HEALTH AND FAMILY WELFARE

Item

Title
HEALTH AND FAMILY WELFARE
extracted text
Plc^A

y/<> c^j"
A' J

^Ux^-cJ

(LjLayRg-vl

P

llu

U

■ 1L j

J)

f\c (tv.

1 "

/7qi zS>'/

(jP At^d. .e^ryctJzc

(R

r

.> If '7 / j v-_ < • ,C

12^^

Rt>//Ch5<c? L.^>

^TZp ' s.

/?&/ —Z/o /rg^ot.^
C. S3--S7; ■— ^&^ 8b '-

-

.Co ^IK-

g/-g z.

1^) &VMJU>ty
’•S’^

/<???*' Co
k~r, bi 'I

7<_3?J____
11,
C

n

e'^Q^cX^

c.p^y

*

Lo^u- c--c~<toQ_c t — c £LvA_Gv<d

I^gJ^ O-A-a Q

R

bfeTVaUCj J-i^

Co to

S

<■ -1(-7

S<7 KA/Il CO

K ' ^^y)e VJ£. ^JL r

[)

VZXCcRmJL^ f .0.^ <<-<

>

66^.

■p\l____

C,

11.11

c \j>-v(S.

Q

' \

! • PLoipu^P

Bmockz . Kr~~J<-

U'-A.O

CJ

-Gak. 6<p ua^.<oLp

JCA L=^£oPI ky

o.^

pCa^p

Ov

» C’-^-a^vS'^x l2_ %

L

^^-0-

v] C », X fl JkJ>

pT Ls^

F>

!,

rU<
1

A n P> -0* r g rxR
_*:^o qj*

j=^- p < K-^crrT/

^U-4^r<Z c~ A,

P-U'vl

.

P

■C.

t.

A U,y

bO

'a_ Eba. (^

L- d

?Uu^ J* '

c

0-

'go^ • c^A_g/f->leA^A>tA^
t-K-^.Z'! AA-4

c- e•
RkX>o

"

'“’i"p>‘ p^ocj~

<

*cl qm^uLitS q-l^ip '77B H

:o-»vi

e-vctA1

r

','' -!

GctkvKo^ -^O-a-OjC

M

c^'—^A-c-^'

r-

.^Q £.

n \- f- 7 R.s'

nl L^ Ttu'"^

/C'f

P.i'1'-

z- -> J r.A

C -e^,

■

f

jo- i'e J
L^ HPbO

L^uL

s

/^g?, ■ ~'

X^-2.

'^AJ^'~

2 c gi-D o q

--a q- GaP

- Pa-c P2
___

Pf IA

Mcu24J>tC / • ""''■

1/

pg A.O A oA-lAy

JLA.

'

-

b)

D

l£L

). .0

C. t

AG

g ^.'s J O^ tJc

»r Pft

A_i^-r'cx <_a-cP C
C^x^tLxxxX^e^l
- *A-

tX <^^<42- ^>VhJLeJ>

s

Cc-A>xA^AA_y <=»

ir^x-^<JLx>-A.

J

Aik5H '1 f

i ia C

v—

^>C<S^A-lKja-j

^o J

>ja o^iJL

?pSUr*M- H^NaLc’fn.^y"sa-AA

La->,

_4f2Lj?_ '

__ _.__rr JTSU ^<e-v ■>
J n

^-l. c<.

JL<a J* <?q?5!)

■[m^o

^U^ykgJ?.

__,

X>—£* CO- b- C3_0 vJp.'-vCxD

<QfcL>Z Cg^^rrvKA^Pc^^Og^ fklQO-A^jOJ* —

fe-c

</p^
Fix

^^vLopJ1 fV-JQ

GJe»->cc=^.

U

A '■^T)

ry^L*'39'-^
'1 J XAh.
SA<W> . ai
.a^>.La<aC

^r—

_ G-y/ e-AA^^

fJ’-A/|T)-£ csJl^ Q

y

/Ufi_

-^yC/O

0 0-^Ax>-0 f

^Is-^zlP _M

J|)

zir p

r7/^<2_»

/

rj? u

tx & e

O-A^xQ^

'_ j^oo^A-AA.^

4- r

77^ f <p£^cy trcr

Q

<^Cy&

^--Pp

2

Aa^-O

("w V -I- C ' ^y- (

jJ> T-

cj

CN-O Q

ff> < /z,-^? ;\ ^ky. fm.n* cxcjLC
- e=> xj41j
tvb>Jij.
Jij. usYr^,
c4rc
(^\ ( o C l J / ^1
h
<?_ o) iack^ ^-^>r->rv-> t Ifirx/ypA-B
q

1^

^Cdu^
aLuQ’^. '-" ~<A_--

fcro c

-*-

f.„; =>

^r''-cJ^ft:

Cc_>^o

xaTT Pl

4

-

4- S>

w

CZ>A L-t£>P

A rP^A.^s^--------

.'../? , ^Ltrr

&LTp<
SclGZZ

CdOSM Jx^JEX—
■<z- A-^aL

C

p

<SU-Af Z — I/CqP

^7 & 11

^£-a^-1a

L_ bCf-K

r

I

Af /G

U- Q- /

—^-A

l'v\. l—»-

f\l r Qg

_____________ _

lz^L

4) /^ -t- gg^A^ s

*-

O-O-Aq-T^Ta

,(^.a ryJ^iP

tPy

s

(’ [ (fi- ^"fo »J^C v/-)

•

-

p^,

lz<0—txr-,,'

.Ci

ajr-

r~

y

—P t.—e

ol

\.-t ^tV[
yvCYc^X -Q-xroJUk Cjg

—U

.’ ■ - .

j-

_9_ <2-<->-A C-A A

K. J

e.

,c=>

-

p'

c-o- |bcs

7

o rUJ

pn

cP
O-<-C' Q--?,

r\A-A->—4-*-A C C-1 (L C-C^-r dPt- C>
*V-Q

^7
A^K.

=1= Jul

rvQ^X^LoA^ J p c •eHs.CQor &^\f> ir .
L^S-TVtM

~jLI! ke2

52 |~<~> 1

,^ry~'

_&7~C ' i -£ l^c-Pi

lJjX^A_s2_ ^tZLSkU'oU 7U-Z

ttl?
&

'v/A

^-lA^kAAXrU

g#? c L<^>a _Aad^T -Q

ZdL^ 7

e-

'ir~SPPP~ UP~^

_A

■iy^ 0

[Lt>f >

fr.

^ck.

x-Ak,p f|<i r Q V

-jLAJdL

o

<^0

tie:

,^x <=5^ i y.r>>/~

4-

Hg ,
T

X-vL

C-gJerrnti

V

r

(?| (T-

g* oaX^

G

Xj

/\p » ~>

< ti i

0—>Az> -- -

p a Q-is--

x

.^.xy

r-k41.

Cttr/n.^Ay,

~*

r^ JP^ J. (r

tirdaic/

=i=*t=i£7

V^ir-P

Aq . •es,
' Z? '

^px553Gb_A_iUi.

t

ffsyk^x y7° y » ph

(Jr' 4,

2.A-1.

ike.

<1- J-'

<~4a -&-V^. J^o \ t»i>
rfed a i- r| LL'

JL

c-*_t ci

O r,

F

Q - _ Z?A <11 0 C.

-^UaA^

Q~C a^r-<

n

3

J L^ 4 fo^.'\\—.^r «

^~e A O

£^_c^s_2p_4,

J
fi.<J La

oG^ J~>\ »_Ctv- . J

t— rXcJUcoJ) SE

J-vxJ)

ih tfk

l^jS

L/yC \ $Li

—k

>

<K kA rvC, ,

TTT^

_t?

SL,

<t>^T

7 ^ P4
JLLCf
|>

De^J-O-y^1 • ~^JCxk Cclj^ bGSO

9^

—

t^S

~['

•Cc_qA

Tec<x^.

GsazJaxJ

caaULTo,
Zcjs f_ ^-G^
~

C/kQ.7 -f <J_ ^sc: -f

e . y. ‘A C

(/o-^U^XX? grkJEI

d‘o m-, 'CTnO jAk*.

. c^i^yeJdoI^ J)o^.

.<2^9q_

J'K^l>

sP Iv.

jLC.
<• Z.

nT £

C-J5-

tS"* £>g—

>- ^'CJ * o.^ /

-

<Z4^Lq pAA.r>jLz> ^--y ^?^A-X?_>Ld. M- 0,JUk od

*¥ CgAA lycJ) ^^^oKxxx^ fiA^fX

___ _ ( S^n free-U,/- Lyl^ ' ^uG—e

tr

/l-iG-iAk ',!

<Xi

Sr^Jtr^

)

C

zV'

wry

c->

•-vAixc^

' -^Lti J

n

-

I

^ko«y /Co.K_0

en/^ya^o dJ

x1 y eaJiQAfe

n

.^.g.x^ fr '-luA..^ 1h7y/, Co ^ ^£yj______
oz R. /SC //. -_> u ^(7/

6

ex--> -} ll
ext • /O£

og 'O^ -f.

’ &h2> ’

ip%W,h
J \

OQ ’ h S

9Z -nol

C.9-/6Z_7

-4-

^5 ■

sb -z/^/

4:

AO’rge-/-

^q-Serzr-/

• 's/SZ

• b?l

U'^fr

cy^t- O/ _p

•ex;. • Q / -*

■=>O • -Z./7-

^■lb~

FS--^^

4?-^

IL

3L'ybi

5V?

>l

J5>'3Si

□/'/7S

/b:W

LF,^

4OSJT

Sh-b'ZI -f-

9SS -I

'§/A
i n^pZ

S5^r

4-9-7A

^■iZ

0 3 • i 51

hs^9\

oq•^5 £

‘H
CX^ • OQ / -t"

aS - -cb-C-f
3^'9^£

IL
is-^ 1£:
k—

Lb'Js^

€*6 •'F.g -)•

.59
-+
3^>b

•tS-L^

6s -ar?

6 3-^3,

^3r 'Su

SL’i'l -+
61-?//

^•3^

3

«■

ci.9 • r£x ■+•

L ' be Z>
Si CX,

/-

->•

exo <SS>

<ih' i«I +

o<>9-+

3t9 > L.0

I

«=«a • A 9 / -ic-o • 3^b

i<S • b' -*^a-Ob

og- - hs t*-

c=

ex;

^Q'bb-^

'^rxi
'c’-^r'’ T? —
—
^£759 <9

', ',YTTT”
*' TL'ISLI "'
—

>^rrs> T
’•
*■ ‘1

"

S0’-Z7»7 5'9

J 7 ^yp-VQ

Z)^^Rx/xV^ C ?

■

?•

^r-rq^T-^-r^y^-Q-^

7^-

7p p th
f

'

Acs ZJ

7-4?

“

2nxfs - dN^J

:

.

- >■

/■

I
-CTN-J O'p'

*>

7? -

-nxiA

t 1 T^- ' ^ly

> ,0'

l

'cn^'^7

7 <gyyMA -jdj

<4

fo.' v qp>

1 -0

‘Q

C>|

JM

■^nsr

>’°T3^

V-T-r-r^rV w f

Mp

;5-s-j-

■*£ ' J\^0

------------------------ ~ q~~>^i5^/

’<?>’

tA^^opn-p)

OpCr^

o~'-~« orx^-vf/k.^r-t^ C7

QT^l^r^P" ~

^7'3 L~^T L

*I ^rv-1
■^r-O’C^

<7^.

7rt^YC>
■^^js (P^ -'T^ ’ W 1

~~^L

ox|j

p

7prv~| -rp^ r^ocA

_ r "^15

Vjjyy- (pp | p TJ *—(

rp-

/

■

^Lk_xx*5 V-t^£>-l|V —
EiV

-h±£

Jx -Uj^Lmz_ 1 H

J^aajJQi—^_

^z ^^VKp^r^L 3355^9 -

H^, a^^-r

K^Q-A K Or

.iLc>c—L^ c-

0

—-Xc^kxA-V—J^-^kca-ftA L^ojg———

&4
Un.

<c> c I’a-s^ .<'

-

i. -i

3 ro L ,

K.

g^g'S'U

Ia Xo^oq

■ -J

cL G^ > b-A^>

( -A-^cJ) ^-L-Ucy^rJ yJf

^//y->

*- ^P-aaXa-ICo 0 ■ >—<£- <A^C> ,__^Y_ Aa-v A.cX

A-K

qulaa

b'’" ptox^ ^o-yogj^/bfirO ^HL -S

U P 4- <>OAk

__________
c

O -IT

Lx&Xg o r- Ka' ca_>zl

/5^Q-esi
/7Z/,_

§

i

&_CH_dL

g^jK 9

XI

ShUjLl OF^to

(

Cne's / ^xA ^-y^_<^t.

T

• <i-JLdJl’

V O-toOL,

^CX A ■ruu^jirJU.'c.^

/L&J^

7^ L^ACX^;'

—

__ K-O . V"

A£oa A

ivkCC.__

t^- c^e

_ ii f-i g>£

. ^>-~r^ L

g_ -Zf ^l-O-P^S-1

^ric

_ kr

O e^J

'A 1/

i

' !

1S^»u3^

Laa^-^ C^kcj^c,. C<£><<a,c_xJ

'g Lf

/

UC yocdJ2a

ILx 0, A-Zr^^j
'vaJul vK

LtessU;

___

~* f_v-»-a 11*- ^gJL^O qJLx^qJ_____

2S$7| -

^a/fc/7 A

1 jsJT^ hl» .
;

Aj\1

P/o^AK-LIA

,/w uU uQx

3^e>cx
i^CUCr- *KrtJ<S

-f^-VY

I

J /

- ?'

—• r|, s.

(<

— r|.eM.

lV

o.

i» V-fi- 4- ^-®-

^Li \*_^ 0-sY~Ux?^?^|L t

~ ^tcaXjL^^vAXl /pJ-MX. q^Jlo IU&~ AO^^>
^AP-p«_i_a-, Tir^Op/*’

"-' Q-C^a f XRX* S i

^^vit i C^pg ftWj’ f JL-wAa,^ tj~^

_•
t_

’* au^^oT-

g^-Xj lxXY^ ~^Tu7 5 ^SMTI
z^-pls^

•'

vJ<^uJ^Q b {^.S^QJ^Lgt^

■

rf ^-r->

-L

h,

(y-OX__________

vv/lJxaII

V-

r

AtiOvA-ica, r'M^stxJLL s

r~~fcx-xA^rv\,

Oca.
Pac

z^J-O-QA^ lIa^

4

akiitOho.. .

-d

___

pca^jg.

*
rt’Ysc^

QvUu g^eAJu>~»nJ>^^ucaJL
.^KcQ-

<^

■ p-

rf .

>->-q^ -S csa-^

----- -

5H

ptcs-y^
5Co*^ ^^V-o^S

pA^CC^

t<>exL
tx>oX-

a

frkA^-yJ.

-t

CSUu \\

t' L^UCU.

UlBws^g^

-t u-q-mx

<Z'~>'£>

a

c

^■•ft

■4L—

-Q

^VlxVv^c

' u-o-^
*g^ <-*->-q

t

z^vzi

V

r^oa<».v» 0

CY-

-SfeJS

uxa , Cj . gA^Vob

'^q Al-g* '-

^—P C^>

-<->>

k^yy"

Z' _

^Qgy^!> ,

.JxxJ^qcuz-

7

r

fc

F\ ) i l

/9

z
<J>.

RpiA ~c^ rf/uULgj'&AJCA^

».

v^ttr^T
_ > 0, >1-.J? in i^

s7pi

a-ry>^

ya 1

ZZZ.^.jLTm^CSSt-tA 7

c

Wal^-^-P

pj,

1 C5_*\ U-x/^

i

-f- ^T^A Jt4aJL-u?
Hy~->

________PrOTv-J) Pf> ^ea,rr>

IO <

_____________________ _

_________/J Q^. LXg<^ pO^L^, Z>

<^‘

e-o

C- a. < *-~-

—3SQ r>_ X

-

5 AjgfljkXxj^-QS

Lx

■J^

Jkzw~ tA-^-tKp

t=)

^cJUK-^
l|

^Ajo g,^ <

Sf «=-£

A c Q~

<aJ
X

7M-

)

'J2^V\>-Q_k

L

VJ-U

________

)

V7 gjkec>-»jL^J rxiLS~

j£ui_p.

-j

---------TT^0

oT 77 - ^Q/

— ^.77 rto

V

/4'
Slolo^

U T7 \

----

t',^ nj,|

<5*'V~» ^Os fifiCMA

LSL 5"/-^

j^3

S# t-L^-z-1
ajl-S^-yx a

• c-, .^. *«Q«n

rr^o^x Ia <7"^*

C H_Th<7 O k ^-/ _______

'

_______ __

_ mgnneE.______ J) IptAl^n

J

<■ ^Xx^s

eg, /T^

SaJpvA^C
uC^r> v- >»

x-M* PzXA aX«_Ms-fi ■ ‘ J^tX^vn

72

J\c<d AAQ

xjdjXol^na-^
aLtsaJTc i^n >-3/

{

L-»_--^

tsT xlr <=>

Z

JL_&

<A3.Q^f/7/y^

-Q.Jk,

w^ua-Kj) Lte, S~

6

J™ ^’^7.
L<£-zx.^>&-/Cf

*V U LAAZULbJ)a7A,

>-_ ___ ____
^eg^^^UudLa^o JB

t-cQ

- ■ ^aXlo

Orv a

4A>cK<^

eP»Av cL»t-^s "

jgo^-o,

JL^xl
. -

ppi b i > ft I

3s>-^r- ^geeA_c?rClHe->sP^ zdLo<v>xA -^-iF
<^) (

/?7? - sn

H^-U)r gcje^sJrp-r-xx^

Is.

■*

*^soio

l'h

---------- r—r

—
;

-

.n

$3 •

Meegi

i>JG '

^kjO-k.

4- gL-AaJ>r»^-jQxaxA^.

()

Ik^M ~~ Inox^^zx'-

t-

f

/gL^ ^jn> *1 ftofi-nOJA
g-Q^r^OJx

^ynAC-

L^c
^ae^XA-AQAA A. frkj-V*P&’JVr'l^-

• CA>-A C-X&-L^>^

X-rQ ^*rfe>OS**-^uL ^*T*^

gr-^1

T5

f

a-k^ y>->ccb<A 3^q-v

e fT< o_

<V~>

< AAA

u

e^ qJLo

‘V^t

l^A

gUx^-^A

a. s.

jJSaJSZ.

-r €-

<2.
‘

k-x

ts-HLa

O-A-E

^Loq.ft

■^€g-»~)

HmP/|V|^,

CO-A

■S^ /M ^lo~v<

fg^c CjUL

so oJp-fl ■gQ-U-AV <Ljg fL-U

^^v^vA^xer-\,

5

&o

-t- CTO, . aV-A /■______

u^4t fAB^ik^

p*

.'SeXo-

J^pnv^AA-t^ L

r

Q- 1 ft

LA&cue^- e^pl»u v ,

&

g-yyser/^ a-O*-^

"t*

a->^

O-C-CQ.V s.

V ■_____

4*

cja_

cIaImlP

pljZ-i^^-Z

,f ~

y>e_AAXxc^

?A

-

\~

a,^a±S

K' (lj geJM

fX )
>. «__

------

j

S zxx-lZx' cjl

--

. /fr-— .•

tjua^snr acJia kxX~X-^
Lew<-Q-

______ P^odk^t|| Z^g-O

‘r^ tCZ* i-axci^P

.TXa. ‘

'.

^^<aeA,<e-M-^Ajx>^A

-— 'Tk>l& -O-Q-aau^A

7^ J7 9

Cg»^> t IPL

alXeopJ

/• < r

.fb-L-s-,

.^x^o
tt rrra'

*4- ^AJOCJLkj^

^
■^----

^A.

CLtA-g^ ex

C^Vi . j^Lgc)

-U-A-fiLA

b'I

Q(2

^.g, DvKO^.CjQ UktU^

^S6_O-4lQ>A

^po-o

2> 7X

4

caU-LoJ Axgia \

(_^fci/Vo

----- 3-----______ ____

JSK~

2

K.0 QcrSr1 d)

If &

■■

3; 3^ '

5-i

2'2

h.

£'T

3-3

Ari

So

I
6\ 6C )i

d^

/eAx-O ty

frj?

LtA ?y Jju-yyp

Pc

<S«L->AJt>UxJlL^ -

■£>- Ul|^^.7G7 SCfi/,

57^ m=JT -ckc^vx-s,

zy <J1>

^jag a.

u-mxQ,

J L»

<2XL^>tIo^ y r^^^^£3^<jc>

0~LXZ2-y~0-^^

XA-EfL._____________________ :________ '

-r,

t2^c.

Q>^—

y0

ca-r-j

raS^pg.^’ «fr_

-1“'r'hr°

e^<j

-A_lr-vn^p . XJ^ljLKfgLU-^A-^.

■■:-______________________________ _

x£LL^

0

tF

AMcQu^g,

i h

A 6k-a d

Q r^n,, > c

f f^g-KA-uA-C-

O^N^p-CX

^-v e_y

. O

.

T£&7

Or

C-Orrrx^i.

g-ioA-i

rJUO(A& ^

^Pfr>g^Li.

?r

■gpua-xA^tl,

K'Tkt''^ 7^ fk 2Q

•j~

<0 ^2^

(

k^JLu^c^

k'fopj__________________ —__ _ _

Fexvr^x

|

e- ^tW
f\. --TT
’7lu>

jL-»xfcJDyvj<_^>

eQ

r

Jt j

r

O1 C^dz^nJl
^-«x Jrt O AI^4>
Q^n J ^XU-D 12)$

(7^o

*A
AJ2-8.{ KAUijO'"

•^It Pl<

hs

og^ -g-xe-o-Oa,

I21X

j-v-ixxal^ 4-»

^Lcdi^

-r

A

|r

t-Sb

la&cux

©■

Q CCJL,

Lo-a-^

O -y^- Q-Kg-g q^A

j-la

f-o i.

{jsS-A^p

X^ jQ, ~ta^.« J)^>,

Q

^kA-Q-cUl

.gfiC-l^> ..
^.oels^y

Aj-*J^- LoJ"

l Vy

1

. a^pCl'^d ^Yp^Y'

^a-J-<~>^^-1

o

o t fl ft

~

v’

'

Sj

e>a*\
JIa7>^-C->^

A-^ r^-f tj N qA

IT^ir-

■<-<?

<2ca^,-C£a-fl

tXX^yH-uP^

^^Sir

,TLo

I (yx, (Xz<

LA

-0 VA cJl_ tX <2,JGZt Icsaa 1 oJk 0>x^ T3-^-'1->v4^.qs>- CkLo^-j^

‘-^ rcc^^c" —
<t--»

----------- —
.■*

^V<£UsCA-Or

■'X.aa.c O’a_a<Iv^

4a

_gt‘-ZTz-^7 \
g-y.^Cp

^^4>>fe>5^gatA_lA_QP 3XSU2^ ^xa

L<

<X

XszLP-

Sa

/y?^-73 tJ7^-77

’ ""A^c^jQo

-Xs1'

JA O G37e

J-uii-t'c^ Xoixa- tv

v 60 -6r -f~

^?3.' ?_3

^^-7^ Ti.ciJ^^L'Zr^fcJ

nr4- _ .-^ luc.tX--x_o-S

<*a=8—

~~

<z4c ^qJ\^ 0. -^-

C^^-Ks^LilA ‘Z^. c^A^3-x-

G

. xA_>-x£ £ (/Iaa-jO

v CajlX. _jLjr<—-^ @0- y~S£?*>-

0P

Ac £i

c^- iUZ

( k_£.

trga^

_

U^aZkoO1 .

(•/V'-Q-’X

c_cy>t£oJ‘~~°-,J~- •<-zl -Pc-A-Z^o

^ecJLo^ n,vCj»^ £>

t-^-) g- g. y G S?ta^A

^2cJ^/ V- c

P<JMa'

F

rux1 O Cv
1_____ _

---- ^S±=!>^=i_ ^Xfe=S^cJk____________ fr-A-C’-Sl-.

L
^xJUVa-V
e>x<uaja-X-Q-c-'

pfp-vy

tU

-p,

•Q >OA t-^Xy^-x

L x. lie

r

i c /-o-& r'tLVsJLbuXCy

Al^peJb^ k^>,

XKxj-ejfclC-

QC

■deJ-A -&-Qj&slr 4 AX..O.I

A O’-AiA-v^A

— J( j»

7^ula_&

JQm , Ck* |P\

o-g <■ ^ Q-i/^A-fl. nz-^

A \ C_. .^e cX&Z ? u. cl£. ^Xa^-C' Q-J~.

V

■

(|. ^s^z_^£-g^=>'

Exs^bG i1-^.
ex) Fxejye^Ac
i>) {^(jZc Cvbu.

./
rJji c^e u. «•-/

a-

cP UG<

•^t V\ C- 6__

*) ,X:X..~

-P

t .. <^z£kCc. aa, t_e_,L

■•

y.^

^-C '-C

.

>-e^E

x4) %' H 4 nS)
-T- . C V>vx iX

, IX

,^=-..0^04^

&£s^_r.K3frx

A<2J?X4_

^Aug.^^c a^x

4 -,

1'- Cs^-l

oo^^e-

-k^.O.cJ'C 3’

T3

tai
&

'

-v zs^x^l
-^f

Te

"i~~*

—tJk

Xie

_^ L

fkAy <9upl.<'

r<M

1

V LVf

■ r-

-OS

K^a--.

<r C a. txv V^O I <7 '

/

.4'--•^ r (_ z<\ ^_r

p r ’ r

<7 ’

£r vvx t Xf

■GtaJ ; pAS3a>AAg>*A

A

='4^--^
<4 ' /-

Ux^ }

La^^Pv u

4> r

O'

Ka

c.

' 5|'V4-^

I ^vC^Qj^r

»J>’;) dj/

Zz^Ac f£oe 0; <

■I c

5-

I ^/Uo% ' t

I clC &- L -35KcTT ^'

k:.'

1*

C

\

‘

-<2-g11 jfot ~Cb

* eQ-c-d-A 3aX ~P

—k-x —
-- -

~

Ct-

0_t £c_s£cl^_

.

c
d-57-v© t

-v /

■AojceXs^p •_ l^o-^&X£. J^'

^<Tr tlc^ _ lkn^\' |pAS ddAtiV
K_Qr^trit^4
^cts-.

' EH2^'-^-

'"-. p*=r€ ‘.^ p^--4>4x-L

'T^,
-KJ-u.—

^-A GJLa /'’

1,4

pC<?. v\. l i

LA^X
» 'V’PXyJ <X '<'’
1

r^XP-U ,

<<4<[<Sa2. ~ ~t^.

o

_Jl*5^AJi
''Ir^

Vkj—■'

Ag e tAu KS laQi

GA-vjOoLa <(/

<.5VJb<4, c2^5 3^ J

~-cw

______ L__________ AS\j—^—
i^^-p-c^j^kv S^A. <g|9^JX

~ (Ae^s *

i^u^S

VmtX.CX

■ 4x?P

f

Tcj ~ 4^Jux£^^
u^tx e^-A x&£" ■• WH L
A .^hXu

w-xoa.if VvaL

G'-eo.^~ L^. ■•-

«f

LV^'V^
<o -^5
^c u
•■

4 o^WoJ

(Lc?

v»c^-,

'jj^

ked-^c_a^ ciiAJt C

r- / J22lJ^ t

A^_cu^( zK_ s._ t < r n y, ;

,

V' /7? c L

~~

JfU-O-^x .

"rv''"-'

k V

s^tz t «=^i: juX i

" vc i. vd 1£

Kvuv> es<^

c=J!. x£> —£ J?

’

L

b^t-Ks

' P^'h0’'/

^J-C . , vx . 4-'c7-C'l->C''. .

^/cA tVxj5-lA

cs^-pry-

t<

.ukcJLv-^—Q

^Vx^vV^t^

JLQ142-JXA.

c

j01

C

^^cJUsS*>a_u^ *7^ •ejcy^CVca-V AnA
-a^i-P
vvivfi^X^e CT*
C?*

<2

e

/jo-L^

<*

x< ta^-^ , S^vrjO jt t^kt iCTZdkj C> ,
.

~^b

^<^£v?r

Tto^?

,C.<<k? S.'-£_v^vd’^

C-Lcdd'~ c-X-s^u,

k

i-xj?

(!(lv^v^

r^e^c-Av.

^vuVe^^lCi-P

<:

‘

J v.-U y

^X'e

)?^3

_______

ie <?xc^i -tu-^C .L^kcCtiJi

<?Jr>«j.K.vvC/ “ ^Jz'^GTc^

"k

ucc—
- C -

: 4 £

t*

C?-~d^ t. x_x. -. Us,\-d"'*r •

Jkav- -^£-

£* <i4_c
/V^ CxiCT:

7 *

cxlla^st, rTtfJ^
cxtl(

PS e

V<C 5Lc»-

<n1c x .

'•

r-ALV-i

' -Uo-C ^S-Q-o .

~ ^>ZlAJI^JSa>x>

'J'
JaZ_'-^-_ c

-

. J u^jjJ- ■5‘-^

«■-

.
yv<oL:C|
._

zy f

s^t^'s.

•

ip
'I' fpS^ryA

_.c-__
Q

Ju -

4- Sv'MTW.

e*>
xj-

c W1_L 1c v'c k '‘ir *'

««? .Vrt <•c

pextJ'~
^^^5JXJvC

tr.P'^C’-^

aj-xz e »v

vr.

\ZcU2~*

l^VUv.^

f px^VuG^.

UfLn t -

JPvv^LX^ I <?^3g>^3
C<?. £

c .

.>--v^S^t77C^S.'C

•r----

pj-C?-LU^,-U.

_j,"~

.tv^, VvVvjXk^,'- c ''

,v

^.a'XS7

F^-bs. otO'

e7 v-c.

J v-nloel. - P,
J-L £

c %-re-c c ^--s^ '

ftSU-C. _<x <a
.

£ Kv<CK-4-2.>
i>1 1.2-i^.^c

Vb k

-t

po-v U

C j p.

CXuJCq-1-l^ C2^»—t vk.CJ
FV-O-r^ ^-C-gy-v^x-^A-C-ZlJ,

Lv.-^JlZ&Ar' ';

D
p. IS’ L-C
<?\ l^cr ) ArCe_<^ p

xS^< v

■£»

(I

S.cr.A^.1^
o

C-

4 - p).

't_;

0 ?£

‘■^yvz ■ Laxl_cAq

-

c

.SU-.
"7c A ^v^ps.ic A l-~^ VK,t C_L'.Vt.V^
x

z_l R. . .\J.

6'7 -' s'S’

•..[A0-1

i('3^ -- r‘'Pa

A_< C

f

x*u?

e. <r^.C‘pr><--xcAe_iKce _. .

«4

u-o^4

PL

^-e^AP

‘rr L'^7 ^-tS- .fe? ) .
uu t i. c/
eV

e_J» 2?c

S'

p]

^Jr rP<^ «<

y9~v^s.^Tso-t.^.v .*_

l&sLlLl_ *

_v

r * *7

^3-g

-._v°j>a^ .-

5. S^Pl -&'S7 tTlB.cfc!

///3o ' 1/

3. :^PI - 4/-61X^''^.

SSi7 > 7

b

|77-_2_

1^11 -O

«).

U'67-

322.7‘b

^■2’ b'

2.2V7-/

< h-?l

ST-7r - 73-7/,

Zi/33'7

21^5*' O

. r7M-7

k^ia

7^7r

73c?-s'

377©. • Li_

_^5^L

7S-77

u

( l7L tAA c MS-c---!?)

ky

VltLU ■> v. e- 1

/^inx^d'

A \^Q vJko(^

t ICLjL —>

A^-

xa^g- 4- ^<r

4.

1

I'f

K-£

-t- O- <^~ L' c—yCsC't , cP

?’/

k* 3

^.8-/

Sfc-^

77-z,

3’7 < S'

33’7

- ‘7'

/7'6
"K^O

$'7 *
-7^7^

fZ’

qX>^^

■ c\ ,g> u, U^-D

v.fe^^XJ^'

Lz -

j^-rgyN g x c (U- y

oA

1 pg
.fev^xs; < x f^MA
y^k
■'^ P^X/fe^zir'<g ^vb^*.^A

2

— 2LC

Jz

^rt<

1

?

r
b'

1V-

r\-J»-^Q- v^JJLV

f

J t_r-^(i_. ‘rX-.-y U«-.St

V

:oJ)

^v? _SF

-

^<4

-^Q f ftA

^O_>J>ZLCZ

cx-

*?

eL A-&CS-V & ■^/ <-7/
,
s^u- TK^ fl^a

-—•

I^z- ^(^kuJSzi

<5-

§'—■«-

>
zJ^5Svx5ii
>z- <• 0>-CkJ<V'^C
Q

A>J&py -ty^ecz^ £5

J-J- eocF ■ ea-uA* <42^^

QCFV jc

J L,

K -L’

<^—t_'

<C.'

Vz- O -JXS'’ j5>?- j^->e
1 v'-cc^

Vcf. [\

V,eQ<’ihf

IkeZe c^Vr xr

Jsl^

•tess^

Af'C’^ V<C

Zt- .^~- A vvHs

C -^S^~> i'-xcA x VvC I

. A-J—< c^L Lx?-~~''Xfc?*

*rn_.-~c i—t*—>• '

^_£iM ^ Jz O~>XC-<2_, g

3i -

^C?.oV

CQ

__ UL^
/\>=.Cl A’ (b

ci4

Aa-?

-x 7s-

7^.

'

S22,®

C,J_L>^

v^CLv^y -•

-e tQ'~

v

r^C’.i' iST

^^._\ LC £

7(n^

r lz-^GX--

J

/gva

<V 'u-^.Q_i,

^/Ps ''"* e 81' ' "T> ■

z

Xr ~ 24

, (—c K.-.^S £.1

r^.c c

P

0^-

t,^. i

ixc^.^4 67(?/v>r? V zX-cV •

s-xC ^»v t v C

' < ^Vb'j

—S2_ O' 1 ~ ' xj’’ ^ '■

lr

A-xX?^ Ui

< p<i.SK.x.'x£A
L^ri

Jn' -sA^Jt^q ts

c c

--- *--- ?J
J-VT^

o
rT<7' ^

t)__ 0 --------- -- *

<■

uA2cP ^joczc-—

&2J Xl<- V^2>X
At

-4.

tur^Z?^Act’

f v^-^oXj ^KJS-v-^—

~P’
■'^-A^txrF.

•fryX
; \

A 2&
rx H-—-C

- UL>^,

..

•'-fl QjJ-X'XlC^

_______________ £^-21au_o 4>e<Llfr-^
Q

) »e>^AA>

“ LKjLvc-C

a • /

uL

yv

rJ
L-a—i

>VU^ lQ-'-‘-< ■/■>

^P-'a C

.ir<s^cA^>se>^=|!
sz^l_^A S ■R~fTfs -•

y

fP-^^T I' S ('X pax'-

£©& ■.

•4^ --X £x ~«-> 'H^r ^g-giJL

<? Kp1-

v,
■^■bgdLA.c 0-7^—^— 1^' t7^-)^
SL_£**

g

Q<^v?>

1 r^jxx

C if

^~^C>

kaa——r

-fc-g—-■

------V^ts^L-xs_l

1 ■> IA

£_

.-X-jJ -V -ClA-\

g

^_- IJ* C~v[V-

^- t

<■

X 6CC-V -^ < ^c.

J

jOa--^<^sR-7c-'

t>]v<

,'y_ c X—L'!

c-' S^JbX^

?. <■

_ «-»)

Xc

c

■

<2_>^-O ^V_xxJL*

<XX2r^

_\»<c>-x_»-~_Q-« M-g_y ~(35

[Xx.1' A u<

^^C-

3,Ag>v»-*-ejXua,fcA CV~ _.-aS<sk^-&-c

'^''V

Triv. pZXiv^ V^£> ^-C->-^J _p \.O-A>1 U^0>^

ihXZO 0-lX

. ^i^Lu. t V rr- Hl
HS

e c. • «=UjS^iJ2

xJ^CU^^L fVjl* iQuS&C^

C

C^QA
1

2.<^X^ v-r

XT’c

^vG c

siJL.tQuP. _

lK_Q.grj|

__e^ ' _fcL r^

fo-X E^y jP^v^jA

1 _JJ^^£ktsQ_‘

.v>^.^L«--vc.>~'V-c ttyXV

cz t \

, <i_ob t-^g-a U

4-? /9-r?g’V'"c7

gev'

fe-^i 7

£^o y^Jo^^oO 1

1

' 7__ J-x^r L

•=- ' -jkj
vgl-^ vp CZ^

J

r' r-’'-yov

«

,cx,r_
Rr5>— o 1 ’

-------------------- ----------- .—_—

A’-e-

^V^cl'L

I

30?-^ J, C-gx-t—C.k_‘-/--^

■p

T 7^7^7? f

3 t X^-^-

J3 J
It <{>=■

..

|

• 2-

^L-

__________
/'2, ^> .

^v-^-

^Ts-vxX^

f5 7s' 73

’ "77- VS

___

*irK

(/> ' K(bC-

* ^1 ct.v^A_t

l2?

?

<_,

/cl-^-CV^

4-^^tt

1

^VM--XQ

f ^S a^i.

_t Xr -UX-j- C- t,.t

7.

OJ

2 - o ?a.

o .

Sf^.

^7, c '

^l-o.

7___ 'o-^oo_______ _______ „ 'CS koXcu^l .■i~->

___ i=iC_^12f_Xi'vvM:.l(r—*X:

c—

J r. '.i, qY lsdd-^_^_£^.s

iJ’i.VLx e_k^jgJ-

^777>a ' pt^'

■&£jv .Lu-Jlk f
j,

AO

J'o-'Vx-C—£

■

.CLt eV®-’1

O'^-ec^_ ’’^

‘ns-1

- ’ c

^Lr-t Vo-V-t S

^•4
3 .0

(

JL-y.^ A^sCj; t K

7?

J*^ex V^.'vx.

c-

,

1 JLx^^S-IL^Aa____

(’'. )-

r ’?

<^? v c-

~t—• - S'v> * ~'~-< .JS&yi ^’Coc!^.,

I £. kAc .LbM

ZZ ^3a_k u\

4

S - CZ-c <•'

x..q„j C.V&

c- L J\x

^r7l>''~l^ u-csC'S

2

&

e CjA<.rl ?.

1^1 , it(37

«■"•-;-^s

e 5=£

1%1

^?!> / cx?-*^

jej - W fe. 3 > Vo

i ■ ^ca> nx

S .17—-<0 0
JP

fbei c «-' 3x,JV .Xc_c:s fkot’

b-r^

tL-^p c Q- r L s3u'0* y

—

\

/V< ~*

_>S-a x^x-xSjvO

Tj?-- CVx 0

A

STQ:

ts^S 14=S- ^O 'i^JSA. a^-~f '--^'p,-.

pt-^n <e-

<r-T s-v^ •-<Ao.^x

c <c..

0- I

Sp-X

Avi_S

Rv«oci-<r^

/^bl

/^7v>

A^Vw*<_xr

.

^?bc- v»

.

c.,

ipLfcL^Uc—
"^' '^->

c<i_o-' uxj 7/ CLvsxA

L’s^Xac 0-5 k-C-!

y U ^i-.> ^.A^j^aZxT-

L-^uc- txS’A^ea^'

0o*^/.©.i '» ^Sx.UwV'^L.. i^(

--l-y ^7a e>vs=5-'.

A-a,

O-t-CL^c s l 5^ yvvSbx-^

ifcxW^U

I .

7

k ?.p

lb

P3^
5~r. 2 ?

_

^i.-\'-.:Z
^ej2^£^2LuAUL^
■ X^_f^t-^5XA_£^, <z_O-A-X-JL-U_p
x-^p-x^vv.

izAlu

j

£>S 9^x-4 • Safest

** fiZhzW—<k•‘-4=t v <£•.£. ULj-.

lot

-- b-Le^l

p^sJLZvj

___eaAAj^AX^Lk 1.1..
I n
c tt CMj
< - Xg
__ Uaj? _ />vi; h( ■. t

.... c;. c r

x■kGr
.k

Jxd". Z) Lax

Xl ClU r 1 j.

5uUtS.

CC*S^3~:UG_ Jp *x?pv' ±

I.

w cJu
l. L?— 4La-~«-rZ cj
U<A
o. >

_______ - CJV' L—£

kLJS -3 -^H
4<lLxx-^

iS-fr.

150 ^£-xJL>Aq. ,$ VA V-kj? to!
4.
2Z psA
—_l_L_^kL Jj?_ 73_
_ Zp sA -'P^L^C&^tAA^J.
.Ap<>_,
,(
z d <- c t
..L

r^-v' Jr-—i.

— IzjL'sX: Xa t_

A V\ t f

Av

Jj> VA

1

€'

Ko 4=£ c s-<e^p -Q AXf—

^b

a.

CC- •-fclAz t - A ,

(4 N^c

« VL^J f'A

Ao-X-Z^

C_c_.ctcv^

/?ou<i <»^vt Cy' XL|
vi I1L<' <4^
£c»a/

r

f

• • At*AG?JU__ -,-AL^s tAq ■A1L^.
y

t V^-r-i JlljYs

ft

.c-r^

C*-£~££-.U

Ji-X ^-CO^-C

^O,J

-f-^Vyy

vn Ci

V1
fekV
SZ
^ rw
w j-^'ALKIZ^* TaTA c .vKa~u tV-^xj3

C\ <.

£ J-^c

.J>' -

_L

%

Tr?o<fi^/Ka

rv^vV<!<•£-.-^^ixkVo^c Aa

<zi j^esear-

hf
sdgfc

T£m

t<z U Lca-KaU pC3*^"Uec C\ZLa

A

czlcu.^'’

Cz€X-kA

_e=A pe vi.^>-4.

'rV<v-»-<_ _zL-_ccA^
zL^-CC-V' Gjt ftJ

O^XevXc^A^r,,^

£3 00 co.tv

'^L-^
eu^^e-g

3 2- [f

lb- <

i

i^xS-.v^

fjel^u-O

t^xdzZX^Z_A <

’^^x-'^Tel

<5 ^- 'J2t<

^rr-

ex^v

i^-%'- •

■3^eU>.

u

C— 11 4X. -j

,-

*^7 1°

S".-L^CC 1^5/

4^^ s e^vK-1 •-€?' ( <-

^bACJt-

JL1-

P.PC
(

C

C^Qv-cr

c t^J^>—-De

- g\^

3[po-A 4 waj^-G.^2^^

f

\

LS-fZ=> M-i

aXCu^cjcc:. t_^

u' / ? ? /

.

;<rf---------------

^LUsra£i|l >
Jse^' ^c

saX.^

""I J-

<X-^

jOs^zL^C ^ c oi' ’^^ypA-c_Qx^

■t

s

/ -<S oyyD^.
Lt’- L<^ v< A-'i, < e &
tX»x. L0*-* '-

. &

■• r^>

V-T^

>J

fc

r1'

x^ -' <2^c^' /txcr "bhx TEZ-x

fl

X 'r>t-^»L t- ^ecJLe-

bk<C5^

22 '-k-p A- ^c--x.C-S? w-SL,

t\vA V^&-

-■p

X k)<.»-Q»^.’v-

fvCS^ <J ■ WAtZe

g<C >> t\,\ x
'^a/

/X- y<^.7 , X-Ty

■
r^coXc

$- O.-

c-SYg. w^cj. Vx-V^-J*

\-«C vV-y

"y? f X^ djL^•

^VK

U>>oot

e e ire v-JKl.cl jC^&^dr
•■'—

Zql-s.

Lfe_e

F,c

0

^CU-^g Q ^*-'—p>C.o^

<

i Q^^ecf L'C,'.. J-1 ^ugv^x j^_ .£<_Q-£ Es^.v A
LFAkr^S-^
i^QgdLx.-sg_a>-A 7t_7^
( 5'k^

kik-^A i-^x^vv.

Ce^^ua-Q^ 6^o cx_zf ctOXo^ (j^J _S
J

lcsLc^
<<2- fc>V'i ■^■-C--’

<o^c5!fC? S4-**

>AL^o.

eserzev -X c

S'5r rv-ccS<^.^

l^cfa: _W—^Cc V—c —

'C cc d

JVj>^g^£e -.

4 7^)v-C_

UO Q C. 65^0

r,

£^ec
L.*-^_e^ jL- f
- >

c

b-^LQ-.

f

't

I>a—c. e-K^<M.CuLX
G^C.‘/e_c.O'
gls^ X<K-<V '-t O zfi.onJvXr
UvI^-^Vv
^yicC^-—
—• _ (Lca.
<^Cc *
L' b..^' f lo-i
I’O-a j.
l^'l p2UUi. I'yV? _ “T^Jty 4,2> ^\<c.
|><L 1^0 'J/
Jj

(X c^"'

X>_—Ij
■.r r-

^U'C vc(

Lk<L^

^•6

^raXC--l

0^t

■ <eL>>*=<b» (<^7

U ^TX sJ^L p-.VAo - c Q r X

~
,

*1

S

P -^rr-k1 v
aj2X^_

5

k

r?

7?-^^ zlLA)^^

t

f
A

R^i*

fc ',

_______

XVAej. __aU 5UA4
v^^'TU^'

tc.

J

j J,

-jr-^

-U^X

„*-c_i/pceXo a

3g^C XU

Jh
.r-,

'-1

c c Xa ejwse.oL

<r '

* -^z.«—

Ac v-sX

£<'71' V S

? X-

/io£\aa=«. ^«<J-A.-U--.
<?’’—jdr^\

KzC CATpy-Sxiv^jLCj

xsC-co Li.

6

^ fej/1. LaXc/ i

pc^ «- <fAc 4r 3 - U'cJ<i_^c!kQcu

"J

jL-

~ ^^et^-sTCZ

A V u--<

> S^Go

7

*

1, frp
52' ki"

•3/ ' I o

«-?l

^7^?.

3- ?c
rjoA.^ci vu2

7>

2

?

^2-^

3<

JlK

2? ,>■<

35-1' </.

3' ^1

7Jr2(r

^■f?.

1^ si

3?'Vs”

3? S3

.^7C:

3• 37

I

e-<ctc^

tfb7tr.

l(b

m.R

73.

57 3 2,
55 SS"

3/-U

^7-7/

12- , r)c^pv<\

3 c-Sl/

■ t) C

^r'T/

v.

^3'^7

-Up-Co..]

X' rA

/|- /I

fe$?7

4=1-/?

II- .gq_

2l<- tt

31-.

33-S;?

u^-i l(L Lj?

/1,

. rfe.p^a.

h#
;•;

0'’'i

)G , Pc-v- /'‘oCcs

0

JX-£r - ° 3 ?K°1^.

J

l°l. 'jb.-J>X' i.

blt-ss.

<2 1 v^ ii

■'/

U'l^O

^-n

5^/7

2ki3(f

^3,

Sb - e-?

-is

2 Kb—\1£
. Qx-CA

^■r3.

317/
\j>) \

qu^?^sq_L

UX)
'<5^

0Kr* 't C-A.Fi —c-^-'"' ’ c^CVv^1- C \ u*'-fe-'- —(

t/2 '

(peL-^c^lA’ JlZi^st e>i ® S 7- 5 , e^.- <?)
£ p 7; , <Sj£ .
7 r> -.'>x . «:!
_«> -P A-•-■3^ \ o G
(C—^<^-3
■.

> .

13

3^-3 2

_D- %

sx> ?X_

3g-/^

r!_o c—

Iv
^x-r

W^7l t£ k
7?

^<2^

I $i yTH

P1

f^£2—^oGSA-uA^ua-

7£.fljg--HaAl

•>

H

^*3 « LteiW

Lv,V-L '

SgCQslb

HOC Vgfi£,

L^>a-b>

C ry

UA-A.

^•u^i_Ux^oAr;
)

£

<A 4Sp^O e* o cl

A-S^T'-Ax-At ^p<_gkYr> OxS-QA

-S Ct

O

A

c^^. 'i> LLGcJa- J

1? .1 b-‘

. g- S 3> ^<Lt
BtkoS j^V’G^ca,
A

VH'\

V-^A

f e-V-Xl a^£>

o JI

. .IK G (xJ .1^0

/ Aa^)vLm,

g fu'

eod V3 pAj_. . _
L'VC-a-—-

cXj ^AvGxJ

n=5=^j- rT—

zok

^x-kol.

CLv-k-xo.

,.Vj2
-X o\

(''2 1'7 J

£i:

’v .

t

jtG g^eAv. ^a

k^Ja22

<2x5’0= t' v-v eJ>. La?'-’^- tiTi

Kill

1'^

^
G. PJ,Wk
P<x

GxJ' •“ <?^P^AmJG\1_Xx£

PO

'

^&*= i M u- C 0 oZS-XjC LL&j l -p

f*6 6- 7) f

Sc-^TLacJ 't-n Iq»xo['

LZY PoJ2eg.(/ti

** Sx^jT'

'?A /S6 crev^4

C Cvdclo^

^--LoA. A' ^-£Jx £_

5^; '

>a4u^

(S--3 ,

ISi QfSi t

^cx-ouL
JL^) &•'
■
! ^S^Crpto-VX
%-

S rx-x/l).. ^AS pCc i zixoji

X\

*~t

»X£2_Ga.'jA.

Q-

Kc juxLq^>v'

_^LjA-^sJ/sJ / Aj Gr

y

G>enA __yA^£l^^_

PoACcU'G*^

vf _ &PZ_

I 3 o - 2 bGy

J-V1

ALA La

;Z,

'I

(oC CcJ

. r^CLxjiL

JubSCLM. ccj.

K-^OCAA U.JAJLS

V'^v^o. Va (Il *

Ci_L-Gk'-AO CaJ_-.

SLi

£(^(5^px5 t

c u G G—A-p

1

1

c.

'-f "P

rj^^cAxk
JL©S.pd <JG0 Lq

A^e

Loti1

L. | d_Q.x—L»- v

<|

<- xA_a-sas^>

<2_X-£L£i-l

&x.£QyM-£ -r 'fe-cG

G U a.9 <

—-

!KS7S^ ^_<3 f

__ ^^C2=^ ^-r
JcG: --- -I

p^J•)<S>-i cA .S

(C?

t

» zJG^p^1 C_CL.^4 ^>

4- ~T

£JS^£U-

r^AJ^X_Gp

I

r

li GZp
QJxC^-A

/S. £~G±'j_

,KcL-x_i

> -<-C- Y

' 6^V-

^T3 p\? .

r d -JgG- 3 .-v^lCs

^u-?

(jjL£^pGdfc.J' J B ptl

S.gJ) JC c-

?_<rtrr»c'k-'-^'X0-G < -'

G.

GlgJLkXA f -Lc-XU txAUl^ t

V/ I

KXa-^- t <*-0-

p)<7AxAo

v Zi_c b-K?^ P

Z v^x^LtA f

s GLfe^ot ^ So cl ,
i

.

c

,JUAC_O

/2^1Io_G

Cox^

V ptAe.|>

*- 1

C»- G—k-r*

■V -• .-^O t_>^_t>0

G;., f^q-c^

U^u> lA^X.O-4 x

KG GJexf v^-

''T^xLqCL. S csfiL -(Tr

!

i'Y

1M—

_i_L_ "TC-^ ^P/j

i -D -

K

&

LU/.

£o

_ L Dd <—x ^'J

flZ

---------- fraeA-sjegL

<■ cP k

,-0

o

kc

T

fl~i

__ It,

e-xcAG^I

~

^cx~C-0 fig-^ygVCL- L* y^-pCtc^M^

____ l"b JU'.x
ch> ho pojirrysl^^c
>p»ec-<iXc

___

a>X^£^<_O^

a<<>

c

. -^J £ 2»trO' ^ , i

.ILAGo/-’

^Jo-

E^x.
pu

e

o-X-jaZc/

^i_ «-A

•‘r

4

w—». o

g_v-~

ZKjuv

- ------ fpA-^-XSC^

>u
K"

-t_‘^-^ CUb-Jo'< v^\_o.oUi—

c-o^ ,^La

^3
.sZV<J^
a

ho
I

(J

/

Ho^p - s-^x

-A- j J_

v</> Lo^p

CUH

/

I S^pU^^L. U
0^^

u-S,

3uX>oVCi-6 lA-^Q^CcalO

.ISdUd5.

■— OA Q qXji

(;

e_c->u

^±z-~

l'
-Sc^P^Eax^^ •- ^-‘2-° rV pp • <jP^JuJLxi.->v\

------

l-e^J> ..AX2-a^^
^£4

j.P>A-^Jjv

(T)
-f J11 <-O"c*(J±)

JL^Uz. <

z

i p<j^ £Uk .
>// zg^cuz

sV^>y

P^8. c ^Jl<r-|

_

<z

__ _
cfX^C^
'

<=<<' ^O<-

fr*^
^~^*^rv 0 ,

A

__

CC C^p y

( -0
(xjz

G-^-0—^^l'

_|__^Sb2sc- - \

f 1

.-^ C C-^_c

<

zoQi

e^'^\jp

oa ^±<
^-'s

<2C

—• -S L>-vU4

eL
e

\ < LcjL abf !
CGa-J/

t-*-

-gj

^'e-A Lko-u^j ao—M_

s'

t."^

-

g.AftC rvmJfeJ.Z^-UiZ's

(O tCrQ^>

Il3f DOQ

c.

_

ua______ u

%

"F

u<

Pk^s

In

J

CXaa^a^-^^J-^-^^P

CS-C<ASr-^

''P

< Hg^TH OmcF-C

’

I -A-fex.'v4

J

»
. A?l»^O4_________

~t~ -Ic^a,

’f

'

r-.'C q’ 0 O<> JUf^x
1&~~

cV^e-v3z

7£a

O.„^ JI

T'“ '

lkg

rvu> V

4 X vU Cp

j^-

xr-JuMP-Crp
JL^T
aaIe • -Jk . Q-»____

CJtA

/Ss^Sc>-kJa.fi /yJ^AzAoc/)

<1- »< 0 W V£o_a^y

uA

"»

d' /O<QJ1/'

^^e-rsfJ j?S*

>r4

g>xff<->-Ac£s

\* a/*~>^

otslt-r^v^

OkAAt o ft. , <24»3g loJTkq^ ^-^-ua-a c_q_jL fyf
>JL v-\-QgP- $:fe-C4 A*tAX >* <AajcK oI

(y) ■ 2*-V»-i>
.J>xje>0. cu^>c-<X4

-».

^KvX-T' 5gA*Jy>/

(3,^

4Jt)

>»>a r> Jii r rx 0-e"1 rx 9^ Q

^y)

°f—»

vi-&nrst^£g C^)

r> r> -CUV gg^AA c. '
□L

7K, Vb h-

cJTqjoaIo J ■•

Ua.

< (UXa, . ee>Ju
ex

^«S^A.e(k ^.P x A C I A

I
gj z-

is*.

tC\/U-A. y'

"■

»K nK7-B CXoIulaKL?

PL

K^rdtoAxj

I

o /Lm~uu^<k

ZXn

^a^XLJGEU1

a-rw .tJ t^.

<0 X gjji

3

-ft.

c-^y

<*ftor»x_*n jP ff

r-fe-H. Ae-ik**-^PK

<? CVK

_____

e-

k

kg, <24.faxft> ,

H Ocx^lr o^~-b_ ,J

tx^fc 4-^X uMxAj<xa-JI
C Qa C-C=>^ t

U>p
£
I

jfcxcfc

J

P<D-av

c^*— C't' V^*UL^P

Q

- .z^

v

P\

•

U^V* Lq- £

j

______ ^4 - ^k^l'%-4.
A _

f ^xi

X>!

5 T MJfi- 4

P

0

^V

<=»A^<a oX

uC.

g-V4

Jjlu

e

txz

I 4U A/

7-^sT He^^L^yxAl .

H/r LUUM*

pH 0 £ ,

CM es .
5ce M v.

l^vA'g

tyeuttejj */^cXr<3
I <S-^r yA

U

a
“XSti o4

p-

0^=5

Q^—

IH CXi2r<^ e

.

p

t^UC
1 ~~ t-

/'we.,c£. ^oft

a4d ■.

<2i£'Oc>

—1
caIKKLp JX^/t o

St> ^s/!
's-y

V O-^-. yxAAjJ^ T\>jy Ia_^^_

l?-e^&-c3L|P TLc-Cq <>x-<t

7^/g^-o

PP.

Aax^^z[)

G 3^

^S-Q—j-*O.

l^'if-SS' __ +■

‘S£ ,

G->

~^rudl

PA n

3^P| ,

■tA?" ?|S7TP^v£ dlxA-^

JL^VqJ) rJvls

So

^,S73O (^xjl

^^ceo

)

_ P

^OsC-^

r^xxA.«_j5^
A '-v-Kxx^

QXjs-^. ,

_

__^_kZDk_ ;^x^y i a^J^AJ''Cr^ f£_ f /^2f>'j,

I Hsjx^k c '■" _^l
+-_ J^vv^aJlU

/ k^xx-s^v 1 f

C-U-Kl^ XnU^ 7^11;^^

aJ T~^

SL_ rA-fs^ ffiyQ -f~~^x<JS>. (jncJUl^r ^^lILl^
2&C i ,i7£tlc ■ i

p
LC

O'1,

e^x c^>^At-^yQ

^(■Gll , d^THcJLJ)

^p>1_-

pPm’^
IPp

-Tq^^ g^tM^ypJ^x__ If t^Q r

<Aq4>G. J^iV P&- (at f >^ ,__
C~

xt/" ^q^o iaa^c)- vS^I

y

IST g£.

A

p>gL>->rid 4- fey L

J-yj/’.CQ^Ukxi.

’

^u7

<r
6 ’

Ci.r-,

^>Mru^c<,od0/

7Lu______
jy.

/ C^nrucL^ y<S^>

k ^fWVSi

-!->--*-£> C -.Q

e Lv <

u~

L> ^

Tie or U^o —

C.U -_^

v>eJl . r^C'J.

LA

, tS(V& efikA

L^
<a

<

ly-

K-<S>TX -_p- ^-O- c Va.

/ (i

■A s^W

Z'J
___

K2L

_2L^25H__

_ _A 'H^C

■•—•-

... t/ifL'gAp:

+

‘Orx* r><

__L— i>-—/

—f
! kU 1 I 5^

■f*

A-ft-jaf I ( ds?o y3 Oy )
-f-^

-

<?tc

r'^b Q-Q-£r<Ji~-<'2

c- ^Ufa, V r-^ 6 Ci^

•^1 etAj-Ct^x

.~ '^~i^>

L~^- ?44^-

^Q-*-^

CU^

W1

v-O—Ss^ M'

GCS<^ZZ

I^Sc-s-l

mo -b]

£ e-«>o
NtKJc8>&4 f I—3 A^JHfS^

_

ti'

5

2p,

1*7,

2^t e^o

/S’y GfeO

2 b l&Cs-C-,

Pvl'S

^■Cj^o

\_jroo_

600

MV-xAJ2_

I zAp-Mi

// Ot>S_J

H A ^s S

(

35VrO

lil,^^____
2xjr^ASD

S^pf ;

T

-4

re

^ ^..4

rexv<<

s.
L V-—/?

^U?>

1^

^S

d-V

<Q_z>Ca~Q. y

!pLJCrLA--^ <-£>w

h-»>-xx<^i>L-O-l

-|t>r

-<Q-S.c-C^cJk.

,

sr^aij

A>

^eus^n;

~

fl

?L-

I Ca- 4v).

1^ ?[.

)Z. 37. v L

.

Sr

t

^G-*JGCq

egUu^Xj -

4

S*A _____________________

re
p^LtvS. Cs

1LlO_ -5^ir

J'C>6. pA.KD «i

C©>%£3__ J
^-»A ;jy<JL>s“''

Gl )

--------—H0"

OX>Ci_fi ^A>uuG^IZL^

.---------------------------------

4- 4gL&*w-> , •£C>JU>^ ^Q— _kL
^2-^2^=^=^
--------------------------’J__Zr
xfi.eiP*' ’**—/?_

ga
^^e*^ coax 4
c3-^>VgL/- GCl-k g- 4 S

<V)

O')

^z-. {r

/o-c^g.

G-o

Pio.

Cyc^-J^c

52^

.

■ _

a

»

<>^y2xSL'«i

^Xp^Gt^r/

.LGJ
^Natss-V
C^ts/^Sv^QV
-r

c_^sr jo.

C^e> >£-•

_xx^4> C* G-k-cI1 a_c-*^ c^ y ^x-J-^yXC'-S Lis xj c c_>
-OS' lx^
J' —

aH

'

\}^iz

-■-f'

^.jj

rr^'

'tt^

SCG-o^Jk

.% y.

'TV^' g>-

Jjx> . Xc^-J1 G>-<^o d>

-Ik^ Sfea-bu?

!W.

__L^JC~ 1^ f^lo^ ->70^31.

t

D

|i'-Q-

4 gJh- 2b< Bill x/e.-c,^? '^ft .

t<

Cn>

P.i^Xla^-

Ls^C^wSj^»^^c> K~g
____ /^~~\ f'-G-A-O

rx7

/X4^

kX.—»

Q—O^. C>02q_ .

_ 2lB_^Aa_ JLx^a^ , cA-E;<j? (U.

~U Z-.

cJ?

^u-2. ^Qao pu-og-G

jlJ)>S3-A

<^> , ’v j C- *=j- rwo^

J^e. ps&w

TEgr jw -gJk^ C^A-Vxj;..

H-aSCs

je~£?

-M>GL

zi.^

A^A tL -clLLC--<- ~J5 2t<kcA;---- 9------------------- -------------------

g L,^

/^

^rjbbdijr ,

___ (pkC-^o-—<^V' LU A/0. ,

4-

uju

4^^:

&r^

y\_J\ ! <?
___ AlaS^v^

Lz

Gkke

C

^c.aT^

C^2Z^=^>3e^^ -,-x~p '

, M U 's. -b O-lx
'V1

_^r — _/>-<2^>~^3--y>

^<:^-A^Ak-£M

_ .

d^t/J
d^t/jk

z

»

.

/g^Oo.^Ls^-^

“

____
^£>

.

1
ft IZ^

--Sy^^lAeAeJU^.

c

^J>W----.Z^£<4 “I
■' td-Xc

'L- Pw K-L-<^,e_

3^fe a
r-

di£Sf^r^^:c^.c-^~cA'

~

oJf- uMU ,

kV c^cJLxi. x

(o

A

ZL_

_ S^Qya eQg^S^op - ^Cc Q-^Ea

K^'

fcsa .a-Ax^cX. L^kfexc—L

+

-<
■^~-ux <_oJ
b-t^P 4^ Ju^,

/J

A

M-sxjl _ke_^_bM^

•/^ | ly-*^ Cs^-c-, c^^\x>v*--*-o

3c>

I^J I -Q- C <KA.SUlXJLg^
£M .4$
/
<:^kz?LJudUZ2t=L^^u

■>-eJLa^,

—U-e_Q

i

r^l

r jl b

e

,

P,
------ 2.-S?~A[.^.----------------------------

T/ThJ
____________ __

i

</

c, 7/X

____ CjkxXvU

C

I

xj

"'fw e^ecKxxk

CbteX-H

TS^ <sxlP

^^^nu-Xuti-otfc dii

-6 pLxvc^CXAz

GX x______________
■>5

<s^

j>M

—

*

•k

! s.g.uxc-> f QlQ J'
Ey-

P&-

-c/

(2-P-Oz-K I^a-**. ~~ X^<^x<k4^.^jA>aC^L-A. ..

*

-O-O^j^a^ -" _L-r<X

Aug Vg?3>g.

^uATT/

C/g^r^

- dY.

bj;^/
rCtx*—Y>. ■ft-t'

( /C2X>-~. k.<-XX Y'=A^J’~ .

^,Z^.

Q/Y> i %,<j)kjkxXJi ,

.

"BY, 7~o-i^oY^
O U~c '

GY7p._r ^
EZ2^__

I

A Cfs® hL 6>^x &-o- 7<sX>vsX
[La.

pcx{\a^

5|±

.tJfeAKY^lY^

J

S-jfo-u^ o^Q_ cCtYY ^.G

^<YLc

Apt ' ^trYrrC-. iC

;

0

——YYx--'—Q
---------- -

f

CXM C_jG>-9- t/2x<Ln

t

1

-/ /<C?C?Jv

4-'^-^’-

t An

L<2

k

.J C-UuSv -X.

Ac sXux e (L? c/^

y

Le^zYeo^ ^._.dAx>o>

v .^o'kx^^^y
kfeS^.

;-< < r

s^e L.C.o')

b«e.

IE

&M-J-

Itsa

-t

^aJ- <X^-,

\

('-

\UUe_

dy^1- "
c>^£

p<=2 fk
.

£ ^.U^tp-c,

p.^'T

-z.

-Q-O<3«-a

_________________

C<Y
La/^
U'
(O. Q.^|-^-Xl

C-

I ^2, Q

^2 o^4‘o>4Lx <.

' 7 i. J^^-^Lo-

-r-

ur><^»^czH f »_c^

cb

-YY

t-C’t-—->

Y'

bJCr^p (a^ Hr <PCxx_U_

t^zY-oY4'.'--C t■

.

—

or?.

C «

o-^p

P-YXo c^‘ "tY Xu 0 p *J

nr

•lXLa o_<^

—f-

XOU _-

o-^o

>£^__C— a>^—<23—Y ( v-^-Q-Y (P^Y- *

vc.Lv-1-^ 1(1. r

---^x

COc-^xx

Ik bk EYl£

(p^k V

X L<»-^ C-Q^

7T_o . j. laJ.x...s. (a_a

Xj—_-^\Co V^.'

S-

~

fiP-^Yc

a

-^l ^kJ

. v

U--C t-'-e JL^-^-

<4

A ,

CClvi
U~Aj^flZ>Gj^
lM uMv<Z'
ixa-j. I— 0

I

v-jZ-k Cy^cr/'

c.^

W“

/‘'Cb^Q' ^ CLA^cL.y^E'

XI. •
/

C'Xflt

— iaOoJ=djXlz ^Oej,£> Ly

bt<A

•2

^.^csijx^-x-CL

Xs
a

4

/^bo-ti

lo—

sg-c^ixyr*

V"
2's J xXlb?

Xy t^<"=

bT 'b

XoVG-

pAA^-^-X

1^ L,

0-^2',

E

<Sac <-’ p> J

-d'1 -8-^ f-^~’

6q - b^r
bh

tn .
' b

c -

-<c’

e.

r) JL.oX<L

pp Vs p KX? (d

(c? G^ ’Uc

/s-^r ^psg^s—c

J -- -^ r >
c

/

<cXe2iO vjlcmrc, T>q

c> \ rv Yi ■

1 ~t

(d

c«

3 G-p-

Kji^_

' "P " bc2^±l
]-^

^p>U
SisjiyX

u

«

-t . lAa
p

m

u t^-U

r

-(j) X t!-O, D •a-cka•. i^_k

.:y lx

■ yTWTte
PvaxJI<s pa—^2

5

-

.0? cA x-

d

fe t'/'y

^rV.

‘

« .p

X

i

vS.y

3,1 Ae-On p p^A «----- «lAJd£>?/C^aJ'
L K^Jlv^,C<vO^ J>U5=X-^ - S

a

<c Jb-JC’-'* t.•
-

^SaC O^lrJd

c-^c’c'-'V

j^LcQxj&-n

___ CO^

Oj—<_0 0

r”

y

I X

S K_k_X^Q

St? t_KQ

.,Ll_-J.^>Ck A

'

aclLC

x»A

G^cjq^S.

e-t co

ll Iz^-L I V «. ^ '- CT^ c- <--, /yep r _
\C Ik.

pd^T* <AM?G-4.0.otyMy

<f
^^C-c? p

iw-tt -

4<J^

_PL^

Ju" x<s o

fl P

\<*

JLlAaoaxSlp-ZglX^

-‘pft

' I Q ouj

v kc(L-C~1-^ <<zx7?>
jJCv-KC
kS-O-iG'

.

iy

£.A-jLr%.OQO-0 <-

u

/

oo—j r

n

'

<

v| ' ftv
r\ <sy
" aa_

- - a-

\

^r-

ll'y'^""

J ,

”

.52-

..<t—p

|x3^

ili-wi

f

^^.-^r^xj<c.O^>-cZ

^e do-L-

( V-rO-KAi-G-AO^

,JLTy_>^_S - f >

"-A

T _£

0'-*<o'*-

r

1 /%<s\

>-CC>^vKC

-4

C,

(' - ^ ; Aa f? ^<S^v^'

Q-c >

C <1^, (j^e-j C

^<:^'L-k f

rx^cr U.,^

c
''^-''-C^

e a-<0K^O^^/ , ~^~ -jAr-'

"

Ag «. < </:■' y

_

J-Vs-^J-C^-'

(y

L

c 5-X

C'\

,f

>a - T lo-*^

.^Vcj> c>-p>

U<

e f.

■'

^WC-O-rx.'
'^1

d<y^.'

'f

I

S&Sc

J dv - A
■“
- '^. ? -Lfeg
JK r .

^/dto-vvc

f

iTtr;

U <-

Z^S>7f;e

eg .
’<-•'•«=

<Q fe^A_xjceJL <-^M2^G__.

“'^ *'('' <rAcf\ t ■

cs^-'ao''

Ca.t

/

7-

J-Q 2C<v>tc^
^..-pc- <1^2. K-C'

^■-/-':;p"'

J

L<o rQO.

\ Z^ Va J"

a^TaT o^S-j-a^-

’ (ct

CCi^ <^g >-

1%^

T

Jys-f

<z>-C

:

^-«gA2_«:

Aac ^qc'

1 1

CalQ

____ __

rLa

tr

J/’ ca^ C '

di

qu

QOC- ,

cCZL

. -f
^gL. '.

jspi

■

^2. u

iii-z ^iko-K

^LiZ-p rv-K-lc.

____________

T

‘ z-p

-^r ^ertLsyx-f

.' ro- £~ I

Q3 >5 ‘nn*.

.

-

^1/^ 7 $. Q.12-£>aJ '

a—ivjL (2u-G7~

Jy~^v

7-6 S’

^cf2 L ^,'^t'

_____
o-

o

■ <1- fi-y

JLoJLo3sUi-e_

’ ” <g^—

f-

tQo.

fr- -x ia e v-‘ ^m2_-.
-c’^-'

K53^ S-

Ctj^oj cxLQ<

c.

c

J cJ &
',va ^_-y < '-d >. •

,_ r “t <aj O r— Gd

c

C<

^r—1^> Co-a *— i-

l»

|C»g^ A’-fy'' <2^0^ 2

is _it.,.^». LUflxA- ^jQ .irwid
|yK^>oJGa^

(LfjfjJL

r4- s^

^-vVbTq^ »S^

gd^Qp-^nOr X or

,Jk-<5

—Pffck^-u ■ «v> }T
*»
9

>)7 t>^jr<xxz^

b eenx^.

^^Se^d-^P*

tQ »

^-eCJRya. <J>eUZftj Xa,"

«a^a.n^

e.

? Tr^
/

<0^-^

Q , x£l4-M^» >-Ag

E
^e-Wy tP
<

} |fy l/v.

EJf

^P/*^ /^-Q

J c-5Sa-£.\AAy Kg

DU)^-kJ)

>JACU. x=AQ-^

.Ao^^z-O^^ *,/

ffi**-*' ^3-- /^rxrqfiAg>x.

£

/e^Jh

o^5^La

5><XM_jLy>cl

Q r^Poi/*

r

Q

- ^trS- p^rM-,

At^ou P1^j>*. 3»^c

*

rags.

L

>M-’

4

> a-.

.

>

?v

k-

g>

7

\

A/cacUJv

~ p:p

TP

Suoo-^ -P^f &S ?

AxxxP^/^z --

AoeA

<P) <5C’w1axP *4 ’ SAj^c^a csjAl

£^222?C£1£=mP gD^0^4-

g^vnA IP— <p

-'B^7

4^^7F

r-^-oc^\ C-sa-J

S-^' i

D.

.CL ~ h-A.O<7 i

ResJMESS

E
■Ags^

J^Lb?

^QP^ ^^1^ 2-

-Tyv’-Gc - (^.-^l k. t— v.7*^<v u,. < c-*^2>r^

P^K

P^tP 'c, U-A tt

z^A-f

-f-

zCQjl^^c-

p.

* ’f c Vs 4 ' t

CLSL

’F
--

.

t^e v-?.-PVjlO'i

, rM <

) 4r

rtc^. P^p\

rere

■/

L_C&
LlTLs _
t2r 12
(93^'

A

Ce—C--J2

•2 I'-zV-ir

J -S2 Qj/s^V ?_£

pp L

1 Le.ypj <^.i^:JLf. C^ X'S' 4>»u2 o 4

gcjr-Z^ ^njgjkieir

.^uu ..
[Ld g>

C.0^

"3

-^~ -SO-Xj-k^^

ou7

Cd

c^ P^tsu^Lp.

^r^-rxCxJlv" A-Cs^tUv^ ) C }

Q>^_

6x
P C^A

y.^ e-■J^

Z-—C»

^cV—gXL^- /oC j^~z2- -- -—

11£^}

%3 _5

IU £ -4 ?

^71. __ th/u

loS '2_y

6- ?7

/^' 'I

5^-s-Q

ISV - 2-T

7972^

«ss-rs

7

*3 •

fi—

____ /
n^sV \

DuJTLp-'^'I ‘j,^ir-GJ^za-^O ^ ,

1/.' HcpL «£ptu, t 1 «/ I

rw<---I

fy

<-o^ (L ( ft feteJl,

I (Pj^ (^

7>-<-aS-oP Q^-q^X.

1 .

v\

,/Ld31

(?!£»—m*v-> L.j»

^ier> v.GP^

Moip =1

b'
Q

)2-?3
^n2.7x/ <=^
UT'-Ol <

Z6-- S3

Wm
'

2.7^
, 17

7<r1—>^.fp
2Hct

PHt’i _

. 751^

'
7
10.7 > 1

gg ■ 7?

—

r;s.r' s.

c ^U. *

r-------- - $?5

e ±'2

Ju

|

Qoca^TLT

pCoAk C- -xp> o Azy-C yjS-*-*-" _ ,

<^o p (?

7^7%

^12Q

IS

<gtp 0-3 J'

ui.

N

S-V-'-c-

C-JJQVCLQ. J~^i^

kO^XS^ I
^Jrr^P C^lM^X

£e

. ■r-.A^U-x-yx f~k_S LvoCp-^

>L

) Cc'6 Cl «P. t cs^ .

Cl ' .'ft^

e_^_>. Q

vy- Q.^

M rf c P

_v

Lxox- v<u^ir

' <- ',—— O.«J — p5

c

yy ■» ■*^K —

cClvJj qJ-

GH
1

"' ■'

2 > C CJ^a. L (jJ ' *

i.
"

3,5 3> • u Vcj-u-Jr.
oZOg c L___

■ <•

e^p g

-

K?

I ?7_£ .__ ;_____
<

\'~

P

C.^oO^

(* >() TTvC^X^" ,k kl c;

xj--~C' rl1

.1

r~ i-y P Cn X.

loV ( > p^' z

UzZ^L <^5. ci
pV vkj^-PcQ ’ic f/m-*, A-'Qj)

C' <=^U\ ^C J*

Lp

, VC V'-C'-C Cl k

P><a S>c opyU sAu

, jJL
(Vc- 5^
pUL-p—

;T

^Q=>

p°c

N'-Cp j I

Wo 1 Phvv\ '7,-k^ tzJ

" Jp>
^c o .

l—<_-v-v t-.-^-' f' <_> v^._ v c

^gXutVgxA

_ •-&-*

_j£ I

Q^ki------

£^-x.»a

f

^no-u
UiJCAA

fe^-ULPC^—

(20 C0'O £

< s Q QQ L 5M?

,-J«oBc^vcfl

r

-/ hs4

<2^. -

^-S..

l(^-^

^oQ-tuokj^x)^

/v

^P> '^P9 £ I

J^-'j^c..

rG^-r . c^li

ii

~^j

-r-fp ,

-*-^1 [ J' f <=£

.-

-LL_Ck>Ck^-~^o^

'<^sxco v~-o o 5

L^ 1 r( o

, £o A

q^AJ CkUo ao^)

C>

G5>cj£ o-A g>^~Cl

c 0A kkA c

^ViCL

e

O <^g C-k C-

^1 t-Jkry
Jj/Ttl hTc, __
_ Qi c Ij,«JpsCQc? k
QlL H ■ £Tb ip

k<Lac Q ogl

—<C

L^00*—

fbex^S^ C-ft. _,y^ k I
or
c
-1

g^-2v

^ACC^yoL

X

* pG-^r P L^vJj KOXO^kC

's

%r~ 7>do ' xo.k>-P?vuz\

F-»-/^g»_ <V<->^gol

<Ji0‘

J r

U

_S1 C- oz^JCCLo^ F,

'' *

■^L-ifZ-dr ipPA

UJU-LUt / LC~-t_p^Lj!-|C>K~*~^ ~

j1 ^/ g / zv o r- (P ,-

j2.

-I

~ <_K.T-Malc £,,>

*—x-<op<' _ <»
<

—-2

jjcxX

A-3- *-**^|\k

—■*—r

‘*
UuA «-JJ

**" CvA, ffL*Sx -t~ A2_e> < WU-CX

. <x

- Vx

fa

Q

gr^v^
2'3 Cf CX&^-e^. ^T*" i-v-roPA ft £ rv^xgr^A c.cZ i_>-

t

3^ P

*** £**7 rzigx^1-crjli cJ*'" Cj<^-<-i rr-t &

• r~(ggj .fz^-AMC *"-

<? ^ckq

Asa , v^cALT

•1~ .

*• Lt

Q<

~ 3>c

e>-^Pfo xn

‘S-

b

■7
q

^3 o-r

:k t_.m-

^(c^ ,
S.

AAi ly C p| . —

A / ?6 ? - /; 5A.S-P

1

~

qIkj^KXm,

K T

Az

' « PQb'-Q A

J-C-fijCECLVtjX

^<000

~

J^tX-S-C-vAA-O-C_____

$ Q-, X5

—F
EF

jUxar^^., A.

7o,i^o

c rJ

lt^

'Tl. Q ' t u--ttej,x.c:

^5 t’l £=■ 'C_^>< -e A 4k a P

•a uk

;l=l>

I o.
I C-O- «^-

p

C/Gj (X

e^g

‘■C^-C^A-A

A— A b-xx. t.

%

ft

P-Vc A

>0

'T C-

,

, L^TI. Q'yts-1 r

2 s7> f ^ZdO,

~ C ^7e» D

rtA1> -^y
)
--- ^£cp^_>_o s>3r ps>c_v_

3^ V. Q-eOU^

«4 - <ck_£.t

lf(>

ISA ^S\

II C-JT,

7; r?M 2,. vi&C^ . A-^;

_

a

^g,c>e^

pp Pl. rruflc^

F^r

P*u

r-________

>1

r t^gCcx-Ulo^- y

~-~ S^r&o3 qx
JlAclcJ>
^ C. ip^?-g.
|r. .
o»<JL^e
p^-gK

^CLXcH

-________ ■

6- c~fiL^_A. t '.

.Cto-iLt,

,-SgASjj

l-f P6r ACK‘iJQ^4-tc~P

z? CKcyf

/?7Z

/• tf<g.t>rv._l_2r:____ 3

r^L^zllep. A^., rerptT

e

P/p.

.

\ b' LAAi

15^ I ■"

—
<-•

kA-^c^

V

1'0 ixcu^ rr> . l 1' X'
U~ ~
ilvt2e
£ .HOZe-tk^

£V - pgp'
g>pec

Q^r^;
SS^evuvjOvU> I J
, Ss

'Iz
11
, ^x^
SX^-

—

eJ^—

k

XQI U-Aa a
o.

Z/i^

J’/o
VOTT

___________

--------- - —

1. -

— ^.4=> / ^-6 fe/’DoA

4<9 Ptfc's

hf
'7^^
p/
> /xFHd_
t/39 7 K.tg /• A ,

„L^xl

fit 0^^;

^oVp^ Pwc^

tfC frl

*

SaZTcLA^ JkUoi

.OL>-AJZ_

PHt^'i
; S'K=^jj'
PHtrX/t Sc\
;
e-X^ca,

tf^^l., eu^sKolei

1-oe^^JSJ Ujjil

‘CV^ocAp 5 Ur*O__

I-o<j£-m^A lTh-Q--^

, \

^-X>>v_Q_/ £Z 7 "^0

^XXj^4. 4

hg

<ZPJL J t

«~> ^

AU. 14g 4>

s

CA^OulDoJ^Qtf.

Q.X QA A

>-i

e|^JSG32L

—g,^.r

*f~ J-r«n

31/0 BtocJ^-l ■ C

£a3~\a-Ga iAp'

|>

P?(c\

Ptic'-i

hs>

^^Tp>zaacJ
ego y^gual^

s^j^.
-4.

<SL>

yX^^-

!±r''
Cr^L 51^(3" z

Czh'cK vy
v

ttSL

“

, ^'^T''

e*-K \\ ~fcg,

,4 u-Xa) gcJELeC^ v_______________
JUxa-OTu <* ^>ok<.J <L^-^

^^_..

f v_aZU eXXj-AJl

Q-W <3.

y*-*^

rwcu4^ -^k-k3

& >9x>-a. t- Q—-*

^A-g,

L

r'-

gv^ Lq^x^D

fc-

v

—
t

G*

Cz

IkmJL a o i.i>A

«_^n>

' —_Q^3g>.QlU

[KL <<■»■•> m.&»A.l

U->xd q

^A_^__<e3^^
a"

h 7>7* CaslsJEI" <x

' ~~^

uOC^kJV^.

‘g-gf.

---------------- !-------------------------------------------------

£a

c^.

i?^., ags

pj' S> ^>XE~ jQc>-kD P

Am.V^ F^c-pxa-UiJ
C*K-A»-e^

t

(r^n QfU ^.Se<

-^«8^

+

, 1/g

Q_Jb-x2e.oe.j3L_* I

Q A < t v- Zt^P <a-M*u- ^- O 3

~jl> £Mh>.

xn t

13 8/

K (-A/t-O-i $>—Jk f_Q *JZk

.2<a<xZ<-o l H- ^Aua<-< frvv pp.

Co

St,.^ O.

ro

/I-<aa

SX <.XJ$ • <^S-O-<

rp 1» iTn P g^S^ob
o p
0

g-

76^

O 5L

LZZ3

"-j

_____

f- c<a 't^cLoj^dlj^a
j)_________ _
<f*o

K
.A—u?Q

^v^-x<jLg
-A^k^La-r

> o

J. \1, J:

gaxJCJ*

P°.'

y.

css^b-t

<O-Mlvv ~

ylT^^^rr

u ,■

gA Ifa-tb, gjr

r.

l/zkb ct

«5^

V\ O Op-jS\c-

<4 5>^^--f

/tKJ tj

gM^>

> q^XZ?7X^qJ

-r c.
I

<2j>

K>g^rs-S>

62-

v,

pOTx?-^-C

--“

CC c^g-*—

H r oQ. tU^*

f

^e^H/e

c__o-»v. fL^J

I

pxjocJ "

0- g r-^/n

.Q

4-^ -—

.^5^

T uc is

a-

.

iu <

1<X'

V--30 Aiv Qi—Jlx

^.2.

lK v tx t VSV-V'J

Z7-J>g —

fraJL^-1^

,' ^-0. <a_ x. L^-tf-

cAxX' ->

-V

_______

\J 5

n

grSjak*. <^J

3>_0, vy^

g-^po c^-C-^

1-^- o esL<_

ci.c bot-*e^1^'

p-—-^>G < ^cJLfr-r

pfeae^ I

H<

A, t
L_ ~ " ~ ’k-,
-^7^-

ol

1 P£ kL

JUs.'.

CkCIkjj^ A

r

.09

^3^ Pf-

(3

»_v

=^±5Aj-

fOlfr-cXT^k

^?42ixa/!^££2g
Lx.uJ^c<'

■J^v-x-oc Ly^tAx

4

£-

^_L

/‘

**!' 11
el

*

) fc-4r<Z-K^£.

u^<-0

\
I' t> pn <

y _ D-QW,!!

^i

■ 041^

o'CvQ^P

SP

|g-T\ i^

13

mi nil rnr

*1 ri rifm■r—n r i '■11 rvMin 11

I ’1 III !

miir

• 1111 ;uiiiimi3s -ni 11= =§ssaiiiii®a

j

» sieg

/7|

T^x

5" ce Uj-J1 X^Ltv-At f

ZK

4 rzl7_ I o. L.O -tx

? OuW A„ 2^z £24 l^hpj AC7
’pjjie 3a

P u^S

i

eo_JU-Jk_«v

/

<y.

■--m-z-

^uA.ux^Kua p___

C

_s_k

04

ftwr-fc.

r

; 1/5^0

7-cy, ^LA_»_*-7S

I ?P r/9^p(ctr’cll

t$r fMcA jLx+Ag, JU

£g

■• 1 c 1

aa.

3bc

4

\

>-•--/< /3

c^L

F5

£

4 lL/ ?p .3

( I -i?D d^^jLirJ

... -,. ' p>6 XfL<
•3

£21^
2-.
, , . x
tf.

>

/^_

3^3,

d^s.

<SA7^

^2b

k!^ ' j

7o g ]

/-J C> ’ £

’3^1

Mo_‘ $ _

3^

Ep b<-p-o-&-o.
V

/ V

^eM-lxA-O

/uj-^o^1 S>.

> . I / t- •. >a ;

(

J

EbJj j^c Oa^GxJ-?

il r

3 r.7 t
1

*£

A

C ' 1■

)

'•

/ '‘ v< c7 •

U^Xo

J—tv t

t^Fto-rf)
V” k -f Co t.L..O 0 <,X>,

LJL -

~r
(^ g y^i- >-c~

X> '

r
'tfo u.
v*_a cjj-s

*■

r-o-o^ e-* b

<2^0 0^

"'

1

—‘^j^LSg ,J •

t.^-o^

u^-?'1 c
A

<2-5>

:«i

e

/Ac 3»< > 7 '•

1 _v 1 y c

e-&«-V- e_^-^-4 Q JI

£

qRcx X.

rc

<L

K- L-

(- C xr

^sluiCx,
H cr>-=>

Cfc

^'- - ,p" sr^sx.

K>S 3' k 7 C Jr (.'sr<-4.

X)

'' p j^_

_ _ /7
cy?x-^r^ <JL?.

AC’(

o.G-r^ i Ga.^c

vr^
CV - TB
.
a h r j'
-

r *--£l^K / ,p l

6 o u-5<_A.v£of /Koi'
j
-------- TP
-------XKzJLj.JLkKjJl
\ L ^coi-w sc-

*+

rs^Crir^a

I Si _

1777

i^C 6e

-j -

0-71 c>-'-C> tr

33 S'

(^|C&. ^0-0

jAEZX
* S•c 3

K e-g-.

31$ 1

3' /3is^

c

3

■

t

-VO.cA <><S ^-'A-

X

/-CM"
tz-JXO-

7b

/

-

de_

CSVS

gd^-c
c
<C^ O 10 nJ I C t^fr-______

(jS/^iS ,/ 7 ?PF 1

2Z'7_ -_ Fp _
t

- or? /EPx ___ \j

i ce P ._____________________________

top

_^o- , AeJ

i KP -—•

Qj

IAJ3 Q-Sk

A

uyv-c^^-^A—-- .^'

\

'

/-fccaJLQVv

7^-

>

■ «#-* ( 0

spcpi

Ci

~tt>yo
?V<-~- tf o A

.t5-xo)

/■<-•h.

H

CKacSl

Av^lcte'j^j-.^a.lt

f 1c y

C> -VC^>

<v^ cAA^-fe.
■ -

fUx.<Jfe-_ /Ux5 ~s lS^C'’"

—

eQ 0 ci
rxfl-a^Uf

r

7e^O

z>lUr^Cc^ L

l^rO

-Uifei

L_

AA±±S5 LA L-A t

At

— xpY^ 5A1-

(\1V

I

kjL^-SL^^

• £oJipv

1

auJ,Zi

f^vy^C

.^<-?-LD4 C-oJ

^r^o? Phc'.

JL^tc C te cl1 <-XKx

*1 kfiTz Ci

U

<7Vll^
S
v

~ 3 3^o JU4.ju tUV U-q-.

lAXrx^iy.

-4 ^tz-*

L t<x'’-''^ ‘-1

^2-^ rv^-xz^A eO-V

k><A>A^ ( eo3 f?

V

;u-.£< >. CnX?-r-f

C> CTCTor c p tAx J1

atLc^1

y

(v-A.Q-t'X

to-jJLp

JUK y

TR>

Obi-')

/- fGi^-X Hd-Ao-

■-■ -^ ; flK

r

M

-th

unli in mr ip-B'i^nmainii iia i tin iP

fp. ti

‘(■Jl-i^C

<aY

z> .

L

Hsu>^ "/k&f
X-g.

A-^-^

Jl

*->5 P<

,

r

vuat

;c a 1

C2S-^-^ -

cJ

cGZcJ O- C-

HojCxlfc -

I

Lt'- ?l

-CA-SO IM^Q-

( >Xju^-.^^kA\

1723-7^

fib#- b>3

/8-5^

i,

<?

A

^LfOl tSKj

SgtrO

Itb&i

57

* 37

^fesLic^

C-

2&r
I

S

1

Io , r^MSp

■oAua-

iS/to^ezi

i2>

/<

kT

<i>L

5'3 b

ST^ro

/pa^^o

/. 3^,. ^3p
ggyCEoo

tfj) t

4L O^<5

17,

3^/ creca

Q^, o^>q

:

3^0 • tsr?

(c^a£)
( Lx^Jjx)

t <-4>S

,%?g> '2 <r

373^ V

^afOaCr<=>

«3c>- Oes>

H -2 ►

^r^O^-<2-tu,juuA^__________

73 ■ ^"fo-V V^^cg^sQ-U.

to3

27, eero

To>3^s^

/7c-<34»

12.

*

?3

7 o, eye>cs

(ixu-vIa^

II.

5^27

•yo/sr^o

ry\ JL&HJ&-WJ1

7. £

•

Ilf2 • 63

^O?-‘

$27O«<>a

>

4^Z

<5b^_

£gp

io

1^

/ s"

n

______■ "*" ' ■

I b.
u&

2^

<V ‘ •» / 1-^ Cfe^z-AA^-t

1^.

}
(" *

fe-

I^ozJLa

3

33~ rxyo

____Sa> /Q»o

, 0^30

LU f^_cic La tQ-"]
Qa.

^QQ-Ur g.

C-fridj j

— JUXXJ

■’“-3 ■

■

' n,—J ir

~'iwi

.«■■ r ii 1 iiiiiiiii

riF

xftp

- */ t*-* r<>2tv

llllll

111

I I ITT ll'llfll

T

■z^u,
Kb *~-q^c oJU _3-________

__________
g^Uv^XSeJ

uf.

S^-^-

1> n^X

P ej^y^

/’4? •. 11 e>-5

j\ n . Qj— t . f}

itUnd'

ma.

7

t. A.P.

■ 357

3

52

5 5 • Zf 2.7

H

5-^7

.tr^
~v

Ju

a5" • 3^3

li£2k.

/

l

b. J-rX

1. Ke-MzCo.

g rf.P
. l/akfiSfXS>kJL»A

12.
/2. 0V7s^

145-7

IX
6?

iTte.
I • BSD

IbS

l^gtf

0-74

12^0

0’32

k#-

zyu

0’373 .

I

21/70

0^^

b

11

/5"

3o? .

S'

7^7

0»37

M7

L

i^3-

O'A7

li

334

/5S^

1

2r»o*i7

0-4A

(is

4

h7- ?77

13 Pu^v^aJ),
/If /K£2^qJ>1\j^\

25t>

Q2E

3

D<

0»2^

i

20'7%'

v-u

7?

39» Db7

If ■

12

.sJo.’&PHt-Lt

5

234

67<f

0’37 •

I

37

/gff7

0'7b

a 9^4

0-37

U£

37-393

$

740

US'

b£. g

1/2. 2S7 6

k

• 2.2SZ

//€?

0'^5^

05? s
o- ^77

/8. /I t

A

/ 5. OXo2o.

t

I

4

iqr

3

■> fr'Vko

)

1^

■ Hl kkxmJLj4

3 • fyO?

t

'll-.

Ilf. I'M# J7$ta-uzlz

O'CSS)

llejlki.

•roT>H_

/

o> tic &
C>‘t/if€
I • 3 83~

^2.^ ’ I hLf

J.

^•l/Q

3-30

I

a£i_

Or A 0

7

25. HcmkU>^
2^. aJE^A2?.
28 - TXl^zuxx

3 if

• -2,

P-o?o
’• 3'??^

21

I- Oo

/

0 > /Q

H.

1

I

12
7^
11

I

&o
0-?^
■^2_

■2-3

53

JZ.2., ^Lb\

0’33

*

r
p (K ->

|O^Upfi-42-<=r

1^

.^4) <-JL1La s*-

r

Pl^
------ - ^3-« Qp c^-.

3^ »

—'

~

» Qe? ojt.

Hfek-—

Jr Pi.

.—

IfJ ’ S

e^yj)

.I

r p>

f^.a z

fr

^-u—V 0

^LA-L

Cjg.

---- - I 3 Or.

U-t?

— v/sr^

/ 6 y'
*.. X-orD ,
O 0-^xkJ3_________

alstULe^ Jkcr
4r>

«-^-A

4

-'

4

Mi

I 21

MT/ WzXLy
ft. fl rv!AJ t Aj (y- (Jc riH f

bp^

^7%1 cAa.^ r

v.—o-*~ "

X

,-T^

frNi K^Go, /

t

-SXsXy

C_

(pJI kIj^-o^A. ,_________________

e*A z

y rx r\. ^A-O:'*-*'-'-^ I [-^

/X xje-xa-«. z

,

- <2-Q-.«

£M

<v

'

_____ _JUt C-^^-A rv-£>

_£Uu-X>^

1( vc«l
fl"

'V>=.»-v-X^. kXt

■ i~{!Lsdl^

i f^- >^-‘i'

V .

UT

l^_
9*

‘6_

- Ml • ^

vxf^

uloJSaI',

-tTL^a/s^C1 ^-»-1 9 >x.\

K.

r^=' JX - C

t

t fL&2_

uJ-J^tl 4'V' Tov^S^

G^-J

1^
''•-i- ’-.►A

u^AZ

,

n^——

)

cb? t

cl-So

f q-

4c (jLfi *
AvxA-uik'

Aoa^ J^Q 1 JX^

^.J 'coGjCvA.

Q» \
»

no '&.

/

O G>

cs

'^4- tee^tcrxy^jXl d

U^TA G

/icc^kv

o £2 <&-

,t

’a<^^s^»aX i

■

“7

-JX
T\S^

o-pU—£

V-ve^Cxtf/'<=> -—

A
■■-■■■—•

L—c^-

<SU

LXx.P

>-£2

^? £

STL^—
.TIC •-

-------------f—

"bk f >c tv>jxx p

1>X

'
?n
t ^5'—•aJ^ CrXky^u

•

i

t

“ C 0oArz~r> <T1c_SL

vV ^S-l

**

*1?$ ^C-

T5

~i s<^5

< ( Ct-42.

"

|

L. B

_

EcV' ' -£V^X r /kJ to " ( '?t>'&-.

VkJ'ctn

$rx z

17^0,

b .

0

crt'^ '^S/sc’CjJ

<- (N2 Jj C,

V<29,

-

v

/ 3 fj 0

^AjD^=> ^7 ‘

i fc,
-^
Kt

Vv

y^y *^G(Xs. G- o of 0 C-aJa

V C>u»A5a. v-jl

..

J<?m. (, f

^-z-^ qJj- (G^

^px^2_^ J7<
<Jf)

IA2^£

DLq C^vxxldjoJ<JO-A

z s5

S\tot£p t

JXcl

f

C v-? cC'^cA c s... et-u-i.

" T^TG? ^sc^-Po-O -p G^_k fXo-ix-c
<?* Ar<^

llffa!^

l^bl^bb

A^Xm,

6-0 X z

,

■'■h <1

J

•4

xsU

Csiy^xi G’-J

|puKC c

•*-*

' ■ t-g
.-^ /Lxjv'vA-C: --- •^— ^-G'

+*

S^Lx-.UGt-C

tST*

*y

Ja£2^CxL>«1^.Z2'^
__ 4 lA

cXS>t^>v-^4ib

^e-e-^CxL

PerU^ ^p&!r

AAgLy^ VA^P j£

^-1

Ado-

\j2-vxA-e*A> '^^-*

C. c-^»ve^^ZC—»

£>O^xKLqu>

Mocp-re^ ,

<a'

1 % ^J?

tVA-T-ZX-c

'I

*■0 -,

""^

r-

ycx^X

JLK
(I^ mJLxajUL*

?r?

PT
k^T"

p

>AftrJr3^2,-

^y-soP-M,'

^aLkc <J "^Sj 0

rx^xAs^-^_Q.
7^

^CJOxAj^rr>.x->>? C-^

_

CCBAA^ /xJ^Iak

J

1.00&.

> IfM

vo-v\

4 ■^^z?v

7 I <3-V\

t^^CjlUDcv*

2^

? ^.^yr-u^arJ

,_^^CLKJUu/ A£^’N.y
r'la wvj.
o

■-

—-/f^ gae^epf"
Ua •

y—-- =--==

P-^-2-QJL^4k Uj A

sJg^o

^SJ" r

--- MDi'r^

-Xcl&O^acq^

tkr^Q^
__ _ /^Jeo-caP

^1

vaJi>4KC<vcSl
— /gajQxx^ PeaogD jp(guxZ»

x-Q.-'x

^$n^

j^rHkaJv-

I1

'~u)

-O

g^h^v.

J

V z<-O-5t ^-A-r-^9 P

U*€

O.C scxS ~~~^>

6^E>V fj^_h-^> .—

*>

o.

,___ _
Po gx-2 £»Qjv^> FfC-C

^QAaz^.U-o>A.& tQr-y

/^2gl5\

IC

A,,7^ (^<AJ^c53ZxT /^K-Cx

Last’s.

kJk C. (> iGaJlx

p

j^5Ua /Jk.

r*-A

"

tn

.-^>^oJLV

exj'

J''^, z

X-A^-

A co1^

t _^0Tet
f ^<GC^

p-A-^k' CV

^c<C-u-J {_-

'V-

iy^o 13^

<S.(>-c>aD

p.Gts 0 2- ^£1^,< czrdltyi^Loc/)

k* -

aj x

•-Sccla^Ij 1j G

•

■

J) ^A£>m« *

ro-d-G-^

<2

/Cz:^.
X-a^'5

•*

—-« JLa-Vv^.-J''^
O

[5Zx>-<^1 Cscs-^tD

Q

r> -*

°r G'

-

Sr

--

bv^ b^'

~C

/

cL^Cs^ e_
t

(

- CKQ-^),

P(a^

<-5jv—tl \^to..»A. __

M.C_xj--<^

7p

y, Q^ i 1 C&."O

.2^1__________ LSL
> I'-C?

3

h, VJ|

$

7L

-XxTc'V

i? f

<r

7,

C e-*_<-A C»-A

I

GJ'S

»oi

£.

_Jh_

7^J •

pl
^P\

lf2jz

15

5

2>

?7^"

J

7oo

*» v^LajJjC^^

?
/<5

9
2P

'5 L*PO

I76e
O’A

9

)b

3T2S

^arnfT*

7^ ,

.

3' ° /-jWc^U^

) ViAi|

.C^xLuCSe

^5
^/sr?

5-3^

foe

9^

i

<2

+rr

5 u.t.
^3.

—#*

cr i % — (^0

<^.

.

c LP

X j. Cc^-t7=r '°^’

•>
I- kx
M'*' <>^4'

% c^ U

(txt

?

~I-------

-2. " 3. 7 1/

Lo

•

X-, i*^g-A-o-ta-C

<v^ |Sr "

SlaJ1'’ t£p

S» i <2

'T, mp4 P [0.

/srp^.

,0 * -('

-Io

ci-vCX*5--*-^1 ^5'** ("^Cq—

i

bL)

/<9O

xcyPre>» MgVxjgS^-ALQ-/1---------17 "7

i 'S’S

•^'Y^'eg-t. t-XCJVS- ^Vea-A.-C-t^

( b C -<--.

I OO

357 c>

7-A

IO5_CL

7.

(Jo)
6

^-JV L^7,

£

5

•*

^/.T t
^4

>^3-

^■e

to

■^-'L

O

Oa_^s3

♦
ft

.^?i

7

c,^

--------------

^7A7iq >

,*->LCiaaQ

,_A<jr^ r-

Cvmxa

.^2 cov^X^/

Q^4»

k>^cx (bX^

^O’^p.vCeXr

A) o .

QCi-

(^L’-Ji.

u.uxUr

r^el\’

* Ro^«R

A=x, CAC?

/Vi

I &L

| ^o)

fcS"

7c

)

ifsi->

-2/1?'=’

^J.L^

Ootf ^‘e
Go^

C cy^uLtk
/ g'l'O

** ^C-Ck^x^ Sj-vaa^M
1U, ^<.a

xA^C-Q-A.

rXj_»_A.

Ca^.a. L^Vt

<S>Jxx c? ,

(U-M^__ f

/^X. /ffffT ^jrQ'Xg
"X
~
•/

(£C^A. c

n

^aaA UG-—>-

SocXnD y^e^a-ML. U &v<£_ 'SL_ fix

O'-xLt^ -

~ fjCj -A / tsc^a•■
sd -$-/

f
/^or6/ V

I

Ex^o fcvjo'’;.

Q-ML»_ (SA- GA_^Q^f *',

Ac " O CUA r.O^ ?

___

*-_J?.

A-feo 0

JL^JlOk

So^co-a

a

?

j^2,

X Uu L

r

^v_e—_lxuc-'Xp<

r<?

-*■

^A^rx^vxA CcA^U J^A=G^Q^

J^O^.

X

’S—cT^La-^iJ" u.

; r >Z^pO^ 4-

^2

0^^173

M<sioK^i4

1“

l-CC'K-*-’ .

^cxoA^

.-Cy>e«s^el

7^^

MGq.

±_g^s/>-.u^

L.^Q S-l^jxgQ.

F

• .Lqd-1^

I

e^cfi t
Ko,_

<^c& e-d

r^,.^

^axJC^aZq
Q

3> o

q_ \

pK^ c (k t_c_ j S Xx

V S

V<

e-vc <r Q \ c ”7 y>^o v/* -

V-N-O-

^-Vpc t

TfcS' £r^Q_S> & t_>-^0 . &
(ok'A

f J.

x

<•/ v~ fc

- £-

p^daj k

UOO-A-

?

UO^

T)

rc.7Q tv^<,

V

|7^>p> -t

gj^JLL,—

€<

!

pe^

^{c’s

'

>e

t

jf^,

~

<j>$sC^ tjood ,

o£^V" /1

<?

“" . >‘/j^jil£’

•?

>^Le o-

r

^xXo^

^ZLL

C^'Ax^P

rp

C«-jO-^ -"TS^''y^<tO

V'c-c-tlcKxvC^
<x-O_s;G^^
- - -----------------_ <2 »X-C^S.^

. ‘-'-f'<- ..1>-L
>
v_t
4 f~

jX2pO-^7‘

d'<: /k

J

(£? > m-*.© 5

L9^

■ <-p \>-K-4''-j

“*

r,5

"

kt

Jt>-

( p <-' «t*

/L-^1-

pu c c^-p^Q r-D

^pyO

'k

R

oQ

<^4^

Lc O'

^ 7 7 7 Avx < ’

v <z~«£r_'— Able 5 ' aJCV»—r-Tp .

^ZT

rvk$£>^£
Q.

,-x^XC-C\;

JjCzlLv^'

^■’■'■e-z^p

___________

Ts^ %.

C2-.1 o

x 4> c b>

^'u-K-O «-7 ^?*x>o_a^ LfcC.x> <5

^si.
p>. '—_^ ^-oJk.ts C_ j piV<x_>C.
’

2^4 Pic^ ,
t^L.

X.CL^Z jl—<j'

hr~a-

£bo

J^O

A^e

t -A

u-£C _1

^20

Lpo

----‘ioe^ I

-' '

I

/o62-

r°’2.

5o

■2bs

Z"(

/5r

^7c

/yjis

23

7S-2.O

J2-?>

^-£ t.—I'

I

'1’AO-»,p^ir
Ger^-r-»

12-7^

1^

/Zf ie

2'

OifC

%r

l^7c

4?

^22^

£

2_-CX>

S>7r:-o

'Tsv^

r r!x^

6

6sT

6
v7

^-D

V (M . A S>r^-<-'

^71 •<>

i7x rx^oA7_ I'^O

36-^
L—

C C

y2«*Ja-k<C^’fc'

3( ^>

62

X.j.

7^ u-

?1>O

^'-jc

^5-

>734

7?

7d2£

/m

4

VlD°

/O.lyfQ

cA Plo^ .

'

(il\ C\A3t—v<|

Pta-

HexaaK

p-<-cyZ

-tfcF A-f -f P P

-^UxfcC.tvOx „

ct

CA^> 3^, , p

(>£1 -

>Z. 3>'^>Pl

c-Jj. 'tO

j-LgejU1'-- -C-gj-A-l^Qr

_a ■^J2xaJl-[L -^-pea^A^

h
C <SJ^ex^ e^^'rx .

<MXp

-kc-y^

^u-oct o. cOtaj J^y’ * /

'’ Of” C^Aja. La-CC C4

g»-og^.

M.g U "

2-

<a-&->yvC-Jg>- v-$ «-*-

Tvvc-a-o r>

c-M^xic-c^

•—-£-

3EuS£
^2-*A_iLi_0x,.

c-Qa

c.

sk . r B^aW O^TZT4.j£tZxX»-^TC.P
3 *A ^r <X’

03c>^_lA

&J S

^-A-Q- 0^V~Wx^-,_Q<.s P-^.<? Q j

I~Cv(Xcl

A'2-

O

K fao -

S^PV .

3^2. G-V t-^-e^ t

CX

<aJb»V~

.

PI

^.97 C-<J^-^X ^>Qu~z^

■n?

SlAffip
,£\ 5» t x j.

0\3r Ca

9

<)

PL<£lcx

KcrV^

\

- £xm

VSte^gA’^M-^U^

v-^

<1 v>-< I

(%>J—<sV ^L* Og»nn<-Yvo>O^Jon.-rv<i- ^c.l

t'

^-^y-A-0-0 z

/os'- 3

<pWs

___

i

7b-o

^•(

4/ (■.

£i i=

3(- 'O

Vo-s'
jSZ -3.

K-O-Cl.»—5 £-»->-*—ft—

6- o

/I -

0*7

3 . s

^7-_0

l^c -o

J2 2-5> -• O

^K-v*/ -^-C-O-f »—-fS^®3«__

p?
/^W

i ’

I
Mr]

££3^3^

Hri

<■

;

j^x-eo ■< g^-a-v- ^/><3cc a_

-

o

mA .

-2^ Pl

— 7^,
IP .

2.2*^0 c

'. ra=

l3pp
2,

<

^4- 6-2_ t^Zodp ,

^Llr- 4r/. 4:

XSills

foCSr> f^3C^ I ( 'Z- C-tr <Xj? V

6> Coo (Pj'
I J

c.

^-7

Xeo

’-I___ L_5±^^aJ__

t qJU z
x.ra.___ o-3 ^>^5j

de aC ! ~

rA, AJKSV-T’

L

<_^)<U.C Z

<-^<2., LcurJ^*-*^>
JK-x :,
<5*^3 <■'"

2_3_^ >i

=^1

-^-G_oh^t-,

g.A,V~- C-Q

C

_0l ca

C < O-i U. J?

S-Q

u,

lU^r <Is - lSkf-6/
^k1—(CL

P<2. *-*—<-■•

L-v/a

(dteLc’^t-

3?-*T

1

' t(

30

Uc e-ci .t

tlA AO^

'bl >1

H4’7

S7-7G

Si ■ V

iip-3

121-1

^43

<T'2 Ca—

^y' p" S.

c

G. L±Lx ■•-> c^

'OC«_G^<_oC

GvvCx-vc

—SLA

P

'

lx-

^ry-p^' .

r

t> ■ Spx-ltA

G.

^y<-o£>&2x-)

<5i xH«»-4.

--------- —

----------------------------- ^z.

_>o C>J Q

*

l^cksZ- ,

>P>lJ py

fVO—;

.(fe

i

I 3>^

3?o

f?^p 'cferL>^«-e<^

/o7

}3i

if.

__Qg_

/G'/

Ay-A_

- ixG<a ______

‘7'g OX^XcA

71?}

' I <sn'

I

Ut^Ak

^■Cfe" pCSCA-Lx-x-^.

J^_
/I o

/n

1-bO

^2°
'

_____

Z~4/^

/An
If 2UQ

3

q- Vw> QsUG

cO-jv

/o

G

|cS7 I

/ 2-&"

( gs

? (Y-? I

J

(1 pr<A^^'

0

V

v ^p^s. A / '-' O '

-^^.v.'-kjC

G t5

.-| ic-\xfi

^f,

rZ-f ^O.

Qc C-Q .^-1

rf<pft<as»*o

CjO-^C

kA-<(A c~x

‘H’

Guxjs^-A' 1/<clc G

tad

<L-*_C

p^uJ 0-

•<L>--C'<r $ •—

OOrv^

' t>_c2-t tb-xx

CK_><

e^Z' (Lxu^ JLQ-0

>ou. ^
| >^>rv- .

C2qG',<Ox-^_

1% <L‘A_l

eft? c -tl v.

- oG

G.

Cx-KX?^

Ao^ <2X2.^.
k)

31

£ c U »J2_- rTf-VAVcC^

L-31q. < O^VSL^

c <>

Q

7

/•75s o

O-l-Lf

<fl A

/3

>77-° c ^ ‘°-

k_£^

A^cr'

f^9!

Hg-foa

°

c x

k

__ / ({,.0
i^-.Ql>_

J

’

£ ^VLS ! k^-O^p \

P

Pnuk J^uJ^p

t^CVteiXsg

^U-i-

-00- -jdv<'.'.Cx,—-- ^£-

/a^loP’ Gfxzi^A

,£^?-v^v C.

£:cu

ZXLAAzl^^od

~ _ txn ip£ aJmAax^ ( Aa
' GXX^^^'4u^
jUu ^7 At^l4U4A jXl.Q> « -EP t KjL>dUg

-«^'/0-

I'C-C S^UPk—

v

■"

c.

-^-

ri

Jlwr^uj:

CXJ

'

r,n
^Q—

.Y^CZx ^2^^

C^A-CtX^.'Tzi _ .A—>

<0^.

C-<QAA ■■ y,

Pho 5» <^11. y^ACt-XS-v^, ^ 'O'^-x rr’tJ-l'k

^u-l'e^v .

<gcKa^^>

C

)

c aoJ—

_s.^
6 Pa tv^zA

. lb e .vt^CT A-0c<>..o^y

s

1^

si'As-

C $u£ <u .4
L-d;

■V
_*—|X2e

c'au: ^-<12. ^

t ''

A "Cd p>^3’’ J -v

U-J3 l'

Xok C’O

c C^. I^b L .^A. pX2A_^X, d c/- £ C_L A-A C_fi^_

fisS^GJ^

eo-x

,^ur-

-^2<-^CJ>_

iZxi Ls^_ fr

p l\ V

y>A} r> 3<±qAA t

: <Le 0-Cxj5

■

h>) /~G>^i^O U-

ft—£Y

O '

; a_db< i' __ __ __________________________

-Sc ^(.P-Jr^C-yL^

c\

aULc£
tU

(r£^J*

3r|

c

So^—t Lx

cp^-c.o

C J)

Qx o .0

^oM vL^_ >»

^0

Ap|ej-xj? 0 I

t

Xx^-^g, V , C -bboC1 __ '

. )2s^

T'kd^

A

j___ -,~--- ------ S--- ;---- =--- =

,a
de..J ka_J^_ L
IqZZLulj^
3^^.’
'G^

^(y, S^oW

.0;

t

.<2<' ’oPA'i.

'ft^X ^>.c Pk C\ ^2^

ko-^-cA dL^-°

y v-e X

- Av Jt

^Al' 4

Tj^CZr? V

^t(o,i y £<L<t Uv.c

/y\

»^-ci-vvjy'c

<u.

e

Q - A10

-^~ 4^ C

'

1

/->—

V^ ftT

lu .l «—^jp £-<-e *-*

.

V^//^A-

_t^A

C2. <2X2..*^ Cj^jC’-tX

A-^v/f CT. Lo^tc-

at-<-q^2~_

a^g>^XA^g-_6

c2^a?<5>->-\-C^

(00/
JQ ^-»rxdL^^^-Z -Kftxj^zJ £? »-Q. cj. , ^S>> df r tVA^Q Q 1 M-A-C -1 ^yVZ’g! ^00/

* ^OvJA.

a.\ C-

a> ..C t"C ".-^><5a_i_a1c O--^>

^sl ^c is

b Pho'c

■

-9A
^-©Apr

(

p-

a c_Qk2 <^T-fe» <jq--2>7o^ i
cv
11.-’ ' e^t. A c?QS
L-sG-A-G
ULU34J

- 6MvJ’ >gH^ g,

T.ftLg?-^

^2 -^'■'^ |

<aa8-^j2-9>^^ ~T I

r%^<g^ p-o

I'^iLl z^UU

UL<c--C

‘4

ftvJU_Q^

_^fX

ut. pr. r.

o

a^or/ U-Afte u.-^J- (o
1 %__S_

<_

JjT

XT

rU^

ftuJvu.

-^xSsaci

XT.!^ rvx_^)d

4<7^ >k_<?

■<^-

Lc:

ijo

L ^D^-ca -r>
XT
. _N
A-’ ^27

^Qo Li-1

e o-^JL e

• ^£3:^£±-^--^-

ZLl^ .^ i.

el -

- Brc- u arc

io m <Co_^
/9^t v 9.^0< fH(.
pb X
e><^

z^-*"

(7

2T

' ;S(

'Tl^J

2a G ^j^-

k.C\

--'■ Jl<? -UJl. pos cJ

Q-^o

Mo^A

JC*Z> rvn.n vp<?^.,-_i.

GG^-O '

r~~^^

c ^4 (■-~

g

oi kc2_
^Xo

t

3

rv^%-<c_

"aQ

. » Jep

o-cAckj^.

<-Tl kc <^T .

LyD «/ ^J|

” t; '

.

y-

c

/ AQ7

*
K»--ad!l, c^l[. L7'(^ Le_ c> ihp-4.. J- ^B—£L
k'? c* <

Xac^^.'^-A

k*-^ yxiLf *■
J?* *—L K

£x

■ ft^-.______
! ^s.^LQ<Lj^_p

jl

b =ap>tx ^;.s

CI)

& tu a c^ZLl .

• (2g>-Kze

"..' l^-vq__y Qm>., _r<\? j—^^H

jV-23

T 3c3r^o

3Gr' £2 p

cAq-^T*

A^^3six^

^'-‘__ f^~C
1

6C*^O. '• I

3>

P^

.J /k2u^

kx^ c<^—

’ / J

0

(J

f

o

L

1

I

J

*5

J

FITffll

J
I1

L
tJ
”%

Q)

1 [
£' / >-<^1 <A
<^2

q

o'

'I HT R ' 1 d;i3 ■ ?
3 aSi r^i

L L T|sd

I Til
11
i
■ I xJ -

\k 1

21

w

£1

i di i
5r,1 1 ?

aI 4, ji Ri

FL 1

1^
■

wff

O

ol

>L dJ

1.

11
4 - ■

4
\
a
FO1

• c1

ci

ld

1 ri 1 4 13 3 2

-D

'1->

115 •■

111

i i

(1

J

i

JL i

I

-9

r

i

1
.
I

y1
Fl 4

••I

1

i

i4

J

T

Jp J
I A. J7

f

3 U’

ft

1^

v

■

*1

1ST

ffli

JLAg
1 TX1 flhtl3J'■

i ■S

R1
114
1
1 "l Tfl dH
> I
'r

^1
^1

Ti Sil
l
si
IF
! 1 i1 1
?Ip
\l
j
II
I
H I H fd
rf A? 1 ) 1if A 1
I 'A tl
11 3l J
' fl 11H _ p
JMi

I (h
<x

JI

q

LT

I
jI G i
fi L j

' 1 1

j»
c

i

i!-"
11

I

2

.*

j.

51 fl
A 4

FA

-<

i

J W

0
L

V fl ; G <2Ti> J i

V

d'

j| d

rx

I

Q

1 4 fl H

sj

X

QI «3l J

’ i

r oH ru

Qi

a
’ _ <4

1 zl
r V

•

J

<)

t

'1 J

O'

/

u

VJ >

1

A,

4

1HJ ft
p
1wi

2?

•=1

J c_

p Gn -JL?

0=^

yL^— £--GsL1 -AjJlJ>

^>V-^4^LV~-C —-~-l'

•'^Ls5'

^ZZ

c?_^O-<vc^b>-^£_- 0gk>ft
4

jLa-^ e—

p^ A=- * L- ojL?evict-

<-*^ <i

' (L<13 A<~)

eCjlLnP

c , ^r- £- f a_Jj

>£_T

_ ^r>k C.o_k t-a e3
' -. I

<gL-*-,O.. l\_zvX>-A-

4<Z, >. v.<|" '.

-^e, *<

•^-t

La.

pjuRsK-Ls. ex-u<_ t-^a&x^L-S— .

,.

^v>

"r^T

ZL

^F' -Z/^rx c<Lc!*-

1^' 2^
p)\Xpc^

G-vt <rs-J_«2

<3^ ^J

'H'

jlt-Eb

t

-s

1^ '-^ L
Qeo

iIiAA /Lo-c

/L^C

k^xa^

pe*'' dc^odoZ
o<±c. Ap <fe
6?42>*_Xm2-

-—

CO-Aiiza Lt

(X^-vJU- ^G_o

-■< cf

X<^cP

p

<-<-L<s_,L<i v\

L v

t

1 st'?6

s

— rtz

PI

rsx^ s n F^f^\(

c.i-x^

f

lb-c<^ ^VJ_Ss_jL_

»^IZ^ <k p(, .Z p ; A z^^STZo - <

<’Lv JUsaZ-^ rVo^

C_\ ex

eju" - c_2- G->^ofo Jj

»—
^-S.-—j£\A->our>Q>- J^-is <O

oLty

I

1/» 5r Co.

\

C^.

—

r<3^

4-

(r

- f

^t-t-—jryvJc^^ -*

f

Ae

Kj>£ii

O.«

y

Mudtacs

jptA-L^e^

P^‘

(

V> 1 G v<

o pJlt.

V—

-- - ■-

_ ~L1 €j)<

^oC

‘;P^-C Li^L? '-V
L-^-A-OAU i

L"J oX^-X-^ofl

_ 0-g>L»

1<>xoJ L^qUL?.^ lAl^a^S,-

r G.

y pu-xzA^L^ ,

■ A £ r<-^

£

^;

ft.

^wsbf
a/Tilib

'TniRb

Wl%

trftM

~-

jkok^JL. ^~zvx-V^

-KiOvk^. a ^-■’432. >14, K

^dSc*
- • t
e Lox

v\ ■-> l ->

.^C^XA

nJ

n3caA_^c^

"rNi

(^f

-{•^OJlaIo-O

NJaw-dLo-

•\/
/1k
' ^-Ka-sLujo- N c-Ujq-aa

,

vvvnk

\j ? sA

S^ c

(S^xr-

, Pl^/jajiN &■

^vs- Vct-2.

t-XX-A U?- t

<•

j

^koA-lb.
ICke^Lx t(

P

z

».. .{fr

^SpGy

-

Cc~V TAi 'J-ccAa

Ha XoJltj. u^fb’LS>, ’ '.. .

5°.C_

p/ £> ft/ PLx
P^OG^SS.

°^u'

p-^r f

dd r e e^Ljz'. ro-k_\j? d SXaJX-^
Shall .
al’ (aS
'Xzkp''’ C\jXIa-M'_D.
c^ia^p/^^O
o n
•l> fcr !kaj

« (Uao W Oi^XVa-C^C

.

r

—

.

C\>-Er-/l&L'u

, p<

Q,e i>-ji.

52<.i-L-JL

j
S.V\>L1J_»

cjTa—v<

r

AJoK

'^n
I

Si

/xji^C
N«<\/'

■/'-A-’-oa

K

^okc n

-+— JlJ\>_^, c C L<o I

h

P'VJV-S U-t Vo-Jbv-*-C

.

Gv^Aw^.0
orw^-i\^Xo v^rj,
m/I,

-

-‘ ’ ■

V-<_^J.

ar r ,

PiJ^

4 <k)^K-

ko?

■TC-S-^ ,§Xko

V-

^pV 6q

7

«-u

—

>^jQoxA>d^

rvvW\l. 'v-vA > Ua

<x3 A””! V—C.

Plsz.*^ ,jOd-i- Jax_ka

^CJ^oX^kt__ __

O-T^q^J) jOjU-x^Qo

k-O
L-c>^

-^e^-^CQ.^

.

^°^t~-4.ir ke cXl*

1>^\
j><Q cQ7\<l al >u^2<j_Q^X

7

fs <./ p
(uLJ.

/^>

z

> -K

,

Jk

f<~e-^O_Ck,

aGx-^ <P

)t^XXX-A^>L v-d 1 C

\ C-K-C AA c.

p

reox^ci
G
' _ _ U/IL

tr^O-’

E>.~~
7^ Xi

"hr

Rc3_v<_r
■ y ■ ■

<s So f

Ck P-Q-*v£ kcx

Fcxx^pkexo-.

It

o O'

f ■X.^pL'

VO

te

f

\/^

j£^
S /c3 JlL<O-q~a^

C£>^_a_----- 1

Pf Ci-XA .

■■ ^tv’-cJlvC P

^>P«= C' <d

'^~*

LX
^k_o
oO^
OQ^

t?-O >—ls^/>

>^C^auQ_xa_1>--L ^4

"•Tl.

.. M
Sero.p
L>.rjCo^,, o^A
e^-Scxx^

PCo^.
&

0

,

I/ 7 G

H?k

P->

/

NVO bb

Ci'-S—
—
* Kf ^<J

/y(^

c

5^?!
3"aP)

£>

aX

p>^SLp’

^xo C-A5 <^~siz^vo xzd- 0 G-C,—«3£3 -^cls-a v-—

C-Q>^~V\

Ca3

.S^V^xc

Q

V~ ■&

» G cvJL <S. I,

,

2e tr^o^s-* £’c£' _a5^ V^v C~ '■

V^X-X K_ ^-0

(P

1/ S2IM1

e-Lx^Gx'^

o<^ OJaX^A^ rX-y?
pa--- 1'

fahjc

. ; ,:r ./u
t- ’ . ■ •.-•*;,.. ■'.

7%_ SGX^U
bM^ i-c^- -£-&

.

e-^.M-E^XAcJ^O^

<—° C_q_>->3Ax.a

G>^-^cAa&.<

I US r^XlC •

AT 2>£*Pb

. .3kj£S->>> KJ> /SvpoO’

cUkt'-' I 2c r^ttl .

/e TB ^o^v-v1’'"'
7

713> C Imu t-A

KJ' <>

CC^-yS <5—^- .

u C CU>-

I

f(-^- XAr\cJt /eJT~

<2^JL<_!L<yKjL.

^.Jksxj-v <xauj_q^

-Si>._X

Go-fi.J-o_. I e? S.^'d k»^zAfl.o»> &C Cr
CoUL-UL.

— yy

>bO
({^O >-~-

|V

^2^0^ ntf,

Qq. nJ-KJei

■(

- Asfc tr' 2Z-->fST>A2> -Uv- I

72 k 0^-0

|T<^ J

t>C_. _XJ__f'e ctTTj

O-y

Islc^-S fko_ 'Xo o^q. , x 4Le> wC <k .VmkJ

D

J

jJtit-J

1
^PuJ tB m. ICS c<

r^ f

S r-AV5=^
>~vsn/ H^-JUJuS -4<_q

u’ H

.4. u-.;

’v.'-}.

■B^QTi

GiA^' - (S;t Um-’ '<_

f?s7
3

VCL

A

tr

,. Kio

a^o'KjZUT *-- ’

-*<- -<' trv\S. v»_uCJ.

H

.Oy-Cl-S,

oFhSjT- i (Xr /"v»<t|,^Lt.

C *Ot- *-£>

^.2x0

grc- a

•A

.3*-1—'

.Q-S^

<—02) Lq_.

2tl La "T sj‘'C>—
-wuy

jL^ " “

(A-<x(S Jlc^ U-A-l «£-z cjst u> c Vx>7 7

O

—

b-=^^ /IcT ' &
5o.c.«>

A3 |\ (r 3 sisa

4

k*-* c^sArt^ L\a->—-y—fGC fSykQ
-^Aslo Db^—^<-4^

^/Vu, a^s..

(

(

Q L=<»4s
1U

c ? .*—

*7 o^G'- CctJ °

PUjsicc^ JS-ytk p^S^OOK^U jfez' 3'^£^ Pj

q1c\—i

I'cx-XxA. tk Vl

^-‘OJ> •' o t

P-'^5 mT->-J.

/7sx>^s'/
7^0

c’ <~x

-*-t) hxto^

5'r-^J'T'ry/^ a tso^o OuO

/St ’*"*

4v^O bt

jcjl^Vc

66

'to-'br

<r^_k|O ,
/O,0^3'0

* <x5. 3t‘_KjZLci>>O

/ ss^^oo

1(2/ 0^^

^be_^S

P^lO's

3o

i^c^ero

7 2s"

’Z&trD

Q2.

^7

2Q 0f/(5o

7^-“

C'55*O

£:k

70

As', e^.

t»^_y----- S_>iA

A>-J A '1 f

PV 's .

^21

/ gs“2>O

2? c-oo

/S.TSo

/7( y&o

SS“oq

S\xi
A-O.

^S.siya

Q? G-So

'PS
f^CCr te.o-----<

I ±

"T

(bn

^7

T/2 esL^O e-f

it o

^0

■Zxe

V>o.

3»

/©

2-2-Ot=<r>

26, S2k>

1

c(

be_^> V

ty, ea^-^
fo ill

Pw<j S

f A^0

Cl) ESC^y/K^P &• 'Y- BUu pGAJx’kt/A-o|

G (boj
(GyxDiL^ SX
1^-’ y">vjc^^ gjuzgC.

' <0-* IkvAr'*.

exIp

i

B.

x-^r

CMGOi.

r

p

XrG

(

Ngo

t j<_c>.

. c o- fre. pxj ^ac Q ‘S-lto
■A-okkp Pkl.Q

CZ

a-y D^-. , / <3 g! X£fl-

c

VT^

^1

tx|| . pAuOgS

e

<5^0-0 . "Ttelur glS, ejxLs

[ ut^e- pA-oXi-^

c-^-E. e_cu<J

^q.^hx

&

!

G>-e_£»Ve3 7i ‘'Ure> gcvUJz <^xp-S>, JjLK^»k_p

£—P> .

»v*-£iJi <=uX-Ca. t

-juu.tOtxjG-k.l'* ** -*_i-3<ej<uj_X1''

A^Q_k»jej>xOi

&r><\p

£. -f.

iU 0

c-.

£oi <^>\c

xs^^LGel) 9 1

ie©»vne_

CjOxjJlz) qJU.O

z

aa?oI

, f3J t^/

-k-»-x.&Y o-l». "Ago^a-• ■

Li

o-

-

+^r

lx> c

Xa-XZc/

t

pcjo-f

Sk

£

uy_^c__

6-

XKT

°TEkt—‘' ’

X-

/Lg'G’

CLtj^ bxe q

-%.

ALgg^I

^.QJkxkGXL

DE

<P-GZua>.ii

K<?

^30^x2 Vi. Ik.

)

ppo-A.r
•I

v-v Sgu^gJ S-- GaaXo-azk

<2 ooIaju

Gag—s <6Lflxj2.G.|

eJkxk- <3 cJLj-cb^

p'

|
P.

J_ji_ t>- ^Z_p.

c

( i^olL^) Ox , S

T

8.^

C

Mo^x’c
X^cx*^ ^pev^ty

yikV^G Lova' C^

oPb's

~

• C^>G»Jp «-*-.£-suo^

0\ ^»2

r^P/ -

2.3> C >r f

2»' pi^

He CAT

-s
p

7b

L?'-

—I cG^y

•S -

CfJ A

»xaJ^-^_axl .. ^'~'C,kpZ 7"

LscX

^9 . iT&C

,x

J

P O^a_C)C^

-/-• z

So'TLo^'

3-^ PI

p>' i f

-V-

f sc 'S

Pr O '£

t !--n

gJ

Jx<A.Ge-r

vk

y7>V'V j~> XQ < -G.C<X? «dk'

^C* o D tt_

f

Q/esc

£

, G Ck-JSSGx<

m-

1GG LqaoJL.CLG’')

^A1

<^G ggI gLu! q „ £) XJUI—

u V)

<A-$ >£ y><C!<JlA.CjL

P(j-^Ld^JLq a

<A <Le_x. .GXA C \_c u-G >*_Lu

rvwiA. »

\S.>«O -<

J'LcLojnK

c

- s—(<2.J

d dv\

cIom3'

PM\J i C2^_<21

lajd >-■.,

• l-1'Q.j'i-<&-

7o -r

Jl3o

t ' •^ / CajxoJJ

V

PJ

C5XA.tr (a-^z ,

I) *
^<0 x^.^. C'^

B va QaJd

)7G' - 71

15^^ <6
/W' bi
"^V^-pEG- c) 02-Cu_£
vl

Aa_xXgA

37-7
41-7

27. lf

ko-7

2/. 6

' t^’s

iaJv>~

M-C^1 JZ-Q.AAG-

£L

o

J?D- O

/75- O

f

IlfL-n
n7- 7

----- <

-T

<2-A-Q.O_^

'"•

♦ M (Z

^og | k £cj ix

Vx_^Ta_ Ia^L<£s-_4J J

Li

3/«66
37-76

'37 if?

4/-^
<^> Vx^JEt

^ZaIxj-Xgg^ is©-!"” CK-a—o..^ 4-

d—^CkaGvJ'’

^-JLqxJ

&j<c

patjX.QV'L Cl
%
■2,^ ?|

f OCxa. L

<

OLMy-i xXS T— 41

G"

$y-\. L^e_ o- Lt v-

CusJ)b Sp

>

■pl, Ccnr-r-> . toe- C| \ u-Kr mJLu

|ec

• l>_A_*-a.c1u*A.c_KXjVx -v p> liVAjA <LA~a—J
Pu^ri/

Lvr- o-a^Xc '

c c-E <L

1 6c

$

—C7~” c <.•

•

f. c

*• <>-u

t,KjoV ,| i-

f

^oJu

pCoETj 1-

'Sts.-'

. (7 /3-,
4 i

.,__ J?4

V.

^/ • u
;.A

c£3Xj>

~

r P

MHt

._r

S-O^-vC. C.’/'p'uJ ' o

Co

■»

^>e^X<JvA. VxXl

.-'Je’vM'’-x'i'

---- ^£>.

, oeJ^A

& c t_€?•

ct-jl

c^^-v3a/>t«L

\j

^1

2 OS" 6 tr Lt

cJ /74X/J o-^C^o

-^j, ©Ci'
(T*

o-Q>r 7 77 C-i^

c^~-

■—.

♦ X-cx^ tc

Vt-G -A-O L*-' o- ?r fkc cx> —Jx_£

z^e-x-v^p y. /k-oT-^ ^(Tolc t. <y

eA-xcJGT

‘

♦a--S.^ gs.v.^~t&-»y-

■’F/

t

pX-xg-x-Mx^JL-AX ’. /^^Mac ^uuiOJC

c-x,

J—

3^ f'.

■- LC_ X,

C vyyQ.Ut , 3- (4 [rf,

-p<^aL^t-GZXy .

__^U 7:^- <cCca.GA'' <,. U .
2 ——-C..QQ
_ ('<.
4_Q0

^OuxX^si,

(7

4
.‘i-<.’‘

4

o-jvc

<r.G^ x (72a

ckj-c^o j -

Zjtc^ , ^QjLecs^Jl- O-A

(2^ €ou^_xj)
-

’

2v^|

1^ P/

3^ ^i

7t.c

/C5T. 3

pMo’^ AjO^sA °» ^?U.'k.p’S

//? -o
5S. c

3b-C

(^oykLccJ

23>i

bh'C

bl - 7
7o«6-

214
04

3b-c

t-X &ev

^/skAO '

-

(lr u^'5 L-—h c^j

cevw

t

LkT 4

‘JZctep S’^s

e2>.

axJ,

7

2^ > 'A
o. 7

CP.
V^T'cEAA_K_t

COPv Ci-4

J~

(2 LvCj —-ptz(A'

APcx^^cl

^1'0

ntc 7<c^^

^A\_k-»kc

—

..CLa CJ

21b CfcX-.

L<V-*-rv4_

4

^,1-A.r —tLo(k C-ACg^al1 ,

I cUxp

J1

7

0

Io- <jvO.

&S,'c P-M feVf-Xc'
Sv^-CM—Ot ' JH-C—^’-J'epv,
Z&ttt J-c-vAl
,T'M bUck^
bCtirllL^. e- p’^sp
Z^C rnrfl >
PI, - 7S -LKik

l)<r <ev-G^
j^.o cX xt-ip

-J- y
’g.jlLoy^ s ■3>'7.^
y-g^sp.,

bb Lf

^c-t«M<D k.

d\

tkjGj-xi “(x
(/i

X<>JV

iau
JLqaa.
l-VjJLcixx

0-2- ■£’
'^2-2- '£’

z^cJLa-o-ux^.
C^c ItcLXz-xc.J

E^jz_xx2tt pn-^^LZk
D^b-kX LA
tt-ij

«->—4

t

laJ-V ~r»7t

e

—

//2_ e_e,- .

.A-U—^j Q_C t^oZ^o d U
^Lyr-x Gtx-K--.

cxk*

CT -

X^-X

uxzp^

iaPC-Eoo-

Pl
£\

(U^jU /37$-

e

zifb2. £to<J)sCc^^rc

ixSo-tov
U<JC> to V- s^-y-Op-^ **

-Sc
kovJ- Oat-Scft-Ob-vo^.

.^CxxT (^Q.c
i<OxJ^0.
v

a.' , -L^Cu—-A CJL^

•f

1 SH ’£

^:oc

/* £

7<>V\

3'C

3^1

<_i.

^>y^U?^-^r-O<e

7

u- z

ii<e >r

IC tpl-

'A?4<3’

zr

if- o
6'0

'-^c, f ' ~

i c OpQ-^^jA
—y^ o

M Mv

^^L-vr^Lx.
'ClcoUK .

C

•-

’

^aD_O_LI{a •+-

J),-VJO»A

/-xp ,

«w

J ex-S^^jiA^

4aU

, ^|0>er_K
4- MU'i

rxjo-A-Sli £ }

JoJl^

p^O

bo

VQ

7 ->u

/>v_X?7YC52‘'o

/^6o - I ]
‘"^Xa_s.I''iI<

>

B

C1(xka-a.

5 "^XXJ

3X£aZ)

l<o^

2S^o

(/2jO

H\)

yL

7s"
3co

7^0^

Sv

SSTD

2.2. ■i’C

^iSTO.

3S

^SgD

S>v

2fS<^

1^

1450

ocxO^r

, <q_L'-

^ LeUn^zx: ^\ o^tictkc^

oAt ZZt'^cD

Ff

€>lX_xC S-g.

aJ^e>k-*-Gi ^-*>'S - /

1^0
TJ

j-v \J<xaa_^_j:

Ql ►ucl

&-C*. la t_r-<3^

a'1

.j A

--A^£-cA kjuA_Lt (J

^xiA-’-J''

|a«L

ZiS-SD

>AA. V—«S<j . O^Ll

c^r~ Pu (Le

ko

3750

n

Fp

gjjx

P(r c^cKac v’-

<?> JTyiQ-lM. <r -A

^U^r

oP

62.&0

376"

'TVCT

1 r-a.v.

Q^3o

grre>o

bSD

/o
c

C^lJQm-a *--

^-Xa.

-=^x'vjl£'\ i~

If £>€H<i>

3o

J^LcaA. iz-AC CaX,LX

- 66.

^T^wtzU^e.

‘zZs^
Ar-J t~t | fAAAri laj-a^^

1

2 CS- n/xc *. -k xJ.

( lr Os Af.'LGL G.7T~ -[C7\Z ^A^okJZ^

/CZcx

‘xn^Qj
O

^XA^z,

w~

i-a^a

(LX j^etA' <4- £XC
^W. aK2> / <_ L.

i'-'—feAw-x

A_Ja_>_x_o'X^/">->—^-.

sr/li

,

Cx^xXX

X

hj2o^

cOxa

Uq_,

<^X“

X£j)

45^,------ g.

K~<9—CP

-XXO-aO I1

.___
Ao. A P ©kr-

'Aa'

-X^K

.

V

A i>-c>-a4 c.» <^r>

.VcxJ3-

xSZx"y>—■>

C5j

c

r,t
e

r.O^Q-G’)

<> p v jX-X^L .^| .

M-

'^r^xn

cXKxa-2 q

4

<■
■

<=

I

fl

fc>^e.TH

f^^e. Ve’H-jS.

JL\^-4y<-'

Z-f" ~

(Arr^t t!_.
•L. I’K-AXSOU-/ vy

fUA

Fl/^/xJ^

* cs-*.'* ' -£.<o c krJ

f^T~ z<a-o-tx-^c.
ua.

P>C>4Llk. i_^

<X_ lr-J

e^-^j^e-Xv vk/j

' V-

CA_OcXj-Xx

q|

t-t-

I p6> C2_

^e>cs_A_L$-v

lx

Pz^AaJaJiisj^- C^r-i/Hi^i <iAJ
^^-c’c koZLiJi.

^^CC J

4*^

C.
qj^-cAa *U_aa3

-C

c

feeCQAA-ui..

^C3^o(L ^i-o) . A<i

l-AU-A.

--^k-Q--2 ^-k-A-clCL 0.0^*

l'~' e-L'^D^n vc^

L' p ^T*

U'

-4

j>j

O
A^-S.poucA oC^j,

I

o rJ

Aa^c. .
aj^Vgj^'j-asl.,

1

.

OJLj
p—

'I
' 1a

c*L(

JUjLcO

CAjy^Xj

’V o*_z

C|

Z(»-x_p

Gz_^

<2C V%-vkC I

1>~AC.

i
C —

«^_J. Q

ck.£ Ccy^

tSVkV

o<-*-/s-z^Lxp<p

VI t/* ■

U^KQ

t(j

CK "^1
=i

«<q/ ^,aj-& (a..<U

l^vcx
/)

e^tfLJ *”.

£_

c^JUp 0 U-V^ |^AaJ\ LvJ2g(7
1 >U^C-eJ^A esL^Cv1/

{^-<_—j__V f^p ct__,

^pc. tv Q

K£u—s x_

v_<c kzJ

r Sh^A • Q
V
v.

CZLp

A-b—

_>aJ2.c c_5l S-vJ? --k vaS'so v-,—'-<q|
■%

i

•o

2J>g>^^XxZ-^A U-Q-Sl-t;

fill

.-^scJ^ S*—-

" *^2. c^-a^va

e c2JST_^e^3^J

■ (

.A$r^' K

Yv
■

• . 1 i .» «i~*

'• •'I.t

f..
‘

’ r|

J

r

^2/77

CHAPTER18

HEALTH AND FAMILY WELFARE
Health (MCH) infrasructure in a phased man­
ner
eg^nihgwith
mg
ner, bbeginning
with the 90 poorly perform
performing
districts. Specific efforts are lalso
’:: being made
t0 promote Indian Systems of Medicine especi ally in view of" the fact that* these* are *tradi
” ­
tionally well accepted by the population,
personnel belonging to these systems are
---------available ----in the
remote and rural areas and
providc treatment at affordable cost. Involvement of voluntary organisations and improved
Information Education and Communication
activities are supported so that there is
adequate community participation and improved utilisation of the available health facili-

HeaKh
18.1 Realizing that achievement of the goal
Health for All by 2000 AD which was laid
down in the National Health Policy(1983) is
unlikely to be achieved within the time speci­
fied. The Eighth Plan consciously and consis•>
tently focused the attention on promoting the
. ,
. ( health care to the under-privileged segments of
ye7iu>s^t"J^u!iwrable population through consolidation
and operationalising the Primary Health Care
infrastructure and strengthening referral systenFtErough District Health Care models,
Thrust areas include :

a)

b)

c)

Major
Major investment
investment in
in development
development and
and
’**-care
-------in­
strengthening of primary ’health
frastructure aimed at improving the qual­
ity and out reach of services.
iiuauvii auu
Consolidation
and expansion _______
of the secondary health care infrastructure upto and
including the district level services.
B
Optimization of the functioning of the
tertiary care.

d)

Building up of referral and linkage sy s­
tem so that optimal utilization of avail­
able facilities at each level is possible.

e)

Control of communicable diseases which
continue to dominate nuuor public health
concerns in the country .

0

fcW L/*

Improving the utilization of Indian Sys­
tems of Medicine and Homoeopathy
(ISM&H).

h)

Creation of well trained skilled medical
and paramedical manpower, adequate in
quantity and appropriate in quality, to
take care of the health needs of the popu­
lation.

—

t’es‘
Comprehensive Review of Public Health
System

Review of Annual Plan 1994-95
18.3 The major problems facing the Public
Health System in the country is need to ensure
the outreach of appropriate services at atioraable cost and at the same time maintain quality
of services. UndcrJhe.direction Qf4he-Prime
Minister an Expert Group has been constituted
under the Chairmanship of Member (Health)
to comprehensively review existing Public
Health System in India and suggest measures
for improving it. The Committee has the man­
date to comprehensively review:

Tackling the emerging problem of noncommunicable diseases.

S)

V*

18.2 Specific efforts have been made to en­
sure that the ongoing economic restructuring
doesn’t lead to any adverse effect on provision
of essential care to meet the health needs of the
most needy segments of the population. Some
of the major efforts in this direction include
reallocation of funds under the Social Safety Net
IScheme to improve Maternal and Child

a)

Public Health System in general and the
quality of epidemic surveillance and con­
trol strategies in particular;

b)

The effectiveness of existing health
schemes, institutional arrangements and
the role the State and local authorities
play in improving public health system;

c)

Status of Primary Health Care infrastruc­
ture (Sub-Centre, Primary Health Centres
and Community Health Centres) in rural
areas especially their role in providing
intelligence and alerting the system to
respond to the signs of outbreak of dis­
ease and the effectiveness of the District
level administration for timely, immedi­
ate action; and

d)

The existing Health Management Infor­
mation System and its capability to pro­
vide up-to-date intelligence for effective

474

surveillance, prevention and remedial ac­
tion.

Health Centres under the Minimum Needs
Programme of the States and Union Territories
was Rs. 386.2 crore. The target set for 199495, 1995-96 along with cumulative achieve­
ments by the end of the year (31.03.1995) are
given in Table 18.1 below:

The Committee, while giving the report, is also
to recommend short and long term measures
to prevent recurrence of epidemics and gener­
ally improve the standards of hygiene in the
country and inter-alia delineate the financial
arrangements to be adopted for achieving the
goal set out in their recommendations.

18.6
During Working Group discussions
with States/UTs on their draft Annual Plans
1994-95 and 1995-96, no targets for additional
Sub-Centres were given to the States. All the
States and UTs were advised to consolidate
and operationalise their primary health care
infrastructure so that qualitative improvement
in the delivery of primary health services is
achieved and made available at the village
level. As far the establishment of Primary
Health Centres and Community Health Cen­
tres, the States of Arunachal Pradesh, Gujarat,
Himachal Pradesh, Jammu and Kashmir, Kar­
nataka, Manipur, Meghalaya and Mizoram
have been able to achieve their targets both for
Primary Health Centres and Community
Health Centres for 1994-95. Nagaland was
able to only achieve the targets for Community
Health Centres and Rajasthan and West Ben­
gal were able to achieve the targets for Primary
Health Centres only during Annual Plan 199495.

Annual Plan 1995-96

18.4
The Committee had so far held three
meetings. In each of the meetings indepth
review of specially prepared background
document on each of the terms of reference
was undertaken and appropriate recommenda­
tions were made . The Report of the Commit­
tee is expected to be finalised shortly. It is
expected that immediate action on some of the
recommendations will be initiated as a part of
the Annual Plan 1996-97. The Recommenda­
tion of the Committee is expected to form the
base and basis for formulation of Ninth Plan
proposals for the Public Health System in the
country.

Rural Health
Review of Annual Plan 1994-95
18.5 Primary Health Care infrastructure pro­
vides mechanism for sustained and continuous
outreach of all health and family welfare pro­
grammes in the country. Earmarked outlay
under Minimum Needs Programme (MNP)is
provided for consolidation and operationalisa­
tion of Primary Health Care infrastructure. The
total approved outlay for the Annual Plan
1994-95 for the improvement of three-tierjystem of rural health sen ices viz. Sub-Centres,
Primary Health Centres and Community

18.7 There has been substantial shortfall in
the achievement of targets set for Primary
Health Care infrastructure. One of the major
reasons for this is the fact that financial norms
for construction were drawn up decades ago
and the States arc unable to achieve physical
targets within the sum allocated. The financial
nonns for construction, as well as recurring
cost of running the Primary Health Care insti­
tutions need be worked out on the basis of

TABLE 18.1
MNP Targets and Achievements

Programme

No. as Sth
on
Plan
1.4.92

1992-93
1993-94
1994-95
Likely 1995Tar. Actual Tar. Ach.
Tar. Ach. No. as 96
get
Ach.
on 1.4.95 Target

1.Sub­

Centres
131605
2. Primary Health
Centres
20716
3. Community
2189
Health Centres

17030

4066

147

18

43

4450
1269

759
259

335
84

640
164

421
80

131795
780
157

296*
66*

21768
2419

Source : Medical, Public Health and Population Control Working Group
discussion 1995-96, Planning Commission.
★ Progress Report for 1994-95, Deptt. of Programme Implementation.

475

601
206

■!?

t

current costs in order to prevent these short­
falls.

Health Manpower in Primary health care :
Review of Annual Plan 1994-95

Annual Plan 1995-96

18.9 Substantial proportion of the specialist
posts in the community health centres are va­
cant; because of this Community Health Cen­
tres (CHCs) will be unable to fulfil their
function as first referral units (Table 18.2). In
view of the serious implications of this lacunae
in the establishment of referral system, as well
as effective provision of MCH/FP care, there
is an urgent need to rectify this.

18.8 The Rural Health Annual Plan 1995-96
has also been formulated keeping in view the
assessment made by Planning Commission on
quality and quantity of rural health services
during Working Group discussions and the
strategics envisaged in the Eighth Five Year
Plan document. The States have been advised
to consolidate the physical facilities by com­
pletion of buildings of Sub- Centres, Primary
Health Centres and Community Health Cen­
tres and their staff quarters that are already
underway; ensure provision of essential equip­
ments, drugs and dressings as per the approved
standard list; filling up of all the vacant posts
and improve in- service and other training of
staff.

18.10 Though the norms require one male and
one female multi- purpose worker per 3000 to
5000 population, the number of sanctioned
posts of male multi-purpose workers is only
half of that of female multi-purpose workers.
The vacancies in radiographer lab-technicians !
and other para-professional posts have serious
implications in malaria and TB control pro­
grammes.
J

Table 18.2

Health Manpower in Primary health care
Category

No.in
% Vacant
No. in
Position
Position
(As on 31.3.95)
(As on 31.03.92)

652
i. Surgeons
355
ii. Obst &
Gynaecologists
399
iii. Physicians
iv. Paediatricians
274
22013
v. Doctors at
PHCs
vi. Block Extension 5125
Educators
vii. Health Assistant 9726
(Male)
viii. Health Workers 64008
(Male)
ix. Health Assist- 21233
nts (Female)/ LHV
x. Health Workers 121765
(Female)/ANMs)
16287
xi. Pharmacists
xii. Lab Technicians
8875
xiii. Nurse Mid­
12479
wives
xiv. Radiographers
565

%Vacant

29.4
63.1

703
576

45.4
47.5

23.6
45.2
14.3

658
436
28135

42.9
43.7
15.8

7.3

5658

9.9

7.6

15916

13.0

12.0

62629

n.r.

12.0

19045

12.4

7.9

132950

5.4

12.6
12.7
16.9

20172
10715
11653

6.7
19.5
26.7

24.2

1200

19.6

476

Annual Plan 1995-96

lection from fever cases and administration of
presumptive treatment as well as delays in
smear reading and administration of radical
treatment:

18.11 The Annual Plan 1995-96 discussion
focussed on this problem of vacancies in the
vital paraprofessional posts and the States
were requested to initiate appropriate steps to
rectify the above lacunae utilising the 10+2
vocational training courses so that the functioningjpfprimary health care infrastructure is
optimised.

Annual Plan 1995-96

18.15 Government of India appointed a Com­
mittee of Experts to identify the worst affected
malaria areas and to suggest specific remedial
measures. The Committee observed that
though appropriate technology lor control of
malaria is available for different epidemiologi­
cal paradigms of malaria, the organisational
wcakness and operational problems, in the
States had led to periodic epidemics and high
mortality. Based on the recommendations of
the Expert Committee, the Directorate of
NMEP has prepared the revised strategy for
the control of malaria in the country which will
be adopted to the extent possible during 199596.
It is envisaged that the State health
authorities will rc-orient the health organisa­
tion conforming with the revised strategy tak­
ing into consideration the new
epidemiological parameters for accelerating
the programme activities in different malaria
paradigms especially hard-core tribal areas,
epidem ic prone areas, development project ar­
eas and problematic urban agglomerations.
The seven North Eastern States predominantly
having tribal population, hilly terrain and high
incidence of falciparum malaria were pro­
vided with 100 per cent Central assistance for
control of malaria, from 1.12.1994. A pro­
posal to intensify malaria control measures in
Tribal areas in some States is currently under
formulation.

18.12 For the Annual Plan 1995-96 target of
601 PHCs and 206 CHCs have been given to
the States and UTs especially in remote, tribal
and hilly areas.
Areas of concern

,

Poor utilisation of funds allocated under
MNP especially in poorly performing
States.

Substantial shortfall in the achievement of
targets for Primary Health Care infra­
structure.

Financial norms for construction and recur­
ring costs of running Primary Health In­
frastructure do not take into account cost
escalation.
Substantial proportion of specialist posts
in CHCs are vacant.

Number of specialists posts and number
of sanctioned posts of Male Multipurpose
worker is only half of the prescribed
norms.

Control of Communicable Diseases
Vector Borne Diseases

Kala Azar

National Malaria Eradication Programme

18.13 The National Malaria Eradication Pro­
gramme (NMEP) is the oldest of the commu­
nicable disease programme of the country and
was launched by the Government of India in
the year 1958. After the initial success of the
modified Plan of operation the estimated num­
ber of Malaria cases have remained around 2
million during the last few years.

18.16 Kala-azar is a public health problem in
the States of Bihar and West Bengal. Pres­
ently, 30 districts of Bihar covering a popula­
tion of 6.81 Crore (1991 Census) and few
districts of West Bengal are at risk of kalaazar. The strategy for kala-azar control
broadly includes the following three major
activities:

Review of Annual Plan 1994-95

(i)

18.14 Resistance to chloroquine and to a vari­
ety of insecticides used for spraying operation
are increasingly being reported in many States.
The country witnessed focal epidemic during
1994 in Rajasthan, Manipur,Nagaland and 3-4
fold increase in malaria deaths. In several
States there are major shortfallsJn smear col-

interruption of transmission by reducing
vector ( Phlcbotomus) population contact
by undertaking indoor residual insectici­
dal spraying twice annually during the
transmission season;

(ii) early diagnosis and complete treatment of
kala- azar cases; and

477

I

I

I

(iii) health education for community improv­
ing awareness and involvement.

control and thereby ensuring their active coop­
eration.

Review of Annual Plan 1994-95

National Leprosy Eradication Programme

18.17 Following resurgence of Kala-azar, a
separate budget under Kala-azar Scheme was
approved in 1990-91, to intensify control
measures. During 1992-93, a total plan expen­
diture of Rs.20 crore was incurred for kala-azar
control of which Rs. 19 26 crore was provided
to Bihar as assistance in kind and Rs.0.74 crore
for West Bengal. During 1993-94, out of
Rs.20 crore plan allocation, expenditure of
Rs. 17.24 crore was incurred by Bihar and
Rs. 1.40 crore by West Bengal. During 199495, a provision of Rs.20 crore was approved
and the same amount has been kept for Annual
Plan 1995-96.

18.23 India has over half of the known lep­
rosy cases in the world. With the availability
of multi drug therapy in the 100% CSS Na­
tional Leprosy Eradication Programme
(NLEP), there has been considerable decline
in the number of leprosy cases. As against 40
Lakh estimated leprosy patients in 1981, there
are about 10 Lakh cases on record now. On an
average, about 4-5 lakh cases are being de­
tected every year. The main aim of the programmc is early case detection and
domiciliary treatment; the ultimate goal is ar­
resting transm ission of the disease in the coun­
try by 2000 AD. The main strategy during the
Eighth Plan is to provide Multi Drug Therapy
( MDT) to all the districts with endemicity of
two and more per thousand population on
modified pattern.

Annual Plan 1995-96
18.18 It is noteworthy that the incidence of
kala-azar cases and deaths due to kala-azar
have shown a decreasing trend in the last three
years. The activities have to be kept up to
ensure that the gains during the last three years
are consolidated.

Other Vector borne Diseases
Annual Plan 1995-96

18.19 Filaria Control Programme which is at
present in operation in only urban areas is
being extended to rural areas by providing
drugs to the cases through Primary Health
Care system.
18.20 Dengue fever was considered essen­
tially an urban problem; in the last few years,
several States have reported Dengue fever in
rural areas. ¥ et another area of concern are the
reports of a Dengue haemorrhagic fever and
Dengue shock syndrome from some States.

18.21 With increasing development of irriga­
tion projects, the areas from where Japanese
encephalitis cases arc reported in the country’
have been progressively increasing.
18.22

18.24 Currently about 50 per cent of the
leprosy patients arc getting benefit of MDT in
the country. To spread the MDT coverage to
as yet uncovered areas and to further intensify
the efforts, the Government has taken World
Bank assistance forextension of MDT services
in the 66 endemic districts on regular vertical
pattern and for extension of MDT services in
253 moderate and low endemic districts
through primary health care services and a
limited number of trained leprosy workers.
The health education and training activities of
the programme are also being intensified. Dis­
ability and ulcer care services are also being
strengthened. The Table 18.3 shows targets
and achievements for case detection, cases
under treatment and cases discharged.

Annual Plan 1995-96
18.25 The following strategy under the pro­
gramme will continue to be pursued during
1995-96:

Increasing morbidity and mortality

due to vector borne diseases can be reduced
by appropriate vector control measures aimed
at reduction of disease transmission and
strengthening of facilities for early diagnosis
and treatment of cases in primary and secon­
dary care settings. It is also necessary’ to intensify the information, education and
communication activities with the objective of
making the community aware about malaria,
filaria, kala-azar and japancse encephalitis

478

7

Review of Annual Plan 1994-95

(i)

provision of domiciliary Multi Drug
Treatment coverage in 201 districts with
prevalence of five or more leprosy cases
per 1,000 population, by specially trained
staff in leprosy;

(ii) provision of Multi Drug Therapy (MDP)
services through mobile Leprosy Treat­
ment Units with the help of existing
health care services in 77 moderately en-

Table 18.3
Targets and Achievements of various activities under National Leprosy Eradication Programme
(In lakh )

Case Detection

Cases under Treatment

Cases Dis
-charged

Case

Targets Achieve­
ments

Targets

Achieve­
ments

Targets Ach­
ieve­
ments

1990- 91
1991- 92
1992- 93
1993- 94
1994- 95

3.69
3.35
2.89
2.65
2.24

3.69
3.35
2.89
2.65
2.24

4.74
5.10
5.41
4.86
4.19

8.81
6.12
5.74
5.25
4.24

4.82
5.13
5.48
4.94
4.29

demic districts and 176 other low en­
demic districts;
(iii) intensification of health education activi­
ties; and

(iv) appropriate rehabilitation.
18.26 A provision of Rs.94 crore was made
for the Annual Plan 1994-95 including
World Bank assistance and a provision of
Rs.80 crore has now been made for An­
nual Plan 1995-96.

National Tuberculosis Control Programme
18.27
The National Tuberculosis Control
Programme (NTCP) is a
continuing Cen­
trally Sponsored Scheme with 50:50 cost shar­
ing between the Centre and the States since
1962 and is integrated with the general health
services. The programme aims to delect cases
early and treat them. The Central share is in
the form of material and equipments including
X-Ray machines and anti-TB drugs. In the
district, the programme is implemented
through the District Tuberculosis Centre
(DTC) and a number of peripheral health insti­
tutions. The DTC organises and coordinates
tuberculosis control activities within the dis­
trict. Out of 460 districts in the country, DTCs
have been established in 390 districts. The
changing prevalence and incidence of the dis­
ease over the last three decades, emergence of
multi drug resistant strains and anticipated in­
creases in number of persons with dual infec­
tion (Tuberculosis and HIV infection) have
been sources of concern. Hence the National
TB Control Programme has been accorded a

9.85
8.26
10.53
7.19
6.26

high priority' by the Government during the
Eighth Plan and the outlays have been in­
creased to Rs.50 crore for 1995-96 so that
additional funding for improving diagnostic
facilities and providing drugs for short course
Chemotherapy for treatment of Tuberculosis.
Review of Annual Plan 1994-95
18.28 The detection of new TB cases has been
doubled within the last 2-3 years and now more
than 18 lakh cases are being detected annually
under the programme. Short Course Chemo­
therapy containing more effective drugs is be­
ing introduced in the country in a phased
manner. So far, more than 250 districts have
been covered. The targets and achievements
of various activities under the programme are
given in the Table 18.4 below:

Annual Plan 1995-96
18.29 The targets under the programme for
1995-96 are sputum examination at PHCs 39.99 lakh and New TB case detection -12.70
lakh.

18.30 The NTCP has suffered due to poor
detection due to acute shortage of Lab tech­
nicians and Radiographers at primary health
centres. Case holding is also poor and is to
some extent attributable to the non availability
of male multi purpose workers to follow up the
defaulters. A Task Force under DGJCMR
developed revised strategy for control of Tu­
berculosis with the following features :

(i)

479

Achieving 90 per cent cure rate of infec­
tious cases through supervised Short

I

TABLE 18.4
Targets and Achievements under National T.B. Control Programme

New case detection

Sputum Examination at PHC level

Year

1990- 91
1991- 92
1992- 93
1993- 94
1994- 95

Target

Achievement

Target

16.50
17.00
17.50
18.00
19.00

16.16
12.79
15.39
13.30

34.00
34.00
34.00
34.00
34.00

13.59
(Provisional)

Course Chemotherapy involving peripheral health functionary ;

(ii) Augmentation of case finding activities
through quality sputum microscopy to
detect at least 70 per cent of estimated
cases; and
(iii) NGO involvement. Information Educa­
tion Communication(IEC),improved
Management and Information System
and operational research.
18.31
The revised strategy was launched
with SIDA assistance in three cities viz. Bom­
bay, Delhi and Gujarat and subsequently in
Calcutta and Bangalore to cover a population
of about 25 lakh. The operational feasibility
and implementation of this strategy is being
tested in one district each of the five States of
Bihar, Himachal Pradesh ^Kerala,"Gujarat and
v West Bengal and one area each of the ten cities
viz. Bombay, Calcutta, Madras, Delhi, Banga­
lore, Hyderabad, Jaipur, Lucknow, Bhopal and
Pune with assistance from World Bank.

National AIDS Control Programme

Achievement
24.21
21.56
26.56
24.44
22.40
(Provisional)

(NACP), the following strategies have been
intensified during the Sth Plan :

(i)

Surveillance of the population with spe­
cial emphasis on high risk behaviour
groups for detection of infection;

(ii) Strengthening of the blood banks and
blood safety measures with priorities on
special areas and metropolitan and large
cities to start with;
(iii) Area specific strategy for control of infec­
tion and target specific IEC activities
based on epidemiological data;

(iv) Integration of the control programme with
the activities of the departments like So­
cial Welfare, Youth & Sports etc. and
other Government and non-Govemmental organisations;

(v) Strengthening of STD Control Pro­
gramme; and
(vi) Training of staff.

Review of Annual Plan 1994-95
18.32 HIV infection has been reported from
almost all the States and Union Territories of 18.33 According to the figures reported to
the country. The common mode of transmis­ NACO till March 1995, 24.76 lakh persons
sion of HIV infection in the country is through have been screened for HIV; 18.02 lakh per­
heterosexual contact; however, the pattern of sons have been found to be sero positive (Sero
transmission in North Eastern States is pre­ positivity rate 7.3 per thousand). A totaljof
dominantly due to sharing of infected needles 1094 AIDS cases have been reportedT in the
by IV drug users. Realising the gravity of the country till March, 1995.
epidemiological situation of HIV in the coun­ Annual Plan 1995-96
try,
the Government of India
launched a 100
zo yo
1
___________
18.34 During the year 1995-96, in addition to
per cent Centrally Sponsored Scheme with an
blood banks,_92 will
, .
! \ estimated cost of_Rs 222.6 crore during the Sth 516 already
- modernised,
_____________
__ _
nV
with t,ie Wor,d Bank assistance.JJnder bc uken UP»lhus mak«ng a total of 608 mod<
the National AIDS Control Programme emised blood banks in the country. The sanclions for establishment of State AIDS Cell

480

have aLeady been issued to all 26 States and
six Union Territories. 62 Surveillance Centres
have also been established in the country. Poor
utilisation of funds and tardy progress of AIDS
programme in some States has been a cause of
concern.
Environmental Health
Review of Annual Plan 1994-95

18.35
The interactive interdependence of
health, environment and sustainable develop­
ment was accepted as the fulcrum of action
under Agenda 21 at the Earth Summit in
Brazil in 1992. The essence and the essentials
of health programmes include control of com­
municable diseases and reduction of health
risks from environmental pollution and its at­
tendant hazards. Population growth and rapid
urbanisation have resulted in marked deterio­
ration of sanitation and waste disposal espe­
cially in large cities. A High Power Committee
on Urban Solid Waste Management in India
was constituted by Planning Commission, un­
der the Chairmanship of Member (Health) ,
The terms of reference of the Committee
were:,.

(i) To assess the impact of the present system(s) of Solid Waste Management on
community health and suggest remedial
measures aimed al minimizing health
hazards and adverse health outcomes.

(ii) To identify the potential hazardous wastes
in cities and towns including hospital
wastes, and the associated health risk.
(iii) To assess the quantum and characteristics
of domestic, trade and industrial solid
wastes in towns exceeding Ten Lakh in­
habitants (1991 census).

(iv) To review the existing technologies for
solid waste collection, transportation and
disposal and suggest the most appropriate
and feasible ecofriendly and cost-effec­
tive technology option(s) keeping in view
the cost-benefit, the waste characteristics,
socioeconomic status and demographic
structure of the community.
Annual Plan 1995-96

18.36 The Committee has submitted its re­
port. Waste reduction, reuse and recycling
utilising appropriate technology, avoidance
of risk transference from one source to other,
reduction in the potential risk to human
health and environmental degradation,conser-

481

vation of energy or its generation through
non conventional sources are the major
thrusts of the recommendations of the
Committee. The report of the High Power
Committee also emphasises the need for ap­
propriate legislation to regulate industry, hos­
pitals and town planning, need for health
iinpact assessment along the lines of environ­
mental impact assessment for major projects.
The report of the High Power Committee was
discussed in the Internal Meeting of Planning
Commission under the Chairmanship of Dep­
uty Chairman,Planning Commission on 23rd
September 1995 and was adopted. It is expectcd that urgent action will be initiated
through allocation of funds for infrastructural
development of solid waste mangement under
the Centrally Sponsored Mcgacity project
during the remaining period of the Eighth Plan.
The implementation of the recommendations
would also require major outlay for urban develpment during the Ninlh Plan.

Control of Non-Communicable Diseases
National Programme for the Control of
Blindness
Review of Annual Plan 1994-95

18.37 The National Programme for the Con­
trol of Blindness (NPCB) was launched in
1976. The programme aims to reduce the rate
of blindness due to cataract to 0.3 per cent by
the year 2000 AD. Reducing disability due to
blindness is imperative in view of the increase
in longivily. The programme is a 100 percent
Centrally Sponsored Scheme. The assistance
provided to the service component under the
programme has been stepped up from Rs.25
crore during 1993-94 to Rs.40 crore during
1994-95 and there is a provision of Rs.72 crore
during 1995-96. The achievement in cataract
operations has gone up. The target in 1993-94
was 24.3 lakh operations and 19.14 lakh op­
erations were perfonned. A target of 24.5 lakh
cataract operations was set for the year 199495 and achievement was about 90 per cent.
During 1995-96, a target of 25.50 lakh cataract
operations has been given to the States. The
new dimension in the implementation of the
NPCB is : (i) improvement in efficiency levels
of existing systems by way of optimum utili­
sation of existing resources,research, introduc­
tion of new technologies and strengthening of
monitoring systems; and (ii) additional inputs
in terms of infrastructure, manpower, new
technologies and equipments. The voluntary
organisations arc also playing a very signifi­
cant role in this programme. With the success

I

achieved and experiences gained through the
pilot district projects, District Blindness Con­
trol Societies are being established throughout
the country. By the end of 1994-95, 40 per
cent District Blindness Control Societies were
established. The grants to non-governmental
organisations are now being released through
District Blindness Control Societies to ensure
timely payment. The targets and achieve­
ments in respect of cataract operations under
the programme are given in Table 18.5 below:
Table -18.5
Target* amd Achievement* of Cataract Opera­
tions under National Programme for Control
of Blindness
(In lakh )

Year

T argots

Achievements

1990-91

12.84

11.83

1991-92

19.90

15.05

1992-93

20.00

16.00

1993-94

24.30

19.14

1994-95

24.50

21.64

1994-95 including World_Bank assistance.
The World Bank project is being implemented
in seven States and similar project is imple­
mented in J&K utilising funds provided by
Govt, of India.

Annual Plan 1995-96
18.39 Programme will be vigorously imple­
mented through the infrastructure and the
machanism created earlier; an amount of Rs.72
crores has been kept under the programme for
the year 1995-96. _

National Iodine Deficiency Disorders Con­
trol Programme
18.40 It is estimated that in India alone, more
than 6.3 Crore people are suffering from vari­
ous iodine deficiency disorders. Realising the
magnitude of the problem of iodine deficiency
disorders, the Government of India re-named
this 100 percent Centrally Sponsored National
Goitre Control Programme which was in op­
eration since 1962 to National Iodine Defi­
ciency Disorders Control Programme
(NIDDCP). Sample surveys conducted by the
DGHS and other agencies have shown that
IDD is confined to sub Himalayan region. The
survey results indicate that out of 243 districts,
IDD is a major public health problem in 200
districts of the country.

Review of Annual Plan 1994-95
The approved strategies of the Eighth Plan
are:
0 Upgradation of District Hospitals to per­
form greater number of cataract opera­
tions. This is done by appointing an
Ophthalmic Surgeon and one P.M.O.A.

ii) Strengthening of Mobile Ophthalmic Units
and creating more permanent infrastruc­
ture for ophthalmic services.
iii) More and more involvement of voluntary
organisation in the National Programme
for Control of Blindness.
iv) Establishment of District Blindness Con­
trol Societies.
v) Increasing the Targets for cataract opera­
tions in successive years with the inten­
tion of speedy clearance of cataract
backlog.

18.38 A provision of Rs.40 crore was made
for various activities under the NPCB for

18.41 Universal iodisation of salt is the strat­
egy adopted by the Government of India
since 1985. To promote the production of
iodised salt, 641 private manufacturers have
been licensed by the Salt Commissioner. The
annual production of iodised salt has been
raised from 5 lakh MT in 1985-86 to 50 lakh
MT in 1994-95. In order to ensure use of only
iodised salt, majority of the States and UTs
have issued notification banning the sale of
uniodised salt for edible purposes under PFA
Act. For ensuring quality control at consump­
tion level i.e. household level, testing kits for
on-the-spot qualitative testing have been de­
veloped and distributed to all the District
Health Officers in endemic States for regular
monitoring.
Annual Plan 1995-96
18.42 For effective implementation of Na­
tional Iodine Deficiency Disorders Control
Programme in all the States/UTs, Iodine Defi­
ciency Disorders Control Cells are being set up
in all the States and UTs. A reference national
lab for monitoring of IDD has been set up at

482

‘ !

Bio-chemistry Division of NICD for training
of both medical and paramedical personnel
and monitoring salt and urinary iodine. Sev­
eral training programmes are being organised.
The IEC activities have been intensified by
broadcasting/telecasting on radio/TV spots.
Video films have been distributed to States.
Posters highlighting the storage technique of
iodised salt for use by wholesaler and retailers
are being distributed.

National Mental Health Programme
Review of Annual Plan 1994-95

18.43
The National Mental Health Pro­
gramme (NMHP) was launched as a purely
Centrally Sponsored Scheme during 7th Five
Year Plan with a view to ensure availability of
mental health care services, did not make
much of a headway in the Seventh Plan. Dur­
ing Eighth Plan, a fresh thrust is being given
to widen the scope of programme. The fol­
lowing specific activities are being under­
taken :
(a)

implementation of district level mental
health programme;

(b) improvement in the mental hospitals with
particular reference to the improvement
in the rehabilitation units;
(c) training of trainers of PHC personnel;

(d) vy.elfare measures for the chronic mental
disabled ensuring gender equity; and
,(e) programme for substance use disorders.

For all these activities, a sum of Rs. 15
lakh has been allocated under this programme
during 1995-96.

18.44 During the Eighth Plan period, there
had been some publicjnterest litigation re­
garding some major menial hospitals in the
country; as directed by the Supreme Court, the
Central Government has been providing addi­
tional funds to improve conditions in these
hospitals.

Annual Plan 1995-96
18.45 A comprehensive review of the situ­
ation in different States to chalk out methods
to improve these institution is under considera­
tion.

7°National Cancer Control Programme

r--18.46 India has pne of the lowest Cancer rates
in the world. It is estimated that incidence of
483

Cancer is 4-6 lakh. The two most common
ones are Cancer of cervix in woman and oral
Cancer in both sexes. Both these Cancers have
easily recognisable symptoms; diagnosis by
biopsy is easy. Inspite of all these advantage,
most cases are detected in stage III or IV even
in States like Kerala, Tamil Nadu, Karnataka
and Goa where health infrastructure is fairly
well-developed. There is a need to educate the
people so that Cancer detection is done at early
stages at the peripheral level.
18.47 During the Eighth Plan, emphasis is on
prevention, early detection of cancer and aug­
mentation of treatment facilities in the country.
The National Cancer Control Programme
(NCCP) was started during the year .1975-76
when a pattern of Central assistance for the
projects of cobalt therapy units for treatment
of cancer patients was laid down. Sub­
sequently, 10 major institutions were recog­
nised as Regional Cancer Centres. These
centres received grant-in-aid from the Govern­
ment under the programme.

I

Review of Annual Plan 1994-95
18.48 During the year projects at district level
for prevention of cancers through health edu­
cation, early detection and introduction ofpain
relief measures have been initiated. Under the
scheme, assistance is provided to the State
Governments for each district project selected
under the scheme. Financial assistance for
development of Oncology Wings in medical
colleges/hospitals for purchase of equipments
is also provided which includes Cobalt Wing.
So far, financial assistance has been provided
to more than 25 medical colleges in the country
and also to regional institutions and to the
registered voluntary organisations for the pur­
pose of undertaking health education and early
detection activities in cancer.

Annual Plan 1995-96

18.49 To implement the programme in a
phased manner in the countiy, a sum of Rs. 15
crore has been allocated for this programme
during 1995-96.

National Diabetes Control Programme
18.50 The National Diabetes Control Pro­
gramme was included in the Seventh Five Year
Plan as one of the Central health programme;
a sum of Rs. 25 lakh was allocated for the
programme to initiate district diabetes control
programme. A Central Steering group coordi­
nated the programme, monitored the progress

L

of the work in different districts. The project
was initiated in two districts in Tamil Nadu
(Salem and South Arcot), one district in J&K
(Jammu) during the Seventh Five Year Plan
period.

Review of Annual Plan 1994-95
18.51 During the Eighth Plan period, some
of the States had initiated District Diabetes
Control Programmes as a part of the State Plan
Schemes; the State of Karnataka has initiated
the programme in two districts and now pro­
poses to expand to three more districts.

Annual Plan 1995-96

.

18.52 Andhra Pradesh, Rajasthan, Maharash­
tra, Himachal Pradesh and Punjab have indi­
cated that they intend to initiate district
diabetes control programme during 1995-96.
Training material and health education mate­
rial in local languages is available in Tamil
Nadu, Maharashtra, Karnataka and J&K. The
Dcptt. of Health is reconstituting and conven­
ing the Steering Committee ; the Committe is
expected to provide necessary guidance and
help in the preparation of necessary' training
material and assessment ofthe requirement of
various states to ensure smooth functioning of
the programme.

Medical Research
18.53 Indian Council of Medical Research
the nodal organisation for biomedical research
in India, formulates, conducts, coordinates and
reports basic, clinical, applied and operational
research studies relevant to major health prob­
lems in the country'. These studies are carried
out in the perniaiicnL.Institutcs of ICMR as
well as the ICMR funded research projects in
Universities, Medical Colleges and Non-Governmental Organisations. In addition to
ICMR, DST, DBT, CSIR fund research studies
predominantly basic research-in R&D es­
tablishments and universities.

Rgvicw of Annual Plan 1994-95
18.54 Major thrust areas of research include
existing problems of communicable diseases,
emerging problems of non communicable dis­
eases, improvement of health and nutritional
status of women and children and increasing
contraceptive acceptance and continuation.
Indigenous development of immuno-diag­
nostics, research studies on improved drug
regimens to combat emerging drug resistance
among several bacteria, alternative strategies

484

for vector control in view of the increasing
insecticide resistance among vectors, testing
innovative disease control strategies through
increased community participation has been
the major focus of research in communicable
diseases.
18.55
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 pre­
vention of cervical cancers in women and oral
cancers in both sexes, life style modification
to reduce the rising morbidity due to hyperten­
sion and cardiovascular diseases, document­
ing the health problem associated with life
style changes and increasing longivity of life
arc some of the major research areas in Non
Commuicable disease. Evaluation of ongoing
Mid day meal programmes in schools, assess­
ment of changes in dietary intake and nutri­
tional status of urban and rural population in
different States over the last two decades, in­
vestigating the health effects of food contami­
nants, adulterants and increasing use of
pesticides are some of the activities in nutrition
research.

18.56 Studies on safety and efficacy of nonsurgical methods for inducing abortion in early
pregnancy, basic research studies to evolve
and test immunodiagnostics, as well as inno­
vative methods for contraception are some of
the major areas of research in Reproductive
Health. Operational research aimed to im­
prove maternal and child health under existing
health infrastructure, and epidemiological
studies to estimate the prevalence of STD/RTI
in different segments of women have also been
initiated in the last year. A case control study
has been initiated to evaluate the long term
health consequences of vasectomy, in view of
the fact that majority of the 1.3 Crore vasectom ised men in India are likely to be over fifty
years of age during the late nineties.

Annual Plan 1995-96
18.57 Research studies in all these areas will
be continued. The Annual Plan outlay for
1995-96 for ICMR is Rs. 7.5 crore from Deptt.
of Family Welfare and Rs. 29 crore from
Deptt. of Health.

Annual Plan 1995-96

Education in Health Sciences
Review of Annual Plan 1994-95
18.58 There is, at present, no proper central
mechanism to interlink the growth and devel­
opment of health manpower with the needs of
health care system, to plan a balanced devel­
opment of all categories of human resources
for health, or to ensure that the quality or
competency of such manpower produced arc
relevant or commensurate with the country’s
needs. The Health Manpower Planning, Pro­
duction and Management Committee in its
Report submitted in 1987 and the Eighth Plan
Working Group on Medical Education, Train­
ing and Manpower Planning recommended
that the Education Commission for Health Sci­
ences must be established as a Central organi­
sation on the lines of the UGC for professional
and para-professional education in health sci­
ences, inter alia, to provide realistic projec­
tions-for national health manpower
requirements and suitable mechanism to con­
tinuously review the projections based on felt
needs. The Draft-National Education Policy
for Health Sciences (1988) prepared by a Con­
sultative Group under the Chairmanship of
Prof. J.S. Bajaj, now Member (Health), Plan­
ning Commission reiterated the urgent need to
set up the Education Commission in Health
Sciences.

Annual Plan 1995-96
18.59 For the establishment of the Commis­
sion through necessary legislation and prepa­
ration of implementation details, a token
provision of Rs. 10 lakh is made for Annual
Plan 1995-96.

Medical Education
Review of Annual Plan 1994-95
18.60 The Medical Education should be ori­
ented towards supplying the necessary' number
of specialists/gcneral duty officer in each cate­
gory with appropriate training. There is also
need to standardise the curriculum both at the
undergraduate and postgraduate level; im­
proved teaching methods and effective train­
ing in the required areas. Funds have been
provided in the State plan for improvement
and augmentation of facilities in terms of stall,
equipment, libraries, laboratories and build­
ings in medical colleges and attached teaching
hospitals to meet the requirements of the stand­
ards laid down by MCI.

18.61 The schemes for strengthening the post­
graduate facilities in specialities and certain
super-specialities taken up by the various State
Governments will ccntinuc. The Centre has
set up regulatory bodies for monitoring the
standards of medical education, promoting
training and research activities. This is being
done with a view to sustaining the production
of medical and para-medical manpower to
meet the requirements of the health care deliv­
ery system at the primary, secondary and ter­
tiary' levels in the country. Special efforts are
also underway to improve the dental education
facilities so as to be able to cope with the
manpower requirements for dental care at primary, secondary and tertiary care lev­
els.Health related vocational courses at 10+2
level of education as part of vocationalisation
of secondary education is being done to pro­
vide manpower required as per the needs and
especially the urgent need for removing the
backlog of paramedical manpower and imbal­
ance of medical and para-medical personnel.
Funds have been provided for this under the
Education sector for 1995-96 also.

-

Nursing Education
Review of Annual Plan 1994-95
18.62 There is an acute shortage of nurses in
the country'. The accepted norm is a doctor­
nurse ratio of 1:3. In India there are an esti­
mated 4.5 lakh doctors belonging to allopathic
system; there are only 2.3 lakh registered
nurses. There is thus a shortage of about 6 lakh
nurses. Nursing education and nursing serv­
ices have been given a high priority during the
Eighth Plan in order to bridge this gap. There
is an increasing need for nurses with special­
ised training in specialities such as oncology,
psychiatry and paediatrics and in wards pro­
viding intensive care to patients for improving
quality of patient care.

Annual Plan 1995-96

18.63 With the objective of improving the
situation regarding nursing training the fol­
lowing schemes are being implemented dur­
ing 1995-96:
(a) Establishment of 10 new school of nursing
with a very substantial intake of SC/ST
students.
(b)

485

t

Strengthening/adding seats to existing
schools of nursing.

i

(c) Training of Nurses under Continuing Edu­
cation Programme.
I

(d) Nurses colony in Delhi.

A provision of Rs. 9 crore has been made for
above activities during 1995-96.

National Board of Examinations

Review of Annual Plan 1994-95

18.64 The National Board of Examinations
(NBE) was established by the Government of
India in 1975 and it became an independent
autonomous body under the Ministry of Health
and Family Welfare with effect from 1st
March, 1982. The Board conducts post-gradu­
ate and post-doctoral examinations in 39 dis­
ciplines of medical sciences and awards its
own degrees known as Diplomate of National
Board
which
arc
equivalent to
MD/MS/DM/M.Ch. of other Indian universi­
ties. The Board is thus a national level body
helping in maintenance of a high and uniform
standard of post- graduate medical education
and training. About 124 hospitals/institutions
with in-take capacity of 550 candidates in vari­
ous disciplines have been accredited by the
Board after inspection.

Review of Annual Plan 1994-95
18.65 The Board has created a well-stocked
question bank in various disciplines. A peerreview for appraisal of examination conducted
by NBE has been initiated. Research into
evaluation methodologies have also been car­
ried out. Several structural reforms have been
introduced in the context of theory, practical,
clinical and viva voce. The Board is develop­
ing linkages for interaction with speciality,
professional associations, other national and
international academic and examination bod­
ies.

Annual Plan 1995-96

18.66 All the ongoing activities will be con­
tinued during 1995- 96.The NBE is now gen­
erating substantial resources for its on- going
activities. For additional support, a sum of
Rs. 17 lakh has been allocated during Annual
Plan 1995-96.

National Academy of Medical Sciences

I

members of the Academy. The National
Academy of Medical Sciences recently has
established regional centres for Continuing
Medical Education (CME) Programmes and
provided seed money to enable the estab­
lishment of m inimal but relevant infrastructure
for the conduct of such programmes.

18.67 The National Academy of Medical Sciences(NAMS) was established in 1961 as a
registered society with the objective of pro3-­
moting the growth of medical sciences. It
1.
recognises talent and merit throughout the
country in the form of election of fellows and

486

18.68 The CME Programme is being imple­
mented by NAMS since. 1982 a& per pattern
approved by the Government of India to keep
medical professionals abreast with newer cur­
rent problems of the country and update their
knowledge in those fields for the required de­
gree of health care and also helps medical
students in preparation for post-graduate ex­
aminations of various universities and Na­
tional Board of Examinations. The CME
Programme also covers human resource devel­
opment by sending junior scientists to centres
of excellence providing training in advanced
methods and techniques. A Memorandum of
Understanding has been signed between the
NAMS and lheJndira Gandhi National Open
University to develop distance education and
learning as a critical mode for ensuring expe­
ditious implementation of the long term poli­
cies developed by the NAMS.

Annual Plan 1995-96
18.69 Efforts will be made to establish more
regional centres during 1995-96 and for its
continuing activities, an amount of Rs.23 lakh
is allocated during Annual Plan 1995-96.
Hospitals and Dispensaries

Primary Health Care in Urban Areas:
Review of Annual Plan 1994-95
18.70 With increasing urban population es­
pecially migrant labourers living in poor and
unhygienic condition settling near major cities
and towns as urban slums, a need for primary
health care for this vulnerable and underprivi­
leged population has been felt. In order to
provide primary' health care to these urban
slum population dispensaries and hospitals are
being established by the state govt’s under
state plan. The slum population of the urban
areas arc also looked after by mobile vans.
Annual Plan 1995-96

18.71 Alternative approaches to provide services to urban slums arc also being tried; the
feasibility, outreach, and cost quality care in

^jj.^each of these approaches will be assessed during the year.
,

Secondary Health Care
Review of Annual Plan 1994-95
18.72 Provision has been made for continu­
ing and further strengthening the schemes for
improvement of medical care facilities in the
hospitals and dispensaries under the charge of
the State Govemments/Ministry of Health and
Family Welfare in order to take care of refer­
rals from primary health care and to reduce
over crowding at tertiary centre.

Annual Plan 1995-96
18.73 Many of the States e g. Himachal
.. Pradesh, Karnataka, Punjab, West Bengal etc.
have formulated project proposals for devel­
opment of secondary level hospitals with the
assistance of bilateral funding agencies. Ade­
quate provision has also been made for aug­
mentation and consolidation of the facilities
already available and opening of additional
dispensaries and hospitals, depending upon
the local needs of the people. The network of
hospitals would be strengthened gradually to­
wards achieving the objective of one hospital
bed for every 1000 population.

District Health Care Model
18.74 Development of District Health Care
model has been initiated by the Planning Com­
mission during Working Group discussions
with State Governments on their Annual Plan
proposals. The primary objective behind these
models is to link the primary health care sys­
tem with secondary care level centres so that
referral for management ofcom municable and
non-communicable diseases and health prob­
lem of women and children could be achieved.
• ' The secondary' care centres, will intum estab­
lish linkages with tertiary- care centres for re­
ferral of cases requiring specialised facilities
not available at secondary level.

, Review of Annual Plan 1994-95
18.75
To begin with, in the Eighth Plan
attempt has been made to develop district
health models in some districts with distinctive
features. The ongoing project in Nagpur dis­
trict explores the feasibility of establishing the
linkage at all levels in a district where over
_ 50% of the population is urban. The project at
Visakhapatnam looks at establishment of simi­
lar linkages in a coastal district.

487

Annual Plan 1995-96
18.76 A proposal for an operationalising dis­
trict care model in two border, desert districts
in Rajasthan is under consideration. It is ex­
pected that the experience gained through
these will be of use in formulating the district
health care proposals in the Ninth Plan.

I

Indian Systems of Medicine and Homocopathy
Review of Annual Plan 1994-95
i.

18.77 Indian systems of Medicine and Ho­
moeopathy (ISM & H) arc widely accepted in
the country specially in the rural, remote and
difficult areas. There arc 5.65 lakh practitio­
ners belonging to these systems who are avail­
able and provide health care at affordable cost
in remote rural areas. Measures for populari­
sation and development of Indian systems of
medicines and homoeopathy arc being vigor­
ously pursued during Eighth Plan. Efforts will
be continued to integrate Indian Systems of
Medicine and Homoeopathy with the main­
stream of primary health care delivery network
has been given a thrust.

i

Annual Plan 1995-96

18.78 For a proper direction and accelerat­
ing the promotion of ISM&H at the national
level, a separate department for Indian system
of medicines and homoeopathy including a
directorate for Ayurveda has been set up vide
notification dated 8.3.95. Emphasis has been
given to the programme by propagating and
promoting the development of medicinal
plants; strengthening of ISM&H research in­
stitutes. An amount of Rs.23.82 crore is allo­
cated for the further development of ISM&H
in the country during Annual Plan 1995-96.

!
I.

Recent Health Legislations
Review of Annual Plan 1994-95

18.79 The legislation on ‘Transplantation of
Hyman Organs’ was enacted to regulate the
removal, storage and transplantation of human
organs for therapeutic purposes and, for the
prevention of commercial dealings in human
organs. The Act and the Rules thereunder
were enforced from 4th February, 1995 in all
Union Territories and States of Goa, Himachal
Pradesh and Maharashtra. Other States have
been requested to adopt the legislation.

I

Voluntary Organisation
Review of Annual Plan 1994-95

tance for health care projects. The institu­
tion s/programmes shown in the Table 18.6
will receive External Assistance during the
Annual Plan 1995-96.

18.80 Voluntary Organisations are being en­
couraged to supplement and complement the
Govt.’s efforts in providing Health & Family
Welfare services to the community and by
educating and motivating them to utilise health
& Family Welfare senices. The financial as­
sistance is provided to voluntary agencies for
providing medical care to rural and high den­
sity urban slum population. The Voluntary
Organisations which are running hospitals in
rural areas or in urban areas (high density
slums) are eligible to get financial assistance
for expansion and improvement of existing
hospital facilities. Financial assistance is pro­
vided for the purpose of purchase of costly
essential equipments. The financial assistance
is also given lor selling up of new hospitals,
dispensaries in rural areas with a maximum
bed strength of thirty. The voluntary organisa­
tions are also being provided with necessary
assistance under several programmes such as
Blindness Control Programme, Leprosy
Eradication Programme, AIDS Control Pro­
gramme and under several schemes of Depart­
ment of Health & Family Welfare.

Table 18.6
External Assistance received under Health
Sector Programmes during 1995-96

(Rs.in crore)
Name of the
Programme

Amount of
Assistance

1. National AIDS Control
Programme
2. National Leprosy
Eradication
Programme
3. Blindness Control
Programme
4. National TB Control
Programme
5. National Institute of
BioJogicals (NOIDA)

Annual Plan 1995-96

61.50
61.00

4.00

19.50

225.00

18.81 To provide further encouragement to
voluntary organisations to participate in the
development of medical care facilities, an out­
lay of Rs.80 lakh has been proposed for the
Annual Plan 1995- 96 under Central Health
Sector Programmes.

I

79.00

Plan Outlay for 1995-96
18.84 For the Annual Plan 1995-96, an out­
lay of Rs.2173.90 crore has been provided for
the health sector as compared to the provision
of Rs.1819.48 crore and revised estimates of
Rs. 1709.59 crore in 1994-95 as shown in Table
18.7.

Funding
18.82 There is an increasing recognition that
human health is an essential prerequisite for
development and the movement to ‘invest’
more, not only ‘in but ‘for' health is gathering
momentum. In India both the State and the
Central Governments provide funding for pro­
grammes aimed al prevention of diseases,
promotion of health, providing curative and
rehabilitative services. In addition the private
and the voluntary organisations play an important role in providing health care to the popu­
lation. The outlays for the various Health
Sector Programmes arc given in Annexure
18.1 and 18.2.

External Assistance
18.83 Over the last few years there has been
an increase in the quantum of external assis-

488

Areas of Concern

Periodic focal outbreaks of malaria with
high morbidity and mortality.
Increasing prevalence of falciparum ma­
laria, chloroquin resistence in parasite
and insecticide resistence in the vector.
-

Re-cmcrgcnce of Kala Azar

Multidrug resistence in tuberculosis
Emerging HIV epidemic and secondary
epidemic of tuberculosis
Poor utilisation of funds and tardy pro­
gress in AIDS control programme.

I-

TABLE 18.7
Annual Plan Outlay for Health Sector for 1994-95 & 1995-96

Centre

States/UT

(Rs. in crore)
Total

1994- 95
Approved Outlay
Revised Estimates
1995- 96

578.00
599.38

1241.48
1110.21

1819.48
1709.59

Approved Outlay

670.00

1503.90

2173.90

Demographic transition, life style
changes and increasing prevalence of
non-communicable diseases such as dia­
betes hypertension, cardio-vascular dis­
eases and malignancies.

in the meeting of the NDC held on 18th Sep­
tember, 1993 and the recommendations made
by the sub-committce were endorsed in the
meeting.
‘
Review of Annual Plan 1994-95

Emerging problem of environmental
health.

18.87 Department of Family Welfare has
taken up implementation of the recommenda­
tion of the Committee; some of these which
involve large financial and policy implica­
tions are under consideration. The Department
is expected to convene the meeting of the
Chief Ministers of the States for wider consult­
ations regarding some of the recommendations
of the Committee.

Family Welfare
18.85 India with 2.5% of the world’s land
mass is the home of l/6th of the world’s
population.The population of the country
was 84.63 Crore in March 1, 1991(1991
census)as against 68.33 Crore in 1981. Tech­
nological advances and improved quality and
coverage of health care have resulted in rapid
fall in mortality rates from 27 in 1951 to 9.3
in 1993. There had been increasing use of
contraceptives over the same period, but the
fall in birth rate, from over 40 in 1951 to 28.7
per 1000 in 1993 has been less steep; as a
result the annual population growth had been
over 2 percent in the last three decades. The
rapid increase in population has come in the
way of improvement of quality of life of
citizens in the country. Rightly therefore,
population stabilisation was recognised as
one of the six major objectives of the Eighth
Plan.The Family Welfare Programme
launched in 1951 aims to deliver a package
services for Family Planning and Maternal
and Child Health through a country wide
network of Primary Health Care System
supported by secondary and tertiary care in-.
Stitutions linked by appropriate referral sys­
tem.

NDC Committee on Population
18.86 With a view to give new thrust and
dynamism to Family Welfare Programme, a
Sub- committee of National Development
Council on Population was constituted. The
report of the Sub- committee w’as considered

Integration of MCH and FP into Family
Welfare Programme
Review of Annual Plan 1994-95
18.88 Recognising the fact that reduction in
Infant and Child mortality' is essential pre­
requisite for acceptance of small family
norm, Government of India has attempted to
integrate MCH and Family Planning as part
of Family Welfare services at all levels. The
NDC in 1991 approved the Gadgil- Muk­
herjee formula which for the first time gave
equal weightage to performance in MCH sec­
tor (1MR reduction) and FP sector (CBR
reduction) as part basis for computing cen­
tral assistance to Non-Special Category
states. The central assistance given under Plan
allocation to non-special category States under
Gadgil-Mukherjee Formula during 1994-95 is
given in Annexure 18.3. At secondary and
tertiary care level FP services are closely
integrated with obstetric / gynaecology and
paediatric care. At the primary health care
level the PHC doctor and the ANM provide
1both MCH and FP services. The integration of
Ithese services has been recognised as a key
iintervention strategy for population stabili­
s
sation
and is accorded a high priority in~the
1
Eighth
Plan.

i

489

I

i.

■i

Performance of FW Programme

18.89
The Eighth Plan targetted to
achieve the following by 1997, the terminal
year of the plan.

Crude Birth Rate 26 per 1000 population
Infant Mortality Rate 70 per 1000 livebirths

Couple Protection Rate 56%

specific targets during the year. In the second
category are the Slates like Bihar and Uttar
Pradesh with poor infrastructure and poor per­
formance; the Deptt. of Family Welfare is
making several special provisions to improve
the infrastructure so that performance could
improve. In between these two extremes are
two categories of States. In one group are the
States with below average level of infrastruc:
lure but average level of performance such as
Himachal Pradesh and Andhra Pradesh; at­
tempt to improve infrastructure in these States
might resulf in rapid improvement in performaance.
nce. The last category arc the States like
pUnjab with above average level of infrastructure and below average performance; in these
L
______specific
r—-_________
States
efforts need ‘be made to identify lhe factors responsible for the relatively
p0Qr performance and correct them .

Review of Annual Plan 1994-95
18.90 The Infant Mortality Rate (IMR)
has declined from 80 per 1000 live births in
1991 to24 in. 1223. The target of IMR of 70
per thousand live births by 1997 is certainly
u
achievable. The target of CBR of 26 -per 0/
thousand and couple protection rate of 56% by
1997 is, however, likely to be more difficult to
achieve within the remaining short period of
the Eighth Plan in view of the fact that CBR in Additional assistance to poorly performing
1993 is 28.7 and estimated couple proteclion­ districts
rate on 31.3.1995 is only 45/4%^ Inspitc of 18.92 Available information indicate that in­
similar norms under this Centrally Spon­ vestment in health especially in the primary
sored Programme, there have been sub­ hcalllLcajxj infrastructure is low in many
stantial differences in the performance poorly pcriorming States (Annxure 18.4 ).
between States as assessed by IMR and CBR Recognising the need for special attention
(Annexurc 18.4). At one end of lhe spectrum and necessity for additional inputs to improve
is Kerala with mortality and fertility rates^ the performance in poorly perfonning Slates,
similar to those in some of the developed one-half nf thn total funds for Social Safety /
countries. At lhe other end there are the four Net Scheme have been providcJlifiLJhcJDe- f
large
Bihar,
—northern
—....... States
- — - (Uttar
'—rPradesh,
—r—
x nartment of Health and-Family. Welfare- On
Madhya,
Pradesh
and
a
s
th
an
withJugh_
fhc basis of dala from 1981 ccnsus,_90_disI
Infant Mortality Rate and Fertility Rates; even tricts with Crude Birth Rates of over 39 per
within the Slates, there arc differences in per­ thousand population, high Infant Mortality
formance between districts. These reinforce Rate and low literacy among women
the need for expeditious implcmetation of the have been chosen and interventions aimed at
recommendations of the NDC Committee on reduction in maternal and infant mortality
Population regarding area specific, decentral­ and increase in institutional delivery have
ised micro-planning and involvement of been initiated in 1992-93. The CSSM pro­
Tanchayati Raj institutions in the programmes gramme was also initiated first in the poorly
tailored to meet the local needs.
performing districts . Besides Area Develop­
ment Projects aimed at establishing primary
Annual Plan 1995-96
health care infrastructure for providing family
18.91
The NDC Committee on Population planning and MCH services have also been
had recommended that a differential area spe­ taken up in some poorly performing Slates. A
cific approach should be followed while at­ projecLainiGd-at revitalising the Family Wel­
tempting to improve the performance in the fare Programme in Uttar Pradesh was initiated
Family Welfare services. Based on the existing with assistance from USAID in 1233.- Effort
infrastructure and the performance as assessed should be made to optimally utilise the avail­
by demographic indicators, States can broadly able funds made available through all these
be classified into four broad categories. In the projects, avoid duplication of efforts and im­
first category are States such as Keraia with prove quality of services so that their utilisa­
good infrastructure and are performing well; tion increases. There is also a need to assess
these Stales require only uninterrupted supply progress of work in these projects through
of drug and devices . Recognising the fact that process and impact indicators.
these Stales are perfonning well Kerala and
Tamil Nadu have been exempted from method
• _

!-------------- ./
I. a * a •

/■’

a■ • ■ 4

a a«

4 V*

‘

-

I M

O fV /X

f“ I

I

490

.« •

.t

1

A*

-1-f

?

i

i

!

18.93
To achieve desired demographic
goals, Family Welfare has evolved an action
plan in consultation with the States and UTs
so as to reach a national consensus in sup­
port of the family welfare programme.Some of•
the features of the action plan are as under:-

(i) Improving the quality and outreach of fam­
ily welfare services;

I

(ii)

Differential strategy for focus on 90
poorly
performing districts (birth rate
of 39 and above per one thousand popu­
lation as per 1981 census);

(iii) Increasing the coverage of younger cou­
ples;

(iv) Introducing new contraceptives and im­
proving the quality of contraceptives;
(v) Strengthening family welfare schemes in
urban slums ;

(vi) Reorientation of information,education
and communication system in spreading
the message of family welfare pro­
grammes;

(vii) Involving voluntary' and non-governmen­
tal organisations to promote community
participation in the programme;
(viii) Evolving high level inter-sectoral coor­
dination mechanism at the national. State
and district levels.
Family Planning
Permanent methods of contraception
Review of Annual Plan 1994-95

18-94 Review of the performance regarding
sterilisation during 1994-95 reveals that there
has been a small decline as compared to the
period 1993-94 (Table 18.8 ). A decline in
performance has been reported in Andhra
Pradesh, Assam, Bihar, Kerala, Punjab,
Jammu & Kashmir, Tamil Nadu and West
Bengal and Bihar. Madhya Pradesh and Uttar
Pradesh have shown an improvement in per­
formance while in Rajasthan, the performance
is stagnant at the level of 1993-94. The decline
in the acceptance of sterilisation is a cause of
concern, because surgical sterilisation is the
safest and most effective method of ensuring
freedom from pregnancy for the next two dec­
ades or longer in young couples who have
completed their family.

491

Annual Plan 1995-96
18.95 Vasectomy is safer, simpler and easier
than tubectomy and the procedure is wellsuited to the primary health care services;how­
ever over the years there has been a progres­
sive decline in number of couples protected by
vasectomy. Efforts to improve the acceptance
of vasectomy should receive due attention in
1995-96.

Reversible methods of contraception
Review of Annual Plan 1994-95
18.96 In the year 1994-95, there has been an
improvement in acceptance of temporary
methods of contraception as compared to
1993-94. The States of Assam , Uttar Pradesh,
Orissa and Madhya Pradesh have shown im­
provement in performance of IUD insertions
during 1994-95 as compared to 1993-94, how­
ever, Bihar , West Bengal and Rajasthan have
shown a decline.
18.97 Reversible methods of contraception
like IUD and Oral Contraceptives are needed
to achieve appropriate spacing between
pregnancies and to prevent unwanted preg­
nancies. Over the last two years, there has
been a progressive improvement in the accep­
tance of IUD, OC and Condoms. But there
has been a fall in the offtake of OC and CC
through commercial and social marketing out­
lets. Continuation rates for these reversible
contraceptives in India are low. Counsel­
ling, providing information on the contracep­
tive options, helping the users to choose the
method best suited to their needs and provid­
ing follow up services arc some of the steps
that might go a long way in improving both
acceptance and continuation rates.

Annual Plan 1995-96
18.98
The expected levels of achievements
during 1995-96 under different contraceptive
methods are sterilisation 50.6 Lakh, IUD in­
sertion 75.5 Lakh and OC Users 33.1 Lakh. In
the year 1995-96, the Department of Family
Welfare has exempted two States - Kerala and
Tamil Nadu from method specific targets. In
addition, one district from each State has also
been exempted from method specific targets.
Data on acceptance of different methods will
be collected and reported in the same manner
as the rest of the States. It is nxpccted that in
a couple of years infonnation on the impact of
removal of method specific targets allocation
on acceptance of suitable contraceptive
method by eligible couple will become avail-

Annual Plan 1995-96

able. This experiment is in line with the NDC
Committee’s recommendation that decentral­
ised planning and area specific approaches
should be adopted for improving performance
in terms of reduction in crude birth rate.

18.102 Though there has been a steep fall in
the reported cases of polio over years, majority
of States still report polio cases. In an effort to
achieve the set goals of eradication of polio by
2000 A. D. Delhi had taken up a pulse polio
immunisation from the year 1994-95. The
lessons learnt from this effort may be of use to
the programme implementors in other metro­
politan cities.

Maternal and Child Health
Review of Annual Plan 1994-95
18.99
As a part of overall strategy for re­
duction of matemaljnfant and child mortal­
ity rates, the Child Survival and Safe
Motherhood Programme was launched in Au­
gust, 1992. The programme aims at sustain­
ing
the
ongoing
programmes
of
immunisation, management of diarrhoeal
diseases,prophylaxis and treatment of anaemia
in pregnant women and children under five
years of age, administration of vitamin A to
children under three years of age. The new
interventions also include treatment of pneu­
monia by the peripheral health staff, im­
provement of essential
obstetric and
newborn care, and establishment of first
referral units for providing emergency ob­
stetric care. This programme was taken up
in a phased manner; under the child survival
component , 51 districts were covered in
1992-93, 103 districts in 1993-94, 101
districts in 1994-95.
As many as 98 new
districts will be taken up during 1995-96.
Under the Safe Motherhood Programme, 21
districts were covered in 92-93, 32 in 93-94,
51 in 94-95.

Ante-natal Care
Review of Annual Plan 1994-95
18.103 Maternal Tetanus Toxide (TT) cov­
erage and iron and folic acid supplements is
given in Tabic 18.8 . There is an urgent need
to improve TT immunisation programme.
There has been some improvement in cover­
age of pregnant women for prophylaxis
against anaemia. The impact of this in terms of
improvement in the maternal Haemoglobin
status or reduction in anaemia in pregnancy
need to be assessed. In majority of the States
availability and utilisation of ante natal and
intra partum care in rural areas continue to be
poor. Il is also noteworthy that while in some
States like Kerala over 90% of women have
access to institutional delivery , majority of
deliveries in poorly performing States are still
conducted at home and by untrained person­
nel.
Annual Plan 1995-96

18.104 Many States have attempted several
innovative strategies to improve ante natal
care and intra partum care; the impact of these
in terms of reduction in neonatal and maternal
morbidity and mortality have to be assessed
and appropriate mid-course correction initi­
ated during the 9th Plan.

Annual Plan 1995-96
18.100 Forty eight districts will be covered in
this programme during 95-96. An allocation
of Rs. 220 crores has been made in 1995-96
for the programme.

Immunisation
Review of Annual Plan 1994-95
18.101 Under Universal Immunisation Pro­
gramme, the percentage achievement of target
under different methods of immunisation dur­
ing 1994-95 are given in Table 18.8. There has
been a decline in achievement under almost all
methods as compared to the achievements in
1993- 94; this is a cause of concern. Though
there had been significant achievement in
terms of overall coverage during the Eighth
Plan period , 100% coverage of vaccine pre­
ventable diseases before infant becomes one
year old is still not achieved. There are occa­
sional slip in the quality of services resulting
in morbidity and mortality.

Child Health
Review of Annual Plan 1994-95
18.105 Available data indicate that there are
marked differences between States in both
neonatal and infant mortality rates. Efforts to
improve neonatal and infant care services are
underway in all States. Making ORS available
through social marketing and supply of ORS
through revamped PDS is being advocated in
areas where ready access to health services are
not available.

492

Research and Development
18.106
ICMR is the nodal research agency
for earn ing out basic, clinical and operation

... Table 18.8
Performance in the Family Welfare Programme Annual Plan 1994-95
i •

'jii!
.

■

>

i:;
,

i

H

■<

Target/ELA Achievt. %age achievt. %age
of propor- increase/
(Lakh )
tionate
decrease
targets
over 93-94
i

Family Planning
Sterilisation
52.4
IUD
75.9
CC users
217.5
OP Users
54.6
MCH
Immunization
DPT
242.9
Polio
242.9
BCG
242.9
DT
214.5
TT (10 years)
203.1
TT (16 years)
181.5
TT
(Pregnant
270.0
Women)
Measles
242.9
Prophylaxis against
Nutritional Anaemia
Pregnant Women
275.0
Children
247.7

42.9
62.4
171.1
47.5

81.7
82.3
78.7
86.8

(-) 3.1
(+)10.2
(-) 0.4
( + )11.3

219.2
220.8
230.8
106.9
84.6
65.1

90.2
90.9
95.0
73.3
61.1
52.2

(-) 1.7
(-) 1.6
(-) 0.9
(+)37.3
(+) 8.1
(+) 5.7

214.5

79.4

(-) 2.2

200.6

82.6

(-) 5.8

208.3
162.9

85.8
94.4

(+)25.2
(+)70.3

*FIGURES PROVISIONAL.
research in contraception/MCH. Some of the
other agencies carrying out research in these
areas include National Institute of Health &
Family
Welfare, Central Drug Research
Institute, Lucknow, and Central Council for
Research in Ayurveda and Siddha.

Review of Annual Plan 1994-95

18.107 Basic research efforts for develop­
ment of newer technology for contraceptives
devices are currently underway; though they
are unlikely to lead to availability of newer
methods for use in the programme during 90s,
these efforts are needed to cater to the require­
ments of the population in the coming decade.
Annual Plan 1995-96

18.108 For improving the contraceptives cov­
erage during remaining years of the Eighth
Plan and during 90s efforts need be directed
towards improving the quality of care and as­
493

sist men and women to choose appropriate
contraceptives from those currently available.
Therefore, more stress is being laid on opera­
tion research for improving the performance
of Family Welfare Programme. In order to
ensure that quality control in products utilised
in the programme, a National Centre for Tech­
nological Evaluation of IUDs and Tubal
Rings has been set up at IIT, New Delhi.

Monitoring of Family Planning Services
Review of Annual Plan 1994-95

18.109 In order to conduct research on vari­
ous socio-economic, demographic and com­
munication aspects of population and
Family Welfare Programme, 18 Population
Research Centres are at present functioning
in various parts of the country’. These are
located in universities and institutions of na­
tional repute. The Centres are provided with
100% grant-in-aid by the Centre. For quick

I

evaluation of the family planning pro­
gramme, the Dcptt. of Family Welfare has
constituted regional evaluation teams which
carry out regular verification and validate ac­
ceptance of various contraceptives. Planning
Commission has suggested, that the Depart­
ment may explore the feasibility whether
these evaluation teams can be used to obtain
vital data on failure rates, continuation rates
and complications associated with different
family planning methods.

since 1981. Currently, more than three lakh
Vifiagc’Hcalth Guides are available in the
country.

18.110 The Office of the Registrar General
of India works out the annual estimates of
crude birth rate, crude death rate and infant
mortality rate through their scheme of
Sample Registration System. The system
provides an independent check / evaluation
impact of the Family Welfare proof the
gramme in the country. Besides, the decennial
growth rate as estimated by the office of the
Registrar General of India on the basis of the
census also provides indirect evaluation of
impact of the Family Welfare programme.

Funding

Involvement of Non-Government Organi­
sations and Voluntary Organisation for
Promotion of Family Welfare
Review of Annua! Plan 1994-95

18.111 The Ministry of Health & Family Wel­
fare has initiated several programmes involv­
ing NGOs in efforts to improve Family
Welfare Programme. These include:
(>)

revamping of Mini Family Welfare Cen­
tre where couple protection rates are be­
low 35%

(ii)

involvement of ISM & H practitioners

(i«i) area specific 1EC activities through
NGOs

(iv) establishment of State Standing Commit­
tees for Voluntary- Action (SCOVA) to
fund NGO projects promptly
(v)

identification of Govt/ NGO organisa­
tions for training of NGOs in project for­
mulation , programme management and
monitoring.

i

Village Health Guide Scheme
Review of Annual Plan 1994-95

18.112
The Vil lage Health Guide
Schcme(VHG) w as slarted jiL_197.7_ for the
purpose of providing primary healthcare and
health education in villages. The DcptofFam­
ily Welfare took up the funding of the scheme
494

Annual Plan 1995-96
18.113 The scheme is being revamped taking
into account the lessons learnt from the past
experiences so that VHGs can play an effective
role in improving communiiy^participaUQn
and effective utilisation of the Health and Fam­
ily Welfare services.

18 114
Realising the urgent need to build
up the primary health care network in order to
reach the services to the vulnerable group of
women and children underserved rural, remote
regions of the country. Family Welfare Programme has been providing funding for estab­
lishment of PHCs and CHCs under MNP. -The
Externally Aided Area Projects also provide
funds for establishment of physical infrastruc­
ture for primary health care, inservice training
and orientation of existing personnel.The Social Safety' Net Scheme provided funds for
establishment of First Referral Units and de­
livery' rooms in an attempt to improve intrapar­
tum care. In spite of all these efforts, the
progress has been tardy in several States and
the achievementSLwell below- the set targets
(Table 18.1)
18.115 There has been a serious concern that
funds earmarked under MNP for creating pri­
mary health care infrastructure has been un­
derutilised. The utilisation of funds under
MNP was worse in the poorly performing
States where primary health care infrastructure
is weak and require urgent improvement.
There had been time and cost overruns in Area
Projects as well as bilateral Externally Aided
Projects in many States.

18.116 Realising the critical role of ANMS
in providing MCH/FP Care the centre has
provided funding for creation of this post in all
Slates. As a result the number of ANM Course
sanctioned and in position fulfils the norms
suggested. However, for the male multipurpose worker, a substantial number of posts are
yet to be sanctioned by the States. There are
also vacancies in the Specialistjiosts at CHCs
(Table 18.2) which have seriously hampered
the establishment of first referral unit to take
care of the emergencies especially during in­
trapartum and nco-natal period.

i*’

Table. 18.9
Scheme-wise Family Welfare Outlay (1995-96)

■t 3<

(Rs. Crore)
No.

1.
2.
3.

r-

Scheme

Outlay for 1995-96

Services & Supplies
Training

755.55
28.22
33.50

Information, Education and
Communication
4.< Research and Evaluation
5.
Maternal and Child Health
6.
Organisation
7.
Village Health Guide Scheme
8.
Area Projects
9.
UP Projects
10. Other Schemes/ New Initiatives

16.72
220.10
11.61
10.00
250.00
30.00
84.30
141.00

11. Arrears
Total

1581.00

18.117
The National Family Welfare Pro­
gramme is a 100% centrally sponsored pro­
gramme. Even' year the problem of arrear
payable to the State Government is an impor­
tant issue in Annual Plan discussion and in­
variably substantial funds are earmarked for
this purpose. The arrears accumulate because
of the increase in maintenance cost of the
various health centres as well as cost of deliv­
ery of services. The reimbursement has to be
made to the States as per the norms Fixed.
There is an urgent need to revise these nonns
in order to check the accumulation of arrears
payable to the States.

Family Welfare Programme Outlay for
1995-96

18.118
The entire outlay under the Family
Welfare Programme continues to be Plan Out­
lay since the beginning of the programme. For
1995-96 an outlay of Rs. 1581 crore has been
approved representing an increase of 10.5
% over 1994-95 approved outlay. The
scheme-wise breakup of the outlay is given in
Table 18.9.

Externally Aided Projects

18.119 Funds are being provided for Family
Welfare Programme from United Nations
Agencies, bilateral and multilateral donors.
A statement of ongoing projects, their cost
and budgetan' requirement is given in Annexure 18.6.
Areas of concern

Small but perceptible fall in the total
number of sterilisation

Continued progressive decline in number
of vasectomies.
Fall in offtake of OP and CC through
social marketing outlets

Shortfall in 100% coverage of infants
under vaccine preventable diseases.

Occasional slip-up in the quality of
immunization services
Poor coverage of pregnant women

Inadequacy of ante-natal, intra-natal and
neo-natal services.

495

I

Amexure

18.1

OJTLAY FCR HEALTH IN THE CENTRAL SECTOR

(Rs.in Crore)

i

PROGRAM€/SCHE)€

I

Sth
PLAN
OUTLAY

1992-95
OUTLAY ACTUAL
EXFDR.

1993-94
ACTUAL
OUTLAY
EXPDR.

(2)

(3)

(5)

(1)

(4)

(6)

1994-95
1995-96
ANTCIPTD. OUTLAY

OUTLAY

EXPDR.
(7)

(8)

(9)

A.CENTRAL SCHMS

I
i

0.10

0.10

0.40

7.00

7.60

9.60

10.45

31.70

20.29
30.34

19.10
26.00

20.92
33.08

17.15
34.55

25.55

28.00

29.00

28.00

30.00

28.70

38.65
10.50
13.28

76.31
13.58
7.57

68.60
21.00
19.11

81.39
14.67

73.25
21.00
27.70

85.62
24.40
25.83

91.36
23.29
39.20

744.00

114.50

187.22

202.55

198.79

202.75

229.55

245.00

425.00

65.00

98.05

110.00

110.54

110.00

167.73

139.00

85.00
140.00
100.00

13.50
24.00
13.50

27.01
33.99
17.59

35.00
35.00
25.00

17.19
50.94
18.81

46.00
94.00
40.00

46.00
94.00
40.00

50.00
80.00
72.00

280.00

70.00

29.71
0.72

73.00
0.50

33.06
0.50

82.55
0.50

71.21
0.50

80.00
0.30

I. RURAL HEALTH
II. CONTROL OF COHJNICABLE

1.00

0.40

0.40

0.40

DISEASES
III. CCNTROL/CCNTAIIMENT OF
NCN-CCM4JNICABLE DISEASES
IV. HOSPITALS AND DISPENSARIES
V. IMMAN COUNCIL OF MEDICAL
RESEARCH 3

14.75

3.82

4.71

7.56

85.00
94.00

11.90
15.95

24.91
34.19

26.18

125.00

20.00

VI11.OTHER PROGRAMMES

266.50
83.00
74.75

SUB-TOTAL A(CENTRAL SCHEMES)

VI .MEDICAL EDUCATION AM)
RESEARCH (EXCLUDING I OR)
VII.ISM AM) HCMOECPATHY

16.10

B. CENTRALLY SPCNSCRED SCHEMES
I.CONTROL OF COMJNICABLE
DISEASES
1 .MORIA CONTROL (INCLUDING
XALA AZAR,FILARIA & JE CONTROL)

2. T.B.CONTROL

3. LEPROSY CONTROL
4. CONTROL OF BLINDNESS
5. NATIONAL AIDS CONTROL
PROGRAMME (INCLUDING STD AM)
BLOD SAFETY MEASURES)
6. GUINEA WARM ERADICATION
7. PLAGUE CONTROL PROGRAMME

1.00

18.00

1031.00

186.00

207.05

278.50

231.04

373.05

437.44

421.30

5.00
20.00

0.50
1.00

1.84

0.25
2.00

1.50

0.20
2.00

0.30
2.00

0.20
3.50

SUB-TOTAL B (CENTRALLY
SPONSORS) SCHEMES)

1056.00

187.50

208.89

280.75

232.54

375.25

439.64

425.00

GRAM) TOTAL (A*B)

1800.00

302.00

395.11

483.30

431.33

578.00

669.19

670.00

SUB-TOTAL B.I
Il .ISM & HCMCECPATHY
III.OTIER PROGRAMME

3 - EXCLUSI\E OF MOS PRCVID®
UNDER FM1ILY 1CLFARE

496

Amexure - 18.2
OUTLAY FOR HEALTH IN THE STATES & UNION TERRITCRTES

(Rs. Lakh)

OUTLAY

STATES
(1)
1 ANDHRA PRADESH
2 MLNACHAL PRADESH
3 ASSM
4 BIHAR
5 GOA
6 GUJARAT
7 HARYANA
8 HIMACHAL PRADESH
9 J*HJ & KASfflIR
10 KARNATAKA
11 KERALA
12 MADHYA PRADESH
13 WLHARASHTRA
14 MANIPUR

IEALTH
(2)

HEALTH
(3)

67687.00
5900.00
24200.00
17611.00

12100.00
17990.00

4800.00
7500.00

34200.00 13050.00
12000.00 2297.00
30087.00 15000.00
55326.00 28100.00
2100.00 1015.00
4000.00 1800.00
2550.00 1500.00
5000.00
640.00
22323.00 7800.00
25475.00 8000.00

15 MEGHALAYA
16 MIZORAM
17 NAGALAM)
18 ORISSA
19 PUNJAB
20 RAJASTHAN
21 SIKKIM

39095.00 15000.00
5220.00 1345.00

22 TMILNADU
23 TRIPURA
24 UTTAR PRADESH
25 NEST BENGAL
TOTAL STATES

26600.00 6500,00
5000.00 2000.00
51757.00 26000.00
28100.00 12178.00
531404.00 222734.00

UNION TERRITORIES
1 A & N ISLWDS
2 OWDIGARH
3 0 & N HA\ELI
4 DAMAN & DIU
5 DELHI

6 LAKSHADLEEP
7 PONDICHERRY
TOTAL UTs
GRAM) TOTAL
(STATES & UTs)

2251.00
6682.00
280.00
240.00
35000.00
362.00
2000.00
46815.00

EXPEJCITURE

OUTLAY

5360.00
1250.00
8100.00
35722.00
1222.00
11787.00
6768.00

18532.00
2802.00
15949.00

ACTUAL

1992-93

Sth PLAN

945.00
75.00
104.00
100.00
0.00
180.00
900.00
2304.00

578219.00 225038.00

(4)

WP
C5)

HEALTH
(6)

1995-94
OUTLAY

HP
(7)

1400.00 700.00 2210.00 753.28
595.00 273.00 565.00 259.35
3700.00 1620.00 3866.00 1620.00
11431.00 5715.00 4619.00 2919.00
1150.00 252.00 1012.00 160.24
4093.00 1650.00 4267.00 1492.12
2431.00 981.00 2061.00 aM.47
2200.00 932.00 2359.00 997.70
3201.00 1499.00 3242.00 1373.18
5646.00 2280.00 5030.00 2671.55
2200.00 660.00 1491.00 219.74
7578.00 3000.00 5348.00 1762.90
8367.00 fOOO.OO 7185.00 3627.32
415.00 210.00 423.00 135.44

HEALTH
(8)
2759.40
695.00

3920.00
12014.00
1232.00
4132.00
2591.70
2460.00
3602.00
11242.00
2450.00
7644.00
10604.00
545.00
1079.00
720.00
1197.00
3040.00
4600.00
5621.00
1375.00

790.00 400.00 857.00 554.34
580.00 300.00 580.00 300.00
1140.00 120.00 506.00
70.00
3020.00 1200.00 2297.00 681.38
6000.00 1335.00 2511.00 608.47
4457.00 2040.00 4346.00 2040.49
1340.00 345.00 629.00 106.10
6509.00 402.00 8035.00 1380.00
850.00 424.00 703.00
705.00 348.00
9058.00 4035.00 8547.00 4242.71
4112.50 2245.00 779.00 400.00
92263.50 38598.00 73468.00 29556.78

7158.00
880.00
9833.00
2906.00
104300.10

216.00 436.23 252.18
27.00 600.81
46.75
24.15
57.67
12.70
25.00
40.60
69.13
0.00 6600.82
0.00
24.%
70.90
35.00
76.29
450.00 178.00 475.18 147.70
8267.15 505.15 8316.13 524.09
100530.65 39103.15 81784.13 30081.67

574.35
1072.00
66.00
63.00
7209.00
81.94
550.00
9516.29
113916.39

314.00
825.00
57.25
50.00
6500.00

Revised approval letter not issued
ReccrrrTBrdad ty the Working Grap

497

MP
(9)
800.00
309.00
1620.00
6711.00
232.00
1660.00
925.00
975.00
1560.00
3517.00
506.00
2808.00
4741.00
60.00
483.00
200.00
100.00
1207.00
601.00
2400.00
245.00
2448.00
450.00
3924.00
1292.00
39764.00

240.00
55.00
24.75
41.00
0.00
35.55
207.00
603.30
40367.30

I

Nrvexire 18.2 (Ccncld.)
OUTLAY FOR HEALTH IN THE STATES & UNION TERRITCRTES

(Rs. Lakh)

1993-94

1995-%

1994-95

ACTUAL EXPENDR.

OUTLAY

OUTLAY

Anticipated.Expdr.

R.E.

STATES

HEALTH

MP

HEALTH

MP

HEALTH

MP

«ALTH

MP

HEALTH

MP

(1)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

1 ANDHRA PRADESH

2686.00

761.83

3259.40

800.00

3259.40

750.00

3259.40

750.00)

4100.00 1029.00

339.00

776.00

346.05i

109.00

1871.00)

9%. 001

2 ARUNACHAL PRADESH

626.00

279.14

773.00

346.05

774.00

448.00

3 ASSAM

4253.00

1890.00

4938.00

1890.00

4500.00

4 BIHAR

2370.00 1818.82 12014.00 2700.00

3900.00

9%.00

3900.00

5 GOA

1151.00

184.60

1253.00

232.00

1152.00

189.00

1152.00

162.00)

6550.00 2048.00
12014.00 2700.00
1309.00 170.00

6 GUJARAT

4402.00

1748.17

4841.00

1718.00

4841.00

1718.00

4841.00

1659.00)

6800.00 2160.00 **

7 HARYANA

2224.00
2432.00

811.47

2547.00

900.00

2446.65

900.00

2446.65

900.00I

3020.00 1063.00

967.70

2875.00

1257.00

3473.00 1344.00

3185.00

1286.85i

3479.00 1400.00

8 HIMACHAL PRADESH

1649.00

4520.00

3627.00 1574 97
6990.00 3^45.00

3876.00 1662.00
10771.00 3438.00

4257.44

8776.00 3438.00

4318.56 1^85.i
10674.00 3414.49»'

11 KERALA

1738.00

3100.00

506.00

3160.00

3100.00

12 MADHYA PRADESH

6261.00 2277.78

7000.00 3921.13

6760.53 2403.48!

7700.00 2919.00

13 MAHARASHTRA

9379.00 4440.99 10140.00 3566.00 10140.00 4884.00
225.00
441.00 166.49
485.00
225.00
485.00
879.00 535.00
759.00 483.00 1079.00 500.00
720.00 328.00
681.00 273.80
770.00 454.68
465.34
95.00
72.00
1053.00
175.00
860.00
2318.00 804.97 3940.00 1489.47 2912.25 909.57
2521.00 717.00 4302.00 1000.00 4009.28 854.08
4900.00 2173.00 7191.00 2950.00 7648.00 32%.00
1351.00 111.55 1337.50 250.00 1349.50 101.00
7259.00 2554.89 8210.00 2679.00 8210.00 2679.00

9998.99 4883.85i

13939.00 66%.97

9 JAMU & KASHMIR
10 KARNATAKA

14 MANIPUR

L'

15 MEGHALAYA

16 MIZCRAM

17 NAGALAND
18 CRISSA

19 PUNJAB
20 RAJASTHAN

21 SIKKIM
22 TAMILNADU

461.00

8450.00 3350.00

23 TRIPURA

810.00

450.00
450.00

24 UTTAR PRADESH

7778.00

3492.23 11095.00

2749.00

800.00

25 WEST BENGAL

TOTAL STATES
II 3^0

900.00

450.00

900.00

1662.00
0.00

450.00

4295.00 10115.00 3976.00

3163.90
3163.90 1107.00
1107.00

29%.90

600.08

80655.0CX32520.28 111895.80 37813.52 98768.76 36025.58
i|
. ............ Lt7.:£

466.00I

4%4.00 1946.00
11472.00 > 3638.00 -> /610 ZV-lltl

3900.00

675.00

485.00

225.00)

678.00

231.50

879.00

535.00I

1331.00

%6.00

681.30

303.82!

787.00

400.00

1053.00

174.68J

2023.00

175.00

3122.16

1098.65

3769.00

1293.00

4302.00

962.50

4600.00

1100.00

8361.26 3700.00

14153.00 82%.00

1337.50

101.00

1258.00

8843.85

2934.20

9244.00 3014.00

900.00

450.00

12616.69 5140.06
3182.90 1325.00
104676.79 37807.48

4

1200.00

170.00

460.00

12998.00 5361.00

3330.00

I

<

995.00

135687.00 49336.47

UNION TERRITORIES

38.10

111.80

45.00

109.47

54.97

100.00

50.00

9120.00

0.00

10055.00

0.00

100.00

48.32

122.00

39.35

172.%

1245.00

214.00

747.35

14702.64

797.91

211.00

656.00

175.00

686.00

597.04 12252.65 MX. 32 12252.65 768.32
89858.12 33117.32 124148.45 38617.84 111021.41 36793.90

12209.97

800.00

90.00

1387.50

3 D & N HAVELI

92.67

10.75

88.40

38.00

88.40

4 DAMAN & DIU

111.02

77.90

70.75

45.00

70.75

5 DELHI

6687.02

0.00

9120.00

0.00

90.93

43.66

100.00

534.00

145.%

686.00

(STATES & UTs)

119.56

88.00

48.32 *

372.00

1387.50

gram; total

330.00

2CX3.84

100.00

800.00

55.00

TOTAL UTs

1025.00

108.00

48.32

263.77

7 PONDICHERRY

325.00

9120.00

557.07
1130.41

6 LAKSHADWEEP

719.00
1387.50

372.00 *
90.00 *
38.00 *
45.00 *
0.00 *

1 A & N ISLANDS

2 CHAMJIGARH

9203.12

116886.76 38554.83

150389.64 50134.38

I

I

b'

498

Annexure 18.3

I
1% Allocation of Central Assistance under Gadgil
Mukherjee Formula to non-Special Category States

(Rs. Crore)

Non-Special Category States

Annual Plan

i

1.
2.
3.

i

4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

1994-95

1995-96

Andhra Pradesh
Bihar
Goa
Gujarat
Haryana
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal

3.96
5.66
6.80
4.00
6.36
4.11
6.80
2.11
5.64
3.02
4.32
4.09
5-69
5.50
3.94

6.50
2.03
8.29
4.15
3.61
5.72
8.29
5.85
7.00
5.88
6.49
2.31
8.29
2.01
7.93

Total

72.00

84.35

f

( Source: FR Division, Planning Commission )

i

i

499

Amexure 18.4

Selected Indicators For Major States

States

1993-94
<n

CutI ay

Expenditure

C8R

CPR

IFR

Life Expectancy

(Rs.Crores)

— (1995)

1

India

Health

MF

Health

2

3

4

113501.05 40367.70

(1993) March'94

(1986-90)

(Provisional)

MF

6

7

8

9

89858.12 33117.32

28.7

74

45.4

57.70

MAJOR STATES
Anchra Pradesh

2759.40

800.00

2686.00

761.83

24.3

64

48.2

59.10

Assam

3920.00 1620.00

4253.00

1649.00

29.5

81

23.6

53.60

Bihar

12014.00 6711.00

2370.00

1818.82

32.0

70

24.1

54.90

Gujarat

4132.00 1650.00

4402.00

1748.17

28.0

58

58.2

57.70

Haryana

2591.71

925.00

2224.00

811.47

30.9

66

54.9

62.20

Himachal Pradesh

2460.00

975.00

2432.00

987.70

26.7

63
JI

56.5

62.80

.11 -- / 02

Karnataka

11242.00 3517.00

6990.00

3245.00

25.5

67

50.3

61.10

Kerala

2450.00

506.00

1738.00

461.00

17.4

13

51.5

6».5O

Machya Pradesh

7644.00 2808.00

6261.00

2277.78

34.9

106

43.1

53.10

Maharashtra

10604.00 4741.00

9379.00

4440.79

25.2

50

54.0

62.60

Qriaaa

3040.00 1207.00

2318.00

804.97

27.2

110

39.0

54.40

Punjab

4600.00

601.00

2521.00

717.00

26.3

55

77.4

65.20

Rajasthan

5621.00 2400.00

4900.00

2173.00

35.1

82

30.3

55.20

Tawil Nadi

7158.00 2448.00

7259.00

2554.89

19.5

56

54.9

60.50

Uttar Pradesh

9833.00 3924.00

7778.00

3492.23

36.2

94

36.5

53.40

West Bengal

2906.00 1292.00

2749.00

800.00

25.7

58

34.9

60.80

Relate to the year 1990

500

> '?

Annexure 18.5

1.

STATE WISE OUTLAY AND EXPEND I TUBE.UNDER FAMILY WELFARE PROGRAMME

(Rs. Lakh )

1992-93

1994-95

1995-96

EXPENDITURE

OUTLAY

OUTLAY

9139.67
67.90
2299.50
7435.86
100.06
6057.38
2800.81
2188.34
1295.31
4^15754/

6412.87
153.17
2036.79

5686.59
138.76
4169.49

6999.29

‘6890.98

125.66
4090.20
1729.21
881.67
2788.68
3624.74
2231.23
5745.48
5979.41
351.80
248.97
170.90
217.94
4521.42
2619.43
3716.58
203.08
5125.47
302.66
16228.41
4761.27

133.91
3477.35
1375.84
922.25
99?.62
64h2.55
2402.52
5356.93
6048.42
390.08
265.28
187.99
209.65
2900.31
1785.82
6294.46
236.86
3976.78
326.65
13721.94
6561.74

1993-94

STATES
OUTLAY
1 ANDHRA PRADESH
2 ARUNACHAL PRADESH
3 ASSAM
.....
4 BIHAR
5 GOA
6 GUJARAT
7 HARYANA
8 HIMACHAL PRADESH
9 JAMMU & KASHMIR
10 KARNATAKA .
11 KERALA
12 MADHYA PRADESH
13 MAHARASHTRA
14 MANIPUR
15 MEGHALAYA
16 MIZORAM
17 NAGALAND
18 ORISSA
19 PUNJAB
20 RAJASTHAN
21 SIKKIM ■
22 TAMILNADU
23 TRIPURA
23 UTTAR PRADESH
25 WEST BENGAL

5445.33
7316.54
147.48
58.09
2251.73
1754.64
4800.15 ^6914.11
125.19
94.77
3386.66
4942.94
1520.05
2322.01
993.11- 1364.48
1137.92
1222.58
4*^8.06
3094.07
2493.69
3100.44
5201.07
6325.25
6491.20
8367.25
373.48
478.49
254.10
234.41
152.01
159.91
217.48
229.21
3196.64
3486.35
1841.37
3247.65
3762.22
5002.37
131.41
190.37
4441.96
7221.54
299.30
556.94
12838.90 14526.10
4895.05
5841.06

UNION TERRITORIES
1 ANDAMAN & NICOBAR I
70.15
2 CHANDIGARH
103.25
3 DADRA & NAGAR HAVEL
20.10
4 DAMAN & DIU
13.30
5 DELHI
619.10
6 LAKSHADWEEP
7.35
7 PONDICHERRY
63.10
TOTAL
70387.92
OTHERS(CENT. SECT./ 29612.08
COST OF SUPPLIES)
ARREARS PAID TO STATES
GRAND TOTAL

EXPENDITURE OUTLAY

5550.30
157.16
2127.81
5188.59
122.84
3740.57
1531.18
1409.82
1003.36
3333.15
2347.72
6575.01
6824.49
368.69
257.31
166.88
213.89
2824.57
1915.42
5037.44
173.59
4530.30
316.83
16506.92
5349.45

3815.43
8155.46
9510.43

347.96
275.38
167.35
256.58
2465.07
3553.01
5439.35
266.25
4790.10
340.21
19945.65
6317.42

72.94
102.15
14.01
13.71
299.68
3.00
61.33
89682.38
19357.62

77.14
65.10
115.75
122.62
:21.80
18.73
18.52
37.53
675.10
816.55
5.67
8.22
78.80
68.00
78545.78 102703.06
48546.22 28559.22

10000.00

21000.00

76.41
70.90
155.75
138.25
24.00
24.72
21.25' v 25.51
1173.00
9.30
80.00
82783.03
60227.00

1518.07
10.65
88.01
82834.89
61165.11 *
14100.00 **

100000.00 119040.00 127092.00 152262.28 143010.03 158100.00
(104100.00)
(142357.00)
(153800.00)
FIGURES IN BRACKETS ARE REVISED ESTIMATE
** PROVISION MADE FOR ARREARS

501

*

Amexure 18.6

Foceicri Assistance Routed Through Budget: ANNUAL PLAN (1995-96)

(Rs. in Crore)
SI. None of the
No. Project

(2)

1.

Foreign
Aid
Sources

(3)

Total
Eighth Plan
Foreign
Aid
Foreign Local

Coiporent

Cost

(5)

(6)

(4)

1992-93 (Actual)
Total

(7)

Foreign Local
Ccnpo- Cost
nent

Total

(9)

(10)

(8)

6.22

6.70

0.00

6.70

0.78

0.00

0.78

LNFP/ii
Family Welfare
7.22
Prog, througfi
Ministry of Labour
3. Child Survival 4 World Bank/ 1125.58
Safe Motherhocd UNICEF

8.00

0.00

8.00

1.20

0.00

1.20

506.70

126.60

633.30

85.00

15.00

100.00

81.84

0.80

0.00

0.80

0.00

0.00

0.00

World Bank/ 1409.97
UNFPA/CDA/
DANIOA/FRG/
Eurcpeen
Ccnni.nity
USAID
$325m

320.00

80.00

400.00

58.16

15.50

73.66

0.00

0.00

0.00

1.00

0.00

1.00

S199,980
0.59

0.80

0.00

0.80

0.00

0.00

0.00

4.46

0.00

0.00

0.00

0.00

0.00

0.00

15.50

0.00

0.00

0.00

0.00

0.00

0.00

206.60 1049.60

146.14

30.50

176.64

1. Provision of
Recanalisation

UNFPA

2.

Project
4. Monitoring and
Sirveillarce

5. Area Projects

6.

Imcvaticns in
fani ly pl ami ng

UNFPA

services project
for Uttar Pradesh
7. New ICCM?
law
Project
UNFPA
NEW SCHBCS

8. Training of Mo- UNFPA
Scalpel Vasectony
9. New Organised'
UNFPA
Sector Project

Total

843.00

502

s

Amexure 18.6 (Ccncld.)

Foreign Assistance Routed Through Budget: ANNUAL PLAN (1995-96)

(Rs. in Crore)

i
i)

Si. Name of the
No. Project

Foreign

1993-94

(Actual)

1994-95

Sources

Foreign Local
Ccrco-

Total

Foreign Local

Cost

Corpo-

nent

1.

(Anticipated)

1995-96 (Anticipated)

Aid

(2)

(3)

1. Prevision of

(11)

Total

Cost

nent

(12)

(14)

(13)

Foreiyi Local
Corpo-

Total

Cost

nent

(15)

(16)

(17)

(18)

(19)

UNFPA

0.05

0.00

0.05

0.14

0.00

0.14

0.50

0.00

0.50

UNFPA

1.10

0.00

1.10

1.20

0.00

1.20

1.20

0.00

1.20

115.82

26.95

142.77

210.00

40.00

250.00

180.00

40.00

220.00

0.00

0.00

0.00

0.00

0.00

0.00

0.10

0.00

0.10

119.08

30.00

149.08

200.00

50.00

250.00

200.00

50.00

250.00

USAID

6.00

0.00

6.00

30.00

0.00

30.00

30.00

0.00

30.00

New ICOP

ICCHP/

0.00

0.00

0.00

0.05

0.00

0.05

0.20

0.00

0.20

Project

UNFPA

0.00

0.00

0.00

0.00

0.00

0.00

0.45

0.00

0.45

0.00

0.00

0.00

0.00

0.00

0.00

0.50

0.00

0.50

242.05

56.95

299.00

441.39

90.00

531.39

412.95

90.00

502.95

Recanalisaticn

i

2.

Fanily Welfare
Prog, through

Ministry of Latour
3.

Child Survival & World Barit/
Safe Motherhood

UNICEF

Project

4.

Monitoring and

UNFPA

Surveillance

5.

Area Projects

World Bait/
UNFPA/CDA/

DANIDA/FRG/
European

Cananity
6.

Irrwatiers in

family pl ami ng
services project

for Uttar Pradesh
7.

NEW SCHEFES

8.

9.

Training of No­ UNFPA
Scalpel Vasectomy
New Organised
UNFPA
Sector Project
Total

503
f

i

■

i

t£

v:

■

M

x - v-’:

.a.-io’

-it

iiicX

•-Z- •'

r.

•7:.

.•V ■

.•'.’J

>{■

1

.

( 1' ' '

I

CHAPTER 12

HEALTH AND FAMILY WELFARE
12.1.1 Health of the people is not only a desir­
able goal but is also an essential investment in
human resources. The National Health Policy
(1983) reiterated India's commitment to attain
"Health for All (HFA) by 2000 A.D". Primary
health care has been accepted as the main instru­
ment for achieving this goal. Accordingly, a
vast network of institutions at primary, secon­
dary and tertiary levels have been established.
Control of communicable diseases through na­
tional programmes and development of trained
health manpower have received special atten­
tion.
12.1.2 Many spectacular successes have been
achieved in the country in the area of health.
Small-pox stands eradicated and plague is no
longer a problem. Morbidity md mortality on
account of malaria, cholera and various other
diseases have declined. The Crude Birth Rate
and Infant Mortality Rate (IMR) have declined
to 29.9 and 80 (1990 SRS data) as compared to
37 and 129 respectively in 1971. JLife expec­
tancy has risen from a mere 32 years in 1947 to
58 years in 1990. However, HFA is a long way
off. Disease, disability and deaths on account
of several communicable diseases are still unac­
ceptably high. Meanwhile, several non-com­
municable diseases have emerged as new public
health problems. Rural health services for de­
livery of primary health caie are still not foUy
operationalised. Urban health services, particu­
larly for urban slums, require urgent attention
due to changing urban morphology.

■-

Programme Thrusts in the Eighth Plan
12.2.1 It is towards human development that
health and population control are listed as two
of the six priority objectives of this Plan. Health
facilities must reach the entire population by the
end of the Eighth Plan. The Health for All
(HFA) paradigm must take into account not only
high risk vulnerable groups, i.e., mothers and
children, but must also focus sharply on the
underpriviledged segments within the vulnerable
groups. Within the HFA strategy "Health for
undsrpriviledged" will be promoted consciously
and consistently. This can only be done through
emphasising the community based systems re-

fleeted in our planning of infrastructure, with
about 30,000 population as the basic unit for
primary health care.

Minimum Needs Programme (MNP)

Rural Health Programme
12.2.2 Development and strengthening of rural
health infrastructure through a three tier system
of Sub-centres, Primary Health Centres (PHCs)
and Community Health Centres (CHCs) for
delivery of health and family welfare services to
the rural community was continued during the
Seventh Han. But, lack of buildings, shortage of manpower and
inadequate provision of
drugs, supplies and equipments constituted ma­
jor impediments to full operaticnalisafion of
these units.
12.2.3 The achievements and the present situ­
ation for healfo infrastructure under the MNP
and availability of building and manpower are
given in Annexures 12.1, 12.2 and 12.3.

12.2.4 The approach and strategy for rural
health during the Eighth Plan would be:-

i) Consolidation and operationalisation, rather
than major expansion, of the network of
Sub-centres, PHCs and CHCs
so that
their performance is optimised. This
would be achieved through (a) strengthening of physical facilities including
completion of building of the centres and
staff quarters ;
(b) provision of essential equipments as per the
standard list;

(c) filling up of all vacant posts within a defined
time frame and in-service training of staff;
(d) ensuring supply of essential drugs, dress­
ings and other material.
ii) To monitor the progress of implementation
of MNP at the District, State and National

322

JI
I

health programme and providing supervi­
sion and support to primary health care
infrastructure.

levels, a health information management
system will be developed and used.

-

iii) The targets regarding setting up of Sub-centre, PHC and CHC on the basis of popula­
tion norm are indicative only. The States
will be given flexibility in establishing
these units as per the local needs depending
on geographical and population considera­
tions, resources, manpower availability,
etc. In opening new centres the needs of
tribal population and communities living in
difficult and inaccessible areas will be
given first priority.

vii) Linkages will be developed with the subdivisional and district hospital to provide
referral back-up.
Urban Health Services
12.2.5 More than one quarter of the popula­
tion in the country now lives in urban areas. In
metropolitan and large cities about
the urban dwellers are estimated to be living in
JJ I
slum areas where the health status of the people
is as bad as, if not worse than, in rural areas,
But infrastructure for primary health care in* “
'
j
urban areas hardly exists. Serious attempts will
be made to develop urban health services as per the recommendations of Krishnan Committee._
'
Organic linkages will be forged with the whan
development schemes including Urban Basic
Services for a comprehensive developmeM of , health and welfare semces. Local hospitals will
be made responsible to run these centres and
treat them as their extension counters for provid- i
ing health services to the community. VoluMary
organisations and local bodies would be encour­
aged to develop partnership and ultimately tak­
ing foil responsibility for carrying out *ese
programmes. Health system research to de­
velop a model of urban primary health care
services will be undertaken.

iv) The rural hospitals and dispensaries will be
suitably modified, equipped and staffed to
convert them into Sub-centres, PHC, CHC
as the case may be, thereby integrating
them into primary health care system.
v)

The backlog of Sub-centres, PHCs and
CHCs in many States is staggering and the
resources required to meet the targets are
astronomical and as such unachievable in
near future. In view of this the entire
policy of establishment of Sub-centre, PHC
and CHC with the present norms will be
reviewed and new policy options devel­
oped to make the primary health care ac­
cessible, acceptable and affordable to all.
Re-organisation of the Indian Systems of
Medicine and Homoeopathy (ISM&H) dispensaries/hospitals in rural areas to create
ISM&H health centres is one such option.
This would be in line with the Govern­
ment's accepted policy of promoting
ISM&H. Reorientation of existing person­
nel of these dispensaries/hospitals, provi­
sion of additional facilities and/or staff,
redefining the roles and responsibilities
would be some of the pre-requisites to put
the concept of ISM&H Primary Health
Centres and Sub-centres in an operational
mode.

Secondary and Tertiary Care Services
12 2 6 Alongwith the emphasis on consolidrtioD
of primary health care, the strengthau« of
secondary care services and optimisation of ter­
tiary care services would be the key objectives
of the Eighth Plan.

vi) Mechanism will be developed to make the
rural health services responsive to the
needs of the rural masses and accountable
to the community. Panchayati Raj system
would become an effective instrument for
eliciting community participation in the

12.2.7 The sub-divisional and district hospitals
which are the secondary level medical care
institutions, lack adequate manpower and focilities, to be able to discharge their responsibilities
satisfactorily. In view of the resource con­
straints, there is need for raising resources to
maintain the quality of care and meet rising
expectations of the people. It is time th* the
concept of free medical care is reviewed and
people are required to pay, even if partiaBy for
the services. The system can be so designed that
the truly indigent population are able to get
free/highly subsidised medical care. Iitoovative approaches/practices to this end and a sys-

'i'»Q

tem of medical audit will be developed during
the Plan. Maximum cost-effective utilisation of
existing services will be another item on the
agenda.

nurses against 4,00,000 registered medical
graduates. Similarly, there is a shortage of
pharmacists, laboratory technicians, radiographers, dental surgeons, etc., in the country.

12.2.8 In accordance with the new policy of the
Government to encourage private initiatives,
private hospitals/clinics will be supported sub­
ject to maintenance of minimum standard and
suitable returns for the tax incentives. Norms
for minimal facilities and accredition of private
hospitals/clinics would be developed to maintain
quality of patient care.

12.2.13 The National Health Policy affirmed
that the effective delivery of health care service*
would depend very largely on the nature of
education, training and appropriate orientation
towards community health of all categories of
medical and health personnel, h is, therefore,
of crucial importance that the entire basis and
approach towards manpower development in
terms of national needs and priorities are re­
viewed and training programmes restructured
accordingly. Besides there is an urgent need to
asess appropriate health manpower mix to de­
liver health services at primary, secondary and
tertiary level and for the purpose of training and
research.

12.2.9 The medical college hospitals and spe­
cialised hospitals have to be used exclusively as
tertiary care centres and for health manpower
development. Important pre-requisites for this
would be improvement in the facilities and
standards of care available at secondary care
level and development of strong referral system.

12.2.10 A conscious decision has to be taken to
enforce a balanced development of primary,
secondary and tertiary care services in the coun­
try with priority for primary health care. Oth­
erwise there is a distinct risk of the paradigm of
primary health care as a tool for "Health for All"
being overrun by the mechanism of "All for a
few’. This tendency and trend can be baited
only with scientific arguments for which sound
epidemiological, health management and health
financing data is needed and hence the need for
health systems research.

Health Man-power Development and
Training
12-2.11 As much as approximately Jwo thirds
of the total expenditure on health services is
spent on personnel. Yet, health manpower pfen­
ning, production and management, which con­
stitute key elements for effective implementation
of health programme, have not received enough
attention.

&

V

h

r'f

12.2.14 The approach and strategy for health
manpower development during the Eighth Plan
would be-

i)

A National Policy on Education in Health
Sciences which when formulated may form
the basis of new imtatives in manpower
development.

ii) The existing situation regarding health man­
power supply, demand and projection and
facilities for training of different categories
will be reviewed.

iii) Appropriate steps will be taken for bridging
the critical gaps in the manpower require­
ment for primary health care and the higher
levels and for training and research needs.
Starting vocational courses as part of vocationalisation of general education at the 42 level of the 10+2 system will be sup­
ported to expeditiously bridge the gap in the
supply of paramedical personnel.

12.2.12 While the States have been more than
anxious to.new medical collegr, their
iv) The distortions created in the past on account
efforts to develop institutions for training of
of over-emphasis on training of doctors,
para medical staff have been entirely suboptioften at the cost of other categories of
mal. This has resulted in a considerable mis­
personnel, and also the undue emphasis on
match between the requirement and availability
specialisation/super specialisation will be
of health personnel of different categories. Ide­
checked.
ally, the doctor- nurse ratio should be 1 : 3 but 1
currently there are less than 3,00,000 registered (

j

I

gruent with the needs of national health
programmes and primary health care.

v) Continuing education for all categories of
staff will be given high priority. For this,
district and regional level training institu­
tions will be suitably strengthened. Medi­
cal colleges and other institutions including
professional bodies like Indian Medical As­
sociation (IMA) will continue to play an
important role, in coordination with the
National Academy of Medical Sciences
(NAMS), which has been identified as the
nodal agency for this purpose.
j

i
i
e
5

Xi) Efforts for re-orientation of medical educa­
tion, started during the earlier plans, will
be pursued vigorously with emphasis on
faculty jdevelopment through workshops
for the teachers to make them conversant
with the health needs of the country, na­
tional policies and programmes, advances
in educational technology, and make them
appreciate the need for re-direction and
reuf^tting of medical edneation, relavent
vi) The existing facilities for traininfdtinedical Ito contemporary and futuristic needs.
graduates has outstepped the needs. No

new medical college or an increase in the Programmes for Control of Communicable
admission capacity of the existing colleges
will, therefore, be supported during the Diseases
12.2.15 A number of national programmes for
Eighth Plan. Instead, resources will be
eradication/control of communicable dis­
used
to
strengthen
the
hospitals,
eases have been initiated in the country
laboratories and libraries of the existing
since the early years of planning. Most of
medical colleges so that the standards of ,
the control/eradication programmes for
training are maintained.
communicable diseases have been in opera­
tion since last several plans at huge finan­
vii) For ensuring uniform standards of medical
cial cost. With a few exceptions, however,
and paraprofessional education, need for
no national level comprehensive reestablishment of universities of medical
view/evaluation of these programmes have
and health sciences at regional level has
been undertaken. During the Eighth Plan
been recognised. Necessary support will be
the following strategies will be followed for
provided as and when a policy decision in
control of communicable diseases the matter is taken.

viii) Statutory councito will be strengthened and
new councils for para-professionals, where
they are needed, will be created so that
standards of training and education can be
laid down and enforced. The proposed
Education Commission in Health Sciences
will promote and coordinate all educational
activities for all categories of health man­
power at all levels.

ix)

x)

Training facilities for epidemiology and
health management, the two disciplines
which contribute to the maximum extent to
efficient functioning of health services in­
cluding hospitals, will be augmented in
medical colleges and created in specialised
institutions where training of teachers can
be undertaken.
Training of doctors of ISM&H will also be
reviewed and re-oriented to make it con-

i) National level review of the ongoing con­

trol/eradication programme to assess the
current strategies and their impact on the

disease status..

ii) Ensuring sufficient supplies and logisic support including mobility for carrying out the
programmes.

iii) Establishment of q?idem iological- cum surveillance centresatdistrict/regioMl lev­
els and improvement ofhealth management
information system for continuous moni­
toring of the disease situation and taking
appropriate and prompt action .
iv) Intersectoral coordination will be strength­
ened with departments of public health
engineering, local bodies like municipali­
ties, Ministries of Information and Broad­
casting, Women and Child Welfare, Water

325
ii ii

-I'

.1!

Resources, etc., for control of vector borne
riand other diseases.

of all malaria cases and 60% of the more dan-,
gerous P.falciparum infections are in the tribal
areas, a major intensification of efforts would be
directed towards these areas.

v) The Information, Education and Communi­
cation (IEC) activities within each pro­
gramme would be given special attention
for enlisting community participation,
which constitutes one of the weakest links,
for carrying out the disease control pro­
grammes.

Kala-azar and Japanese Encephalitis
12.2.17 jCala-azar and Japanese Encephalitis
(JE) have emerged as major public health prob­
lems in recent years. For control of Kala-azar
the twin approach of (i) vector control by insec­
ticide spraying and (ii) case detection and treat­
ment at PHC and referral hospitals was adopted.
The reported cases and deaths due to JE in the
affected States viz. Andhra Pradesh, West Ben­
gal, U.P. Tamil Nadu and Assam have shown
considerable decline during the Seventh Plan
with the use of indigenously produced vaccine.

vi) Strategy of training of staff at horizontal
level, both within the primary health care
and higher level, is essential.
vii) Training in epidemiology is woefully inade­
quate in the country. Unless this situation
is rectified decisions regarding control of
communicable diseases and its implemen­
tation will be handled by the group of
professionals and para-professionals who
are not sufficiently equipped to do so with
i its attendant consequences. Specialised institutions/departments to carry out both
pre-service and in-service training in epi­
demiology for different category of staff
will be created and the existing ones
strengthened.

12.2.18 The existing guidelines for Vectorborne disease control include (i) Residual indoor spraying with appropriate
insecticide in areas with population having
API 2 and above in any of the last 3 yean.
(ii) Spraying of BHC in districts reporting 100
or more cases of JE in any one of the years
during the past decade.

Programme-wise strategies are briefly outlined
hereunder -

(iii) DDT spraying in PHCs reporting 10 or
more cases of Kala-azar in any one of the last
three years.

Vector Borne Diseases

Malaria Eradication
12.2.16 As a result of introduction of modified
plan of operation in 1976 the incidence of ma­
laria has come down from about 6.5 million
cases in 1976 to about 1.89 million cases in
1990. The problem of drug resistance of P.
falciparum malaria in several States is a cause
for concern. Several operational problems and
non-availability of matching funds from States
to this 50% Centrally Sponsored Scheme-(CSS)
has resulted in shortfalls in spray operations,
decline in blood slide collections and incomplete
treatment of cases. Irrigation projects without
adequate strategies for management of water
resources and floati ng labour population to cities
and major project sites has also contributed to
the increased incidence of malaria. Since 30%

(iv) Continuation of the anti-larval operations;
and.
(v)

Malathion fogging/ULV spraying to be
undertaken as a contingency measure in
out-break of JE and Malaria.

These conventional approaches of use of inceticides and chemicals would have to be supple­
mented or replaced, depending<pon the local
situation, by newer strategies such as biodegrad­
able inceticides, biocides, bioenvironmental im­
provement and preventive measures like
b
___________
_____
impregnated
bed nets._____
Finally, the surveillance
activities would need to be sirenghened so as to
improve case detection and case management,

Vifi

■>

I

i

resulting in a break in the chain of infection/
transmission.
Leprosy Eradication

•z
I
j

5

12.2.19 The approach under this 100% Cen­
trally Sponsored Scheme has been early case
detection and domiciliary treatment and health
education. Multi Drugs Therapy (MDT) has
been introduced in all 201 endemic districts and
41 low endemic districts (till March 1991) for
case treatment. The programme has shown
steady progress in achieving its objectives dur­
ing the Seventh Plan.
12.2.20 Within the Leprosy Eradication Pro­
gramme the following activities will be pursued

(i) Creation of additional physical facilities in
all the endemic districts.
(ii) Extention of MDT to remaining endemic
districts and in low endemic districts in
phases.
(iii) Training of the PHC staff in leprosy eradi­
cation activities, both in endemic and low
endemic districts, with the aim of preparing
them to take over the responsibility of
leprosy eradication activities following re­
duction in the ptevalance and incidence of
the disease.

(iv) Creation of vocational and rehabilitation
facilities for the patients declared cured in
those districts which have been under MDT
for more than 5 years.
Tuberculosis Control

12.2.21
Early case detection and treatment
have formed the strategy for control of Tuber­
culosis (TB) under a CSS with 50% Central
funding.
A major achievement of the pro­
gramme during the Seventh Plan was the suc­
cessful introduction of short course
chemo-therapy in 212 districts, thereby reducing
the treatment duration from 18-24 months to 6-8
months. However, the programme has suffered
from poorcgge holding leading to treatment
default^ Problem of drug resistance is yet an­
other cause for concern.

I

12.2.22 During the Eighth Plan, the TB Con­
trol Programme will be further expanded and
strengthened by opening District Tuberculosis
Centres (DTCs) in those districts where these do
not exist. Short course chemo-therapy will also
be introduced, and supply of drugs ensured, in
all the remaining (fistricts of the country under
the Programme. The DTCs will be strengthened
by providing necessary equipments like X-ray
machines and maintaining essential supplies like
drugs, X-ray films etc.

Blindness Control Program^
12.2.23 This programme which>w^s launched
in [1976hs a 100% CSS aims at reducing blind­
ness prevalence from 1.4% in 1980-81 to 0.3%
by 2000 AD. Cataract is the cause of more than
80% of blindness. Demographic shift leading to
larger old age population has increased the
prevalence of cataract in recent decades. So for
the main strategy has been to provide access to
opthalmk services through eye camps and mo­
bile units. While this has suceeded to some
extent, it has fallen short of the requirements.
Besides the inherent limitation of the camp ap­
proach, the magnitude of the problem demands
creationofpermanent ey^ care infrastructure,
operational throughout the year and within easy
reach of the people.
12.2.24 These initiatives will be combined
with an intensification of efforts aimed at oph­
thalmic manpower developmemt with the ulti­
mate objective of improving the outreach and
quality of ophthalmic care at primary, interme­
diate and tertiary levels.

Guinea Worm Eradication
12.2.25 This programme was launched during
1983-84 with the objective of achieving zero
incidence of guinea worm by 1990-91. Al­
though the estimated number of cases has come
down from 39,790 in 1983-84 to about 20,000
in 1990-91 the objective of "Zero Guinea worm"
still remains unachieved. Total eradication of
the disease through better surveillance system
and improvement of drinking water supply in the
endemic areas will be achieved during the Plan.
AIDS Control Programme

12.2.26
Acquired Immuno Deficiency Syn­
drome (AIDS) has emerged as a new public
health problem in the country. The AIDS Con­
trol Programme was launched in 1986. as a

I ‘ uoijuoAAJd Xjriuuj sfBjidsoq jofeui jaqio
pus sa9a||oo (Boipoui oqi jb pouaqd?uajjs joqpnj
sq pjnoM jooubo joj soijijiobj iuoiuiboji pus
.( -3 -fl "C^>
0<|SOu3Bfp oqj UB|d qiqSta
3uun<] Zt‘Z'Z\
•ub|j q)U0A0$ oqi 3uunp siSBqdaio jo snooj
oqj SBAA OUO )SB| Oqj, O[BOS |BUOI)8U B UO SOI)
-yioBj iuoujjboj) jo SunioqjSuoJis pus uoisuojxo
(Hl pnw l^ZAJOO OUUOjn JO JO0UB0 JO UOyQOA
-aid XjBpuooos (n Ijooubo po)B|OJ -oooBqoj jo

*r

■

uoyuoAOJd XjBtuud (1 jo OAitoofqo oqi qip* £g£1
QI ouiuiBjSojd (BUOIJBU B OJUl pOJJOAUOO SBM
*9/55161 3uunp pojByiui 'oujuibjSojj 10JJU03
J00U83 oqx -suoiiiim q z oj $• | oq 01 pojBtuijso
SI Xjjunoo O<n Ul JOOUBOJO OOUB|BAOklJ UTII

-'f

Sts
‘’

-uoo sosBOStp [BOoqjJBiQ QjnjonjjsBjjui q)(Boq
tuysno oqj qSnojqj 0|qB|iBAB opsui sbm aoyBjp
-Xqop jo juoojjboji pus aoijuoAOjd joj jibs noy
-BjpXqoj [bjq svojjp 33i SuiXjisuojui sopisoq
jjoddns puB uoiiB)Uotuo|dui! ouiuiBjSojd oqj joj
pOUIBJl OJOM S|BUOISSOJOJd-BJBd pUB S|BUOISSOJ
-ojd jo joquinu o3jb( b ‘oiuuiBjSojd oqj JOpoq
□bij qjuoAOS oqj ui soijiaiiob qi|Boq pjiqo pire

(Buj jurjo iredrsBpopnptr puB pouoq)3uaj]s
sbaa u«tj qu>S 9<P 3uunp pojBijrai scm qonpA
aujunMSoJd 10JIU03 osbosiq (BooqjJBia %1'Z‘Zl
dSBOSIQ IBOOqXIBIQ

•JJBIS JO 3ui
-aiBJ) puB oujuibjSojj QXS J° 2uruoq3aoj)s (a

(Ojjuoj jkmivj

PUB tsuoyus

- SMO||qj sb oq ||iaa sosoosip o|qBoru
-nrauioo-uou oyioods jo (ojjuoo oqj joj soi3ojbjjs
oqx 'Xjiaijob (bijuosso ub oq (|im JOAAoduBin
jo Iuiuibjj puB uoysonpo joj sfBuojBUi oajnosoj
3unUB0| OJBUdOJddB JO JUOUldO|OAO(I SOSBOSIp
ofqworanaiuioo-uou jo (ojjuoo oqj joj XSojbjjs
uoyuoAJojui juBjJoduii ub uuoj ijiaa Bipoai ssbui
3uipn|oui uiojsXs 331 pojnjoiujs (|oaa q3nojqj
uoyoB qj[Boq Xjiunuunoo Suisipqoca ‘ojqjojoqx
uoijBonpo qj|Boq Xq uoyuoAOJd oj soAfosmoqj
puo| Xoqj ‘sosBosip osoqj jo jsoai jo oouopiout
3uisu oqj qjiM pojBioossB sojqsuBA juBjJoduii ojb
jnoiABqoq qsu q3iq pus ojXjs ojij oqj ooui$ X80
-jbjjs oqj jo juouodiaoo juBjJoduii ub oq p|noqs
sooiajos qj|Boq (bjouoS oqj oj jojsubjj sji pus X3o
-(ouqooj ojBudojddB jo juoiudo|OAO(] OAijoojyo
-jsoo uioqj oqBtu oj ojiuoujjsbjjui qj|Boq Smjsixo
oqj qjiM pojBJSojui oq jsnui Xoqj. XqdBjSoai
-op pus XSojoiuiopido jo uoijBJopisuoo panes
uo posuq oq oj OAtq sossosip oiquoiunuiuioo
-uou jo (ojjuoo oqj joj soiSojbjjs oqj, O£ Z ZI

-IUbSjO JUOUIUJOAOS-UOU pUB 1U0U1UJ0A09

■XlifByaassa ub jnq Xinxnf
b jo3uo| ou ojb ‘ojojojoqj ‘sosBosip ofqBoranui
JOJ SoujuiejSojd
SOlULUBjSojd (ojjudd
(OJJUOO pGB
pat ojbo
OJBO jo
JO
--UJOO-UOU
ujoo-uou joj
sppoiu jo juouidopAOQ Xjjunoo oqj ui sossosip
ofqBoiuntuiuoo oj onp Xji|bjjoui pus Xjipiqjoui jo
oopjnq XABoq XpBOjjB oqj oj poppB OABq qoiqAA
sosBosip ofqBoiunuiuioo-uou jo ujojqojd oqj ui
jqSnojq OABq *0|dood oqj jo O|Xjs ojy 3at3uBqo
oqj puB XouBjoodxo oji( ui osbojoui oqj, 6Z Z ZI

(0JJU03 S3SB3
-sia 0|qB3iunuiiuo3-uof\j joj auiuiBjSojj

ouiuiBjSojd
pooqjoqjotu ojes pus (baiajrs p|iqo oqj jo usd
sb ubij qiqftig 3uunp ponuijuoo oq p|noM (ojj

joqjo pus 010 *suod$
qinoA ‘ai«J
-PM l»!oos oiffl sjuompBdop oqj JQ^y^fl
qiiM ouauiBjSojd (ojjuoo oqj jo uoijbjSoju] (ai

iBJBp (BOlSofOIUJOpido uo posBq sop
-iaijob Jal oyioods joSjb) puB uoiioojui jo
(ojjuoo Suijunom joj XSoibjis oyioods bojv (!!!
!qjim MBjs

oj sapio q3jb| pOB aB)t|odoj)aui pUB sbajb
(Bioods oo soijuoud qiiM sojnsBaai Apjbs
poo|q pOB sjpieq poofq aqi jo SuruaqjSusuis (!!
Iuoijosjui jo uopoapp
joj sdnojS jnoiABqaq )fsu q3iq uo sisBqduw

IBtoods qjiM aoijBjndod aqj jo aouB||K>Ajns (i

- jo osuduioo p|noM (ojjuoo SOIV Joj poidopB
oq oj XSojbjjs oqx UBy qiqSig oqj 3uunp
poqounBf oq ((iaa ouiuiBjSojd (buoijbu b SOIV
jo (ojjuoo oqj puB uoyuoAOJd oqj joj £,Z'Z'^]
uoijoojui ui oSjnsdn
siqj oj pojnqujuoo osnqB 3njp shouoabjjui jo oob
-uom 3uiaaoj3 oqj puB sjonpojd poo|q pus poofq
jo uoijbuiujbxo joj soiji(iobj jo oouosqB pus ujoj
-sKs 90UB[|pAJns ajenbapwi X66I ‘I IM^V
pojsaj suosjad sq^B|
StaotUB ssAijisodojas
ZLZL oi £861 XbW °» dn
000* It Suoure
ssAtjisodojas ££{ uiojj dSBdJoui ub QMoqs
SBq asBasip aqj jo aouappui oqj ‘jng 9uiuibj3
-ojd aqj uiqjiA\ sapiAipB uiblu aqj paiujoj
uoijBonpa q)|Baq ssbui puB puuosjad jo SuruiBJj
‘uopoajui joj sosbo jo 3uijsaj ‘sajjuao aoiiBUpA
-jns jo juaiuqsiiqejsg atuaqos JOP^S |W1<KD

■V1’

I

ticularly for tobacco related cancer and uterine
cervix cancer, will form the sheet anchor of the
Cancer Control Programme. It will be carried
through IEC activities and early case detection
approach, mounted on the primary and secon­
dary health care infrastructure and through mass
media.
Iodine Deficiency Disorder

12.2.33
The National Goitre Control Pro­
gramme which was operated during the Seventh
Plan as a "Mission" programme, is a purely
Central scheme under the £^ljral health sector.
According to the present estynates, about 45 '
million people suffer from goitre and another 6
to 8 millions from other iodine deficiency disor­
ders. Universal iodization of salt and IEC ac­
tivities are the main strategies of the programme.

12.2.36 The programme has been reviewed
and would be fiirther extended to cover addi­
tional districts in different states during the
Eighth Plan. The experience gained in the pilot
districts will be used to develop the programme
as an integrated model for diabetes, hyperten­
sion and heart disease. The learning resource
materials, both print and non-print, developed
and validated in the pilot districts, will be used
for the training of nurses and primary health care
workers.

Accidents
12.2.37 For the treatment and rehabilitation of
accident victims, accident and trauma services
will be started in major cities and also, on pilot
scale along some of the high traffic density
national highways.

Mental Health Services
12.2.38 The Seventh Plan document had sug- f^

12.2.34 Iodine Deficiency Disorder Control
Programme would have continued thrust during
the Eighth Plan. The basic approach of the
programme being universal iodization of salt,
proper coordination with major departments
concerned with production and distribution of
iodised salt namely, the Department of Industry
and Railways, will be brought about . Iodized
salt will be made available through the public
distribution system. To prevent the losses of
iodine in the salt due to long-distance transpor­
tation under adverse conditions, iodization of
salt on small scales in the States far away from
the present production centres will be considered
and operationalised. Double fortification of the
salt with iodine and iron will also be explored to
combat the wide- spread problem of anaemia.

12.2.39 During the Eighth Plan mental health
services will be given priority. The strategies
for mental health programme will be community
based utilising the existing primary health care
and district hospital services. A psychiatric
centre in each of the distncts/di visions will be
established. Also, every medical college will be
encouraged to start a separate Department of
Psychiatry so that the required manpower, both
medical and para-medical, can be trained.

Diabetes Control

Other Non-communicable Diseases Control

12.2.35 The National Diabetes Control Pro­
gramme was launched in 19871 as a Central
Sector health programme in the districts of
Salem and South Arcot in Tamil Nadu and
Jammu & Kashmir on a pilot basis. The main
thrust during the Seventh Plan was to develop an
appropriate model for care and control of diabe­
tes mellitus at_ the district level. The major
objectives include (i) prevention of diabetes
through identification of high risk subjects and
early intervention; and (ii) early diagnosis of
disease and institution of management so as *,
prevent diabetes associated morbidity and mor­
tality.

Programmes

gested initiation of a National Mental Health
Programme with emphasis on community based
approaches. However, due to fund constraints
the programme has not made satisfactory pro­
gress.

12.2.40 The programme for control of other
non-communicable diseases will also be taken
up on pilot basis. Resource constraints will not
be allowed to come in the way of developing
experience and appropriate technology for im­
plementation of the control programme at a later
date.
Medical Research
12.2.41 The Indian Council of Medical Re­
search (ICMR) is the premier institution which
is responsible for carrying out bio-medical and
operational research in India.
Important
achievements of the ICMR during previous
plans include: demonstration of improved vec-

5

tor control using bio-environmental techniques
' for control of malaria and filaria; establishment
• of Natiomd Cancer Registry; multi drug therapy
’ and short course chemo therapy for leprosy and
TB respectively and a national surveillance sys­
tem for AIDS infection. Various other institu­
tions under the Ministry of Health & Family
: Welfare Md medical colleges have done notable
work in Ik field of medical research.

vii) Enhancement of Research and Develop­
ment on Family Planning and Maternal &
Child Health.

12.2.42 Research and Development activities
by Indian Council of Medical Research and other
academic institutions will be pursued during the
Eighth Ptan through the following strategies -

12.2.43 Teaching and training programmes in
ISM & H were promoted during the Seventh
Plan. Clinical research on drugs of various
systems, collection, cultivation and propagation
of medicinal plants and standardisation of drugs
were encouraged. The Central Councils dealing
with these systems of medicine have been
strengthened to provide support for training and
research in their respective area.

i)

viii) Collaboration with international agencies
for transfer of appropriate technology to
the Indian scientists.
Indian Systems of Medicine and Homoeop­

athy

FxtaHwhm net of an integrated Bio-medical
Research Complex to strengthen research
activities and to optimise the utilisation of
the available resources and facilities.

ii), Promotion of excellence by rationalising
grants to promising scientists in medical
colleges and strengthening of extramural
centres for research under eminent scien­
tific leadership.

iii) Establishment of a network of research units
in medical colleges for multi-centric stud­
ies.

iv)

Optimal utilisation of resources through
coordination and development of proper
linkages with sister agencies, commercial
utilisation of research findings, constant
review of the status of application of re­
search findings by user agencies, continu­
ing interaction with State authorities to
determine area specific research needs, and
through providing proper guidance and as­
sistance as well as strengthening of re­
search activities under the State Councils
of Medical Research.

v) Development of a Centre for Epidemiological Intelligence.
vi) Augmentation of research activities in spe­
cific priority areas viz., integrated Vector
Control Programme for Malaria, Filaria
and Japanese Encephalitis, integrated con­
trol of non-communicable diseases and de­
velopment of vaccines for communicable
diseases as well as fertility regulation.

12.2.44 The National Health Policy assigned an
important role to ISM&H in the delivery of
health services. There are about 5.25 lakhs
institutionally trained practitioners of ISM & H.
These practitioners are close to the community
not only in geographical proximity but also in
terms of cultural and social ethos and as such
they can play significant role in primary health
care delivery. The strategy for utilisation of
ISM&H for health care delivery during the
Eighth Plan would comprise of the following i) There are more than 200 colleges of ISM &
H. One of the important tasks during the
Eighth Plan would be to provide adequate
facilities for training in these colleges so
that the ^graduates emerging from these
acquire the desired level of knowledge and
skill necessary for patient care. Post­
graduate training programmes also require
strengthening for the purpose of manpower
development for teaching and research in
ISM & H.

ii) To integrate the practitioners of ISM & H in
the mniustream or health cari^TTIymy.sy*’
tem, the graduate
curriculum of these
systems will be suitably oriented to make
them conversant with the national health
problems, policies and programmes. Re­
fresher courses will also be organised for
the inservice practitioners of ISM &
towards the same objective.

330

iii) There are more than 5000 pharmaceutical
units, engaged in the production of drugs
of these systems of medicine. Suitable steps
will be taken to enforce the provisions of
Drugs A Cosmetics Act to maintain the
quality of products of ISM A H produced
in the country.

12.3.3 The country is committed to social and
economic justice to the millions of peopIeTfving
under conditions of poverty and deprivation.
Failure to do so within a reasonable time-frame
may generate social tensions and (inrest. Besides
this, the environmental degradation which is
associated with unchecked growth of population
carries the inherent risk of natural calamities and
disasters.

iv) Research and Development for the produc­
tion and standardisation of drugs of ISM'&
H will be supported during the Plan. The
existing research institutions will be
strengthened for this purpose.

12.3.4 In this context, population control as­
sumes an overriding importance in the Eighth
Plan.

'
v) The cultivation, conservation and regenera­
tion of medicinal plants will be supported
in State/joint sector farms. There Is great
potential for internal sale and export of
these plants, herbs and formulations.
vi) Separate departments, directorates and druf
control organisations at the Central and
State Government level will be established,
wherever they are not existing currently.
vii) Central Councils for Research in ISM A H
would continue to receive support during
the Plan so that they can discharge their
responsibilities efficiently.

Family Welfare Programme
12.3.1 High growth rate of the population con­
tinues to be one of the major problems facing the
country. Although the 1991 Census recorded a
marginal decline in the annual growth rate of
popu’
i from 2.22% in 1971-81 to 2.11%
,| in 19e. 91 this would still mean an addition of
18 million people to the country's population
^annually.
12.3.2 The fast rate ofpopulation growth means
that the economy has to grow faster to protect
the already low level of per capita availability of
food, clothing, housing, employment and social
services.

Review of the Performance
12.4.1 The basic premises of the Family Wel­
fare Programme till now have been -

i)

Acceptance of the family welfare is volun­
tary.

H) The Government's role is to create an envi­
ronment for the people to adopt small fam­
ily norm. This . is done by spreading
awareness, information and education by
ensuring easy and convenient availability
of family planning aids and services and by
giving incentives for adopting family plan­
ning.
iii) The programme, which Is a 100% Centrally
Sponsored Scheme has integrated family
planning and Mother and Child Health
(MCH) services and is being implemented
through countrywide network of primary
health centres and supporting institutions.

12.4.2 In spile of massive efforts in the form of
budgetary support and infrastructure development,'
the performance of family welfare programme has 1 /
not been commensurate with the inputs. Right '
from the beginning the achievement of the set goals
has been unsatisfactory, resulting in the resetting
of targets, as indicated in Table 12.1.

Seventh Plan Performance

Table 12.1
Year

i

Specified Year by
Actual
demo­ which the achievegraphic goal was
ment
bjective
to be
(CBR)* achieved

1962
1966
1968
1969
'Beginning of Plan

25
25
23
32
25

1973
34.6
as expeditiously
1978/79
33.3
1974/75
34.5
33.8
1979/81

1974

30
25
30
25

1979
1984
1978/79
1983/84

33.7
33.8
33.3
33.7 ,

30
25

1978779
1983/84

33.3
33.7

Beginning of Plan
April 1976
I. Population
(reduce the gap)
April 1977
II. Population
Policy
January 1978
Central Coucil of
Health
National Health
Policy

Seventh Plan
Eighth Plan

30

1982/83

33.8

31
27
21
29.1
26.0

1985
1990
2000
1990
1997

32.9
29.9
29.9

12.4.3 With the long-term objective of achiev­
ing the Net Reproduction Rate (NRR) of unity,
the Seventh Plan had set the following demo­
graphic goals -

Seventh Current Status
Plan Target
Couple Protection 42.0% 44.1 (31.3.91)
Rale (C.P.R.)
Crude Birth Rate (BR)
29.1
29.9(1990)*
Crude Death Rate
10.4
9.6 C1990)*
(DR)
Infant Mortality Rate
90
80(1990)*
(IMR)

* Provisional (SRS Data)
While the Seventh Plan targets of achieving CPR
of 42% was achieved, this was not matched by
a commensurate decline in the birth rate, possi­
bly because of improper selection oflhe cases. ’? o
12.4.4 The performance in terms of various i.
methods of couple protection were not uniform.
While the targets for Intra Uterine Device (IUD)
were fully achieved and those for oral contra­
ceptives and conventional contraceptives were
exceeded, the targets for sterilisation operations
fell short by about a quarter. The targets and
performance of the Seventh Plan and the yearwise break up of performance are given in
Tables 12.2 and 12.3.
12.4.5 State-wise analysis of performance of the
programme reveals that Punjab, Kerala, Ma-

*CBR: Crude Birth Rate

Table 12.2 Target and Performance of the Seventh Plan
(in million)
Target

Achievement % Achievement

1.. Sterilisation

31.00

23.70

76.50

2.1.U.D.
3 CC & OP Users*

21.25
14.50

21.28
15.94

100.14
109.93

There is a shortfall of 7.30
million sterilisations.
Targets fully achieved.
Achievement exceds the
targets

♦ Indicates terminal year targets and achievement.

332

Remarks

;

I

Table 12.3 Yearwise Performance of the Seventh Plan
(Nos. in million)

Sterilisation

IUD
x , ( CC & OPUsers

1985-86

1986-87

1987-88

1988-89

1989-90

4.9
(88)
3.3

5.0
(84)
3.9
(105)
11.6
(100)

4.9
(82)
4.4
(103)
13.4

4.7
(87)
4.8
(97)
14.3
(94)

4.2
(76)
4.9

(101)
10.7
(103)

r

Q°4)

(93)
15.9
(99)

Note: The figures within brackets indicate percentage achievement.

and other socio-economic parameters. Table
12.4 illustrates this.

harastra and Tamil Nadu have performed very
well in achieving the targets while Assam, U.P.,
M.P., Bihar, Rajasthan and some North-Eastern
States have performed poorly.
12.4.6 Under the Maternal and Child Health
Programme, which is an integral part of family
planning programme, targets for reducing Infant
Mortality Rate to 90 per thousand live births and
for reducing maternal mortality were fixed for
the Seventh Plan. The Universal Immunisation
Programme (UIP) launched in 1985 with the
objective of providing universal coverage of
immunisation to pregnant mothers and infants
was a major initiative in this direction. Al­
though all the districts in the country have been
brought under UIP, the targets for immunisation
could not be fully met due to problems of cold
chain facilities, inadequate trained manpower,
logistic problems, etc. Other programmes
aimed at women and children viz., control of
diarrhoeal diseases among the children, prophy­
laxis against anaemia and Vitamin A supple­
mentation for prevention of nutritional blindness
achieved varying degrees of success. Never­
theless these efforts were able to achieve a
substatiai reduction in IMR from 97 per thou­
sand live births in 1985 to 80 in 1990.

Constraints
12.4.7 Containment of population growth is not
merely a function of couple protection or con­
traception but is directly correlated with female
literacy, age at marriage of the girls, status of
women in the community, IMR, quality and
outreach of health and family planning services

12.4.8 The Family Welfare Programme has
essentially remained a uni-sector programme of
the Ministry of Health and Family Welfare. It
has yet to be recognised as a major national j
concern drawing priority attention and concommitant strong political, social and administrative
commitment for the purpose of making it a
significant part of our economic development
strategy. A national consensus and strong public
opinion in its favour, cutting across political,
ethnic, religious and geographical boundaries is
as yet lacking.
12.4.9 The family welfare programme has also
suffered on account of centralised planning and
target setting from the top. Regional variations
and diversities have not been generally taken into
consideration, with the result that similar set of
approaches and policies and targets have been
applied in Stetes like UP, MP, Bihar and Rajast­
han where foe
health infrastructure is weak
and related social inputs are lacking and also for
the States like Haryana and Andhra Pradesh
where factors other than development of infra­
structure contributed to poor performance.
Monitoring mechanism under foe programme
has been reduced to a routine target reporting
exercise incapable of identifying roadblocks and
applying timely correctives.

12.4.10 Both pre-service and in-service training
of programme personnel is poor because of lack
of due emphasis at all levels on training pro-

333

Table 12.4

Selected Indicators

States

CBR
(1990)

IMR
(1990)

Bihar
Kerala
M.P.
Maharashtra
Rajasthan
Tamil Nadu
U.P.

32.9
19.0
36.9
27.5
33.1
22.4
35.7

75
17
111
58
83
67
98

grammes for family welfare. Absence of proper
training, education and motivation of the pro­
gramme personnel including supervisory staff
has led to an ineffective, insensitive implementation of the programme.

12.4.11 The programme has remained a Gov­
ernment programme, the community's active
involvement and participation being marginal.
Due to inadequacy of Information, Education
and Communication (IEC) activities the knowl­
edge of the community about the contraceptives,
their availability, safety, etc. are at a low level.
Adoption of the small family norm and use of
appropriate measures for birth control are mat­
ters of personal choice and decision. The IEC
activities have to take this into account. How­
ever, till recently, the IEC activities have been
directed more to national issues rather than
personal issues. Undoubtedly, this incongruity
of perception between the people and the provid­
ers of services has cost the programe dearly.

Female lit- Female age
People
eracy rate at marriabelow
(1991)
ge(1981) poverty line
in years (1987-88)%

23.1
86.9
28.4
50.5
20.8
52.3
26.0

16.5
21.8
16.5
18.8
16.1
20.3
17.8

40.8
17.0
36.7
29.2
24.4
32.8
35.1

12.4.13
Lot of incentives and awards have
been built into the programme. The incentives
and awards have not been unequivocally shown
to be very effective in the promotion of small
family norms. On the other hand , defects such
as over-reporting, low quality acceptors and
neglect of non-terminal methods of contracep­
tion and MCH activities have often been ob­
served to creep into the programme. The
element of disincentives is also missing from in
programme.
12.4.14 The efforts for the containment of
population growth have to be intensified simul­
taneously on several fronts. This calls for an
integrated approach and concerted efforts
through both the government and the non- gov­
ernment organisations, besides social and politi­
cal commitment to make it a national movement.
Strategy for the Eighth Plan

12.5.1 Containing population growth has been
12.4.12 Family Planning Programme is being
accepted by the Government as one of the six
run as a 100% Centrally Sponsored Scheme. . must.
most iui
important
^>viuiui objectives vi
of uic
the dj^im
Eighth nau,
Plan,
The entire outlay is included in. the Plan with the with the aim of reducing the bitiij rate from 29.9
result that a major portion (60-70%) of the outlay
per thousand ;;;! 990 to 26 per tho’ ind by 1997.
goes for meeting the expenditure of maintenance I The IMR will also be brought down from 80 per
nature, leaving,very little resources for further ’ thousand live births in 1990 to 70 by 1997^
expansion, and strengthening of the programme
12.5.2 To give a major thrust in this priority
or for any new initiatives. Further, the entire
expenditure is borne by the Centre, although the area, which constitutes the pivotal point for the
success of all developmental efforts, a National
implementing agency is the States Government.

334

Kt
ilny

11
11"
1 e3
Sip s'5i r
£1 o- e ?
Jit

•o v o E

5f -s £

o $0 c
c o <«

&?S

•2
e£
3 ■a —
•P33
|c

“■•- —

£>

o 2 V

8

HI
’4
£3 3 § §=p
o. a •g - "* " - 60-g
V)

43
U

■©

?•? 2 •s.=a •

•-■82

c

o

■■/>

O

m? if^si
n

5^4 8 >

V
o ei

V

c:

q

■3

fJ 1?■mo - I
_ ,T3
4

c e=4

o
■£

iip3
§- 2? i ‘1 in
h

9p

- o E

—
„ .2o

“0 "
V

3

*

.0

e £ 2 E £ -S * £

.

- - 3

o r

1

« JZ
c

2OE

60-

-

Q

•

« —

60

?
E c* 3 - ~
nh’i.pr
■
“ ■.a ’§» Sc -*tu h 161 <3
- Q O
o
CO

C

y=l
« -o
O

3 §
H 3
o Q. C 60 .=

«J ■5

= •£ « 2 ,
> C
2
> ’>

■s =

M

G

o -s
U

Ep4
nM
£§
11SO
:|
“0 r
fl
gj»

u a _E

"

«

J

1

>«-^

" ‘ £1-

. ~ JJ

* '18 b

o

«6

*

4)

t>

2

3

.©

8 E .3
2 .» 5

- li!

43

j=

■D ’8 =

l“f

I

ij
el M'* s§2- «! 8:-S<£
o

us to >

5 w JZ

S n C_ 2

Z-5

V

3 — •= <6fa
*- 5 =
«
« 3
3
: Q. 43
. E £■ o 3
u rt E

t 1) 2

c
~ a a E

o

2 4> © e v

°

a. 43 u w)
£
3 > c 60 -

3= -r 3
mL
E c "a
*• —
T?

8
2.3
5S8ii-gH2gEK
! o
<« 3 75
8
fe °
«

O

2 a
J'
£ Bh 8 -n8 --§ ■ss
•5-i S 2 J2
t ifj 11
it _ J jf r.<2-iI:
«

o

Q

to q.
_ £
o
x:
*
’c j ° o
— 2?.E
o
-S 3 31 e o
E E 0 2?-3 o -C
- Q
—
•*•
p 8 E o
§
-=03 3g 8 •2~ E C _ c 3

v

~ E E

'

“

S a
a x —
o e.i
o S 2 -3 75
D as «
u
g * 2 E 11 Ti! S -8 8f*
ffl

IS
c

V

«

n»ns?
IF
. - -51^1 s.-=i5 .1! Ih
j'Mi gl
60 JO’c

V
8 •s
'*« £
o
g
e

lh
HM"
3 2 §_ i i11 •
Hi <3
8^ H

i
to .2
£ ? 8
c t“
.!
>«■£ v e.E

nr

*

I = 3 Ji's
Hh^
’“ »= 8. E e “ e
sf liS-s-’

4>

4^

5» “
s 5; 8
gI
02 -a.h

£o •52 -gS .=

CO

</> —

43 o
to u

in
(*L

6 •a e § -s 'S =

Hi dsF
= P<3] I
.. _:i
I’M
ISI a» a3
1 ” “
i -to.^i 0 nlhi
g -.2
E es " e g. s a'So
h
MI^
g s g.2
V a.
J8 6 _
C © E “2
v 3
g . js
=! «.2
98
«
*>»
• •E

- < ,
»> « -x
S
S 2^
o
■3
g.8 « o
- £
6 - S3 JU
Si
•£
=1 S
■8 o
-c o c 5 nJ «
...Sc
J=
60
= :
C/5
£
s O w « O.
aj.£
e
C4
® Esjf
i £a£3' §
Q.
JU
q.3
3?1
•2
—
<*
2
2
V ra
£ ■£ E
u a
60 _ _ O C6 43
V “* 0 .2
s 8 8

1 Silis
i £5
’bf"
2

V

~ £J
A -o

- 60 US «

2 = 33
« ’S 2
S .1 E 1

m

41l<22

Is

11 u|

Wil
£ 5»
.2 3^

5 i c21=
..-

i« -°_$ £§• 60J2°

€
- iz ?■
i.3 |e_elV 5
“
60
8.u ■SC -cs2 73c ■H
ig,g’aS3g2Is P _e <§
4> .
.2
K a .■ «
o
G
sl
’
f
-2
“
5
o
u~
8
S?i=
‘
-a-z’S
.§£ SJeoc
££
!“£8
°
48^
*
>
: -c 60 S
«
3 5 ‘SI -• -« i*13
o
! 89
t 73 S.ai73«
>M

h

$ Uy
Ol
H 8 kimtnihsill
8

S 0 ,H E O u.

I!

Hi
Sq-ii
31
£z * w

c
o e •§ -3 c
.2 V
0
"
L2
c
c
a r- “

• • c ■ ■3 jj
C 1 2 5 c
o E 2 o 2 wc .02
3
E —
a -q «, u

•gX4 - -S E

S-S i

3 50 rjj

3 E E e C
%- > *' -^ g
§ .2
.2 2 c
g
o
0 o ’X*
?=
C

5 £ S h
g12
_ to
sS«

>

•° « c « Eo* .S 3- .2=e-» >« •:=s «" o i© g * i-i"
B J=
F:2 5 g 8 5 J8 F
-ilg-ESsfeg
ia

o jj c
v B £ :

g “ C

tilnpnl
is Ep5 i
K1

Q. D.—

•2 2-2

2

©.

e w

<S

3 «

□

■g v c c
□
TJ

<E L
=
2

V

E

to

g V
e 2 o
E 8 .H
c o H 60 S
v
v>
—
E
43 ‘5
•yj

2."

1

£
o -o
c
JZ «

«

Q.

-■ c
3 E
=
c.£
a. E
E < t> Q S
-- ^- us
to

D

-

Pc

£ E ic

e. v

E
8 ? •“ 2
to

JS

5 2

e

e e :c J!
1 « .= 2
2
1 eI sg| 5 «:£
1
g
oji
St
si
>>
g E_> 3 sa c F7?
M
>P 73> 2so —2_e aBh.m
•s S3 f

'o

c S

5 L.

73

O

•gL-TS'S s

M

§

3

O <•• E
O

o

\

m 2 v
E -2 «
vj

o

V

Ei!§O
i p?3

i
«
«u

3-2 •'

4)

c_

«e E = £

to 2
c-. c_

s a ■g a-w u 1to
G

to

Q
O

i
2 c

>

c E 2

11 JI
■D

cC

r S.E.J
V —

<*)

model, becomes of paramount importance.

£

vi) The targetted reduction in the birth rate will
be the basis of designing, implementing and
monitoring the programme against the cur­
rent method of couple protection rate.
While broad guidelines may be prepared by
the Centre, suitable parameters would be
designed by the individual States for this
purpose. Identification and registration of
eligible couples, enforcement of civil reg­
istration scheme, registration of mothers
and children for child survival and safe
motherhood activities are areas requiring
special monitoring.

vii) The outreach and quality of family welfare
services will be improved. For this, the
■ health services infrastructure will have to
be made fully operational and efficient.
This would involve -

(a) completion of infrastructural facilities initi­
ated during the earlier plans like buildings
for subcentres, PHCs, CHCs, etc., and
installation of necessary equipments;
(b) ensuring placement of adequate number of
welltrained workers specially at the grass­
root level;

(c) providing mobility to workers, specially the
peripheral ones; and

ix) Child survival and safe motherhood initia­
tives will be vigorously pursued. These
initiatives will include (a) strengthening of
Universal Immunisation Programme, (b)
greater emphasis on Diarrhoea ^Control
Programme and effective implementation
of ORT programme, (c) Acute Respiratory
Infections Control Programme, (d) Anae­
mia Management Programme and not just
Anaemia prophylaxis, (e) Safe Mother­
hood Programme with high risk pregnancy
approach and (f) intensified effort for train­
ing of birth attendants.

x)

Any system is as good as the people who
operate it. Therefore, major emphasis will
be laid on health manpower planning along
with a review of the education and training
programmes of all categories of health care
providers. Training will not only aim at
providing requisite knowledge and skill,
but also ensure development of such be­
havioural attributes that will be conducive
to a closer interaction with the community.
The methodology, the logistics and the
content of training programme will be con­
tinuously reviewed. Special programmes
would be chalked out for imparting pre­
service and inservice training in pro­
gramme management and IEC activities.
To meet the training needs,
various
training institutions will be strengthened or
new ones established, by providing ade­
quate funds, staff, equipments and mobil­
ity.

(d) ensuring adequate drugs and other essential
supplies at the Sub-centre and PHC by
suitably increasing the funds
for this
purpose.

xi) The entire package of incentives and awards
will be restructured to make it more pur­
poseful. Individual cash incentives have
not made any impact and hence will be
phased out. The payment of compensation
viii) The entire chain of CHC, PHC and Sub­
to the acceptors for the wages lost due to
centres will be equipped to deliver general
hospitalisation, etc., will be left to the
health and MCH services in an integrated
discretion of the States, thus providing
manner with a strong referral suppport and
flexibility in approach to suit the local
. j (pu
linkage at the Distrir* level. For this,
requirements.
Community
incentives
in
facilities for services for mothers ana chii- •
the form of priority consideration under )
dren including reservation of beds for them
IRDP programmes, e.g., opening of >
at different levels will be ensured. Setting
schools, provision of drinking water facili­
up of Regional Maternal and Child Health
ties, linkage by roads, etc., will be built up
Institutes will be part of the strengthening
in the programme. The possibilities of
process of MCH infrastructure.
introducing certain disincentives to the
non-adoptors of family planning will also

336

‘t
n rj

I

be explored and introduced with due regard
to the freedom and the fundamental rights
of the people. The performance of the
States in this vital sector of human and
national concern will be recognised
through additional resource allocation as a
part of Central Plan assistance to those
States which show better performance in
terms of pre-determined demographic pa­
rameters.

major objective of all voluntary organisa­
tions concerned with health and/or educa­
tion-related activities.
Substantially
increassed amount of funds will be chan­
nelised through these agencies during the
Eighth Plan. The establishment of an apex
organisation to develop networking be­
tween all such voluntary organisations
committed to the promotion of national
efforts in this important area of human
endeavour will be considered.

di) There is an urgent need to secure involve­
ment and commitment of practitioners of
all systems of medicine infthe Population
Control Programme. The practitioners of
IndianSystem of Medicine andHomoeopathy, whose number is estimated to be more
than half a million and who are the closest
to the community both in terms of place of
practice and the socio-cultural milieu of
the community will be involved in the
programme by -

sx&apolation of the concept of vol
xiv) As an ej&apolation
vol-­
untary organisations, is the role and place
of organised corporate sector which covera")
approximately 70 millinn workers and their [
families. Effective methods will be
evolved to get the organised sector involved
in the implementation of family welfare
programme.

xv) Special efforts will be made to involve the
community in the Family Planning Pro­
gramme. The strategy will be to prepare
thejxjmmunity to accept the responsibility, the ownership and the control of the
programme fuily^nlhe long runJ Panchavats, youth clubs, village committees, Nehru
Yuvak Kendras, women organisations,
etc., can play an important role in commu­
nity motivation, organisation of camps and
contraceptive distribution. Grassroot level
functionaries, e.g., village dais. Village
Health Guides .(VHGs), Auxiliary Nurse
Midwives (ANMs), Anganwadi workers,
village extension workers, primary school
teachers. Gram Panchayat staff etc.will
play a facilitatory and supportive role to the
community organisations for generating
the necessary momentum for population
control movement by the people. The vil­
lage level local functionary will be the
kingpin of these new initiatives.

a) providing well structured educational mod­
ules of instructions and training in popula­
tion dynamics and family planning at the
undergraduate level;
b) providing short-term re-orientation courses
to the practising doctors;

c)

providing incentives and recognition for
exhibiting initiative and leadership in popu­
lation control activities; and

d)

promoting a sense of comraderie between
these practitioners and the grassroot func­
tionaries of the health and family welfare
programme with a view to synergising and
potentiating their mutual input. A similar
approach is also needed to strengthen and
secure deeper involvement of practitioners
of modem system of medicine. Organisa­
tions such as Indian Medical Association
(IMA) will be involved in a greater meas­
ure in this national task.

Kiii) The role of voluntary organisation in a mass
movement such as population control is
critical tor generation of momentum and
accelerating the pace of progress. There is
a need to incorporate family planning as a

xvi) The village/neighbourhood tea shops, pan
shops, public distribution system shops,
pharmacies, cooperatives, etc., will be util­
ised for community based contraceptive
sale and distribution.
xvii) The social marketing programme, which
was originally launched for Nirodh distri-

337

I

o

bution has demonstrated the significance
and importance of involvement of the cor­
porate sector to achieve the family planning
objectives. This programme will be ex­
tended to the social marketing of oral pills
as well as for market research and educa­
tional activities for which the Corporate
Sector possesses special skill and sensitiv­
ity.

xviii) Information, Education and Communica­
tion, which are critical inputs will be fur­
ther strengthened and expanded. The DEC
activities of the health and the family wel­
fare sector will be integrated. Greater use
of the mass media will be made to dissemi­
nate the message of family planning to the
remotest corner of the country. The entire
system of pricing the media time vis-a-vis
its social responsibility has to be given a
fresh look, different from the commercial
angle. Area specific IEC material will be
developed and produced. At the viewers'
level, efforts will be made to pool resources
of various social sectors and to provide
community TV/radio sets, besides main­
taining them. The backbone of the DEC
efforts will, however, remain the inter-per­
sonal communication for which the grass­
root level female worker will have to be
trained and effectively utilised.
xix) A new thrust in the research and developmeet of methods aimed at regulation of
fertility in the male, and of vaccines for
fertility regulation, both in the male and
female, will be given. Fertility regulation
practices such as the use of special herbs
by the community particularly in the tribal
areas, will also be subjected to research.
While intensification of bio-medical re­
search is necessary, research in social and
behavioural sciences to explore the human
dimensions is vital. Health systems re­
search to optimise operational framework,
to improve the efficiency and effectiveness
of the service provided and to evolve costeffective interventions in various areas of
family planning operation, will be given
high priority.

xx) A continuous monitoring, review and evalu­
ation is an essential component for the
successful implementation of the pro­
gramme. Development and strengthening
of health management information system,
with district and sub- district data bases of
health and demographic parameters and
linkages aimed at concurrent evaluation of
family planning programme will be devel­
oped. This will provide critical inputs at
the district and sub- district level and the
much needed data for area-specific plan­
ning and time-bound implementation.

xxi) The family planning programme has a
multi-sectoral dimension. For the purpose
of effective intersectoral coordination and
to provide the programme appropriate fo­
cus and priority, a proper institutional set­
up with the backing of the highest political
and administrative authority is an essential
requirement. The recommendations of the
Committee on Population, constituted by
the NDC, will be implemented.
12.5.4 To sum up, the base and the basis of the
population control programme during the Eighth
Plan will be decentralised, area-specific micro­
planning, within the general directional frame­
work of a national policy aimed at generating a
people's movement with the total and committed
involvement of community leaders, irrespective
of their denominational affiliations and, linking
population control with the programmes of female literacy, women's employment, social se­
curity, access to health services and mother and
child care.

Outlays
12.5.5 The total outlay for the Central Health
Sector is Rs. 1800 crores. The outlays for the
Central, States and Union Territories Plans un­
der the Health Sector are shown in . nexures •
12.4 and 12.5.
cj.

12.5.6 The outlays for the Family Welfar®
Programme are Rs.6500 crores. Details are
given in Annexure 12.6.

X

f

1

I

Annexure 12.1

Progves of Eitabfishmeot-Minsmum Need Programme

7th Plan

No. as
Scheme

1

-V’

1. Sub-Centres
2 P.H.Cs*
3 C.H.Cs

oi

No. as 1990-91 1991-92
Act
Anti.
on
Ach.Achievem
1.4.90
ent

Likely Sth Plan 1992-93

No. as Target
1.4.92(1992-97)

1.4.85

TargetAchievem
ent

2

3

4

5

6

7

84263
9134
813

54612
12392
1523

4^6937

131200

10115
1261

19249
2074

515
1315
162

5968 7^37683
1241 21805
2549
313

8

Target

9

10

17030
4450
1269

4066
759
259

♦ : Excluding Subsidiary Health Centres, Mini Health Centres etc.
Source : Working Group Discussions for Annual Plan 1992-93, Planning Commission.

Annexwre 112

Constructkm of Buildings for Sub-centres, PHCs & CHCs

SI.

Health Institution

No.

1.

1.
2.
3.

2
Sub-centres
Primary Health Centres
Community Health Centres

Number No. of Bldg. No. of Bldg. No. of Bldg. Col. 6 m
percMtMa
Functioning constructed /
under
yet to be
of Cd. 3
functioning construction constructed
in Govt. /
Panchayat
Bldg.

3

131385
22328
1955

52267
12685
1206

7

6

5

4

7906
1371
271

71212
8272
478

SO

Source : Bulletin on Rural Haelth Statistics in India - December 1991 issued by the Directorate O«aMi
of Health Services , Ministry of Health and Family Welfare , New Delhi.

Annexure 12.3
Health Manpower Working in Rural Areas

SI.
No.

Category

Sanctioned
Posts

Number in
position

Vacant Posts

Col.5 as
percentage
of col.3

1

2

3

4

5

6

1. Specialists in Rural Areas

3523
25671

2481
22078

1042
3593

29.6

3. Block Extension Educators

6068

24850
25726

5513
23266
22999*

555
1584
2794

9.2

4. Health Assistants (Male)

80701
119906
17702
518
8744

7481
11035
1523
149
1772

^.Doctor? at Primary Health
Centres

5. Health Assistants (Female)
/LHVs
6. Health Workers (Male)

8. Pharmacists

88182
130941
19225

9. Radiographers

667

10. Lab. Technicians

10516

7. Health Workers (Female)/ANMs

14.0

6.4

10.9
8.5
8.4

7.9
22.3
16.9

Source : Bulletin on Rural Health Statistics in India - December 1991 issued by the Directorate
General of Health Services , Ministry of Health and Family Welfare , New Delhi.
*

Includes 67 posts in position in J & K for which corresponding sanctioned posts are not indicated.

340

I

I

Annexure 12.4
Eighth Plan Outlay - Health Sector
(Rs. Crores)

S I •
No.

1

Programme

States/UTs

2

3

1. Minimum Needs Programme/Rural Health
2. Control of Communicable Diseases
|
3. Hospitals and Dispensaries
|
4. Control/ Containment of Non-communicable)
Diseases

Centrally
Central
Sponsored Schemes
Programmes
4

2250.38
1031.00

j

5. Medical Education and Training
|
6.ICMR
|
7. Indian System of Medicine and Homoeopathy |
8. E.S.I.
I
9. Other Programmes
|
Total

•'if •

Total

5

6

1.00
14.75J
94.00|
85.00|

2251.38

I
3525.54
5.00

267.00 ) 5324.54
124.50)
83.00)

-I
5775.92

20.00
1056.00

74.75)
744.00

7575.92

*

Annexure-12.5
Eighth Plan Outlays-Health Sector-Distribution by States/Union
Territories.
(Rs Crores)

State/UT

Outlay

MNP

Andhra Pradesh
Anmachal Pradesh
Assam
Bihar
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Karnataka
Keraia
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
West Bengal
Total: States
Union Territories
Andaman & Nicobar Islands
Chandigarh
D«dra & I4agar Havefi
Daman & Diu
Delhi
Lakshadweep
Pondicherry
Total :UTs
Grand Total :States & UTs

183.32
28.02
159.49
676.87
59.00
242.00
176.11
121.00
179.90
342.00
120.00
300.87
553.26
21.00
33.73
25.50
50.00
223.23
254.75
390.95
52.20
266.00
50.00
517.57
281.00
5307.77

53.60
12.50
81.00
337.22
12.22
117.87
67.68
48.00
75.00
130.50

Si. No.

States
1.
2.
3.
4.

5.
6.

7.
8.
9.
10.

11.
12.
13.
14.
15.
16.

17.
18.
19.
20.
21.
22.
23.
24.
25.

1.
2.
3.

5.
6.

7.

22.51
66.82
2.80

2.40
350.00
3.62
20.00
-468.15
5775.92
•2.2^39^

22.97
150.00
281.00
10.15
18.00
15.00
6.40,
78.00
80.00
150.00
13.45
65.00
20.00
260.00
121.78
2227.34
9.45
0.75
1.04
1.00

1.80
9.00
23.04
2250.38

I
■

.-•I,,

i

Armexure 12.i

i

Eighth Plan Outlay - Family Welfare Sector

(Rs. Crorea)

Programme

SI. No.

Services and Supplies

'a

2.
3.

Training
Information, Education and Communicatioo

Resertcb and Evaluation
I
t

■u -

5.

Maternirnity and Child Health

6.

Organisation

7.

Village Health Guide Scheme

8.

Area Projects

9.

Other Schemes

10.

Provision for Settlement of arrears payable to
States

‘■s:

TOTAL

i

,<■

343

Outlays

3086.00
59.00
127.00
89.00
1982.00
71.00
140.00
400.00
46.00
500.00

6500.00
Media
RF-TB-2.12.pdf

Position: 1470 (6 views)