Union Ministry seeks explanation from top Health officials

0% implementation of NRHM activities
Neeraj Rohmetra

JAMMU, Apr 19: Even as the State Health Ministry had celebrated with great fanfare the foundation day of National Rural Health Mission (NRHM) last week, the Union Ministry of Health and Family Welfare has expressed serious concerns over various lacunae in the implementations of several programmes being introduced as part of the Mission.
The Union Ministry, while pointing out several areas of concern has sought clarifications from the top Health officials of the State regarding the poor implementation of NRHM programmes and take some remedial measures immediately.
While some of the core activities of the NRHM have shown miserably low expenditure, there were other programs showing far excess expenditure beyond defined limits. The Ministry has told the State officials to examine the reasons for the same and share the exact details with them, said a letter written by Director (Finance), Ministry of Health & Family Welfare vide D.O. NO. G-25020/5/3009-NRHM (F) dated 08-02-2012, which has been addressed to Commissioner Secretary, Health and Medical Education Department and Mission Director, NRHM, J&K.
The letter has instructed the State Health officials to initiate remedial measures to bring improvement in programme/ financial management, better utilization of funds under various activities of RCH and Mission Flexible Pools.
These observations have been made by the Union Ministry in its latest Financial Monitoring Report of Jammu and Kashmir while conducting a detailed financial analysis of the funds released, utilized, unspent balance and the trend of expenditure under various components of RCH and Mission Flexible Pools.
While elaborating on the areas of concern, the Report comments, “the State has reported very low expenditure on its core activities under Mission Flexible Pool. The acitivities of the Program, which had registered low expenditure, included United funds (44%) and Annual Maintenance Grant (49.83%)”. The Corpus Grants to Hospital Management Society/ Rogi Kalyan Samiti (Patient Welfare Committee) – a concept in which a group of trustees is formulated to manage the affairs of the different hospital has also registered a very low expenditure (58.26%).
The Union Ministry has also asked the State Government to look into as to why less than 75% expenditure has been reported under mainstreaming of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy). This has happened despite the fact that NRHM seeks to revitalize local health traditions and mainstream AYUSH (including manpower and drugs), to strengthen the Public Health Systems at all levels in the State.
While the State Health Department has been maintaining lower expenditure in some programs of NRHM, it had been over-zealous in implementation of others like the category of Hospital strengthening. The Ministry has questioned the rationale of the excess expenditure and told the officials to examine the entire issue.
“The State has incurred expenditure to the tune of 1243.44% under Hospital Strengthening even as out of the total expenditure of Rs 51 crores nearly 12.8 crores is expenditure against the committed unspent balance of 2010-11”, says the report.
Expenditure reported by the State under New Constructions/ Renovation and Setting up (32.8%), Innovations (46.5%) and other Expenditure Power Backup, Convergence (32.8%) is less than 50% of the approved SPIP. “The health officials need to look into this”.
While commenting on the RCH Flexible Pool, the Report says that out of the approved annual SPIP of Rs 124.56 crores, reported expenditure is only Rs 51.56 crore during the third quarter under RCH Flexi pool i.e only 41.39 %.
The State has reported low expenditure on the core activities including Child Health (2.16%) and they need to identify the reasons for this whilst taking necessary steps to improve its performance. Expenditure reported by the State under Maternal Health (other than JSY) (41.85%), Infrastructure & Human Resource (46.3%), Programme Management (47.48%) is less than 50% of the approved State Programme Implementation Plan (SPIP).
There is also need for improvement in performance of several activities including Urban Reproductive and Child Health Care (RCH) and Pre-Natal Diagnostic Technique (PNDT). The State has also reported negligible expenditure under Training (14.11%).
Interestingly, there are several other activities which have shown nil (0%) or very low utilization including Mobile Medical Units, PPP/NGOs, Procurement, Regional drugs warehouses, Panchayati Raj Initiative and Child Health. Since the Panchayati Raj institutions are still in their infancy, the State has also failed to utilize the funds provided under NRHM for them. This had also been pointed out by the Union Health Minister, Ghulam Nabi Azad during his visit to Billawar yesterday.
Since many areas in the country including hilly areas of Jammu and Kashmir are prone to accidents and lack basic health care infrastructure limiting access to the health services at present, the provision of Mobile Medical Unit (MMU) in each District was one of strategies aimed to take health care to the doorsteps of people. Though the State was provided nearly Rs 5 crores under this head, it had failed to utilize funds (0%) meant for this purpose.
The State has also reported negligible expenditure under Referral Transport (11.21%), PPP/NGOs (0.00%), Procurement (4.3%), New Initiatives/Strategic Interventions as per State health policy and for the important Regional drugs warehouses (0.00%).