Eleventh Five Year Plan

Health and Family Welfare and AYUSH 69Percentage30252015105024212219 20 191986–87 (42nd) 1995–96 (52nd) 2004 (60th)Medical Expenditure1400012000100008000600040002000011553740853443877430021952080 32381995–96 2004 1995–96 2004NSSO RoundUrbanRuralRuralUrbanGovernment HospitalPrivate HospitalSource: NSSO 60th Round (2004).Source: NSSO 60th Round (2004).FIGURE 3.1.12: Percentage of Treated Ailments ReceivingNon-hospitalized Treatment from Government SourcesFIGURE 3.1.13: Average Medical Expenditure (Rs)per Hospitalization Casegiven more importance than comprehensive primaryhealth care. The review of the plan not only throwslight on the gap between the rhetoric and reality butalso the framework within which the policies wereformulated.3.1.41 It was important to question whether it is onlythe low investment in health that is the main reasonfor the present status of the health system or is it alsoto do with the framework, design, and approach withinwhich the policies were formulated. Keeping this inview the NRHM was launched.3.1.42 The original approved health and family welfareoutlay for the Tenth Plan CSS and CS was Rs 36378crore. However, the sum of annual outlay increased toRs 41585 crore. Against this, the actual expenditurehas been Rs 34950.45 crore, that is, 84.05% of the sumof annual outlay. In 2005–06, all family welfare schemesand major disease control programmes were putunder the umbrella of the NRHM. Scheme-wisedetails of Tenth Plan outlay and expenditure are providedin Annexures 3.1.1 and 3.1.2. State Plan outlayand expenditure during Tenth Plan have been providedin Annexure 3.1.3.3.1.43 Review of the NRHM at the end of the TenthPlan reveals that in order to improve the public healthdelivery, the situation needs to change on a fast trackmode at the grassroots. The status as on 1 April 2007is as under:• 17318 Village Health and Sanitation Committees(VHSCs) have been constituted against the targetof 1.80 lakh by 2007.• No untied grants have been released to VHSCspending opening of bank accounts by the Committees.• Against the target of 3 lakh fully trained AccreditedSocial Health Activists (ASHAs) by 2007, the initialphase of training (first module) has been impartedto 2.55 lakh. ASHAs in position with drug kits are5030 in number.• Out of the 52500 Sub-centres (SCs) expected tobe functional with 2 Auxiliary Nurse Midwives(ANMs) by 2007, only 7877 had the same.• 9000 Primary Health Centres (PHCs) are expectedto be functional with three staff nurses by 2007. Thishas been achieved at 2297 PHCs.• There has been a shortfall of 9413 (60.19%) specialistsat the CHCs. As against the 1950 CHCsexpected to be functional with 7 specialists and9 staff nurses by 2007, none have reached that level.• CHCs have not been released untied or annualmaintenance grant envisaged under the NRHM asthey have not reached upto the expected level.• Number of districts where annual integratedaction plan under NRHM have been preparedfor 2006–07 are 211.TOWARDS FINDING SOLUTIONS3.1.44 The Eleventh Five Year Plan will aim for inclusivegrowth by introducing National Urban Health