Improving Access and Efficiency in Public Health Services ― Mid-term Evaluation of India's National Rural Health Mission

This study is field-based, insightful and useful in its recommendations. It has rightly emphasized the need for further stregthening the systems of programme management and delivery. It also brings out the fact that ASHAs have made a difference in connecting households to health facilities. It has taken note of the increase in institutional deliveries and the growing pressure on public facilities for healthcare. We will certainly examine suggestions made for further strengthening the ASHA programme . I am sure that this study's insights will help us move effectively towards achieving the Millennium Development Goals. Ghulam Nabi Azad Union Minister for Health and Family Welfare Government of India.

The National Rural Health Mission (NRHM) is designed to restructure the public health delivery system in rural areas to provide all people with reliable healthcare, it is a flagship programme of the Government of india and is a key ingredient of the strategy for inclusive growth it has been in operation only for a few years, but it is vitally important that both its successes and also its shortcomings be subjected to a careful evaluation. This volume makes an important contribution in this area and deserves careful study, along with the results of other independent evaluations that are taking place.---Montek Singh Ahluwalia Deputy Chairman, Planning Commission Government of India

The National Rural Health Mission (NRHM) is steering a radical transformation of India's health system through several innovations that aim to enhance outreach, efficiency and equity of healthcare. Evaluation of such a bold and imaginative public health programme is essential, not only to assess its impact within India but also because of the lessons that it can offer to many other countries which are attempting to energize their health systems. This mid-term appraisal of NRHM profiles the performance of the programme across the diversity of India's states, identifies factors which need remedial attention and suggests ways in which different programme components can be strengthened. This book is essential reading for all students of health systems and evaluation research.---Prof. K. Srinath Reddy President, Public Health Foundation of India

This book presents a systematic mid-term evaluation of the processes of the National Rural Health Mission (NRHM), India's biggest rural health programme. Data from District Level Health Surveys (DLHS), National Family Health Surveys (NFHS), and Sample Registration System (SRS) as well as primary data collected from field surveys and interviews with health functionaries have been utilized for undertaking empirical analysis in the study. It discusses the challenges and successes of the Mission with the help of extensive field observations, data analysis and inputs from experts on health and nutrition sectors focusing on maternal, newborn, and child health issues and chronic diseases.

The book draws from data collected in field visits in the three states of Madhya Pradesh, Uttar Pradesh, and Rajasthan. After assessing the NRHM processes and progress achieved so far, it discusses important ground realities, identifies the gaps and bottlenecks in the implementation of the Mission, and recommends corrective actions.

The book will be useful for all those concerned with the issue of health and public administration in general and rural health in particular, such as, NGOs, IGOs, journalists, columnists, public policy planners, civil servants, and other practitioners.

Nirupam Bajpai is Senior Development Advisor and Director, South Asia Program, Center on Globalization and Sustainable Development, The Earth Institute, Columbia University, New York.
Jeffrey D. Sachs is Director of The Earth Institute, Quetelet Professor of Sustainable Development, and Professor of Health Policy and Management, Columbia University, New York.
Ravindra H. Dholakia is Professor of Economics and Public Systems, Indian Institute of Management Ahmedabad.