EMPHASIS ON IMPROVING PRIMARY HEALTH CARE SERVICES
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- EMPHASIS ON IMPROVING PRIMARY HEALTH CARE SERVICES
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swasth
hind
NEW NATIONAL
FAMILY WELFARE STRATEGY
In this Issue
swasth hind
Page No.
12th Joint Conf, of C. C. H. & F. W.
Emphasis on improving primary health
care services
289
New National family welfare strategy
291
Secrets of spacing
Dr. (Kum.) Sneshlata Misra
298
Media and health—partners to progress
301
December 1986
Agrahayana-Pausa
Vol. XXX No. 12
Saka 1908
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Twelfth Joint Conference of Central Councils of Health and Family Welfare
EMPHASIS ON IMPROVING
PRIMARY HEALTH CARE SERVICES
f I *HE Union Health Minister, Shri P. V. Narasimha
-*• Rao, called for a revamping of the medical educa
tion system to meet rural health needs. While inaugu
rating the 12th Joint Conference of the Central Councils
of Health and Family Welfare in New Delhi on 22
September, 1986, he said that the doctors must be moti
vated through knowledge and right training. “A doctor
spends five years in the MBBS course learning curative
medicine. How can he then provide preventive health
care services in the village?”, he asked.
The Minister expressed his resentment on the negli
gent approach to the blindings in the eye camps. He
urged that a Committee be set up to go into the eye
camp disaster and those responsible be held liable.
Decrying the bickerings between the various Indian
systems of medicine, he asked them to work in coordi
nation with one another.
He also called for roundthfe-year meetings to constantly monitor the health and
family welfare programmes.
The Annual meeting
should be a wrap up, he said.
The revised family Welfare strategy was approved
by the 12th Joint Conference of Central Councils of
Health and Family Welfare, which was held in New
Delhi from 22-24 September, 1986. The Council also
approved of the Honoured Citizen Card Scheme, re
commended restructuring of medical education and
iproposed setting up of a Standing Committee chaired
Uby Union Health Minister to ensure speedy follow-up
on recommendations.
IWTedical Colleges
No new medical colleges can be established without
ajpproval of State Governments, the Medical Council of
Imdia and the Centre. The Council urged the Centre
amd States to ban capitation fees, and to establish Health
Sesrvices Universities to ensure coordination
between
colleges of modern and alternative medicine systems.
Thue M.B.B.S. course will now lay emphasis on preven
tive and promotive health care and include a family wel
fare component.
December 1986
Primary Health Care
The Council emphasised the need to improve the qua
lity of primary health care services and urged for in
creased outlays for PHCs. The Council expressed the
view that reservation in MD courses should be given to
candidates who have put in stipulated rural service and
recommended that the legal and other aspects of this
matter be gone into in detail.
It called for incentives
like rural and house rent allowance, etc. to doctors to
work in villages.
It also urged that technical and
management skills at PHC levels be upgraded and modi
fied to suit rural needs.
Noting the urgent need to
improve school health services, the Council called
for coordination between Health, Education and I.C.D.S.
programmes in the States.
Malaria Eradication
In the health field, the Council called for revamping
of the Malaria Eradication Programme.
The Centre
may take responsibility for procurement and supply of
insecticide drugs, spraying equipment. It recommended
State Governments to fund operation and surveillance
of the NMEP. Vector control measures like sanitation,
social forestry, biological and environmental control must
be integrated with the NMEP.
It recommended that
State Health Secretaries be authorised to sanction funds
to avoid delays.
AIDS Control
The Council called for a fresh look at the AIDS con
trol strategy to see if the course, content and profile of
the programme need to be modified. The Council
called for health education packages to prevent and
detect cancer at early stage. Media campaigns against
tobacco use including smoking and chewing and involve
ment of voluntary agencies in demystifying the disease
were called for.
289
Goitre Control
The Council recommended that time bound actions to
control and eradicate goitre be taken. Immediate action
to increase production of iodised salt and its supply to
goitre-endemic areas must be taken.
The Council
also called for an appropriate health strategy based on
health education for prevention and cure of oral diseases,
especially in children.
The Council strongly called
for linkages between the dental health programme and
ICDS. Use of indigenous products like Jamun, neem,
coconut must be incorporated in the overall health stra
tegy.
This means linkages with socio-economic factors
having a bearing on fertility.
Women’s literacy,
raising women’s status and mean age of marriage, old
age security, links with poverty alleviation programme,
maternal and child health care, will for the first time
be brought under the gamut of family welfare.
The Department has been holding talks with lead
ers of trade unions, cooperatives, ISM doctors, social
scientists and voluntary agencies to involve them in
this effort.
The Council also recommended the set
ting up of a Family Welfare cell in all Ministries to
ensure intersectoral coordination.
Rehabilitation of Leprosy Patients
High priority is to be given to rehabilitation of cured
leprosy patients in MDT districts.
Facilities for re
constructive surgery should be made more easily avail
able. The Council also called for specific reservation
in jobs for leprosy cured physically handicapped per
sons. The general medical practitioners in urban areas
be involved in the detection and treatment of leprosy
cases, the Council recommended. It asked all States
to repeal the Lepers Act 1898. Monitoring and evalua
tion at district level must be improved by creating
sample survey-cum-assessment units at the rate of one
for every three districts.
The strategy also seeks to launch a mass contact
programme. A women’s volunteer corps will be set
up in villages to meet eligible couples and inform them
of the need for planning a family.
Differential area
approach was emphasised and the need for proper
maintenance of the Eligible Couple Register noted.
The Honoured Citizen Card Scheme is part and
parcel of the incentives which will be rationalised and
revamped.
Couples with two children may get a
package of benefits under Central and State schemes,
including a preference in selection of beneficiaries.
[Also see page 291].
T.B. Control
The TB Control Programme must get priority on par
with other programmes.
The Council recommended
that a multipurpose lab technician be posted in all
PHCs.
Blindness Control
The conference emphasised that the monitoring of
the National Blindness Control Programme must be
strengthened.
Voluntary efforts must be encouraged
and agencies in this field must register themselves with
the States.
A high level Central Standing Com
mittee to review eye relief camp activities may be
set up.
It also recommended posts of ophthalmic
assistants at PHCs.
Family Welfare Programme
The conference praised the record achievement of
19 million fresh acceptors in the family welfare pro
gramme.
The main planks of the new strategy are
a multidisciplinary approach and people’s involvement.
The strategy adopts a beyond family planning approach.
290
The Council took note of the growing realization of
the .role played by practitioners of Indian Systems of
Medicine and Homoeopathy (ISM&H). The Council
called for monitoring of the time-bound action plan
formulated by the ISM&H Division.
It said funds
should be placed at the disposal of State Governments
for training and for compensation for retaining the
interest of private practitioners in the family welfare
programme.
The conference called for increasing
undergraduate and postgraduate facilities in ISM&H
colleges.
The conference also lauded the attempts
to increase awareness of medicinal plants.
It called
for setting up of a Medicinal Plants Development Cor
poration, with 49 per cent Central aid. The Council
said at least 50 per cent of the new PHCs and sub-cen
tres under the Minimum Needs Programme should be
of ISM&H.
The three-day conference was attended by State
Health Ministers and Secretaries and other health and
family planning experts.
q
Swasth Hind
NEW NATIONAL FAMILY WELFARE
STRATEGY
The Ministry of Health and Family Welfare had commissioned three mar
keting research organisations in the private sector to carry out independent
evaluation of the family welfare programme and make diagnostic studies about
contraceptive attitudes and practices of the people. In addition, more than 120
studies and research papers on various aspects of the family welfare programme
have been analyzed. The findings of these studies have formed a substantial
basis for the new strategy.
The revised strategy gives family planning the broadest possible dimen
sions of social engineering including not only Health and Family Welfare but
also child survival, women's status and employment, literacy and education and
socio-economic development including anti-poverty programmes. It seeks to stream
line the entire spectrum of programme management, formulate for family welfare
a multi-disciplinary and integrated effort of all relevant developmental agencies
and elevate the programme into a genuine voluntary people's movement. This
will be the realisation of the call given by the late Prime Minister, Shrimati
Indira Gandhi, who said “Family Planning must become a movement of the
people, by the people, for the people”.
December 1986
291
rj^HE National Family Planning Programme started
1 in 1951 with a clinical approach. Extension edu
cation approach was adopted in mid-sixties and since
late seventies Family Planning service delivery system
has gradually expanded into a community oriented ser
vice network in which family planning services arc
offered as part and parcel of the overall health package
of services particularly the maternal and child health
and nutrition activities.
Although, reduction in birth
rates over the years has fallen short of the Plan targets,
the Programme has made a significant impact on ferti
lity.
During 1970s, the birth rate declined from 40
to 34, but during 1979-84, it has been stagnating
around 33.
The programme is estimated to have averted about
70 million births in the country so far at a total invest
ment of Rs. 2400 crores upto the end of 1984-85. Thus,
only about Rs. 340 have been spent per birth averted
and this includes the cost of a substantive infrastruc
ture which has been set up. The average annual popu
lation growth rate which rose from 1.25% in ’40s to
1.96% in the ’50s and 2.20% in the ’60s reached a
plateau during ’70s when the growth rate was 2.25%.
Since the inception of the programme, in every Plan
period, there have been varying levels of shortfalls in
the Family Planning performance. In particular, the
programme suffered a serious setback during 1977-82
and picked up during the later period of the VI Plan.
During the VI Plan period, achievements in sterilisation,
IUD, CC and OP users have been 79%, 82%, 85%
and 129% respectively.
Nearly full target realisa
tion of all family planning methods, an all-time annual
record of over 19 million acceptors and an overall
couple protection rate of over 35% has been achieved
in 1985-86, the first year of the VII Plan.
easy access is lacking and so is the utilisation of
the institutions.
— Apathy and concern regarding the effects on
health, religious beliefs and illiteracy are some
of the major inhibitors to adoption of various
methods of contraception.
Future Goals and New Approaches
The long-term goal is to reach zero population
growth rate by 2050 A.D. with an estimated population
of around 1300 million.
The medium-term goal is
to reach Net Reproduction Rate of Unity (NRR : 1)
by 2000 A.D. with a birth rate of 21, death rate of
9 and infant mortality rate below 60. According to
the 7th Five Year Plan, the goals to be reached by
1990 are. birth rate of 29.1,. death rate of 10.4 and
Infant Mortality Rate of 87.
The specific objectives sought to be achieved during
1986-90 are to:
—
Raise mean age at marriage for women over 20
years.
—
Promote ‘two-child family
family size.
— Substantially increase demand for contraception to
achieve a couple protection rate of over 42%.
Improve and strengthen the infrastructure and the
quality of services.
—
A recent study (covering over 32,000 respondents)
conducted through private marketing research compa
nies has provided valuable information in addition to
confirming and re-inforcing several findings of studies
conducted earlier.
The findings of the Study have
highlighted the areas and issues that need to be focuss
ed upon and have provided valuable clues to framing
communication approaches and messages. The salient
research findings are:
— Awareness of Family Planning is very widespread
and over 60% people have attitudes favourable to
restricting/spacing births.
— A majority of couples want 3‘or more children
with a preferable composition of 2 sons and
one daughter.
— Customs and traditions play a major role in deter
mining the age at marriage and there are favour
able trends towards increase in age at marriage.
— Literacy increases the acceptance of one son as
ideal and is positively correlated with the increase
in marriage age.
—
292
Medical institutions in urban areas are accessible
and are being increasingly utilised; in rural areas
limit’ as preferred
— Enhance child survival through universal immuni
zation and promotion of Oral Rehydration Therapy
(ORT).
Broad-base programme outreach
by maximum
involvement of non-governmental structures.
—
— Secure more effective Intra-sectoral and Inter-sec
toral coordination.
— Streamline and improve programme management
at all levels.
—
Generate environment for fertility decline through
relevant socio-economic interventions.
Major tasks to be achieved during the 7th Plan are:
—
31 million sterilisations, 21.2 million IUD inser
tions to be achieved and 14.5 million CC and OP
users to be enrolled by 1989-90.
— Attempt to reach higher targets by converting
awareness and knowledge into acceptance through
mass media and inter-personal communication and
motivation.
Swasth Hind
Child survival through universal immunization and promotion of oral rehydration
therapy—that is one of the aims of the revised National Family Welfare Strategy.
— Immunize 82 million infants and 90 million mothers.
Universalize (150 million
Oral Rehydration Therapy.
households) the use of
— Population Education to all children in the agegroup of 11-15 years (estimated 109 million).
— Family life lessons for youths (15-19 years).
■ — Population Education to those out of schools and
colleges as a part of Adult Education and NonFormal Education System.
— One round of training for all personnel (about
eight lakhs) to improve professional and other
relevant skills.
— Success of the Population Control Programme
depends upon effective linkages of Family Welfare
Programme with other socio-economic develop
ment programmes of poverty alleviation, literacy,
child survival, women’s status and employment,
December 1986
MCH, Family Planning, nutrition, etc. Intra- and
Inter-sectoral coordination amongst various deve
lopmental departments will be strengthened and
enhanced. The present health and family planning
infrastructure will be properly consolidated, suit
ably augmented and optimally utilised through
organisational and management improvement.
— Various apprehensions about the existing methods
of family planning will be removed through effec
tive communication programmes and improved
quality of services.
— Research focus will be on developing more accept
able techniques and improving the acceptability of
the existing methods.
— The two-child family norm will be promoted
through a structured system of material and non
material incentives.
— Female literacy and employment programmes will
be substantially stepped up.
293
—
The Programme will be progressively debureau
cratised and non-governmental structures promoted
on a much wider scale to effectively involve the
community at large in the programme.
Approaches and Strategies Beyond
Family Planning
Certain socio-economic correlates greatly influence
fertility behaviour. These factors would require to be
effectively tackled for creating an atmosphere to pro
mote a more rapid fertility decline. Special focus will
be given on the following:
Increasing Mean Age at Marriage
In India, every year about 4| million marriages take
place of which in about 3 million
the brides
are
in 15-19 age-group.
The salient reasons for early
marriage are:
pressure from elders, customs and
anxiety of parents about the grown up unmarried
girls.
There are indications that slightly higher age
at marriage is now being favourably perceived. This
encouraging trend will be re-inforced to raise the mean
age at marriage for women beyond 20 years through
specific interventions indicated below:
—
Intensified publicity campagin highlighting the
specific
benefits of delayed marriage for the
health of the mother and the children.
—
Appropriate amendments in the law relating to
the minimum age at marriage and its better en
forcement.
— Generating a social reform movement through
voluntary action to combat the forces of custom
and tradition.
— Intensive motivation through grass-root level wor
kers.
—
Preferential treatment to those beneficiaries under
the development programmes who conform to the
minimum legal age at marriage.
mosphere enabling them to act as equal partners
with men.
— A massive I EC campaign through multi-media
channels and grass-root level workers and volun
teers for creating awareness and generating activi
ties to raise women’s status in society.
—
Particular focus on schemes of educational and
vocational training to help young girls to build
up skills for their gainful employment.
Vocatio
nal and nutritional elements of the ‘Gopalan Plan’
for young village women should be considered by
the Ministry of Human Resource Development.
— Comprehensive district-wise surveys about employ
ment opportunities for women to explore 'larger
avenues and linking of supportive services such as
child care, community cooking, etc. with these
schemes.
Nationalised banks will be encouraged to provide
loans through mahila mandals on coilective security
basis for income generating schemes to improve the
economic status of women.
— Introduction of appropriate technologies like im
proved Chullah, bio-gas, inexpensive pressure
cookers in rural areas, to reduce burden of house
hold work on women to enable them to participate
in income generating activities.
Female Literacy
It is well established that increase in female literacy
leads to increase in marriage age, decline in birth rate
and infant mortality rate.
Female literacy in India
is only 25% compared to male literacy of 47%. A
massive push to the programme of female literacy is
necessary.
The health workers and women volun
teers will also be utilised for propagating the message
of female literacy.
Special focus will need to be
given to resistant pockets.
Proper linkages will be
forged between female literacy programmes and. the
family planning programmes.
Raising Status of Women
Significant impact on fertility can be brought about
when the status of women is raised and they become
equal partners in decision making.
The perception
of women about themselves and the way society per
ceives them will have to be changed by a mass move
ment.
A programme for women’s mobilisation and
upliftment will constitute a major thrust of the pro
gramme to bring to surface the latent demand for
family planning services.
This, will essentially have
to be the nodal responsibility of the Ministry of Human
Resource Development which will coordinate various
schemes and activities in this regard.
The major in
terventions would be:
—
294
A mass movement through voluntary organisations
engaged in women’s welfare for creating aware
ness about the equal constitutional rights and
opportunities for women thereby promoting an at
Enhancing Child Survival and Development
A correlation between child/infant mortality and
the desire to have large number of children is well
accepted.
A massive effort will be made in the 7th
Plan to enhance infant and child survival and improve
their physical and mental development.
Programmes
aimed at steep reduction in child and infant mortality
will be given the highest priority.
Special focus will
be on the following activities:
—
Programme of immunisation of expectant mothers
and infants will be scaled up to reach the level
of universal coverage by the year 1990.
A Pro
gramme of this magnitude will be carried out with
effective planning and managemen * and will take
care of production of adequate quantity of vac
cines and streamlining of the service delivery sys-
Swasth Hind
The new National Family Welfare Strategy seeks to promote “two-child family
limit” through a structural system of material and non-matcrial incentives.
tem. Effective coordination with the Department
of Education and Women’s Welfare and Child
Development and voluntary organisations will be
secured for the successful implementation of this
mission.
— Nutrition intervention programme will include dis
tribution of iron and folic acid tablets, adminis
tration of Vit. A to children, popularisation of
iodised salt as prophylaxis against anaemia, blind
ness and goitre respectively.
—
Promotion of Oral Rehydration Therapy and
appropriate feeding practices tQ prevent a large
number of infant and child deaths and growth
interruptions resulting from childhood diarrhoea.
A massive educational programme will be under
taken in this regard along with production and
easy provisioning of Oral Rehydration Salt (ORS)
packets.
— The Integrated Child Development Scheme has
helped in improving MCH Services and reduction
December 1986
of birth rates in ICDS blocks. Accelerated expan
sion of the Scheme will greatly help in reducing
birth rate.
Linkage with Poverty Alleviation Programmes
There is a two-way
relationship between fertility
and poverty. During the 7th Plan anti-poverty efforts
have been intensified. The major programmes in this
regard are:
— The minimum needs programme which widens
the access of the poor to the basic social ser
vices.
— Targeted assistance for social groups or areas
like IRDP, NREP, RLEGP, TRYSEM.
It is proposed that while selecting beneficiaries
under any of the poverty alleviation schemes, prefer
ence may be given to those who accept the small
family norm. Couples with a two-child certificate and
295
youths who voluntarily give a pledge to limit their
family may be selected on preferential basis for grant
of loan under various schemes. On the other hand,
family welfare has to be promoted on a massive scale
among the below poverty line segment of population
so as to break the vicious circle of high fertility and
poverty.
Old Age Security
There is universal feeling that children especially
sons are a security for old age. Old age security
schemes are being run by States and few voluntary
organisations, but these serve a very small fraction of
the old age population. A tangible improvement in
the social security coverage of old age people will
have a definite impact on the desired small family
norm. States will be persuaded to accord preference
to parents of ‘Small Family’ in providing old age
pensions. Similarly, old age couples with small family
and with no male child may be given overriding prio
rity in admission to ‘old peoples’ homes.
INFRASTRUCTURE
Various studies conducted through piivate and
other organisations have highlighted that the existing
infrastructure is not being optimally utilised mainly
because of its inadequacies to provide proper services
and relatively unfavourable attitudes of the people
towards it. The major inadequacies relate to poor
quality of services, non-availability of staff, lack of
empathy of the staff and poor management. Energi
sing existing infrastructure with a view to optimising
its output is an area requiring priority attention. To
wards this end, some major steps are being taken
.
which include clear delineation of job responsibilities,
filling up of vacant posts, improving employees’
motivation and service conditions, improving skills
and capabilities of the staff, improving PHC manage
ment system by devising appropriate monitoring and
supervision systems. In addition, Block and Village
level Committees would be set up to involve people
in exercising vigilance over the work of various func
tionaries. These measures will lead to a favourable
perception of the health facilities by the target groups
and optimal utilisation of the existing infrastructure.
Augmentation of Infrastructure
In the rural areas services are provided through a
network of integrated Health and Family Welfare
delivery system. There are 83,000 Sub-Centres, 11,000
Primary Health Centres and Subsidiary Health Cen
tres and 650 Community Health Centres in the
country. This infrastructure will be expanded as en
visaged in the strategy approved at the time of for
mulation of Sixth Plan : One Sub-Centre for 5,000
population (3,000 population for hilly-tribal areas);
a Primary Health Centre for 30,000 population
(20,000 for HTA’s) and one Community Health Cen
tre for four PHCs.
In addition there are Community Workers which
include about 5 lakh trained Dais, 3.8 lakh Village
Health Guides. Village Health Guides Scheme will
be overhauled and Dais Training will be intensified.
Rural infrastructure would need to be augmented to
bring services within easy reach of the beneficiaries.
Following table provides an idea of the
situation and the future needs:
■ required
In posit ioji
as oil 1-4-85
All practising Dias in rural areas.
5.80
lakhs
(approx.)
5.14
lakhs
(approx.)
1 lakh
2. Health
Guides
One for every
pulation.
village/1000 po
4.50
lakhs
3.83
lakhs
1 lakh
3. Sub
Centres
One for 5000 population in
general and one for 3000 popu
lation in tribal, hilly and difficult
areas.
1.30
lakhs
82,946
50,000
(54,883)
4. PHCs/
Subsidairy
Health
Centres.
One for 30,000 population i.e.
one for every six sub-centres.
21,666
11,029 (7,284
PHCs & 3,745
Subsidiary
Health Centres)
12,390
5. Upgraded
PHCs/
CHCs.
One for every 4 PHCs and for about
1 lakh population.
5,417
655
1,553
Category
Institution
Norm/ Unit
1. Dias
296
Total No.
present
Target for 7th
Plan (1985-90)
Swasth Hind
In the urban areas, there are 554 Post-Partum Cen
tres at District level. 700 Post-Partum Centres have
been sanctioned at the Sub-district level. During the
Seventh Plan. 500 more Sub-district level Post-Partum
Centres will be sanctioned. Studies have shown that
the Post-Partum Programme has been providing
Family Planning and M.C.H. services in a cost-effec
tive manner.
There are 2583 Urban Family Welfare Centres and
2592 beds have been approved under the scheme of
Reservation of Sterilisation Beds. During the Seventh
Plan, 2000 more sterilisation, beds will be reserved in
Non-Government sector. Even with this expansion,
the urban infrastructure would not be adequate to
cope with the work. The urban infrastructure will be
revamped and reorganised to. include extension ser
vices, particularly in the slum areas. In addition,
voluntary organisations will be encouraged to set up
and operate facilities in the urban areas and tax re
bates will be proposed for the corporate sector com
ing forward to establish such facilities in Urban and
Rural areas.
Upgrading Technical Services
Poor quality of services has resulted in relative
under-utilisation of facilities and lowering of the
image and credibility of the health infrastructure. The
apprehensions about) possible adverse effects on
health associated with sterilisation, IUDs and Pills
are the major inhibitors to acceptance of those me
thods. Improving facilities and upgrading the tech
nical quality of services will, therefore, be a major
thrust for widening acceptance of Family Planning.
• All PHCs at Block level will be equipped to render
the services like vasectomy, minilap, MTP and IUD
insertions (Special emphasis will be given to improv
ing the general environment in the PHCs).
•Medical Officers will be trained in a two-year time
frame so that these basic family planning services are
available on a continuing basis at Block Level
PHC’s. Various initiatives will be introduced to en
sure enhanced services of doctors in rural areas.
• The medical curriculum will be amended to en
sure that medical graduates undergo a minimum
prescribed training in Family Planning Methods be
fore they are awarded MBBS Degree—Post-Graduate
courses will be established in Human Reproduction
and Population Management in selected Institutes.
With a view to ensure observance of the existing
guidelines, various types of FP services will be re
viewed and updated to make them comprehensive
and a strict system of providing appropriate follow
up services will be devised and enforced. One Centre
of Excellence will be established in each major State
for planning and coordinating training programmes
of medical personnel. These Centres will also be
equipped to provide recanalisation facilities. Opera
tion research projects will be commissioned through
December 1986
Improving and strengthening Maternal and Child Health and ’Family
Welfare infrastructure and the quality of life—that is yet another
aim of the new National Family Welfare Strategy.
autonomous/private agencies to assess and evaluate
quality of services and to suggest measures for further
improvement.
Satisfied acceptor is the best ally of the programme.
Only quality services can provide such satisfaction.
Therefore, Monitoring and Evaluation of quality of
services will be organised on systematic lines. High
level technical committees at the Centre and State
levels will be constituted to oversee and guide in all
(Continued on page No. 308)
297
About 25 lakh people are added each year to the 121.4 million eligible couples as of 1982-83 in
India. Women over 30 account for no more than 30 per cent of all births in the country. There
fore, young women who produce 70 per cent of children in India need to be urgently covered by
spacing methods. Of the 402.2 lakh couples in the reproductive age-group, 15-44 years,
effectively protected (March 1985), 25 per cent are protected by sterilization.
SECRETS OF SPACING
Dr (Kum) Snehlata Misra
children and women is an important
part of national health. For children to grow
into healthy adults they need first of all a good start
in life. It is possible only if the mother herself is
healthy. Statistics show that women in child-bearing
years and children under 15 make up about 70 per
cent of the third world people. An estimated 150
lakh children below five years die each year in deve
loping countries including India. Another five lakh
women there die during pregnancy and child-birth
every year. Of these, about 80,000 are in India alone.
The Infant Mortality Rate (I.M.R.) in India is still
very high, f.e., 110 per 1000 live births (1981). The
Government of India envisages to bring it down to
below 60 by 2000 A.D. The maternal mortality
which at present is 300 to 500 per 100,000 live births
also must be brought down to less than 200.
ealth of
H
How could all this be achieved? The answer is
family welfare through spacing of children. The
WHO Expert Committee on maternal and child health
found that it could “favourably influence health,
development and wellbeing of family and has a strik
ing impact on health of mothers and children”. It
improves children’s health by helping women to
space child-births, have smaller families and avoid
pregnancies at unfavourable ages. Best age for re
production is 20 to 34.
It can also prevent highrisk, teenage pregnancies. By providing women with
safe contraceptives, unwanted pregnancies and illegal
abortions are reduced. A study in Hyderabad show
ed that by increasing birth interval to three years the
incidence of malnutrition could be reduced by 60
per cent effortlessly.
Spacing methods
Spacing of children can be achieved by various
methods. Natural methods include coitus interruptus
298
and rhythm methods. But since these methods re
quire lot of self-control, they are not practical for
the majority. Also rhythm method requires an ade
quate knowledge of menstrual periods and is prac
tical only when the woman has regular periods.
Failure rates of these methods are variable and high.
Abstinence would be 100 per cent effective but it is
not viable for the majority.
Artificial aids include conventional contraceptives
such as condoms, diaphragms and spermicidal jelly
creams, and Intra-Uterine Contraceptive Device
(lUCDs) and oral contraceptives (OCs).
Condoms, lUCDs and OCs are very effective and
convenient. Average failure rates of different artifi
cial methods are—-OCs 1-2 per 100 women per year,
lUCDs 2-3 per 100 women per year, condoms 10
per 100 women per year, diaphragm 12 per 100
women per year and natural methods 20 per 100
women per year.
Average number of children, a woman has when
she receives an IUCD is 2.6. It is 3.5 to 3.9 when
she requests sterilization. So, spacing methods need
to be promoted actively both for achieving demo
graphic goal of achieving a net reproduction rate—
one—and also because of their health promoting
benefits both for the mother and children. Once the
optimum family size, the usual being two children,
is reached, sterilization should be advised. At pre
sent, by the time a woman opts for sterilization, the
damage is already done as she is a mother of three
or four children. Most Indian women at the peak of
their fertility already have three to four children.
Thus spacing methods are all the more important,
both for delaying the first birth and for proper spac
ing of the next child. Three-to-four-year interval
is best
Swasth Hind
India's first
Advantages of 'O.Cs
India is the first country to launch a National Fa
mily Welfare Programme (1952). At present, there
is an extensive infrastructure both in the urban and
rural areas. Family welfare services in urban areas
are given by medical college hospitals, clinics, district
hospitals and clinics and urban family welfare centres.
In rural areas, these services are offered through pri
mary health centres (PHCs) and sub-centres. There
are 7284 PHCs and 82,946 sub-centres (1985). One
PHC caters to 100,000 population and a sub-centre
to 10,000—5,000 people.
The beneficial effects of O.Cs. are many. O.Cs are
100 per cent effective in contraception, if used pro
perly. Real failure rate is 1-2 per 100 women in a
year;
Various spacing methods offered include lUCDs,
OCs and nirodh. Acceptance of various spacing me
thods has varied from time to time. In early 1960s
the focus was on lUCDs. In 1974, OCs were intro
duced and in 1975, Cu-T 200 was introduced. Use
of Cu-T 200 has steadily increased and Lippes Loop
is being phased out. Cu-T 200 use has increased
from 45.5 per cent in 1980 to 85.7 in 1984-85. lUCDs
are more popular among rural people. In 1970-71,
it was 59 per cent and in 1982-83 it is 66 per cent.
Performance of spacing methods has shown an im
provement in 1984-85 as compared to 1983-84.
Smaller States like Punjab, Andhra Pradesh,
Haryana, Karnataka and Maharashtra achieved more
than 100 per cent of given targets. Big States like
U.P., Bihar and M.P. are much below their annual
goals.
About Pills
Oral contraceptive pill (the pill) consists of a com
bination of small doses of oestrogens and progestogens. It is the most effective of all reversible me
thods of fertility control available.
Technical
effectiveness of the pill is 100 per dealt. Real effec
tiveness varies depending on the regularity with which
it is used. The Pill prevents pregnancy by inhibiting
ovulation. When it was introduced in 1956, fairly
high doses of oestrogens and progestogens were used.
Pills were used extensively in developed countries.
Harmful effects of the pills on thromboembolic
phenomenon were publicised widely resulting in base
less fears, both in developed and in developing
countries. In developed countries because of the
prevalence of smoking and high cholesterol diets,
pills were not given to women over 35-40 years.
Controlled prospective and case controlled studies
from the U.K. and the U.S.A, now clearly show that
O.Cs. containing oestrogens less than 50 mcg are
safe.
Low dose combined pills which contain only
30-35 mcg of oestrogens are even safer, and being
used now. Government agencies are supplying two
types of pills both containing Ethinyl-oestradiol and
either Norethisterone acetite or D. Norgestrel (Pro
gestogen). O.Cs. require prescription to purchase.
December 1986
Menstrual disorders, e.g., dysmenorrhoea, pre
menstrual tension and menorrhagia are relieved as
ovulation is suppressed.
Protection against diseases like Pelvic Inflamma
tory Diseases (PID) by obstructing movement of
bacteria and prevention of illegal abortion are addi
tional advantages. Pills reduce iron deficiency anae
mia by 50 per cent because it reduces menstrual
flow. Benign breast diseases like fibrocystic disease
and fibroadenoma are reduced by 50-75 per cent.
Benign breast disease is a forerunner of breast cancer.
Cancer endometrium (uterus cancer) and ovarian
cancer are reduced by 75-90 per cent in pill users.
They do not prepone or postpone menstruation.
Benign hepatoma (liver tumor) may develop in
pill users in only 1 to 5 per 100,000 women per year.
It can be readily discounted because of its rarity.
Studies confirm that subsequent fertility is also not
affected; 25-30 per cent pill users become pregnant in
the first post-pill cycle and fertility returns in 90-100
per cent cases within two days of discontinuation of
pills.
O.Cs detrimental effects on cardiovascular system
are minimal.
The incidence is only one in 1000
women a year, much less in Indian women. In the
U.K. and the U.S.A, and in a group 21 European
countries there was no increase in death-rate of women
despite great increase in O.C. use.
Since O.Cs. lower glucose tolerance, actual or poten
tial diabetic women should not use the pill. Women
having gall bladder disease or impaired liver function
should not use pills.
Minor ailments like nausea, lack of appetite, head
ache, weight gain are
temporary and pass off in
couple of months. Breakthrough bleeding is easily
controlled by adding a small dose of
oestrogens
for 6-7 days. The Indian women because of their
genetic,
constitutional, nutritional and
environ
mental factors are less likely to develop C.V.S.
diseases. Benefits of O.Cs outweigh the risks. Mother
mortality from child-birth is 300-500 per 100,000 in
our country whereas pill risk is only half per 100,000
women.
Pills are ideal for avoiding pregnancy in the adole
scent and for delaying first pregnancy. For spacing
of births, continuous use for 3 to 5 years is good.
299
The WHO Expert Committee on maternal and child health found
that family welfare through spacing of children “favourably in
fluence health, development and well-being of family and has a
striking impact on health of mothers and children”.
helping women to space
It improves
child-birth,
have
smaller families and avoid pregnancies at unfavourable ages.
Best
children’s health by
age for reproduction is 20 to 34.
It can also prevent
high-risk,
teenage pregnancies.
Where it should! not bn*
There are certain conditions in which the pills
should not be used. e.g., heavy smokers, history of
theomboembolic disorders, liver disease, jaundice,
cancer (breast or genital tract), migraine, high blood
pressure, fibroid uterus and diabetes.
O.Cs. users must be seen and examined by a medical
officer within 3-6 months of starting O.Cs and later
once a year.
O.Cs must be stopped if any of the following sym
ptoms appear. Severe migraine, visual disturbance,
sudden chest pain, severe cramps and pain in legs,
excessive weight gain, severe depression and patient
wanting pregnancy.
IUCDs
At present, two types of IUCDs are available—
medicated and non-medicated. Cu-T 200 introduced
in 1975 is becoming popular. A modification known
as Multi load Cu-250 is also available. Non-medicated devices are generally for women who may not
return for check-up. Initial side-effects like bleeding,
pain and infection are minimal when insertion of
IUCD is done. Any time there is excessive bleeding,
pain or missed period, consultation with a doctor is
needed. IUCDs prevent pregnancies by preventing
implantation of fertilized
ovum. IUCDs do not
abort.
300
IUCDs should not be used for delaying first preg
nancy. Perhaps it may cause infertility in about one
per cent. These are not recommended for adolescents
or older married women who want children. IUCDs
also , do not adversely affect fertility when used for
spacing of children, 60 per cent conceived within
three months and 90 per cent within a year after re
moval of IUCD. These are contra-indicated for
women having irregular vaginal bleeding, tumors of
cancer of genital organs, pregnancy and pelvic infec
tion. IUCDs can be inserted any time, but post
men trual insertion is best. Woman wearing an IUCD
must have a check-up at least once after insertion.
Cu-T 200 needs to be changed every 2-3 years. Any
time when side-effects like excessive bleeding, pain or
missed periods occur, a visit to the doctor is impera
tive. In the event of pregnancy occurring when using
IUCDs, malformation of the foetus does not occur.
About 25 lakh people are added each year to the
121.4 million eligible couples as of 1982-83 in India.
Women over 30 account for no more than 30 per cent
of all births in India. Therefore, young women who
produce 70 per cent of children in India need to be
urgently covered by spacing methods. Of the 402.2
lakh couples in the reproductive age group, 15-44
years, effectively protected (March 1985), 25 per cent
are protected by sterilization.
The usage of these methods needs to be promoted
further and an all-out effort has to be made in this
direction if we want to avert a population explosion.
Swasth Hind
MEDIA AND HEALTH
PARTNERS TO PROGRESS
Jack C. S. Ling
Communication channels, traditional and modern, have a vital role to play in
primary health care which is “essential health care, made universally accessible
to the people through their full participation in the spirit of self-reliance and
self-determination”. Inter-personal educational methods “can only reach but a
small percentage of the community. Media, when properly employed can reach
a large number of people”.
Jack Ling opines that media cooperation on a long-term basis was needed;
there should be a partnership between media and health sector and not com
petition. Also, “Fireworks syndrome”, as Jack Ling refers to the episodic
media support, should give place to permanent light. There is widespread
interest in information and education for health. As part of efforts to strengthen
education!communication of the health sector, two regional workshops in
SEA RO and AFRO have been held to develop training modules on community
education.
■HE health educators should be
congratulated for their foresight
in developing the “golden principle
of involvement” long before others
in the development field came to
the same truth. The health educa
tors championed this in the forties
and fifties, stressing that there could
be no learning and education with
out involvement and participation;
the community development move
ment did not again ground until
the fifties: the communications
scientists did not focus on the twoway dialogue until the sixties; and
social development specialists did
not begin stressing marketing me
thods that identify the needs of
people until the seventies and early
eighties.
Only recently the eco
logical view of health had made its
appearance calling for involvement
of all sectors in society for the
promotion of health.
So, congratulations are in order
for the pioneering work. Pioneers,
as expected, often struggle against
hostile
environment,
against
conventional wisdom, against many
odds. But no profession has been
more misunderstood, more underappreciated, more wrongly blamed
than health education. Most people
December 1986
equate health education with disse
mination of information and teach
ing. Indeed, dissemination of infor
mation is part of health education.
and a necessary starting point in
most instances.
Learning Process
Not enough people realize that
health education, above all, is a pro
cess, a learning process that should
lead to action. To the woman and
man in the street, education means
schools, classrooms, blackboards.
Since Ministries of Education which,
among other tasks, build schools
and train teachers, will continue to
have extensive outreach, this popu
lar definition of education will per
sist. Be that as it may, at least
among the development workers,
health educators have been vindi
cated, for there is now widespread
recognition that community parti
cipation is the missing link, and in
the development circle today the
watchword is “involvement”.
However, we should not rest on
our laurels. The task is gigantic,
the challenge is difficult and above
all, health educators are still
a
relatively small number and the
resources very limited. Time has
come for us to do some advocacy
for health education and to take
postive steps to encourage a con
vergence of approaches, to form an
alliance of all who share similar
views—overlooking
terminologies,
narrow definitions and professional
allegiances for the larger good
of development.
Also, it is felt that community
involvement alone is not enough—
unless the term
“community”
embraces the whole of society—
because community activities need
support at various levels of the so
ciety. Without such support, com
munity action will be frustrated from
the start. There must be a suppor
tive policy framework, which may
require decisions at the political
level: there must be legislative sup
port; there must be supportive
action by health-related sectors such
as agriculture,
education, public
works; there must also be support
from different professional societies,
civic organizations, women’s groups,
cultural and religious institutions,
and other bodies. Those, in health,
need to reach out to the decision
and policy makers, those in finance,
301
those in commerce, those in indus
try. etc. In short, there is need to
mobilize everyone for social action
for health, to promote health, to
embark on a comprehensive ap
proach in favour of physical and
mental well-being, against disease,
against abuse, against dependence.
Advocacy sans Betrayal of
Democracy
Now, following the golden prin
ciple of involvement does not mean
being passive. For it is well-known
that, in a competitive world, advo
cacy is an indispensable part of any
major effort. It is also known that
there is a price to pay for being
late when other interests fill the vaccum. We can be forceful advo
cates, without betraying the demo
cratic principle of “involvement”
of listening and of learning from
the people, of being empathetic.
The deliberations in different
groups in the last four days of the
conference have shown that there has
been some progress in health for all.
If, however, the term “health for all”
is to be taken in its totality, it must
be acknowledged that inter-personal
educational methods can reach but
a small percentage of the community.
While the qualitative advantage of
one-to-one dialogue is recognised, it
should be realised that these are
the very many who are beyond di
rect personal contact. At the very
least, there is a need to awaken
their interest, provide them with in
formation, help them realize they
can do much to improve their own
health.
This can and must be
done through the various channels
of communication—traditional as
well as modern. Only then will we
have paid heed to the “all” in Health
for All. Otherwise, our critics may
well criticize us for aiming at health
for “some”.
This means that all the means
available must be utilised to reach
people, to intensify our efforts—
through the growing network of
schools, through the existing social
and cultural institutions, through re
ligious organizations, through civic
groups and through compatible
special interest groups. Above all,
302
It is true that many unplanned
and poorly executed media efforts
have failed in the past. This, how-.
ever, should not deter us from work
Media cannot solve many prob ing with the media. We should in
lems but, when properly employed, volve the media in our joint endea
media do reach large numbers of vour to reach the people to improve
people. In fact, radio, when intro their health. This kind of involve
duced early this century, worked ment is just as valid* and important
like a blanket of democratization and as it is with the people at the com
was credited to have played a role munity level.
in breaking down the rigid class
barriers. When people had equal
The media sector is complex. Very
access to radio programmes, whe often, health workers think of the
ther they were plays hitherto avail media mainly in terms of news. Me
able only to the relatively wealthy dia professionals have a clear no
theatre-going crowds or broadcasts tion of what makes news; the item
of useful information about how has to be timely, significant to a
people could take actions to im large number of people, fairly close
prove their own lives, some move to home and related to the interests
ments towards equalization were of the audience or readers. If health
strengthened and others were laun workers want the support of news
ched.
editors, they must take these crite
It is well recognised that
any ria into account.
enlightened involvement of the
people requires an informed public.
Reinforcing Social Norms
The kind of decisions on the in
volvement of people rests on the
But media encompass more than
quality of information they receive, news. There are service columns
which in turn rests on how well and educational pages, departments,
those in the health sector can get for children and women, and of
the messages across. There is to course, items and programmes of en
day a clear, urgent need for better tertainment value.
For lifestylepresentation and greater communi related health issues, cultural and
cation skills for health education.
entertainment programmes are very
Traditional forms of communica important. Media can often confer
tion like puppet plays and popular status and certainly reinforce social
theatres can be very effective, but norms and can be very effective,
unfortunately, are little utilized on because health messages should be
a systematic basis. This is an area presented within real-life circum
in which we need to do more, much stances as entertainment programmes
often reflect life situations and can
more.
provoke emotive response which is
so necessary for behaviour modifi
‘Fireworks Syndrome’
cation.
we must not overlook the various
mediated forms of communication to
reach the total population.
Unfortunately, many attempts to
harness the modem media have been
done haphazardly, without thought
to other elements of the package
of activities that constitute a pro
gramme, without consideration of
the many determinants of health
behaviour.
The sporadic use of media is lite
rally like fire-works that fizzle out
in the dark night. We should turn
the
fireworks into a permanent
light. Media activity that is not
part of package of programmed acti
vities, including inter-personal fol
low-up, with clearly defined objec
tives and a comprehensive strategy,
would be wasteful.
Multi-sector Interest: When we
seek cross-sectoral involvement for
health, we tend to think of educa
tion, agriculture, community deve
lopment, youth or whatever, but
we often leave out media as a sector.
This is probably because it is a
sector that is cross-sectoral in itself.
It is not organized like the other
sectors and not confined to one
aspect of our life. It has interests
in all sectors and in fact can playa
useful role to stimulate other sectors
to support health. For example,
news stories on smoking can point
out contradicting policies of diffe
rent Ministries. Health wants to
curb smoking.
Agriculture may
encourage tobacco growing for
Swasth Hind
export;
Industry wants to create
jobs; and the Treasury cannot do
without tax revenues. Media can
help provide a forum for debate
which is often a good platform for
public education.
— help deliver technical health May, some 50 countries—an un
messages for the public; and precedented number—spoke about
and
education for
— foster community involvement information
by reflecting public opinion, health.
encouraging dialogue,
and
Regional Programmes
facilitating feedback from the
community.
Social Responsibility: Going to
We are beginning to tackle the
Soon after the Hobart Conference need to strengthen education/
the media for “help” in connection
with a project might get us episodic (iuhe Conference in 1983) we had communication of the health sec
support. What is needed is, rather an extremely successful Expert Com tor—first with an international con
their cooperation on a long-term mittee on ‘New Approaches to sultation on criteria and guidelines
basis. Media personnel today do Health Education in Primary Health and now with two regional work
recognize their social responsibility Care’. The Committee’s report is shops in searo and afro to deve
in the development process, and being distributed widely and has lop training modules on community
realize the power of mass media to received very positive response. The education. And we hope to work
help create a political will in favour Technical discussions on New Poli with the Asia
Pacific Academic
cies for Health Education in Primary Consortium of Schools of Public
of social issues including health.
Health Care during the World Health Health on testing and using the
Note Competitors: Sometimes the Assembly in 1983 was very success modules.
We are increasing our
health sector appears to avoid the ful and some 300 participants took cooperation with Member States on
media, perhaps because some health part in these discussions.
training of health education per
professionals have viewed media as
The Seventh General Programme sonnel, ranging from postgraduate
competitors, or critics, rather than of work of WHO (covering the pe level to community worker. We
partners. Perhaps we simply have riod 1984-89) has brought together have had quite a number of inter
not understood how to develop the public information and health edu regional, regional
and country
partnership. In fact, of course, the cation. so that information and round-tables or workshops, involv
two sectors have much to gain from education for health now constitutes ing health and media sectors at
effective collaboration. I would go a continuum of activities ranging both the policy and professional
further: I believe the media sector from advocacy at the policy level levels.
We are also involving
cannot fulfill its responsibility to to mobilizing resources and various unesco and unicef in our forth
society without the health sector, health-related professional support; coming Consultation on Health Edu
because
the interest and concern from launching information
pro cation for School-age Children, a
of the public, the raison d’etre jects to developing community edu very important area of work. The
of public media certainly includes cation activities. We have a clear European Regional Office has laun
health. This means that media objective to foster activities which ched a health promotion programme
and health have to forge a part will encourage people to want to which is gaining momentum. We
nership on the basis of mutual de to be healthy, to know how to stay are also trying to develop some indi
pendence, if each is to fulfill its healthy, to do what they can cators for health educators.
purpose.
individually
and collectively to
Work at Policy Level:
Though
maintain health and to seek help the overall pictures is somewhat
as needed. And we are recognized encouraging, there lies also a dan
as a major programme within the ger. With the increase of attention
WHO Programmes
health infrastructure thrust, which and enthusiasm, we must move
the Director-General, Dr. H. Mahler, steadily to fulfill this rising expec
The latest WHO Expert Com has singled out as the main empha tation. We must strive to bring in
formation and education for health
mittee on Health Education con sis of WHO, work.
cluded that the role of the mass Strengthening Communication to the policy level and include it
in the managerial process for nati
media in the field of health was to:
onal health development. We must
There
has
been
an
upsurge
of
in
— help strengthen political will
claim a larger share of staff and
terest
in
information
and
educa
by appealing to policy makers;
resources; we must
tion for health. The next biennial budgetary
budget of who, for instance, reflects improve our professional qualities,
— raise general health conscious a substantial increase of informa particularly in
presentation and
ness and clarify options con tion/jejducation expenses—both at communication skills; we must do
cerning action that have a country and regional levels. In fact, more to support the community
strong bearing on health even with a real no-growth budget health workers in reaching out to
levels;
for 1986-87, information and educa the people; and we must make a
tion for health enjoys a substantial conceited effort in stimulating in
Otherwise,
— inform decision-makers and ■increase at the field level—for ex ter-sectoral support.
education
for
health
will
suffer a
the public about the latest ample, in thfe Africa Region the in
developments and limitations crease is 36% and for the Eastern loss of credibility and there will be
in health sciences and publi Mediterranean it is 60%. During the retrogression.
—Courtesy : SEARB Bulletin
cize relevant experiences for discussion of this budget at the
Jan. 1986 O
replication;
1985 World Health Assembly last
December 1986
303
WHO Regional Director’s Annual Report for 1985-86
STEADY PROGRESS IN HEALTH
DEVELOPMENT IN SOUTH-EAST ASIA
Thirty-ninth session of the
WHO Regional Committee for
South-East was held in Chiang Mai
(Thailand) from 9 to 15 September,
1986.
increase in health care for the popu logue between the users and pro
lation in all countries of the Region. ducers of health manpower.
Greater attention was being paid to
support primary health care and to
Steps were also being taken to
improve
the quality of services.
Involving the community, encourag streamline the utilization of availa
The seven-day
session of the ing intersectoral action for primary ble manpower to optimize their
Regional Committee was attended health care support, development of contribution to health development.
by senior health administrators and middle-level health managers and Sharpening the job description for
officials from Member Countries of primary health care for the urban each category of health worker,
the Region—Bangladesh,
Bhutan, poor were some of the steps taken introduction of sound supervisory
organisation of taskInnovations in practices,
Burma, Democratic People’s Repub in this direction.
lic of Korea, India, Indonesia, Maldi community involvement in planning oriented training were some of the
ves, Mongolia, Nepal, Sri Lanka and and implementation had been tried activities supported by the Organi
Continuing education had
The experiment zation.
Thailand.
Representatives from in some countries.
other United Nations agencies and to train villagers to acquire manage been identified as a priority to
several non-governmental and inter ment skills and ultimately take the maintain the knowledge and skill
running health of health workers of all categories
governmental organizations in offi responsibility for
cial relations with WHO also attend programmes as a self-managed vil and to help them, to meet the chang
lage activity proved successful in ing needs of the health system.
ed the meeting.
Thailand.
Similarly, the People’s
The Regional Committee, which Health Programme was being ex Public Information and Education for
is the highest-level
constitutional tended in Burma, with the training Health
governing body of
WHO at the of community health workers being
With the emphasis increasing to
regional level, meets
annually to focussed on quality and competence.
wards
ensuring community involve
review the health situation in the As a mark
of achievement, the
in health
Region, examines the programme Ayadaw Township’s Primary Health ment and participation
and budget estimates and sets policy Care Programme was awarded the development activities, several initia
guidelines.
It also provides neces Sasakawa
Health Prize at the tives had been taken by Member
sary direction to further strengthen Thirty-ninth World Health Assem Countries to enlarge the degree of in
volvement of the media in health
health development efforts in the bly in May 1986.
development.
At the same time,
Member Countries of the Region.
steps were being taken to enhance
The Regional Director’s Annual Health Manpower Development
the communication skills of both
Report for the year 1985-86 high
professional and
non-professional
lighting health developments in the
The problem of shortage of ap health workers. The emphasis had
Region was presented to the Com propriate and adequate manpower been on bringing the health infor
mittee.
We publish here the high to support the national health sys mation and health education sectors
lights of the Report.
tems persists.
To bridge the gap, closer in a mutually-supportive man
the Organization was
collborat ner to develop a well-informed com
Organization of Health Systems
ing with the Member Countries to munity that could take the right deci
* 'he health infrastructure contin establish health services manpower sions towards maintaining positive
development mechanisms for fos health at both personal and com
ued to expand leading to further tering an information-based dia munity levels.
T
304
he
Swasth Hind
and Develop* development in all countries of the community-oriented mental health
Region. Not only does this group care and to provide appropriate
constitute more than fifty percent of health education using the existing
The Regional Research Promo* the total population, it is also the
primary health care infrastructure.
tion
Programme continued to most vulnerable
to malnutrition,
strengthen national research capabi infection and disease.
Hence, Environmental Health
lities, coordinate research activities maternal and child
health and
to solve priority health problems family planning activities as an in
A review in terms of the targets
and to promote research to facilitate tegral part of health and socio-eco set under the International Drink
the use of existing and emerging nomic development efforts continu ing Water Supply and Sanitation
scientific knowledge.
The South- ed to be accorded high priority in Decade (1980-1990) revealed that
East Asia Advisory Committee on all Member
Countries of
the water supply enjoys wide popular
Medical Research had not only pro Region.
support, while sanitation continued
vided a sound framework for deve
to receive low priority.
What was
loping research in support of HFA/
required was hard look at the
The Organization’s activities were procedures traditionally
2000 but also emphasized the need
follow
for stimulating health services and concentrated on training manpower, ed in planning and implement
health behavioural research.
A evaluating ongoing programmes, ing rural water supply
and
conceptual base had been develop strengthening and further expand sanitation
projects.
The
gap
ed in this regard and was being ela ing the programmes, instituting between the planners and the peo
research on priority areas, and im ple needed to be bridged by the
borated into a plan of action.
proving the relevant information adoption of the primary
health
base and
information dissemina care approach with greater commu
The Organization had established tion.
nity involvement, including the in
a research management system in
■support of and in coordination with
A number of research projects volvement of women and disadvan
Primary health
the national health research manage had been undertaken which covered, taged groups.
ment institutions and a network of among other aspects, indicators for care workers and others at the com
collaborating centres in the Region. physical and psychosocial develop munity level must be harnessed for
A proper mix
Under the
research programme, ment in children, epidemiological bridging this gap.
and software
around 120 projects had so far been studies on the growth of infants and between hardware
has to be found, so that
completed successfully.
children, assessment of the relative components
can operate and main
importance of factors leading to a communities
Nutrition)
high infant mortality rate and feed tain their own facilities, protect
their water sources and adopt hygi
enic practices.
The problem of malnutrition con ing patterns in infants.
Research
ment
Promotion
tinued in most
countries of the
Diagnostic, Therapeutic and Rehabili
Region with a wide range of nutri Mental Health
tative Technology
tional deficiency diseases. A multi
The promotive and preventive as
sectoral thrust including the health,
The major thrust of WHO colla
education, agriculture and rural pects of mental health are being
boration
in this area continued to
by Member
development sectors had been laun given due priority
be in the fields of development of
Countries.
Efforts
have
also
been
ched to tackle the problem. Steps
technical
and
managerial man
had also been taken to promote the made to draw attention to the in
power,
introduction
of appropriate
fluence
of
psychosocial
factors
in
establishment of a mechanism for the
technology
in
the
diagnosis
of prio
coordination of nutritional activities the promotion of health and human rity diseases, and improvement in
development
and
have
resulted
in
at the national level.
Most coun
quality of the laboratory work
tries in the Region now have nutri defining the indicators of mental the
to provide effective support to pri
health
in
its
various
facets.
tion units or analogous bodies in
mary health care programmes.
their Ministries of Health for multi
sectoral nutritional activities.
Alcohol and
drug abuse are
In the field of therapeutic techno
threatening to become
not only logy, the Organization actively pro
Several
encouraging develop health problems but also a difficult moted the concept
of essential
ments had taken place
at the socio-economic problem in several drugs.
Almost all countries in the
Regional level, including thb formu countries.
This situation had led Region have prepared lists of essen
lation of the Regional lodine-Defici- to increasing
interest in India, tial drugs and established mecha
ency Disorders Control Programme, Nepal and Sri Lanka in developing nisms for their updating.
Steps
streamlining of the, regional xerop- control programmes in this area were also being taken to streamline
thalmia/vitamin A deficiency blind similar to the ones in Burma and storage and distribution systems so
ness control activities and thb initia Thailand.
as to ensure timely supply of re
tion of a regional network for train
quired quantities of essential drugs
ing in nutrition.
The prevention and early detec for the primary health care pro
tion of mental and
neurological grammes.
Maternal and Child1 Health
disorders was also receiving increas
Mothers and children constitute ing attention. Steps were being
Member Countries
were being
a major target group for health taken to train
health workers in assisted in attaining self-reliance in
December, 1986
305
the production of vaccines.
At
Because of the changing nature of
least three countries in the Region the problem and the emphasis on
had developed the
technological control rather than eradication, the
competence and capability to pro process of integration
of malaria
duce vcccines required for the Ex control programme with the general
panded Programme on Immuniza health services was being actively
tion (EPI).
The Organization had pursued and control strategies adap
collaborated with India in the trans ted to local epidmiological situation
fer of technology for oral polio vac and the availability of resources.
cine production. Burma, Indonesia
and Thailand had plans for introduc Diarrhoeal Diseases
ing appropriate technology for the
production of viral vaccines against
Diarrhoeal diseases have been
rabies, measles, polio and hepatitis B. recognized as one of the major teasons for high infant mortality in
several countries of the Region, lead
Expanded Programme on Immuni ing to the
development of contol
zation!
programmes with the immediate ob
jective of reducing mortality due to
Available data on the incidence these diseases and the long-term ob
of some of the target diseases showed jective of morbidity reduction.
a downward trend in some countries,
•indicating the impact of the pro
The major strategy to achieve
gramme. The Programme continued
to follow the five-point strategy of objectives has been prompt treatment
integrated development* with PHC, by oral rehydration therapy (ORT).
training of adequate and appropriate The countries had developed the
manpower, mobilization of adequate capacity, to a great exlent, to pro
resources, continuous evaluation and duce the appropriate packages of oral
use of feedback information to achi rehydration salts, either through
eve the target of coverage and dis large-scale manufacture or through
ease reduction, and, finally, health small-scale cottage industry type of
services research to solve problems production, or a combination of
both. These efforts needed further
related to the programme.
stimulation to enable the countries
to become self-reliant. To achieve
the proper and timely ORT and en
Malaria
sure appropriate nutrition of the pati
Malaria continued to be a major ents, it was necessary to train the
communicable diseases in at least mothers and other members of the
eight countries of the Region. While family and the community. In this
t*he malaria situation showed some regard, health education activities
improvement in terms of reduction had been developed and relevant
of incidence in only two countries, health workers trained in the epide
namely, India and Thailand, it re miological and therapeutic aspects
mained the same in the remaining of diarrhoeal diseases.
six countries. The technical problems
of vector resistance to insecticides
and parasite resistance to drugs per Tuberculosis
sisted. The menace of P. falciparum
continued.
Tuberculosis continued to be a
major public health problem. With
introduction of the multidrug
To deal with the situation the the
regiment to treat infectious cases
countries were developing realistic promptly with the aim of reducing
policies and programmes to ration transmission, the chances of control
alize the use of new anrimalarial
drugs like mefloquine, and to adopt ling the disease have increased.
an integrated vector control metho
The strategies of national pro
dology including bioenvironmental
methods. Steps were also being taken grammes in the Member Countries
to stimulate community participation are mainly based on immunization
and intersectoral cooperation and to with BCG, case-finding and treat
mobilize internal and external re ment. The problems of identifying
sources to maintain
the smooth infectious cases as early as possible,
providing adequate supplies of drugs
supply of appropriate insecticides.
306
and ensuring proper multidrug the
rapy required not only physical faci
lities, trained manpower and resour
ces but also an effective organization
al infrastructure and managerial
skills, WHO support had been provi
ded to meet some of these needs
through technical advice, training of
personnel and mobilization of re
sources. In addition, research related
to therapy, immunology and prophy
laxis had been stimulated in some
countries.
Leprosy
Based on the success of the multi
drug regimen for leprosy in cutting
down the period of treatment and
diminishing the possibility of resis
tance, most countries of the Region
facing this problem had introduced
this treatment regimen. The social
stigma associated with leprosy, how-'
ever, contributed to low rates of case
detection, irregular treatment and
inadequate case-holding which im
peded the progress of the control pro
grammes.
Mhasuers were being
taken to strengthen the infrastruc
ture of the programme, training man
power, procuring drugs, organizing
research and evaluating programme
activities.
Research on the development of
an immunizing agent against leprosy
was continuing
under the joint
UNDP/World Bank/WHO Special
Programme on
Tropical Diseases
Research, and a number of candi
date vaccines were now ready for
field trial.
Sexually Transmitted Diseases
The problem of sexually transmit
ted diseases was creating concern in
some Member countries of the
Region because of their increasing
incidence and their human, econo
mic and social implications. Control
programmes were being implemented
in several countries through streng
thening of diagnostic facilities, orga
nizing treatment centres, training
health staff and promoting health
education.
A new dimension had recently
been added to the situation by the
Swasth Hind
“The health infrastructure continued to expand leading to further increase in
health care for the population in all countries of the Region.
Greater attention
was being paid to support primary health care and to improve the quality of
services.
Involving the community, encouraging inter sectoral action for primary
health care support, development of middle level health managers and primary
health care for the urban poor were some of the steps taken in this direction.
The emphasis had been on bringing the health information and health education
sectors closer in a mutually—supportive manner to develop a well-informed com
munity that could take the right decisions towards maintaining positive heath at
both personal and community levels.”
impending risk of Acquired Immuno-deficiency Syndrome (AIDS). Al
though no indigenous case of AIDS
had been reported in the South-East
Asia Region, the high fatality rate
due to AIDS and the possibility of
its introduction in the Region had
become matters of concern. Nine
countries had established task forces,
reviewed the situation and develop
ed guidelines to prevent introduction
of the disease. The countries had
been kept informed about the re
cent developments on the scientific
and public health aspects of the dis
ease and appropriate measures were
being taken according to the needs
of the situation in the Region.
Other Communicable Diseases
Dengue haemorrhagic fever was
limited to Burma. Indonesia and
Thailand as a public health pro
blem. The WHO Collaborating Cen
tre for DHF in Thailand had been
engaged in developing a vaccine
against DHF.
Regarding viral hepatitis, it had
been established that non-A and
non-B types of viruses were the
major causes of viral hepatitis in the
region. A number of studies on
December 1986
viral B hepatitis had been under
taken and had revealed that hepati
tis B vaccine can successfully pre
vent placental
transmission of
HBsAg to infants bom to HBsAgcarrying mothers.
Blindness
Although cataract, vitamin A
deficiency, trachoma, glaucoma and
trauma were the known common
causes of blindness in this region,
a recent assessment of the etiologi
cal factors of blindness in several
countries of the Region had confirm
med that cataract remained the lead
ing cause of avoidable blindness.
The' lack of access to surgical
treatment had, in large sections of
the population, led to an immense
backlog of unoperated, yet curably
blind persons. Efforts in most coun
tries for the control of blindness have
included the development of strate
gies for the restoration of vision in
these persons through an outreach
approach whereby facilities and
opportunities for surgical treatment
are provided closer to their homes.
Cancer Control
The thrust of control activities has
been on preventive measures supple
mented by early diagnosis and treat
ment. The most common cancers
prevailing in the Region are oral and
lung cancers in males and cervical
and breast cancer in females.
So far as oral and lung cancers
are concerned, if had been establi
shed that consumption to tobacco
was the most important contributing
factor. In view of this, WHO had
mounted a programme on “Tobacco
or Health”. Eight’ countries in the
Region had formulated plans of
action to control tobacco-rclated dis
eases and more specifically to con
trol tobacco consumption. Intensive
health education, particularly among
children of school-going age, had
b,een emphasized.
Cardiovascular Diseases
Community approach in the pre
vention and control of cardiovascu
lar diseases was continued to be
pursued in the countries of the region.
Health education played an impor
tant role to promote health
life
styles, physical exeicise and proper
diet' among the target population.
The Organization extended support
in training manpower and provided
research grants to the countries of
the region. O
307
NEW NATIONAL FAMILY WELFARE STRATEGY—Contf. from Page 297
technical aspects of the programme. These Commit
tees would give appropriate feedback to subordinate
formations on a continuous basis. 1CMR and the
Centres of Excellence will be involved in concurrent
evaluation of the technical aspects of the programme.
Special teams will be deputed from the Central Gov
ernment to review and enforce the quality of services.
Integration of Family Planning with other
Economic Development Programmes
Socio-
The ‘clinical’ approach of the ‘50s developed into
‘extension’ approach during ‘60s and during ‘70s, was
further consolidated when Family Planning services
were integrated with the Mother and Child Health
services. This integration has been perceived to be
beneficial both by workers and beneficiaries and has
resulted in increasing FP acceptance. The new stra
tegy will further deepen the integration of the Health
and Family Planning systems at the primary health
care level through
reorientation
programmes for
health workers, strengthening of existing facilities and
increasing delivery outreach by using special mobile
teams. In this new integrated system non-govern
mental structures will be involved. Recognising the
interplay of social factors like family structure, pro
perty rights, inheritance, old age security etc., the
approach of integrated action would be extended to
link Family Planning with other programmes of so
cio-economic development, e.g., Poverty Alleviation,
Social Welfare, Agricultural & Cooperative Develop
ment, Women’s Welfare, Education,
Employment
Generation and Urban Development.
Information Education Communication —De
mand Generation
the reach of TV transmission or have no electricity,
it' is proposed to undertake a programme for provid
ing Video Cassette players and generators with TV
sets. Appropriate software will be developed with
the help of professional experts which will provide
a package of messages relating to Health, Family
Welfare, Agriculture, Women’s status and welfare
and other key areas of socio-economic development.
Cinema, which is watched by a large number of
people both in urban and rural areas and is a
powerful communication medium, will be fully ex
ploited through more systematic distribution of films
and persuading the State Governments to grant en
tertainment tax exemption liberally to films with
family planning as the dominant theme. Emphasis
will be given on films aimed at dispelling doubts and
fears about methods of contraception and such films
will be shown to rural masses in an interesting pac
kage organised with suitable entertainment.
News
papers, magazines and other print media will be uti
lised imaginatively. Journalists and Editors will be
encouraged to write on population themes.
Multi-media communication
mounted with primary focus on:
campaigns
will be
— Reinforcing the two-child family limit norm;
— Promotion of inter spouse communication:
— Child survival programme;
— Increasing the age of marriage;
— Neutralising male preference syndrome; and
— Improving the image
health workers.
of family planning and
The recent research study has shown that 60 per
cent eligible couples hold
favourable
attitude to
family planning. The percentage of those adopting
family planning methods, however, is much less. The
major communication task, therefore, is to convert
the favourable attitude to practice of family planning.
In working out the media campaign for the family
welfare programme, professional talents available in
Government and private sectors will be harnessed. A
high level inter-media committee comprising com
munication professionals and eminent non-officials
will be set up in t'he Ministry to advise on the use of
appropriate media channels depending upon their
capabilities for promoting specific messages and
effectiveness of their reach.
Communication messages will be targeted not only
at eligible couples but also other important influencers.
The communication strategy will aim at maximising
the total impact through judicious mix of mass media
and inter-personal channels. It will not only promote
contraception, but also address the different variables
that influence decision making regarding family size.
The strategy will also aim at stimulating discussion
within the community on how rapidly increasing popu
lation is eroding the quality of life for each individual
family as also that of the community through the de
gradation of the physical and ecological environment.
Television is an effective medium but the availa
bility of television sets in rural areas is limited. It is
proposed to promote community TV viewing by pro
viding sets with the co-operation of TV manufacturers
and other development departments of the Govern
ment like Agriculture, Rural Development, Educa
tion, Women’s Welfare, etc. Provisions of commu
nity TV sets could be linked to the interest shown
by the village community in promoting acceptance
of family planning. For villages which are outside
The preparation of software and messages will be
professionalised by involving the private advertising
agencies. The medical and para-medical workers will
also be given proper education particularly about the
safety and efficacy of spacing methods so that they
could communicate convincingly with the people. In
order to ensure that the messages put forth continue
to be effective and meaningful, regular system of evalu
ation will be set up. Eminent communication experts
from official and non-official areas will be associated
308
Swasth Hind
to assess the reach and effectiveness of the communi*
cation programme periodically in different areas. Cam
paign strategies will be revised in the light of this
feedback.
Preparation of software based on regional, folk and
traditional arts will be encouraged by setting up Re
gional Communication Resource Centres. These
Centres will promote local skills of departmental
workers and also take help from non-official bodies
for designing, producing and evaluating the software
including communication aids. They will also help
in designing and implementing the training modules
for basic health workers. The communication and
extension personnel will be selected with care and on
the basis of their professional capabilities for com
munication work. Wherever the reach of mass media
like radio and television is insufficient, the interper
sonal communication will be specially strengthened
and made more efficient.
Besides improving the
knowledge and communication skills of the basic
health workers, attention will be given to improving
their image and credibility in the community.
Population Education
Population Education—Internalised to the whole
spectrum of education system can greatly help in in
fluencing the fertility behaviour of the coming genera
tions in the desired direction. In 1981, out of 685
million population, there were 181 million children in
the school age group of 6-17. Out of these, there were
106 millions in the schools. There are about 3.14
million students going to colleges and universities. The
potential of population education in the formal and
non-formal system will be fully harnessed. Training
of nesource/key persons, instructional material for
different target groups and preparation of population
education lessons will be the crucial activities for the
success of population education programme. A high
level committee will be set up to oversee and co-ordi
nate the programme.
Assistance from the United Nations Fund for popu
lation m Activities (UNFPA) was made available to
enable the Ministry of Education to initiate projects
for imparting population education during the Seventh
Plan with specific quantitative targets:
Target Group
No. to be covered
Students in the age group 6 to
56.44 million
16 or classes I - X
Students in the age group 16-18
(ii)
2.75 million
or classes XI - XII
(iii)
Out of school children in the
45.06 million
age group of 9-14
(iv) Teachers in Primary, Middle
2.49 million
and Secondary Schools
(v) Teachers in Higher Secondary
0.26 million
Schools
(vi) plnstructions
in Non-formal
0.15 million
Education Centres
(i)
December 1986
Target Group
No. to be covered
(vii) University/Collcge students
3.14 million
(viii) University/Collcge Teachers
0.21 million
It is recommended that for the students at 10 + 2
stage and college-going students, Population Educa
tion should include compulsory lessons on family life
cycle to make them fully aware of the essentials of
reproductive physiology and contraception. Popula
tion education through the non-formal school educa
tion system will be strengthened to cover the 45 mil
lion children out of schools. A population project has
been developed for adults in the age-group of 15-35
under the Adult Education Programme. This project
will greatly help in motivating this highly fertile agegroup to limit their family size.
In the organised sector, there are 24 million workers
who are involved in group activities. Trade union
leadership and employers associations will be motivated
to arrange population education amongst the members/
employees. Population education will also be included
in all the curriculum of vocational schools. This scheme
will also be extended to unorganised sector on the
pattern of pilot project for Bidi Workers by identifying
suitable groups like handloom weavers and plantation
workers. Nehru Yuvak Kendras, Mahila Mandals and
Co-operatives will also be encouraged for imparting
population education. Messages and materials will be
developed by expert groups.
An integrated approach by the functionaries of
various developmental departments at grass-root levels
in promoting family planning will greatly enhance
programme acceptance. A mechanism will be estab
lished whereby all these functionaries will inter-act
with community not only in family planning, but in
the entire range of programme of social engineering.
The sub-centre can act as nucleus where liaison bet
ween the primary functionaries of different departments
could be operationalised and linkages established with.
the public representatives. Their inter-action will have
to be under the supervision of Panchayat Samities or
Village Panchayats. The Block Extension Educators
would be assigned the task of bringing into inter-play
communication between the functionaries of different
departments.
Incentives
Incentives which seek to dinectly influence fertility
behaviour can play a crucial role in population control
strategy. At present, some incentives are available to
the employees of Central Government, Public Sector
Undertakings and State Governments. Central Gov
ernment does not give any incentives to the members of
the general public except a small amount by way of
compensation for the loss of wages. Some States have
introduced incentives in the form of lottery tiefet
scheme and a scheme of issuing Green Cards which en
title the acceptors of sterilisation with two or less
children, preferential treatment in certain areas. It is
309
NATIONAL FAMILY WELFARE AWARDS 1984-85
Union Minister for Health
and Family Welfare and Human
Resource Development, Shri P. V.
Narasimha Rao, presented the An
nual National Family Welfare
Awards for the year 1984-85.
T
he
Punjab* Tamil Nadu and Assam
were awarded Rs, 2.5 crore each for
best family planning performance
during 1984-85.
In all, awards to the tune of Rs.
10.25 crore were presented by the
Minister. The other recipients were
Haryana and Karnataka who got
Rs. 1 crore each. Manipur was
given Rs. 50 lakh, and the Andaman
and Nicobar Islands got Rs. 25
lakh.
The awards scheme was started in
1983 to encourage the States and
Union Territories to do better on self the target of reaching 60 per
the family planning front. The cent couple protection level by the
States were classified into five diffe turn of the century.
rent categories on the basis of their
While Haryana and Karnataka
population.
bagged the second prize of Rs. 1
Punjab, which bagged the top crore each in Groups A and B, no
prize in Group A, had during 1984- State qualified for this prize in
85 achieved 106 per cent of its tar Group C.
gets. recording a 6.9 per cent rise
In Group D, which includes
in the State’s couple protection
States and Union Territories with
rate.
population ranging from 10 lakh to
Tamil Nadu in Group B, attain 1 crore, Manipur secured the top
ed 98 per cent of its targets, while award of Rs. 50 lakh. It achieved
Assam, in Group C, achieved 97 82 per cent of its target.
per cent of the targets.
In Group E, comprising States
and UTs with less than 10 lakh
The couple protection rate of the population, Andaman and Nicobar
three States had reached 49.8 per Islands bagged the top award of
cent, 36 per cent and 24.7 per cent Rs. 25 lakh. The Union Territory
respectively by the end of March, achieved 109 per cent of the
1985. The country has set for it
target.
QO
necessary to review the entire system of individual and
community incentives. It is felt that any scheme of in
centives should follow a differential approach .encou
raging limitation of family size within two children.
Following are some of the incentive schemes which
could be considered for introduction in the pro
gramme:
An economic incentive to the small family to be
built into all the Socio-economic Development pro
grammes of the Central and State Governments which
are beneficiary oriented. A preference is to be given
for the two or less 'child family norm in the selection
of the beneficiaries and also additional subsidy/grant
and an interest rebate is to be granted on loan/payment.
Schemes being considered for these economic link
ages are the IRDP, NREP, RLEGP and other rural
development programmes of assistance to individuals,
loans under agriculture training and employment sche
mes, loans under small scale and village industries, wel
fare schemes of all beneficiary-oriented development
corporations, insurance schemes, bank and co-opera
tive loans, allotment of land and housing and such
other activities are have a strong bearing on the citi
zens’ life.
Acceptors of sterilisation with two or less children
may be given ‘Honoured Citizen Cards’ which will
entitle them to preferential treatment in all possible
areas where facilities are available to the public..
Acceptors of sterilisation after two or less children
will be entitled to an Insurance Policy of high value
but low premium to serve them in old age.
A National Lottery Scheme for acceptors of sterilisa
tion with two or less children offering attractive prizes.
Issuing of bonds of the face value of Rs. 25,00.0 ma
turing after 15 years to acceptors of sterilisation having
two female children. Such a scheme will help in rais
ing the age of marriage of women, their status and neu
tralise the male offspring preference.
Community Awards for Pariwar Kalyan Villages
which exceed contraceptive prevalence of 70 per cent.
Stale and National merit system and awards/recognition to workers, programme managers at various
levels, individuals and corporate bodies in the private
sector and voluntary organisations.
Voluntary Action
Non-Governmental Structures
These benefits will be subject to a small family
acceptor being eligible otherwise under a particular
scheme. The non-governmental sector including cor
porate sector and voluntary sector is to be persuaded
to implement the same economic linkages under their
activities.
310
Family Planning has to be made a people’s move
ment. Non-Government structures will be promoted
to supplement and strengthen the Family Planning acti
vities. The following major initiatives will be taken in
this regard:
Swasth Hind
All voluntary organisations, irrespective of their pre
sent 'field of operation will be encouraged to work
in the sphere of family welfare and depending upon
their capabilities they can take up motivational and
educational work as also the task of providing services.
A Committee
for Supportive Voluntary Action
(SCOVA) will be established which will provide con
sultancy services, identify suitable voluntary organi
sations, sanction financial assistance
to them and
monitor their performance. Procedures for giving grants
will be simplified. An estimated number cf 70,009
voluntary organisations exist in the country with the
membership of nearly 1.75 million. The aim will be to
involve the maximum number in the programme at all
levels.
The organised sector has a total of over 25 million
employees. Organised sector units will be persuaded to
provide family welfare services to their employees and
make available to them a minimum prescribed package
of rewards and incentives. Larger units will also be
persuaded to adopt areas and townships for intensive
family planning motivation and service delivery. A
Tripartite National Committee of Government, Em
ployers Association and Trade Unions is being consti
tuted to exploit the potential of the organised sector.
There are nearly 35,000 Co-operatives in the country
covering 95% of villages and almost 50% of rural
population. These are well-knit units with functional
linkage systems that join the village to the district and
State to the National level agencies. This sector will
be used to act as a conduit for education, communica
tion and motivational activities. Specific projects will
be designed and entrusted to the Co-operative sector in
areas where they have institutional facilities and
capabilities.
The professional and financial capabilities of the
Corporate sector will be harnessed by offering suitable
tax incentives for setting up corporate structures for
providing integrated family welfare services.
Community Participation
Community participation is vital for programme
success.
Following approaches will be pursued to
secure full-scale community participation, particularly
at the grass-root levels so that the concept of family
planning is internalised in the social polity.
Popular Committees consisting of Government offi
cials and eminent public leaders will be organised at
State, District, Block and Panchayat levels for plann
ing and overseeing the implementation of motivational
and service delivery aspects of the programme. At
least half of the members of these Committees will
be women.
Special schemes will be developed for involvement
of Organisations of Women and Youth such as Mahila
Mandate and Youth Clubs in the Family Welfare
Programme integrated with socio-cultural activities
which such organisations are engaged in.
Medical students will be given proper orientation in
community work through suitable restructuring of
December 1986
their syllabus.
General student community will also
be involved through a scheme of compulsory rural
and urban slums work as part of the educational pro
gramme. The involvement of the student community
will be for over all community development within
which health and family welfare issues will have a
primary focus.
The Parliamentarians, Members of State Legisla
tures, Zila Parishad Members, District Committee
Members, Block Pramukhs, Gram Panchayat Members,
Gram Pradhans, Youth Wings and Mahila Wings
of the political parties, irrespective of their party
affiliations, can bring about significant change in peo
ple’s attitudes to family planning. They will be in
volved in motivational work.
It can also be considered whether the front organi
sations of the political parties, especially those of
Women, Youth and Students can encourage their
members to take a pledge to observe and promote
small family norm. This pledge administered in
large rallies will have good demonstration effect.
The large reservoir of practitioners of Indian Sys
tems of Medicine will be harnessed to further the
programme. They will be involved not only in moti
vational work but also in providing the services accord
ing to their capabilities. A scheme will be launched
to improve their technical, managerial and motivational
skills to get their best support for the programme.
The Opinion Leaders Training Camps will be more
effectively organised in close co-ordination with Pri
mary Health Centres and voluntary organisations in
the local area.
Apart from providing orientation,
these Camps will also serve to extend family planning
services.
Women Volunteer Corps
A village level Women Volunteer Corps will be
organised. The volunteers would interact with the
eligible couples in their areas and provide them with
knowledge of health, immunisation, family planning,
nutrition, etc. They would be given proper orientation
training for this purpose.
Women volunteers will
be chosen at the rate of one for every 60 families
both in rural and urban areas. These volunteers will
be preferably those who are acceptors of family plan
ning with three or less children and will be selected
from amongst the concerned group of eligible couples.
The role of women volunteers is not limited to family
planning, but would include overall emancipation of
women. A cadre of approximately 2 million such
workers from within the community will be a major
catalyst for social change.
Social Marketing of Contraceptives
The programme of social marketing of Nirodh has
been in existence for the last 15 years and is being
executed through 12 large and well established private
and public sector undertakings. The sale of Nirodh
through these channels was 16 million pieces in 196869 and is expected to cross 300 million next year.
Even though there is sufficient awareness or the part
311
Improve Quality of Health Services
—Says Kum. Khaparde
We have achieved significant pro
gress towards increasing the health
status of our people. Smallpox
and plague have been eradicated;
malaria has been controlled to a
large extent. We have also brought
down the incidence of several com
municable diseases which have been
the scourge of developing countries,
said Kum. Saroj Khaparde, Minis
ter of State for Health and Family
Welfare, while addressing the 12th
Joint Conference of Central Councils
of Health and Family Welfare in
New Delhi on 22 September, 1986.
Since Independence, the mortality
rates have been halved; the nutri
tional level of our people has im
proved; the life expectancy at birth
of our country-men has increased
from 32 years to 56 years. This has
been possible because of the large
investments made in setting up a
net-work of health delivery system
which reached out in the country
side. It is also a tribute to the
medical professionals who managed
these facilities, said the Minister.
She referred to some mishaps re
ported from eye camps conducted
by voluntary agencies at Khurja and
Moradabad in U.P. A large num
ber of individuals who got their eyes
operated in these camps were re
ported to have lost eye-sight. She
said “Centre has been issuing guide
lines and instructions regarding orga
nisation of eye camps. It appears
that these guidelines are not strictly
adhered to. All the organisers of
eye camps irrespective of the fact
whether they solicit grant-in-aid
from the Government or not, must
invariably obtain prior approval and
permission of the camps from the
competent health authorities of the
District.
The authorities, while
granting permission, should properly
scrutinise the potential of these orga
of the consumers about Nirodh, adequate infrastruc
ture and delivery system, the main job of creating a
large demand leaves much to be desired.
This de
mand creation depends upon aggressive marketing,
advertising and product promotion. The present Cell
in the Ministry is ill-equipped for mounting a large
scale and successful programme. A marketing board
will be set up in the Ministry to review periodically
the policy on social marketing, draw up an action
programme and oversee its implementation. This
Board will have as Members, experts on marketing and
communication. The Board will ensure a cohesive
and integrated approach to marketing, provide policy
guidance and Central Management Coordination, sales
forecasting, review and related management support
services.
Greater involvement of Marketing Companies will
be enlisted and their responsibilities and areas of
operation broadened. Better quality condoms will
be introduced in the Social Marketing System. Apart
from popular retail outlets, non-coventional outlets
will also sell contraceptives. The main thrust will
be that people should be able to purchase condoms
in an impersonal atmosphere from easily accessible
places.
The social marketing programme will also be ex
tended to include oral pills and other spacing con
traceptives.
While extending the social marketing
programme, free distribution of contraceptive will
312
nisations. qualifications and experi
ence of the surgeons conducting ope
rations and other relevant details.
One of the officers of the Health
Department, preferably an Ophthal
mologist, should oversee the activi
ties in the camps”.
She said that the Government hos
pitals were perhaps the major source
available to the common people for
curative
services. Image of the
health service was largely related
to the functioning of these hospitals.
The functioning of these hospitals
required serious attention and im
provement.
Cleanliness, environ
mental improvement, courteous be
haviour and proper management
could go a long way in improving
the quality of service. She urged
to pay proper attention to this aspect
of improving the services in a costeffective manner. Hospital wards
providing mother and child care
would need special attention,” she
added.
be scaled down. Community based distribution sys
tem worked by voluntary organisations will also be
considered for participation wherever necessary. All
these steps will lead to much higher level of know
ledge and achievement than what has been targeted
in the 7th Plan.
Improving Programme Management
Experience has shown that in States where pro
gramme has been handled more efficiently, performance
has improved significantly. An analysis of the exist
ing situation based on the research findings reveals
that inadequate administrative structure, lack of
management system at P.H.C. level, insufficient mobi
lity, deficient supply systems, shortage and poor main
tenance of equipments are some of the basic weak
nesses in the programme. All these areas will be
given priority and focussed attention.
At the National level, the administrative structure
in the Department of Family Welfare will be reor
ganised and reoriented towards modern programme
management. A number of initiatives will be taken
to build professionally competent structures and sub
structures manned by most suitable resource persons
so that policy, planning, implementation, review
and evaluation aspects of the programme are handl
ed with maximum efficiency. There will be apex
S'wasth Hind
level bodies to review the policies, programme and
their implementation. Separate satellite structures will
be established within the Ministry for giving advice
and direction on specific aspects of the programme.
Full use will be made of the specialised autonomous
organisations such as National Institute of Health
& Family Welfare, Indian Council of Medical Re
search, International Institute for Population Sciences
for the overall planning, decision making and imple
mentation of the programme.
At the State level, there will be a high powered
Committee for overall review and monitoring. Posts
of Additional Chief Secretaries would be created in
•certain States for more effective coordination of family
welfare with other social sector programmes. State
Family Welfare Bureau would be strengthened and
State level institutions like Population Research Cen
tres will inter-act more effectively with the State
machinery.
At the District level, the Collector will be invested
with the overall supervisory responsibility of the
programme to forge effective coordination. A Popular
Committee will be set up under his leadership to
serve as an instrument of bringing together various
resources in the district for a common Action Plan.
The Chief Medical Officer will serve as the principal
resource to the Collector and his position will be
strengthened. District Family Welfare Bureau will
also be adequately strengthened in line with the dis
trict-wise thrust in the programme.
At the Block level, the Block Development Officer
will be fully involved in the programme. A mechanism
will be established by which he will get support and
advice from various Government departments and
popular institutions. He will coordinate and mobilise
the functionaries of different development departments
and work in close collaboration with the Medical
Officers in charge of Primary Health Centres.
Improving Primary Health Centre Management
The Primary Health Centre at the Block level is a
critical unit in the service delivery system. Planning
and management of the programme in the Primary
Health Centre requires talents of a Manager apart
from the skills of an Epidemiologist. The Medical
Officer in charge of the Primary Health Centre will
have to be trained in the skills of programme planning
and management so that he can organise both official
ad non-official agencies for proper delivery of Family
Planning and MCH services. A detailed exercise
would be undertaken to assess management needs of
the Medical Officer in charge of Primary Health Cen
tre and of the functionaries working below him and
modules developed for on-the-job and off-the-job train
ing of these functionaries and a structure of incentives
will be built up, allowing for upward mobility in
their professional careers based on commitment and
objective performance.
Improving mobility, streamlining Supplies and Equip
ments
Mobility is of prime importance for service delivery,
supervision and emergency assistance. Regular avail
December 1986
ability of supplies and equipments is vital to the suc
cess of the programme. Following steps will be taken
to improve the existing situation in these areas:
—
Vehicles under the programme will be main
tained at optimal efficiency. Old vehicles will
be replaced and additional vehicles provided
for districts of large size and difficult terrain.
—
Para-medical workers will be given interest
free loans to purchase Mopeds/Motor Cycles
for their official use to increase their mobility
and efficiency. Adequate allowance will be
given to enable them to maintain the two
wheelers and to meet the POL costs.
The necessary supplies and equipments like surgi
cal instruments, refrigerators, vaccines, contraceptives,
audio-visual equipment, will be regularly made. Their
proper upkeep and maintenance will be ensured. Ap
propriate training will be given for scientific manage
ment of inventories.
Eligible couple registration system
Eligible Couple Register is the basic document
for organising the work programme of Family Plann
ing field workers. There are about 126 million eligible
couples and this number is likely to increase to around
170 million before 2000 A.D. The system of preparing
Eligible Couple Registers will be streamlined to make
it an effective instrument of monitoring and manage
ment.
Each functionary will have registers of cou
ples falling within his jurisdiction. These will be re
gularly updated and definite ■responsibilities
fixed
for their preparation and authenticity of informa
tion. The Eligible Couple Roll will be printed and
displayed at accessible points in each village
for
public scrutiny. These registers are vital in proper
enforcement of a system of structured incentives apart
from improving information on the vital statistics.
Differential Area, Region and group
specific approaches
The socio-economic conditions and demographic
situation in the country vary considerably from State
to State and within a State, from region to region.
This diversity dictates the need for differential appro
aches and region specific strategies. These are:
State level
Each State will devise its strategy to achieve the
goal of unity NRR by the year assigned to it, besides
preparing medium term Action Plans for the remain
ing period of the Seventh Plan. Each State will carry
out a situational analysis to identify thrust areas and
devise differential approaches for different districts,
areas, communities and groups. To enable the State
to efficiently implement their strategies, greater decen
tralisation and flexibility in implementing the pro
gramme will be provided.
313
PEOPLE
AND RESOURCES
THE outstripping of the world’s
resources by a population projected
to reach 6,000 million people in
15 years is the focus of the State
of the World 1986 report by the
World Watch Institute.
A quarter of the world’s families
live in makeshift shelters. Fully
half of the third world’s urban
dwellers live in shanty towns which
double in population every five to
10 years.
Per capita grain production has
dropped since 1950 in 40 develop
ing countries, home to more than
700 million people, states the re
port.
A thousand million people lack
safe drinking water and 2,000 mil
lion have no basic sanitary faci
lities.
The decline in per capita grain
production in most countries is not
exclusively due to ecological deterio
ration. Failed or nonexistent popu
lation policies can expand demand
for food and undermine agricultural
support systems. In essence) popu
lation growth hastens the process
of ecological decline.
According to State of the World
1986, two per cent of the world’s
tropical forests are destroyed each
year. Far faster in South-east Asia
and West Africa, where moist tro
pical forests will have virtually dis
appeared by the end of the century.
Seven per cent of the earth’s top
District level
Based on the State level strategy, each District will
prepare an Action Plan for the next four years, which
will include all aspects of planning, implementation,
monitoring and evaluation. Specific targets to be achi
eved will be decided by the State Family Welfare
Bureau in consultation with the District Family Wel
fare Bureau.
Block/PHC level Action
The Medical Officers in charge of the PHC will
prepare Action Plan for the Block for extensive cove
rage of all eligible couples. This will include updating
of Eligible Couple Registers, identification of low
acceptance villages, schedules of holding family plan
ning and immunisation camps and well planned sup
portive supervision.
Municipal/ Urban areas special strategy
Population in poor pockets of urban areas is grow
ing very fast. Most urban areas have Health &
Family Welfare infrastructure, but that is ‘clinic’
oriented. The approach will have to be changed to
a community-based motivation and extension services.
Adequate coordination, lacking at present, will be
provided among various health institutions and volun
tary organisations will be mobilised in providing com
prehensive and coordinated services.
Lagging Groups and. Communities
Owing to various socio-economic reasons, acceptance
of family planning amongst certain communities and
identifiable groups is relatively much lower than the
national level of acceptance. Each State and District
will identify such groups and regions, assess their
314
soil is lost each decade. The fish
catch per person, including from
fish farming, is down 15 per cent
since 1970. Biggest consumption
cuts are in third world countries
such as the Philippines. Water de
mand is outpacing sustainable sup
plies in many parts of the world.
One in ten children born in de- •
veloping countries dies before its
first birthday. Every year, five mil
lion infants and children die from
malnutrition and diarrhoea and 12
million more die from infectious
and preventable diseases. Almost
half a million women die in child
birth each year. Half of these lives
could be saved through access to
family planning.
QO
attitudes and perceptions and devise group specific
programme of packages. A special feature will be
to involve members of the lagging community groups,
both for motivational work and for providing services.
A package of group specific communication messages,
special focus on education,'provision of better facili
ties and involvement of members of specific groups
will help in reducing the variations which now exist.
Programme Coordination
Intra-sectoral Coordination
A v large number of agencies in Government, volun
tary and corporate sectors are engaged in promoting
family planning in one way or the other. There is no
system of effectively coordinating their efforts in a
purposive manner on regular basis. It is essential
to harmonise the work of the various institutions and
ensure that experience gained is. commonly shared.
For this purpose, specific tasks will be assigned to
various agencies to avoid unnecessary duplication
and a standing mechanism will be established for shar
ing of experiences and concerted joint action.
Int'?ir-sectoral Coordination
Socio-economic development which is a major cor
relate of fertility is a process of overall national deve
lopment effort.
While it is the responsibility of the
Ministry of Health and Family Welfare to promote
contraception and provide necessary services, the res
ponsibility to gear up efforts for economic and other
developments which will help in fertility reduction
falls within the purview of other Ministries. Apart
from this, other Ministries will also have to inbuild
some component of Family Planning in their pro
grammes. All socio-economic development schemes
Swasth Hind
should have family welfare as an integral component.
While dispensing benefits of various development
schemes, other, things being equal, preference should
be given to those who observed two-child family norm.
A standing mechanism will be set up at the Centre
and in the States for securing effective inter-sectoral
coordination from the National to the grassroot level
of all the relevant Ministries, Departments and agen
cies.
Manpower
Policies
Development,
Training and
Personnel
Manpower Development is an essential element of
programme improvement efforts. Doctors and para
medicals need to be trained for- being developed into
health administrators, programme managers and for
rendering specialised family planning services. Para
medical personnel constitute the peripheral point of
the delivery of family welfare services. Adequate
facilities for training these categories exist except
for male MPWs, which would have to be created.
However, a general strengthening of these institutions
in terms of faculty and equipment would also be neces
sary.
Awamess of family planning programme is nearly
universal but acceptance rate is estimated to be only
35%. The role of extension personnel at village level
becomes crucial for converting awamess into accep
tance.
This needs inter-personal communication
skills. To impart necessary skills, communication
training needs will be identified and training pro
grammes introduced/reoriented.
There are nearly 6 lakh traditional birth attendants
who conduct majority of the deliveries. Dai enjoys
the position of an influential opinion leader in matters
of maternal and child health. They, thus, constitute
an excellent potential of developing into an effective
agent for providing pre-natal care, asceptic delivery
and post-natal care. To draft dai as an effective sales
person for Family Planning/MCH services, her op
posing interests to family planning would have to
be neutralised through an incentive scheme. As the
number of dais is declaining, new entrants would be
encouraged through suitable schemes.
The Village Health Guide Scheme aims, at involv
ing community in health and family welfare pro
grammes.
Improper selection, inadequate training
and incorrect implementation has resulted in unsatis
factory performance of the scheme. Male Health
Guaides are sub-salient in family welfare services
which mainly relate to women. It has been decided
to replace all the male Health Gudies by female
Health Guides.
The reluctance of doctors to move into rural and
remote areas makes it imperative to think in terms
of introducing a new category of health personnel
with skills intermediate to those of doctors and para
medical workers.
These Community Health Super
visors would be imparted training for a period’ of
three years and equipped to deal with majority of
the common ailments of the rural people nearest to
their doorsteps.
They would also become an effec
December 1'986
tive link between the peripheral worker and the
medical officer and thus be able to contribute subs
tantially in the area of supplies and services of family
planning programmes.
Under-utilisation and low quality of services high
light the need for an intensive training of the family
planning workers. Areas critical for programme per
formance will be identified. An exercise of assessing
training needs wil be carried out for each PHC. Re
gional training institutions will be strengthened
to
provide a continuing education programme to cover
each health worker for a period of training upto three
weeks once in five years.
We have at present 7
Central Training Institutes and 47 Regional Health
and Family Welfare Training Centres. About 8 lakhs
para-medical and extension workers of different cate
gories would need to be covered.
To cover these
workers, in addition to the existing infrastructure,
PHCs and sub-centres are also to be developed as
training resources.
Personnel Policies
A scheme of carrer development would be imple
mented to provide for adequate opportunities for
upward mobility to various health functionaries com
bining merits and experience.
Research, Monitoring and Evaluation
Family Planning Research
Family planning research is a very critical element
for improving the quality and effective out-reach of
the programme. The main thrust would be to make
research directly relevant to the programme needs.
Following are the major areas which will receive
priority.
The Research Study 1986 as well as other Studies
done in the past have provided better understanding
of people’s response to family planning in terms of
their socio-economic conditions, values and percep
tions, availability and accessibility of services and
suitability of the existing contraceptive methods, etc.
This has helped in devising appropriate programme
policies and strategies. Since human society is dyna
mic, • similar psycho-social research will be taken up
in future as a regular feature.
It is commonly believed by the Demographers that
the couple protection rate of 60% will reduce the
birth rate to 21.
The validity of this hypothesis
needs to be investigated empirically through field
studies.
Towards this end, a rigorous and properly
designed research .project will be commissioned.
High priority will be given to operational research
aimed at bringing about more effective utilisation of
the current delivery system and in identifying alter
native and cost-effective strategies.
Research focus will be given on improving the ac
ceptability of the existing methods by minimising the
complications/inconveniences associated/perceived to
be associated with them.
315
New technologies like injectables, sub-dermal im
plants are currently undergoing trials prior to their
introduction in thje programme. The procedures and
protocols of induction of new technologies will be
reviewed to enable faster introduction of such tech
nologies in the programme.
Development of simple, reversible, safe and longacting contraceptive such an Anti-Fertility Vaccine
would seem to offer greater potential. Research efforts
in developing such a vaccine will receive high prio
rity. At the same time, contraceptive ileseach
by
the Research Councils in the Indian Systems of Medi
cine will also be expedited.
Management information system
A Management Information System will be develop
ed from the sub-centre level upwards to the national
level. This system will have two functions. The first
is to generate necessary information at the ground
level and beam it upwards through PHCs to the dis
trict level and above. This will facilitate monitoring
and evaluation of the performance. Secondly, the
system will really information, guidance and feedback
from higher levels to lower formations. Information
collected at each level will be critically analysed in
order to identify gaps and enable corrective responses.
Monitoring and Evaluation
A proper Monitoring and Evaluation system must
provide for bench-mark data, periodic review, and
evaluation of performance with a view to ensuring
that the programme is moving on the lines laid down,
in the time-frame prescribed and most importantly,
produces the results which are sought to be achieved.
States have the bench-mark data in terms of birth
rates, deaths rates and infant mortality rates. Such
data are not available at the district levels. For
a proper monitoring and evaluation of the pro
gramme, a system will have to be devised to collect
such baseline data for the districts. Thereafter, what
has to be achieved during the next 4-5 years will have
to be targeted.
Various targets for Family Planning and their
method-mix will be decided to reach the targeted
levels of birth rate, death rate, etc. The specific acti
vities which need to be organised, will be spelt out
for each district yearwise. When this is done, it
would be possible for the programme managers at
higher levels to monitor the programme performance
to see whether the activities are being performed on
time and in the manner desired. This will facilitate
mid-term corrections wherever necessary.
A system of concurrent evaluation will be intro
duced so that the quality of services being provided
and the programme impact can be assessed from time
to time in a more effective manner.
The impact
measurement in terms of reduction of fertility and
mortalty rates wll be the most mportant index of the
evaluation system and a semi-independent mechanism
will be set up to continuously monitor the impact of
the programme on birth rates and age specific fertility
rates. ~ The system should enable computation of
316
SHIBIR ON FAMILY WELFARE
FOR INDUSTRIAL WORKERS
IN BARODA
A one-day Shibir on family welfare for industrial
workers was organised at Baroda on 29 July, 1986,
by the Federation of Gujarat Mills and Industries.
The Shibir aimed at making the family welfare
campaign a people’s programme, especially for involing labour leaders, industrial management and key
personnel of the industries of the industrial complex
of Baroda region.
The temporary and permanent methods of family
planning, medical termination of pregnancy (MTP),
and population explosion were discussed with the
help of slides for the industrial workers to clarify
their doubts, misconceptions, and apprehensions. The
Assistant Professor, Dr Pankaj Desai, Medical
Officer, Dr G. N. Patel and Health Education Officer,
Shri A. B. Shah addressed the workers. A leading
surgeon, Dr C. O. Sura spoke on the simple and safe
method of vasectomy as well as recanalisation proce
dure besides treating of sterility under the family
welfare programme.
The children who are born today can lead a longer
and healthy life, thanks to the immunization services,
said Deputy Health Officer, Dr Dalal and Shri
S. C. Parikh from the Municipal Corporation of
Baroda. A film show on I.U.D. insertion and M.T.P.
was also a part of the campaign. The group of 44
participants included cross section of textile engineers,
production officer and technical staff, representatives
of labour union, etc. The Shibir would go a long
way in spreading the message of small family among
the labour population of about five lakhs around
Baroda.
A. B. Shah
the birth rate at any point of time obviating the time
lag of waiting for the SRS estimates.
Computerisation
Monitoring and evaluation of the programme will be
computerised firstly at the national level and subse
quently at district levels.
The programme of com
puterisation will be synchronised with the growth of
the computer network NICNET of the National In
formatics Centre.
Currently, the facilities of the
National Informatics Centre are being used to moni
tor and evaluate the achievements of the States in
various programme components, setting of targets,
etc. It is proposed to utilise the nation-wide net
work for linking the National Headquarters with the
Regional, State and District Headquarters. Computer
will be utilised to monitor the performance of each
Block; vacancy positions; establishment of PHCs and
Sub-Centres; evaluation of the impact on birth rates
and age specific fertility rates. Appropriate software
will be developed to measure cost-effectiveness of
various schemes under the programme.
A
Swasth Hind
A-1. D. S.
How To Protect Yourself
— Clothing.
A.I.D.S. is a serious disease and
so far there is no known cure for it.
You can protect yourself from the
disease and prevent its spread if
facts about it are understood.
AUTHORS OF THE MONTH
Dr. (Kum) Snehlata Misra
-- - Toilet seats, door knobs, food, Professor of Obstetrics and Gynaecology
glasses and cups.
Lady Hardinge Medical College
New Delhi
You do not catch AIDS when you
What is Aids?
— Donate blood.
AIDS stands for Acquired Immuno
Deficiency Syndrome. It is caused
by a virus that destroys the body’s
natural defence system.
- - Have injections or any other
treatment from your doctor,
dentist or any other health
care worker.
What you should Avoid
Jack C. S. Ling
Director
Division of Public Information and
Education lor Health
WHO, Geneva
Not everyone who carries the
virus develop AIDS. In fact most
will not. But any me who has the
virus can pass it on, even if they
feel and look completely well.
— Casual sex with strangers. It
is always risky. You may not
know that the stranger is an
infected person.
How is AIDS spread?
— Anal sex. It involves the
highest risk and should be G. Vcnkataraman
avoided;
Field Publicity Officer
The only likely way for someone
to catch the AIDS virus is from the
blood or semen from an infected
person to get’ inside his or her body.
Most people get AIDS virus by
having sex with an infected person.
The rest have it by injecting them
selves using needles shared with an
infected person as happens com
monly among the drug addicts.
Only rarely transfusion of blood
from an infected person have been
responsible for its spread.
— The more the sex partners
the more is the risk to have
sex with an infected person.
— Sharing injection needles.
Remember
AIDS is not a disease to take
risk with. There is no cure. AIDS
control depends on how people
behave.
A. B. Shah
Fore more information
You do not get AIDS From
— Normal social contact such
as shaking hands, touching
and hugging.
— Coughs, sneezes and spitting.
You may write to the Asstt.
Director General (AIDS), Director
ate General of Health Services,
Nirman Bhavan, New Delhi- 110011
BUT YOU CAN CERTAINLY
AVOID IT
ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU
DELHI-110 002
AND
Lecturer, (Health Education
and Family Welfare)
Post Portum Unit
Medical College
Baroda
Gujarat
YOU CANNOT CURE AIDS
— Swimming pools, restaurants
and other public places.
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You can prevent dysentery
Thread worm
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You can prevent Dengue Fever
You can prevent Jaundice
Smoking can cause cancer
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Our children need clean habits
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When the unexpected happens
You can prevent Typhoid
Safe water, clean surroundings
Our children need healthy recreation
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Your sputum may spread disease
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You can prevent Cholera
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You can prevent Rabies
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V.D. (S.T.D.) is curable
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Oral Cancer
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Regular treatment for at least one year
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Presistent cough—have sputum test
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Prevent goitre
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Our children need.Safeguard
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Ring worm
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Care of the ear
You can prevent Lathyrism
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Asha visits the Dentist
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