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Robbing the Poor

The National Rural Health Mission (NRHM) programme of the Government of India aims to reach health services to the “poor” in rural India. It is funded by the Government of India and implemented through the State Governments, who are federating units of the Union of India. It has become an election issue in the Uttar Pradesh (UP) election campaign currently underway. Allegations are being made that there has been terrible acts of corruption in the implementation of the scheme. The state government is being targeted, in particular the Chief Minister Ms Mayawati and her party, the BSP(Bahujan Samaj Party). The Chief Minister has already sacked the Minister in charge of the Department. Since the start of these allegations by Rahul Gandhi, General Secretary of the Congress Party a few months ago, during his early election campaign, a few assassinations have already taken place. These murders have jolted the political establishment across party lines and the public. Among those dead are: Dr Vinod Arya, Chief Medical Officer(CMO), shot by motor-cycle borne killers; Dr B.P.Singh, CMO, shot dead during morning walk; Dr Y.S.Sachan, Officiating CMO, found dead in hospital toilet in Lucknow jail in U.P. As the CBI (Central Bureau of Investigation) accelerated its investigation, raids have been conducted at scores of offices and residences of several other accused. F.I.R. (First Information Report) lodged by the CBI contains names of many more suspects. One of them, Sunil Verma, Assistant Engineer with the U.P. Jal Board (Water Corporation) has committed suicide. He was the Project Manager with the construction & Design Services of the Jal Board, which handled NRHM related construction work.

It is necessary to give the details of some acts, actions and the actors in this lucrative business of robbing the “poor”. Before I proceed further, a cursory look on the objectives of the NHRM programme would be necessary. I quote from the website of the ministry of Health of the Government of India:Quote

“Recognizing the importance of Health in the process of economic and social development and improving the quality of life of our citizens, the Government of India has resolved to launch the National Rural Health Mission to carry out necessary architectural correction in the basic health care delivery system.  The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of  nutrition, sanitation, hygiene and safe drinking water. It also aims at mainstreaming the Indian systems of medicine to facilitate health care. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of organizational structures, optimization of health manpower,

decentralization and district management of health programmes, community participation and ownership of assets, induction of management and financial personnel into district health system, and operationalizing community health centers into functional hospitals meeting Indian Public Health Standards in each Block of the Country. 

The Goal of the Mission is to improve the availability of and access to quality

health care by people, especially for those residing in rural areas, the poor, women and

children.

THE VISION

• The National Rural Health Mission (2005-12) seeks to provide effective

healthcare to rural population throughout the country with special focus

on 18 states, which have weak public health indicators and/or weak

infrastructure.

• These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh,

Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram,

Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim,

Tripura, Uttaranchal and Uttar Pradesh. 

GOALS

· Reduction in Infant Mortality Rate (IMR) and Maternal Mortality

Ratio (MMR)

· Universal access to public health services such as Women’s health,

child health, water, sanitation & hygiene, immunization, and Nutrition.

· Prevention and control of communicable and non-communicable

diseases, including locally endemic diseases

· Access to integrated comprehensive primary healthcare

· Population stabilization, gender and demographic balance.

· Revitalize local health traditions and mainstream AYUSH

· Promotion of healthy life styles” Unquote. 

Note: For full details kindly visit www.mohfw.nic .in

The policy and planning of the poor oriented schemes raises public expectations in a democracy. Such assurances tend to make the poor believe that the government cares for them. Just take note of words and expressions like basic health delivery systems, importance of Health in the process of economic and social development and improving the quality of life of our citizens, relating health to determinants of good health viz. segments of  nutrition, sanitation, hygiene and safe drinking water, improve the availability of and access to  quality

health care by people, especially for those residing in rural areas, the poor, · Reduction in Infant Mortality Rate (IMR) and Maternal Mortality. They have magnetic effect on the average citizen, especially the poor living in remote, far flung, inaccessible rural areas, which have remained deprived of any health facilities for centuries. Thousands die every year in these areas for lack of qualified health services in maternity or diarrhoea. Economic activities are crippled due to illness of the poor farm worker, who has no other wage work. Malnutrition among the hungry and the poor is common. If they get some health care, their productivity and income will not be adversely affected. Hence their long persisting demand from their government, who gets reminded of their needs once in five years only when it promises the heaven to them.

The government does follow up its election time promises by drawing up excellent policies, programmes and schemes. However, the problem lies in their implementation. A mission does not become a mission simply by adding the word mission to any programme, unless the delivery agents are endowed with a missionary mindset. The word mission actually owes its association to the Church. Now that religion has been totally abandoned by modernity in favour of economics, missionary zeal has long disappeared from the social consciousness of the people. In fact, it has already been replaced by other potent expressions in the form and figure of corruption or terror. Had the goals of the NRHM been achieved, India would have already become an economic superpower by now.

The NRHM for me is only a metaphor for all poor oriented schemes of the Government of India. On the strength of my long years of experience of the civil service, I vouch for my statement. There are more than 120 such centrally sponsored schemes, funded liberally by the government of India, but assigned the implementation to the state governments. Majority of them are source of easy income for the corrupt,who seem to have launched some kind of a programme to change the Union Of India to Union of the Corrupt of India!

I am not on the subject of corruption per se in this piece. My aim is to provide a new insight into the whole issue of reaching the benefits of government schemes to the poor. Everyone, including Rahul Gandhi & his mother Sonia Gandhi, are fixated on corruption in the NRHM in UP, as if the scheme is free from such corruption in other states. No state, no district, no Block, no panchayat in the country is free from corruption. Even the local elected Office of the Panchayat, which is headed by a man or a woman from among the residents of the village, is afflicted by the cancer of corruption. Assign the responsibility of implementation to anybody in the whole chain from the highest bureaucrat to the lowliest in the Panchayat  Office, they will only compromise its honest implementation, depriving the “poor” of the benefits.

So the attention of the politician should have been fixed on the genuine implementation and delivery of the benefits to the target group rather than hitting each other in the name of corruption. But nobody seems to be honestly interested in implementing the welfare schemes for the poor, deprived or disadvantaged groups. All they are interested in is winning electoral battles by hook or crook. Were they to check corruption, they would be snatching away the sources of meager incomes to millions of their supporters, who work for them at no salary (called free in Indian political parlance)  twenty four hours all the days, and ensure their electoral victories. For such victories money is needed, which comes from such corrupt practices. Voters have to be bribed by giving them money, liquor, goodies or promises of all kinds ranging from employment to protection from the long arm of the law whenever required. The NRHM in UP is a casualty of this disease.

While UP affair has been highlighted, others remain to be uncovered. Historically  the health and family planning schemes have been the biggest sources of corruption in India ever since the central government and also the WHO (World Health Organization) pumped in huge funds from early 1950s onwards. Grants have also flowed from bilateral sources. One of the corruptest ministers in state governments have been the Health & Family Planning Minister, with rare honourable exceptions! These facts are not only known to the powers that be, but such ministers have always enjoyed the patronage of the High Command or the highest political office of the ruling party. Excepting for some difference in degree, the NHRM will throw up similar results in states other than UP.

 

I have always considered it a more serious crime to deprive the poor, disadvantaged and other target groups of the benefits of the schemes than corruption. It does not allow social, political or economic development. It stalls growth. It destroys initiatives for healthy changes in the country. It stands in the way of nation building. It diverts scarce financial and human resources to chasing criminal cases, which are non-productive and a huge liability on the state and its budget. It costs valuable lives of high quality professionals, who are always in short supply in a developing country situation. It attacks the democratic system and values. It drives talent away to seek employment abroad. It savages a country and tends to drive it to medieval ages.

It demands high quality political leadership in the country to save it from falling into total decline. That would not be possible if we continue to talk only corruption. For the healthy all round development of India, our focus should be on 100% delivery of services in accordance with the preamble, goals, vision and tasks under any scheme, be it the NRHM or any other. It will automatically reduce chances of corruption, which will be the better option than wasting resources on chasing the corrupt. 

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