HEALTH AND FAMILY WELFARE
11.1 Human resources are a country's most precious endowment. The success of a Plan depends on the extent to which human resources are developed in terms of education, skills, health and well-being. India is a signatory to the Alma Ata Declaration (1978), whereby it is committed to achieving "Health For All by 2000 AD". The programmes initiated and executed over the last three decades have strengthened the health care system in the country and yielded considerable dividends, particularly in the field of communicable diseases. Measures have been initiated to correct the regional imbalances prevalent within the system, to improve referral services and to augment health-care services in the rural areas through the Minimum Needs Programme (MNP).
11.2 Life expectancy at birth has gone up from 27.4 years from the 1941-51 decade to an estimated 54.71 years in 1985-86, while the infant mortality rate has come down from 146 per thousand live births during the fifties to 110 in 1981. The health infrastructure has been strengthened considerably. The country has presently about 83,000 sub-centres, 11,000 primary and subsidiary health centres and 650 community health centres. This infrastructure is supported by curative and specialist care facilities provided by the sub- divisional/tehsil/district and teaching hospitals, and the regional and national institutes.
11.3 The per capita expenditure on health incurred by the State has gone up from about Rs. 1.50 in 1955-56 to Rs. 27.86 in 1981-82. Plague and smallpox have been eradicated. Mortality from cholera and related diseases has decreased. The modified plan of operation initiated in 1976 under the National Malaria Eradication Programme (NMEP) brought the disease under control to a considerable extent though of late there has been seen some resurgence in its incidence. Significant indigenous capacity has been established for the production of drugs and pharmaceuticals, vaccines, sera and hospital and other equipment.
REVIEW OF HEALTH PROGRAMMES IN THE SIXTH PLAN 11.4 One of the most significant things that happened during the Sixth Plan was the adoption of the National Health Policy by both Houses of Parliament. Health Care Programmes were restructured and reoriented towards this policy. Priority was given to extension and expansion of the rural health infrastructure through a network of community health centres, primary health centres and sub-centres, on a liberalised population norm. Efforts were made to develop promotive and preventive services, alongwith curative facilities. High priority was given to the development of primary health care located as close to the people as possible.
Minimum Needs Programme 11.5 Under the minimum needs programme, population norms have been revised to one sub-centre for 5,000 population, one primary health centre for 30,000 and one community health centre with four basic specialities for a population coverage of 100,000. In some States, particularly in the north-eastern region, a relatively liberalised norm was necessary in view of their dispersed population and difficult terrain. Priority has been accorded to stepping up training capacity of auxiliary nurse midwives (ANMs) and other para- medicals, keeping in view the manpower requirements.
11.6 The targets set, the likely achievements and the position emerging in the last year of the Sixth Five-year Plan are given in Table 11.1
TABLE 11.1
Progress in Rural Health Inrastructure-Sixth Plan (1980-85)
Sl. Programme Number in Sixth Plan Likely Likely
No. 1979-80 Target achivement cumulative
(additional) during end
1980-85 1984-85
1 2 3 4 5 6
1. Sub-Centres 47517 40000 35509 83026
2. Printry Health Centre
including subsidiary
Health Centres 7399 1600 3702 11101
3. Community Health Centres 249 174 400 649
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11.7 Shortage of construction materials like cement and steel and
in some States shortage of trained doctors, nurses, ANMs and other
para-medicals were impediments in the achievement of the targets. To
overcome these, the intake of ANMs for training was increased and sub-
centres established in public or rented buildings. Full financial
assistance was provided to the States to train para-medical personnel.
Multi-purpose workers' Training
11.8 The training of uni-purpose health workers into multipurpose
functionaries has not progressed satsifactorily. This programme is
the mainstay of the rural health services, which ensures an integrated
approach to the delivery of health and family welfare services for the
rural population. Lack of rationalisation of the pay scales of the
multi-purpose functionaries by the States has been a serious
impediment to the successful progress of the Scheme. Population norms
for the posting of multipurpose workers have not been generally
followed. The training programmes of uni-purpose health workers sche-
duled for completion by 1984-85 are likely to spill over into the
first year of the Seventh Plan in many States.
Control of Communicable Diseases
11.9 Malaria: After its resurgence, a modified plan of operation
was introduced in 1976 to effectively control malaria. The incidence
of malaria, which stood at 75 million cases in 1954 had, by the end of
the Sixth Plan come down to less than 2 million cases. The number of
deaths also came down steeply from the initially estimated level of
750,000 due to direct causes and another 750,000 due to indirect
causes, to a few hundred. The incidence of malaria has increased in
some States, mainly in Orissa, Gujarat, Tamil Nadu. Higher incidence
of P. falciparum infection was noticed in many new areas. Lack of
adherence to scheduled spraying operations on scientific lines,
management failures, biological resistance of vectors and parasites,
and inadequate provision of resources are some of the underlying
reasons for the resurgence of the disease in the late 60's and early
70's.
11.10 Leprosy: The National Leprosy Control Programme has been
further augmented and converted into a National Leprosy Eradication
Programme, based on the strategies and policies formulated by a high
level committee 350 million people living in areas of the country
where the disease is endemic have been covered under the programme. A
total of 3 million cases are under active treatment against an
estimated 4 million leprosy affected patients. The Sixth Plan target
of 90 per cent case detection could not thus be fully achieved.
11.11 Tuberculosis: Tuberculosis continues to be a major
health problem. Control operations against this disease were
augmented considerably by ensuring the required quantities of quality
anti-TB drugs and equipment. The programme to detect and bring under
treatment new TB cases was stepped up Examination of sputum at the
Primary Health Centre level is being pursued with vigour, on a target
oriented basis. This is backed by a network of 358 district TB
Centres, 300 TB clinics and 45,000 TB beds in the country. The
programme has picked up considerably. Far greater efforts are still
needed to control the disease. The VIth Plan target to raise the
number of cases detected from 30 per cent to 50 per cent has been
partially realised.
11.12 Blindness control: Ophthalmic care facilities at
various levels of infrastructure have been augmented under the
national programme for control of blindness and prevention of visual
impairment. It was targeted to reduce the prevalence rate of
blindness from 14 per 1,000 in the year 1980-81 to 10 per 1,000 by
1984-85. There is no feedback on the degree of achievement. Under
the target-oriented cataract operations programme initiated in 1981-
82, over 3 million cataract operations were performed upto the end of
1984-85. Critical shortage of ophthalmic assistants and ophthalmic
surgeons and poor functioning of the mobile teams are some of the
basic impediments to faster progress.
11.13 Guinea-worm eradication programme: Two active case
searches were conducted in 1984 in the seven endemic States of Andhra
Pradesh, Karnataka, Gujarat, Madhya Pradesh, Maharashtra, Rajasthan
and Tamil Nadu. The independent appraisal of the programme conducted
in 1985 considered Tamil Nadu as free from disease as no indigenous
case of guineaworm had been reported from that State during the
previous three years. During 1985-90, active case search, provision
of safe water supply in the affected villages, chemical treatment of
drinking water, health education of the community and management of
cases by use of bandages will continue.
11.14 Other communicable diseases: For control of filaria,
sexually transmitted diseases and diarroheal diseases, efforts are
being gradually strengthened. Most of the concerned control
programmes suffer from poor management and monitoring. During the
Seventh Plan, these areas will be appropriately strengthened.
11.15 Secondary and tertiary care: Curative care facilities
in the existing network of hospitals and dispensaries, under the
administrative control of the Central Health Ministry and of the
States and UTs have also been organised to the extent possible.
Financial support is provided to the establishment of post-graduate
institutions, with provision for super-specialities on a regional
basis, so as to meet the needs of the population as close to their
habitation as possible. Referral linkages are weak and need
strengthening.
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Reorientation of Medical Education
11. 16 The scheme for re-orientation of medical education (ROME)
was introduced with the objectives of (i) introducting community bias
in the training of undergraduate medical students with emphasis on
preventive and promotive services, (ii) reorientation of the role of
medical colleges, so that they became an integral part of the health-
care system and did not continue to function in isolation, (iii)
reorientation of all faculty members so that hospital-based and
disease-oriented training was progressively complemented by community-
based and health-oriented training for providing comprehensive primary
health care, and (iv) the development of effective referral linkages
between PHCs, District Hospitals and Medical Colleges. The scheme has
been implemented in its first phase, in about 106 medical colleges.
In spite of a one-time grant-in-aid of about Rs. 16 lakhs to each of
the participating institutions, the objectives of the scheme could not
be achieved to the desired extent. This was largely due to (i) lack
of commitment to the programme at all levels, (ii) slow progress in
the utilisation of Central funds, and (iii) absence of efforts in the
restructuring of teaching and training programmes at the college
levels.
Medical Research
11.17 Medical research covers a broad spectrum of discipline,
from basic work at the frontiers of modern biology to innovations for
ensuring the most effective application of available knowledge.
Medical research is carried out principally under the auspices of the
Indian Council of Medical Research (ICMR). A detailed account of the
work done under the ICMR is given in Chapter 17. A considerable
amount of research work is also being carried out in the other
institutions, some under the Ministry of Health and Family Welfare
(including those under the DGHS). Some of the institutions which have
done notable work are the National Institute of Communicable Diseases,
All India Institute of Medical Sciences, New Delhi, Post-Graduate
Institute, Chandigarh, National Institute of Mental Health & Neuro
Sciences, Bangalore, and All India Institute of Hygiene and Public
Health, Calcutta. Many medical colleges in the country also have an
excellent record of research to their credit.
Indian Systems of Medicine
11.18 The Indian Systems of Medicine had been given due
importance during the Sixth Plan. They are popular in the country and
there are about 4.5 lakhs practitioners of these systems. Most of
them are working in far flung rural areas. Attempts are being made to
use them for providing meaningful primary health care services and
strengthening the national health programmes. Teaching and training
programmes for Ayurveda, Siddha, Unani Naturopathy, Yoga and
Homoeopathy have been augmented and streamlined. Separate councils of
education and research have been established for the various systems
of medicine. Financial assistance was provided to programmes of
research, standardisation of drug and production of medicine.
SEVENTH PLAN-OBJECTIVES,
GOALS AND STRATEGY
11.19 The nation is committed to attain the goal of health
for all by the year 2000 AD. For developing the country's vast human
resources and for the acceleration and speeding up the total
socioeconomic development and attaining an improved quality of life,
primary health care has been accepted as one of the main instruments
of action. Primary health care would be further augmented in the
Seventh Plan. In the overall health development programme, emphasis
will be laid on preventive and promotive aspects and on organising
effective and efficient health services which are comprehensive in
nature, easily and widely available, freely accessible, and generally
affordable by the people. Towards this objective, the major thrusts
will be in the following areas:
(i) The Minimum Needs Programme would continue to be
the sheet-anchor for the promotion of the primary health
measures, with greater emphasis on improvement in the
quality of services rendered and on their outreach.
These will be backed up by adequately strengthened
infrastructural facilities, and establishment of
additional units where they are not available.
(ii) Health programmes suffer considerably because of
poor inter-sectoral coordination and cooperation.
Serious efforts for effective coordination and coupling
of health and health-related services and activities,
e.g., nutrition, safe drinking water supply and
sanitation, housing, education information and
communication and social welfare will be made as part of
the package for achieving the goal of Health for All by
2000 AD.
(iii) Community participation and people's involvement
in the programme being of critical importance,
programmes involving active participation of voluntary
organisations and the mounting of a massive health
education movement would be accorded priority.
(iv) Qualitative improvements are required in Health
and Family Planning services. Supplies and logistics
require greater attention, education and training
programmes need to be made more needbased and community-
oriented and, since management and supervision are
vulnerable areas, management information systems need to
be developed. Adequate provision of essential drugs,
vaccines and sera need special attention for ensuring
production, pricing and distribution and universal
accessibility, availability and affordability.
264
(v) Urban health services, school health services and
mental and dental health services also need special
efforts to ensure comprehensive coverage.
(vi) For the control and eradication of communicable
diseases, programme implementation at all levels needs
strengthening, with strict adherence to the sharing of
the costs of the programme by State Governments. The
National Goitre Control Progammes has not achieved much,
and needs to be implemented vigorosuly as it has the
potential of quick and complete success.
(vii) Cancer, coronary heart diseases, hypertension,
diabetes, and traffic and other accidents are emerging
as major health problems in the area of non-communicable
diseases. There is need to initiate appropriate action
for their control and containment. Several of these
diseases are susceptible to control as regards incidence
through primary and secondary preventive measures.
Development of specialities and superspecialities will
not to be pursued, with proper attention to regional
distribution.
(viii) Training and education of doctors and
paramedical personnel needs a thorough overhaul.
Teaching and learning have to be related to the health
problems of the people. Medical training must be need-
based, problem-centred and community oriented. Health
manpower development has been a neglected field which
needs urgent attention and action. Medical education is
a life-long process and continuing education is
essential. Health management support and supervision is
an area that needs considerable strengthening by a
proper selection, training, placement, promotion and
posting policy. Health management experience and
expertise for all categories of health and health-
related managerial jobs will have to be ensured.
(ix) Medical research of special relevance to the
common health problems of the people, would be pursued.
Evaluation of intervention and technologies will be
given greater emphasis and priority. Modern biology and
biotechnology will receive special attention in order to
find more effective and acceptable tools to fight
several of the endemic diseases. Research efforts in
the area of immunological approaches to fertility
control, immunodiagnostics, operational research, and
effective utilisation of electronics and computers in
the health programmes will be pursued. There is an
urgent need for evolving an effective and efficient
management information system (MIS) for proper planning,
implementation and evaluation of health services.
(x) The Indian systems of medicine lend themselves to
better standardisation, integration and wider
application, particularly in the national health
programme. Teaching, training and research and service
activities in the development of the Indian systems of
medicine would need to be pursued vigorously. Extension
planning in this sector is essential.
Programme Thrusts in the Seventh Five-Year Plan
11.20 Rural health programmes: The approach and strategy for
developing health care delivery system in rural areas initiated in the
Sixth Plan would be pursued vigorously, with stress on the following
aspects:
(i) Programmes formulated and executed in the Seventh
Plan would aim at consolidation of the health
infrastructure already developed, by making up
deficiencies in respect of trained personnel, equipment
and other physical facilities.
(ii) The three-tier system of sub-centres, primary
health centres (PHC) and community health centres (CHC)
would be further strengthened by converting the existing
maternity and child health (MCH) centres and rural
dispensaries into PHC's and sub-district hospitals into
CHCs and by setting up new functional units wherever
necessary. Construction works would be taken up in
areas where rented buildings are not easily available.
Low-cost models of housing for health centres would be
adopted to the extent possible.
(iii) The multi-purpose workers (MPW) scheme would be
extended, with emphasis on training for ensuring
attitudinal changes and developing the required skills
among them. Effective deployment of trained personnel
and the resolution of administrative problems, e.g.,
connected with rationalisation of pay scales, is
important.
(iv) Efforts would be made for complete integration of
the organisational set-up under health, family welfare
and MCH programmes. Financial integration towards the
objective of funding all the services as a package
programme under a common budget head will also be
attempted by the States and the Centre. Delegation of
adequate administrative and financial powers in order to
integrate health organisations would be necessary for
speedy and effective execution of approved Plan
programmes.
(v) Measure for encouraging community participation in
the programme will be encouraged. Village Health
Committees need to be activised. The block and district
level panchayats would be fully involved in the
planning, organising and running of health services.
Greater participation by voluntary organisations in the
provision of health care delivery services in rural
areas would also be promoted.
265
(vi) The State sector Minimum Needs Programme would be
further strengthened by the following programmes-some
on-going and some newunder the Central Sector:
(a) Village Health Guides Scheme.
(b) Establishment of Sub-centres
(c) Basic training of paramedical and para-
professionals required for rural areas.
(d) Augmentation of laboratory facilities, and
(e) Orientation-training, integrated health management
information system, supply of manuals, kits and other
education material as part of multipurpose workers'
scheme. The physical achievements under the health
programmes by the end of the Sixth Plan and the targets
set for the Seventh Plan are given in Annexure 11.1.
11.21 Health care services in urban areas-In recent years the
urban population has been growing at a very high rate. In its wake,
urbanisation is gradually creating serious health problems. The
existing urban health services are under pressure, services in the
slum areas being most vulnerable and inadequate. There are multiple
agencies providing health services in urban areas, but poor
coordination among them results in duplication and inefficiency of
services. Poor sanitary conditions in urban slums continue to create
favourable conditions for disease transmission and health hazards for
not only the slum population but of the entire urban population.
There is urgent need for a coordinated, organised, integrated urban
development programme which would include proper health services as an
essential and integrated part.
11.22 Medical and health care facilities in the urban areas
will be futher augmented in the Seventh Five Year Plan in consonance
with the guidelines provided in the National Health Policy. The
following would be the directions in which action will be taken:
(i) The network of hospitals needs to be further
strengthened gradually towards the objective of one
hospital bed for every 1000 population, taking into
account the hospital facilities available, voluntary
organisations and other private institutions. Hospital
beds should be distributed rationally so as to provide
adequate support to primary health care services. This
would be done by allocating about 15 per cent of the
total beds for primary health centres, 30 per cent for
the first referral, i.e., in community health centres
and sub-district hospitals, 40 per cent for the district
level hospitals and 15 per cent for medical college
hospitals, regional hospitals, specialised hospitals,
and super-specialities. Specialities need to be de-
ployed appropriately along with beds and other
facilities.
(ii) Appropriate administrative steps will be taken to
curb the tendency to divert health personnel from rural
areas and to deploy them in urban areas.
(iii) The organisation of family welfare and primary
health care services in urban areas could be broght
under the supervision of medical colleges in
collaboration with the local health authority in the
towns where they are located. Medical
studnents/interns/postgraduates could be actively
involved in the organisation of these services.
(iv) Voluntary organisations and local bodies need to
be encouraged to undertake responsibility for family
welfare and primary health care services in a more
systematic manner.
(v) Considering the fact that the urban health ser-
vices organisation, besides providing primary health
care to the urban population, has also to provide back-
up support to the rural health organisation through the
referral system and specialist services, the need is
clear for district hospitals to be provided with
specialised services in important branches such as
surgery, obstetrics and gynaecology, medicine,
psychiatry, paediatrics, ophthalmology, anaesthesia,
ENT, skin, rehabilitation and dental care. District
hospitals would have to provide diagnostic facilities in
X-ray, ECG, pathology and biochemistry, including
facilities for early detection of cancer. Each district
hospital should also have specialists in radiology
and pathology including blood transfusion. At district
levels there is need to establish epidemiological
centres with a well-equipped public health laboratory to
keep the morbidity and mortality profiles of the
district under constant surveillance, detect disease
outbreak early and take necessary corrective action.
(vi) In order to meet the needs of the most vulnerable
sections of the population, conscious efforts need to be
made to ensure 40 per cent of all beds for children and
mothers. This group not only constitutes two-third of
the population but also is the most vulnerable to
disease and subject to relatively high morbidity and
mortality.
(vii) Considering that the facilities for specialised
treatment in the country are limited, and not available
in all regions in equal measures, efforts have to be
made to bridge critical gaps, and also rectify the
regional imbalances through strengthening of specialised
institutions and super-specialities in areas where
serious deficiencies exist.
(viii) Organised referral services are almost non-
existent. To optimally use the existing scarce
specialist facilities, all institutions providing spe-
cialised services should be declared as referral
institutions so that they attend only to cases
266
referred from the first and second levels of referral
services. It is further recommended that any individual
seeking the services of specialised institutions
directly should be made to pay the full cost for such
services.
Control of Communicable Diseases
11.23 Communicable diseases account for more than two-thirds
of the total morbidity and mortality in the country. Programmes for
their control and eradication would be further intensified on the
following lines:
(i) Innovative measures and appropriate technology
would be introduced to strengthen the on-going
control/eradication programmes to ensure benefits to a
larger segment of the population. These include
integrated Vector Control Programmes with peoples'
active participation.
(ii) The primary health care system would be optimally
utilised for delivering comprehensive frontline care and
for better disease surveillance and control.
(iii) Health education component of all disease control
programmes would be accorded high priority to enlist
individual as well as community support.
(iv) Control/eradication programmes could be made
effective only through inter-sectoral collaboration in
the areas of industry, housing, water supply, sanitation
and environment. Measures needed to bring forth this
coordination would be accorded priority.
(v) National and regional programmes to identify new
and emerging health problems and the strategies for
their control and eradication will be taken up.
11.24 Malaria-The modified plan of operations for control of
malaria initiated in 1976 would need to be reviewed in depth to ensure
necessary technological and operational changes, besides intensifying
malaria control in urban areas.
11.25 Leprosy-Under the national leprosy eradication
programme, priority would be assigned to consolidating the gains
through effective utilisation of the vast infrastructural network
already set up. The stress would be on the introduction of available
modern technology to significantly reduce transmission, backed up by
measures to promote health education and economic rehabilitation of
leprosy patients. Priority would also be assigned to enlist community
participation and the aid of voluntary organisations in the programme.
11.26 Tuberculosis-Optimum utilisation of the existing
network of district TB Centres and beds besides the establishment of
additional units where needed for further extension would be the main
planks of the national TB control programme Provision of essential X-
Ray and laboratory equipment would also be ensured under the programme
towards the objective increaing the detection rate to 2 million new
cases per annum against the present detection rate of 1.2 million
cases per annum. Steps would be taken to provide extensive health
education, produce health education material and to involve the
community and medical and para medical personnel in the programme. In
respect of both tuberculosis and leprosy, enduring efforts have to be
made to ensure early detection and compliance with therapy.
11.27 Blindness control-The programme thrusts and strategies
already initiated under the national scheme for the control of
blindness and prevention of visual impairment would continue in the
Seventh Plan. The objective of reducing the overall incidence of
blindness to 10 per thousand by the terminal year of the Seventh Plan
with potential for further reduction of 5 per thousand by 2000 AD will
be pursued. Steps to overcome the deficiencies in infrastructure,
monitoring and evaluation, conduction of eye camps etc. would also
form an important part of the programme.
Control and Constraint of Non-Communicable Diseases
11.28 Non-communicable diseases also contribute significantly to
morbidity and mortality in the country and their share will increases
with rising life expectancy. There has been hitherto no systematic
attempt to measure the extent of their prevalence to take counter
measures. Isolated schemes exist for the detection treatment and
control of these diseases in urban areas, generally as part of the
overall health care development programme. Efforts will now be made to
quantify magnitude of incidence and prevalence and the following
measure will be intiated to test intervention strategies.
11.29 Pilot Projects-Pilot projects will be initiated in
selected places to develop a comprehensive programme of action with
emphasis on preventive action and facilities for controlling diabetes,
hypertension, ischemic heart disease (IHD), rheumatic heart disease
(RHD) and respiratory infections. The intervention strategy would be
innovative in character, with emphasis on health education for raising
people's awareness of these diseases. The possibility of training
village health guides and other para-medicals with supporting
availability of certain essential drugs at the primary health care
level for first level treatment will be explored. An integrated
approach to non-communicable disease control which is cost-effective
has to be developed. Human behavioural factors impining on health
will need special attention.
11.30 Cancer-The on-going cancer research and control
facilities would be augmented, with increased participation by the
States under the programme. Priority will be assigned to promote
prevention and early detec-
267
tion. Medical colleges will be developed to function as a, link
between the Regional Cancer Centres and the peripheral health
infrastructure.
11.31 Mental health-Organised and planned mental health care
activities are vital for obviating the ill-effects of major
socioeconomic changes. A beginning in this direction is proposed in
the Seventh Plan by according priority to strengthening the existing
psychiatry departments, promotion of community psychiatry by provision
of drugs and services through the primary health care system and
organisation of training programmes.
11.32 Dental care-The twin problems of peridental disease and
caries need to be addressed on a national footing. Pilot projects
would be taken up to provide basic dental care facilities and to
organise counselling at primary health care level. An objective of
these pilot projects would also be to develop organised dental health
care facilities as an integral part of the school health services.
11.33 Goitre/ido-The iodine deficiency diseases control
programme will be mounted on an extensive scale in the Seventh Plan
through coordination of the activities of all the concerned agencies.
The primary thrust of the programme would be iodisation of all edible
salt on a time-bound basis so as to ensure availability of iodised
salt to the community throughout the country by the terminal year of
the Seventh Plan.
Blood Bank and Transfusion Services
11.34 Organised blood-bank and blood transfusion services
will be further developed with the active participation of the Centre,
the States and voluntary organisations. Alongside attempts will be
made to ensure quality control/standards and to organise the required
training for medical and paramedical personnel.
11.35 Other Programmes-The prevalence of preventable
disability in the country is unacceptably high. Preventive and
prophylactic programmes, such as immunisation against polio and
vitamin 'A' prophylaxis will be pursued vigorously. Simple,
accessible and affordable rehabilitation technologies are needed.
11.36 The rising incidence of accidents including the high
prevalence of burns, calls for a vigorous programme of prevention,
treatment and rehabilitation. The high incidence of industrial
hazards and accidents, highlighted by the Bhopal gas tragedy,
underscores the urgency of developing an adequate Industrial Health
Service. This calls for coordinated and effective monitoring and
surveillance of the environment within and around industrial
locations.
Medical Education
11.37 Undergraduate education-In view of the increasing
unemployment of medical graduates and also the imbalance in the ratio
of doctors to paramedical workers, establishment of new medical
colleges or increase in the intake capacity of the existing
institutions is not supported as a matter of policy. This position
would continue in the Seventh Plan period also. Priority would,
however, be accorded to improving the quality of training and making
it need-based and community-centred.
11.38 The Reorientation of Medical Education (ROME) scheme
would be restructured to ensure its successful operationalisation
towards the objectives of active involvement of medical institutions
in the promotion of primary health care and imparting training to
undergraduates, preferably in rural community set-up.
11.39 Postgraduate education-Postgraduate medical education
in the basic and broad specialities would be rationalised with a view
to removing imbalance and make it need-based and community-oriented.
Postgraduate training facilities in public health, community medicine
and health management would need to be substantially increased so that
health managers can benefit from such training. Development of
specialised institutions and training in superspecialities would be
encouraged in the public and the private sectors.
Training and Manpower Development
11.40 Priority would be assigned to promoting continuing
education facilities to all categories of staff. Supportive training
and on-the-job training would be strengthened as an essential element
of continuing education. Secondly, training of paraprofessionals and
auxiliary personnel would be accorded high priority to meet the
community health services requirement. Efforts will be made to
correct imabalancs and improve quality. An attempt will be made to
direct vocationalisation of 10+2 stream of education to develop these
functionaries. Thirdly, the possibility of establishment of
universities of Health Sciences with the objective of linking all the
training centres and institutions funcionally on State, regional and
national levels will be explored. Fourthly, efforts will be made to
encourage States to participate fully in their own manpower
development activities. District level planning will be introduced
towards realising the objective of promotion of the decentralised
planning process. Establishment of health manpower planning and
development bureaus, etc., will be accorded special attention.
Medical and Health Services Research
11.41 Research efforts in several problem area initiated
through the thrust areas and task-force approach in the Sixth Plan
would be further intensified. Priority would also
268
be assigned to enlarge the scientific basis of preventive, medicine
and health promotion. Development of immunodiagnostic tests to
facilitates the study of epideimilogy of common diseases and their
control will receive priority. Development of linkages between
biomedical research system and the health care system with special
attention to promotion of research in immunology, molecular biology,
genetics and genetic engineering will be emphasised. Development of
health services research and augmentation of information and
communication would continue to receive high priority.
11.42 The programme areas that will be accorded high priority
in the Seventh Plan within the framework of the above approach would
relate to the following:
(a) In the field of communicable diseases, controlled
clinical trails to improve chemotherapy regime for
treatment of tuberculosis and leprosy, besides
operational research to improve detection of cases and
case-holding would be accorded priority. R&D support
for the National Malaria Eradication Programme would be
intensified. Simple, sensitive and specific tests for
detection of subclinical leprosy would be encouraged.
Studies on the genetic aspect of drug resistance,
development of immunodiagnostic tests for detection of
filaria specific antigens, development of appropriate
methodologies for prevention and control of virus
diseases and vaccine development programmes would be the
other priority areas in this field.
(b) In the field of family planning, the focus would
be on increasing the availability and improving the
acceptability of the existing methods of contraception
and on the phased introduction of longacting injectables
and subdermal implants in the field of spacing methods.
Operational research for development of integrated
package of MCH, family planning and nutritional services
through evaluation of appropriate modules would also be
accorded priority, in addition to studies to improve the
system of delivery of primary health care. Efforts
would be intensified to develop an immunological agent
for fertility control.
(c) In the field of non-communicable diseases, the
thrust areas in research would be in consonance with the
programme details identified for implementation in the
Seventh Plan.
11.43 The Indian Council of Medical Research would continue
to play a pivotal and coordinating role in medical research. The All
India Institute of Medical Sciences, New Delhi; the Post-Graduate
Institute, Chandigarh; National Institute of Communicable Diseases,
Delhi; AIH & PH, Calcutta; JIPMER Pondicherry, etc., would be
supported in a coordinated way in consonance with priority assigned at
the national level.
Indian System of Medicine and Homoeopathy
11.44 Popularisation and development of Indian system of medicine
in Ayurveda, Unani, Siddha, Yoga and Naturopathy as well as of
Homoeopathy would be taken up more vigorously in the Seventh Plan.
The majority of the pracitioners of these systems of medicine live in
the rural areas and enjoy high local acceptance and respect. They
consequently exert a considerable influence on health beliefs and
practices among the rural population. Measures to enable each of
these systems to develop in accordance with its own genius will
receive priority. Concerted efforts would be made to dovetail the
functioning of these systems and integrate their services at
appropriate levels into the overall health care delivery system,
particularly the national health programmes and the programme of
primary health care. Separate Central Councils for the various Indian
systems of medicine would continue to guide the activities in regard
to promotion of research, undergraduate and postgraduate education
curricula and promotion of health care delivery system, etc.
11.45 The Central sector and Centrally-sponsored schemes will
be related to setting up standards for postgraduate/undergraduate
education, development of postgraduate education, standardisation of
drugs and monitoring the availability of raw materials for the produc-
tion of drugs. The State Plan schemes will continue to deal with the
delivery of health care, undergraduate education, production of drugs,
etc.
Drug Control and Medical Stores Organisation
11.46 Measures initiated for balancing demand and supply of
essential and life-saving drugs, strengthening of vaccine production
units, rationalisation of the pattern of drug production, import and
distribution systems for promoting the objective or primary health
care, etc., would be strengthened in the Seventh Plan. The drug
industry is poised for rapid growth. This places further
responsibility on both the Central and State level drug-control
administration responsible for regulating the quality of drugs. The
Central and State organisations would, therefore, need to be
adequately strengthened in the Seventh Plan period. Zonal offices of
the Central Drug Control Organisation, Central Drug Laboratory,
Calcutta, and the Central Indian Pharmacopoea Laboratory, Ghaziabad,
which function as appellate laboratories under the Drugs and Cosmetics
Act and assist the States, also need to be strengthened and properly
equipped.
11.47 In view of its vital role and added responsibilities in
furthering the promotion of health care and family welfare programmes,
the Medical Stores Organisation would be appropriately strengthened on
the following lines:
(i) improvement and expansion of storage facilities;
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(ii) strengthening, improving and modernising quality
control at Government Medical Depots;
(iii) improvement and modernisation of existing manu-
facturing facilities;
(iv) strengthening and expanding the personnel compo-
nents of Medical Stores Organisation; and
(v) establishing a sound inventory control system and
rationallisation of the system of accounting with the
aid of computers.
Prevention of Food Adulteration
11.48 The Prevention of Food Adulteration (PFA) Act has been
on the Statute Book since 1954. Its enforcement, however, has many
shortcomings. These relate to (i) inadequacies in post-harvest
handling and storage facilities, including unhygienic and insanitary
environment and food-handling practices, (ii) lack of quality control
in process, (iii) large distribution of unpacked food in bulk and
retail sale, (iv) infrastructural deficiencies such as lack of
qualified and trained food inspectors, inadequacy of well-equipped
laboratories, absence of advisory and extension services, inadequates
in programming and in planning quality control activities, and
inadequate monitoring information system and community involvement.
11.49 To achieve the objective of providing wholesome food to
consumers, further measures on the following lines with adequate
budgetary support are contemplated in the Seventh Plan:
(i) augmentation of existing infrastructural food
control services at the Central level for proper
coordination, monitoring and evaluation;
(ii) establishment of an inspection and investigation
unit and laboratory for coordinating the activities of
the States; curbing inter-State adulteration and check-
ing quality of imported foods in different zones;
(iii) strengthening of Central Food Laboratories, which
function as referral laboratories under the provisions
of the PFA Act and also undertake research and
standardisation work;
(iv) augmentation of the State Governments efforts for
strengthening the existing food laboratories and for
creating spot testing facilities;
(v) motivating State Governments to create consumer
awareness through co-operation with voluntary
organisations by means of audio-visual aids, etc; and
(vi) helping the State Governments to make available
library facilities to technical personnel working under
the programme.
11.50 The main thrust in the Seventh Plan will be on
monitoring, evaluation and surveillance through better coordination
and guidance.
Health Education, Information, Education and Communication (IEC)
11.51 Progress made so far in the promotion of health
education is far from satisfactory. Schemes to strengthen health
education bureaus, training of medical and paramedical personnel in
health education etc., would continue to be implemented with added
emphasis. Efforts in the Seveth Plan would be basically directed to
develop and strengthen health education as an essential component of
health services in the country. This will be supported by adequate
budgetary provision. Measures would be initiated to actively involve
social and preventive medicine as well as community medicine
departments of the medical colleges, to strenthen health education
training programmes for medical teachers, paramedical personnel etc.
Organisation of School Health Education activities as an integral part
of formal and non-formal education, would need to be developed through
appropriatve measures.
11.52 Efforts will be made for the active use of different types
of media to create awareness among the people and motivate them to
utilise health services and to adopt healthful practices. Behaviorial
sciences research (to study human behaviour) for wider expansion of
health education, will be encouraged.
Outlays
11.53 The total outlay for the Health Sector is Rs. 3392.89
crores. The outlays for the Central, State and Union Territories
Plans under the Health Sector are shown in Annexures 11.1 and 11.2.
These also include provision for the States share of Centrally-
Sponsored Schemes. The indicative targets for Primary Health Care
Programme are given in Annexure 11.3.
FAMILY WELFARE
11.54 The family welfare programme occupies an important
position in the socioeconomic developmental plans. It plays a crucial
role in human resources development and in improving the quality of
life of our people. It forms an essential and integral part of the
20-point Programme which stresses the need for the promotion of
"family planning on a voluntary basis as a peoples' movement".
11.55 The country's population which was about 342 million at
the time of Independence rose to 361 million in 1951. It was 439
million in 1961. It further increased to 548 million in 1971. The
1981 Census shows that India's population was 685 million, almost
double the figure (342 million) at the time of Independence.
11.56 India was the first country in the world to have a
government-level programme of family welfare and planning. It became
an integral part of economic planning right
270
from the First Five Year Plan, 1951-56. The beginning was modest,
with a largely clinical approach. The services were being extended to
those who sought the services on their own. Over the successive
Plans, greater emphasis and larger outlays have been provided to
strenghten the programme. It received and extension education
orientation in 1963. In 1966 the programme was consolidated, expanded
and extended, and a new Family Planning Department was creaded in the
Ministry of Health. However, the programme received a setback during
the years 1977-79. The effective couple protection rate, which
touched a figure of 23.7 per cent in 1976-77, slipped down to 22.5 per
cent in 1979-80, the begining of the Sixth Five Year Plan.
Review of the Programme during the Sixth Plan
11.57 Objectives of the Sixth Plan: A working Group on Population
Policy was set up by the Planning Commission in 1979. This Group
recommended the adoption of the long-term demographic goal of reducing
the Net Reproduction Rate (NRR) to 1 by the year 1996 for the country
as a whole and by 2001 in all the States. The implications of these
long-term demographic goals were spelt out as follows:
(i) The average size of the family would be reduced
from 4.2 children to 2.3 children.
(ii) The birth rate per 1000 population would be
reduced from the level of 33 in 1978 to 21.
(iii) The death rate per 1000 population on would be
reduced from about 14 in 1978 to 9 and the infant
mortality would be reduced from 129 to 60 or less.
(iv) As against about 22 per cent of the eligible
couples protected with family planning, 60 per cent
would be protected by the year 2000 AD.
If these goals are achieved; the population of India would be
around 950 million by the turn of the century and stabilise at 1200
million by the year 2050 AD.
11.58 Keeping in view the long-term demographic goals,
(reducing NRR to 1 by 1996, as approved by the National Development
Council), the following targets were envisaged for the Sixth Plan,
keeping in view past performance, available capacity and future
potential: