The national rural health mission: An ailing initiative?

In 2005, the National Rural Health Mission (NRHM) was launched by India's Ministry of Health and Family Welfare. Its objective was to provide affordable and effective healthcare across rural India. The NRHM was to operate for a period of seven years (2005–2012), after which its achievements and progress would be reviewed, and the extension of the Mission would be considered if required. By mid 2012, the limited success of the NRHM had become evident, and the programme was granted a five-year extension. As the Mission enters its second phase of operations, it becomes necessary to examine some of the key challenges that it faces. This paper explores eight such challenges: (1) India's underinvestment in public health; (2) the NRHM's poor distribution and management of funds; (3) the weaknesses of health infrastructure in rural India; (4) flaws in programme planning under the NRHM; (5) the inadequate decentralization of NRHM services; (6) the lack of medical human resources; (7) the limited availability of basic drugs and medicines; and (8) insufficient community participation and citizen engagement in healthcare delivery. The paper makes a number of recommendations for strengthening the NRHM, and concludes that systemic reforms, sustained innovation and a strong political will are essential if India is to address its formidable health agenda effectively.