|9th Five Year Plan (Vol-2)||<< Back to Index|
and Social Development
Sectoral Overview || Basic Minimum Services || Education || Health || Family Welfare || Indian System of Medicine and Homoepathy || Housing, Urban Development, Water Supply and Civic Amenities || Empowerment of Women and Development of Children || Empowerment of the Socially Disadvantaged Groups || Social Welfare || Labour and Labour Welfare || Art and Culture || Youth Affairs and Sports
National AIDS Control Programme
3.4.110 Sexually transmitted diseases (STD) have been a global problem since time immemorium. Fear of STD and pregnancy had been the major deterrents against promiscuous multi-partner sex and hence, STD levels remained relatively low in general population. With the ready availability of antibiotics for treatment of STD and contraceptives for prevention of pregnancy, sexual mores in most countries underwent a change during the last three decades. Increasing multi partner sex and consequent increase in STD were reported from many countries. Increase in STD rates did not result in rising morbidity or mortality rates because of availability of effective treatment. With the advent of HIV infection the situation underwent a dramatic change because there is no effective drug for treatment or vaccine for protection against HIV infection.
3.4.111 In India, a National STD Control Programme has been in operation since 1967. Its outreach and coverage have been sub-optimal. Available data from small-scale studies indicate that the annual incidence of STD may be about 5% (40 million new cases every year). This however, could be gross under-estimate or overestimate. There is no nationwide surveillance system for STD.
3.4.112 The ICMR initiated a National Serosurveillance for HIV infection in 1986 not only among the high-risk groups but also among general population to define the magnitude and major mode of transmission of HIV infection in the country. India was the first country in the world to initiate national serosurveillance in the silent phase of the HIV epidemic. The data from the serosurveillance showed that
3.4.113 Probable source of infection as reported by National AIDS Control Organisation till 1996 is shown in Fig-4.
3.4.114 Available data indicate that HIV infection exists in all States both in urban and rural areas. The apparent differences between States/ districts/ cities might to a large extent be due to differences in the type and number of persons screened. Over the last ten years there has been a progressive rise in the prevalence of infection in all groups. However, the prevalence of infection in the screened population still remains low (Fig-5). Utilising the available data on estimated size of high, intermediate, and low risk groups and available data on sero prevalence in these three groups, ICMR had estimated that the number of HIV infected persons in the country is between 2 and 3 million. More than 50% of them are women and children. Every year approximately 30,000 deliveries in India occur among seropositive women and between 6-8000 infants are perinatally infected with HIV. At present the number of AIDS patients in the country is small (Fig-6). However, over the next decade persons who got infected in the eighties will develop AIDS, resulting in a steep and progressive increase in the number of AIDS patients in India.
The major components of the Programme include:
3.4.116 There have been delays in the implementation of the Programme in many States. The performance under STD control and blood banking components had been sub-optimal in all States. The IEC activities had improved awareness in some States; however, the effect, if any, on behavioural change appears to be marginal. Sentinel surveillance, which is an essential component for forecasting the future course of the epidemic in the country has not been carried out according to protocol in most States. Because of this, there is lack of epidemiological database for forecasting the epidemic in the country and evolving appropriate, affordable interventions. Utilisation of funds under the programme has also been sub optimal (Table-3.4.10).
3.4.117 During the Ninth Plan the focus will be on:
Control of Non-Communicable Diseases
3.4.118 Soon after Independence, the focus of the health sector programme of the Government was on control of communicable diseases. However, the programmes (either Central Sector or Centrally Sponsored) for control of some non-communicable diseases which were perceived as public health problems were also initiated. The National Goitre Control Programme initiated in 1962 is the oldest Central Sector Scheme for control of non-communicable diseases (NCD). The National Blindness Control Programme the first CSS was initiated in 1976. Subsequently, several Central Sector Schemes for control of non-communicable diseases, including the following were taken up:
3.4.119 In addition some of the State Governments have initiated pilot projects for district based integrated non-communicable disease control in some districts.
National Blindness Control Programme
3.4.120 It is estimated that there are 12.5 million economically blind persons in India. Of these over 80% of blindness is due to cataract. It is estimated that every year about 2 million cases of blindness occur in the country. Most of cataract blind individuals are in their 60s. They may not have the means for cataract surgery. These patients may also have difficulty in accessing services, unless services are available in the vicinity of their house. The National Blindness Control Programme was initiated in 1976 with the objective of providing comprehensive eye care services at primary, secondary and tertiary health care level and achieving substantial reduction in prevalence of eye disease in general and blindness in particular.
3.4.121 The long term objective is to reduce prevalence of blindness from 1.4% to 0.3% by 2000 AD through
3.4.122 The major thrust of the programme during the seventies was to provide ready access to cataract surgery free of charge to the blind persons so that they could regain their vision, enabling them to be independent socially and economically. There had been a gradual rise in cataract surgery from 5.5 lakh in 1981 to 11.34 lakh in 1984-85. However, subsequently there was a plateau in the performance to around 11-12 lakh per year. Surveys carried out in 1986-89 showed that the prevalence of blindness due to cataract and cataract backlog is high in Andhra Pradesh, Jammu and Kashmir, Madhya Pradesh, Maharashtra, Orissa, Rajasthan, Tamil Nadu and Uttar Pradesh. Therefore, a major thrust was given during the Eighth Plan to strengthen the programme in these States and in J and K and Karnataka. Funds from domestic budget as well as EAP were provided for this. District Blindness Control Societies were formed to coordinate the activities of Government voluntary and private sectors and to remove any bottlenecks in the implementation of the Programme.
The major objectives of the Programme were :
3.4.123 The performance during the Eighth Plan is given in Table3.4.11. There has been a substantial increase in the number of cataract operation from 1.6 million in 1992-93 to 2.7 million in 1995-96. However, the target of reduction in prevalence of blindness to 0.3% by 2000 AD is unlikely to be achieved. The quality of care especially in camp situations had been sub-optimal and needs improvement. Infections resulting in permanent blindness have occurred due to slip up in asepsis; these should be eliminated. The need to restore vision by operating on one eye in economically blind people has not been given conscious priority over operating on the cataract in the second eye. Upgradation of medical colleges and district hospitals as well as training of ophthalmologists for ECCE/IOL insertion is being carried both in tertiary care and district hospital setting. A comparative assessment of ECCE/IOL in terms of cost of care, complication rate, and logistics of implementation and follow up at tertiary hospital level as well as at district hospital level needs to be carried out.
3.4.124 During the Ninth Plan the Programme will be geared up to clear the backlog of cataracts requiring extraction and also address other causes of blindness such as glaucoma and corneal opacity. Correction of refractory errors especially in school children and treatment of ocular infection will also be taken up. Infrastructure and manpower development and IEC will receive due attention. Attempts will be made to ensure that all available funds are optimally utilised. The target set for the Ninth Plan period is 17.5 million cataract operations and 100,000 corneal transplants.
National Cancer Control Programme
3.4.125 India has one of the lowest cancer rates in the world. The estimated caseload is around 2 million. Every year about 7 lakh new cases are detected. Tobacco- related cancers (especially cancer of oral cavity, lung and cancer cervix) form more than 50% of the overall cancer burden in the country. Over the next two decades it is expected that there will be a substantial increase in the prevalence of cancers because of increasing longevity, greater exposure to environmental carcinogens due to industrialisation, use of fossil fuels, wide variety of chemical agents in industry, agriculture, and continued use of tobacco (both smoking and chewing). Thus, it is possible that the country may face the problem of increasing cancer incidence. There may also be a change in the type of cancer seen. Increasing tobacco smoking instead of tobacco chewing might lead to increase in incidence of lung cancer which is more difficult to detect and treat. Changing dietary patterns (high calorie, high fat intake) and lower parity may result in increasing incidence of breast cancer.
3.4.126 The Cancer Control Programme was initiated in 1975-76 as a 100% centrally funded Central Sector project. It was renamed as National Cancer Control Programme in 1985. The objective of the programme were
3.4.127 During the last two Plan periods financial assistance has been provided for the establishment of 12 Regional Cancer Centres and oncology wings in 26 medical colleges. The District Cancer Control Programme for preventive health education, early detection and pain relief was undertaken in collaboration with Regional Cancer Centres in 32 districts. Assistance has been given to 33 voluntary organisations for undertaking health education and early detection. The estimated requirement of cobalt units in the country is 900 (1/1 million). Only 232 cobalt machines are currently available in the country.
The focus during the Ninth Plan will be on
National Diabetes Control Programme
3.4.128 The National Diabetes Control Programme was included as a pilot programme in the Seventh Five-Year Plan. The project was initiated in two districts in Tamil Nadu and one district in Jammu and Kashmir during the Seventh Plan. Several States had initiated district diabetes control programme as a part of the State Plan scheme during the Eighth Plan period. Experience gained in implementing the district diabetes control programme during Seventh and Eighth Plans have shown that integrated treatment of diabetes mellitus, hypertension and heart disease within primary and secondary care level is possible provided functional linkages between these and tertiary care centres are developed and utilised. During the Ninth Plan period these experiences will be utilised to develop integrated programme of non-communicable diseases prevention, detection and management programmes at primary and secondary care level in all districts.
National Mental Health Programme
3.4.129 It is estimated that 10 to 15% of the population suffer from mental health problem. Qualified professionals providing mental health care are few and the outreach of services in rural area is very low. The National Mental Health Programme was initiated by the Government of India in 1982 with the objective of improving mental health services at all levels of health care (primary, secondary and tertiary) for early recognition, adequate treatment and rehabilitation of patients with mental health problems within the community and in the hospitals. However, the Programme did not make much headway either in the Seventh or Eighth Plan. Mental Hospitals are in poor shape. The States have not provided sufficient funds for mentally ill requiring inpatient treatment. The Supreme Court has directed the Centre and the States to make necessary provision for these hospitals so that the inmates do get humane and appropriate care.
3.4.130 The Mental Health Act, 1987, which came into force with effect from April 1993, requires that each State/UT set up its own State level Mental Health Authority as a Statutory obligation. Majority of the States/ UTs have complied with this and have formed a Mental Health Authority.
3.4.131 The Central Council of Health and Family Welfare reviewed the progress and resolved that the National Mental Health Programme should be accorded due priority and full-scale operational support (including social, political, professional, administrative and financial back up) are provided.
3.4.132 During the Eighth Plan, NIMHANS developed a district mental health care model in Bellary district with the following aims;
3.4.133 During the Ninth Plan period the experience gained in implementing mental health care both in Central and State Sector will be utilised to provide sustainable mental health services at primary and secondary care levels and to build up community support for domiciliary care. IEC on mental health especially prevention of stress-related disorders through promotion of healthy lifestyle and operational research studies for effective implementation of preventive, promotive and curative programmes in mental health through existing health infrastructure will receive due attention.
National Iodine Deficiency Disorder Control Programme.
3.4.134 Iodine deficiency disorders (IDD) have been recognised as a public health problem in India since mid-twenties. Initially, IDD was thought to be a problem in sub-Himalayan region. However, surveys carried out subsequently showed that IDD exists even in riverine and coastal areas. No State in India is completely free from IDD. It is estimated that 61 million population are suffering from endemic goitre and about 8.8 million people have mental/motor handicap due to iodine deficiency. Universal use of iodised salt is a simple inexpensive method of preventing IDD.
3.4.135 The National Goitre Control Programme was initiated in 1962 as a 100% Centrally funded, Central sector programme with the aim of conducting goitre survey supplying good quality iodised salt to areas having high IDD, health education and resurvey after five years. The programme was renamed as the National Iodine Deficiency Disorder Control Programme in 1992. Implementation of the Programme during the initial three decades of operation was sub-optimal and IDD prevalence had remained essentially unaltered. Inadequate production of iodised salt, problems in transport, lack of awareness about the need to take iodised salt are responsible for the poor performance.
3.4.136 During the Eighth Plan period there had been a substantial improvement in the production, quality and transport of iodized salt. The annual production of iodised salt has risen from 5 lakh tonnes in 1985-86 to 40 lakh tonnes in 1996-97. By mid-1995, a ban on the sale of non-iodised edible salt has been implemented fully or partially in all States/Union Territories except Kerala, Goa and Pondicherry. Currently, it is estimated that about 80% of all edible salt is iodised and the use of iodised salt at household level has increased significantly. However, the target of Universal Iodisation of Salt is yet to be achieved.
3.4.137 During the Ninth Plan period the major thrust of the Programme will be on (a) production of adequate quantity of iodised salt of appropriate quality; (b) appropriate packaging at the site of production to prevent deterioration of quality of salt during transport and storage; (c) facilities for testing the quality of salt not only at production level but also at the retail outlets and household level so that consumers get and use good quality salt (d) IEC to ensure that people consume only good quality iodised salt and (e) survey of IDD and setting up of district level IDD monitoring laboratories for estimation of iodine content of salt and urinary iodine excretion.
3.4.138 Efforts to reduce price differentials between iodised and non-iodised salt and provide ready access to iodised salt through Targeted Public Distribution System will be considered.
Integrated Non-Communicable Disease Control Programme
3.4.139 Accelerated economic growth in the nineties does not necessarily imply improvement in health status. Increasing longevity, demographic transition resulting in rapidly rising numbers of aged population, urbanisation, increasing pollution, change from traditional diets, sedentary life style and increase in the stress of day-to-day living have led to an increase in lifestyle-related disorders and noncommunicable diseases. The ongoing change in disease burden is producing a major health transition; over the next two decades, non-communicable diseases are likely to contribute significantly to the total disease burden in the country. Cardio-and cerebro-vascular diseases, diabetes mellitus and malignancies are emerging as major public health problems in the country. It is essential that preventive, promotive, curative and rehabilitative services for NCD are made available throughout the country at primary, secondary and tertiary care levels so as to reduce the morbidity and mortality associated with NCD. However, vertical programmes to control individual non-communicable diseases would neither be feasible nor cost-effective.
3.4.140 Pilot projects for district-based integrated non-communicable disease control programmes carried out through the existing primary and secondary level facilities, using diabetes as a model, were initiated in the Eighth Plan. Therefore, during the Ninth Plan period an integrated non-communicable disease control programs at primary and secondary care level will be developed and implemented with emphasis on prevention of NCD, early diagnosis, management and building up of suitable referral system. Tertiary care centres will be strengthened so that treatment facilities for complications will improve. As the anticipated increase in prevalence of NCD over the next few decades is at least in parts due to changing lifestyles, it is imperative that health education for primary and secondary prevention as well as early diagnosis and prompt treatment of NCD receive the attention that it deserves. The increasingly literate population can then be expected to take a pro-active role and reduce morbidity and mortality due to NCD. Mobilising community action through well-structured IEC system including mass media will form an important intervention strategy for the control of NCD. Development of appropriate learning resource materials for education and training of manpower will be an essential activity.
Environment and Health
3.4.141 Environment can affect human health in many ways. Deficiency of iodine in soil, water and foodstuffs is the cause of iodine deficiency disorders. Excessive fluoride content in the water is the cause of fluorosis. Environmental degradation may affect air, land and water. Pollutants may enter the food chain. All these may enter human body through various portals and affect the health status.
3.4.142 Rapidly growing population, urbanisation, changing agricultural, industrial and water resource management, increasing use of pesticides and fossil fuels have all resulted in a perceptible deterioration in the quality of environment and attendant adverse health consequences. Environmental pollution due to developmental activities are increasingly becoming the focus of concern. The interactive interdependence of health, environment and sustainable development was accepted as the fulcrum of action under Agenda 21 at the Earth Summit in Brazil in 1992. Environmental health in its broader perspective would have to address the detection, prevention and management of:
3.4.143 Following the suspected plague outbreak in the country during 1994 the Planning Commission constituted a High Power Committee on Urban Solid Waste Management in India under the Chairmanship of Member (Health). This Committee undertook a comprehensive review of current situation of urban solid waste management, specially in cities with one million or more inhabitants and made recommendations for safe methods for collection, transportation of waste and suitable cost- effective, environmentally friendly methods for disposal of these wastes. Pilot projects exploring the dimensions of the problem and aimed at seeking realistic solutions were initiated during the Eighth Plan period. During the Ninth Plan period it is expected that many more cities will initiate programmes for the efficient methods of management of wastes generated and improve environmental sanitation.
3.4.144 So far, the major focus has been on communicable disease burden due to poor environmental sanitation in urban areas and due to improper disposal of human excreta, garbage and waste water in rural areas and methods to tackle these. These efforts will be intensified during the Ninth Plan. In addition, efforts to reduce pollution and related non-communicable disease burden will also be strengthened. Efforts will be made to document the extent of the problem of environmental pollution and its impact on health status of the population through linkages between existing environmental monitoring data and data on health status of population living in these areas. Prevention and management of health consequences of environmental deterioration will receive increasing attention.
3.4.145 The Expert Committee on Public Health System had noted that major developmental activities in any field such as agriculture, industries, urban and rural development may result in environment changes which could have adverse health implications and recommended that health impact assessment may become a part of environmental impact assessment of all large developmental projects. Efforts will be made to implement this recommendation during the Ninth Plan period. The feasibility of making appropriate provision for health care of people involved in developmental activities and prevention and management of health consequences of developmental activities on the population living in the vicinity of the project as a part of the project budget will be explored.
3.4.146 A healthy work force is an essential pre-requisite for agricultural and industrial development. Efforts to provide health care to workers through schemes such as ESI, creation of health care facilities in industrial towns, arrange for health care services for workers and their families through existing public and private health care services have continued through the last five decades. However, both coverage and quality of care have remained sub-optimal. There is no attempt to link existing data from ongoing work environmental monitoring in the work place with health status of workers and initiate appropriate intervention as and when required. Workers in the agricultural and unorganised sectors have so far not been covered under any programme. Increasing use of mechanisation, induction of poorly trained workers who operate machines with which they are not familiar, use of insecticides, pesticides and chemicals by persons without appropriate knowledge of precautions to be taken are resulting in increasing health hazards to workers in these sectors. During the Ninth Plan continuous monitoring of safety of work environment and workers' health status, both in the organised and unorganised sectors of industry and in agriculture, health problems of vulnerable groups such as women and children with focus on prevention, early detection and prompt treatment of health problems will receive special attention. Documenting the magnitude and types of the occupational health problems, initiating appropriate preventive and remedial measures will be developed into a structured health programme and taken up where ever possible.
Accident and Trauma Services
3.4.147 Increasing mechanisation in agriculture and industry, induction of semi and relatively unskilled workers in various operations, rapid increase in vehicular traffic, have resulted in increase in morbidity, disability and mortality due to accident and trauma. Overcrowding, lack of awareness and implementation of essential safety precautions result in increasing number of accidents of all types. Consumption of poisonous substances accidentally or intentionally is also on the rise. Technological advances in the last twenty years have made it possible to substantially reduce mortality, morbidity and disability due to accidents, trauma and poisoning.
3.4.148 In view of increasing morbidity and mortality due to accidents, a model accident and trauma service was proposed to be initiated in Delhi with the objective of:
3.4.149 A modest beginning was made in procuring ambulances fitted with essential equipment and strengthening of tertiary care hospitals in Delhi. However, a comprehensive accident and trauma services for National Capital Territory of Delhi has not yet been established.
3.4.150 During the Ninth Plan period efforts will be made to improve the availability and utilisation of the emergency care services at all levels of health care. Adequate training to medical and paramedical staff in emergency management at each level of care, provision of transport facilities for transfer of patients and suitable strengthening of emergency and casualty services in tertiary care centres so that they could handle the workload will be initiated. Rehabilitation services for those who have residual disabilities also will be strengthened. Steps to improve public awareness about available services and where and how to access them will also be taken up so that the population can fully utilise available services.
Health Management Information System (HMIS)
3.4.151 HMIS is an essential management tool for effective functioning of the health system. Timely reporting and analysis of data from HMIS could also serve as an early warning of focal outbreak of diseases so that appropriate interventions can be initiated. The Central Bureau of Health Intelligence (CBHI) and the States Bureau of Health Intelligence are nodal agencies for HMIS. During the Eighth Plan period an attempt was made to provide a major thrust for HMIS. The CBHI in consultation with the National Informatics Centre (NIC) and State Health Departments have developed HMIS version 2.0 for sending information through NICNET on essential health indices. This system is being used by 13 States/ UTs for sending district level information. The system is still not fully operational in most States. During the Ninth Plan efforts will be made to ensure that the entire country is covered and all the data pertaining to the Health and Family Welfare Programmes are collected, collated and reported from all the districts through NICNET. The data from HMIS will be utilised not only for improving the efficiency and effectiveness of the health care system but also for effective policy planning.
Comprehensive Review of Public Health System in India
3.4.152 An Expert group under the chairmanship of Member (Health) undertook a comprehensive review of major problems facing the public health system in the country in ensuring outreach of appropriate services at affordable cost and maintaining quality of services. The Committee recommended several policy and programme initiatives including administrative restructuring, health manpower planning, improving operational efficiency of existing health care services, improving disease surveillance, epidemic control strategy, epidemiological surveillance system and development of appropriate support services. The recommendations of the Committee form the base and basis for the formulation of strategies for revitalisation of the public health system in the country during the Ninth Plan period.
Production and Quality Control of Drugs
3.4.153 Provision of appropriate drugs of good quality at affordable cost is essential for the success of disease control programmes. Equally important is to restrict, and if possible, eliminate, the use of irrational drug formulation, detect and eliminate spurious drugs. The Central Government is responsible for the control over the quality of imported drugs, control over the manufacture and import of new drugs into the country, amendments to the Drugs and Cosmetics (D and A) Act and Rules, coordinate the activities with the State Drug Control Authorities for uniform implementation of D and A Act and Rules, laying down standards for drugs and updating Indian Pharmacopoeia, training of drugs analysts and drugs inspectors and licensing of whole human blood and blood products, large volume parenterals, sera and vaccines. Provisions for strengthening Drug Control Organisations in the States and the Centre were made in the Eighth Plan. However, the implementation of the scheme has been patchy and tardy. This task will be taken up on a priority basis during the Ninth Plan.
3.4.154 India's need for essential drugs are still not fully met. Patent laws do not cover over 95% of the essential drugs. Bulk manufacture of the generic drug and dispensing them in inexpensive packages to bulk consumers like hospitals will substantially reduce the budget needed to meet the drug cost in public health system. The possibility of providing a dual pricing system for generic and brand drugs will be explored so that essential drugs under generic name are available at affordable cost. This approach can subsequently form the base and basis of "drug cooperatives" as community-managed institutions.
3.4.155 Supply of essential drugs, vaccines/devices holds the key to success in any disease control programme. Funds for drugs used for primary, secondary and tertiary care centres come partly from the State funds and partly from Central Plan funds (CSS). Procedures for procurement and distribution vary and bottlenecks in these at the national and State level have been a recurrent problem. Inefficient indenting procedures adversely affect drug procurement. Poor inventory management results in unsatisfactory drug procurement and distribution. Some States such as Tamil Nadu have attempted strengthening drug procurement and distribution through formation of a Medical Services Corporation. This Corporation has drawn up an essential drug list, improved purchase and storage of drugs and organised efficient drug distribution within the States and brought about effective inventory control. During the Ninth Plan efforts in improving procurement and inventory control and distribution for drugs at Central and State level will receive priority.
Prevention of Food Adulteration
3.4.156 The Prevention of Food and Drug Adulteration Act, 1954 is aimed at ensuring that consumers get pure and wholesome food of good quality and protecting them from the trade malpractice and frauds in sale of food products. The Act is implemented jointly by the Central and State Government. During the Ninth Plan period, efforts will be made to augment food quality control both at the Central and State levels.
Bio-Medical and Health Services Research
3.4.157 The Indian Council for Medical Research is the nodal organisation for bio-medical research in India. Bio-medical and Health Systems Research is carried out by research institutions, universities, medical colleges and non-governmental organisations and are currently funded by several agencies including ICMR, DST, DBT, CSIR and concerned Ministries. Basic, clinical applied and operational research studies relevant to major health and population problems in the country have been the focus of research programmes during the last fifty years.
3.4.158 The major thrust areas of research include existing problems of communicable diseases, emerging problems of non communicable diseases, improvement of health and nutritional status of women and children and increasing contraceptive acceptance and continuation. Indigenous development of immuno-diagnostics, research studies on improved drug regimens to combat emerging drug resistance among several bacteria, alternative strategies for vector control in view of the increasing insecticide resistance among vectors, testing innovative disease control strategies through increased community participation have been the major areas of research in communicable diseases.
3.4.159 The ICMR has recently completed a 10-year study on health consequences of Bhopal Gas Disaster providing data base for planning the infrastructure needed to meet the health care requirements of the population exposed to toxic gas over the next decade. Anti-tobacco community education, early detection and prevention of cervical cancer in women and oral cancers in both sexes, lifestyle modification to reduce the rising morbidity due to hypertension and cardiovascular diseases, documenting the health problems associated with lifestyle changes and increasing longevity of life are some of the major research areas in non-communicable diseases. Evaluation of ongoing Mid-day Meal programmes in schools, assessment of changes in dietary intake and nutritional status of urban and rural population in different States over the last two decades, investigating the health effects of food contaminants and adulterants are some of the research activities in nutrition research.
3.4.160 Keeping in view the magnitude of the problem of providing effective comprehensive health care to the population, the major research and developmental activities in the country during the Ninth Plan will be directed to applied, operational research for improving quality, coverage, efficiency and the cost-effectiveness of health services. Research studies to test the operational feasibility and economic viability of comprehensive health service schemes similar to National Health Service (NHS) of United Kingdom suitably modified to meet the Indian milieu will be taken up. Multi-disciplinary, multi-centre operational research studies will be carried out by teams with medical scientists, social scientists, health planners and decision-makers, public health experts, health economists, and health managers.
3.4.161 During the Ninth Plan period optimal coordination of the basic and applied research activities will be attempted by networking and if needed by multi-agency funding of important projects.
The major thrust areas for basic research will be:
3.4.162 Adequate operational research studies do not precede initiation of major national programmes. There are many operational problems in these programmes, which are realised at the time of implementation, and time is lost in rectifying these. During the Ninth Plan, development and testing of alternative strategies for control of communicable and non-communicable diseases will be the focus of operational research. Funds will be made available from ongoing major disease control programmes for research aimed at improving programme implementation. Operational research for efficient implementation of ongoing health programmes and horizontal integration of the vertical programmes for health and family welfare at the primary health care level are some of the major research initiatives being contemplated during the Ninth Plan period. The mechanisms by which those in the research, service and teaching cadres can move into each other's areas and participate in programme development, testing and implementation will be worked out.
Review of the National Health Policy
3.4.163 The National Health Policy was formulated and adopted in 1983 providing comprehensive framework for planning, implementation and monitoring of health services. Successive plans have evolved and implemented intervention programmes to achieve the goals set in the National Health Policy. The status for various Health and Family Welfare indices prior to formulation of National Health Policy, goals set in the National Health Policy for 2000 AD, the Eighth Plan goals and achievements, and the goals set for the Ninth Five Year Plan are given in Table 3.4.12.
3.4.164 2000 AD is just two years away. The time is therefore, appropriate for review of achievements against the set goals in the National Health policy. During the last two decades there have been major changes in disease profile, health care infrastructure and health care seeking behaviour of the population. Several newer technologies for diagnosis and management of health problems have become available. These, in turn, have widened the gap between what is possible and what is feasible and affordable at the level of the individual and the country. Increasing expectations of the population, rising cost of diagnosis and treatment and diminishing resources have brought into fore the issue of how to meet the rising health care costs. The essential inter-linkages between health services delivery and health manpower development are still not fully understood and operationalised. Taking all these into consideration it is essential that the National Health Policy undergoes a re-appraisal and re-formulation so that it provides a reliable and relevant policy framework not only for improving health care, but also measuring and monitoring the health care delivery systems and health status of the population during the next two decades.
Outlay and Expenditure
3.4.165 The outlay for health during the last Eight Plans is given in Table 3.4.13. Over the years there has been a substantial increase in the total Plan outlay. However, the outlay for health sector has remained less than 2% of overall Plan outlay.
3.4.166 Plan outlays for health sector and MNP (under the State sector) during the last three Plan periods are given in Fig 7.
3.4.167 There has been a progressive increase in outlays for health sector and MNP, over this period. In addition to funds from MNP, Externally Assisted Project funds have also been utilised for improving primary health care infrastructure.
3.4.168 The outlay and expenditure in Health sector during the Eighth Plan period in States are given in Table 3.4.14. The outlays and utilisation of MNP funds during each of the last five years at aggregate national level is shown in Fig 8. Even though the utilisation of funds under Health sector and under MNP is satisfactory at the aggregate level, the utilisation is sub-optimal in some of the poorly performing States.
3.4.169 Outlays and utilisation of funds under central sector programmes are given in Table 3.4.15. Though over all utilsation of funds is satisfactory , utilisation of outlays provided for specific CSS such as AIDS control programme and blindness control programme was poor.
Ninth Plan outlays:
3.4.170 Restructuring of the health care infrastructure, redeployment and skill development of the manpower, development of referral network, improvement in the Health management information system, development of disease surveillance and response at district level are some of the critical steps that have to be taken up by the state Govt. in order to improve the functional status and efficiency of the existing health care infrastructure and manpower in the states. The centrally sponsored disease control programmes and the family welfare programme provide funds for additional critical manpower and equipment; these have to be appropriately utilised to fill critical gaps. The ongoing and the proposed EAPs are additional sources for resources. Health is one of the priority sector for which funds are provided in the central budget under the head Additional Central Assistance (ACA) for basic minimum servcies. The States will also be able to utilise these funds for meeting essential requirements for oprationalising urban and rural health care.
3.4.171 Health is one of the sectors identified under the Special Action Plan. In addition to the funds available from Domestic Budgetary Support, several centrally sponsored disease control programmes are receiving funds from EAPs. Taking all these factors into consideration, the Department of Health has been provided with an outlay of Rs. 5118.19 crores for the ninth plan period. The outlay for the annual plans will be adjusted depending upon the requirements of the department and the availability of funds including reimbursement from EAPs.
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