REPORTS OF THE WORKING GROUP ON HEALTH FOR THE ELEVANTH FIVE YEAR PLAN (2007-2012)
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REPORTS OF THE WORKING GROUP ON
HEALTH FOR
THE ELEVANTH FIVE YEAR PLAN
(2007-2012)
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11
REPORTS OF THE WORKING GROUP ON
HEALTH
FOR
THE ELEVANTH FIVE YEAR PLAN
(2007-2012)
No- Zs.
GOVERNMENT OF INDIA
PLANNING COMMISSION
2006
il
SI. No.
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2
3
4
5
6
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Pages
Title________________________
Report of the working group on Integrating Nutrition with Health for the
1 lnFive Year Plan______________
Report of the working group on “Access to Health Systems including
AYUSH” for the 11 thFive Year Plan
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x_-•
REPORT OF THE
,1
WORKING GROUP ON
INTEGRATING NUTRITION WITH HEALTH
11th FIVE-YEAR PLAN
(2007-2012)
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GOVERNMENT OF INDIA
MINISTRY OF WOMEN AND CHILD DEVELOPMENT
NOVEMBER 2006
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Chapter 3
EXISTING NUTRITION AND HEALTH INTERVENTIONS AND GAPS
3.1
Malnutrition being a multi-faceted problem requires a multisectoral approach for
its prevention and control. A number of direct and indirect nutrition interventions are
being undertaken by different sectors of the Government with a view to promote
nutrition of the people. Some of the direct nutrition interventions are as under:
Department of Women and Child Development
■ Integrated Child Development Services (ICDS) Scheme.
• Nutrition Programme for Adolescent Girls (NPAG)
• Nutrition Advocacy and Awareness Generation Programmes of Food and
Nutrition Board (FNB)
• Follow up action on National Nutrition Policy (1993)
Ministry of Health and Family Welfare ■ Iron and Folic Acid Supplementation of pregnant women
• Vitamin A supplementation of children of 9-36 months age group.
• National Iodine Deficiency Disorders Control Programme
Department of Elementary Education and Literacy
■ Mid Day Meal for primary school children
Some of the Indirect Interventions include:
Department of Agriculture and Cooperation
• Increased Food Production
• Horticultural Interventions
Food and Public Distribution
« Targetted Public Distribution System
• Antodaya Anna Yojana
■ Annapurna Scheme
Rural and Urban Development
■ Food for Work Programme
■ Poverty Alleviation Programmes
• Safe Drinking Water and Sanitation
• National Rural Employment Guarantee Scheme
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Ministry of Health
• National Rural Health Mission
• Integrated Management of Neonatal and Childhood Illnesses (IMNCI)
■ Various Public Health Measures
Department of Elementary Education and Literacy
■ Sarva Siksha Abhiyaan
* Adult Literacy Programme
II
>
Rural Development and Public Distribution System should state explicit nutrition
goals.
Panchayati Raj Institutions to be empowered to serve as focal point for all
developmental schemes.
Families and communities to be sensitised towards prevention of malnutrition
among infants between the age of 0-2 years, adolescent girls, pregnant and
lactating women, delaying the age of marriage, education of girl child, hygiene
and sanitation and utilising timely medical care
The Education sector to include nutrition in all its formal and non-formal activities.
The nutritional requirements of the country should be met before decisions to
export any commodities are taken, e.g., sugar, oil, pulses etc.
Agriculture sector to promote production of coarse grains, pulses, red palm oil,
fruits and vegetables.
Horticulture interventions for nutritional improvement to be taken up at all levels.
Home Science Colleges (numbering about 101 in the country) to be strengthened
and actively involved in nutrition training of functionaries and nutrition advocacy
and communication.
Nutritionists to be positioned as advisers at various levels by Central and State
Governments.
Nutrition Monitoring and Surveillance System to be established utilising ICDS
infrastructure - ICDS to be universalised to take on this responsibility.
NNMB to be expanded to cover all States for supporting nutrition surveillance.
Nutrition to be reviewed as a separate subject in the State/UT development
reviews. An Annual nutrition review to be instituted at national level and Nutrition
Awards to be given to best District/State.
Food & Nutrition Board bearing nodal responsibility for coordinating the
implementation of National Nutrition Policy to be strengthened.
5.10 For the first time the X Five Year Plan had set goals for infant and young child
feeding indicators and reduction of undemutrition in children including micronutrient
malnutrition. Many of the X Five Year Plan Goals are yet to be realized. Keeping in
view the mandate of the Millennium Development Goals and the unmet goals of X Five
Year Plan, the following National Nutrition Goals are recommended for the XI Five
Year Plan to be met by 2012. The State specific goals would need to be identified
accordingly.
Reduce the prevalence of underweight in children under 5 years to 20%.
Eradicate the prevalence of severe undernutrition in children under five years.
First hour breastfeeding rates to increase to 80%.
Exclusive breastfeeding rates to increase to 90%.
Complementary feeding rate at six months to increase to 90%.
Reduce prevalence of anaemia in high risk groups (infants, pre-school children,
adolescent girls, pregnant and lactating women) to 25%.
• Eliminate vitamin A deficiency in children under 5 years as a public health
problem and reduce sub-clinical deficiency of vitamin A in children by 50%.
• Reduce prevalence of Iodine Deficiency Disorders to less than 5%.
•
•
•
•
•
•
20
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5.11 The achievement of the National Nutrition Goals for the XI Five Year Plan would
require a multi-pronged action on various issues. A number of policy decisions at the
macro and micro level would be required at center and state levels to achieve the goals.
5.12 The Food and Nutrition Board, MWCD has been undertaking nutrition advocacy
of policy makers at central and state levels on strategies for promoting nutrition of the
people. Five Regional Consultation Meets on Nutrition have been organized during
2005-06 for North Eastern States at Shillong in February, 2005, Western States at Pune
in May, 2005, Eastern States at Bhubaneswar in July 2005, Northern States at
Chandigarh in January, 2006 and Central States at Bhopal in June 2006. The
Recommendations of three high level advocacy meets are given in Annexure XIV.
Strategies for achieving the nutrition goals in the XI Five Year Plan are discussed
in the following chapter.
21
Chapter VI
STRATEGIC RECOMMENDATIONS FOR THE XI FIVE YEAR PLAN
6.1. Articulating malnutrition as number one public health problem in the
country.
61.1 All available data conclude that malnutrition is the only single most important
contributory factor towards high infant and under 5 mortality rates and maternal
mortality. Further, foetal and early childhood nutrition not only determines the growth,
development, nutrition and health of the child but has life long consequences for the
health of a human being throughout his life span because of poor metabolic
programming during this critical period. Currently most of the public health programmes
are directed for control of specific nutritional deficiency, infectious disease, emerging
problem of diet related chronic diseases like diabetes, hypertension, cardiovascular
diseases, cancer etc. Very little attention is given to preventive aspects or to say to the
nutritional issues working as indirect causes of disease and mortality.
6.2
Greater emphasis on Nutrition Action by Health Sector at all levels
6.2.1 The Health sector needs to give due emphasis to 'nutrition' at all levels, such as:
6.2.2 Strengthening Nutrition in Medical, paramedical, AYUSH and
Agriculture education
o There is an urgent need to strengthen and update nutrition curricula of
medical and para medical education in the country involving Medical
Council of India and similar bodies.
o Optimal infant and young child feeding (IYCF) practices in medical
books need to be updated incorporating the Resolutions of the 55th
World Health Assembly, Global Strategy on IYCF and Innocenti
Declaration, 2005.
o The second edition of the National Guidelines on Infant and Young
Child Feeding (FNB, MWCD, GOI, 2006) released in May 2006 needs
to be incorporated in all such curricula. Adequate emphasis on
national problems like delayed initiation of breastfeeding, poor
exclusive breastfeeding and delayed and inadequate complementary
feeding of infants and young children needs to be addressed.
Micronutrient malnutrition, food and nutrition security issues for
different age groups, social causes of malnutrition and shared
parenting also needs to find a place in medical and para medical
curricula.
o There is no separate subject of nutrition in the MBBS courses at
graduate level. Nutrition is taught through Preventive and Social
Medicine and Paediatrics. Medical graduates, therefore, do not have
adequate knowledge of food based approaches to the problem of
malnutrition. Nutrition needs to be made a separate subject at
graduate level in medical and para medical courses.
o National guidelines on IYCF need to be built into implementation of
their medical and nursing teaching curriculum.
22
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o
o
6.2.3
o
o
o
o
Core Nutrition Module need to be integrated in all agriculture and rural
development training programmes.
Nutrition advocacy and education for agriculture students and
scientists need to be undertaken.
Training Programmes for Health Personnel
All training programmes for different level functionaries should equip
the trainees to address the problem of malnutrition, low birth weight,
nutritional efficiency disorders and issues concerning breastfeeding,
complementary feeding, nutrition and health education etc. A core
Nutrition Module needs to be integrated into the training curricula of
various training institutions under health and family welfare, namely
National Institute of Health & Family Welfare, State Institutes of Health
& Family Welfare and in-service and pre-service training courses.
Crash courses on critical issues like infant feeding and child survival,
micronutrient malnutrition, under-nutrition, stunting and wasting in
children under-5 years, home based care of low birth weight babies
and severely malnourished children needs to be organised for health
personnel with a view to address the problem of malnutrition
effectively.
Define skills training needs of health care providers at different levels,
integrating breastfeeding education effectively in existing programmes,
their curriculum should include at least three days of training in infant
and young child feeding counselling. Existing (CDS workers should be
given additional training. Similarly, in the context of the recentlylaunched National Rural Health Mission, the accredited social health
activist (ASHA) must be properly trained in all areas, but should have
at least three days of training in infant and young child feeding
counselling. This will ensure basic education to impart correct
information, and help all women to solve the ‘not enough milk’ problem
and other common problems related to feeding. The ASHA should also
be trained to refer women to a higher level for complicated problems
(ike breast infection and abscess. This higher level support could be
established by creating breastfeeding support centres /clinics at block
level run by trained women, after having received 7 days training.
Integrated Management of Neonatal and Childhood Illnesses
(IMNCI) launched under the RCH II programme in 125 districts is
another opportunity to promote infant feeding skills. Urban hospitals
staff and HIV counsellors should also be trained for counselling on
breastfeeding. For those health workers from whom it is expected that
they will counsel on breastfeeding, complementary feeding as well as
HIV and infant feeding, the training package of 7 days would be
necessary. Ail these packages are based on WHO/UNICEF training
courses on the three subjects and have been adapted in India by the
Breastfeeding Promotion Network of India (BPNI). Needless to say,
this component must also be included in pre-service training.
National
Rural
Health Mission
(NRHM):
Framework of
implementation of the NRHM and the Indian Public Health Standards
(IPHS) should clearly reflect nutrition inputs through action at village
level, cluster of 4-5 villages and 30 villages, and at the Block level.
Nutrition inputs can only be ensured through building of Infant and
23
Nutrition inputs can only be ensured through building of Infant and
young child feeding support centres/clinics at the cluster level and
block level by a skilled female workers. ASHA at village level should
actively engage in promotion of Breastfeeding and provide support
within one hour at birth to begin Breastfeeding. (Details in the Annex).
The project implementation plans at district level under NRHM
should include details micronutrient malnutrition control programme
namely Iron & Folic Acid Supplementation, Vitamin A Supplementation
and National IDD Control programme. The District Media Officers
under NRHM need to be sensitised towards the problem of malnutrition
including micronutrient malnutrition and equip to undertake nutrition
orientation, awareness generation and IEC activities on various
nutritional issues. At present the job responsibility of the District Media
Officers do not include nutritional issues.
6.2.4 Primary Health Care to include Nutrition as important service
o An ICMR study undertaken during 1989 revealed that although
nutrition is an important part of job responsibility of health personnel,
many of them do not even know about it and those who know fail to
give adequate attention to these aspects for want of supen/ision of
nutritional inputs into the primary health care.
Recognizing the
importance of nutrition in prevention, the management and treatment
of disease, it is important that all the contact points with the people
either at PHC, hospital or immunization days, are utilised for
communicating nutrition messages to the people. Needless to say, a
word from the doctor’s mouth is a bible truth for the patient. Many of
the anganwadi workers have expressed that they were promoting
optimal norms for breastfeeding and complementary feeding, but for
want of support from the medical personnel of PHC, district hospital or
registered medical practioners, they find it difficult to convince the
community about the correct norms for IYCF.
o Nutrition needs to be recognized as an important service under primary
health care.
6.2.5 Clinic/beds for severely malnourished children at PHC, CHC and
district hospitals
o Severely malnourished children and low birth weight babies contribute
significantly to the IMR and Under-5 mortality rates in the country. It is,
therefore, imperative that severely malnourished children are given
special attention by the primary health centres, community health
. centres and district hospitals. A separate set up with an OPD clinic
and a few beds for severely malnourished children should be made
available at all PHCs, CHCs and district hospitals in the country. This
is urgently needed to reduce infant and child mortality due to
malnutrition. It needs to be appreciated that severe malnutrition is
often accompanied with infection and such children may require
parental nutrition, treatment of infections with antibiotics and treatment
of any other complication which could be interfering with the weight
gain of such children on dietary regime.
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The Government of Madhya Pradesh under their ‘Balsanjivini’
programme through ‘Balshakti’ component has shown convincingly
that with modest expenditure on malnourished children through the
health system, it is possible to reduce malnutrition levels in an
accelerated manner.
The Government of Rajasthan has also
demonstrated management of severely malnourished children
involving the health infrastructure.
o Nutrition rehabilitation centres have contributed significantly to
reduction of malnutrition in Bangladesh.
o At present there is no generic system in the country to handle severely
malnourished children through hospital set up on a regular routine
basis. This important service needs to be created in XI Five Year Plan.
o
6.3
Establishing Nutrition Information System in the country
6.3.1 There is no system to reveal the current status of under-nutrition, micronutrient
malnutrition and diet related chronic diseases among the people in the country at
present. Many a times one is faced with an embarrassing situation with reports from
international and UN agencies quoting India as worse than even the countries of the
developing world as far as data on nutrition and health are concerned.
6.3.2. The country must assess the outcome of the precious resources being spent. In
other words, whether the valuable inputs into the existing nutrition and health
interventions are bringing desired results or not and what mid course corrections are
needed. The existing data on nutrition and health is available from the following
sources although all have their own limitations:
. National -Nutrition Monitoring Bureau (NNMB) undertakes diet and nutrition
surveys periodically in 8-10 States in the country and projects the State level
scenario for these States. NNMB continues to function in a project mode under
ICMR since 1972 resulting in heavy turnover of staff, and poor staff strength.
The National Nutrition Policy adopted by the Government in 1993 mandated that
nutrition monitoring and surveillance system should be established in the country
and that the National Institute of Nutrition entrusted with this responsibility and to
be made accountable to MWCD for nutrition surveillance. In order to achieve
this, it is imperative that NNMB is established in all States and UTs and is
assigned the task of establishing a system of nutrition monitoring, mapping and
surveillance.
NNMB should also undertake district level food and nutrition surveys including
survey on prevalence of diet related chronic diseases every five years in the
country to enable area specific planning and programming using disaggregated
data.
• Management Information System (MIS) of various services under NRHM and
ICDS also provides useful information on the coverage under various
programmes. The MIS of various services need to be improved and utilised to
serve as an important source of information for enabling nutrition monitoring,
mapping and surveillance.
. National Family Health Survey (NFHS) undertaken by International Institute of
Population Sciences are coordinated by the Ministry of Health & Family Welfare
and are undertaken at an interval of 5-6 years. In fact this is the only source of
nation wide data on under-nutrition among children under 5 years and anaemia
25
.
among women and children. In fact, anaemia was added at NFHS 2 stage
(1998-99) while NFHS currently in progress has taken a little more indicators on
nutrition. However, NFHS will not be able to supply any information at the district
level and information on prevalence of important micronutrient deficiencies like
vitamin A deficiency in children, anaemia in adolescent girls in the age group of
10-15 years, prevalence of iodine deficiency disorders and other nutritional
deficiency diseases. Still it is important that NFHS should include nutritional
indicators to a great extent and provide district level data for atleast the backward
districts of the States/UTs.
District Level Health Survey (DLHS) covers all districts in a phased manner
and is an important resource for projecting district level nutrition and health
scenario in the country. Presently very few indicators on nutrition are included
under the DLHS. Due emphasis to nutrition under DLHS and making reports
available to all every two years is required. Infant and young child feeding
indicators should be the lead ad first indicators
6.3.3. The Ministry of Health & Family Welfare has Central Bureau of Health
Intelligence, Statistical Division, ICMR, NIN, NNMB, NFHS and DLHS etc. The need of
the hour is that efforts of all these institutions, including ICDS and NRHM are pooled
together to design a Nutrition Information System for the country so that the country has
the following:
• Annual Nutrition and Health Reviews instituted at national, state and district level
with best State, best district in each State and best village in each district awards
annually.
. Annual publication on nutrition and health status of the people with special
emphasis on children under-5, adolescent girls, pregnant and lactating women,
elderly and tribal population.
. District wise disaggregated data on nutrition including micronutrient deficiencies
and health status every 5 years.
. Review of malnutrition in monthly development reviews by the Chief Secretaries
in States/UTs.
. District level and if possible block level mapping of high malnutrition areas with
the help of software like CIS (Geographic Information System) of NIC, KIM of
FAO, Dev Info of UNICEF or any other utilising district level electronic network of
NIC under health, WCD and related sectors.
• NIN under ICMR to undertake training and capacity building of States for the
purpose.
. Nutritional status of children under 3 years and IYCF indicators to be the key
progress indicators in NRHM, State/District plans.
6.3.4 Surveillance on Folic Acid deficiency related birth defects needs to be
undertaken atleast in institutionalized deliveries, in view of the increased ases of NTD’s
and spina bifida cases being reported.
6.3.5 Developing a National Nutrition Information System through community based
monitoring mechanism has been illustrated in the Figure at Annexure IX.
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Infant and Young Child Feeding and Nutrition Security for Infant Survival
6.4.
o
o
o
o
o
o
Infant and Young Child Feeding (IYCF) counselling to be taken as a component
of ‘service delivery'. This is crucial to make the functionaries aware of their key
responsibilities, or Core job both in ICDS and NRHM/RCH II (MOHFW & WCD).
The objective should be clear to achieve high rates of initiation of
Breastfeeding, exclusive breastfeeding within first hour of birth for the first
six months and complementary feeding at six months, thus ensuring
mainstreaming Infant and young child feeding in all sectors and implementation
of the National guidelines on Infant and Young Child Feeding and the Infant Milk
Substitutes, Infant Foods and Feeding Bottles (Regulation of Production, Supply
and Distribution) Act 1992, as Amended in 2003 (IMS Act).
Job Responsibility of Health care providers: It should include home visits
during last trimester of pregnancy, first hour at birth, first week, 6-8 months, 911 months 12 to 18 months. Skilled support at birth for early and exclusive
breastfeeding: Provision of skilled support service at birth, for the first 1 hour to
ensure timely initiation of breastfeeding within one hour, should be made an
entitlement both at family level and facility level, and in public as well private
sector. In fact first one-hour support should be made an entitlement.
Legislative support /entitlement: Dealing these issues is important to ensure
rights of mothers and babies: Prioritize food and care for pregnant and lactating
women. Maternity entitlements (leave and other benefits), which allow the
women to absent herself from work for six months after the birth of child without
economic loss should be provided. Otherwise women are forced to adopt
inappropriate feeding practices, which cause diarrhoea, and perpetuate poverty.
This should include enough food supply during pregnancy, skilled support at
birth to ensure initiation of breastfeeding within one hour, cash benefits for
all working women, 6 months maternity leave for those in organized sector. It
should be a minimum essential package on a universal basis.
Create clear adequately resourced budget head on nutrition including IYCF
in NRHM.
Create a network of resource centres/institutions for promoting optimal IYCF
viz National level IYCF resource centre, State resource centre and district
resource units. A flow chart for the purpose is given in Annexure X. The
existing training resources of Breastfeeding Promotion Network of India (BPNI) to
be utilised to create decentralised training capability for IYCF in both NRHM and
ICDS.
Making the under 6 months visible in NRHM and ICDS
. The criticality of addressing the first day, week, month ( neonatal care) and
early infancy is well recognized as a key strategy for accelerating reductions
in neonatal and infant mortality and malnutrition. The 0-6 months infant is
often left out of initial weighing/ child care counseling sessions, because most
deliveries take place at home, mothers are superstitious about new boms
being weighed, and also because 0-6 months infants are to be exclusively
breastfed and hence no SNP is to be provided to them - and most ICDS
records/reporting is SNP centred.
. The inclusion of extent of exclusive breastfeeding practiced by the for the first
6 months of life in the ICDS MPR - as recommended by GOI, as an outcome
variable, is already being practiced in States such as Rajasthan is another
way of ensuring adequate attention to these crucial early months of life, and
27
.
.
the care practice of exclusive breastfeeding — for better young child survival
growth and development outcomes.
Create Nutrition and breastfeeding support centers, initially in all district
hospitals- and followed by at CHC, PHC levels in a phased manner - manned
by skilled counselors to provide lactation management support, and
management of severe malnutrition.
Preventing the onset of malnutrition by adopting a life cycle approach needs
to be emphasized in the NRHM. Six months to three year old children have
to be targeted with special attention on feeding advice. Preparations of
complementary foods from family pot have to be reinforced through
interpersonal communication at various contact points. Sattu like cereal-pulse
mixes need to be demonstrated for feeding of infants and young children. Due
care of adolescent girls with special emphasis on iron and folic acid
supplements, balanced diet, family life education, mother and child care
education and skill development training is essential to break the intergenerational cycle of malnutrition. Gender sensitive nutrition indicators need
to be adopted in the health services as well as NRHM.
6.4.1 A framework in which Nutrition and Health Integration could be conceptualized,
implemented and monitored is at Table 1.
6.5
Creating Nutritional Awareness at all levels
6.5.1 A National Nutrition Education Programme (NNEP) needs to be launched to
create a climate of nutritional awareness at different levels so that the invisible and
silent emergency of malnutrition could be addressed effectively. Currently only the
infrastructure of Food and Nutrition Board (FNB) of Ministry of Women & Child
Development is taking up nutrition advocacy and awareness generation as a service. In
all other nutrition related interventions, nutrition and health education is treated as an
appendix and is not given due emphasis. The Tenth Five Year Plan recognized the
importance of nutrition and health education and mandated intensifying nutrition and
health education to reduce malnutrition in children by enhancing IYCF rates.
. Expanding nutrition education through FNB of MWCD enlisting cooperation of
Home Science and Medical Colleges, Nehru Yuvak Kendra Sangathan,
Panchayati Raj Institutions and NGOs besides strengthening FNB in large States
like Uttar Pradesh, North Eastern States and at the centre would be required in
the XI Five Year Plan.
. The most important change agents for nutrition are the anganwadi workers and
the ANMs. It is important to enhance the capacity of the States and their
institutions to train the anganwadi worker, ASHA, ANM and different functionaries
under ICD.S to enable them to focus on malnutrition.
6.5.2 A comprehensive National Nutrition Education Programme would include the
following:
. Advocacy and Sensitisation of Parliamentarians and senior policy makers at
Centre and State level with a view to create ‘political will’ and 'administrative will’
respectively for addressing the problem of malnutrition with high priority.
. Nutrition orientation of programme managers and implementers of various
direct and indirect nutrition interventions of the Government.
28
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.
Capacity building of field functionaries of health, women and child development,
education, rural development, food and public distribution, civil supplies etc, on
various nutrition issues.
Nutrition Education of the public by launching a vigorous awareness campaign
on nutrition in the form of 'Poshan Jaghti Abhiyaan’ on the lines of Pulse Polio
and HIV/AIDs campaign is needed to create awareness among different target
groups on the issues of consequences of malnutrition on growth, development
and learning ability of children, the importance of micronutrients, promoting
correct norms for infant and young child feeding, providing information on
existing nutrition and health services and the role of family and community
towards nutrition promotion.
Awareness generation on nutrition to be undertaken through newspaper
columns, a daily programme of Poshan Charcha on radio and T.V. and mass
awareness campaigns through melas, fairs etc. Development of nutrition
software for different target groups, its production in all languages and
dissemination to remote corners of the country is a gigantic task and needs to be
undertaken.
6.5.3 A diagram at Annexure XI would reveal as to how these four components of
Nutrition Education Programme could be undertaken and what would be their
outcomes. The ultimate goal is to have a Self Sustaining Development Model where
people are empowered with nutrition and health awareness to take care of their nutrition
and health.
6.5.4 In addition to the NNEP primarily to be undertaken jointly by FNB of MWCD and
NRHM of Ministry of Health & Family Welfare, Nutrition Education needs to find a place
in the following:
•
.
.
.
.
.
.
.
.
•
.
Nutrition education to be included as a service under primary health care.
The Central Health Education Bureau and IEC Bureaus of Ministry of Health and
Family Welfare needs to focus on malnutrition through nutrition education.
Nutrition Education to be an important component of CHEB, SHEB and NRHM.
Nutrition component of medical education to be strengthened.
Nursing curricula to include appropriate norms on infant and young child feeding,
prevention and management of various forms of malnutrition including
micronutrient malnutrition.
AH contact points for antenatal care and immunization to be utilised for imparting
nutrition to the community.
A core module on nutrition can be included in the induction training programmes
of all Government officers and staff, including IAS officers.
Launching a People’s Movement through country wide campaign for making
malnutrition visible is needed.
A policy decision to include a degree in community nutrition at graduate level in
all universities, available to both boys and girls, would be required so that the
country has nutrition literate citizens and enough supply of nutrition qualified
people to serve the basic nutrition and health related interventions of the
Government.
Nutrition also needs to be included in all formal and non-formal educational
systems, namely the curricula of school children from III to X standards, as a
>
■
29
.
subject in BA (Pass) and B.Sc (Genl.) courses and in various adult education and
functional literacy programmes etc.
Nutrition needs to be included in various Agricultural and Rural Development
training prpgrammes so that nutrition orientation of agricultural and poverty
alleviation programmes is possible.
Micronutrient Malnutrition Control through Intensified Programmes
6.6.
6.6.1 Micronutrient malnutrition is not only most devastating for pre-school children and
pregnant women, it is debilitating in all age groups. It is also debilitating for the national
economy as well. A World Bank study states that micronutrient malnutrition robs many
countries 5% of their national income, while addressing the problem would cost only
0.3%. The control of vitamin and mineral deficiencies offers an opportunity to improve
life at a very low cost and in a short time. With political will and financial support,
micronutrient malnutrition could be reduced significantly within this generation.
6.6.2 The National Nutrition Policy adopted by the Government in 1993 had directed
controlling micronutrient malnutrition particularly anaemia due to iron and folic acid
deficiency, vitamin A deficiency and iodine deficiency disorders through intensified
programme. The nutrition scenario reveals that anaemia continues to be a cause of
concern resulting in high prevalence of low birth weight babies, maternal mortality, poor
cognitive development of children and low work capacity and productivity of adults
resulting in poor purchasing power and food insecurity at the household level.
.
Double Fortification of Salt (DFS) - The Tenth Five Year Plan had given
directions to utilise DFS (common salt fortified with both iodine and iron) for
controlling anaemia. The technology of DFS developed by the NIN is based on a
simple method of dry mixing of iodised salt with iron and does not involve
elaborate or expensive measures. Large scale production of DFS (upto 60 MT)
was successfully demonstrated in factories. NIN formulation of DFS contains
refined common salt (100%), potassium iodate (0.0067%), ferrous sulphate
hepta hydrate (0.508%) and sodium hexa meta phosphate (1%) as a stabilizer so
as to provide 40 ppm iodine and 1000 ppm iron. NIN formulation of DFS showed
good stability under the most adverse testing conditions. Sensory acceptability
trials carried out using several commonly consumed Indian foods containing DFS
indicated that the DFS compared well with control salt in attributes such as taste,
colour, flavour and overall acceptability. Bioavailability studies demonstrated that
iodine and iron are well absorbed and utilized in the body under dietary
conditions prevailing in the country. Production, long-distance transportation and
distribution in 0.5/1 kg pouches or 50 kg sacs were found to be feasible.
The Government of India has already accepted the formulation of NIN for
DFS and is in the process of releasing the guidelines for use of DFS in the
country. On the recommendation of the ICMR, the MWCD had directed all State
Governments to utilise DFS, if available, in supplementary feeding programmes
under ICDS.
The Government of Chattisgarh has been utilising DFS since 2003 and
the NFHS 3 has clearly demonstrated that Chattisgarh has dramatically reduced
malnutrition and anaemia levels in its population.
The group strongly
recommended that DFS should be adopted and utilised in the country. The
Department of Women and Child Development, Government of Chattisgarh has
30
■
been providing 500g packet of DFS/month free of cost to each ICDS beneficiary
as take home ration.
. A national programme of manufacturing and distributing salt fortified with
iron, iodine, vitamin A and folic acid for which proven technology is available
was recommended by the Group.
. Fortified Wheat Flour and RTE foods - Instead of supplying rice and wheat in
major food based programmes like TPDS, Antodaya Anna Yojana, Anapurna
scheme, Food for Work programme etc, enriched foods should be supplied.
Micronutrient enrichment of ICDS and Mid Day Meal was also necessary.
. The formation of Nutrition Development Corporation as an adjunct to Food
Corporation of India - This Corporation can procure rag/and other millets on the
same line as FCI is procuring rice and wheat, and support the manufacture and
sale of different food mixes enriched with vitamin premix.
. Self Help Women Groups to prepare food mix to serve as complementary
food for children, for marketing in rural areas.
. Horticultural Interventions - Although India is the largest producer of fruits and
vegetables in the world, the per capita availability of these protective foods is far
from satisfactory. Horticultural interventions have long been recognized as an
important strategy for achieving nutrition security for the people. Talking of
kitchen gardens, a school garden etc alone is not sufficient. A comprehensive
approach to promote production of these foods at household and community
level is needed. The foremost task would be to assess the requirements of fruits
and vegetables with special emphasis on green leafy vegetables for the
population and plan for ensuring production of that amount for domestic
consumption. Household and community level horticultural interventions need to
be promoted through agricultural extension and nutrition and health education
efforts. Provision of ‘cool, chambers' at the community/village level would be
necessary for ensuringjhe safe storage of these perishable foods.
Every school to have drumstick tree and nutrition garden of greens.
Propogation of growing green leafy vegetables in empty tins or as creepers on
the roof tops of the households on the pattern of Thailand’s experience, needs to
be taken up.
The Self Help Women Groups (SHWG) would need to be trained in home
scale preservation of fruits and vegetables so that they could preserve the
produce when available in plenty for use during the lean seasons. Marketing link
up would also be necessary to help the SHWG to sell their products over and
above their own community requirements.
. A National Programme of Dietary Diversification needs to be implemented
utilising services of Home Science Colleges who could disseminate dietary
guidelines in local languages and train the self help women groups and NGOs to
help the households in diversifying their diets. Proper counselling on basic and
primary biotechnology tools in improving the quality of diets like fermentation,
using parboiled rice, sprouted grains, leafy vegetables is also necessary.
* Strengthening the existing Iron & Folic Acid and Vitamin A
Supplementation programmes was universally recommended. In case of
iron and folic acid supplementation the two high risk groups, namely infants and
young children and adolescent girls are still not covered under this national
programme. Iron deficiency during infancy can cause permanent brain damage
while iron deficiency during preschool years can inhibit their learning ability and
concentration power thus affecting school performance.
In fact, IFA
31
supplementation of pre-school children in the age group of 2-5 years through
paediatric IFA tablets receives very low priority. IFA supplementation of infants
and young children in the form of syrup needs to be taken up on priority.
Similarly, adolescent girls in the age group of 10-19 years need to be provided
with weekly IFA supplements both through schools as well as out of school
adolescent girls. Kishori Shakti Yojana (KSY) has been identified as a viable
scheme for providing iron and folic acid supplements to adolescent girls. Since
KSY has a universal reach and is implemented by WCD Departments of the
States/UTs through ICDS, modest financial support for IFA supplementation of
adolescent girls through this scheme could give fruitful results. Incidentally,
financial support is necessary since the existing financial norms of the KSY
scheme are very weak. Deworming tablets should also be given to adolescent
girls every six months.
Fortified supplementary food need to be given to ICDS beneficiaries since
the gap in the existing diets and the RDAs are too high. For infants and young
children, fortified complementary foods in the form of take home ration needs to
be given since children in the age group of six months to three years do not need
to visit anganwadi on daily basis. The existing nutritional norms and the financial
norms do not permit fulfillment of RDAs by ICDS beneficiaries. The calories and
protein norms for children in age group of six months to six years need to be
enhanced to 500 calories and 10g protein/child/day from the existing 300 calories
and 8-10g protein. Severely malnourished children in this age group need to be
given 600 calories and 20g protein/child/day. Financial norms for normal children
for supplementary food per day should be enhanced to Rs. 4.00 while for
severely malnourished children to Rs. 10. A severely malnourished child requires
nutrient dense food 5-6 times a day. The background of the child reveals that
such nutritional inputs are not feasible with the existing financial condition of the
family. Rs.5.00 for double the ration and Rs^5.00 for take home ration/child/day
is required. Similarly, for pregnant and lactating mothers 500 calories and 20g
protein with a financial norm of Rs. 4.00/beneficiary/day is recommended. Only
when the financial norms are raised to this minimum level that one can expect
provision of nutritionally dense supplementary food for ICDS beneficiaries to
create an impact on nutritional outcome. Incidentally, the Ministry had revised
the nutritional norms for ICDS beneficiaries in January 2006 with a view to
provide 50% of the RDA of various micronutrients through supplementary food
under ICDS.
Flexibility to districts to provide nutritionally dense supplementary food to
ICDS beneficiaries in the form of cereal-pulse combination supplemented with
vegetables and fruits or micronutrients was also considered necessary.
Fortification of supplementary food with soyabean flour in the range of 5-10% has
also been made compulsory in Maharashtra to enhance protein and mineral
content.
<
An Inter Ministerial Coordination Committee on Micronutrient Malnutrition
Control has been constituted in the MWCD under the chairpersonship of the
Secretary to look into various issues connected with the problem of micronutrient
malnutrition and suggest an action plan. The first meeting of the Committee was
held on 30th May, 2006 and the recommendations that emerged are at
Annexure XV.
32
6.6.3 A Committee of Secretaries under the Chairpersonship of the Cabinet
Secretary has been meeting regularly to deliberate on the need to accelerate
programmes to overcome micronutrient deficiencies. In the last meeting held on 17th
October, 2006. The Ministry of Women & Child Development was asked to prepare the
Agenda Papers for the meeting. The Issues of Concern prepared by MWCD and
considered by the Committee in the aforesaid meeting are as under:
Issues of Concern
•
Micronutrient Malnutrition continues unabated in the country leading to heavy
economic loss.
•
Existing programmes do not address the problem in a holistic manner. Only nutrient
supplementation programmes are in existence and that too not covering the entire
high risk group.
•
There is no monitoring of micronutrient deficiencies in the country.
NFHS
undertaken every six years covers only anaemia levels in women and children under
3 years and project only state level picture. NNMB exists only in 10 States giving
State level projections for the 8 States only.
•
Food fortification has not been given adequate attention.
•
Nutrition oriented horticultural interventions to promote production of fruits and
vegetables at household and community level is yet to be taken.
•
Awareness generation on consequences of micronutrient malnutrition, its prevention
and management is not being addressed adequately.
6.6.3(i) The Committee observed that the problem of micronutrient deficiencies
continues to be unabated in the country. The existing programmes did not address the
problem in a holistic manner. The data available was inadequate and very little
monitoring was being done. There was a need to prioritize food fortification,
horticultural interventions and generating awareness in the people regarding this
problem.
6.6.3(ii) A five pronged strategy had been advised to accelerate the programmes to
overcome micronutrient deficiency in the country. These related to (i) Dietary
Diversification Awareness Creation concerning the Ministries of Health & Family
Welfare, women & Child Development and Information & Broadcasting. This needed to
be attempted through intensive IEC; (ii) Nutrient Supplementation concerning the
Ministries of Health & Family Welfare, Women & Child Development and Department of
School Education and Literacy. This could be achieved through biannual campaigns for
administration of vitamin A to children between 6 months to 6 years, providing iron and
folic acid supplements to children from 6 months to 2 years and to adolescent girls 1019 years, administering iron tablets to all pregnant and lactating women and by
emphasizing breastfeeding of infants upto 6 months under the NRHM Project
implementation Plans; (iii) Food Fortification involving the Ministries and Department
of Health, Food Processing Industries, Food & Public Distribution, Consumer Affairs,
33
Finance, Panchayati Raj and State Governments. This would be achieved by providing
the composition and quantity of fortificants to meet the micronutrient needs in different
foods, by providing incentives to industry for production and identifying appropriate
channels for distribution; (iv) Horticulture Intervention involving the Ministry of
Agriculture for the supply of seeds, extension and storage support; and, (v) Public
Health Measures involving the Ministries and Departments of Health & Family Welfare,
Women & Child Development, Commerce, Rural Development and Urban
Development. This would require streamlining procedures of procurement and supply,
building institutional capacity in organizations for monitoring and mapping micronutrient
deficiencies and provision of safe drinking water and sanitation.
6.6.3(iii) To achieve the above goals, nutritional security needs to be prioritized during
the XI Plan with the provision of earmarked funds. Estimated costs per day per
beneficiary would be around 16 paise and with 50% cost sharing with the States, the
total expenditure will be around Rs. 500 to 600 crores per month. The issues involved
need a high degree of Inter Ministerial Coordination necessitating a Mission Mode for
achieving synergies for the best delivery of facilities. Panchayati Raj bodies would also
need to be made partners in this endeavour. On these issues being decided, Planning
Commission will be approached for funds for this Mission.
6.6.3(iv) The Committee also noted that overcoming micronutrient deficiency was
internationally accepted as one of the major goals of rural development initiatives,
second only to fighting infant malnutrition, both being linked. The direct cost benefit
ratio was 1:37 for this programme and accounting for indirect benefits will make the
multiplier many times higher. The time had come when the country needed to seriously
address this problem as one of the core issues affecting the quality of rural life and for
developing strategies to fight rural poverty. There was need to segregate the short term
and long term plans to implement the scheme in a decentralized manner in the States.
It will require appropriate financial backing from the Government of India. For effective
implementation the programme will need to be monitored at the highest levels, for
ensuring synergies between the Ministries/Departments as also for ensuring quality.
Upgrading the level of awareness about the importance of overcoming micronutrient
deficiency would add to the effectiveness of the project. An hour long session on this
important subject in the next Chief Secretaries conference was also suggested.
6.6.3(v) The Committee also observed that fighting micronutrient deficiency was
important for ensuring a better quality of life, specially for children and women in the
rural areas. A fast growing/globalizing economy like India could not ignore such issues.
A Mission Mode Project was needed to achieve the best results, which would include
inputs from Ministries/Departments of Health & Family Welfare, Food and Public
Distribution, Food Processing Industries, School Education & Literacy, Rural
Development, and others proposed by the Secretary, Ministry of Women & Child
Development. The project could be implemented during the XI Plan with' appropriate
budgetary support from the Government.
6.6.3(vi) After detailed deliberations, the Committee of Secretaries recommended that:
i)
A Mission Mode Project would be launched during the XI Plan with
appropriate budgetary support from the Government for overcoming
micronutrient deficiency in the country. Ministry of Women & Child Development
34
will prepare a detailed plan for this in consultation with the concerned
Ministries/Departments and the Planning Commission.
ii)
The technical issues involved with respect of fortification of rice, wheat,
vegetable and edible oils and salt will be sorted out by the Department of Food
and Public Distribution in consultation with representatives of Asia Micronutrient
Initiative for upscaling these operations.
iii)
The Committee of Secretaries will review the progress made every
quarter.
6.7
Strengthening Inter Sectoral Coordination Mechanism
6.7.1 A high level inter agency coordination mechanism is required to enable policy
directions to the concerned sectors. A multi-pronged action by various key sectors of
the Government is possible only when a high level coordination mechanism is set under
the Prime Minister/Cabinet Secretary at Centre and Chief Minister/Chief Secretary in
States. The main function of this high level coordinating body should be to make policy
decisions required for promoting nutrition of the people for concerned sectors. The Role
of concerned sectors towards nutrition is given in Annexure XII.
6.7.2 A regular coordination between health and women & child development is
essential since these two key sectors implement the largest health and nutrition
programmes in the country. It would be desirable to have a Coordination Committee on
Nutrition and Health under the joint Chairpersonship of Secretary (Health) and
Secretary (WCD) so that the Secretaries of these two sectors could be the chairpersons
of the same committee alternately. Such a committee can evolve tools for joint
supervision and monitoring of the health and nutrition interventions.
6.7.3 Similar joint coordination committees at State and District levels are also
required. At programme implementation level, the programme managers could form
small task force of key officials and meet frequently for implementation and monitoring
of the programme.
6.8
Enhancing Investment in Nutrition and Health
6.8.1 An analysis of the expenditure at different stages of the life cycle in the country
reveals that there is a mismatch between the allocation and the requirement. Infants
and pre school children who are most vulnerable and where maximum physical and
brain development takes place have the least budgetary provision. Figure 3 illustrates
this mismatch.
6.8.2 The National Common Minimum Programmes mandates health care as one of
the seven thrust areas wherein it is proposed to increase the expenditure in health
sector as proportion of GDP from 0.9% to 2 to 3% over the next five years. The
percentage expenditure on nutrition is still lower. As per the calculations of the Planning
Commission, the expenditure on SNP component of ICDS accounts for only 0.05% of
the GDP during the years 2002-05.
6.8.3 Investment in nutrition promotion programmes needs to be viewed as an
investment in human resource development, higher economic growth and overall
development Adequate funds, atleast equal to 6% of GDP should be the minimum
35
allocation since without basic human development no amount of expenditure on
education and other sectors will yield positive results. Imposition of nutrition cess could
also be considered for the XI Five Year Plan.
6.8.4 The budgetary requirements for the Nutrition Schemes proposed to be taken up
by the FNB of MWCD during the XI Five Year Plan would be Rs. 370.00 crores as
detailed in Annexure XIII.
6.8.5 Recognizing the magnitude of the problem of micronutrient malnutrition in the
country, the Committee of Secretaries (CoS) under the chairmanship of the Cabinet
Secretary has recommended a Mission Mode Project during the XI Five Year Plan with
appropriate budgetary support from the Government for overcoming micronutrient
deficiency in the country. The estimated cost per day per beneficiary would be around
16 p and with 50% cost sharing with the States, the total expenditure will be around Rs.
500-600 crores per month. The Ministry of Women & Child Development has been
asked to prepare a detailed plan for this in consultation with the concerned
Ministries/Departments and the Planning Commission. CoS will be reviewing the
progress made every quarter.
6.8.6 The existing programmes of IFA supplementation, vitamin A supplementation
and National IDD Control programme being implemented by the MHFW need to be
strengthened and budgetary allocation enhanced for these programmes.
6.8.7 In order to give thrust to nutritional issues in the XI Five Year Plan, adequate
budgetary provision would be prime pre-requisite. Building institutional capacity for
nutrition action is also essential and would require adequate budgetary provision for the
purpose.
6.9.
Building Institutional Capacity for Nutrition Action
6.9.1 There has been very little attention given to building institutional capacities during
the last five decades. The national institutes in the field of nutrition have not expanded
over the years, rather their structures have shrunk. To quote a few, National Institute of
Nutrition, National Nutrition Monitoring Bureau, Food and Nutrition Departments of
Home Science Colleges and Food and Nutrition Board of MWCD. To take forward the
gigantic task of promoting nutrition and health of the people, nutrition has to be brought
to centre stage with adequate capacity building for various actions. The following is
recommended to build institutional capacity for nutrition action.
6.9.2 Nutrition Foundation of India
The National Institute of Nutrition with its present structure cannot undertake the
amount of work in the field of surveys, research and training for the entire country. The
Nutrition Foundation of India (NFI), an NGO of international repute could be adopted by
the Government to serve as an institute of nutrition for carrying out surveys, research
and training in Northern and Central part of India. During the X Five Year Plan there
had been a lot of dialogue between the Cabinet Secretariat, PMO and the Ministry for
utilising the services of NFI on a regular basis for improving nutrition profile of the
country. NFI could serve as a resource centre for the MWCD as well as health and help
promote issues like bringing out nutrition scenario publication annually, development of
36
educational and training material and capacity building of programme managers of the
concerned sectors.
6.9.3 National Nutrition Monitoring Bureau (NNMB)
The NNMB of the National Institute of Nutrition has its field units only in 10 States
in the country which continue to work in project mode even after 34 years of existence.
The NNMB units need to be established in all State/UTs to assist the Ministries of WCD
and Health & Family Welfare in undertaking nutrition monitoring, mapping and
surveillance and to be made permanent to ensure effective functioning.
6.9.4 Breastfeeding Promotion Network of India (BPNI)
Recognising the importance of infant and young child nutrition (IYCN) for
promoting nutrition and health of the people, an exclusive institute for promoting IYCF
would be required. There is no institute or NGO specialized in this area other than
BPNI. The BPNI has a network in States and Districts with paediatricians working
honorarily for the cause of IYCN. BPNI with its national network needs to be adopted
by the Government to serve as an institute for promoting IYCN in the country.
Needless to say, adopting an existing set up may be much easier, economical
and faster than creating a new structure for the purpose.
6.9.5 Food and Nutrition Board (FNB) of MWCD
The infrastructure of FNB comprising of 488 Group A to D officers in the country
was transferred with the orders of the Prime Minister in pursuance of the National
Nutrition Policy (NNP) in 1993 from Ministry of Food to the MWCD. Over the years it’s
strength has reduced to less than 400 while the mandate of coordinating the
implementation of NNP had been entrusted to it. The NNP Review 2004 reveals that a
number of initiatives were taken up by FNB since 1993.
The proposed National Nutrition Mission (NNM) constituted under the
chairpersonship of Hon’ble Prime Minister vide Gazette Notification in July 2003
includes implementation of NNP and National Plan of Action on Nutrition among its
Terms of Reference. FNB needs to be strengthened to serve as a secretariat for NNM
as well as to intensify creation of nutritional awareness at different levels.
A Nutrition and Diet Council of India is needed on the pattern of Medical Council
of India to ensure quality education in the field of nutrition and dietetics and their
utilisation in Government programmes.
6.9.6 Home Science Colleges
The Food and Nutrition Departments of Home Science Colleges in the country
could be strengthened for their support in training and capacity building, research and
nutrition extension in respective areas.
Building institutional capacity for nutrition in the country needs to be viewed as
infrastructure development for ensuring nutrition and heath of the people for
37
accelerating national development. Nutrition and health of the people will determine the
strength of the nation when the country will be one of the leading economies in the
world.
EPILOGUE
Malnutrition is a complex problem, the determinants of which vary from food
adequacy, literacy levels, conditioning infections, access to health care, empowerment
of women, access to safe drinking water and sanitation to economic growth.
No single organisation can ever address the multifaceted problem of malnutrition
alone.
Many inputs in different spheres are required from different sectors both public
and private.
Policy decisions at macro level and integrated planning and programming at
different levels would be required in each of the important areas like nutrition monitoring
and surveillance, nutrition advocacy and public education, infant and young child
nutrition, micronutrient malnutrition control etc.
38
1353
10254
10067
9647
9242
9007
8489
8070
7690
7321
7433
7212
920
920
921
926
926
926
928
1990
1991
1992
1993
1994
1995
1996
929
928
930
-♦
932
1997
1998
1999
2000
853
—♦—linfant survival (Number reaching the age of one per 1.000
live births
-•■-Income (percapita income in Rs)
Source : Selected Socio -economic Statistics, India 2001 and Sample Registration System
Figure 2
39
Critical Period In Brain Development — Financing Gap
8000
100
£•
7000
90
'y
6000
80
70
'sc
o
a
cn
c
tS
e
5000
M 60
4000
50
40
3000
- 30
2000
3?
re n
2?
I
20
Q.
(O
■2
1000
.<
10
0
0
6
7
8
9
10
11
12
13
14
15
16
17
18
Age (years)
--------- Average spending per beneficiary In the age group
■■Cumulative brain growth
Figure 3
World Bank, 2004
40
Table.!
INTEGRATING NUTRITION WITH HEALTH IN THE XI PLAN
Framework in which Nutrition and Health integration could be conceptualized,
implemented and monitored.
What is missing
Some examples of
Program level
The packages
/CDS
Feeding of LBW not adequately
reflected
Health
ANC contact: No advice on early,
exclusive BF
IMNCI contact:
Skills of
providers
AWW
Issues such as care of LBW babies
(warmth, assisted feeding) not explicit
What should be done in XI Plan
(some examples)
1) Skill development joint training
of AWW, ANM, and ASHA on
IYCF, new born care, kangaroo
care for LBW etc.
2) Ensure stronger, problem
oriented pre-service training of
new AWWs
3) Include lactational counseling
skills in ASHA training program
ASHAs
Training materials don’t provide enough
lactation counseling skills to the ASHAs
ANMs
Male workers
Inadequate skills in nutrition counseling
Doctors
MOs Govt
Coverage
Private
Specialists
General
AYUSH providers______________
Nurses______________________
ICDS
Contact coverage soon after birth is
very low____________ ____ _
Health
Post-natal I post partum contact
coverage is very low.
Supervision
Program managers of health at the
district level donot see promoting BF
and CF as their responsibility
Managerial
Convergence system at the district level
needs strengthening
Ensure crash courses on Nutrition
and Health Education.
Develop education tools on IYCF
for MBBS course
Revise job responsibilities of
AWWs to include this
Regular and frequent contact
during the first month and
periodical contacts for the entire
infancy to be emphasized.______
Joint Supervision, Joint
Coordination Committee of Health
and ICDS to be chaired alternately
by the Secretary (Health) and
Secretary (WCD) at Centre and
State levels will improve
convergence.
Monitoring •
Facility level
Common health and nutrition indicators
should be owned by both the health and
ICDS_________ _
_______ •
Care of the child with severe
malnutrition under-emphasised
Feeding / nutrition counseling often not
seen as a responsibility
IEC
Community
participation
Policy level
Expertise for feeding of LBW babies
poor_________ _
___________
IEC messages often do not link health
and nutrition
RCHII
Recommendations on iron
supplementation not identified
Zinc supplementation not included
Nutrition rehabilitation of severely
malnourished children to become
an important service under Health
and ICDS.
Nutrition to be an integral part of
all health education efforts of IEC
biireauxs, CHEB, SHEBs etc.
Iron syrup for infants and IFA for
adolescent girls already
recommended by ICMR expert
group to be implemented as a
measure to cure diarrhoea, t be
recommended.
ICDS to support IFA, vitamin A
and zinc supplementation.
ICDS
Higher profile of health and nutrition
required at the State and District level
Resources
Health
Resources for breastfeeding
promotion not earmarked in
State PIPs
Accountability
ICDS - no separate budget head.
ICDS
Progress measured through Process
Indicators
Health
Not accountable to reduce malnutrition
levels
Nutrition to be made a subject of
Development reviews at State
Level.
District Nutrition Cells to be
created to enable microplanning,
monitoring, mapping and
surveillance._____ ________ __
A separate budget head with
adequate resources to be created
under RCH II and ICDS for
promotion of IYCF as committed
under Innocenti Declaration 2005.
Accountability and flexibility to be
Introduced.
Annexure I
No.2(13)/06-H & F.W
Government of India
Planning Commission
(Health, Family Welfare & Nutrition)
Yojana Bhavan
Sansad Marg
New Delhi
25th May, 2006
ORDER
Subject:
Constitution of Working Group on integrating nutrition with health
for the Eleventh Five-Year Plan (2007-2012).
In the context of formulation of the Eleventh Five Year Plan (2007-2012), it has
been decided to set up a Working Group on integrating nutrition with health under the
Chairpersonship of Secretary, Ministry of Women & Child Development.
The
composition of the Working Group will be as follows:
1.
2.
3.
4.
5.
6^
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Secretary, Ministry of Women & Child Development, New Delhi
Representative, Department of Health and Family Welfare, New
Delhi________________ ______________________________
Representative, Department of Food Processing & Industry, New
Delhi______________________ ________________________
Dr. K.V.Rao, DG, NSSQ, RK Puram, New Delhi______________
Secretary, Health & Family Welfare, Government of Orissa,
Bhubaneswar, Orissa _________________________________
Secretary, DWCD, Government of Chattisgarh, Raipur________
Secretary, Department of Women & Child Development,
Government of Maharashtra, Mumbai_____________________
Salt Commissioner, Government of India, Jaipur_____________
Dr. B.K. Tiwari, Adviser (Nutrition), DGHS, New Delhi__________
Director, National Institute of Nutrition, Hyderabad____________
PPG, Social Statistics Division, CSO, New Delhi_______
Director, NIPCCD, New Delhi____________________________
Dr. Vinod K Paul, Dept of Paediatrics, AllMS, New Delhi_______
Prof. Amitabh Kundu, JNU, New Delhi_____________________
Shri Ambrish Kumar, Director (H&FW), Planning Commission, N.
Delhi____________________________________
Shri K.M, Gupta, Director, Ministry of Finance, New Delhi_______
Director (WCD), Planning Commission, New Delhi____________
Dr. Umesh Kapil, Department of Human Nutrition, AllMS, New
Delhi_______________________________________________
Dr. Rajagopalan, MS Swaminathan Research Foundation,
Chennai________________________________________ _
Dr. Prema Ramachandran, Director, Nutrition Foundation of India
Dr. Kamala Ganesh, D-l, Gulmohar Park, New Delhi
Chairperson
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
43
22. Dr. Indu Capoor, CHETNA, Ahmedabad__________
23. Prof. Mehtab Bamji, Nutrition Expert, Hyderabad
24. Dr. Arun Gupta, National Coordinator, BPNI_______
25. Dr. Saraswati Bulusu, National Programme Manager,
Micronutrient Initiative, New Delhi ____________
26. SmT^Shashi Prabha Gupta, Technical Adviserr Ministry of
Women & Child Development, New Delhi___________________
27. Joint Secretary, Ministry of Women & Child Development, New
Delhi
Member
Member
Member
Member
Member
Member
Secretary
The terms of reference of the Working Group will be as follows:
2.
1)
To assess the magnitude of under nutrition, micro-nutrient deficiencies, other
nutritional disorders and associated health problems in different segments of
the population in different regions of the country,
2)
To assess the progress achieved as a result of intervention strategies and
programmes aimed at reduction of the prevalence of nutritional disorders,
review the findings of evaluation studies and suggest remedial actions to
effect desired improvements,
3)
To suggest institutional mechanism for nutritional monitoring and surveillance,
legislation, if any, required for improving nutritional status,
4)
To define mechanism for improving the implementation of ongoing nutritional
interventions through intersectoral coordination between various Central and
State Departments and collaboration among Government, Voluntary and
Private Organizations, the Panchayati Raj Institutions and the Community,
5)
To assess progress towards achievement of food security at the national,
state and household levels,
6)
To review the progress in implementation of Action Plan of National Nutrition
Policy,
7)
To assess the magnitude of the emerging life style related nutritional
problems of obesity ■ and over nutrition, its associated health hazards,
adolescent nutrition, nutritional problems in the elderly and ongoing
programmes aimed at prevention and management of these problems,
8)
Based on the review, draw up priority areas of research, intervention
strategies and programmes required during the 11,h Plan Period for improving
nutrition of the population especially of all the vulnerable groups,
9)
To review funding for nutrition in center and state sectors during different plan
periods and State-wise investment in nutrition during X Plan; analyse the
problem of mismatch between outlays and needs (as identified by prevalence
of poverty and under-nutrition) and suggest remedial measures for the 11th
Plan,
10)
To deliberate and give recommendations on any other matter relevant to the
topic.
3.
The Chairperson may form sub-groups and co-opt official or non-official
members as needed. The Working Group will submit its report by 31st August, 2006.
4.
Ms. Radha R. Ashrit, SRO (H & FW), Room No.343, Planning Commission, New
Delhi-110001 will be the nodal officer for all further communications (Tel. No.230966662383, Email radha-pc@nic.in)
5.
The expenditure on TA/DA in connection with the meetings of the Working Group
in respect of the official members will be borne by the parent Department / Ministry to
which the official belongs as per the rules of entitlement applicable to them. The non
official members of the Working Group will be entitled to TA/DA as permissible to Grade
I officers of the Government of India under SR 190 (a) and this expenditure will be
borne by the Planning Commission.
(Sd/-xxxx)
(Ambrish Kumar)
Director (H & FW)
23096530
(ambri$h.kumar@nic.in)
i
To Chairman and Members of the Working Group.
Copy to:
1.
PS to Deputy Chairman / MOS (Planning)/ Members (KP)/(AS)/(VLC)/ (BLM)/
SH/(BNY)/(AH)/ Member-Secretary, Planning Commission, New Delhi
2.
All Pr. Advisers/Advisers/ HODs in Planning Commission,
3.
Prime Minister’s Office, South Block, New Delhi,
4.
Cabinet Secretariat, Rashtrapati Bhavan, New Delhi
5.
US (Admin.I) / Pay & Accounts Officer/ Accounts-I-Section, Planning
Commission / DDO, Planning Commission,
6.
Information Officer, Planning Commission
(Ambrish Kumar)
Director (H & FW)
■>
)
Annexure (I
Working Group on Integrating
Nutrition with Health for the XI Five Year Plan (2007-2012)
Composition of the four Sub Groups
Sub Group I
Chairperson
Dr. B. Sesikeran, Director, National Institute of Nutrition, P.O. Jamai Osmania,
Hyderabad - 500 007
Tele: 040-27018083
Email: DIRNIN_HYD@yahoo.co.in
Members
Dr. K.V. Rao, Director General & CEO, NSSO, Sardar Patel Bhavan, Parliament
Street, New Delhi-110 001
Telefax: 011-23742026
Email: kvrao@nic.in
Mr. K.D. Maiti, Director (MH), Ministry of Health & Family Welfare, Room No. 529 A,
Nirman Bhavan, New Delhi-110 011.
Tele: 23062667
Shri Ambrish Kumar, Director (Nutrition and H&FW), Planning Commission, Yojana
Bhavan, New Delhi.
Tele: 23096530
Email: ambrish.kuiriar@nic.in
Dr. P.N. Mari Bhat, Director, International Institute of Population Sciences, Govandi
Station Road, Deonar, Mumbai-400 088.
Tele: 022-25563254-56
Email: director@iips.net, diriips@vsnl.com
Dr. Prema Ramchandran, Director, Nutrition Foundation of India, C-13, Qutab
Institutional Area, New Delhi-110 016. .
Telefax: 26859814
E.mail: premaramchandran@gmail.com
Dr. Umesh Kapil, Professor, Department of Human Nutrition, AllMS, Ansari Nagar,
New Delhi —110029
Tele. 26593383, Mobile: 9810609340
E.mail: umeshkapil@yahoo.com
Prof. Amitabh Kundu, Jawaharlal Nehru University, Room No. 004, School of Social
Sciences Building II, Ground Floor, New Delhi
Tele:26704404
E.mail: amit0304@mail.inu.ac.in
Dr. G.N.V. Brahmam, Deputy Director, National Institute of Nutrition, Hyderabad-500
007.
Tele: 040-27019141
Email: gnvbrahmam@yahoo.com
Shri G. Sajeevan, Social Statistic Division, CSO, East Block 10, R.K. Puram, New
Delhi-110 066.
Tele: 23304593
E.mail: gsajeevan@gmail.com
Ms. Radha R. Ashrit, SRO, Room No.393, Health Division, Planning Commission,
Yojana Bhavan, New Delhi
TeIe:.23O96666
E.mail: radha-pc@nic.in
Sub Group II
Chairperson
Dr. Prema Ramchandran, Director, Nutrition Foundation of India, C-13, Qutab
Institutional Area, New Delhi-110 016.
Telefax: 26859814
E.mail: premaramchandran@gmail.com
Members
Shri Ajay Singh, Secretary cum Commissioner,' Department of Women & Child
Development, Government of Chattisgarh, B.K.S. Bhavan, Raipur-492001
Tele: 0771-4080996
Email: ajaysingh@nic.in
Shri R.N. Senapati, Principal Secretary, Department of Health & Family Welfare,
Government of Orissa, Bhubaneswar
Tele: 0674-2536632, Fax: 0674-2405235, 2395235
Email: orhealth@ori.nic.in
Prof. Vinod K. Paul, Department of Paediatrics, AllMS, New Delhi
Tele: 26594372, Fax : 26588663, 26588641
Email: vinodkpaul@hotmail.com
Dr. G.S. Toteja, Deputy Director General, Indian Council of Medical Research, V.
Ramalingaswamy Bhavan, Ansari Nagar, New Delhi.
Tele: 26588762
Email: gstoteja@yahoo.com
Shri Surinder Singh, Assistant Director, Ministry of Food Processing Industries,
Room No. 115, Panchsheel Bhavan, Khel Gaon Marg, New Delhi.
Tele: 26492216
Email: tarkar2002@yahoo.co.uk
Dr. Dinesh Paul, Additional Director, NIPCCD, 5 Siri Institutional Area, Hauz Khas,
New Delhi-110 016.
Tele: 26963383, 26962447
E.mail: pauldinesh@vsnl.com
Shri S. Sundaresan, Salt Commissionerj Ministry of Commerce & Industries, Lavan
Lane, 2-A Lavan Marg, Jhalana Doongari, Jaipur-302 004.
Telefax: 0141-2705571
E.mail: lavanjpr@dataone.in
Smt. Shashi Prabha Gupta, Technical Adviser (FNB), Ministry of Women & Child
Development, R.No. 105, Jeevan Deep Building, Parliament Street, New Delhi110001.
Telefax: 23362519
Email: shashi_p_gupta@hotmail.com
Dr. B.K. Tiwari, Adviser(Nutrition), DGHS, Ministry of Health & Family Welfare,
Nirman Bhavan, New Delhi.
Tele:23062113
E.mail: advnut@nb.nic.in
Dr. Sangeeta Saxena, Assistant Commissioner (MH), Ministry of Health & Family
Welfare, Nirman Bhavan, New Delhi-110 011.
Tele: 23061218
Email: sgsaxena@nb.nic.in
f
Dr. Arun Gupta, National Coordinator, BPNI, BP-33, Pitampura, Delhi - 110034
Mobile: 9911176306
E.mail: arun@ibfan-asiapacific.org
Sub Group III
Chairperson
Dr. S. Rajagopalan, M.S. Swaminathan Research Foundation, III Cross Road,
Taramani Institutional Area, Chennai - 600 013.
Tele.: 044-24939305
E.mail: dr_s_rajagopalan@hotmail.com
Members
Smt. Vandana Krishna, Principal Secretary, Department of Women & Child
Development, Government of Maharashtra, New Administrative Building, 4th Floor,
Madam Cama Road, Mumbai - 400 032
!
Tele: 022-22027050
Email: vandanakrishna@maharashtra.gov.in, sec_w&chd@maharashtra.gov.in
Shri Vijay Prakash, Commissioner & Secretary, Department of Social Welfare,
Government of Bihar, Main Secretariat, Patna - 800 001
Tele: 0612-2224742
Fax: 0612-222125
Dr. S.K. Nanda, Principal Secretary, Department of Food & Civil Supplies, Block
No.14/6, Sachivalaya, Government of Gujarat, Gandhinagar-380020
Tele: 23251162,23251163
Email: secfcs@gujarat.gov.in
Shri Balvinder Kumar, Secretary, Department of Women & Child Development,
Government of Uttar Pradesh, Secretariat Bhavan, Lucknow - 226 001
Telefax: 0522-2237157
Smt. Anita Chaudhary, Joint Secretary, Department of Food and Public Distribution,
Krishi Bhavan, New Delhi
Tele: 23384308, Fax: 23070239
Email: js-ic@nic.in
Dr. S.N. Shukla, Assistant Director General (Food Crops), ICAR, Room No. 216,
Krishi Bhavan, New Delhi-110001
Tele: 23381753
Dr. Mahtab S. Bamji, Dangoria Charitable Trust, 1-7-1074,
Hyderabad-500 020.
Tele: O+R 040-27615148, O: 27661422, Mobile; 9246886442
E.mail: mbamji@sancharnet.in, mahtabbamji@yahoo.com
Musheerabad,
Dr. Saraswati Bulusu, Nation Program Manager, The Micronutrient Initiative, C-43,
Niti Bagh, New Delhi
Tele: 41009801-07, Mobile: 9810803310
E.mail: sbulusu@micronutrient.org.in
Dr. M. M. A. Faridi, Prof. & Head, Department of Pediatrics, UCMS & GTB Hospital,
E-11, GTB Hospital Campus, Dilshad Garden, Shahdara, Delhi - 100 095
Tele: 22586262, Mobile; 9810847190
Email: mmafaridi@yahoo.co.in
Sub Group IV
Chairperson
Ms. Indu Capoor, Director, CHETNA, Lilavatiben Lal Bhai’s Bunglow, Civil Camp
Road, Shahibaug, Ahemdabad - 380 004 (Gujarat)
Mobile: 9824021686
E.mail: chetna@icenet.net
Members
Dr. S.K. Satpati, Director, Central Health Education Bureau, Kotla Road, (Opp. Mata
Sundari College), New Delhi-110002
Tele: 23239943, Fax: 23238674
Ms. Radha R. Ashrit, SRO, Room No.393, Health Division, Planning Commission,
Yojana Bhavan, New Delhi
Tele:.23096666
E.mail: radha-pc@nic.in
Dr. Kamala Ganesh, Consultant (Obs. & Gyane), D-1, Gulmohar Park, New Delhi110 049.
Tele: 26868390, 26564950
E.mail: kamalaganesh@vsnl.com
Smt. Neelam Bhatia, Joint Director, NIPCCD, 5 Sih Institutional Area, New Delhi-110
016.
Tele: 26967078
Email: nb121@rediffmail.com
Dr. Arun Gupta, National Coordinator, BPNI, BP-33, Pitampura, Delhi -110034
Mobile: 9911176306
E-mail: arun@ibfan-asiapacific.org
Shri K.M. Gupta, Director, Department of Expenditure, Ministry of Finance, GOI
Shri Srikara Naik, Director (WCD), Planning Commission, Yojana Bhavan, New
Delhi.
Tele: 23096735
Email: srikara@nic.in
Smt. Shashi Prabha Gupta, Technical Adviser (FNB), Ministry of Women & Child
Development, R.No. 105, Jeevari Deep Building, Parliament Street, New Delhi110001.
Telefax: 23362519
Email: shashi_p_gupta@hotmail.com-
Prof. Aneja, Kalavati Saran Children Hospital, New Delhi
Annexure III
Minutes of the first meeting of the Working Group on Integrating Nutrition
with Health for the XI Five Year Plan (2007-2012) held on 14th July, 2006.
The first meeting of the of the Working Group on Integrating Nutrition with
Health for the XI Five Year Plan (2007-2012) constituted by the Planning
Commission was held on 14th July, 2006 at 11.00 a.m. in Shastri Bhavan. The List of
Participants is annexed. Incidentally, the State Representative from Maharashtra,
Orissa and Chattisgarh could not participate. Although Dr. B.K. Tiwari, Adviser
(Nutrition), DGHS attended the meeting, there was no representation from Ministry’s
side for maternal and child health programmes.
Shri Chaman Kumar, Joint Secretairy (CDN), MWCD and Member Secretary
of the Working Group welcomed the members and highlighted the Terms of
Reference (TOR) set by the Planning Commission for this Working Group. He
expressed that there was some overlap in TOR of different working groups for XI Five
Year Plan, such as food and nutrition security which figures in this working group also.
It was, therefore, important that while dealing with food and nutrition security issues,
greater emphasis is laid on the health perspective. This was following by self
introduction and discussion.
Smt Reva Nayyar, Secretary, MWCD end Chairperson of the Working
Group highlighted the importance of nutrition.. ( She said that health interacts with
several areas of growth and development as well as with lives of everyone. The broad
perspective for giving recommendations for this Working Group would be to promote
integration of nutritional concerns in every dimension of health at every level. Creation
of health awareness could be considered as an important responsibility of the health
infrastructure since many of the nutrition and health disorders could be alleviated if
people were made aware about basic nutrition and health facts. She requested the
members to give their best for this Working Group, which is coming after 60 years of
independence, since this would help in formulating the draft XI Five Year Plan in the
area of nutrition and health which needs to address malnutrition and health problems.
There was a general discussion on all TOR of this Working Group. Dr. Mahtab
Bamji, Nutrition Expert, Dangoria Charitable Trust, Hyderabad expressed concern
as to why with different nutrition related programmes in the field, there was no impact or
say there was programme failure. According to her the biggest lacuna in the failure of
these programmes was lack of nutritional awareness and there was very little attention
given to this' aspect.
The group should deliberate in detail as to which
Ministry/Ministries should look into these issues.
Dr. S. Rajagopalan from M.S. Swarninatimn Research Foundation, Chennai
highlighted the need to translate food security into nutrition security at the grass root
level. He observed that the focus of nutrition inter, ontions has changed drastically over
the years. The vertical programmes are not being synergised at the grassroot level. He
also highlighted the need for expanding the National Nutrition Monitoring bureau
n
(NNMB) in all States/UTs to enable nutrition monitoring, mapping and surveillance in the
country.
Dr. Rajagopalan highlighted the structure of Food and Nutrition Board (FNB) in
early 70s when it undertook a number of food processing and fortification projects
through Modern Food Industries, Roller Flour Millers, research on iron fortified salt etc.
Today when the need is even much more, it has shrunk to a very small size and that
there was need to strengthen FNB to effectively serve as the Secretariat for the National
Nutrition Policy.
The Chairperson stated that FNB was brought to this Ministry in pursuance of the
National Nutrition Policy and it is only the FNB which is undertaking nutrition education
and awareness generation while health and other sectors should also devote equal
attention to this important factor.
Dr. Arun Gupta, National Coordinator, Breastfeeding Promotion Network of
India, New Delhi expressed that while the important issues like integrating nutrition with
the health is being discussed, the presence of a senior representative from the Ministry
of Health & Family Welfare was absolutely essential. He stated that there was no active
mechanism that dealt with nutrition across the key sectors.
The question of legislation in nutrition and health was also discussed. Dr. Prema
Ramachandran, Director, Nutrition Foundation of India, New Delhi expressed that
food processing and preservation is increasing in a big way. Additives, labeling, colors
and many other food safety issues may require legislation.
Dr. Indu Kapoor, Director, CHETNA, Ahemdabad expressed that the diagnosis
of the problem of malnutrition has to be correct if we really want to solve it. She stated
that nutrition supplementation alone can never solve the problem. Nutritional status
was the end result of many variables like poverty, food availability, access to health care
and other social services and to equate it to food supplementation was rather
simplification of the entire problem.
Dr. B.K. Tiwari, Adviser (Nutrition), DGHS, Ministry of Health & Family
Welfare stated that National Rural Health Mission (NRHM) takes care of various
nutrition and health issues although the worker ASHA is available only in 18 States.
Prof. Amitabh Kundu of Jawaharlal Nehru University, New Delhi highlighted
the importance of National Sample Surveys and stated that the unit data from the 61st
Round of National Sample Survey (NSS) could be made available to different
organisations dealing with nutrition and health. He expressed that it was possible to
map nutrition situation utilising the data on socio-economic parameters from NSS. He
emphasized that food security was essential but not sufficient to address the problem of
malnutrition. According to him, with the decline in poverty, 77% of the people were in a
position to buy adequate food but they were not doing so. There are, therefore, certain
factors which create this imbalance. Fast foods, food processing were other important
issues to be dealt with.
Dr. Umesh Kapil, Professor, Department of Human Nutrition, AllMS, New
Delhi stressed that Health Ministry was implementing the micronutrient malnutrition
control programmes since long and is responsible for these programmes. The other
Ministries particularly MWCD need not direct what the Health Ministry could do. It was
clarified by the Chairperson and Smt. Shashi P. Gupta, Technical Adviser (FNB),
MWCD that there is a National Nutrition Policy adopted by the Government under the
aegis of MWCD in 1993 which assigns the responsibility of coordinating the
implementation of various nutrition related interventions of the other sectors to the
MWCD. The Chairperson further expressed that for this reason only it was necessary
to have a high policy making body in the country in the field of nutrition like the National
Nutrition Mission, with the Prime Minister as the Chairperson, so that directions for
promoting nutrition through sectoral programmes of the Government could be given at
the highest policy making level to enable effective in,piementation.
While the 9th TOR relating to the funding for Centre and State sectors during
different time periods and state-wise investment in nutrition during X Plan was being
discussed, Dr. Saraswati Bulusu, National Programme Manager, The Micronutrient
Initiative informed that they had carried out such an exercise a few months back for the
Planning Commission and that The Micronutrient' Initiative could provide the requisite
data to this Working Group.
Realising that there was no nation wide data on nutritional status of the people,
there was a strong recommendation from various members of the Group that the scope
of NNMB should be expanded to all States/UTs as well as to include nutrition
surveillance. The Group noted that for several years the need for expanding NNMB to
all States/UTs had been felt and recommended at various fora but it has not been
implemented so far.
Dr. G.N.V. Brahmam, Deputy Director, National Institute of Nutrition,
Hyderabad explained that the NNMB was undertaking only nutrition monitoring at
present and that nutrition surveillance was a continuous activity.
After detailed discussions on different TOR, it was decided to constitute four Sub
Groups of this Working Group to enable concrete suggestions on important issues.
Considering that there was some overlapping in the TOR, the same were clubbed under
different groups. The following four Sub Groups were constituted:
Sub Group I
Assessing the magnitude of various nutritional disorders and associated health
problems and suggesting institutional mechanism for nutrition monitoring,
mapping and surveillance, legislation if any required for improving nutrition
status (TOR 1,. 3 & 10)
Chairperson
Dr. B. Sesikeran, Director, National Institute of Nutrition, Hyderabad
Members
i)
i<)
iii)
Dr. K.V. Rao, Director General, NSSO, New Delhi
Mr. K.D. Maiti, Director (MH), MHFW
Shri Ambrish Kumar, Director (HFW), Planning Commission
iv)
v)
vi)
vii)
viii)
ix)
x)
Dr. G. Sanjeevan, Social Statistics Division, CSO, New Delhi.
Prof. Amitabh Kundu, JNU, New Delhi.
Dn Prema Ramachandran, Director, NFI
Dr. P.N. Mari Bhat, Director, International Institute of Population Sciences,
Mumbai
Dr. G.N.V. Brahmam, Deputy Director, N1N, Hyderabad.
Ms. Radha Ashrit, SRO, Planning Commission
Dr. Umesh Kap.il, Department of Human Nutrition, AllMS, New Delhi
Sub Group II
Reviewing the progress achieved as a result of interventions strategies, National
Nutrition Policy and suggesting remedial actions and mechanism for intersectoral
coordination at different levels (TOR 2, 4, 6 & 10)
Chairperson:
Dr. Prema Ramachandaran, Director,' Nutrition Foundation of India
Members
i)
ii)
iii)
iv)
v)
vi)
vii)
viii)
ix)
x)
x<)
Shri Ajay Singh, Secretary cum Commissioner, Department of WCD,
Government of Chattisgarh
Shri R.N. Senapati, Principal Secretary, Department of Health & Family Welfare,
Government of Orissa
Dr. B.K Tiwari, Adviser (Nutrition), DGHS, MHFW
Dr. Sangeeta Saxena, Assistant Commissioner (MH), MHFW
Dr. Dinesh Paul, Additional Director, NIPCCD, New Delhi.
Dr. Vinod Paul, Department of Paediatrics, AllMS, New Delhi
Shri S. Sunderesan, Salt Commissioner, Ministry of Industries, Jaipur, Rajasthan
Dr. Arun Gupta, National Coordinator, BPNI
Dr. G.S. Toteja, Deputy Director General, ICMR
Shri Surinder Singh, Assistant Director, Ministry of Food Processing Industries,
Panchsheel, New Delhi
Smt. Shashi Prabha Gupta, Technical Adviser (FNB), MWCD.
Sub Group III
Food and Nutrition Security including micronutrients (TOR 5 & 10)
Chairperson
Dr. S. Rajagopalan, M.S. Swaminathan Research Foundation, Chennai
Members
i)
i<)
iii)
Shri Vijay Prakash, Commissioner & Secretary, Department of Social Welfare,
Government of Bihar
Shri Balvinder Kumar, Secretary, Department of WCD, Government of Uttar
Pradesh
Smt. Vandana Krishna, Principal Secretary, Department of WCD, Government of
Maharashtra
5't
iv)
iv)
V)
vi)
vii)
viii)
Smt. Anita Chaudhary, Joint Secretary, Department of Food and Public
Distribution, GOI.
Dr. S.K. Nanda, Secretary, Department of Food & Civil Supplies, Government of
Gujarat
Dr. Saraswati Bulusu, National Programme Officer, The Micronutrient Initiative,
New Delhi.
Dr. S.N. Shukla, Assistant Director General (Food Crops), ICAR, Krishi Bhavan
Dr. Mehtab Bamji, Nutrition Expert, Hyderabad
Prof. M.M.A. Faridi, Department of Paediatrics, GTB Hospital, Delhi
Sub Group IV
Community Awareness on Nutrition (TOR 7, 8, 9 & 10)
Chairperson
Dr. Indu Capoor, CHETNA, Ahemdabad
Members
•)
ii)
iii)
iv)
v)
vi)
vii)
viii)
ix)
Dr. Kamala Ganesh, Consultant (Obstetrics) and Gynaecologist, New Delhi.
Prof. Aneja, Kalavati Saran Children Hospital, New Delhi
Dr. S.K. Satpati, Director, Central Health Education Bureau, New Delhi
Dr. Arun Gupta, National Coordinator, BPNI, New Delhi
Shri K.M. Gupta, Director, Department of Expenduiture, Ministry of Finance, GOI
Shri Srikara Naik, Director (WCD), Planning Commission, GOI
Ms. Radha Ashrit, SRO, Planning Commission
Smt. Neelam Bhatia, Joint Director, NIPCCD
Smt. Shashi P. Gupta, Technical Adviser (FNB), MWCD, GOI
All the Chairpersons of the Sub Groups were requested to deliberate in their sub
groups both electronically as well as through meetings which would be facilitated by
FNB at Shastri Bhavan. It was informed that the TA/DA for participation in the sub
group meetings would be borne by the MWCD. The Chairpersons were requested to
submit the Sub Group reports latest by 10th August, 2006 so that the reports could be
consolidated for the final report of the Working GroCip and discussed in the meetings of
the Working Group before finalization and submission.
The meeting ended with a vote of thanks to the chair.
*****
^5
First meeting of the Working Group on Integrating
Nutrition with Health for the XI Five Year Plan (2007-2012)
14th July, ^006 at 11.00 a.m.
LIST OF PARTICIPANTS
Chairperson
1.
Smt Reva Nayyar,
Secretary, Ministry of WCD./GOI
2.
Shri Chaman Kumar, Joint Secretary, Ministry of WCD, GOI
Tele. No.23386227
E.mail: jscd.wcd@nic.in ‘
3.
Dr. Mahtab S. Bamji, Dangoria Charitable Trust, Hyderabad-500 020
E.mail: mbamji@sancharnet.in, mahtabbamji@yahoo.com
4.
Dr. Prema Ramchandran, Nutrition Foundation of India, New Delhi-110 016.
Telefax: 26859814
E.mail: premaramchandran@gmail.com
5.
Dr. G.N.V. Brahmam, Deputy. Director, National Institute of Nutrition, Hyderabad500 007.
Telefax: 040-7019141, Mobile 09441491797
E.mail: gnvbrahmam@yghoo.com
6.
Dr. S. Rajagopalan, M.S. Swaminathan Research Foundation, Chennai.
Tele.: 044-24939305
E.mail: dr__s__rajagopaian@hotmail.com
7.
Dr. Dinesh Paul, Additional Director, NIPCCD, New Delhi.
Tele.: 26963383, 26962447
E.mail: pauldinesh@vsnl.com
8.
Dr. Umesh Kapil, Professor, Department of Human Nutrition, AllMS, New Delhi.
Tele. 26593383, Mobile: 9810609340
E.mail: umeshkapil@yahoo.com
9.
Dr. Saraswati Bulusu, Nation Program Manager, The Micronutrient Initiative, New
Delhi
Tele: 41009801-07, Mobile: 9810803310
E.mail: sbulusu@micronutrient.org.in
10.
Dr. Kamala Ganesh, Consultant (Obs. & Gyane), D-1, Gulmohar Park, New
Delhi-110 049
Tele: 26868390, 26564950
E.mail: kamalaganesh@vsnl.com
Shri S. Sundaresan-, Salt Commissioner, Jaipur
Telefax: 0141-2705571
E.mail: lavanjpr@dataone.in
11.
5/
12.
Prof. Amitabh Kundu, Jawaharlal Nehru University, New Delhi
Tele: 26704404
E.mail: amit0304@mail.jnu.ac.in
13.
Shri G. Sajeevan, Social Statistic Division, CSO, New Delhi.
Tele: 23304593
E.mail: gsajeevan@gmail.com
14.
Ms. Radha R. Ashrit, SRO, Room No.393, Health Division, Planning Commission
Tele:.23096666
E.mail: radha_pc@nic.in
15.
Dr. B.K. Tiwari, Adviser(Nutrition), DGHS, Ministry of Health & Family Welfare,
New Delhi.
Tele:23062113
E.mail: advnut@nb.nic.in
16.
Dr. Arun Gupta, National Coordinator, BPNI/New Delhi,.
Mobile: 9911176306
E.mail: arun@ibfan-asiapacific.org
17.
Ms. Indu Capoor, Director, CHETNA, Ahemdabad
Mobile: 9824021686
E.mail: chetna@icenet.net
18.
Smt. Shashi Prabha Gupta, Technical Adviser (FNB), MWCD, GOi.
Telefax: 23362519
E.mail: shashi_p_gupta@hotmail.com
19.
Dr. Jai Singh, Deputy Technical Adviser, MWCD, GOI
Tele: 23365345
E.mail: drjaisinghdta@yahoo.co.in
20.
Shri Ravi Shankar, , Deputy Technical Adviser, MWCD, GOI
Tele: 23365345
21.
Smt. Anita Makhijani, Assistant Technical Adviser, MWCD, GOI
Tele: 23743978
57
Annexure IV
Minutes of the second meeting of the Working Group on Integrating Nutrition with
Health for the XI Five Year Plan (2007-2012) held on 8th September, 2006.
The second meeting of the Working Group on Integrating Nutrition with Health for
the XI Five Year Plan (200’7-2012) constituted by the Planning Commission was held on
8th September, 2006 at 10.30' a.m. under the Chairpersonship of Smt. Deepa Jain
Singh, Secretary, Ministry c5 W men & Child Development at Shastri Bhavan.
The List of Participants is annexed.
The Chairperson welcomed .the members and highlighted the importance of the
Working Group on Integrating.- Nutrition with Health elaborating as to how nutritional
levels of the population, prrticularly of the vulnerable groups were influencing the health
and mortality indicators.
She edded that various scientific studies reveal that
malnutrition accounts for more than 60% of child deaths while nutritional anaemia takes
heavy toll of pregnant women-; II wasi therefore, imperative that nutrition is given due
emphasis at every level by the health and family welfare infrastructure. She talked
about the diversity in - the country, grassroot level problems and hoped that the
deliberations of this Working Group would be able to bring out some doable
suggestions. This was followed by self-introduction.
Shri Chaman Kumar, Joint Secretary, MWCD narrated the developments since
the first meeting of the working group held on 14th July, 2006.
The first presentation '! as made by Dr. S. Rajagopalan of M.S. Swaminathan
Research Foundation, the Chairman of Sub Group 111 on Food and Nutrition Security
including micronutrients, taking c; re of TOR 5 & 10 of the Working Group. He
enumerated the emerging nutrition scene in which micronutrients and phytonutrients
had acquired the central stage in the field of nutrition. Phytonutrients in the foods have
biological property for disease prevention and health promotion, thus making nutritious
diet an essential instrument for promoting health and preventing diseases. He talked of
Article 47 of the Constitution of India, the need for adopting a life cycle approach
followed by identified strategies for addressing the nutritional requirements across all
phases of human life. He enumerated the double burden of childhood malnutrition and
diet related adult diseases. He projected thb time trend in malnutrition levels in the
country. He advocated a comprehensive approach for addressing micronutrient
malnutrition involving food based approach, synthetic nutrient supplements and
fortification of foods. Some of the recommendations for the XI Five Year Plan made
by Sub Group III are as under:
•
•
•
•
Strengthening existing iron and folic acid and vitamin A supplementation
programmes.
A national programme on manufacturing and distributing salt fortified with iron,
iodine, vitamin A and folic acid'for which proven technology is available.
Horticultural Interventions - every school to have drumstick tree and nutrition garden
of greens.
Self Help Women Groups to prepare food mix to serve as complementary food for
children, for marketing in rural areas.
x'.
.
•
.
The formation of Nutrition Development Corporation as an adjunct to Food
Corporation of India. This Corporation can procure ragi and other millets on the
same line as FCI is procuring rice and wheat, and support the manufacture and sale
of different food mixes enriched with vitamin premix.
Instead of supplying rice and wheat in major food based programmes like TPDS,
Antodaya Anna Yojana, Anapurna scheme, Food for Work programme etc, enriched
foods should be supplied. Micronutrient enrichment of ICDS and Mid Day Meal was
also necessary.
The National Programme of Dietary Diversification to be implemented utilising
services of Home Science Colleges who could disseminate dietary guidelines in
local languages and train the self help women groups and NGOs to help the
household in diversifying their diets. Proper counselling on basic and primary
biotechnology tools in improving the quality of diets like fermentation, using
parboiled rice, sprouted grains, leafy vegetables was necessary.
Dr. Rajagopalan concluded by saying that micronutrient malnutrition was most
devastating for pre-school children and pregnant women, but it was debilitating in all
age groups. It was also debilitating for the national economy as well. He ^u.4eu a
World Bank study stating that micronutrient malnutrition robs many countries 5% cr th.;ir
national income, while addressing the problem would cost only 0.3%. The x: rol
vitamin and mineral deficiencies offers an opportunity to improve life at a very Li co.
and in a short time. With political will and financial support, micronutrient rnaini -ritic/.:
could be reduced significantly within this generation.
Dr. Prema Ramachandaran, Director, Nutrition Foundation of trfciU
Chairperson of Sub Group II on Reviewing the progress achieved as u
it .
interventions strategies, National Nutrition Policy and* suggesting remedied .
•
mechanism for intersectoral coordination at different levels, taking care of TOR
* 6&
10, highlighted the paradigm shift in the Tenth Plan, improvement in nutn-fional status
over the last three decades and the short falls, and.role of intersectoral coc •dinatio' r for
improving nutritional status. Maternal undernutritiori and consequences and amc- Ir- c
interventions were enumerated in detail. Thp current concerns highlighted by
included reducing low birth weight, improving exclusive breastfee^hv^ if ’
first six months and timely and appropriate complementary feedin.
•
nutritional anaemia in high risk groups.
The relationship between birth weight and health was highlighted by
studies that reveal that low birth weight is associated with increased r;cl- c: J .
diabetes and coronary heart diseases in later life. Mother Child dyc.d wc =
inseparable unit and to reduce low birth weight, nc.lrition and health care of tnou-ei
essential. She quoted the World Bank 2006 Report highlighting the need to addi-1^
foetal and early childhood nutrition as that is the only window of opportunity
addressing malnutrition.- She advocated the need for giving high priority to ininn' ■
young child feeding in XI Plan so that universal breastfeeding, early iniu-rJoi
breastfeeding, exclusive breastfeeding for first six months, complementary iee
initiated at six months, continued breastfeeding for 24 months or longer ccuic '
achieved. Setting State specific goals for IYCF were alsc recommended by her.
The relationship between nutrition and infection was also highlighted,
focus for the XI Plan as recommended by Sub Group 'I was as under:
1! ?:
Prevention of undernutrition through nutrition education by inter-personal
communication by ANM/AWW/ASHA aimed at o Ensuring appropriate lYCF practices, appropriate intra-family distribution of
food
o Dietary diversification to meet the nutritional needs.
o Strengthening heakh components and integrated approach under ICDS
through convergence of services.
She concluded by saying-that poverty was no longer the driving force behind
undernutrition nor affluence t ie reason for over nutrition. The country has knowledge,
technology and resources, including human resources, to combat the dual burden of
malnutrition.
Dr. G.N.V. Brahman, Deputy Director, National Institute of Nutrition,
Hyderabad made a presentation on Sub Group I on Assessing the magnitude of
various nutritional disorders and associated health problems and suggesting institutional
mechanism for nutrition monitorng, mapping and surveillance, legislation if any required
for improving nutrition status taking care of TOR 1, 3 & 10. The monitoring of nutritional
status of the people particularly the preschool children through existing interventions
was highlighted by Dr. Brahmam.
He narrated the nutrition surveillance model
developed for Andhra Pradesh’on behalf of the MWCD during 1994-98 under which a
quarterly progress report for nutrition monitoring was advocated. He explained the
various sources of data on nutrition in the country which included ICDS, NNMB, NFHS
and NSSO. Since ICDS was in operation in more than 80% of the area and has regular
growth monitoring of children under six years, data on nutritional status of children
should be utilised for monitoring nutrition situation and creating a Nutrition Information
System in the country.
Some of the important recommendations of Sub Group I included:
•
.
.
.
Establishment of a State level Surveillance Cell consisting of a Nutritionist and a
Programmer to monitor the activities and bring out reports periodically.
Early warming system to be established to forecast impending nutritional disaster
due to natural calamities (drought, floods, famines etc) and initiating timely and
appropriate remedial measures to minimize the harm.
NNMB service to be made a permanent activity.
NNMB operating in 10 States has to be strengthened and extended to remaining
States and entrusted with the nutrition monitoring and surveillance in the country as
mandated in the National Nutrition Policy, 1993.
Dr. Indu Capoor, Director, CHETNA, Ahemdabad, the Chairperson of Sub
Group IV and Vd. Smita Bajpai of CHETNA could not participate in the meeting
because of floods. Dr. (Mrs.) Adarsh Sharma made a presentation of Sub Group IV
on Community Awareness on Nutrition taking care of TOR 7, 8, 9 & 10 on behalf of
CHETNA. Dr. Sharma highlighted the nutritional concerns in life cycle particularly
during infancy, adolescence, maternal malnutrition and nutritional status of elderly,
particularly the elderly females. She advocated the need for a “National Nutrition
Education Programme” linked to all pubic health services provided to the people.
Optimal use of existing structures like FNB, CHEB, NCERT, ICDS, Primary Health Care
for impacting Nutrition and Health Education to various sections of the society was
advocated. Social mobilization, involving adolescents and young people as changed
agents, school based approach for achieving nutrition goals were considered critical by
Sub Group IV. Nutrition and Health Education particularly on infant and young child
feeding, micronutrient malnutrition, infant milk substitutes act, growth monitoring, etc
were highlighted.
After the four presentations, the Working Group deliberated in depth on the
recommendations made by these Sub Groups.
Smt. Deepa Jain Singh, the
Chairperson and Shri Chaman Kumar gratefully acknowledged the practical
suggestions given by the four Sub Groups.
The Chairperson summed up the discussions and invited the volunteers from
different Sub Groups for constituting a drafting committee for preparing the Report of
the Working Group on Integrating Nutrition with Health for the XI Five Year Plan. The
Drafting Committee including the following:
.
•
.
.
•
.
Dr. Prema Ramachandran
Dr. S. Rajagopalan
Dr. G.N.V. Brahmam
Ms. Deeksha
Dr. Adarsh Sharma
Smt. Shashi P. Gupta as member-convener.
The Secretary requested the Drafting Committee to sit for half an hour or so and
strategize the line of action for preparing the Report of the Working Group so that the
group could work electronically and the Working Group Re'port could be produced at the
earliest.
The meeting ended with a vote-of thanks to the chair.
^•1
Second Meeting of the Working Group on Integrating Nutrition with Health for the
XI Five Year Plan (2007-2012) held on 8,h September, 2006.
List of Participants
1.
Smt. Deepa Jain Singh, Secretary,
Ministry of Women & Child Development
Shastri Bhavan, New Delhi
2.
Shri Chaman Kumar, Joint Secretary,
Ministry of Women & Child Development
Shastri Bhavan; New Delhi
3.
Smt. Rita Teaotia,
Joint Secretary,
Ministry of Health & Family Welfare,
Nirman Bhavan, New Delhk
4.
Dr. Prema Ramachar.dran,
Director, 'Nutrition Foundation of India,
New Delhi-110 016. .
5.
Dr. S. Rajagopalan,
M.S. Swaminathan Research Foundation,
Chennai.
6.
Dr. G.N.V. Brahmam,
Deputy Director, National Institute of Nutrition,
Hyderabad-500 007.
7.
Dr. Saraswati BuI jsu,
Nation Program Manager,
The Micronutrient Initiative, New Delhi.
8.
Dr. Kamala Ganesh,
Consultant (Obs. & Gyen.),
D-1, Gulmohar Park, New Delhi-110 049
9.
Shri S. Sundaresan,
Salt Commissioner, Jaipur
10.
Shri Srikara Naik,
Director (WCD),
Planning Commission,
11.
Ms. Radha R. Ashrit, SRO,
Room No.393, Health Division,
Planning Commission.
In Chair
12.
Shri Surinder Singh,
Assistant Director,
Ministry of Food Processing Industries,
Panchsheel, New Delhi
13.
Smt. Neelam Bhatia,
Joint Director, NIPCCD, New Delhi.
14.
Shri Pratik Khare
Joint Director (ICDS)
Government of Raipur
Chattisgarh.
15.
Shri Ujwal Uke,
Commissioner (ICDS), Government of Maharashtra
Raigarh Bhavan, Belapur, Navi Mumbai.
16
Ms. Deeksha
BPNI, New Delhi.
17.
Smt. Shashi P. Gupta,
Technical Adviser (FNB), MWCD.
18.
Dr. Jai Singh,
Deputy Technical Adviser (FNB), MWCD.
19.
Shri Ravi Shankar,
Deputy Technical Adviser (FNB), MWCD.
20.
Shri J.H. Panwal,
Deputy Technical Adviser (FNB), MWCD.
Z}n/i exaAe
I integrating nutrition with health
FOR THE XI FIVE YEAR PLAN (2007-12)
MEMBERS
Dr. B.Sesikeran., Director, N.X.N., Chair Person
Dr. K. V. Rao, Director General, N.S.5.O.,
Shri. ICV.Moiti., Director, (NH), N.H.F.W.,
SUB GROUP 1
Shri. Ambresh Kumar, Director (HEW), Planning Commission,
Dr. G. Sanjeevan., Social Statistics Division, C.S.O.,
Assessing the magnitude of Nutritional disorders
Prof. Amitabh Kundu, J.N.U.,
& associated Health problems and suggesting
Dr. Prema Ram ac handran., Director, N.F.L,
Institutional Mechanisms for Nutrition Monitoring,
Dr. P.MMari Bhat. Director, I.LP.S.,
Dr. Umesh Kapil, Prof. Of Nutrition, AII.M.S-,
Ms. Radha Ashrit, S.R.O, Planning Commission, and
Dr. G.N.V.Brahmam, Dy. Director, MI.N.,
Mapping and Surveillance, Legislation if any
required for improving the nutritjanal status.
TERMS OF REFERENCE
NUTPITTON MONITORING
1. To Assess the magnitude of undemutritron.
Micronutrient Def iciencies, other Nutritional
Disorders and associated health problems in
different segments of the populations in
different regions of the country.
■ Nutrition monitoring is the measurement of
changes over time in the nutritional status of a
population or a specific group of individuals.’
3. To Suggest Institutional Mechanisms for
nutritional monitoring and Surveillance,
Legislation if any, required for improving the
Nutritional Status.
10. To deliberate and give recommendations on any
other matter relevant to the topic.
SOURCES OF DATA ON NUTRITION
MONITORING IN THE COUNTRY
EVALUATION
Evaluation is a process of reaching a judgment,
an the basis of clearly defined criteria, about
> INTE&RATED CHILD DEVELOPMENT SERVICES (ICDS)
the success of any operation. This includes
>
NATIONAL NUTRITION MONITORING BUREAU (NNMB)
consideration of effectiveness and efficacy.
> NATIONAL FAMILY HEALTH SURVEYS (NFHS)
>
NATIONAL SAMPLE SURVEY ORGANIZATION (NSSO)
ICbS
INTEGRATED CHILD DEVELOPMENT
SERVICES (ICDS)
MERITS
> Established under the aegis of Department of
Women and Child Development, Gol.
> It is in operation in more than 80 7o of the area.
> Steps ore being initiated for its universalization,
covering all habitations.
> Growth monitoring of children < 6 yrs at regular
intervals is one of the impartant activities.
> Regular growth monitoring of children <6 yrs helps
the AWW in early identification of undernourished
and growth faltered children and timely initiation
af interventions.
> Data on Nutritional sratus of children based on
weight far age is generated at various levels (from
AWC to State level).
NATIONAL NUTRITION MONITORING
BUREAU (NNMB)
ICbS
LIMITATIONS
> Established under the aegis of Indian Council
of Medical Research, in 1972.
> There are lacunae and delay in collection,
reporting, collation and analysis af data.
>
> No mechanism to utilize the data for
monitoring
and
iritiation
of
mid-course
corrections at different levels of program
implementation, if needed.
Operating in 10 Statels viz., A.P., T.N.,
Karnataka, Kerala, M.P., Maharashtra, Gujarat,
Orissa, U.P., <1 W.B
> Collects information an a regular basis on
nutritional
status
of
communities ond
prevalence of morbidities along with household
demographic and socio-economic particulars.
NNAAB
NNMB
MERITS
It is the only organization that generates information on
>
limitations
Food and nutrient intakes at both household and
Individual levels.
• > It is currently operating in only ten States.
Nutritional status in terms of
- Anthropometry
- Prevalence of Clinical signs of nutritional
deficiency
>
>
> Provides only State level estimates but not
disaggregated data at district level.
> Operating on ad-hoc basis since it's inception in
1972, leading to very high turn-over of staff
- Prevalence of Obesity, Hypertension, Diabetes
- Blood levels of Ht and Vitamin A in target groups
Covers different age, gender and physiological
groups.
Time trends
Hp' I’xo
poG
NATIONAL FAMILY HEALTH SURVEYS
(NFHS) ’
> Initiated under the aegis of Sol, in the year
1992-93
> Repeated once in 5 yrs to assess nutrition and
health status of women in reproductive age
group and their children.
NFHS
MERITS
> NFHS generates information from all parts of
the country except Union territories.
LIMITATIONS
> .Women aged 15-49 yrs
< 3yrs old only are covered.
and
their
children
> Na data on food and nutrient intakes is generated.
NATIONAL SAMPLE SURVEY ORGANIZATION
(NSSO)
N55O
MERITS
> Covers all regions af the country.
> Provides time trends in the pattern af food
consumption.
> It assesses consumer expenditure on food and
non-food items and estimates average per capita
food intake at household level, once in 5 yrs .
LIMITATIONS
> Does not provide information on intake of Proteins
and Energy but not other Nutrients
> Does not provide data at the household and
individual levels.
> Does not provide information on nutritional status
in terms af anthropometry, clinical and sub-clinical
undernutrition.
NUTRITIONAL SURVEILLANCE
APPROACH TO NUTRITION SURVEILLANCE
" To watch over nutrition in order to make decisions which
will lead to improvement in nutritional status in
ESTABLISHMENT OF NUTRITION
SURVEILLANCE SYSTEM
populations-.
Nutritional surveillance provides information about
nutrition in population on a continuous basis. The data is
drawn from most suitable sources that are already
available.
“Triple An Approach
A SSESSMENT OF CURRENT SITUATION
*
•
A NALVSIS OF THE CAUSES/REASONS
• A CTION TO IMPROVE THE SITUATION
FAO/WHO/UNICEF EXPERT COMMITTEE (1976) AND ELABORA TED
UPON BY MASON ct al, 1984
REASONS FOR SELECTING ICDS INFRASTRUCTURE
NUTRITION SURVEILLANCE (contd.)
> Gol
under
National
Nutrition
Policy
(NNP)
recommended to establish a National Surveillance
System (NSS), to achieve the nutrition goals so as
to promote the nutritional status of the
populations.
> National Institute of Nutrition on the request of
DWCD developed NSS using ’Triple A' approach in
Andhra Pradesh utilizing the ICDS infrastructure.
> NSS was later extended to five other States
namely, Rajasthan, Madhya Pradesh, Meghalaya,
Maharashtra and Karnataka.
.1. DWCD IS THE NODAL AGENCY FOR IMPLEMEN
TATION OF NATIONAL NUTRITION POLICY.
2. ICD5 COVERS MORE THAN 80% OF THE POPULATION.
BEING EXTENDED TO COVER ALL RURAL. TRIBAL AND
50% OF URBAN AREAS.
3. IT HAS INFRASTRUCTURE FROM VILLAGE LEVEL TO
STATE LEVEL.
4. MOST OF THE NUTRIHON GOALS RELATES TO ICDS
ACTIVITIES.
5. IT HAS A REPORTING SYSTEM.
a IS EASIER TO IMPROVE AN EXISTING SYTEM HAVING
NECESSARY INFRASTRUCTURE. RATHER THAN ESTGA8USH A
NEW SYSTEM
Modification of Existing MPRs of AWWs
Triple - A Cycle
To enable :
> Identification of individuals as well as AMCiJ Sectors/
Projects/ Districts with.
■
High rates of Underrutrition. morbidity, mortality
•
Low coverage for various services under ICDS viz..
Immunization, Supplementary feeding , Suppin. of
Massive Dose Vitamin 'A' & Iron folic ocid tablets
> Analysis of the underlying causes and
> Action Taken
1
To be prepared ond submitted as Quarterly Progress
| Reports coinciding with "Survey month", once in three months
MERITS OF NSS
> It helps the AWW to identify individual children who
are malnourished, identify probable underlying causes
and
facilitate
appropriate
remedial
actions
at
household level by counseling the mother and regular
monitoring of the child .
> It provides information on nutrition and health status
of children and helps to identify and map the areas
under nutritional stress at the village, sector, project,
district and State levels.
> It assists in management and evaluation of nutrition
and health related services such as Vitamin A & iron
folic acid supplementation.
MERITS OF NSS (contd.)
> Provides early warning of impending nutrition stress and
helps in early initiation of appropriate interventions (or
prevention
* •
> Enables planners to design and conceive appropriate
action plans and the programme implementers to
translate them in to action at various levels.
RECOMMENDATIONS OF THE SUB GROUP 1
> As NNMB operating in 10 States need to be
strengthened and extended to the remaining States,
in a phased manner
> NNMB surveys should be made a permanent activity.
> Nutrition surveillance system to be made an integral
part of ICOS, facilitating best use of data generated in
targeting Interventions to .the needy.
> Early warning system to be established ta forecast
impending nutritional disasters due to natural
calamities (droughts, floods, famines etc) and initiate
timely and appropriate remedial measures to minimize
the harm.
LIMITATIONS OF NSS
> Since it is based on ICOS infrastructure, information
on nutritional status of preschool children only are
generated while nutrition information of other age and
physiologicaf groups are not collected.
> Information on food and nutrient intakes is not
generated.
RECOMMENDATIONS OF THE SUB GROUP 1
(Contd...)
> Early warning system to be established to forecast
impending nutritional disasters due to natural
calamities (droughts, floods, famines etc) and initiate
timely and appropriate remedial measures to minimize
the harm.
> To provide computers and data entry operators at
Project/bistrict and State level for efficient and
accurate management of data and analysis.
> To establish a State level Surveillance cell consisting
of a nutritionist and programmer to monitor the
activities and bring out reports periodically.
TERMS OF REFERENCE
REVIEW THE PROGRESS ACHIEVED
>AFTER NATIONAL NUTRITION POLICY & NAP
/AS A RESULT OF INTERVENTION STRATEGIES,
>PROBLEMS
IN
INTERVENTIONS
^SUGGEST
MECHANISMS
STATUS
IMPLEMENTATION
OF
ACTION
REMEDIAL
AND
FOR IMPROVING NUTRITIONAL
/ROLE OF INTER-SECTORAL COORDINATION
AT
DIFFERENT
LEVELS
IN
IMPROVING
NUTRITIONAL STATUS
Over the last three decades
COMPOSITION OF THE GROUP
Dr. Prema Ramachandaran, Director, NFI
Secretary, Department cfWCD, Chattisgarh
Secretary, Department of Health & Family Welfare,
Orissa
Dr. B.K. Tiwari, Adviser (Nutrition), DGHS, MriFW
Dr. Sangeeta Saxena, Asst Comm, MHFW
Dr. Dlnesh Paul, Additional Director, NIPCCD,
Dr. Vinod Paul*, Department of Paediatrics, AIIMS
Shri S. Sunderesan*, Salt Commissioner
Dr. Arun Gupta*, National Coordinator, BPNt
Dr. G.S. Toteja, Deputy Director General, ICMR
Shri Surinder Singh, Ministry of Food Processing
Smt Shashi P Gupta*, Technical Adviser ,FNB
MWCD &{Dr Sesikeren* Director NIN)
there has been
<Substantial reduction in severe grades of
chronic energy deficiency (CED),Kwashiorkor,
rparasmus
/Vitamin A deficiency blindness
is
rare
BUT
>1/3fd of children weigh < than 2.5 kg at birth,
/half of the pre school children suffer from
mild and moderate under nutrition.
/ More than 213rd of women and children are
anaemic.
z-vitamin A deficiency and iodine deficiency
disorders still remain public health problems
Conceptually correc,t. Progress in, tnouihcatioA of
programmes from social welfare mode to nutrition
INTERSECTORAL COORDINATION TO IMPROVE
NUTRITIONAL STATUS
^improving purchasing power of the poorer
segments of population through poverty alleviation
and employment guarantee scheme
/support for agriculture/food processing
sectors to address supply side
^demand creation for consumption of balanced
food in adequate quantities through nutrition and
health education
/universalizing the coverage, improving the
content and quality of ongoing programmes
•for improving nutritional status of vulnerable
groups under the ICDS
mode of implementation- rather slow but improving
•combating anaemia, IUD & Vita mi nA deficiency
PARADIGM SHIFT IN THE TENTH PLAN
/household food security& freedom from hunger to
nutrition security for the family and the individual;
/untargeted food supplementation to screening of
all
the
persohs
from
vulnerable
groups,
identification of those with various grades of under
nutrition and appropriate management;
/lack of focused interventions on the prevention of
over-nutrition to the promotion of appropriate
lifestyles and dietary intakes for the prevention and
management of over-nutrition and obesity.
Nutrition security has wider connotation than .mere
food security and freedom from hunger.
For nutrition security it is important to meet the
macro and micronutrient requirements .
To ensure adequate protein intake from pulses,
there is a need to increase access to pulses at
affordable cost
(perhaps through PDS) to
the poorer segments of the population.
improve
For preventing IDO it is desirable to
access to iodised salt - perhaps through PDS .
There is an urgent need to invest in prevention of
anaemia (affecting over 75% of Indian population),
through dietary diversification and access to iron
and iodine fortified salt through PDS .
CURRENT CONCERNS
Low birth weight- how to reduce
How to improve exclusive breast feeding for the
first six months and timely appropriate & adequate
complementary feed
What is responsible for continued low dietary
intake& high under-nutrition rates in preschool child
What can we do to reduce anaemia in children
Massive dose Vit A -Where do we go now ?
Can we achieve universal access to iodised salt by
2010
What should we do to tackle over- nutrition
What are the priority areas for R&D
Effect of pregnancy on nutritional status
Weight (kg) MUAC(cm) FFT (mm)
NPNL
42.3‘
22.5
10.5
1st trimester
41_.5;
22.2
9.6
2nd trimester
44.6 f
22.1 ]
9.7'
Maternal under nutrition -consequences
and corrective interventions
SrdTrimester:.... ' ' 46' ........ 217:.......... 9.2:
©Women from poor households subsist on 16180Ckcal/day; there is no increase in dietary
intake during pregnancy.
©Mean weight gain during pregnancy is 5-8 kg.
There is a reduction In FFT indicating that there
is mobilisation of fat.
Effect of lactaUon on nutritional
Birth weights in relation to maternal
BMI
^4 5
n
■
<t>42 5
60
2100
3000
2900
2600
2700
2600
2500
2400
2300
2200
< 16
16-17
1718.5
18.5-20
20-2!
I
>25
8M (Kjj/rrO)
^■i Mean Birth Weight (g)
—•—Prevalence of LBW (%}
Source; Tenth Five Yeer Plan 2002
41 5
50
40
30
20
10
0
ctatua
45
40 5
40
WSU
*1
h
_____
II
I
Ct
HP
©There Is no increase in dietary intake during
lactation.
©There is reduction in body weight and FFT
during first year of lactation suggesting that there
is mobilisation of fat to meet the energy needs.
Body weight improves after 12 months
■
-HutiiHC-n «>» Wtoww-niBMi
To sum up
Pregnancy and lactation Impose additional nutritional
demands;
KvvaIa
Tfimil N/iifu
Sr
A4M|<«en Prn<lrwl«
MmuAtnkn
Situations associated with deterioration in maternal
nutrition and reproductive performance are:
<lwi>al
Aa« oni
Bbhftt
Ovoual
^Pregnancy in undernourished adolescent girls
r Pregnancy in young adolescent girls
♦Pregnancy In lactating women
♦Pregnancy within two years of last delivery
♦ Dual stress of work at and outside home
O'nt a
Utin< pr»cje*h
MRdhra f’rffdeeti
O«ctv
HijnitiUii
kicliA
O
10
90
K)
4d
i4>
mt
M*, *>• •Not’ ilion in Wonv’ n< (r?.eJ1 It* 2 6 O) NFHC..2
Suggestions for 11 th Plan
India has entered the era of dual nutrition
burden; so it is important to identify
undernourished and provide them with food
supplements
J
KwrwiUiU
Taml Nmlii
AMRm
Universal weighment
lactating women
VMI Baixm*
of
pregnant and
MMHtvai J'xlMh
Identify pregnant women with weight below
45 kg provide 6 kg food grains for the
remaining period of pregnancy
IMM nadaaft
RatallMm
IXa'a'tt
Qa»a
w
o
. 30
WrwnwH
9*
39
Trends in Low Birth Weight
50 'Z/fMM
Rourkela
North
North
(OR) Airol (TN) Arcot (TN)
Vellore
j B Current BPrttioui|.
Mumbai
40
IdenLfy lactating women below 40 kg and
provide 6 kg food grains for three months or
until she completes first year of lactation
Low birth weight-10 Plan strategy
>anganwad.' workers to report all births in village,
>weigh all neonates delivered at home soon after
birth and
>refer those weighing less than 2.2 kg to a
hospital witi a peciatrician.
Current status
’/■•Feasibility demonstrated in small studies
>Anganwadis should have a 10kg tubular Salter
scale for reasonably accurate weighing of
neonate
>Need o have information about nearest hospital
with a pediatrician
;
>Unfi.. shed agenda - action will help in]) NNMR
"71
Birth weight and health
With improvement in survival new questions
emerge.LBW is associated with
>Low growth trajectory; what is its contribution
to under nutrition in later life
Breast feeding'- protection from under
and over nutrition
>?lncreased risk of obesity, diabetes and
coronary heart disease in later life
How far have we succeeded in protection
and promotion of breast feeding
R&D to assess these
Emerging challenges
are needed
Mother child dyad is an inseparable unit
To achieve reduction in LBW and further decline
in IMR, there is a need to to improve nutriUcn
and health care lor Mother
Exclusive breast feeding in first six month of
life is advocated because it provides
•appropriate nutrients in .adequate quantify
and promotes cpthnal growth in infants
•reduces the prevalence of infections
• protects against pregnancy
during the critical first six months.
It. also
provides protection against over
nutrition in infancy, childhood and in adult
life
Infant feeding practices -NFHS -2
Source: NFHS 1^8-99
100
Progress since then
1990 Innocenti declaration
1395 Bellagio consensus
2000Assessment of Innocenti declaration
2001Global consultation on EBE and
complementary feeding
2002WHA approval of the Global Strategy on
Infant and Young Child Feeding
2002 Tenth Five year Plan strategies for IYCF
- state specific goals for IYCF
Prevalence of undernutrition (Weight
for age % below -2 SD)
60
SO
40
30
20
10
0
ILiJill
j < is °
ir1
0 WanSlO-3 moots I« n3jv»tt, br ea led
■
fccdng ohrfjnts EiStrtfK
Breast feeding is universal in India but exclusive breast
feeding upto six months and introduction of
complementary feeds at six months is not common
Souiw HFHS IMS-M
<e
fi-11
12-23
Age-group*
24-35
■ '*-280 ■ %-3SD
As^a result*'oft&cse faulty infant feeding habits there is
steep increase in under nutrition between 6-23 months of
age. Data from DLHS shows a similar picture. Urgent
need to implement Tenth Plan strategy ’ to achieve X
Plan goals for IVCF aod improvement in nutritional
status.
■a
Window of Op|M)rtunity for Malnutrition ?
IYCF IN THE ELEVENTH PLAN
Universal breast feeding, early initiation of
breast feeding, exclusive breast feeding for
the
first six months, complementary
feeding initiated at six months, continued
breast feeding for 24 months or longer.
Specific
strategies
appropriate IYCF.
promotion
for
of
State specific goals for IYCF taking into
account the current status.
Mean Energy Consumption- NNMB 2000
Males
A^je groups
Kcals RDA
Under nutrition in Preschool children
Role of poverty and poor caring practices
Screening, early detection and effective
management can change the scenario
88 9_ 1357
1464 1929
School Age
Adolescents 2065 2441
Adults_____ 2226 2425
Pre-school
Females
®/o ’
%
Kcals :RDA
RDA
6S.5
897
RDA
11351 66.4
1409
1670
1923
1876 75.1
1823 91.6
1874 102.6
75.9
84.6
91.8
The gap between RDA and the actual energy
inUke is greatest in preschool children and
lowest in adults
Po^r caring practices rather than poverty appear
to be the major factor for low energy intake in
children in’APL households
Comparlaon of Knaray
Btatua of Pretohool
CHIdron «nd Adults
Tr*. H npwttorcrOI
r><-x» r a.
n
vuvofTtcr
y
«
ICO
« *
Oihers
■ 1075-BO
DlCUl'
lauLc
■ 1008-07
ScurcoMMI
|
P ret chop I
Adult
Malc_
Adult
Fem ale
Adequate
Adequate
Adequate
Adequate
Inadequate
liiadcquaic
Inadcquaic
Adequate
tnadequaic
Children
Over yeans there has been a increase in the number of
households where aduhs are getting adequate food but'
children are not; this confirms that poor child feeding
and curing practices rather.than poverty is becoming the
common cause of of undernutrition in preschool child
k
’H H 1
r”
I i
U H I U VMlh
I
» VS<ng4<35D
Oyer years there has been a decline in severe under
nutrition (weight for age and height for age) ?due to
better access to health care but not in wasting.
Hi Iti implica lions of wasting arc not well documented
Does low Misting rate explain the South Asian paradox ?
73 &
Ohscnntion^l Evidence: Infccr'cia <md Growth
Rckifiunship Between Xuhilion and Infectitiii
3
tkrrrivttd
dim ry intake
Impaired
immune
M*lnhwpuo«i
function
♦,cxt»b«.i|i»in,
Impaired
nutt'inil
IxvricT
di«pvt "1
pOMCCtivn
Nutt Kt«i
[ ; ■ Jytakuitriubfl/ jl
K-quctlTBlroO
Br-mn KU. J Sulr 3i«J: I >1: J1KS
Mala if *il.
/A*/ rfiifhliiliriit Syntp- ■ iitnt
11; JI I.
Energy Intake (INP) & Undercut: ;tion
among children (NTHS II)
35
Nulritional Status of children by
Income
30
I
.25
20
15
IO
5.. •
O •
i
H» ht5 |2
I
MKAiCAna
•S CikJw p-3ytan)
irte'wr^t n
kCHSU
Higher family dietary intake is not associated with lesser
child under nutrition unless infections are controlled
J
Lkk
I
L si J
*/>
&
• Low
Orissa has demonstrated that these goals are
achievable with, in the existing constraints if the
suggested strategies are followed
I
■ H>Qh
I’ndermrtrition rates among poor in Kerala are
similar to undernutrition rates among the rich
in. UP. Appropriate IYCF and caring can lead to
stenp fa’I in undernutrition fates in preschoolers
Ter th Plan Goals
Reduce prevalence of
■severe undernutrition in children in 0-6 age
group by S0%
■Mild and moderate under-nutrition from
current level of 47% to 40%
«• RAxiftirn
kk
RM
' - < ?
Hol
j
J
Tenth Plan recommended strategies for reduction
of undernutrition have not been operationalised
Available data from DLHS Phase I does not
indicate that there has been much change in
undernutrition since 1998-99.
Door step of the anganwadi in Delhi - children
stand on the door step to get take home food
supplements of Dalia , Murmura and Channa .Very
small room serves as Anganwadi
7'f
What can an AWW do to reduce IMR
Weigh home bom babies soon after birth; refer those
who weigh less than 2.2 kg
Ensure early initiation of breast feeding
Ensure exclusive breast feeding for first six months
INTERSECORAL COORDINATION AND
CONVERGENCE OF SERVICES
Collect infants in AWC on Immunisation days so that
infants get immunised on schepule by the ANM
Provide nutrition education and enable the mother to
give adequate quantities of appropriate
complementary feeds from home food
Advise regarding feeding during illness and
convalescence
Act as depot holder for ORT,
Convergence of services
AWW can
> identify undernourished
pre-school
children by weighing them at least once
every three months and -give food
supplements on priority to them;
>act as.depot holder for ORS.
/-assist in emergency referral
>Remind pregnant women to take IFA
Immunisation rates can go up rapidly if there is
good coordination between the AWW and the
ANM
During immunisation days the AWW and ASHA
can collect the children and pregnant women
ANM can immunise them in the anganwadi
PRI can help in awareness building and
community mobilisation efforts
Convergence of services
ANM will
> Immunize all infants, pregnant women and
children as per schedule.
> Screen children - especially the under
notnished ones for health problems and
manage/ refer those with problems.
AWW will
> Assist ANM in organizing immunization
health check ups in anganwadi;
> Assist ANM in administering massive dose
Vitamin A
Supportive services through intersectoral
coordination
Improved acc ssto safe drinking water and
sanitation will reduce infections
Improved access to health care for early
' detecticu& effective treatment of infections on
health and nutrition days can reduce adverse
impact of infection on nutritional status
Facilities for child care in the form of creches,
day care centres (perhaps through self help
groups) can be made available at affordable
cos. fo. women working in formal & informal
sectors
ANGANWADI IN HARIL WAR- majority
Take home supple'*' nts
Pregnant and lactating won i cannot come
daily and so need once a m >ntii take home
supply of food grains
Under threes
Stomach capacity is small in under three
children
If they need additional food, p.fras to be given
in small quantities in 3-5 sitti’ gs
Those
with
moderate
and
severe
undernutriticn ir espective o' •
They can increase their intake s’ bstantially
only if food is made enc. jy dense and is
given repeatedly in small quartitles
INTERVENTIONS FOR THE MZ-NAGE^ENT OF
UNDERNUTRlflON
Normal children- encouragement to si stain the
good infant feeding and canng practices
Mild undemutrition- teach mothers tare of these
children with home available foods;
Moderate undernutrition: appropriate health and
nutrition advice. If needed provide once a week
take home food supplements (roasted cereal pulse
oil seed mixed and powdered);
Severe undernutrition : give appropriate nutrition
&health care; give take home food supplements;
closely monitor these children; identify, those
who fail to improve under home management,.
those with infections and other complications and
refer them to hospitals for care_________________
Children (3-6yrs) eating Sattu Burfis
Focus during the XI plan
Prevention of under-nutrition through nutrition
education by interpersonal communication by
ANM/AV7W/ASHA aimed at:
> ensuring appropriate infant and young child
feeding practices
> promoting appropriate intra-family distribution
of food;
> dietary diversification to meet the nutritional
heeds of the family
Operationalising universal screening of all infants,
preschool and school children for under-nutrition
COMBATING UNDER- NUTRITION THROUGH ICDS
>Universa!ise access to ICDS services both in
urban and rural areas
<Enhance quality & impact of ICDS through
•improving the knowledge and skills of the AWW
through effective training,
•creating nutrition awareness through IEC at all
levels establishing effective supervision of the ICDS
functioning
•ensuring inter-sectoral coordination and
strengthening nutrition action by the health sector
■improving monitoring so that problems in
implementation of the programme are identified
and appropriate mid course correction
T.
-■)
J
Assessment of nutritional status
in children and adolescents
Assessment of nutritional status In dual
nutrition burden era
Are we using th£ right indices for early
detection of both under and over nutrition?
Indices used for assessment are
>Height forage
> Weight for age and
> Wcight/llctglit2 for age
I
I
Of these weight for age is the most commonly used
Weight/lleight2 for age has not yet found wide
usagv
'J
NORMAL
CHILD
WASTED
CHILD
SHORT
CHILD
SHOR’Y
AND
WASTED
CHILD
A NORMAL
CHILD
I
B TALL & SLIM CHILD
A & B have same
bodyweight
J
B should
get
to
more food
reach
appropriate
weight for his
and
height
continue
Ilinear
growth
A NORMAL
CHILD
B SHORT FAT CHILD
- Weight for age and BMI for age
A & B have
same
height. B is
short
and
Veqdires
more
^exercise to
get
to
appropriate
weight
for
his height
The WHO norms for BMI
published
for age
¥
have been
In clinical settings it worth while to put in the
additional effort to compute BMI for age to assess
nutritional status in children & adolescents
because it will enable early detection of both under
and over nutrition and appropriate management so
that these children grow into healthy adults.
77
Prevalence of Anaemia ('A)(DLKS 2003)
100%
o
cn
§
Micronutrient deficiences
£
Ali effort for combating anaemia
B0%
i
‘ 60%
.40%
?0%
0%
Review Vitamin A supplementation
a
preschool
cbiWrcn
Universal access to iodised salt .
•dotescent girts
pregninl w omen
Ooup
■ severe
□ moderate
■ mild
a no anaemia
Anaemia is a major problem right from
childhood; it worsen during adolescence in girls
Advent of pregnancy further aggravates anaemia
Coverage Under Massive dose of Vitamin A
Combatin j an< emia
RCH1 8. F8ZK2: O->iWr«n ao« 12 to 3d rrontn*.
NFHS2: OiUdron 0ookl2 to 35 rronthi
Promote breastfeeding, improve complementary
feeding
Dietary diversification
Double fortified salt
Screen all children and n-regnant women for
anameia
—A— RCHI < IWO-BP)
Detect and treat anaemia vigorously
—o— NFHNy < toon-twi I
Coverage can be improved -Orissa, UP
But overall coverage remains low
o.s
0.5
L
-0.1
Prevalence (%) of Bitot Gpots
among 1
5 yrs. children
T
EQ
I
NNNB-MNO
UVHO C
15
1
EQ
I
■I
oPW£71001
Hoaltti significance
Process o(lodsefl sit production m rda
L
S’*
S
51
Yh n ■ ? n « n m h H
SaKtSitDfoafOntrt
Aoaxton
Huge installed capacity for producing iodised salt
Prevalence of Bitot spot has declined
Is this the right time to review the massive
dose vitamin A programme ?
This is under utilised. We supply iodised salt to
other countries who attain high rates of iodised
salt use
___________________
12
o .
% Hxnsnolo oonsumpton of odseO san sou<ce
Prevalence of goi:re (children 6-12yrs)
14
12
&10
i e
8 6
J
I
I _ I
I il fl
1
II
ffl
0
I
i
*
I
3
fi
J
Many coastal, salt manufacturing states with good
health indices have low iodised salt use. Prevalence of
goitre in these non endemic states is high
A
A
so
<50
00
20
10
zy/zz/
I
Source: NNM3 2002
A
100
$0
60
70
60
Other initiatives needed
We are in the early phase of over-nutrition
epidemic and can prevent its escalation by
promotion of appropriate dietary intake and
lifestyles
Nutrition monitoring and surveillance to enable
the country to track changes in the nutritional and
health status of the population to ensure that:
existing opportunities, for improving nutritional
status are fully utilized; and
^emerging problems are identified early and
corrected expeditiously.
Source DIHSK02CJ
[■« RCH2l2002>-» NFHS2IHWW.)
Decline in household access to iodised salt
seen after the ban on sale of non- iodised salt
was lifted can now be reversed . We can
achieve lOthplan goals
Tenth Plan strategy
’
I
Research efforts to be directed towards:
>review of the recommended dietary intake of
Indians;
> building up of epidemiological data on:
•relationship between birth weight, survival,
growth and development in childhood and
adolescence;
•body mass index norms of Indians and health
consequences of deviation from these norms.
•Role of body fat and its distribution as
determinants of cardiovascular diseases and
diabetes
I
rCalcium and Vit D - and bone health
Poverty is no longer the driving force behind
undernutrition nor affluence reason for
overnutrition.
We have the knowledge, technology and
resources including human resources to
combat the duel nutrition burden
We should use this opportunity window
effectively, to ensure that we improve the
nutritional status of the population
1(\
Eleventh Five Year Flan 2*0072012 To Treat and Prevent
Micronutrient Deficiencies
Group 111 Members
Dr.S. Rajagopeian, Ctwirperson
Smt. Vandana Krishna, Shn Vijay Prakash, Dr. S.K. Nanda,
Shn Balvmder Kumar, Smt. Anita OauChary, Or. S.N. Shuki i.
Dr. Mahtab S. Bamji, C*. Saraswati Bulusu
The Stafe sbn//
/be
/he level uf
unlrifuHi tin/i the slandtud ofThhi«
afitf peop/e t/ud the ‘imprcttment nfft/tblie bctdlh t/s
an/on^ its pvlmaiy duties
’
— Arriclc
47 of rhe Consrirurion of India
& Dr. M. M. A. Farldi.
Emerging Nutrition Scene
In recent years micronutrients and phyto
nutrients have acquired central stage in the field
of nutrition. Phyto nutrients in the foods have
biological property for diseases prevention and
health promotion. Truly nutritious diet is’one
which promotes health and prevents diseases.
Dr. Gopalan graphically describes that
all nutrient in the food act collectively,
synergistically, each nutrient playing
part in an orchestra, ‘it will be poor
strategy to converge, what is essentially
an orchestra in to solo’'. In a real life
situation, diets of the poor, even of
some rich people, may be deficient in a
number of nutrients.
Thus there is considerable imcnictjon as between
difl'crcnt micronutrients with respect oictabolic
lunctitJn. From available data it may be reasonable
to argue that in a healthy slate, a dynamic
equilibrium between micronutrients is achieved
according to Dr.C.Gopalan. Uowcxactly
equilibrium is achieved is not yet well understood.
Perhaps it is a god given gift. Some kind of auto
regulatory mechanism may be helping the body lo
keep the dynamic equilibrium, necessary to maintain
health as suggested by Prof. P.V.Sukhatmae.
The life cycle approach involves clear
recognition of ail the socio-biological phases in
a human life, followed by identifying and
addressing the nutrition requirements across all
phases of human life from before conception to
old age. Nutrition challenges vary as one
progresses through the life cycle.
A new paradigm of the life cycle based nutrition
must consider the double burden of childhood
malnutrition ’and diet related adult diseases.
.y
3
13 major studies and 600 published papers
demonstrates clearly that the national nutrition
goals articulated in 1995 namely a) reducing
anaemia among pregnant woman to 25% b) ,.
eliminating blindness due to vitamin A
deficiencies and iodine deficiency disorders to
10% each by the year 2000, are still unmet.
Nutritional anaemia is one of the India's
major public-health problem. Prevalence is
high in all vulnerable groups (children
adolescent girls, pregnant and lactating
mothers) in all the states of the country."
The present review reveals that high
prevalence has changed very little in the last
50 years indicating need for reviewing the
current policies and programmes.
3
Contn....
An overview of current nneronutnent deficiency and steps to nmiyaie
tlieni in the^country.
Currcm Esli mated Status of
Ntxncnt
Vitamin A
IVn'cntig.-.if I'liJdriii unili r 5
< luklrni ■■ ndvr A nv„i ni)-. Jl
null <ul>-diiiicul \ iuiimii A
lexsi tim-diKi'iif VitJlimi V |»ii
Current Hilus of protection
dcftcicncs in India
.k-iKHnlv S'"-
Picputu Huoicii sikisunwngai
I'rrsAknce nf iron Urtwcoci
< >m«inMii^>if\ iiamni \
Number of child deaths
4IU11III.I m dlddrvil iMlih-r 5
IraM <4i ntiii-iI lisle laldviii-
scaw: 75M*
Jtr..
Pres’slenrr nfir»«i Jrrkiiiwy in
AiMm-nii g«l» rsvosing
IV^miUii-mi
iwunril ugrd 15-4'1 yraw. vl“-
uvckls mm f.ilmr suppli-nHiir
iibuk-qiMli- zim inuLr 2<i" •
AiiuimI dcallis from seserr
tic.
fi.ruin'd li.nl<
piccipilalcd aiinualh
iron
J?<l.<li!il
i«Hh/f4r*/.iilii*r*< <1
Zinc
n.k Ilf
No signilic.ini intersciiuoii
Siiuiii.igni cli.ldo'ii under 5
Consuiuptiou of iroii-fonilicd
ivjW <4 jgr»4V'..
aiMcmu' 22,<MK1
food (wheat flour.ccrcal flour/
Mil). <1%__________________________
Kobe Acid
Annual number of children
Esliiiiatcd houieliolds using
born unprotected frnm mental
adequately iodised salts (15
impairment due to iodine
ppm) 37".k
todinc
Number of neural tube birth
No cigiuticaiu inter*cntHui
defects per scar. .'lUMH)
deficiency: r><> luillinn
■>
Overview of Under tuiiiilioti stains in India IW
Percentage of adulti and children whose nulncnl intake it
below Mkt ofRDA in rural areas, India jtKi|
i
£2122
■>
■■
| Percentage nf children
Percentage of Mothers
- >i i uni \
> >.•
| l-r.-M,
A|!C
ItOjlJll
AlM-inni
ItMl
A|X-
I llkkl
ctlonp
Weiutu
SllHIlUql
Awnuu
|ha
A5-4'I
I’.U
31 I
!*’
5<i 5
«.iu.«<ili.
11 ihiuuIi
1J-2* iuiHiIi
1*M
•Illi.
I l<V>
S1-24
l*.f«
j
:.-r l-0,
i
ll x
M.'li
24-Jr. nnmlh
5X4
ixx
<~‘l IV.ll'
NA
<am
121
•---------- 11.17
SI
&
Ki.V'.s'V'kiuLmc.i^
Strategics for Control of Micronutrient Malnuuirion
a a. Foods based approach
B b. Synthcric nurricnc supplcmcnrarion
c. C. Food based.approach supported by
limited use of synrheric nutrients as
adjuncts.
'Ik 1.1' I"* )€.<r;»l.in
Dislrihution of Iron and Pulis Acid Cablet* m«l
pharmacopical dose of Vuanm A in the IO*' plan may he
continued in the 11* fiver yiar plan Tltw will cox er only
al risk iitoiltcraand children with low*1icinoglobinrlow
mlakc of iron and x irautin A
•
A National programme of ■■nimfactiiriiii* and disinhutilitf
salt fortified with iron, iodine. Vtiamin A and Folic acid
for which proxen technology is available
<
Horticulture nirervention - under this programme cxerx
school should have sonic important trees like Muruneai
and oiiiruion garden of greens
d. Forrifienrion of foods.
Conrn....
liexelopmcnt of food mix and manufacture by women self
help group for marketing in rural area. A* food mix
developed to serve as i contplemenury weaning food for
t.ttnplrinriiurv h cj i uut I uud
llrjitt
Vilirji ibHir.’XUi/v d-’iir
MjheJ Rjp flour
IlvngJ gr.im ouMril Ihwir
Sug4< ■p'HVikwJf
ktgNjiJrinl
X itsimii prxsMix - I •f) mg
< 'al.'iunl CarfoMMlc - 7i«' mg
,
Conrn...
5. I''onnatitin of a nutrition development
corporation as an adjunct to Pood
Corporation <»f India. This corporation
can procure Ragi and other millers on rhe same
lines PCI procuring rev and wheat. I‘sing ragi
and millet procured t »v corporation will support
rhe innnufacrure and sale of different food mixes
TINPofTamil Nadu is given below.
enriched with Vitamin premix.
.
I ecruus Milplutc - 15“ mg
hiul
('rutin
Contn...
6. Major food based nuiriiion programme in India ire
Ihil'IiC Ih'tnliim><n Ststrm
Aur\><djM \iiim V<>|.nu
Siuuptirn.i SchciiU'
'
«
S.iuipom.i < imnun Itizgur Y<>|.iim
|'i«^l iicu'^rit
In flcad of supplying nee and wheat in the>c prograntntes should
supply enriched foods
Micronutrient enrichment of ICDS and Noon Meal Scheme
7. A national progranune to utilize services Home
science colleges io develop dietan' guidelines in the
local language and guide women self help groups and
NGOs in helping the households in the diversifying
their diets, tn addition with proper counselling to use
basic and primary biotechnology tools in improving
the quality of diets. Tl)cst may Ik* fcrmeiuation. using
parboiled rice, use of sprouted grains, use of leafy
vegetables etc.
Concluding:
Micronuirienis maluourishmciit is most devastating for
prcscltool children and pregnant women, but it is debilitating
for ail age groups. It is also debilitating for tlie national
economy as well. One of the important findings from the
study of world bank (hat micro nutrient malnourishment robs
many couniries 5% of their national income through death and
disabilities. Yet addressing this problem could cause as little
as 0.3% of national income. The control of vitamin and
mineral deficiency is most extraordinary development in the
nxent years. No other technology offers as large an
opportunity to improve life in such a low cost in such a short
time. With political will and adequate fiiiancial support
micronutrient malnutrition can be reduced significantly within
this generation.
1
^3
Am ex umEIP
•
Report of the Sub-g onp Is
.:••• i;. Members of VVorking Grotip
'•y
Chiiir Pervin
Working Group on Intcgratirg Nutrition
with Hcahh
for the XI Fi\ c Year Plan
(2007-2012)
Sts. Imlu (
CIIFTNA
Mvmtwr'
Dr. KkiiiiiIic Giiuoh. {'niisuldinl (<ItiMiirk» amt <i>neci>li>ul>11 Nvw Di'IM
l’r<>r.Anv).'i. KiWMl Siy.in tlmpilal. X<n Ik'llii .
Dr. S'alpall, birwinr.CcMral Itcwlih tillicaiiiMi tlureun. Ni-« Ih'lhl
Dr. Arun (iirpiii. NntinnnlC'nnrdtnaior. RPM.
Delhi
Shrl. K.M GuiKxtlircchtr, Min«trj nt finance. GOt
Shr>.Srikarn Xnik. Directin' <w( Di PlM«niiieCiimini»*iua.<><>l
XU. Rmlha Aehrit.XHO .I’bnnlnv r<winn»inn
SiniA’ccliiin Hhsita. Jl.Dirvrt«ir.XU*CTD
Sn«. Shrnhi P <;<i|il;i.Terkntail Aih her tFXRl.MWCD.GOt
<'unlril>v<i<'rt Jn>l O*n'piIIi<hi hj
Vil. SnitiH
jrtd M*. fl-ih.ii D.ihl
(HHTbA
Present Nutritional Scenario
• Malnutrition is a problem of considerable magnitude across
various sections of thfc soeierj.
• Incidents of diabetes, ol’csny and cardiovascular problems arc
escalating in urban areas.
, ’
• Caloric, protein and micromicrient deficiencies aliects large
segments of lhe population
*
• Il contributes lo greater • economic and lieahh burden
|wnieulai\v of urban society
•'
• Infants, pre-schuul children, adolescent girls, expectant and
mirsing mothers and aged arc nmong the must vulnerable
groups.
■Nutrition concerns in life cycle
■ ♦ Infancy
* Nearly 30% of all children bom in India weigh less than 2.5
ky
* !x»w birth weight accounts for 5(1“o of the infant mortality
mtes.
•> Miihnmrislimeni during intrauterine state.to three years alter
binh impacts the cognitive, iinclleciunl and jihysical
development of human resource.
Eftbrta tn communiente rKe importance of exclusive breast
feeding in the first six months of life and timely imrodneiion
of adcqiinie quantify of energy dcu. c complementary food
ntkr six months have been initiated on a vuir fooling
Si
Contributing Factors
• Mnl nuirilicm is. a social problem linked to the uch of
econnmtCi political, cultural, biological and social factors
• particularly linked lo the production and distribution of food,
econnmic and geiider inequalities.
• Poverty and ignorance continues to be major comribining
factors. ,i
• Kceurriug natural calamities affects the nuintiun axnilnbilily
and intake of the population.
• Dietaiy changes compounded by lifestyle changes ivmiIi hi
chronic degenerative diseases
• Limited access to food and under utilization of liHrally
'available nutritious foods
••y: Contd....
<£.
♦ Nutrilionxl stHlus of uiloltf&ccnts
« There has been increase in the prevalence <>f obesity fliid
microintliieni deficiencies.
♦ Geiider discrimiiiHiion in liealih care and nuiritiona! ininke
among girls especially fiutn poor faniilio coinpoundh the
problem of nutritional intake
♦ Under nutrition and anemia in adoleseeiil girls lends imi
onlj lo iimiernal monalitv and niorbiditv but also io a higher
incidence of low birth weigh) and peri-natal mortality
<£•
□
□
Recommendations
^sContd....♦ Maternal Mnlnutrilitm
« Anemia is pervasive among women in the India, nearly. -10X8% pregnant women arc anemic, and suller Iron) ns
clTec)>.
• Nutririoiial Status of elderly
• Old age population is likely to increase from 70 billion in
1095 to Hi million by 2020 and 508 million by 2100
according to World Bank Project.
* Challenge belbre us is to prevent physiological ageing
getting converted into pathological ageing with chronig
disensc.
• National Nutrition l-duealion Programme linked to all ilk*
public health services provided Io lire people
• Optimal use of the cxisiliiig structures like llw CllliB.
NCI-KT. ICOS. PHS, to imparl nutrilion education ricioss
various sections of the country.
• Right based approach
• Lite cycle approach
• Nutrition education
• Social mobilization
• Invok e adolescents and young people as change agents
• School based approach
Monitoring and Evaluation
i^Contd....
• Nutrition should be incorporated into hcahb. education and
agricultural policies.
• Promotion of •home and school gardening, fruit trees,
fisheries and production of milk to combat micronutrient
deficiencies. Advocacy and sensitization of parliamentarians
and policy makers
• Mobilization of Development Machincix <if Government
and potential partners.
• Nuinlion orientation programme can be developed for
Programme managers
• Capacity building of the functioiwries can be done by ■
organizing awareness uantps and community meetings
• Policy level
• National Infant and Young child l-'ecdinu SclicnictlYCTl
with specific plan of action and allocated budget w expedit
implementation of national Guidelines on IYCT
• 'Ihc National Nutrilion MissioulNNM) will be held
accountable at* Central level for the implementation of
National Infant nnd Young Child Feeding Scheme.
• Hold six-monthly review meeting by Slate DWCD with all
tissigned authorities and take immediate action on divisions
« Set state inspection and monitoring committee facilitating
state level nutrition monitoring anssnrvillancc.
1*1
gcontd
p \Contd...
♦ Operational In cl
♦ Key indicators of state level goals include . early
breast feeding, esclusi'.c breastfeeding for o months and
timely com pic meta iy feeding nnd mother's nuintipnal
stat us.
* Ittvcsitgate mechnnisms to facilitate nsscssmeiit of first hour
support and baty’ friendly practices prior to renewal of
rcgisiraiion ofeiimes.
• Eftcctive implementation Infant Milk Subsiiiuie Act by
notifying stale nodal officers and 1*171*0$ to act n> Block
resource persons to educate public and AWW on provoMons •
of IMS Act and monitoring and reporting ol’ilte same.
II
• I’hc iHple A’ approach ( A.sscssiikiiii. Anal>>»> and Aclimu
is iinponam
• Ptopei rnomioiiitg has lo. I>c lullonud In cxahwtioii
inech.'inisin. which can bring in ilw inpnrs inio the ongoing
ninriiion and liealih progranimcs
Annexure IX
COMMUNITY BASED NUTRITION MONITORING MECHANISM
Creating a database and
a Nutrition Information Svstem
Instituting annual nutrition
Reviews and Awards
>
-■ . ■ *Slhsywg
Publishing Annual
Nutrition Scenario
. DIsaggreggted DSta on Nutrition
every 5 yr thru Nat Nutrition purveys
I
BO
Reviewing Nutrition in
Monthly Develooment reviews
r
•
Identifying Areas with
Hiah Malnutrition Levels
ir <■
Creating database on Nut. Scenario
with Primary and Secondary data
■/
*fiu<0ance,ta bistri
I -4 uu !
i
F
•
.
Monitoring Nutrition &.-I tealth
•
'
Statusl ’
Monitoring supplementary Feeding
Immunization, Vitamin A, Iron & Folic
Remedial Measures in Collaboration
with other Aaencies
QO
Source : Shashi P Gupta, Nutrition Module for WHO 2005
*
!
< ) ; ) (
)
■
■
■)
(J
o
U <J
1
Annexure X
NRHM-MOHFW
ICDS-MWCD
I NIHFW
State
Directorate
National Res Centre IYCF
18 Collab
N1PCCD
3 Res
.CPMU
Med
College
. District
Hospital
SIHFW
State Res Centre IYCF
SIHFW
District Res Centre IYCF
MLTC
_________ _J
AWTC
■;
State
ICDS
Director
DPO
CHC
oo
PHC
Block Res Centre IYCF
CDPO
JHV
Cluster Res Centre IYCF
LS
Village Res Centre IYCF
Peer Counsellors etc.
AWW
Sub Centre
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Annexure XII
ROLE OF CONCERNED SECTORS TOWARDS NUTRITION
H Women and Child Development
J
■
■
■
■
■
■
To reach all eligible children under six years, pregnant and lactating
women in 14 lakh habitations with appropriate supplementary nutrition
alongwith nutrition education.
To reach information on appropriate infant and young child feeding
practices for children under two years to every household.
To screen grade II, 111 and IV malnou^shed children and concentrate
on rehabilitating them by organising camps and supplying sattu like
instant food for a period of about 3 months.
To reach all. adolescent girls from BPL families with food and
micronutrient supplements.
.
Launch a national level Nutrition Programme for pregnant women and
girl child.
To expand nutrition advocacy, sensitisation, capacity building and
education of public to a national scale enlisting cooperation of Home
Science Colleges, established NGCs etc.
H Agriculture
■
■
/
■
To promote production of coarse grains, pulses, fruits and vegetables,
milk,, nuts and oil seeds.
. ,
To promote nutrition, oriented horticulture at the community and
household levels. ■ .
To undertake fortification of milk with vitamin A (Department of Animal
Husbandry and Dairying).
n Food and Public Distribution
To ensure food and nutrition security at the household level.
Antodaya Cards for all households at risk of hunger to be introduced
and all Antyodaye households to be supplied with either a vitaminmineral premix or multiple fortified salt with a view to launch a frontal
attack on-hidden hunger caused by the'deficiency of micronutrients.
■ To set up grain t anks in chronically food insecure areas and some
tribal areas in Madhya Pradesh, Maharashtra and Andhra Pradesh
which tend to remain isolated during monsoon season.
1000
Community Grain Banks to be established at the rate of Rs. 2.00 lakhs
• per grain bank with the he’p of Gr-.in Sabhas and managed by
Community Grain Bank Self Help Groups of Women.
■ . Households with vulnerable age groups like infant, pre-school child,
adolescent girt, pregnant or lactating women to receive additional
quota of foodgrains under TPDS.
■ Including iodized salt, sattu like, low cost instant infant food mixes,
pulses, coarse grains and oil under public distribution system.
■
■
n Food Processing Industries
■
•
To undertake fortification of wheat flour, cereal products, RTE energy
foods for children with iron, folic acid, vitamin A etc.
To promote production of health foods based on traditional foods of
India.
■'
‘
'
H Education
•
■
•
■
“Feeding Minds Fig;.ting Hunger” - an initiative of FAO as a follow up
of World Food Summit, involves introducing Food and Nutrition issues
in primary,-secondary and high school curricula needs to be given due
consideration.
t
"
To include nutrition in curricula of all formal and non-formal educational
systems.
To introduce B.Sc./B.A. degree In ‘Community ’ Nutrition’ in all
universities so that both boys and girls have equal opportunities for
becoming nutrition literate.
Mid Day Meal scheme and school health programme to include
nutrition education as an integral component.
H Health and Fanr.:!y Welfare
■
■
■
■
■
To give due emphasis to nutrition at every level.
Nutrition and health education to be made an integral part of job
responsibility of different level health functionaries.
Joint Trainings and supervision of ROH and ICDS functionaries need
to be evolved.
Integrated planning and programming to address various forms of
malnutrition need to be adopted.
To ensure universal coverage under IFA and Vitamin A
supplementation-.
n Rural Development and Urban Development -
■
■
To ensure universal access to safe drinking water and sanitation.
To improve purchasing power through poverty alleviation programmes.
n Information and Broadcasting
■
To help create a climate of nutritional awareness in the country by
launching a daily progra'mme dn ‘Foshan Aur Swasthya’ on AIR and
Doordarshan:
■
>
Annexure XIII
PROPOSED NUTRITION SCHEMES FOR XI PLAN
Funds requirement
(Rs. In crores)
Schemes
1.
2.
3.
4.
5.
National Nutrition Education
Programme (NNEP)
Training and capacity building
for improving IYCF practices.
Development of District Nutrition
Profiles to enable area specific
planning.
Establishing Nutrition Information
System through ICDS (nutrition
monitoring, mapping and surveillance).
Strengthening. FNB to serve as
Secretariat for the NNM.
Total
250
50 ■
20
30
20
370 crores
-'i
QI
/ nnexure XIV
RECOMMENDATIONS OF TH : 1O.TTH EAS~ CONSULTAT'ON • MEET ON
NUTRITION HELD AT SIllC OllG, MEGHALAYA
Recommendations , ’
1. The picture that emerce'-' from several expert presentations both by the
Department as well as by eminent experts from other institutions and UNICEF is
not very optimistic. The rf; tri on and health status of children-and women in
North East is far from satislac’ory. For instance, the anaemia levels in women
are quite high. The infant mortality rate and-under-5 mortality rates in many of
the North Eastern States a e rather high and'most surprisingly the percentage of
children vaccinated agains' ■ ill diseases (a l the six vaccine preventable diseases
in children), is low inrpite .T high female literacy and matriarchal society of the
North East. The North East, therefore, deserves more focus through various
nutrition and health interve Tons of the Government.
2. The nutritional status of tl vulnerable i ou;s is the outcome .of complex and
interrelated set of factors. Jlany o' these factors relate to health care, hygiene,
sanitation, safe drinking w ter, public hea th measures etc. Needless to say, if
the non-food factors are ot taken care of the supplementary food given to
children through ICt)3 wil. ha e no impact. It would be just like-a 'leaky pot’
where food provided through mouth finds the way out through various infections.
3. The hilly terrain of some- of the regions probably makes it difficult for the
population to access health and welfare services. Innovative interventions of
reaching health care, imm; lisation, health and nutrition education to the people
need to be evolved on priority^ Deworming cf children and women in areas with
high anaemia levels need to be implemented.
4. Capacity building of field: perscchol, t ainir-g institutions and professional
organisations in the region also deserve di e attention.
•
•
*
•
5. Six critical areas v ere ideri’jied for action by the State Governments:
i.
ii.
iii.
iv.
v.
vi.
Bringing nutrition issues centre stage.
Strengthening inter-sectoral coordination and creating synergy.
Establishing Nutrition Monitoring, Mapping and Surveillance System.
Ensuring Optimal Infant and Young Child Feeding practices.
Addressing Micronutrient Malnutrition due to deficiencies of vitamin A,
iron, folic acid and iodine through intensified programmes.
Creating' nutritional awareness at different . levels utilizing all available
channels of communication. ‘
.
RECOMMENDATIONS OF THE REGIONAL CONSULTATION MEET ON NUTRITION
AT PUNE, 19-20 MAY, 2005 ‘
The important Recommendations that emerged from the two-day Regional
Consultation Meet on Nutrition for Western Region, covering the States/UTs of
Maharashtra, Gujarat, Goa Dadra & Nagar Haveli, Lakshadweep and Daman & Diu, are
enumerated here:
1.
Giving high priority to malnutrition contrcl •
Nutrition is an input into development. Nutrition was considered critical for
human and economic development and its neglect would adversely impact on health,
cognitive development of children, productivity of the people, economic growth and slow
pace of national development. Nutrition agenda th refore, needs to be given high
priority with greater investment for accelerating human, economic and national
development.
A proactive approach for prevention and control of malnutrition was needed.
A revolution in nutrition programming to reach all infants and young children, to
address every stage of the life cycle including adolescent girls,, to strengthen
micronutrient malnutrition control programmes and to monitor behavioural change was
required.
□
2.
State Nutrition Mission
Every State should have a State Nutrition Mission to reduce malnutrition and
mortality rates among children and women on the pattern of Maharashtra Nutrition
Mission. The Mission’ should focus on eradication of malnutrition among children and
women, motivation and training of the cadre, accountability and flexibility, addressing
mother child dyad and empowering community to address the problem of malnutrition
on their own. After antenatal registration of the pregnant women, each case should be
followed up to ensure child survival as well as optimal infant and young child feeding,
immunization etc. Village Health Committees and Panchayati Raj Institutions need to
be empowered.1
'
3.
Convergence for synergistic impact
Achieving convergence between Departme’nts implementing developmental
programmes was crucial for achieving the synergetic impact.
The village level
community based micro planning was essential to Involve all the available functionaries,
numbering about 17-20, in nutrition related services.* A resource team was needed to
build alliance between Government functionaries’ and the community so that
Assessment, Analysis and Action could become a regular activity. Training institutions
like NIPCCD, YASHADA etc could be utilised in micro planning exercise.
The Department of WCD being the nodal Department for implementing the
National Nutrition Policy in the country needs to establish stronger linkages with
Ministries of Agricu’ture, Food and Public Distribution, Elementary'Education and
^3
Literacy, Health & Family Welfare, Informarcm & Broadcasting, R • al and Urban
Development, Tribal Affairs*to ensure improved food and nutrition seei jity and access
to health care. “Community Grain banks” in hunger hot spots to be managed by Gram
Sabhas, Women Self Health Groups utilising grain surpluses should'also be set up.
4.
Utilising Civil Registration System
Civil Registration System need to be gainfully utilised to provide valuable
information on sex ratio, low birth weight of the new boms as was- being done in
Gujarat. Computerised civil, registration at district level'interlinked to State level needs
to be set up. Audit of all deaths need j to be undertaken. •
5.
Urban Malnutrition
The problem of malnutrition was invariably much worse in urban slums than in
rural areas. Urban malnutrition, therefore; needs to be addressed more effectively.
6.
Tribal Areas
Special attention vC< s required to address the problem of malnutrition in tribal
pockets.
7.
infant and Young Child Nutrition
National Guidelines on Infant and Young Child Feeding needs to be integrated in
the- curricula of various training institutions particularly for health and ICDS
functionaries. A diploma in Lactation, management needs to be instituted. Certification
of- creches was necessary io prevent botile feeding and other harmful practices
concerning breastfeeding and complementary feeding.
The ICDS needs to focus on children under three years with duo emphasis on
the care of the pregnant women, new born care, breastfeeding issues, complementary
feeding, hygienic practices for f eding Infants and psychosocial stimulation through
active feeding.
Skill development training of ICDS personnel was an important
prerequisite to focus on IYCF issues.
8.
Nutrition and Health Education
A paradigm shift was required from Nutrition and Health Education (NHE) to
Nutrition & Health Education and Communication (NHEC) in ICDS. Empowerment of
women is an important objective of ICDS but NHEC from an empowerment and
behaviour change perspective was one of the weakest links in ICDS.
NHEC has great potential to improve infant and young child feeding practices,
improve utilization of services and reduce malnutrition.in women and children underthree years. Reorientation of ICQS was needed to make time and resources available
for NHEC on a regular and sustained basis, strengthening supervision and monitoring of
NHEC. Adequate budget allocation for development, production and dissemination of
quality NHEC materials was required. Training.in communication and counselling and
ensuring outreach of services through home visits also needed strengthening.
}
NHE should focus on communication for behaviour change, should address
family as a’whole and not just the women, and should have gender sensitivity built into
it.
NHEC has not been given a chance so far. It needs to be taken up as a service
and successful experiences giving cost benefit analysis and operations for best
practices need to be documented.
Strong networking between Government, Home Science and Medical Colleges,
international organisations, private sector etc was needed. The role of media and
opinion leaders‘in . NHEC need to be recognized and their representation ensured in
various nutrition and capacity building workshop? etc so that they serve as the
secondary target group and contribute to the communication and advocacy efforts by
covering nutrition issues regularly.
9.
Networking with Home Science Faculties and Colleges of Standing
Home Scientists with foods and nutrition specialization were a large untapped
human resource that needs to be utilised for improving the nutritional status of families
and communities.; Premier nutrition teaching institutions need to be identified and
regional and zona! centres for nutrition promotion established. These centres should
help in building the capacities of extension Home Scientists/Nutritionists in improving
the nutrition situation in their state or region. International organisations working in the
area of food and nutrition could come forward and support the setting up of such
centres by providing necessary infrastructure, expertise and support.
Good nutrition and dietetic practices need and must be a part* of daily life if
people are to be healthy. It was, therefore, important that those who dp not pursue a
professional career in food and nutrition must have P4UTRITION LITERACY” so they
do not fall a prey to wrong mass media advertisements. A con pulsory course on
“NUTRITION LITERACY” needs to be included by LGC in all academL; courses for all
students. •
It is high iime to work towards “N'jtRITION REVOLUTIC?'!” in the country.
10.
Improving status of Training Centres.
The present status of Middle Level Training Centres (MLTC) deserved
strengthening’in terms of honorarium, career management, motivation and recognition
to attract properly qualified trainers and Principals or a sustainable basis (currently the
Principal was drawing only Rs. 4900/- and Trainer Rs. 4500A per month)
11.
Involvement of Women’s Technical Education and Research Institutes
The area of work of Women’s Techmeal Education and Research Institutes of
Ministry of HRD has been currently extended to co\ br EPL population of urban areas
including physically and mentally challenged people although it ' basically a rural
based project There are 450 community polytechnics in the’co iat y (Maharashtra
A S'
having 37 eac .) with a fund allo ;ation of Rs. 7.00 lakhs/ Networking vith community
polytechnic of mdis would he p r ch nutrition and health information to villages. Rural
Diet Counselling Centres couid t.c- started in each extension centres of fjese Institutes.
12.
Formation of Nutrition/D ot Council of India
A Nutrition or Diet Cou icil ’.ike the Medical Council of India is needed to promote
the cause of nutrition and dietetics’ in the country. Quality manage nent of various
courses and training programmes in this field, employment potential, recruitment details
for this important paramedical course, associated matters like nufrition/health tourism
and hospitality, industry, intellect ral property rights, nutraceuticals etc factors could be
looked into by such a Council Al! these* are,needed for improving the quality of
teaching in this area and its utiliz lion in the overall nutrition and. health delivery system
of the country.
13.
Micronjtriont Malnutriti: i Control
A holistic approach for addressing the widespread problem of micronutrient
malnutrition was required. The prevalence of vitamin A deficiency (VAD) being still of
public health significance re quire; concerted efforts for its elimination. The prevalence
of VAD was I igh in 3-6 year age group also besides 1-3 years and hence it was
necessary tha. Vitamin A Supplementation Programme was extended to children upto
the age of six years, as was being done in other South East Asian Counties also.
Nutritional Anaemia continued to be a cause of concern as its prevalence was
above 70% i ■ high risk groups namely- infants and young children, adolescent girls,
pregnant and lactating women.. Iron and folic acid supplementation for adolescent girls
needs to be undertaken on a* national .scale on top priority. ‘ Similarly, IFA
supplementation for infants who were not covered so far under the programme
deserved top priority.
The Ministry of Consumer Affairs, Fcod and Public Distribution need to make
adequately iodized salt available through the Targetted Public Distribution System.
Supplementary Feeding Programmes under ICDS and Mid Day Meal to use only
adequately iodized salt.
.
14.
Fortification of Common Foods
Fortification of common foods is one of the important strategies for addressing
the problem cf micronutrient deficiencies in a short time in cost effective manner.
Fortification of wheat flour with on and folic acid and double fortification of salt with
both iron and iodine need to be taken on priority.
The supply of wheat through various Government schemes, PDS needs to be
changed to fortified wheat flour. States with some reservations could initiate a pilot
project.
Roller Flour Milling industry needs to be motivated to wheat flour fortification till
mandatory provisions are enacted.
)
The Integrated Food Law being enacted may include micronutrient fortification of
foods as per the CODEX guidelines.
X
The Information, Education and Communication (IEC) on wheat flour fortification
was also required to create awareness among the people. States could examine
accessing funds for Staple Food Fortification Programme from GAIN (Global Alliance for
Improving Nutrition) through their State Nutrition Mission/Fortification alliance.
■>
***
)
q1?
o
RECOMMEND/ TIC NS OF HE E EGIONAL CONSULTATION MEET ON NUTRITION
HELD AT BHUBANESWAR ON 18-19 JULY, 2005
The important Recomme? ations that emerged from the twe-day-Regional
Consultation M jet on- Nutrition ' r Eastern Region, covering the Slate's of Bihar,
Jharkhand, Orissa and West Bengal, are enumerated here:
1.
Malnutrition is a ^rain
i Economy and a silent’emergeacy requiring
urgent multipronged action
*
•
•
•
Malnutrition is a drain m economy and adversely affects national
development. Thus, malnutrition was a Silent Emergency and required
innovative measures for its prevention and control. A multipronged
ac on involving all developmental sectors was requi ed urgently to
ad tress the problem of malnutrition in a time bound manner.
The action :nd progress to be monitored in months and not years.
UTan malnutrition was as. bad as rural pxture if not worse, and
deserved due emphasis.
■ •
2. Panchayati Raj Institutions for convergence and effective de ivcry cf services
at periphery
Out of I .e six services provided through ICDS, three and a half services
concerned health sector. . Convergence of services’ was important and the
Panchayati Raj Institutions could he utilized to achieve convergence. Interface
between Government and Fi\l system needs to crystallize.
3. Food and Nutnlion Mission axthe State.Lnvel
State Le- el CoordinTionl’ chank n is essential for policy iniDatives*r:nd greater
synergy Letv een various programmes. Z. centrally sponsored Food and Nutrition
Mission nt State level could be ’he best option to address the problem of
malnutrition i a mission mode.
4. Better Linkages between ICDS rnc’ Department of Elementary -ducation and
Literacy
•
“Sa/warg” comprising c' 3 - 6 year old children need pfeschool education as
well as supplementary feeding and micronutrient supplements.' Such children
covered under ‘Sarva Shiksha Abhiyari should be provided quality preschool
education and nutrition, through convergence between MID Day Meal and
ICDS as Education has'a separate teacher for 'Balwarg'.
' .
•
The existing training institutions under Education like Block Resource Centres
(BRCs), Cluster Resource Centres (CRCs) (for a group of villages in good
middle school) and DIETs should be utilized for training ICDS personnel too.
One training centre could take care of two ICDS projects. .
1
•
•
•
•
'I
Joint Committee of Education and ICDS should look after both programmes
for better convergence.
Nutrition Education should become an important service under ICDS.
Syllabi ’of all formal and non-formal educational systems should have basic
nutrition information. The syllabi should be reviewed and nutrition content
incorporated utilizing the expertise of FNB and NIN.
School children can prove to be the best change agents.. NIN has converted
FAO “Feeding Minds Fighting Hunger” publication to suit Indian system. The
Indian module on Feeding Minds Fighting Hunger should be incorporated in
primary, secondary and senior secondary school curricula.
5. Effective positioning of Infant and young child Feeding in ICDS, RCH,
NRHM etc.
•
•
•
•
•
•
•
•
A
Optimal breastfeeding i.e., early initiation, exclusive breastfeeding for the first
six months and continued breastfeeding upto two years and beyond alongwith
complementary feeding introduced at Six months of age, was considered
critical for child survival, development and health'. Exclusive breastfeeding for
first six months and continued breastfeeding for another six months along
with adequate complementary feeding has shown to reduce infant mortality
rate by 16% (Lancet 2003).
Priority to infant and young child feeding has to be reflected in
national/state/local plan resources and goals.
Effective positioning of infant and young child feeding in ICDS, Reproductive
anc Child Health, National Rural Health Mission and others - focusing on
best possible start to life, survival, growth and development, maternity
protection and family support is required..
Adopting / translating National Guidelines on Infant and Young Child Feeding,
integrating these in the training curricula under ICDS, Reproductive and Child
Health, Panchayati Raj Institution and Rural Development needs to be
undertaken on priority.
ICDS monitoring to include indicators on ea.rly initiation of breastfeeding,
exc’usA e -breastfeeding for first six mornhs, complementary feeding with
home bused foods from six months along /it. continued breastfeeding up to
twe yea’ s or beyond.
Fac.s . e’breastfeeding prevents obesity, it has economic value-, exclusive
breastfeeding prevents HIV in infants, etc. need to be utilized in Behavioural
Chang^Communicatioh.
Reposition ICDS with a focus on under twos. Deliver IYCF counseling as a
service,;n ICDS.
"
BPNI’s network in States and Districts tc be utilized for skill development
•training, capacity building and awareness generation on IYCI .
6. Promoting p eduction of low cost processed and fortified complementary
foods for inf<- its and young children a. District, Bxck and Vi’lage levels
•
Prc.duc on of low cost processed and fortified blended foods for ICDS
ben ficla.ies utilizing Sdlf Help V/omen Groups needs to be promoted at
dis? ct and block levels.
•
•
7.
Addre3s;:;g critical stages of liffo cyclo adopting life cycle approach
•
•
8.
Focus on prenatal cr re and counseling, under threes,- pregr .ant and lactating
mothers and adolescent girls.
Emphasis cn early action and preventive approach is required.
Joint Training and Supervision of ICDS and Health personnel for synergetic
impact
•
•
9.
Self Help Women G oi ps to be the owners of such produ tion units (2 MT
capacity/day) with one time financial assistance as has been done in Orissa.
Public - Private partnership .for reaching ‘Sattu’ like instant infant mixes at
village shops should also be explored.
Joint training of iCDT and health personnel is essential.
Using a common mother-child growth and development card by RCH and
ICDS and an entitlement card for unreached population would be desirable.
Monitoring of performance under ICDS to, be based
indicators” and not “Process indicators” alone
on “Outcome
Monitoring of ICDS through Monthly/Quartefly Progress Reports to be based on
“Outcome” indicators like improvement in nutritional status of the children rather
than “process” indicators like receiving supplementary food, preschool education
etc.
10.
Ensuring 100 % weighing efficiency in ICDS
•
•
11.
Weighing efficiency was reported to be directly proportional to reduction in
malnutrition levels.
Universalisation of ICDS should also mean 100 % registration of all children
under three years, all under threes to be weighed and al! under three families
to be provided with mother child card.
Addressing micronutrient malnutrition in a holistic manner
•
•
•
•
•
Micronutrient malnutrition, control requires concerted action on all the five
major strategies viz. P;etary Diversification, Supplementation, Food
■ Fortification, Horticultural Interventions and Public Health Measures.
Ensuring universal coverage under Iron and folic., Acid supplementation
programme and extending the anaemia control programme to cover
infants and adolescent girls needs to be taken up on priority.
(CDS workers could identify moderate and severe anaemia through pallor
of mucosal membranes and take remedial measures.
Importance of iodine in brain’ development to be emphasized in
communication efforts.
Vitamin A supplementation coverage should be universalised for children
under 3 years and all efforts made to cover children up to 6 ye^rs.
Household and community production and consumption of red, yellow and
(CC
)
green coloured fruits and vegetables besides milk and eggs needs to be
promoted.
\
12.
'i
Fortification of Foods
•
•
•
)
•
•
13.
Vigorous Av/areness Campaign on Nutritio..
•
•
•
•
•
•
14.
Multipronged strategies with due focus on fortification is required for
addressing micronutrient malnutrition.
Micronutrient malnutrition has been effectively addressed through fortification
in West and also in some South American and African countries. Fortified
wheat flour in Darjeeling district of West Bengal demonstrated a significant
reduction in anaemia (15 - 16 % in adolescent girls) in 18 months period.
Supplementary foods for ICDS beneficiaries and Mid Day Meals for primary
school children should be fortified with essential micronutrients.
Iodised salt and fortified supplementary foods should be made available to
people through fair price shops.
Fortification of cereals with iron and folic acid, salt with iron and iodine needs,
to be adopted on priority. '
The link between nutrition education and health needs to be emphasized.
Awareness on consequences of malnutriticn on physical and mental growth,
school performance, productivity and economic growth needs to be
generated.
•
; .
Nutrition education should address family as a whole and not just the women.
Nutrition education should focus on communication for behavioural change.
Advocacy and sensitisation of policy makers and Parliamentarians should be
undertaken to create “Administrative” and ’olitical” will.
Networking with professional institutions like Food and Nutrition departments
of Home Science Colleges, Medical Co.leges and NGOs was needed to
extend the coverage under nutrition education.
Electronic media to be involved in Advocacy and Behavioural Change
Communication.
All commercial advertisements need to bv. censored and celebrities need to
dissociate themselves from the same.
Achieving Convergence between iCDS and .IC.'
Observe Nutrition and Health days in A'A’Cs to increase outreach coverage
With ■ focus on ANC, :weighment; immunisation and micronutrient
•supplementation.
• Regular subcentre level meetings for better coordination between AWWs,
ANMs a.id PRI functionaries.
• Continuous capacity building cf AWWs and ANMs.
•
K'l
15.
Nutritior Monitorir g, IV upping ?.nd Surveillance
•
•
•
•
•
The successful exp riences of West Bengal and Orissa on reducing
malnutrition through Nutrition Monitoring, Mapping and Surveillance need to
be replicated in other States.
Community based monitoring to be adopted and Social, audit at the village
level using social maps/para-maps done on a regular basis.
Resources available with the ICDS could be utilized effectively for monitoring
and data analysis.
Tha Monitoring 7ro .adure could be as under:
o Data compilation at the Project level by CDPO.
o District level compilation by the DPO
o Electronic transmission and state level compilation at the Directorate.
o Data analysis with various indicators
o Nutritional and growth monitoring on the basis of these indicators and
available resource maps.
Coordination Committees at State and District levels, monitoring Committees
at Subdivision and Project levels and Village Level Committee at the AWC
should be the Monitoring Infrastructure.
******
;s .
I
Annexure-XV
RECOMMENDATIONS OF THE FIRST MEETING OF THE INTER MINISTERIAL
COORDINATION COMMITTEE ON MICRONUTRIENT MALNUTRITON CONTROL HELD ON
30th MAY, 2006 AT 11.00 A.M.
1.
Micronutrient Malnutrition continues to be unabated in the country. Ensuring
adequate vitamin and mineral status to maximize human potential should be
considered a priority.
2.
The National Nutrition Policy advocated the need for intensified programmes for
reduction and elimination of micronutrient deficiencies way back in 1993.
Several recommendations from national and international organisations have
emerged thereafter for addressing micronutrient malnutrition adopting a holistic
approach, on priority, to improve productivity and economic growth of the
country.
3.
Food fortification has been successfully adopted by the West. In India also some
States have taken up food fortification in a big way with convincing results like
wheat flcur fortification in Gujarat. The States of West Bengal, Andhra Pradesh,
Chattisg~rh and Bihar have also adapted food fortification in different ways with
good results. There is need to-adopt food fortification in a big way in the country
to accel. rate the reduction in malnutrition levels in the population.
4.
Nutrition Monitoring, Mapping and Surveillance particularly of micronutrient
deficiencies are also negligible. ■ The MHFW should take up this task with the
help of NNMB and NIN and create a database on micronutrient deficiencies.
NNMB must be expanded to all States/UTs to provide State level as well as
disaggregated data up to district level of various micronutrient deficiencies. The
F’.VIMS experience of Department of Food . nd Public Distribution should also be
utilised in developing a system for nutrition monitoring, mapping and surveillance.
5.
I FA supplementation for infants and adolescent girls recommended since long
should be initiated immediately by the MHFV /.
6.
The Public Distribution Syst3m should inclu':.' 3 pulses, soybean, and soya fortified
wheat flour so that poor people could be provided food with important nutrients at
reasonable rates.
7.
The Ministry of Agriculture should consider fixing minimum support prices for
pulses also so that the production and consumption of pulses could be promoted
in the country.
8.
The Ministry of Food Processing Industries may extend financial support to the
industries for production of fortified food by way of meeting the cost involved in
purchase/modification of equipments.
9.
The.MHFW should provide specifications for DFS under the FFA so that the rate
contract <or the same could be fixed for the cenefit of different States/UTs.
<7
O
n
O
3
3
fo3
‘
10.
There is need to regulate the prices, concentration of micronutrients, safety,
packaging of fortified foods so that the shelf life of the product is ensured and the
consumer is not cheated. The Central Monitoring Body for food fortification with
adequate budget allocation needs to be set up.
11.
Awareness about the consequence^ of micronutrient malnutrition was extremely
important for people to make efforts to prevent and control the same. The
Ministries of Health & Family Welfare and Women & Child Development should
create such awareness,utilising ali available channels of communication.
12.
Ministry of Information ana broadcasting should contribute effectively in creating
a climate of nutritional awareness in the country.
13.
A National Workshop on Food Fortification should be organised to inform various
States/UTs about the importance of food fortification and how it could be made
feasible.
14.
The MHFW, which is implementing the three major programmes on
micronutrients, should include specific programmes in the XI Five Year Plan for
addressing micronutrient malnutrition in a holistic manner.
■'k
c•
k
k
k
c
c.
k
Working Group on
‘Access to Health Systems
including AYUSH’
Government of India
Planning Commission
P.O. NO.G-20018/3/2006-P&E
July 31, 2006
Dear
Planning Commission has constituted a Working Group on “ Access to Health Systems
including AYUSH” under the chairmanship of Secretary (AYUSH). Secretary (AYUSH) in turn had
constituted Sub-Groups on following five issues:
(i)
(ii)
(iii)
(iv)
(v)
AYUSH Education.
Standardization and Quality Control of AYUSH drugs.
Research & Development.
Medicinal Plants.
Mainstreaming of AYUSH.
The above Sub-Groups have submitted their reports which were discussed in the
meeting of the Working Group chaired by Secretary (AYUSH) recently (Minutes enclosed). On
the basis of a discussion in the Working Group and the Sub-Groups the Department has
formulated its 11th Five Year Plan proposals. The change in priorities and schemes in the 11th
Plan are reflected in the introduction chapter. The Department proposes to scale up Plan
provision for Department of AYUSH from Rs. 1057.26 crore (actual expenditure of first four years
of the 10th Plan and B.E. of 2006 - 2007) to Rs.2473.45 crore in 11th Plan. The Department has
been very cautious and realistic in making its Plan projections and it is hoped that by improving
utilization of Plan funds and the quality of Plan expenditure the Department would be able to
come back to the Planning Commission for raising its Plan provision midway during the 11th
Plan.
Please find enclosed herewith the proposals of the Department of AYUSH for 11th Five
Year Plan for AYUSH sector which have been duly approved by Secretary (AYUSH).
I am also enclosing the copies of the reports of the 5 Sub-Groups constituted by
Secretary (AYUSH) on the above mentioned five subjects. The 11th Five Year Plan proposals
alongwith the 5 reports of the Sub-Groups may be treated as report of the Working Group on
“Access to Health Systems including AYUSH” constituted by the Planning Commission under the
chairmanship of Secretary (AYUSH)..
With regards,
Yours sincerely,
( SHIV BASANT)
Prof. N.K. Sethi,
Adviser (Health), Planning Commission,
Yojana Bhawan,New Delhi.
INTRODUCTION
Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established
in 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani and
Homoeopathy (AYUSH) in November, 2003. There has been a three fold increase in the Plan
budget of the Department in the 10th as compared as 9th Plan, most of which was on account
of scaling up of the budget provision in the last two years of the 10,h Five Year Plan i.e. 2004
2005 and 2005 - 2006 in line with the declared policy of the Central Government to increase
the budgetary provision for AYUSH sector for mainstreaming it in the national health care
delivery network.
Department has utilized the increased budget provisions in the 10th Plan for raising
standards of AYUSH education, upgradation of national institutes set up by the Department to
lay down benchmarks for teaching, research and clinical practices of different systems. With a
view to prevent the mushroom growth of sub-standard colleges, the Indian Medicine Central
Council and Homoeopathic Central Council Acts were amended in 2003 to provide for prior
permission of the Central Government for establishing new colleges, starting new and higher
courses, increase in the admission capacity in Ayurveda, Siddha, Unani and Homoeopathy
colleges.
The Centrally Sponsored Schemes of Strengthening of Institutions was effectively
utilized for providing assistance to Government and Government aided colleges for ensuring
conformity with the minimum infrastructural standards laid down by the statutory bodies.
The
Department would like to develop Government, Government aided and private but not for
profit AYUSH colleges to the level of Centre of Excellence by providing enhanced scale of
assistance on the basis of college specific upgradation plan which will clearly outline the
responsibility of the college management and the State Governments for effective utilization of
central assistance to be provided in the 11th Plan for the upgradation of these colleges.
Department of AYUSH attaches very high priority to laying down of pharmacopoeial
standards for single and compound formulations, scientific validation of herbo-metallic
compounds, standardization and quality control of AYUSH drugs.
It is proposed to set up a
Pharmacopoeial Commission for Indian Medicine in the 11th Plan which will be housed in the
newly constructed building of the Pharmacopoeial Laboratory of Indian Medicine, Ghaziabad.
The basic objective is to create an independent scientific body which will undertake laying
down of pharmacopoeial standards and their revision from time to time on a more permanent
footing.
The Centrally Sponsored Scheme of Drugs Quality Control in the 10th Plan was utilized
for providing financial assistance to the State Drug Testing Laboratories and State Pharmacies.
The experience has not been a happy one as inspite of provision of financial assistance, State
Drugs Testing Laboratories have been functioning at a sub-optimal level due to a variety of
managerial problems.
Offtake under the strengthening of enforcement mechanism
component has also been very poor.
The Department would like to shift the emphasis in the
1 l,h Plan from strengthening of State Drug Testing Laboratories to utilization of a vast network of
NABL accredited laboratories all over the country for random testing of Ayurveda, Siddha and
Unani drugs and Homoeopathic mother tinctures for ensuring quality control of AYUSH
medicines.
It is proposed to modify the existing drug quality control scheme to provide
financial assistance to States in terms of reimbursement of expenditure incurred by them on
random testing of AYUSH medicine through NABL laboratories.
The Department has enforced
Good Manufacturing Practices and mandatory testing of heavy metals for export of purely
herbal Ayurveda, Siddha and Unani medicines.
Hon'ble Members of Parliament and informed
sections of the public are also pressing for mandatory testing of AYUSH medicines for domestic
consumption as well which would require in-house quality control laboratories in most of the
AYUSH manufacturing units. A large number of AYUSH manufacturing units fall in the small and
medium scale, it is felt that without a liberal financial assistance from the Government they
would not be able to purchase costly equipments like Atomic Absorption Spectrometer for
testing of heavy metals, TLC/HPTLC/GLC for testing of crude drugs. Therefore, it is proposed to
provide backended subsidy of Rs.50.00 lakh or 50% of the project cost whichever is less to
Ayurveda, Siddha and Unani drug manufacturing units for acquisition of requisite equipments
and instruments for enabling them to test their ingredients, their raw materials and finished
products inhouse.
The subsidy would be released only through scheduled banks on the basis
of a certificate to be issued by State Licensing Authority or any NABL Laboratories to the effect
that the concerned manufacturing unit has obtained the requisite equipments and has started
inhouse testing of raw materials and medicines.
This assistance will be provided only to those
units which has an annual turnover not exceeding Rs.25.00 crore.
Units whose annual turnover
exceeds Rs.25.00 crore should be able to avail of soft known facilities under the Pharma
Development Fund which is administered by the Department of Science & Technology.
As
regards the State Drug Testing laboratories for which 1st instalment of upgradation grants has
been released in the 10th Plan would be eligible for 2nd and 3rd instalment in the 11th Plan on
proper utilization of funds.
Mainstreaming of AYUSH is one of the key strategies under the National Rural Health
Mission (NRHM) under which it is envisaged that all PHCs/CHCs would be provided AYUSH
facilities under the same roof.
While the AYUSH manpower would be arranged either by
relocation of AYUSH doctors from existing dispensaries or from contractual hiring of AYUSH
doctors under NRHM funds. The other infrastructure and supply of medicines to PHCs/CHCs
would be done through the Centrally Sponsored Scheme of Hospitals and Dispensaries which
has received a very good response from States in the last two years of the 10fh Plan.
Hence, it
is proposed to substantially increase the Plan provision for this scheme to Rs.625 crore in 11th
Plan. A minor modification in the scheme for providing upgradation and assistance to existing
AYUSH hospitals and dispensaries is also proposed.
The need for in-situ conservation and promotion of ex-situ of medicinal plants cannot be
over emphasized.
On the basis of the recommendations of the Task Force of Planning
Commission the National Medicinal Plants Board (NMPB) was set up in the 10th Plan which is still
grappling with infrastructural constraints.
However, the National Medicinal Plants Board has
been able to provide a strong impetus to medicinal plants sector through promotional and
contractual farming schemes.
Keeping in view the vast experience and constraints in the
implementation of these two schemes, it is now proposed that the promotional and
conservation scheme of the NMPB would be continued as Central Sector Scheme while the
contractual farming scheme should be converted into a Centrally Sponsored Scheme for
better monitoring and implementation by the State Medicinal Plants Board (SMPB). It has been
felt that the States have not strengthened their Medicinal Plants Board as NMPB has been
directly implementing the contractual farming scheme as a
Central Sector Scheme.
Conversion of this into Centrally Sponsored Scheme will provide the right impetus to the States
to strengthen their SMPBs for better planning, implementation and monitoring of the
contractual farming scheme which has a huge potential of generation of additional
employment and income to the farmers through crop diversification.
The Central Sector
Scheme of the NMPB will concentrate on conservation/regeneration through joint forest
management committees in forest areas, establishment of Gene Bank and community herbal
gardens, etc.
Whereas the Centrally Sponsored Scheme would encourage cultivation by
farmers and provision of post harvest management and marketing support by State Medicinal
Plants Boards and other State agencies in collaboration with National Medicinal Plants Board.
Accordingly it is proposed to scale up the plan financing of the NMPB from approximately
Rs. 134.64 crore to Rs.465 crore in the 11th Plan.
AYUSH research councils have done a lot of research based on survey of medicinal
plants and observatory clinical trials. Department has been emphasizing on focused, protocol
based and peer reviewed research in a specified time frame and with specified outcomes.
The major hindrance in the working of the AYUSH research councils has been non
implementation of the flexible complimentary scheme made applicable to other scientific
institutions for in-situ Assured Career Progression as a result of which AYUSH councils are not able
to attract talent.
This matter has been taken up with the Department of Personnel & Training
and Ministry of Finance on a number of occasions without much success. It is hope that the
Sixth Pay Commission on the anvil will be able to address this anomaly.
Another area of
weaken of the AYUSH research councils has been lack of adequate equipments and good
laboratories for standardization and quality control work. The Department has now entrusted
the
Pharmacopoeial work to
the AYUSH research
councils so
that laying
down of
pharmacopoeial standards and SOPs can be attended to on a sustained basis in a scientific
environment.
Keeping in view the requirements for upgradation of various peripheral units of
the research councils, it is proposed to scale up the Plan provisions** of Central Council for
Research in Ayurveda and Siddha (CCRAS) from Rs.54.37 crore to Rs.100.00 crore in 11th Plan,
for Central Council for Research in Unani Medicine (CCRUM) from Rs.59.45 crore to Rs.90.00
crore and for Central Council for Research in Homoeopathy (CCRH) from Rs.37.39 crore to
Rs.77.50 crore.
**
Plan Provision indicates actual Plan expenditure of that 1st four years of 10th Plan and Budget
Estimates of 2006-07.
Suitable scaling up of Plan outlays for other Central Sector Schemes of the Department,
namely, IEC and International Exchange is also proposed.
The proposal for setting up of a
National Ayurveda Hospital in Delhi and North-Eastern Institute of Ayurveda and Homoeopathy
was conceived in the 10th Plan.
Land has also been acquired for the National Ayurveda
Hospital in Delhi and detailed project reports for these projects are being revised keeping in
view the advice received from Expenditure Finance Committee. A Plan provision of Rs.75.00
crore for National Ayurveda Hospital in Delhi and another Rs.75.00 crore from out of that 10% NE
corpus for North-Eastern Institute of Ayurveda and Homoeopathy is proposed in the 11th Plan.
The Department has showed in the last two years of the 10th Plan that it has the capacity
to plan for and utilize higher Plan allocation in priority areas of strengthening of AYUSH
institutions, standardization and quality control of AYUSH medicines, mainstreaming of AYUSH in
national health care delivery network and focussed research for meeting national health goals.
Keeping in view the enhanced Plan provisions a second post of Joint Secretary was sanctioned
in the Department for strengthening planning, coordination and monitoring of various Central
Sector and Centrally Sponsored Schemes. The posts of Directors, CCRUM/CCRAS/CCRH and
the posts of Director of National Institutes were upgraded in the last two years of the 10th Plan
and the proposal to upgrade the post of Director, PLIM to the Joint Secretary level is on the
anvil.
Due to sustained efforts, the Department has been able to find regular Directors for its
research councils
and autonomous institutions and fill up such vacancies timely.
The
Department of AYUSH has been maintaining a constant dialogue with all the stakeholders
including the AYUSH industry. Successful launching of the Golden Triangle research initiative in
collaboration with the ICMR, CSIR and creation of Traditional Knowledge Digital Library (TKDL)
for defensive protection of ASU classical formulations from misappropriation are indicative of
the fact that the Department of AYUSH has been providing effective leadership and
momentum to the scientific validation and mainstreaming of AYUSH systems in the national
health care delivery network. Keeping in view the tremendous potential of these systems for
better health care for Indian citizens and for obtaining a better share of the world herbal
market, these systems need to be supported by a quantum jump in Plan funding of the various
Central Sector and Centrally Sponsored Schemes of the Department of AYUSH. Accordingly, it
is proposed to scale up Plan provision for Department of AYUSH from Rs. 1057.26 crore in the 10th
Plan to Rs.2486.45 crore in the 11th Plan.
The Department has been very cautious and realistic
in making its Plan projections for 11th Plan and it is hoped that by improving utilization of Plan
funds and the quality of Plan expenditure the Department would be able to come back to the
Planning Commission for raising its Plan provision midway during the 11th Plan.
*****
DEPARTMENT OF AYUSH
MODIFIED SCHEMES IN XI FIVE YEAR PLAN
CENTRALLY SPONSORED SCHEMES
1. DEVELOPMENT AND UPGRADATION OF AYUSH INSTITUTES/COLLEGES
This is one of the Centrally Sponsored Schemes being implemented by the Department
for Development of AYUSH Institutions. This Scheme has been in operation since last three plan
periods and the present plan period. The scheme has following components:(i) Development of UG colleges.
(ii) Assistance to P.G. Medical Education
(iii) Re-orientation Training Programme for AYUSH Personnel.
(iv) Renovation and strengthening of Hospital wards of Govt./ Govt, aided teaching
(v) Establishment of computer laboratory.
(vi) (vi) Up-gradation of academy institutes to the status model Institutes of AYUSH.
(i) Development of UG colleges.
Assistance for equipment (Rs. 10 lakhs per college), library books (Rs. 2 lakhs per
college), capital works (Rs. 50 lakhs per college) and a corpus fund Rs. 5 lakhs (one time assistance)
is provided under the Development of UG College scheme. There is provision for another add-on
component of Pharmacy and Nursing Education but the same would be implemented only after the
Pharmacy and Nursing Education is regulated by statutory council. Only Govt./ Govt, aided colleges
are eligible for assistance for capital The assistance under this scheme is to be provided only once in
the 10th Plan period.
(ii) Assistance to PG Medical Education
Under this scheme only new Department for new Government aided institutes are eligible to
receive grant for a period of five years. The assistance is given for staffing, stipend and also to meet
sum non-recurring expenditure.
(iii) Reorientation Training programme of AYUSH Personnel
Government/Pvt./NGO AYUSH institutions are eligible to take up this training programme
teachers and doctors though from Government/Government aided private and non-aided pvt.
Institutions AYUSH are also available, preference will be given Government, colleges. Under this
scheme rate of assistance as well as size of batch varies from category to category.
(iv) Renovation and strengthening of Hospital wards of Govt./ Govt, aided teaching Hospitals of
AYUSH.
One time financial assistance upto Rs. 20 lakhs for hospital will be admissible for
Government. Institutions and Rs. 10 lakhs for Government aided institutions.
(v) Establishment of computer laboratory.
Use of information technology in promoting the educational standards is main aim of the
scheme. Rs. 10.00 lakhs is provided as assistance to existing Government PG colleges for setting up
small computer laboratory with five P.C. alongwith other prescribed equipments.
(vii)
Up-gradation of academy institutes to the status model Institutes of AYUSH.
The scheme envisages development of one Model Institute of AYUSH per system per state
during the 10th plan. Government Institutes recognized by the Central Council at least for 10 years
and fulfilling at least 50% Council norms are eligible for assistance. A total of Rs. 3 crores is
admissible for capital works (Rs. 1.5 crores) Machinery, equipment and computers
(Rs. 1 crores),
Books etc. (Rs. 10 lakhs) and staffing (Rs. 60 lakhs).
The total outlay for the scheme during the 10th Plan was Rs. 120 crores. During the first four
years of the 10th Plan, the total expenditure was Rs. 98.08 crores. Thus the total expenditure is
likely to exceed the original outlay for the 10th plan. During the first four years the number of
colleges assisted under the scheme was 434. 2 statement indicating the physical and financial
achievements are enclosed as Annexure I & IL
Xlth Plan Proposal
So far continuation of these schemes during the Xlth Plan is concerned, it is felt that
existence of so many components for the same purpose is not required. In view of the past
experience of implementing these schemes, this Department is of the view that instead of attending to
a small component of assistance required for various AYUSH Institutions, it would be appropriate to
concentrate on the overall development of these Institutions so that they may be in a position to
impart quality education in AYUSH systems and also contribute to the effectiveness and spread of the
Indian Medicine Systems. This would result in better utilization of the funds and the results are likely
to be tangible.
To achieve the above goal it is felt that instead of existing 6 components, the department
may assist only two categories colleges i.e. U.G. Colleges & P.G. Colleges and provide for fixed
amount of assistance to be spent on the items actually needed by them on the basis of a master plan.
All colleges would be accredited and only those colleges which are viable and can maintain proper
standards would be supported. For this purpose a detailed list of the activities /items can be drawn
and the colleges should have flexibility in choosing from the same as per their needs. Besides we
may have a third component pertaining to model institutes. Under this component some good
colleges may be selected and developed into model institutes which would be utilized as Centre of
Excellence. For U. G. Colleges the assistance may be Rs. 2 crores per college and for P.G. Colleges
the limit may be Rs. 3 crores. So far as development of model institutes is concerned the amount will
be decided on the basis of the college specific plan with an upper limit of Rs. 5 crores. Then under
fourth component one time capital grant of Rs. 10.00 crores for institutions to States for starting
AYUSH Pharmacy/Para Medical Courses in the existing AYUSH colleges is proposed to be provided
during Xlth Plan.
In effect we will have a scheme “Development of AYUSH institutions” with following four
components:-
Schemes
S
No
UG
Rate
at
which
assistance is
to be given
(Rs.
in
crores)_____
2.00
Tentative No.
of
Institutions
to
be
assisted.
Likely
expenditure
60
120
(Rs.
crores)
1
Assistance to
colleges
2
Assistance to P.G.
Medical Education
3.00
40
120
3
of
Development
Model Institutes
One time capital
grant to States for
starting
AYUSH
Pharmacy/Para
Medical courses in
existing
AYUSH
colleges.__________
Total
5.00
25
125
10.00
5
50
4
in
415.00
Yearwise financial projection is as follows:
Financial
Year
2007-2008
Amount (Rs.
crores)
83.00
2008-2009
83.00
2009-2010
83.00
2010-2011
83.00
2011-2012
83.00
Total
415.00
in
The existing component of ROTP and CME shall be dealt under a Central Sector Scheme and
a hence a Central Sector Scheme is proposed separately.
ANNEXURE-I
Grant-in-aid released during 2002-03 to 2005-06 for four years under Centrally Sponsored Scheme
of Development of Institutions
(Figure in lakh)
Financial
Year
2002-2003
UG Scheme
PG Scheme
ROTP/CME
815.00
204.93
19.96
2003-2004
(34)
653.79
(16)
119.78
(15)
71.08
269.61
1286.00
50.00
(65)
2450.26
2004-2005
(25)
800.00
(4)__
200.00
(27+15=42)
54.17
(14)
100.00
(8)___
1589.80
(5)
80.00
(98)
2823.97
2005-2006
(39)__
1256.52
(9)__
208.04
(32+ 16 = 48)
124.95
(6)__
220.09
(16)
1604.70
(8)
80.00
(126)
3494.30
Total
(41)__
3525.31
(10)
732.75
(34+28=62)
270.16
(12)
589.7
(12)__
4480.50
(8)__
210.00
(145)
9808.42
(139)
(39)
(167)
(32)
(36)
(21)
(434)
Renovation
Model
College
LT.
Total
1039.89
Note: figure given in parameters shows the no. of institutions assisted under the scheme.
Annexure - II
Physical Targets and Achievements during first four years of Tenth Plan under Centrally Sponsored Scheme
of Development of Institutions
Sl.No.
Name of
the
Scheme/
Unit
Project/
Programe
2
1
3
Tenth
Plan
approved
Target
(colleges
to
be
assisted)
4
2003-04
2002-03
Target
(colleges to
be assisted)
Achievement Target
(colleges to
(colleges
be assisted)
assisted)
2005-06
2004-05
Achievement Target
(colleges
(colleges to
assisted)
be assisted)
Achievement
(colleges
assisted)
Target
(colleges to
be assisted)
Achievement
(colleges
assisted)
(Ist quarter)
7
6
5
8
9
10
12
11
1
UG
140
35-40
34
40-45
25
20-25
39
28-30
41
2
PG
30
12-15
8+9*
18-20
1+3 *
6-7*
10
10-12*
10
3
ROTP/
CME
250
15
15
12-15
42
50-52
38
50-52
62
4
Renovati
on
70
12-15
14
14-16
6
35-40
12
5
State
Model
College
25
6
8
5-6
8
8-10*
12
6
IT
5-6
5
6-8
8
6-8
8
* New Colleges
15
2. HOSPITALS AND DISPENSARIES
The scheme has been designed with a view to make
available the benefits of Ayurveda, Unani, Siddha, Yoga & Naturopathy and
Homoeopathy to the public at large, so that people can exercise their choice in
accessing the health services and to achieve this, it was felt necessary to
encourage setting up of general and specialized treatment centers of ISM&H in the
allopathic hospitals. Through this scheme the Central Government intends to
encourage setting up of general and specialized treatment centers of ISM&H in
allopathic hospitals and support the efforts of State Governments to improve the
supply position of essential drugs in dispensaries situated in rural and backward
areas, so that the faith of people in ISM&H could be enhanced.
During the Tenth Plan period so far, the Department sanctioned an amount of Rs 108.00
crores for setting up of 183 ISM Wings in District Hospitals, 44 Special Therapy Centres with
Indoor facility and 348 Special Clinics of ISM&H with Specific Outdoor Treatment. An amount of
Rs 145.00 crores has been sanctioned for supply of essential drugs to 26,000 AYUSH dispensaries
during the period in the country.
In the implementation of this scheme has been observed that the implementing agencies i.e.
the concerned hospitals and dispensaries complain about the delay in the receipt of money from the
State Govt channels. To avoid this delay, the Planning Commission has approved distribution of
funds through the State Govt Health Societies from the next Plan period onwards.The State Govts
complain that they are finding it difficult to provide the manpower in the absence of any fund for
this purpose.
XI PLAN PROPOSAL
The various components under the scheme Hospitals & Dispensaries are as follows:
Setting up of Speciality Therapy Centres and Speciality Clinics of ISM&H:
It was felt that the physical achievements relating to these schemes had been less than
satisfactory which may be mainly due to the reason that State Governments were not able to
provide for manpower component/ experts which are essentially needed for operationalization of
these schemes. It is therefore essential to provide for manpower component on outsourcing or
contractual basis. Hence, it is proposed that 10% of the grants given to States under the Scheme of
Hospitals & Dispensaries may be used by States for hiring contractual Medical/Para Medical
personnel during the Xlth Plan period. The responsibility of the recurring expenditure beyond Xlth
Plan period will have to be borne by the States.
Setting up of ISM&H Wings in District Allopathic Hospitals:
Since operationalization of this scheme also depends on available of medical and
paramedical staff which the State Governments are not normally able to provide for, it will be
important to keep provision for manpower component viz medical and paramedical staff and
enhance the overall ceiling of the scheme to Rs 40.00 lakhs in place of Rs 35.00 lakhs per ISM&H
Wing.
At present, the execution of the scheme depends on the initiative of the state Government
and is on pick and choose basis. If integration is to be effected in a realistic fashion and if a choice
16
is to be provided to the common man, opening of an AYUSH wing be made mandatory for all
District Hospitals and for which funds should be given for all the District hospitals to all the States.
Strengthening of existing AYUSH healthcare facilities:
The Scheme of Hospital and Dispensaries should be extended to existing AYUSH
Hospitals & Dispensaries also since at present it caters to only allopathic facilities. This will help
in recovering and strengthening certain ailing Treatment and Patient care units which need
equipment, infrastructure, medicine and training etc but the State Governments find it difficult to
support. It is proposed to provide an assistance of Rs. 50.00 lakhs to AYUSH hospitals and 15.00
lakhs to AYUSH dispensaries for their upgradation.
Supply of essential medicines:
This is one of the very good schemes under which funds for providing AYUSH drugs in rural,
backward and remote area dispensaries are given to the States.
Under this scheme, an amount of Rs
25,000/- per annum, per dispensary is given which comes to only Rs 2083/- per month per dispensary and Rs
69/- per day per dispensary. Even if a meager strength of an average of 20 patients per dispensary per day is
taken into account, the allocated sum comes to Rs 3.45 per patient per day. It is obvious enough that the
amount is quite less and therefore it is recommended that it should be increased to Rs 50,000 per annum per
dispensary. Besides, at present it is only the ‘rural and backward area dispensaries’ which are eligible for
grant under this scheme despite Planning Commission agreeing to giving grants to all the AYUSH
dispensaries, the requisite amendment in the scheme was not reflected and hence there is need to do so in
the 11th Plan. It is also proposed to cover all dispensaries including CHCs/PHCs/District Hospitals having
AYUSH wing and also existing AYUSH hospitals at those levels for supply of essential medicines. Even
mobile dispensaries are proposed to be covered under this. Accordingly, it is proposed to provide essential
AYUSH medicines to PHCs @ Rs. 1.00 lakh per annum, CHCs @ Rs. 2.00 lakh per annum and District
Hospitals having AYUSH Wing/AYUSH Hospitals @ Rs. 3.00 lakhs per annum.
Since there is a proposal to provide funds for manpower also and to extend the scheme to
cover not only Allopathic Hospitals but also for strengthening AYUSH Hospitals, the annual
provision for the next plan period is tentatively projected as given below.
Year
Total Outlay
during Xlth
17
Plan
2007- 08
2008- 09
2009- 10
2010- 11
2011- 12
Total
(Rs in crores)
115
120
125
130
135
625
This Scheme will re-enforce the Rural Health Mission by providing financial assistance to
States both for mainstreaming of AYUSH in allopathic facilities as well as for upgradation of existing
AYUSH hospitals and dispensaries.
3. DRUGS QUALITY CONTROL OF ASU & H DRUGS
The Scheme was implemented in the year 2000-01 of 9th five year plan with two sub
schemes.
1.
To strengthen state Drug Testing Laboratories
2.
To strengthen state Pharmacies of ASU&H drugs.
Under the scheme maximum of Rs. 100.00 lakhs were provided to each State DTL and
Pharmacies for following components i.e. renovation of building, procurement of sophisticated
instruments and machines and human resource on contractual basis ( for DTL only) The scheme
was revised during the mid term appraisal of 10th five year plan and two more sub-schemes were
added in the scheme with slight changes in original two sub-schemes which are as under:-
1. To establish/strengthen the State Drug Testing Laboratories for ASU&H drugs.
2. To establish /strengthen the State Pharmacies of ASU&H drugs.
3. To strengthen state Drug Controllers on ASU&H enforcement mechanism.
4. To assist AS&U drug manufacturing unit to improve their infrastructure to meet GMP
requirement.
Under the sub-scheme No.l, State Drug Testing Laboratories for ASU&H drugs
maximum of Rs. 150.00 Lakhs were assisted to each SDTL for the three components (Building,
Machinery/equipment and manpower on contractual basis) Apart from the State Drug Testing
Laboratories eminent Laboratories/universities laboratories/ research councils are also eligible for
grant-in-aid to strengthen their AYUSH Department with a maximum of financial assistance of
Rs. 85.00 Lakhs.
Under the sub-scheme No.2, to strengthen the State Pharmacies of ASU&H drugs,
maximum of Rs. 200.00 Lakhs were provided to each state Pharmacies for two components i.e.
Building as well as Machinery and Equipments. Apart from State Government Universities/
Institutions of ASU&H drugs, co-operative Pharmacies and Research Councils are also eligible for
the Central assistance.
18
Under the sub-scheme No. 3, to strengthen state Drug Controllers on ASU&H
enforcement mechanism, each State Government/Union territory are eligible for Grant-in-aid for
five year for the salaries of one drug controller/Licensing Authority of ASU&H drugs, drug
inspectors (one for 500 units), data entry operator, purchase of computer with printer and fax etc.
expenditure on TA/DA/training and stationary etc.
Under the sub-scheme No.4, to assist AS&U drug manufacturing unit to improve their
infrastructure to meet GMP requirement, every AS&U drug manufacturers were assisted with 20%
incentive on the expenditure incurred by him for the infrastructure in terms of building and
equipments made by them for getting GMP certificate. The maximum limit of the subsidy is Rs.
5.00 Lakhs.
During the Xth Plan, against the total outlay of Rs 45.40 crores under this scheme the
expected expenditure/revised outlay is Rs 55.28 crores. During the 4 years of the 10lh plan 8 State
Drug Testing Laboratories, 15 State Pharmacies of ASU&H drugs were assisted, and till date 26
ASU State Drug Testing Laboratories and 43 State ASU&H Pharmacies were assisted. In addition
13 States have been assisted to start Enforcement Mechanism of ASU&H drugs and incentives to
45 AS&U drug manufacturers for getting GMP license have been given under GMP Scheme.
Fund have been released through respective state Governments but till date only 30% of
the grantee institutes are functional/ partly functional due to the reasons as under:i) State Governments are not releasing the Grant-in-aid to the concerned grantee institute well in
time.
ii) Grantee institute have to award building contract to Government body like PWD etc. after
completing the codal formalities from their respective Government.
iii) Regarding procurement of sophisticated machinery and equipment grantee institute have again
asked to their respective State Government to procure the instruments by tender basis or by rate
contract basis.
XI PLAN PROPOSAL
To modify the scheme in 11th five year plan, following changes are proposed:1. Regarding sub-scheme No.l and 2, the scheme may not be continued as such. Only second
and third instalment will be released to States for completing the work of upgradation of Drug
Testing Laboratories/State Pharmacies which were taken up during the Xth Plan.
2. Regarding sub-scheme No.3 no more grant will be released for manpower on contractual
basis. Concerns have been expressed in the Parliament as well as in the media regarding weak
quality control of AYUSH medicines. Emphasis on strengthening of State Drug Testing
Laboratories has not yielded results intended. In the Xlth Plan, it is proposed to institute a random
testing of AYUSH medicines at the Central as well as at the State levels by involving NABL
accredited laboratories spread over the country. It is proposed to assist the State by actual
reimbursement of expenditure incurred on random testing of AYUSH medicines through NABL
laboratories @ Rs. 500 to Rs. 1000 per sample depending upon various parameters. Under this
Scheme, Department of AYUSH’s laboratories PLIM, Mohan HPL will also be eligible to do the
testing and avail the assistance.
3. Under the existing Drug Quality Control Scheme in Xth Plan a meager assistance of Rs. 5.00
lakhs as subsidy was provided to AYUSH manufacturing units for becoming GMP compliant.
19
Now, the Department of AYUSH has made testing for raw materials/finished products/heavy
metals etc. mandatory for which manufacturing units require costly equipments like Atomic
Absorption Spectometer, HPTLC, HPLC, GLC etc. Accordingly, it is proposed to provide a back
ended subsidy of Rs. 50.00 lakhs or 50% of the total project cost whichever is less, on
establishment of in-house Drug Quality Control/R&D laboratory. The assistance to be provided
only to those ASU units having annual turnover below Rs. 10.00 crores. This subsidy will be
released to AYUSH manufacturing units through a Scheduled Bank on installation of the requisite
equipment and on submission of report by any State Licensing Authority or a NABL laboratory to
the effect that the such unit has started testing of its raw materials/finished products in their in
house drug quality control/R&D labs.
The projected outlay for the Xlth Plan is as following:
Year
2007-08
2008-09
2009-10
2010-11
2011-12
Total
Outlay(Rs crores)
20.00
25.00
30.00
35.00
40.00
150.00
CENTRAL SECTOR SCHEMES
STRENGTHENING OF DEPTT. OF AYUSH
1. Secretariat Social Services
This is to meet the need of the Secretariat Services (salaries, travels, office expenses, rent
etc.). To be continued to provide Secretariat support to the implementation of AYUSH
programmes. The expenditure including B.E. 2006-07 in Xth Plan period is Rs. 21.88 crores. The
projected outlay for Xlth Plan is Rs. 30.00 crores.
2. Strengthening of Pharmacopoeial Committee on ASU
This is to lay down and update pharmacopoeial standards of Ayurveda, Siddha, Unani and
Homoeopathy drugs and to prepare and update formulary of the drugs of these systems. The
outlay/expenditure in Xth Plan is Rs. 5.37 crores.
To be continued as laying down pharmacopoeial standards of compound poly-herbal
formulations is a priority area for development and acceptability of AYUSH systems. It is
proposed to constitute a Pharmacopoeial Commission of Ayurveda/Siddha/Unani drugs. For this,
a Plan expenditure of Rs. 8.00 crores is proposed for the Xlth Plan.
EDUCATIONAL INSTITUTIONS
3. Institute of Post-Graduate Training & Research, Jamnagar (IPGTR).
The Institute of Post-Graduate Teaching & Research in Ayurveda(lPGTRA), Jamnagar is one
of the constituents of Gujarat Ayurved University(GAU). It is one of the oldest P.G. teaching centre
of Ayurveda. The institute is fully financed by the Government through grants-in-aid for its
maintenance and development.
There are six teaching departments in the institute, which provide facility for teaching and
research in 13 specialties for post-graduate degree and decorate degree. The admission capacity is
34. The institute also renders clinical patient care. During the X Plan , it provided medical treatment
to more than 7 lac patients at IPD and OPD level, and produced more than 150 PG Ayurvedic doctors.
20
Expenditure in X Plan and XI Plan Outlay
Tenth Plan approved
outlay
Expend iture/Outlay
XI Plan outlay
proposed
Rs.5.50 crore
Rs.3.8 crore
10.00 crore
The savings has accrued on account of non-filling up of certain faculty posts, non-procurement
of equipment/furniture, non-execution of some capital works.
The scheme may be continued during XI PLAN as it fulfills its objectives of imparting
teaching, training and research in Ayurveda and also renders clinical patient care through OPDs,
IPDs, and a 150-beddd hospital. This is one of the oldest institutes of Ayurveda in the country.
Break-up of XI Plan Outlay
Rs.in crores)
2007-08
2008-09
1.50
1.75
2009-2010
2010-2011
2.00
2.25
2011-2012
TOTAL
2.50
10.00
4. National Institute of Ayurveda, Jaipur (NIA)
The National Institute of Ayurveda established in 1976 at Jaipur is an apex Institute of
Ayurveda for evolving high standard of teaching, training, research and patient care
activities. It imparts education at the level of UG, PG and Ph.D.The admission capacity is
60 for U.G., 55 for P.G. and 12 seats for Ph.D. in 6 Specialities. The Institute is also involved
in research activities and researches on Diabetes, Cancer, Vitiligo, AIDS have been
started recently besides others.
The Institute has a 180 bedded hospital having OPD with Pathological, BioChemical, ECG, CTMT, Spirometery, Sonography, Dental, Audio-meter facilities
etc. There is a separate Panchakarma Hospital for specialised treatment. .
Medical Camps are organised in the SC/ST inhabited districts of Rajasthan. During
X Plan so far, the institute organized 145 mobile camps of variable durations;
produced 400 graduates and post-graduates in Ayurveda and rendered clinical
patient care at OPD and IPD levels to more than 4.50 lac patients. A Diploma
Course in Ayurveda Compounder/Nurse Training has been started from 20042005.Post-Graduate Course started in 2 more subjects viz. Swastha Vritta and
Panchakarma from 2004-2005.Panchakarma Department has been developed
and furnished and necessary facilities are being provided to the patients.An
international seminar on “Plant Based Medicine” was organized.
The scheme may be continued during XI Plan as it fulfils its objectives. Some of the Plans
of the institute for XI Plan are:to acquire land for Herbal Garden and develop it for cultivation of
rare and useful medicinal plants for teaching and research purpose;to establish National Repository
21
of Ayurvedic Drugs;to start short-term courses for foreign students;to start PG and regular Ph.D.
courses in the remaining subjects;Construction of Panchakarma Hospital. ;Construction of
PG(Girls) Hostel; Modernization of Yoga Unit to introduce Vyadhikshamatava (Immunology) and
Swasthya (Mental Health) Unit for children To develop museum in Rasa Shastra Department etc
Outlay/ Expenditure in X Plan and Projection for XI Plan
Expenditure
Tenth Plan
approved outlay
Rs.25.00 crore
Rs.28.96 crore
XI Plan outlay
Projection
37.00 crore
Break-up of XI Plan Outlay
(Rs. in crores)
2007-08
7.50
2008-09
7.50
2009-2010
7.50
2010-2011
7.50
2011-2012
7.00
TOTAL
37.00
5. Rashtriya Ayurved Vidyapeeth, New Delhi (RAV)
Rashtriya Ayurveda Vidyapeeth (RAV) is an autonomous organization under the Department
of AYUSH and fully funded by the Government of India. It started functioning from the year 1991.
The Vidyapeeth was established with the main aim to preserve and arrange transfer of
Ayurvedic knowledge from eminent scholars, and traditional Vaidyas who do or do not have formal
qualifications but trained under Gurukula system, to the younger generation through the Indian
traditional system of education ‘Guru Shishya Parampara” and to prepare experts in Ayurveda with
clinical skills.
Guru Shishya Parampara is the traditional method of residential form of education wherein the
Shishya remains with his Guru as a family member and gets the education as a true learner. This
system gradually vanished with the disappearance of Gurukuls. However, it is still a very effective
means of transfer of knowledge from the Gurus (teachers) to Shishyas (students). RAV is making
efforts to revive the system through its courses.In colleges and institutions only relevant portions of
the Samhitas (texts of Ayurveda) are being taught in the form of syllabus. Guru Shishya Parampara
programme of RAV provides the students to study whole text and get adequate knowledge of selected
Samhita and its Teeka (commentary) and traditional skill of the Ayurvedic clinical practice. The
Shishyas get sufficient time for interaction and discussion on the issues taken for study.
RAV is running two types of courses:
Acharya Guru shishya Parampara : Two-year course of Member of Rashtriya Ayurveda Vidyapeeth
(MRAV). During the 10th Plan, RAV trained 18 scholars in this course:
Chikitsak Guru shishya parampara : One-year course of Certificate of Rashtriya Ayurveda Vidyapeeth (CRAV):
During the 10th Plan RAV produced 120 young graduates trained under these Vaidyas.
22
During the current Plan 52 scholars and Vaidyas have been awarded Fellow of Rashtriya Ayurveda
Vidyapeeth (FRAV). Vidyapeeth conducts a Conference/ Seminar/ Workshop every year on a topic that requires
discussion and exchange of the views and clinical experience on the diagnosis and treatment of the disease. So
far Conferences/Seminars have been conducted on Kshara Sutra, Heart diseases, Ayurvedic Education,
Training and Development, Nadi Vigyan, Fast Acting Ayurvedic Medicines and Techniques, Cancer, Shothahara
Avam Jeevanu Nashak Ayurvedic medicines, AIDS, Thyroid disorders, Rasayana, Ayurvedic management of
kidney and urinary disorders , Management of Hepato-biliary & Splenic disorders, Diabetes Mellitus and Mental
Health through Ayurveda. On all the occasions the souvenirs with selected papers have been published.RAV has
conducted 8 Interactive Workshops during the 10th Plan and released books of Questions and Answers.
PROPOSALS FOR XIth PLAN:
Continuation of Present activities: Attempts will be made to enroll more vaidyas and institutions
that are practicing clinical skills that are required to be transferred.
Recognition of the courses: One of the main issues related to these courses is recognition of the
courses. During the next Plan period attempts will be made to get the courses recognized by any
university.
Teachers Training Centre: RAV may take up teacher training activity initially in different
identified institution and later on the new campus of the institute.
Expenditure in X Plan
Tenth Plan approved
outlay____________
Rs.3.00 crore
Expenditure
Rs. 4.80 crore
XI Plan outlay
proposed
5.00 crore(excluding
salary component*)
(including salary
component)
* It is submitted that its salary component may now be transferred to Non-Plan Budget in Xlth Plan.
Break-up of XI Plan Outlay
(Rs. in crores)
2007-08
0.80
2008-09
0.90
2009-10
1.00
2010-11
1.10
2011-12
1.20
TOTAL
5.00
The institute fulfilled its objectives of promoting knowledge of Ayurveda, organizing
workshops, seminars etc. and trained UG/PG students through informal method of training and hence
23
need to be continued during XI plan as well. It is submitted that its salary component may now be
transferred to NON-PLAN Budget w.e.f. 2007-08.
6. National Institute of Siddha, Chennai (NIS)
The Siddha the oldest system of traditional medicine is widely prevalent and practised in
Tamil Nadu. The only institute of national character in Siddha system fulfilling the mandate of
National Health Policy of establishing the national institutes in all systems of AYUSH National
Institute of Siddha is a premier institute for education, research and development of Siddha System
of Medicine. The proposal to establish a National Institute of Siddha(NIS) was taken up during the 9th
Five Year Plan period with the Govt, of Tamil Nadu by Govt, of India for which State Govt, of
Tamil Nadu provided 14.78 acres of land at Tambarrm, Chennai.The Institute is being developed by
the Government as a joint venture with the Government of Tamil Nadu and share the capital
expenditure in the ratio of 60:40 and the recurring expenditure in the ratio of 75:25.
The Institute has been become functional during 2004-05 Till date, 32 faculty posts
(including Director) and 97
posts for Para Medical and administrative staff have been
created/approved by the Ministry of Finance. The Institute imparts P.G. education in 6 subjects with
admission capacity of 30 students per year from 30.9.04. Outdoor Patient Department and
Pathological laboratories are functioning in full swing. There would be a 120-bedded hospital with
OPD/IPD facility. It is expected to produce best quality physicians, teachers, researchers of Siddha
who will be able to raise the standards of clinical care, education, research in Siddha system of
medicine.
This Ministry has also accorded approval for construction of a 60-Seat Girls’ Hostel at an estimated
cost of Rs.1.89 crore. The Standing Finance Committee
in its meeting held on 19.7.06 approved the
construction of a 4-room guest house through CPWD at an estimated cost of Rs.99.00 lac. The construction
may be completed during 06-07 and 07-08.
The scheme may be continued during XI Plan as well to fulfill its objective of producing
post-graduate Siddha physicians, treating sufficient humanity, conducting research, etc. During XI
Plan following facilities such as creation of Anatomy laboratory ,Animal House, Yoga Hall , Green
House, Drug Testing Laboratory,etc to strengthen NIS are proposed to be established .
Outlay/Expenditure in X Plan and Outlay for XI Plan
X Plan outlay
Rs.25.00 crore
Expenditure during X
Plan______________
Rs.27.75 crore
XI Plan Projection
20.00 crore
Break-up of XI Plan Outlay
(Rs. crores)
2007-08
3.00
2008-09
3.50
2009-10
4.00
2010-11
4.50
7. National Institute of Homoeopathy, Kolkata (NIH)
2011-12
5.00
TOTAL
20.00
24
To evolve and demonstrate high standard of teaching, research, treatment to the poor patients
through Homoeopathic system of medicine.
To be continued as the Premier Institute of Homoeopathy imparting teaching, training and
conducting research in Homoeopathy and rendering the tertiary hospital and clinical care.The Xth
Plan outlay/expenditure is Rs. 36.50 crores. It is proposed for an outlay of Rs. 40.00 crore in Xlth
Plan.
8. National Institute of Unani Medicine, Bangalore (NIUM)
To promote the growth and development of Unani Medicine, to produce Post-Graduate and
Research in Unani Medicine, to provide medical relief to the suffering humanity on no profit no loss
basis etc.
To be continued as the Premier Institute of Unani imparting teaching, training and
conducting research in Unani and rendering hospital and clinical care. On completion of the first
phase the teaching has commenced in four subjects and 100 bedded hospital has become
operationalised.. The construction activity of second phase has been taken up and on completion of
second phase the Institute will have Post-Graduate teaching in another four subjects.
The Xth Plan outlay/expenditure is Rs. 21.00 crores. It is proposed to have an outlay of Rs.
25.00 crores in Xlth Plan.
9. Morarji Desai National Institute of Yoga, New Delhi (MDNIY)
It acts as a centre of excellence in Yoga and is to develop, promote and propagate the
science of Yoga. It also provides scientific education in Yoga leading to diploma and degree
courses. It is to be engaged in treatment and research, clinical, fundamental and literary research in
the field of Yoga.
To be continued as being a premier Institute of Yoga engaged in developing, promoting and
propagating the science of Yoga and also imparting education in Yoga. In Xlth Plan, a new
scheme for Yoga Centre is to be started.
The outlay/for Xth Plan was Rsl 1.00 crores. It may be increased to Rs. 20.00 crores in Xlth
Plan including a token provision of Rs 2.00 crore for the yoga project being coming up at
Gaziabad.
10. Vishwayatan Yogashram, New Delhi
A premier Institute of Yoga engaged in developing, promoting and propagating the science of
Yoga and also imparting education in Yoga. Also engaged in clinical, fundamental and literary
research in Yoga.
To be continued as in compliance with the Court Order salary/wages are being paid or to be
paid till further court order to the employees of J&K unit accommodated in the premises of MDNIY,
New Delhi.
As in Xth Plan, an outlay of Rs. 1.00 crores is projected for Xlth Plan.
11. National Institute of Naturopathy, Pune (NIN)
It is for promotion and propagation of Naturopathy and also to encourage research in the field
of Nature Cure treatment to prevent/cure diseases.
25
To be continued or handed over to the Govt, of Maharashtra if they are willing. Central Govt,
has left it to the States to regulate Naturopathy.
The outlay/expenditure in Xth Plan is Rs. 7.68 crores. The projected outlay for the Xlth Plan
is Rs. 8.50 crores.
STATUTORY INSTITUTIONS
12. Central Council of Indian Medicine, New Delhi (CCIM)
Maintains Central Register of Ayurveda, Siddha and Unani. Responsibilities to lay down the
minimum standards of education in these fields to recommend regarding permission of a new college,
increase of seats or starting of a new or higher course Also responsible for laying down the standards
of professional conduct, etiquette and code of ethics to be observed by the practioners of these
systems.
To be continued as this is a statutory body for regulation of standards of education in the
Indian Systems of Medicine.
The outlay for Xth Plan was Rs. 0.60 crores. It is proposed to increase to Rs. 0.70 crores in
Xlth Plan.
13. Central Council of Homoeopathy, New Delhi (CCH)
Maintains Central Register of Homoeopathy.. Responsibilities to lay down the minimum
standards of education in this field to recommend regarding permission of a new college, increase of
seats or starting of a new or higher course Also responsible for laying down the standards of
professional conduct, etiquette and code of ethics to be observed by the practioners of these systems.
To be continued as this is a statutory body for regulation of standards of education in
Homoeopathy.
The expenditure/outlay in Xth Plan is Rs. 0.20 crores. A provision of Rs. 0.25 crores is
projected for Xlth Plan.
14. Central Pharmacy Council for AYUSH
To regulate the education and practice of pharmacy in Indian Medicines and
Homoeopathy. A Bill for the establishment of the Council is pending with Parliament. A
provision of Rs. 2.00 crores is proposed for the Xlth Plan.
RESEARCH COUNCILS
15. Central Council for Research in Ayurveda & Siddha, New Delhi (CCRAS)
For Clinical research including health care research, drug research, survey of medicinal
plants, drug standardization, literary research and family welfare research programmes.
To be continued.This is an apex council for research in Ayurveda and Siddha. Research is a
continuing process and CCRAS being the only organization in the Govt, sector for conducting
research in Ayurveda and Siddha system of medicine needs to carry out its work to fulfill the
26
objectives. In the process of conducting research through its regional CRIs/RRIs/units spread all over
the country, it is not only conducting research but also providing clinical facilities in Ayurveda and
Siddha to the general public.The Xth Plan outlay/expenditure is Rs. 54.37 crores.
In view of the permission granted to CCRAS to fill up the vacancies arisen since last three
years, the provision for payment of the salaries of scientific and administrative staff recruited for the
plan units has to be made. Also increase in the number of Extra Mural Projects, research activities is
expected. It is also proposed to get the NABL accredition of its five laboratories and hence these
laboratories are to be equipped with high value equipments and instruments. Also, the capital works
in six places of its institutes for having own building has to be undertaken in the Xlth Plan.
In view of the above proposals, an outlay of Rs. 100.00 crores for Xlth Plan is projected. The
year-wise outlay is as follows:
Year
2007- 08
2008- 09
2009- 2010
2010- 2011
2011- 2012
Total
Outlay in Rs. crores
18.00____________
19.00____________
20.00____________
21.00____________
22.00____________
100.00
16. Central Council for Research in Unani Medicine, New Delhi (CCRUM)
The Central Council for Research in Unani Medicine which was established in the year 1979
is a premier institution of research in Unani System of Medicine. This Council is inter-alia engaged
in multi-faceted research activities in the areas of Clinical Research including Clinico-Pharmacology,
Drug Standardization and Quality Control, Literary Research including Medico Historical Research
and Survey and Cultivation of Medicinal Plants, through a network of 25 research centres functioning
in different parts of the country.
During the 10th Five Year Plan there have been some significant leads where the Council have
finalized Clinical Studies on 20 drugs out of which monographs on 12 were published and 8 have
been applied for patent rights. 17 other formulations out of Kit Medicines have been filed for patents
and have also been commercially exploited. Besides continuing General OPD, Mobile Clinical
Research, School Health and the OPD at Dr. RML Hospital, New Delhi the Council have completed
Phase-I study of the fundamental research pertaining to Humors and Temperaments. SoPs are being
worked out for Regimental Therapy.
In the collaborative research programme with CSIR on development of bio-active molecules
for Unani formulations, 54 formulations were passed on to the CSIR in which in-vitro and in-vivo
activities have been observed in 16 samples. The work is in progress. The Council have been able to
finalize Pharmacological and Toxicological studies on 10 drugs during this plan period. Under the
EMR Programme, 15 projects have been allotted during the plan period and work on 11 projects has
been completed and the reports have already been sent for printing.4050 medicinal folk claims have
been collected and documented. In the Literary Research Programme 20 manuscripts/books have
been translated from Arabic and Persian Languages and have been published.
With a view to streamline the functioning and to accelerate the pace of work, the Council is
presently in a mode of re-organization of different research schemes and number of centres is being
brought down from present 25 to 12. The Council would like to continue the research work in 3
Central Research Institutes and 9 Regional Research Institutes and Drug Standardization Research
27
Institutes. These institutions will be further developed to provide for optimum facilities for multi
faceted research programme, as envisaged in the documents for the 11th Five Year Plan. However,
based on the availability of funds, the Council would like to develop independent institutes for
molecular pharmacology and upgrade different Institutes in terms of Equipments and Manpower.
Apart from designating the existing institutes for fundamental research, for Regimental Therapy, for
Metabolic Disorders, Skin Disorders and Musculo-Skeleton disorders and cardiac ailments.
The Drug Standardization Research Programme shall include the standardization of classical
formulations included in the National Formulary of Unani Medicine. 300 formulations will be taken
up for quality standards during XI five year plan. The work shall include standardization of classical
formulations, safety studies and upgradation of three laboratories. The Council will also take up
DNA finger printing and HPTLC of single and compound formulations and this will be an important
segment of this programme.
The survey and cultivation of medicinal plants programme would be continued with more
emphasis of having pharmacological survey of medicinal plants and raw drugs. The collection of
information of Unani Medicinal Plants in different forests areas in establishing a separate referral
centre for confirmation of botanical identity will be an important segment besides setting up of 2
Tissue Culture Labs at Srinagar and Hyderabad attached to Council’s Institutes.The Council will take
up construction of buildings for CRIUMs at New Delhi and Lucknow, RRIUMs at Silchar, Bhadrak,
Allahabad and Patna during the 11th Five Year Plan.
The X Plan expected expenditure for the full period is Rs 59.45 crores. An outlay of Rs.90.00
crores is projected for the 11th Five Year Plan.
The year-wise outlay is as following
Year____
2007- 08
2008- 09
2009- 2010
2010- 2011
2011- 2012
Total
Outlay in Rs. crores
16.00____________
17.00____________
18.00____________
19.00____________
20,00____________
90.00
17. Central Council for Research in Yoga & Naturopathy, New Delhi (CCRYN)
The objective of the Council is to conduct Scientific Clinical Research to verify the efficacy of Yoga &
Naturopathy in treatment of various disorders; Publication of ancient Yoga & Naturopathy texts and meaningful
standard literature based on modern scientific research. To disseminate the knowledge of Yoga & Naturopathy
among common public as well as professionals. To disseminate the knowledge of Yoga & Naturopathy among
common public as well as professionals.
32
(e) Evolve and notify Good Agriculture Practices (GAPs), Good Collection Practices (GCPs),
Good Storage Practices (GSPs) for medicinal plants. These will consists of two sets of guidelines.
There will be generic guidelines followed by species specific GAPs/GCPs/GSPs for the major
medicinal plants under cultivation for which monographs are proposed to be prepared with the help of
the Research Institute/ Universities having expertise in the subject. In all 100 monographs are
proposed to be prepared during the 11th Plan. It is also proposed to fund R & D so as to develop
protocols for sustainable harvest of such medicinal plants which should include such plant parts which
may not involve destructive harvesting. It is proposed to cover 20 species during the 11th Plan.
(f)
It is proposed to identify agencies in the government and non-Government sector, backed up by
independent certification, which will be used as focal points for raising nurseries and supplying
Quality Planting Material to the farmers and cultivators.
(g) Independent Certification mechanism is proposed to be put in place which will not benefit the
growers but also the manufacturers and users of medicinal plants. For small and marginal farmers,
group certification of GACPs and organic farming backed by government support may have to be
considered. It is proposed to provide financial support for strengthening testing labs where they
already exist and set up new ones preferably through a public private parternership mechanism.
(h) A network of storage godowns and semi processing facilities near the major collection centres
and cultivation areas, managed either by government, PSU, Co-operative Federations or Panchayats
will go a long way in quality aw material being made available to the manufacturers besides
improving the safety and efficacy of the final product. It is proposed to take up projects for post
harvest management and capacity building the thrust areas of the sector in areas not covered by
MPZs.
(i)
R&D activity is being supported in a substantial way by CSIR, DBT, DST, ICFRE and ICAR
through their research institutes, regional research institutes, research laboratories also. This is
expected to continue during the 11th Plan.
(j)
A Venture Capital fund/Technology Upgradation fund of the size of Rs. 200-300 crores is
required to be created for modernization of Ayush/Herbal industry. The scope of the scheme of crop
insurance should be enlarged to cover medicinal plants. It is proposed that the uniform exemption of
VAT/sales tax regime should be introduced for medicinal plants to give a boost to the sector and its
trade within the country. This would be in line with the Government exemption of essential food
related commodities from VAT incidence.
(k) In order to fulfill the large mandate of the Board the existing organizational structure of the
Board is under review through a Consultant. Based on the report of the consultant, the matter is
proposed to taken up with the Cabinet for appropriate decision.
MODIFIED SCHEME IN XI PLAN.
The existing Central Sector Scheme of Medicinal Plants Board is proposed to be bifurcated
into two schemes as follows:
A.
Central Sector Scheme for conservation, promotion and development of medicinal
plants. This scheme will be 100% centrally funded and cover the follows activities:
In-situ/Ex-situ conservation.
Community herbal gardens (including Vanaspati Vans).
Research & Development.
33
Monographs on Good Agriculture/Collection Practices (GACP), Good Storage
Practices (GSP), Good Harvesting Practices (GHP).
•
Independent certification of planting material, cultivation practices and quality of
raw material.
•
IEC.
•
Monographs on medicinal plants and registration thereof in major importing
countries.
•
Market surveys.
•
B. Centrally Sponsored Scheme for cultivation, processing, value addition, marketing
of medicinal plants. This scheme will be 100% centrally funded. As a Centrally
sponsored scheme this will ensure better planning, appraisal and implementation by the
State Government while at the same time, the Central Government retaining the authority
to control and monitor the outputs and outcomes. Following activities will be supported
under the Scheme:
Contractual Farming/cultivation.
Support for processing, semi-processing/Value addition, ware houses and
packaging.
Marketing support by way of minimum support price.
Support for brand promotion.
(I)
Financial outlays:
A. Central Sector Scheme on Conservation, cultivation, processing, value addition,
marketing of medicinal plants.
#
Activity
i.
Conservation/Regeneration hectares)
ii.
Gene Banks (100 hectares each)
iii.
Community herbal gardens (500
hectares each)___________________
R&D
iv.
v.
vi.
Rate Per Unit
(in Rs.)
20,000/-
Physical
Target
20,000
Outlay (Rs.
in Crores)
40
20,000/-
50
10
10,000,000/-
10 nos.
10
Lump sum
15
Lump sum
15
Lump sum
10
Lump sum
15
Quality control, standardization and
certification____________________
IEC
vii. Organisation, IT etc.
Total
115
B. Centrally Sponsored Scheme for cultivation, processing, value addition, marketing
of medicinal plants.
Activity
Rate Per Unit
Physical
Target
Outlay (Rs.
in Crores)
34
(in Rs.)
30,000
i.
Cultivation (hectares)
ii.
Post Harvest Management and
Marketing support____________
Total
1,00,000
300
Lump sum
50
350.00
YEARWISE OUTLAY
#
i
ii
Scheme
Central Sector
Scheme
on
conservation and
development of
medicinal plants
Centrally
sponsored
on
scheme
cultivation etc.
Total
200708
15
Year wise Outlay
20102009200811
09
10
25
25
25
201112
25
Total
(Rs. in
Crores)
115
60
65
70
75
80
350
75
90
95
100
105
465
STRENGTHENING OF PHARMACOPOEIAL LABROATORIES
27. Pharmacopoeia Laboratory of Indian Medicine, Ghaziabad (PLIM)
PLIM is a National level laboratory set up for laying down standards for identification of
Ayurvedic drugs etc. and for testing of these medicines for enforcement of quality control to
implement Drugs & Cosmetics Act and Rules at the Central level. It is a recognized Drug Testing
Laboratory for Ayurvedic, Unani and Siddha medicines for whole of India. It is also recognized as a
scientific and technological institute/organization by the Department of Science & Technology. The
laboratory is also engaged in work pertaining to survey and introduction/cultivation of medicinal
plants.
In the Xth Plan, an outlay of Rs. 1.78 crores was made. A new building has been
constructed and set of equipments has been purchased from the Scheme of Strengthening of PLIM
and eight new posts have also been sanctioned for the same purpose.
During Xlth Plan, it is proposed to build training hostel from guest house and also the
toxicological/ pharmacological laboratory.
In view of above, the projected outlay for Xlth Plan is Rs. 19.50 crores. The year-wise
outlay is as follows:
Year_____
2007- 08
2008- 09
2009- 2010
2010- 2011
Outlay in Rs. crores
6.49_____________
3.65_____________
3.75_____________
2.80
35
2011-2012
Total
2.81
19.50
28. Homoeopathic Pharmacopoeia Laboratory, Ghaziabad (HPL)
HPL is a national level laboratory set up for laying down standards for identification of
Homoeopathic drugs and for testing of Homoeopathic medicines for enforcement of quality control
to implement Drugs & Cosmetics Act and Rules at the Central level. It is recognized Drug Testing
Laboratory for Homoeopathic drugs for whole of India. It is also recognized as a scientific and
technological institute/organization by the Department of Science & Technology. The laboratory is
also engaged in work pertaining to survey and screening of formulations and drugs, introduction and
cultivation of medicinal plants. The laboratory is also recognised as Central Drug Laboratory for
testing of Homoeopathic Drugs. During Xth Plan, the outlay was Rs. 0.97 crores. A new building
has been constructed and set of equipment has been purchased from the Scheme of Strengthening of
HPL and four new posts have also been sanctioned.
The proposed outlay for Xlth Plan is Rs. 3.00 crores. The year-wise outlay is as following:
Year____
2007- 08
2008- 09
2009- 2010
2010- 2011
2011- 2012
Total
Outlay in Rs. crores
0.50_____________
0.55_____________
0.60_____________
0.65_____________
0.70_____________
3.00
29. Strengthening of PLIM/HPL
This scheme is discontinued as a separate scheme and it stands merged with the above two schemes,
viz., PLIM/HPL.
30. Public Sector Undertaking (IMPCL, Mohan, U.P.)
To manufacture quality medicines of Ayurveda, Unani and Siddha.
This is the only PSU of Department of AYUSH in a remote backward area. It needs to focus
on brand building/marketing and creating a niche for itself. The unit is not making cash losses for
last three years. There is need to develop IMPCL for laying down bench marks for Ayurveda, Unani
and Siddha drugs. With this objective in view, modernisation plan of this unit is under
implementation. It needs to be made clear to the management and labour that if the unit relapses into
cash losses then it may be privatized or closed down. An assistance of Rs. 5.00 crore was provided
to IMPCL in the Xth Plan for its modernisation activities. Another Rs. 5.00 crore is proposed in the
Xlth for Surveys/Exhibitions.
31. Information, Education & Communication
31.1 Awareness building on merits of AYUSH through surveys/exhibitions/roadshows, print
and electronic media in India and abroad.
To create awareness about the efficacy of the AYUSH systems, their cost-effectiveness and
the availability of herbs used for prevention and treatment of common ailments at their door-steps
through various channels including the production of audio-visual educational material to achieve the
objectives of health for all.
I
36
Under the Scheme, the Department is organizing AROGYA fair in Delhi since 2001 to
generate awareness among the general public and to give a boost to the AYUSH drug manufacturing
industry as well as to create awareness among the industry about Good Manufacturing Practices
(GMP). Various provisions of the Enforcement Mechanism for ASU& H drugs. In view of the
popularity of the fair and demand from various quarters, it was decided to organize regional
AROGYAS also. The first regional AROGYA was organized at Chennai in January, 2005 and later
during 2005-06. Regional AROGYAS have been organized at Hyderabad and Chennai. For this
purpose, both audio-visual and print media is also being utilized. The Department proposes to
continue to organize AROGYA fairs in metro cities during Xlth Plan.
Under the Scheme, some video spots and films and documentary films on all the systems,
viz., Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy as well as films on home
remedies in Ayurveda and Unani have been prepared. The spots have been released through Radio
and T.V. and the films have been utilized in AROGYA fairs as well as at other National/International
fairs/exhibitions. The Department proposes to continue to prepare audio-visual and print material
during Xlth Plan.
The services of NGOs have been utilized for generating awareness about the strengths of
AYUSH systems among general public and for creating awareness among the practitioners of
AYUSH systems to practice their own systems as well as creating awareness among farmers for
cultivation of medicinal plants at District/Block level.
Getting utilisation certificates from NGOs is the major constraint in the implementation of
NGO Scheme.
The three components of the scheme are to be merged and to have following two modified
components in the Xlth Plan:
i) Awareness building through AROGYAS and print and electronic media through DAVP/media
agencies/ITPO/FICCI/PHARMAXECIL and other reputed organizations.
ii) Awareness generation in State capitals and other places other than metro cities by organizing mini
AROGYAS through reputed, identified media agencies/other organizations.
A provision of Rs. 19.00 crore was kept for IEC in the Xth Plan which is proposed to be
increased to Rs. 25.00 crores in the Xlth Plan.
OTHER PROGRAMMES AND SCHEMES
32.1 International Exchange Programmes on AYUSH and Scholarship scheme for foreign
students in AYUSH
For supporting visits of officials/experts to foreign countries to participate in
meeting/seminars/workshop/exhibition for propagation of AYUSH systems abroad and providing
scholarship to students from foreign countries to study in AYUSH institutions in India. An
outlay of Rs. 8.00 crores was made in Xth Plan.
To be continued in modified form. The modified scheme would help in promoting and
propagating AYUSH abroad. A provision of Rs. 10.00 crores is projected for Xlth Plan.
1
37
32.2 Assistance for organizing national/international Seminar/Conference/Workshop on
AYUSH.
To create and increase awareness among the community about the preventive,
promotive and curative aspects of ISM & H systems, its cost effectiveness and provide
opportunity for intellectual interactions and deliberation through Seminar/Conference/Workshop.
To be continued with modifications as it serves very important purpose of creating
awareness about ISM&H and providing opportunity for high level intellectual interaction through
seminar/conferences/workshop for scientific development of these systems.
The projected provision for Xlth Plan is Rs. 5.00 crores.
32.3 Organization of Trade Fairs/Exhibition/Roadshows/Conference abroad
This is a new scheme with aim towards popularization of AYUSH medicines in U.K.,
U.S.A., Europe, Middle East/Africa/South East Asia by holding trade fairs/roadshows by the
Department of AYUSH/Research organizations/PHARMAXCIL/CII/FICCI/ITPO and other
organizations. This would help significantly in promoting and propagating AYUSH systems and
medicine abroad.
The provision of Rs. 5.00 crore is projected for Xlth Plan.
32.4 Programme for training/fellowship/exposure visit/up-gradation of skills etc. for AYUSH
personnel
To promote AYUSH systems through educational institutions as there is demand from
many foreign countries to depute teachers for teaching AYUSH systems in their institutions.
Therefore, to be continued with modifications. In Xth Plan, the provision was of Rs. 3.00 crores.
The projected provision for Xlth Plan is Rs. 5.00 crores.
32.5 Incentive to AYUSH industry for participation in fairs/conducting market study for
creating a developing market opportunity in India and abroad.
To encourage AYUSH industry to develop markets in India/abroad, there is need to give
incentive AYUSH industries for participating in trade fair/exposition for popularizing Indian
Medicine in India and abroad and conducting market study for developing market opportunity.
The scheme to be continued in modified form. A provision of Rs. 5.00 crore was kept in the
Xth Plan. The provision in Xlth Plan is proposed to be at Rs. 5.00 crore.
33. Acquisition and Publication of Text Books & Manuscripts
To prepare and publish good quality text book written by highly experienced teachers of
ISM & H colleges. To acquire, preserve and publish manuscripts and out of print books, which will
provide easy access on the manuscripts of ISM.
The response for submitting the proposals under the scheme is very poor. As the sufficient
literary staff is available in the respective councils-CCRUM/CCRAS and the proposals relating to
manuscripts has been evaluated by the Steering Committee of the respective councils before placing it
to the Screening Committee. The scheme may be transferred from the Department of AYUSH to
Research Councils. They will implement the schemes from their Plan grant-in-aid.
38
May be transferred from the Department of AYUSH to AYUSH Research Councils. A
provision of Rs. 7.00 crore was made in the Xth Plan. The projected outlay for Xlth Plan is Rs. 7.00
crores.
34. North Eastern Institute of AYUSH
It is proposed to establish a North-Eastern Institute of Ayurveda and Homoeopathy at
Shillong, Meghalaya. The proposal envisages the establishment of the institute in two phases spread
over four years with the setting up of an Ayurvda college with an admission capacity of 60 students
and a Homoeopathy college with an admission capacity of 50 students along with a 200 bed hospital,
laboratories etc. The teaching infrastructure in Ayurveda and Homoeopathy is almost negligible in
north-eastern states. There are 1 ayurvedic college and 3 homoeopathy colleges in Assam and 1
homoeopathy college in Arunachal Pradesh. In order to propagate the AYUSH educations and
systems one national level institute need to be opened. It is with this end in view a proposal initially
formulated for Arunachal Pradesh was considered by the EEC in its meeting held on 29th June, 2005
wherein after detailed discussions, the EFC recommended it subject to certain observations. In the
meanwhile a draft CCEA note seeking approval of the cabinet was prepared and circulated to
Ministry of Finance, etc. seeking their comments. The Ministry of Finance expressed doubts about
the need and viability of the present. After considering the observations, it was decided to establish
the institute at Shillong, Meghalaya in the campus of North Eastern Indira Gandhi Regional Institute
of Health & Medical sciences, Shillong, where adequate land has been made available for the project.
The proposal was considered in the meeting of Cabinet Committee of Economic Affairs in
its meeting held on 2nd June, 2006. However, the outcome of the proposal is not yet known.
Expenditure in X Plan
X Plan outlay
Rs.0.05crore
Expenditure
Rs. Nil
XI Plan outlay proposed
75.00 crore
It is submitted that there is adequate provisions of fund under Lumpsum Provision for NorthEastern States & Sikkim, if approved, requisite funds available under this head would have been reappropriated to meet the expenditure.
Break-up of XI Plan Outlay(tentative)
_____ Rs. in crores)
TOTAL
2009-2010 2010-2011 2011-2012
2008-09
2007-08
75.00
13.00
12.00
10.00
20.00
20.00
The scheme may be continued into 11th Plan so as to enable the Department to implement the
proposal.
35. Re-orientation Training Programme of AYUSH Personnel/Continuing Medical Education
(ROTP/CME)
These AYUSH practitioners usually remain unaware of the scientific developments and recent
trends and advances in clinical practice. As a result the clinical competence of the practitioners
declines over the years which may adversely affect their professional skill and deprive the masses
from the benefit from recent health sector developments. There is also a need to keep them trained in
the National Health Programme so that they can contribute in achieving the objectives of programme.
39
The ROTP/CME being implemented in X Plan is as a component under Centrally Sponsored
Scheme on Development of Institutions. The total expenditure under this component in X Plan is Rs
2.70 crores
XI PLAN PROPOSAL
It appears that it would be appropriate if this scheme is taken up in the Central Sector since the
purpose would be effectively served as the money will reach the user directly and it will reduce time
in implementation/achievement of the scheme. It is proposed to to make a provision of Rs 10.00
crores in XI Plan. The year wise break up is as follows:
(Rs Crores)
2007-08
2.00
2008-09
2.00
2009-10
2.00
2010-11
2.00
2011-12
2.00
TOTAL
2.00
40
Department of AYUSH
Scheme-wise Projected Outlay for Xlth Five Year Plan
SI
Scheme
No.
Tenth
Plan
Outlays
Tenth Plan
Expenditure
Projected
Outlays
BE/R.E for
2006-07
1
2
3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Centrally Sponsored Schemes_____________
Development and upgradation of AYUSH
Institutes/Colleges________________________
Hospitals & Dispensaries__________________
Drugs Quality Control_____________________
Central Sector Schemes__________________
Strengthening of Deptt. of AYUSH________
Secretariat Social Services_________________
Strengthening of Pharmacopoeial Committee
on ASU_________________________________
Educational Institutes____________________
IPGTR, Jamnagar________________________
NIA, Jaipur_____________________________
RAV, New Delhi_________________________
NIS, Chennai____________________________
NIH, Kolkata____________________________
NIUM, Bangalore________________________
MDNIY, New Delhi______________________
Vishwayatan Yogashram, New Delhi________
NIN, Pune______________________________
Statutory Institutions____________________
CCIM, New Delhi________________________
CCH, New Delhi_________________________
Central Pharmacy Council for Indian Medicine
and Homoeopathy________________________
Research Councils_______________________
CCRAS________________________________
CCRUM________________________________
CCRYN________________________________
CCRH__________________________________
Central Combined Building Complex________
Extra Mural Research_____________________
TKDL__________________________________
Survey on Usage & Acceptability of AYUSH
National Ayurvedic Hospital in Delhi________
Expansion of CGHS Dispensaries___________
Ayurveda Hospital, Lodhi Road, New Delhi
Setting up of National Board for Medicinal
Plants
120..00
144.06
415.00
59.00
45.40
284.41
55.28
625.00
150.00
17.50
5.00
21.88
5.37
30.00
10.00
5.50
25.00
3.00
25.00
25.00
15.00
11.00
1.00
6.00
3.85
23.96
3.05
27.75
36.50
21.00
9.56
1.00
7.68
10.00
37.00
5.00
20.00
40.00
25.00
20.00
1.00
8.50
0.60
0.05
2.00
0.51
0.20
0.45
0.70
0.25
2.00
45.00
42.00
10.00
22.00
6.00
10.00
1.50
1.00
15.00
7.00
6.50
93.50
54.37
59.45
8.63
37.39
7.92
30.86
7.67
1.18
29.11
0.89
1.61
134.64
100.00
90.00
25.00
77.50
15.00
35.00
1.50
2.00
75.00
7.00
6.50
451.00
41
27
28
29
30
31
Pharmacopoeial
Strengthening
of
Laboratories
PLIM, Ghaziabad
HPL, Ghaziabad
Strengthening of PLIM/HPL_____________
IMPCL, Mohan________________________
Information. Education and Communication
1.78
0.97
20.00
5.00
19.00
31.1 Awareness building on merits of AYUSH
through surveys/exhibitions/road shows, print
and electronic media in India and abroad._____
Other Programmes and Schemes__________
32.1 International Exchange Programmes on 8.00
AYUSH and Scholarship scheme for foreign
students in AYUSH
organizing
for
32.2 Assistance
national/international
Seminar/Conference/Workshop on AYUSH
of
32.3 Organization
Trade/Fairs/Exhibition/Roadshows/Conference
abroad.__________________________________
32..4 Programme for training/fellowship/exposure 3.00
visit/upgradation of skills etc._______________
32.5 Incentive to AYUSH industry for participation 5.00
in fairs/conducting market study for creating a
developing market opportunity in India and
abroad.__________________________________
33
Acquisition and Publication of Text Books and 7.00
Manuscripts_____________________________
34
North Eastern Institute of AYUSH___________ 0.05
35
ROTP/CME_____________________________
TOTAL
695.35*
0.77
1.00
3.81
5.00
19.26
19.50
3.00
0.00
5.00
25.00
4.86
10.00
5.00
5.00
0.11
5.00
0.56
5.00
1.65
7.00
0.01
75.00
10.00
2473.45*
1057.26
*Lumpsum provision for North Eastern States and Sikkim is not included.
42
Minutes of the First Meeting of Working Group for Eleventh Five Year Plan
(2007-2012)
on “Access to Public Health including AYUSH” held on 24th July, 2006
The First Meeting of Working Group for Eleventh Five Year Plan (2007-2012) on “Access
to Public Health including AYUSH" was held
under the Chairmanship of
Shri Vijay
Singh,Secretary(AYUSH) on 24th July,2006 at 11.00 AM in Committee Room, IRCS Bldg, New
Delhi.
The list of participants is annexed.
At the outset, Secretary (AYUSH) welcomed the members of the working group and
other invitees. In his introductory remarks, he briefed the participants about the terms of
reference of the working group and pointed out that this Department had started with a
modest budget in 1995 which has grown manifold in the last decade. At this stage, there is
a need to review and analyze AYUSH sector priorities and different schemes that could be
carried forward in the XIth plan.
Shri Bala Prasad, Director (AYUSH) made a presentation covering the recommendations
of the various task force constituted on AYUSH Education; Standardization and Quality
Control of AYUSH Drugs; Research and Development; Mainstreaming of AYUSH; and
Medicinal Plants.
Dr. G.S. Lavekar, Director, Central Council for Research in Ayurveda and
Siddha (CCRAS) and Shri B.S. Sajwan, Chief Executive Officer, National Medicinal Plants
Board
(NMPB) elaborated the recommendations of task force on Research and
Development and Medicinal Plants respectively.
Shri
Verghese
Samuel,
J.S.
(VS)
clarified that task force on education has felt that AYUSH professionals with very high
academic credentials should only be nominated or elected in CCIM and CCH.
Shri Shiv Basant, J.S. (SB) explained the process of physical integration of AYUSH at
PHC/CHC level under NRHM and expressed the hope that the States would provide for
provision of AYUSH facilities in 100% PHCs/CHCs under NRHM in the 11th Five Year Plan for
integration in health delivery system.
For the purpose of smooth integration of AYUSH in
health care delivery there should be a common Directorate at state level with due
representation of AYUSH. Dr. S ,K. Sharma Adviser (Ayurveda) and Dr. H.M. Chandola,
Reader, Institute of Post Graduate Teaching & Research in Ayurveda (IPGT&RA), Gujarat
Ayurveda University, Jamnagar, felt that separate Directorates for AYUSH at State level
provide a better impetus to the growth of AYUSH in the States.
Secretary (AYUSH)
43
supported the creation of separate AYUSH Directorate at the State level but also highlighted
the need for proper coordination between AYUSH and Health Directorates for convergence
and synergy in health care services.
Shri B.S. Sajwan, CEO, NMPB explained the achievements in the 10th Five Year Plan of
the Central Scheme for the development, conservation and cultivation of medicinal plants.
Further, explaining about Vanaspati Van, Community Herbal Garden, to use of modern
agro-techniques to increase quality production of medicinal plants, he informed that
modalities for taking over the Vanaspati Van scheme from the Department of Family
Welfare are being worked out by the National Medicinal Plant Board. Preparation of
monographs, R & D collaboration with CSIR, ICAR and DBT through their research institutes
are some important areas which need to be given impetus in 11th Plan.
Recalling the
discussion in Department related Parliamentary Committee meeting in which relevance of
NMPB was questioned, probably because of the small scale of its operation, Secretary
(AYUSH) was of the view that there is a need for a quantum jump in the plan funds for
medicinal plants sector and Chief Executive Officer, National Medicinal Plants Board may
work out a comprehensive proposal for the 11th Plan.
Dr. B.L. Gaur, Vice-Chancellor, Rajasthan Ayurved University, Jodhpur emphasized
that universities should be empowered to maintain the standards of medical education in
AYUSH colleges/institutes and CCIM should provide only core curriculum. He suggested that
recruitment of teachers should be done by a Centralized Board to ensure proper standard
of teaching.
He also stressed the need of publishing ancient AYUSH literature and their
commentaries of in different languages otherwise people would not be able to translate
them properly later on.
Proper access to reserved forest and Good Collection Practices
should be formulated for harvesting medicinal plants to ensure sustainable supply of
medicinal plants products to the industry and practitioners.
Teaching Institutions should
have separate research wing as the teachers normally do not have knowledge of research
methodology.
Dr. Darshan Shankar, Director, FRLHT, Bangalore supported autonomy to Ayurveda
Universities and Centres of Excellence in different regions in deciding the curricula. Uniform
curriculum across the country can only be at the expense of regional excellence. He also
supported flexibility in curricula of PG education.
He pointed that the Professionals of
AYUSH are not aware of public health issues. Therefore, there is need to prepare them for
substantial contribution in public health care system. For reorienting them there is need for
10597 P°6
44
creation of public health institutions. He also pointed out that research in AYUSH has been
sub-critical in size; and therefore, there is less impact. There is need for all India coordinated
research projects.
According to him, AYUSH research should not be confined to drugs,
which has been the focus of research in allopathy. As AYUSH system is based on holistic
approach, their research should also develop new framework of validation of complete set
of therapeutic regime including diet and drugless therapies.
National Medicinal Plants
Board should also address the need of medicinal fauna and role of metals and minerals
used in AYUSH.
He also suggested public and private partnership to support buy-back
arrangements. He specifically proposed higher plan allocation in the XIth Plan and provision
of Plan funding to Universities and other Centres of Excellence working in medicinal
plants/AYUSH systems.
Dr. Katiyar, Director, Herbal Division, RANBAXY emphasized the need for upgrading
He
quality of AYUSH education to make Ayurveda an attractive carrier option,
emphasized a certification mechanism for quality control AYUSH
medicines.
He also
suggested establishment of a National Repository of crude drugs and marker compounds.
Dr. H.M. Chandola, Reader, IPGTRA emphasized on minimum prescribed syllabus by
COM to which universities can add additional modules. He also proposed restructuring of
syllabus. He cited an example on research paper by Japanese on Prakarti, according to
which diabetes can be identified through colour of skin
and proposed research on
diagnosis based on Prakriti. He also suggested supporting cooperatives in medicinal plants
sector as it has been successfully demonstrated in
milk sector.
He supported
encouragement to “Ayurvedic Medical Tourism”
Dr. Mattoo, President, Natural Resources India Foundation emphasized that different
Govt. Agencies are working on medicinal plants with little or no coordination. There must be
one nodal agency to coordinate with all stakeholders for better development of medicinal
plants sector.
He suggested separate Commissionerate at Centre and State level.
He
pointed out need for undertaking survey of Medicinal Plants.
Dr. Vasantha Muthuswamy, Senior DDG, ICMR emphasized the need to focus on
what can be achieved in coming five years. She pointed out the need for sensitization of
students and practitioners of different medical systems regarding the strengths of other
systems to cultivate a scientific temper for cross system referrals for providing a patient the
45
best treatment.
However, she regretted that most AYUSH physicians are only indulging in
allopathic practice. She also explained the need for coordinated research and clinical
trials and informed that ICMR has established an institute at Belgaum devoted to traditional
medicines.
CCRAS/CCRUM should build linkages with that institute.
Prof. Shakheel Jamil, Dean, Faculty of Unani medicine, Jamia Hamdard pointed out
that most of the Unani Institutions have come up in the private sector and there is need for
one time funding for upgradation of their infrastructure. He also emphasized the need for
fundamental research, particularly, on Regimental Therapy.
Vaidya Devendra Triguna, President, Ayurvedic Congress, New Delhi pointed out that
in Government sector AYUSH colleges are not being opened. After a lot of efforts, one
college is going to be opened in Delhi by Delhi Government. In private sector colleges are
coming up. But they do not meet the minimum standards as their threshold is very high.
He emphasized that minimum standards laid down by the Government should be realistic.
He underlined the need to have proper vision and focus in AYUSH research.
He also
suggested the need to promote Ayurvedic veterinary care products.
Dr. V.K. Khanna, Former Principal, Nehru Homoeopathy College, Delhi pointed out
that most Homoeopathic colleges do not have a proper IPD, OPD and students do not get
adequate clinical experience.
There is very little clinical training. There is a need for
enforcing some basic minimum standards for AYUSH educational institutions.
Dr. P.R. Ramesh, Chief Physician, Kottakkal Arya Vaidya Sala
laid emphasis on
standardization of Ayurvedic raw materials, optimizing of formulations and dosage forms,
modernization and updating of formularies, starting Ayurvedic scholarship schemes and
setting up a multi-disciplinary research centre capable of undertaking research work at
molecular level.
Dr. R. Vijay Kumar, Commissioner, ISM&H, Tamil Nadu emphasized the need for
clinical research, statistics and research methodology component in AYUSH education. He
suggested introduction of training for AYUSH physicians and training of teachers.
The
expertise of local healers like bone setters needs to properly evaluated for inclusion in
AYUSH/modern medicine curricula as well coopting local healers in the health care delivery.
Moreover, mainstreaming of AYUSH should be extended to urban areas.
He suggested
broadening of scope of Reorientation Training and Continuous Medical Education.
46
Dr. Mohd. Qasim a noted Homoeopathic practitioner and former Professor, B.R. Sur
Homoeopathy College brought out the need to have teacher training programmes and
upgradation of professional knowledge of teachers to contemporary relevance.
emphasized comprehensive clinical training for students.
He
He specifically mentioned the
need for research-oriented training.
Dr. S.K. Sharma, Advisor (Ayurveda), Department of AYUSH mentioned that some
States have no AYUSH college, such States should be supported for opening of AYUSH
College in Govt. Sector with one time lumpsum funding from the Central Government.
Secretary (AYUSH) expressed the view that the Central Government can only respond to
locally felt needs and concerned States should come up with specific proposals indicating
their own commitments for recurring and
non-recurring expenditure and Central
Government can at best do gap filling for capital expenditure.
supported creation of a AYUSH Pharma Development Fund.
Adviser (Ayurveda) also
J.S. (SB) mentioned that the
Pharma Development Fund administered by Department of Science and Technology is also
available to AYUSH Pharma Units. The need for increasing the corpus would arise only when
more and more viable proposals are submitted to Department of Science & Technology by
AYUSH Pharma Units than they can fund from the existing corpus. He suggested a meeting
with Department of Science & Technology and AYUSH Pharma representatives to sort out
this issue.
Dr. Jiyalal of Rashtriya Guni Mission emphasized the need for validation of treatment
given by Gunis and their cooperation in the national health delivery network.
Shri G.P. Singh Jhala, Rashtriya Guni Mission suggested the need for proper
documentation of their practices. He also suggested establishment of herbal gardens in
public places and schools and cautioned against haphazard cultivation of medicinal
plants.
Dr. A. A. Ansari, Adviser (Unani), Department of AYUSH emphasized that the
conditions of Government Colleges should be improved.
Assistance to five Centres of
Excellence in Unani Medicine, which were identified during 10th Five Year Plan should be
assisted in the 11th Five Year Plan. According to him. Government grants should be confined
to State Government Institutions.
47
Shri B.P. Sharma, Joint Secretary, Ministry of Health and Family Welfare generally
supported the recommendations of the Task Force on mainstreaming of AYUSH.
He,
however, mentioned that National Rural Health Mission (NRHM) funding is limited and
contractual hiring of AYUSH doctors would be possible only for CHCs/PHCs and not for sub
centers. According to him, this proposal would need approximately Rs. 1000 crore, which
would not be feasible from NRHM budget at this stage.
J.S. (SB) clarified that States were
asked to examine this proposal in the joint letter issued under the signature of Secretary
(Health) and Secretary (AYUSH).
JS (SB) requested all the members to send their suggestion by e-mail quickly so that
the report of the Working Group could be sent to Planning Commission.
The meeting ended with the Vote of thanks to the Chair.
48
SI.
No.
ANNEXURE
LIST OF PARTICIPANTS
IN THE 1st MEETING OF WORKING GROUP HELD ON 24.7.2006
AT 11.00 A.M. IN THE COMMITTEE ROOM IN IRCS BUILDING,
NEW DELHI
Name, Designation & Address
1.
Shri Vijay Singh, Secretary, Department of (AYUSH)
2.
Shri Shiv Basant, Joint Secretary, Deptt. of AYUSH
3.
Shri Verghese Samuel, Joint Secretary, Deptt. of AYUSH
4.
Shri B.P. Sharma, Joint Secretary, Deptt. of Health
5.
Shri B.S. Sajwan, CEO(NMPB)
6.
Dr. S.K. Sharma, Adviser (Ay)
7.
Dr. S.P. Singh, Adviser (Homoeopathy)
8.
Dr. Anis A. Ansari, Adviser (Unani)
9.
Dr. V.V. Prasad, Director, RAV, New Delhi.
10.
Dr. G.S. Lavekar, Director, CCRAS, New Delhi.
11.
Dr. D.R. Lohar, Director, HPL/PLIM, Ghaziabad
12.
Shri Bala Prasad, Director, Deptt. of AYUSH
13.
Dr. N.P. Singh, Director, Deptt. of AYUSH
14.
Dr. G.P. Garg, Chief Chemist, Medicinal Plants Board.
15.
Shri A.K. Harjani, Deputy Director(PW), Deptt. of AYUSH.
16.
Shri T.S. Bhatia, Deputy Secretary, Deptt. of AYUSH.
17.
Dr. D.C. Katoch, Dy. Adv.(Ay.), Deptt. of AYUSH
18.
Dr. M.A. Kumar, Dy. Adv.(Siddha), Deptt. of AYUSH.
19.
Dr. S.N. Sahu, Dy. Adv.(Homoeo), Deptt. of AYUSH.
20.
Dr. Abhimanyu Kumar, Associate Professor, National Institute of Ayurveda,
Jaipur.
21.
Dr. M. Qasim, (Homoeo), B-36, Nizammudin West, New Delhi-13
22.
Dr. S.K. Gupta, Research Officer, Planning Commission, New Delhi.
23.
Shri Rajeev Lochan, Director, Planning Commission, New Delhi.
24.
Shri K. Kalaivovi, Director, Incharge, National Institute of Health & FW., New
Delhi.
25.
Dr. Vasantha Muthuswamy, Sr. DDG, ICMR, New Delhi.
26.
Dr. R. Vijay Kumar, Special Commissioner, ISM&H, Govt, of Tamil Nadu,
Chennai.
27.
Dr. N.S. Dharmshaktu, Director General, Directorate General of Health
Services, New Delhi.
49
28.
Dr. Darshan Shankar, Director, FRLHT, Bangalore.
29.
Dr. C.K. Katiyar, Director, Herbal Division, RANBAXY
30.
Dr. K.S. Rawat, Deputy Director, Ayurvedic & Unani Services, Uttaranchal.
31.
Dr. V.K. Khanna, Principal, Nehru Homoeopathy College, Delhi.
32.
Dr. Anirban Pal, Scientist, CIMAP(CSIR), Lucknow.
33.
Prof. Shakir Jaimir,
34.
Dr. G.P. Singh, Jwala Jagaran Jan Vikas Samiti
35.
Vaidhya Jiyalal, Rashtriya Guru Mission.
36.
Vaid Devendra Triguna, President Ayurvedic Congress, New Delhi.
37.
Dr. R.P. Mattoo, President, Natural Resources India Foundation.
38.
Dr. Ramesh P.R., CMOPSUDENT,
Karkerdooma, Delhi-110099.
39.
Dr. H.M. Chandela, Reader, KC, Institute of Post Graduate Training and
Research in Ayurveda, Jamnagar.
40.
Dr. B.L. Gaur, Vice Chancellor, Rajasthan Ayurveda University, Jodhpur.
Arya
Vaidya
Sala
Ay.
Hospital
50
Government of India
Department of AYUSH
Report of the Task Force on AYUSH Education
1.
Present status of AYUSH Education
1.1
The Regulatory System
Medical education in the Ayurveda, Siddha and Unani Systems is governed by the Indian
Medicine Central Council Act, 1970 (IMCC Act) while medical education in the Homoeopathy
System is governed by the Homoeopathy Central Council Act, 1973 (HCC Act). Both these
Acts, which are broadly similar in nature, have provisions for the setting up of autonomous
regulatory Central Councils which have wide ranging powers to prescribe the courses of
study and their duration and the conduct of examinations in medical colleges. The major
source of power for the Councils in the past lay in their discretion to grant permission for the
setting up of new colleges and the starting of higher courses of study and the increase in
admission capacity in existing colleges. Neither the IMCC Act or the HCC Act gave the
Councils the power to grant such permissions, but this did not in any way inhibit the Councils
from processing cases and granting permission for the opening of hundreds of medical
colleges in the country in recent years. The mushroom growth of sub-standard new colleges
became so alarming that the Government was forced to amend both the IMCC and HCC
Acts to specifically empower the Central Government to grant permission for the opening of
new medical colleges, etc. It is also noticeable that the role of the Universities in AYUSH
education has progressively become more and more limited given the wide ranging and
extraordinary powers wielded by the Central Councils with respect to all academic matters.
There is no Central legislation for the regulation of Naturopathy and Yoga medical
education.
51
1.2
The availability of AYUSH medical colleges
At present, there are 450 AYUSH medical colleges in the country, of which 99 colleges offer
post-graduate courses. The admission capacity at Under Graduate level is 24880 while the
admission capacity at Post Graduate level is 2325. The details are given below:-
Ayurveda
Unani
Siddha
Naturo
pathy
Homoeop
athy
Total
219
37
6
10
178
450
9865
1525
320
385
12785
24880
Post Graduate
Colleges
Exclusive PG
Colleges
57
8
3
31
99
2
1
1
2
6
Admission
Capacity (PG)
905
73
110
1040
2128
Admission
Capacity
(Exclusive PG )
40
28
30
99
197
Under
Graduate
Colleges
Admission
Capacity (UG)
1.3
Course design
The Graduate and Post Graduate courses in Ayurveda, Siddha, Unani, and Homoeopathy
and the Degree course in Naturopathy and Yoga are based on the corresponding Allopathic
medical courses and are designed to lead to the award of Degrees from the Universities to
which the colleges are affiliated. In all these systems there is a uniform five and a half year
Degree course which includes one year of internship training. There are three year Post
Graduate courses in 22 specialties of Ayurveda, 6 specialties each of Unani and Siddha and
7 specialties of Homoeopathy which are offered by various colleges. Admission to these
Post Graduate courses is generally on the basis of a qualifying test. There is no Post
Graduate course in Yoga and Naturopathy. The course design for both Under Graduate and
Post Graduate courses is blindly imitative of the corresponding courses in Allopathic
medicine.
52
1.4
Pharmacy and Para medical Education
There is no Central regulation of Pharmacy and Para-medical training in AYUSH systems.
There are 14 Ayurveda pharmacy colleges, 2 Siddha pharmacy colleges, 4 Unani pharmacy
colleges and 8 Homoeopathy pharmacy colleges which offer Pharmacist training courses at
Certificate, Diploma and Degree levels. The duration of these courses ranges between 10
months to 4 years and the minimum qualification for admission is Matriculation or Senior
Secondary. The course content and curriculum vary widely from state to state and the
quality of the training is by and large unsatisfactory These colleges turn out only 915
Pharmacists every year which is only a fraction of the present demand. The position of para
medical education is more or less the same.
1.5
Quality of AYUSH medical education
There was a consensus in the Task Force that in spite of the tremendous expansion in
AYUSH education facilities in recent years or, perhaps, because of it, the general quality of
AYUSH medical education remains very unsatisfactory. With some honourable exceptions,
most AYUSH educational institutions do not provide quality medical education and the
products of these institutions lack knowledge of the fundamentals of the concerned system
of medicine. It was recognised that AYUSH education is just producing half baked
practitioners who are barely able to practice in the best traditions of their systems. More
importantly, this lack of quality in the AYUSH practitioners is responsible for the decline in
the quality of AYUSH health care delivery and is preventing AYUSH systems from playing
an active role in the national health programmes.
53
1.6
Attempts by Government to improve the quality of AYUSH education
In recognition of the fact that the quality of AYUSH education had to be upgraded, the
Government of India is implementing a Centrally Sponsored Scheme “Development of
Institutions” under which financial assistance is provided for the expansion and renovation of
buildings; purchase of library books, equipment and scientific instruments; the strengthening
of teaching hospitals; the development of computer laboratories and internet facilities; the
development
of
postgraduate
departments;
for
conducting
re-orientation
training
programmes; and, for the development of model colleges. However, the scheme does not
cover private colleges as far as capital works are concerned and the financial assistance
provided has not always managed to improve the educational standards to the desired
extent. The scheme cannot be said to have improved the quality of AYUSH educational
institutions to any significant extent.
2.
Problem Areas
2.1
Breakdown of the regulatory system
The regulatory system created by the IMCC and HCC Acts has clearly been perverted by
the regulatory Councils themselves in their single minded concentration on enabling more
and more sub standard new colleges to be set up. This has ensured that the elected seats
on the Council have been effectively captured by non academic persons who run colleges or
have a direct interest in the management of colleges. The Councils do not even go through
the pretence of being concerned about academic standards or about the manner in which
the medical colleges are being managed. The only issue which concerns the Councils
nowadays is the opening of new colleges and, more importantly, the attendant activity of
conducting inspections of the candidate colleges. The idealistic experiment of having
autonomous regulatory Councils has most certainly broken down.
2.2.
Poor infrastructure
The general quality of the AYUSH teaching infrastructure in the country is far from
satisfactory. The major reason for this is the lack of investment. In the case of government
institutions, there is benign neglect as the finances of the State Governments do not permit
adequate funding. This is a particular problem since many old and reputed institutions are in
54
the government sector. Even when funds are available, proper utilisation does not take place
because of problems with financial and procurement procedures. In the case of private
institutions, the promoters are often unwilling to invest in any facility which will not give a
commercial return on investment. The position of the newer colleges set up in recent years
is particularly bad since the promoters rarely make any attempt at setting up sufficient
academic infrastructure in terms of the minimum standards prescribed by the Councils.. The
situation has deteriorated to such an extent that most promoters of AYUSH medical colleges
now feel that there is no need to create infrastructure in terms of the minimum standards
since it is perfectly possible to ensure that a student obtains a degree purely on the basis of
classroom instruction.
2.3.
Lack of qualified and committed teachers
The Task Force felt that the lack of teachers and, more importantly, the lack of good quality
teachers was a major problem affecting not just the development of the AYUSH education
but also the development of the entire AYUSH sector. In the government sector, the poor
financial condition of the State governments and the accompanying stringent budgetary
controls have ensured that posts are not created whenever required and that even existing
posts are not filled up. In the private sector, the promoters of medical colleges have realised
that they can manage with far fewer teachers than stipulated in the regulations by either
hoodwinking or colluding with the Councils. The widespread practice in the private sector of
teachers being engaged on contract basis has also had a very adverse effect on the quality
of teaching. Another problem in the private sector is the low salaries paid to teachers as a
result of which only below average persons are attracted to teaching jobs. The quality of the
existing teachers remains less than satisfactory in spite of the Central scheme for the re
orientation training of in-service teachers having been in existence for quite some time. It is
felt that the teachers are not conversant with the latest thinking in research and that their
professional knowledge has not been updated. They are also perceived as being ignorant of
the larger world of science. Demotivation of teachers is a serious problem.
2.4.
Mushroom growth of sub standard colleges
The greatest threat to AYUSH education in recent years has been the extraordinary growth
of sub-standard private medical colleges. During the period 1996-2006, as many as 198 new
colleges were set up, the vast majority being in the private sector. To put it in perspective, it
55
must be remembered that this constitutes a full 44 percent of the total number of AYUSH
medical colleges in the country. These colleges in general have little or no infrastructure in
terms of the minimum standards prescribed; staffing levels are generally inadequate; and
the quality of instruction is poor. Most of these newly opened colleges are churning out ill
trained and barely educated AYUSH practitioners. The responsibility for this appalling
situation rests entirely with the statutory Councils which actively colluded with the promoters
to ensure that these colleges were set up in violation of the regulations issued by the
Councils themselves with regard to minimum standards, staffing, infrastructure, etc.
2.5.
Unsatisfactory curriculum and course content
There is a general consensus that curriculum and course content of the AYUSH Degree and
Post Graduate courses require significant improvement. The existing curriculum is imitative
of the Allopathic curriculum to the extent that the very character of the Ayurveda, Siddha,
Unani and Homoeopathy systems gets compromised. The load on undergraduate students
in terms of subjects and papers at Degree level appears to be excessive and unnecessary
when compared to the load for MBBS students. The Allopathic medicine component at
Degree level appears to be disproportionately large for no apparent reason. The
examination system is compromised by the fact that not enough suitably qualified examiners
are available. The problems in this area are due to the fact that it is the CCIM and the GOH
which exclusively regulate the curriculum and course content and the role of the Universities
is restricted to the conduct of examinations.
3.
Recommendations
3.1.
The regulatory system
3.1.1
The role of the Councils to be re-defined
There is an imperative need for root and branch reform of the regulatory Councils. The
simplest option would be the IMCC and HCC Acts to be amended to ensure that only
academics and persons of high repute can get elected to the Councils and, more
importantly, to ensure that the Councils cannot be captured by commercial interests with
deep pockets. Amendments are also required to restrict the membership of the Councils to a
fixed tenure of five years. The regulatory Acts should also have provisions enabling the
Government to give directions to the Councils on matters of public policy and to enforce
56
these decisions. In extreme cases, the Government should also have the power to dissolve
the Councils. The Bills to amend the IMCC and HCC Acts which have been introduced in
Parliament contain many of these provisions. The Department of AYUSH should attempt to
get these Bills enacted as quickly as possible.
3.1.2 The role of the Universities
The Universities should be given a significant role in regulating AYUSH education. The
Universities could prescribe course curricula and syllabi, training modules and organize the
examination system. The Councils should prescribe the broad outline of the curriculum and
the Universities should prescribe the subject content, the duration and phase wise break up
of courses, pass standards, required faculty levels and required infrastructure, etc. It is
obvious that the Universities should be given the responsibility of maintaining and enforcing
educational standards as this is not something which cannot be done with any effectiveness
in a centralized manner as has been successfully demonstrated by the Councils.
3.1.3 Setting up of Regional AYUSH Universities
In the long run, the Task Force is of the opinion that the cause of AYUSH education would
be best served by setting up 4 regional AYUSH universities which would be Centrally funded
including the existing Ayurveda Universities of Gujarat and Rajasthan to which all the
AYUSH institutions could be affiliated. The various National Institutes could also be affiliated
to these Universities or alternatively could be given Deemed University status. The proposed
decentralization of regulation in academic matters would definitely result in higher standards
of training and this would certainly have a beneficial effect on the development of AYUSH
systems in the country.
3.1.4 Setting up of an Accreditation system
The setting up of the regional AYUSH Universities will take a certain amount of time given
the need for Central legislation. Since educational standards are declining rapidly and given
the drift in the policies of the CCIM and the CCH, it is necessary to adopt certain measures
outside the existing regulatory system to check the decline in educational standards. The
Task Force is of the opinion that a formal accreditation system for the ranking and gradation
of colleges on the basis of the quality of their teaching and training facilities and
infrastructure should be set up. The accreditation system will not only inform the public about
S'!
the standards of education in different colleges but also help the Government to identify
institutions which can be given financial assistance for further development of academic
standards. The accreditation mechanism should be operated by the Department of AYUSH
through a Board comprising eminent academics and experts.
3.1.5
Regulation of Yoga and Naturopathy
The issue of whether a separate statutory regulatory authority should be set up for Yoga and
Naturopathy on the lines of the existing Councils was discussed. It was noted that there
were only 10 colleges offering BNYS courses at present. The number of practitioners is also
guite low. This being the case, there does not seem to be any justification for setting up a
separate statutory regulatory system for Yoga and Naturopathy. That said, there is still a
case for regulating Yoga and Naturopathy education by means of alternative institutions. At
the moment it is the Universities which are setting the curriculum and course content and
conducting examinations. Since there are only a few such Universities and since the
intellectual content of Naturopathy makes it inherently more liable to be misused, it is
essential that some kind of standardization and rationalization of the curriculum and course
content be imposed. The optimal solution appears to be an accreditation system for
institutions and a registration system for practitioners to be to be implemented by the
CORYN or NIN for Naturopathy and by MDNIY for Yoga.
3.2
Improvements in professional training
3.2.1
Training at Degree and Post Graduate levels
There is an urgent necessity to improve clinical training. The emphasis should be on starting
clinical training as early as possible in the Degree courses. The basic objective of AYUSH
education should be to produce professionally competent doctors who are thorough with the
fundamentals of their systems and who have undergone intensive practical clinical training.
The training should enable AYUSH doctors to handle patients and to diagnose conditions
purely in terms of the accepted principles of the system concerned without unnecessarily
taking recourse to the diagnostic technigues used in Allopathic medicine. It is also important
that the doctors do a compulsory rural posting of two years before they are considered for
post graduation.
58
3.2.2 In service Training
The need for a complete overhaul of the in service training system cannot be
overemphasized. Given the rapid changes in scientific and technical knowledge, it is
imperative that an opportunity be given to all practitioners to update their professional
knowledge. The existing system which has been funded through a component of the
Centrally Sponsored Scheme for the Development of Institutions has not been particularly
successful. A change of strategy may therefore be considered and dedicated training
centres may be designated or set up where necessary. National Institutes, the Rashtriya
Ayurveda Vidyapeeth and certain Universities or premier AYUSH institutions should be
designated as Training Centres where Continuing Medical Education and the periodic re
orientation of practitioners and teachers would be provided throughout the year.
3.3
The financing of Medical Colleges
It is clear that the Centrally Sponsored Scheme for the Development of Institutions was
conceptually flawed since It was too rigid and the guantum of financial assistance was not
adeguate. Given the crisis in AYUSH education, it is essential that the scheme be
reformulated so that it can be more flexible such that it can take account of the reguirements
of individual institutions while at the same time ensuring that larger amounts of money are
made available to the institutions. This would also mean that it would be necessary to focus
on a smaller number of institutions rather than spread the money thin as at present. The
Government should select around 20 or 30 good institutions and fund development schemes
for improving infrastructure and facilities and the hiring of guality staff. The ultimate aim
should be to produce world class institutions by the end of the 11th Plan period. Institution
specific development plans should be implemented rather than the one-size-fits-all plans
now being implemented. There should also be no distinction between government owned
and privately owned institutions for the purpose of receiving funding under the scheme. The
outlay on the scheme should be increased threefold
3.4
Preventing the opening of sub-standard medical colleges
3.4.1. Legal provisions to be strengthened and better enforcement
The strict enforcement of the provisions of the IMCC Act and the HOC Act regarding the
grant of permission for starting new medical colleges, starting higher courses of study and
59
increasing admission capacity is probably the only way to prevent the mushrooming of sub
standard medical colleges. The regulations to govern the enforcement of section 13A of the
IMCC Act are inadequate and require immediate replacement or extensive amendment. The
regulations should be realistic and the intention should be to ensure that minimum standards
of staffing, infrastructure and facilities are in place before a medical college is permitted to
admit students.
Regulations for the enforcement of section 13C of the IMCC Act are
urgently required so that the formal permission required under the Act for the medical
colleges which were in existence when the IMCC Amendment Act was amended in 2003
can be processed. The position regarding new Homoeopathy medical colleges is more
problematic since the CCH has blatantly defied the Government by refusing to notify the
regulations framed under section 12A of the HCC Act. It is urgently required that regulations
be notified to govern the enforcement of the amended provisions of the HCC Act relating to
the starting of new colleges, etc.
3.4.2 State Governments and Universities to be responsible when giving No Objection
certificates and Affiliation to new medical colleges.
State Governments and Universities should act responsibly when granting No Objections
and Affiliation to new colleges. The indiscriminate grant of No Objections by the State
Governments and the routine grant of Affiliation by the Universities is one of the reasons for
the mushroom growth of AYUSH medical colleges during the past ten years. New colleges
should be allowed to come up only when there is a gap in the availability of AYUSH medical
practitioners in that particular state which cannot be filled up in any other way. It must be
remembered that the total annual output of AYUSH medical graduates and post graduates in
the country is around 27000. The comparative figure for Allopathic medical graduates and
postgraduates is around 29000. It can therefore be seen that there is no critical shortage of
AYUSH doctors such that the standards of training require to be lowered or compromised to
enable greater output. The blatant commercialization of AYUSH education must be checked
before it affects the development of the systems themselves.
3.5
Monitoring the standard of instruction in Medical colleges
3.5.1
Regulatory Councils to monitor the standard of instruction
Monitoring the quality of instruction in medical colleges is probably one of the most important
regulatory functions of the CCIM and CCH. Unfortunately, this is something which gets very
60
low priority with the Councils which concentrate shamelessly on the grant of permission for
new colleges for very obvious reasons. The impact of this non-concern is evident in the
declining standards of AYUSH education. Amendments must be made to the relevant
regulations to ensure that the Councils are duty bound to monitor the standard of instruction
in colleges. It must also be ensured that a qualitative assessment is done rather than a mere
counting of the number of teaching staff available, the number of class rooms, etc. The
Universities must also be involved in this exercise by the Councils.
3.5.2 Punitive action to be taken against colleges where the quality of instruction is
unsatisfactory
One reason why colleges do not bother about maintaining academic standards is that there
is no compulsion to do so. The IMCC Act contains a provision for de-recognition which is
precisely meant for situations where a college is not maintaining the prescribed academic
standards. For reasons which are not clear, this provision is rarely, if ever, invoked against
erring medical colleges. It is essential that the inspections proposed at para 3.5.1 should
identify the colleges which are not maintaining appropriate academic standards. These
colleges should then be given an opportunity to take suitable corrective action and in the
event no action is taken or if the action taken is insufficient de-recognition should be resorted
to. If the provision for de-recognition is fairly and ruthlessly enforced, there is little doubt that
there will be a perceptible improvement in academic standards.
3.6.
Pay structure for Teachers
One of the reasons why AYUSH medical colleges do not attract quality teachers is the fact
that most colleges do not offer satisfactory pay scales for teachers. It should be recognized
that unless pay scales are improved it would not be realistic to expect good teachers to work
in AYUSH colleges. UGC scales should be available to teachers in AYUSH colleges subject
to the introduction of appropriate accreditation systems for ensuring that teachers acquire
higher qualifications, etc.
3.7
Post graduate education
The strengthening of Post Graduate education is vital for the development of teaching and
research. There is a shortage of good teachers and there has to be focus on research if the
systems are to achieve a high degree of scientific credibility. It is therefore essential that
61
Post Graduate education be given the necessary attention it requires There is an immediate
need to strengthen Post Graduate departments and this can be done as a part of the new
scheme for the creation of institutions of excellence to be introduced in the 11th Plan. Post
Graduate education requires rationalization because a large number of irrelevant courses
have been introduced, particularly in Ayurveda, in an attempt to mimic the specialities in
Allopathic medicine. In the interest of the development of AYUSH systems, it is essential
that specialization should only be in classically recognized areas of the systems and not in
artificially created areas merely on the analogy of specializations in Allopathic medicine.
Opportunities should also be created for the admission of Ayurveda, Unani, Siddha and
Homoeopathy graduates in system-neutral non-clinical Post Graduate medical courses like
Anaesthesia, Radiology, Anatomy, Physiology, Optometry, Hospital management etc.
offered by Allopathic medical colleges and other institutions instead of trying to create
AYUSH versions of these specialities. It would also be necessary to start Post Graduate
diploma courses in specialities for AYUSH medical graduates at University level.
3.8
Pharmacy education
There is an urgent necessity to regulate Pharmacy training in AYUSH systems so as to
provide adequate numbers of Pharmacists for manufacturing units and hospitals. The ISM
&H Pharmacy Bill which has been introduced in Parliament would be sufficient for this
purpose. The Department of AYUSH should take urgent steps to get the Bill approved by
Parliament.
3.9
Para Medical education
Para medical education requires to be systematized and standardized. Ideally, para medical
courses should be started by existing AYUSH teaching institutions. Without adequate
numbers of para medical personnel, it will not be possible to popularize or expand the reach
of AYUSH systems. This particularly relevant given the participation of AYUSH systems in
the NRHM and other national health programmes and the expansion of AYUSH
dispensaries and hospitals envisaged under the Centrally Sponsored Schemes in the 11th
Plan. The provision of Central assistance for encouraging AYUSH institutions to start para
medical courses should also be considered by the Department of AYUSH.
62
REPORT OF 11th PLAN WORKING GROUP ON
STANDARDIZATION & QUALITY CONTROL OF ASU & H
MEDICINE
To publish Pharmacopoeial standards for Ayurveda, Siddha and Unani and
Homoeopathy (ASU&H) medicines both for single and compound drugs is one of the priority
work of the Department of AYUSH. The Ministry had taken up the task of developing
pharmacopoeial standards through Pharmacopoeia Committees.
Four different
Pharmacopoeia Committees are working for preparing official formularies/pharmacopoeias,
to evolve uniform standards in preparation of ASU drugs and to prescribe working standards
of single drugs as well as compound formulations. Pharmacopoeial standards are important
and are mandatory for the implementation of the drug testing provisions under the Drugs
and Cosmetics Act, 1940 and Rules thereunder. These standards are also essential to
check samples of drugs available in the market for their safety and efficacy.
The Department of AYUSH launched a Central Scheme to develop Standard
Operating Procedure of manufacturing processes, to develop pharmacopoeial standards
and shelf life studies of Ayurveda, Siddha & Unani Compound drugs under 10th Five Year
Plan, and achieved significant results, but still lots of work have to be done in the field of
standardization and quality control. For this strengthening/upgrading of various drugs
testing laboratories (Government/ autonomous/states/ other accredited
laboratories),
ensuring of availability of genuine raw materials of commonly available drugs as well as rare
and endangered drugs of plants/animals/minerals origin, substitutes of similar species have
to taken up in the 11th Plan to handle the task of drugs quality control. New area relating to
drugs e.g. strengthening of Drugs Control department of States and Central, Developing
Herb garden/Museum/herbarium are essential requirement for quality medicines. For this
Planning Commission has constituted a Working group headed by the Secretary, AYUSH, to
access the Health System, Department of AYUSH, further constituted a task force on
“Standardisation and Quality control of AYUSH Drugs”. The following members participated
in the meeting:-
1.
2.
3.
4.
5.
6.
Dr. S.K.Sharma, Adviser, Deptt. of AYUSH, New Delhi
Dr. G.S. Lavekar, Director, CCRAS, New Delhi
Dr. C.K.Katiyar, Ranbaxy, Gurgaon
Dr. P.K.Warrier, Arya Vaidya Shala, Kotakkal,
Dr. (Mrs.). S.K. Khanrasad, Scientist -F, Deptt. of Science & Technology
Dr. D.R.Lohar, Director, HPL/PLIM, Ghaziabad, Member Secretary,
Special invitees
7. Dr. Padma Venkat, Jt. Director, FRLHT, Bangalore
8. Dr. Y.K.S. Rathore, Jt. Director, CRCL, New Delhi.
The TASK FORCE held two meetings on 3rd July ,2006 and on 14th July,2006 at CCRAS,
Janakpuri, New Delhi, discussed various issues and after detailed deliberations on
Standardisation and Quality control on AYUSH drugs, made the following recommendations.
63
RECOMMENDATIONS OF THE WORKING GROUP ON QUALITY CONTROL
& STANDARDISATION OF ASU & H DRUGS.:
1. LAYING DOWN OF PHARMACOPOEIAL STANDARDS:
To undertake testing of multiple ingredients compound formulations, it
is necessary first to have the test for single drugs going in the formulation.
Therefore, Ayurvedic, Siddha, Unani & homoeopathic Pharmacopoeia
Committee have undertaken this work at priority and has made significant
achievement in case of single drugs.
Five Volumes of Ayurvedic
Pharmacopoeia of India containing 418 monographs and one volume of
Unani Pharmacopoeia of India containing 45 monographs has been
published. There is an urgent need to complete the major single remaining
ASU drugs. The number of such drugs is about 200 to be worked in 11th
Plan. Nine volumes of Homoeopathy Pharmacopoeia containing 1000 Drugs
have been published. Work on finished Products (Mother tincture) need to
be taken up in 11th Plan.
The Standardized monographs on minerals and metals to be used as
raw-materials are equally important before developing the SOP and Quality
Standards of Bhasmas. Therefore, the work initiated in 10th Plan need to be
continued in the 11th Plan. The animal bye-products, marine products are
also used in ASU drugs for which the standards are to be developed.
Although, the Pharma industry is making use of extracts in various
dosage forms yet there are no pharmacopoeial standards of extracts to be
used as intermediate raw material. Therefore, it is necessary to develop the
Quality Standards along with their Safety Profile for the extracts of the most
common drugs used in ASU system. It is also necessary to develop
pharmacopoeial & quality standards for Indian medicinal plants used for the
purpose of food and cosmetics and official substitutes of non available
drugs/ plants/animals. This work should be give priority in the 11th Plan.
Thin Layer Chromatography (TLC/GLC) technique are quite relevant to
identify the marker compound as well as major ingredients. Therefore, there
is a need to prepare chromatograms/finger-printing Atlas of the single drugs
used in ASU system.
All these Pharmacopoeial activities will be carried out with the help of
PLIM/HPL, CCRAS, CCRUM, CCRH, University Laboratories, CSIR & other
laboratories capable of undertaking this work.
Pharmacopoeial Standards of Multiple Ingredient Compound
formulation is one of the priority area wherein the work has been initiated in
the 10th Plan for 300 formulations. This needs to be taken more vigorously
64
in the 11th Plan and target should be to publish SOPs and Quality
Standards, Shelf Life monographs for at least 100 compound formulation per
year to complete the work on 500 ASU drugs in the 11th Plan.
There is an urgent need to revise and up-date the various volumes of
Pharmacopoeias and Formularies. This needs constant documentation and
networking of the laboratories. The existing arrangement of Ayurvedic
Pharmacopoeia Cell in the Department of AYUSH/ and CCRAS is inadequate
to provide technical and scientific assistance to the Pharmacopoeial work.
Keeping in mind the increasing demand of AYUSH & plant based
drugs, there is a need to give top priority to the Pharmacopoeia work of
Ayurveda, Unani, Siddha and Homoeopathy.
This work can be
systematically carried out with the help of an Autonomous body ‘Ayurvedic
Pharmacopoeia Commission’ fully supported and staffed
by the
Department of AYUSH. This could be housed in the new campus of PLIM,
Ghaziabad.
For Pharmacopoeial, Quality Standard work as well as setting up of
Ayurvedic Pharmacopoeia Commission, an allocation of Rs. 20 crores will be
required for 11th Plan.
2.
Capacity Building:
Strengthening of DTLs for ASU & H for the acceptability of the ASU & H
drugs:
It is necessary that the Pharmacopoeial Standards published by
Government of India are complied by the manufacturers as well as DTLs.
There are about 10,000 manufacturing units preparing lakhs of classical and
P&P formulations. As per new provisions of the Drugs & Cosmetics Act
various labeling provisions for domestic and export purpose require huge
infrastructure of laboratories. Department of AYUSH has supported 22 State
Government DTLs in tune of Rs. 1 crore each, but their functioning capacity
is very limited. There is acute shortage of trained experts as there is
constraint of regular employment of scientists in the State DTLs etc. The
new GMP provisions require regular testing during the process of
manufacturing as well as for the products. Therefore, there is a need of
developing and supporting large number of DTLs for ASU &H systems. The
following categories of institutions/ laboratories will be supported for this
purpose
i)
ii)
PLIM & HPL/ CCRAS/CCRUM/CCRH
State DTLs
65
Eminent Laboratories/Institutions having good infrastructure to
undertake testing of AYUSH drugs in the Universities as well as
other such institutions.
All
the PG teaching Departments of Dravya Guna, Ras Shastra,
iv)
Bhaishajya Kalpana, Gun Padam, Ilmul Advia and Materia
Medica & Good Pharmacy Departments
In-house DTL of the industries
v)
Labs run by Associations of ASU&H drug industry
vi)
vii) Co-operative Labs run by a group of drug industry
viii) Development or identification of a lab dedicated to isolation of
marker compounds.
All such institutions require generous funding to develop infrastructure
as well as expert human resource. This work can be carried out with
the help of an Autonomous body ‘Ayurvedic Pharmacopoeia
Commission’ fully supported by the Department of AYUSH. This will
require an amount of Rs. 100 crores during the 11th Plan.
iii)
3.
Centre for Safety Evaluation/Toxicity Studies for Ayush Drugs:
Although, the most of the classical ASU medicines are used in the
human being for centuries in India and they are considered safe. However,
there is a felt need to establish the safety of various single drugs as well as
formulations containing poisonous ingredients in various dosage forms. To
implement the concept of Pharmaco-vigilance, it is essential to pick-up the
samples of the products containing heavy metals as well as poisonous
ingredients and confirm their safety. In the present scientific era, the Indian
consumer also want to re-ensure the safety profile of ASU&H drugs.
Therefore, there is a need to set-up and support national facilities for safety
evaluation of ASU drugs. The institutions like PLIM/HPL/CCRAS can also
have Pharmacology/Toxicological Department with Animal House facilities
etc. PLIM should have a centre for conducting pharmacology toxicology on AYUSH
products. This centre should have expertise in both
in-vitro and in-vivo
pharmacological experiments suitable for AYUSH drugs. Special emphasis should be
laid down on molecular pharmacology with a view to elucidate the mode of action of
these products to the maximum possible extent. A Centre for Pharmaco vigilance
may also be created in 11th five year Plan.
An amount of Rs. 20 crores will be required to support/establish the
facilities at couple of places in the country.
4.
National Herbarium, Museum, Herbal Garden for ASU&H Drugs:
For R&D purpose, as well as for reference purpose, there is a need to
establish/strengthen a couple of medicinal plant garden containing all the
medicine plant Species used in ASU & H system. These gardens will act as
66
Demonstration Garden as well as source of authentic raw-drug samples.
Some of the gardens established by State/Institutions like Himachal Pradesh
Garden at Joginder Nagar, CCRAS Garden at Pune & Jhansi, 4 Gujarat
Government Gardens at Ahmedabad and other places and other such
gardens having predominant species of ASU plants needs financial support.
A proper documentation of the herbarium sheets and samples in the
form of herbarium and museum at various places require financial
assistance. Various survey material & Herbarium sheet samples collected
by CCRAS/CCRUM/CCRH need proper preservation as well as
documentation. The herbarium at PLIM/HPL and research Councils and at
our National Institutions also needs an up gradation.
This will require Rs. 20 crores in the 11th Plan.
Training and provisions of Scholarships/Fellowship in ASU&H
Pharmaceuticals, Quality Control & Standardization:
5.
Degree, Post Graduate & Post Doctorate training is required in ASU&H
drug sector. CME & various short-term/long term training courses for
Quality Control, Standardization etc. are required to up-to-date the skills of
the Scientists. Courses like B. Pharma (ASU& H), M. Pharma (ASU & H),
P.G. Diploma in testing procedures, various MS/MSc/Ph.D programmes on
ASU drugs require financial assistance. There is a lot of scope to float
Junior/Senior Research Fellowships as well as P.G. & Ph. D. Fellowships for
students undertaking research in the area of ASU & H drugs. Similarly
training is required for working Scientists, Drugs insectors, Drugs Analysts,
Pharmacists, Manufacturing Chemists, Pharmacy Professors, medical
officers and Quality enforcement agencies in latest development in quality
control. This will require strengthening of infrastructure as well as HRD
related issues, fellowships etc and will require Rs. 20 crores in the 11th
Plan.
6.
Strengthening of PLIM/HPL, Ghaziabad
Buildings of HPL and PLIM Ghaziabad have been completed. This
require proper latest equipment. In the new building there is a need to
establish toxicology laboratory. Similarly, PLIM/HPL are conducting regular
training programmes for all India level, and there is no provision for staying
of these trainees. Therefore provision for toxicology Laboratory and a guest
house may be kept in 11th five year Plan. The laboratory should also be
provided adequate scientific staff. The pay scale & promotions of PLIM/HPL
should be on the pattern of CSIR laboratories/institutions. This will require
Rs. 10.00 crores in the 11th Plan.
7.
Scheme to work on Metal Based Bhasmas & Ras Aushadhis:
There is lot of scope and urgent need to work on different aspects of
preparation , standardization, safety, efficacy, doses forms and
Pharmacology of metal based Bhasmas and Ras Aushadhis. One Hundred
most common Ras aushadhis will be taken up for R&D. This will require
participation of various institutions in the 11th Plan. An amount of Rs. 20
crores will be required for this activity in the 11th Plan.
8.
Scheme relating to ASU Drug Industry:
ASU drug industry is a green industry, cause minimum pollution,
make use of all indigenous material and giving job opportunities for .needy
people. There are about 10000 manufacturing pharmacies. Most of them are
medium scale and small scale.
Government is bringing new rules &
regulation for the manufacturing process, Quality Control etc. which require
lot of investment. The annual turnover of this sector is about Rs 5000
crores out of which only Rs. 2000 crores belong to medium and small scale
industry. To support the R&D based production of classical and P&P drugs,
there is a need to allocate ASU& H “Pharma Industries Support Corpus”
fund of Rs. 100 crores to meet the bank interest (amount of interest
difference between the bank rate and soft loan rate of interest) which will be
recoverable in 10 year period. Similar Scheme already implemented by the
Department of Science & Technology. The details of the various components
under the Scheme could be worked out. Other R&D Schemes relating to
AYUSH drug like clinical trials support, Revise Pharmacology of Chemical
ASU medicine, industry will require
Rs. 100 crores.
9.
Availability of the Raw-material of Endangered Species of Plant
and Animals:
ASU system fundamentally believe to work in harmony with the nature.
There is a symbiosis of human race with the plant and animal kingdom.
Ayush system fully believes to work for protection of endangered species.
However, bye-products of the nature are used in ASU drugs for centuries and shown
lot of beneficial effects. In the last couple of years, the various departments like Wild
Life Protection etc has banned number of items which are bi-products of animal like
deer antlers, Kauri Shells, Dead corals, musk deer etc. Deleting such ingredients
from ASU medicines has deprived number of very good formulations for treating
complicated problems. Therefore, rearing of musk and deers for various bi-products
need to be taken-up in collaboration with the Department of Environment, Wild Life
and Marine Department etc. The cultivation of such plant/animal species need to be
undertaken in the 11th Plan. The countries like China, Mongolia are already rearing
68
musk deer and other deer species to meet the medicinal requirements. System of
registration of vendors and certification of raw material and finished products should be
developed and a ‘Ayush product certification board/agency’ may be set up to certify the
quality of the Ayush products like Agmark for food.
An amount of Rs. 20 crores is needed for this activity in 11th Plan.
10.
Scheme to Supply of authentic raw-material for ASU&H Drug
Industry:
ASU drug industry is facing the problem on availability of authentic
raw-material with proper knowledge on source and test reports of quality
etc. It is suggested that the sale of raw-drugs should also be regulated in the
Drug & Cosmetics Act and Quality Pharmacopoeial Standards should be
applicable at the sale point of raw-drugs.
This initiative require
procurement, gradation, storage, quality certification and packaging of the
raw materials.
This will require the co-operation of Warehousing
Corporation, National and State Medicinal Plants Boards and other private
agencies dealing with the business of Medicinal Plants sector. Further, the
support for Quality Testing facilities near such Mandies/Trade Centres need
the support of the Department of AYUSH. This initiative will require input of
Rs. 20 crores.
11.
Strengthening of the Drug Control Division in Centre and States:
There is utter lack of infrastructure, human resource expertise and other
requirements to regulate the provision of Drug & Cosmetics Act at Centre and State.
The AYUSH component has negligible visibility in terms of Drug Controller, Drug
Inspectors, Drug Analysts and other manpower required to regulate the provision of
Drugs & Cosmetics Act. There is an urgent need to strengthen Centre and State
Licensing & Regulatory Authorities. There is a need for comprehensive review of
regulatory provisions of AYUSH products. To begin with, regulatory changes can be started
by implementing a system of registration on AYUSH products on the basis of proper product
dossier with State licensing authority on the basis of proper guidelines developed by the
Central Government. There is an urgent need to support technical experts in Drug Control
Section of AYUSH along with supporting staff. This will enable to enforce the provision of
drug Act effectively. This will require Rs. 20 crores in the 11th Plan.
Summary of the Proposal:
S.
No.
Activity
1.
Laying down of
Pharmacopoeial
Standards e.g. single
Financial
Requirements
Rs. In Crores
Rs. 20.00
Implementing Agency
PLIM/HPL, CCRAS, CCRH,
CCRUM, University Labs,
CSIR & Other capable
69
2.
&compound drugs,
Bhasmas and Extracts .
Strengthening of DTLs
for ASU & H for the
acceptability of the
ASU&H drugs
Labs/institutions
Rs. 100.00
PLIM/HPL, CCRAS, CCRUM,
CCRH, State DTLs, eminent
Labs, PG teaching Deptt. of
Dravya Guna, Ras-Shastra
and Pharmacy Deptts.,
National Institutes of ASU & H.
PLIM/HPL and at other couple
of institutions engaged in the
field in different parts of the
country___________________
PLIM/HPL, State Garden at
Joginder Nagar (H.P.),
CCRAS Garden at Pune &
Jhansi and 4 Gardens of
Gujarat Government________
Degree , PG and Post
Doctorate, training in the
country, infrastructure and
HRD related issues at Centres
like NIPER, RRL, Jammu,
NBRI, CIMAP, BHU, IPGTR
etc. and other Universities
3.
Centre for Safety
Evaluation/Toxicity
Studies for Ayush Drugs
Rs. 20.00
4.
National Herbarium,
Museum, Herbal
Garden for ASU & H
Drugs
Rs. 20.00
5.
Training and provisions
of Scholarship/
fellowship in ASU&H
Pharmaceuticals,
Quality Control &
Standardization
Rs. 20.00
6.
Strengthening of
PLIM/HPL Ghaziabad
7.
Scheme to work on
Metal based Bhasmas
& Ras Aushadhis
8.
Scheme relating to ASU
Drug Industry
9.
Availability of the Raw
material involving
endangered Species of
Plant and Animals
10.
Scheme to supply of
authentic raw-material
for ASU & H industry
Equipments, toxicology
laboratory and Guest House at
PLIM/HPL along with scientific
manpower_________________
Rs.20.00
Preparation, standardization,
safety, efficacy, dosage forms
and Pharmacology of metal
based Bhasmas and Ras
Aushadhis at SASTRA,
Thanjavur, BHU, Sriram
Institute, CCRAS and other
Industries_________________
Rs. 100.00 (for To support the R&D based
soft loans)
production of classical and
P&P drugs. Soft loan to the
Rs. 100.00 for medium and small scale ASU
R &D work
industry.___________________
Rs. 20.00
Cultivation of plant and raring
of animal species with the help
of Deptt. of Environment, Wild
Life and Marine Department
etc._______________________
Procurement, storage and
Rs. 20.00
quality certification of rawmaterial for ASU & H drugs
Rs. 10.00
70
11
Strengthening of the
Drug Control Division in
Centre and States
Rs. 20.00
with the co-operation of
Warehousing Corporation,
NMPB, State MPBs and other
like-wise agencies__________
Infrastructure, HRD and
expertise etc. to be provided to
Centre and State Licensing &
Regulatory Authorities in
different States of the country
12
Traditional quality
standards on
manufacturing & testing
Rs. 10.00
Expert Institutes/lndustries
13.
Survey & Marketing of
Raw materials,
Documentation/
Pharmacovigilance
Total financial
implications during
the 11th Plan
Rs. 05.00
Expert institutes/ PLIM/ HPL
Research Councils
Rs. 485.00
71
Recommendations
of
Task Force
on
“Research and Development (AYUSH)"
for
i rH Five-Year Plan
(2007-2012)
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72
CONTENTS
Page No.
3
Introduction
1. Priority Areas
2. Strengthening of Research
Councils under AYUSH
7-8
3. Support for HRD activities
and Development of Infrastructure
8-9
4 Focus on Amchi system of Medicine
(Sowa-Rigpa)and Tribal Health care
10
Summary and budgetary details
Conclusions
11-13
14
13
Introduction
The Indian Systems of Medicine (Ayurveda, Siddha, Unani, Yoga and Naturopathy) &
Homoeopathy have been in vogue in the country from earliest times and catering the medical needs of
most of our people. During last decade the use of these systems has expanded globally and gained
popularity. They have not only continued to be used for primary health care of poor and developing
countries, but have been used in where conventional health care system is predominant in National
Health Care Delivery.
The Deptt. of AYUSH, Ministry of Health & Family Welfare has established the Research
Councils as apex bodies for formulations of research in Ayurveda, Siddha, Unani, Homeopathy &
Yoga and Naturopathy on scientific lines. These research councils are focusing on major areas viz.
Literary and Fundamental Research, Drug Research comprising of cultivation, collection,
standardization and safety profile evolution, Clinical Research including RCH, Nutraceuticals,
Cosmetics and Biomedical Instrumentation Research being executed through a network of field Units,
Laboratories throughout the country.
For sustainable utilization, potentials of these systems and sensitizing the public, the R & D
activities are to be disseminated among masses through well-designed IEC material, health melas,
exhibitions and other health awareness programmes.
Research on National Priorities and the areas where these systems have potential are to be
stressed. The emphasis should be projected on life style disorders and refectory conditions viz.
Cancer, AIDS, Diabetes etc. including quality of life concerns.
Exploration and validation of
knowledge in public domain, ethno-botanical and tribal folk claims find place in the projection of the
research Councils and research Institutes. For quality research in AYUSH the infrastructure as well as
the promotional avenues in research councils is to be strengthened.
Currently the quality of research is hampering due to insufficient human resources and lack of
proper infrastructure facilities in the research comment under AYUSH as well as in the other AYUSH
setups viz. academic Institutions and Universities all over India.
1. Priority Areas: The Research areas needs to be identified on the basis of national
priority and considering the strength of AYUSH system; comprising of Life Style Disorders,
Psychosomatic conditions. Refractory conditions. Degenerative conditions.
1.1 National Priority Programmes: Emphasis should be given to National Priority
programmes viz. Malaria, Filariasis, HIV/AIDS and conditions viz. Diabetes mellitus,
Hypertension, Cardiovascular diseases, Cancer etc.
74
1.2 Fundamental Research: The AYUSH systems are based on certain unique concepts
and philosophies. Scientific exploration of fundamentals (Prakriti/Mijaj -Bio-identity,
Pharmaco-kinetic principal -Rasa, guna etc.) is essential to evolve objective parameters for
diagnosis and management. Biomedical instrumentation is to be developed to rationalize
these basic concepts. Need is also felt to modernize therapeutic procedure based therapies
like Panchakarma etc. to achieve clinical success through maintaining controlled
conditions. The expertise and facilities etc from reputed national institutes, teaching
institutes etc may be well utilize for this purpose.
1.3 Drug Research: With tremendous expansion in the use of these systems worldwide,
safety, efficacy and quality control of these medicines and procedures based therapies have
become important concerns for both health authorities and public. The quality assured
drugs play a pivotal role in achieving clinical success
1.3.1 Focus needs to be emphasized on Safety aspects of ASU & H drugs to induce
confidence among consumers besides enhancing the acceptability of these drugs
globally. A data bank of safety profile of most commonly used ASU & H drugs
indexed in respective formularies may be generated. This can be used as referral
safety margins.
1.3.2 Pharmaco-dynamics of the AYUSH drugs needs to be studied viz., half-life,
drug receptor interaction and therapeutic index etc. to understand the possible mode
of action. Simplified parameters may be evolved to create gross evidence.
1.3.3 Isolation of marker compounds and a library of such compounds may be developed to meet the
quality assurance requirements of ASU & H drugs. This can be executed through strengthening the
existing councils institutes.
1.3.4 The Primary screening of safety and efficiency of AYUSH drugs / new therapies / claims using
cell lines, in vitro techniques may be focused to evaluate their action rapidly.
1.3.5 As the drugs of metal/mineral and marine origin are required in lesser doses, fast acting, more
efficacious, patient compliant and prevalent among the prescribers, research is to be focused in this
area to create evidence on safety, efficacy and quality assurance. At present parameters are lacking in
this area from raw to finished products as these data are needed for quality checks and licensing. For
75
this purpose suitable protocols are essential. One existing center of Research councils under AYUSH
may be developed as centre of excellence with modern sophisticated instruments like ICP - MS etc.
for Metal based drug research. This institute will execute and coordinate research with other institutes
having such expertise.
1.3.6 User friendly, commercially available kits may be developed for rapid
screening of adulterants like steroids, heavy metals etc. A project should be initiated
at CCRAS in collaboration with the institutes having such expertise to evolve
methodology and development of kits during the plan period. This will help the
licensing authorities, policy makers, industries and public for checking safety of ASU
& H drugs.
1.3.7 National Medicinal Plants Repository; The information and technical
know how related to proper identification, availability, distribution,
abundance, threat status, growing techniques, collection, utilization and
other related aspects of wild as well as cultivated medicinal plants may be
provided through this centre for the benefit of AYUSH researchers and
industry.
1.4 Clinical Research:
1.4.1 Observational Research: Gross information on
efficacy and clinical
safety of classical ASU & H drugs may be generated to create evidence through
observational research. A concise case record form may be designed to generate the
information. For first instance, 50 most commonly prescribed drugs may be studied
involving 100 ASU & H physicians in 20 hospitals /teaching institutions. This will
create primary evidence on clinical safety, efficacy, and prevalence of use and patient
compliance of ASU and H drugs and generate leads for further research.
A
centralized computerizing monitoring setup may be established to co ordinate the
work
1.4.2 Contraceptive agents: In recent years greater emphasis is being laid to
find out a safe, effective and reversible drug for control of fertility the major
advantage in developing an antifertility agent from ASU & H drugs is cost
effectiveness, and low toxicity. Emphasis is to be focused on various ASU & H
drugs and folklore claims for safe and effective contraception.
1.5 Promotional Health:
1.5.1 Nutraceutical Research: The ASU & H systems offer numerous potential
immunomodulatory, antistress; antioxidant and nutritive agents. Focus may
be emphasized on development of ASU & H Nutraceuticals for school going
children, and sports personnel geriatric population, military personnel
working in adverse climatic conditions to improve their physical and mental
endurance, and improvement of quality of life etc.
1.5.2 Promotive medicine: As ASU & Homoeopathy systems are having
potential in preventive and promotive medicine, the R&D in this area may be
stressed. . Certain drugs may be developed as preventive agents in various common
chronic conditions (e.g. Cardio-protective drugs). Besides this certain Naturopathic
and Yoga measures need to be validated to create scientific evidence.
2. Strengthening of Research Councils under AYUSH
2.1 Promotional Avenues: The Government of India Ministry of Health and Family Welfare,
Research Councils under AYUSH for formulation of research on scientific lines as per the pattern
of ICMR. Even though the Research councils are executing research in respective AYUSH system
more than 35 years, the scientists who are engaged in the research are not being benefited by a
time bound promotional avenues. Many of them are even retiring in the same post after serving
for more than 30 years. This is causing great dissatisfaction frustration and discrimination
among the researchers as their contemporaries in other organization are benefited with
time bound promotions. Besides this the research councils failed to attract of intellects and
the scientist who are joining are leaving the council since there is no different carrier
advancement prospectus. This ultimately affecting the quality of Research. Considering
this, a definite time bound promotional policy may be evolved for the Research councils
under AYUSH, which presently non -exists. The existing promotional policies adopted by
other sister councils, Viz., ICMR, may be implemented in AYUSH Research Councils.
This would definitely improve the quality of research in AYUSH Research councils.
2.2 Reorganization:
The
peripheral units of Research councils have been scattered in
various states with insufficient infrastructure, insufficient technical expertise and
supporting staff. This is hampering the quality research output. In view of increasing
popularity of AYUSH systems globally and to execute the research work at per global
standards need is being felt to develop specialty centres in various sub specialties of
AYUSH. Keeping in view the above issues the need is felt to reorganize the field units by
merging some of them to develop centers of excellence. These centers would be focusing
on research in specific aspects. These centers of excellence will have to be facilitated with
centralized networking for effective functioning and monitoring.
77
2.3 Establishment of New Peripheral Institutes under CCRYN: Central Council for Research in Yoga &
Naturopathy so far does not have any peripheral Institutes. Thus this Council has to establish 5 Central
Research Institute (CRIs) and 10 Regional Research Institutes (RRIs) in different parts of the country. The
CCRYN would manage to get 5-10 acres of land free of cost from the State Govts, or from the private
organizations. These CRIs and RRIs certainly would make a break through in the research of preventive,
promotive, curative aspects of Naturopathy & Yoga.
3. HRD activities and Development of Infrastructure for
RfitD:
3.1 Selected existing centres under AYUSH may be developed as a NABL certified
laboratories. These Institutes will screen the ASU & Homoeopathy drugs for their quality.
Once this setup is successful, it will help in formulation of policy.
3.2 To update the knowledge and skills among the AYUSH Researchers, teachers, and
students and supporting technical staffs, need is felt to impart periodical trainings. One
existing Institute of the council may be developed as a training Institute in AYUSH
Research & Teaching. This will also provide Continuing Medical Education (CME)/Re
Orientation Training Programme (ROTP) to physicians of ASU and H/conventional
medicine/teachers and students.
Data management is a prime requirement of clinical
research and for this purpose one existing centre under AYUSH councils may be
developed as a centre of excellence in biostatistics.
3.3 The past and present work of M.D. and Ph.D research of AYUSH institutes
/colleges may be indexed. A central data bank may be generated and the
same should be updated in yearly basis. For first instance, one nodal AYUSH
institute in each state is to be identified to index the data.
3.4 IEC cell in AYUSH Research Councils: For dissemination of concept and research finding
of AYUSH system, each council may establish an IEC cell. This setup will be responsible for
preparing IEC material, organizing camps, health melas, health awareness weeks, campaigns etc.
for sustainable utilization of AYUSH system and sensitizing the mass.
3.5 Collaborations would be established with National and International Universities and
Colleges, institutions, Pharmaceutical industries etc to carry out research in various
aspects of AYUSH system by making use of their expertise in related fields. Projects may
78
be invited from international organization in line with existing extra mural projects with
appropriate modification and hike in the budget.
3.6 Support for development of R&D infrastructure in AYUSH medical colleges &
Pharmacy colleges: Financial assistance to selected AYUSH /Medical Colleges and Pharmacy
Colleges may be extended for development of infrastructure for research in AYUSH systems to
educate & initiate the research activities. Establishment of Integrated Research Departments
in major institutes viz., Medical Colleges, Universities, AYUSH Colleges may be
encouraged to boost the integrated and interdisciplinary research as existing in USA /UK
etc. The research councils should extend proper guidance, consultancy and Scholarship to Post
graduate and Doctoral scholars for appropriate designing and executing the research.
4. Focus on Amchi system of Medicine (Sowa- Rigpa) and Tribal
Health Care: The Amchi system of Medicine is an integral part of Ayurveda has further developed
during Buddha’s period. Besides Ayurvedic Philosophy and concepts, certain more information on diagnosis and
therapeutics has been added. This system is prevalent in confined regions of India viz. Himalayan region and
other countries. To preserve the cultural heritage and proper utilization of benefits of this system, more focus is
required during the next Five Year Plan. The existing centre under AYUSH (CCRAS) at Leh may be upgraded
with all facilities.
The Research councils are maintaining Tribal Health Care Research Projects at different parts of
country, engaged in study the living conditions of tribal people .Collect folk medicines used by them, availability
of medicinal plants of the area, Propagation of knowledge about hygiene, Prevention of diseases, Use of
common medicinal plants of the area, Provide medical aid at their door steps, Collect information related to
health statistics, Geographical picture, climate and environmental profile, Study of dietetic habits and of
prevalence of diseases. More focus needs to be accorded on the issue to protect the knowledge in public
domain.
80
Summary and budgetary details
Activity Financial
S.No.
Requirements
1.
Implementing
Agency
Priority Areas
t. 1 National Priority
1.2 Fundamental Research
20 Crores
Research councils
under AYUSH
Research councils
under AYUSH /
Academic
institutes
1.3 Drug Research
1.3.1 Safety studies ASU and
H Drugs
30 Crores
1.3.2 Pharmacodynamics
Kinetics of AYUSH
drugs
30 Crores
1.3.3 Isolation of marker
compounds of
AYUSH drugs
1.3.4 In Vitro Rapid
screening of AYUSH
drugs for Safety.
1.3.5 Research on Metal and
Mineral/ Marine
AYUSH drugs
15 Crores
15 Crores
20 Crores
1.3.6 Rapid screening kits for
ASU and H drugs
4 Crores
1.3.7 National Medicinal
plant Repository
1.4 Clinical Research
10 Crores
Research councils
under AYUSH /
Academic
institutes
Research councils
under AYUSH /
Designated
Collaborative
Institutes
Research councils
under AYUSH /
Designated
Collaborative
Institutes
Research councils
under AYUSH /
Designated
Collaborative
Institutes
CCRAS
CCRAS
CCRAS
81
2.
1.4.1 Observational Research
25 Crores
Research councils
under AYUSH /
Designated
Collaborative
Institutes
1.4.2 AYUSH Contraceptive
drug development
5 Crores
CCRAS/CCRUM
Designated
Collaborative
Institutes
1.5 Promotional Health
1.5.1 Nutraceuticals Research
15 Crores
1.5.2 Promotive Medicine
5 Crores
CCRAS/CCRUM
Designated
Collaborative
Institutes
Research councils
under AYUSH /
Designated
Collaborative
Institutes
Strengthening of Research
Councils Under AYUSH
2.1 Promotional Avenues
2.2 Re organization
AYUSH Dept. /
Research
under
Councils
AYUSH
CCRAS/CCRUM
and CCRH
60 Crores
(@ of 20 Crores
for
each
of
CCRAS/CCRUM
and CCRH
2.3 Establishment of New
Institutes under CCRYN
115Crores
-5 CRI@ of 11
Crores each = 55
Crores
-10RRI@ of 6
Crores each = 60
Crores
CCRYN
82
Support for HRD related
activities to R&D and
of
Development
Infrastructure
3.1 Up gradations of
50 Crores
AYUSH Labs
3.
3.2 Training for AYUSH
Personnel
3.3 Indexing of Research
2 Crores
CCRAS
5 Crores
Research
Councils
AYUSH
under
Research
Councils
AYUSH
under
Research
Councils
AYUSH
under
3.4 IEC Cell in research
councils
5 Crores
3.5 Collaborative studies
25 Crores
3.6 Development of R&D
Infrastructure in other
institutes
15 Crores
Focus on Amchi system of 10 Crores
Medicine (sowa-Rigpa)and
tribal health care__________
4.
Total
CCRAS/CCRUM
/CCRH
Dept.
AYUSH
Research
and
councils
CCRAS
481Crores
CONCLUSIONS
•
Focus on stream lining of AYUSH research so as to get quality output
of scientific evidences for global acceptance.
•
focus on safety and quality concerns of ASU and Homeopathic drugs.
• Validation of basic and fundamental aspects and certain unique
procedure based medical and Para surgical therapies of AYUSH
systems.
83
•
To accelerate the research, national and international networking as
well as collaboration is to be established through physical and
functional integration.
• The AYUSH
setups viz.,
councils,
universities,
medical colleges
,industries are to be strengthened in terms of RstD to streamline the
research.
•
Streamlining
the
AYUSH
research
through
Integrated
Drug
Development.
• To
improve the
professional efficiency of the researchers,
the
promotional avenues in AYUSH councils should be implemented in
line with ICMR patterns.
84
Meeting of Task Force (ReiD) of AYUSH Dept, for 11th Five Year
Plan
Venue: - CCRAS HQrs. Date: - 4th July, 2006 at 11.00 a.m.
The following attended the meeting
Experts
Dr.G.S.Lavekar, Director, CCRAS
Dr.S.K.Sharma, Advisor (Ay.), Dept, of AYUSH
Prof. Shakir Jameer, Dean, Jamia Hamdard
Dr.C.K.Katiyar, Director, Herbal Division, Ranbaxy
Dr. G.P. Dubey, Former Dean (Ay), BHU, Varanasi (Not Attended)
Dr. Vasantha Muthuswamy, Sr. DDG, ICMR, New Delhi (Not Attended)
Dr. Muhammed Majeed, CMD, Sami Labs, Bangalore (Not Attended Attended by Dr. S. Natarajan Executive Vice President, R&D, Sami
Labs)
Invited Experts
Dr.Padma Venkat, FRLHT, Bangalore
Dr.Y.K.S.Rathore, Director I/C, Central Revenue Control Lab., New Delhi
Dr.M.K. Siddiqui, Director, CCRUM, New Delhi
Dr.B.T.C.Murthy, Director, CCRY& N, New Delhi
Dr.C.Nayak, Director, CCRH, New Delhi
Dr.G.Veluchamy, Director, CRI (S), Chennai
Secretariat
Sh R.S Yadav , A.D.(Doc)
Dr.S.Venugopal Rao, A.D. (P’cology) CCRAS
Dr.N.Shrikant, A.D. (Ay.) CCRAS Dr.A.C.Kar, A.D. (Ay.) CCRAS
Dr. M.M. Padi A.D. (Ay.), CCRAS
Dr.V.P.Singh, A.D.(Hom.) CCRH
Dr. Shamshad A.Khan, A.D. (Chemistry) CCRUM
Dr.Rajiv Rastogi, A.D. (Nat.), CCRY&N
Dr. Sulochana Ro(Ay)
Sh Rk.Shingal S.O
Dr.Khalid Mahmood Siddiqui, R.O. (U), CCRUM
Dr.Bishnupriya Dhar, R.O.(Botany) CCRAS
Dr.G.V.RJoseph, R.O. (Botany), CCRAS
Shri Ravinder Singh, R.O. (Chemistry), CCRAS
Dr.Alka Aggarwal, R.O. (Chemistry), CCRAS
Dr.Pramila Pant, R.O. (Chemistry), CCRAS
Dr.Sudesh Gaidhani, R.O. (P’cology), CCRAS
Dr.Ritu Sethi, Consultant, GTP, CCRAS
85
NATIONAL MEDICINAL PLANTS BOARD
DEPATMENT OF AYUSH
Report of the Task Force on Medicinal Plants
for the Eleventh Five Year Plan
17th July 2006
New Delhi
86
CONTENTS
S. No.
A___
L___
2.___
X___
£__
5.___
£__
7.___
£__
9. ___
10. __
11. __
12. __
13. __
14. __
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Page Number
Abbreviations____________________________________
Background______________________________________
AYUSH Systems of Medicine______________________
Trade in Herbal and Medicinal Plants________________
Medicinal Plants____________________________
National Medicinal Plants board_____________________
Functions of the Board_____________________________
Main features of the schemes implemented by the NMPB
Funding______________________________________ __
Priority Species of Medicinal Plants__________________
Major Achievements______________________________
Budget and Expenditure
_______________________
Achievements during the 10th Plan___________________
Monitoring and Evaluation_________________________
Evaluation study by IIFM and ICFRE________________
Approach to 11th plan________ _____________________
PROPOSAL FOR 11th FIVE YEAR PLAN
Conservation/Regeneration in forest areas_____________
Ex situ conservation/setting up of Herbal Garden_______
Cultivation______________________________________
Medicinal Plants Processing Zones__________________
Prioritized list of medicinal plants___________________
Pattern of subsidy_________________________________
Standardization and Quality Control_________________
Vanaspati van scheme_____________________________
Post Harvest management__________________________
Marketing_______________________________________
Research & Development__________________________
Information, Education and Communication___________
Other Policy Initiatives____________________________
Organizational Issues______________________________
Role of other Ministries____________________________
Financial Outlays_________________________________
Annexure -1_____________________________________
Annexure - II____________________________________
Annexure - III
________ OL
___________ 1_
______ L
____________ 2_
____________ 2_
____________ 3_
_________ £
___________ 5_
£
_________ £
____________ 9_
_________ £
___________ 10
___________ 10
___________ 13
___________ 15
___________ 15
___________ 15
___________ 16
___________ 17
___________ 18
___________ 19
___________ 21
___________ 23
___________ 25
___________ 25
___________ 26
___________ 28
___________ 28
___________ 29
___________ 30
31
87
ABBREVIATIONS
AEZ
Agri Export Zone
APEDA
Agricultural and Processed Food Products Export Development Authority
AYUSH
Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy
ASU
Ayurveda, Siddha and Unani
CSIR
Central Scientific Industrial Research
CITES
Convention on International Trade in Endangered Species of Wild Fauna & Flora
DBT
Department of Bio-Technology
DST
Department of Science and Technology
GAP
Good Agriculture Practices
GACP
Good Agricultural and Collection Practices
GCP
Good Collection Practices
GHP
Good Housing Practices
GSP
Good Storage Practices
ICFRE
Indian Council of Forestry Research & Education
ICAR
Indian Council for Agriculture Research
IIFM
Indian Institute of Forest Management
ISMH
Indian Systems of Medicine and Homoeopathy
MDAF
Market Development Assistance Fund
MPCA
Medicinal Plants Conservation Areas
NRHM
National Rural Health Mission
NMPB
National Medicinal Plants Board
QPM
Quality Planting Material
SMPB
State Medicinal Plants Board
WHO
World Health Organisation
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TASK FORCE REPORT FOR THE ELEVENTH PLAN
Background
1.1 The World Health Organisation (WHO) estimates that 80% of the population in developing
countries relies on traditional medicines which are mostly plants based.
Also, modern
pharmacopoeias contain at least 25% drugs derived from plants and many others, which are
synthetic analogues, built on prototype compounds isolated from plants.
Transition from
synthetic drugs and microbially produced antibiotics to plant based drugs is rapidly gaining
acceptance.
1.2 While modern medicines has in many parts of the world, replaced traditional medicinal practices
for the benefit of individual and public health, people world over are becoming increasingly
aware of their limitations i.e. ineffectiveness in dealing with large number of diseases conditions,
the often unforeseen negative side effects of synthetic drugs and the ever - rising cost of medical
treatment.
As a result, the public and public health specialists throughout the world are taking
second look at alternative or complementary medicine in general and traditional plant based
drugs in particular.
AYUSH Systems of Medicine
2.1
The Indian Systems of Medicine viz. Ayurveda, Siddha, Unani, Yoga, Naturopathy &
Homoeopathy cover both the systems, which originated in India and outside but got adopted
and adapted in India in course of time.
Originating from the Vedas, Ayurveda is the oldest
surviving medical system in the world which is about 5,000 years old. These systems are based
on theory, formal education and a traditional pharmacopoeia which emphasizes the “Holistic
approach”.
2.2
The features of Indian Systems of Medicine, namely, their diversity and flexibility,
accessibility, affordability, a broad acceptance by a large section of the public, comparatively
low cost, a low level of technological input and growing economic value have great potential in
the larger sections of our people’s need. It is estimated that about 500 million people in India
wholly or partially rely on traditional systems for their health care.
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2.3
Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) offer a wide
range of preventive, promotive and curative treatments that are both cost-effective and
efficacious. There is need for ending the long neglect of the system in our health care strategy.
The resurgence of interest in Ayurveda. Yoga and in other Indian Systems of Medicine in India
and abroad and the opportunities created by such interest have been well perceived by the
Government. The ISM industry has also to play a key role in the overall growth of the health
care system and, therefore, under NRHM government has taken steps for mainstreaming of
AYUSH. Also, the Research and Development activity has to keep pace with the growing
demand and expectations of the people.
Trade in Herbal & Medicinal Plants
3.
International market of medicinal plants is estimated to be over US $ 60 billion per year, which is growing
at the rate of 7%. It is estimated to grow to US $ 5 trillion by 2050. Indian herbal exports valued at about
Rs. 874 crores in 2001-02 constitute about 73% in the form of crude drugs and extracts and 27% as
finished products. Medicinal plants constitute nearly 13% of the global market. There is thus an enormous
scope for the India to also emerge as a major player in the global herbal product based medicines.
However, this requires a grand strategic plan, which takes a holistic view of the entire situation to boost
exports.
Medicinal Plants
4.1
India is one of the 17 mega bio-diversity rich countries and has 7% of the world’s bio-diversity. There are
15 agro-climatic zones, 45,000 different plant species out of which 15,000 are medicinal plants. About
8,000 plants are used in Indian Systems of Medicine and folk medicines. Out of these 1,700 medicinal
plants, have been documented in Traditional Medicines of which about 500 species are mostly used in
the preparation of drugs.
4.2
In a wider context, there is a growing demand for plant-based medicines, health products,
pharmaceuticals, food supplements, cosmetics, etc., in the national and international markets.
Conservation and sustainable use of medicinal plants are issues on which immediate focus is required in
the context of conserving biodiversity and promoting and maintaining the health of local communities,
besides generating productive employment for the poor with the objective of poverty alleviation in tribal
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and rural areas,
It is estimated that medicinal plants, their collection creates 35 million mandays of
employment.
4.3
At present, about 90% collection of medicinal plants is from the wild, generating millions of mandays
employment (part and full) and since 70% of plants collections involve destructive harvesting many plants
are endangered or vulnerable or threatened. Currently medicinal plants are collected without paying
attention to the stage of maturity and their sustainability. They are stored haphazardly for long period of
time under unhygienic conditions.
This results in deterioration in quality.
Such materials are not
acceptable to importers and standard manufacturing drug units. Promoting cultivation of medicinal plants
on an extensive scale, therefore, assumes importance for conservation of bio-diversity, uniformity of the
quality of raw material in terms of active ingredients, quality of drugs and standardisation.
National Medicinal Plants Board
5.1
The National Medicinal Plants Board was set up through a Government Resolution notified on 24th
November, 2000 under the Chairmanship of Union Health & Family Welfare Minister.
5.2
The Board is guided by an apex body headed by Minister of Health & Family Welfare as its Chairperson
and Minister of State for Health & Family Welfare as its Vice-Chairperson. The other members are:
4- Secretaries of Ministries/Departments of AYUSH, Environment & Forest, Scientific and Industrial
Research, Bio-technology, Science & Technology, Commerce, Industrial Policy and Promotion,
Expenditure, Agricultural and Cooperation, Agricultural Research & Education and Tribal Affairs as
Ex-Officio members.
Four nominated members having expertise in the field of medico-ethnobotany I pharmaceutical
industry of ISM, marketing and trade, legal matters and patents.
4 Four nominated members representing exporters of ISM&H drugs, NGOs responsible for creating
awareness and increasing availability of medicinal plants, growers of medicinal plants, and research
and development industry groups in the area of medicinal plants.
X. Two nominated members representing federations/co-operatives dealing with medicinal plants,
One member from Research Councils of Department of AYUSH, One member from Pharmacopoeial
Laboratory of Indian Medicines /Homoeopathic Pharmacopoeia Laboratory, Ghaziabad , and Two
members representing State Governments (by rotation every two years).
CEO as the Member Secretary.
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5.3
The term of nominated and other non-official members is for 2 years.
Functions of the NMPB
6.
Co-ordination with Ministries/Departments/Organisations/State/UT Governments for development of
medicinal plants in general and specifically in the following fields:
(i)
Assessment of demand/supply position both within the country and abroad.
(ii)
Advise concerned Ministries/Departments/Organisations/State/UT Governments on policy
matters.
(iii)
Provide guidance in the formulation of proposals, schemes and programmes etc.
(iv)
Identification, inventorisation and quantification.
(v)
Promotion of ex-situ and in-situ cultivation and conservation.
(vi)
Promotion of co-operative efforts among collectors and growers and market their produce
effectively.
(vii)
Setting up of database system for inventorisation, dissemination of information and facilitating
the prevention of Patents.
(viii) Undertaking and awarding Scientific, Technological research and cost-effectiveness studies.
(ix)
Development of protocols for cultivation and quality control.
(x)
Encouraging the protection of Patent Rights and IPR.
Main Features of the Schemes Implemented by NMPB
7.1 Promotional Schemes:
Grants can be provided for following activities:
■A Survey and inventorisation,
In-situ conservation and ex-situ cultivation,
4- Production of quality planting material,
•4 Extension activity (IEC),
4 Demand & Supply studies,
4 R&D,
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4 Value addition
7.2 Commercial Schemes
Grants can be provided for following activities:
4 Production of quality planting material,
4 Value addition,
4 Innovative marketing mechanism,
7.3
Contractual Farming Schemes
Financial Assistance is provided for Cultivation of identified medicinal plants by farmers.
7.4 Eligibility
7.4.1
Promotional and Commercial Schemes:-
GovernmentOrganisations/NGOs/ Universities/Co-operatives, etc.
7.4.2
Contractual Farming Scheme: -
Registered growers, association/federation of growers, traders, manufacturers, society,
pharmaceutical company, NGO & recognized research institutes Public Sector Undertakings
(PSUs) or any group of people who have three years experience in medicinal plants.
Funding Pattern:
8.1 For Promotional Scheme of R&D, technology transfer, production of QPM, In-situ conservation/Ex-situ
cultivation - A grant of Rs. 10 lacs per year subject to the maximum of Rs. 30 lacs over a period of three
years and a maximum of Rs. 25 lacs for R&D projects.
8.2 For training, workshop and seminars Rs. 2 lacs for State level, Rs. 3 lacs for Regional level, Rs. 5 lacs
for National level and Rs. 10 lacs for International level.
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8.3 For Contractual Farming schemes there is a subsidy of 30% of the project cost subject to a maximum of Rs.
9 lacs.
Priority Species of Medicinal Plants
9.1 The Board has identified 32 species of medicinal plants based on their commercial value for
overall development through its schemes. The identified 32 plants are:-
COMMON NAME
BOTANICAL NAME
ENGLISH NAME
1.
Amla
Emblica officinalis Gaertn
Indian gooseberry
2.
Ashok
Saraca asoca (Roxb.) de wilde
Ashok
3.
Ashwagandha
Withania somnifera (Linn.) Dunal
Winter cherry
4.
Atees
Aconitum heterophyllum Wall, ex Royle
Aconite
5.
Bel
Aegle marmelos (Linn) Corr.
Stone apple
6.
Bhumi amlaki
Phyllanthus amarus schum & Thonn.
Bitter gooseberry
S.
NO
(P. niruri Linn.)
7.
Brahmi
Bacopa monnieri (L.) Pennell
Thyme leaved gratiola
8.
Chandan
Santalum album Linn.
White sandalwood
9.
Chirata
Swertia chirata Buch-Ham.
Chirata
10.
Daruhaldi
Berberis aristata DC.
Indian barberry
11.
Gudmar
Gymnema sylvestre R. Br.
Ram’s horn
12.
Guduchi
Tinospora cordifolia Miers.
Heart leaved moonseat
13.
Guggal
Commiphora wightii (Arn.) Bhandari
Indian bedellium tree
14.
Isabgol
Plantago ovata Forsk.
Physilium husk
15.
Jatamansi
Nardostachys Jatamansi DC.
Musk root
16.
Kalihari
Gloriosa superba Linn.
Malabar glory lily
17.
Kalmegh
Andrographispaniculata Wall, ex Nees
Kreat
18.
Kesar
Crocus sativus Linn.
Saffron
19.
Kokum
Garcinia indica Chois.
Kokum
20.
Kuth
Saussurea costus C. B. Clarke (S.lappa)
Costus
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21.
Kutki
Picrorhiza kurroa Benth ex Royle
Picrorhiza
22.
Makoy
Solarium nigrum Linn.
Black night shade
23.
Mulethi
Glycyrrhiza glabra linn.
Liquorice
24.
Pathar chur (Coleus)
Coleus barbatus Benth.
Coleus
25.
Pippali
Piper longum Linn.
Long pepper
26.
Safed Musli
Chlorophytum arundinaceum Baker
Musli white
(C. borivillianum)
9.2
27.
Sarpgandha
Rauwolfia serpentina Benth. ex Kurz
Rauwolfia
28.
Senna
Cassia angustifolia Vahl.
Senna
29.
Shatavari
Asparagus racemosus Wil Id.
Indian asparagus
30.
Tulsi
Ocimum sanctum Linn.
Holy basil
31.
Vai Vidang
Embelia ribes Burm.f
Butterfly pea
32.
Vatsnabh
Aconitum ferox wall.
Indian aconite
The Board, however, entertains projects covering species other than those listed above based on local
demand.
Major Achievements:
10.1
The National Medicinal Plants Board has so far sanctioned 3888 projects involving financial
assistance of Rs.89.22 crores under Contractual Farming Scheme which are being
implemented in different parts of the country. (Annexure I)
10.2
About 33,190 hectares of area covered under cultivation of various prioritized medicinal
plants.
10.3
739 projects involving financial implication of Rs.89.19 crores sanctioned under Promotional
Scheme since the year 2001-02.
10.4
More than 23,000 hectares of land has been covered under programmes for conservation of
medicinal plants/herbal gardens.
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35 State Medicinal Plants Boards (SMPBs) have been set up in States/UTs and financial
10.5
assistance provided for their functioning.
In order to ensure availability of raw material of quality and safety, the Board has sanctioned
10.6
141 projects under its promotional scheme for production of quality planting material.
Budget /Expenditure
Information regarding the budget allocation and expenditure during the 10th Five Year Plan period is as
11.
under
S. No.
Year
Budget Estimate
Revised Estimate
Actual Expenditure
(Rs. in lacs)
(Rs. in lacs)
(Rs. in lacs)
1
2002-2003
2316.00
1500.00
1580.12
2.
2003-2004
2000.00
1500.00
1829.09
3.
2004-2005
2305.00
2310.00
2755.38
4.
2005-2006
3000.00
3000.00
3491.98
5.
2006-2007
3800.00
3800.00
1162.36 (upto June,2006)
Total
13421.00
12110.00
10818.93
Achievements during the 10th Plan Period
12.1
Information regarding the expenditure incurred, number of projects sanctioned etc under Promotional
Schemes during the 10th plan period is as under:
#
Year
Expenditure
No.
of Activities undertaken
Projects
1
2002-03
735.26
109
In-situ & Ex-situ conservation, in-situ & ex-situ
cultivation, QPM, Herbal Garden, R&D, Value addition
or survey & inventorisation
2
2003-04
450.70
65
-do-
3
2004-05
988.70
178
-do-
4
2005-06
1252.15
229
-do-
96
5
2006-07
169.85
22
QPM, Herbal Garden, R&D, Value Addition, IEC
The details are indicated at Annexure II.
12.2
Information in respect of Contractual Farming Scheme is as under:
#
Year
of Area of land covered (in
Expenditure (Rs.
No.
in Lacs)
Projects
acres)
1
2002-03
193.07
63“
3917.50
2
2003-04
836.32
688
8645.45
3
2004-05
1576.02
1316
43933.00
4
2005-06
1608.81
1233
17481.00
5
2006-07 (Part)
1116.91
588
8999.00
Monitoring and Evaluation
13.1
The Medicinal Plants Board has facilitated setting up of 35 State Medicinal Plants Boards (SMPBs) in
States/UTs. Proposals for financial assistance are to be submitted (relaxable in case of govt,
organisations) through these SMPBs.
13.2
With a view to strengthening the capability for monitoring, evaluation and project management of funds to
the tune of 5% of the amount released during the previous year to a State/UT are provided to SMPBs for
the purpose of monitoring and evaluation. This is being released to the State/UT governments based on
the demands received.
Evaluation Study by IIFM, BHOPAL and ICFRE, DEHRADUN:
14.1
Evaluation study was carried out by IIFM, Bhopal and ICFRE, Dehradun with a view to
assessing the impact of the programme, the constraints with regard to organizational and
financial aspects and delivery of subsidy and marketing.
sampling methodology.
The study was carried out by
14.2
Under the Commercial Projects the emphasis has been on a few species like Safed Musli,
Amla, Isabgol, Senna and Ashwagandha. The other prioritized species have been cultivated
over less than 30% of the total area covered.
14.3
The average success rate of commercial projects is more than 77%. The average per acre
production was recorded as the highest in Chhattisgarh and lowest in Rajasthan.
The
production in Rajasthan is lowest due to the harsh soil and climatic conditions.
14.4
Most of the In-situ conservation projects under Promotional Schemes were implement by
Forest Departments and regeneration of targeted species were found satisfactory. However,
survey and inventorisation of endangered species was not properly carried out.
14.5
Though the Quality Planting Material was raised under the Promotional projects, there was no
proper networking for its supply to the cultivators.
14.6
The Commercial projects resulted in 36% of the cost being incurred on employment. More
than 50% of the cultivators were those with area more than 6 acres.
In other words the
beneficiaries were mostly medium and large farmers. The average representation of women
was 17%.
14.7
Satisfaction level of flow of loan and subsidy and service provided by State Medicinal Plants
Boards (SMPB), Banks and other Departments was recorded as unsatisfactory.
14.8
Community participation in In-situ/Ex-situ/QPM production projects was recorded as very low.
14.9
MoU between the Buyer and Seller was a very weak link. More than 50% of the cultivators
claimed to have sold 100% of their production. Only less than 7% were not able to sell their
products. 30% of the growers sold their products after some processing. Marketing, therefore,
remained a constraint.
However, there were Farmers Federation in some states which had
taken the responsibility of marketing and such innovations were found useful and therefore,
needed to be replicated.
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14.10 Most of the farmers wanted the Contract Farming supported by National Medicinal Plants
Board (NMPB) to continue by better networking between corporate, retailers, manufacturers
and the farmers.
14.11 The National Medicinal Plants Board (NMPB) promoted projects had a positive impact in
terms of production of medicinal plants, which has increased quantitatively. Performance of
the projects implemented by some of the NGOs was noteworthy.
14.12 Monitoring by the SMPBs was found to be either absent or weak except in some of the states
like Rajasthan and Madhya Pradesh.
14.13 Requirement of certification of UCs by a Chartered Accountant has been a cause of delay in
submission of UCs by farmers, affecting delay in release of next installment. This in turn
delayed the project implementation.
14.14 There were isolated cases of SHGs providing linkage for implementation of Promotional
projects. This had a positive impact on the project implementation.
14.15 The organisation structure of SMPB is generally weak. Mostly the SMPBs are located in the
ISM&H Departments headed by ISM&H officials. There are also states where SMPBs are
located in the Forests/Horticulture Departments. In states where either the SMPBs are in the
Forest Departments or where IFS officer are on deputation with ISM&H Department, the
functioning of SMPB is much more effective.
14.16 On the whole, the implementation and achievement of objectives presents a mixed picture.
There is, therefore, need to critically look at the shortcomings so that the progarmme achieves
the objectives of increasing availability of quality raw material for industry, improved
economy for the farmers, employment generation and better health security for the people.
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APPROACH DURING THE 11^ PLAN
15.1
The Medicinal Plants Board has been able to implement various programmes for cultivation,
conservation and overall development of medicinal plants sector throughout the country. It is
observed that there is good awareness created among the government/non-govemment
organizations and individuals regarding the medicinal plants and their development due to the
activities of the Board. There is, however, an urgent need for a quantum jump in its activities
both qualitatively and quantitatively in view of the emerging challenges that the herbal sector
faces globally. India has the strength and potential which needs to be harnessed.
15.2
The Board is thus required to discharge its functions to ensure sustainable development of the
medicinal plants, related knowledge and the trade of plant products at national and global
level and thus play a major pivotal role in development of national economy and public
health. The Board also needs to develop policies and strategies to facilitate achieving such
objectives,
and
implement
the
same
through
concerned
agencies
including
the
Central/State/UT governments. Along with it, the Board is to provide financial support as
well as technical guidance for collection, cultivation of raw material, its marketing and
production of finished product. The Board, in conjunction with other Ministries/Departments
and other stake holders, will have to work towards eliminating export of raw herbs and
medicinal plants by the end of the 11th plan so that only valued added items and finished
products are exported out of the country. Another equally important goal for the 11th Plan will
be to reduce the dependence on forest for the raw material from present 90% to close to 50%.
Thus the thrust Areas for Medicinal Plants Sector during XI Plan will be;
(i)
Survey and inventorisation of data regarding demand and availability of medicinal plants
at national level at the first instance and successively establish such data in respect of other
countries.
(ii)
Identification of medicinal plants for development and cultivation on priority, and
implementation of programmes in this regard, keeping in view the requirement of industry
at national level and for export separately.
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(iii)
Development of Good Agriculture Practices for prioritized plants.
(iv)
Development of data base regarding availability and trade of medicinal plants in wild.
(v)
Conservation along with sustainable collection and re-generation of medicinal plants in the
wild.
(vi)
Cultivation on an intensive scale preferably in clusters with facilities for value addition,
processing and marketing through the mechanism of Processing Zones in identified
regions
(vii)
Measures to ensure conservation and re-generation especially of rare, threatened,
endangered plants.
(viii)
Development of suitable cultivars, agro-technologies and availability of sufficient quality
plantation material.
(ix)
Setting up of e-network and Web Portal for complete information on demand, supply,
markets, plant varieties, availability of plantation material, agro-technologies, market
demand, GAP monographs, trade and prices etc.
(x)
Implementation of programmes for large scale cultivation and sustainable harvesting of
identified medicinal plants as well as coordination with other departments and
organizations in government/non-government sector for this purpose.
(xi)
Development of Good Collection Practices to ensure sustainable harvesting and proper
utilization of wild sources.
(xii)
Preparation of monographs of important medicinal plants
(xiii)
Development of techniques to assess and objectively state a sustainability index of given
forest area.
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PROPOSALS FOR THE 11™ FIVE YEAR PLAN
Conservation/regeneration of medicinal plants in forest areas
16.1
Out of about 800 species of medicinal plants only less than 30 species are cultivated to any significant
degree. Most of the other species are still sourced from the forests. In-situ conservation of medicinal
plants therefore has been an important plank of the strategy so far. During the 10
Plan, 20,000
hectares of forest area was covered with survey & inventorisation and in-situ conservation of
medicinal plants occurring in different forest types. During the 11th Plan it is proposed to cover
50,000 hectares of forest area in different forest types and agro-climatic zones. This is sought to be
achieved through Joint Forest Management Committees/Van Panchayats who will be actively
associated in planning, identification of species of medicinal plants to be regenerated/ planted and
supported with infrastructure for value addition and marketing. At the State level the programme will
be supervised and coordinate by Forest Department and at District level by the Forest Development
Agencies (FDAs).
16.2
In addition, Medicinal Plants Conservation Areas (MPCA) need to be established to conserve rare,
endemic and endangered medicinal plants which will be used as a germ plasm for future scientific
study and a source of authentic seed material in different forest types of India. One of the major
constraints in the cultivation and production of quality raw material for industry is the authentic seed
material of certified quality. During the 11th plan it is proposed to establish 100 such gene banks in
different agro climatic regions and forest types targeting top 300 species of medicinal plants identified
on the basis of their conservation status, and market demand.
Community Herbal Gardens
17.1
Whereas In-situ conservation seeks to conserve/regenerate rare and endangered medicinal
plants in forest areas where they occur, ex-situ conservation aims at propagation and
multiplication of medicinal plants outside their normal habitat. Community herbal gardens
seek to serve the twin objective of creating a germ plasm of rare and endangered medicinal
plants outside their normal habitat on the one hand and propagation and multiplication of
medicinal plants in vacant public lands, panchayats and government lands with active
participation of the local community and thereby serve not only the health care need of the
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community but also produce raw material of quality. During the 10th Five Year Plan 4,000
hectares of area has been brought under the herbal gardens.
17.2
During the 11th Five Year Plan it is proposed to cover 30,000 hectares of area with community
Herbal Gardens in 10 states. This is proposed to be done by merging the Vanaspati Van
scheme with the NMPB scheme as indicated in Para - 23.
Cultivation
18.1
Unsustainable harvest from forest areas, growing demand of domestic AYUSH/herbal
industries for the raw material, increasing export demand for herbal extracts, phytochemicals
and other plant based products, dietary supplements, neutraceuticals, cosmeceuticals and the
increasing emphasis on quality, safety standards of herbal products makes it essential to go in
for large scale cultivation of medicinal plants. During the 10th Plan, 35,000 hectares of area
was brought under cultivation under the Contractual Farming scheme of the Board. Although
the Board has prioritized 32 species of medicinal plants based on their demand in domestic as
well as in export market, more than 50% of the area was covered with four species, namely,
Isabgol, Senna and Safed Musli and Aonla.
18.2
During the llthtn Five Year Plan it is proposed to cover 1,50,000 hectares of area under
Contract Farming with financial support from the Board. Out of this, 1,20,000 hectares is
proposed to be done in six Medicinal Plants Processing Zones and the balance 30,000 hectares
in States/areas not covered under MPZs.
18.3
Ministry of Agriculture on the initiative of Medicinal Plants Board has decided to include
medicinal and aromatic plants within the scope of National Horticulture Mission (NHM).
Considering the higher outlays available under NHM it is proposed to suggest additional
1,50,000 hectares to be covered with medicinal and aromatic plants under NHM during the
11th plan. Thus, in all total area proposed to be brought under cultivation with medicinal and
aromatic plants during the 11th Plan will be 3, 00,000 hectares.
18.4
Cultivation under contractual farming scheme under the existing operational guidelines is a
part of the Central Sector Scheme which the Medicinal Plants Board operates. Based on the
experience gained during the 10th plan, it is proposed to take up this activity as a Centrally
Sponsored Scheme, with 100% Central share. This is being suggested to ensure greater
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involvement of State Governments and to devolve responsibility for planning, implementation
and monitoring at the State level.
Medicinal Plants Processing Zones
19.1
During the 10th Plan emphasis has been on cultivation. However, such cultivation has been
sporadic. As a result cultivation and post harvest management could not be synergized in a
holistic manner. The concept of MP processing zones attempts to take a comprehensive look
at a particular produce/range of products located in a contiguous area for the purpose of
development and sourcing the raw material, their processing/packaging leading finally for
marketing and export. The entire effort is thus centered on clustered approach for identifying
potential products, their geographical region in which these products are grown and adopting
an end to end approach of integrating the entire process right from the stage of production till
it reaches the market.
19.2
Agriculture Produce Export Development Agency (APEDA) under the Ministry of Commerce
during the 10th Plan has set up two Agri Export Zones for medicinal plants in Kerala and
Uttaranchal. There are in all 60 AEZs for fruits, vegetables, flowers etc. in the country. Their
implementation however has several short comings.
These short comings have to be
addressed while setting up Medicinal Plants Processing Zones. It is proposed to set up six
Medicinal Plants Processing Zones during the 11th Five Year Plan with the following
activities:
(viii)
Setting up six Medicinal Plants Processing Zones in different agro-climatic zones.
(ix) Identification of 20 species of medicinal plants for different agro-climatic zones.
(x) Cultivation @ of 20,000 hectares per zone = 1, 20,000 hectares.
(xi) Post Harvest Management (Storage cum drying, grading, sorting etc.).
(xii)
Marketing (Price support, setting up mandies, brand promotion etc.).
(xiii)
Extension (Quality Planting Materials, training and farmers' mobilization).
(xiv)
Explore possibility of creation of additional infrastructure in existing Agri-Export
Zones to make them suitable for requirements of medicinal Plants Sector.
19.3
The activities will involve an outlay of Rs. 85 crores for each of the MPZs during the 11th
Plan.
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Prioritized List of Medicinal Plants
20.1
The Board has prioritized 32 medicinal species for cultivation/ conservation. During 10th Plan
the cultivation has, however, been limited to about 20 species. Out of these four species,
namely, Isabgol, Senna, Aonla and Safed Musli covered more than 50% area brought under
cultivation programme.
20.2
The inclusion of plants in prioritized list has to be on the following grounds:
(i) Demand from domestic ASU/herbal industry.
(ii) Criticality for ASU formulations.
(iii) Status in the wild - endangered, critically endangered, threatened etc.
(iv) Demand in International market.
20.3
Based on the above parameters the prioritized list is under revision.
Pattern of Subsidy
21.1
The existing Operational Guidelines provide for 30% subsidy for projects under Contractual
Farming scheme. Selection and prioritization of plant species for financial assistance under
the schemes of National Medicinal Plants Board (NMPB) should however be based on the
demand in domestic and international markets, their availability in the wild and their
conservation status (critically endangered, threatened, vulnerable etc.). Priority should also be
accorded to plants which are presently imported. Also, the quantum of subsidy should be
105
different for trees which have long gestation period as opposed to crops that are annuals, bi
annuals and perennials but start yielding after 1-2 years. In order to encourage cultivation of
plants of long gestation period the matter needs to be pursued with the state Forest
Departments / Ministry of Environment & Forests to cover about 50% of trees/perennials of
medicinal use in their afforestation programmes implemented through Joint Forest
Management. Also, the existing level of subsidy under Contractual Farming scheme needs to
be reviewed considering that trees have long gestation.
21.2
The species like Isabgol and Senna, included presently in the prioritized list of 32 plants, are
extensively cultivated in the states of Rajasthan, Gujarat and Tamil Nadu and have got
integrated in the farming systems in these states. In the light of this, the crops like Isabgol,
Senna and Safed Musli should be accorded lower priority and subsidy reduced from the
present level of 30%.
21.3
There are other species like Guggal, Ashok, Arjun, Bael, Harad, Baheda, Nagkesar, Amla
which have long gestation period and, therefore, will require support during the gestation
period.
Also, there are species which are on CITES Appendix I and II, Schedule VI of
Wildlife (Protection) Act, and plants presently imported negative list of plants for export
which need to be supported through cultivation.
The Technical Committee of medicinal
Plants board after deliberations decided to recommend graded pattern of financial assistance
by way of subsidy as detailed below:
(i)
10% subsidy for plants which are under commercial cultivation largely like
Senna, Isabgol and Safed Musli.
(ii)
50% subsidy for cultivation of plants which are presently imported and require
specific technology expertise and greater inputs.
(iii)
75% subsidy for species of plants which are included in CITES list, schedule
VI of Wildlife Protection Act and negative list of exports. This will convey
strong bias in support of conservation of medicinal plants and protection of bio
diversity.
(iv)
30% subsidy for other identified and prioritized plants.
106
21.4
At present, subsidy is chanelised through banking institutions who carry out the appraisal and
also advance loan. The minimum requirement of loan is 10% of the project cost. Suggestions
have been received that as an alternative, the subsidy could also be chanelised through the
industries or producer companies. A producer company as per amendment in the Company’s
Act in 2002 is company in which the farmers are the share holders. Such mechanisms for flow
of subsidy need to be considered on a pilot scale with necessary safe guards.
21.5
Subsidy should, also, be linked to the adoption of quality standards, conservation of rare and
threatened plants, propagation of long gestation crops like trees and other perennials and
cultivation on marginal and waste lands.
Also, to make the whole value chain quality
conscious, the subsidy as well as loan should be targeted only to those farmers, processors and
manufacturers of value added products and traders who deal with certified materials.
I
Standardization and Quality Control
22.1
At present 90% of the medicinal plants (in numbers) are sourced from the forests collected
from different forest areas with different soil, climatic conditions and forest types. Even the
season of collection for the same species could vary from forest type to forest type. Also the
system of harvesting, drying, storage could vary from place to place. These affect the quality
of the raw material which may vary in its active ingredients, potency, presence of microbial
contaminants, heavy metals etc.
Standardization of raw material quality and the finished
products, therefore, are crucial to the quality, safety, efficacy of the finished products. This
will depend upon standardization in agricultural practices, collection, harvesting and storage
practices.
Developing Good Agriculture and Collection Practices (GACPs)
107
22.2
WHO has evolved Good Agriculture and Collection Practices (GACPs) for medicinal plants.
Some of the countries like China, Japan and European Union have also evolved their own
GACPs for medicinal plants. It is proposed to evolve and notify Good Agriculture Practices
(GAPs), Good Collection Practices (GCPs), Good Storage Practices (GSPs) for medicinal
plants during the 11th Plan. These will consists of two sets of guidelines. There will be
generic guidelines followed by species specific GAPs/GCPs/GSPs for the major medicinal
plants under cultivation for which monographs are proposed to be prepared with the help of
the Research Institute/ Universities having expertise in the subject. In all 100 monographs are
proposed to be prepared during the 11th Plan.
22.3
Promotion of organic farming and introducing the use of bio-fertilizers and bio-pesticides as a
component of GAP will have to be a major initiative during the 1 1th Plan.
Development of Monographs for important medicinal plants
22.4
Comprehensive monographs on important medicinal plants backed by scientific research on
quality, efficacy and safety standards is crucial to acceptance of our herbal/medicinal plants
products in the developed countries where regulatory laws are very strict. Through a
collaborative programme it is proposed to prepare monographs of important medicinal plants
and registration thereof in the positive list of plants in the main importing countries.Yearly
monitorable targets for preparation of monographs and their registration in the positive list
will have to be worked out.
22.5
A large number of medicinal plants which are perennial (like shrubs and climbers) and tress
which have long gestation period do not have protocols for sustainable harvest. Almost 70%
of the medicinal plants are harvested by destructive means involving uprooting of plants,
debarking of trees or complete felling of trees.
It is proposed to fund Research &
Development activities so as to develop protocols for sustainable harvest of such medicinal
plants which should include such plant parts which may not involve destructive harvesting. It
is proposed to cover 20 species during the 11th Plan.
Quality Planting Material
22.6
For any cultivation programme to succeed, it should be backed by a strong network of
nurseries which will produce planting material of certified quality. For medicinal plants it is
essential that while selecting the variety/genotype due regard is paid to the presence of active
108
ingredients, disease resistance and growth in the agro-climatic conditions where cultivation of
plants is proposed to be taken. During the 1 1th Plant it is proposed to identify agencies in the
government and non-Government sector, backed up by independent certification, which will
be used as focal points for raising nurseries and supplying Quality Planting Material to the
farmers and cultivators.
Certification
22.7
Independent Certification of the quality and safety standards right from the stage of seeds,
planting material to GAPs, GCPs, GSPs and eventually the raw material produced is key to
securing remunerative price for the produce. At present there is no institutional mechanism
for independent certification of the quality of seeds used in the nurseries, quality of planting
material. GAPs, GAPs and GSPs and the raw material produced. During the 11th Plan an
Independent Certification mechanism is proposed to be put in place which will not benefit the
growers but also the manufacturers and users of medicinal plants. For small and marginal
farmers, group certification of GACPs and organic farming backed by government support
may have to be considered.
Setting up laboratories for quality testing
22.8
APEDA has schemes for reimbursement of quality testing charges for horticulture, agriculture
and animal products. They also have an infrastructure for testing facilities. These subsidies,
reimbursements and use of quality assurance structures should be available to the entire value
chain of medicinal plants, both for exports as well as domestic consumption.
22.9
Price of raw material produced by growers is intimately linked to the quality. At present the
quality testing labs are few and far between. It is proposed to provide financial support for
strengthening testing labs where they already exist and set up new ones preferably through a
public-private parternership mechanism.
109
Vanaspati Van Scheme
23.1
In order to augment availability of medicinal plants for Reproductive and Child Health
Programme (RCH) under the Indian Systems of Medicine, the scheme of Vanaspati Van was
started during the 9th Plan and continued during the 10th Plan.
The scheme is being
implemented by the Department of family Welfare. Though the scheme was to be transferred
from Department of Family Welfare to the Department of AYUSH, the transfer could not
materialize.
23.2
Under the scheme plantations of medicinal plants are proposed to be raised over waste lands
and denuded forest lands of 3,000 - 5,000 hectares of contiguous area.
The scheme is
implemented in states which agree to constitute a state level body, registered as a society
under the Societies Registration Act. The guidelines provide for the societies to be headed by
forest officials with representatives of Department of Family Welfare and Department of
Indian Systems of Medicine as their executive members. Each Vanaspati Van is rligible for
financial assistance not more than Rs. 5 crores @ Rs. 1 crore per year.
23.3
At the time of formulation of the scheme, it was recognized that it should be administered by
the ISM&H Department.
However, the scheme was kept with the Department of Family
Welfare in view of the inadequate infrastructure with the Department of ISM&H at that point
of time.
23.4
So far, the Department of Family Welfare has financed 9 Vanaspati Vans and released Rs.
18.65 crores with Rs. 26.35 crores to be released during the remaining period of 10th Plan and
11th Five Year Plan.
23.5
In view of the fact that the scheme of Vanaspati Van and the schemes of Herbal Garden that
are being implemented by National Medicinal Plants Board (NMPB) have identical objectives,
it is proposed that the scheme of Vanaspati Van may be merged with scheme of National
Medicinal Plants Board (NMPB) along with the outlays that are proposed for the scheme with
enhanced coverage during the 11th Plan.
The modalities for transfer of scheme from
Department of Family Welfare to Department of AYUSH are being finalized with the
110
department of Family Welfare and the transfer is expected to materialize in the next few
months.
23.6
During the llthtn Five Year Plan it is proposed to cover 30,000 hectares of area with
Community Herbal Gardens( as vanaspati van) in various panchayats, government and public
lands. These community herbal gardens, which should focus on perennials and trees, will be
managed with active participation of the community through the institution of joint forest
management committees/ van panchayats
Post Harvest Management
24.
For cultivation programme to succeed it must have forward linkage with the infrastructure for
value addition, processing, drying and storage network and a market. During the 10th Plan the
emphasis has largely been on in-situ conservation and cultivation programme. One of the
estimates suggests that on an average 30 to 40 % of the raw material received by the
manufacturers gets rejected at the factory site on account of the presence of microbial
contaminants, moisture, soil, dust, stone chips and even heavy metals. While extensive
training to the collectors/cultivators/farmers will be a major activity, a network of storage
godowns and semi processing facilities near the major collection centres and cultivation areas,
managed either by government, PSU, Co-operative Federations or Panchayats will go a long
way in quality raw material being made available to the manufacturers besides improving the
safety and efficacy of the final product. It is proposed to take up projects for post harvest
management and capacity building the thrust areas of the sector during the 11th Plan.
Ill
Marketing
25.
The activities that are proposed to be taken up for marketing during the 11th Plan are as under:
(i)
Online registration and trading of medicinal plants through a e-portal developed
by National Medicinal Plants Board (NMPB).
(ii)
Periodic reporting of information on medicinal plants traded in different mandies
in the country with volumes and prices. This will create a transparent system of
information, dissemination of information on market and prices of medicinal
plants traded across different regions. This will also impart transparency to an
otherwise unorganized trade.
(iii) Most of the manufacturers source their raw material from traders. There are a
number of intermediaries involved between the basic collector and the
manufacturer. Consequently, it becomes difficult to ascertain the correct source
of the raw material, whether cultivated or collected from the wild and the period
of collection. In order to establish traceability it is proposed to initiate a system
of registration of traders and manufacturers and mandatory maintenance of
records by the manufacturers and traders with regard to the raw material used,
purchased and sold. It is proposed to put in place an institutional mechanism
with necessary statutory support, if required, during the 11th Five Year Plan.
(iv) Medicinal plants cultivation being a new and up coming activity in agriculture
sector, there are risks and uncertainties about the markets and prices.
It is
proposed to provide support price to cultivators of medicinal plants to insulate
them from the vagaries of market fluctuations and unfavourable climatic factors.
This is proposed to be done by providing financial support to state level
organisations identified for the purpose of marketing of medicinal plants in the
state.
(v)
There is a Market Development Assistant Fund (MADF) available with Ministry
of Commerce. It is proposed that fund should support brand and market
development initiatives of the Ayush sector in view of its unique niche market.
This will require higher investment and expenditure to gain market penetration
and exporters should be assisted to enable them to participate in trade fares and
as well as sale promotion activities. On the lines of support to horticultural
112
produce, APEDA pavilion in international trade fares should also promote
medicinal plants.
Research & Development
26.1
Under the Promotional scheme, NMPB has been supporting Research & Development projects
through various research institutes/agricultural universities.
The nature of the projects
financed and their outlays are indicated at Annexure - III.
26.2
R&D activity is also being supported in a substantial way by CSIR, DBT, DST, ICFRE and
ICAR through their research institutes, regional research institutes, research laboratories also.
This is expected to continue during the 11th Plan.
NMPB will in particular support R&D in following areas:
(a) Implementation of specific projects to ensure basic and strategic research for
developing information on processes/products and patenting of active
molecules of important plants so as to provide leadership role to India in the
emerging IPR regime.
(b) Development of plant varieties for important, endangered and threatened
medicinal plants based on their usage in Ayurveda and other Indian Systems of
Medicine.
(c) Identification of gaps in documentation of medicinal plants resource data,
different agro-climatic zone-wise, detailed inventory of medicinal plants, their
region-wise occurrence and preparation of a National Atlas on medicinal
plants.
(d) Development of agro-techniques. Good Agriculture and Collection Practices
(GAP), Good Collection Practices (GAP), Good Storage Practices (GSP) for
important medicinal plants species and preparation of monographs.
100
species are proposed to be covered.
(e) Development of protocols for micro propagation (Tissue culture) for species of
plants which are otherwise difficult to propagate.
(f) R&D on value addition, sustainable harvest and storage.
113
(g) Bio-prospecting of new medicinal plants for desired activities to switch over to
species not covered in Red Data book but with activity and target molecules
similar to those present in the endangered species.
(h) Studies on inter-cropping of medicinal plants with agri/ horticultural crops and
evolve models of different crop combinations for different agro-climatic
conditions.
(i) Converting new leads into commercial technologies - the missing link with
high tech science and the traditional knowledge.
(j) Scientific studies on uptake of heavy metals by medicinal plants and
technologies to remove/minimize such contamination.
Information, Education and Communication
27.
The activities proposed to be covered under IEC during the 11th Plan are proposed to be as
under:
(a) Training of primary collectors in Good Collection Practices (GCPs) and Good
Harvesting Practices (GHPs).
(b) Awareness through audio-visual aids, talks, seminars, training, workshops etc.
(c) Training & visit of growers and collectors to demonstrations plots, research centres
and other related organisation in the country.
(d) Training of farmers and cultivators of medicinal plants in GAPs and GSPs.
(e) Extension/Publicity material on medicinal plants.
(f) Participation of progressive farmers, cultivators, collectors, manufacturers and
other stake holders in important trade events/exhibitions and expositions in
Herbal/Medicinal plants sector in India and abroad.
Other policy initiatives
28.1
There are about 9,000 Ayush pharmacies/manufacturing units. Most of the pharmacies of the
units are not GMP compliant. In addition, there are herbal units manufacturing extracts and
114
other herbal products. For these units to be competitive in the world market, they have to be
GMP compliant. There is a lot of technological upgradation required even in respect of
medium and large industries. Therefore, a Venture Capital fund/Technology Upgradation fund
of the size of Rs. 200-300 crores is required to be created for modernization of Ayush/Herbal
industry.
28.2
Considering that most collection from forest areas is in an unsustainable manner without due
regard to the conservation status of medicinal plant, the industry using material collected from
forest areas needs to contribute towards conservation which could be contributed by way of a
cess. In other words, industry using raw material collected from forest could be imposed a cess
where as those using cultivated medicinal plants could be given incentive. This would
harmonize pricing of medicinal plants and give better returns to growers of medicinal plants.
28.3
Special rates of interest for agricultural/horticultural crops (7% announced recently by the
Government) should be available to medicinal plants also. Besides, the scope of the scheme of
crop insurance should be enlarged to cover medicinal plants in view of the risks that a new
crop like medicinal plants is subjected to due to climatic and market related factors.
28.4
Electricity rates in most states are charged at commercial rates for energy used in cultivation
of medicinal plants as opposed to electricity rates for agricultural/horticultural crops which are
subsidized. This needs to be taken up with appropriate authorities to permit same tariffs for
cultivation of medicinal plants as for agricultural crops.
28.5
The wide variety in medicinal plants usage (about 500 species which are actively traded) make
them vulnerable to variation in taxation norms under state sales tax/VAT rules. It is proposed
that the uniform exemption of VAT/sales tax regime should be introduced for medicinal plants
to give a boost to the sector and its trade within the country. This would be in line with the
Government exemption of essential food related commodities from VAT incidence.
Organizational Issues
29.1
A comprehensive study is presently being undertaken to recommend the organizational
structure, its size, the number of administrative and technical posts required and whether the
Board should be an administrative board as at present, or a statutory/autonomous Board
115
created under an Act of Parliament or a registered society under the Societies Registration Act.
Based on the report of the consultants, the matter is proposed to taken up with the Cabinet for
appropriate decision.
Role of other Ministries
30.
NMPB has a role of coordinating with other ministries/departments. Some of the important
ministries/departments where close coordination will be required are as under:
sustainable Ministry
and
(a) Conservation
friendly
harvesting/cultivation
Forest/wildlife
of
Environment
&
Forests.
laws
of
(b) Cultivation of Medicinal & Aromatic plants Ministry
which have an established market at national and
Agriculture/NHM/ICAR
international level; Market networking, Support
for
warehouses,
buy-back
arrangements,
extension of information under NHM
(c) Research and Development, identification of Ministry
suitable
SOPs,
monographs,
certification,
documentation,
cultivars,
pharmacological
of
Science
&
Technology/ CSIR/ICAR/ICFRE
I PR related research etc
(d) e - network: Centre - State - Village level
Ministry
of
Information
Technology
(e) MPZs (Creation of infrastructure of Laboratories,
warehouses, processing facilities etc)
Ministry of Commerce
&
116
Financial Outlays
31.1 The financial outlays for the activities proposed during the 11th Plan are as under:
SI
Rate per unit
Activity
N
Total
Outlay
coverage
(Rs
(Crores
o.
1
in
Conservation/re-generation
@ Rs. 20,000 per/ha
50,000
Too
100
20
10
50
30,000
90
1,20,000 ha.
510
(hectare)
2
Gene
Banks
100
hectare
Vanaspati
20,00,000
per/gene
bank
each (nos.)
3
Rs.
@
van
Herbal
/
@ Rs. 5,00,00,000/garden
gardens (nos.)
@ Rs. 30,000
4
Cultivation (hectare)
5
Medicinal Plants Processing
Zones(6),
1.
Cultivation
Rs.
60
crores/MPZ
covering
( @ 20,000
cultivation 1,20,000 ha) and
2.
PHM : Rs. 15 crores/MPZ
ha. per
PHM infrastructure
3.
QPM/Certification : Rs. 5
MPZ)
crores/MPZ
4.
Marktg & Project Mgmt
etc. Rs. 5 crores/MPZ
5
Post harvest management
Lump sum
50
6
R& D
Lump sum
100
7
IEC
Lump sum
50
Organization, marketing, IT Lump sum
30
including
capacity
building and training
8
etc.
Total
1000
117
Yearly phasing of outlays
31.2 The year - wise outlays will be as under
Financial Year
Financial outlays proposed (Rs. in crores)
2007-08
150
2008-09
175
2009-10
200
2010-11
225
2011-12
250
Total
1000
****************************
118
REPORT
OF
TASK FORCE ON MAINSTREAMING OF AYUSH SYSTEMS IN XIth PLAN
Introduction
1.
There is global resurgence of interest in Indian Systems of Medicine,
particularly Ayurveda and Yoga. Homoeopathy also is getting popular in India and
abroad. There are many indicators, which underline the shift towards global
acceptance of complementary/alternative systems of medicine because of their
holistic approach, cost effectiveness, cultural-friendliness and virtually no side
effects. Though modern medicine has played a critically important role in reducing
drastically the morbidity and mortality due to communicable diseases, Allopathy
(modern medicine) falls short of patients' expectations in non-communicable and
life style related disorders.
2. The National Health Policy (1983) envisaged integration of Indian Systems of
Medicine & Homoeopathy with the modern medical system for the first time. This was
intended to pave the way for improved outreach & delivery of health services. The
Government of India established a separate department under the Ministry of
Health & Family Welfare in 1995 for giving focused attention to the development
and optimal utilization of Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homeopathy (AYUSH), which are officially recognized systems of medicine in India.
The highest policy-making body for health sector- Central Council for Health &
Family Welfare resolved several times the need to have integration of different
medical systems for improving health delivery. The 10th Five Year Plan reiterates the
need for integration and mainstreaming of ISM&H with modern systems of medicine
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so that people have access to both modern as well as time tested Indian systems
of health care.
3. Presently, the state of policy, regulation and development of AYUSH systems in the
country is by and large in accordance with the WHO guidelines for utilization of
traditional medicine in national health system. Recognizing the inherent strengths of
the Indian systems of medicine, the National Policy on Indian Systems of Medicine
and Homoeopathy-2002 underlines the need for integration of AYUSH in health care
delivery system and national programmes and optimal use of the vast infrastructure
of hospitals, dispensaries and trained practitioners. The policy is aimed at promoting
comprehensive & holistic health and expand the outreach of health care to the
masses through preventive, promotive and curative interventions by improving the
quality of clinicians and teachers by revising curricula to contemporary relevance
and to re-orient and prioritize research in ISM&H to gradually validate therapies and
drugs to address in particular the chronic and emerging life style diseases.
EXISTING STATUS
4. The Indian Systems of Medicine and Homoeopathy (ISM&H) include Ayurveda,
Siddha, Unani, Homeopathy and drugless therapies such as Yoga and Naturopathy.
The major strength of the systems is their easy accessibility, wide acceptability, cost
effectiveness, simple technological inputs for manufacture of medicines, and use of
natural products.
institutions.
India has a vast network of governmental and private AYUSH
There are 458 AYUSH colleges with admission capacity of 23,555, 98
colleges with post graduation facilities, 3,100 hospitals with over 65,000 beds, 22,300
dispensaries, 6,95,024 registered practitioners and 9,257 licensed pharmacies. In the
central sector apart from 45 hospitals there are 81 dispensaries under CGHS, 54
dispensaries under central research councils, 162 under Ministry of Railways, 159
under Ministry of Labour, 28 under Ministry of Coal and 2 Ayurveda dispensaries
under Ministry of Defence. The primary health network comprises of 1,42,611 Sub
centres, 22,974 PHCs and 3,215 CHCs. The number of PHCs is comparable to 22,300
AYUSH dispensaries, which are otherwise not symmetrically distributed.
5. As per an estimate, about 70% Indian population uses traditional medicine for
health care. The rate of population coverage through AYUSH is Health about 7
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doctors per 10,000 population. The regulatory, administrative and institutional set
ups of AYUSH are by and large similar to that for allopathic system. As far as the
acceptability of indigenous medical systems is concerned, Ayurveda is popular in
Kerala, Gujarat, Himachal Pradesh, Rajasthan, Karnataka, Maharashtra, Madhya
Pradesh, Jharkhand, Chhattisgarh, Uttar Pradesh, Uttranchal and Orissa. The
prevalence of Unani system is comparatively higher in Andhra Pradesh, Karnataka,
Tamilnadu, Bihar,
Maharashtra, Madhya
Pradesh,
Uttar Pradesh,
Delhi and
Rajasthan. Siddha system is well established in Tamilnadu and of late is spreading to
other southern states.
Homeopathy is more or less equally spread all over the
country but in higher demand in Kerala, Uttar Pradesh, West Bengal, Orissa, Andhra
Pradesh, Maharashtra, Punjab, Tamilnadu, Gujarat, Bihar and North Eastern states.
THE PROBLEM
6.
The full potential of AYUSH still remains to be realized due to varied reasons.
The foremost among them are lack of essential staff, infrastructure, diagnostic
facilities and drugs in the existing health care network of AYUSH. The other important
reasons are inadequacies in quality of training of practitioners and their non
involvement in the national health and family welfare programmes.
Treatment
meted out to the institutions & manpower of these systems is not at par with that
being given to allopathic system.
Not only there is a strong justification for the
coexistence of both allopathic and AYUSH systems in PHCs/CHCs and district
hospitals, but that every effort must be made to bring about functional integration
without compromising the ethical purity of either system. Many valuable insights into
the best possible management of many chronic ailments may well come from non-
allopathic systems of health care. However, it would be essential to take steps to
ensure that the AYUSH systems grow in a pristine form by research and development
of their own concepts. While use of modern diagnostic tools and quality control
techniques is an absolute must to place these systems on a sound evidence base,
modernization process should not be allowed to reduce these systems to a mere
appendage to allopathy. We must not try and produce a hybrid doctor who has
the strengths of neither system and the faults of both
Mainstreaming of AYUSH.
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7.
The concept of mainstreaming of AYUSH revolves around optimal use of all
available human resources for health care provision in the country. Mainstreaming
has essentially two aspects.
Firstly, qualified AYUSH practitioners can fill the
manpower gaps in Primary Health Care, particularly at the sub-centre/PHC level.
Secondly, there should be a cafeteria approach of making AYUSH and Allopathic
systems available under one roof at the PHC/CHC/District Hospital level for
facilitating patient choice and cross-system referrals. Apart from improving peoples
access to health services, it will also provide choice of treatment to the patients.
There are areas, where the traditional system has overwhelming evidence of better
cure and / or disease management e.g. Ayurveda has better cure for piles, fistula,
jaundice, arthritis; Unani in menstrual disorder, psoriasis; Homoeopathy in allergic
disorders. Similarly Yoga has proven strength in managing life style disorders and
psycho-somatic diseases.
Therefore, there is a need for service integration by
providing the best from each system to patients as a Complementary/ Alternate/
Adjuvant therapy. Efforts should be made to provide quality education in each of
the system to develop confident physicians of each systems, visionary teachers and
researchers
for a need based health care.
Health care involves curative,
preventive, promotive and rehabilitative aspects. Therefore the education, research,
drug development and practice should address all these aspects.
8.
As far back as in 1920, the Nagpur Session of the Indian National Congress
recommended that there should be an Integrated System of Medicine & Research
which should be combination of both our Ayurveda, Unani Tibb, Siddha and Modern
Medicine system choosing the best out of the all and thus supporting one system by
another to serve mankind to its best. For the purpose of promotion and education
of Integrated Medicine, first such college was started in 1934. After Independence,
the Chopra Committee, Pandit Committee, Dave Committee & Uduppa Committee
etc. constituted by Central Government also recommended Integrated System of
Medicine.
9.
FACTS IN MEDICINE
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Every medical discipline has something to offer in Health care- The objective
•
of education and Research should be to harness these strengths.
No system can tackle all the health concerns of the society- Encourage different
•
systems to bring their best remedies in the menu on offer to patients.
•
Several diseases are self limiting; no medication is needed- Educate public.
•
Every system can tackle few diseases effectively- Integrate this in the Health care
delivery. Public shall have a choice to avail what they want.
No system has credible treatment option for few diseases- Try the benefit of
•
different systems as adjuvant. Enhance the medical research in those areas.
Majority of the health problems are at primary level. Increase the out reach of
•
health care delivery at the village level
•
Most of these can be managed with any one of the systems of medicine
•
Each of the systems has its own unique strength to tackle few diseases for which
there is no effective treatment in other systems.
Educate people and
professionals through the IEC programmes through Government media.
Status of Mainstreaming of AYUSH
Centrally Sponsored Scheme on Hospital and Dispensary
10.
Centrally Sponsored Scheme
under the
plan
head
of
‘Hospitals &
Dispensaries' administered by the Department of AYUSH is being utilized for creating
AYUSH facilities in allopathic hospitals / dispensaries.
The scheme has following
components:
I.
Establishment of Specialized Therapy Centre with hospitalization facility for
Panchkarma / Kshar Sutra therapy of Ayurveda or Regimental Therapy of
Unani Medicine or Siddha or Yoga & Naturopathy or Homoeopathy as the
case may be;
II.
Establishment of Specialty Clinic of ISM&H i.e. system specific outdoor
treatment center;
III.
Setting up of ISM&H wing in District Allopathic Hospitals - Outdoor as well as
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Indoor facility of one or two systems of ISM&H is required to be set under this
component of the scheme; and
IV.
Supply of essential drugs to State rural & backward area dispensaries.
The provision of 100% Central assistance under the scheme has facilitated
States in relocation/creation of AYUSH outdoor facility in PHCs and specialized
therapy facility in CHCs and AYUSH wing in District/Sub-divisional hospitals. However,
the scheme does not provide for supporting salary component of manpower
required to run such facilities.
implemented the scheme.
As detailed in Annexure - 1, many States have
Under the NRHM operational frameworks States would
be able to utilize NRHM funds for hiring AYUSH doctors for providing AYUSH facilities
at PHC/CHC level.
States would be able to dovetail AYUSH components in their
State’s Specific action plans.
MAINSTREAMING UNDER NATIONAL RURAL HEALTH MISSION (NRHM)
11.
The National Rural Health Mission (NRHM) has been launched with a view to
bringing about improvement in the health system and the outreach of health
facilities for the benefit of people living in the rural and backward areas of the
country. The mission seeks to provide universal access to equitable, affordable and
quality health care, which is accountable as well as responsive to the needs of the
people, reduction of child and maternal deaths, population stabilization, gender
and demographic balance, etc. Revitalization of local health traditions and
mainstreaming of AYUSH have been incorporated in visions, goals and strategies of
the National Rural health mission. The objective of the integration of AYUSH in the
health care infrastructure is to re-enforce the existing public health care delivery
system, with the use of natural, safe and eco-friendly remedies, which are time
tested, accessible and affordable. The roadmap of mainstreaming of AYUSH has
been conveyed to the States through a joint letter dated 12.08.2005 from Secretary
(AYUSH) and Secretary (Health) (Annexure - 2). The roadmap seeks provisioning of
AYUSH facilities in PHCs and CHCs with placement of AYUSH doctors and providing
medicines.
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12.
NRHM is fully committed to mainstreaming AYUSH within the mainstream
health delivery system. This involves support to the physical and functional
integration of the systems so that both systems flourish under one umbrella. In line
with its commitment to mainstream AYUSH activities the Department has agreed
that in the current year at least 2000 AYUSH doctors in the eight EAG states and in
J&K, would be located either at the PHC or the CHC. Of that 1000 would be by
relocation from the existing AYUSH doctors in Government. Service. The remaining
one thousand would be contractual doctors whose remuneration would be
supported trough NRHM funds. The state wise break up of the 2000 doctors would be
based on the number of PHCs/CHCs existing in the State. In the IPHS standards for
CHCs, which has been finalized by the Department of Health and Family Welfare,
there is already a provision for an AYUSH wing. The Standard has been disseminated
to the States. NRHM is committed to the upgradation of CHCs to IPHS. However, the
matter can be communicated to the States after due approval of the Cabinet of
the Implementation Framework of NRHM. The MoU which is under preparation for
the XIth Plan would also provide for mainstreaming of AYUSH on the suggested lines.
Can Qualified AYUSH practitioners be utilized for delivery of National Health
Programmes?
13.
Recognized AYUSH training courses provide basic knowledge to under
graduates regarding anatomy & physiology/biochemistry in addition to clinical
knowledge of their own systems. In some States e.g., Maharashtra, Punjab, Himachal
Pradesh, Madhya Pradesh, Uttar Pradesh, Gujarat, Chattisgarh and Uttaranchal,
these doctors have been authorized by the State Governments to practice modern
medicine and are posted in PHCs.
As per the judgements of the Hon’ble Supreme
Court in Mukhtiar Chand and Poonam Verma cases, a medical practitioner is
expected to bring a certain degree of expertise and training to his practice and
could be expected to understand the indications/contraindications etc. of the
medicines he prescribes to patients.
These judgements basically define what is
medical negligence. It is the considered view of a study carried out by National Law
School, Bangalore that these judgements do not bar cross system practice as long
as the same is specifically permitted by a State Government (if the State Medical
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Register recognizes qualified AYUSH practitioners as part of that medical register
(Annexure-3)).
Therefore, subject to a State Government authorizing AYUSH
practitioners to prescribe certain categories of Allopathic medicines and AYUSH
practitioners being provided proper orientation training, they could be utilized in the
delivery of National health programmes like Malaria/TB/HIV-AIDS etc. When these
programmes can be administered by ANMs there is no reason why AYUSH doctors
should not be roofed in to strengthen the nation-wide implementation of these
programmes.
Recommendation
14.
Physical Integration
14.1 Mainstreaming under NRHM is being pursued by facilitating convergence of
AYUSH infrastructure with that of modern medicine. It has been decided to
have AYUSH facilities in PHC and CHC either through relocation of AYUSH
dispensaries or contractual appointment of AYUSH doctors. On account of
asymmetrical budgetary provisions and infrastructure of AYUSH in the states,
the task of physical as well as functional integration of AYUSH with modern
medical system is progressing slowly. NRHM guidelines for supporting salary
component/contractual appointment of AYUSH doctors in PHCs/CHCs are
likely to be issued shortly.
Relocation of AYUSH dispensaries to the nearest
PHCs and creation of AYUSH facilities in remaining PHCs has also not been
undertaken by the states to the desired extent.
State
Directors/Licensing
Authorities it
In a recent meeting with
has come to light that
AYUSH
dispensaries could be shifted to not more than 25% PHCs, remaining 75% PHCs
will have to be provided with required infrastructure and AYUSH doctors &
paramedical staff.
Hence, to fast track mainstreaming creation of AYUSH
facilities in 25% of such PHCs each year in each state should be supported for
next three years under NRHM with a view to achieve 100% coverage of
PHCs/CHCs in the 11th Five Year Plan.
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14.2. Hospitals and Dispensaries Scheme of Deptt. of AYUSH should be used to
scale up provision of requisite Ayush infrastructure in PHCs/CHCs/District
Hospitals while salaries of Ayush doctors would come from NRHM, other
infrastructure and Ayush medicines should be provided under the Centrally
Sponsored Scheme of Hospitals & Dispensaries.
Functional Integration
14.3 AYUSH manpower after proper training should be utilized in National Health
and Disease control programmes to fulfill the unmet needs of the health
sector and augment health delivery & outreach. Department of Health needs
to issue directions to the NIHFW and to the states to prepare need based
training modules for AYUSH doctors and identify training centres. Similarly
ASHAs, ANMs and Anganwadi workers and even Allopathic doctors working
in PHCs & CHCs should be given adequate orientation training about the
local health
practices,
simple AYUSH
remedies/therapies
for common
ailments and uses of medicinal plants. National Institute of Health & Family
Welfare and Department of AYUSH should operationalize this and bring out an
action plan implementable in a specified time frame.
14.4 Proper utilization of AYUSH practitioners in health delivery in small villages,
clusters and tribal pockets is a feasible proposition, if sub-centers are manned
by AYUSH
doctors.
Presently, the sub-centers are the first points of
institutionalized health delivery under the supervision of ANMs.
There is a
strong case for posting an Ayush doctor to a cluster of 3 sub centers with each
sub center being visited twice in a week which will improve not only the
quality of health delivery but also the outreach. ANMs would be in a position
to spare more time for preventive and RCH activities. AYUSH doctors apart
from attending to the patients in the sub-centers could be involved in public
health education/awareness activities as well.
Revision of AYUSH and Medical Education
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14.5
The AYUSH course curricula also needs modification with inclusion of
orientation modules related to National Health Scenario, National Health &
Family Welfare programmes,
Regulatory Acts, pharmaceutical industry,
global perspectives in Traditional Medicine, Complementing the public health
programmes etc. There should be regular mechanism in place for imparting
periodic updates on professional knowledge to the AYUSH Practitioners and
Para-medics.
Similarly, AYUSH modules should be included in the MBBS course-curriculum
for sensitizing medical students about basic principles of Indian systems,
which are time-tested, cultural friendly and aimed at preventing diseases and
promoting health care. AYUSH wings may be promoted in existing medical
colleges for effective integration of AYUSH within the existing health care
infrastructure.
Thus,
The
undergraduate
(and
perhaps
the
postgraduate) curricula of both these systems must have a component of
orientation of the other system. The purpose is not to encourage cross system
quackery but sensitize practitioners of one system regarding the strength of
the others. The purpose must be to build a system of respect for the other
systems and an understanding of how they can mutually complement each
other to provide the most comprehensive and cost effective care.
Scientific validation of AYUSH systems.
14.6 Integration of Research Programme for scientific validation and R & D on
AYUSH relevant to the national health needs should be evolved and
encouraged. Duly researched and validated AYUSH therapies and remedies
with evidence of safety and efficacy should be considered for introduction in
National Health Programmes. ICMR/CSIR laboratories/institutions should also
undertake need-based research on AYUSH remedies for diseases of national
and global importance.
Ayush Research Councils must be integrated with
the new Department of Medical Research which is proposed to be set up for
bringing about synergy in the function of ICMR and Ayush Research Councils.
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14,7 AYUSH Research Councils should undertake collaborative protocol based
peer reviewed researches in collaboration with reputed research institutions in
public and private sector. Emphasis should be on collaborative studies aimed
at standardization/quality control and building an evidence base for national
and global acceptance of Ayush systems so that they should become
central to national health care delivery and not remain at the margins.
14.8
Research in AYUSH systems needs to be prioritized with equal emphasis on
fundamental and applied researches.
AYUSH Research Councils need to be
completely revamped and professionalised and brought under the umbrella of
Flexible Complementary Scheme of in situ promotions for attracting and
retaining talents.
If the Central Government is not prepared to treat them as
Scientific establishments for purposes of time bound promotion, it would be far
better to merge them with ICMR.
Ayurveda/Siddha/Unani Drugs Development
14.9 Standardization and quality control of Ayurveda, Siddha, Unani drugs is a
problem area as botanicals do not lend themselves to as precise a quality
control as synthetic molecules manufactured under controlled laboratory
conditions.
This
requires
State
of
the
art
research
for
developing
chemical/biological markers/chromatogram fingerprints/standardized operating
procedures and phyto-chemical characterization of Bhasmas. A state of the art
Ayurveda/Siddha/Unani
Drug Standardization and
Development laboratory
should be set up jointly by the Deptt. of AYUSH and CSIR for development of
pharmacopoeial standards of ASU drugs for India to capture a fair share of the
approx. $ 70 billion international herbal market.
15.
Action plan for Central Government.
(')
National Institute of Health and Family Welfare, Indian Council of Medical
Research (ICMR), Central Council for Research in Ayurveda and Siddha
(CCRAS) and Central Council for Research in Unani Medicine (CCRUM) should
be tasked to evolve an operational framework for mainstreaming of AYUSH in
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national health care delivery network based on the underlying philosophy
of
providing
choice
of
treatment
to
the
patients
at
Sub-
centres/PHCs/CHCs/district level and to facilitate cross system referrals
complimentary and adjuvant uses of drugs and drugless therapies of various
systems with a view to provide cost effective and comprehensive health care.
Indian public health standards should accordingly be modified.
(ii)
There should be a proper integration of AYUSH in Directorate General of
Health
Services
(DGHS),
Central
Government
Health
Scheme
(CGHS),
National AIDS Control Organization (NACO) and the proposed Department of
Medical Research.
AYUSH Research Councils should be brought under the
umbrella of the proposed Department of Medical Research for encouraging
collaborative and need based research for addressing India’s health care
problems in a cost effective and comprehensive manner
(iii)
Keeping Sub-Centres and PHCs without doctors either due to vacancies or
absenteeism should not be allowed to continue any further.
All such
vacancies should be filled by qualified AYUSH doctors. A cluster of three Sub
Centres should be provided the services of a qualified AYUSH doctors who
should visit each Sub-Centres twice in a week. The first resort of majority of
patients in rural areas is traditional medicine instead of leaving patients to find
for themselves and be fleeced by quacks, it is better to institutionalize AYUSH
systems in sub-centres as a first point of reference for institutionalized health
care.
AYUSH doctors at sub-centres should also be involved in the
administration of National Health Programmes like TB/HIV AIDS/Cancer for
which they should be properly trained.
This should be a priority area under
the newly launched National Health Mission and States should be assisted on
a 50:50% matching basis for meeting the expenditure on posting of qualified
AYUSH doctors at sub-centres on contractual basis.
(iv)
At present 7 Ayurveda and 5 Unani medicines have been included for
distribution in 9 States and 4 cities under the Reproductive and Child Health
Programme of the Department of Health and Family Welfare. This course of
action should be taken to its logical conclusion. This list should be expanded
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more and more to include Ayurveda, Siddha, Unani and Homoeopathic
medicines which have proven efficacy in treatment of various diseases and
which have been standardized. ICMR, CCRAS, CCRUM and CCRH should be
tasked to take this initiative further.
(v)
Under-graduate and post-graduate courses of various systems should be
modified to reflect the global resurgence of interest in traditional and
alternative medicine.
Medical students of various disciplines need to
internalize the basic truth that every system has something to offer and no
system can tackle all the health problems.
Various systems of medicine are
complimentary to each other and their complimentarity should be fully
utilized in providing a cost effective and comprehensive health care.
Statutory bodies charged with the responsibility of regulating the education of
various systems of medicine are not likely to take the lead in this direction.
Sensitization/orientation modules should be developed by the National
Institute
of
Health
and
Family
Welfare
in
collaboration
with
ICMR/CCRAS/CCRUM/CCRH for introduction in under-graduate courses of all
systems.
16.
Action Plan for States.
Most States have expanded Ayurveda, Siddha, Unani and Homoeopathy
infrastructure mostly at primary heath care level in response to locally felt needs and
gaps in the existing health care infrastructure.
This does not necessarily mean that
they have mainstreamed Ayurveda, Siddha, Unani and Homoeopathy in their health
care delivery at primary and secondary level. There is a lot of dysfunctionality in the
functioning of facilities of various systems at various levels.
Functional rigidities are
being noticed in most States where there is little coordination between Directorates
of Health and AYUSH systems.
Having separate Directorate of AYUSH or even separate Department of AYUSH
at State level is not the right approach.
There should be functional integration
between allopathic and AYUSH systems at the State, District, Sub-district and PHCs
level with the single line administration at each level.
To begin with, allopathic
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doctors con be expected to head Directorate, District, Sub-District and PHC set
up with an Addl. Director at the Directorate level and an Addl. CMO at the District
level and so on but in due course at all public health administrative positions should
be filled on the basis of inter-sa seniority and administrative capability should be the
criteria for managerial positions in public health.
Integration of AYUSH with allopathy under single line administration at
primary, secondary and tertiary level is crucially important for the purposes of
bringing about synergy and of economy.
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Conclusion
17.
The long term process of mainstreaming of AYUSH has been initiated with
remarkable success in the last decade. However, this has been a more or less
bottom up State driven initiative in response to felt needs for health care at the
District/CHC/PHC level.
There is a need to spell out an overarching strategy to
ensure that available resources are optimally utilized for achieving national health
goals and outcomes. Given due emphasis on safety of drugs, drug standardization,
evidence base, quality education infrastructure and strong regulatory systems,
AYUSH systems would in due course get public acceptance in India as mainstream
systems of health care. The draft approach paper for the 11th Plan rightly accepts
the centrality of AYUSH systems for meeting the gaps in the primary health care. It
notes “across States 6% to 30% posts of doctors remain vacant and random checks
showed that from 29% to 67% doctors were absent. The trained ISM practitioners
represent a valuable human resource at village and block levels. This could be
leveraged and co-opted into providing primary health care”.
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Year -2003-2004
Details of specialist Wings/clinics/Centers for which grant-in-aid released under the scheme for AYUSH Hospitals
S.No.
Name of the
State/U.T.s
Details of specialist Wings/clinics/Centers for which grant-in-aid released.
ISM & H Wings in district
Hospitals @ Rs.35.00 lakhs
No. of Wings
Amount
Sp. Therapy Center with
indoor facility @ Rs.22.00
fakhs
No. of
Amount
Centers
Sp. Clinic of ISM & H Specific
out
door
treatment
@
Rs. 10.00 lakhs
No. of Clinics
Amount
Total amount
sanctioned.
3.
Andhra
Pradesh
Arunachal
Pradesh
Maharashtra
4.
Manipur
Hom. - 1
35.00
35.00
5.
Meghalaya
Hom.- 7
Ay. - 1
150.78
15.82
166.60
6.
7.
Rajasthan
Tamil Nadu
West Bengal
1.
2.
8?
Ay.-1
Siddha - 4
Ay.-4
Ay.-6
Hom. - 8
Siddha -4
30.24
100.00
100.00
431.84
Unani -1
10.00
10.00
Hom - 5
46.76
77.00
Ay-2
19.52
19.52
Hom -1
Siddha - 6
10.00
60.00
Ay.-2
Siddha -6
Unani -1
Hom. - 6
146.28
10.00
160.00
100.00
578.12
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Year 2004-2005
STATE-WISE RELEASE OF FUND TO THE STATES/UTs UNDERCENTRALLY SPONSORED SCHEMES (CSS) Hospital & Dispensaries
Rs. in Lakhs
S.No.
Name of the
State/U.T.s
ISM Polyclinic
Specialty Clinics in
Allopathic Hospitals
1.
2.
3.
4.
5.
6.
Andhra Pradesh
Arunachal Pradesh
Assam__________
Bihar____________
Chhattisgarh_____
Delhi____________
Goa_____________
Gujarat__________
Haryana_________
Himachal Pradesh
J & K____________
Jharkhand_______
Karnataka_______
Kerala___________
Madhya Pradesh
Maharashtra_____
Manipur_________
Meghalaya_______
Mizoram_________
Nagaland________
Orissa___________
Punjab__________
Rajasthan_______
Sikkim__________
Tamil Nadu______
Tripura__________
Uttar Pradesh
Uttaranchal______
West Bengal
22.00
100.00
40.00
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Supply of Essential Drug for
dispensaries
Total
112.25
86.50
234.25
40.00
86.50
147.25
343.57
146.25
59.75
202.00
100,00
146.25
111.75
202.00
100.00
70.00
63.50
27.68
243,00
190.62
50.47
292.68
17.89
ISM Wing
In District Allopathic Hospitals
174.32
22.00
22.00
30.00
42.50
43.47
22,00
17,89
44.00
14.62
07.00
44,00
9.52
118.00
350.00
280.00
6.25
123.00
18.75
382.00
28.00
140.00
30.00
Home Remedy Kit (2nd installment)
TOTAL
235.86
349.14
1070.00
60.50
7.50_______
179.25
134.75
65.25
2137.75
37,14,200
2174,89,200
350.00
295.77
123.00
18.75
382.00
206.50
147.50
179.25
134.75
95.25
37,14,200
3829,89,2
00
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Year -2005-2006
Details of specialist Wings/clinics/Centers for which grant-in-aid released under the scheme for AYUSH Hospitals
S.
No.
Name of the
State/U.T.s
Details of specialist Wings/clinics/Centers for which grant-in-aid released.
ISM & H Wings in district Hospitals @
Rs.35.00 lakhs
1
Andhra Pradesh
Ay.
No.
-20
______ Amount
Rs.700.00 lakhs
2
Assam
ISM &H - 24
Rs.840.00 lakhs
3
Chattishgarh
Ay-10
Rs.350.00 lakhs
4
Jammu & Kashmir
Rs.490.00 lakhs
5
Karnataka
Ayurveda/ Unani14_____________
Ayurveda-1
6
Kerala
7
Maharashtra
8
Madhya Pradesh
Ayurveda - 8
Homoeo. - 1
Rs.279.37 lakhs
9
10
11
Meghalaya
Ayurveda - 3
Rs.101.30 lakhs
Manipur
Nagaland
12
13
Rs.35.00 lakhs
Sp. Therapy Center with indoor
facility @ Rs.22.00 lakhs
______ No.
Ay. & H-1
Y & N.
-1
Amount
Rs.44.00
lakhs
Ay-22
Rs.484.00
lakhs
Rs.105.00 lakhs
Rajasthan
Sikkim
ISM & H-26
Rs.910.00 lakhs
14
15
Tamil Nadu
West Bengal
Ayurveda- 13
Ayurveda - 4
Rs.455.00 lakhs
Rs.140.00 lakhs
16
Uttaranchal
Hom -8
Rs.280.00 lakhs
Total
ISM & H - 64
Ayurveda - 62
Homoeopathy - 9
Rs.4685.67 lakhs
Sp. Clinic of ISM & H Specific out door
treatment @ Rs. 10.00 lakhs
Ay
Unani
Hom
No.
- 14
______ Amount
Rs.350.00 lakhs
Rs.1094.00 lakhs
-8
-13
Rs.840.00 lakhs
-40
-1
-1
Ay
Unani
Hom
Rs.420.00 lakhs
Rs.1254.00 lakhs
Rs.490.00 lakhs
Ayurveda- 1
Rs.22.00
Ayurveda- 2
AYUSH-1
Hom. -1
Ayurveda - 3
Y& N- 1
Rs.88.00
Rs.57.00 lakhs
-1
Hom.
Rs.10.00 lakhs
Rs.88.00
Rs.98.00 lakhs
Rs.88.00 lakhs
Rs.279.37 lakhs
Rs.101.30 lakhs
Hom. -1
Ayurveda - 3
Total amount
sanctioned.
Rs.10.87
Rs.690.00 lakhs
Rs.10.87 lakhs
Rs.795.00 lakhs
Amchi -1
Rs.10.00 lakhs
Rs.910.00 lakhs
Rs.10.00 lakhs
Siddha
-135
Hom
-2
Ay, - 18___
Ayurveda -1
Y& N -1
Hom - 7
-93
Ay
Y& N -1
Siddha
- 135
Unani
-9
Hom
-73
Rs.1350.00 lakhs
Rs.200.00 lakhs
Rs.1805.00 lakhs
Rs.340.00 lakhs
Rs.90.00 lakhs
Rs.370 lakhs
Rs.3080.00 lakhs
Rs.8542.54 lakhs
Ay
Hom
Ay
-22
AYUSH-3
Hom
- 1
Rs.736.87
lakhs
-19
-50
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Year-
2005-2006
No. of AYUSH Dispensaries covered under the scheme for AYUSH Dispensaries (Supply of Essential Drugs) (as on 31.3.2006)
SI.
No.
Name of the State
No. of Dispensaries covered
Ay.
Siddha
1
Andhra Pradesh
550
2
Arunachal
Pradesh________
Chhatishgarh
Delhi___________
Meghalaya______
Himachal Pradesh
Kerala__________
Uttranchal_______
Maharashtra_____
Madhya Pradesh
Meghalaya______
Gujarat_________
Haryana________
J& K___________
Jharkhand______
Karnataka_______
Nagaland_______
Orissa__________
Rajasthan_______
Sikkim_________
Tamil Nadu______
Uttar Pradesh
West Bengal
Total
4
3
4.
5
6.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
632
26
1101
1521
475
490
Homoe
193
283
1026
256.50
37
41
10.25
52
690
26
3
1105
2063
546
515
498
172.50
6.50
0.75
277.25
515.75
136.50
128.75
124.50
4.85**
214.00
123.75
177.25
42.50
158.50
50.00
162.50
171.25
5.00
110.50
333.75
190.00
3372.60
2
3
4
525
71
25
________ 498____________
Supply of home remedy kits
I
216 i
640
495
474
110
541
64
350
685
12
235
18
51
58
42
42
78
300
8
442
1235
280
9685
100
463
Amount released in Rs. (in
lakhs)
Unani
6
15
Total No. of Disp. covered.
782
480
2639
856
495
709
170
634
200 '
650
685
20
442
1335
760
13469
** Total amount is Rs.4,85,150/-
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Annexure 2
Ministry of Health and Family Welfare
Dated the 12th August, 2005
Dear Shri
Subject: Roadmap for Mainstreaming of AYUSH under NRHM
Mainstreaming of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha &
Homoeopathy) is an important strategic intervention under the National Rural Health
Mission (NRHM).
The objective of the integration of AYUSH in the health care
infrastructure is to reinforce the existing public health care delivery system, with the
use of natural, safe and friendly remedies, which are time tested, accessible and
affordable.
The Indian Systems of Medicine have age old acceptance in the
communities in Indian and in most places they form the first line of action in case of
the common ailments. No initiative which seeks to provide cost-effective health care
to the rural communities can ignore the vast local knowledge base available in India
in the form of the Indian Systems of Medicines.
Mainstreaming of AYUSH under NRHM was discussed in a series of meetings
jointly held by both Departments.
It is proposed that the following steps for
appropriate utilization of AYUSH at the various level of health care set up be
considered for implementation as part of the NRHM:
A. : Integration of AYUSH in the Health Care infrastructure
1.
All Primary Health Centres (PHCs) ought have an AYUSH doctor,
If
space permits, the AYUSH dispensary may be relocated in the existing
building of the PHC. In places where the AYUSH infrastructure is good,
the feasibility of shifting the PHC to the same building be examined.
Although there could be constraints in the availability of spaces, at lease
10% of the PHCs with adequate space could accommodate AYUSH
dispensaries. Action to shift the AYUSH dispensaries to such PHCs may
be taken on priority during the first year of the mission period.
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2.
140
Where relocation of AYUSH practitioners is not feasible due to lack of
AYUSH dispensaries, qualified AYUSH practitioners
may be hired on
contractual basis and funds for which would be provided from NRHM
budget.
3.
The guidelines for IPHS for CHCs, which have been disseminated to the
states are being updated so as to adequately address the parameters
applicable to the AYUSH component also.
Once the guidelines are
received, priority should be given for upgradation of AYUSH facilities to
those standards.
4.
While constructing new PHCs as per IPHS, adequate space should be
provided for locating the AYUSH dispensary within the same premises.
B. : Integration of AYUSH with ASHA
1.
The Accredited Social Health Activist (ASHA) is the main pillar of the
NRHM and is to provide the first response of the Public Health Care chain
to any illness at the village level.
The first training module for ASHA
includes the ASHA component as well. The in-service training modules
for ANMs and MOs are also being updated to incorporate information on
AYUSH.
2.
As of now the ASHA drug kit would contain only one AYUSH preparation
in the form of the iron supplement.
However, the drug list could be
expended in due course to include more AYUSH medicines. Suggestions
in this regard are invited from the State Governments.
C. : Other initiatives
1.
As of now, the Sub-Centres are no manned by qualified medical doctors.
Suggestions have been received about making available and AYUSH
practitioner at the Sub-Centre level at least on part-time basis.
The
feasibility of this proposal should be examined by the State Government.
2.
The guidelines to include AYUSH practitioner at all levels in the NRHM
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including the State Health Mission, District Health Mission and Rogi
Kalyan Samitis have been issued earlier. The action in this regard should
be expedited.
3.
It is intended to provide for flow of funds under the relevant Centrally
Sponsored Schemes for the Department of AYUSH through District
Health Societies for convergence at the District level under NRHM. Chief
District Medical Officer would be the over-all coordinator of AYUSH
related initiatives under the NRHM at the District level.
It is proposed to have total functional integration between the AYUSH
dispensaries / hospitals and the health care facilities under the allopathic system so
that the entire spectrum of treatments is made available to the rural poor at
affordable costs.
The enthusiastic participation of the states in this initiative is
imperative for the success of the NRHM.
We would, therefore, request you to
ensure that the AYUSH component of NRHM is adequately addressed at the grass
root level. We solicit you whole hearted cooperation in the matter.
(PRASANNA HOTA)
Secretary (Health and Family Welfare)
(UMA PILLAI)
Secretary (AYUSH)
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Annexure 3
LEGAL POSITION REGARDING PRESCRIBING MODERN MEDICINE
BY AYUSH PHYSICIANS
•
“IMCC Act 1970 Sec.2 (1) e, which states that the Indian Medicine means the
system of Indian Medicine commonly known as Ashtang Ayurved, Siddha or
Unani Tibbia whether supplemented or not by such modern advances as the
Central Council may declare by notification from time to time”. Under this
provision the COM vide the Resolution of its Executive Committee dated
30-08-1996 and a Press Note released on the same date and Notifications
No.
8-5/96-Ay(MM)
dated
30-10-1996,
No.
8-5/2002-Ay(MM)
dated
22-11-2004 and No. 28-5/2004-Ay(MM) dated 19-05-2004 supports that the
institutionally qualified ISM doctors are authorized to practice allopathic
medicine by virtue of their teaching and training in modern scientific system of
medicine.
•
The provision of IMCC Act under Sec.17 (3) (b) that the privileges (including
the right to practice any system of medicine) conferred by or under any law
relating to registration of practitioners of Indian Medicine for the time being in
force in any State on a practitioner of Indian Medicine enrolled on a State
Register
of
Indian
Medicine.
Accordingly
the
Supreme
Court
in
Dr. Mukhthiar Chand & Others Vs The State of Punjab & Others No. AIR
1999, SC 468, dated 8-10-1998 declared that an Ayurvedic practitioner of a
State is eligible to practice/use modern medicine if the State Act, under which
he is registered, allows for the same. The provision to allow practitioners of
ISM to practice allopathic medicine was allowed by the State of Punjab vide
The Punjab Ayurvedic and Unani Practitioners Act 1963 and the State of
Maharashtra by The Maharashtra Medical Practitioners Act 1961 and the
Maharashtra Medical Education & Drugs Department by two Government
Notifications dated 25-11-1992 and dated 23-2-1999, the latter for the
purpose of the Sub-clause (iii) clause (ee) of rule 2 of the Drugs and
Cosmetics Act, 1940 (23 of 1940).
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•
The Hon’ble Supreme Court of India in its decision in Subhash Bakshi and
State of West Bengal in January 2003 has stated ‘while recognizing the rights
of Vaids and Hakims to prescribe allopathic medicines this court also took into
account of the fact that qualified allopathic doctors were not available in rural
areas and the persons like Vaids/Hakims are catering to the medical need of
residence in such areas. Hence, the provision which allows them to practice
modern medicine was found in public interest’.
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