The report of the Comptroller and Auditor General on Jammu district has sent a shiver down the spine as it reveals startling failures in promoting healthcare especially in rural Jammu. Various schemes sponsored by the Union Ministry of Health and Family Welfare to be completed within time frame in the district have either been floated half-heartedly or not at all. No targets have been reached. The bench mark of 90 per cent for institutional deliveries by 2010 and 100 percent by 2012 in the District Health Action Plan (DHAP) 2005-12 of Jammu district could not go beyond 62 percent target. The most alarming part of the report in question is about enormous foeticide happened during the period of the Action Plan. 57,503 cases of pregnancy were registered since 2006 in test-checked blocks of Jammu district while only 35, 669 deliveries had been registered by the department. The 21, 834 registered pregnancy cases have neither been traced nor has department any information about them. The inference is that chances of huge foeticide, to the tune of 21, 834 cases, could have happened after illegal sex determination or abortion. The Chief Medical Officer of Jammu district, however, in his statement has said that the variation was due to registration of cases more than once as foolproof system was not available with the department. This has happened despite several statements by the State Health Minister that the department had made foolproof arrangement of stopping pre-natal gender tests in private and public diagnostic centres and that centres found violating the rules were deprived of the licenses.
Revealing an associated corrupt practice that has crept into the NRHM, the report says that in order to reduce maternal and neo-natal mortality, the Government under the Janani Suraksha Yojna (JSY) encouraged pregnant women to have an institutional delivery rather than domiciliary delivery. Under the programme, Rs 1,400 are given to the rural mother for institutional delivery. The records suggested that out of 49,821 women only 17,353 were paid the incentive of Rs 1400 in five test blocks of Jammu district. The Health Department will have to explain why the financial assistance was provided to only one-third of total number of mothers entitled? Either the amount accruing to the cases was embezzled or never paid at all. In either case an enquiry should be instituted and responsibility fixed. It has to be noted that a mechanism is in place to trace and record the pregnancies as part of the NRHM. It is the Accredited Social Health Activists (ASHAs) with one ASHA for 1000 population. The report says that there are 881 ASHAs when the sanctioned strength is 974. This means that nearly one lakh women have been left out of the purview of the scheme without any reason.
There are several more areas of NRHM in which the State Health Department has failed to make attempt of attaining the targets. For example, the goal was set for achieving 90 percent vaccination during 2010-11 but only 49 to 72 percent of the children had been immunized during the year. The report said sufficient number of ASHAs have been engaged by the department for tracking the immunization of the children. It has questioned the role of ASHAs for not tracking the immunization of the children. Further, the report says it has failed to ascertain the performance of the department with regard to vaccination of Hepatitis-B, Hepatitis-B1 and DPT-1 and DPT-2 as the records have not been maintained at the district level by the department. The report said that as per the mission guidelines of the NRHM regular training was to be provided to medical staff to update their skills. The data collected by the CAG reveals that no training was imparted to the medical officers and Para-medical staff for upgrading of skills despite adequate budgetary provisions.
This report of the competent authority paints very dismal picture of the functioning of the State Health Department. In particular, it appears that the department has been taking various national schemes and projects very lightly and handling public health related matters non-seriously. Strangely the department has not formulated its annual action plans during the period 2006 to 2010 which meant defeating the basic objective of the NRHM of decentralizing planning and implementation arrangements. The report further said that lack of infrastructure facilities had deprived the rural population of the envisaged healthcare benefits forcing it to move to urban areas for healthcare facilities.
All this suggests that the State Government needs a drastic shaking of the entire Health Department and purging it of incompetent and inefficient elements. Various national health scheme are devised to provide healthcare facilities to the people especially in rural areas so that they are not compelled to move to urban areas just to reap the benefit of healthcare facilities available there. Migration to urban areas is to be stopped as far as possible if we want to maintain equilibrium in our social and economic dynamics. The Chief Minister has been emphasizing upon the efficiency in delivery system. This is a clear case of disregarding his instructions and administrative priorities. Therefore it is desirable to appoint a committee to report on the reasons and circumstances of non-implementation of various Health schemes sponsored by the Union Ministry of Health and Family Welfare in collaboration with the State Government.
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