Rajendra Pratap Gupta
President & Board member
December 27th, 2012
Dr. Murli Manohar Joshi
Public Accounts Committee
6, Raisina road, New Delhi 110001
Ref: Auditing of the unused budgetary allocations for Healthcare sector
Dear Dr. Joshi,
Greetings from the Disease Management Association of India (DMAI).
This has reference to the meeting at your residence on 25th December 2012, and the discussions that we had on the Public Accounts Committee report on NRHM (PAC NO. 1939). I have gone through the PAC report submitted by your good self to the Parliament. I wish to draw attention to the following references in your report;
Page 9: Mission Steering Group (MSG) was required to periodically monitor progress of the mission and to meet twice a year. Audit scrutiny revealed that MSG met only four times in four years instead of 8 times as per the laid guidelines.
The delegation of powers to the MSG and EPC (Empowered Programme Committee) was subject to the condition that a progress report regarding NRHM, also indicating deviation from the financial norms and modifications in ongoing schemes, would be placed before the cabinet on an annual basis. However, during the past four years, the Mission had submitted a progress report to the Cabinet only once in August 2008 (as per the PAC report).
Page 12: Public Private Partnerships (PPP) in RCH services is not up to the expected levels
Page 18: Regarding composition & functioning of the VHSC (Village Health & Sanitation Committee)
Secretary Health’s statement,
“To be very honest with you, we have got a survey done recently by the Institute of Population Sciences, and yesterday they gave us a presentation. It is not a very happy picture on the village health societies. In many of them, people did not know if they existed; they did not know who the members are; they did not know if they are functioning; that was the finding of the planning Commission’s mid-term review also, when they had gone round the country and seen… that is VHND. There is certainly a vision in the NRHM when it was designed. That has not been fructified……….
“ Our experience with Panchayat raj is not good. They also complained about it. Half of the fund is not spent because he is the co-signatory – either he is not living in the village or if he is, he harasses her and why should she sign? The entire Panchayat raj system, with due respect, has not really worked; the ideal is one thing, but practically it is not; those who take interest, have got excellent experience, but those who are not interested, it is not good. It is very difficult for these people; it has not worked out well”.
Page 19: Health Secretary’s response on, “how the ministry ensures that the disbursal of funds by the state health societies to VHSCs is monitored”?
“This is a huge task for the states. They are finding it very difficult to keep a track of so many small accounts. But we have given them accountant at every block level. In a block there will be some 100 VHSCs. He should have been able to get these accounts and see what they have spent on and do the auditing. We will have to streamline it further and get them to do the auditing. But we suspect about Rs.100-200 Crore lying unspent. That is our present assessment”
Page 20: Table 3 highlights the gap between the funds released and expenditure.
Page 23: Point 55, “ However, the Ministry have clarified that actual utilization of the funds allocated shall depend upon a number of factors in particular the absorptive capacity of the system. In fact, one of the argument put forward by many is that while the actual allocation in the Eleventh Plan was lower than the original plan allocation, the actual expenditure has still been lower i.e. the system has not been able to utilize the curtailed outlay”
Page 28: “It may be observed that rural households account for around 55 % of the total out of pocket expenditure within the country”
Page 31: Audit examination revealed that 71 PHCs (11 per cent) in 15 states were functioning without an allopathic doctor. In 518 PHCs (86 per cent) of 28 States / UTs, an AYUSH doctor had never been appointed. 69 test checked PHCs were functioning without an allopathic doctor or an AYUSH doctor. This meant that population residing in their sphere of coverage had no doctor available at all in the public domain. In Andhra Pradesh, Haryana, Himachal Pradesh, Kerala, Madhya Pradesh, Mizoram, Punjab, Sikkim, Tripura and Lakshadweep, none of the test checked centres had an AYUSH doctor.
Page 33: “As per norms, Specialists are appointed only at CHCs level and not at PHCs level. As per the data available in Bulletin on Rural Health Statistics in India (Updated up to March 09), a total of 5789 specialists are in a position at CHCs across the country, as against the sanctioned posts of 9028 specialists…………”
Dr. Joshi, as discussed during our meeting, it is imperative that the PAC / CAG, or any competent independent regulator, starts the audit of unspent funds allocated for each social sector so that the benefit of the plan reaches the targeted population. As DMAI, we would be interested in pursuing this issue further with the concerned authorities. Also, a clear and enabling policy framework is required, so that the bureaucrats can take decisions without fear on fund allocation utilization, and the absorptive capacity of the system increases to 100 %.
I have been visiting the rural sub-centres and have been gathering first hand information about the impact of NRHM. This communiqué is marked to the PMO and MOHFW for information. Will meet you shortly with more details
Thanks for your continued support
Best wishes for a great year ahead, & tons of good wishes for your birthday, in advance. Wish you good health & long life.
With best regards
Rajendra Pratap Gupta
CC: Dr.Manmohan Singh, Prime Minister,
Shri Ghulam Nabi Azad, MOHFW
Dr.Syeda Hameed, Member, Planning Commission
Secretary – MOHFW
President , PHFI
DMAI urges govt to have a strong action plan on NCD policy
The Disease Management Association of India (DMAI) has urged the government to enter into public private partnership (PPP) with NGO’s and others mall scale and medium organisations for successful implementation of the non communicable disease (NCD) policy. It wants the government to frame a strong action plan so that it can be completed effectively.
Recently Union health minister Ghulam Nabi Azad had informed that the government is soon going to launch an NCD policy that will specifically deal with ways to prevent NCDs like diabetes, stroke, cancer and cardiovascular diseases, etc. and its complications so as to reduce its impact on individuals and society.
A policy expert, Rajendra Pratap Gupta who is also the president and director, DMAI informed that the policy is soon to come in as the government has already completed the discussion with the stakeholders on the same in September.
DMAI said that though the Governments take on the NCD Policy which is soon expected to be launched in the country is appreciative, it seems to be lacking the lasting impact as the government’s approach on the same is not realistic.
Gupta said that though the Government’s commitment to address this issue is commendable, the claims that the government is trying to make is too high. “I have personally given my suggestions for the policy and if steps are taken at proper directions lot can be done in this front. But right now all that the government is trying to do is create hype in this issue, all words and no action. It is imperative for the government to have a decent action plan before going on claiming high stands.”
This comes in after the tall claims made by the Union health minister recently at an international gathering where he said that India’s target is to screen about 150-200 million people by next March under this pilot project covering 20,000 rural sub-centres and urban slums.
Under the current plan, around Rs.2000 crore has been set aside by the government for the NCDs. A source from the industry informed that under the 12th Five Year Plan the government has demanded for around Rs.55,000 crore from the planning commission for the same.
“Government must be very careful when announcing plans especially at an international arena since we will be made accountable for it later. How can the Government claim to achieve something like this in an year’s time when it does not even have one partnership to boost off to take this ahead,” exclaimed Gupta.
He further added that the government’s conceptualization on the NCD policy is very novel but if not handled properly it will lead to mockery of the whole system in front the world. “The Government cannot handle this alone and it needs to involve other stakeholders also into this programme to make it successful. Our suggestion to the government is that it should engage itself till the policy making procedure and for the execution of the same it should let the functions be handed over to private parties like NGO, small and medium scale companies etc.”
He further suggested that to ensure that these organisations are undertaking their functions properly the Government should even do special audit on their activities to check for any discrepancies if any. “Only with a solid action plan in hand can we even think of going on fulfilling the claims made by the government. The government must be more reasonable while speaking out and sharing agendas so as to ensure that people take us seriously.”
DMAI wants the government to take initiatives on the line of public private partnership (PPP) and move ahead so that India can actually do something constructive in this front than just playing with words.