COMMENTARY

National Health Policy 2015

A Narrow Focus Needed
Javid Chowdhury

Since independence, Indias

national health policies have been
aspirational but the end results
have been limited. The National
Health Policy 2015, which is in the
process of being finalised, should,
in place of the earlier broadband
approach, adopt a narrow focus
on primary healthcare through
the National Rural Health
Mission. The latter has focused
on primary healthcare and has
shown visible results. A slew of
suggestions as to how this can be
done are made in this article.

he Government of India is in the

process of framing the National
Health Policy (NHP) 2015 with the
draft already in the public domain for
comments and suggestions. This article
traces the features of the previous two
national health policies of 1983 and 2002
and arrives at some recommendations
for NHP 2015. The Health Policy of 1983
drew upon the general ideas of the Alma
Ata Declaration, a global milestone in
propagating public health, principally
through primary healthcare. Its follower,
the Health Policy of 2002, was less general in approach, looked at the health
terrain from a lower altitude, and made
recommendations on strategy and policy
that were more pointed. Also, the 2002
policy recommended focus on primary
healthcare more forcefully. After the introduction of the 2002 health policy, the
Ministry of Health and Family Welfare
(MoHFW) adopted a new programme, the
National Rural Health Mission (NRHM)
which was in the nature of a ring-fenced,
exclusive, primary healthcare scheme.
In the eight years since it has been introduced, its outcomes have been promising. Rural health indices have been
seen to be improving as never before.
Looking at this background, we would
recommend that the ring-fenced, primary healthcare scheme be adopted
across the country with assured funds,
and no possibility under the rules for
diversion of these funds. This article
also makes some other recommendations on key policy issues relating to
this sector.
1 Disease Profile

Javid Chowdhury (javid.chowdhury@gmail.

com) is a retired IAS officer who has served as
the Union Health Secretary. He is now
associated with NGOs and continues to
research public health policy issues.
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february 28, 2015

The NHP 2015 would necessarily have to

be set in the existing health scenario.
Today we face what is called the double
burden of disease a large volume of
age-old communicable diseases (tuberculosis, malaria, respiratory tract disorders, gastrointestinal infections, etc),
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and now increasingly combined with

a heavy burden of non-communicable
(diabetes, cancer, and cardiovascular),
also known as lifestyle diseases. Malnutrition is still widely prevalent in the
country with 44% of the children under
the age of five being underweight, while
72% of the infants and 52% of the
women are anaemic. Even the very
inexact estimates of morbidity and mortality for the major diseases that are
available indicate a staggering disease
burden: TB two million new cases and
0.4 million deaths per year; malaria
15 million cases per year; HIV-AIDS
(prevalence) 2.4 million cases. If in a
developed country the disease burden
was even a fraction of that given above,
the concerned government would have
immediately declared a health emergency, if not a more broad-based
national emergency.
2 Resources for the Health Sector
As in any other country, the challenge of
maintaining a state of good health and
well-being of the citizenry has to be met
through interventions in the primary,
secondary and tertiary sectors. For India,
the total health expenditure (THE) is 4.5%
of its gross domestic product (GDP), a
small fraction of the modest norm of 6.5%
of GDP suggested by the World Health
Organization (WHO) for developing
countries. What the Indian citizen gets in
the health sector is a derisory amount
compared to that in the developed world:
US 16.9%; France 11.6%; Switzerland
11.4%; Germany 11.3%; Japan 10.3%;
UK 9.3%. Even more distressing is the
fact that the public health expenditure
(PHE), which is the state contribution over
the years, at 1% of the GDP has hovered
close to that of the lowest five countries
of the globe. These figures clearly indicate
that even in highly developed countries,
where the capacity of the average citizen
to finance his/her own health services
independently is very high, the state
considers it a prime component of the
responsibility of governance to fund
healthcare. Strangely, in India this
responsibility has been implicitly abdicated by the state on the specious ground
that we cannot afford the required
resources for the sector.
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COMMENTARY

2.1 Plan Contributions

As a deliberate departure from the past,
the government for the Eleventh Five
Year Plan had fixed an enhanced resource
allocation target of 2% to 3% of the GDP.
This was not overambitious, but as it
transpired, even this turned out to be an
optical illusion. In the event, the actual
release of resources over the plan period
amounted to 1.04% of the GDP, no different from the earlier five-year period.
Over the Twelfth Plan period the
government commitment was to provide
Rs 3,00,018 crore. In point of fact, the
budgetary releases over the first three
years have been only 56% of the plan
allocation. The persistent failure in meeting plan commitments by making commensurate budgetary allocations gives a
very poor impression of the sincerity
of the government in supporting the
social sectors.
3 Health Policies Over Time
The health policy has to be determined
in the context of the prevailing health
scenario and the existing health organisational structure. Despite some improvement in the health standards of the
country in the decades after independence, the strategy of service delivery
over much of the period was ad hoc,
particularly so in the private sector.
At this stage of the discussion it would
be appropriate to briefly recall the principle stages through which the health
policy has traversed in the years after
independence.
3.1 NHP 1983: Base Camp
The paramount need for a well-designed
national health policy came to be highlighted after the Alma Ata Declaration.
The NHP of 1983 was our first attempt to
draw up a structured policy specific to
Indias health sector. As it followed the
Alma Ata Declaration, the NHP 1983
turned the arc-light on a well-dispersed
network of primary healthcare services
linked with extension services and health
education. However, along with the primary healthcare component, almost
every other area of concern was included in the policy document like drinking
water, sanitation, nutrition, environmental
impact, etc. It is recognised that the
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various social determinants of health

have a significant impact on the state of
health of the community, and the contributory impact of the social determinants
is crucial to the ultimate quality of the
health scenario. However, I believe that to
keep the span of the study manageable,
the NHP 2015 should cover only the core
components of the health sector, while
the other social determinants should be
left to an independent policy document.
The NHP 1983, after covering at a
generalised level almost every possible
element in the universe of health, did
not provide adequate conceptual guidance to the public health administrators
as to how they should strategise and
projectise. In result, the strategies and
projects adopted by the government in
the decades after that were at best sui
generis and at worst ad hoc. What we
now find staring us in the face is that
most of the elements of the policy of
1983 were projected at an aspirational
level, and these proved to be of limited
assistance to the public health administrator in actually strategising schemes
and implementing them. If any strategy or
scheme achieved an internal coherence
with an element of the policy, it was
entirely a matter of accident. Improvements achieved in the health sector were
of an accidental nature, not linked to any
health sector targets, and were helped
along by the other contemporaneous
developments in the economic sectors.
3.2 NHP 2002: One Step Forward
I had the good fortune of piloting the exercise for drawing up the NHP 2002 and
thereby gained first-hand experience of
what it involved. In the course of drawing up of the NHP 2002 extensive consultations were held with health experts
from academia and administrators of
non-governmental organisations (NGOs).
But, without in any way denigrating the
expertise of these contributors in their
own areas of functioning, it was apparent
that their exposure to national policy
formulation was limited. Most such individuals/organisations are passionate about
their own areas of interest, but few have
broader exposure to national level issues.
Quite often the experts from academia
and the administrators of NGOs tend to

swing the policy document towards their

areas of special interest without being
able to stitch together inherent coherence in the broad features of a balanced
policy document.
Nearly two decades after NHP 1983
had been adopted, in 2002 a dire public
need was felt to draw up a fresh health
policy. It was observed that over the
period many elements of the earlier NHP
had not really been internalised by the
public health functionaries, and did
not significantly result in practicable
strategies. Improvement in the primary
healthcare services in the rural health
sector was woefully inadequate the
state could not in good conscience claim
that it had adequately discharged its
responsibilities of governance. The drafting team for NHP 2002, therefore, sought
to design a corrective thrust for what
was seen as conceptual inadequacies in
the NHP of 1983. To make the policy
more user-friendly, the NHP 2002 made a
conscious effort to pitch it such that the
conceptual direction was plain to everyone, and strategies/programmes automatically followed. To put it differently,
the attempt in NHP 2002 was to bring
the level of discourse down from the
stratospheric level to cruising level.
To assist the stakeholders in optimising operational efficiency a road map
was set out in NHP 2002, which had the
following principle components:
(i) An enhanced quantum of central resources for the health sector, as these were
inordinately low. Specific change of the
resource allocation suggested was an
increase of the PHE to 2% of the GDP and
the THE to 6% of the GDP by year 2010.
NHP 2002 also advocated an increase
of the share of central government
expenditure to 25% of the PHE from the
existing level.
(ii) Focus on the goal of equity in the
health system by increasing the share of
primary healthcare, which is the more
cost-effective category of expenditure
with the suggested ratio of 55% of the
resources for primary healthcare, 35%
for secondary healthcare and 10% for
tertiary healthcare.
(iii) Convergence of all disease control
programmes under a single field administration (except the vertical programmes),

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4 National Rural Health Mission

While no significant improvement in the
national health scenario was observed
even till the turn of the millennium,
of late there has been a change in the
situation which holds out a degree of
promise as never seen before. About a
decade ago, health administrators came

to the conclusion that we needed a radical change in our priorities. It was felt
that it was unrealistic to try and meet
resource requirements for all desirable
elements of the health sector. More serious, primary healthcare, our priority,
came to be neglected. In this unacceptable situation it was considered necessary
to adopt a health programme, which,
without any scope for deflection, focused
on primary healthcare.
The resources released under previous
annual budgets were nowhere near the
committed amount and the management attention required for a flagship
programme was never made available.
In the circumstances, the health administrators felt that they must cut away
from the old-style budget-making where
everyone is kept happy, and design a
rural sector project that is funded and
implemented entirely as a fire-walled
project. The objective of the scheme was
to provide primary healthcare to every
citizen free of cost and the project was
named Universal Health Coverage (UHC)
by the United Progressive Alliance (UPA)
government (and renamed Universal
Health Assurance by the National Democratic Alliance government).
The central governments NRHM
launched in 2005 has completed eight
years (200506 saw the finalising of the
programme and there were no field
operations in this period). In my personal
capacity, I undertook an evaluation of
its performance based on programme
statistical returns up to June 2014.1 My
analysis on the performance and prognosis is contained in a monograph published by the National Institute of Health
and Family Welfare titled National Rural Health Mission: Performance and
Prognosis.2 I have relied on some of my
findings in that monograph in this article.
The programme was essentially a timebound, mission-mode one, with many
novel features.
The significant ones are: (i) It is a focused programme to strengthen and improve the rural health organisational
structure, thereby radically improving
the quality of primary healthcare service
delivery, particularly relating to women
and infants; (ii) increased deployment
of the requisite skilled human resources

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in order to establish unity of command

and economy and flexibility of operations.
(iv) Implementation of field programmes
through autonomous organisations at
state and district levels to ensure operational autonomy.
(v) Use of only generic drugs and vaccines
in primary healthcare services. Providing of essential drugs under central
funding in order to kick-start the
activities in the otherwise moribund
rural health system.
(vi) It was accepted as a situational
reality that the contribution of the private
sector in providing services had to be
factored into the architecture of the
health system. Also, it was noted that
with such a large portion of the services
coming from the private sector, statutory
norms needed to be put in place immediately for regulating infrastructure,
clinical practice and medical service
standards.
Before we set out to make suggestions
for NHP 2015, it would be appropriate to
assess how much impact the NHP of
2002 had on the health scenario in the
decade after its adoption. The overall
performance was not impressive in the
early period. The allocation of financial
resources to the health sector (as percentage of the GDP) was on the same
scale as in the pre-policy period. As had
been happening in the past, rural
healthcare had largely been provided as
a diluted form of primary healthcare.
The apportionment of allocation of health
resources to the primary sector had not
changed much, primary: 55%; secondary:
18%; tertiary: 27%. There was an
undesirable swing towards the expensive tertiary sector. Pooling of public
health personnel for other than vertical
programmes has been introduced, but
only fairly recently. Autonomous bodies
have been set up in many states for
managing the health programmes.

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at the different levels of the rural health

system; (iii) increased allocation of
financial resources on a sustained basis
for consumables, infrastructure and for
emergent situations; (iv) redesign of the
matrix of administrative and financial
procedures, particularly including delegation of adequate powers at different
levels; (v) creation of community-based
entities at different levels of the rural
organisational structure for increasing
community participation in planning,
execution and monitoring of the rural
health services. Some of these are old-time
elements of the existing rural healthcare
system, and it is only that they are to be
strengthened by large infusions of the
human, financial and material resources.
Others like those relating to the co-option
of community-based entities in the process
of planning, implementation and supervision of the healthcare services have
been introduced for the first time.
So far under the NRHM the health
structure has been substantially reinforced with infrastructure, technical
staff and an additional management
module. Another module that was introduced in the NRHM was of community
participation through voluntary workers
and community institutions. The volunteers were called accredited social
health activists (ASHAs) and were paid a
nominal honorarium of Rs 500 per
month, plus any other amount they
could pick up from other government
schemes on a piecework basis. These
ASHAs were put through an elementary
orientation course for: diagnosing/treating simple medical conditions, mediation between the patient and the health
administration, and interceding in matters relating to advocacy in public health
and hygiene.
More budgetary items permitting
flexi-funding have been introduced in
the NRHM, and reproductive and child
health (RCH) budgets. Under the NRHM
administrative processes have also been
modified delegating much more administrative/financial powers to the lower
formations. In sum, much more flex has
been brought into the organisation of the
rural health system, both at the level of
service delivery and at the administrative/
management level. It has also been
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noticed that these additional powers and

facilities have been widely and beneficially used under the programme.
In addition to the organisational
changes, significant changes have been
made by way of providing substantial
additionalities of infrastructure and
consumables. Deployment of graduate
doctors and clinical specialists has also
improved noticeably in the primary
health centres/community health centres (PHCs/CHCs), even though they are
still short of the norms. The improvement in service delivery over the period
200506 to 201314 has been marked.
There is much more evidence of activity
at the rural service centres. The outpatient department (OPD) attendance in
certain parts of the country, where the
additional inputs have reached, has
increased dramatically. Along with the
impact of the Janani Suraksha Yojana,
institutional deliveries under the NRHM
have also increased dramatically. From
the limited statistics available at this
stage, it is clear that there is a very
encouraging trend in the improvement
of infant and maternal mortality rates
(IMR and MMR) during the period of the
NRHM programme. The growing trend
in the annual decline rate over the
previous year in MMR has increased
from 2.6 to 6.4 in the period 2007 to
2012; and, the under-five mortality rate
(U5MR) decline trend has ranged from
7.8 at the highest to 5.4 at the lowest in
the same period, i e, from 2007 to 2012.
This marks a significant breakthrough in
the outcome of services delivered in the
rural health sector.
Despite the improvements in many
areas, for the NRHM to establish itself
over the entire country, more time is
required. For the first time in memory
the primary healthcare services had been
energised and the rural health sector
seemed to have acquired a new life. In
this promising situation, it is imperative
to ensure that the programme does not
slacken for any reason. The NRHM has
completed eight years and would need
at least another eight years to stabilise.
This estimate should not discourage
anyone. The programme is nothing but
primary healthcare services delivered in
a more efficient and tight management
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structure, and this is a fundamental

duty of state governance. So far very
small amounts of resources have been
made available for it.
Since it has a bearing on the NRHM, it
again needs to be highlighted that the
aggregate resources for the health sector
are grossly inadequate. In monetary terms,
the per capita THE in 201112 was
Rs 3,000, out of which Rs 900 (30%)
was PHE. The figure of PHE is the state
commitment for all manner of activities,
out of which that for primary healthcare
at 50% of PHE, would be Rs 450. This is
the situation in respect of availabiity of
resources when the NRHM initiatives of
largely covering primary healthcare have
been rolled out unevely and thinly over
much of the country. To implement the
scheme on the scale it was planned, we
would require a much higher quantum of
THE, and a much higher share of PHE out
of that THE. To bring the PHE somewhat
closer to that in developed countries, it
must be raised to at least 50% of the THE
(i e, Rs 2,800 per capita) by 201617.
Though the NRHM was launched in
200506, which was quite proximate to
the launch of the NHP 2002, it is not my
claim that the outcomes of the NRHM
were necessarily the direct result of only
the conceptual elements of the NHP
2002. It needs to be recognised that any
transformation in the social sectors is a
creeping change through an osmosis-like
process. With our changing perception
over time, change would be expected to
be creeping into the mindset of the public
health administrators. The conceptual
strands contributed through the NHP 2002
may also have to some extent contributed
to the outcomes of the NRHM. The progress
made by the programme in the first
eight years can be said to be substantial,
even if it has been slow. The experience
of the NRHM seems to indicate that it
would be best to conceptually frame the
NHP 2015 around primary healthcare, as
incorporated in the NRHM.
5 NHP 2015: Two Steps Forward
5.1 Broadband or Narrow Focus
As we have moved from the NHP 1983
to the 2002 Health Policy, and now
move towards NHP 2015, the conceptual

concerns of the new policy seem to suggest themselves. The policy should lean
heavily towards primary healthcare.
The claims from the other sectors, no
matter how pressing, would have to be
declined. Some of the central elements
required in the NHP 2015, as I assess
them, are discussed below:
(i) As the first strand of NHP 2015, I
would suggest that, to discharge its
minimal responsibility of governance, the
central government must very substantially increase its contribution of resources
to the health sector. Looking to the
success in the NRHM, it is very much in our
national interest to honour the resource
commitments earlier made under this
programme. The country now has a real
opportunity to pull itself out of a situation of permanent ill-health. The Twelfth
Plan allocation is 2.5% of the GDP. Inadequate though this is, we naturally have to
work within it. However, plan commitments in respect of resources cannot be
allowed to be illusory on an indefinite
basis. The budgetary allocations in the
first three years have been about 56% of
the proportionate entitlement for the
Twelfth Plan period. There must be a
quantum jump in the last two years of
the plan period if the government can
defend its sincerity in making plan allocations. Since the NRHM has markedly
picked up momentum, it would be possible for the sector to gainfully absorb
double the allocation in 2016 and 2017,
i e, Rs 80, 000 per year. This allocation
would bring the per capita allocation in
the last two years of the Twelfth Plan to
about Rs 650 per capita. The additional
allocation would make it possible to give
a significant boost to the NRHM which is
presently being choked for want of funds.
(ii) It has been observed earlier that the
health status over different parts of the
country varies greatly. As was explicitly
emphasised, one key element of the NHP
2002 was the objective of bringing about
equity in the health status over the country as a whole. There is no evidence to
show that this has been achieved to any
extent even after eight years of the
NRHM. Primary services are much more
cost-effective than secondary and tertiary
services. As a result of this, the outreach
of primary services is much more per

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unit cost than secondary and tertiary

services. Currently, the primary sector is
getting only about 55% of the health
sector resources. This adverse skew
needs to be corrected. Considering that
the policy imperative is that an unwavering focus be placed on the primary
sector, I would suggest a distribution of
resources, thus primary: 70%; secondary:
20%; and tertiary: 10%. This normative
allocation of resources between the
categories should be treated as unalterable under the budget so that resources
are not arbitrarily diverted.
Currently, the state provides about
20% of the OPD services and 40% of the
inpatient department (IPD) services in
the health sector. The goal of providing
equitable services from the state sector
requires that the share of OPD and IPD at
least be increased to 50% each, to make
access of the state services available to
the vulnerable sections.
A review of the NRHM indicates that the
expenditure has been more or less the
same in states with inferior health status
(high focus states for the purpose of the
NRHM) as that in states with superior
health status. Such a continuing situation will never ensure a levelling of unequal health standards. I am of the view
that in order to ensure improved equity in
the underserved areas, the health policy
statement could even go to the extent of
recommending a budgetary allocation
norm for weaker health states that is
twice that for the stronger health states.
It is widely accepted that there is overmedicalisation in the health sector, and
much of the use of drugs is unscientific.
While there should be no corner cutting,
it is beyond doubt that there would be no
compromise to the quality of treatment
if primary healthcare is restricted to a
limited list of generic drugs. In these
circumstances, I would advocate that, in
order to minimise the cost of the primary
care package, only generics from a
limited list be used as therapeutic drugs.
In the course of time the compulsory use
of generic drugs could be extended to
private sector primary healthcare also.
(iii) There is no escaping the fact that
the Universal Health Assurance (UHA)
would place an enormous burden on the
resources of the state as compared to

what is provided today. It is therefore

imperative that the primary care package
which is finalised and offered be realistically limited. Emphasis should be placed
on the preventive and promotive
components of primary care as these are
low-cost and are largely based on community participation. There is always a
populist demand for comprehensive
healthcare. I am of the view that this
should be resisted till the NRHM, with
a modest primary healthcare package,
has stabilised.
(iv) There is a significant shortage in the
country of trained health service providers. At the highest level the graduate
doctors there is a severe shortage in
the public sector. In our system staff
nurses/auxilliary nurses and midwives/
multipurpose workers are supposed to
discharge only those limited duties for
which they have been specifically trained.
At least in the near future, it cannot be
expected that their skills can be enhanced to cover much greater responsibilities. The prevailing problem of nonavailability of graduate doctors is virtually disabling the rural health system.
For quite some time now the health administrators have been considering a
scheme of starting a short-term graduate
course of two and a half years with one
year internship BSc (Community
Health) with a service domain limited
to primary healthcare. These short-term
graduate doctors will be from the rural
areas and they will come to replace the
totally untrained practitioners who are
today the only service providers there.
All in all, at a policy level, there seems to
be no conceptual danger in the introduction of the scheme for starting of the
short-term graduate course.
(v) For a balanced national health system,
the contribution of the state sector, both
by way of financial resources and services,
should not be less than 50%. For the state
to make a contribution to the health sector, the public health service specialisation must be available in an adequate
quantum. Currently, the number of public health specialists is extremely low.
For the public sector to discharge its
role, a minimum of 25% of the certified
health insurance specialists should belong to the public health sub-cadre. In

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this backdrop, it seems essential to correct the disproportionately low presence

of public health specialists in the health
system in the shortest possible time. In
sum, it can be recommended that the
public health specialists be recruited
against vacancies on an overriding basis
till the share of the central health services
cadre reaches 25%.
(vi) Our national health system had
a unique organisational structure for
the programmes relating to the heavy
burden diseases like the Revised National
TB Control Programme, vector-borne
diseases, leprosy, cataract blindness and
HIV/AIDS. To have any impact on the
burden of these diseases, it was felt
necessary to have independent health
service teams and budgets. The NHP
2002 had observed that, where the need
for vertical programmes had reduced,
these could be wound up and merged
with the unified rural health administration. Pursuant to that recommendation in the NHP 2002, the RNTCP was
removed from the vertical programmes,
though recent field reports indicate that
this move may have been a little premature. Both leprosy and cataract blindness
are diseases which have come down to
manageable levels and, perhaps these
could be removed from the category of
vertical programmes. In the light of
the above, it is recommended that the
diseases to be retained in the category of
vertical programmes be reviewed.
(vii) The health services in the country,
both in the public and private sectors
are virtually unregulated. While there are
professional councils (of doctors, dentists,
nurses, and pharmacists), to oversee the
professional ethics and conduct of the
service providers, these councils are riven
with corruption and are practically dysfunctional. Also, there is no institution to
technically regulate the quality of services
provided by these practitioners. Since
the NHP 2015 is likely to make several
recommendations entrusting service
responsibilities to lower order health
personnel, it is necessary to put in place
robust institutions to supervise the ethical
standards and technical performance of
the health practitioners. In sum, I would
recommend that regulatory bodies be
set up at the centre and the states at the
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earliest to oversee the service delivery

and ethics of the professional service
providers in the health sector.
(viii) The spread of medical colleges is
very uneven over the country. To improve
the spread and create quality standardsetting institutions, it would be necessary
to set up government colleges in states
in which very few exist. In the circumstances, it would be appropriate to increase the number of government medical colleges so that the total number in
the country is equally divided between
the public and private sectors.
6 Summation
Over decades we have pursued an aspirational health policy but with very limited outcomes. For the last eight years

30

we have seen a shift in tack. Through the

NRHM, the health system has attempted
to turn the single-minded focus to primary healthcare in its well-structured
format. The programme has shown visible results and the system seems set for a
makeover. In a parliamentary democracy
public policies are often determined on
the basis of voter response rather than
technical assessment. In areas where the
NRHM has been implemented the voter
enthusiasm has been immense. In addition to an improved primary healthcare
system for the citizenry, the political
executive could hope for a windfall of
votes! With these promising circumstances, it is recommended that the NHP 2015
adopt the singular conceptual stance of
promoting primary healthcare through

the NRHM, even if it be at the cost of

some other areas of the health sector. I
would recommend that this policy, in
categorical terms, declare that in place
of the earlier broadband approach, it
would be desirable to adopt a narrow
focus approach on primary healthcare through the NRHM. It would be a realistic assessment that in a decade, with
a modest amount of financial resources
and some operational hand holding, we
should be able to achieve UHA in the
country in respect of primary healthcare.
Notes
1
2

february 28, 2015

State Data Sheets, National Rural Health Mission

(as on 30 June 2014).
National Rural Health Mission: Performance
and Prognosis, National Institute of Health
and Family Welfare 2013.

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