THIRUVANANTHAPURAM: The statement of the Union Minister of State for Health, Mullappally Ramachandran, the other day that the local bodies had failed to utilise National Rural Health Mission (NRHM) funds comes as no surprise. The last report of the Comptroller and Auditor General (CAG) on the implementation NRHM in Kerala had pointed out in detail the deficiencies such as absence of a perspective plan, accumulation of huge unspent funds in banks, diversion of funds, slow pace of upgradation work in some institutions and lack of medical and para-medical staff. The CAG report has made it clear that no perspective plan for the mission period was prepared by the State Health and Family Welfare Society to ensure execution of projects along a critical path. Further more, the report states that NRHM funds of Rs 1.48 crore were spent during 2007-08 and 2008-09 for activities not approved by the Government of India in the annual programme implementation plans and Rs 51.86 lakh was diverted without Central approval. The report pointed out that only sample household surveys were carried out in the three test-checked districts in the state, facility surveys required for identifying the healthcare needs of rural areas were conducted only in Community Health Centres though the guidelines stipulated that these were also to be carried out in Primary Health Centres and sub centres. The report said that the management expenditure exceeded the prescribed limit of six per cent. ‘’Manpower, infrastructure and equipment in Community Health Centres and Primary Health Centres did not meet the Indian PublicHealth Standards despite upgradation through NRHM. Guidelines and the Purchase Preference Policy prescribed by the Government of India for procurement of medicines were not followed. No pre-despatch or post-despatch inspections of drug kits, surgical kits and Accredited Social Health Activists’ drug kits were conducted. Non levy of penalty for delayed supplies of medicines amounted to Rs 3.18 crore,” the report said. As per IPHS norms, seven specialists and nine staff nurses with supporting staff were required in each Community. Health Centre (CHC). Forty nine CHCs did not have any specialists, while 21 CHCs had less than the prescribed number of specialists and only one CHC had the full complement of specialists. As regards staff nurses, nine CHCs had nine or more staff nurses, 57 had less than nine and four CHCs had no staff nurse. The CAG report also had suggested that the state-level action plan should be a part of the perspective plan and prepared only on the basis of consolidated action plans at the village, block and district-levels so that actual requirements are projected.
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