Dear Vinod Bhanu

In the Empowered Action Group (EAG) states, there is an extreme shortage of trained manpower. Usually, the locally trained doctors and nurses move to better paying States. There are provisions under the NRHM to duly compensate the technical and support staff. However, in states like Bihar and Orissa, the contractual specialist doctors are still being paid Rs. 20000-25000 only and the contractual nurses Rs. 6500 as lump sum remuneration. In such a system, we cannot expect the best minds to stay back and that too in difficult places.

If the Ministry can ensure that all the States pay at par with each other to their regular and contractual staff, it would be beneficial for the Public Health System of the country.

Also, the NRHM review at many stages consists of high level meetings and an occasional random visit. There are problems in the review system in two ways:

Mostly it is a staged visit wherein the States get prepared to showcase their best
The Ministry officials can only write to the state bureaucrats in a politically correct tone about the shortcomings observed if any.

Moreover, a strong monitoring system to ensure implementation of NRHM initiatives with full vigour is required. Such a system should also have some mechanism with an ultimate objective of improving the system.

The laggard states seem to be a big challenge in letting India and the world achieve the Millennium Development Goals (MDGs).

Om Prakash Kansal,
 UNICEF,
Patna