On the eve of the 12th Plan that promises to launch an urban equivalent of the National Rural Health Mission, an extensive survey of villages has shown that even the NRHM dream is far from being realised. n Indian health program for improving healthcare delivery across rural India. Conducted by the Institute of Social Sciences, New Delhi (a research organisation working on contemporary social challenges), the study finds that half of all elected women panchayat members across the country have not heard of NRHM launched by the government in 2005 and that has since commanded a chunk of the Health budget. The programme is struggling for presence on the ground and there’s lack of convergence between the local health department and panchayati raj institutions, conceived as primary vehicles for the delivery of health goals under NRHM. The surveyors reached 400 elected women panchayat members across 19 states and found that half of them had heard of NRHM, but didn’t know the nature of services available under the same. The most disturbing finding relates to the absence of health facilities in villages with 43 per cent respondents saying there were no Primary Health Centres (PHCs) or community health centres in their gram panchayats or nearby areas and 50 per cent saying doctors didn’t visit even if the centres existed. Almost 47 per cent respondents complained of absence of paramedics at centres. In Haryana, the status of health facilities appears dismal. A whopping 87 per cent respondents said there were no PHCs in the village and an equal number said they didn’t know of NRHM; 66 per cent complained about lack of doctors at PHCs and 69 per cent said there was no paramedical staff. In Himachal, 43 per cent women panchayat members had not heard of the programme while a quarter said PHCs did not exist; 42 pc per cent doctors did not visit the centres. George Mathew, director of the surveying institute, said, “About 55 per cent respondents told us that doctors visited the health centres occasionally. Free medicines are a dream.” Free medicines are critical to NRHM’s success, but the government itself admits that only 21 states have a policy for free drug provision in PHCs. “Many states do not have the Essential Drug List,” Health Ministry’s agenda notes for the November 1 state health ministers’ meeting said. It added that NRHM convergence with panchayats was a challenge. The new study reflects these realities, with 45 per cent respondents saying no medicine was available at their PHCs. Another shocker was that 45 per cent respondents did not know anything about the standing committee on health, sanitation and nutrition in their panchayats. While 89 per cent knew about Accredited Social Health Activists (ASHAs), the cornerstone of NRHM, many knew nothing of their specific roles. Importantly, India has fewer ASHAs than the NRHM requires. The current shortage, as projected by the government, is 43,819 with Goa, Puducherry and Chandigarh having no ASHAs. The survey was conducted in Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Goa, Gujarat, Haryana, Himachal, J&K, Karnataka, MP, Maharashtra, Manipur, Odisha, Rajasthan, UP, Uttarakhand and West Bengal. Almost 78 per cent respondents were literate. Haryana, HP far behind A whopping 87 per cent respondents said there were no Primary Health Centres (PHCs) in the village and an equal number said they didn't know of NRHM 66 per cent complained about lack of doctors at PHCs and 69 per cent said there was no paramedical staff In Himachal, 43 per cent women panchayat members had not heard of the programme while a quarter said PHCs did not exist; 42 per cent doctors did not visit the centres