Reproductive and Child Health (RCH)

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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
    National Rural Health Mission (NRHM) was launched in Assam in November, 2005 with a view to providing accessible, affordable and quality health care to the rural population, especially the vulnerable sections. 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 Reproductive and Child Health (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. The results of audit indicated 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.
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    Performance Audit on Reproductive and Child Health under NRHM in Telangana (2013-2017)
    (CAG of India, 29-03-2018) CAG of India
    The Reproductive and Child Health (RCH) programme initiated under NRHM emphasised public health measures essential for enhanced maternal and child survival and lower RCH morbidity. The performance audit of Reproductive and Child Health under National Rural Health Mission was conducted (during April to August 2017), covering the period from 2012-13 to 2016-17. Annual Facility level surveys for identification and fixing of decentralised monitorable goals, indicators and gaps/deficiencies in the existing healthcare facilities and areas of interventions were not conducted. Bottom-up and community owned approach to public health planning was also not followed in preparation of State Program Implementation Plans (SPIPs). The Department had not utilised fully the funds released in any of the years under review. Utilisation ranged between 38 and 44 per cent only during 2012-14 and between 39 and 46 per cent only during 2014-17. Shortfall in spending on maternal health ranged between 31 to 50 per cent during 2014-17. The expenditure on child health component did not exceed 26 per cent of the approved outlay in any year during the period 2014-17. The institutional deliveries declined from 69 per cent (2013-14) to 42 per cent (2016-17) in public health facilities as compared to deliveries in private health facilities which registered an increase from 31 to 58 per cent. Telangana had a very high rate of Caesarean-section deliveries at 45 per cent out of the total deliveries reported in the State. In private health institutions it was higher at 67 per cent. Adequate attention on availability of required physical as well as human infrastructure in the health facilities was not accorded. Maternal Death Review (MDR) and the Infant Death Review (IDR) were largely not conducted. In other cases, these Reviews were ineffective. The State had achieved 100 per cent immunisation of children of 0 – 1 year age group. Maternal Mortality Ratio and Total Fertility Rate was satisfactory at State level.