iv) Research and Development for the production and standardisation of drugs of ISM & H will be supported during the Plan. The existing research institutions will be strengthened for this purpose.
v) The cultivation, conservation and regeneration of medicinal plants will be, supported in State/joint sector farms. There is great potential for internal sale and export of these plants, herbs and formulations.
vi) Separate departments, directorates and drug control organisations at the Central and Rate Government level will be established, wherever they are not existing currently.
vii) Central Councils for Research in ISM & H would continue to receive support during the Plan so that they can discharge their responsibilities efficiently.
Family Welfare Programme 12.3.1 High growth rate of the population continues to be one of the major problems facing the country. Although the 1991 Census recorded a marginal decline in the annual growth rate of population from 2.22% in 1971-81 to 2.11% in 1981-91 this would still mean an addition of 18 million people to the country's population annually.
12.3.2 The fast rate of population growth means that the economy has to grow faster to protect the already low level of per capita availability of food, clothing, housing, employment and social services.
12.3.3 The country is committed to social and economic justice to the millions of people living under conditions of poverty and deprivation. Failure to do so within a reasonable time-frame may generate social tensions and unrest. Besides this, the environmental degradation which is associated with unchecked growth of population carries the inherent risk of natural calamities and disasters.
12.3.4 In this context, population control assumes an overriding importance in the Eighth Plan.
Review of the Performance 12.4.1 The basic premises of the Family Welfare Programme till now have been -
i) Acceptance of the family welfare is voluntary.
ii) The Government's role is to create an environment for the people to adopt small family norm. This is done by spreading awareness, information and education by ensuring easy and convenient availability of family planning aids and services and by giving incentives for adopting family planning.
iii) The programme, which is a 100% Centrally Sponsored Scheme has integrated family planning and Mother and Child Health (MCH) services and is being implemented through countrywide network of primary health centres and supporting institutions.
12.4.2 In spite of massive efforts in the form of budgetary support and infrastructure development, the performance of family welfare programme has not been commensurate with the inputs. Right from the beginning the achievement of the set goals has been unsatisfactory,resulting in the resetting of targets, as indicated in Table12.1.
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Table 12.1
Year Specified Year by Actual
demo- which the achieve-
graphic goal was ment
bjective to be
(CBR)* achieved
1962 25 1973 34.6
1966 25 as expeditiously
1968 23 1978/79 33.3
1969 32 1974/75 34.5
Beginning of Plan 25 1979/81 33.8
1974 30 1979 33.7
Beginning of Plan 25 1984 33.8
April 1976 30 1978/79 33.3
I. Population 25 1983/84 33.7
(reduce the gap)
April 1977 30 1978/79 33.3
II.Population 25 1983/84 33.7
Policy
January 1978
Central Coucil of 30 1982/83 33.8
Health
National Health 31 1985 32.9
Policy 27 1990 29.9
21 2000
Seventh Plan 29.1 1990 29.9
Eighth Plan 26.0 1997
*CBR: Crude Birth Rate
Seventh Plan Performance
12.4.3 With the long-term objective of achieving the Net Reproduction Rate (NRR) of unity, the Seventh Plan had set the following demographic goals -
Seventh Current Status
Plan Target
Couple Protection 42.0% 44.1 (31.3.91)
Rate(C.P.R.)
Crude Birth Rate (BR) 29.1 29.9 (1990)*
Crude Death Rate 10.4 9.6 (1990)*
(DR)
Infant Mortality Rate 90 80 (1990)*
(IMR)
* Provisional (SRS Data)
While the Seventh Plan targets of achieving CPR of 42% was achieved, this was not matched by a commensurate decline in the birth rate, possibly because of improper selection of the cases.
12.4.4 The performance in terms of various methods of couple protection were not uniform. While the targets for Intra Uterine Device (IUD) were fully achieved and those for oral contraceptives and conventional contraceptives were exceeded, the targets for sterilisation operations fell short by about a quarter. The targets and performance of the Seventh Plan and the yearwise break up of performance are given in Tables 12.2 and 12.3.
12.4.5 State-wise analysis of performance of the programme reveals that Punjab, Kerala, Ma-
Table 12.2 Target and Performance of the Seventh Plan
(in million)
Target Achievement %Achievement Remarks
----------------------------------------------
1.Sterilisation 31.00 23.70 76.50 There is shortfall of 7.30
million sterilisations.
2. I. U. D. 21.25 21.28 100.14 Targets fully achieved.
3. CC & OP Users*14.50 15.94 109.93 Achievement exceds the
targets
*Indicates terminal year targets and achievement.
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Table 12.3 Yearwise Performance of the Seventh Plan
(Nos. in million)
1985-86 1986-87 1987-88 1988-89 1989-90
Sterilisa-
tion 4.9 5.0 4.9 4.7 4.2
(88) (84) (82) (87) (76)
IUD 3.3 3.9 4.4 4.8 4.9
(101) (105) (103) (97) (93)
CC & OPUsers 10.7 11.6 13.4 14.3 15.9
(103) (100) (104) (94) (99)
Note: The fires within brackets indicate percentage achievement.
harastra and Tamil Nadu have performed very well in achieving the targets while Assam, U.P., M.P., Bihar, Rajasthan and some North- Eastern States have performed poorly.
12.4.6 Under the Maternal and Child Health Programme, which is an integral part of family planning programme, targets for reducing Infant Mortality Rate to 90 per thousand live births and for reducing maternal mortality were fixed for the Seventh Plan. The Universal Immunisation Programme (UIP) launched in 1985 with the objective of providing universal coverage of immunisation to pregnant mothers and infants was a major initiative in this direction. Although all the districts in the country have been brought under UIP, the targets for immunisation could not be fully met due to problems of cold chain facilities, inadequate trained manpower, logistic problems, etc. Other programmes aimed at women and children viz., control of diarrhoeal diseases among the children, prophylaxis against anaemia and Vitamin A supplementation for prevention of nutritional blindness achieved varying degrees of success. Nevertheless these efforts were able to achieve a substatial reduction in IMR from 97 per thousand liVe births in 1985 to 80 in 1990.
Constraints 12.4.7 Containment of population growth is not merely a function of couple protection or contraception but is directly correlated with female literacy, age at marriage of the girls, status of women in the community, IMR, quality and outreach of health and family planning services and other socioeconomic parametrers. Table 12.4 illustrates this.
12.4.8 The Family Welfare Programme has essentially remained a uni- sector programme of the Ministry of Health and Family Welfare. It has yet to be recognised as a major national concern drawing priority attention and concommitant strong political, social and administration, commitment for the purpose of making it a significant part of our economic development strategy. A national consensus and strong public opinion in its favour, cutting across political, ethnic, religious and geographical boundaries, is as yet lacking.
12.4.9 The family welfare programme has also) suffered on account of centralised planning and target setting from the top. Regional variations and diversities have not been generally taken into consideration, with the result that similar set of approaches and policies and target have been applied in States like UP, MP, Bihar and Rajasthan where the health infrastructure is weak and related social inputs are lacking and also for the States like Haryana and Andhra Pradesh where factors other than development of intrastructure contributed to poor performance. Monitoring mechanism under the programme has been reduced to a routine target reporting exercise incapable of identifying roadblocks and applying timely correctives.
12.4.10 Both pre-service and in-service training of programme personnel is poor because of lack, of due emphasis at all levels on training pro-
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Table 12.4 Selected Indicators
States CBR IMR Female lit- Female age People
(1990) (1990) eracy rate at marria- below
(1991) ge(1981) poverty line
in years (1987-88) %
Bihar 32.9 75 23.1 16.5 40.8
Kerala 19.0 17 86.9 21.8 17.0
M.P. 36.9 111 28.4 16.5 36.7
Maharashtra 27.5 58 50.5 18.8 29.2
Rajasthan 33.1 83 20.8 16.1 24.4
Tamil Nadu 22.4 67 52.3 20.3 32.8
U. P. 35.7 98 26.0 17.8 35.1
grammes for family welfare. Absence of proper training, education and motivation of the programme personnel including supervisory staff has led to an ineffective, insensitive implementation of the programme.
12.4.11 The programme has remained a Government programme, the community's active involvement and participation being marginal. Due to inadequacy of Information, Education and Communication (IEC) activities the knowledge of the community about the contraceptives, their availability, safety, etc. are at a low level. Adoption of the small family norm and use of appropriate measures for birth control are matters of personal choice and decision. The IEC activities have to take this into account. However, till recently, the IEC activities have been directed more to national issues rather than personal issues. Undoubtedly, this incongruity of perception between the people and the providers of services has cost the programe dearly.
12.4.12 Family Planning Programme is being run as a 100% Centrally Sponsored Scheme. The entire outlay is included in,the Plan with the result that a major portion (60-70%) of the outlay goes for meeting the expenditure of maintenance nature, leaving very little resources for further expansion, and strengthening of the programme or for any new initiatives. Further, the entire expenditure is borne by the Centre, although the implementing agency is the States Government.
12.4.13 Lot of incentives and awards have been built into the programme. The incentives and awards have not been unequivocally shown to be very effective in the promotion of small family norms. On the other hand , defects such as over-reporting, low quality acceptors and neglect of non-terminal methods of contraception and MCH activities have often been observed to creep into the programme. The element of disincentives is also missing from in programme.
12.4.14 The efforts for the containment of population growth have to be intensified simultaneously on several fronts. This calls for an integrated approach and concerted efforts through both the government and the non- government organisations, besides social and political commitment to make it a national movement.
Strategy for the Eighth Plan 12.5.1 Containing population growth has been accepted by the Government as one of the six most important objectives of the Eighth Plan, with the aim of reducing the birth rate from 29.9 per thousand in 1990 to 26 per thousand by 1997. The IMR will also be brought down from 80 per thousand live births in 1990 to 70 by 1997.
12.5.2 To give a major thrust in this priority area, which constitutes the pivotal point for the success of all developmental efforts, a National
334
Population Policy needs to be enunciated and adopted by the Parliament. Given the political commitment at all levels, it must generate a cascading effect to become a people's movements. Social determinants scuh as female litieracy, age at marriage, employment oportunities for women, and their status in society are as important as achieving a reduction in infant mortality, improving health and nutrition of pre-school child and providing a comprehensive package of maternal health care services. Such an inter-sectoral interaction, supported by political commitment and a popular mass movement, will constitute the approach to strategic interventions during the plan period. A Committee of the National Development Council(NDC) on Population has been constituted in February, 1992 to consider these issues and based on its report, a concrete plan of action will be worked out.
12.5.3 Within the above mentioned broad guidelines, which have been enunciated in the Eighth Plan Directional Paper already accepted by the NDC the following strategies will be adopted for achieving the goals of family welfare during the Eighth Plan.
i) Convergence of services provided by various social services sectors, e.g., welfare, human resource development, nutrition, etc. Based on a holistic approach to social deVelopment and population control, integrated programmes for raising female literacy, female employment, status of women, nutrition and reduction of infant and maternal mortality will be evolved and implemented. The strategy will he (a) to pool the existing resources available for individual and fragmented schemes on these activities and provide additional resources required; (b) to restructure, re- design and integrate these under a common .umbrella; and (c) to evolve proper mechanisms for planning, implementing, and monitoring those programmes at various levels.
ii) Decentralised planning and implementation will be another strategy. Although there are likely to be commonalities of approach in the general contours of population policy, it is critical that the programme content relates to area-specific planning at the district, the sub-district and. the panchayat level based on critical and indepth dissegregated analysis of a constellation of sociobiological indices and demographic determinants. Area specific strategies would men flexibility of approach and fund utilisation. Targets, if any, will be determined, fixed and monitoried at the district level and the process will be from below upwards.
iii) As a natural corrolary to decentralised planning and implementation, Panchayati Raj institutions like Gram Parichayat and Zila Parishads, etc., will have to play significant role in planning, implementing and administering the programme. The role of the Centre will be limited to general policy planning and coordination, providing technological inputs where required, safeguarding, critical areas and taking innovative leads.
iv) With greater involvement of the people in the population control and family planning programmes through the panchyati Raj System as envisaged in the Constitution (Seventy-Second Amendment) Bill 1991, the programme will become one of "people's operation with government cooperation". The health planners and administrators must not only become sensitive and responsive to the felt needs of the people but must also adapt to the instrumentality of local self-government.
v) The younger couples, who are reproductively most active will be the focus of attention, with necessarily a greater emphasis on spacing methods, although the terminal methods would continue to remain the important means of birth control. Medical Termination of Pregnancy (MTP) will have to play an important role in the entire scheme of family planning in the Eighth Plan. The coming generation will have to be, therefore, prepared well to accept the small family as a social responsibility. Population education and family life education need to be made a part of general education in which school teachers' role, both as an educator as well as a role