THE STATE OF THE WORLD'S CHILDREN
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- THE STATE OF THE WORLD'S CHILDREN
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A Summary
The following is a summary of the State of the
World’s Children report for 1991, issued by the
Executive Director of UNICEF, James P. Grant
For details of the full report, please see back cover.
On Sunday, September 30th, 1990, a great
promise was made to the children of the 1990s.
On that day, 71 Presidents and Prime Ministers
came together for the first World Summit for
Children. It was the largest gathering of heads
of state and government in history. And the
outcome was an extraordinary new commitment
- a decision to try to end child deaths and child
malnutrition on today's scale by the year 2000
- and to provide basic protection for the normal
physical and mental development of all the
world’s children.
This overall goal was broken down into more
than 20 specific targets listed in the Plan of
Action agreed on by the 159 nations represented
* The goal of immunizing 80S of children under the age of
one is expected to have been reached for the developing world
as a whole on the basis of the percentage of infants who have
received the necessary three shots of DPT vaccine (considered
by WHO and UNICEF to be a good indicator of the
effectiveness of the immunization system as a whole). For
BCG, the target has already been surpassed. For Polio (three
shots) overall coverage of 78% by 1989 is expected to rise
beyond the 80% target by the end of 1990. Measles
at the Summit. All governments will review their
plans and budgets and decide on national pro
grammes of action before the end of 1991.
'We are prepared to make available the resources
to meet these commitments”, said the final
Declaration. All national and international
organizations have been asked to participate. In
particular, the worlds of religion, education, the
communications media, business, and the non
governmental organizations in every country
are invited to join this decade-long effort.
As the Summit met, the world was nearing the
deadline set just over 10 years ago for reaching
another great human goal - 80% immunization
coverage for the children of the developing world.
At the time, approximately 15% were being
immunized. Today, despite all the difficulties of
the last decade, the 80% goal is expected to have
been reached when the latest figures become
available early in 1991.
immunization, which is not normally given before the age of
nine months and which began the decade at very low levels,
reached 71% in 1989 and may still lag a few percentage points
behind as 1990 ends.
The diseases which vaccines prevent are also major causes of
child malnutrition; the immunization effort of the last decade
has therefore also kept uncounted millions of children from the
downward spiral of frequent illness, poor growth and early death.
The year 2000:
what can be achieved?
The following is the full list of goals, to be attained
by the year 2000, which were adopted by the World
Summit for Children on September 30th 1990. After
widespread consultation among governmentsand
the agencies of the United Nations, these targets were
considered to be feasible and financially affordable
over the course of the decade ahead.
Overall goals 1990-2000
O A one-third reduction in under-five death rates
(or a reduction to below 70 per 1,000 live births whichever is less).
O A halving of maternal mortality rates.
O A halving of severe and moderate malnutrition
among the world's under-fives.
O
Safe water and sanitation for all families.
O
Basic education for all children and completion
of primary education by at least 80%.
O A halving of the adult Illiteracy rate and the
achievement of equal educational opportunity for
males and females.
O Aone-third reduction in iron deficiency anaemia
among women.
O Virtual elimination of vitamin A deficiency and
Iodine deficiency disorders.
O All families to know the importance of suppor
ting women in the task of exclusive breast-feeding
for the first four to six months of a child's We and of
meeting the special feeding needs of a young child
through the vulnerable years.
O Growth monitoring and promotion to be institu
tionalised in all countries.
O Dissemination of knowledge to enable all
families to ensure household food security.
Child health
O The eradication of polio.
O The elimination of neonatal tetanus (by 1995).
O Protection for the many millions of children In
especially difficult circumstances and the acceptarea and observance, in all countries, of the recently
adopted Convention on the Rights of the Child. In
particular, the 1990s should see rapidly growing
acceptance of the idea of special protection for
children In time of war.
O A 90% reduction In measles cases and a
95% reduction in measles deaths, compared to
pre-lmmunization levels.
Protection for girls and women
O A halving of child deaths caused by diarrhoea and
a 25% reduct co in the inaderca of diarrhoeal diseases.
O Family planning education and services to be
made available to all couples to empower them to
prevent unwanted pregnancies and births which
are 'too many and too close' and to women who
are loo young or too old'.
O All women to have access to pre-natal care, a
trained attendant during childbirth and referral for
high-risk pregnancies and obstetric emergencies.
O Universal recognition of the special health and
nutritional needs of females during early childhood,
adolescence, pregnancy and lactation.
2
Nutrition
O A reduction in the incidence of low birth weight
(2.5 kg. or less) to less than 10%.
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Immunization coverage of one-year-old children
and universal tetanus immunization for women in
the child-bearing years.
O A one-third reduction in child deaths caused by
acute respiratory infections.
O The elimination of guinea worm disease.
Education
O In addition to the expansion of primary school
education and its equivalents, today's essential
knowledge and life skills could be put at the disposal
of all families by mobilizing today's vastly increased
communications capacity.
That extraordinary effort has saved over 12
million young lives and prevented over one and a
half million children from being crippled by polio.
It has also given the world new hope by
showing what can be achieved when the inter
national community commits itself to a great
endeavour.
Fig.l Increase in immunization
coverage for infants in developing
countries, 198 i -89
The araoh snows the ceveloping worte's orocress
tcwarcs the target ci S0% .mmunization ov the er.c
ot ' 990. Figures tor 1990 will be avaiiaole in eany
:991. China is not mclueeo in the oata until 1985.
The quiet catastrophe
Two principal facts dominated the World
Summit for Children.
The first was the fact of the quiet catastrophe
- the 40,000 child deaths each day from ordinary
malnutrition and disease, the 150 million children
who live on with ill health and poor growth, the
100 million 6 to 11-year-olds who are not in
school.
The second was the fact that the means of
ending this quiet catastrophe are now both
available and affordable. Large-scale trials and
studies in many nations in recent years have
vastly increased both the world's understanding
of the problems and its capacity to solve them.
The question at the centre of the World
Summit was therefore whether morality would
keep step with capacity, whether what could
now be done would now be done.
Porcorilcicjc iminunizcilion covu-taijii
That question could not be answered at the
Summit itself. For it is a question which will be
answered .not by the declarations of a day but
by the deeds of a decade.
The goals
The seven overarching goals adopted for the
year 2000 by the Summit may be summarized
as follows:
Reduction of 1990 under-five child mortality
rates by one third or to a level of 70 per 1,000 live
births, whichever is the greater reduction.
•
O
° 1981 32
83
84
85
86
Year
87
88
89 1990
At present, approximately 14 million children
under five are dying each year in the developing
world - more than a quarter of a million each
week. The immediate causes of more than 60%
of those deaths can be numbered on the fingers
of one hand - diarrhoea! disease, measles, tetanus,
whooping cough and pneumonia. All of these
can now be prevented or treated at very low
cost. Several countries with per capita GNPs of
under S 1,500 a year - including Chile, China,
Jamaica, Mauritius, Sri Lanka and Thailand - have
already succeeded in reducing under-five death
rates to less than 50 per 1,000.
3
Child survival:
and population growth
The surest way to achieve a sustained decline
in fertility is to give a new prionty to 'social' or
''women's resources' investment, to improving
mother and child health, women's status and edu
cation and to making family planning as widely
available as possible to both women and men."
The State of World Population 1990,
Dr. Nafis Sadik, Executive Director,
United Nations Population Fund
Doing what can now be done to reduce child
deaths in the developing world would also help to
slow population growth. Some of the reasons:
The physiological factor
An infant death means the end of breast-feeding,
an important 'natural contraceptive'.
The replacement factor
The death of a young child prompts many
couples to replace the loss of the child by a new
pregnancy. Studies in Bangladesh show that an
infant death reduces the average interval between
births from more than three years to less than two.
Families which experience the death of a child are
much less likely to use any method of birth planning.
Thn ln<^!irpnro fHCtOf
When child death rates are high, parents often
insure against an anticipated loss by having more
children. Planning on the basis of the worst that can
happen, rather than on the basis of statistical prob
abilities, often means over-compensation and an
average family size greater than desired.
The confidence factor
Empowering parents with today's child survival
knowledge helps build the confidence which Is so
crucial a factor in the acceptance of family planning.
As the UN Population Division has concluded, 'Any
given improvement In mortality will be more likely to
initiate fertility control behaviour among those who
understand and participate in that improvement
than among those who do not".
The direct effect of child survival strategies
Three of the most important means now avail
able for reducing child deaths are also among the
most powerful means of reducing birth rates:
O Promoting the knowledge that children can be
protected by exclusive breast-feeding for the first
four to six months will also help to lower birth rates,
because breast-feeding is one of the most effective
ways of preventing pregnancy during that period.
O Most child deaths happen to mothers who are
younger than 18 or older than 35, who have had
more than four children already or who give birth
less than two years after a previous delivery. Pro
moting knowledge about the importance of timing
births, and providing the means to act on it, is
therefore one of the most powerful child survival
strategies - and also reduces birth rates.
O Female education, in addition to the advant
ages it can bring to women, improves child health
and survival. Educated mothers are also more likely
to opt for smaller families.
The synergism between this array of child survi
val actions and effective family planning programmes iTieSTiS u idi. u >ci ivVO logoinsr can bring
about population stabilization at an earlier date and
at a lower level than either acting alone. The 1990s
offer a remarkable opportunity to use this synerg
ism, as many developing countries are now at the
critical 'point of parental confidence' where further
reductions in child deaths are likely to bring even
greater reductions in births.
The experience of individual countries shows the
power of this combination. If ail countries were to
achieve the same under-five death rates and the
same birth rates as Chile or Sri Lanka, for example,
then the world would see approximately 10 million
fewer deaths each year - and approximately 20
million fewer births.
!*
Reduction of maternal mortality rater to half
of 1990 levels.
O
At present, approximately 500,000 women
are dying every year - one young woman each
minute - because something has gone wrong in
pregnancy or childbirth. Many of those deaths
follow long hours of agony and fear. And many
of those women leave behind motherless
children. At least half of all maternal deaths
could now be prevented by elementary, lowcost means.
Reduction of severe and moderate malnutrition
among under-five children by one half of1990 levels.
O
At present, one child in every three in the
developing world is prevented from growing to
his or her mental and physical potential by
persistent malnutrition. Many parents are
unable to feed their children adequately because
of war or famine or because they do not have
the land to grow food or the jobs and the income
to buy it. But the majority of child malnutrition
occurs in households where there is sufficient
lood. The cause is the frequency of illness and
a lack of knowledge about the special feeding
needs of the young child. Today’s knowledge
about birth spacing, breast-feeding, weaning,
growth promotion, and the prevention and
treatment of common illnesses, plus welltargeted food supplements, has shown that the
problem of mass child malnutrition can be
overcome at an average annual cost of approxi
mately 310 per child.
Universal access to safe drinking water and to
sanitary means of excreta disposal.
O
At present, more than one third of all families
in the rural areas of the developing world do
not have access to clean water and one half do
not have safe sanitation. Yet costs have fallen
dramatically in the last decade. The average
initial investment required to provide both safe
water and sanitation is now less than S30 per
person, and the recurring cost can be as low as
81 or 32 per person per year.
O
Universal access to basic education and com
pletion of primary education by at least 80% of
primary school age children.
At present, only 55% of children in the
developing world complete four years of pri
mary education. Boys have twice as much
chance of becoming literate as girls, despite the
fact that the education of girls is probably the
best single investment that any country can
make in its future health and well-being. In
recent years, low-cost strategies have succeeded
in providing the vast majority of children with
at least five years of basic education even in some
of the world’s poorest countries.
Reduction of the adult illiteracy rate to at least
half its 1990 level, with emphasis on fanale
literacy.
O
At present, there are over 900 million adults
in the world who cannot read or write. Two
thirds of them are women.
Protection of children in especially difficult
circumstances, particularly in situations of armed
conflicts.
O
At present, an estimated 80 million children
are exploited in the workplace and 30 million
are left to fend for themselves on city streets.
Millions more are victims of war, their develop
ment disrupted by the interruption of food
supplies, the closing of schools and clinics, and
the destruction of homes, roads and crops.
A practical investment
This range of goals for the year 2000 will
clearly be more difficult to accomplish, by
several orders of magnitude, than any targets
previously attempted. It will demand an extra
ordinary effort, stepped up over the next two
years and sustained throughout the decade, by
individual nations, by the United Nations family,
by the international community, and by non
governmental organizations and members of
the public in every country.
But if the demands are great, then so are the
incentives. Basic protection for the lives and the
normal growth of all the world’s children is not
only the greatest of all humanitarian causes; it
is also the greatest of all practical investments.
s
It is a practical investment because vast numbers
of unnecessary child deaths increase population
growth by pushing millions of parens into
having more children than they want in order
that some may survive.
It is a practical investment because persistent
malnutrition saps the physical and mental
development of people and, ultimately, the
economic and social development of nations.
It is a practical investment because even four
years of basic education can make a significant
difference to productivity and incomes as well
as to child health and the acceptance of family
planning.
It is a practical investment because basic
education for every child is also a fundamental
prerequisite for environmentally sound develop
ment in the years to come. The choices which
today*s children will have to make in the twentyfirst century, whether they be choices about
family size or land use, energy source or waste
disposal, can only be made wisely by a popula
tion which is capable of absorbing new
knowledge and responding to it Environ
mentally sustainable human development will
therefore depend in large measure on the level
of commitment which is made to education in
the decade ahead.
Finally, it is a practical investment because
communications technology has ensured that
the children bom into the 1990s will know more
about the world and expect more from it than
any previous generation. And if there is one
lesson which history insists on, it is that political
and social turmoil will follow when persistent
poverty and personal tragedy sit side by side
with the evident capacity for improvement in
the lives of the poor.
The achievement of the goals decided on at
the World Summit for Children, however
difficult and daunting the prospect, would
therefore represent not only one of the greatest
humanitarian achievements of this or any other
century, but also one of the greatest practical
investments which the human race could now
make in its future economic prosperity, political
stability, and environmental integrity.
6
The best chance we have
The specific goals which make up this invest
ment have been decided on after a long process
of consultation, and endorsed by 159 govern
ments at the largest gathering of political leaders
ever assembled. They therefore represent the
best chance the world has, in the decade ahead,
for a unifying framework of action and a world
wide mobilization by governments, inter
national agencies, educators, religious leaders,
health professionals, voluntary organizations,
the mass media, the business community, and
members of the public.
The goals are undoubtedly ambitious. But
while recognizing the difficulties, it is also
important to recognize that these are the goals
which are the most achievable, the goals for
which the knowledge and the technology
already exist, the goals which can be achieved
at minimum financial and political cost, the
goals which, if they are not achieved, will make
a mockery of our hopes of meeting the broader
challenges of environmentally sustainable
human development in the twenty-first century.
Keeping the promise
Among the tens of thousands of words which
appeared in the world’s press following the
Summit for Children, one persistent strain was
summed up by an editorial in The New York
Timer.
“The largest global Summit meeting in history
pledged to do better by the world’s children. Their
promises were eloquent, their goals ambitious. But
children cannot survive or thrive on promises. The
world’s leaders now have an obligation to find the
resources and the political win necessary to trans
late hope into reality.”
In, short, can the promise be kept?
That question, and particularly the question
of whether the resources can be found, is bound
up with the broader picture of economic develop
ment in the 1990s.
The economic context
Economic progress in the decade ahead is not
the only factor which will influence the progress
of nations towards the year 2000 goals. It may
not even be the most important factor. Several
developing countries have already achieved the
goals for under-five mortality and school enrol
ment despite per capita incomes which are
significantly lower than the average for the
developing world.
Nonetheless, for most countries, economic
progress would make it considerably easier to
devote the necessary resources to the task.
The bad news is that the developing world’s
debt still stands at approximately SI,300 billion,
that annual interest repayments on that debt
amount to almost S200 billion, that interest and
amortization payments exceed new net flows
from the industrialized countries by 330 billion,
that aid levels are increasing only marginally,
and that primary commodity prices are still at
their lowest level since the 1930s.
Debt, in particular, still shackles many
developing nations, claiming a large proportion
of the resources which might otherwise have
been available for investment in human
progress. With falling family incomes, and cuts
in public spending on services such as health
and education, many African and Latin American
children are still paying heavily for their nations’
debts; and the currency they arc paying with is
their opportunity for normal growth, their
opportunity to be educated, and often their lives.
With no less urgency than at any time in the
last five years, UNICEF must again say that it
is the antithesis of civilization that so many
millions of children should be continuing to pay
such a price.
The better economic news is that projections
for the 1990s show the industrialized nations
growing at an average 3% per annum and the
developing nations growing at just over 5% per
annum. Such forecasts, even should they prove
accurate, screen great disparities. Most of Asia
should see continued steady progress, accom
panied by a significant fall in the numbers of
the absolute poor. Latin America, the Middle
East and North Africa are expected to see
slower growth with a smaller reduction in the
numbers of the poor. Sub-Saharan Africa, facing
rapid population growth as well as economic
stagnation and severe ecological problems, will
struggle to maintain per capita incomes; without
debt cancellation, a renewal of investment, and
an increase in real aid, the sub-continent may
well see an increase in the numbers living in
poverty during the decade ahead.
Development strategy
After 40 years of conscious and often conten
tious debate about strategies of development,
there is perhaps more unanimity on the subject
as the 1990s begin than at any previous time.
The 1990 World Bank report has summed up
the emerging consensus:
Fig.6 Proportion of ODA going to
basic health and education, 1986-87
Less than 25% of the industrialized world's aid is
devoted to health and education, and this
proportion has fallen by about one third over the
last decade. Three of the most basic elements of
human development - primary health care,
primary education, and rural water supply and
sanitation - receive only just over 3% ol ail aid.
Allocation of official development
assistance (ODA) 1986-87'
Health (inc.family planning)
5.0%
Primary health care
1.5%
Education
11.0%
Primary education
1.0%
Water and sanitation
6.0%
Rural water and sanitation
1.0%
Source: OECD.DAC 1989. Figures based on detailed sector reporting Irom
OECD Credit Reporting System Data Base (which covers bi lateral technical
assistance only partially!.
7
"The evidence in this Report suggests that rapid
and politically sustainable progress on poverty has
been achieved by pursuing a strategy that has two
equally important elements. The first element is to
promote the productive use of the poor’s most
abundant asset - labor. It calls for policies that
harness market incentives, social and political
institutions, infrastructure, and technology to that
end. The second is to provide basic social services
to the poor. Primary health care, family planning,
nutrition, and primary education are especially
important.
"The two elements are mutually reinforcing; one
without the other is not sufficient.”
It is in the second part of this ‘two-part
strategy for development* that the goals adopted
by the World Summit for Children find their
place in the overall development effort of the
1990s. For the year 2000 goals are essentially a
statement of the most obvious, achievable, and
affordable elements in the task of investing in
human capacity and providing basic social
services to the poor.
lives, and their opportunities to earn a fair reward
for their labours. This is the kind of development
which the majority ofpeople in the poor world seek
and the majority of people in the industrialized
world would support. ’’
In similar vein, World Bank President Barber
Conable has also said: “The allocation of aid
should be more closely linked to a country’s com
mitment to pursue development programmes geared
to the reduction of povertf'.
There could be no better measure of that
commitment than progress towards the goals
which a majority of the world’s political leaders
- from both industrialized and developing
worlds - have already considered and endorsed.
In this way, the ambitious goals adopted at
the World Summit for Children can contribute
to the overall development effort of the decade
ahead and provide a sharper focus for the
industrialized world’s aid. And it is in this
context that we turn again to the initial question
of where the resources might come from to
fund this investment in today’s children - and
tomorrow’s world.
The role of aid programmes
This overall context is especially important in
considering the role which aid programmes
might play in the years ahead.
Ln the State of the World’s Children report
two years ago, UNICEF proposed that:
“Aid can make it politically easier to take
decisions of which the principal beneficiaries would
be the poor, the environment, and the future.
"The time has come when not only aid but also
debt reduction and trade agreements should form
part of a real development pact by which partici
pating industrialized nations would make a com
mitment to increase resources and participating
developing nations would make a corresponding
commitment to a pattern of real development which
unequivocally puts the poor first.
“The ultimate aim and measure of that real
development is the enhancement of the capacities of
the poorest, their health and nutrition, their edu
cation and skills, their abilities to control their own
8
Finding the resonroe*
It is virtually impossible to calculate the over
all financial cost of reaching all of the goals
adopted at the World Summit for Children. But
for the sake of bringing the cost into overall
perspective, a ‘best guess’ would put the figure
close to S20 billion a year for the next decade.
To put this S20 billion a year into perspective,
it is approximately one eighth of one per cent
of the world’s annual income. It is half as much
as Germany will find for the process of national
reunification in 1991. It is as much as the world
spends on the military every 10 days. “The
financial resources required are modest', says the
Plan of Action adopted at the Summit, “in
relation to the great achievements that beckon.”
Such comparisons are made almost every
year in The State of the World’s Children report.
And they are made here again because it must
never become accepted as normal and unremark
able that a fifth of mankind should be without
adequate food, safe water, basic health care, and
elementary education, or that millions of
children should die or be stunted in brain and
body, in a world which clearly has the knowl
edge and the resources to enable all its people
to meet their own and their children’s needs.
However ritualistic such comparisons may
seem, they serve to make a mockery of the idea
that the world cannot yet afford to contemplate
the great step forward for our civilization which
would be represented by achieving the year
2000 goals and bringing basic protection to the
lives and the growth of all its children.
Fig.4 Health, education, and debt
The chart shows the percentage of Gross Domestic
Product devoted to debt servicing as compared to
spending on health and education in the 95 low and
middle income developing countries during 1987,
the latest year for which data are available
But it is equally clear that such comparisons
do not mean that S20 billion a year will be
forthcoming for this purpose. On a practical
basis, where might the money come from?
Overall, the developing countries will prob
ably have to find about two thirds of that sum
themselves.
The two major internal sources of such sums
are the restructuring of present spending in
favour of the social sector and the restructuring
of present spending within the social sector.
To take the first of these, more than 25% of
all present government expenditures in the
developing world are devoted to the military, to
inefficient state-controlled companies, and to
subsidies which are not targeted to those most
in need. Military spending is the greatest of
these. The developing nations as a whole are
now spending more on the military than on
education and health combined
*.
With the ending
of the cold war and the easing of regional
tensions, it cannot be too unrealistic to suggest
a 5% cut in defence spending - which would in
itself liberate half of the estimated 820 billion a
year needed to reach the year 2000 goals.
“New
*
resources could also be found within
the amounts which are already allocated to
* Thia overall figure for the developing world hide
*
wide
regional diaparidex. Moat Latin American nation
,
*
for example,
ipend lea
* on the military than on health and education and
many Middle Eaitem exxintriea spend conaiderably more.
Source. World Development Report 1989, World Bank.
social services. In health, hospitals which reach
at most 15% to 20% of the population often
claim 80% of the budget. In education, more
than half of all government spending is often
allocated to secondary and higher education for
the minority, usually from higher-income
families. In water and sanitation schemes, 80%
of the 810 billion now being invested each year
is being devoted to schemes costing 8550 or
more per person, while less than 20% is being
allocated to today’s low-cost strategies costing
less than 830 per person served. Relatively
modest spending shifts from high per capita
cost services, which generally serve the relatively
better off, to low per capita cost strategies for
the poor could therefore release enough to meet
the developing world’s share of the overall bilk
External aid
Approximately one third of the 320 billion
needed might be expected to come from the
industrialized world. And that contribution of
an extra seven billion dollars a year could be
made in many different ways.
First, debt relief might be specifically linked
to investments in reaching the agreed goals.
9
Seven billion dollars is, after all, only as much
as the industrialized world now receives from
the developing world in debt repayments every
10 days. As the Plan of Action adopted at the
World Summit for Children urges:
“ Debt-relief schemes could be formulated in ways
that the budget reallocations and renewed economic
growth made possible through suih schemes would
benefit programmes for children. Debt relief for
children, including debt swaps for investment in
social development programmes, should be con
sidered by debtors and creditors."
Increases in aid are another possibility, but
more efficient use could be made of the S50 billion
a year currently allocated. At the moment, far less
than 25% of all the industrialized world’s bilateral
official development assistance is devoted to
health and education, and this proportion has
fallen by about 30% over the last decade.
Within this small and shrinking slice of the
aid pie, it is again the higher cost services for
the relatively better off which take the greater
part. Aid for primary health care, including
family planning, primary education, and rural
water supply and sanitation, totals only just over
3% of the industrialized world's aid
It would therefore require less than drastic
changes in the orientation of existing aid pro
grammes to release the resources needed to
support the year 2000 goals. Even if only the
projected increases in aid over the next few years
were devoted to primary health cafe, primary
education, and low-cost water and sanitation
schemes, then the annual amount of aid avail
able for these purposes would be doubled'.
Ideally, the process of making these relatively
small shifts in spending - both in developing
* Di/Tcrencei between tbe nsdujtrudixed *aQoa
hsve
become more mirkxd in recent yv
jv
*
Canid,. Denmark,
Fir.Urvt, the NctherUndx, Ncmy and Sweden, contribute
roughly twice m much aid per capita aa moet induimahicd
counxrica, and their aid programmes arc generally more biaaed
*
toward
baric rervice
*
and poverty alleviation. If all aid-pving
nationa were to move in thia dime don, then the resource
*
required tn meet the year 2000 goal
*
would quickly be
a uh scribed.
io
country budgets and in the industrialized
world’s aid budgets - would be a co-operative
effort. Few changes could make the achieve
ment of the year 2000 goals more likely than a
series of compacts by which one or more
developing countries made agreements with
one or more industrialized countries on adequ
ately funded plans for making measurable pro
gress towards those goals.
As the Plan of Action adopted at the World
Summit for Children recommends:
"Hoch country is urged to re-examine in the
context of its particular national situation, its
current national budget, and in the case of donor
countries, their development assistance budgets, to
ensure that programmes aimed at the achievement
of goals for the survival, protection and develop
ment of children will have a priority when resources
are allocated. Every effort should be made to ensure
that such programmes are protected in times of
economic austerity and structural adjustments. "
If the promise of the World Summit for
Cluldren is to be kept, then this re-examination
of spending priorities in both industrialized and
developing worlds will need to be completed no
later than the end of 1991,
Commitment to the goals
The World Summit for Children, which was
the culmination of a long process of consultation
with governments and technical experts from
all regions, has given a flying start to this process
of establishing the year 2000 goals. But the
declarations and commitments of political
leaders arc not enough. Goals must become the
goals of society as a whole; and it is essential
that, within the next few months, all organiza
tions and individuals who share the dream of a
world without preventable malnutrition and
disease, a world which protects the lives, the
growth, and the rights of its children, should
also consider what part they might play in ’
entrenching the year 2000 goals and in enlisting
sustained support for them over the decade
ahead. The Plan of Action adopted by the *
World Summit for Children specifically asks all
national, regional, and international organiza
tions, governmental and non-governmental, to
"examine how they can contribute to the achieve
ment of the goals and strategies enunciated in the
Declaration and this Plan ofAction as part of more
general attention to human development in the
1990s. They are requested to report their plans and
programmes to their respective governing bodies
before the end of 1991 and periodically thereafter."
The Infrastructure
Another essential factor is the availability of
low-cost technologies and strategics which
reduce die costs involved and therefore the
political will required. Goals must not only be
technically possible but also politically and finan
cially feasible. Much careful thought has already
been given to this manor in the selection of the
year 2000 goals, and the available techniques
and strategies are discussed in the full text of
the State of the World’s Children report
The more difficult question today is tfie
means by which toda/s knowledge and tech
nique can be put at the disposal of the majority.
Many of the year 2000 goals are dependent on
the delivery of low-cost technologies - be they
vaccines, oral rehydration salts, antibiotics,
growth charts, iron tablets or vitamin A supple
ments. Many also depend on the delivery of
knowledge which can empower families them
selves to take more control over their own
health: today’s knowledge about the importance
of birth spacing, about special care in preg
nancy and childbirth, about the importance of
breast-feeding, about safe ways of weaning,
about promoring normal growth, about pre
venting and coping with common illnesses, and
about preventing the spread of AIDS - is
knowledge which every family, and not just
every health worker, should have.
Most of the year 2000 goals depend on the
combination of both - 'on trained help and
appropriate technologies and on empowering
families with knowledge. The question of infrastructure, of the capacity to deliver, can there
fore be considered in two overlapping parts.
In particular, it is the effective community
health worker who can enable families to use
today’s knowledge for the improvement of their
own and their children’s lives. With a few
months’ basic training, supported by referral
and supervision systems, a community health
worker can offer advice and practical help with
such things as birth spacing, pre-natal care, safe
delivery, breast-feeding, weaning, feeding a
child during and after illness, growth moni
toring, disease prevention, immunization, oral
rehydration therapy, the use of antibiotics
against acute respiratory infections, and the
distribution of vitamin A capsules, iron supple
ments or malaria tablets. Such information and
such techniques constitute a large part of what is
required to meet the year 2000 goals of reducing
child deaths by one third and child malnutrition
Fig.10 The children of the 1990s
142 million children have been born into the world
during 1990. The chart below presents this huge
number as just 100 children and gives a schematic
overview of what will happen to them in the decade
ahead.
Industrialized world
|
j Developing world
100 Born
Source UNICEF estimates cased on United Nations projections.
11
'ey half. Yet the job can largely be done by
community health workers who can be trained
for as little as S500 (as opposed to fully qualified
doctors whose training may cost S70,000 or
more). It is therefore reasonable to assume that
those countries which succeed in reaching the
goals for the year 2000 will be those countries
which also succeed in putting a well-trained,
well-supervised, and well-supported c mmunity
health worker within reasonable reach of every
family.
The communications capacity
The other half of the ‘infrastructure’ question
is a country’s capacity to put new knowledge at
people’s disposal. And here, too, recent years
have seen advances which could amount to
nothing less than an information revolution for
the poor. Rising literacy and the growth of
newspapers, the spread of radio into almost
every home and television into almost every
community, the popularity of cinema and more
recently the video theatre, the new outreach of
religious leaders, the rise of the numbers
enroled in school, the proliferation of non-govemmental and voluntary organizations, the
growth of professional societies, employers’ asso
ciations, trade unions, and government services
all mean that the capacity of the developing
world to communicate with the majority of its
people has been transformed. The task that
remains is the mobilization of this new capacity
in order to empower people with today’s knowl
edge. "AU forms of social mobilization ’, says the
Plan of Action adopted at the World Summit,
"including the effective use of the great potential of
the new information and communication capacity of
the world, should be marshalled to convey to all
families the knowledge and skills required for dra
matically improving the situation of children"
In this sense, therefore, the question of
whether or not the year 2000 goals can be
achieved, whether or not the promise can be
kept, is a question not just for governments but
for the mass media, for the schools, for the
churches, temples and mosques, for business
and commerce, for the professional associations
12
and the academic community, for the non
governmental organizations and the women’s
movements, for the employers’ associations and
the trade unions, for the youth organizations
and the sports and entertainment industries.
In short, the question of whether the promise
will be kept is a question for us alt
A new ethic for children
Targets and strategies alone will not achieve
the year 2000 goals. All significant social change
- be it the abolition of slavery, the spread of
democracy, the end of colonialism, the discre
diting of racism and apartheid, the advent of a
new respect for the environment, or the struggle
for female equality - has both required and
stimulated a change in the prevailing ethical
climate.
The goal of ending mass child deaths and
mass child malnutrition, and of providing basic
protection for the lives and the normal develop
ment of all children, is as difficult and signifi
cant a social change as any of the great changes
that have gone before. And this dream, too, will
be realized only with the wide acceptance of a
new ethic for children.
The essence of a new ethic for children is the
principle referred to in the Plan of Action
adopted by the Summit as "the principle of a
first callfor children' - a principle that the essential
needs of children should be given high priority in
the allocation of resources”.
The need for that new ethic arises, as ethics
usually do, from practical as well as moral roots.
The special vulnerability and the special
responsiveness of the early years, demand that
the child’s one chance for normal growth should
be given a first call on our concerns and capacities.
Those same reasons also demand that children
should be able to count on that commitment in
good times and in bad - in lean times and in
times of plenty, in times of peace and in times
of war, in times of recession or in times of
steadily advancing prosperity. The mental and
physical growth of a child cannot be asked to
wait until interest rates fall, or until commodity
prices recover, or until debt repayments have
been rescheduled, or until the economy returns
to growth, or until after a general election, or
until a war is over. The ethic of first call for
children does not demand that protection for
the lives and the development of the young
should be a priority; it demands that it should
be an absolute. It does not demand the kind of
commitment which can be superseded by other
priorities that su ' 'cnly seem more urgent, but
the kind of commitment that will not waver in
the winds of change which will always blow
across the world of human affairs.
s
t
There will always be something more
immediate. There will never be anything more
important.
In the past, it may often have been inevitable
that the physical, mental and emotional develop
ment of children should be exposed to the slings
and arrows of adult society. But in our time, for
the first time, we have the chance to begin
shielding the lives and the normal growth of
children from the worst excesses, misfortunes,
and mistakes of the world into which they are
bom. And the fact that our societies do not now
do so will one day be regarded as being as
strange and uncivilized as is the notion of
slavery today.
*
<
All of this is directly relevant to the accom
plishment of the goals which the world has now
set for its children in the years ahead. For the
principle of first call would demand that
whether a child survives to adulthood, whether
a child grows normally in mind or body,
whether a child is well nourished, has health
care, is immunized, has a school to go to, should
not, by the year 2000, have to depend on such
things as the balance of payments, or on the
level of interest rates, or on fluctuations in the
terms of trade, or on the election of any par
ticular political party, or on any other of the
inevitable turbulences of the adult world.
Like other great changes in prevailing ethic,
the world-wide acceptance of this principle of
first call for children will not come quickly or
easily. But like other such changes, it will
represent nothing less than an advance for
civilization itself.
Conclusion
Despite the crises which continue to occur
in international affairs, the ending of the cold
war offers the possibility of a new era for
mankind. The price of preoccupation with war
has been more than financial; it has been a price
paid in the distortion of our science and tech
nology, in the absorption of our management
and political skills, in the waste of our energies
and ingenuities, and in the distraction of our
vision and our imagination. The dividends of
peace may also, therefore, be paid to the
human race in many currencies, and above all
in the liberation of financial and human resources
for a renewal of what Robert Heilbroner, in the
1960s, called ‘the great ascent*. In our times,
the vision of a world in which every mar.,
woman and child has adequate food, clean
water, decent housing, modem health care, and
a basic education, could at last be realized.
The World Summit for Children has given
the world an extraordinary opportunity to take
a series of concerted actions which would
arnoun, to the first steps on that long journey.
It is an opportunity to pursue a known mix of
strategies which could prevent the deaths of
millions of women and children, invest in the
health and education of the rising generation,
and at the same time make a major contribution
to the slowing-down of population growth.
That mix of strategies is now within the capacity
of any developing nation to implement and of
any industrialized country to support.
On the Sunday before the Summit, over a
million candles were lit for its success by ordi
nary people around the world. Each of those
candles represented the inextinguishable hope
in the hearts of people everywhere that, amid
all the problems and the dangers of the years
ahead, the world can still be made a better place.
That hope has now taken on a definite form
and a clear strategy. The challenge has been
defined. Meeting that challenge will, as the
Summit’s Plan of Action says, "demand
13
consistent and extraordinary effort on the part of
all concerned".
On present trends, the number of children
being bom into the world each year is predicted
to peak in about the year 2000 and begin to fall.
The children of the 1990» will therefore be the
largest generation ever to be entrusted to man
kind. And the present generation will rightly be
judged by how it meets the challenge of pro
tecting their lives, their growth, their education,
and their rights.
To guide that effort in the decade ahead,
widespread acceptance must be won for a new
ethic for children; an ethic which demands that
14
children should be the first to benefit from
mankind’s successes and the last to suffer from
its failures; an ethic which recognizes that it is
on how society protects and cares for its children
that its civilization is measured, its humanity is
tested, and its future is shaped.
The full text of the 1991 State of the World’s
Children report is available from all UNICEF
offices or by writing to the Division of Infor
mation, UNICEF House, 3 UN Plaza, New York,
NY 10017, USA. The report is also published
by Oxford University Press.
C.H ( 2_>
KARNATAKA STATE PROGRAMME OF ACTION
FOR THE CHILD
Chapter:
I
Introduction
Background
Karnataka Situation
Major & Specific Goals
Guiding Principles for Operationalization
Mechanism for implementation and monitoring
Chapter
II:
Sectors
Child Health
Maternal Health
Nutrition
Education
Drinking Water Supply
Environmental Sanitation
Chapter:III
Cross Cutting Themes
Child Labour
Girl Child & Adolescent Girl
Urban Child
Childhood Disability
Children in Especially Difficult
Circumstances
1
STATE PROGRAM,.'! OF ACTION FOR THE CHILD
CHAPTER I
I.1
:
INTRODUCTION
BACKGROUND
Today’s
children are the citizen's
of
tomorrow's
world;
the most valuable legacy of
the
future.their
survival, protection and development is a pre-requisite
for the future development of humanity.
Empowerment
of
children with knowledge and resources
to meet their
basic
human needs should be a primary
goal
of
development.
The opportunities given today for children
to realise their fullest potential will
determine the
quality of human development in the generations to come.
The
Constitution of
India.
in its
directive
principles of State Policy made many provisions germane
to development of children: Article 15 (3)
enjoins
on
the State to make special provisions for
children and
women;
Article 23 prohibits forced labour;
Article 24
prohibits
employment of children under 14 years of
age
in
factories,
mines and other' hazardous occupations;
Article
39 (a) requires the State to direct its policy
towards ensuring that young and vulnerable children are
not abused; Article 39 (f) requires the State to direct
its policy to protect
children and youth
against
exploitation;
Article
45 provides
for
free
and
compulsory education for all children under the age of
14 years; Article 47 makes it one of the primary duties
of
the State to raise the level of nutrition and
the
standard of living of its people and to improve public
heal th.
The
guidelines
enshrined
in
the
Directive
Principles
of
the Constitution have been given clear
policy articulation through the:
*
Rights of the Child 1959
*
National Policy for Children 1974
*
National Health Policy 1982
*
Child Labour (Prohibition & Regulation)
Act 1986
*
National Policy on Education 1986 / 1992
(modi f i cat ions)
*
Infant Mi.lk Substitutes,
Infant Foods Act 1992
*
National Policy on Nutrition 1993
2
Feeding
Bottles
&
More recently, the 1990 UN Convention on the Rights
of the Child unanimously adopted by the General Assembly
of the Uniter' Nations set universal legal standards
for
the protection of children against neglect,
abuse and
exploitation.
It
also guarantees
their basic
human
rights
including
survival,
development
and
full
participation
in
social, cultural,
education
and
other endeavours necessary for their
individual
growth
and well
being.
The September
1990 Uorld Summit for Children,
a
mile stone for child development attended by 70 national
heads and
152 country representatives
resulted in a
declaration of
Plan of Action which recognises the
Rights of Children on their nation’s resources resulting
in a set of specific commitments.
These
commitments
were
expressed as a series of new goals to be achieved
by the end of the present century.
The goals
include
control
of the major childhood diseases, a halving of
child malnutrition, a one third reduction In under
five
deaths, a halving of maternal mortality rate, safe water
and
sanitation
for all
communities,
universally
available basic education and women’s literacy.
To give these promises weightage and to make them a
reality,
Government
of
India
has
developed
a
comprehensive
Plan of Action devoted to basic health
care,
primary
education,
nutrition,
water
and
sanitation, as a commitment to the Indian Child.
But, policy articulation at the national level will
need
to be translated
into a clear and realistic
programme of action for the child at the state level for
ameliorating
the plight of children and moving towards
their
optimal
growth and development in a time bound
manner.
It is in this context that a
’’State Programme
of Action for
Children”
has been formulated by the
Government of Karnataka.
1.2
THE KARNATAKA SITUATION
Several
positive developments affecting women and
last
children have taken place In Karnataka during the
four decades:
Birth Rate, which in the 1950s, was 42
p«'„
1000,
declined to 31 in the 1980s and further declined to
26.2 in 1992.
Death Rate, which in the 1950s was 23, declined to
11
in the
1980s and came down to
8.5 per
1000
population in 1992.
3
Infant Mortality Rate (IMR) has declined
from 89
per
1000 live births in 1976 to 73 per
1000
live
births in 19°2 .
Expectat. y
years.
of
Life at birth has increased
to
62
Age of marriage has been increasing at one year per
decade
from 16.5 years in 1961 to 19.2
years
in
1991
Child Marriages are on the decline.
Programmes
for
increasing
awareness
through
Education, Total Literacy Campaigns (TLCs),
Mahila
Samakhya, and other awareness activities are taken
up systematically.
the
positive
developments
are
Overshadowing
ortunately a host of negative indices as follows:
Sex ratio which in 1981 was 963, declined to
960
in 1991.
Neighbouring states of Andhra Pradesh
(974) have
(972),
Orissa
(971)
and Tamil Nadu
higher sex ratios.
Age specific death rates indicate higher rates for
female children and women upto 35 years of age.
Total
Fertility Rate
is
3.3
as per
Sample
Registration System (SRS)
1992.
There are
in
addition many incomplete pregnancies.
Over 50%
of
women suffer from anaemia during pregnancy,
which
accounts
for a large number of maternal
deaths.
Moreover, nearly one-third of children born have a.
low birth weight due to
low maternal nutrition
status, frequent child bearing etc.
National Nutrition Monitoring Bureau data reveal
that the level of severe protein malnutrition has
remained stagnant at 8.3% since
1988.
Moderate
Protein Energy Malnutrition (PEM) has on the other
hand shown a sharp Increase from 48.8% in 1988-90
1 to 54.5% in 1991-92.
The incidence of Bitot Spots
in pre-school children is as high as 2.5%.
Peri-natal
deaths,
a sensitive index reflecting
standards
of health care prior to &
during
pregnancy & child birth as well as effectiveness of
measures
in support of the vulnerable sections
increased from '43.2 in 1981 to 57 in 1987.
Mean age of marriage, though increasing at the rate
of one year per decade, remained virtually stagnant
during 1981-1991, and is still lower than that
in
4
states like Punjab, Kerala.
Child marriages are still prevalent, especially
in
the northern. districts.
A study of
82,000
ever
married
.-iris in the 10-14 age -group shoved
that
54% were
in four districts of
Bijapur,
Belgaum,
Gulbarga and Raichur.
Devadasi
system is still prevalent,
mainly among
scheduled
castes
in northern Karnataka.
The
practice of dedication of girls to prostitution
is
kept
alive by superstition and poverty despite
state and private
efforts
to mobilise
public
opinion against this practice.
As per
1991
census,
59%
of women are
still
illiterate.
This is compounded by a high drop-out
rate estimated at 34% at primary and 59% at
middle
school 1evel.
5
I-----------------------------------------------------------.--------------------------I
I
I
CHILD HEALTH :
MAJOR GOALS!
i) Reduction in IMR to 65/1000 4 1-4 year mortality to < 20/1000 by 1995
ii) Rs-uction in IMR to 55/1000 & 1-4 year mortality to < 10/1000 by 2000
I
I
\---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
SPECIFIC GOALS
1995
1997
2000
i) Immunisation
357. coverage
for each
antigen
1007. coverage
for each
antigen
Sustain
1007.
cove rage
ii) Neo-natal
Tetanus
Elimination
Sustain
Achievement
iii) Measles
957. & 907.
reduction in
mortality &
luorbi lity
levels
Sustain
Achievement
Sustain
Achievement
(a) Reduction in Vaccine
Preventable Diseases
<iv)
Poliomyelitis
1007. coverage
of OPV-3
(b) Reduction in
Diarrhoael
diseases/deaths
poliofree
status in
10 dlS
Pol iofree
status in
15 U. L 5
poliofree
status
in all dts
807. 0R3 usage
507. reduction
in diarrhoael
deaths
707. reduction
in diarrhoael
deaths
307. reduction
in diarrhoael
uSS. l h
157 reduction
in diarrhoael
cases
257. reduction
in diarrhoael
cases
107. reduction
in diarrhoael
casses
(c) Reduction in deaths
caused by ARI
(d) HIV/AIDS Awareness
f
•\
Reduction in
ARI deaths
by 107.
Reduction in
ARI deaths
by 107.
Reduction in
ARI deaths
by 407
Awareness in
50'Z population
Awareness in
707. population
Awareness in
1007 population
6
------------------------------------------------------------------------------------------------------------------------------------------------------------------- -
MATERNAL HEALTH :
I
MAJOR GOAL :
Reduction in Maternal Mortality Rates to 300/1,00,000 by 1995
I
Reduct!"” in,Matern.-i Mortality Rates to 200/1,00,000 by 2000 AD I
-------------------- ----- ----------------------------------------------- /
(a) Prevent pregnancies
below 21 years /
ensure 3 year
birth spacing/
promote singletwo children norm/
increase couple
protection to 557.
by 1995 S 657.
by 2000
(b) Ensure 1007. coverage
of pregnant mothers
with ante-natal care
protection against
tetanus protection
against iron
deficiency anaemia
2000
1995
SPECIFIC GOALS
reduce CBR to
21/1000
Reduce CBR to
24k5/1000
Reduce CBR to
23/1000
807. deliveries
attended by TBAs
907. deliveries
attended by TBAs
1007. deliveries
attended by TBAs
Availability of
referral services
for ever 3-5 lakh
population in
10 dts
Availability of
referral services
for every 3-5
lakh population
in 15 dts
Availability of
referral services
for every 3-5 lakh
population in
all dts
7
/---------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
I III
i
!
NUTRITION :
MAJOR GOAL :
Reducti
in severe and moderate malnutrition among under five
children by half the present level
!
I
'
\------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -
1995
SPECIFIC GOALS
1997
2000
Reduction in
level of severe
S moderate mal
nutrition to half
the 1990 level
(a) Reduction in severe
and moderate mal
nutrition among
under five year olds
to half the 1990 level
Recuction in
malnutrition
levels in
northern and
eastern dts
to levels prevalent in other
parts of the
State
(b) Control vitamin A
deficiency and its
consequences
including blindness
Mapping out areas Reduclion in bitot
where bitot spots spots prevalence
prevalence exceeds to less than 17.
27. and reduction
to less than 27
(c) Reduct ion in lo*1
Birth Weight Babies
(LWB)
Provision to MCH
care to all
pregnant women
Reduction in
LWB by 107
Reduction in
LWB by 207.
(d) Reduction in Iron
Deficiency Anemia
(IDA)
Reduction by 107.
Reduction by 207.
Reduction by 307.
(e) Growth Promotion
Extend ICDS
facilities to
ail blocks
Cover urban
population and
involve mother
growth monitoring
Institutionalised
monitoring for
all children
(f) Empowerment of all
women to breastfeed
their chiIdren for
4-6 months
Creating aware
ness on impor
tance of breast
feeding & timely
introduction of
weaning foods
Practice of
exclusive breast
feeding by 507.
mothers
Empowerment of all
women to breast
feed their children
(g) Control of Iodine
Deficiency disorder
(IDD)
Ensure consump
tion of iodised
salt in endemic
district
8
Reduction in
level of severe
malnutrition to
half the level
of 1990
Control vitamin A
deficiency to less
than levels of
public health
sign ificance
Introduction of
supplementary
food by SOX
mothers
Ensure universal
consumption of
iodised salt
Control IDD
(i) Making all hospitals
baby friendly
All hospitals
with > 1000
’eliveries Lu be
certified as
baby friendly
9
All hospitals
to be made
baby friendly
807. mothers in all
districts/PHCs/HSCs
urban areas to
follow correct infant
child feeding
practices
■I
I
IV
EDUCATION :
MAJOR GOAL :
ACHIEVc.: IENT OF UNIVERSAL. ELEMENTARY EDUCATION FQR EVERY CHILD
TO COMPLETE 7 YEARS OF SCHOOLING
SPECIFIC GOALS
(a) Providing to all
children access to
PE/Ensuring effective
retention of children
& reducing drop out
1995
2000
1007 enrollment
of children in
6-7 age group in
fqrmal schools.
1007. enrollment of
children in 6-10
age group in formal/
non—formal system.
Special focus on
enrollment of
girls.
Continued focus on
75% enrollment of
enrollement & reten
chiIdren in 11-12
age group in fromal/ tion of girls.
nonformal system.
907. enrollment of
children in £-10
age group in
formal/nonformal
system.
1007. retention of
children in class
1 £ II with 80%
attendance.
Reduction in
overall dropout
rate by 507.,
I-IV = 157.
V-VII = 307.
<b> Emphasing quality
of education &
improving T.L
activities per
MLLs.
1997
Introduction of
MLL in classes
i-IV in 3000
Schools
Training of
35 teachers per
block in MLL
strategies
Continued focus on
girls.
1007. retention in
classes I-IV with
807. attendance.
Reduction in over
all dropout rate
by 757.
I-IV = 107.
V-VII- 427.
Sustaining achieve
ment of 1007. enroll
ment with 1007.
completion of
elementary education
for every child.
Reduction in dropout
Attainment of MLL
in Classes 1 - IV
in 3000 schools
Attainment of MLL
in all schools
Introduction of
MLL in classes
I - IV in all
Schools
Continuous
teacher training
and orientation
Retraining of 35
teachers per
block
Training of all
teachers in
classes I-IV
10
1007. enrollment ofchildren in 6-13
age group in
formal/nonformal
system.
(c) Reduction in dis
parities by bringing
girls to the same
level as boys and
making education
and instrument of
women's equality.
. Reduction in
Reduction in
dropout rat?-- . ;■ dropout rates
for g i r1s by
" r girls by
757. of. existing
5U7. of existing
level
.evel
Reduction in
dropout rates
for girls by
807.
(d) Providing
Opportunity for
literacy and
continuing education.
757. ’iteracy in
15-35 age group
757. of female
literacy in
15-35 age group
75-807. total
1 iteracy
11
I-------------------------------------------------------------------------------- \
! V
'
I
i
I
I
DRINKING WATER SUPPLY & r NV IRONMEN 1:1. SANITATION
MAJOR GOAL ■'
Universal access to safe drinking water and improved
access ,o sanitary mean-- of excreta disposal
I
I
\------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -
SPECIFIC GOALS
1995
■1997
2000
1007. coverage
of rural
habitations
with safe drinking
water S 40 Ipcd
Coverage of
al 1 existing
habitation
Partial to full
coverage of all
existing
habitation.
5000 partially
covered habit
ations to be
fully covered
Coverage of
newly identified
habitations
Completion of
iRWSS in 3
major taluks
i.iungund,
Jagallur
Mui hagai)
IRWSS in 191
villages in
Bijapur and
Dharwar
Solving water
quantity problem
in all effected villa
including brackish,
fluoride water oroble
(b) San i tat i on
57. Coverage of
rural Population
157. of Coverage
of rural
population
307. Coverage
of rural
population
(c) Guinea Worm
eradication
Zero case
Eradication of guinea Norm disease
taking into account 3 year surveilance
period
(a) Safe Drinking Water
12
/"—______—______----------------------------- ’■---- ---------------------------------------------------------------------------------- \
: VI
1
GIRL CHILD & ADOLESCENT 5I.1l:
MAJOR GOAL :
IMPROVE STATUS OF GIRL CHILD TO ACHIEVE EQUAL SEX RATIO
I
I
I
I
I
!
\--------------------------------------------------------------------------------------------------------------------------------------------------- --------------- /
SPECIFIC.GOALS
1995
1997
2000
(a) Reverse trend of
decline in sex ratio
Arrest declining
Reverse declining
trend of sex ratio trend of sex
ratio to 970
to 960
Achieve sex ratio
of 990
(b) Cover 30% adolescent
girls by special
health camps S improve
personal health
awareness
Coverage of 40%
adolescent girls
in health camps
Coverage of 70%
adolescent girls
in health camps
Coverage of 30%
adolescent girls
m health camps
(c) Provide vocational
skills for self
reliance among 50%
schools dropout
adolescent
girls
25% coverage of
adolescent girls
in vocational
training
35% coverage of
adolescent girls
in vocational
training
50% coverage of
adolescent girls
in vocational
training
13
----------------------------------------------------------------------------------------------------------------------------------- I VII
I
I
CHILD LABOUR :
MAJOR GOAL s
ELIMINATION of CHIu. LABOUR IN HAZARDOUS INDUSTRIES FOR CHILDREN
UPTO 14 /EARS AND FULL TIME CHILD LABOUR OF ALL CHILDREN AND
12 YEA. ’3
I
I
I
I
\------------------------------------------------------------------------------- ,
SPECIFIC GOALS
1995
1997
2Q00
(a) Elimination of child
labour in classified 4
non-classified
hazardous industries
Formulating and
initiating POA
for el imin. tian
of child labour
in key industries
Eliminating child
labour under
12 years
Eliminating child
labour under 14
years
(b) Elimination of full
time child labour in
all industries for
children under 12
years
Eliminating child
labour for under
ten years
Eliminating
child labour
for under
twelve years
Sustaining
achievement
14
/------------------------------------------------------------------------------------------------------------------------------ ------------------------------I VIII CHILDHOOD DISABILITIES !
MAJOR GOAL :
;
3REVENTiu.EARLY DETECTION, INTERVENTION AND REHABILITATION
OF CHI. .'HOOD DISABILITIES FOR ALL CHILDREN BY. THE YEAR 2000 AD
SPECIFIC GOALS
1995
1997
(a) Elimination of oolio
(b) Control of Vitamin A
def iciency
ic) Control of iodine
deficiency
As in Sectoral Goals
< d) Reduction in other
preventable childhood
di seases
(f)
Early detection and
community based
rehabilitation
(g)
Integration of
children with mild
or moderate
disabi1ities into
mainstream education
(h)
Institutional rehabi
litation support and
care
15
2000
IX.
CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES
MAJOR GOAL:
IMPROVED PROTECTION, CARE AND DEVELOPMENT OF CHILDREN
IN DIFFICULT CIRCUMSTANCES
199i>
SPECIFIC GOALS
407. coverage in health
and education programmes
Universal coverage in
medical camps of all
children in existing
institutions
16
1997
2000
757. coverage in
health and education
programmes
907. coverage
in health
education
programmes
Sustain achievement
Sustain
achievement
1.4
GUIDING PRINCIPLES FOR OPERATIONALISATION
The
following principles will guide the overall
implementation of the programme of action for the child:
Holistic View :
Going beyond implementation of a
disjointed set
of individual schemes,
perceiving the
task
in its
totality and
integrating all
measures
necessary to achieve the goals.
Forging alliances
: Enlisting help of persons
representing different sections of society, ihcluding:
all political parties;
-
teachers,
health workers,
anganwadi workers,
associations; other grass root functionaries
voluntary agencies as well as activists groups;
-
training and research institutes;
saksharata samities, mahila mandals, women
organisations;
mass media and other communication agencies.
Mobilisation
:
Placing confidence in people for
imbibing new ways of learning, health care and
economic
sust enanc e.
Communication i Training
: Induction of available
communication modes and suitable training of key persons
and trainers.
Traditional forms of expression would be
harnessed to
create a new understanding and dialogue
among people.
Communication technique of
Kala Jatha
will be used for dissemination of well defined messages
repeatedly conveyed.
Participatory
Planning
:
The community would be
empowered to take responsibility of identifying its own
needs
and given an assertive
role
in
ensuring the
successful
implementation of programmes devised
to
fulfil them.
Effective Decentralisation of functions to enable local
personnel
the
flexibility to devise local
specific
schemes and respond to the demands special to the area.
Gender
to be
perspective
reflected;
women
consistently
and
are the hub around which
moves
- reaching out to women means reaching
core of the present and the future.
17
visibly
the
the
family
very
Encouraging Voluntary Agencies to develop new ideas
approaAes
for replication and
integration into the
development . 'del.
Vulnerable
groups:
insuring
/encouraging
the
participation of socially deprived groups so.that their
priorities are reflected.
I .'5
MECHANISM. FOR IMPLEMENTATION AND MONITORING
The State
Programme of Action for the child in
Karnataka deals with multi-faceted issues and dimensions
related
to child survival, development
and protection
requiring a co-ordinated and multisectoral approach in
planning and implementation for optimum efficiency and
impact.
This would require clarity of
roles
and
linkages between functionaries ensuring an effective use
and
convergence
of services at the radial
point
of
delivery.
Achievement of the goals and time bound tasks
in an efficient and cost effective manner would require
monitoring of
the process and
evolving of suitable
indicators to ensure the same.
Community participation
and
area specific planning will
require
greater
flexibility in resource allocation and budget planning.
State Task Force: A State Task Force comprising
senior officials from the concerned sectors will be set
up to monitor, review and oversee resource management of
the programme' of action:
1) Chief Secretary
Chairman
2) Add1.Chief Secretary
Co-Chairman
3) Secretaries to Govt.
representing Social
Welfare, Health,Education
RD&PR,Labour HUD,Finance
and Planning
Eight Members
4) Representatives from
Voluntary agencies
Four members
5) Representatives from
Media
Two members
6) Nominee of Government
of India representing
Department of Women and
Child Development
One Member
7) Director, U&C Devt.
Member Secretary
18
Sector Action Plans:
An indepth study and review of
the state programme action for children will be made by
the secreta-Le.i and oiaer senior officials^in order
to
facil:tate the specific action plans of
each sector,
outlining the various strategies to reach the 2000 goal,
as well as a projection of the required human, material,
and monetary resources.
Every concerned department
involved
in the
implementation of
child survival
&
development
programmes will prepare an action plan
for
the year and present it to the State Task Force for
discussion and approval.
For effective
implementation
at
the district level Deputy Commissioner
and Chief
Executive Officers may be given orientation on the State
Programme
of Action to
facilitate dissemination to
officials at district level.
Review at State Level:
The Task Force will undertake
a review once in six months. Quarterly reviews will
be
conducted by the Secretary, Social Welfare which will be
attended by all Heads of Departments: Education, Health,
Labour,
Rural
Development,
Panchayat
Raj,
Urban
Development,
Finance,
Planning, Information,
Women &
Child Welfare and Social Welfare.
Progress Indicators:
In order to facilitate review at
the state and district levels, the Heads of
Departments
in their plans will indicate the process,
initiation,
direction and impact indicators to be adopted.
Furtherreview at
the Taluk, sub-Taluk level will be done by
officials of local bodies and panchayats to monitor the
process and impact effectively.
District
Level
Implementation
& Review
:
At
the
district
level
the Chief Executive Officer will
be
responsible for the overall implementation of all
child
survival,
protection and development
programmes.
The
Chief
Executive Officer will ensure an orientation on
the Programme of Action to all concerned officials as
well as development of key indicators to monitor.
These
will ba
incorporated
Into the district
reviews
for
development
schemes.
Innovative strategies and trends
can be studied in depth with micro
level
studies
to
build up the data base, with the advice of
the Chief
Executive Officer
.
Similarly mid term reviews
or
evaluations
can also be
initiated with the
Chief
Executive Officer participation and advice.
The Chief
Executive Officer will
be the
focal
point
for NGO
collaboration in the district.
Check
lists
on the
progress of the goals would be developed at the district
level.
Role
of
local
self government
19
and
communities:
The
regular reviews at Taluk, sub-Taluk levels by officials
and panchayats will help in community mobilisation and
participation in .area1"' related to
child
development.
Women member.'. of wards and panchayats will be oriented
and trained in order to realise and fulfill their roles
sr-d
functions
effectively.
Panchayat/taluk
level
meetings on Programme • of Action can be held
for
orienting
and
evolving
effective
mechanisms
for
monitoring.
Feedback to State Monitoring Cell: The periodic reviews
at
all
levels with various functionaries
as well
as
inputs from N'GOs and others will reflect the achievement
and progress
towards the decadal
goals
for
child
development.
This will
be reported to the
State
Monitoring Cell ensuring continued advocacy and policy
support
and priority for .State Programme of Action at
the highest level.
20
CHILD HEALTH
MAJOR GOAL:
.
BY 1995
REDUCTION OF INFANT MORTALITY RATE (IMR) TO LESS
THAN 65 PEP 1000 LIVE BIRTHS AND 1-4 YEAR CHILD
MORTALITY RATE (CMR) TO LESS THAN 20 PER 1000
LIVE BIRTHS
BY 2000
REDUCTION OF IMR TO LESS THAN 50 AND 1-4 YEAR CMR
TO LESS THAN 10 PER 1000 LIVE BIRTHS
21
!
A.SPECIFIC GOALS.
Reduction of Vaccine Preventable Diseases by:
each
Sustaining Immunisation Coverage of 100
district using Coverage Evaluat1 on Survey data.
Elimination of neonatal tetanus by 1995 .
Reduction in measles deaths by 9
in measles cases by 90% by 1995.
and reduction
Elimination of poliomyelitis in 10 districts
1995 and all districts by 2000 AD.
by
Rehydration
Achievement of
100% usage of Oral
Therapy
(ORT) by 1995:
Reduction of 50% deaths
due to diarrhoeal
dehydration in children 0-5
years and 25% reduction in diarrhoeal incidence
rate by 2000 AD.
Reduction of mortality rates due to Acute
Respiratory Infection (.ARI) among children under
5 years by 40%
Achievement of universal awareness abot HIV/AIDS
B.
PRESENT SITUATION:
Infant
and Child mortality rates are s
indicators of socio-economic development as well as the
and
medical
e f f i cacy
health
of
various public
programmes.
According to Sample Registrat ion System
(SRS),
the
82
and
I MR. of Karnataka is 73 : the rural
The National Health Family Survey (NFHS) 1992
urban 41.
has
however reported a lower THR of 65.4, the neonatal
mortality being 45.3 and post neonatal mortality 20.2.
1990
The under five children mortality is 21.1 as per
SRS.
Infant and Child Mortality have declined during the
past 15 years.
However, during the past five years
the
decline has not been appreciable.
This is also true of
neonatal and post neonatal mortality; in the case of the
former the decline is perceptible only during the past
10 years.
It is observed that in the past five years,
neonatal mortality rate has been twice the level of post
neonatal mortality.
The health condition of the mother,
her age and parity at child bearing, the quality of
22
maternal
care during pregnancy and at
the time of
delivery
are some
of
the
important
factors
that
influence
neonatal
mortality
rate.
Therefore
appropriate programme interventions with these
factors
are
necessarQ
for
further reduction
in
neonatal
mortality rate.
SPECIFIC
DISEASES
A*
B.
GOAL (I): REDUCTION OF VACCINE
PREVENTABLE
Sustaining Immunisation Coverage o f 10 0°; in
Goal
each district usL'g Coverage Evaluat 1 on Survey data.
Present Situation:
Karnataka attained Universal Immunization Coverage
in 1990 and has succeeded in sustaining coverage
levels
since then.
In 1992-93, over 85%
coverage
for
each
antigen was
reported
in practically all
districts,
barring some of the northern and
eastern districts.
However, even in the relatively well covered districts,
Coverage
Evaluation Surveys (CESs) have revealed
lower
level
of
achievement especially for measles
vaccine.
The cold chain
is
a critical
variable as
far the
programme
is
concerned.
The
cold
chain
equipment'breakdown rate’ has been held less
than
6%.
More than 85% of OPV samples tested have been
found
satisfactory with regard to potency level.
Universal Immunisation Programme:
Coverage of
all
pregnant women with atleast two doses of tetanus
toxoid
and all
infants with one dose of BCG, three doses
of
OPV,
three doses of DPT and one dose of Measles.
The
major ongoing strategies include:
The
fixed day as
the major strategy is
followed. Immunization sessions are held in
all
hospitals and health centres as well as
outreach
s ess ions for
every 1000 population once a month.
In addition immunisation services are available
daily in large hospitals.
Catch up rounds are organised every year in
areas with low immunisation coverage.
Collecting information about cases and deaths due
to poliomyelitis, neonatal tetanus, measles
etc
is strengthened.
Information Education
& Communication
(IEC)
activities through mass media and
interpersonal
communication are promoted.
23
1
Involvement
of NGOg
, like Rotary,
Lions and
private sectors,
Particularly
in urban areas
contribute to higher coverage.
C.
Aim
by 19 9 5:
Each district to reach more than 85% coverage
for
each antigen verified
by
Coverage
Evaluation Survey (CES)
by 1997:
Achieve 100% coverage for each antigen
by 2000:
Sustain 100% coverage for each antigen
D.
Major Strategies:
The fixed day strategy for providing immunization
outreach services, catch up rounds for increasing
coverage in high risk areas where the coverage is
and a good surveillance
inad equate
system
for
sustaining high
immunization coverage will
be
continued and further strengthened.
Cold chain maintenance would be
ensured
by
periodic and timely servicing and repairs of cold
chain equipment, attendance of breakdown within a
week, keeping sufficient stocks of spares in the
float
assembly, lifting vaccine samples
once a
month
in randomly selected taluks
for potency
testing
and recording temperatures in the
cold
chain
equipment twice daily and replacement
of
defective cold chain equipment.
Monitoring of proportion of immunization sessions
held would be vital
for sustenance of high
coverage levels.
Mapping of the high risk areas will be undertaken
for
each district where coverage needs to be
increased.
Attention will be on analysis of
the
causes
of
low coverage, early registration
of
antenatal
mothers,
conducting
special
immunization camps/sessions to increase coverage
and
ensuring that booster doses
are given on
schedule.
All factors for low coverage would be
identified
and
attended to
with
people’s
involvement.
Regular reviews and monitoring of performance at
state
/
district / PHC level will be carried
out.
24
Private practit!oners will be
involved through
Indian, Medical Association to ensure that
they
adhere to the national immunization schedule and
norms for cold chain maintenance. Support to them
wherever possible will be provided.
E.
Process indicators:
Proportion of estimated infants immunized,
using
measles coverage as proxy.
(>85% coverage to be
achi eved)
<
-
Proportion of
sessions held versus
9xJJ. te s-a. level sessions to
planned.
Trends
of
vaccine
(positive decline)
diseases.
preventable
Reported
immunisation coverage
vs
coverage
evaluation survey (to be within 10%
of
survey
results)
Percentage
of
vaccine
samples to be +)
Proportion
(<5%)
F.
potency
tests.
of Ice Lined Refrigerator
(>95%
breakdown.
Issues to be addressed:
Coverage
in urban areas especially in the slums
need to
be
improved and sustained.
Though
outreach services and urban ICDS projects have
addressed this
issue there are areas
where
coverage is still inadequate.
Like wise sessions
beyond the sub-centre level need to be organised
and monitored for improvement.
Availability of
all
antigens especially measles in all
sessions
need to be ensured.
The private sector is actively involved in urban
areas.
There is need to evolve a mechanism for
- • ■ —trbngpel?C3rmance surveillance" cTaTT^bh Vaccine
Preventable Diseases like Poliomyelitis, Neonatal
Tetanus and Measles.
Cold chain maintenance in
private sector also needs greater attention.
Quick replacement
of ageing vehicles
chain equipment's need attention.
and
cold
Reporting of Acute Flaccid Paralysis (lameness of
limbs),
measles,
and tetanus
to
be
made
mandatory.
25
Administrative
issues
the
like filling up of
posts
require greater attention.
of
19 posts
Refrigeration Mechanics need to be filled up.
Training, reorientation and updating of knowledge
and
skills
for all
categories of
persons,
including
medicals,
para-medicals
staff
of
ancilllary departments,
NGOs ,
administrators,
private practitioners, representatives from the
community needs to be taken up on priority.
26
A**
B.
Goal
Elimination of neonatal
districts by 1995.
tetanus
in
all
Present Situation:
Karnataka has achieved more than 90%
1mmunlzat i on
o£
pregnant women against tetanus.
The percentage of
institutional deliveries
is
33.8% as
per SRS
1990.
Similar
findings (37%) have been reported by National
Family Health Su; vey (NFHS).
In the state as a whole,
about
37
per cent of deliveries
occurred
in medical
institutions
and the remaining
63 per
cent’
were
domiciliary deliveries,
most of which were attended by
the
Traditional
Birth Attendants
(TBAs)
or
other
persons.
Among the deliveries that occurred in medical
largest
institutions,
the public sector accounts
for
share with 58% as compared to 42% by the private sector.
An analysis of the background characteristics shows
women residing
in urban areas,
women with
higher
literacy,
women with lesser number ot
living children
had a higher prevalence of
institutional
deliveries.
This trend is in the expected direction.
District have
formulated plans
of
action
for
control
of Neonatal
Tetanus
(NNT).
The
strategy
includes
two major components: (a)
elevating tetanus
toxoid coverage of all pregnant women to near
100%
in
all
districts, and (b) promotion of safe deliveries at
home and
in
institutions.
14 districts are
in the
control
stage and 6 are in elimination-stage
according
to GOI classification.
There has been a gradual decline
in the number of reported cases from 221 in 1989 to
42
in 1992
C.
Aim :
by 1995:
Eliminate Neonatal Tetanus
by 1997:
Sustain Achievement
by 2000:
Sustain Achievement
D.
Major Strategies:
Early
level
registration
of pregnant women
at
village
Cent percent
coverage of pregnant women with 2
doses of Tetanus Toxoid and booster doses in cases
where earlier protection is less than 3 years
Promoting
clean
27
deliveries
by
making
available
disposable delivery kits (DDKs) to pregnant women
well
before
the
expected date of delivery and
achieve
100%
coverage of deliveries assisted by
Trained personnel.
Identification and mapping of high risk areas and
improving practices of TBAs in appropriate care and
safe deliveries.
Investigating
all NNT deaths and
system of ZERO cases
recording.
instituting
a
Creating a political urgency and commitment for NNT
eliminat ion.
Training and reorientation of all Traditional Birth
Attendants (TBAs).
E.
Process Indicators:
No. of NNT cases and deaths per 10,000 deliveries.
Percentage of
all reporting sites
that
submit
surveillance data on due date and ZERO reporting of
cas es.
Proportion of Neonatal Tetanus cases
and action taken
investigated
Proportion of domiciliary deliveries
trained personnel
attended
No of districts that are NNT free.
28
by
A Goal
B.
Reduction in measles deaths by 95
95%
and
reduction in measles cases by 90
by 1995
to
Present Situation:
The reported measles vaccine coverage
is more
than 85%
in the state as a whole with considerable
inter-district
variations.
Four
districts
Uttara
Kannada,
Bellary,
Dharwad and Chickmaglur
failed to
achieve even 80% coverage in 1992-93.
CES reveal lower
levels
of
coverage
in
some
districts
(>10%
difference).
A marked reduction in number of cases has
been noted
from 4417 cases reported in
1992
to
1829
reported during January to June 1993.
C.
Alm :
by
1995:
95% reduction in measles mortality and
in measles morbidity
by
1997 :
Sustain achievement
by
2000 :
D.
Eliminat ion
morbidity
of
measles
mortality
90%
and
Major Strategies:
Improving
overall
measles vaccine
coverage
through
fixed day strategy
especially in low
performing and remote areas
through quarterly
catch up rounds.
Strengthening routine reporting of measles
and deaths
and active surveillance.
cases
Improving epidemic management principally through
acceleration of measles vaccination coverage
in
pre-epidemic periods.
Correct case management of all acute
respiratory
infections
and
management
of
post-measles
complications.
Administering
Vitamin
A
concentrate @ 2 lakh International Units (IUs) to
all children affected by measles during outbreak.
Initiating
concerted communication
efforts
for
creating awareness of measles as a killer disease
in the community, looking out for early signs of
complications
and
focussing on referrals
to
appropriate health facility.
Upgrading the skills
of health workers
for
correct
case management and equipping the
first
referral units with oxygen and essential drugs.
'I
Immunising children over one year of
age not
covered
earlier rather than wasting
measles
vaccine, unused in the immunisation session.
Strengthening routine reporting of msaslea
cases
and deaths by making
measles
a
notifiable
disease.
E.
Process Indicators:
-
Percentage
of under one year old children
with measles vaccine.
Annual number
of cases of measles in
years children.
covered
under.
five
Annual
number of deaths due to measles under
years children.
five
Measles case fatality rate C< 3% in outbreaks)
-
Annual no.
of measles cases & deaths.
30
J1
A****
B.
Goal
Elimination of poliomyelitis ip 10
districts by 1995 and eradication
throughout the state by 2000 AD.
•
i
Present situation:
The year
1992-93 recorded 92%
coverage as per
objective performance.
ip districts
are
in
endemic
stage while 10
are in control stage according
to GOI
criteria.
Marked reduction of reported case has
been
observed
from
465 cases in 1992 to
208
cases during
January to June 1993.
C.
Aim :
by 1995 :
100% coverage of 0 PV-3 throughout the state
Polio free status in 10 districts
by 1997 :
Sustenance of OPV- 3 coverage levels
free status in 15 districts
by 2000 :
Sustenance of OPV- 3 coverage levels Polio
free status in all districts throughout
the state
D.
Polio
Major Strat egi es :
-
Elevating
coverage throu gh
centre and
outreach
approaches and identifying areas of low performance
for catch up rounds.
-
Provision of three doses of OPV along with DPT at
6,
10, 14 weeks to all infants as part of
primary
immunization,
administering boost er ' d'o'se ""after a
year along with DPT vaccine.
A zero dose to be
provided at
birth in cases of
all
institutional
deliveries.
Undertaking mop up rounds for 3 consecutive years
in areas
reporting
cases
during specific
low
transmission months.
Two doses of OPV at 1
month
interval to be given to all children below 3 years
in respect of previous immunisation status.
Ensuring
early identification,
listing of polio cases.
reporting and
line
Instituting measures
for
early containment
of
outbreak
cases:
Two doses of
OPV towards
ring
immunisation to all children under 3 years of
age
in 5000 population surrounding the rural area and
10000 in urban area within 2 weeks of outbreak.
No
ring
immunisation to be done after one month of
outbreak.
31
Promoting vaccine quality control
<
Developing a system of collection of faceal samples
and referral of specimens to reference laboratories
for polio virus.
Ensuring, effective and
efficient
use of
mass
communication
tor awareness,conscientization and
action.
Undertaking spot mapping
"high risk " pockets
and
identification
Strengthening
surveillance of
cases
Flaccid Paralysis (AFP) among children.
of
of
Acute
Encouraging reporting of lameness by the community
and others from the private and Health sectors and
NGOs .
E.Process Indicators:
Percentage
than 85%.
of districts with OPV-3
coverage
more
■Proportion of OPV-2 coverage in mop up rounds by
achieving over 80% coverage of less than 3 years in
mop-up round.
Number of districts that report polio cases within
the prescribed time period on a line listing
Number of polio cases reported.
Proportion
of
polio
measures are taken.
cases
where
containment
Percentage of cases being followed up 60 days after
the onset of paralysis.
Number of districts that are polio free.
Proportion of OPV samples satisfactory
OPV samples to be found satisfactory)
32
(over
9^%
SPECIFIC
A
B.
GCAL
( i..): IMPROVING USAGE OF
ORAL
REHYDRATION THERAPY
(ORT)
TO
100% AND REDUCTION
IN
DEATHS AND INCIDENCE RATE
DUE TO DIARRHOEA
Present situation
Diarrhoea is a major cause of mortality in children
under
five years
of
age.
The National
Diarrhoeal
Diseases Control Programme was starred during the sixth
plan and intensified during the subsequent plans with an
objective to reduce mortality due to diarrhoeal diseases
through promotion of Oral Rehydration Therapy (ORT) and
health education in the home management of diarrhoea.
A
distribution system of
Oral
Rehydration Salt
(ORS)
packets was
integrated with the primary health care
system.
The ORT use rate as revealed by Coverage Evaluation
Survey data
is
around 30
35%.
Nine
Diarrhoea
Training
Units
(DTUs)
are
functioning
in
medical
colleges.
12-16 lakhs of ORS packets are distributed to
all
the districts.
Mothers meetings are being held to
improve
the knowledge.
Flip charts
are
in
use.
District Hospitals have been equipped with utensils
for
demonstration
of
preparation of
ORS solution.
The
present approach includes:
Educating mothers and communities to enable them to
initiate home care of 90% of the children suffering
from diarrhoea by using home-available
fluids,
continuing feeding during diarrhoea and recognizing
early signs
of dehydration.
The home available
fluids propagated for use include rice water,
dal
water and coconut water.
Improving the
case management of
cases
at
all
health
facilities by training health personnel
involved in primary health care services,
district
hospitals and medical colleges.
Providing free ORS packets at all health facilities
and taking up social marketing of
ORS so that
packets are easily available at affordable rates to
the people in each village, preferably, through fair
price shops.
33
Aim:
1007. GRT usage rate For cases of diarrhoea treated at
iioroe
and 80Z of cases leaving home
seeking
treatment
receiving 0R8.
by 1995:
Reduct icn in diarrhoeal deaths by 30Z
Reduction in diarrhoeal cas ea■by 10 %
by 199 7 :
Reduct ion in diarrhoeal deaths by 50%
Reduct Ion In diarrhoeal cases by 15%
by 2000:
Reduct i on in diarrhoea1 deaths by 707.
Reduction in diarrhoeal cases by 25‘Z
Major Strategies:
Propagating ORT: Culturally acceptable Home
Fluids
have been identified and
included in programme
training
materials.
These now need
to
be
communicated much more widely.
Training
of
medical
officers
and
health
functionaries
on correct case
management
of
diarrhoeal ^diseases through the CSSH programme as
well as ICDS Infrastructure.
Ensuring. 24 hours availability of ORS at village
level
through
health system,
village
level
functionaries as well as Public Distribution System
(PDS).
Depot holders in each village and urban
slum to be
identified and trained
in correct
management of diarrhoea.
These depot holders could
be
village
level
functionaries
like
school
teachers,
Traditional Birth Attendants
(TBAs),
members
of Women's Groups
or
Panchayat members
besides the health and nutrition functionaries.
Setting
up
hospitals
ORT
corners
in
health
centres
/
Ensuring
correct
case management
in all
public
sector health facilities and in the private sector
through Indian Medical Association & Indian Academy
of
Paediatrics,
Karnataka.
Alliances
with
orofessional
bodies offers considerable potential
"for achieving change
in the prescription
and
treatment practices in the private sector.
Going
beyond
the health
sector;
empowering
household families with the appropriate knowledge
for
correct
case management
of
diarrhoea
By
promoting use of home available
fluids
by all
mothers at the first sign of diarrhoeal disease and
34
timely referral for management of dehydration.
Mobilising professional bodies and specialists
for
promoting'ORS as a standard and life'saving regimen
for correcting dehydration
A4vocatir.»
c'one urn er movement £ 0 r safe r medicine:
OP-' use and dissuading use of anti diarrhoeals
Konijoring
ORT/ORS
use for all
children
seeking
Promoting activities aimed at diarrhoea prevention
eig.
hand washing,
household water
storage
&
protection, immunization against measles, Vitamin A
suppl am ent at .'.on
community
based
Identifying
and
invol vine
organisations
for promoti on and assessment of ORT
and
use
and
continued
feed ing and promoting
including
protecting the culture of breastfeeding
colostrum," and environment al sanitation.
Intensifying
Information,
, Education
Communication activities to focus on
and
mass media network for information dissemination &
education interpersonal communication by health and
nutrition workers, and local opinion leaders
such
as teachers.
communication to promote ORS prescription
through
physicians,
nurses and health workers,
and rural
medical practitioners.
The concept of
not
using
antibiotics
and anti-motility drugs
for
acute
diarrhoeal diseases to be emphasized.
mothers to be taught to start giving Home Available
Fluids (RAF) if the child has any alteration in the
£ 1 u i d i t y and frequency of stools
for display of
standard
diarrhoea
provis i on
charts
in
all
health/nutrltlon
management
f ac i1i11es schools and public places
E.
Processors Indicators:
Proportion of villages with ORS availability at any
point of time.
ORT use rate - proportion of all cases of diarrhoea
in under five children receiving ORT.
ORS
access
rate
- proportion
of
all
cases
of
diarrhoea
iji under five seeking care outside
and treated with ORS
home
Continued
feeding rate - proportion of
cases of
diarrhoea
in children under five
children given
same or increased amounts of food during diarrhoea.
36
A. SPECIFIC
B.
GOAL (ill):-
REDUCTION
OF
MORTALITY
RATES
DUE
TO
ACUTE
RESPIRATORY
INFECTION
(ARI) AMONG CHILDREN UNDER
5 YEARS BY 40%.
Present Situation:
Nearly one-third of the hospital outpatients
and
one
fifth
of the hospital admissions belong to ARI
problem category.
Medical Officers and Health Workers
are being trained under CSSM programme to
improve the
knowledge and skills
for detection of ARI
case ' and
instituting
proper
case management.
ARI
control
programme was launched in 1989-90 as a pilot project
in
selected districts
of
the country,
Chickmaglur
in
Karnataka - with the primary objective of reducing ARI
associated
mortality
through provision
of
anti
microbials at the most peripheral level.
C.
Aim :
by 1995:
Reduction in deaths due to ARI by 10
by 1997:
Reduction in deaths due to ARI by 30
by 2000:
Reduction in deaths due to ARI by 40
D.
Major Strategies:
Training
of
health workers
on
correct
case
management of ARI and provision of cotrimaxazole to
them.
Promotion of home management of mild infection
and
timely referral to health centre if the child does
not improve.
Provision of antibiotics and other facilities
for
correct case management
at health c-are
facilities
especially FRUs/
gfipcert ffitgpmmug^5Ag? ef f orts throj^h mass media
through
I CDS/CSSM/UBSP programmes.
"±C&1°ft
Upgradation of the skill of Mid Level Managers
management of complicated cases.
for
E.
Process Indicators:
Proportion of staff trained against number
for ARI case management
planned
Proportion of sub-centres having availability of
cotritnaxazo 1 e in LS^>rI districts (>80?; subcentres to
have availability)
Proportion of FRUs having oxygen and
antibiotics for ARI management
38
second
line
A.
SPECIFIC
B.
GOAL
st?
ACHIEVEMENT
OF
UNIVERSAL
AWARENESS ABOUT , HIV/AIDS
BY
2000 AD
/
Civ).
Pres->rit Situation:
I
HIV/AIDS
la an emerging health problem.
Of
the
289f022
blood samples screened 1.160' have been fotind
positive.
There has been a progressive increase J in
seropositivity.
Unless HIV/AIDS prevention and control
programmes are implemented speedily not to reverse the
gains achieved in child and maternal health
indicators
will
be reversed CDR, IMR, common infectious
diseases
especially Tuberculosis
i 11 rise. There will be a heavy
burden on medical institutions with concurrent rise
in
health care costs.
AIDS orphans, AIDS in new borns
and
rising
incidence of HIV/AIDS among women are bound to
affect
the status of children.
A strategy has
been
developed at national level for HIV/AIDS prevention and
control with well defined components.
State AIDS cell
has been established. A State level Empowered' 'Committee
has also been formed.'
C.
Aims
:
by
1995:
Awareness
of HIV/AIDS among
population
by
1997 :
Awareness of HIV/AIDS among 70%
populat ion
by
2000:
Awareness
of
population
D.
Major Strategies:
HIV/AIDS among 100%
Development
of
communication
prevention and control of AIDS
Sensitisation of
National
Service
NGOs
50%
of
the
of
the
of the
strategy
youth
: h.ough
involvement
Scheme/l-ehru ' Yuvak Kendras
for
of
and
Support village depots for condoms
Promoting
youth
positive health
action
for
AIDS
control
and
Training of
medical, para-medical staff
and
non
medical
functionaries
in Government
and
Private
Sector
E . Pi-oeeaa Indicators
Proportion of awareness among youth of basic
facts
about AIDS and its promotion (50%
of
university
students, 50% of. high school students, 30% of
outof
schools/college youths,
25%
women
groups
oriented through ICDS/UBS/DWCRA sectors by 1995)
Proportion of' awareness among health workers
about
AIDS/STDs
and its prevention (80%
health workers
aware of AIDS/STD by 1995)
40
MATERNAL HEALTH
t—-------- ------------------------------------------------ -----
MAJOR GOAL:
!
r
I
I
i
!
BY 199b
REDUCTION OF MATERNAL MORTALITY RATE !
(MMR) TO 300 PER 100,000 LIVE-BIRTHS !
I
!
BY 2000
REDUCTION OF MMR TO 200 PER 100,000
LIVE-BIRTHS
i
I
!
i
A.
SPECIFIC GOALS:
(i)
Prevent pregnancies below 21 years ; promote birth
Interval of
thre ' years and restrict total number
of births to two
(ill
Ensure
cent
percent coverage of
pregnant women
with antenatal care; cent percent births
attended
by
trained
birth
attendants
and
referral
facilities for high risk pregnanclea and obstetric
emergencies
available
’ for
every
3-5
lakh
populati on
PRESENT
E.
.
SITUATION:
Maternal
mortality rate in Karnataka is
estimated
to be between 400-500 per 100,000 live births.
In otherwords an estimated that 11,200 mothers die due to
child
birth
every year or 30 die in a day, that is one
every
hour.
The major immediate causes of maternal deaths are
Bleeding
(22% or 2,500 deaths per annum), Anaemia
(20%
or 2,250 per annum), Puerperal Sepsis (12% or 1,350
per
annum),
Toxaemia
(12%
or
1,350
perannum).
The
underlying
factors
are
early marriage,
early
and
frequent child bearing with short spaced pregnancies
In
the context of low literacy level, malnutrition and poor
availability of proper maternity services.
90% of these
deaths
can be prevented over
time with appropriate
health,
social
and economic measures;
and over
twothirds' of
these deaths can be prevented
"now”,
if
appropriate health measures are instituted.
A.SPECIFIC GOAL (i)
41
-Pr event-- pr-ggtrarnri es
below 21
years
; promote birth
interval
of three years;
restrict total
number of’births to two
\
3.Present Situation:
Crude Birth Rate stands at
26.2 per
1000:
rural
27.3
and urban 23.3. According to SRS data the total
fertility rate in 1987 was 3.7 in rural 2.9
in urban
and 3.4 for the state. Which the state average declined
to
3.1 in 1992.
The,annual exponential growth rate
is
2.19%, Couple Protection Rate is estimated at 48.2%
c.
Aim :
by 1995 :
Reduce CBR to 24.5/1000 population
by 1997:
Reduce CBR to 23/1000 population
by 2000:
Reduce CBR to 21/1000 population
D.ldajor Strategies
-
:
Family planning built into a comprehensive
of MCH/CSSM
package
Focus on younger couples and spacing methods.
Involvement of all systems of health care and NGOs
Social marketing of contraceptives
Involvement
of
People’s groups
-
Panchayati
Ra ]
Innovative
approaches
for
activity for small family
Institutions
and
strengthening
IEC
Special efforts in poor performing districts.
E.
Process Indicators:
Proportion of women with first pregnancy after
age" of 2 0 years
-
Proportion of women who space
deliveries three years apart
Contraceptive prevalence rate.
-
Couple protection rate.
42
their
the
succesive
A.SPECIFIC GOAL (il)
B.
Ensure
100
%
coverage
of
pregnant women with antenatal
care;
100% births attended by
Trained Birth Attendants
and
referral
facilities
for high
risk pregnancies and obstetric
emergencies available for every
3-5'lakh population
Present Situation:
More than 60% of the pregnant women are receiving
iron
folic acid:
40
70%
antenatal
care;
while
deliveries by trained birth attendants is more than 60%.
According
to the 1993 National
Family Health Survey
Study, . the utilisation of antenatal services was
found
generally high.
74.8% of the women received Iron Folic
Acid
(1FA)
tablets.
About
6B%
of
the women
had
antenatal
check
up done by doctors
In
medical
institutions.
41.9%’of women received antenatal
care
from health workers during home visits.
Mother & Child
Health is being addressed through the ongoing programmes
like:
-
Child Survival & Safe Motherhood Programme (CSSM)
—
Family Welfare Programme
—
India Population Projects — VIII & IX
C.
Aim:
by 1995
80%
non-institutional
deliveries
to
attended by trained birth attendants
be
by 1997
90%
non-institutional deliveries
to
attended by trained birth attendants
be
by 2000
100%
non-Inst 1 tut 1onal deliveries
to
attended by trained birth attendants
be
by 1995
Ensure referral facilities for every 3-5
lakh population in 50% of the districts
by 1997
Ensure referral facilities for every 3-5
lakh population in 75% of the districts
by 2000
Ensure
referral facilities for every 3-5
lakh population in all the
districts
of
the state.
43
Major Strategies:
>
Intensification of
CSSM Programme providing.
a
package of
services : essential
obstetric
care,
early detection of
complications
and
emergency
services for those who need it.
Supporting
MCH
services:’
ante-natal
care,
immunization,
management
of anaemia,
timing and
spacing of births, clean delivery etc.
Developing an appropriate communication strategy:
bridging the gap beween awareness and utilisation
of MCH services through 'intensified motivation,
education and communication.
Upgrading of knowledge and skills
of
Medical
Officers and Health Workers for essential obstetric
care,
early detection of
and management
of
complications.
Ensuring services
for immunization with tetanus
toxoid,
prophylaxis
and treatment
for anaemia,
■services
for birth spacing and timing,
antental
care management of sepsis and toxemia through the
CSSM. programme
Providing
first referral services
for
obstetric
emergencies specifically bleeding and obstructed
labour
for
every 500,000 population in a phased
manner
Developing alternate modes for transportation
emergencies through community support
of
Process Indicators:
Proportion of
doses of TT.
Proport ion
Acid
pregnant women protected
with
of pregnant women consuming Iron
(I FA) for anaemia prophylaxis or for
two
Folic
anaemia
treatment.
Proport ion
of pregnant women receiving
ante-natal
Proportion of pregnant women attended by a
birth, attendant.
Proportion of institutional deliveries
-’■lumber
of functional FRUs per CSSM district
44
trained
NUTRITION
!
I
!
MAJOR GOAL..
!
i
!
• BETWEEN 1990 AND THE YEAR 2000 REDUCTION IN SEVERE !
! AND MODERATE MALNUTRITION AMONG UNDER - FIVE AGE
!
! CHILDREN BY HALF.
!
i.I
A.SPECIFIC GOALS:
(i)
Reduction
in
severe
as
well
as
moderate
malnutrition among under-5 age children by half
of
1990 levels.
(ii) Reduction in incidence of low birth weight (2.5
or less) babies.
kg
(iii)Reduct ion of iron deficiency anaemia in women.
(iv) Universal consumption of iodated salt.
(v)
Control
of
Vitamin
A
deficiency
consequences including blindness.
and
its
(vi; ^JEinp«wsxain=ent
of
all womeh to breast-feed their
children exclusively for four to six months and to
continue breast-feeding with complementary food
well into the second year
(vii)Making all hospital and maternities ’’baby-f r i endly”
as
defined by the Ten Steps
to
Successful
Breast f ceding
(viii)Growth promotion and its regular monitoring by the
end of the 1990s.
(ix) Dissemination of knowledge and supporting s ervi c es
to
increase
food production to
ensure hous ehold
food security.
A. SPECIFIC
B.
GOAL (1)
Reduction in severe as well
as
moderate
malnutrition
among
under five children by half of
1990 levels.
Present Situation:
Protein Energy Malnutrition
(PEN)
is
the most
widespread disorder among children.
Severe malnutrition
is estimated to be around 3% in 1989 compared to around
45
6% during 1 976-79
period.
Chronic malnutrition iif
estimated to be around 37% in 1989.
PEM prevalence
is
higher
in northern and eastern Karnataka
compared to
western
and southern areas.
Clinical
forms
of
malnutrition are prevalent in 1.8% of children compared
to 3% in 1975.
Though there is significant decline
of
severe malnutrition, improvement in child nutrition
is
not
reflected in the growth performance.
A
vast
majority of children in the lower socio economic group
show varying degrees of growth retardation.
The mean
heights and weights of the children have almost remained
the same over the last decade.
Attention therefore
is
to be paid to these children with growth
failure.
Efforts should be made to see that these children attain
better nutrition and growth, and develop to their
full
pot entia.l.
The nutr Lion component __of
I CDS
programme
is
mainly aimed at prevention of
PEM "among pre-school
15~r c- n
To months to 6 years)
through suppTementary
•TTTding a:. Anganwadi Centres.
Late
introduction of
h-■ up j ’. eMv;i: Lat'-y——triri-l-a—weaning a child is the most
i .iportant cause
for growth faltering and subsequent
severe malnutrition.
Thus
,it must be
ensured that
-children receive supplementary feeding through receive
supplementary
feeding through community action
to
prevent the onset of malnutrition.
Special
attention
must be paid to children in the 6 months to 2 years age
group through^awareness programmes so' that all
Pre
school
children are provided adequate feeding
in the
homes by families and communities.
C.
Aim :
by 1995:
To bring down the levels of malnutrition in
the northern and eastern areas to the levels
of other parts of the state
by
1997:
To
bring
down the
level
of
severe
malnutrition to half of the level of 1990
by
2000:
To bring down the level
of moderate and
severe malnutrition to half of the levels of
1990
D. Major Strategi es:
Formulation of a State level Nutrition Policy based
on National Policy^
Extending and strengthening the existing maternal
and
child nutrition programme with
focus
on
reaching the unreached.
Strengthening inter-sectoral co-ordination.
46
Addressing *
child
&
maternal
nutrition
comprehensively through ICDS, Health, Tribal, Urban
poverty alleviatioi. schemes.
Improvin.;
sani cation.
access
to
health/'
water
safe
and
Ensuring supplementary nutrition for children under
three.
Improving preventive
facilities.
health
care
and
referral
Strengthening support to health and nutrition by
better targetting so that
expectant mother has
access
to
information,
additional
food
and
resources.
Encouraging small family norm and adequate spacing.
Ensuring supplementary
with risk.
food to
pregnant
mothers
Instituting
community
based
growth
monitoring/promotion with mother’s involvement and
focus on 'at risk’ children.
Intensifying Health & Nutrition education.
Sensitizing
training.
frontline
workers
through
frequent
E.Process Indicators:
%age of children below 4 months receiving exclusive
breast £eeding.
%age of 6-12 months children getting
food.
complementary
%age of new borns with birth weight less that
gms .
2500
%age
of
pregnant
supplementation
receiving
food
%age of pregnant women receiving I FA for at
100 days
least
women
lags of
less
than
24 months with severe and
moderate malnutrition provided with supplementary
feeding under
ICDS
Mapping of high risk areas
A.SPECIFIC
GOAL
(ii) :
Reduction in incidence of low
birth weight (2.5 kg or less)
babies
B. Present Situation
The
intra uterine development of the
foetus,
the
birth weight, growth and development of the infant later
on,
depend mainly on the nutritional
status
of
the
mother.
The prevalence of low birth weight
babies
ranges
from 27 to 56% in urban and 33 to 41%
in rural
areas.
Low birth weight is a major
contribution to
neonatal
mortality and maternal malnutrition the major
cause.
The other risk factors for
are age of
the
mother, height and weight, interval between pregnancies,
anaemia etc.
The mean age at marriage is 19.21 (female)
: much lower in rural areas.
15-20% of the mothers have
less
than
the height/weight
standard thus
posing
obstetric risks
leading to low birth weight
babies.
Though data on anaemia is scanty, but anaemia is also
a
contributing
factor.
Malnutrition in
early childhood
results in poor growth and development of the mother and
early motherhood also prevents realisation of
full
growth potential.
Aim
By 1995:
Provision of MCH care to all pregnant women
By 1997:
Reduction of low birth weight babies by 10%
By
Further reduction by 20% from
1 evel
D.
2000:
the
current
Major Strategies:
Nutritional communication to be developed to create
greater awareness of nutritional problems and their
solut i ons.
Nutrition
education to be closely linked
to
activities
like
immunization,
oral
rehydration
therapy, promotion of breastfeeding, birth spacing,
training and female literacy.
Correct dietary habits for
improving nutritional
levels through behavioural change to be promoted
Ante-natal
and post-natal care for preventing
birth weight babies to be provided.
low
Ensuring better nutritional coverage right from the
first
trimester to the major period of lactation.
48
E.
Process Indicators:
Percentage of new borns with less than 2.5 kg birth
weight.
/
A.SPECIFIC
GOAL
Reduction of Iron Deficiency
Anaemia (IDA) in women
(iii)
B. Present Situation:
IDA is one of the major nutritional problems
affecting
the health of women & children.
Anaemia in pregnant
women leads to maternal morbidity and mortality, and
is
also
associated with premature delivery and low birth
weight babies.
ICMR studies have indicated that 80%
of
pregnant . women are anaemic.
About
67%
of - preschool
children are estimated to be anaemic in Chitradurga and
90% in Bidar district.
Under the prophylactic programme
against Nutritional Anaemia combined tablets
of
folic
acid and
ferrous sulphate are being distributed to
pregnant
& nursing mothers and pre-school children.
If
found anaemic,
an additional
course of
tablets
is
provided
to the pregnant women in order to reduce the
risk factors contributing to maternal mortality.
m
by 1995 :
Reduction
o£
I ron Def iciency Anaemia by 10%
by 1997 :
Reduction
o£
I ron De f ici ency Anaemia by 2 0%
by 2000 :
Reduction o £
I ron Def iciency Anaemia by 30%
Major Strategies:
D.
Consumption of
iron-rich foods will be
through ongoing schemes like ICDS, MCH,
DWCRA programmes.
promoted
UBS and
”UIP
Plus"
package will include control
of
deficiency
anaemia
through
ensuring
supplements to pregnant women.
iron
iron
All pregnant women and 50 percent of young anaemic
children will be covered with iron and folic acid
Improved quality packaging and distribution of iron
and folic acid tablets will be ensured.
E.
Process Indicators:
Proportion of pregnant women receiving and
consuming IFA tablets for anaemia prophylaxis
or
and
or
women receiving
Proportion of pregnant
consuming IFA for anaemia tr eatment.
50
A. SPECIFIC
Universal consumption
iodated salt.
GOAL (iv)
o£
B. Present ■p tnation:
Iodine
Def i ci ency not
only causes disf iguring
disorder/goitre, but also leads to various complications
like abortions, still births, low birth weight,
birth
defects,
increase
in
IMR,
subnormal
intelligence,
hypothyroidisnt and
endemic
cretinism comprising
of
mental retardation/deaf mutism, squint,
thus indicating
that
iodine, though in small quantity, affects greatly
the child development and survival.
Surveys carried out
in
144
taluks
in
404
villages
covering
237,000
individuals indicated that four districts (Chickmagalur,
Kodagu,
Dakshina Kannada & Uttara Kannada)
have more
than >10% prevalence of goitre.
Smaller endemic pockets
in other districts have also been mapped out,
thus
IDD.
Hid icating
that
the State
is not
free
from
However,
the State has banned entry and sale o f non
iodised salt in these four districts.
C. Aim:
by 1995:
Ensure iodised salt consumption in the endemic
areas
by 1997:
Ensure universal consumption of iodised salt
by 2000:
Control Iron Deficiency Disorder in the stat e
D.
Major Strategies:
Creating awareness
in the community through the
ongoing programme ICDS,
UBSP ,
DUCRA,
School
Education, Healtn
Supporting
IEC
iodised salt
activities for
promoting
Strengthening state monitoring cell for
monitoring at field levels.
use
of
effective
Ensuring adequate supply of iodised salt
Mobilising the dec ision/po1icy makers for a total
ban on the sale of non-iodised sale in the state
Orienting
functionaries , manufacturers,
traders,
wholesalers
and
retailers
in
the
effective
implementation
Strengthening local production capacity of
salt
51
iodated
Process Indicators:
90% of salt at retail level particularly in endemic
districts to have iodine level more than 15 ppm.
I5 er cent Age of households consuming iodated salt.
Happing ana identifying
52
high risk’ areas
A.
SPECIFIC GOAL (v)
Present
B.
Control of Vitamin A deficiency
and
its consequences
including
blindness.
Situation
Vitamin A deficiency in its severest form leads
to
permanent blindness.
This often associated with severe
PEN,
is mostly confined to pre-school
age children,
although milder forms like night blindness and Bitot’s
spots
are seen
in older children as well.
Studies
reveal
that
Vitamin A deficiency is
associated with
Surveys conducted
reduction in morbidity and mortality.
have shown that
the prevalence of
Bitot’s spots
is
around 2.8% which has remained static for the past
one
decade.
The prevalence of Bitot’s spots was as high as
7% during 1975-82 in urban slums and around 2.5%
during
1987 in urban ICDS projects.
Subclinical deficiency
of
Vitamin A is still wide spread even though xerophthalmia
is
showing a declining trend.
Strategies have been
adopted by linking the administration of Vitamin A with
measles vaccination to cover children below one year.
C.
Aim :
by
1995 :
To reduce the pr evalenc e o £ Bitot ' s Spot
less than 2%
to
by
1997 :
To reduce the prevalenc e o f Bitot’s spot
less than 1%
to
by
2000:
Elimination of Vitamin A deficiency
D.
Major Strategies
Providing Vitamin A supplementation through
& ICDS
Health
Providing 100,000 Ills with measles vaccination and
200,000
Ills with second year booster contacts
for
OPV and DPT.
Nutrition
education/counsel 1ing for
incorporation
of Vitamin A rich foods through ongoing
schemes
and encouraging local production of such foods
Monitoring
clinical signs of Vitamin A deficiency
through
contacts
during
immunization,
growth
monitoring etc.
Ensuring adequate
distribution
53
supply
of Vitamin
A
and
its
E.
Process indicators
Percentage of infants exclusively breastfed for the
first four months
Percentage of
children covered by
2
doses
of
Vitamin A: first at measles immunization and second
at 18-xnonth booster contacts
Percentage of
children under-3
doses of Vitamin A
54
covered
with
5
SPECIFIC
A.
Present
B.
GOAL (vi) Empowerment
of.
all
women tc
breastfeed
children
exclusively
f<_r
4-6
months
and
continue
breastfeeding with complementary
complementary
food well into the
2nd year.
Situation:
Faulty breastfeeding habits
like discarding of
colostrum,
giving prelacteal
feeds
and
feeding
of
complementary milk before
4 months of
age,
are the
hindering
factors.
A study around Bangalore
revealed
that 30% mothers were not feeding, colostrum, 68% giving
prelacteal feeds and 60% in rural and 35% in urban areas
of
mothers
feeding complementary milkAlthough 94%
but
majority
were
breast
feeding upto
4 months
period.
Faulty
introduced complimentary milk by this
supplementary feeding habits like delay in introduction,
incorrect
use
of
improper
weaning
foods
and
hindering
frequency/quantity are the major
factors
of
proper
supplementary
feeding leading to the
onset
of
malnutrition.
The same study
revealed '32-57%
mothers did not introduce suoplementary feeds to
their
infants
even after 8 months.
Commercial
formula milk
foods were fed to 17% of infants and bottle f eeding was
observed in 69% in urban areas.
C.
Aim :
by 1995:
Awareness
among
all
mothers
on
the
importance of
exclusive
breast
feeding
during
the
first
4
months and
timely
introduction of supplementary foods.
by
1997:
Exclusive breast feeding upto 4
months by
50%
mothers
and
introduction of
proper
supplementary foods by 80%.
by
2000:
Empowerment
of All women to breast
feed
their
children exclusively for 4-6
months,
continue breast feeding with complementary
foods, well into the 2nd year
D.
Major Strategies:
Creating awareness amongst functionaries of various
UBS,
BUCRA,
health,
doctors,
programmes-.
ICDS,
mothers
for
promotion
of
families
and
breast f feeding.
Training of village level functionaries to
55
• VC
promote
appropriate lactation management and breastfeeding.
Appropriate
communication strategy
for
child
survival fid health to include breastfeeding as an
integral component.
E.
Process Indicators:
Percentage of infants exclusively
four months
Percentage of
infants
after 4-6 months
56
on
breastfed
complimentary
upto
feeding
A.
SPECIFIC GOAL (vii)
Uakins all hospital
and .
maternities "baby-friendly”
(BFHI)
as defined by the
Ten Steps
to
Successful
Breastfeeding
B.Present Situation:
The state is committed to implementation of Act on
Infant Milk Substitutes, Feeding Bottle and Infant Foods
and making major hospitals as defined ’’Baby Friendly”.
JJM Medical College, Davangiri has taken a lead in this
direction and
is on the verge of being recognised as
'Baby Friendly’.
A state level task force has also been
set up for initiating the BFHI activities.
C.
Aim :
by
1995:
All hospitals & maternities with over
1000
deliveries per year certified as
'babyf r iendly’ .
by
1997:
All Hospitals
'baby-f ri endly’
by
2000:
30% mothers to follow correct
child feeding practices;
D.
1
maternity
centres
made
infant
and
Major Strategies:
Setting up of a BFHI task force with representation
from Government, Private Sectors, IMA, IAP,
FOGSI
etc
-
Networking of NGOs .professional bodies,
corporate
and private sector for propagating the concept
-
Training
for
lactation management
for
staff in private and government sectors.
hospital
Implementation of Act on breast & infant feeding
Education
&
Promotion
of
the
benefit
of
breastfeeding
through various programmes
like
ICDS/CSSM/UBSP/DUCRA
Supportive
measures
to promote
and
protect
breastfeeding
with
emphasis
on
exclusive
breastfeeding for 4 to 6 months.
57
Process Indicators:
Proportion o£ hospitals oriented for BFHI with 1000
plus bir^h rate annually (>50% of hospitals to be
oriented by 1994 and 100% hospitals by 1995)
Proportion of recognised hospitals with 1000 plus
birth rate .annually (30% hospitals to be recognised
by 1994
and >80% recognised by 1995)
58
A»
B.
SPECIFIC
GOAL (ix)
Reduction
in percentage of
households with
inadequate
household
food security by
50% of current levels.
Present Situation:
Approximately
32%
of the sample households have
been issued green cards meant for poorer sections of the
society.
This
is
indicative of
the
fact
that
practically all households below the poverty line have
received green cards since the extent of poverty among
households in the state is estimated to be in the range
of 30-40 per cent.
C.
Aim :
by 1995 :
Reduction by 10%
by 1998 :
Reduction by 20%
by 2000 :
Reduct ion by 50%
D.
Ha jor Strat egi es:
foods
Increasing
production of protective
considerations
strengthening
nutritional
agriculture and horticulture sectors
Promoting
concepts of kitchen garden
household food security
Identifying
ins ecur i ty
to
by
in
increase
fami 1ies/groups at great risk of
food
Covering all families at health and nutrition
risk
under Public Distribution System to ensure monthly
household food security
Introducing
innovative concepts like distribution
of
low
cost
weaning
food
through
public
distribution system to make quality weaning
food
available to mothers and children in villages
Introducing thrift and credit system among cohesive
women’s groups to promote coping strategies among
communit i es
Targetting
poverty
alleviation
and
income
generating schemes
to
families with inadequate
household food security.
59
E.
Process Indicators:
Percentage of families with
food sectr. tj.
inadequate,
household
Percentage
of
families with
inadequate
food
security benefitting from poverty alleviation and
income generating schemes.
60
E< I’CATION
i
i
MAJOR
!
!
GOAL : ACHIEVEMENT 'OF UNIVERSAL ELEMENTARY 1
EDUCATION
’
i
!
i
A.
SPECIFIC GOALS:
i)
Providing to
education.
ii)
Ensuring
effective retention of
children
in
schools' through participation of all children
in
teaching learning activities, and reducing
drop
out
rate between class I and IV and I to VII
by
80% of the existing level.
iii)
Emphasising quality of education and
improving
teaching
learning activities for achievement
of
minimum levels of learning at primary stage.
iv)
Reduction in disparities by bringing girls to
the
same
level
as boys,
and making
education an
instrument of women’s equality.
v)
Providing opportunity for literacy, continuing and
life long education.
*
vi)
Ensuring
effective peoples’
education management.
-.11
B.
PRESENT SITUATION :
1.
Literacy
children
access
to
primary
participation
in
Karnataka has a literacy rate of 56%.
It
ranks
17th out of 25 States and 20th out of
32 States
and
Union Territories. Male literacy is 67.25%
and
female
literacy is 44.34%. The district wise
female
literacy
rate is shown .in the chart below:
61
While the State has
recorded some' remarkable
achievements
in several districts
through the Total .
Literacy
Campaigns
(TLCs),
interregional
and
intend?strict
vat iati• ns
in
literacy
continue
to
prevail. Raich, c district has the lowest female literacy
of
17.23V.
Rural
literacy rate stands at
29.63%
compared to urban literacy level of 63.63%. Fourteen out
of
the twenty
districts in the State have a
female
literacy lower than the national
average.
Literacy
levels among scheduled castes is
20.59%
compared to
33.46%
among other communities. Literacy level
among
Scheduled Tribes is equally low.
PRIMARY EDUCATION
In primary
education Karnataka has achieved a
gross enrollment of 100% in the 6-10 age group, and
70%
in the
11-13 age group. The drop out rate at primary
level (I-VII) has declined from 71% in 1961 to 56.24% in
1990-91.
According to statistics Primary schools
exist
within walking distance of one kilometer in practically
all habitations with a population of 300 persons.
There
are 40,776 lower and upper primary schools in the State.
74.78
lakh children are studying
in schools between
classes
I-VII and there are ■.42 lakh teachers working
in these schools. The teacher-pupil ratio is more than
1:45;
567 schools are still with only a single teacher.
While there has been a significant spatial spread
of primary education infrastructure,
the rates
of
stagnation and wastage are high and the quality of
education is uneven. The propotion of girls'
enrollment
to
total
enrollment
at primary level
has
been
increasing;
however the number of
girls,
especially
girls belonging to scheduled castes and tribes, at
the
primary stage as a propotion of girl in the relevant age
group requires specific interventions for
improvement.
Low motivation and morale of
teachers,
emphasis
on
theoretical and pedantic teaching learning methods, dull
and demotivating atmosphere in school due to
lack of
basic amenities
are the major reasons for the
large
scale drop-out at each stage in school. The
inflexible
rigidly structured and urban oriented educational system
is also responsible for poor enrollment,
participation
and achievement in primary schools.
Ongoing programmes
in the State which aim at
improving the quality of primary education, include the
Operation Blackboard, Vidya Vikasa, Akshaya, DIETs/CTEs.
Several Special
Programmes have also been
initiated,
such as MLLs, Microplanning, DPEP etc.
63
Specific Goal 1.
Specific
Providins to all children access
to Primary school facility
Goal II.
Ensuring
effective retention of
children
in
schools
through
participation of
all
children
in
learning
activities,
and
reducing drop-out rates in Classes
I-IV
and
I-VII
by 80%
of the
existing level.
Present situation
A large number of children have no access to
school.
Many others, shown as
enrolled hardly enter
school.
45% of enrolled children are absent every day,
and another 30%
drop out between Classes
I-IV.
The
problem is particularly grave at upper primary stage,
specially for girls.
19 95
10 0% enrol Iment of children in 6-7age
in formal system
group
Special focus on enrollment of girls
90% enrollment of children in 8-10 age group
in formal/non-formal system
100%
retention of children in classes
1-11
with at least 80% attendance
Reduction
in overall drop-out rates by 50%
of existing level, viz reduction in Classes
I-IV to 15%; Classes I-VII to less than 30%.
1997
100
% enrollment of children in 6-10 years
age group in formal and non-formal systems
75%
enrollment
of children in 11-13
group in formal/non-formal systems
age
Continued focus on enrollment of girls.
100% retention in Classes I-IV with at least
80% attendance
Reduction in overall drop-out rate by
75%
of
existing level, viz reduction to 10%
in
Classes I-IV; and 14% in Classes I-VII.
64
2000
100
-i
‘
enrollment of children in
gro'|p in fo; Tal/non-formal systems.
6-13 age
C'ntinued focus on enrollment and
of girls
retention
Sustaining
achievement
of
100%
enrollment
with
100%
completion
elementary education for every child
Reduction ir drop-out rate
net
of
by 80%
Classes- I-IV- less than 6%
I-VII less than 12%
Activities
i.
Formation of Village Education Committees (VEC)
in
all
habitations,
with at
least
2/3rd
women's
membership.
ii
Orientation
ii.
Systematic school mapping of every habitation by VEC
and
training
of
members
of
VEC
Survey of exact position
Discussion with village community
of plan for access to education by
-
Preparation
children
iii.
Ensuring enrolment and regular participation of all
children through micro-planning:
VEC maintains
a register as
the
monitor enrollment/participation;
instrument
all
to
Headmaster/mistress keeps contact with VEC to
inform status of enrollment and particiapt ion
-
VEC members approach families yhose children are
not enrolled or are irregular in attendance, or are
showing signs of dropping out
to
alleviate the
problem.
iv.
Ensuring village wise monitoring of progress
in
enrollment
and participation at
block
level;
developing a computerised MIS at State level.
65
'
PROCESS INDICATORS:
Based on
monitor:
estimates
of
6-11
year
fage
grade
children,
a.
Proportion
education
enroled in first
b.
Proportion
that age
of 6-7 year children who
c.
Age specific enrolment in primary school
66
of
primary
enter
at
Specific
Goal
3
Emphasising quality of education
and improving teaching-le.arning
activities
for achievement of
Minimum Levels of Learning.
Present Situation
The , overall uneven quality of education in the
State is largely due to poor school infrastructure with
unsatisfactiry buildings, insufficient and poor quality
equipment as also lack <. f teaching aids. There is a high
teacher-pupil
ratio,
added to which
is the general
problem of teachers not being trained and
equipped to
handle multi-grade teaching. Moreover, schools do not
function
for the required number of days. As
a result
the level of achievement of students is sub-standard.
A comprehensive programme for
introduction of
Minimum Levels of Learning will be introduced, focussing
on learning acquisition and outcomes. The programme will
include an assessment of the existing level of learning;
a definition of the MLLs for the area and the specific
time
fraffle for achieving it; reorientation of
teaching
practices to competency based teaching; introduction of
evaluation of learning outcomes; review and revision of
text books and provision of inputs to improve
learning
acquisition, including provision of physical facilities,
teacher training, supervision and evaluation.
Aims
1995
Introduction
schools.
of
35
Training of
strat egi es
1997
Attainment
schools.
Introduction
schools.
MLL in Classes
of
MLL
3000
in
per
block
on
MLL
in Classes
I-IV
in
3000
in Classes
I-IV
in
all
teachers
MLLs
of
I-IV
Retraining of 35 teachers per block handling MLL
in 3000 schools.
Training of all teachers handling MLL in Classes
I-IV
2000
Attainment of MLL in all schools
Continuous teacher training and orientation.
67
Activities
measures to improve teachers’
status
Designing TILL curriculum and pedagogy; training
and materials; Evaluation techniques and tools.
modules
Initiating
and training.
Orienting VEC memeber to MLLs.
Making necessary investment to increase the number of
teachers;
enhancement
of
the
competence
of
headmasters/mistresses;
and
making
provision
for
teaching-1 earning materials.
Process Indicators
Number of teacher training sessions held and number
of percentage of teachers trained.
-
Number of
approach.
schools
which
MLL attainment per child,
68
have
introduced
class and school
FILL
Specific
goal
4
Reduction
in
disparities
by
bringing girls to the same level as
be s
and making
education
an•
instrument of women's equality.
Present Situation
Although there has been progress
in
girls’
education,
the
male-female
differential
is
not
narrowing.
Girls
are
engaged
in
fuel
and
fodder
collecting
, fetching water and care of
siblings.
The
educational indicators m respect of girls are therefore
adverse,
while the enrollment levels of girls
is
low
their drop-out rates are high.
There
is need
for transformation of
social
attitudes,
and for inititating family wise, child wise
microplanning, to facilitate education of girls.
Micro
planning will aim at bringing to school all children who
can be enrolled, seeing that all
children participate
regularly and actively to achieve the minimum levels of
1 earning.
Aims
19 95
1997
2000
I- IV
)
21%
I- VII
31%
I- IV
11%
I- VII
16%
I- IV
9%
I- VII
13%
)
)
(by 50%)
)
)
)
(by 7 5%)
)
)
)
(by 80%)
Strategies/Activities
Initiation of a well planned programme for
formal education for girls’
non-
Micro-planning activities through VECs.
Focus
on girls
through
existing
incentive
programmes of Vidya Vikasa, Akshaya, scholarship
incentives through programmes of Dept of Women &
Child Development and Social Welfare etc.
Review of
school
gender biases .
69
text books
for
removal
of
Training of teachers, both pre-service and
in
service on gender issues
for
elimination of
gender disparities.
Sensitising
parents
women’s/girls issues.
and
community
on
Process Indicators
Increase
in net
enrollment
especially SC/ST girls.
rate
of
girls,
Attendance rates per school (boys/girls)
Number and percentage of children, separately
for boys and girls completing class IV within
four years.
70
Providing opportunity for
literacy, continuing and life
long education.
Specific Goal 5
Present Situation
Total
Literacy Campaigns have been accepted as
the principal strategy for eradication of
illiteracy.
Through a well planned communication and mobilisation
strategy
with emphasis
on
folk
media,
including
Yakshagana, Gigipada, Ko1ata, Bylata, the essential link
between literacy and vital needs of life is established,
and a systematic time bound programme for training of
literacy workers, activists and volunteers undertaken,
to enable all learners identified in a survey to achieve
predetermined
levels
of
literacy through the
IPCL
technique of learning.
Over the
last
2-3 years TLCs have been
initiated in 15 districts. Several of
these districts
are
already in
the post
literacy and
continuing
education stage.
The other districts
are
in various
stages of preparation/ teaching- learning activities.
A perspective plan for achieving total
literacy
in the State has' been prepared by classifying districts
into categories, based on (a) available
infrastructure,
(b)
literacy
(c)
rates,
of
existence
agencies/NGOs,
(d)
stage of implementation'
etc,. The categories are:
Category
A
Category
C
TLC/PL
Bakshina Kannada,
Shimoga,
Tumkur,
Nandya.
(Already
in Post
Literacy
stage)
Bidar, Bijapur, Raichur.
effort
required for
programmes)
Category B
voluntary
of
(Substantial
mop-up
literacy
Dharwad,
Mysore,
Uttara
Bangalore (Rural).
Kannada
Category D
Kodagu, Chickmaglur, Bslgaum, Gulbarga.
Category E
Hassan, Chitradurga, Bellary, Kolar,
Banaglore(Urban)
71
’I
Aims
Through sustained literacy and post
literacy
efforts it is expected that
the State will achieve the
following
goals:
1995
75% literacy in the 15-35 age group
1997
75%
female literacy in the 15-35 age
group
2000
75%-80% total literacy
Activities/Strategies
To
cover all eligible persons in the 15-35
group in campaigns for total literacy.
age
Sustain
the
environment
created
for
achievement
of
total
literacy
through
appropriate communication and media material;
giving continued
impetus
to
folk media
for
dissemination
of
messages
of
literacy,
especially
women’s
literacy
and
universal
primary education
Develop improved training modules and materials
for all levels of literacy workers/volunteers.
Ensure achievement of pre-determined levels
learning through IPCL pedagogy.
of
Emphasise systematic learner evaluation through
on-going process evaluations conducted by Zilla
Saksharta Samitles and by Involving
external
evaluation
agencies,
institutes
of
social
sciences research etc.
Improve and facilitate participation of women in
the management of TLCs .
Initiate appropriate and timely steps for post
literacy and continuing education programmes.
Establish inter-departmental/inter-sectoral
linkages,
especially for promotion
of
ECCE,
Primary Education, Health, Immunisation,
Girls’
and women’s equality.
72
Process Indicators
Percent'gr
IPCL no^tns
of wc.r.ien made literate according
*'*
Percentage of TLC learners participating in post
literacy programmes.
73
to
S p e c 1 £ i.c Goal 6 :
Ensuring
effective peoples’
involvement in education
management.
Present Situation
School
Education
Committees
have
been
constituted and in many areas are actively engaged
in
the physical development of the institutions,
including
building,
teaching-1 earning materials and playgrounds.
To a limited extent however, School Education Committees
are also
involved
in ensuring active attendance of
children in schools.
GOALS:
1995
1997
2000
)
)
)
)
)
)
)
)
)
)
i)
Ensuring
establishment and
active
participation of Village Education
Committees through out the State.
il)
Involvement
of Gram Sabhas
in the
achi evement
of universailsat ion of
Elementary Education.
iii)
Involvement
of
local
level
gram
panchayar,
Yuvak and Yuvati Handals
and other agencies available at
the
village level in the UEE programme.
Activitles:
Gran Sabhas and Village Education Committees will
ensure that
all children including girls
of
the
school-going age will be enrolled, regularly attend
and actively participates in the teaching-1 earning
programme by motivating the parents, the elders and
other people in the village community.
Formation of VECs and their training orientation to
education
action
Pr eparat i on of village level plan of
education by VEC
Ensure
teachers’ regular attendance in the
and class room teaching activities
school
Involve
in classroom construction programme
creat e
an attractive school
climate
for
children inside and outside the classroom
Ensure
regular
maintenance
campus/building/play grounds
74
of
for
and
the
school
Ensure supply of teaching-learning materials and
its effective utilisation by teachers and children
Approach
families whose children are not
enrolled
or
a' o
irregular
in
attendance
and
persuade/motivate
them for sending their
children
to the school
- Maintain contact with the Headmaster and
involve
themselves
in all the developmental activities of
the school
Process Indicators:
No.of VEC established and actively functioning
No.of
District
operationalised
plan
75
of
action
prepared
and
DRINKING WATER SUPPLY AND ENVIRONMENTAL SANITATION
WATER AND SANITATION
Major Goal
:
Universal access to safe drinking water
and
improved access to sanitary means
of excreta disposal.
The norms for providing drinking water
in rural areas and those pertaining to
sanitation are as follows:-
To
provide the
entire
rural
population with potable water
supplies @ 40 litres per ccapita
per day (I ped).
To cover 5 percent
of
population
with sanitary facilities by the
year 1995.
To eradicate guineaworm disease by
1995 .
To provide safe water with fluoride
content within tolerable limits by
the year 2000 A.D.
UNIVERSAL ACCESS TO SAFE DRINKING WATER
Present Situation
Karnataka has made substantial strides
in the
provision of drinking water facilities. As of March 1992
100%
rural and urban population have been
covered by
one drinking water source @
250 persons.
All
villages
identified in the Problematic Villages list are covered.
Out of 52,682 habitations identified in the
1991 census
and
27,733 habitations are fully covered,
19,729
are
partially covered. Of the partially covered habitations
25% copulation have access to 40 Ipcd; 37% have 30
Ipcd
29% population receive
201pcd and
9%
receive upto
lOlpcd.
76
Ongoing Schemes/Pro j ects
I.
Drinking water to Rural areas is being supplied
through the
following schemes under both State and
Centra] sectors under Normal, SCP and TSP categories.
Pipea Water Supply Scheme
Mini Water Supply Scheme
Borewell fitted with Handpump scheme
II.
Integrated Rural Water Supply and
environmental
sanitation scheme have also been taken up under
the
following externally aided projects.
Integrated Rura.l Water Supply and Sanitation
projects
under Netherlands Assistance(Bijapur
and Dharwad Districts)
Integrated Rural Water Supply -Enviornmental
Sanitation project under World Bank Assistance
in 12 districts.
Integrated Rural Water Supply --- Sanitation
project
under
DANIDA Assistance
(
Hungunda,
Jagalur and Bagepalli taluks)
III.
CDD-WATSAN C Control of Diarrhoea DiseasesSupply and Sanitation) Programme has been taken up
the assistance from UNICEF, in Mysore Districts.
Water
with
Goals
1995
All existing habitations
to be covered.
5000
partially covered habitations out of
19,729 balance to be fully covered.
Completion of IRWSS in three pilot
talukas
(Hungund, Jagalur, Mulbagal) under DANIDA
1997
Partial coverage to full coverage
habitations.
of
all
Coverage of newly identified habitations.
IRWS in 191 villages in Bi japur and Dharwar
districts
under Motherland assistance to be
complet ed.
Solving water quality problem in 25% affected
villages, including brackish, fluoride water
problem etc.
77
2 0 00
100% coverage of rural habitations with safe
drinking water @ 40
LPCD under different
programmes.
Solving the Water Quality problem in all
the
affected
villages
including brackish,
fluoride water problem etc.
Major Strategies/Activities
Coverage of partially covered habitations.
Coverage
of habitation with special emphasis
Scheduled Castes (SC)/Scheduled Tribes (ST).
on
Augmentation of service level.
~
Improved operation and maintenance.
Quality improvement.
Involvement
of women
in the management
and
maintenance
of water source through a
50%
representation
in
all
village
water
and
sanitation committees under all externally aided
projects and rural water supply programmes in the
State and Central Sectors.
Process Indicators
No. of partially covered villages
with 40 LPCD.
fully
covered
No.
of villages with brackish,
sources
fully converted to safe
fluoride
drinking
water
water
No o f
Supply
in Village
women
Committees.
78
Water
and
Sanitation
ENVIRONMENTAL SANITATION
Present Situation
Rural
of
The Rural Sanitation coverage in Karnataka as
using
1.991
30/06/93
is 0.47% through Govt, programmes
initiative
is
census
figure.
Coverage with private
approximately 7%.
Ongoing Schemes/Projects
I.
Rural Sanitation Programme is taken up under both
State and Central
sectors.
The programme
is
confined mainly to construction of
individual
latrines.
Institutional and
community
latrines
are being taken up on a small scale.
II.
Under the following externally aided projects,
Integrated Environmental Sanitation and Rural
Sanitation Programmes have been taken up.
Integrated
Rural
Water
Supply
Environmental
Sanitation project with
World Bank Aid ;.n 12 districts.
and
the
Integrated
Rural
Water
Supply
and
Sanitation Project with the assistance from
Government
of Netherlands in Bijapur and
Dharwad Districts.
Integrated
Rural
Water
Supply
and
Sanitation Project with assistance
from
Government of Denmark in Jagalur, Mulbagilu
and Hungunda Taluks.
III.
Nirmala Grama Y.ojana ( Rural Sanitation
)
has
been taken up
in Mysore,
Belgaum and Kolar
distrlets(with the.assistance from UNICEF).
IV.
CDD-WATSAN ( Control of Diarrhoea Diseases- Water
supply and Sanitation) Programme has been taken
up with the assistance from UNICEF
in Mysore
district.
79
Aims
1995
5%
coverage with State assistance of
rural
population under rural sanitation programme.
1997
15% coverage of rural population under rural
sanitation programme.
2000
30%
coverage
of rural population under rural
sanitation programme.
Ma j or Strategies/Activities
-
Taking sanitation as a package.
-
Adoption of a demand and need based approach to
make the programme a people’s movement.
-
Establishment/Strengthening
Sanitation Cell.
-■
Intensive district programming.
-
Development of appropriate delivery system.
-
of
State/District
Adoption of an appropriate Information,
Communication strategy.
Education,
improved
sanitary
Empowerment
practices.
of
women
on
Co-ordination with other related programmes.
Involvement of community, voluntary organisations
and NGOs.
R & D to develop appropriate area specific low
cost technology to suit different geo-hydrological
conditions.
Emphasis on sanitary marts exclusively for women
in rural areas
Process Indicators
No. of districts and households covered.
Proportionate coverage in districts
to population.
No.
according
of trained masons per each Gram Panchayat.
No. of divisions with Rural Sanitary Harts.
No. of villages with at least 5 individual
latrines.
30
GUINEA NORM ERADICATION
PRESENT SITUATION
The Guinea Norm Eradication Programme was started
in Karnataka during 1981-82.
Out of 20
districts,
8
districts were
found
to be
endemic namely Bellary,
Raichur,
Gulburga, Bidar, Dharwar, Karwar, Belgaum and
Bijapur.
From 1937 to 1990, 5 Districts were found to
be
free
from Guinea Norm Cases i.e.
Belgaum,’ Karwar,
Bellary,
Dharwar and Bidar.
At present active Guinea
Norm cases
are reported only from 3
districts
i.e.,
Gulbarga,
Raichur and Bijapur, where 11
villages have
reported 29 cases.
Aims
Zero Case of Guinea worm
1995
1998
Eradication of Guinea Norm Disease taking
into account the three year surveillance
period
4
HA JOR STRATEGIES/ACTIV1TIES
Identification and mopping up of cases.
-
Active
surveillance
survei1lance.
and
community
based
Provision of safe drinking water.
Health education.
Active search for cases and extraction of worm.
Case containment measures.
PROCESS INDICATORS
Number o f villages reporting cases.
Number o f cases reported.
Number o £ containment of cases.
Number of step wells converted.
Number of vi1lages/hamlets with handpumps
Percentage of cases with guineaworm extracted.
31
GIRL CHILD
1
■
j
i
ADOLESCENT GIRL
"
.*3aL
i"!.' L
__
_
:
_
Improve status of girl child to achieve
equal sex ratio
!
________________ !
!
!
Specific Goals
'io reverse the trend of decline in sex ratio.
10 cover SOI of'adolescent girls by special health
camps
and improve personal health awareness
and
Health, status.
-
To provide vocational skills for self
reliance
among 50% school drop-out adolescent girls.
Present Situation
Tisfl isiTtiatioft of the girl child in Karnataka is a
matter
of
concern.
An adverse sex ratio,
higher
malnutrition,,
maternal
mortality,
poor
school
enrollment
levels
and high drop out rates,
low skill
levels with
low value at work, are
indicators
of
a
fundamental
preferance for the male child and a belief
that girls
are more a liability than
an asset.
This
belief,
thus results in perpetuation of
socio-cultural
practices
which affect the entire life cycle
of girls
and women.
The sex ratio in the State has been declining.
The sex ratio, which stood at 963 in 1981, higher than
the
1961 and 1971 rates, declined to 190 in 1991.
Even
States
such as Andhra Pradesh (972), Orissa
(971)
and
Tamil Nadu (974) have higher sex ratios than Karnataka.
The goal for reversing the trend of
decline
sex ratio in Karnataka is therefore as follows:
1995
in
Arrest declining trend of sex ratio to 965
existing declining
1997
Reverse the
ratio to 970
2000
Achieve sex ratio of 990
trend
of
sex
To cover 80% of adolescent girls by special health
and impro.-e personal health awareness and
camps
health ,-tatus.
2.
19 95
Coverage of 40% adolescent girls in health camps
adolescent girls in health camps
1998
Coverage o f 70
2000
Coverage o f 80% adolescent girls in health camps.
reliance’
ocational skills for self
school* drop-out adolescent girls.
3.
To provide
among 50
1995
20 % coverage of adolescent girls in
training
vocat ional
1998
35% coverage of adolescent girls
training
vocational
2000
50% coverage o f adolescent girls
training
vocational
STRATEGIES/ACTIVITIES
HEALTH & NUTRITION
Providing health services to all
children below 14 years of age.
f emale
Enforcing ban on sex identification of foetus.
Instituting.
home-care of’ low birth
weight
infants through promotion of early and exclusive
breast feeding, and timely and adequate weaning
foods.
Postponing
age of marriage through
proper
communication and mobilisation;
provision of
training and self-employment opportunities
for
out-of-schoo1 girls of age 15 and above.
Promoting single-two
child norm;
increasing
birth interval to three years; concluding child
bearing age by 27 years.
Assessing current malnutrition levels among 6-14
year
old girls;
monitoring
and
improving
nutritional
status,
especially of
adolescent
girls to maximise growth during adolescence and
reducing micro-nutrients deficiencies.
Conducting special health camps for
adolescent
girls; administering tetanus toxoid at age 10 &
16 to all girls.
83
EDUCATION
Organising creches and balwadis to relieve girls
of
child and sibling care for easier access
to
primary schools.
Try-out of local community based
escort systems
for girls to ensure security and thereby regular
attendance in schools.
Priority targetting of girls, especially girls
belonging
to scheduled castes
and
tribes,
working girls
for significant
improvement
in
enrollment,
participation
and
achievement
1evels.
-
Teachers’ training on gender issues
Training
in Yoga as well
as self
defence
activities
for
better
ejcposure
and
self
reliance.
WATER & SANITATION
Provision of drinking water and sanitary
in primary and secondary schools
facilities
CHILD LABOUR
Communication
and
social
mobilisation
improvement in status of girl child
for
Process Indicators
No.
of girls completing primary education
Nutritional status of girls below 14 years of age
Age specific death rates for female children
Coverage of girls in health camps
84
U£3AN CHILD
i
1
I
MAJOR GOAL : All sectoral goals to be attained in !
urban areas
specifically among
"at risk” children, specifically:
i
i
i
*
Pavement dwellers
i
*
Street children
i
i
I
*
Migrant groups, including
construction workers
children
of
!
I
i
I
i
!
!
!
i
Present Situation
Karnataka has an urban population of 13.85 people
spread over 254 cities and towns. The State ranks
fifth
in the degree of urbanisation. The urban population of
the
State accounts
for 6.3% of the total
urban
population
in the country. There are 17
Class-I
towns
with a population of aiore than one lakh each, the total
population in the Class I cities itself accounts for 72°<
of the total urban population in the State.
There are
237 towns with a population of
than one lakh and the population in these towns is
million.
less
4.91
The rate of growth of urban population in Class I
and Class If towns was 42% and 47% respectively during
the 1981-91 decade. The rate of growth and migration to
the metropolitan city and other major towns is
creating
acute problems of housing, trffic and transportation.
Children of families living in poverty in such
areas
have
not
been adequately
targetted
under
many
programmes.
For the overall
sectoral goals
to
be
achieved in the State, the 'at risk’ children need to be
specifically focussed on.
Ongoing Programmes
The
main focus
in the strategy for
urban'
development
in Karnataka is to stem the further growth
of metropolitan cities where the problem is most
acute,
through
locating
employment
generation
activites
elsewhere,
increase
in
investments
for
urban
developments
in small
and medium towns,
as well
as
incentives and isinc entives, such as taxation measures,
subsidies etc. Current strategies also include priority
attention to housing and
environmental
improvements,
especially for slum and pavement dwellers through sites
and services,
as well as
improvements to
lighting,
water, latrines, drainage etc.
05
There is need
for preparation of
an overall
action plan to focus attention on the poorest of poor
in urban areas. Thus the following specific sector-wise
activities are outlined
below:
General
Identification and mapping of all locations and
areas where the poorest population groups are
found,
including pavement dwellers
and street
children and rag pickers.
Assessment of the status of children and women
in terms
of
health,
living
in these areas
access to basic
nutrition and
education as
facilities such as shel er and drinking water
supply and sanitation.
Targettting
available
basic
services
and
programme coverage to th se most
crticallly in
need,
and ensuring acces
to health,
nutrition
and education facilities.
Preparation
of
city/town action
plans
by
municipalities to focus on vulnerable groups
for
the
achievement
of
sectoral
goals
through
covergence of existing programme and services.
Health and Nutrition
Providing outreach services for families on the
street under IPP-VI1I; establishment of a health
identity card system.
Undertaking
periodic
training
and
upgradation programmes for all municipal
officers under CSSM programme.
skill
health
Providing adequate supplies of ORS packets
for
urban at risk families through
IPP-VIII,
ICDS,
UBSP .
Addressing household food security needs through
better targetting of the PBS ystem to reach urban
'at risk’ children.
Ensuring proper provision of ration
acceae to Fair Price Shops to urban
groups.
Making
available
iodised salt
Price Shops at affordable prices
cards
and
'at
flak'
through
Fair
Educat ion
Undertaking
to
ensure
children.
school mapping with community support
access
to
education by
at
risk'
Initiating
systematic
Non-formal
activities for school drop-outs.
education
Establishing linkages between anganwadi centres and
primary schools
to
ensure that
children
from
anganwadi centres enter and complete the stage of
primary education.
community support for improving
Mobilising
including buildings, water and
facilities,
f ac i1it i es , and basic teaching equipment.
school
toilet
Water
Ensuring the achievement of the urban norm of
one
source
for
100
persons
(20
families)
through
devement
of
alternate systems
(handpumps
and
wherever possible providing additional
storage
capacity)
Environmental Sanitiation
Covering all urban poor, with special
facilities
for pavement dwellers under the existing programme
of
low cost sanitation
(LCS)
and
Environmental
Improvement of Urban Slums (EIUS)
Developing community maintenance systems for water,
sanitation, drainage and solid waste caollection in
UBSP project areas.
Providing apace for- smaller- community latrine units
for better access in 'at risk'
communities under
Slum Clearance and Slum Upgradation Schemes.
Developing special designs for community
latrines
to meet the basic needs of women and children.
Women’s Development
Promoting thrift
and credit societies
for
women
in the
'at
risk’
groups
through
programme in 27 cities.
urban
UBSP
Ensuring issue of joint pattas
in the name of wife
and
husband under
all
site distribution
and
house/tenements construction programmes.
n
tr ai ni ng of women
volunteers
I1'1 i t1 <4 I i ng
CQmmunity 1eadership on the concept of local
and the
Implications
of
the
government
Amendment.
and
self
74th
NRY/U8SP
women
to
become
economically
Encour ag i ng
by targetting them as
beneficiaries
independent
Enterprises
programme(UME,
a
under
Urban Micro
component of NRY) to the extent of atleast 30%.
Similar reservations
for women can be made in
respect of allotment of shops/commercial
complex
constructed by the Municipalities under IDSMT and
othe schemes.
Process Indicators
Preparation and operationalisation of towns plans
Coverage
.. eveis of health,
sanitation in urban areas.
88
education,
water
and
Childhood Disability
i
MAJOR
GOAL :Prevention, early detection, intervention 1
and
rehabilitation
of
childhood !
disabilities for all children by the year I
2000 AD
!
Specific Goals
Elimination of poliomyelitis in 10 districts by
and eradication by 2000 AD
Control
of Vitamin A deficiency and its
Including blindness.
Control
of
cretinism
-
iodine
deficiency
disorders
1995,
consequences
including
Reduction in other preventable childhood disabilities
Early
detection,
especially of blindness
and
deafness and community based rehabilitation for all
children under 5 years of age
Integration
of
children with mild
or
moderate
disabilities into the mainstream of formal education.
-
Ensuring institutional rehabilitation support and care
for children with disabilities.
Creation
of
public
awareness
regarding
consanguinous marriages to avoid birth of
children
with 'Downs' syndrome.
Present Situation
The number of disabled children in the 0-14 age
group is estimated to be 1,33,892, representing 38.4% of
the total number of disabled persons in the State.
The
breakup is as follows:
Visually handicapped
10,585
Hearing Impediments
18,807
Orthopaedically handicapped
89,239
Mentally handicapped
14,366
The maker causes of childhood disabilities are:
Poliomyelitis
Vitamin A deficiency causing Blindness
Iodine deficiency causing goitre,
cretinism
and mental retardation
Maternal causes leading to intra-uterine growth
Environmental effects during pregnance,
as
communicable diseases,
accidents,
prescribed medication etc.
such
non
Accidents during childhood
Birth asphyxia, leading to spastic
mental retardation
paralysis
Advanced maternal age
Lack of awareness re.
infervention
prevention
&
early
Activities
i.
Strenghtening health and nutrition programmes,viz
*
immunisation
*
Provision of Vitamin A prophylaxis
*
Use of iodised salt
*
Nutrition education through ICDS
*
Institution
based
r ehab i1i t at i on
*
Free
distribution
appliances
&
detection
of
orthopaedic
li.
Strengthening community based rehabilitation
NG Os
iii.
Screening
of
risk Infants
iv.
Concerted communication effort for mass awareness
cr eat ion
v.
Establishment of early detection centres
vi.
- rehabilitation of skill development
new borns and follow up
of
by
high
- opening special schools in uncovered districts
- providing scholarships to all disabled children
90
Star. ng training & production centres
Establishing fabrication and repair units
Research for appropriate technology
vi i .
Extension of IED approach tc all pre and
schools
vi i i .
Providing
emergency care to all
complicated
deliveries to prevent birth asphyxia
ix.
Ensuring facilities for neo-natal care
resustication
including
x.
Creating mass awareness for
avoiding
below 18 years and above 30 years
pregnancy
xi .
Legislations
for
the protection of
disabled
persons against discrimination, segregation and
protection of their rights.
xi i .
Establishment of marriage counselling & guidance
bureaus with facilitie
for chromosome tests at
district level
xlii .
Strengthening
of community■based rehabilitation
programme,
especially
for children in 0-3 age
group to prevent blindness and deafness,
and
providing surgical and physical treatment.
primary
P roc es 3 Indicators
Reduction
chi 1dr en
the
in
polio
of
numbers
affected
Percentage of visual disability due to Vitamin A
Percentage of Iodine deficiency
Percentage
detect.iv
services.
f
1
children
com.:.- >nl t.
benefitted by
early
based
rehabilitation
Number
of
children enrolled
formal education.
in
mainstream
of
Percentage of children with severe or multiple
disabilities benefitted by institutional care.
91
CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES
! MAJOR GOAL:
!
1
I
IMPROVED PROTECTION, CARE AND DEVELOPMENT
OF CHILDREN IN ESPECIALLY DIFFICULT
CIRCUMSTANCES
i
i
i
I
i
Specific Goals:
i)
Addressing the problem of street children
through reinstatement of younger children
in families and encouraging government and
non governmental organisations to maintain
night shelters,initiating formal/non formal
and vocational education and providing
health facilities
ii)
Strengthening
institutional services
for
neglected orphans and destitutes and encou
raging non institutional services for their
care
iii)
Preventing juvenile delinquency through
community based services
iv)
Erradicating child prostitution through
social moblization
v)
Rehabilitating Aids orphans into the main
stream of society
vi)
Addressing the problem of Drug Addiction
among children
92
Present S bust ion :
As
in most parts of the
country child neglect,
abuse,
exploitation, abandonment and destitution is
on
an increase in Karnataka. This situation is attributable
to
pressures
of
demographic
growth
and
shifts-,
unemployment
and
underemployment,
migration,
urbanization and is further aggravated by poverty.
In Karnataka there are 20 Observation Homes,
22
Juvenile Homes,
4 After care Homes,
and
9
Juvenile
Service Bureaus. In addition, there are
260 Destitute
Cottages and 10 Fit Person Institutions run by voluntary
agencies.
Karnataka has also initiated a programme
for
assisting NGOs to provide services to street
children,
rag pickers as well as drug addicts.
To date 26 NGOs are implementing programmes
for
street children ,rag pickers and drug addicts in the
urban and semi urban parts of the streets.
Activities
A. Street Children
i)
Create
a
magnitude,
chi 1dr en
ii)
Reach education facilities to
chiIdren
iii)
Evolve community
services
iv)
Ensure health coverage
V)
Improve
the quality o £
life
for
street
children,
to
create a.n
enviornment ■ and
condition to help them grow.
data base parti cularly on
the
dimensions and problems of
street
based
non
the
street
institutional
E. Neglected and Orphaned Children:
i)
Advocate
and
promote
non-institutional
approaches in government policy and programme
like adoption, fostercare and sponsorship
ii)
Provide- counselling services to the ’at
risk
families’
to
prevent
abandonment
and
institutionalisation of
the child due
to
social and economic ci -cumstances.
ill)
Co develop community based outreach programmes
for the children in
especially
difficult
:i rcumstances.
93
C
Children of Prostitutes/child prostitutes
i)
To assist NGOs make an assessment and document
the condition of child prostitutes and develop
programmes on the basis of the study.
ii)
Ensure better
income
women and girls in the
generating skills
'at risk families'.
to
D Juvenile Delinquency
Prevent juvenile deliquency through community
ba.sed services and juvenile service bureaus
clinics
with
guidance
Start
child
professionally trained persons in slums etc.
AIDS
E
i)
Create
ii)
Start counselling and guidance centres and
access to referral services
F.
awareness through NGOs
Drug Abuse
ij
Awareness programmes through NGOs and media on
drug, and alchohal abuse
i)
Opening
of
deaddiction centres
government district hospitals
iii)
Assisting
children of drug addicts for
education and training purposes
in
all
their
- Media
RF_CH_1A_SUDHA.pdf
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