SUBSTANTIAL PROGRESS TOWARDS POPULATIONS STABILISATION
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In this Issue
Page No.
Sravana-Bhadra
August 1985
Saka 1907
Vol. XXIX
No. 8
Editorial and Business Offices
Substantial progress
stabilisation
towards
population
181
Smt. Serla Grewal
National malaria eradication programme
184
National tuberculosis control programme
187
Diarrhoeal diseases control programme
189
National goitre control programme
190
National leprosy eradication programme
192
Health education progress
194
National programme for control of blindness
197
Family welfare—a big leap forward
198
Prevention of food adulteration
202
Maternal and child health programme
203
Rural health services
204
38th World Health Assembly—health for all
and all for health
205
Central Health Education Bureau
(Directorate General of Health Services)
Kotla Marg, New Delhi-110 002
ASST. EDITOR
D. N. Issar
Sr. SUB-EDITOR
M. S. Dhillon
CO VER DESIGN
J. P. Sharma
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SUBSTANTIAL PROGRESS TOWARDS
POPULATION STABILISATION
Smt. Serla Grewal
health situation remained, by and large,
satisfactory in the country during 1984. How
ever, incidence of malaria showed an increase of
18.1% over 1983 and that caused by Plasmodium
Falciparum also registered
an increase of 12.9%.
This was essentially due to the fact that the prescrib
ed three rounds of insecticidal spraying was not done
in several States. The attention of the State Govern
ments has time and again been drawn to the need for
making adequate budget provision, for timely sanc
tion of schemes as also for timely release of funds
to the fields formations so that the three rounds of
spraying could be done in the months of May—Sep
tember with the required concentration of insecticides.
P
ublic
Effective steps were taken
to combat the out
break of dysentery caused by the bacillus known as
Shigella Shiga in West Bengal as well as the men
ace of Viral B Hepatitis in certain parts of Gujarat.
The National Institute of Enteric and Diarrhoeal Dis
eases, Calcutta, helped to identify the Shigella bacil
lus in West Bengal and the Ministry rushed chlorine
tablets, bleaching powder and drugs to the State for
controlling the spread of the disease. The National
Institute of Virology, Pune, similarly helped the Go
vernment of Gujarat in identifying cases of Viral B
Hepatitis, and the WHO extended help by procuring
vaccines as well as immunoglobulins to protect the pu
blic and the medical and para-medical personnel who
were particularly exposed to the risk of getting the
infection.
Action under the National Programmes for the
Eradication of Leprosy and for the Control of T.B.
was intensified during 1984-85. All time high fin
ancial allocations of Rs. 15 crores Rs. 10.5 crores
have been made available for the two programmes.
Out of the total estimated number of about 4 milli
on leprosy cases, about 3.2 million have been detect
ed, about 3 million put under treatment and about
AUGUST 1985
1.7 million patients discharged after completion of
treatment. In another five years, we should be seeing
light at the end of the tunnel. Although Parliament
has repealed the Lepers Act, 1898 several States have
yet to take similar action with a view to removing
the social stigma attaching to the leprosy patients
and the disabilities they are put under. Tuberculo
sis is more easier to detect but more difficult to tac
kle. Out of an estimated ten million cases (of which
2.5 million are likely to be sputum positive or infec
tious) a total of 3 million cases have been detected
so far. In order to ensure maximum detection of
cases, a target of 2 sputum examinations per day
per PHC has been prescribed. This -would work out
to '■about 600 sputum examinations per annum per
PHC or over 3 million sputum examinations in a year
for the country as a whole. The progress in this is
somewhat impeded by the sizeable number of vacan
cies in the rank of Laboratory Technicians in the
PHCs and the States have been requested to take
energetic steps to recruit laboratory technicians. The
Central Government has been assisting the States in
organising Training Courses for the Laboratory Tech
nicians. The current regimen for the treatment of
Tuberculosis extends over 2 years. Case holding be
comes a problem since patients tend to start neglecting
the treatments as soon as they see improvement in
their symptoms. In order to overcome this pro
blems, short-course chemotherapy has been introduc
ed on trial basis which would convert the infectious
cases into non-infectious within a short time and re
duce the total duration of the treatment to 9-12 months.
Mention must be made of another National Pro
gramme, namely, that for the control of Blindness.
There is an estimated number of 9 million blind per
sons, about 55 percent of whom have cataract. The
national programme has strengthened the infrastruc
ture at the national, state, district and the PHC level
and has been providing financial assistance to Volun
181
tary Organisations to carry out cataract operations
on a large scale. More than a million cataract opera
tions were performed in 1983-84 alone and at this
rate the backlog of cataract cases would be over in
the next few years. On the preventive side, the ad
ministration of Vitamin ‘A’ to school going children.
as a prophylaxis against blindness, has been taken
up in a big way under the Mother and Child Health
(MCH) Programme.
Family Planning and MCH constitute the two main
ingredients of the Family Welfare Programme. The
ultimate aim of the Family Planning Programme is
to inhibit the birth rate and thereby the population
growth rate and achieve population stabilisation. The
figures given below would give an idea of India’s
position in the Indian Sub-Continent :
Name of the Country Crude birth Crude death Percen- change
rate per
rate per
tagc in
in
. 1000 pop u- 1000 popu--------------------------lation
lation
----------------------------------- Crude Crude
birth
death
1960 1982’’ 19601H982 rate
rate
Bangladesh .
Nepal .
.
Pakistan
Burma
India .
Sri Lanka ,.
47
46
49
43
48
36
47
43
42
38
34
27
22
26
23
21
24
9
17
19
15
13
13
6
The measure by which the results of the Family
Planning Programme is computed is the Effective
Couple Protection Rate (CPR). The table would
show the vital rates (birth rates and death rates) as
reported by the Registrar General and the levels of
effective C.P.R. achieved in the different years:
Year
1
0.2 —24.7
—6.5 —27.3
—13.6 —34.3
—11.3 —37.9
—28.3 —46.81
—25.7 —34.8
1970-71
1971-72
1972-73
1973-74
1974-75
1975-76
1976-77
1977-78
1978-79
1979-80
1980-81
1981-82
1982-83
1983-84
1984-85
(Prov.)
As a result of further efforts, the Ministry’s own
assessment is that the Crude Birth Rate (CBR) in
India should be around 32.6 per 1,000 population
for the year 1984. It may be seen that except for
Sri Lanka which had a head start over us, India’s
performance in bringing about a decline in Fertility
Rate and Mortality Rate compares very favourably
with those of the other countries of the sub-continent.
The official Family Planning Programme of India
comprises broadly two elements namely public in
volvement through a massive programme of educa
tional campaign publicity and the augmentation of
services and supplies in line with the “cafetaria” ap
proach to facilitate the selection of any of the methods
that the eligible couples may find suitable or appro
priate. The mass media, particularly the Doordarshan and AU India Radio are being utilised increas
ingly for the motivational campaign in view parti
cularly of the fact that the all-too-powerful medium
how covers about 70 per cent of the country’s popu
C.P.R.
%
2
1960-82 1960-82
{Source : World Development Report 1984 published by
World Bank).
182
lation. Spacing methods arc encouraged as much as
terminal methods and the two child family norm is
now emphasised. Since child survival is amongst
the foremost factors which induce the couple to adopt
the two child family norm. MCH programme has
been given due importance. Immunisation of pregn
ant mothers against tetanus and of infants against
DPT, Polio and Tuberculosis is the thrust of the MCH
Programme. The Infant Mortality Rate (IMR) which
was at the level of about 127 or above for a number
of years has declined to 114 in 1982.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
10.6
12.4
14.6
14.8
14.9
17.0
23.6
22.5
22.3
22.2
22.7
23.7
25.9
29.2
31.6
Variation in
CBR
C.D.R.
Natural
CPR over pre per 1000 per 100C> growth
ceding year
popula popu
rate in
tion
(+)(—)
lation
popu
lation
3
—
(+)1.8
(+)2.2
(+)0.2
(+)0.l
(+)2.1
( )6.6
(—)1-1
(—)0.2
(—)0.1
(+)0.5
(+)i.o
(+)2.2
(+)3.3
(+)2.4
(1970)
(1971)
(1983)
(1984)
4
5
6
36.8
36.9
36.6
34.6
34.5
35.2
34.4
33.0
33.3
33.7
33.7
33.9
33.8
33.6
32.6*
15.7
14.9
16.9
15.5
14.5
15.9
15.0
14.7
14.2
13.0
12-6
12.5
11.9
11.9*
2.11
2.20
1.97
1.91
2.00
1.93
1.94
1.83
1.91
2.07
2.11
2.14
2.19
2.17
♦This figure is estimated by the E&I Division of the Ministry.
Note : The figure of vital rates {CBR and CDR) upto 1978
do not include those of Bihar and West Bengal as stated
by Registrar General.
The fact would emerge from the above table that
the Birth Rate has no doubt declined but that the
Death Rate has declined more steeply than the Birth
Rate, what with the better nutrition and health care
services as a result of which the life expectancy has
risen to early 54 years of age. The Birth Rate would
have also registered a sharper decline than it has
but for the set-back that the Programme received in
the year 1977—80 as would be clear from the table
given above. The above table would
also bring
SWASTIT HIND
Family Planning and MCH constitute the two main ingredients of the family welfare programme.
of a Rural Family Welfare Planning Centre.
out the point that the result of the programme efforts
of one year in the form of a fall in birth rate be
comes visible after a time-lag of one or two years.
The National Health Policy lays down the target of
32 births per 1000 population for achievement by
1985. As stated above the Birth Rate, according to
the estimation of the Ministry’s E & I Division, has
A scene
come down to 32.6 per 1000 population by 1984.
The target of achieving a Birth Rate of 32 per 1000
population by 1985 thus appears to be well within
reach.
(Excerpted from the Introduction to the Annual Report of the
Ministry of Health and Family Welfare 1984-85)
FAMILY SUPPORT AND. THE ELDERLY
The family is the greatest single source of support and the centre of activity for most elderly people.
Traditionally, older people are viewed as an integral part of the family, with high esteem and prestige,
despite the many forms that the family and its social organization take in different parts of the world.
On the one hand, the aging of population has led to the new phenomenon of families spanning four or
five generations. On the other hand, the decrease in the number of children, and their dispersion owing to
migration and urbanization, means that care for dependent old parents cannot be easily shared by several
siblings. Moreover, family care of an elderly person almost always means in effect care by a daughter
or daughter-in-law, and the changing role of women and their participation in the labour force further
diminishes the chances of family support. This change, seen over the past decades in developed countries,
is now occurring at an increasing rate in some developing countries as they undergo social and demo
graphic changes.
From: WHO Technical Report Series, No. 706, 1984 (7'Ae uses of epidemiology in the study of the elderly), pp. 45—46.
AVGUST 1985
183
National Malaria Eradication Programme
in view the resurgence of malaria the
Government of India decided in October, 1976
to undertake a Modified Plan of Operation for NMEP
to control the disease and the same has been imple
mented from April, 1977.
eeping
K
is an increase of 18.10 per cent in the total cases over
the corresponding period of 1983. Similarly, there
is also an increase by 12.90 per cent in P. falciparum
cases.
Steps to control malaria
Since the implementation of the Modified Plan
of Operation, there has been a gradual downward
trend in the cases of malaria in the country as is
evident from the following table: —
Total
BloodJ
Slides
IncidenceJ
examinedJ
(in mil
lion)
Year
P. falci
parum
cases
6467215
753713
57.01
4740900
461484
60.46
4144385
548567
....
61.42
3064697
558423
1980
....
66.98
2896000
586438
1981
....
67.30
2679795
583268
1982
.
65.03
2182303
551057
1983 (Prov.) .
62.20
1932516
549649
1984* ....
30.97
908096
189495
1983**
31.74
768934
167816
1976
....
1977
....
1978
.
1979
.
55.98
*As per report received upto 30-9-1984.
♦♦Corresponding peiiod.
From the above table it will be seen that there
is reduction in both malaria incidence and P. falcipa
rum type of malaria which has been achieved in 1983.
There is an overall decline of 11.44 per cent and
0.25 per cent in total cases and P. falciparum cases
respectively during 1983 over the corresponding peri
od of 1982. However, an overall decrease in malaria
incidence was noticed in the year 1983 by 70.11 per
cent in comparison to the base year 1976.
It is observed from the epidemiological situation
of malaria in India during the year 1984 that there
184
To contain the transmission of malaria indoor
residual insecticidal spray has been carried out in
areas where Annual Parasite Incidence (API) is 2
and above (2 cases or above per 1000 population per
year). Stress has been laid for regular fortnightly
surveillance in all malarious areas of the country. To
deal with vector resistance to insecticides, entomo
logical teams in the zones are engaged to find out
alternative solution to the problem. For prompt de
tection and treatment of malaria cases and to pre
vent death due to malaria, a large number of drug
distribution centres and fever treatment depots are
functioning. Surveillance and Spray staff have been
are being augmented as per increase in the mid year
population.
Laboratory services have been decen
tralised at the PHC level for prompt examination of
blood smears and immediate treatment.
Research
Six monitoring teams are working in several parts
of the country to identify the P. falciparum sensiti
vity to Chloroquine. One team is working to under
take testing of alternate drug wherever resistance to
Chloroquine has been detected in the P. falciparum
strain. In established P. Falciparum Chloroquine
resistance areas the drug regimen has been changed
and cases are now being treated with alternative drug
like combination of Pyremethamine and long acting
sulpha.
People’s Co-operation
Un'der the Modified Plan of Operation, Health Edu
cation has been made an integral component to seek
public cooperation. The Village Health Guides are
already involved fully in the anti-malaria work.
Training
To implement the Modified Plan of Operation, tra
ining in malariology has got paramount importance.
SWASTH HIND
Laboratory services have been decentralised at the PHC level for prompt examination of blood smears and
immediate treatment. A blood smear of a patient is being taken.
The National Institute of Communicable Diseases.
Delhi, is conducting malariology and malaria entomo
logy courses for the officers engaged in anti-malaria
work in the District and above. Tn 1984, two courses
in Malariology and one in malaria entomology were
conducted in which a total of 71 participant received
training.
The Budget provision and estimated expenditure
under 50 per cent Central share is given in the fol
lowing table:
Year
198081
82
198183
198284
198385
1984-
Budget Provision (Rs. in lakhs)
Estimated
Expenditure
4450.00
5107.31
5500.00
5900.00**
8400 00
3350.58
5460.85
5511.14
6883.33
—
(An additional amount of Rs. 10 crores has been
provided under grant for meeting the expenditure).
AUGUST 1985
Realising the difficulties of the States regarding
procurement of costly insecticide malathion, the Go
vernment of India has decided to procure and sup
ply malathion on 100 per cent basis to the States.
P. falciparum Containment Programme
At present, 80 districts are under this Programme
in various parts of the country covering a population
of 96 million.
Provision of US $ 2,97,000 was made during 1984
and 1985 under the WHO regular Biannum budget
for Various components of the programme which, in
clude in materials and equipments as also fellow
ships.
International Border Coordination Conferences
These conferences between India and the border
ing countries, viz., Sri Lanka, Bangladesh, Burma,
Nepal and Maldives are held periodically to review
these conferences to plan strategy for insecticidal co
ordination and discuss malaria
problem on both
sides of the bordering countries. Deliberations are
185
also held in these conferences to plan strategy for in
secticidal spray operations synchronising in the border
areas of the concerned countries.
The following International anti-malaria border co
ordination conferences were held during 1984:
VII Burma-India-Bangladesh Anti-malaria Co-or
dination Conference at Rangoon (Burma) from 9 to
11 May, 1984.
XIII Indo-Ncpal Anti-malaria Co-ordination Con
ference at Lucknow (India) on 28 and 29 May, 1984.
URBAN MALARIA SCHEME
Urban Malaria Scheme was initiated in 1971-72
under the Directorate of National Malaria Eradica
tion Programme. It was planned to include 132
towns under the ambit of this Scheme by the end of
6th Five Year Plan. The Ministry of Health, Gov
ernment of India, has sanctioned the Scheme for 131
towns so far, distributed in 17 States and 2 Union
Territories. The State Governments/UT have imple
mented this Scheme in 115 towns till now. Six towns
out of 131 towns were sanctioned by the Ministry of
Health during 1983 for inclusion under the Scheme.
One more town is yet to be sanctioned under the
Scheme. The Malaria cases recorded in these urban
malaria towns for the last three years are as follows:—
1981
*
2,75,783
1982
2,39,669
1983
2,48,625
It is evident that there is a marginal increase in
the malaria incidence in the urban malaria towns
from where the malaria incidence reports are receiv
ed. Out of 119 towns from where the malaria in
cidence reports were received during 1983, 70 towns
(59 per cent) showed decrease in the malaria incidence
during 1983 in comparison to that recorded in 1982.
Out of 16 States and 2 Union Territories, only a few
States namely Andhra Pradesh, Madhya Pradesh,
Maharashtra, Rajasthan and West Bengal recorded
high malaria, incidence in the urban malaria towns
in 1983. The towns which showed higher malaria
incidence are Vijayawada (Andhra Pradesh); Ahmedabad, Rajkot and Anand (Gujarat); Bhiwani (Har
yana); Jodhpur (Rajasthan); Salem (Tamil Nadu) and
Calcutta (West Bengal). The high incidence recordded in Calcutta is due to the accumulation of water
owing to deep ditches made for underground railway
186
system. Malaria is still a problem in Madras town.
The total number of malaria cases recorded in Mad
ras town for 1983 is 44,817 while it was 44,981 for
1982. The data for 1984 is under compilation.
NATIONAL FILARIA CONTROL
PROGRAMME
Filariasis is a major public health problem in
India. All States except Jammu and Kashmir, Har
yana. Chandigarh, Himachal Pradesh, Punjab, Delhi,
Rajasthan, Manipur. Tripura, Nagaland, Arunachal
Pradesh, Sikkim and the North-eastern region are en
demic for filariasis. To control filariasis. the Natio
nal Filaria Control Programme was launched in 1955.
During 1984 anti-larval activities and anti-parasitic measures were continued in 184 towns by as
many control units. In addition to these, 12 head
quarters units, 27 survey units and 107 filaria clinics
are functioning. Out of these 4 control units, 1 sur
vey unit and 4 filaria clinics were set up in 1984.
K ALA-AZ AR
The Kala-azar unit of NMEP is monitoring the
Kala-azar situation in India except
Bihar. Kalaazar in Bihar is being looked after by the National
Institute of Communicable Diseases, Delhi. This
unit is regularly collecting the Kala-azar report and
is keeping a close vigil over the situation. The Kalaazar incidence in India (including Bihar) since 1981
is given below: —
Years
1981
1982 .
1983 (Prov) .
1984' .
.
.
.
Cases
Deaths
14611
12360
14406
9573
42
38
135
51 (as per
reports received
upto 17-10-1984)
Kala-azar is endemic in the States of Bihar and
West Bengal which alone account for 90.93 per cent
and 9.03 per cent of the total cases respectively. The
States have been requested to spray DDT in the affec
ted areas for effective control. A “Brochure on Kalaazar” has been developed for the use of health wor
kers. At present, there is no separate budget for
Kala-azar and the insecticides are supplied out of
NMEP Budget. However, a plan for 100 per cent
central assistance for Kala-azar control submitted by
NMEP is under consideration of the Government of
India.
A
SWASTH HIND
National Tuberculosis Control Programme
ational TB Programme has been in operation
since 1962 and its primary objective is to provide
TB case finding and treatment activities on domicil
iary basis for TB patient by establishment of an
equipped and staffed District TB Centre in each of
the Districts of the country to undertake district-wide
TB Programme. 359 districts have been provided
with District TB Centres which are undertaking Dis
trict TB Programme in association with the medical
and health institutions located in the districts.
At
all such centres, a team of medical and paramedical
personnel duly trained at National TB Institute, Ban
galore* is available. In addition, there are about 300
IB Clinics functioning in the country, which are par
ticipating in the National TB Programme. There are
about 45,500 beds available in the various institutions
for the treatment of seriously sick TB patients.
N
Seventeen TB Training and Demonstration Centres
have been established in major States of the country
to undertake the basic training of the paramedical
personnel required for the programmes for conduct
ing re-orientation training courses for the medical
practitioners, etc. These Centres also provide the
necessary technical guidance to the developing District
TB Centre in the respective States.
During the Sixth Plan period the schemes of esta
blishment of District TB Centres and TB Beds have
been included in the State Plan Sector. The Scheme
of supply of Anti-TB drugs/materials and equipments
has been classified as a Centrally Sponsored Scheme
with 50 : 50 sharing basis between the Centre and the
States. The Scheme of supply of Anti-TB Drugs to
Voluntary body run TB Clinics and supply of mate
rials and equipments/Anti-TB Drugs to Union Terri
tories is classified as 100 per cent Centrally Sponsor
ed Scheme.
The International Agency like Swedish International
Development Agency (SIDA) continues to assist the
National TB Programme by way of essential X-ray
equipments with Odelca Cameras and miniature X-ray
films and stock of latest anti-TB drugs like Rifampi
cin and Pyrazinamide. A fresh agreement is being
entered into with the Swedish International Develop
ment Agency for continuation of their assistance to
the National TB Programme for another five years.
AUGUST 1985
Primary Health Centres are actively involved in the
T. B. case finding activities.
The WHO is also actively assisting the Programme.
The two premier TB Institutes, namely National TB
Institute, Bangalore, and TB Research Centre. Madras.
are provided essential material and equipments requir
ed to augment the research and training activities,
fellowships and consultants as per the requirements.
During 1984-85, to augment the diagnostic and
treatment activities under the Programme, much larger
amount of funds have been provided under the Cen
tral Sector for supply of material and equipments
and anti-TB drugs to the State-run IB Centres and
TB Clinics run by voluntary bodies. Standard antiTB drugs for domiciliary treatment of TB patients
to the State-run TB centres and to the TB Clinics run
187
by voluntary bodies are being continued to be suppli
ed during the year and the budget has been consider
ably augmented. Anti-TB drugs worth about Rs. 930
lakhs are expected to be supplied to the TB Centres/
TB Clinics run by States/U.Ts./Voluntary bodies. In
addition, X-ray equipments, etc., worth about Rs.
120 lakhs as received out of SIDA assistance are ex
pected to be supplied during the year.
Short course Chemotherapy drug regimen has been
introduced in eighteen selected districts all over the
country on a pilot basis.
With the inclusion of Tuberculosis Programme in
the new 20 Point Programme, a thrust has been given
for the case finding and treatment activities. Targets
laid for detection of new TB cases for the first time
during 1982-83 was achieved in full. During 1983-84,
a target of 12.50 lakhs new TB Case detection was
laid and nearly 12.08 lakh new TB Cases were detec
ted giving 96.5 per cent achievement. During 198485 to step up case finding activities the targets of new
TB Case detection has been increased to 13.75 lakhs.
In addition to involve the Primary Health Centres
actively in the TB Case finding activities, targets have
also been laid for conduction of 600 sputum examina
tions of new Chest symptomatics per year per Pri
mary Health Centre since 1983-84.
In order to periodically review the performance of
the National TB Programme in the various States/
U.Ts., a Central Coordination Committee consisting of
eminent experts in the field, and participants from the
States/U.Ts. has been constituted during 1984-85.
BCG Vaccine Laboratory
B.C.G. Vaccine Laboratory, a subordinate Office of
the Directorate General of Heatlh Services at Guindy,
Madras, has produced and supplied the following biologicals from April to September, 1984—
Supply
Production
Ampoules Doses
Freeze Dried BCG
Vaccine 20 doses
per ampoule
Tuberculin 100
doses per vial .
Ampoules Doses
vials
In lakhs
In lakhs
vials
In lakhs
In lakhs
4.06
81.17
3-83
76.66
0.097
9.65
0.104
10.37
The Laboratory is also working as a W.H.O. Colla
borative Centre for testing BCG Vaccine manufactur
ed by other Laboratories. The Laboratory is provid
ed with $ 1,000 towards expenditure of file tests by
the W.H.O. which is being utilized for procuring
spares of some imported machineries.
The Laboratory conducts production oiiented re
search. Attempts are being made to manufacture
heat-stable BCG Vaccine. One experimental batch
was manufactured. The Preliminary results are en
couraging. Post-graduate students from Madras Uni
versity doing M.D. in Microbiology are trained by
this Laboratory.
A
188
Sexually Transmitted
Diseases Control
Programme
S
ince the growing dimension of the disease could
not be checked during the past plan periods it
was then decided to give a new dimension to the
scheme by uplifting the scheme from its very grass
root level so as to combat the disease in all aspects.
With attention focussed on this aspect, the scheme
was entirely restructured to induct the scheme as a
purely Central sector scheme with 100 per cent Cen
tral assistance during the Sixth Five Year Plan laid
importance mainly on teaching, training and research
in the field of S.T.D. and with this objective in the
forefront the (a) Regional teaching-cum-training cen
tres to impart orientation courses to the in-service
medical and para-medical personnel in the discipline
of venereology in its various aspects viz. clinical dia
gnostic therapeutic, laboratory control, etc., of S.T.D.
have been/are being established at Calcutta, Nagpur,
Hyderabad in addition to the existing teaching and
training centres at the Institute for S.T.D., Madras,
Medical College, Madras and STD Training and De
monstration Centre, Safdarjang Hospital, New Delhi,
(b) Regional S.T.D. Reference Laboratory to provide
(i) orientation courses to the Lab Technicians work
ing in the district hospitals/P.H.Cs/Civil Hospitals/
S.T.D. Clinics in the lab. diagnosis of S.T.D., (ii) con
duct inter-laboratory evaluation of V.D.R.L. test which
all the District hospital laboratories would participate
in order to set up a uniform standard of doing the
D.R.L.
V.
test throughout the country and (iii) con
duct research orientation work in the field of S.T.D.
have been/are being established at Calcutta, Delhi,
Hyderabad and Nagpur in addition to the existing
Central reference Laboratory at the Institute for the
Study of Venereology, Madras, Medical College,
Madras; and (c) Regional Survey-cum-Mobile S.T.D.
Units to go into the epidemiological aspect of the
disease and provide immediate therapy to the pa
tients suffering from STD, have been are being esta
blished at Calcutta, Hyderabad, Madras and Nagpur
in addition to the existing survey team at N.I.C.D.
Delhi.
UNICEF is also assisting the programme by sup
plying equipments, viz, a shaker, a water bath and
a hot air oven to the district hospitals laboratories/
sub taluka hospitals/PHCs for ’ instituting VDRL test
in their respective hospitals/centres in order to bring
down the infant mortality and morbidity. This test
will certainly unearth the hidden forces of syphilis
and will eventually cause a decline in the disease.
UNICEF has so far supplied 61 sets of equipments
to the district hospitals in the States and another 100
centres have already been identified for supply of the
said equipments by UNICEF.
A
SWASTH HIND
Diarrhoeal Diseases Control Programme
iarrhoeal Diseases constitute one of the major
cause of morbidity and mortality specially in
children below 5 years of age. Multiplicity of the
organisms, drug resistance, low environmental sani
tation, lack of adequate personal hygiene, lack of
Isafe water supply add to the problem.
Except
cholera, the other diarrhoeal diseases are not notifia-.
ble in the country and as such it is difficult to estimate
the exact nature of the problem in terms of morbidity
and mortality based on available information.
D
During 1984, outbreaks of dysentery due to
Shigella were reported from West Bengal, Tripura,
Assam and Orissa.
Government of India has formulated a National
plan of action to control diarrhoeal diseases under
Primary Health Care. The following activities have
been undertaken during the current year:
Supply of ORS
Under the Village Health Guides’ Scheme, every
Health Guide (more than 3 lakhs) is supplied with
60 packets of Oral Rehydration Salts through the
composite drug kits. These are being utilised at the
community level to control dehydration in diarrhoea
cases.
Health Education
A hand book on Diarrhoea containing all rele
vant information on diarrhoea and its preventive and
control measures is under publication. A total of 11
lakh booklets will be printed all over the country for
use by mothers, community members, school teachers,
village health guides, etc.
Training Programme
With additional inputs provided by. WHO, the
following training programmes have been conducted:
Training in Laboratory diagnosis from 1 to 10 May;
Clinical Management Course for Paediatricians from
2 to 11 July; and the first course of supervisory skill
training for district level officers from various States
from 27 August to 2 September, 1984 at NICED,
Calcutta. The second course on supervisory skill was
AUGUST 1985
arranged at NICD, Delhi, from 19 to 24 November,
1984.
In collaboration with the State Governments, 53
National Seminars on O.R.T. have been held so far.
Orientation of Private Practitioners
In association with Indian Medical Association,
six Orientation courses for private practitioners on
O.R.T. have been held so far at Rohtak, Dehradun,
Calcutta, Jabalpur, Nagarcoil and Palghat.
Training for State level Programme Officers
A training programme for the State level officers
dealing with diarrhoeal diseases was arranged from
10th to 19th December. 1984.
Review of the Programme
A review of the diarrhoeal diseases programme be
ing implemented by the States and Union Territories,
was made in programme officers meeting held at
Calcutta on 21 and 22 April, 1984.
400 Primary Health Centres (one from each dis
trict) have been identified Sentinal Centres for re
porting on morbidity and mortality due to diarr
hoeal diseases in children.
A detailed survey on morbidity and mortality due
to diarrhoeal diseases among children below 5 years
has been planned as under : ,
A. Urban areas—Delhi, Calcutta, Bombay, Mad
ras and Hyderabad.
B.
Rural areas—Himachal Pradesh (Kangra)
Tamil Nadu (Coimbatore)
Andhra Pradesh (Nizamabad)
Manipur (Central district)
Uttar Pradesh (Selected rural.
districts).
1st survey was carried out in November, 1984. It
will be followed by a repeat survey in the summer
month. Other areas will be covered in a phased
manner.
A
189
National Goitre Control Programme
thyroid gland is known as Goi
tre. Goitre is said to be endemic when this
condition affects a significant number of people liv
ing in any circumscribed areas. From the public
health point of view, it has been suggested that en
demic goitre can be defined as prevalence of 10 per
cent or more among the population.
nlargement of
E
Goitre is primarily caused due to environmental
iodine deficiency. Apart from disfiguring swelling
in the neck endemic goitre may cause respiratory
difficulties. The most serious health consequences of
endemic goitre are the high incidence of endemic
cretinism, deaf-mutism and mental retardation.
Activities/performance:
For the identification of
goitre endemic regions two survey teams have been
established in the Directorate General of Health Ser
vices. These teams have completed surveys in vari
ous parts of the country.
The findings of the surveys have revealed that
nearly 40 million people are suffering from varying
degrees of goitre and an estimated number of 140
million people are living in the known hyper goitre
endemic areas. Further, goitre problem has been
found to be equally alarming in areas which were
not known to be goitre prone earlier. Rather these
results suggest that no region in the country can be
considered completely free from goitre.
In order to control the problem of goitre, the Minis
try of Health is supplying iodized salt to the popu
lation living in the goitre endemic areas under the
National Goitre Control Programme. The Ministry
of Health also provides subsidy for extra cost of iodi
zation of salt in order to avoid any financial burden
on the consumers.
Twelve iodization plants are working under the
Management of the Hindustan Salts Limited and Salt
Commissioner, Government of India for the produc
tion of iodized salt with the following units:
Sambhar Salts Ltd., Sambhar Lake
Hindustan Salts Ltd., Kharaghoda
Govt. Salt Golhas, Howrah
190
5 Plants
3 Plants
4 Plants
The two iodization plants installed at Gauhati
have not yet been commissioned. These plans have
now been handed over by the Salt Commissioner to
the Government of Assam.
The existing 12 iodization plants in the public
Sector produce on an average less than 2.00 lakh
M.T. of iodized salt per annum against the total an
nual requirement of 8—10 lakh M.T. Even though
the annual production capacity is 3.76 lakh M.T.
Actual production of iodized salt during the last 5
years is given below : —
1978 1979 1980 1981 1982 1983 1984
1.06 1.20 1.22 1.29 1.23 1.30 1.40 (Anticipated)
SWASTH HIND
Keeping in view the very fact that the public sec
tor is not in a position to meet the requirement of
iodised salt for the goitre endemic areas, the Minis
try of Health and Family Welfare have decided to
liberalise, the production of iodised salt in the Pri
vate Sector in addition to the Public Sector.
Surveys on goitre were conducted in Ernakulam
district of Kerala, Buldhana district of Maharashtra
and. Pauri Garhwal of Uttar Pradesh.
1.18 lakh M.T. of iodised salt was produced at
the various iodization units and 1.6 lakh MT of io
dized salt was supplied to the goitre endemic areas
of Himachal Pradesh, Jammu and Kashmir, Pun
jab, Haryana, Madhya Pradesh. Uttar Pradesh, Guja
rat, Maharashtra, Bihar, West Bengal, Manipur, Na
galand, Sikkim and Union Territories of Delhi, Chan
digarh, Arunachal Pradesh.
During the period under report, supplies of iodized
salt have been introduced in 4 Districts of Madhya
Pradesh, viz., Shahdol, Sarguja, Raigarh & Sidhi. Par
tial supplies have been introduced in Sikkim and Uni
on Territory of Mizoram.
The working group constituted for the purpose of
advising the Govt, of India on Iodization of entire
edible salt in the country by 1990 has submitted the
draft report.
Goitre Control Committee
In order to periodically review the progress made
under the National Goitre Control Programme, three
quarterly review meetings of the Goitre Control Com
mittee were held under the Chairmanship of Addi
tional Secretary, Ministry of Health & Family Wel
fare. The meetings were attended by the representa
tives of the Ministries of Health, Industry. Railways
Food & Civil Supplies, Social Welfare, Salt Commis
sioner’s Office, UNICEF, State Governments
of
Jammu & Kashmir, Himachal Pradesh, etc.
The major recommendations of the Committee are:
I. Since the problem of goitre is wide-spread in
the country, the entire edible salt should be iodi
sed by 1990 to tackle the problem urgently.
2. The State Governments should set up Goitre
Control Cells in their State Health Directorates
for effective implementation of National Goitre
Control Programme.
3. In order to ensure regular supplies of iodised
salt, the concerned State Governments should set
up a single agency for procurement and distri
bution of iodised salt in their endemic areas.
4. The Directorate General of Health Services
should bring out a quarterly news bulletin
on goitre for information of all concerned.
5. Constitution of a working group to go into
various aspects of iodization of entire edible
salt in the country, viz., production centres,
technology of iodization, participation of pri
vate sector, subsidy and quality, etc.
O
Mental Health Programme
do not have sufficient understanding to seek
treatment on a voluntary basis, and to pro
tect the rights of such persons while being de
tained.
Important work is being done in the field of Men
tal Health by the Central Institute of Psychiatry at
Ranchi and the National Institute of Mental Health
and Neuro Sciences, Bangalore. The
Government
of India have also been keen that the Indian Lunacy
Act, 1912 should be replaced by a more comprehen
sive enactment covering the latest concepts on the
scientific treatment of the mentally ill in the country.
For having this replacement, the Government intro
duced a comprehensive legislation on the subject in
the Rajya Sabha in December, 1981, viz., the Mental
Health. Bill, 1981. The Bill was referred to the
Joint Select Committee of Parliament and is receiv
ing their attention. This Bill aims at consolidating
and amending the present law relating to treatment
and care of mentally ill and to make better provi
sion with respect to their properties and affairs and
pther matters connected therewith and incidental
thereto. This Bill would replace the existing Indian
Lunacy Act, 1912 which is out-moded as the con
cepts of mental illness and the mentally ill have since
Ibeen changed. The broad features of the Bill are:—
(vi) To regulate the powers of the State Govern
ments for establishing licensing and controll
ing mental hospitals and similar institutions
for mentally ill persons; and
(i) To provide regulations for admission to men
tal hospitals of such mentally ill persons who
(vii) To provide for legal aid to mentally ill per
sons at State expense in certain cases.
A
AUGUST 1985
(ii) To protect society from presence of mentally
ill persons who have become or might be
come a danger or nuisance to others.
(iii) To protect citizens from
being detained in
mental hospitals without sufficient cause.
(iv) To regulate
responsibility for maintenance
charges of mentally ill persons who are ad
mitted to mental hospitals.
(v) To provide facilities for establishing guardian
ship . or custody of mentally ill persons who
are incapable of managing their own affairs.
191
National Leprosy Eradication Programme
is one of the major health and socio
economic problems in the country. It is a chro
nic infectious disease and spreads mainly by
close contacts with infected patients. However, drop
let infection is also considered responsible as a
mode of spread of the disease. The disease is as
sociated with crippling deformities and destitution,
if not treated in time.
eprosy
L
According to the 1981 census, about 400 million
population in 31 State and Union Territories is living
in the hyper endemic zones of Leprosy. Projected
on the basis of 1981 census population, about 4 mil
lion people are estimated to be suffering from leprosy
in the country at an average prevalence rate of 5.77
per 1000 population. Out of this estimated total
number, about 3.19 million cases have been detect
192
ed and 2.96 million cases have been brought under
treatment till October 1984. This number is not
constant each year as about 3-4 lakhs new cases are
detected and about 2 lakhs cases are discharged an
nually as cured, disease arrested, died, left, etc. As
per assessment of I.C.M.R. and some voluntary or
ganisations, there has been reduction of the disease
in some control areas while there has not been no
ticeable reduction in many other areas.
In addition to the augmentation of the 5th Plan
Scheme of upgradation of old centres, several new
schemes have also been proposed during the 6th
Plan Scheme. The new schemes are (i) establish
ment of more Regional Leprosy Training-Cum-Referral Institutes to impart training to medical and non
medical personnel engaged in leprosy control,
SWASTH HIND
(ii) establishment of leprosy rehabilitation promotion
units in the country for referral treatment, and (iii)
establishment of epidemiological surveillance teams
and sample survey cum-assessment units for study
ing the epidemiological situation
and defining the
magnitude of the problem to assessing the impact of
the Control programme and the introduction of in
tensified field trials with the multi-drug regimen in
hyper-endemic districts to convert infectious patients
into non-infectious within a short period so that the
chances of the infection in the community are suc
cessfully interrupted and controlled. Out of the to
tal 6th Five Year Plan outlay of Rs. 4000 lakhs, Rs.
1500 lakhs have been allocated for the year 1984-85.
(A) Physical achievement
Since the inception of the programme the follow
ing components have been achieved.
SI.
No.
1984-85
Achieve
ment
T
till
Components
A
October
11
1 Leprosy Control Units
2 Survcv, Education & Treatmen* Centres 20
6
3 Urban Leprosy Centres
15
4 Temporary Hospitalisation Wards
5 Reconstructive Surgery Units
6 Upgradation of Leprosy Control Units
7
„
Urban Leprosy Centres
,,
District Lcprc sy Unit
8
9
,,
Leprosy Training Centres..
20
10 Non-Medical Supervisors
11 Leprosy Training Centres .
45
.12 District Leprosy Units
13 Leprosy Rehabilitation Promotion Units
14 Maintenance of Voluntary Leprosy
Beds......
18275
15 Sample Survey-cum-Assessment Unit
16 Total numbci of Leprosy Beds
17 Voluntary Organisations
3
398
6985
2
661
2
250
75
165
52
76
21
10
1157
42
7
178
8
(Sanctioned)
1159
4850
5
32480
42
i(B) Field Achievement
With the help of the above mentioned physical
iinfrestructure the objective achievement position till
tthe end of October 1984 is as under:
Million
11. Total population covered till Oct over, 84
22. New case detected during 84-85 till Octooei
31. Progressive total of cases detected till Oct. 84 .
4.. New cases registered for treatment drilling the year
till October, 1984 ......
5.. Progressive total of cases registered for treatment
till October, 1984 ......
6.. Cases discharged during 1984-85 till October
7.. Total cases discharged till October, 84
AUGUST 1985
351.00
0.217
3.19
(C) Research _
Research on the various aspects of leprosy is be
ing conducted by several institutions in the Govern
ment Sector on the recommendation of the I.C.M.R.
The Central J ALMA Institute for Leprosy at Agra,
U.P., CLTRI, Chingleput Cancer Research Centre
Bombay, A.I.I.M.S., Nev/ Delhi. School of Tropical
Medicines, Calcutta, are carrying out various resear
ches on leprosy including development of a suitable
vaccine against leprosy. A number of voluntary or
ganisations are also carrying out specified items of
research. The WHO is providing apporpriate fin
ancial assistance from the Tropical Disease Research
$. Fund to certain Institutes engaged in the research
in the country.
Intensified leprosy control project with multidrug
regimen (M.D.R.P.) has completed its 3 years on
2nd October, 1984 in the districts of Ward ha and
in the district of Purulia will be completing its 3
years in Feb., 1985. In the first phase, six districts
were covered under the M.D.R.P. and six more have
been taken under the programme during the year,
1984-85. All the 98 hyper-endemic districts having
a prevalence rate of 10 per 1000 and above are plan
ned to be undertaken under the MDRP as the Pro
gramme has shown very good results in the areas
where it has been started. The project is being as
sisted by the Swedish International
Development
Agency towards supply of anti-leprotic drugs, i.e.,
Rifampicin and Clofazimine capsules and meeting
the operational cost. The object of this scheme is
to detect all infectious cases in the districts and treat
them with the combination
of anti-leprotic drugs
namely Dapsone, Rifampicin and Clofazimine cap
sules with a view to rendering them non-infectious
within a short time so that risk of development of
drug resistance is minimised and the chances of trans
mission of the disease in the community are effectively
reduced.
The bill introduced in the Parliament to repeal the
Leper Act, 1898, to create a favourable climate for re
moval of the -age-old social stigma of leprosy and
to obtain cooperation of patients and public, has been
passed by the two houses of Parliament. The same
has been sent to all the States/U.Ts. for the simi
lar action and two States, viz., Tamil Nadu and Ma
harashtra have already repealed the Act.
0.204
2.99
0.13
F69
The National Leprosy Eradication Board consti
tuted on the recommendation of the Working Group
(continued on page 201)
193
Health Education Progress
' | ' HE Central Health Education Bureau has com1 pleted 28 years of its existence. The Bureau im
plements the policies and programmes of health
education in the country. The Bureau has six Tech
nical Divisions, i.e, Training; Research & Evaluation:
’Media; Field Study and
Demonstration Centre;
Health Education Service; School Health Education
and an Administrative Division.
Training activities
The Bureau conducted long and short term train
ing courses in health education.
(i) CHE Course: Two Courses in Certificate in
Health Education i.e., 17th and 18th were conducted
during the year in which 37 and 43 candidates were
trained respectively.
194
(ii) Media Personnel Training Courses: This
course of one month’s duration was conducted for
artists, photographers and audiovisual
technicians.
Eight trainees from various States attended the course.
(iii) District Extension Media Officer’s Courses:
This course of 60 days duration was conducted in
which seven officers participated.
Diploma Course in Health Education (JDHE): The
XIII Diploma Course in Health Education with 13
students concluded in March 1984, and the XIV
course began from 1st April, 1984, with 15 students.
Orientation in Health Education: Orientation
training in health education was provided to 19 WHO
fellows. Orientation training was also provided to
526 visitors from 14 institutions in the country.
SWASTH HIND
Research studies
The Bureau continued to promote
behavioural
research activities in the country. The following
research studies were in progress:
(i) Social-cultural Aspects of Venereal Diseases
and Health Education opportunities.
(ii) Study on community participation in Expanded
Programme on Immunization in Maharashtra
and Orissa.
(iii) Study on Impact of Different Educational and
Health Education Methods on Practices of
Health Behaviour of Mothers- in Management
and Prevention of acute Diarrhoea.
(iy) Health Education acivities as perceived by the
Physicians and Non-physicians Health Educators.
Besides the research studies, the Bureau was engag
ed in preparing the report of the Working Group in
Health Education and Community Participation in
Water Supply and Sanitation
Decade Programme.
The Bureau is also monitoring the activities relating
to the celebration of the International Youth Year.
The Bureau plans to undertake studies on tropical
diseases and water and sanitation programmes
in
future.
Media
The Media Division of the Bureau which comprises
Editorial and Exhibition Sections, continued to pro
vide media support to all the on-going health and
other programmes. Health education material was
produced to disseminate health information to the
public for creating awareness and also produced edu
cational aids for health workers. The Media Division
maintained liaison with AIR
and
Doordarshan,
DAVP, Films Division and other wings of the Infor
mation and Broadcasting Ministry for strengthening
educational programmes in respect of various health
programmes including those mentioned in the 20Point Programme The Media support included publi
cation of posters, folders, reports, etc.
The monthly journals; Swasth Hind (English):
Arogya Sandesh (Hindi) were brought out regularly
covering various issues relating to health education,
public health, health programmes, behavioural re
search, book reviews, information for States, etc.
Special issues of 'Swasth Hind’ and ‘Arogya Sandesh’
were brought out on World Health Day and Children’s
Day. The quarterly journals “D.G.H.S. Chronilcle”
and “Swasthya Shiksha Samachar” were published to
AUGUST 1985
disseminate technical information on health and to re
port about the achievements of the Directorate-Gene
ral of Health Services.
Health Education material: The Division pro
duced various prototype material in English and
Hindi; posters, pamphlets, folders, hand-bills
on
health programmes which were provided to the States
and Union Territories.
Educational material in the form of folders on
Thread Worm, Round Worm, Dengue Fever, Guinea
Worm. When the unexpected happens, show card on
Immunization and posters on regular treatment cures
T.B. and Persistent Cough—Have Sputum Test were
brought out both in English and Hindi during the
year.
In addition to the above, four folders each on
safe water, jaundice, dysentry and goitre; two book
lets, each on food adulteration and diarrhoea; posters
one each on accidents, guinea worm and goitre; one
hand-bill on goitre and one flipbook on guinea worm
have been prepared.
The Bureau prepared a proposal to develop and
produce a health telecast series which would make
the community aware of the body-structure, its func
tions and various health problems and how to take
preventive and promotive measures for healthy liv
ing.
Campaigns: Suggestions for observance of the
World Health Day and the background material of
the World Health Day 1984 were issued. An adver
tisement on the theme “Children’s
Health’ Tom
morrow’s Wealth” was also issued to newspapers
through D.A.V.P.
Health Education drive was launched in four
hospitals, i.e., All-India Institute of Medical Sciences.
Ram Manohar Lohia Hospital, Lady Hardinge
Hospital and Safdarjang Hospital.
Thirteen exhibitions on varied areas of health were
arranged including the World Health Day and the
Children’s Day—script of which was sent to
the
States for developing similar exhibitions in their areas.
As a part of hospital health education campaign.
four exhibitions were put up in major hospitals of
Delhi. Exhibition material and teaching assistance
was given to other agencies requisting such assistance.
& Films'. As many as 191 film shows were
organised on demand from different quarters. Film
195
prints numbering 1,599 were loaned to various organi
sations.
Scripts have been completed for produc
tion of 8 video films to be used on Doordarshan.
Photo: During the period under review, 2,839
prints including 751 big sized photographs (enlarge
ments) were prepared as an integral part of the
material for use in different communication activities.
In addition, 142 slides were produced for these pro
grammes.
Field Study & Demonstration Centre
As a part of health education activities in the
F.S.D.C. (U), five projects were undertaken in DDA
flats, Mata Sundari Road in LNJP Hospital, Vikram
Nagar, Government of India Press, residences, and
C.G.H.S. Dispensary, Minto Road.
The students undergoing Certificate Course in
Health Education and Diploma in Health Education
were provided field training. Moreover four trainees
of Diploma in Health Education from the Gandhi
Gram Institute of Rural Health and Family Welfare
were provided 2-months supervised field training.
A proposal has been made to strengthen the
FSDC of the Bureau and set-up an Urban FSDC de
monstration room in the Bureau.
Health Education Services
The Bureau worked for growth and development of
health education services in the country. It main
tained liaison with international agencies like WHO.
UNICEF, UNDP to facilitate their support and assis
tance for overall development of health education
programmes in the country. It maintained close liai
son with State Health Education Bureau, through
which it helped to develop Health Education Pro
grammes in the whole country. It also helped in
developing Health Education in various health agen
cies, organizations, and institutions. The National
Health programme wing attended to development and
promotion of health education component in all the
national health programmes. The implementation of
Centrally sponsored scheme for strengthening health
education in the 9 Union Territories was continued.
The Union Territories of Pondicherry, Mizoram,
Andaman & Nicobar Islands, and Arunachal Prad^h
have taken action to strengthen their Bureau.
196
School Health Education
The Bureau continued to strengthen educational
programmes for younger generation and to work as
a technical resource with the Ministry of Education,
NCERT and Directorate of Adult Education and
helped in population education and produced type
instructional material. The Division has developed
syllabi for classes IX and X for Central Board of
Secondary Education as separate subject under Phy
sical Education and Health education for classes XI
and XII of Central Board of Secondary Education.
It also developed syllabi of health education to inte
grate health education in training of Adult Education,
B.T. & B.Ed. Population Education Guide for Secon
dary School Teachers was developed for School
Health Education Departments.
Under the Intensive Pilot Project the Bureau is also
monitoring Centrally sponsored “National School
Health Scheme” for the primary class students in
eight U.Ts except Delhi.
Workshops
1. One-day Workshop on Teachers' participation
in the Prevention of Blindness among Primary School
Children was organised at the Bureau with Dr A. V.
Baliga Memorial Trust for training of teachers to take
up their responsibilities and develop educational
material.
2. Training was provided to different batches of
NSS volunteers from Delhi College at CHEB Scripts
of 16 brochures on different health areas for National
Services Scheme Volunteers in the country were
finalised with representatives of the Ministry of
Sports.
The Bureau is collaborating with Indian Council of
Medical Research for development of educational
motivational material in relation to injective contra
ceptives.
Out of 22 states, 21 have established Health Edu
cation Bureau/Units/Cells. Most of the States and
UTs produced health education material and also
have liaison with publicity units like AIR/TV, etc.,
in their respective States. Some of the State Bureau
also produced monthly health magazines.
A
SWASTH HIND
National Programme
for
Control of Blindness
he National Programme
for Control of Blind
ness has been included in the ‘New 20-Point
Programme’. The object of the programme is to
make a significant reduction in the incidence of blind
ness from the present level of 1.4 per cent to 0.3
per cent by 1999. The Programme envisages the de
velopment of various services at peripheral, inter
mediate and central levels. The peripheral sector
includes development of mobile units to provide im
mediate relief to the community in remote villages
.and strengthening of eye care services at primary
levels. The Central Sector includes upgradation of
medical colleges, Regional Institutes and National In
stitutes mainly responsible for training of personnel
and research
on eye problems besides providing
specialised eye-care service.
T
Hundred per cent Central Assistance is offered to
State Govt./U.Ts. for procurement of material and
equipment and also for meeting recurring expendi
ture on maintenance and operation of these services.
Cataract cases constitute 55 per cent of the total
blindness in the country. Emphasis is being laid
on performance of as many cataract operations as
possible both through Governmental and non-Govemmental Institutions including Voluntary Organi
sations.
The present position of development
services is given below: —
Services
1 Mobile Units
2 Primary Health Centres
3 District Hospitals
4 Metrical Colleges
5 Regional Institutes
6 Training Schools for Opthalmic Assistants
7 District Mobile Units
8 •Eye Banks
9 Ophthalmic Cells
of various
Targets
upto
Vlth
Plan
Achieve
ment
upto
1983-84
80
2000
400
60
10
80
1660
360
51
5
37
30
30
18
35
Target
1984-85
340
40
9
5
2
30
30
18
Under the Programme, financial assistance is offer
ed to Social/Voluntary Organisations for holding eye
camps in rural and urban areas upto the population
AUGUST 1985
of 1 lakh. Financial assistance is being given @ Rs.
60/- per intra-ocular operation performed within a
ceiling of Rs. 12,000/- per eye camp. In order to
enhance the participation of voluntary organisations
in eye relief work, the procedure of disbursement of
financial assistance has been decentralised with
effect from 1 September 1982. The metropolitan slums
and Panchayat bodies have also been covered under
this scheme.
Community eye health education is an important
part of the programme as a built-in component at
all levels of implementation. The programme pro
vides for different activities involving mass media
and interpersonnel channels of communication. Suffi
cient funds are provided every year to produce litera
ture on eye care and develop other eye health edu
cation activities.
One of the most important factors responsible for
blindness is the loss of vision by cataract. Cataract
is curable through surgery. Efforts are being mo
bilised through Government and voluntary sectors
to maximise the number of cataract operations. The
performance has shown significant .increase ever
since the programme formed a part of the 20-Point
Programme. The performance on this front from
various States during the last three years, is as in
dicated below :
Years
1981-82
1982-83
1983-84
1984-85
Performance (In
lakhs)
|
5.5
8.05
10.67
2-04
(April to
October 84)
197
Family Welfare — A Big Leap Forward
N order to realise the long
term demographic goals of the
country as spelled out in the
National
Health Policy, to attain
a Net Reproduction Rate of one by
the year 2000, efforts to give fur
ther fillip to the
acceptance of
small family norm were inten
sified. The programme gathered
so much momentum as to yield a
record level of 14.4 million acce
ptors during the year 1983-84.
This represents a big leap forward
over the level of 5.5 million ac
ceptors during 1979-80. In the
current year which is the closing
year of the Sixth Plan, the perfor
mance is expected to be still bet
ter. This will give us a good base
to build on during the 7th Plan
period. At the end of the 7th
Plan, the couple protection rate
is expected to reach around 42
per cent.
I
1984. In these meetings the Re
ports of the five Working Groups,
viz., incentives and disincentives.
organisation
and
management
community participation, research
and Technology and communica
tion strategy, were discussed in
detail. At the official level the
Health Secretary, the Additional
Secretary and Commissioner for
Family Welfare, and other senior
officers of the Ministry maintain
ed a close liaison and follow-up
with the State Governments.
A highlight of the 10th Joint
Conference was the presentation of
cash awards to the best performing
States and UTs for 1982-83 in the
field of family welfare. In group
A States Maharashtra got the first
prize (Rs. 2.5 crore) and Haryana
the second prize (Rs. one crore).
In group B Punjab bagged the first
prize (Rs. 2.5 crore) while Karna
taka won the second price (Rs.
one crore).
In group C, Ma
dhya Pradesh got the first award
of Rs. 2.5 crore.
In group D,
Himachal Pradesh won the award
(Rs. 50 lakhs) while in group E.
the UT of Dadra & Nagar Haveli
got the award of Rs. 25 lakhs.
Consistently improved perfor
mance during the last 5 years has
been possible -due, among other
things, to a close monitoring of
the Programme at the highest level.
The system of annual regional
neetings with
Health
Ministers
of States and UTS taken by the
Union Health Minister, in which
The awards for the year 1983-84
detailed State-wise reviews are have also been announced which
made, followed by the Joint Con are as follows:—
ference of the Central Council Group A
Maharashtra (1 st prize):
of Health and Family Welfare in
Haryana (2nd prize)
which all aspect of the Programme Group B
Punjab (1st prize)
are discussed in the national per
West Bengal (2nd prize)
spective, has yielded rich divi Group C
Assam (1st prize):
dends by way of removing the bot
Madhya Pradesh (2nd prize)
tlenecks and fostering a sense of Group D
Himachal Pradesh
urgency. This year the 10th Joint Group E
Pondicherry
Conference of the Central Coun
A recommendation of the Con
cils of Health and Family Wel
ference
to give suitable cash awards
fare was held at New Delhi from
to
the
States/UTs
who achieve 100
9th to 11th July, 1984 after a
series of regional meetings
held per cent of their annual targets in
earlier. The two meetings of the terms of equivalent sterilization, is
Population Advisory Council were also under the consideration of the
held in quick succession on 8th Central Government.
June and 29th June, 1984 after
Under the leadership of the
an earlier meeting on 8th March. Union Health Minister a broad-
198
bused delegation of India participat
ed in the International Conference
on Population held in Mexico City
from 6 to 14 August, 1984. One
hundred and forty seven govern
ments participated in the consensus
on the 88 recommendations for the
further implementation of the
World Population Plan of Action.
At the conclusion of the Conference
and under the leadership of Mexico
and 28 States, including India, the
Mexico City Declaration on Popula
tion and Development was approv
al
Approach and1 Strategy
As part of the new 20-Point Pro
gramme, the family welfare is
sought to be pursued on a purely
voluntary basis as a people’s own
programme. Our approach is to
promote responsible and planned
parenthood through a well design
ed strategy.
Continuous efforts are being made
to expand and streamline the net
work of health and family welfare
services, to the doorsteps of the peo
ple. These include:
(i) With a view to provide liai
son between the community
and health services network,
a Village Health Guide func
tions in each village or within
a population of one thousand
in larger villages. About
350,000 Health Guides are
already
working.
Health
Guides are selected by com
munities from amongst them
selves and preference is given
to females. These voluntary
workers are trained for a
period of three months and
arrangements for continuous
training are in-built in the
Efforts to give further fillip to the
acceptance to small family norm
were intensified.SVVASTH HIND
The Village Health
Guides also promote small
family norm and the use of
contraception.
scheme.
fii) Deliveries by trained
health
personnel in hygienic and
aspetic conditions are critical
in reducing the maternal mor
tality and infant mortality.
Most villages in the coun
try have traditional birth at
tendants who are customa
rily handling deliveries in
their areas. A scheme to
train these traditional brith
attendants to upgrade their
skills has been in operation
and till now over 4,00,000
birth attendants have been
given training. It is propos
ed to trained all untrained
‘dais’ during the 7th Plan.
(iii)
Health Sub-Centres are be
ing established for every three
to five thousand population.
These are manned by a team
of one qualifield male and
one female (paramedic). They
promote small family norm
and meet the health needs
of the community. They
also provide maternal care
and immunisation services
in addition to family plann
ing education, motivation,
and supplies and services in
spacing methods. There are
over 70.000 sub-centres in
the country and their num
ber will increase to about
120.000 by 1990. The cur
rent year’s target is 9,071
new sub-centres. One male
and one female Health Super
visor provide support and
assistance for every four
Sub-Centres.
(iv) There are nearly 7,000 Pri
mary Health Centres (PHCs)
one for every 100,000 popu
lation. Each PHCs is to
have three medical officers
(including one Lady Medical
Officer) to provide curative
and clinical services, includ
ing MTP and they supervise
and guide family planning
programme
performance.
The team of medical and pa
ramedical personnel at the
PHC level have been train
ed well in all the family wel
fare/planning methods, in-
AUGUST 1985
199
eluding sterilisation, follow
up care and treatment of
complications when
they
arise. This network of medi
cal services are to be streng
thened by opening new onedoctor Primary Health Cen
tre for every 30/20 thousand
of the population. Existing
Primary Health Centres will
be upgraded as referral, con
sultative and supervisory
centres with the addition of
more beds and specialist
services.
. (v) At the apex of the pyramid
of health services are the
district level (412) and State
level referral service Centres.
There are 106 medical col
leges which impart medical
education and also provide
specialist services and help
supervise, guide and train
the personnel at lower levels.
Services and Supplies
Services and supplies are provi
ded entirely free of cost at various
levels of the health delivery sys
tem according to the facilities avai
lable. While all services are avai
lable at district and sub-divisional
hospitals and above, the Primary
Health-cum-Rural Family Welfare
Centres provide all services except
female sterilisation (many PHCs
are now providing this service also)
and the sub-centres manned by
Auxiliary Nurse Mid-wife (ANM)
usually provide only non-terminal
methods others than IUD (IUD)
.insertion is also being carried out
in many sub centres after train
ing of ANMs/LHVs).
Post Partuni Programme
’ Post-partum scheme is one of the
more successful components of the
family welfare programme. It is
hospital-based and maternity orient
ed’. At the time of delivery, a
woman is generally more receptive
to adopt one or the other family
planning method so as to stop fur
ther addition to the family. The pro
gramme offers necessary facilities
to such women. The number of
medical institutions approved under
the programme at district level or
above is 554 and 400 at the sub
district level.
200
Medical Termination of Pregnancy
India does not permit abortion
as a means for fertility regulation.
However, from 1972 onwards Medi
cal Termination of Pregnancy has
been allowed as a part of health
care facility for pregnant mothers
on health and related socio-cultural
considerations. Primarily, this faci
lity is provided to save health ha
zards to the millions of women who
take recourse to clandestine abor
tions by ill-qualified doctors or qua
cks in un-hygienic conditions. We
believe that child bearing should
be a joy, not a burden; and since
it is the mother who bears and
rears the child, we are concerned
not only with her health but with
her will and well-being. More than
10.000 doctors have been trained
in MTP technique and over 32 lakh
pregnancies terminated since the in
ception of this programmes. It is
proposed to make available at least
one trained doctor in M.T.P. in
each PHC.
Mother and Child Health Care
Maternal and Child Health
(MCH) services play an important
role and constitute a vital compo
nent of the family welfare pro
gramme. These services contribute
to better health and better chances
of survival of mothers and children.
We are pledged to provide basic
health care facilities like safe and
aseptic delivery and immunisation
of children against childhood di
seases. In view of the vastness of
the country, it may take some time
to provide full package of services
to every child and expectant mother.
We aim at providing universal im
munisation by 1990. This presents
an enormous problem in logistics,
supplies and trained manpower
which are proposed to be tackled
in the 7th Plan.
Some New Initiatives
With a view to giving further
fillip to the Programme, the Govern
ment have taken some policy deci
sions and initiatives. More impor
tant of these are outlines below:
(i) Major States have been ask
ed to conduct detailed exer
cises taking into account their
present couple protection
level, conditions in the field
and their management- capa
city so as to fix appropriate
targets for themselves in
order to realise the overall
national goals. This is inten
ded to decentralise the pro
cess of target-setting and en
sure the participation of the
programme managers in the
planning process.
(ii) The staffing pattern at various
levels under the Family Wel
fare Programme was laid
down in 1966. Since then
there has been manifold in
crease in the size and sweep
of the programme. A high
level Task Force was set
up in November, 1983 to
review the existing situation
vis-a-vis staff pattern at
various levels and suggest
appropriate need-based sta
ffing pattern for various levels
at the Centre, States and
Union Territories.
(iii) In consultation with the
Planning Commission and
the Ministry of Finance, a
special fund has been creat
ed at the Centre to provide
expenditure on items which
may not be covered by the
approved pattern of assis
tance under the Family Wel
fare Programme. This step
is expected to remove quite
a few bottlenecks experienc
ed in the implementation of
the programme. This scheme
is being continue during the
current year with an alloca
tion of Rs. 1.5 crore and is
known as the Additional Se
cretary ‘Commissioner Fami
ly Welfare* Discretionary
Fund.
(iv) Keeping in view the impor
tance of birth interval for
child survival and mother’s
health as well as the contra
ception needs of younger
couples who have not yet
achieved the desired family
size, the government has
initiated a vigorous policy
to promote spacing methods
—IUD devices like Copper
T, oral pills and condoms—
on a large scale. This will
be done on campaign basis.
A Contraceptive Market
ing Organisation has since
SWASTH HIND
been registered under the
Societies Registration Act to
promote spacing methods
and arrange for needed sup
plies and materials. It is
estimated that by 1990 spac
ing methods will account for
20 per cent of protected
couples against the present
level of 5.5 per cent.
(v) Injectable contraceptives as
yet do not form a part of
the programme. A pilot pro
ject, on injectable contracep
tives— NET — OEN — at
PHCs attached to 15 medi
cal colleges is underway.
Based on the results
this
pilot project, it is hoped to
introduce this spacing method
next year.
(vi) Indian Council of Medical
Research is also continuing
its studies with Norplant
—a female contraceptive de
vice. It is expected that an
appropriate version of this
device will be available by
the end of 1985 to enable to
start the programme intro
duction studies at the PHCs.
(vii) The scheme for involvement
of private medical practi
tioners of modem and in
tegrated medicine in perform
ing sterilisation operations
and IUD insertions has been
extended till 31-3-1987. An
evaluation of this scheme
is also being undertaken to
make it more effective.
(viii) Last year a new scheme was
initiated for involving local
village communities with a
view to ensure that all the
eligible couples in a particu
lar village community start
practising one or the other
family planning method. Ma
li ila Mandate and Village
Health
Committees were
motivated to implement the
campaign. The scheme has
made a very good impact
in a few selected districts of
Rajasthan and it is proposed
to recommend this innova
tive scheme of “Parivar Kalyan Villages” with cent per
cent acceptance of family
planning methods to other
States after perfecting the
strategy.
People’s Participation
Family Planning being a volun
tary programme, needs the partici
pation of millions of men and wo
men. The aim is to conduct this
programme as a people’s movement
with the active involvement of vo
luntary and non-governmental or
ganisations. A favourable climate
in support of small family norm
is sought to be created with the
help of mass media, folk media and
inter-personnel communication by
trained personnel.
Opinion lea
ders, especially elected representa
tives of the people from the gram
panchayat to the national Parlia
ment, are getting increasingly invol
ved in this programme. Motivation
and training camps where such
leaders get together for discussion
is an important extension strategy
being pursued with vigour. Thus,
(ix) A popular family program acceptance and practice of family
me—Hum Log—on the pat planning is being promoted by
tern of the Mexico Soap motivation and education regarding
Opera has been introduced the benefits of the small family
on the Doordarshan. Some norm, community involvement and
such popular programmes on provision of supplies and services of
A
the radio and T.V. are in good quality.
[Continued from page 193]
headed by the then member Planning Commission
Dr M. S. Swaminathan has held its three meetings
so far.
Medical and Technical personnels are being given
enhanced stipends, from Rs. 450/- p.m. to Rs. 800/p.m. to doctors and from Rs. 250/- p.m. to Rs.
620/- p.m. respectively for training in leprosy.
Govt, of India have revised the rates of (i) grants
to voluntary Training Centres, (ii) POL for vehicles
supplied under the NLEP, (iii) construction of lep
rosy training centres, Leprosy Rehabilitation pro
motion units.
The following quantum of anti-leprotic drugs was
supplied to the various States/U.Ts. during the year
1984-85 till November.
1. D.D.S. Tablets-! 3.07 ton (includes 5 ton from
German Leprosy Relief Association).
AUGUST 1985
the pipeline and are expect
ed to carry forward the pro
cess of mass education and
motivation vis-a-vis adoption
of small family norm.
2. (a) Clofazimine (100 mg) capsules-2.50 lac cap
sules
(b) Clofazimine (50 mg) caps tiles-200.00 lac cap
sules
(c) 3 lac Clofazimine capsules from the Leprosy
Mission.
In addition to above 10 lac Rifampicin (300 mg)
capsules and 32 lac Clofazimine (100 mg) cap
sules are expected to be received from WHO
soon.
(d) SIDA has been requested to supply 40 lac
Rifampicm 300 mg capsules and 80.00 lac
Clofazimine (100 mg) capsules for MDRP
districts.
(e) 17.50 lac Clofazimine (100 mg) capsules and
7.50 lac Rifampicin
(300 mg) capsules are
expected to be received soon for MDRP use.
(f) One ton DDS received from Italian Leprosy
Association and six ton DDS received from
Danion Foundation are under* release. A
201
Prevention of Food Adulteration
he prevention of Food
Adulteration Rules
covering the standards of various items of food
regulating use of addictive, presence of contaminants
etc., are amended from time to time on the recom
mendations of Central Committee for Food Stand
ards, which is a statutory committee, constituted by
the Central Government, under the provisions of
the Act to advise the Central and the State Govern
ments, on matters arising out of the implementation
of the Act. The Committee had met 31 times. The
last meeting of the CCFS was held on 24-25th August,
1984 at Ahmedabad.
T
In order to keep the knowledge of all functionaries
at all time up-to-date in service training courses for
Food Inspectors, Analysts and Senior Officers of the
States are organised with the objective of achieving
uniform implementation in food laws. The PFA
Cell in the Directorate General of Health Services
regularly conducts such training programme in colla
boration with various institutions.
Food Contamination Monitoring Programme'. The
Food Contamination Monitoring Programme which
was in operation in co-operation with FAO and
Nine National Laboratories since 1979, terminated
on completion in December 1984. The survey has
been in operation for estimating the presence of pesti
cides, toxic metals and all toxins occurring in com
monly used food articles.
W.H.O. Fellowship: The 4th meeting of Coordi
nating Committee for Asia was held at Patchburi,
Thailand from 28th February to 5th March 1984, to
discuss the interests of the countries in the region in
area of international food standards and acceptance
of Codex Standards. The country was represented by
a two member team from Directorate General of
Health Services/Ministry of Health. The Indian deligation also included representative from the Depart
ment of Food.
Visits of Consultants and Fellows: The Directorate
General of Health Services in the Ministry of Health
and Family Welfare organised a visit of the FAO con
sultant which visited India in October 1984, to study
the current situation and capabilities of various coun
tries of the Asian region for manufacture and distri
bution of infant formulae and weaning foods with
special reference to preparations based on locally avai
lable raw materials.
Education & Publicity: As only legislation may not
be able to curb menace of food adulteration until and
202
unless the consumers and traders are made aware of
their responsibilities in the implementation of PFA
Laws, the Central Government advises the State Govvernments from time to time to undertake educational
programme through seminars, exhibitions and talks and
through use of other mass media to create an aware
ness among the consumers and traders and also to
make them familiar with the provisions of the Act
and Rules. Some pamphlets on Food Adulteration
have been published by the Central Government for
the purpose of educating the consumers. The Central
Health Education Bureau is bringing out pamphlets
on food hygiene and documentary films on program
me of food adulteration. Tn addition, cinema slides on
programme of food adulteration are also proposed to
be brought out for mass education.
Central Food Laboratories: A Central Food Labo
ratory is an appellate laboratory under the PFA Act
whose report is considered to be final. At present,
there are four Central Food Laboratories functioning
under the provisions of the PFA Act. Two Laborator
ies, namely Central Food Laboratory, Calcutta and
Food Research and Standardisation Laboratory, Ghaziabad are under the administrative control of D.G.H.S.
while the Central Food Laboratory, Mysore and Cen
tral Food Laboratory, Pune are under the adminis
trative control of C.S.I.R. and State of Maharashtra,
respectively, in addition to legal samples, these labo
ratories also undertake research and investigational
work relating to problem of analysis and standardisa
tion of Food articles. The Central Food Laboratory,
Pune and Mysore are provided an annual grant of
Rs. 3.00 lakhs for undertaking the responsibilities of
appellate work.
The number of samples of food articles analysed
and found adulterated during the last five years are
as follows: —
Year
No. of
samples
analysed
No. of
samples
found
adulte
rated
Percent
age of
adulte
ration
1978
-
1,32,975
24,682
18.4
1979
-
1,32,003
19,520
14.8
1980
.
1,29,698
17,847
13.8
1,33,242
19,050
14.2
1,29,595
16,765
12.9
198J
1982
.
.
A
SWASTH HIND
Maternal and Child Health Programme
1984-85 special emphasis was laid on the
health status of mothers and children in the context
of the 20-point Programme which stipulates accele
ration of programmes of welfare for women and chil
dren and nutrition programme for pregnant women
and nursing mothers and children. The National
Health Policy has also attached great importance to
the MCH Programme. The infrastructure of delivery
of maternal and child health services has been and is
being expanded both in rural and urban areas by the
setting up of primary health centres, rural family wel
fare centres and sub-centres, urban family, welfare
centres and post-partum centres. In addition, the De
partment. of Family Welfare has sponsored several
schemes namely, immunisation of expectant mothers
against tetanus; immunisation of children against
Diphtheria, Whooping cough, tetanus, poliomyelitis
typhoid and tuberculosis, prophylaxis against nutri
tional anaemia among mothers and children as well
as prophylaxis against blindness due to Vitamin ‘A’
deficiency in children. The performance of most of
these programmes during the current year has shown
improvement compared to that of the corresponding
period of last year.
(figures in lakhs)
uring
D
Scheme
Target
1984-85
Physical
Achieve
ment
upto
Sept. 84
Physical
%age
achieve
ment of
annual
target
during
1983-84
1
2
3
4
130
130
84.54
78.75
65.1
60.6
270
131.55
53.7
Prophylaxis against nutritional
anaemia
(Mothers)
(Children)
Prophylaxis against blindness
among children due to Vita
min ‘A’ deficiency
Prophylaxis against nutritional anaemia among
mothers and children'. Anaemia is one of the major
health problems affecting women of child bearing age
and children contributing to maternal mortality and
morbidity leading further to a still-birth, premature
birth and low-birth weight babies. In order to pre
vent nutrition anaemia among mothers and children,
daily dietary requirements for iron and folic acid, the
deficiency of which causes anaemia, is. given in the
form of tablets. Pregnant and nursing mothers and
women acceptors of family planning, and children are
the beneficiaries.
A child is being weighed as a part of nutritional monito
ring programme which helps in preventing blindness by
detecting vitamin ‘A’ deficiency.
Prophylaxis against blindness due to Vitamin ‘A’
deficiency among children'. Vitamin ‘A’ deficiency is
found to be prevalent among children of pre-school
age in many parts of the country. Severe forms of
Vitamin ‘A’ deficiency Keratomalacia coupled with
malnutrition and infection is believed to be an im
portant cause of blindness among children. As a pre
ventive measure, concentrated Vitamin ‘A’ solution in
oil form is given to children in the age-group of 1—5
years every six months. Targets and achievements
upto 30th September, 1984 are given below:
The Expanded Programme on Immunisation'. The
expanded programme on immunization was started
in India in 1978 with the objective of reducing the
morbidity and mortality due to diphtheria, pertussis,
tetanus, poliomyelities, tuberculosis and typhoid. Vac
cination services are proposed to be made available
to all eligible children and pregnant women by 1990.
It is also proposed to include measles in the EPI
during the 7th Plan. It was also aimed to achieve self
sufficiency in the production of vaccines required for
the programme.
AUGUST 1985
203
Rural Health Services
main programmes/schemes being implemen
ted under the Minimum Needs Programme, to
provide primary health care relevant to the actual
needs of the community in the rural areas are indica
ted below:
Sub-Centres: The additional sub-centres to be esta
blished during the 6th Plan period will raise their num
ber to about 80,000 against the estimated total re
quirements of 1,30,800. Their progress is as follows: —
he
T
(a) Functioning on 1-4-1980
(b) Target for the 6th Plan period
(c) Established during 1980-84
(d) Target for 1984-85
47172
40000
(approx.)
27135
9071
Functioning on 1-4-1980
Target for the 6th Plan period
Established during 1980-84
Target for 1984-85
5484
756
1726
192
Subsidiary Health Centres I Hew Primary Health
Centres'. It is proposed to convert the Rural Dis
pensaries into Subsidiary Health Centres/New Pri
mary Health Centres.
(a) Functioning on 1-4-1980
2056
(b) Target for the 6th Plan period
2270
(c) Established during 1980-84
1558
(d) Target for 1984-85
396
Upgraded Primary Health Centres: It is proposed
to establish rural hospitals by upgrading the existing
Primary Health Centres. Each of the upgraded Pri
mary Health Centre will have 30 beds to meet the
need for the rural population.
(a) Functioning on 1-4-1980
217
(b) Target for the 6th Plan period
315
(c) Established during 1980-84
258
(d) Target for’1984-85
118
Health Guide Scheme: Upto 30-9-84, 4234 Primary
Health Centres have been covered under the Scheme.
From the inception of the Scheme, till 30-9-1984,
3,45,548 Health Guides have been trained. In 1984-85
upto September 84. a total of amount 2300 Health
Guides had received training.
The states of J&K, Kerala, Tamil Nadu and U.T.
of Arunachal Pradesh have not accepted the Health
Guide Scheme. They are implementing alternative
204
Multipurpose Workers Scheme: Implementation of
the scheme involves: (i) conversion of all the existing
unipurpose workers at different levels into multipurpose
workers after suitable training, (ii) integration of all
National Health and Family Welfare Programmes and
(iii) employment of additional workers.
Training
Primary Health Centres
(a)
(b)
(c)
(d)
schemes.
J&K is implementing ‘Rehbar-e-Sehat’
Scheme. Under this as per the information available
29 bocks have been taken up and 2450 volunteers have
been trained. Kerala is implementing ‘Strengthening
of Primary Health Centres’ in three districts of Tri
vandrum, Kozhikode and Wynad. Tamil Nadu is im
plementing ‘Mini Health Centre’ Scheme. 251 Mini
Health Centres are functioning there. In Arunachal
Pradesh ‘Medics’ scheme is in operation. 542 persons
are functioning under this scheme.
(a) The seven Central Training Institutes conduct
training programmes for the key trainers and the Dis
trict Level Medical Officers;
(b) The 47 Health and Family Welfart Training
Centres impart training to the Medical Officers and the
Block Extension Educators (BEEs) of the Primary
Health Centres (PHCs).
(c) Trained Medical Officers and BEEs organise
training at their own PHCs. at tht selected PHCs. for
their para-medicals.
Achievements: According to the information received
and compiled as on 30th September, 1984, retraining
is complete in 348 districts and it is in progress in 30
districts. The States of Gujarat, Karnataka, Mahara
shtra. Mad ya Pradesh, Haryana, Punjab, Kerala,
Himachal, Orissa, U.P., Rajasthan, Meghalaya and
Sikkim have completed the training.
The position
with regard to the total number trained is:
S.
No.
Category
1. Distt. Level Medical Officers
2. Key Trainers ....
3. D.E.M.Os./Dy. D.E.M.Os.
4. Medical Officers
5. B.E.E................................................
6. Health Assistant (Male) .
7. Health Assistant (Female)
8. Health workers (Male)
9. Health Workers (Female)
Total No
Trained
upto
31-3-84
1650
706
304
17256
5998
27128
12849
84037
58286
No. of
Persons
trained
during
1984-85
upto
30-9-84
16
20
8
218
261
479
719
823
2786
SWASTH HIND
38th World Health Assembly
Health for All and All for Health
The Thirtyeight World Health Assembly was
held from 6—20 May, 1985, in Geneva. Over
1000 delegates, including over 100 minister of
health, representing most of the 166 Member
States of the World Health Organisation par
ticipated. We publish here the highlights of
the Assembly.
growing partnership between governments and
non-governmental organizations (NGOs) is essen
tial for the attainment of Health for all by the year
2000. The World Health Organization (WHO) has a
crucial role to play in promoting, fostering and
strengthening this partnership. These are the overrid
ing conclusions of the eminently successful Technical
Discussions held in connection with the 38th World
Health Assembly.
A
Nearly 600 people, including numerous representa
tives of national nongovernmental organizations, par
ticipated in these discussions on the theme of Colla
boration with Nongovernmental Organizations in Im
plementing the Global Strategy for Health for All.
Under the chairmanship of Dr Maureen Law (Canada),
these discussions consisted of two plenary meetings
and three sessions held by eight working groups.
Partcipants defined and debated in detail both the
scope for collaboration between NGOs and govern
ments, and the obstacles to be overcome in such colla
boration. The discussions underscored the fact that it
is often the unmet needs of a country or region which
stimulate nongovernmental organizations to creative
action.
Action; at community level
Many NGOs work primarily or entirely at the com
munity level. As a result, they are often particularly
sensitive to the needs of the community, especially
those whose health needs arc greatest. Relatively un
bound by the legislative framework of governments,
NGOs in general have the flexibility to experiment
with innovative approaches to solving health pro
blems. They often achieve cost-effective breakthroughs
which can provide new models for national planning.
It is vital that the momentum generated by the
Technical Discussions be neither lost nor allowed to
weaken. The final report devoted to these particularly
successful Technical Discussions underlines the im
portance of taking immediate follow-up measures to
AUGUST 1985
harness this enthusiasm, notably by encouraging Mem
ber States to lake stock of the existing NGO commu
nity, and to determine what must be done to reinforce
collaboration with them at all levels, WHO will under
take new steps to facilitate and support Member States
and the NGOs with which it works, so that the new
partnership sketched out during the World Health
Assembly in Geneva in May 1985 quickly becomes a
reality.
Dr Halfdan Mahler, Director-General of WHO, who
welcomed participants to the Technical Discussions,
said that this meeting was convened at a time when
millions of people had empty stomachs and were
living in despair. He had been impressed with the
build-up emotional energy which must now be harnes
sed in the direction of primary health care. In
the closing session of
the Technical Discus
sions, Dr Mahler expressed satisfaction that this
emotional energy was so clearly present in partici
pants' discussions, and that they were looking to
WHO to promote this new alliance between govern
ments and NGOs in a partnership which is the chief
recommendation of the report. The Director-General
wholeheartedly echoed the formulation which naturally
emerged from these discussions: “Health for all and
all for health”.
Earlier on 6 May, 1985, Dr Suwardjono Surjaningrat. Minister of Heath of the Republic of Indonesia
was elected by acclamation President of the 38th World
Health Assembly when it opened in Geneva.
Dr Surjaningrat, a specialist in obstetrics and gynae
cology, was chairman of the national family planning
coordinating body and later secretary general to the
Ministry of Health, before becoming Minister of Health.
Addressing the opening session of the Assembly,
Professor Guillermo Soberon Acevedo, President of
the 37th World Health Assembly, told delegates that
improving the health of the people and safeguarding
social rights was now part and parcel of many Nation
al Constitutions. Governments, he said, have a res
ponsibility to organize the resources of society to en
sure better health for all, including the true develop
ment of human potential.
IOC and WHO join hands
Strong support for the possibility of future colla
boration between the International Olympic Committee.
(IOC) and the World Health Organization (WHO)
was voiced by Mr Juan Antonio Samaranch, the IOC
President, in an address to the World Health Assem
bly on 10 May 1985.
205
“It is not surprising to see that the World Health
Organization and the International Olympic Commit
tee have adopted many similar ideas, including the
recognition of the importance of physical activity for
better health”, said Mr Samaranch. “You call it
‘Health for AH’, we call it ‘Sports for AH’ ”.
Mr Samaranch said that in addition to physical ex
ercise the IOC would like to stress the importance of
proper nutrition and diet as a means both of preventing
disease and improving health. His Organization was
fully in agreement with WHO in emphasizing the
importance of personal responsibility in health.
JACQUES PARISOT FOUNDATION
MEDAL
Dr Anant Menaruchi (Thailand) was presented
on 16 May 1985 with the Jacques Parisot Founda
tion Medal by Dr Suwardjono Surjaningrat, Presi
dent of the 38th World Health Assembly, for his
study of a methodology for community-based sanita
tion programmes.
INDIA AMONG THE RECIPIENTS
Dr Menaruchi was awarded the Jacques Parisot
Foundation fellowship in 1984, which enabled him
to carry out a project located in rural villages of the
Ban Phai district of the Khon Kacn province in the
northeast region of Thailand.
Dr Suwardjono Surjaningrat, President of the 38th
World Health Assembly, on 9 May, 1985, presented
the first Sasakawa Health Prize and Statuette to three
recipients: Dr Tesus Azurin (PhiliDDinesk Dr David
Bersh Escobar (Colombia), and the Rural Society for
Education, Welfare and Action (SEWA) of Gujarat
Province, India, in recognition for their innovative
work in health development. The prize was establish
ed and funded by Mr Ryoichi Sasakawa, Chairman
of the Japan Shipbuilding Industry Foundation and
President of the Sasakawa Memorial Health Foun
dation.
In the course of the past five years, Dr Menaruchi
has been deeply involved with
numerous primary
health care (PHC) activities in his country, including
the organisation of PHC field demonstration projects
leading to the creation of village drug cooperatives,
.sanitation cooperatives, and nutrition
cooperatives.
He set up PHC training programmes for religious
leaders, school teachers and primary school children,
emphasizing health promotion and health education.
He also paid particular attention to the role of com
munications for health through primary health care at
village level.
These contributions have been shared by a num
ber of WHO programmes including leprosy control,
the smallpox eradication campaign, the Special Pro
gramme for Research and Training in Tropical Di
seases (TDR), the Expanded Programme on Immuni
zation (EPI), the Programme for the Prevention of
Blindness (PBL), various activities in the Western
Pacific Region, and primary health care programmes
in a number of countries.
The IOC President said the two organizations should
set themselves a target—to make the year 2000 a year
of victory for health and well-being everywhere. “We
must win this race against time. It is the only race in
which everyone can win. Let us all be winners for
health”, he'concluded.
FIRST SASAKAWA HEALTH PRIZE
Dr Lata Desai, representing the Rural Society for
Education, Welfare and Action (SEWA) in the Gu
jarat Province of India, is Associate Director of
SEWA’s Rural Community Health Project. SEWA
is a recently created voluntary organisation working
with the Government to develop primary health care
for disadvantaged rural populations. SEWA’s dedicat
ed efforts have already led to the adoption of several
innovative yet simple approaches to strengthen com
munity-based health services.
Mr Samaranch said that a joint working group has
now been set up by the two organizations; its mem
bers include Prince Alexandre de Merode, Chairman
of the IOC Medical Commission, and Dr Jacques
Hamon, Assistant Director-General of WHO. This
group, which has begun a series of contacts, is study
ing various areas and possibilities of collaboration.
Mr Samaranch said the aim would be to develop
programmes designed to encourage sport and health
in a strongly positive sense, and to encourage per
sonal responsibility in maintaining health.
206
Maturity of debate
Closing the general debate at die 38th World Health
Assembly on 10 May, 1985 Dr Halfdan Mahler,
Director-General of the World Health Organization
(WHO) welcomed the frankness of delegates’ com
ments1 on their countries’ health problems.
“This frankness is a sure sign that we are becoming
more mature as an Organization”, commented Dr
Mahler.
The Director-General reiterated his plea for “faith
in human development”, noting that technical, mater
ial and financial resources are only well used if they
give rise to an improvement in the quality of life of
the people who inhabit this planet.
Dr Mahler expressed satisfaction with the import
ance given by delegates to the role of nongovernmental.
organizations in the Health for All movement. He
added that this recognition of people’s desire to
assume ever-increasing responsibility for the health
and welfare of all was an additional sign of maturity.
SWASTH HIND
Keep Political Matters Out.
Dr. Suwardjono Surjaningrat, President of the As
sembly, made an earnest plea to the Assembly in its
Plenary Session on the “imperative needs for all of us to
constantly remaind ourselves that wc must make sincere
efforts to keep extraneous political matters away from
our deliberations.”
New Members for Executive Board
The Assembly elected the following 12 States as
Members entitled to designate a person to serve on the
Executive Board of the World Health Organization
(WHO).,
They are:Lesotho, Canada, Cuba, Ecuador, Indo
nesia.. Germany. Federal Republic of. Malta, Poland.
Cyprus, Democratic Yemen, Australia, and Tonga.
Their term of office begins immediately after the
closure of the 38th World Health Assembly.
THE LEON BERNARD PRIZE
For outstanding services in the field of social medi
cine Professor Raoul Senault (France) was awarded
the Leon Bernard Foundation Prize and Medal, pre
sented to him by Dr Suwardjono Surjaningrat. Presi
dent of the Assembly on 14 May 1985.
Professor Senault, who heads the French delegation
to the Assembly, is Professor of Public Health at the
Faculty of Medicine of Nancy. During his 30-year ca
reer in social medicine and public health, he contri
buted to many aspects of public health, including edu
cation for health, the control of tuberculosis, cancer
and alcoholism, maternal and child health, studies in
atmospheric pollution, and regional epidemiological
and laboratory studies. He always managed to com
bine hospital work with social medicine activities.
Since 1961, he has been a member of France’s Higher
Council for Public Health, of which he was a Vice-Chair
man from 1975 to 1984.
RESOLUTIONS
The Assembly concluded its work on 20 May 1985
on a background of earnest pleas made by its Presi
dent, Dr Suwardjono Surjaningrat, and by the Director
General of the World Heath Organization (WHO), Dr
Halfdan Mahler, to concentrate efforts on the attain
ment of health for all by the year 2000 and keep extr
aneous political matters out of WHO.
The Assembly displayed renewed faith in the potenial for people’s development and the dynamic role
of strategies for health for all in ensuring it.
AUGUST 1985
A.T. SHOUSHA FOUNDATION MEDAL
AND PRIZE
Dr Mohamed Hamad Satti (Sudan) was awarded the
Dr Aly Tewfik Shousha Foundation Medal and Prize
by Dr Suwardjono Surjaningrat, President of the As
sembly, on 15 May 1985 for his most significant con
tribution to the solution of health problems in the
Eastern Mediterranean region in which Dr Shousha
served the World Health Organisation (WHO).
Dr Satti is at present Director of the Institute of
Tropical Medicine Research at the Medical Research
Council of Sudan. Since his early years, his interests
covered many different aspects of public health, in
cluding communicable diseases such as leishmaniasis,
malaria, smallpox, yellow fever, filariasis and oncho
cerciasis, to which he devoted vigorous and brilliant
attention.
The Assembly also decided to strengthen WHO
support to countries cooperating amoung themselves
for health development on their own initiative and
to involve nongovernmental organizations more than
ever before, to attain the goal of healh for all as a
social contract between governments, people and WHO.
Technical and economic cooperation
Action to build up a critical mass of health-for-all
leaders was supported by the Assembly as suggested
by the Director-General. A comperhensive strategy
for leadership development is required and all concern
ed, including Member States, international organiza
tions and bilateral, multilateral, nongovernmental and
voluntary agencies, were urged to concentrate on acti
vities strengthening technical and economic coopera
tion among developing countries (TCDC/ECDC).
Women, health and development
There was general concern about the slow progress
in realizing the objectives of the UN Decade for wo
men, particularly regarding high maternal mortality
rates, the frequency and severity of the repercussions
on women’s health of certain practices, inadequate
conditions of domestic work or paid employment, the
frequency of nutritional anaemia, and the prevalence
of adolescent marriages and pregnancies. The Assemb
ly felt there should be greater concern for the protec
tion of women’s health and suggested “inter alia” in
formation and education campaigns to intensify the
participation of women—who play a key role in health
and development—in the implementation of the global
strategy for health for all by the year 2000.
207
Prevention of disability and rehabilitation of the dis
abled
Emphasis was placed on the prevention of disability
paticularly through the Expanded Programme on Im
munization (EPl), and by strengthening environmental,
occupational and other health programmes. Member
States were also requested to increase opportunities
for the participation of disabled persons in community
life and in decision-making: to expand education,
training and job opportunities for disabled persons;
to facilitate their acceptance by the general population;
to increase public information and education so as to
prevent disabling accidents: and to remove all barriers
which prevent disabled persons from leading socially
and economically productive lives.
Prevention of deafness and hearing impairment
Deafness is estimated to afflict 70 million people in
the world, and bearin'! impairment effects at least eight
per cent of the population in every country. Most of
the hearing impairment results from causes that can be
prevented at the primary health level. Great advances
in technology in otolaryngology and audiology have
also been acheived. Aware of these facts, the Assembly
requested the Director-General of WHO to “assess the
extent, causes and consequences of hearing impairment
and deafness in all countries”. Proposals for streng
thening measures of prevention and treatment of hear
ing impairment and deafness are to be made to the
39th World Health Assembly.
Childbearing and maturity
Premature pregnancies in immature adolescent wo
men, have disastrous world-wide consequences especi
ally when they occur in a context of poverty, illiteracy,
undemutrition, and an unhealthy environment. WHO
is requested to increase its collaboration with Member
States in providing programmes for adolescents based
on primary health care, with an emphasis on informa
tion, education and guidance. The same resolution
urges all Member States to advocate the delay of
childbearing until both parents, but especially the
mother, have reached maturity.
Malaria control
The spread of malaria jeopardizes health and de
velopment in many developing countries. To prevent
a further deterioration of this situation, the control
of malaria is essential, with full and active commu
nity participation. It should be integrated into na
tional primary health care programmes. The Assemb
ly therefore urged Member States concerned; (1) to
208
CHILD HEALTH FOUNDATION
MEDAL AND PRIZE
Professor Perla Santos Ocampo (Philippines) was
presented with the Child Health Foundation Medal and
Prize by Dr Suwardjono Surjaningrat, on 17 May 1985
for her outstanding service in the field of child health.
Professor Santos Ocampo received many awards and
scholarships in her career. She is the author of some
100 publications in the field of child health. Since 1981,
she has held the position of Chairperson of the De
partment of Paediatrics at the University of the Phi
lippines. The quality of life of children in the
Philippines and elsewhere
has been immensely
improved following her community involvement
in numerous innovative
projects. In 1962, she
organised a medical centre for indigents. As Secretary
of the Manila Medical Society, she persuaded the Mi
nistry for Education and Culture to establish the fit st
school for chronically-ill children in the Phillippines
General Hospital.
As President of the Philippines Paediatric Associa
tion, she inaugurated child advocacy centres in Manila
and mobilized paediatricians to facilitate access to
health care for children at all school levels. With
UNICEF’s support, she organized courses for medi
cal and auxiliary personnel in deprived and disadvan
taged areas.
A
undertake an immediate appraisal of the malaria situ
ation and of existing control strategies, (2) to plan anti
malaria activities, utilizing appropriate technologies,
to be integrated into PHC programmes. WHO conti
nues- to support research for malaria vaccines.
Chronic noncommunicable diseases
Member States are called upon to promote studies
on. population behaviour with the aim of preventing
and controlling cardiovascular diseases, lung cancer,
diabetes mellitus and chronic respiratory and other
noncom municable diseases. The Assembly also re
quested the Director-General to foster and support com
munity studies aimed at the joint control of a num
ber of risk-related noncommunicable diseases, rela
ted to styles of life.
. This resolution was passed bearing in mind that
information is accumulating which points to a num
ber of features common to several noncommunicable
diseases, such as their origins in, and aggravation by,
tobacco smoking and other lifestyle factors. The ad
verse effect of smoking on health was stressed on a
number of occasions.
A
SWASTH TEND
BOOKS
ALCOHOL RELATED PROBLEMS
Public health implications of Alcohol production
and trade, by B. Walsh & M. Grant. Geneva, 1985,
55 and pages (WHO Offset Publication No. 88).
ISBN 92 4 170088 2 Price: Sw. fr. 8.—.
Concern has now been expressed by many Member
States about the seriousness of the growth in alcoholrelated problems that they are currently experiencing,
and much of this concern relates specifically to the
situation in developing countries.
The Technical Discussions at the Thirty-fifth World
Health Assembly provided an opportunity for iden
tifying areas for priority action.
One pressing de
mand was for more reliable information about trends
in global production and trade in alcoholic beverages.
A new WHO publication analyses these trends and
relates them to public health issues.
The publication is based on data from a wide range
of international statistical reports and trade publica
tions. It reveals that world commercial beer produc
tion more than doubled between 1960 and 1980. The
long established beer producing countries in Europe
and North America still have the highest rates of
consumption per person. A number of developing
countries have, however, experienced sharp increases
in recent years, as shown in the graph, which com
pares beer production per person in the United King
dom and Cameroon over the period 1960-81.
By contrast, the production of wine has kept appro
ximate pace with world population growth. Production
‘remains concentrated in the traditional wine growing
hreas of Europe and European settlement, al
though there has been a sharp fall in consumption per
person in France, Italy, and Portugal.
Commercial production of spirits rose by two-thirds
between 1965 and 1980, while consumption per capita
rose by about one-third. Non-commercial production
is, however, likely to be particularly important and the
recording of commercial production is far from satis
factory, so that these increases may be underestimates.
Very rapid increases took place in several countries,
such as the Republic of Korea, Mexico, and the Philip
pines, where production was initially very modest.
The publication also looks at total production of
alcohol and finds that it rose by almost 50% between
1965 and 1980, while production per capita rose by
about 15%. Although most alcoholic beverages are still
consumed in their country of origin, it is not only those
with the highest levels that are of concern from a
public health perspective. In some other countries,
although consumption per person is comparatively
low, the rate of increase is very steep. If sustained, it
will result in high consumption levels by the end of
this century.
The fact that the production of beer, wine, and
spirits has been increasing more rapidly than popu
lation in most parts of the world suggests that the
available public health resources will be increasingly
burdened with additional alcohol-related problems in
tjhe future. This prospect is of particular concern in
those developing regions of the world where very
steep rates of increase in drinking are being record
ed. In view of this, the WHO publication suggests
ways in which countries can use data on production
and consumption to help in the process of developing
alcohol policies and programmes, within the context
of national health planning.
RABIES
WHO Expert Committee on Rabies. Seventh re
port. Geneva, 1984, 104 pages (WHO Technical
Report Series, No. 709). ISBN 92 4 120709 4
Price: Sw. fr. 9.—.
In spite of recent advances in research and field
control methods, rabies continues to exact a heavy toll
in many countries and is even spreading. The WHO
Expert Committee notes in its seventh report that over
i98% of all human cases of rabies of the world are due
to rabies reservoirs in dog populations, and that such
reservoirs are almost exclusively in the developing
countries. A full chapter is devoted to national pro
grammes for the control of rabies in dogs and other
domestic animals.
New approaches to the control of rabies presented
in the report are based upon: (a) a managerial guide
for the initiation and step-by-step development of na
tional programmes of rabies control, taking into con
sideration the needs for intersectoral cooperation and
community participation; (b) the endorsement of a
WHO Programme for the Control of Human and Ca
nine Rabies; (c) schedules for the use of (and potency
requirements for) new rabies vaccines used in human
pre- and post-exposure treatment; (d) potency require
ments for animal rabies vaccines,
which should
confer immunity for at least two years after a single
inoculation and would thus be particularly suitable for
use in mass campaigns of dog immunization; (e) a pro
posal to simplify the multiplicity of national require
ments for the international transfer of animals depen
ding on the epidemiology of rabies in the countries of
origin and destination; (f) an evaluation of research on
the ecology and natural barriers of wildlife rabies and
on the use of attenuated oral rabies vaccine to stop the
spread of the disease or to eliminate the infection in
its national reservoirs; and (g) consideration of a great
number of other new laboratory, management, and
field techniques as well as advances in basic virology
and epidemiology with a view to improving diagnosis,
vaccines, dog population management, and disease con
trol in domestic animals and wildlife.
As in previous reports, the Expert Committee in
cludes in its report a brief guide to the local treat
ment of wounds and to specific systemic treatment after
human exposure to rabies.
The main recommendations formulated by the Ex
pert Committee concern the
above-mentioned ap
proaches to programme development and improve
ment of regulations and methods, especially the stepby-step development of national programmes and the
WHO Programme for the Control of Human and Ca
nine Rabies. Emphasis is also placed on the improve
ment of rabies surveillance techniques in countries and
the use of new diagnostic methods to classify rabies
field isolates, the replacement of present human rabies
vaccines by safe and highly potent tissue culture vac
cines of low cost, the development of virus strains and
application procedures for oral vaccines for wildlife and
stray dogs, ecological studies of host species including
vampire bats, and research on dog population control.
—WHO Chronicle
ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU, KOTLA MARG, NEW DELHI-110 002 (DIRECTORATE GENERAL OF
HEALTH SERVICES) AND PRINTED
BY
THE MANAGER, GOVERNMENT OF INDIA PRESS, COIMBATORE-641 019.
Regd. No. D—(C) 359
Regd. No. R.N. 4504/57
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The articles should be written in simple and non-technical language so as to
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Articles should not exceed 1,500 words in length.
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