Training of Multi-purpose workers is expected to be completed by 1983.

22.23 The Re-orientation of Medical Education Scheme was initiated with the twin objective of providing curative health care facilities to the rural people and giving a rural bias to medical education. The 106 medical colleges in the country were provided each with three mobile clinics obtained from the UK Government for the purpose. The scheme provides for one-time assistance to the medical colleges for meeting a part of the recurring and non- recurring costs, the State Governments meeting the required additional non-recurring and recurring costs. The scheme will be continued in the Plan and each medical College would cover a whole district in due course.

22.24 Schemes to train public health and para-medical workers will be taken up in the Plan at present there is dearth of trained workers in various fields and the present training courses and curricula are also not standardised in some cases. The requirements of various categories of personnel would be identified and training programmes mounter for the required number. Full advantage would be taken of the 10+2 system and para-medical courses would be introduced in that system to the extent possible.

Control of Communicable Diseases

22.25 Next to rural health, the control of communicable diseases will be given priority.

22.26 Diseases like TB, Gastro-intestinal infections, malaria, filaria, infectious hepatitis, rabbies and hook worm are interrelated to evnironment.

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They accounted for 17.2 per cent of morbidity and 20.8 per cent of mortality in 1970. Other preventable diseases like diphtheria, whooping cough, polio and tetanus accounted for 1.0 per cent of morbidity and 0.4 per cent of mortality. Improvement of environmental sanitation and expanded immunization programmes coupled with improved preventive and promotive facilities through the network of hospitals, community health centres and sub-centres would be the main strategy for control/eradication of the communicable diseases.

22.27 The ongoing programmes of control/eradication of communicable diseases like malaria, Maria, leprosy, TB would be further intensified and fully integrated with other health care programmes to ensure effective reach of these services through a net- work of multi-purpose health workers under the supervision of medical officers at the primary health centres. Efforts would also be made for involvement and participation of the community in the programmes. Research and training components of these programmes would be stepped up towards the objective of developing more effective alternate approaches to control of these diseases.

22.28 The details of the programmes are briefly indicated below:-

(i) Malaria: Keeping in view the current status of malaria as discussed earlier, the modified operational plan of control initiated in 1977 will be implemented vigorously. The salient features of the Plan are:-

- Re-organisation of malaria units to conform to geographical boundaries of the district for better supervision by the Chief Medical Officer of the District entrusted with the responsibility to implement the programme;

- Linking residual insecticidal spray with incidence by continuing spraying in areas with in annual parasite index (API) of 2 or more per 1000 population;

- Full surveillance including focal spraying in areas with an API less than 2;

- Priority attention to P. falciparum infection;

- Assured supply of required quantity of anti malarial drugs through community health volunteers, sub-centres, primary health centres, panchayat agencies, school teachers etc.

- Multi-media publicity to arouse public awareness and participation; and

- A step up in research effort both in the laboratory and field.

A large allocation of over Rs. 400 crores, has been made in the Plan for control of malaria. Research on immunological and therapeutical aspects of Japanese Encephalitis and P. falciparum infection would be intensified.

(ii) Filaria Control: Experimental studies have been initiated in the selected pockets of the country for evolving an effective strategy to control the disease in rural areas. These studies will be further intensified so as to evolve a suitable strategy by 1985 to protect the rural population susceptible to Bancrofti filariasis. Filaria and malaria control measures would be integrated into a composite programme for maximum utilisation of available resources and effective implementation in urban areas.

(iii) Leprosy: The leprosy control programme will be intensified in the Plan towards the objective of its eradication as early as possible. The programme will be directed towards the following objectives:

(a) To cover the entire endemic population of the country to the extent of 90 per cent by 1985 and 100 per cent by 1990 with a corresponding step up in disease arrested cases from present level of 20 per cent to 40 per cent in 1985 and 60 per cent in 1990.

(b) To introduce newer drugs, multi-drug therapy and specially supervised treatment of infectious cases and epidemiological surveillance by a network of early detection measures.

(c) To provide medico-surgical facilities to leprosy patients for rehabilitation through reconstructive surgery, physiotherapy, occupational therapy, jobs and tools adoption etc.

(d) To improve and extend training facilities in leprosy through training centres, Regional Leprosy Training-cum-Referral Institutes and workshops.

(e) Encourage the participation of voluntary agencies through financial support. Public education and mass publicity will be stepped up to remove the social stigma attached to the disease.

(iv) Control of Visual Impairment and Blindness: Among the major causes responsible for visual impairment and blindness, cataract accounts for 55-58 percent followed by trachoma and other eye infections 20-22 per cent. The balance is due to injuries, mal- nutrition and other causes. Under the Centrally Sponsored Scheme, Ophthalmic treatment facilities in primary health centres, rural hospitals and District hospitals will be improved. Provision will be made for mobile units and strengthening of ophthalmic departments in selected medical colleges and regional ophthalmic institutes. Comprehensive eye health care facilities through the strengthened infrastructure should belt) reduce blindness in the country from the present 1.4 per cent to about 1 per cent by 1985.

(v) Control of other diseases: Measures for control and prevention of TB and Cholera, and maintenance

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of zero incidence of small-pox would be continued. The Centrally Sponsored Scheme concerning Sexually Transmitted Diseases programme will be integrated with general health care facilities provided through the State. Plans with effect from 1981-82. Goitre is one of the deficiency diseases which will be tackled in the identified endemic pockets. Attention will be paid to vector borne diseases which are gaining in importance in the areas covered by major irrigation projects.

Hospitals and Dispensaries

22.29 Except in the national capital and selected centres like Chandigarh and Pondicherry, E.S.I. and Central Government Health Service Scheme, hospitals and dispensaries are under the, control of the State Governments/Union Territory Administrations. The facilities in the hospitals of the medical colleges/ district levels have in the, past been improved and upgraded systematically to cater to the requirements of curative services. in selected hospitals and institu- tions, super-specialties have also been set up. These facilities are expected to provide curative facilities to the rural population on an increasing scale under the scheme of referral services. Further development of these hospitals would be with reference to felt needs of the region. Measures will be taken for efficient management of the hospitals through consolidation of existing facilities and proper maintenance of equipment and establishment of convalescent homes, poly-clinics and Dharamshalas in the vicinity of hospitals to help reduce pressure on hospital beds would be encouraged.

22.30 Super-specialities will be developed only to the limited extent necessary to meet the regional requirements and to fill in critical gaps.

22.31 The rural dispensaries set up by the State Governments will be gradually oriented towards total health care instead of providing curative facilities only. A good number of them are being converted into subsidiary health centres, in the Sixth Plan as already discussed under the minimum needs programme.

Medical Education

22.32 Under-graduate Medical Education: From the 106 medical colleges existing at present in the country, an estimated 11,000 doctors pass out every year. In view of the increasing unemployment of medical graduates and also the imbalance in the ratio of doctors to para-medical workers, the policy of the Government is not to increase the number of medical colleges or the intake capacity. The emphasis would be on bringing about qualitative improvement in medical education and training. Despite the high yearly outturn of medical graduates and growing unemployment among them, in several States there are no doctors available to serve in the rural primary health cen- tres/hospitals. This phenomenon can be explained only by the fact that many of the young medical graduates, by their background, training and career ambitions find themselves out of place in a rural set up.

22.33 It will, therefore, be necessary in the years ahead to reorient medical education to meet the requirements of rural areas. The Centrally Sponsored Scheme of Re-orientation of Medical Education would be continued and the present deficiencies noted in the implementation of the schemes set right. The Medical Council of India has also prescribed service in rural medical institutions for six months as part of the compulsory internship. In addition, reforms in other directions like modification of the curriculum, training of medical under-graduates in cerain fields relevant to the problems of rural health care, community orientation etc., would be necessary. These would be given adequate attention in the Sixth Plan.

22.34 Besides providing incentives to government doctors to serve in rural areas, it would also be necessary to encourage private practitioners to settle in the rural areas so that their services could supplement the efforts of Government in the field of rural health. This would also correct the situation where almost every medical graduate, who comes out, looks up to Government to provide him with a job. in fact, it is precisely this situation that has contributed to growing unemployment amongst doctors in some States and not lack of opportunities for service. The nationalised banks have already a scheme for providing financial assistance to professionally qualified people for self-employment including doctors. Efforts would be made to ensure that adequate number of medical graduates are enabled to avail of this assistance. The Government of Andhra Pradesh have initiated a scheme under which some allowance is provided to medical practitioners who settle down in a village where there is no doctor and provide part-time service at the nearest sub-centre. The Tamil Nadu Government have taken up the Mini-health Centre Scheme under which financial assistance is provided to voluntary organisations which provides medical care facilities at the village level through doctors employed on part-time basis. Based on the experience gained from such schemes, suitable steps can be taken to promote the settling of doctors in rural areas.

22.35 Post-Graduate Education : Post-graduate Medical Education would be rationalised to effect a balance between the national requirements of specialities and advanced opportunities for medical graduates.

22.36 The National Academy of Medical Sciences will be strengthened and assisted to fulfil the objective of improving the quality of post-graduate level medical education.

22.37 Improvement of Skills: Continuing education and inservice training facilities will be promoted to help updating the knowledge of service doctors, improve the skills of teaching doctors and familiarise them with modern advances in medical sciences.

22.38 Improvement of facilities: Deficiencies in terms of equipment, "teaching beds", buildings, laboratory staff etc., in the existing medical college hospitals would be assessed and steps taken to overcome these deficiencies under a phased programme within the, available resources.

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Medical Research

22.39 The current health status of the country discussed earlier calls for vigorous research efforts in several problem areas. Research on Bio-medical and public health problems, particularly communicable diseases call for a high priority. There are also areas such as economic aspects of health administration and management, contraceptive methods and family planning which need attention.

22.40 Task oriented research programmes in the following fields would be initiated towards the above objectives:

(i) Promotion of research on epidemiological, microbiological and immunological approaches towards control of communicable disseases accounting for major causes of morbidity and mortality.

(ii) Research in curative practices like rehydration towards the control of diarrhoeal diseases especially among children.

(iii) Research in the field of nutrition, metabolic problems, food production, processing, preservation and distribution,

(iv) Research in the field of drugs for various non- communicable diseases, keeping in view the aspects of quality, safety, toxic effects etc.

(v) Close and continuous studies in the area of information support, manpower development, appropriate technology, management and community involvement to ensure the reach of benefits of primary health care pro- grammes to the rural population.

22.41 Besides the Indian Council of Medical Research which would play a pivotal and coordinating role in medical research, other institutions such as the All India Institute of Medical Sciences, New Delhi; Post-Graduate Institute, Chandigarh; National lnstitute of Communicable Diseases, Delhi; A.I.I.H. & P.H. Calcutta; JIPMER, Pondicherry under the control of the Health Ministry would also continue to be engaged in relevant research work. Adequate funds for research have been earmarked for the activities of the Indian Council of Medical Research and other institutions under the control of the Health Ministry.

22.42 Cancer research and treatment facilities will continue to be developed through a net-work of early detection centres, cobalt units and development of selected regional research and training centres.

Traditional Systems of Medicine and Homoeopathy

22.43 In recent years some attention has been paid to development and popularisation of traditional systems of medicine like Ayurveda, Siddha, Unani and Homoeopathy. There are certain States where each individual system enjoys prestige and popularity such as Ayurveda in Kerala and Siddha in Tamil Nadu.

22.44 Each of these systems has now a Central Council and an attached Research Council. Centrally Sponsored Schemes were initiated in the past for providing grants-in-aid to States for promotion of postgraduate education and establishment of pharmacies with Government of India providing 100 per cent financial assistance. These will be continued.

22.45 The State Governments have also schemes for development of medical education, setting up hospitals and dispensaries under these systems.

22.46 There is need for coordinated efforts for further research for providing drugs for communicable diseases like Malaria, T.B. etc. as also for such other diseases like cancer, diabetes etc. The traditional system can also contribute to the national effort for finding effective methods of contraception.

22.47 It would be necessary to take steps in the following directions :

(i) Prevention of the growth of sub-standard teaching institutions under these systems.

(ii) Adequate financial support to existing recognised institutions for improving the quality of teaching and research.

(iii) Introducing modern and scientific methods of investigation and equipping students with adequate knowledge of subjects like physiology, pathology, anatomy etc.

(iv) Developing curative facilities under these systems through hospitals and dispensaries and involving them in public health activities also.

(v) Co-ordinating all research efforts to ensure purposive and fruitful research.

(vi) Standardising the pharmacopoeia and production of quality drugs.

Drug Control and Prevention of Food Adulteration

22.48 Effective measures will be taken for balancing demand and supply of essential and life saving drugs. Vaccine production units will be strengthened to meet the requirements of the country. The pattern of drug production/import and distribution system would be rationalised towards the objective of promoting primary health care and to overcome the short supply of inexpensive anti-infective drugs like Sulphenimides, anti-TB drugs, anti-leprosy drugs like Depsone etc. Measures like cheap packing, marketing by generic-names in preference to brand names and transfer of advantage of exemption from customs/excise duty on drugs to the consumers etc., would be pursued. The infrastructure for testing drugs would be strengthened to ensure that public health is not endangered by spurious/harmful drugs.

22.49 The problems of drug addiction particularly among the student community is causing concern. The problem will be tackled through psychiatry departments of medical colleges in the country and through

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deaddiction centres in problem pockets of urban areas for which a new scheme has been included in the plan.