Union health secretary’s report says urban local bodies ‘accorded low priority’ to the NationalUrban Health Mission, did not co-ordinate with state health department

Maharashtra has failed its urban poor because of its apathy to implementing central health schemes, a report by the Union Ministry of Health and Family welfare has said. The report, by Union health secretary B.P. Sharma, highlights how the state machinery did not make efforts to implement the National Urban Health Mission (NUHM), under which Rs. 2,578 crore has been distributed to all states and Union Territories for improving primary health care in urban slums.

The report has found the progress of activities under the scheme to be ‘not very satisfactory’ in Maharashtra, and claims that no effort was made to spend central funds on time or implement the NUHM seriously.

It has stressed that there has been no coordination and co-operation between municipal corporations and the state health department in implementing the scheme, and the state government did not bother to recruit staff to effectively monitor and implement it. The report says: “While the urban local bodies and corporations accorded low priority to NUHM, there was poor reporting of expenditure by state and municipal corporations for central funds.” It also claims that leadership was lacking in implementing the programme, and no periodic reviews were carried out to monitor the scheme’s progress.

The NUHM was launched against the background of rapid urbanisation in seven metro cities, and health indicators for the urban poor were found to worse that those of the rural poor. The scheme endeavours to put in place community-based Mahila Arogya Samitis and ASHA women’s groups.

A letter by Mr. Sharma and Rajiv Gauba, secretary, Union Urban Development Department, claimed coordination between the state health department and urban local bodies has collapsed. “We suggest that additional municipal commissioners of urban local bodies (ULB) be appointed as nodal officers of the scheme in the state, and be tasked with future implementation of NUHM activities,” the letter says.

The report also suggests that the state accord ‘top priority’ to implementing the programme, and provide good leadership for this. “Similarly periodic reviews involving ULBs, health departments should be carried out to solve co-ordination issues and hasten the pace of implementation.”

The NUHM was launched in Maharashtra in 2013 to enable universal access to affordable, accountable and quality health care services. It covers slum dwellers and marginalised groups in cities with a population above 50,000. The project implementation plan for Maharashtra is pegged at Rs. 283.09 crore, of which Rs. 51.6 crore has been set aside for Mumbai and Rs. 231.4 crore for the rest of the state.

The state government is providing healthcare through 29 hospitals and 15 medical colleges with a total bed strength of 13,512. In addition, there are 1,811 primary health centres, 360 rural hospitals and 86 sub-district hospitals which implement all central and state schemes.

The report says, “Being a high-priority programme, we urge the state to accord priority to its implementation as its success largely depends on leadership. While some states have been able to work out effective implementation of NUHM and put in mechanisms because of proper co-ordination between the urban development department and the health department, it is observed after reviews that in others, the progress with regard to approved activities has been less than satisfactory.” ‘

A senior health department official said NUHM’s implementation has been slow but Maharashtra has put in place a three-tier health infrastructure for both rural and urban areas. The primary tier comprises sub-centres, PHCs and community health centres (CHC), he said, adding, “Sub-district hospitals in rural and semi-urban areas constitute the second tier, while medical colleges comprise the third tier. The central schemes are taken care of when implemented through these barring a few glitches.”

Implementation slow but we have 3-tier infrastracture for health, says state govt. official