A/HRC/14/20/Add.2 and Maharashtra 9–10. At the central and state levels, this will mean the appointment in India of about 110 maternal health technical officers with no other responsibilities. Those officers should have a background in public health, obstetrics, midwifery or related fields and should be provided with adequate administrative support. Working within an agreed framework, the officers should have the authority to plan, implement and monitor maternal health programmes without having to go back repeatedly to non-technical officers for approvals. At the national and state levels, there should be maternal health technical advisory committees to provide expert advice to the technical officers. Planning Commissions, the National Institute of Health and Family Welfare, and international organizations should also strengthen their maternal health expertise. 34. Taking into account resource availability, India is in breach of its right-to-health obligations because it falls far short of having a sufficient number of technical senior managers. 3. Accessibility 35. Whether or not India has a sufficient number of maternal health workers with the necessary competencies, are they accessible on an equitable basis? For example, are they equitably distributed throughout the country and affordable to all? Inequitable access: systemic disadvantage 36. Access is profoundly inequitable in India’s health system. The Government recognizes this unacceptable state of affairs. For example, after listing some of the chronic conditions afflicting the population, the NRHM emphasizes that the “large disparity across India places the burden of these conditions mostly on the poor, and on women, scheduled castes and tribes especially those who live in the rural areas of the country. The inequity is also reflected in the skewed [distribution] of public resources between the advanced and less developed states”. 21 Of course, this systemic disadvantage is reflected in maternal health indicators, for example, illiterate mothers and women from the lowest wealth quintile have reduced access to basic maternal health care.22 To their credit, the authorities have developed numerous strategies, policies and plans, and invested considerable resources, to put the situation right. Many of these initiatives, not least the NRHM, are impressive and highly commendable, suggesting that the Government of India takes seriously its commitment and obligation to enhance access for all. 37. The following paragraphs provide a few comments on some of these initiatives, signal some problems and outline steps that should be taken. Providers of emergency obstetric care: delegation or task-sharing23 38. The Government estimates that 6,000 doctors are needed to provide 24-hour comprehensive EmOC in the 2,000 rural first referral units scheduled to become operational by 2010. However, in 1999 there were only approximately 800 obstetricians in government service capable of performing caesarean delivery (one of the functions of comprehensive EmOC) at rural first referral units. Recognizing that there are around 25,000 general practitioners (or medical officers) in rural areas, the Government, with the Federation of 21 22 23 10 India, National Rural Health Mission, para. 1. K.S. Vora and others, “Maternal health situation in India: a case study”, Working Paper No. 2008-0302 (Ahmedabad, IIMA, 2008), pp. 8 and 9. This section draws extensively from Evans and others, “Where there is no obstetrician – increasing capacity for emergency obstetric care in rural India”, International Journal of Gynecology and Obstetrics, vol. 107, No. 3 (December 2009). GE.10-12866