|7th Five Year Plan (Vol-2)||<< Back to Index|
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 ca'pacty 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 Infrastructure-Sixth Plan (1980-85)
11.7 Shortage of construction materials like cement and steel and in some States shortage of trained doctors, nurses, AN Ms 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 satsifac-torily. 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 scheduled 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 hunderd. 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 Vlth 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.
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.
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 Natur-opathy, 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 prog-ammes of research, standardisation of drugs and production of medicine.
SEVENTH PLANOBJECTIVES, 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 socio-economic 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 need-based 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 afforda-bility.
(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 Prog-ammes 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 taining 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, im-munodiagnostics, 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 l&nd 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.
(vi) The State sector Minimum Needs Programme would be further strengthened by the following programmessome on-going and some new-under the Central Sector:
11.21 Health care services in urban areasIn 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 deployed'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 foi family welfare and primary health care services in a more systematic manner.
(v) Considering the fact that the urban health services organisation, besides providing primary health care to the urban population, has also tc provide back-up support to the rural health organisation through the referral system anc 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 ir X-ray, ECG, pathology and biochemistry, including facilities for early detection of cancer. Eacr district hospital should also have specialists ir radiology and pathology including blood transfusion. At district levels there is need to establish epidemiological centres with a well-equippec public health laboratory to keep the morbidity anc mortality profiles of the district under constan surveillance, detect disease outbreak early anc take necessary corrective action.
(vi) In order to meet the needs of the most vulnerable sections of the population, conscious efforts neec to be made to ensure 40 per cent of all beds fo children and mothers. This group not only consti tutes two-third of the population but also is th( most vulnerable to disease and subject to relative ly high morbidity and mortality.
(vii) Considering that the facilities for specialisec treatment in the country are limited, and no available in all regions in equal measures, effort; have to be made to bridge critical gaps, and also rectify the regional imbalances through strong thening of specialised institutions and super specialities in areas where serious deficiencie;exist.
(viii) Organised referral services are almost non existent. To optimally use the existing scare* specialist facilities, all institutions providing spe cialised services should be declared as referra institutions so that they attend only to case;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:
11.24 MalariaThe 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 LeprosyUnder 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 TuberculosisOptimum 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 of increasing 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 controlThe 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 increase 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 initiated to test intervention strategies.
11.29 Pilot ProjectsPilot 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 CancerThe 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 detection. Medical colleges will be developed to function as a link between the Regional Cancer Centres and the peripheral health infrastructure.
11.31 Mental healthOrganised and planned mental health care activities are vital for obviating the ill-effects of major socio-economic 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 careThe 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/idoThe 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 para-medical personnel.
11.35 Other ProgrammesThe 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 bums, 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.
11.37 Undergraduate educationIn view of the increasing unemployment of medical graduates and also the imbalance in the ratio of doctors to para-medical 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 educationPostgraduate.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 para-professionals 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 be assigned to enlarge the scientific basis of preventive medicine and health promotion. Development of immuno-diagnostic 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 immuno-diagnostic 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 production 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:
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:
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, para-medical personnel etc. Organisation of School Health Education activities as an integral part of formal and non-formal education, would need to be developed through approp-riatve 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.
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 socio-economic 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 Independecne.
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 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 educaction 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 populationon 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: Sterilization 22 million (later raised to 24 million) IUD 7.9 million CC Users 11 million in the terminal years 1984-85
Effective couple protection 36.6 percent
11.59 Strategy for the Sixth Plan: Limiting the growth of population was one of the main objectives of the Sixth Plan. This had to be achieved through education of the people to adopt a small family norm voluntarily, backed by apporpriate programmes of supplies and services. The family planning and welfare programmes had to be made a part of the total national effort at providing a better quality of life. The Plan sought to make a massive attack on the problems of unemployment and poverty through specific programmes directed towards the weaker sections of society. Special attention had to be paid to the education and employment of women to liberate them from dependence and insecurity, thus improving their social status, and at the same time changing their attitudes.
11.60 The Sixth Plan emphasised that the family planning and welfare programme must rise above all controversies and should be accorded high priority. It was reiterated that the programme would not be the sole responsibility of any one department of the Government but the responsibility of Government as a whole. The role of extension education, motivation and involvement of official and voluntary agencies was stressed. Health, Family Welfare and Nutrition programmes directed towards the vulnerable populalationmothers and childernwere vigorously pursued.
11.61 Performance during the Sixth Plan: Against a target of 24 million sterilisations by the end of the Sixth Plan, little over 17 million sterilisations had been carried out. Against the target of 7.9 million IUD insertions about 7 million IUP insertions were done. Against a target of 11 million CC users during the year 1984-85 about 9.31 million CC users were enrolled in the programme during the year 1984-85.
11.62 A critical analysis of the above performance highlights the following features:
11.63 The Performance analysis also reveals that the national averages are substantially lowered because of the relatively poor performance in the States of Uttar Pradesh, Bihar and Rajasthan. It may be mentioned here that these three States which account for a sizeable population of the country have a couple protection rate of less than 20 perUttar Pradesh 16.7 percent, Bihar 16.8 per cent and Rajastnan iy.a per cent against the national agverage of 32 per cent. Madhya Pradesh and West Bengal have a couple protection rate of 29 per cent. Special efforts for raising the couple protection rate are, therefore, necessary in these five States.
11.64 The Family Welfare programme is integrated with the Health programme, especially Maternal and Child Health (MCH). The performance of the MCH programme during the Sixth Plan, particularly in the field of immunization and ante-natal care, is far from satisfactory. Measures for strengthening the programme and increasing the child survival rate are essential for the success of the programme.
11.65 The highlights of the Family Welfare programme are:
11.66 Most of the State/UTs showed better family planning performance than before the Sixth Plan. The pick up was, however, uneven among the States. Among the major States, the effictive couple protection rate increased by 17.9 percentage points in Punjab, by 12.2 percentage points in Maharashtra and 9.9 percentage points in Haryana during the first four years of the Sixth Plan (1980-84). All these are much above the national average increase of 6.6 percentage points. The increase in Madhya Pradesh (5.9 percentage points) and West Bengal (6.0 percentage points) was a little below the national average. The major States showing an increase in couple protection rate (CPR) of less than 4 percentage points during this period are Assam (1.7), Bihar (3.5), Tamil Nadu (3.5), U.P. (3.6) and Andhra Pradesh (3.8) Of the other States, Tripura (-0.5) and Meghalays (-0.9) registered a decline in CPR. Among Union Territories, the performance of Dadra and Nagar Haveli, Chandigarh, Pondicherry and Andaman & Nicobar Islands was quite satisfactory. The increase in the couple protection rate in Lakshadeep (1.2) and Delhi (1.7) was rather poor.
11.67 The shortfalls in the achievements under the programme could be attributed to:
11.68 Against the Sixth Plan allocation of Rs. 1078 crores (inclusive of Rs. 68 crores transferred from the Health Sector for Village Health Guides Scheme), the likely expenditure in the Sixth Plan is around Rs. 1448 crores.
Seventh Plan Programmes and Perspective
11.69 In the light of the progress made in the initial years of the Sixth Plan, the health policy targeted a net reproduction rate of 1 by the year 2000 AD a review, however, indicated that this goal would be reached only by the period 2006-2011. The Family Welfare Programme envisages the following goals for the year 1990: (i) Effective couple protcection rate 42 per cent (ii) Crude birth rate per thousand population 29.1 per cent (iii) Crude death rate per thousand pupulation 10.4 per cent (iv) Infant mortality rate per 90 per cent thousand population (v) Immunisation Universal coverage (vi) Ante-natal care 75 per cent
11.70 To reach the above targets, particularly 42 per cent cuple protection, the Seventh Plan stipulates 31 million sterilisations by its close 21.25 million IUD insertions and, during the terminal year, 14.5 million CC Users.
Seventh Plan Targets for Family Planning Methods
11.71 The target of 42 per cent CPR by the end of the Seventh Plan can be reached provieded the rate of increase in CPR of 2 percentage points annually is maintained. This is an enormus task in view of the increasing number of eligible couples and the need to compensate for the increasing number of cases of attrition amongst the past acceptors. On an average, 3 million couples are expected to join the reproductive group every year. Determined efforts will, therefore, be necessary to keep the CRP rising. The targets to be reached regard to different methods in the Seventh Plan are given in Table 11.2
11.72 Taking into consideration the realities of the situation, differnt sets of targets have to be fixed for different States, both in terms of level of CPR to be attained and in terms of the method-mix of the acceptors. The year by which NRR of 1 to be attained by different States is shown in Table 11.3. TABLE 11.2 Required Acceptors of Family Planning Methods (Numbers in lakhs)
TABLE 11.3 Date of reaching NRR 1 State-wise
Seventh Plan Family Welfare and MCH Strategies
11.73 For attaining the long-term goal of reaching NRR=1 by 2000 AD, a suitable strategy of implementation of the programme must be designed taking into account the differential CPR achieved by differnt States, with attention being concentrated on those where it is low, particularly the group "C" States in the above table which account for about 33 per cent of the total population.
11.74 Targets for family planning, particularly sterilisation, are being achieved by special drives and camps. There is need to develop the programme on a sustained and continued basis. Laparascopic sterilisation has become very popular and availability of laparascops and trained personnel has to be stepped up. Much greater effort will have to be mobilised for implementation of the programme relating to lUDs, oral pills and conventional contraceptive users. Imaginative and innovative measures will have to be adopted for spreading the use of conventional contraceptives and oral pills and steps need to be taken to make them freely and widely available, through an effective social marketing mechanism.
11.75 To achieve the national long-term demographic goals, educating and enlightening people on the benefits of late marriage and its social enforcement will have to be greatly emphasised. Special programmes and incentives oriented towards eligible couples, particularly in the younger age-groups, are needed. Incentives for attracting coupis with two childern and younger age-groups are necessary.
11.76 Inter-sectoral coordination and cooperation and the involvement of voluntary agencies in the programme will be necessary in this programme to an even greater extent than in health. Community participation is essential for the voluntary acceptance of the Family Welfare programme. Identification and active involvement of nongovernmental organisations and of informal leaders in the community and imparting to them the necessary training to motivate and to participate in the programme are important aspects of efforts in this field.
11.77 For the achievement of the "two child" norm, it is essential that the child survival rate in our country is enhanced. The infant mortality rate of 114 per 1000 is staggeringly high and unacceptable. Here also, there are wide inter-State differences, with some States having done remarkably well, e.g., Kerala in lowering infant mortality, while others lag far behind, e.g., UP and Bihar. As more than half of the infant mortalities are in the neo-natal period, the maternity and child health programme (MCH) will have to be considerably strengthened. The MCH component of training of medical and para-medical needs to be carefully planned and implemented. The associated areas of child immunisation, nutrition and control of communicable diseases in infants will need special attention and strengthening. For immunisation, the 'cold chain's till poses a big problem, which needs to be solved. Diarrhoeas are still among the major causes of infant child mortality and ORS therapy needs to be used in more effective manner. Acute respiratory infections too constitute a major risk, and they also require to be tackled.
11.78 Vigorous steps will have to be taken to reduce maternal mortality. More than two-thirds of the women in the rural areas are still being attended to at childbirth by untrained Dais and there is, therefore, need to augment the Dais training programme.
11.79 Activities and aspects in the Family Planning programme on which stress will be specially needed in the Seventh Plan are the following:
11.80 Some State Legislatures have passed unanimous resolutions in support of the family welfare programme. This form of political commitment enhances the credibility of the programme and boosts the morale of those engaged in the family planning field. It is desirable that similar resolutions be adopted in the remaining State Legislatures.
11.81 The network of programme services has been expanded considerably in different Five Year Plans, but it has not yet reached close enough to the people. Several studies have shown that these facilities have not been optimally utilised for various reasons such as ignorance, inaccessibility and lack of credibility of services. There is, therefore, an urgent need not only to expand and strengthen the programme infrastructure but also to enlarge its acceptability. The following actions will be taken towards this end:
11.82 Incentives do play an important role in the promotion of the family welfare programme. During the Seventh Plan, the following suggestions can be activised:
(i) The present pattern of payment of compensation money to States and individual acceptors is considered cost-effective and satisfactory and will, therefore, continue. (ii) There is also the need to provide some concrete incentives for programme officers. These need necessarily be monetary incentives. National awards can be given in recognition of outstanding and meritorious contribution. (iii) It is recommended that donations to family planning and MCH activities be tax-exempt.
11.83 The efficiency and capabilities of the existing infrastructure can be greatly enhanced through certain managerial and administrative interventions which may be relatively inexpensive. Some of the major deficiencies are non-availability of service personnel in rural areas (due to reluctance, shortage of manpower or for some other reason), relative inadequacy of monitoring and supfirvis-ory mecnanisms, occurrence of unexpected difficulties, and inadequacies in the existing procedural systems to cope with such unforseen circumstances, etc. With a view to removing such deficiencies, the following measures are proposed to be implemented during the Seventh Plan.
(i) A sizable percentage of admissions to postgraduate courses in Government Medical Colleges would be reserved for doctors who are borne on the State Health Service and have put in at least three years of service in rural areas.
(ii) Facility or rent-free accommodation in rural areas would be provided and where such facility is not available, house rent allowance would be given in lieu thereof.
(iii) To meet the shortage of trained para-medicals, particularly female multi-purpose workers, local women with lower educational qualifications may be recruited for training. In addition, the sandwich type of course, being followed in the State of Maharashtra, would be adopted.
(iv) All medical students would be given training in vasectomy, minilap tubectomy, MTP and IUD insertions so that they are capable of contributing to the programme as soon as they graduate.
(v) "Reorientation and continuing education" would be a regular part of training activitives. For this purpose, adequacy and efficiency of different types of training centres like those for female multi-purpose workers, and of health and family welfare training centres would be assessed. The Central Training Institutes would develop functional linkages with such training centres to improve their capabilities.
(vi) Managament and Information, Education and Communication (IEC) skills of various categories of personnel would be suitably upgraded. For this purpose training needs of different personnel would be identified. Capabilities of various institutes at the State, regional and Central levels would be ascertained and suitably strengthened. At the national level there will be a consortium of premier management institutions with National Institute of Health and Family Welfare as a focal point to coordinate, plan and undertake training activities.
(vii) Allocation of funds for IEC activities would be regulated in an appropriate manner and not be only confined to agencies like the Ministry of Information and Broadcasting, and Directorate of Audo-Visual Publicity. The strategies and .channels would be diversified for better and more effective educational coverage. State would be allowed flexibility for adopting innovative approaches.
(viii) The "Monitoring, Evaluation and Reserach" activities at the Centre and in the States will be suitably strengthened.
(ix) To strengthen "Inter-Sectoral Coordination", all Ministries and Departments, both at the Central and State levels, concerned with socio-economic development programmes would identify concrete areas of tackling population problems and action plans for such departments would be clearly spelled out.
(x) "Demand Generation" activities under the programme will be vigorously implemented during the Seventh Plan.
Research and Technology Development
11.84 Greater emphasis would be placed on "Operational Behavioural Reserach" with a view to popularising the existing family planning methods, increasing their acceptability and removing or reducing the complications or inconveniences associated with various methods of family planning.
11.85 Research related to new methods of family planning which have been found efticatious and safe for their introduction into the national programme would be completed expeditiously, e.g., long-acting injectables and subdermal implants wilt be introduced progressively in the Seventh Plan. The methods which have been found safe and effective elsewhere and have been approved by the competent authorities abroad may be introduced in the programme on a pilot basis as an operation research scheme and then gradually expanded in the programme.
Policy Thrust Areas for Maternal and Child Health (MCH) in the Seventh Plan
11.86 The major thrust of MCH in accordance with the National Health Policy in the Seventh Plan would be directed as follows:
(i) Recognising the close relationship that exists between high birth rate and high infant mortality, high priority will be given to the MCH programme.
(ii) Preventive, promotive and educational aspects of MCH services will be given the highest priority.
(iii) A close linkage of health and health-related sectors with MCH activities will be developed.
(iv) Health care for mothers and children will be strengthened through the primary health care approach, which includes integrated, comprehensive MCH care and suitable strengthening of referral services.
(v) Increased emphasis will be laid on people's participation in MCH activities by supporting voluntary organisations, NGOs, village health committees, women's organisations, women's clubs and traditional -birth attendants.
11.87 The implemention of the MCH programme would be along the following lines :
(i) MCH services would be provided on the basis of 'high risk' approach. (ii) Health and family planning services would be assessed and, depending upon the needs, adequate beds would be provided for women and children. (iii) A sizeable proportion of Plan would be for women and children. (iv) Logistic, technical, consultative and referral support for primary health care will be provided at the secondary level in community medicine, obstetrics, gynaecology, paediatrics and management. (v) In order to bring more women and children within the easy reach of MCH services, the primary health infrastructure would be strengthened. (vi) Efforts would be made to maximise the use of ICDS infrastructure for the enhancement of MCH programmes. (vii) Special IEC campaigns would be organised to educate women on the advantages of prolonged breast-feeding.
Programme Outline for MCH
11.88 The health of mothers and, in particular maternal mortality, is significantly affected by induced abortions performed by unqualifed persons under unhygienic conditions. The Medical Termination of Pregnancy Act (1971), (MTP) is a legislative measure for improving maternal health through the stipulation of conditions under which pregnancies may be terminated. By the end of the Seventh Plan period, it is anticipated that MTP services would be provided at all primary health centres. In urban areas it would be available in all maternity homes and centres. MTP services would be an integral part of maternal and child health services and would be closely linked with the MCH programme. Training programmes would be conducted for improving the delivery of servies. An intensive education and publicity programme making use of all available facilities would be undertaken for improved services utilisation.
Health care for Woman
11.89 In addition to services provided through the general health care system, this programme will aim at raising health consciousness among women. A comprehensive, field-based information, education and communication programme will be developed. Women would be organised around available economic activities to enable them to actively participate in the entire process of socio-economic development including health.
Care of Pregnant and Nursing Mothers
11.90 Pregnant and nursing women are a vulnerable segment of the population. (Maternal Mortality rate is estimated to be about 4-5 per 1000 live births. Abortion handled by quacks and anaemia are some of the important causes of maternal mortality. Services for the health care of mothers during ante-natal, intra-natal and post-natal period will be strengthened. Efforts will be made to cover ail mothers by prophylaxis against anaemia. Services of obstricians and gynaecologists would be provided at community health centres, and at subdistrict and district levels.
Care of the New Born
11.91 About half of infant deaths occur during the first months of life and a large number of these occur during the first week of life. Some of the causes of these deaths are low birth weight, inadequate ante-natal and intra-natal care of the mothers, poor care of the neborn soon after birth (resulting in deaths due to asphyxia etc.,) and indaequate levels of care. The importance of prevention and promotive aspects of newborn care are well recognised. During the Seventh Plan, neo-natal services will be expanded and extended at appropriate levels.
Care of the Young Child
11.92 The infant mortality rate in India is still very high, and deaths in the pre-school age is responsible for half the total mortality. The major causes of death are infections (such as respiratory diseases, diarrhoeal disease and others), dehydration and malnutrition. Most of these are preventable.
11.93 Reduction in deaths due to diarrhoea, respiratory infections and malnutrition could be brought about by training multi-purpose workers and traditional birth attendants in the recognition of these problems, administering primary care, as well as in referral of selected patients. Facilities for secondary level care will have to be created. Support facilities and supply of drugs at primary and secondary levels of care will have to be augmented.
11.94 Additional paediatricians will have to be trained to provide the required services for the Seventh Plan period. Facilities for training doctors from primary health centres, as well as para-medical personnel, in aspects related to delivery of MCH services would be strengthened. Training centres for trainers of multi-purpose workers in the delivery of child health services will be established.
Expended Programme of Immunisation (EPI)
11.95 A significant part of high morbidity and mortality among infants and children can be attributed to a few common communicable diseases which can be prevented by immunisation. Under the expanded programme of immunisation, vaccination against these diseases is provided. The objectives of the immunisation programmes during the Seventh Plan will be to reduce the incidence of diptheria, whooping cough, tetanus, poliomyelities, childhood tuberculosis and typhoid fever, by making veccina-tion services available to all eligible children and women by 1990. Efforts would be directed to achieve self-sufficiency in the production of vaccines; their quality control and distribution will also be ensured. Measles immunisation will be included in the EPI.
11.96 In order to achieve the objective of universal immunisation, it will be essential to augment the inputs of trained manpower, 'cold chain' equipment, transport facilities and other essential supplies and equipment. Immunisation services will be privided through all health institutions and health care camps and teams, and the 'cold chain' will be suitably strengthened for vaccine storage. The epidemiological pattern of diseases will form the basis for programme operations. Surveillance of diseases would be suitably strengthened to document the impact of services. Information dissemination and health education will be promoted to raise the health consciousness of people as well as to provide support to health workers.
Health Services for School-Age Children
11.97 The health care programme for school-age children (416) will emphasise the detection of correctable disabilities which will prevent major handicaps later. The multiplier effect of education of children and of child-to-child extension are important aspects of the comprehensive child health care programme. Appropriate programmes of health services for children both in schools and in the community will be organised.
11.98 There is need to develop a National Institute of Maternal and Child Health to develop and coordinate various aspects of MCH.
Indian System of Medicine (ISM) and Family Welfare
11.99 There are over 500,000 practitioners of ISM in India employed in the public sector as well as in private practice. Practitioners of the ISM are mostly functioning in far-flung rural areas. They have a long tradition of acceptability among the people. This vast resources would be gainfully used in promoting family welfare, MCH and the expanded programme of immunisation. They can play a very vital role in extension education, supply of contraceptives, etc.
11.100 In the success of the Family Welfare and MCH programmes, the most important single factor is the active participation and involvement of the people, non-Governmental organisations and community organisations. The role of Mahila Mandals, Youth Clubs and Village Health Committees is of paramount importance.
Seventh Plan Outlays
11.101 The outlays for the family welfare programme are being stepped up to Rs. 3,256 crores. Details are given in Annexure 11.4. Annexure - 11.1 Seventh Plan Outlays Health Sector (Rs. crores)
Annexure-11.2 Seventh Plan Outlays-Health Sector Distribution by States/UTs (Rs.crores)
ANNEXURE11.3 Seventh PlanPrimary Health Care Indicative Targets
ANNEXURE11.4 Seventh Plan Outlays Family Welfare Programme (Rs. crores)
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