HEALTH AND FAMILY PLANNING
THE broad objective of the health and family planning programmes in the Third Plan is to expand health services, to bring about progressive improvement in the health of the people by ensuring a certain minimum of physical wellbeing and to create conditions favourable to greater efficiency and productivity. Increased emphasis will be laid on preventive public health services. As in the Second Plan, specific programmes have been formulated for the Third Plan for improvement of environmental sanitation, specially rural and urban water supply, control of communicable diseases, organisation of institutional facilities for providing health services and for the training of medical and health personnel, and provision of services such as maternal and child welfare, health education and nutrition. The Third Plan also accords very high priority to family planning.
2. As against outlays of Rs. 140 and Rs. 225 crores in the First and Second Plans respectively, programmes in the Third Plan involve a total outlay of about Rs. 342 crores, about Rs. 297 crores being in the States and the rest at the Centre. These amounts are distributed under different heads as follows :
Table 1 : Distribution of outlay
(Rs. crores)
Programme First Second Third
Plan Plan Plan
Health
water supply and sanitation
(rural and urban) 49.0 76.0 105.3
Primary health units hospitals
and dispensaries 25.0 36.0 61.7
control of communicable
diseases 23.1 64.0 70.5
education, training and research 21.6 36.0 56.3
Indigenous system of medicin,
homoeopathy and nature
cure 0.4 4.0 9.8
other schemes 20.2 6.0 11.2
family planning 0.7 3.0 27.0
total 140.0 225.0@ 341.8
I
HEALTH
PROGRESS AND PROGRAMMES 3. During the past ten years, substantial progress has been made in various health programmes, and in several directions there have been notable advances. Measures adopted for the control of malaria have resulted in marked decline in the incidence of the disease. In 1958, in place of control, the programme of complete eradication of malaria was adopted. In controlling other communicable diseases like filaria, tuberculosis, leprosy and venereal diseases also appreciable progress has been made. The number of hospitals and dispensaries has increased from 8600 in 1950-51 to 12,600 in 1960-61 and of beds from 113,000 to 185,600. A basic type of health organisation providing an integrated preventive and curative service has been established in 2800 development blocks with a population of about 200 million. At the end of the Second Plan, there were 78 institutions teaching indigenous systems of medicine, their annual intake being 1375. Facilities according to the indigenous systems are at present available in 98 hospitals and 5372 dispensaries with a total bed strength of 24462. About 664 schemes of urban water supply and drainage entailing a total cost of Rs. 112 crores have been completed or are in progress. In addition to schemes of rural water supply implemented under the programmes for community development, local development works and welfare of backward classes, about 228 schemes with an estimated cost of Rs. 20 crores have been taken up under the Health programme.
4. Statistics concerning birth and death rates are subject to serious limitations, and for the period subsequent to 1951 only rough estimates can be made. Nevertheless, the following Table indicates In broad terms steady improvement in the health of the population :
Table 2 : Birth rates, death rates and expecta-
tion of life-1941-61
birth death infant mortality expectation of life
period rate rate rate at birth
male female male female
1941-51 39.9 27.4 190.0 175.0 32.45 31.66
1951-56 41.7 25.9 161.4 146.7 37.76 37.49
1956-61 40.7 21.6 142.3 127.9 41.68 42.00
5. Although there has been considerable development in the field of health and in the related services, at the end of the Second Plan, certain deficiencies were specially marked. Thus. in relation to needs the institutional facilities were quite inadequate, specially in the rural areas. Doctors were not evenly distributed
@The actual experience is expected to be of the order of Rs. 216 crores.
344
THIRD FIVE YEAR PLAN 345
between urban and rural areas and, as against concentration in many urban areas, in the rural areas generally there were shortages, and the existing institutions did not have their full complement of personnel. Progress in the control of communicable diseases was hampered in several parts of the country on account of shortages of trained personnel and to some extent also of supplies of the equipment. Despite a measure of progress in rural water supply, there were large rural tracts which lacked safe drinking water. In many urban areas problems of drainage have been accentuated on account of the rapid growth of population.
6. The broad aim in the Third Plan will be to remove the shortages and deficiencies mentioned above. A major objective is that, to as large an extent as possible, supplies of good drinking water should be available in most villages in the country by the end of the Third Plan. Institutional facilities will be expanded so that medical and health services reach progressively larger numbers of persons, specially in the rural areas. The programme for the eradication of malaria will be completed and efforts will be made to eradicate small pox and to control filaria, cholera, tuberculosis, leprosy and other communicable diseases. Drainage programmes will be undertaken on a larger scale in the urban areas.
The specific physical targets proposed for the Third Plan along with statistics of progress in the First and the Second Plans are given in summary form in the Table below :
Table 3 : Achievements and targets
catagories/units 1950-51 1955-56 1960-61 1965-66
hospitals and dispensaries
institutions 8600 10000 12600 14600
beds 113000 125000 185600 240100
primary health units 725 2800 5000
medical education
medical colleges 30 42 57 75
annual admissions 2500 3500 5800 8000
dental education
dental colleges 4 7 10 14
annual admissions 150 231 281 400
training programmes
doctors@ 56000 65000 70000 81000
nurses@ 15000 18500 27000 45000
auxiliary nurse-mid-
wives and midwives 8000 12780 19900 48500
health visitors@ 521 800 1500 3500
nurse-dais/dais@ 1800 6400 11500 40000
sanitary inspectors@ 3500 4000 6000 19200
pharmacists . N.A. N.A. N.A. 48000
control of communicable
diseases malaria
units 133 390 390*
population covered
(millions) . 107 438 497
filaria-
units 11 48 43
population covered
(millions) 15.1 24.6 N. A.
tuberculosis--
B.C.G. teams 15 119 167 167
T.B. clinics . 110 160 220 420
T.B. demonstration and
training centres 3 10 15
beds 10371 22000 26500 30000
leprosy--
subsidiary centres 33 135 235
venereal diseases-
V.D. clinics 83 189
maternity and child
health centres 1651 1856 4500 10000
WATER SUPPLY AND ENVIRONMENTAL SANITATION 7. Rural water supply.-Problems of rural water supply vary from region to region and often within the same region. Rural water supply schemes have been taken up, in the main, under the programmes for community development, local development works and welfare of backward classes. These are supplemented by the national water supply and sanitation programme under Health which deals with the provision of water supply to groups of villages through works requiring a measure of technical skill in design and construction. The programme gives priority to areas of great water scarcity and salinity and those in which waterborne diseases are endemic. The expenditure incurred on this scheme during the First and Second Plans is estimated at about Rs. 33 crores and 11,000 villages were provided with water supply through pipes.
8. Surveys to ascertain the present state of rural water supply are being undertaken in a number of States. Where such surveys have not been initiated, it is necessary to arrange for them, so that for every State a correct assessment of the extent of the problem may become available as a basis for detailed programmes to be implemented during the Third Plan. To achieve the objective of making supplies of good drinking water available to most villages in the country by the end of the Third Plan, it will be necessary not only to make an intensive effort, but also to ensure that at every stage there is effective coordination between all agencies concerned in carrying out the programme of rural water supply at the district and block levels and to mobilise local initiative and contribution to the utmost. Experience during the First and Second Plans has shown that great care is needed in preparing technical designs and estimates of rural water supply schemes and in keeping down their cost.
@Number indicates the number in practice or in service.
N.A.-Not available.
*The units will be withdrawn gradually in the latter part of the Third Plan.
346 THIRD FIVE YEAR PLAN
9. Under different programmes a provision of about Rs. 67 crores is available in the Third Plan for rural water supply. This includes Rs. 35 crores for the Village Water Supply Programme, about Rs. 16 crores under the plans of the States under Health, about Rs. 12 to 13 crores under the community development programme and about Rs. 3 to 4 crores under the programme for the welfare of backward classes. The greater part of the amounts provided for the Village Water Supply Programme are intended to be available for (a) backward areas, (b) areas not covered by community development programme, (c) pre- extension blocks, and (d) blocks which have completed their first and second stage in the community development programme. The Village Water Supply Programme is intended primarily to deal with the rural water supply at the village level. As a rule, the ceiling of Rs. 10,000 per village is to be observed. The public contribution is generally expected to be about 50 per cent, but this proportion may be changed and modified in difficult areas or in backward areas. Schemes for groups of villages which involve provision of piped water supply and works of an engineering character are to be catered for by provisions under the Health programme, but for such schemes there could be a part contribution from funds available under the Village Water Supply Programme on the scale of Rs. 10,000 per village. The Village Water Supply Programme is to be undertaken at the block level through Panchayat Samitis and Village Panchayats, the funds being routed through the organisation at the block level. It is proposed that there should be a broadly agreed programme at the local level under which all the provisions available for water supply are effectively utilised. The programme should be based on careful surveys.
10. Along with rural water supply much greater attention should now be given to the programme of rural sanitation specially to the sanitary disposal of excreta in the villages. Problems relating to the proper design and construction of village latrines and the educational and organisational aspects of the programme for their promotion have been recently studied. The broad lines of an action programme in this field may be said to be fairly established. Although, in the beginning progress may be slow, it is important that in each development block an effort should be made to create greater awareness of rural sanitation problems and to introduce the use of sanitary latrines in schools and camps for groups of houses and, where possible, in individual houses. It would facilitate the introduction of latrines if the local sanitary inspectors are trained in casting the latrine sets. With the participation of the local people these latrines can be constructed at a fairly low cost. If this work is undertaken as a block programme it should be possible to achieve substantial results within a foreseeable period. Health education is of course a most important aspect of the programme of rural sanitation. The advantages and convenience of clean, odourless and cheap latrines are obvious. They are no less essential for conserving the fertilizer value of human wastes and enriching the soil.
11. Urban water supply.-Urban water supply schemes are being executed by municipalities and corporations with loans provided by the Central and State Governments. The following priorities for the selection of areas for urban water supply programmes which were accepted for the Second Plan will also be observed in the Third Plan :
(1) municipal areas without any protected water supply arrangements ;
(2) improvement or expansion of existing facilities for water supply in urban areas where the present arrangements are either inadequate or unsafe from the public health point of view;
(3) pilgrim centres ; and
(4) areas having piped water supply and therefore requiring new sewerage or improvement to existing sewerage to remove waste and eliminate hazards to public health.
12. Urban water supply and sanitation schemes taken up in the first two Plans were designed to provide safe water supply and drain- age facilities to a total urban population of 15 million. Of these, 450 schemes will be completed by the end of the Second Plan and the rest wilt continue into the Third Plan. Among the important schemes taken up during the First and the Second Plans are : Vaitarna-cum- Tansa of Bombay, schemes for the improvement of water supply and drainage in the cities of Delhi, Calcutta, Madras, Bangalore, Ahme- dabad, Kaval Towns of Uttar Pradesh, and Visakhapatnam in Andhra. In carrying out these programmes there were certain shortfalls. These were mainly due to shortage of trained personnel, inadequate organisation and planning, and lack of materials, particularly, galvanised iron pipes, pump sets and related accessories.
13. As a result of the experience of urban water supply schemes during the Second Plan, three main suggestions may be made. In the first place, urban water supply schemes, specially the larger ones, need to be phased carefully, so that different parts of a project are in the correct sequence with one another and at each stage certain returns on the outlays incurred are realised. The technical scrutiny of plans and estimates is important if delays are to be avoided. Secondly, to ensure that the funds available are used to the best advantage it would be desirable to avoid dispersing them too thinly over a large number of schemes. This implies careful selection of urban water supply schemes on the basis of suitable criteria. Third- ly, once a project is accepted. the municipal body concerned should not only accept respon-
HEALTH AND FAMILY PLANNING 347
sibility for maintenance but also contribute to the cost of construction to an extent which may be determined by the State Government. There is also need for well-organised Public Health Engineering Departments in all States. These Departments could ensure adequate coordination between the engineering and health aspects of various water supply schemes, whether undertaken by the State Governments or by corporations and municipalities. Where this coordination has been lacking, there have been delays in execution and maintenance has been unsatisfactory. Statutory water and sewage boards, empowered to float loans and levy cesses, and set Lip with the object of undertaking water supply and sewage schemes within their jurisdiction are likely to be helpful in the effective and efficient management of water supply schemes.
14. A sum of Rs. 89 crores has been provided for urban water supply and drainage schemes during the Third Plan period. The number of new schemes that can be taken up against the allocation for urban water supply is necessarily limited. Along with other water supply and drainage schemes to be taken up by the States, the following important schemes will be completed or taken up: water supply and drainage schemes of Madras, Jabalpur, Bangalore, Mangalore, Delhi, Calcutta, Bombay and Kaval Towns of Uttar Pradesh, Visakhapatnam and Manjeera Water Supply schemes of Andhra Pradesh, Ernakulam- Mattancherry and Trivandrum water supply and drainage schemes of Kerala.
15. The urgency and importance of providing drainage and sewerage and arranging for safe disposal of sewage in towns and cities need greater attention. These facilities are at present lagging behind the water supply facilities, and it is necessary that schemes of drainage and sewerage are considered simultaneously with those for water supply and are carried out tinder a coordinated programme. This would insure against the risk of increased breeding of mosquitoes and deterioration in the sanitary conditions of the towns as a result of water supply schemes. It would be desirable to set apart for sewerage schemes, say, 20 to 30 per cent of the estimated cost of water supply projects in cities with a Population over 100,000.
PRIMARY HEALTH UNITS. HOSPITALS AND DISPENSARIES