Articles

Changing moves: Missioning health in India

By on June 1, 2015

Arima Mishra is an associate professor at the school of development in Azim Premji University in Bangalore, India.

The public policy scenario in India has moved from a program mode to a “mission” mode. In the field of health, the year 2005 marked the beginning of this shift with the launch of the National Rural Health Mission. This is followed by a spate of related missions including the National Urban Health Mission, National Health Mission, National Nutrition Mission, National AYUSH Mission* and National Health Assurance Mission. What does this shift entail? Does missioning imply greater political priority for health? Does it allow reframing of health (beyond disease control programs for example)? Or does it indicate distinct mode of governance? More importantly, what does this mean to those who are at the helm of translating the mission objective through everyday implementation of its different components?

I had the opportunity to explore the last question with health system officials in one of the states in India as part of a larger study on health system strengthening within the National Rural Health Mission.  Three distinct ways of understanding the spirit of a mission emerge from my discussions with these officials. This shift is articulated, for example, as a “Mission implies a service mentality (in the line of Christian missionary). This would reorient the ways public sector officials implement programs and deliver care”.  The connotation of service orientation is evoked to reinstate greater accountability of the public health system.

The second mode of understanding the mission indicates decentralized ways of implementation of national policies. A district health official thus explains, “Missioning health like the National Rural Health Mission allows greater flexibility in how programs are implemented at local levels. This is what makes it different from the usual ways we were implementing national health programs earlier”.

The third articulation of a mission mode is the urgent need for concerted and serious efforts to address health priorities in a country. A sub-district official sums it up saying, “Mission evokes a sense of urgency. The National Rural Health Mission came into being to combat maternal and infant mortality. Millennium Development Goals can’t be achieved in any routine way”.

Though articulated differently, missioning health has meant to these officials going beyond ‘business as usual’ in prioritizing health problems, implementing health programs and delivering care.  One sincerely hopes that missioning health indeed reflects this spirit of beyond ‘business as usual’ to reframe health and development, reinstate health as a political priority in India and relook at efforts to ensure equitable access to ensure Health for All.  It is only then one can sing along Prime Minister Narendra Modi’s catch slogan ‘Ache din ayenge’ (Good days will come).

*AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) refers to the officially recognized traditional systems of medicine in India (along with Homeopathy).

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