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model becomes of paramount importance.
vi) The targetted reduction in the birth rate will he the basis of designing, implementing and monitoring the programme against the current method of couple protection rate. While broad guidelines may be prepared by the Centre, suitable parameters would be designed by the individual States for this purpose. Identification and registration of eligible couples, enforcement of civil registration scheme, registration of mothers and children for child survival and safe motherhood activities are areas requiring special monitoring.
vii) The outreach and quality of family welfare services will be improved. For this, the health services infrastructure will have to be made fully operational and efficient. This would involve -
(a)completion of infrastructural facilities initiated during the earlier plans like buildings for sub-centres, PHCs, CHCs, etc., and installation of necessary equipments;
(b) ensuring placement of adequate number of welltrained workers specially at the grassroot level;
(c) providing mobility to workers, specially the peripheral ones; and
(d) ensuring adequate drugs and other essential supplies at the Sub-centre and PHC by suitably increasing the funds for this purpose.
Viii) The entire chain of CHC, PHC and Subcentres will be equipped to deliver general health and MCH services in an integrated manner with a strong referral support and linkage at the District level. For this, facilities for services for mothers and children including reservation of beds for them at different levels will be ensured. Setting up of Regional Maternal and Child Health Institutes will be part of the strengthening process of MCH infrastructure.
ix) Child survival and safe motherhood initiatives will be vigorously pursued. These initiatives will include (a) strengthening of Universal Immunisation Programme, (b) greater emphasis on Diarrhoea Control Programme and effective implementation of ORT programme, (c) Acute Respiratory Infections Control Programme, (d) Anaemia Management Programme and not just Anaemia prophylaxis, (e) Safe Motherhood Programme with high risk pregnancy approach and (f) intensified effort for training of birth attendants.
x) Any system is as good as the people who operate it. Therefore, major emphasis will be laid on health manpower planning along with a review of the education and training programmes of all categories of health care providers. Training will not only aim at providing requisite knowledge and skill, but also ensure development of such behavioural attributes that will be conducive to a closer interaction with the community. The methodology, the logistics and the content of training programme will be continuously reviewed. Special programmes would be chalked out for imparting preservice and inservice training in programme management and IEC activities. To meet the training needs, various training institutions will be strengthened or new ones established, by providing ade- quate funds, staff, equipments and mobility.
xi) The entire package of incentives and awards will be restructured to make it more purposeful. Individual cash incentives have not made any impact and hence will be phased out. The payment of compensation to the acceptors for the wages lost due to hospitalisation, etc., will be left to the discretion of the States, thus providing flexibility in approach to suit the local requirements. Community incentives in the form of priority consideration under IRDP programmes, e.g., opening of schools, provision of drinking water facili- ties, linkage by roads, etc., will be built up in the programme. The possibilities of introducing certain disincentives to the non-adoptors of family planning will also
336
be explored and introduced with due regard to the freedom and the fundamental rights of the people. The performance of the States in this vital sector of human and national concern will be recognised through additional resource allocation as a part of Central Plan assistance to those States which show better performance in terms of pre-determined demographic parameters.
xii) There is an urgent need to secure involvement and commitment of practitioners of all systems of medicine in the Population Control Programme. The practitioners of Indian System of Medicine and Homoeopathy, whose number is estimated to be more than half a million and who are the closest to the community both in terms of place of practice and the socio-cultural milieu of the community will be involved in the programme by -
a) providing well structured educational modules of instructions and training in population dynamics and family planning at the undergraduate level;
b) providing short-term re-orientation courses to the practising doctors;
c) providing incentives and recognition for exhibiting initiative and leadership in population control activities; and
d) promoting a sense of comraderie between these practitioners and the grassroot functionaries of the health and family welfare programme with a view to synergising and potentiating their mutual input. A similar approach is also needed to strengthen and secure deeper involvement of practitioners of modern system of medicine. Organisations such as Indian Medical Association (IMA) will be involved in a greater measure in this national task.
xiii) The role of voluntary Organisation in a mass movement such as population control is critical for generation of momentum and accelerating the pace of progress. There is a need to incorporate family planning as a major objective of all voluntary organisation concerned with health and/or education - related activities. Substantially increassed amount of funds will be channelised through these agencies during the Eighth Plan. The establishment of an Organisation to develop networking between all such voluntary organisations committed to the promotion of nail, efforts in this important area of human endeavour will be considered.
xiv) As an extrapolation of the concept of untary organisations, is the role and place of organised corporate sector which covers approximately 20 millions workers and their families.Effective methods will be evolved to get the organise sector involved in the implementation of family well. programme.
xv) Special efforts will be made to involve community in the Family Planning Programme. The strategy will he to prepare the community to accept the responsiblity the ownership and the control of the programme fully in the long run. Panchayat youth clubs, village committees Nehru Yuvak Kendras, women organisations etc., can play an important role in community motivation, Organisation of camps contraceptive distribution. Grassroot level functionaries, e.g., village dais, Village Health Guides (VHGs), Auxiliary Nurse Midwives (ANMs), Anganwadi workers village extension workers, primary school teachers, Gram Panchayat stall play a facilitatory and supportive role to the community organisations for generating the necessary momentum for population control movement by the people. The village level local functionary will be the kingpin of these new initiatives.
xvi) The village/neighbourhood tea shops. shops, public distribution system pharmacies, cooperatives, etc. will be utilised for community based contraceptive sale and distribution.
xvii) The social marketing programme, which was originally launched for Nirodh distri-
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bution has demonstrated the, significance and importance of involvement of the corporate sector to achieve Me family planning objectives. This programme will be ex- tended to the social marketing of oral pills as well as for market research mid educational activities for which the Corporate Sector possesses special skill and sensitivity.
xviii) Information, Education and Communication, which are critical inputs will be further strengthened and expanded. The IEC activities of the health and the family welfare sector will be integrated. Greater use of the mass media will be made to disseminate the message of family planning to the remotest corner of the country. The entire system of pricing the media time vis-a-vis its social responsibility has to be given a fresh look, different from the commercial angle. Area specific IEC material will be developed and produced. At the viewers' level, efforts will be made to pool resources of various social sectors and to provide community TV/radio sets, besides maintaining them. The backbone of the IEC efforts will, however, remain the inter-personal communication for which the grassroot level female worker will have to be trained and effectively utilised.
xix) A new thrust in the research and development of methods aimed at regulation of fertility in the male, and of vaccines for fertility regulation, both in the male and female, will be given. Fertility regulation practices such as the use of special herbs by the community particularly in the tribal areas, will also he subjected to research. While intensification of biomedical research is necessary, research in social and behavioural sciences to explore the human dimensions is vital. Health systems research to optimise operational framework, to improve the efficiency and effectiveness of the service provided and to evolve cost-effective interventions in various areas of family planning operation, will be given high priority.
xx) A continuous monitoring, review and evaluation is an essential component for the successful implementation of the programme. Development and strengthening of health management information system, with district and sub- district data bases of health and demographic parameters and linkages aimed at concurrent evaluation of family planning programme will be developed. This will provide critical inputs at the district and sub- district level and the much needed data for area- specific planning and time-bound implementation.
xxi) The family planning programme has a multi-sectoral dimension. For the purpose of effective intersectoral coordination and to provide the programme appropriate focus and priority, a proper institutional setup with the backing of the highest political and administrative authority is an essential requirement. The recommendations of the Committee on Population, constituted by the NDC, will be implemented.
12.5.4 To sum up, the base and the basis of the population control programme during the Eighth Plan will be decentralised, area-specific microplanning, within the general directional framework of a national policy aimed at generating a people's movement with the total and committed involvement of community leaders, irrespective of their denominational affiliations and, linking population control with the programmes of female literacy, women's employment, social security, access to health services and mother and child care.
Outlays 12.5.5 The total outlay for the Central Health Sector is Rs. 1800 crores. The outlays for the Central, States and Union Territories Plans under the Health Sector are shown in Annexures 12.4 and 12.5.
12.5.6 The outlays for the Family Welfare Programme are Rs.6500 crores. Details are given in Annexure 12.6.
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Annexure 12.1
Progres of Establishment-Minimum Need Programme
No.as 7th Plan No.as 1990-91 1991-92 Likely 8th Plan 1992-93
Scheme on ------------ on Act Anti. No. as Target Target
1.4.85 Target Achi
evem 1.4.90 Ach.Achievem 1.4.92(1992-97)
ent ent
1 2 3 4 5 6 7 8 9 10
1. Sub
-Centres 84263 54612 46937 131200 515 5968 137683 17030 4066
2 P.H.Cs* 9134 12392 10115 19249 1315 1241 21805 4450 759
3 C.H.Cs 813 1523 1261 2074 162 313 2549 1269 259
* : Excluding Subsidiary Health Centres, Mini Health Centres etc.
Source Working Group Discussions for Annual Plan 1992-93, Planning
Commission.
Annexure 12.2
Construction of Buildings for Sub-centres, PHCs & CHCs
Sl. Health Institution Number No.of Bldg. No.of Bldg. No.of Bldg. Col. 6 as
No. Functio
ning constructed under yet to be percentage
functioning constru
ction constructed of Col. 3
in Govt. /
Panchayat
Bldg.
1. 2 3 4 5 6 7
1. Sub-centres 131385 52267 7906 71212 54.2
2. Primary Health Centres 22328 12685 1371 8272 37.0
3. Community Health Centres 1955 1206 271 478 24.5
Source : Bulletin on Rural Haelth Statistics in India - December 1991 issued by the
Directorate General of Health Services , Ministry of Health and Family Welfare , New
Delhi.
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Annexure 12.3
Health Manpower Working in Rural Areas
Sl. Category Sanctioned Number in Vacant Posts Col.5 as
No. Posts position perce
ntage
of col.3
1 2 3 4 5 6
1.Specialists in
Rural Areas 3523 2481 1042 29.6
2.Doctors at Prim-
ary Health 25671 22078 3593 14.0
Centres
3 Block Extension
Educators 6068 5513 555 9.2
4.Health Assistants
(Male) 24850 23266 1584 6.4
5.Health Assistants
(Female) 25726 22999* 2794 10.9
/LHVs
6.Health Workers
(Male) 88182 80701 7481 8.5
7.Health Workers
(Female)/ANMs 130941 119906 11035 8.4
8.Pharmcists 19225 17702 1523 7.9
9. Radiographers 667 518 149 22.3
10.Lab. Technicians 10516 8744 1772 16.9
Source : Bulletin on Rural Health Statistics in India - December 1991
issued by the Directorate General of Health Services , Ministry of
Health and Family Welfare , New Delhi.
*Includes 67 posts in position in J & K for which corresponding
sanctioned posts are not indicated.
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Annexure 12.4
Eighth Plan Outlay - Health Sector
(Rs. Crores)
Sl. Programme States/UTs Centrally Central Total
No. Sponsored Schemes
Programmes
1 2 3 4 5 6
1.Minimum Needs Prog-
ramme/Rural Health 2250.38 - 1.00 2251.38
2.Control of Communi-
cable Diseases 1031.00 14.75
3.Hospitals and Dispe-
nsaries - 94.00
4.Control/ Containment
of Non-communicable - 85.00
Diseases
5.Medical Education
and Training 3525.54 - 267.00 5324.54
6.lCMR - 124.50
7.Indian System of
Medicine and Homeopathy 5.00 83.00
8. E. S. I. - -
9.Other Programmes 20.00 74.75
Total 5775.92 1056.00 744.00 7575.92