2012 Articles

Model Districts as a Roadmap for Public Health Scale-Up in India: Strategic planning experience from Assam

Bajpai, Nirupam; Dhillon, Ranvir; Towle, Megan; Vynatheya, Jyothi

Providing at-scale, high-quality public health services in rural India is one of the country’s greatest challenges. In 2005 the Ministry of Health and Family Welfare (MOHFW), Government of India, launched its flagship programme the National Rural Health Mission (NRHM) to improve rural access to quality primary health care. At the request of the MOHFW, the Earth Institute, Columbia University, has been convening an International Advisory Panel (IAP)1 that meets biannually to review NRHM progress, and the panel conducted a mid-term evaluation of the NRHM in 2009. The evaluation demonstrated that coverage of high-priority interventions remains inadequate, the quality of programming is insufficient, efficient management and governance is lagging, and deeprooted inequities further complicate delivery and uptake (Paul et al. 2011, Bajpai et al. 2009). The MOHFW and the IAP determined that efforts required to strengthen health systems towards meeting health Millennium Development Goals before 2015 would best be piloted and scaled-up as regional models, given India’s size and the wide variances in health system performance, disease burden, and socio-cultural, political, and economic contexts.