementation of the Mission Objectives. Performance review of implementation of NRHM in Mizoram revealed that the State Mission has performed satisfactorily in controlling of tuberculosis, leprosy and iodine deficiency. The review, however, also revealed that the State Mission failed to conduct household/facility survey to make rural health centres fully functional with the requisite manpower and other infrastructural facilities. Planning for the implementation of the programme was ineffective and consequently, the objectives of the scheme could not be fully realized even after three years of its implementation. The review also revealed short release of funds, non release of State matching share, under utilisation of the available funds, mismanagement of funds, shortage of manpower in key posts, inadequate infrastructural facilities, arbitrary procurement practices, insufficient stock of drugs and vaccines, lack of attention to endemic areas, undue financial benefit to the suppliers, diversion of funds and non fulfillment of the objectives of the scheme.