Kala-azar and Japanese Encephalitis 12.2.17 Kala-azar and Japanese Encephalitis (JE) have emerged as major public health problems in recent years. For control of Kala- azar the twin approach of (i) vector control by insecticide spraying and (ii) case detection and treatment at PHC and referral hospitals was adopted. The reported cases and deaths due to JE in the affected States viz. Andhra Pradesh, West Bengal, U.P. Tamil Nadu and Assam have shown considerable decline during the Seventh Plan with the use of indigenously produced vaccine.
12.2.18 The existing guidelines for Vectorborne disease control include -
(i) Residual indoor spraying with appropriate insecticide in areas with population having API 2 and above in any of the last 3 years.
(ii) Spraying of BHC in districts reporting 100 or more cases of JE in any one of the years during the past decade.
(iii) DDT spraying in PHCs reporting 10 or more cases of Kala-azar in any one of the last three years.
(iv) Continuation of the anti-larval operations; and.
(v) Malathion fogging/ULV spraying to be undertaken as a contingency measure in out-break of JE and Malaria.
These conventional approaches of use of inceticides and chemicals would have to be supplemented or replaced, depending upon the local situation, by newer strategies such as biodegradable inceticides, biocides, bioenvironmental improvement and preventive measures like impregnated bed nets. Finally, the surveillance activities would need to be strenghened so as to improve case detection and case management,
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resulting in a break in the chain of infection/ transmission.
Leprosy Eradication 12.2.19 The approach under this 100% Centrally Sponsored Scheme has been early case detection and domiciliary treatment and health education. Multi Drugs Therapy (MDT) has been introduced in all 201 endemic districts and 41 low endemic districts (till March 1991) for case treatment. The programme has shown steady progress in achieving its objectives during the Seventh Plan.
12.2.20 Within the Leprosy Eradication Programme the following activities will be pursued
(i) Creation of additional physical facilities in all the endemic districts.
(ii) Extention of MDT to remaining endemic districts and in low endemic districts in phases.
(iii) Training of the PHC staff in leprosy eradication activities, both in endemic and low endemic districts, with the aim of preparing them to take over the responsibility of leprosy eradication activities following reduction in the prevalance and incidence of the disease.
(iv) Creation of vocational and rehabilitation facilities for the patients declared cured in those districts which have been under MDT for more than 5 years.
Tuberculosis Control 12.2.21 Early case detection and treatment have formed the strategy for control of Tuberculosis (TB) under a CSS with 50% Central funding. A major achievement of the programme during the Seventh Plan was the successful introduction of short course chemotherapy in 212 districts, thereby reducing the treatment duration from 18-24 months to 6-8 months. However, the programme has suffered from poor case holding leading to treatment default. Problem of drug resistance is yet an- other cause for concern.
12.2.22 During the Eighth Plan, the TB Control Programme will be further expanded and strengthened by opening District Tuberculosis Centres (DTCs) in those districts where these do not exist. Short course chemotherapy will also be introduced, and supply of drugs ensured, in all the remaining districts of the country under the Programme. The DTCs will be strengthened by providing necessary equipments like X-ray machines and maintaining essential supplies like drugs, X-ray films etc.
Blindness Control Programme 12.2.23 This programme which was launched in 1976 as a 100% CSS aims at reducing blindness prevalence from 1.4 % in 1980-81 to 0.3 % by 2000 AD. Cataract is the cause of more than 80% of blindness. Demographic shift leading to larger old age population has increased the prevalence of cataract in recent decades. So far the main strategy has been to provide access to opthalmic services through eye camps and mobile units. While this has suceeded to some extent, it has fallen short of the requirements. Besides the inherent limitation of the camp approach, the magnitude of the problem demands creation of permanent eye care infrastructure, operational throughout the year and within easy reach of the people.
12.2.24 These initiatives will be combined with an intensification of efforts aimed at ophthalmic manpower development with the ultimate objective of improving the outreach and quality of ophthalmic care at primary, intermediate and tertiary levels.
Guinea Worm Eradication 12.2.25 This programme was launched during 1983-84 with the objective of achieving zero incidence of guinea worm by 1990-91. Al- though the estimated number of cases has come down from 39,790 in 1983-84 to about 20,000 in 1990-91 the objective of "Zero Guinea worm" still remains unachieved. Total eradication of the disease through better surveillance system and improvement of drinking water supply in the endemic areas will be achieved during the Plan.
AIDS Control Programme 12.2.26 Acquired Immuno Deficiency Syndrome (AIDS) has emerged as a new public health problem in the country. The AIDS Control Programme was launched in 1986 as a
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Central Sector Scheme. Establishment of surveillance centres, testing of cases for infection, training of personnel and mass health education formed the main activities within the programme. But, the incidence of the disease has shown an increase from 137 seropositives among 41,000 tested up to May 1987 to 7272 seropositives among 13.49 lakhs persons tested by April 1,1992. Inadequate surveillance system and absence of facilities for examination of blood and blood products and the growing menace of intravenous drug abuse contributed to this upsurge in infection.
12.2.27 For the prevention and the control of AIDS a national programme will be launched during the Eighth Plan. The strategy to be adopted for AIDS control would comprise of -
i) Surveillance of the population with special emphasis on high risk behaviour groups for detection of infection;
ii) Strengthening of the blood banks and blood safety measures with priorities on special areas and metropolitan and large cities to start with;
iii) Area specific strategy for mounting control of infection and target specific IEC activities based on epidemiological data;
iv) Integration of the control programme with the activities of the departments like Social Welfare, Youth & Sports, etc. and other Government and non-government organisations; and
v) Strenghening of STD Programme and training of staff.
Diarrhoeal Disease 12.2.28 Diarrhoeal Disease Control Programme which was initiated during the Sixth Plan was strengthened and included as a part of maternal and child health activities in the Seventh Plan. Under the programme, a large number of professionals and paraprofessionals were trained for the programme implementation and support besides intensifying IEC efforts. Oral rehydration salt for prevention and treatment of dehydration was made available through the existing health infrastructure. Diarrhoeal diseases control would be continued during Eighth Plan as part of the child survival and safe motherhood programme.
Programme for Non-communicable Diseases Control 12.2.29 The increase in life expectancy and the changing life style of the people, have brought in the problem of non-communicable diseases which have added to the already heavy burden of morbidity and mortality due to communicable diseases in the country. Development of models of care and control programmes for non-communicable diseases, therefore, are no longer a luxury but an essentiality.
12.2.30 The strategies for the control of noncommunicable diseases have to be based on sound consideration of epidemiology and de- mography. They must be integrated with the existing health infrastructure to make them costeffective. Development of appropriate technology and its transfer to the general health services should be an important component of the strategy. Since the life style and high risk behaviour are important variables associated with the rising incidence of most of these diseases, they lend themselves to prevention by health education. Therefore, mobilising community health action through well structured IEC system including mass media will form an important intervention strategy for the control of non- communicable diseases. Development of appropriate learning resource materials for education and training of manpower will be an essential activity. The strategies for the control of specific non-communicable diseases will be as follows -
Cancer Control 122.2.31 Prevalance of cancer in the country is estimated to be 1.5 to 2.0 millions. The Cancer Control Programme, initiated during 1975- 76, was converted into a national programme in 1985 with the objective of i) primary prevention of tobacco- related cancer; ii) secondary prevention of cancer of uterine cervix; and iii) extension and strengthening of treatment facilities on a national scale. The last one was the focus of emphasis during the Seventh Plan.
12.2.32 During the Eighth Plan the diagnostic and treatment facilities for cancer would be further strengthened at the medical colleges and other major hospitals. Primary prevention , par
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ticularly for tobacco related cancer and uterine cervix cancer, will form the sheet anchor of the Cancer Control Programme. It will be carried through IEC activities and early case detection approach, mounted on the primary and secondary health care infrastructure and through mass media.
Iodine Deficiency Disorder 12.2.33 The National Goitre Control Programme which was operated during the Seventh Plan as a "Mission" programme, is a purely Central scheme under the Central health sector. According to the present estimates, about 45 million people suffer from goitre and another 6 to 8 millions from other iodine deficiency disorders. Universal iodization of salt and IEC activities are the main strategies of the programme.
12.2.34 Iodine Deficiency Disorder Control Programme would have continued thrust during the Eighth Plan. The basic approach of the programme being universal iodization of salt, proper coordination with major departments concerned with production and distribution of iodised salt namely, the Department of Industry and Railways, will be brought about . Iodized salt will be made available through the public distribution system. To prevent the losses of iodine in the salt due to long-distance transportation under adverse conditions, iodization of salt on small scales in the States far away from the present production centres will be considered and operationalised. Double fortification of the salt with iodine and iron will also be explored to combat the wide- spread problem of anaemnia.
Diabetes Control 12.2.35 The National Diabetes Control Programme was launched in 1987 as a Central Sector health programme in the districts of Salem and South Arcot in Tamil Nadu and Jammu & Kashmir on a pilot basis. The main thrust during the Seventh Plan was to develop an appropriate model for care and control of diabetes mellitus at the district level. The major objectives include (i) prevention of diabetes through identification of high risk subjects and early intervention; and (ii) early diagnosis , disease and institution of management so as to prevent diabetes associated morbidity and mortality.
12.2.36 The programme has been reviewed and would be further extended to cover additional districts in different states during the Eighth Plan. The experience gained in the pilot districts will be used to develop the programme as an integrated model for diabetes, hypertension and heart disease. The learning resource materials, both print and non-print, developed and validated in the pilot districts, will be used for the training of nurses and primary health care workers.
Accidents 12.2.37 For the treatment and rehabilitation of accident victims, accident and trauma services will be started in major cities and also, on pilot scale along some of the high traffic density national highways.
Mental Health Services 12.2.38 The Seventh Plan document had suggested initiation of a National Mental Health Programme with emphasis on community based approaches. However, due to fund constraints the programme has not made satisfactory progress.
12.2.39 During the Eighth Plan mental health services will be given priority. The strategies for mental health programme will be community based utilising the existing primary health care and district hospital services. A psychiatric centre in each of the districts/divisions will be established. Also, every medical college will be encouraged to start a separate Department of Psychiatry so that the required manpower, both medical and paramedical, can be trained.
Other Non-communicable Diseases Control Programmes 12.2.40 The programme for control of other non-communicable diseases will also be taken up on pilot basis. Resource constraints will not be allowed to come in the way of developing experience and appropriate technology for implementation of the control programme at a later date.
Medical Research 12.2.41 The Indian Council of Medical Research (ICMR) is the premier institution which is responsible for carrying out biomedical and operational research in India. Important achievements of the ICMR during previous plans include: demonstration of improved vec-
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tor control using bio-environmental techniques for control of malaria and filaria; establishment of National Cancer Registry; multi drug therapy and short course chemo therapy for leprosy and TB respectively and a national surveillance system for AIDS infection. Various other institutions under the Ministry of Health & Family Welfare and medical colleges have done notable work in the field of medical research.
12.2.42 Research and Development activities by Indian Council of Medical Research and other academic institutions will be pursued during the Eighth Plan through the following strategies-
i) Establishmnet of an integrated Bio-medical Research Complex to strengthen research activities and to optimise the utilisation of the available resources and facilities.
ii) Promotion of excellence by rationalising grants to promising scientists in medical colleges and strengthening of extramural centres for research under eminent scientific leadership.
iii) Establishment of a network of research units in medical colleges for multi-centric studies.
iv) Optimal utilisation of resources through coordination and development of proper linkages with sister agencies, commercial utilisation of research findings, constant review of the status of application of research findings by user agencies, continuing interaction with State authorities to determine area specific research needs, and through providing proper guidance and assistance as well as strengthening of research activities under the State Councils of Medical Research.
v) Development of a Centre for Epidemiological Intelligence.
vi) Augmentation of research activities in specific priority areas viz., integrated Vector Control Programme for Malaria, Filaria and Japanese Encephalitis, integrated control of non- communicable diseases and development of vaccines for communicable diseases as well as fertility regulation.
vii) Enhancement of Research and Development on Family Planning and Maternal & Child Health.
viii) Collaboration with international agencies for transfer of appropriate technology to the Indian scientists.
Indian Systems of Medicine and Homoeopathy 12.2.43 Teaching and training programmes in ISM & H were promoted during the Seventh Plan. Clinical research on drugs of various systems, collection, cultivation and propagation of medicinal plants and standardisation of drugs were encouraged. The Central Councils dealing with these systems of medicine have been strengthened to provide support for training and research in their respective area.
12.2.44 The National Health Policy assigned an important role to ISM&H in the delivery of health services. There are about 5.25 lakhs institutionally trained practitioners of ISM & H. These practitioners are close to the community not only in geographical proximity but also in terms of cultural and social ethos and as such they can play significant role in primary health care delivery. The strategy for utilisation of ISM&H for health care delivery during the Eighth Plan would comprise of the following -
i) There are more than 200 colleges of ISM & H. One of the important tasks during the Eighth Plan would be to provide adequate facilities for training in these colleges so that the graduates emerging from these acquire the desired level of knowledge and skill necessary for patient care. Postgraduate training programmes also require strengthening for the purpose of manpower development for teaching and research in ISM & H.
ii) To integrate the practitioners of ISM & H in the mainstream of health care delivery system, the graduate curriculum of these systems will be suitably oriented to make them conversant with the national health problems, policies and programmes. Refresher courses will also be organised for the inservice practitioners of ISM & H towards the same objective.
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iii) There are more than 5000 pharmaceutical units, engaged in the production of drugs of these systems of medicine. Suitable steps will be taken to enforce the provisions of Drugs & Cosmetics Act to maintain the quality of products of ISM & H produced in the country.