A crisis has engulfed the healthcare sector in Kerala with the National Health Mission (NHM) getting paralysed with the central government refusing to release its commitment of a whopping over Rs 826.03 crore for this financial year.
The crisis has gone to the extent that the staff under NHM who have not been paid salary for January resorting to a token strike at district centres and central government offices across the state on Tuesday while they have threatened an indefinite stir if salary was not disbursed without further delay.
The scheme has been pulling on since April last year with Rs 440 crore allotted by the state government. Of this, Rs 50 crore each was provided in the last two months for necessary interventions, including the salary for NHM employees and the incentives for ASHA workers.
A slew of services in the primary health centres, community health centres, taluk, and district hospitals are covered by the NHM.
“The NHM programme is implemented with 60% of funds granted by the central government and 40% by the state government,” said an NHM official. “The projects for the financial year 2023-24 were submitted well on time and approved by the central government and Rs 826.03 crore was approved. The 40% of it, as addition, is allocated by the state government for the NHM project. One quarter of the amount is released in the first quarter and 40% of it is released by the state government. Likewise, fund disbursal for the next three quarters follow. But this year, the Centre has not released a single paisa so far for NHM projects in Kerala, landing all activities in crisis, and the latest to hit is the salary of the staff,” the official said.
Meanwhile CITU State Secretary U P Joseph said several projects under NHM are stalled. “Even those for infants are stalled because of lack of funds. It will turn into a major crisis it this is allowed to prolong as the health of the country's future is affected,” he said.
A total of 13,000 contract staff are working in different departments in the state under the NHM scheme and they deliver the same kind of job as carried out by their counterparts working under the Director of Health Services (DHS). However, the NHM staff are being handed out a raw deal by providing a lesser salary. Even the salary hike effected six months ago could not be implemented due to the stalemate.
“The salary delay started three months ago, and it has worsened this month. Last month the salary was released in the third week, that too after the state government made an emergency intervention. So far this year, the NHM was run with the funds advanced by the state government though rules stipulate to remit it only after the gentral government has given its funds. The incentives for Asha workers too come through the NHM funds. Now all these are stalled, including Asha workers’ salaries,” Joseph pointed out.
The major issue in releasing the funds is the central government directive to brand the healthcare institutions in the state like PHCs, CHCs, family health centres, taluk, and district hospitals. Nearly 800 Ayush primary health centres in the state also operate under the NHM scheme. The state, which assiduously built the healthcare system over the years with pucca buildings and other infrastructure, equipment, and facilities, in return suggested co-branding by the State and Centre.
“We completed 99% co-branding and uploaded the details on the website for it and it was also approved by the Centre. Later they reversed their stand and as the State Health Minister said the Centre wanted to brand them as ‘Ayushman Arogya Mandir’ but Kerala stuck to the co-branding proposal which has resulted in the stalemate,” the NHM official said.
“The central government is putting hurdles in the implementation of NHM by putting forth new conditions like renaming health centres. It is quite unfortunate and the co-branding suggestion of the state is just and appropriate which should be accepted and the stalemate over fund disbursal broken,” said Joseph, who is leading the protests of the NHM Employees Federation and Asha Workers Federation. He added that they want the smooth implementation of the project as well as prompt payment of their salary.
