On November 28, 2012, the Comptroller and Auditor General submitted its report on the implementation of the Jawaharlal Nehru National Urban Renewal Mission (JNNURM). According to the report most of the projects initiated under JNNURM have not been completed. For instance with respect to urban infrastructure projects, only 231 projects out of the 1298 sanctioned projects have been completed. Similarly, with respect to housing projects, only 22 of the 1517 projects have been completed. Some of the other key recommendations of the report are:
The need and objectives of JNNURM According to the 2011 census India’s urban population has increased from 286 million in 2001 to 377 million in 2011 . With the increase in urban population, there is a requirement to improve the urban infrastructure and improve the service delivery mechanisms. With these specific objectives in mind, the central government launched the Jawaharlal Nehru National Urban Renewal Mission 2005-2006. The aim of the Mission is to encourage reforms and fast track planned development of identified cities (such as cities with a population of more than 1 million as per the 2001 census). JNNURM has two main components namely : (i) Urban Infrastructure and Governance and (ii) Urban Infrastructure Development for Small and Medium Towns. The duration of JNNURM was from 2005-06 to 2011-12. However, as the projects have not been completed the Government has extended its duration until March 2014. Funds for JNNURM The funds for JNNURM are provided through the Additional Central Assistance. This implies that the funds are provided as grants to the states directly from the centre. In the 2012 Union Budget, the central government has allocated Rs 12,522 crore for JNNURM. This represents around 10 % of the total central assistance through the different schemes to states and union territories in 2012-13. As on June 30 2012, 554 projects at a total cost of Rs 62,253 crore have been sanctioned under the Urban Infrastructure and Governance sub-mission of JNNURM. The table below shows the status of the sanctioned JNNURM projects in the different states. State wise status of the projects under JNNURM (as on August 6, 2012)
| Name of State | Total Allocation (Rs Lakh) | Number of sanctioned projects | Completed Projects |
| Andhra Pradesh | 2,11,845 | 52 | 18 |
| Arunachal Pradesh | 10,740 | 3 | NA |
| Assam | 27,320 | 2 | NA |
| Bihar | 59,241 | 8 | NA |
| Chandigarh | 27,087 | 3 | NA |
| Chattisgarh | 24,803 | 1 | NA |
| Delhi | 2,82,318 | 23 | 4 |
| Goa | 12,094 | 2 | NA |
| Gujarat | 2,57,881 | 72 | 40 |
| Haryana | 32,332 | 4 | NA |
| Himachal Pradesh | 13,066 | 5 | NA |
| Jammu & Kashmir | 48,836 | 5 | NA |
| Jharkhand | 94,120 | 5 | NA |
| Karnataka | 1,52,459 | 47 | 22 |
| Kerala | 67,476 | 11 | NA |
| Madhya Pradesh | 1,32,850 | 23 | 7 |
| Maharashtra | 5,50,555 | 80 | 21 |
| Manipur | 15,287 | 3 | NA |
| Meghalaya | 15,668 | 2 | NA |
| Mizoram | 14,822 | 4 | NA |
| Nagaland | 11,628 | 3 | NA |
| Orissa | 32,235 | 5 | NA |
| Punjab | 70,775 | 6 | 1 |
| Puducherry | 20,680 | 2 | NA |
| Rajasthan | 74,869 | 13 | 2 |
| Sikkim | 10,613 | 2 | NA |
| Tamil Nadu | 2,25,066 | 48 | 12 |
| Tripura | 14,018 | 2 | NA |
| Uttar Pradesh | 2,76,941 | 33 | 4 |
| Uttarakhand | 40,534 | 14 | NA |
| West Bengal | 3,21,840 | 69 | 15 |
Source: Jawaharlal Nehru National Urban Renewal Mission; PRS.
Recently, the Standing Committee on Health and Family Welfare submitted its report to the Parliament on the National Commission for Human Resource for Health Bill, 2011. The objective of the Bill is to “ensure adequate availability of human resources in the health sector in all states”. It seeks to set up the National Commission for Human Resources for Health (NCHRH), National Board for Health Education (NBHE), and the National Evaluation and Assessment Council (NEAC) in order to determine and regulate standards of health education in the country. It separates regulation of the education sector from that of professions such as law, medicine and nursing, and establishes professional councils at the national and state levels to regulate the professions. See here for PRS Bill Summary. The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders. It felt that concerns of the professional councils such as the Medical Council of India and the Dental Council of India were not adequately addressed. Also, it noted that the powers and functions of the NCHRH and the National Commission on Higher Education and Research (to be established under the Higher Education and Research Bill, 2011 to regulate the higher education sector in the country) were overlapping in many areas. Finally, it also expressed concern over the acute shortage of qualified health workers in the country as well as variations among states and rural and urban areas. As per the 2001 Census, the estimated density of all health workers (qualified and unqualified) is about 20% less than the World Health Organisation’s norm of 2.5 health workers per 1000 population. See here for PRS Standing Committee Summary. Shortfall of health workers in rural areas Public health care in rural areas is provided through a multi-tier network. At the lowest level, there are sub health-centres for every population of 5,000 in the plains and 3,000 in hilly areas. The next level consists of Primary Health Centres (PHCs) for every population of 30,000 in the plains and 20,000 in the hills. Generally, each PHC caters to a cluster of Gram Panchayats. PHCs are required to have one medical officer and 14 other staff, including one Auxiliary Nurse Midwife (ANM). There are Community Health Centres (CHCs) for every population of 1,20,000 in the plains and 80,000 in hilly areas. These sub health centres, PHCs and CHCs are linked to district hospitals. As on March 2011, there are 14,8124 sub health centres, 23,887 PHCs and 4809 CHCs in the country.[i] Sub-Health Centres and Primary Health Centres
Table 1: State-wise comparison of vacancy in PHCs
|
Doctors at PHCs |
ANM at PHCs and Sub-Centres |
|||||
| State | Sanctioned post | Vacancy | % of vacancy | Sanctioned post | Vacancy | % of vacancy |
| Chhattisgarh | 1482 | 1058 | 71 | 6394 | 964 | 15 |
| West Bengal | 1807 | 801 | 44 | 10,356 | NA | 0 |
| Maharashtra | 3618 | 1326 | 37 | 21,122 | 0 | 0 |
| Uttar Pradesh | 4509 | 1648 | 36 | 25,190 | 2726 | 11 |
| Mizoram | 57 | 20 | 35 | 388 | 0 | 0 |
| Madhya Pradesh | 1238 | 424 | 34 | 11,904 | 0 | 0 |
| Gujarat | 1123 | 345 | 31 | 7248 | 817 | 11 |
| Andaman & Nicobar Isld | 40 | 12 | 30 | 214 | 0 | 0 |
| Odisha | 725 | 200 | 28 | 7442 | 0 | 0 |
| Tamil Nadu | 2326 | 622 | 27 | 9910 | 136 | 1 |
| Himachal Pradesh | 582 | 131 | 22 | 2213 | 528 | 24 |
| Uttarakhand | 299 | 65 | 22 | 2077 | 0 | 0 |
| Manipur | 240 | 48 | 20 | 984 | 323 | 33 |
| Haryana | 651 | 121 | 19 | 5420 | 386 | 7 |
| Sikkim | 48 | 9 | 19 | 219 | 0 | 0 |
| Meghalaya | 127 | 23 | 18 | 667 | 0 | 0 |
| Delhi | 22 | 3 | 14 | 43 | 0 | 0 |
| Goa | 46 | 5 | 11 | 260 | 20 | 8 |
| Karnataka | 2310 | 221 | 10 | 11,180 | 0 | 0 |
| Kerala | 1204 | 82 | 7 | 4232 | 59 | 1 |
| Andhra Pradesh | 2424 | 76 | 3 | 24,523 | 2876 | 12 |
| Rajasthan | 1478 | 6 | 0.4 | 14,348 | 0 | 0 |
| Arunachal Pradesh | NA | NA | NA | NA | NA | 0 |
| Assam | NA | NA | NA | NA | NA | 0 |
| Bihar | 2078 | 0 | NA | NA | NA | 0 |
| Chandigarh | 0 | 0 | NA | 17 | 0 | 0 |
| Dadra & Nagar Haveli | 6 | 0 | NA | 40 | 0 | 0 |
| Daman & Diu | 3 | 0 | NA | 26 | 0 | 0 |
| Jammu & Kashmir | 750 | 0 | NA | 2282 | 0 | 0 |
| Jharkhand | 330 | 0 | NA | 4288 | 0 | 0 |
| Lakshadweep | 4 | 0 | NA | NA | NA | 0 |
| Nagaland | NA | NA | NA | NA | NA | 0 |
| Puducherry | 37 | 0 | NA | 72 | 0 | 0 |
| Punjab | 487 | 0 | NA | 4044 | 0 | 0 |
| Tripura | NA | NA | NA | NA | NA | 0 |
| India | 30,051 | 7,246 | 24 | 1,77,103 | 8,835 | 5 |
| Sources: National Rural Health Mission (available here), PRS.Note: The data for all states is as of March 2011 except for some states where data is as of 2010. For doctors, these states are Bihar, UP, Mizoram and Delhi. For ANMs, these states are Odisha and Uttar Pradesh. | ||||||
Community Health Centres
Table 2: Vacancies in CHCs of medical specialists
| Surgeons | Gynaecologists | Physicians | Paediatricians | |
| State |
% of vacancy |
|||
| Andaman & NicobarIsland | 100 | 100 | 100 | 100 |
| Andhra Pradesh | 74 | 0 | 45 | 3 |
| Arunachal Pradesh | NA | NA | NA | NA |
| Assam | NA | NA | NA | NA |
| Bihar | 41 | 44 | 60 | 38 |
| Chandigarh | 50 | 40 | 50 | 100 |
| Chhattisgarh | 85 | 85 | 90 | 84 |
| Dadra & Nagar Haveli | 0 | 0 | 0 | 0 |
| Daman & Diu | 0 | 100 | 0 | 100 |
| Delhi | 0 | 0 | 0 | 0 |
| Goa | 20 | 20 | 67 | 66 |
| Gujarat | 77 | 73 | 0 | 91 |
| Haryana | 71 | 80 | 94 | 85 |
| Himachal Pradesh | NA | NA | NA | NA |
| Jammu & Kashmir | 34 | 34 | 53 | 63 |
| Jharkhand | 45 | 0 | 81 | 61 |
| Karnataka | 33 | NA | NA | NA |
| Kerala | NA | NA | NA | NA |
| Lakshadweep | 0 | 0 | 100 | 0 |
| Madhya Pradesh | 78 | 69 | 76 | 58 |
| Maharashtra | 21 | 0 | 34 | 0 |
| Manipur | 100 | 94 | 94 | 87 |
| Meghalaya | 50 | NA | 100 | 50 |
| Mizoram | NA | NA | NA | NA |
| Nagaland | NA | NA | NA | NA |
| Odisha | 44 | 45 | 62 | 41 |
| Puducherry | 0 | 0 | 100 | NA |
| Punjab | 16 | 36 | 40 | 48 |
| Rajasthan | 57% | 46 | 49 | 24 |
| Sikkim | NA | NA | NA | NA |
| Tamil Nadu | 0 | 0 | 0 | 0 |
| Tripura | NA | NA | NA | NA |
| Uttar Pradesh | NA | NA | NA | NA |
| Uttarakhand | 69 | 63 | 74 | 40 |
| West Bengal | 0 | 57 | 0 | 78 |
| India | 56 | 47 | 59 | 49 |
| Sources: National Rural Health Mission (available here), PRS. | ||||
[i]. “Rural Healthcare System in India”, National Rural Health Mission (available here).
