National Consultation (NC) on Engendering Health: The Experience of NRHM : July 5-6, 2012

A National Consultation (NC) on NRHM was jointly organised by the Centre for Development Studies (CDS) and UN Women at the CDS in Trivandrum. The NC is being held on 5-6 July at the CDS. The theme of the NC is “Engendering Health: The Experience of NRHM”.

The NRHM, as is well known, was launched in 2005 for a period upto 2012. It aimed to undertake an ‘architectural’ correction of the basic health care delivery system in the country to enable it to provide affordable, accessible and accountable quality health care to people living in remotest rural locations with special focus on women and children. A concomitant reduction in IMR / MMR / TFR was its major objective.

That in these 5-6 years of its functioning NRHM has put rural public health care firmly on the agenda, cannot be denied and some progress in reduction of all these indicators is seen.

However, there is also no doubt that the NRHM needs much greater strengthening in terms of several of its components, whether it is human resources for health including ASHAs, communitisation of health care in terms of VHSCs and RKSs, service guarantees, drug availability, inter-sectoral convergence in the absence of universal access to water and sanitation, strengthening of JSY perceived as a ‘success’, especially in the management of emergency obstetric care, neo-natal and child care and safe abortion, virtually neglected in JSY.

While mainstreaming gender into NRHM is a stated objective in the RCH II documents there is no doubt of a need for much greater commitment to engendering health, which we would like to foreground in the context of this Consultation. A gender approach in health, while not excluding biological factors, considers the critical roles that social and cultural factors and power relations between women and men play in promoting and protecting or impeding health. It therefore follows that gender is an important social determinant of health. Engendering health would recognise spousal violence as a gender related health problem to which women are disproportionately more exposed; as also frequent abortions that threaten safe pregnancy. While the NRHM document talks of universalizing health care for women and children; emphasizes safe motherhood via JSY; ASHA, its key component in the communitisation of health care is a woman worker, there are important ways in which existing gender inequities operate at the household, community and institutional levels (such as hierarchies in the health system, low female autonomy and inadequate infrastructural support for women, underpaid female health workers etc) which, if neglected/underestimated, impinge on health outcomes.

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