Health
and Family Welfare
National Health Programmes
Medical Relief and Supplies
Drugs
Medical Education and Research
Family Welfare
Indian Systems of Medicine and Homoeopathy
Chronological Highlights
Under the Constitution, health is a State Subject. Central
government’s intervention to assist the state governments is needed in the areas of
control/eradication of major communicable and non-communicable diseases, broad policy
formulation, medical and para-medical education along with regulatory measures, drug
control and prevention of food adulteration, besides activities concerning the containment
of population growth including child survival safe motherhood (CSSM), and
immunisation programmes.
The crude mortality rate declined from 27.4 per 1,000 population at the time of
Independence to 8.9 in 1996, and infant mortality rate has been brought down from
134 per 1,000 live births to 71 over the same period. Life expectancy has risen from a
mere 32 years in 1947 to about 62 years. The country has been able to achieve zero
guineaworm status as no new cases of guineaworm have been reported in 1996. We are making
steady progress towards elimination of leprosy, polio, neonatal tetanus and Iodine
Deficiency Disorders.
HEALTH PLANS
The Several National health programmes are being implemented as Centrally-sponsored
schemes aimed mainly at reduction of mortality and morbidity caused by major
diseases. The major health schemes include the National programmes for eradication
of malaria, blindness, leprosy, tuberculosis, AIDS including blood safety measures
and STD control, Cancer control. Special attention is also being paid to Trauma and Spinal
Injuries. Pilot projects have also been taken up in respect of cardio-vascular
diseases, diabetes and rehabilitation of the medically disabled.
During 1998-99, an outlay of Rs 1145.20 crore
including Rs 524.00 crore as oreign aid has been approved for Central sector health
programmes.
NATIONAL HEALTH PROGRAMMES
MALARIA
The National Anti-Malaria Programme is the world’s biggest health programme
against a single communicable disease and continues to be the ountry’s most
comprehensive and multi-faceted public health activity. With the successful implementation
of the programme in 1958, the annual incidence of malaria was drastically reduced
from 7.5 crore at the time of Independence to about one lakh in 1965. Deaths due to
malaria were completely eliminated. Unfortunately, due to various factors, these
achievements could not be maintained. Resurgence of malaria necessitated renewed
vigourous anti-malaria activities and the programme was modified in the
context of escalating malaria incidence. This Modified Plan of Operation (MPO) was
implemented from April 1977.
Since the implementation of MPO, the malaria incidence has
gradually gone down, to 1.66 million cases in 1987 as against 6.47 million cases
during 1976. Since 1989 onwards the total incidence has been between two to three million
cases per year.
During 1998 (provisional), 2.1 million malaria cases were
reported of which 0.91 million P. falciparum(Pf) cases were reported and 653 malaria
deaths were recorded. In view of the high incidence of malaria and resource constraints in
seven north-eastern States, cent per cent Central assistance is being provided with effect
from December 1994. For the effective control of malaria, the Enhanced Malaria Control
Project with World Bank assistance was launched in September 1997. Under this project 100
hard core and tribal predominant districts of Andhra Pradesh, Bihar, Gujarat, Madhya
Pradesh, Maharashtra, Rajasthan and Orissa and 19 problematic towns of various States have
been included.
FILARIA
The National Filaria control programme was launched in 1955 for the control of
fillariasis. Activities taken up under the Programme include :
(i) delimitation of the problem in hitherto unsurveyed areas and
(ii) control in urban areas through recurrent antilarval measures and antiparasite
measures.
It is estimated that out of about 428
million people living in known endemic areas, about 113 million people are in urban areas
and the rest inv rural areas. At present about 49.87 million urban population is being
protected through recurrent anti-larval measures by 206 control units, 199
filaria clinics and 27 filiaria survey units .Training in filariology is imparted at three
Regional Filaria Training and Research Centres situated at Calicut, Rajahmundry and
Varanasi under the National Institute of Communicable Diseases of Delhi. During 1997
14.18 million population in thirteen districts of seven states namely, Bihar, Uttar
Pradesh, West Bengal, Orissa, Andhra Pradesh, Tamil Nadu and Kerala were covered under the
revised strategy for filaria control with single dose annual mass drug
administration of diethyle carbamazine (DEC). This strategy is to be continued for five
years.
KALA-AZAR
Kala-azar is a serious public health problem endemic in Bihar and West Bengal. Until
1990-91, the assistance for Kala-azar Control was being provided by the Government of
India out of the National Malaria Eradication Programme (NMEP). During 1998, 13,360
cases with 217 deaths were reported provisionaly. The Centre provides insecticide,
anti Kala-azar drugs and technical guidance to the affected states.
JAPANESE ENCEPHALITIS
Japanese Encephalitis (JE) caused by minute virus and spread by mosquitoes, has a high
mortality rate of 30 to 45 per cent. Andhra Pradesh, West Bengal, Assam, Tamil Nadu,
Bihar and Uttar Pradesh reported maximum cases of Japanese Encephalitis deaths.
During 1998 year, 1,617 cases with 355 deaths were reported and during 1998 (up to
March) 100 cases and 20 deaths were reported. Japanese Encephalitis vaccine is developed
indigenously by Central Research Institute, Kasauli. Funds for JE control activity are
utilised out of NMEP budget.
DENGUE FEVER / DENGUE HAEMORRHAGIC FEVER
Dengue fever is a viral disease which is transmitted through the bites of female Aedes
mosquitoes. In India, the virus was first isolated during fifties. Outbreaks have been
reported from various parts of the country primarily from urban areas. There are four
serotypes of dengue virus which are prevalent in India. Dengue viral infection may remain
a symptomatic or manifest either as undifferentiated febrile illness (viral syndrome),
Dengue Fever (DF) or Dengue Haemorrhagic Fever (DHF).
An outbreak of Dengue was reported in Delhi in 1996, when 10,252
cases and 423 deaths were reported. Incidence of dengue was also reported from Haryana,
Punjab, Uttar Pradesh, Karnataka, Maharashtra and Tamil Nadu the same year with 16,517
cases and 595 deaths. During 1997 there were, 1,177 dengue cases with 36 deaths. In 1998,
704 cases and 18 deaths were reported from Tamil Nadu, Karnataka, Delhi, Kerala, Haryana,
Maharashtra, Orissa and Rajasthan. Formulation of a National Dengue Control Programme is
under consideration of the Central government.
TUBERCULOSIS
It is estimated that 14 million people are suffering from active tuberculosis in India of
which 3 to 3.5 million are highly infectious cases. About 0.5 million die of this
disease every year. District TB Centres (DTCs) are functioning in 446 districts. There are
330 TB clinics in big towns and cities, 17 TB Training and Demonstration Centres and about
47,600 TB beds in the country.
The National TB Control Programme has been accorded high
priority by the Government. There has been considerable increase in the budgetary
allocation for implementation of the programmes from Rs 183.05 lakh in 1981 to Rs 10,500
lakh in 1999-2000.The targets have been revise in the light of the Revised
Strategy with emphasis on diagnosing sputum positive cases and achieving 85 per cent cure
rate in patients put on treatment. The Revised National Tuberculosis Programme
(RNTCP) was launched in the country on 26 March 1997. The revised strategy is proposed to
be implemented in a phased manner in 102 districts of the country, covering a
population of 271 million, with the assistance of World Bank. Presently RNTCP is covereing
a population of about 120 million. In RNTCP nearly 8 out of 10 patients diagonosed are
being cured. As on date nearly 1 lakh patients have been put on RNTCP tratement, more than
15000 lives saved and lakhs of people who would have been infected have not been affected.
LEPROSY
India has ranked foremost among the countries with people infected with leprosy,
sharing about 58 per cnet of the globally recorded leprosy-case load. The National
Leprosy Eradication Programme (NLEP) was launched in 1983 as a hundred per cent
Centrally-sponsored scheme. The programme has the objective of eliminating leprosy
as a public-health problem by 2000 A.D., thereby reducing the case-load to less
than 1/10,000 population. Till March 1998, 778 leprosy control units, 907 urban
leprosy centres, 290 temporary hospitalisaton wards, 278 district leprosy units,
5,744 Survey Education and Treatment (SET) centres, 75 Reconstructive Surgery
Units (RCU), 49 leprosy training centres and 40 sample survey-cum-assessment units
and 350 mobile leprosy treatment units have been established in various states/UTs.
Besides 490 District Leprosy Societies have been created to provide free MDT
services in all the districts of the country. About 285 voluntary organisations in
coordination with NLEP are supplementing the Government efforts in the fight against
leprosy. By March 1998, 0.53 million patients are on record in the country.
The prevalence of leprosy has been reduced from 57/10,000 population on 1981 to 5.7/10,000
population by March 1999 (provisional).
The first round of Modified Leprosy Elimination
Campaign (MLEC) is to be implemented in all the States and UTs to create mass awareness
through massive IEC activity, training of all the general health care staff and to detect
the hidden cases of leprosy. So far 30 States/UTs have successfully launched the
campaigns. During the campaigns a total of 28.16 lakh new suspected patients were
identified out of which 4.66 lakh persons have been confirmed to be having leprosy. All
confirmed patients have been put under free Multi Drug Therapy. The Government of India
provides grant-in-aid to the NGOs engaged in the survey, education and treatment
activities.
BLINDNESS
The National Programme for Control of Blindness (NPCB) was launched in the year 1976 as
100 per cent Centrally-sponsored programme. Various activities of this programme include
establishment of Regional institutes of ophthalmology, upgradation of medical colleges and
district hospitals, development of mobile eye units, recruitment of required ophthalmic
manpower and provision of various ophthalmic services. A national survey was conducted
during the period 1986-89 to evaluate the programme. The prevalence of blindness revealed
by the survey was 1.49 per cent.
As per the National Survey, it is estimated that
there are more than 12 million economically blind persons in India. Of the total 80.1 per
cent are blind due to cataract. In absolute terms, more than two-thirds of blind
persons are in Andhra Pradesh, Orissa, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu
and Uttar Pradesh. The activities under the programme are yet to show an impact in
reducing the prevalence of blindness to the goal level of 0.3 per cent by the year 2000
A.D. To achieve this target a minimum of 21 million cataract surgeries have to be
conducted during the project period of seven years. At the tertiary level of ophthalmic
care there are eleven regional institutes of ophthalmology including the apex institute,
Dr R.P. Centre for Ophthalmic Sciences in the All India Institute of Medical Sciences, New
Delhi. These centres have been established as centres of excellence in the field of eye
care. In addition, 82 medical colleges have been upgraded under NPCB. There are 39 medical
colleges which have been designated as training centres for paramedical ophthalmic
assistants. So far 166 eye banks have been developed in the Government and non-government
sector.
At the secondary level 445 district hospitals have been equipped for
ophthalmic services. Under the programme the concept of District Blindness Control
Societies (DBCS) has been successfully implemented in all States. Based on the success, as
many as 510 DBCS have been formed so far. These societies have representatives of
Government, NGO and private sector as members. The concept of DBCS is to decentralise
management of ophthalmic services and evolve a partnership among Government,
non-government and private sector.
The problem of blindness is acute in rural areas and hence the
programme has tried to expand accessibility of ophthalmic services. At present, there are
80 central mobile units (attached to medical colleges) and 341 district mobile units which
cater to mobile eye camps for eye care in general and performance of cataract surgery in
particular. Most of the cataract operations on rural population are conducted through
these mobile camps. So far 5,633 primary health centres, have been equipped with
ophthalmic equipments and by posting para medical ophthalmic assistants.
SEXUALLY TRANSMITTED DISEASES
Control of Sexually Transmitted Diseases (STDs) was introduced as a national control
programme by the Government of India during the Fourth Five Year Plan. Recognising
STD is one of the major determinants for transmission of HIV infection, the
programme has been merged with the National AIDS Control Programme. The Government
of India has laid emphasis mainly on teaching, training, research, epidemiology and health
education in sexually transmitted diseases. The STD component of the National AIDS
Control Programme seeks to take up activities to strengthen clinical services
including diagnosis and case management activities in STD clinics and through primary
helath care systems. At present there are 504 STD clinics functioning in the country
at medical colleges, district, municipal, taluka and sub-centre level. There
is involvement of private practitioners in STD control through Indian Medical
Association (IMA). A manual on syndromic management of STD cases has been developed
and circulated for the training of government health sector and private sector doctors. An
IEC package for prevention of STDs has been developed and being distributed to all
levels of health delivery system. Throughout the country, 500 community health
centres have been developed with dark field ground illumination microscope for
efficient laboratory diagnosis of STDs. There is a proposal to establish 256 new STD
clinics in the country this year where counselling facility will also be made
available.
AIDS
The available data show that HIV prevalence is increasing and so have the number of
AIDS cases. As on March 1998, 74,960 of 32,92,238 high-risk and suspected AIDS cases
screened were found to be positive. The sero-positivity rate per thousand was 22.73.
At the same time a cumulative total of sero-positivity rates above the national
average have been reported from Manipur—177.71; Maharashtra 106.83; Nagaland
50.19; Punjab 46.68; Pondicherry 34.15. All the states and UTs have reported HIV
positive cases. Out of a total of 5,204 AIDS cases reported till March 1998, 2,518
are reported by Maharashtra followed by Tamil Nadu 1,092 and Delhi 214. The majority of
the states and UTs have reported full blown AIDS cases. It is estimated that there
are 3- 5 million HIV-infected people in India, likely to be the largest number of
HIV-infected people in the world by 2000.
Realising the gravity of the epidemiological nature of
HIV infection, the Government of India launched a National AIDS Control Programme in
1987. In 1992, National AIDS Control Organisation was established and a five-year
strategic plan was implemented with a US $ 84 million soft loan from the World Bank
and another US $ 1.5 million in the form of technical assistance from World Health
Organisation. The overall objective of the project has been to slow the spread of
HIV in India so as to reduce the future morbidity, mortality and impact of AIDS on
socio-economic development.The main components of the objective are:
(a) strengthening the management capacity for HIV
control;
(b) promoting public awareness and securing community support;
(c) improving blood safety and rational use of blood; and securing community
support; and
(d) building surveillance and clinical management capacity and controlling STDs.
At the national level, National AIDS Committee under the
chairmanship of Minister of Health and Family Welfare has been constituted. Generic
IEC packages based on research findings for the high risk groups namely commercial sex
workers, I.V. drug users, street children and slum dwellers have been
developed and circulated to the state governments for further dissemination of
information. AIDS education in schools has been taken up to sensitize the students
from class IX onwards. The electronic media, print media and other field based
organisations of the Govenment have been involved in awareness generation on
HIV/AIDS. Till March 1998, 3,500 consellors had been trained in various states at the
grass-root level under the national training programme of NACO. National AIDS
telephone helpline in cooperaton with Department of Telecommunications has
set up with a toll free four digit number 1097 for computerised information and
counselling on b telephone for HIV/AIDS and STDs. The first project under this
helpline has been functioning in Delhi since October 1997. Telephone counselling
facilities have also been set up in Chennai, Hyderabad, Calcutta and Guwahati and proposed
to be expanded to other cities.
For ensuring safe blood supply, a net-work of HIV testing
facilities has been established with 154 Zonal Blood Testing Centres all over the
country. These centres provide linkages to blood banks located in government,
voluntary and private sectors. In all 815 blood banks (government 727/chairtable 88)
have been modernised in phases by supply of basic blood bank equipments and
contingency grant for purchase of consumables, chemicals and re-agents. National
Blood Transfusion Council and State Blood Transfusion Councils have been set up for
promotion of voluntary blood donation. The licensing of blood banks has been made
mandatory with effect from 17 May 1997. This is being monitored by Drug
Controller General (India). So far 1,212 blood banks have been licensed.
Professional donor system has been banned with effect from 1 January 1998. For the proper
management of HIV/AIDS cases, training of medical doctors working in Government and
Non-government sectors is being undertaken through government institutions, IMA,
Voluntary Health Association of India (VHAI) etc. States are being given 100
per cent financial support in implementation of the National AIDS Control
Progrmme including clinical management.
IODINE DEFICIENCY DISORDERS
Iodine is an essential micronutrient and is required at 100-150 mg daily for normal human
growth and development. Deficiency of Iodine in the daily diet may cause goitre and other
Iodine Deficiency Disorders (IDD). Endemic goitre has been recognised as a major health
problem in India. Results of sample surveys conducted in 275 districts of 25 States and
four union territories have revealed 235 districts endemic for IDD where the prevelance of
IDD is above 10 per cent. It is estimated that in India more than 71 million people are
suffering from various Iodine Deficiency Disorders. The Government launched fully Central
assisted National Goitre Control Programme (NGCP) in 1962 with focus on provision of
iodised salt to identified endemic areas. In 1985 the Government decided to iodise the
entire edible salt in the country by 1992 in a phased manner. To date the production of
iodated salt is 42 lakh MT per annum. About 532 of the 790 private manufacturers licensed
by the salt commissioner have commenced production of iodated salt. The NGCP has been
redesignated as National Iodine Deficiency Disorders Control Programme (NIDDCP) to
emphasise the importance of all the IDDs. As per the directions of the Centre, 29 States/
Union Territories have completely banned the use of salt other than iodated salt for
edible purpose under PFA Act, while another two States have imposed a partial ban and have
also set up IDD monitoring laboratories in their respective health directorates.
DISEASES SURVEILLANCE PROGRAMME
National Surveillance Programme for Communicable Diseases mainly focuses on diseases which
has potential of causing large outbreaks such as acute diarrhoeal diseases and cholera,
viral hepatitis, dengue/DHF, Japanese encephalitis, leptospirosis and plague. The
objective of the programme is capacity building at the district level for strengthening
the disease surveillance system and appropriate response to outbreaks. The programme was
taken up as a pilot project during 1997-98 in one district each of the five identified
States which was extended to another 20 districts of 10 States the same year. During
1998-99, 20 more districts and eight States were added. By the end of the Ninth Plan
period, the programme will be extended to cover 100 districts of 31 States. An amount of
Rs 2.9 crore and Rs 4.85 crore were released to the State authorities during 1997-98 and
1998-99 respectively.
MENTAL HEALTH
The National Mental Health Programme was started in 1982. The District Mental Health
Programme was launched in 1996-97 as a pilot project. The programme envisaged a community
based approach to tackle the mental health problems within the community at the periphery
and aims at early detection and treatment of cases as well as follow up of cases
discharged from the mental hospitals at the community level. For this purpose free
medicines are being given. The project is under implementation in 16 States in which one
district and one nodal institution has been chosen for the purpose. Mental health
authorities have been set up in most of the States. Conditions in mental hospitals are
being improved. The National Institute of Mental Health and Neuro Sciences (NIMHANS),
Bangalore has been providing technical help wherever necessary. During 1997-98, the
programme has been extended to seven more districts, one each in Himachal Pradesh, Uttar
Pradesh, Haryana, Punjab, Madhya Pradesh, Maharashtra and Arunachal Pradesh. A sum of Rs
4.00 crore has been provided in the budget estimate. The Programme envisages a community
based approach to the problem, which includes (i) training of the mental health team at
the identified nodal institute within the state; (ii) creating awareness about mental
health problems; (iii) provide services for early detection and treatment of mental
illness in the community itself with both OPD and indoor treatment and follow-up of
discharged cases, and (iv) provide data and experience at the level of community in the
State and Centre for future planning, improvement in service and research. The training to
the trainers at the State level is provided by the National Institute of Mental Health and
Neuro Sciences, Bangalore.
CANCER
As cancer has a high rate of mortality unless detected and treated early, the emphasis is
on prevention, early detection of cases and augmentation of treatment facilities in the
country. Under the National Cancer Control Programme the following schemes are under
implementation: (i) Development of Regional Cancer Centres; (ii) Development of
Oncology Wing in Medical Colleges; (iii) Setting up of Cobalt Therapy Unit; (iv) District
Cancer Control Programme; and (v) Health education and early detection activities.
Fourteen Regional Cancer Centres in different States have been recognised as referral and
research centres. During 1996 an estimated 6,70,000 persons in India developed cancer.
GUINEAWORM ERADICATION PROGRAMME
After the successful eradication of Small Pox from the country in 1977, guineaworm
disease was targeted for eradication. In 1983-84, India became the first country to
launch an eradication programme against the disease, which had been causing great
human suffering and economic loss to the people living in the remote rural areas of
the country where adequate, safe drinking water was not available. The programme is
implemented through the existing primary health care infrastructure of the country in
collaboration with the Ministry of Rural Areas and Employment at the Centre and the state
public health engineering departments.
As a result of the effective strategies and concerted
efforts by the Central and state governments, the last case of guineaworm disease was
reported in July 1996. Since then the country is free from the scourge. The zero guinea
worm disease status has also been validated in January 1998 and again in April 1999.
YAWS ERADICATION PROGRAMME
Yaws is a disfiguring, disabilitating non-venereal treponemal infection and is totally
preventable. It can be cured and prevented by a single injection of long acting
(benzathine benzyl) penicillin. Yaws is amenable to eradication. Yaws occurs in remote
areas which have limited accessibility to health care services. The pilot project to
eradicate the disease in Koraput district was started in 1996-97. The programme has been
extended to districts in Madhya Pradesh, Andhra Pradesh, Maharashtra and Gujarat in
1997-98 and 1998- 99. Training of medical and para-medical personnel in some districts has
been completed and IEC material has been developed. The programme is proposed to be
extended to all affected districts during the Ninth Plan for which Rs 4 crore have been
earmarked.
MEDICAL RELIEF AND SUPPLIES
HOSPITALS AND DISPENSARIES
Medical services are primarily provided by the Central and state governments. Certain
charitable voluntary and private institutions also provide medical relifef. The district
and sub-divisional hospitals are being further developed by removing deficiences in
referral services. The number of hospital beds (both government and private) was 8.70 lakh
as on 1 January 1996 as compared to 1.17 lakh in 1951. The bed-population ratio as on
1 January 1996 is 93 per lakh population which was 32 at the commencement of
First Five Year Plan. At the end of 1996, the number of registered doctors was 4.76
lakh whereas, the number of nurses was 5.66 lakh.
RURAL HEALTH INFRASTRUCTURE
The Govenment has started concentrating on the development of rural health infrastructure
under the Minimum Needs Programme so as to provide health care services to rural
population. The stress in the National Health Policy is on the provision of preventive,
promotive, curative and rehabilitative health services to the people. The idea is to place
the health of the people in their hand through the primary health care approach.
In the rural areas services are provided through a network of integrated health and family
welfare delivery system. As on 30 June 1997 an extensive network of 2,622 Community
Health Centres, 22,010 Primary Health Centres and 1,36,339 Sub-centres has been set up to
provide primary health care at the grass root level. One Sub-centre is manned by one
female and a male multi-purpose worker covering a population of 5,000 in plain ares and
3,000 in Scheduled Caste (SC) and Scheduled Tribe (ST) and difficult terrain areas.
One Primary Health Centre is staffed with medical officer, pharmacist, staff nurse,
female multi-purpose worker, health educator, laboratory technician, female health
assistant, male health assistant each, besides other four or five ministerial staff,
for covering a population of 30,000 in the plain areas and 20,000 in tribal and
difficult terrain areas. One Community Health Centre is staffed with medical specialist,
surgical specialist, child specialist, gynaecologist each, besides 25 other
para-medical and ministerial staff. It has 30 indoor beds, well-equipped laboratory
and X-ray facility. It covers 80,000 to 1.20 lakh population.
CENTRAL GOVERNMENT HEALTH SCHEME
The Central Government Health Scheme (CGHS) was introduced with a view to providing
comprehensive medical care facilities to the Central government employees and
pensioners and to their families and to do away with the cumbersome and expensive
— reimbursement of medical expenses under Central Services (Medical
Attendance) Rules, 1944. The Scheme, which was started with 16 allopathic
dispensaries in Delhi/New Delhi covering 2.33 lakh beneficiaries has grown
over the years, both in coverage and scope. The scheme presently covers 9.48 lakh families
comprising 42.76 lakh beneficiaries which includes Central government employees,
pensioners, M.Ps, Ex-M.Ps, Ex-Governors, Ex-Vice Presidents and other entitled
categories. It is operative presently in 20 cities including Ranchi and Bhubaneshwar where
it is exclusively functioning for AG employees, as the AG concerned are bearing all the
expenditure. As on 31 March, the number of various categories of dispensaries/
laboratories established under the Scheme are : Allopathic-241, Ayurvedic-31,
Homoeopathic-34, Unani-nine, Siddha-two and Yoga-three, Polyclincis-19, Laboratories-71,
and Dental units-17.
The CGHS beneficiaries have now the
option of availing specialised treatment at a CGHS recognised hospital of their choice
after a specialist of CGHS/Government hospital has recommended the procedure. The
reimbursement is, however, restricted to the package rates/ceiling laid down by the
Government. Officers drawing a basic pay of Rs 12,000 and above are entitled for direct
consultation with the specialists in Government/State government hospitals. More than 200
private hospitals have been recognised in the country for CGHS beneficiaries.
EMERGENCY MEDICAL RELIEF
India with her variety of geographical features is the most disaster prone country of
Asia-Pacific region as it is exposed to devastating floods, cyclones and landslides all
the year round. There were reports of occurrence of waterborne diseases in Assam, West
Bengal, Andhra Pradesh, Uttar Pradesh and Gujarat, but timely measures undertaken during
1998-99 succeeded in containing them. Disaster management is the responsibility of State
governments. The Directorate General of Health Services, Ministry of Health and Family
Welfare, Government of India provides technical assistance to the States to improve the
health sector. The responsibility is discharged by the Emergency Medical Relief Division
of the Directorate. For this purpose, a constant communication is maintained with the
State governments. The Division also co-ordinates medical supplies to the foreign
countries as humanitarian assistance on behalf of the Ministry of External Affairs. During
1998-99 medical supplies were sent to Afghanistan, Kyrgyzstan, Cambodia, Bangladesh,
Sudan, Sierra Leone, New Papua Guinea and Peru.
DRUGS
The Drugs and Cosmetics Act, 1940, as amended from time to time, regulates import,
manufacture, sale and distribution of drugs and cosmetics in the country. Under the Act,
import, manufacture and sale of sub-standard, spurious, adulterated or misbranded drugs
are prohibited. The Government is empowered to check the quality of imported drugs,
coordinate the activities of the states, lay down regulatory measures and standards
of drugs and grant an approval for the import or manufacture or new drugs. The control
over the quality of drugs which are manufactured, sold and distributed in the
country, is exercised by state governments. Zonal offices of the Central Drugs Standards
Control Organisation (CDSCO) at Mumbai, Calcutta, Ghaziabad and Chennai, and
sub-zonal offices at Lucknwo and Patna maintain close liaison with state organisations for
enforcement of the provisions of this Act.CDSCO also arranges training programmes for the
personnel concerned with drugs standard control. Central Drugs Laboratory (CDL),
Calcutta functions as the testing laboratory for imported drugs and analytical quality
control of drugs manufactured within the country on behalf of the Centre assisted by
Central Indian Pharmacopoeia Laboratory, Ghaziabad and Central Drug Testing
Laboratory at Chennai and Mumbai and State Drugs Control Authorities. CDL, Calcutta is the
appellate laboratory under the Drugs and Cosmetics Act to test samples of drugs sent to it
by courts. Central Licensing Approval Authority (CLAA) at CDSCO, New Delhi approves
the licences for blood banks, blood products, large volume parenterals and sera and
vaccines jointly with the state licensing authorities.
The Department of Chemicals and Petrochemicals
controls the prices of bulk drugs and formulations under statutory control since 1962, but
more effectively from 1970. The Drugs (Prices Control) Order, 1970 has now been replaced
by the modified Drugs (Prices Control) Order, 1994. As a result of these measures,
the wholesale price index of drugs and medicines has been kept at a steady level vis-a-vis
other commodities.
VACCINE PRODUCTION
India is self-sufficient in the production of all vaccines, including measles,
required for the National Immunization Programme, except polio. The Polio vaccine is being
imported in bulk in a concentrated form and blended at the Haffkine Bio-Pharmaceutical
Corporation Limited, Mumbai, Bharat Immunologicals and Biologicals
Corporation Limited, Bulandshahar (UP), Radicura Pharma, Delhi and Biomed Private
Limited, Ghaziabad (UP). The indigenous production of polio vaccine may be started
very soon. Sixty per cent of the demand of BCG Vaccine is being met by the
indigenous production. To fulfill the balance demand of BCG vaccine required for the
National Immunization Programme, the expansion of BCG Laboratory, Guindy, Chennai
is in progress.
NUTRITION
Major nutritional problems in India are Protein Energy Malnutrition (PEM), Iodine
Deficiency Disorders (IDD), Vitamin A Deficiency (VAD) and anaemia. Besides,
fluorosis is also prevalent and lathyrism is localised to certain regions. The
Nutrition Cell in the Directorate General of Health Services provides technical
advice on all matters related to nutrition. State nutrition divisions set up
in 17 states and union territories assess the diet and nutritional status in various
groups of population, conduct nutrition eduction campaigns, supervise supplementary
feeding programmes and other nutritional ameliorative measures. Surveys
onducted by state nutrition divisions and National Nutrition Monitoring Bureau under ICMR
reveal that malnutrition and other deficiency disorders are found more in
young children, pregnant and lactating mothers. To combat these problems, Government
has initiated several schemes. The Integrated Child Development Scheme (ICDS)
provides a package of services to control nutritional and health problems. To
prevent blindness among children due to Vitamin A deficiency, a concentrated dose of
Vitamin A is given orally every six months through peripheral health workers. Similarly,
to prevent nutrutional anaemia among women and children, tablets of iron and folic
acid are distributed through health centres. A Pilot Programme agains
Micronutrient Malnutrition has been initiated in five districts in Tripura, Bihar, Orissa,
West Bengal and Assam to assess and improve micronutrients status in school children,
adolescent boys and girls, women of child-bearing age and elderly population. The
National Institue of Nutrition, Hyderabad and All India Institute of Hygiene and Public
Health, Calcuttta are the principal organisations for nutrition research and
training.
MEDICAL EDUCATION AND RESEARCH
INDIAN COUNCIL OF MEDICAL RESEARCH
The Indian Council of Medical Research (ICMR) established in 1911, is the apex body in
India for the formulation, coordination and promotion of biomedical research. The
primary functions of the Council are discharged through its 21 permanent research
institutes/centres which are mission-oriented research institutes of national and
international repute and six regional medical research centres, and centres for advanced
research, national task force projects and multicentric collaborative projects in
different parts of the country. In addition, there are ad-hoc schemes and
fellowships generated by active scientists in biomedical institutions/universities in
differen parts of the country. ICMR also attempts to strengthen indigenous capabilities,
promote a broad-based balanced cadre of research personnel in the country and
develop facilities to handle the present and future health problems.
The priorities of the Indian Council of Medical
Research coincide with the national priorities. Infectious diseases, malnutrition and
excessive population growth here continued to constitute the major priorities of the
Council. In recent years, with increasing life span the burden of non-communicable
diseases has increased significantly. Hence research has been intensified progressively on
such health problems as cardiovascular diseases, metabolic disorder, neurological
disorders, blindness, liver diseases, hearing impairment, cancer, mental health
problems, drug abuse, etc. The Council has consolidated its research on important
communicable diseases such as tuberculosis, leprosy, diarrhoeal diseases, malaria,
filariasis, and more recently on AIDS. Research on traditional medicine/herbal remedies
has been revived with a disease-oriented approach. Attempts have also been made to
strengthen and streamline medical informatics and communication to meet the growing
demands and needs of the bio-medical community.
MEDICAL EDUCATION AND RESEARCH
INDIAN COUNCIL OF MEDICAL RESEARCH
The Indian Council of Medical Research (ICMR) established in 1911, is the apex body in
India for the formulation, coordination and promotion of biomedical research. The primary
functions of the Council are discharged through its 21 permanent research
institutes/centres, six regional medical research centres, and centres for advanced
research, national task force projects and multicentric collaborative projects in
different parts of the country. In addition, there are ad-hoc schemes and fellowships
generated by active scientists in biomedical institutions/universities in different parts
of the country. ICMR also attempts to strengthen indigenous capabilities, promote a
broad-based balanced cadre of research personnel in the country and develop facilities to
handle the present and future health problems. The priorities of the Indian Council of
Medical Research coincide with the national priorities. Infectious diseases and excessive
population growth continued to constitute the major priorities of
the Council. In recent years, with increasing life span the burden of non-communicable
diseases has increased significantly. Hence research has been intensified progressively on
such health problems as cardiovascular diseases, metabolic disorder,
on such health problems as cardiovascular diseases, metabolic disorder, neurological
disorders, blindness, liver diseases, hearing impairment, cancer, mental health problems,
drug abuse, etc. The Council has consolidated its research on important communicable
diseases such as tuberculosis, leprosy, diarrhoeal diseases, malaria, filariasis, and more
recently on AIDS. Research on traditional medicine/herbal remedies has been revived with a
disease-oriented approach. Attempts have also been made to strengthen and streamline
medical informatics and communication to meet the growing demands and needs of the
bio-medical community.
MEDICAL COUNCIL OF INDIA
The Medical Council of India (MCI) was established as a statutory body under the
provisions of the Indian Medical Council Act, 1933 which was later repealed by the
Indian Medical Council Act, 1956 with minor amendments in 1958. A major amendment
in the I.M.C. Act, 1956 was made in 1993 to stop the mushroom growth of medical
colleges/increase of seats/starting of new courses without prior approval of the Ministry
of Health and Family Welfare. The main functions of the Council are maintenance of
uniform standard of medical education both at the undergraduate and the
post-graduate level; maintenance of Indian Medical Register; reciprocity with
foreign countries in the matter of mutual recognition of medical qualifications;
continuing medical education and granting of provisional/permanent recognition of
doctors with recognised medical qualifications, registration of additional
qualifications and issue of Good Standing Certificate for doctors going abroad to
commonwealth countries. At present there are 164 medical colleges in the country out
of which 148 medical colleges have been recognised by MCI. Of these 148, 105 are
Government medical colleges and the remaining 43 are private medical colleges. The
admission capacity in these colleges is approx. 17,000 students per year.
DENTAL COUNCIL OF INDIA
Dental Council of India was established under the Dentists Act, 1948 with the prime
objective of regulating dental education, profession and its ethics in the country.
It periodically carries out inspections of dental institutions to ascertain the
dequacy of teaching facilities. One hundred and four dental colleges
are functioning in the country with an admission capacity of 5,220 students in the
BDS courses.
PHARMACY COUNCIL OF INDIA
The Pharmacy Council of India is a statutory body constituted under the Pharmacy
Act, 1948. It is responsible for regulation and maintenance of uniform standard of
training of pharmacists. It also prescribes syllabi and regulations for diploma courses
in pharmacy and registration of pharmacists. At present,
there are 325 institutions imparting Diploma in Pharmacy to 19,245 students per
annum and 112 institutions offering degrees in pharmacy to 5,610 students.
NATIONAL ACADEMY OF MEDICAL SCIENCES
The National Academy of Medical Sciences (NAMS) was established as a registered
society with the objective of promoting the growth of medical sciences. It
recognises talent and merit in the form of election of fellows and members of the
Academy. To keep medical professionals abreast with new problems and update their
knowledge in those fields for the required delivery of health care, a programme of
Continuing Medical Education (CME) is being implemented by the Academy since 1982.
NURSING EDUCATION
Nursing Education is primarily imparted at five levels: (i) Auxilliary Nurse Midwife
(ANM); ii) General Nursing and midwifery (GNM); (iii) B.Sc. Nursing;
(iv) Master’s Degree in Nursing and (v) M.Phil/Ph.D in Nursing. The
Indian Nursing Council, a statutory body, constituted under the Indian Nursing
Council Act, 1947, lays down the minimum standards of Nursing education and prescribes
syllabi and norms for various nursing courses.
HEALTH EDUCATION
The Central Health Education Bureau (CHEB)- an apex Institute in Health Education -
imparts inservice training to all categories of personnel in health and related
sectors at the state and district levels. They in turn disseminate the message of health
education in the community at large. The Bureau, set up in 1956, also continues to
provide up-to-date information on current issues and development in health
education, besides communication and training. The Bureau achieves its objectives through
eight technical divisions, namely, Training, Media, Editorial, Health Education
Services, Research and Evaluation, Field Study and Demonstration Centre and
Health Related Vocational Courses. The Training Division runs a post-graduate Diploma
Course in Health Education of two years duration at the University of Delhi; Media
personnel training course of eight weeks duration; Certificate courses in
Health Education for para-medical professionals, medical officers, teachers and key
trainers; district-level medical officers course, etc. Besides about 28 orientation
courses of one-day duration are held for Nursing, para-medical professionals
and international visitors.
The Media Division is the Information Education and
Communication unit of the Bureau. The Editorial Division brings out three
periodicals, namely, Swasth Hind English monthly), Arogya Sandesh (Hindi
monthly) and Swasth Siksha Samachar devoted to important public health
problems, plans and policies of the Ministry of Health and Family Welfare. It also
prepares and produces printed materials like folders, pamphlets, etc., on important
public health subjects. The School Health Division promotes health education in the
school system. The Health Education Services Division renders technical
guidance to State Health Education Bureaux and assists government and non-government
agencies in promoting health education in the country. It also co-ordinates with
international and national agencies.The CHEB is a nodal agency for promoting
Health-Related Vocational Courses (HRVCs) at the 10+2 stage of education in the country in
collaboration with the Department of Education. The HRVC Division develops curricula and
text-books for various HRVCs and persuades the states/UTs the start these courses.
The Research Division conducts Behavioural Studies on various aspects of health problems
that serve as a basis for launching health education campaigns. It also conducts Social
Science Research Methods Courses. The Field Study and Demonstration Centres of the Bureau
are field laboratories to test and evaluate methods and the media of health
educatiion which can be adopted elsewhere.
NATIONAL ILLNESS ASSISTANCE FUND
The National Illness Assistance Fund (NIAF) has been set up in the Ministry of Health
and Family Welfare with an initial contribution of Rs 5 crore in 1997. The fund
could be subscribed by individuals in India or abroad, corporate bodies in private
or public sector, philanthropic organizations. All contributions made to this Fund are
exempt from payment of Income Tax under Section 80-G. The Fund will provide
necessary financial assistance to patients living below the poverty-line, suffering
from major life-threatening diseases, to receive medical treatment at any of the
superspeciality hospitals/institutes or other government private hospitals. Financial
assistance to such patients would be release in the form of a one-time grant
which will be released to the Medical Superintendents of the hospitals in which the
treatment has been/is being received. In a bid to speed up the assitance to needy
patients, the Scheme has been modified to provide an advance release of Rs 10 lakh
to the Medical superintendents of AIIMS, New Delhi, Dr. RML Hospital, Safdarjung Hospital
and LHMC and Smt. S.K. Hospital, New Delhi, and PGIMER, Chandigarh, JIPMER, Pondichery to
enable immediate sanction of an amount up to Rs 25,000 in each deserving case
reporting for treatment in the respective hospital/institute. This amount would be
replenished as and when the report of its utilization are received.
All the state governments/UT administrations have
similarly been advised to set up an Illness Assistance Fund in their respective
states/UTs. It has also been decided that grant-in-aid from Central government would be
released to each of these states/ UTs where these funds are set up on the lines
advised to them. The grant-in-aid would be reckoned with reference to the
contributions made by the respective state government/UT administration as well as the
proportion of population living below poverty-line in the respective state/UT. It
has been provided in the scheme that Union Territories which do not have a
legislative assembly will be sanctioned a budget outlay of Rs 50 lakh each from out
of the National Illness Assistance Fund as and when the UT administration have set
up an Illness Assistance Society/Committee. The Illness Assistance Fund at the
state/UT level would release financial assistance to patients giving in their respective
areas up to Rs 1.5 lakh in an individual case and forward all such cases to NIAF
when the quantum of financial assistance is likely to exceed Rs 1.5 lakh to patients
living in their respective areas.
FAMILY WELFARE
India is the largest functioning democracy in the world with the second largest
population. On 2.4 per cent of the world’s land area she supports 16 per cent of its
population. The population is increasing by about 16 million every year. Recognising that
the planning of families would enhance individual health and welfare, the Government of
India was the first in the world to initiate a comprehensive Family Planning programme in
1951. In keeping with the democratic traditions of the country, the Family Welfare
Programme seeks to promote on a voluntary basis, responsible and planned parenthood,
through independent choice of family welfare methods best suited to the acceptors.
At the time of India’s Independence, there were but
few health facilities serving the rural poor. The past five decades have witnessed
significant investments in developing a network of health centres all over India.
Through this vast infrastructure of sub-centres, primary-health centres and
community health centres, the Government has been playing the role of a facilitator
by providing family planning services for the people to plan their families.
The investments made have shown significant results: death
reates have declined significantly; infant mortality rate has been halved and life
expectancy has almost doubled since Independence, though a lot of ground is yet to
be covered.
Since success of the family welfare programmes is dependent
on various factors like improved literacy rate, female education, socio-economic status of
individuals and families etc., the Cairo Conference on Population Development
in 1994 called for a broad-based approach to population stabilisation and fulfilling
the eproductive needs of people. The Government of India is a signatory
to the Plan of Action emerging out of the Cairo Conference.
The Child Survival and Safe Motherhood (CSSM) programme
introduced in India in 1992, has brought about great improvements in the field of
immunisation. Significant decline in the reported incidents of vaccine preventable
diseases mark the CSSM period.
REPRODUCTIVE AND CHILD HEALTH PROGRAMME
The Reproductive and Child Health (RCH) Programme, which was launched on 15 October
1997, draws its mandate from the Programme of Action of the International Conference
on Population and Development 1994. Under the RCH Programme a comprehensive package
of services for family planning, maternal and child health and management of
reproductive tract infections, including sexually transmitted diseases, will be
implemented. Inputs will be provided to improve access to services to bridge the gap
between services provided and unmet need. In addition to improving the
reach of the services a major emphasis would be on ensuring good quality of services
through appropriate logistics, in-service training and monitoring and supervision. A
differential approach will be adopted while providing inputs to various districts
to ensure that these are commensurate with the capacity of the individual
districts to utilise them effectively.
The various Districts have been categorised as A(58),
B(184) and C(265), on the basis of Crude Birth Rate and Female Literacy Rate which
reasonably reflect the RCH status of the District. The districts will be covered in
a phased manner over three years.
The estimated cost of the RCH Programme will be Rs 5,112.53
crore during the 9th Plan. The RCH initiatives in the form of nationwide
programmes will cost Rs 4,565.03 crore. This would be supplemented by 24
District Projects in 17 States, costing Rs 283.88 crore, which will be strengthenened by
inputs for infrastructure and facilities to bring them up to the State level.
Foreign assistance for the RCH programme will be worth more than US $ one billion
during the 9th Plan. The World Bank has sanctioned phase-II of the project to begin
after two-and-a half years. The European Commissioin has approved the project
for US $ 250 million, UNICEF for US $ 121 million and UNFPA for US $ 100 million.
Bilateral agencies like DANIDA, DFID, KFW have also committed themselves to sizeable
amounts.
COMMUNITY NEEDS ASSESSMENT APPROACH
From 1 April 1996 the Family Welfare Programme is being implemented all over Indiaon the
basis of target-free approach. This approach renamed Community NeedsAssessment Approach,
envisages replacement of the system of setting contraceptivetargets from the top by a
system of decentralised participatory planning at thegrassroots level. This decentralised
planning will take into account the needs of thecommunity and is expected to lead to
improvement in quality of services, clientsatisfaction as well as greater acceptance by
the people.
PULSE POLIO IMMUNIZATION
The Pulse Polio Immunization (PPI) was successfully implemented during 1998-99 and 13.59 crore children in the age-group of 0-5 years were given doses
of oral polio vaccine in the country on 6 December 1998 and 13.84 crore children in the
same age-group were given oral polio vaccine on 17 January 1999. A system of Surveillance
for cases of Acute Flaccid Paralysis has been set up for the detection and containment of
poliomyelitis all over the country. Additional round of PPI was conducted on 14 March 1999
in Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan. Despite such gigantic efforts so
far, 5-7 per cent children are still not immunized under PPI. Because of these
shortcomings, the strategy has been intensified with additional measures for the year
1999-2000. In a bid to eradicate polio from the country, four rounds of PPI have been
planned during this year for the whole country and two more rounds extra for the eight
States.
ACHIEVEMENTS
The National Family Welfare Programme was launched in India in 1951 with
‘theobjective of reducing the birth rate to the extent necessary to stabilise the
populationat a level consistent with the requirements of the National Economy (First Five
YearPlan Document). The achievements of the Family Welfare Programme since its inception
are summarised below:
| PARAMETER |
1951 |
1981 |
1991 |
LATEST (Source and No. year in
parenthesis) |
| Birth Rate |
40.8 |
37.20 (Census) |
29.5 (SRS) |
27.5 (SRS 97) |
| Death rate |
25.1 |
15.0 (Census) |
9.8 (SRS) |
8.9 (SRS 97) |
| Total Fertility Rate |
5.99 |
4.5 |
3.6 |
3.5 (SRS 95) |
| Infant Mortality Rate(per 1000 live births) |
146.0 |
110.0 |
80.0 |
71.0 (SRS 97) |
| Couple Protection |
10.4 |
22.8 |
44.1 |
45.4 (Servicedata-98) |
| Cumulative Number of |
Nil |
44.2 |
130.1 |
226.97 (31 March 1998) |
SRS : Sample Registration System
India’s population rose from 36.11 crore in 1951 to
84.63 crore as per the 1981-91census.The average annual exponential growth rate has fallen
after Independence to2.71 percent in 1981-91 from 2.14 per cent in 1991census.As per the
Sample Registration System (SRS), the annual natural growth rate of population has come
down to 1.83 per cent in 1997 from 1.97 per cent in 1991.
Among the states, there is considerable variation in
reducing the growth of population, e.g., states like Kerala and Tamil Nadu with crude
birth rates of 17.9 and 19.0 respectively, have performed very well. On the other hand,
the crude birth rates in Bihar (31.7), Madhya Pradesh (31.9), Rajasthan (32.1) and Uttar
Pradesh (33.5), which constitute about 40 per cent of India’s population, are higher
than the national average of 27.2 per thousand population in 1997. Total fertility rates
in Bihar (4.5), Madhya Pradesh (4.2), Rajasthan (4.4) and Uttar Pradesh (5.0) are
significantly higher than the all-India average of 3.5 (SRS: 1995). Similar variations are
seen in respect of the infant mortality rates. At one end of the spectrum, Kerala has an
IMR on only 12 per thousand live births whereas it is as high as 94 in Madhya Predesh and
96 in Orissa (SRS : 1996).
IMPLEMENTATION MACHINERY
The Family Welfare Programme is implemented through the state governments with cent per
cent Central assistance. In Rural areas, services are provided through the network of
sub-centres, primary health centres and community health centres. Establishment of
sub-centres has been made a hundred percent Centrally-sponsored Health and Family Welfare
scheme (except the salary of male health worker and construction of sub-centre building)
since April 1981. Against the requirement of 1.34 lakh sub-centres, there are 1.37 lakh
sub-centres functioning as on 30 June 1998.
BIRTH CONTROL METHODS
During 1998-99, 40.8 lakh sterilisations were performed in the country. The number of IUD
insertions during the same period was 61.4 lakh. Besides, there were 140.2 lakh
condom-users and 55.9 lakh OP users. It is estimated that 45.4 per cent of 16.59 crore
eligible couples were protected by one or the other approved family planning methods as on
31 March 1998 averting 226.97million births, since the inception of the programme.
SOCIAL MARKETING OF CONTRACEPTIVES
Social Marketing of contrceptives aims at making contraceptives available to that segment
of population which can afford to buy the same from the market at a lower cost. Under the
scheme of Social Marketing of Contraceptives, condoms and Oral Pills are currently being
sold at subsidised prices through the distribution network of private/public marketing
companies and NGOs. Subsidy ranging from 55-88 per cent on the procurement cost is being
provided by the Government.
MATERNAL HEALTH
The existing maternal health situation of the country is a cause of concern for all.
India’s maternal mortality rate at 437 per one lakh live births is 50 times higher
than the developed world. The causes of maternal deaths are known and treatable. However,
it is not largely preventable or predictable. To tackle this enormous problem, a number of
interventions have been provisioned for the current RCH programme. They are: provision of
emergency obstetric care through establishment of First Referral Units ; promotion of
institutional delivery by providing round the clock delivery services in PHCs/CHCs;
ensuring early ante-natal registration of pregnant women to provide regular check ups for
taking preventive and promotive steps and to detect early complications to enable prompt
action; at least three ante-natal check ups to monitor the progress of the pregnancy as
well as three post-natal check ups to monitor the post-natal recovery have been provided
for; linking the community with service delivery system through Panchayat by providing
corpus fund for transportation costs of the pregnant prices
through the distribution network of private/public marketing companies and NGOs. Subsidy
ranging from 55-88 per cent on the procurement cost is being provided by the Government.
MEDICAL TERMINATION OF PREGNANCY
It is estimated that about 12 per cent of the maternal mortality and a significant number
of maternal morbidity are due to illegal abortions. In order to prevent these health
hazards to women, the Medical Termination of Pregnancy Act, 1971 was promulgated. Under
this Act, medical termination of pregnancy can be done in pregnant women up to 20 weeks,
if pregnancy is likely to result in birth of a congenitally malformed child or
continuation of pregnancy is likely to harm the mother in the existing circumstances and
in cases of contraceptive failures. Since the inception of the programme in April 1972,
115.8 lakh terminations up to December 1998 were conducted under the MTP Act.
PREVENTION OF PRE-NATAL SEX DETERMINATION
Any test to determine the sex of an unborn child has become illegal since the Pre-natal
Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 came into effect
from January, 1996. Punishment is prescribed for illegal use of pre-natal diagnostic
techniques like ultrasonography, amniocentesis, etc., to determine and communicate the sex
of an unborn child (foetus) to prospective parents. These techniques can be conducted and
genetic counselling can be offered only by genetic clinics, genetic laboratories and
genetic counselling centres registered under the Act.
The Department has launched a mass media campaign on this
issue through press advertisements and video spots to raise awareness about the provisions
of the Act.
RESEARCH AND EVALUATION
The Union Ministry of Health and Family Welfare has established a network of 18 Population
Research Centres (PRCs) scattered in 17 states for carrying out research on various topics
of population control, demographic and socio-economic surveys in Family Welfare programme.
Of these, 11 centres are located in universities, 6 in non-governmental institutions of
repute while one centre is functioning under the state-government of Madhya Pradesh. These
centres are provided with 100 per cent financial assistance in the form of grants-in-aid
on year-to-year basis towards salaries, books and journals, stationary, vehicle for field
surveys and other infrastructural equipments, etc. Research activities continued in the
field of demography and also communication through 17 PRCs in various states.
INDIAN SYSTEMS OF MEDICINE AND
HOMOEOPATHY
Indian Systems of Medicine such as Ayurveda, Siddha and Unani and drugless therapies like
Yoga and Naturopathy, have been widely practised in India. These systems attained a high
level of development centuries ago and were the only stream of treatment in pre-British
India. Homoeopathy though relatively a young system of medicine, which originated in
Germany, has been widely accepted and practised in India.
The Vaidhas and Hakims had been
practising these systems on the strength of their own merit. Public demand has given rise
to a large number of practitioners without adequate training on the one hand and
manufacture of non-quality medicines on the other. However, in post-Independence India,
the Government recognised the merit of each of the Indian Systems of Medicine and
Homeopathy (ISM&H)) and made attempts to develop them as viable systems of medicine
for the health care needs of our people.It was felt that the goal of the World Health
Organisation of ‘Health for All’ cannot be achieved through the modern
Allopathic system alone and there is need to involve the ISM&H. Practitioner in the
national mainstream for achieving this goal. This has resulted in recognising our
traditional systems of Ayurveda, Siddha and Unani and Homoeopathy as National Systems of
Medicine along with Allopathy. This recognition has paved the way for the organised
development of all these six systems of Medicine based on their individual merit and
strength. Each of these systems of medicine is based on its own individual philosophy and
principles. Each has its own core areas of strengths and weaknesses. ISM & H systems
of medicine are found to be safe, easy to use, economically viable and are widely accepted
by the masses. These systems have had a broad policy support of the Government. As a
result, a broad institutional framework exists today.
INSTITUTIONAL FRAMEWORK
The institutional framework of these systems consists of : (a) two Statutory Regulatory
bodies, viz., (i) Central Council of Indian Medicine and (ii) Central Council
of Homoeopathy; (b) Four apex research councils viz., (i) Central Council for
Research in Ayurved and Siddha (CCRAS); (ii) Central Council for Research in Unani
Medicines (CCRUM); (iii) Central Council for Research in Homoeopathy (CCRH) and
(iv) Central Council for Research in Yoga and Naturopathy (CCRYN); (c) Four
Pharmacopoeial Committes for different systems of Medicines i.e., (i) Ayurvedic
Pharmacopoeia Committee, (ii) Unani Pharmacopoeia Committee, (iii) Siddha
Pharmacopoeia Committee,(d) Unani system of Medicine; (e) Pharmacopoeial Laboratory
for Indian Medicines, Ghaziabad; (f) Homoeopatic Pharmacopoeial Laboratory,
Ghaziabad; (g) The Rashtriya Ayurveda Vidhyapeeth, New Delhi; and (h) The
Indian Medicines Pharmaceutical Corporation Limited, Mohan (in Distt. Almora, UP).
A wide network of undergraduate and post-graduate colleges
both in the Government and private sector have now come up to teach these systems of
medicine. There are about 2,850 hospitals, 21,817 dispensaries and 8,000 pharmacies
manufacturing the drugs in these systems. In December 1995, the Government created a
separate Department for ISM & H.
A Working Group was set up for the development of these
systems which identified the areas of interventions and suggested a plan for the Ninth
Plan period. Accordingly the Planning Commission approved an outlay of Rs 266.35 crore for
the Ninth Plan period. The plan allocation for 1998-99 and 1999-2000 has been Rs 50 crore
and Rs.59.13 crore respectively.
THRUST AREAS FOR DEVELOPMENT
The Department of ISM & H has adopted the following thrust areas for the development
and promotion of these systems: (1) Improvement and upgradation of standards of education
in ISM&H; (2) Standardisation of Drugs; (3) Enhancing the availability of
raw material, i.e., medicinal plants, metal and minerals, materials of marine and animal
origin etc.; (4) Research and Development; (5) Information, Education and
Communication; and (6) Involvement of ISM&H in the National Health Care
Programme and Family Welfare Proframme.
STANDARDS OF EDUCATION
Education is one of the thrust areas of the Department. There are 295 undergraduate
colleges and 47 post-graduate colleges under Department of ISM&H in the country. The
Statutory Regulatory bodies, namely, Central Council of Indian Medicine, and Central
Council of Homoeopathy, lay down the minimum standards of education and norms, curriculum,
etc., and register the practitioners of these systems. The Government has also set up the
National Institute for Ayurveda at Jaipur, National Institute for Homoeopathy at Calcutta,
National Institute for Unani Medicine at Bangalore, National Institute of Naturopathy at
Pune and Morarji Desai National Institute of Yoga at Delhi.Efforts have been made to
strengthen the existing institutions and to operationalise the new ones. Project reports
have been prepared for the National Institute of Yoga, National Institute of Naturopathy
and for the National Institute of Unani Medicine. The National Institute of Unani Medicine
will act as a post-graduate institute.
The Government of India has been
providing financial assistance to the under-graduate colleges for strengthening and
upgradation. As a part of the continuing education and in order to instil confidence and
update the skill, reorientation training programme for teachers, physicians and
para-medics has been implemented. The State governments sponsor teachers and physicians to
these courses. No separate Statutory Council has been set up as yet for laying down the
standards and norms for pharmacy and nursing colleges of ISM&H. Meanwhile, a component
of ISM&H pharmacy education has been incorporated in the existing schemes for
strengthening of ISM&H under-graduate and post-graduate colleges. In the field of Yoga
and Naturopathy education, the course content has been worked out. The matter of having a
separate regulatory body is under examination. The Statutory Regulatory Bodies, namely,
CCIM & CCH, lay down the minimum standards of education and norms, curriculum, etc.,
and register the practitioners of these systems. Also international/national exchange
programme has been introduced for propagating Indian Systems of Medicine at international
level.
STANDARDISATION OF DRUGS
Pharmacopoeial standards for ISM&H drugs have not been evolved and prescribed in majority of the drugs though the Pharmacopoeial committees have
been in operation for long. The Pharmacopoeial committees have been reconstituted recently
and a thrust is being given to a time bound programme to complete the work of laying down
of standards by the Ninth Plan period. At present two drug testing laboratories of the
Department, viz., the Pharmacopoeial Laboratory for Indian Medicine, Ghaziabad; and the
Homoeopathic Pharmacopoeial Laboratory, Ghaziabad are providing the technical support to
these Pharmacopoeial committees. In order to accelerate the work of evolving of standards,
research institutions/laboratories have been involved to work on the standards for 10
drugs per year. Thirty-one such organisations have been provided financial assistance for
the purpose and 300 drugs have been allocated. The drug research units of the research
councils are also engaged in this work. The Department is concerned with Drug Legislation,
namely, the Drugs and Cosmetics Act, 1940 and the rules thereunder. There are separate
chapters under the Act. Ayurveda/Siddha/Unani Drugs Technical Advisory Board and the Drug
Consultative Committee have been set up to advise the Government on matters relating to
ISM drugs. The Government have notified guidelines on the good manufacturing practices for
Ayurveda, Siddha and Unani Drugs.
ENHANCING THE AVAILABILITY OF RAW MATERIALS
Medicinal Plants, minerals, metals and materials of marine and animal origin are the raw
materials used in the preparation of ISM&H drugs. Eighty per cent of the drugs are
based on medicinal plants. The Department has been taken steps to enhance the supplies of
medicinal plants by their conservation and preservation through in situ and ex situ
cultivation, developing tissues culture, storage in gene banks, developing large scale
gardens of medicinal plants, etc. A special scheme to provide assistance to research
organizations for development of agro techniques has been introduced in which the
government, semi-government organizations have been involved. Twenty-six such
organisations are participating in the scheme and 94 plants have been allotted to them.
The Government has recently banned 29 medicinal plants supposed to be endangered for use
in drugs to be exported.
RESEARCH AND DEVELOPMENT
The four apex research councils, viz., (i)
Central Council for Research in Ayurveda and Siddha (CCRAS);
(ii) Central Council for Research in Unani Medicines (CCRUM);
(iii) Central Council for Research in Homoeopathy (CCRH) and
(iv) Central Council for Research in Yoga and Naturopathy (CCRYN)
are carrying out research activities like clinical research, drug standardisation research, drug proving research, family welfare research,
tribal research, etc. The CCRAS has more than 86 units in the country.
The Council has patented 18 Ayurvedic and Siddha drugs. The
CCRUM has a netework of 32 institutions/units spread all over
the country. This council is in the process of patenting the
products developed by it. CCRH has a network of 50
institutes/units in the country. The CCRYN is providing grants to
voluntary yoga and nature cure institutions for undertaking various activities, viz., conducting clinical research, strengthening patient care
centres, running one-year diploma course and conducting
seminars/workshops/ conferences, etc. A
Central Research Institute in yoga now merged with the Morarji Desai
National Institute of Yoga, Delhi has been providing training in yoga and also treatment to the public. A new dimension
has been added to research activities. Under a scheme of Extra
Mural Research financial assistance is provided to accredited research
institutes for conducing research activities.
INFORMATION EDUCATION AND COMMUNICATION
The Indian Systems of Medicine and Homeopathy can offer excellent and effective medical
treatment particularly in chronic diseases. There is need to create an awareness about the
merits of these systems and highlight some points like Swastha Vritta, Sadvritta, Aahar,
Panchakarma, Ksharsutra, Regimental therapy of Unani system, Shatkarmas of Yoga, etc. A
scheme has been evolved for involving the NGOs to spread the messages of these systems.
INVOLVEMENT IN NATIONAL HEALTH PROGRAMMES
The National Health Policy of 1983 envisages integration of ISM&H with the modern
system of medicine. The services of practitioners of ISM&H are being used for
distribution of drugs and medicines of modern system of medicine. Out of the six lakhs
practitioners of these systems, about 30,000 doctors are in the Government Sector. There
are 74 CGHS dispensaries/units and one Ayurvedic hospital under the CGHS. The Department
has recently set up Clinics of Ayurveda and Homoeopathy in the Safdarjung Hospitaland a
clinic of Unani Medicine has been set up in Ram Manohar Lohia Hospital,Delhi.
Under the reproductive child health (RCH) scheme, the
ISM&H has been associated with the Department of Family Welfare. For providing
training to ISM&H physicians in RCH, training institutions have been identified. The
research projects related to drugs of ISM&H that can be used in RCH have been approved
for funding through the Department of Family Welfare. Also the research project on
Pipilayadi Yoga as a contraceptive has been approved. The Department of Family Welfare is
financing cultivation of medicinal plants on 3,000-5,000 hectares of denuded
forests/wasteland. Projects on cultivation of medicinal plants in the States of Haryana
and Himachal Pradesh have been sanctioned along with some projects under the district
plan.
CHRONOLOGICAL HIGHLIGHTS
1948 India joined WHO as member State.
1951 BCG vaccination programme launched.
1953 National Malaria Control Programme launched. — National
Family Planning Programme started.
1956 Central Health Education Bureau established .
1958 National Malaria Control Programme converted to National
Malaria Eradication Plan.
1962 National Small Pox Eradication Programme launched.
1963 Extension approach for Family Planning started.
1966 Separate Department of Family Planning constituted.
1972 Medical Termination of Pregnancy Act (1969) came
into force.
1975 India became small pox free on 5 July 1975. — Integrated
Child Development Scheme (ICDS) started.
1976 New Population Policy announced.
1982 National Health Policy announced.
1983 National Leprosy Control Programme changed to National Leprosy
Eradication Programme
1985 Universal Immunization Programme launched. — Department of
Women and Child Development created under Ministry of Human Resource Development.
1987 National AIDS Control Programme initiated.
1989 Blood Safety Programme launched.
1992 Child Survival and Safe Motherhood (CSSM) launched.
1995 ICDS renamed Integrated Mother and Child Development (IMCD)
Legislation on Transplantation of human organs enacted.
1996 Family Planning Programme made target free.
1999 New National Health Policy announced. — New National
Population Policy announced.
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