Health is an integral part of the social development of any country. In India today, the buzzword in this sector is decentralisation - which means a bottom-up approach of planning and development. However, this may not be an effective system for a country like India because we have very few
skilled health professionals at the block and district levels.
However, it is not their fault. The problem is that the government is not investing enough in public institutions at the national and state-levels to improve the skills of the medical staff who are stationed at the block and district levels, even though this was the plan when the State created national/state-level apex training centres in the 1970s. Instead of strengthening and expanding the scope of these institutions of excellence, we have now started supporting certain parallel organisations. Moreover, there is no system in place through which one can monitor the performance of these health officials who are posted in far flung areas.
In the 2012-13 budget, the allocation for the National Rural Health Mission (NRHM) increased from R18,115 crore to R20,822 crore. This hike will not be enough because the medical infrastructure of the country is in dire straits. A review of the NRHM's last year's spending shows that the maximum spend has been on salaries and infrastructure. Only Bihar and Chhattisgarh spent 6-8% of their funds on training of health personnel but it would be a mistake to equate such trainings with capacity building.
Our public health centres at the local level are also not equipped to handle non-communicable diseases like diabetes, hypertension and malignancies. We often blame the Accredited Social Health Activists (ASHA) and the anganwadi workers for not doing enough for the health of the people they are supposed to look after, but the truth is that we need additional human resource, who are skilled, to deliver on the certain thematic areas.
Even though the ministry of health has started focusing on adolescent health and development in 12th Five-Year Plan, a significant gap area in our national health planning, the key challenge here will again be core skills and competencies of functionaries. For example, does the system have enough medical professionals at the block and district levels to address issues of adolescent sexuality and mental health of the target groups?
Despite such pressing issues in the health sector, Parliament failed to debate any of these or the country's Millennium Development Goals during its 60th anniversary session. This only shows that we lack the courage and vision to handle this challenge. To improve India's health sector, we need to do simple things: first, we have to stop shuffling and transferring health functionaries frequently; second, we need to understand that this sector needs people with some core competency; third, capacity building has to continue at all levels and continuously. We must realise that spending money without making these structural and skill changes will not take us very far.
Sunil Mehra is executive director, MAMTA, an NGO that works on women, adolescents and children. The views expressed by the author are personal.
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