STATE PLAN OF ACTION FOR THE CHILD IN TAMIL NADU
Item
- Title
-
STATE PLAN OF ACTION
FOR
THE CHILD IN TAMIL NADU - extracted text
-
STATE PLAN OF ACTION
FOR
THE CHILD IN TAMIL NADU
GOVERNMENT OF TAMIL NADU
NOVEMBER 1993
TABLE
•
PART ONE:
♦
♦
1.
•
•
•
*
e
II.
■
OF
CONTENTS
Introduction
A.
Preparation and Organisation of the State Programme of Action
B.
Major Goals and Objectives
C.
Strategies for Operationalising the State Programme of Action
Mechanisms for Implementation and Monitoring of Progress
PART TWO:
e ■
1.
<
e
Sectors:
Chapter One
:
Child Health
Chapter Two
:
Maternal Health
Chapter Three
:
Nutrition
Chapter Four
:
Education, Sports and Recreation
Chapter Five
:
Drinking Water Supply
Chapter Six
:
Environmental Sanitation
9
♦
e
9
9
9
9
II.
9
9
Inter-Sectoral Issues:
Chapter Seven
:
Child Labour
Chapter Eight
:
Girl Child and Adolescent Girl
Chapter Nine
:
Children In
Circumstances
Chapter Ten
:
Urban Child
Chapter Eleven
;
Childhood Disability
9
9
9
r
0
i
r
Especially
(
z
Difficult
PART ONE :
I. INTRODUCTION
1
STATE PLAN OF ACTION
FOR THE CHILD
/.
INTRODUCTION
Nurturing the human potential is a universal responsibility and there is no greater
human potential than the millions of children on whom progress and National
development depend. The National and State policy, especially in recent times, has
focused on human resource development and perhaps for the first time in history we also
have the means - material, technological and institutional - to achieve this. The
emphasis has also rightly moved from ensuring just child survival to ensuring growth and
development of children.
The global concern for children has been reflected in the World Summit for
Children in 1990 and the SAARC Summit on Children that followed. The Summit
commitments, designed to reflect the human and technological resources now available,
were expressed as a series of specific goals to be achieved by 2000 AD. These goals
include:
control of major childhood diseases;
a halving of child malnutrition;
a one third reduction in under-five death rates;
a halving of maternal mortality rates;
safe water and sanitation for all communities;
universally available family planning services; and
basic education for all children.
AH countries which signed the Declaration and Plan of Action also agreed to
prepare National programmes and strategies for reaching the agreed goals.
The National Plan of Action was formulated and released by the Department of
Women and Child Development, Government of India, in August 1992. The document
records the positive trends in many of the basic indicators on the child such as:
a steady reduction in infant mortality rate;
a decline in severe and moderate malnutrition; and
an increase in primary school enrolment rates.
It also points out to the lingering problems of:
low birth weight among children;
\
high morbidity;
’
. '
' •
micronutrient deficiencies;
problems in access to basic education; and
low achievements and high drop out rates in schools.
Recognizing all these factors, and the available national resources, the Plan of
Action has set major goals and objectives in areas of basic needs, universal protection
and development for children.
One of the pre-requisite for development plans to be successful is area specific
planning that will help deliver services in a convergent manner. Thus, the National Plan
of Action needs to be modified and adapted to reflect the status of children, the
problems, the resources, and the potential specific to the State. A State Programme of
Action will generate the right political decisions, professional support and community
organisation.
The basic needs of children are known - safe water, nutritious food, preventive
and primary, health care, clean environment, basic education, loving care. Towards
achieving these for all children of the State, especially to the disadvantaged group, the
Tamil Nadu Government has now formulated the State Programme of Action.
The operationalisation of this programme calls for strengthening the existing
sectoral projects/programmes, adopting strategies of convergence; community
mobilisation and management, experimenting innovative approaches, close NGO
collaboration as partners in this effort and continuing review, monitoring and concurrent
evaluation. The State Government proposes to achieve these through, a high level task
force to oversee implementation so that the vision of the Government for its children is
actualised by
T "
2000 AD.
This document is a commitment dedicated to all the children of Tamil Nadu
who will also be the driving force for the State to achieve the objectives of child
survival, protection and development.
3
PREPARATION AND ORGANISATION OF THE STATE PROGRAMME OF
ACTION
A.
The Tamil Nadu State Programme of Action for the Child was prepared by all the
concerned Departments through a joint consultative process coordinated by the
Departments of Social Welfare, Health and Finance. Drafts prepared by individual
Directorates were reviewed and revised in a 5-day workshop by groups drawn from
different Directorates as well as representatives from selected Non-Governmental
Organizations. The Chapters were then compiled, edited and cross-checked by a small
editorial group for review and finalisation by the concerned Departments.
The
Departments in alphabetical order are:
1.
2.
3.
4.
5.
6.
7.
8.
Education
Health & Family Welfare
Housing & Urban Development
Information & Tourism
Labour and Employment
Municipal Administration & Water Supply
Rural Development
Social Welfare & Noon Meal Programme
Part // of the document, which covers each topic that concerns the survival,
protection and development of the child, is divided into two sections. The distinct Sectors
all have defined Major Goals to be reached by the end of the last decade of this century:
2000 A.D. as well as Specific Goals defined in terms of two Milestones of 1995 (Mid
Decade) and 1998 (end of the 8th Plan period).
The second section covers cross-sectoral topics which need and deserve special
attention. The goals defined in the respective Sectors are relevant to the special
categories of children and have therefore not been repeated. In cases where goals could
not be defined due to lack of data on the current status, objectives have been set. These
special categories need to be addressed by several different Departments in a multi
sectoral approach.
4
Apart from setting state-specific goals, each Chapter contains a brief Situation
Analysis, Current Strategies, New/Additional Strategies, On-going Schemes and Projects
and Key Indicators to monitor progress. In some instances, issues requiring attention
have been mentioned. The State Programme of Action has attempted to address the
needs of the Child from the perspective of the Child and not from the perspective of line
Departments. This document is therefore to be translated into Departmental Plans (as
well as at Directorate level) for each of the remaining years of this decade.
Above all, the focus has been on how current programmes, projects and schemes
can be fine-tuned and geared up to achieve the goals, requiring few additional inputs.
However, a few critical gaps have been identified which will need additional-resources.
The Needs of the Child represent a critical investment for the future of Tamil Nadu
and will therefore receive the highest priority of the Government.
5
B.
MAJOR AND SPECIFIC GOALS AND OBJECTIVES
While all major goals have been set for the year 2000 AD, the specific goals have
been set for certain "milestones" of 1995 (mid decade) and 1998 (end of 8th Plan).
This is to facilitate monitoring of progress to achieve the decadal goals. Objectives
have been set where the current status is not known or in cases which are not
quantifiable.
I.
CHILD HEALTH
MAJOR GOAL:
REDUCTION OF INFANT MORTALITY RA TES TO LESS
THAN 30 PER 1000 LIVE BIRTHS AND REDUCTION OF 1-4
YEAR MORTALITY RATE TO LESS THAN 10 BY 2000 AD.
SPECIFIC GOALS:
1.
Reduction of Vaccine Preventable Diseases by:
a.
Sustaining immunisation coverage of 100% in each district using Coverage
Evaluation Survey data.
b.
Elimination of neonatal tetanus in all districts by 1995.
c.
Reduction in measles deaths by 95% and reduction in measles cases by
90% by 1995 compared to 1985. levels.
d.
Elimination of poliomyelitis in all districts by 1995 and eradication by 2000
AD.
2.
To achieve >90% usage of ORT by 1995. Reduction of 100% deaths due to
diarrhoeal dehydration in children 0-5 years and 50% reduction in diarrhoeal
incidence rate by 2000 AD.
3.
To reduce mortality rates due to AR! among children under 5 years by 40% from
the present level by 2000 AD.
4.
To reduce perinatal and neonatal mortality rate by 50% from 1990 levels.
5.
To achieve a 50% reduction in the incidence of HIV infection estimated for 2000
AD.
6
MATERNAL HEALTH
II.
MAJOR GOAL:
REDUCTION OF MATERNAL MORTALITY RATE BY 80% OF 1990 BASE
LEVEL BY 2000 AD.
SPECIFIC GOALS:
1.
Prevent pregnancies below 21 years; ensure birth interval of a minimum of 3 years
and restrict total number of births to 2.
2.
Ensure 100% coverage with antenatal care, 100% births attended by trained
attendants and referral facilities for high risk pregnancies and obstetric
emergencies available for every 3-5 lakh population.
3.
Improve nutritional status of women by increasing pre-pregnancy weight to >42
kg, by reducing prevalence of anaemia during pregnancy by 30%, eliminating
Vitamin-A and iodine deficiencies, and ensuring adequate weight gain of more than
7 Kg. during the period of pregnancy.
4.
Ensure accelerated literacy programmes for women and universal access to
primary education for girls.
III.
NUTRITION
MAJOR GOAL:
REDUCTION BY HALF IN SEVERE AND MODERATE
MALNUTRITION AMONG CHILDREN BETWEEN 1990
LEVELS AND THE YEAR 2000.
SPECIFIC GOALS:
1.
Reduction in severe Energy Protein Malnutrition (EPM) to less than 3% and
moderate EPM to less than 15% among under-5 children.
2.
Reduction in incidence of low birth weight (2.5 kg. or less) babies and increase in
mean birth weight to 3 Kg.
3.
Reduction in severe malnutrition among 6-14 year children by half of current levels.
7
4.
Reduction of iron deficiency (anaemia) in pregnant women, adolescent girls and
children 0-5 years.
5.
Universal consumption of iodised salt.
6.
Elimination of Vitamin-A deficiency and its consequences including blindness.
Objectives:
1.
Empowerment of all women to breast-feed their children exclusively for four to six
months and to continue breast-feeding with complementary food, well into the
second year.
2.
Growth promotion and its regular monitoring to be institutionalised.
3.
Dissemination of knowledge and supporting services to increase food production
to ensure household food security.
IV.
EDUCAT/ON, SPORTS AND RECREA TION
MAJOR GOAL:
ACHIEVEMENT OF UNIVERSAL PRIMARY EDUCATION. FOR
EVERY CHILD TO COMPLETE 5 YEARS OF PRIMARY SCHOOL.
SPECIFIC/SUPPORTING GOALS:
1.
Universal enrolment and retention for five years of primary education by children
6-11 years;
2.
Ensure adequate facilities and materials for improvement in quality of education.
3.
Improve teaching-learning activities for Minimum Levels of Learning (MLL) at every
stage and holistic development of every child (scholastic, non-scholastic, values,
behavioural & health).
4.
Extend knowledge and skills on early childhood development of children in the 0-3
age group for all mothers through ICDS/TINP functionaries.
5.
Ensure access to pre-school education for children 3-5 years.
9
3.
Objective: Increased awareness in the community with a view to bringing
behavioural change in maintaining personal hygiene, home sanitation with a
particular emphasis on washing of hands and voluntary construction of sanitary
facilities without any subsidy by a majority of the households.
VII.
CHILD LABOUR
MAJOR GOAL:
ELIMINA TION OF BONDED CHILD LABOUR AND CHILD
LABOUR IN HAZARDOUS INDUSTRIES FOR CHILDREN
UPTO 14 YEARS AND FULL-TIME CHILD LABOUR OF ALL
CHILDREN UNDER 12 YEARS.
SPECIFIC GOALS:
1.
Elimination of child labour in the match and fireworks industries.
2.
Elimination of child labour in other classified and non-dassified hazardous
industries which affect the normal and healthy development of a child.
3.
Elimination of full-time child labour in all industries and categories for children
under 12 years, in line with the Universal Primary Education goal.
4.
Elimination of bonded child labour in all industries and categories.
VIII.
GIRL CHILD AND ADOLESCENT GIRL
MAJOR GOAL:
IMPROVE STATUS OF GIRL CHILD TO ACHIEVE EQUAL
SEX RATIO
SPECIFIC GOAL:
1.
To reverse the trend of decline in sex ratio.
Process Objectives:
1.
To cover 80% of adolescent girls by special health camps to improve personal
health awareness and health status.
2.
To provide vocational skills towards self-reliance for 50% of school drop-out
adolescent girls.
10
IX.
CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES
MAJOR OBJECTIVES:
1.
TO ENSURE THAT SECTORAL GOALS RELATING TO EDUCATION
(FORMAL AND NON-FORMAL), INCLUDING OPPORTUNITIES FOR
SKILL DEVELOPMENT, HEALTH AND NUTRITION ARE ACHIEVED.
2.
TO ADDRESS NEEDS OF CHILDREN IN ESPECIALLY DIFFICULT
CIRCUMSTANCES FOR THEIR PROTECTION, CARE AND
DEVELOPMENT FOCUSSING ON THE FOLLOWING GROUPS:
STREET CHILDREN
NEGLECTED, DESTITUTES & ORPHANS
CHILDREN OF PROSTITUTES
JUVENILE DELINQUENTS
CHILDREN OF AIDS AFFECTED PARENTS/AIDS
AFFECTED CHILDREN/AIDS ORPHANS
DRUG ADDICTS
3.
TO REDUCE DISINTEGRATION OF FAMILIES AND DESTITUTION OF
CHILDREN BY FOCUSSING ON SITUATIONS OF ’AT-RISK’ FAMILIES
THROUGH INTER-SECTORAL COOPERATION AND COLLABORATION
IN PREVENTIVE STRATEGIES.
X.
URBAN CHILD
A
MAJOR OBJECTIVE :
ALL SECTORAL GOALS TO BE ATTAINED IN URBAN AREAS
SPECIFICALLY AMONG "AT RISK" GROUPS SUCH AS:
PA VEMENT DWELLERS
STREET CHILDREN
MIGRANT GROUPS INCLUDING CONSTRUCTION WORKERS
AS WELL AS AMONG POPULATIONS LIVING IN SLUM POCKETS AND
AREAS SUCH AS:
NOTIFIED SLUMS
UNAUTHORISED SLUMS (INCLUDING THOSE ON PRIVATE
LAND)
FRINGE AREAS, RECLASSIFIED MUNICIPAL AREAS AND
RESETTLEMENT SCHEMES
11
XL
CHILDHOOD DISABILITY
MAJOR GOAL:
PREVENTION, EARLY DETECTION, INTERVENTION AND
REHABILITATION OF CHILDHOOD DISABILITIES FOR ALL
CHILDREN BY THE YEAR 2000 A.D.
SPECIFIC GOALS:
1.
Elimination of poliomyelitis in all districts by 1995 and eradicate by 2000 A. D.
2.
Control of Vitamin A deficiency and its consequences, including blindness.
3.
Control of iodine deficiency disorders including cretinism.
4.
Reduction of other preventable childhood disabilities.
5.
Early detection and Community Based Rehabilitation for all children under 5 years.
6.
Integration of children with mild or moderate disabilities into the mainstream of
forma! education.
7.
Ensured institutional rehabilitation support or care for children with severe or
multiple disabilities.
72
C.
OVERALL STRA TEGIES FOR OPERA TIONALISING THE STA TE PROGRAMME
OF ACTION FOR THE CHILD
While strategies have been defined for goals and objectives set for each sector or
topic, the over-riding strategies are given below to operationalise the programme of
action throughout the state.
1.
Holistic Development
By nurturing the physical and mental potentials of children and by minimising all
environmental constraints, the State will focus on the holistic development of the
child. This will be the guiding principle for all sectoral programmes for children.
2.
Intersectoral Co-ordination
The administrative machinery will improve intersectoral linkages and co-ordination
among various Government departments to achieve and sustain a high level of
functional integration at various critical levels.
3.
Convergence of services
Convergence of services at community level will be a key strategy to minimise
adhoc or vertical approaches to problems of children.
This will include
transformation of child welfare centres into child and women’s welfare centres
allowing an integration of services beyond the noon meal, ICDS and TINP services.
4.
Target socially and economically disadvantaged
Developmental programmes for women and children in the State will be extended
and strengthened, targeting the socially and economically disadvantaged
segments.
5.
Bridging gaps in coverage
Existing gaps in service provision for mothers and children will be bridged to
ensure universal access to services.
6.
Community mobilisation
All Sectoral programmes will promote community mobilisation of human and •
material resources for sustainable development of children and women.
13
7.
Community Assessment, Analysis and Action
The State will take all steps needed to create awareness, to train and to enable
communities and their representatives to assess, analyse and initiate and sustain
action at the community level for necessary interventions to tackle issues relating
to development and protection of children.
8.
Management by Local Self-governments
Local self government (panchayats and wards) will be made responsible for
community based interventions leading progressively to decentralised
management based on informed decisions.
9.
NGO Collaboration
The State Government will collaborate with Non Government Organisations as
partners in reaching goals for children.
10.
Advocacy & Communications
The State Government through its various channels for public information,
education and communication, advocate for the focus on the development of
children, removing all gender disparities.
The information, education and communications strategy of all programmes for
women and children will be planned and coordinated to ensure uniform messages
to bring in behavioural change in practices affecting child development.
11.
Innovative Schemes
The State will encourage and participate in replicable and sustainable models of
innovative schemes for development of children and women.
12.
Research and Development
The State will co-ordinate with academic institutions and research organisations
and encourage special studies on the situation analysis of children in minority
groups, geographical regions, migrants and disabled and use the information
generated to support and strengthen policy. The state will also undertake
Operations Research in social service sectors to identify cost-effective sustainable
ways of service delivery for women and children.
14
13.
Legislative measures and enforcement
By providing legislative sanction to tackle issues concerning protection and
development of children and women and by committed enforcement of existing
and proposed legislations, the state will remove all obstacles for protection and
development of children.
14.
Monitoring, Review and Evaluation
By constituting a task force for state level monitoring, review and concurrent
evaluation, and by making the review of implementation of the State Programme
of action for the child an integral part of District Development reviews, the State
will operationalise the programme to reach goals for survival protection and
development of children by 2000 AD.
II. MECHANISMS FOR
IMPLEMENTATION AND
MONITORING OF PROGRESS
15
//. MECHANISMS FOR IMPLEMENTATION AND MONITORING OF PROGRESS
The issues relating to child survival, protection and development are multisectoral
in nature and hence require a multi-sectoral approach in planning and implementation.
However, the history of many development efforts indicate that unless the mechanisms
for implementation and review are carefully planned and designed, multi-sectoral plans
fail to achieve the impact.
Management of multi-sectoral plans call for clearly defined linkages between
functionaries at various levels and convergence of services at the interface of service
delivery.
Achieving time bound goals in such plans also requires close monitoring of
carefully chosen process and impact indicators. Cost-effective approaches need to be
continuously studied and adopted and this calls for flexibility in resource allocation and
area specific planning.
Establishment of a High Level Committee:
While planning and implementation at the community level will necessarily adopt
a participatory approach, the State Plan of Action for the Child, due to its dimensions and
necessity for resource allocation on priority basis, requires that a high level Committee
be set up for reviewing action plans and taking key decisions on management of
resources and periodic reviews.
Establishment of a Research and Monitoring Cell:
To support the review process by the highest levels of government, a special Cell
will be established with the objective of promoting research, monitoring and evaluation
of programmes for children. The Cell will:
a.
Generage and disseminate information needed for planning area-specific
interventions by developing child specific and gender specific indicators at
sub-block level.
b.
Identify areas requiring research into the extent of problems relating to
children, adolescent girls and women as well as operations research in
service delivery in social sectors.
c.
Monitor and evalaute the scheme for children.
16
Development of Action Plans and Presentation to State Committee:
The Strategies to reach the goals by 2000 AD have been identified. Many sectors
also have formulated programmes under the Eighth Plan to implement some of these
strategies. However, comprehensive department action plans (year-wise) need to be
developed. This will help to quantify the requirements for resources and manpower
development.
It is envisaged that every Head of Department implementing programmes for child
survival, protection and development will prepare an action plan, year-wise, and present
this to the Committee for discussion and approval. At the first instance, overall plans till
2000 AD will be finalised for each department which will also help in prioritising resource
allocation.
Key indicators
As part of presentation of year-wise action plans, the Heads of Departments will
also suggest the key process and impact indicators to be adopted for review at the State
and district levels. The indicators that will be measurable for monitoring progress at the
sub-block level to be used by the Panchayat Union Commissioner and local self
government will also be suggested.
State level reviews
The Committee will review the progress once in six months while the Secretary
Social Welfare and NMP will conduct quarterly reviews which will be attended by Head
of Departments.
District level implementation and review
The Collector will be responsible for the overall implementation of all programmes
for child survival protection and development. He will send monthly reports on key
indicators to Secretary Social Welfare and NMP. The key indicators will form part of all
District Development Reviews. Area based studies and evaluations will be taken up
based on Collector’s advice and participation. Collector will also be the nodal officer for
NGO collaboration at the district level.
Role of Local Self Government and Communities
The block and sub-block reviews will help in problem identification and community
mobilisation. Sensitisation and training of all local and panchayat leaders will be
undertaken to guide and support them in their newly defined role and functions.
Chapter One:
CHILD HEALTH
and co-oreG
use 04
social , educaHonal and
X/OCP.tioy'.^ mea^rea
£oy 4* t>.
o.y^
ve.Wo.:^’^
individuals 4o W>e ^•igV'e/
p^sci^dc \eve\ oC l^cboM aWAu .
The
vnechcai (
Mi meaiMvc® amed a4 veduema H<
Vfi'ipacf <r
eAijta Idina
cw^cl navrai
widlHant
and *
4
enabling
*c?
dwaHW and Handicapped
C^oal iMMpwtoo’H '•
./r
*C
atM»
£&aa\
\nWdvc4iw - MMe paibcipa^on
04
chs<abte<$
4mA Handicapped people
m W»e \ r^mc^TOiVb ! 1 c( covntnMvMj VfC.
,
*ipe&
T
<4
Teavn
Wwt.
Ae ^odb <6, • ^
4-a uW awd
*
elttabilih
eapAcj^ .
'
U, YtiJuMtol and veVainu/
w©vk tin Uwilh e( Hu
4© Hu Hl^ 04 Im£
Puypck^e
&»Uab 1$ +0 vnakt pVid/zOk m?
peepte u'a> <4 \novi px> d’Ack Mt people.
HealHi ^07 <Al|
bM xoo©
'
feiMt
af RFlbM)
FOR ALL
17
1.
CHILD HEALTH
MAJOR GOAL:
REDUCTION OF INFANT MORTALITY RATES TO LESS THAN 30 PER
1000 LIVE BIRTHSAND REDUCTION OF 1-4 YEAR MORTALITY RATE
TO LESS THAN 10 BY 2000 AD.
Infant Mortality Rate
Tamil Nadu
Trends
t3 Goals
Source: SRS (1976-1991)
I.
SPECIFIC GOALS:
A.
Reduction of Vaccine Preventable Diseases by:
1.
Sustaining immunisation coverage of 100% in each district using
Coverage Evaluation Survey data.
18
II.
2.
Elimination of neonatal tetanus in all districts by 1995.
3.
Reduction in measles deaths by 95% and reduction in measles
cases by 90% by 1995 compared to 1985 levels.
4.
Elimination of poliomyelitis in all districts by 1995 and eradication by
2000 AD.
B.
To achieve >90% usage of ORT by 1995. Reduction of 100% deaths due
to diarrhoeal dehydration in children 0-5 years and 50% reduction in
diarrhoeal incidence rate by 2000 AD.
C.
To reduce mortality rates due to ARI among children under 5 years by 40%
from the present level by 2000 AD.
D.
To reduce perinatal and neonatal mortality rate by 50%> from 1992 levels of
52.4 and 56.2 respectively.
£
To achieve a 50% reduction in the incidence of HIV infection estimated for
2000 AD.
SITUATION ANALYSIS AND CHALLENGE
The overall basic indicators on children in Tamil Nadu show a positive trend. For
example, the infant mortality rate fell almost steadily from 93 per 1000 live births
in 1980 to 57 in 1991.(SRS) The 1-4 year mortality rate in Tamil Nadu has declined
from 30 in 1980 to 17 in 1990.
The rural infant mortality rate is higher (65 per 1000) when compared to the urban
infant mortality rate (42 per 1000).
The post-neonatal component of infant mortality has been declining steadily, from
31.9 in 1980 to 17.6 per 1000 live births and contributes to 28.9% of total infant
mortality as of 1989 (SRS).
19
The main causes of postneonatal infant mortality in Tamil Nadu are Acute
Respiratory Infections, Diarrhoea, Dysentery and Fevers.
The neonatal mortality was 60.8 in 1980 and 50% in 1989 and contributes to
73.68% of total infant mortality. The perinatal mortality rate was 53.2 in 1980 and
53.8 in 1989. Still birth rate is also high, 17.11 in 1991, which contributes to high
perinatal mortality rate. The causes of neonatal deaths are prematurity and low
birth weight due to maternal malnutrition, birth asphyxia due to obstetric
complications, infections and the lack of adequate new born care.
The data point to the fact that attempts to reduce infant mortality further in Tamil
Nadu should address issues related to maternal health, low birth weight, care
during childbirth and immediate postnatal and newborn care.
The achievements with regard to immunisation in Tamil Nadu are remarkable with
100% coverage being reported for all vaccines in 1992-93. Vaccine potency is
above 95% for Ora! Polio Vaccine (OPV) indicating a high level of cold chain
maintenance in the State. The incidence of Poliomyelitis, Neonatal Tetanus (NNT)
and Measles has shown a striking decline.
According to SRS data, the percentage of institutional deliveries is 48.7% in 1989
(rural 36.7%> and urban 86.7%). According to reported figures, the percentage of
deliveries conducted by trained persons is 71% in Tamil Nadu. In rural areas,
majority of births are still conducted by untrained personnel indicating the need to
train traditional birth attendants and promote institutional deliveries.
20
As per recent Coverage Evaluation Survey data, the Ora! Rehydration Therapy
(ORT) use rate in the State is 82% and ORS use rate is 59.7%. Studies suggest
that 65% of children with diarrhoea are taken out of the home for consultations. Of
these, 80% seek care from private sector 'health providers'.
The State of Tamil Nadu features second in the country for HIV/AIDS prevalence.
There are currently 4,900 persons HIV+ and 150 persons with AIDS. 5.5 lakh
persons were tested for HIV. The projection for Tamil Nadu are a rising trend with
an estimate of 1 million HIV+ and 1 lakh AIDS by 2000 AD.
Unless HIV/AIDS prevention and control programmes are implemented speedily,
the health profile of Tamil Nadu may show a worsening trend. The Crude Death
Rate, Infant Mortality Rate, incidence of common infectious diseases especially
Tuberculosis, is expected to rise and it is expected that there will be a heavy
burden on medical institutions with concurrent rise in health care costs. AIDS
orphans, AIDS in newborns and rising incidence of HIV/AIDS among women will
specifically affect the status of children.
III.
STRATEGIES FOR EACH GOAL
1
A.
SPECIFIC GOAL ONE:
1.
REDUCTION
DISEASES
OF
VACCINE
PREVENTABLE
Sustaining immunisation coverage.
1995: Achieve 100% coverage in the state verified by Coverage Evaluation
Survey.
1998: Sustain 100% coverage in the state.
2000: Sustain 100% coverage of fully immunised children in the state.
21
Elimination of neo-natal tetanus.
2.
1995: *
*
100% coverage with Tetanus Toxoid-2 (TT2) by CES in all
districts, towns, blocks, PHCs, HSCs and urban slums.
100% deliveries attended by trained persons.
*
100% districts free of Neonatal Tetanus.
1998: Sustain achievement.
2000: Sustain achievement.
Trends in Vaccine Preventable Diseases
Neo-natal Tetanus - Tamil Nadu
Year
TRENDS
GOALS
Cases * Deaths +Cases
Source: Routine Surveillance, DPH & PM
Deaths
22
3.
Reduction of measles mortality and morbidity.
1995: 100% Measles vaccine coverage in all districts, towns, blocks, PHCs,
HSCs and urban slums; 95% reduction in measles mortality and 90%
measles morbidity.
1998: Sustain achievement.
2000: Elimination of measles mortality and morbidity.
Incidence of Vaccine Preventable Diseases
Measles - Tamil Nadu
TRENDS
GOALS
Cases * Deaths + Cases
Source: Routine Surveillance, DPH & PM
Deaths
23
Elimination of poliomyelitis.
4.
1995: *
*
100% coverage with OPV5 in all districts as per Coverage
Evaluation Survey.
Achieve polio-free Tamil Nadu (eliminate).
1998: Sustain elimination status.
2000: Eradicate poliomyelitis.
Trends in Vaccine Preventable Diseases
Polio - Tamil Nadu
GOALS
TRENDS
Cases ^Deaths
Source: Routine Surveillance, DPH & PM
~ Cases
Deaths
24
2
A.
SITUATION ANALYSIS:
1.
According to data reported by health functionaries, the coverage for all
vaccines is 100% in 1992-93. However, coverage according to Coverage
Evaluation Survey 1993 is as follows:
Vaccine
State level
District-wise range
DPT3
0PV3
BCG
MEASLES
FULLY IMMUNISED
89.9%
89.5%
90.4%
75.1%
63.8%
70 - 99%
70 - 99%
72 - 99%
50 - 95%
41 - 93%
TT2
92.3%
82 - 99%
Now the challenge is to achieve 100% coverage
verification with CES in all districts.
for all vaccines Dy
2.
Vaccine potency is above 95% for OPV indicating a high level of cold chain
maintenance in the State. The challenge is now to sustain and improve
upon the achievement.
3.
High risk mapping has indicated that most of the Vaccine Preventable
Diseases (VPD) cases are largely confined to the areas which are
inaccessible, sparsely populated, areas with migratory population, refugee
camps and urban slums, etc.
4.
According to reported figures, the prevalence of Vaccine Preventable
Diseases in Tamil Nadu is as follows:
a.
The number of NNT cases in 1992 is 56. The number of districts with
zero cases of NNT is 13.
b.
The number of measles cases in 1992 is 4873 as compared to 10029
in 1985.
25
c.
Polio incidence in Tamil Nadu has dropped from 3394 cases in 1985
to 420 cases in 1992. One district, Nilgiris, has been polio-free for the
past 3 years. Two other districts, Kamarajar and Kanyakumari, have
not reported poliomyelitis for the past one year.
d.
According to reported figures, the percentage of deliveries
conducted by trained persons is 71% in Tamil Nadu. The challenge
is now to increase this figure to >80% in all districts, blocks, HSCs,
PHCs and urban slums and verified by Coverage Evaluation
Surveys.
STRATEGIES:
A. 3
1.
Current Strategies:
a.
The fixed day strategy for providing immunisation outreach services,
catch-up rounds for increasing coverage in high risk areas where the
coverage is inadequate and a good surveillance system are the
current strategies for sustaining high immunisation coverage. These
will be continued and strengthened.
b.
Cold chain maintenance is ensured by preventive maintenance of
cold chain equipment, attendance of breakdowns within 3-10 days,
keeping sufficient stock of spares in the float assembly, lifting
vaccine samples once a month in randomly selected blocks at all
storage points for potency testing (ensuring reverse cold chain) and
recording temperatures in the cold chain equipment twice daily.
c.
Current strategies for NNT elimination include two major components
viz: improving tetanus toxoid (TT2) coverage amongst pregnant
women and promotion of clean deliveries. Districts are classified into
three categories according to NNTincidence rates, TT2 immunisation
coverage and proportion of dean deliveries by trained personnel.
d.
Current strategies for measles reduction include improving measles
immunisation coverage, strengthened routine reporting of measles
cases and deaths and epidemic management.
26
e.
2.
The current strategy for polio eradication is on effective surveillance
system, containment immunisation and ’mop-up’ rounds.
New Strategies:
a.
Overall Strategies:
Since there is high level of immunisation coverage the main thrust of
the new strategy would be to maintain this coverage in addition to
strengthening and improving the quality of services in certain areas
such as urban and high risk areas, through:
i.
Sustaining high level of coverage by fixed day strategy.
ii.
Mop up, containment and catch up rounds.
Hi.
Monitoring of proportion of immunisation sessions held is an
important strategy to sustain the high immunisation coverage
levels.
iv.
Informing the private practitioner through IMA about the
necessity to strictly adhere to the national immunisation
schedule, and norms for cold chain, maintenance and also
providing systems support to them wherever possible. For
example: vaccine supplies.
v.
Strengthening the existing surveillance system by investigation
of all neonatal deaths and suspected cases of polio and
measles; line listing of all VPD cases and auditing of all
neonatal deaths and VPDs at PHC level meetings by Medical
Officer of PHC.
vi.
Mapping of the high risk area for each district where coverage
needs to be increased. Attention to be on analysis of the
causes of low coverage, early registration of antenatal
mothers, conducting special immunisation camps/sessions to
increase coverage and ensuring that booster doses are given
on schedule.
27
3.
vii.
In all districts, promote dean deliveries by making available
disposable delivery kits to every pregnant woman well before
the expected date of delivery and training of all TBAs and
achieve 100% coverage of assisted deliveries by trained
persons.
viii.
Promote institutional deliveries at HSCs/PHCs
in rural areas.
lx.
Widespread use of interpersonal communication drives in
order to increase uptake of immunisation services and clean
delivery practices.
Specific Strategies:
a.
For Measles:
i.
Repeat dose of measles vaccine to infants immunised before
the 9th month of age.
ii.
Immunisation of children above one year of age instead of
wasting measles vaccine unusedin the immunisation session.
(To be approved as a State policy.)
Hi.
Administration of Vitamin A concentrate 2 lakh I. (J. to all
children affected by measles during outbreaks.
iv.
Ring immunisation as an outbreak response. Coverage of all
children under 3 years of age in surrounding 5000 population
in rural areas and 10000 population in urban areas
irrespective ofprevious immunisation status. (Policy clearance
required from GDI.)
v.
Correct case management of all acute respiratory infections
and post-measles complications to be ensured through
training of all health care providers, both public and private.
vi.
Strengthen routine reporting of measles cases and deaths by
making measles a notifiable disease. (Policy required.)
28
For Poliomyelitis:
b.
i.
5 doses of primary immunisation against polio will be the
norm with OPVzero dose at birth and one dose of OPV along
with Measles Vaccine, in addition to the 3 doses along with
DPT at 6, 10 and 14 weeks.
ii.
Outbreak response: One dose of OPV towards ring
immunisation to all children under 3 years of age in 5000
population surrounding the case in rural area and 10000 in
urban area within 2 weeks of outbreak. No ring immunisation
will be done after one month of outbreak.
Hi.
Mop-up rounds for 3 consecutive years in areas reporting
cases during specific low transmission months. Two doses of
OPV at 1 month interval will be given.
iv.
Catch-up rounds in urban slums, SC/ST colonies, tribal and
inaccessible areas will be conducted every year on National
Immunisation days during October, November and December.
v.
Surveillance of occurrence of cases of AFP among children.
Surveillance indicators to monitor polio surveillance.
vi.
60th day folio w-up for residua! paralysis in poliomyelitis cases.
vii.
Stool culture of polio cases for polio virus isolation.
v
29
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS
A. 4
1.
Universal Immunisation Programme launched in 1985:
a.
Coverage
The entire State is covered under UIP including all rural and urban
areas with an annual target of 11.85 lakh infants and 12.97 lakh
expectant mothers.
b.
Activities
i.
Immunisation sessions are held in all hospitals and health
centres as well as outreach sessions for every 1000
population once a month on Wednesdays throughout the
State. In addition Immunisation is available daily in large
hospitals. BCG, DPT, OPV, TT and Measles Vaccine are
provided.
ii.
Special immunisation sessions are organized on National
Immunisation days, and on other specified days in ’high risk’
areas
Hi.
Mop up rounds for polio eradication and containment
measures for polio and measles are being organized in all
districts.
iv.
An effective community based surveillance and sentinel
surveillance exists in the State.
v.
Mass media and interpersonal communication has been
extensively used for creating awareness and acceptance of
immunisation.
ISSUES TO BE ADDRESSED:
A. 5
1.
Immunisation coverage especially in slum population needs to be improved.
Though the area projects such as India Population Project V, Outreach
Services and urban ICDS projects have addressed this issue considerably,
there are certain areas where coverage is still inadequate.
30
2.
It is observed that nearly 50% of the children in the urban areas are
immunised by the private sector. This is of concern because of appreciable
non-adherence to the national immunisation schedule by a large number of
private practitioners which has adversely affected the programme. Also the
question of private sector cold chain maintenance needs closer attention
and review.
3.
The high immunisation coverage of children and its sustainenance, mop up
rounds containment measures etc., requires large quantities of vaccines.
The additional quantities of the vaccines required will have to be made
available by the Government of India.
4.
Replacement of ageing vehicles and cold chain equipments are other
problems will also require attention.
5.
The intervention presently taken up for measles reduction is providing one
dose of measles vaccine after completion of 270 days after birth. The
reports available for developing countries show clearly that this schedule
does not provide full protection. The age factor for immunizing the children
causes difficulty in the field. It has been suggested that Tamil Nadu switch
over to a 2 dose schedule.
6.
Regulation of cold chain maintenance in the private sector.
7.
Reporting of Acute Flaccid Paralysis, measles, and tetanus to be made
mandatory under Section 56 of the Tamil Nadu Public Health Act 1939.
8.
Administrative:
The ongoing programme will need to be strengthened in the following
aspects:
a.
Strengthen the fixed day strategy by ensuring full manpower strength
with appropriate training and skills at all levels.
b.
Catch up rounds will be organised for increasing coverage in
villages, hamlets, or habitations which are cut off most of the year or
where infrastructure is still poor and coverage is low.
31
c.
A.6
Analysis of immunisation coverage will be done by blocks, PHCs,
HSCs and urban slums in order to focus on low coverage areas.
KEY INDICATORS
1.
Immunisation coverage for each district, town, block, PHC, HSC, village and
month-wise through routine reporting.
2.
Coverage evaluation survey on rural and urban coverages.
3.
Proportion of planned immunisation sessions held and vaccine lifting
efficiency.
4.
Coverage in containment and mop-up immunisation against targeted
population.
5.
Cold chain break down rate and response time.
6.
Vaccine quality (OPV) through potency testing.
7.
Incidence of Vaccine Preventable Diseases.
8.
Monitoring of Surveillance indicators.
9.
Proportion of deliveries attended by trained, persons.
10.
Proportion of institutional deliveries.
32
B. 1
SPECIFIC GOAL TWO:
IMPROVING USAGE OF ORT AND REDUCTION IN
DEATHS DUE TO DIARRHOEA IN CHILDREN 0-5
YEARS AND
REDUCTION IN
DIARRHOEA
INCIDENCE BY 2000 AD.
1995: ORT use rate 100%, ORS 80%
1998: Reduce by 50% in diarrhoea deaths and 25% in incidence.
2000: Reduce to zero in diarrhoea deaths and by 50% in incidence.
SITUATION ANALYSIS:
2
B.
According to recent CES data, the ORT use rate in the State is 82% and according
to a special survey the ORT use Rate was 59.7%. Studies suggest that 65% of
children with diarrhoea are taken out of the home for consultations. Of these, 80%>
seek care from private sector 'health providers’.
■
The incidence of diarrhoeal diseases among 0-5 year children varies in different
surveys. According to the latest CES (1993), incidence in the "previous two weeks"
was 1.3%. As per a special survey conducted by the DPH&PM in 1991, the two
week incidence was found to be 1.74%.
Current challenge is to ensure that ORS is widely available (particularly at critical
periods during the year such as the diarrhoea season from June to August) and
to mobilise the private sector manufacturers and health providers for promoting
the use of ORS.
Decisions to ban irrational preparations including anti-diarrhoeals was taken
recently by the National Drug Controller.
3
B.
STRATEGIES:
1.
Current Strategies
a.
Propagation of ORT: Culturally acceptable home fluids have been
identified and included in programme training materials. These now
need to be communicated much more widely.
•if-
33
2.
b.
ORS is made available at village level through the Health, ICDS and
TiNP functionaries.
c.
Training of Medical Officers and Health Functionaries on correct case
management of diarrhoeal diseases is being organised through the
CSSM programme.
New Strategies and Activities:
a.
24 hour availability of ORS can be ensured through depot holders
in each village and urban slum. These depot holders can include
school teachers, TBAs, and Members of Women’s Groups or
Panchayat members besides the Health and Nutrition functionaries.
The depot holders need to be trained in correct management of
diarrhoea.
b.
Promote ORS use rate among public and private sector medical
practitioners for all cases of diarrhoea coming for treatment.
c.
Promote use of home available fluid (HAF) by all mothers at
the first sign of diarrhoea and timely referral for management
of dehydration.
d.
Promote correct case management of diarrhoea in all public sector
health facilities and in the private sector through the IMA and IAP.
Alliances with IMA and Rural Medical Practitioners offer considerable
potential for achieving change in the prescription and treatment
practices in the private sector. Pressure to be mounted for change
in prescription practices through increased consumer awareness on
correct treatment practices.
e.
Promote washing of hands, protection of household water, proper
disposal of child faeces as actions to prevent diarrhoea.
f.
Propagate the concept of continued and additional feeding during
diarrhoea. Breast-fed infants should continue to get more frequent
breast feeds. Older infants should receive usual foods but an
additional feed is recommended for at least two weeks after
recovery.
34
g.
One dose of Vitamin-A 200,000 IU to be given after each episode of
diarrhoea.
h.
Propagation of the use of OPS for dehydration.
i.
The WHO (citrate) formula only is recommended.
ii.
OPS packets must be made available with depot holders, (at
least one depot holder in each village and urban slum).
Information, Education and Communication activities to focus on the
following aspects:
i.
i.
Mass media publicity: messages to be transmitted during
prime time on TV/radio.
One minute spots are to be
prepared.
ii.
Interpersonal communication by health and nutrition workers,
and local opinion leaders such as teachers etc.
Hi.
One day workshops for IMA/IAP/GP on Standard
Management of Diarrhoea and Dehydration to be organised
at district level. The concept of not using antibiotics and anti
motility drugs for acute diarrhoeal diseases is to be
emphasized. The workshops are to be conducted once in six
months.
iv.
' Mothers to be taught to start giving HAF if the child has any
alternation in the fluidity and frequency of stools.
v.'
Provision for display of standard diarrhoea management
charts in all health/nutrition facilities.
vi.
Preparation of booklet on Prevention and Management of
Diarrhoea for school children.
C)'"-
-■-v .
-... atoocA
35
4
B.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
CSSM/MCH/TINP/ICDS/DANIDA/IPP-V/DTTUs
1.
Coverage:
Entire State with main target population being 0-5 year children and
mothers for education regarding HAF.
2.
Current activities:
These include:
3.
a.
Provision of ORS supply to all village depot holders, HSCs, PHCs
and hospitals.
b.
Training of health functionaries (Medical Officers and Health Workers)
on correct case management of diarrhoea.
c.
Community education to mothers and women’s groups on home
management of diarrhoea with special reference to use of home
available fluids, use of ORS, continued and additional feeding and
timely referral.
d.
Establishment of Diarrhoea Treatment and Training Units (DTTUs) in
all teaching hospitals and district hospitals as per GO! guidelines.
New Activities
(Details are primarily covered in the Chapters on Water Supply and
Environmental Sanitation)
a.
Provision of latrines to all schools, anganwadis, noon meal centres,
HSCs and also in urban slums and ST/SC areas in villages.
36
B. 5
b.
Provision of safe drinking water and storage facility in schools (pot
with cup with long handle) and also HSCs.
c.
Production of additional communication materials for training and for
mass education activities.
d.
Increased coverage of drinking water supply and environmental
sanitation.
ISSUES TO BE ADDRESSED:
Change in purchase regulations to allow local purchase. Currently, all ORS is
supplied by GOI. In order to facilitate regular and smooth supplies at local levels,
it is suggested that State Governments be allowed to purchase locally. In addition,
the purchasing policies of Government of Tamil Nadu to be simplified so that local
purchase at District, PHC or town level may be possible.
6
B.
KEY INDICATORS
1.
ORS availability with depot holders at any given time.
2.
ORS availability in all immunisation sessions, institutions and outreach
sessions.
3.
ORT use rate (through Coverage Evaluation Survey).
4.
Continued feeding rate during diarrhoea (through Coverage Evaluation
Survey).
5.
More fluid intake rate during diarrhoea.
6.
% of cases of diarrhoea among 0-5 year children who are taken to a health
facility who receive ORS from any provider (through Coverage Evaluation
Survey).
7.
% villages and urban slums with depot-holders having ORS stock at time
of survey.
37
1
C.
SPECIFIC GOAL THREE:
,
TO REDUCE MORTALITY RATES DUE TO
ACUTE RESPIRATORY INFECTIONS (ARI)
AMONG 0-5 YEAR CHILDREN BY 50% FROM
THE CURRENT LEVEL OF 30% TO 15% BY
2000 AD.
1995: Reduce AR! mortality from current level of 30% of child deaths to 20%.
1998: Reduce ARI mortality to 18%.
2000: Reduce AR! mortality to 15%.
2
C.
SITUATION ANALYSIS:
Acute Respiratory Infections are a major cause of infant and child mortality
carusing 30% of all 0-5 year deaths especially now that high ORT use rates in Tamil
Nadu have resulted in less diarrhoea mortality. As with Diarrhoea, mothers prefer
to seek the help of private sector health providers. ■
The prevalence of ARI is more in urban areas than in rural areas due to
overcrowding and air pollution.
3
C.
STRATEGIES:
1.
Current Strategies:
Medical and paramedical staff were trained in the standard case
management and supply of Co-trimoxazole to the female Health Worker.
Only one district, Ramnathapuram, was covered.
Under CSSM programme, field health functionaries of North Arcot
Ambedkar, Dharmapuri, Tirunelveli Kattabomman QM, Ramnathapuram
districts have been trained for correct case case management of AR! cases
as part of CSSM package other districts will be taken up for training in a
phased manner. Supply of Cotrimoxazole tablets have been made to all
female health workers.
2.
New Strategies:
a.
Training of Health care providers, both public and private sector on
correct case management of ARI.
38
4
C.
5
C.
b.
Mass communication activities to be undertaken through mass
media and through interpersonal communication through
TINP/ICDS/CMNMP/CSSM programmes to enhance use of services.
c.
Promotion of home management of mild infection and timely referral
to a health worker or an appropriate facility.
d.
Providing antibiotics and other facilities to ensure correct case
management of API at all health care facilities.
e.
Transportation of cases to referral centres to be supported through
some form of community action preferably through the Panchayat
System.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
1.
Coverage: To be phased as part of CSSM package.
2.
Activities:
a.
Current activities include ARI training as part of CSSM training for
Medical Officers and health workers. 8 districts have been covered
so far and the entire State will be covered by 1997. Co-trimoxazole
has been supplied at all HSCs throughout the State.
b.
New activities to include providing facilities for managing pneumonia
at FRUs and clinical skill training for health and nursing staff at
FRUs.
ISSUES TO BE ADDRESSED:
1.
Adequate supplies of co-trimoxazole to be made available at all health
facilities.
2.
Supplies for FRUs to be sought from T1NP funds.
3.
Panchayat funds to be made available for transport costs for delivery in
institutions.
39
KEY IND!CA TORS:
C. 6
1
D.
1.
% districts covered with AR! training and supplies.
2.
% AR! cases managed correctly at health facilities.
3.
Proportion of mothers who recognise referral signs.
4.
Trends in ARI mortality as contributor of infant and child mortality.
SPECIFIC GOAL FOUR: TO REDUCE PERINATAL AND NEONATAL
MORTALITY RATES (NNMR) BY 50% FROM
CURRENT LEVELS BY 2000 AD.
1995: Reduction of perinatal and NNMR by 30% from 1990 level.
1998: Reduction of perinatal and NNMR by 40% from 1990 levels.
2000: Reduction of perinatal and NNMR by 50% from 1990 levels.
Components of Infant Mortality Rate
Tamil Nadu
TRENDS
GOALS
Perinatal + Neo-natal ^Perinatal
Source: Routine Surveillance, DPH 4 PM
Neo-natal
40
2
D.
SITUATION ANALYSIS AND CHALLENGE:
Currently 70% of infant mortality is in ihe neonatal period. Low birth weight, birth
asphyxia and infections are important causes of neonatal deaths.
Still birth rate is also high, contributing to a high perinatal mortality rate.
50% of births are still conducted by untrained personnel in rural areas indicating
the need to train traditional birth attendants and promote institutional deliveries.
Facilities for basic essential newborn care are not available in rural areas and
grossly inadequate in teaching and training institutions.
In urban areas, institutional deliveries are more than 90% and consequently,
perinatal and neonatal mortality is less. Ho we ver, prematurity, Io w birth weight and
neonatal infections continue to be a problem.
3
D.
STRATEGIES:
1.
Current Strategies:
a.
Under CSSM programme all field Health functionaries are being
trained in a phased manner for safe delivery and new born care.
b.
Disposable delivery kits are being supplied to all field health
functionaries. Traditional birth attendants for safe delivery and new
born cases.
c.
AH Traditional Birth Attendants in North Arcot Ambedkar and Nellai
Kattabomman district were trained for conduction of safe delivery
and giving new born care under safe motherhood project.
d.
Supplementary feeding is given to all ante-natal mothers under
TINP/ICDS projects for improving the health and nutrition of the
mother and as the growing baby.
41
New Strategies:
2.
a.
Low cost neonatal care units for referral care of newborns to be
established in all district and taluk hospitals in the entire State.
b.
Home care of newborn infants (LBW infants) by promotion of early
breast feeding, colostrum feeding, provision of warmth, prevention
of infection and exclusive breast-feeding.
c.
Training of TBAs/Health workers on simple resuscitation techniques
for management of birth asphyxia.
d.
Recognition of high risk newborns for referral. High risk factors
include birth weight below 2 kg, jaundice, respiratory distress and
congenital anomalies.
1
4
D.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
CSSM/1PP- V/TINP/ICDS
1.
Coverage:
in 8 districts under CSSM, training on newborn care has been given to all
medical officers and health workers.
2.
Current Activities:
Limited to training of Medical Officers and female health workers.
3.
New Activities:
a.
Newborn care to be included in IPP-V/TINP/ICDS and adequate
resources to be allocated for training, equipment, drugs and supplies
for District and Taluk Hospitals, PHCs and HSCs.
b.
Education of community to include home care of LBW infants, early
initiation of breastfeeding and colostrum feeding, providing warmth
and timely referral.
42
4.
5
D.
Budget
a.
IPP-V to provide funds for infrastructure, equipment, drugs and
supplies at all district and taluk hospitals for strengthening
emergency obstetric care and newborn care.
b.
TINP/DANIDA to provide funds for IEC.
c.
UNICEF to provide funds for skill training at FPUs.
ISSUES TO BE ADDRESSED:
1.
Policy to establish neonatal care inputs at all First Referral Units (district and
taluk hospitals).
2.
A state level Task Force will need to be instituted to operationalise the FRUs
for improving Emergency Obstetric Care and Newborn Care.
KEY INDICA TORS
D. 6
1.
% FRUs having facilities, staff, skills and supplies for Emergency Obstetric
Care and Newborn Care.
2.
Perinatal mortality trends.
3.
Stillbirth rate trends.
4.
Neonatal mortality trends.
43
1
E.
SPECIFIC GOAL FIVE:
TO ACHIEVE A 50% REDUCTION IN THE
INCIDENCE OF HIV INFECTION ESTIMATED FOR
2000 AD.
1995:
*
*
*
*
*
*
*
*
All blood banks in the state (both private and public) to screen
every unit of blood for HIV.
STD control facilities strengthened in all district and taluk
hospitals/teaching institutions and PHCs.
Availability of condoms increased to 500% of current supply.
Increase condom use rate for non-famity planning purposes.
>80% youth made aware of basic facts about HIV/AIDS and how
to prevent it.
50% of all towns covered with high risk intervention programmes
through NGOs.
100% of health workers to be trained in HIV/AIDS and practising
preventive and protective procedures eg. sterilisation and use of
gloves, syringes, needles and other obstetric instruments.
All known HIV+/AIDS cases provided adequate care.
1988:
*
*
*
*
*
*
Sustain blood safety achievements.
STD prevalence to be reduced by 50% of 1990 levels.
Production and distribution to ensure condom availability
according to estimated requirements.
100% of youth made aware of HIV/AIDS.
100% of towns covered by high risk intervention programmes
through NGOs
Ail known HIV+/AIDS cases provided care.
2000: 50% reduction in estimated incidence of HIV+.
2
E.
SITUA TION ANAL YSIS:
Tamil Nadu features second in the country for HIV/AIDS prevalence with 4,900
persons HIV+ and 150 persons with AIDS. 5.5 lakh persons were tested so far
for HIV. The projection for Tamil Nadu indicate a rising trend with an estimate of
1 million H/V+ and 1 lakh AIDS by 2000 AD.
44
Unless HIV/AIDS prevention and control programmes are implemented speedily,
the gains achieved in health indicators may be nullified. CDR, IMR, common
infectious diseases especially Tuberculosis, will rise and there will be a heavy
burden on medical institutions with concurrent rise in health care costs. AIDS
orphans, AIDS in newborns and rising incidence of HIV/AIDS among women will
specifically affect the status of children.
3
E.
STRATEGIES
A very well defined strategy has been developed for HIV/AIDS prevention and
control by NACO/State AIDS Cell with eight programme components.
It is proposed that initial focus of activities be in urban areas. Urban areas are of
crucial importance in HIV/AIDS because there is a concentration of:
all blood banks
most hospitals
most colleges/high schools
commercial sex industry
4
E.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
The Tamil Nadu AIDS Control and Prevention Programme started in 1989.
1.
Coverage: The programme is planned to cover the entire state.
2.
Activities:
a.
Programme management: An AIDS Cell has been established with
staff appointed as per NACO guidelines. An Empowered Committee
has been formed and programme is underway.
b.
Control of Sexually Transmitted Diseases (STD) is being addressed
by strengthening of Taluk, District and Teaching Hospitals and
extending STD care services to PHCs.
c.
Blood safety is being addressed by legislation to enforce HIV
screening at all blood banks.
45
3.
5
E.
d.
Public awareness is being created through Mass media and social
mobilisation of youth in colleges, schools and NFE centres. Training
of all health and health related functionaries is being planned.
e.
Surveillance/research centres are being strengthened to help study
trends in the HIV infection.
f.
Condom promotion is being undertaken through public and private
sectors.
g.
Reduction of impact by improving hospital infection control practices
are being done through training of health functionaries.
Budget Available:
USAID : 10 million dollars (for activities by NGOs)
NACO
: 111 lakh rupees (1993-94)
WHO
: 123 lakhs (1990-93)
ISSUES TO BE ADDRESSED:
1.
Existing legislation on blood safety measures in private and government
blood banks to be made more stringent.
2.
To include HIV/AIDS in the formal curriculum and text books in schools and
colleges.
3.
Administrative:
a.
State level coordination committee to be formed and regularised.
b.
Funds allocated by NACO/other donors can be managed by a
registered society rather than through government to facilitate
speedy implementation.
KEY INDICA TORS:
E. 6
1.
% of blood banks implementing safety measures.
2.
STD/AIDS/HIV prevalence trends.
3.
Condom availability/sales.
4.
KAP trends among various target groups.
5.
Proportion of health functionaries using protection procedures.
Chapter Two:
MATERNAL HEALTH
46
MATERNAL HEALTH
2.
MAJOR GOAL:
1995: REDUCTION OF MMR BY 25% OF 1990 BASE LEVEL.
1998: REDUCTION BY 50%.
2000: REDUCTION BY 80%.
Maternal Mortality Rate
Tamil Nadu
~~~ Trends
Source: Routine Surveillance, DPH & PM
£3 Goals
47
I.
II.
SPECIFIC GOALS:
1.
Prevent pregnancies below 21 years; ensure birth interval of a minimum of
3 years and restrict total number of births to 2.
2.
Ensure 100% coverage with antenatal care, 100% births attended by trained
attendants and referral facilities for high risk pregnancies and obstetric
emergencies available for every 3-5 lakh population.
3.
Improve nutritional status of women by increasing pre-pregnancy weight to
. >42 kg, by reducing prevalence of anaemia during pregnancy by 30%,
eliminating Vitamin-A and iodine deficiencies, and ensuring adequate weight
gain of more than 7 Kg. during the period of pregnancy
(See Chapter on Nutrition for details)
4.
Ensure accelerated literacy programmes for women and universal access
to primary education for girls.
(See Chapter on Education for details)
SITUATION ANALYSIS AND CHALLENGES:
The MMFl is 3/1000 live births (SRS 1990). The MMR according to civil registration
system is 1.4 for 1991 which is not reliable. Most social indicators including the sex
ratio (972/1000 males) and literacy (51% for female and 73%> for male) point to the
depressed status of women in the state.
Socio-cultural bias combined with poverty weigh heavily on women who marry
early and bear children young and bear too many children, and who work for long
hours in the house and outside with unequal access to heath and nutrition,
educational and other opportunities, as well as insufficient legal protection and
social and political participation.
ljuabifthj hmlhUon: 7c pvevenV ov Uch>
W< ftmneibon ©v |v»e disease pwccss jp«vh
...4© V>©wd)C
*p
.
l^y)O’s¥'(Y)WV :
„,j
'OV
Arwy \.0£&
Ofc fundio
*
p.bvi ©YWS li
'
•
VlSlW f MR ,
c,;«l
C»»>
"
5iS»cxbU<Hj : ?>eoj^iR
on
r>$ecW |xvb©v>
vmy be
*mj
Ga
iwipoiirivienV
unoAle t©
' c^m
a eft vi He© cone icU^d
*
+»•
a^c,
W
0
*
$e
•
pev^w
expevicnw entain
in
cv^d is h©4 able
•U ducha»rj2 W ©bV^aVie^s vecyuuvecl
*tow qwd
of Vwfn ivt a
'•
•
.
Hie vole . <x pecM
society.
•
*■
’ *r .<
InHYvew+icn i*
chtablttty; - MCehC^I
.
<
A
social Qnd envivonbocnM
''••'’ v«np^iYwwvik
DuabHlfy and fcndi&lp
48
///.
STRATEGIES
1
A.
SPECIFIC GOAL ONE:
PREVENT PREGNANCIES BELOW 21 YEARS;
ENSURE BIRTH INTERVAL OF A MINIMUM OF
THREE YEARS AND RESTRICT TOTAL NUMBER OF
BIRTHS TO TWO.
Reduce Crude Birth Rate to 18/1000.,
Reduce % pregnancies below 21 years by 50%
Ensure average birth interval is 3 years.
Reduce average parity to 2.
1995:
*
*
*
*
1998:
*
Reduce Crude Birth rate to 16/1000.
*
Reduce pregnancies below 21 years to zero.
*
Ensure minimum birth interval is 3 years.
*
Ensure minimum parity is 2.
Reduce Crude Birth rate to 15/1000.
2000:
Crude Birth Rate
Tamil Nadu
—~ Trends E3 Goals
Source SAS (1975-1991)
49
Total Fertility Rate
Tamil Nadu
Year
Trends ®Goa/s
Source: SRS (1975-1989)
2
A.
SITUATION ANALYSIS AND CHALLENGE:
The crude birth rate is 20.8 in 1991 according to sample registration scheme.
Pregnancy and childbirth is the major cause of mortality and morbidity among
women in the child bearing age group. Prevention of pregnancies especially those
pregnancies that are too early, too closely spaced, toojnany and too late will have
a significant impact irTprsventiofTofniaternal deaths and morbidity. ~~
Teenage deliveries constitute around 25% of all deliveries. The third para and
above still constitute 40% of total births. Thus, the challenge is to delay age of
marriage and first pregnancy, space pregnancy/birth intervals and reduce the
number of pregnancies for each woman.
50
It is now being recognised that achievement of sterilisation targets and 'couple
protection' rates do not absolutely correlate with trends in birth rates. Factors that
tend to influence the prevention of births are many:
1.
Literacy and educational status of women.
2.
Age at marriage being above 21 years.
3.
Chances of survival of children as influenced by birth weight >3 kg, the
inter pregnancy interval >3 years.
4.
The child bearing age concluded by 27 years.
5.
The contraception prevalence rate.
A. 3
STRATEGIES:
1.
Current Strategies:
Current national strategies focus predominantly on contraception and more
specifically on sterilisation. The programme is very much target oriented
and incentive based.
In Tamil Nadu, the Family Welfare Programme has received the highest
political and administrative support. Family planning services are widely
available through postpartum centres in hospitals and through laporoscopic
camps. MTP services are available at PHCs and IUD services are available
at PHCs and HSCs. Oral contraceptives and condoms are made available
at village level by the VHN.
Notwithstanding the efforts of the Government of Tamil Nadu to make
available a wide range of contraceptive services, the community acceptance
of birth spacing methods is negligible and the thrust of the programme still
focusses on female sterilisation. Male sterilisation through vasectomy has
more or less disappeared.
51
A number of incentive schemes are available that attempt to address some
of the factors such as male preference, early marriage, <female education
etc.
2.
a.
Cash advance of Rs.5,000 to couples at marriage, provided the bride
is educated upto 8th standard and married after completion of 18
years of age.
b.
Rs.2000 is deposited as fixed deposit to the second female child if
one parent adopts permanent method of contraception; in order to
dissuade the desire for male child. The amount so deposited is
given at various stages of the child’s education and finally at maturity
Rs. 10,000 (20 year fixed deposit) is paid. On a whole the child gets
Rs.20,000 from this scheme.
c.
Under Dr. Muthutakshmi Reddy Maternity Benefit Scheme, a
pregnant woman upto second pregnancy is eligible to get Rs. 300 for
improving nutritional status during last trimester of pregnancy and
early postnatal period.
d.
Training and self employment opportunities are created for girls so
that the age at marriage is postponed indirectly.
e.
To increase literacy in women and also create employment
opportunities for women, Government has appointed women
teachers for all primary schools.
f.
The VHN is encouraged by an incentive of a gold coin if no women
in her area of 5000 population gives birth to a third child.
New Strategies:
A major shift is needed in communications, from the focus on smalt family
norm and population control to acceptance of family planning for the health
of the mother and child.
A major change in strategy is needed from the focus on female sterilisation
to a broad ’cafeteria’ approach with availability of a wide range of
contraceptive services from which couples can choose appropriate
methods.
52
A major change is needed in strategy to address the various factors
influencing reproductive behaviour such as age at marriage (to be above
21 years), female literacy (to be 100%), the birth weight (to be >3 Kg), the
birth interval (to be >3 years), child bearing period (to be concluded by 27
years).
The registration of marriages should be made compulsory.
The incentives system for family planning adoption should be stopped
Instead it should become a people’s movement. The Panchayat may be
encouraged to take up leadership and responsibility for achieving the health
and nutrition goals with special reference to mothers and children. Funds
may be allotted for health care and development activities and communities
that have achieved certain goals may be given wide recognition and
publicity.
Health camps for adolescent girls may be organised in order to increase
awareness on health and nutrition, to ensure Tetanus Toxoid immunisation
to be given in the pre-pregnancy stage, to ensure supplementation with iron
or iron rich foods to prevent/treat anaemia, to ensure supplementation with
Vitamin A or Vitamin A rich foods, ensuring iodised salt consumption,
ensuring adequate nutritional intake to attain a pre-pregnancy weight of 42
kg, to enable the adolescent girl to acquire skills and knowledge in relation
to maternal and child health care.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
A. 4
CSSM/IPP- V/TINP/ICDS/DANIDA
1.
Coverage:
a.
Child survival and safe motherhood programme is implemented
throughout Tamil Nadu in a phased manner.
b.
IPP-V is extended to 25 urban centres.
c.
TINP/ICDS/DANIDA projects are implemented in most of the areas
of Tamil Nadu.
C W ' ' CTO
09821
53
2.
3.
Current Activities:
a.
Family Planning Services:
In urban areas, family planning
sterilisation services are made widely available through Postpartum
Centres, IPP-V, outreach centres and local body MCH centres. In
rural areas, laparoscopy camps are conducted to reach those
women who are unable to reach an urban centre. MTP (Medical
termination of pregnancy) training is given to all MOs at PHCs and
hospitals. IUD training is given to all VHNs so that the services of
contraception are made available at village itself. Ora! contraceptives
and condoms are made available at the village level by the VHN.
b.
Maternal Health care: All pregnant mothers are given antenatal
care from 12-16 weeks onward.
c.
Community Education: Regular Orientation training camps are
conducted. Home visits and mothers meetings are conducted by
VHNs to increase the awareness and knowledge level of mothers
and to motivate them to accept family planning services.
New Activities/Approaches:
a.
Existing activities to be strengthened in the following aspects:
i.
Early registration of pregnancies to be ensured so that
unwanted pregnancies can be detected and referred for
medical termination.
ii.
The nutritional status of mother during pregnancy needs to be
addressed more effectively through a better designed
intervention programme. The objective will be to ensure a
minimum weight gain of 7 kg during pregnancy, ensure a
birth weight of 3 kg. and control and prevention of anaemia,
Vitamin A deficiency and iodine deficiency.
Hi.
First referral units to be equipped to provide emergency
obstetric care and referral linkages to be developed to ensure
that all referred cases actually reach the referral facilities and
avail of appropriate care
54
iv.
The availability of oral pills and IUDs to be enhanced without any
interruption throughout the year.
b.
Change in camp approach for sterilisation to providing the service
throughout the year.
c.
Weekly family welfare services day to be observed to popularise different
available contraceptive techniques and facilitate dialogue with potential
acceptors at village level.
A. 5
ISSUES TO BE ADDRESSED:
1.
Incentives for family planning to be removed.
2.
Programmes to be planned jointly by concerned sectors and departments
in a coordinated fashion to address the issues of age at marriage, female
literacy and education, female employment, birth interval, birth weight, age
at last birth, and availability of a range of contraceptive services.
3.
Particular attention to be focused on organising women at village level for '
enabling health action by all members of the community through peer
pressure
\
KEY INDICA TORS:
A. 6
1.
Average age at first delivery.
2.
% of third para births.
3.
Average birth interval/proportion of births with 3 year interval.
4.
Crude birth rate.
5.
Coverage with birth spacing methods.
55
1
B.
SPECIFIC GOAL TWO:
ENSURE 100% COVERAGE WITH ANTENATAL
CARE, 100% BIRTHS ATTENDED BY TRAINED
ATTENDANTS AND REFERRAL FACILITIES FOR
HIGH RISK PREGNANCIES AND OBSTETRIC
EMERGENCIES AVAILABLE FOR EVERY 3-5 LAKH
POPULATION BY 2000 AD.
1995: **
*
*
*
Reduce MMR by 25% of 1990 levels.
Ensure 100% antenatal care coverage.
Ensure >80% births attended by trained persons.
Ensure referral facilities for emergency obstetric care for every 35 lakh population in 50% districts.
1998: *
*
*
Reduce MMR by 50% of 1990 base.
Ensure 100% births attended by trained persons.
Ensure referral facilities for emergency obstetric care for every 35 lakh population in 100% districts
2000:
Reduce MMR by 80% of 1990 base.
2
B.
SITUATION ANAL YSIS AND CHALLENGE:
Presently antenatal registration and TT coverage are very high in the state, both
in rural and urban setting.
The institutional deliveries are more than 90% in urban areas and about 50% in
rural areas. Deliveries by untrained birth attendants continue to be quite high in
rural areas with home deliveries conducted under non-aseptic conditions. Most of
the houses in the villages have single rooms and thatched huts especially in SC/ST
colonies.
3
B.
STRATEGIES:
1.
Current Strategies:
The strategies for improving health and nutritional status of women during
pregnancy, childbirth and postnatal period are very clear and well defined.
However, the operationalisation of these strategies has been a problem.
56
The health infrastructure developed in the state to manage the MCH
services to promote institutional deliveries especially in the rural areas is not
satisfactory on many fronts. Only 50% of Health sub-centres have building.
Even where buildings are available, they are not occupied by VHN, due to
many reasons such as undesirable locations. Many sub-centres are not
provided with water supply, electricity and required equipment to provide
quality ante natal care services. The sub-centres in rental buildings also are
not able to provided institutional deliveries due to socio-cultural reasons and
taboos. The buildings which are occupied by the VHN are not being
maintained for want of funds.
The referral services are not functional due to lack of skills to detect risks
in pregnancies, unavailability of emergency transport facilities from the
villages and non-availability of adequate facilities at the first referral units to
handle emergency obstetric care.
Therefore, it is recommended that these various resource and administrative
problems be addressed immediately to enable access of quality care to
mothers.
2.
New Strategies:
It is proposed that a ’delivery booth’ ie., a small well- constructed building
with necessary facilities such as water, electricity- and stone/cement floor is
made available at every village/hamlet or habitation perhaps through
Panchayat funds so that trained TBAs can conduct deliveries under aseptic
conditions.
Community action for emergency transportation will be encouraged to
address the problem of obstetric referral. The women Panchayat members
will be motivated to design a locally appropriate plan for making available
the transport facilities to reach the nearest functional referral centres in
times of need and emergency.
57
4
B.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
CSSM/UIP/TINP/DANIDA/IPP- V
1.
2.
3.
Coverage:
a.
CSSM programme in 2 districts (North Arcot
Tirunelveli districts).
b.
UIP plus in all other districts of the state in phased manner.
Ambedkar and
Current Activities:
a.
A minimum of five ante-natal check-ups during pregnancy are done
for providing various ante natal services and to detect the "risks" and
"complications" during pregnancy at an early stage for timely referral.
b.
Universal immunization of pregnant women with 2 doses of
TT/booster are provided.
c.
The village level ICDS/TINP/CMNMP functionaries are being actively
involved to assist the VHNS in effectively reaching all mothers with
MCH services such as immunization,
micro-nutrient
supplementation, clean delivery and care at birth and immediate
postnatal period and management of ADD and ARI care in infants.
d.
Disposable delivery kits are used for conducting aseptic deliveries.
e.
Traditional birth attendants are trained to ensure aseptic deliveries.
New Activities:
a.
The TBAs will be retrained for providing aseptic deliveries. They will
be given an incentive of Rs. 10 as reporting fee for the deliveries
conducted by them.
58
b.
The first referral units will be identified one for every 3-5 lakhs
population (taluk or district hospitals) and will be strengthened to
handle emergency obstetric care by providing additional
infrastructure (if needed), equipment, drugs, supplies and skill
training to the medical officers in emergency obstetric care, neonatal
care, blood transfusion techniques and anaesthesiology.
c.
Developing and strengthening the management information system
for MCH services by utilising the Nicnet computer facilities.
ISSUES TO BE ADDRESSED:
B. 5
1.
Sub centres and PHC buildings should be constructed.
2.
Maintenance of all HSC and PHC buildings should be done by identifying
an agency and by providing adequate budget annually.
3.
Essential equipment and supplies should be provided to improve quality of
services at HSC, PHC and FRU level.
4.
Under Government of India programme of CSSM, Tamil Nadu will be
supported only for two districts for strengthening Safe Motherhood
activities. The State Government has to extend this to all remaining districts
by utilising funds from Area Projects like TiNP/iPP-V/ DANIDA/SIDA-ICDS.
5.
Out of 1,417 functioning PHCs in the state, only 40% have vehicles. All
PHCs should be provided with vehicles for better health care delivery.
6.
To improve the Health Management and Information System, all District
Health Officers should be provided with a personal computer with printer
and terminal connection to DISNIC.
59
KEY INDICA TORS:
B. 6
1.
% of antenatal registrations done in first trimester.
2.
% of TT-2 coverage.
3.
% of cases referred to FRU.
4.
% of referred cases managed appropriately at FRUs.
5.
Maternal Mortality Rate.
6.
Still birth rate, Perinatal and neonatal mortality rates.
7.
% of deliveries by trained attendants.
8.
% of institutional deliveries.
Chapter Three:
NUTRITION
60
3.
MAJOR GOAL:
I.
NUTRITION
REDUCTION IN SEVERE AND MODERA TE MALNUTRITION
AMONG CHILDREN BETWEEN 1990 LEVELS AND THE
YEAR 2000.
SPECIFIC GOALS:
1.
Reduction in severe Energy Protein Malnutrition (EPM) to less than 3% and
moderate EPM to less than 15% among under-5 children.
2.
Reduction in incidence of low birth weight (2.5 kg. or less) babies and
increase in mean birth weight to 3 Kg.
3.
Reduction in severe malnutrition among 6-14 year children by half of current
levels.
4.
Reduction of iron deficiency (anaemia) in pregnant women adolescent girts
and children 0-5 years.
5.
Universal consumption of iodised salt.
6.
Elimination of Vitamin-A deficiency and its consequences including
blindness.
Objectives:
1.
Empowerment of all women to breast-feed their children exclusively for four
to six months and to continue breast-feeding with complementary food, well
into the second year.
2.
Growth promotion and its regular monitoring to be institutionalised.
3.
Dissemination of knowledge and supporting services to increase food
production to ensure household food security.
61
II.
SITUATION ANALYSIS AND CHALLENGE:
Tamil Nadu has seen a decade of fairly successful nutrition programmes for
vulnerable groups and unmatched investments in the nutrition sector. The results
are visible in the more than one-third reduction in severe malnutrition among
children. Yet moderate and severe malnutrition continue to aggravate major
causes of infant mortality. Mild, moderate and severe malnutrition put together
continue to affect more than 70% of child population under-five with approximately
a tenth of them suffering from severe malnutrition.
The consumption levels for protein and energy has declined from 1975-79 levels.
Average consumption (CU/day) of protein has declined from 55 to 46 grams and
of energy from 2,275 to <1,900 calories during 1975-90 (NNMB). The marginal
increase in consumption of green leafy vegetables still leaves the gap in
micronutrient deficiencies unbridged. Though there is a reduction in severe ocular
manifestations of Vitamin-A deficiencies, many young children continue to suffer
from milder damages to vision and possibly other adverse effects of Vitamin-A
deficiency.
Severe malnutrition is estimated to be around 4-8% in different districts while
moderate malnutrition (weight for age, IAP classification) is estimated to be around
25-30%.
However, a decline in levels of all types of malnutrition was experienced during the
late 1980s. Rates of decline was relatively slow at an estimated 0.5% per annum
with severe malnutrition declining at a faster rate.
Low birth-weight rate reported at 30% has not declined over the last three
decades suggesting a need to focus attention on problems of maternal health and
nutrition. Major contributing factors to extensive malnutrition include continued
population growth (itself a part function of improved levels of child mortality), early
pregnancy/short birth intervals, infection, with low mean age at marriage.
While only 48.7%> births take place in hospitals, these institutions play an important
role in establishing norms in infant feeding practices likely to be emulated
elsewhere by health professionals.
62
The use of infant formula and feeding bottles is increasing and counselling on
breast-feeding during antenatal care as well as assistance after delivery and after
discharge remains rare - 26% continuing breastfeeding rate in urban and 45% in
rural.
The Baby Friendly Hospital Initiative programme started in May 1992 and 21
hospitals in the State have been declared "baby-friendly" by the National Task
Force in March 1993 out of a total of 30 nationally. This is a record for Tamil
Nadu.
In terms of determinants of child nutritional status, factors vary considerably across
settings including insufficient availability of food; skewed distribution of food within
the household, and inadequate care contributed by lack of time, skills and
knowledge of the mothers. In many drought prone or tribal areas, household food
insecurity remains a problem, particularly in certain seasons.
In Tamil Nadu, 50% of pregnant women and 40%> of children 0-5 years suffer from
anaemia. This has been a major and chronic problem and there is no declining
trend, it is related to general levels of female malnutrition and reflects less access
to food and iron rich food; greater loss through menstruation, frequent child birth,
worm infestations and greater physical stress and burden. The adverse effects of
malnutrition and anaemia among women are: an increase in maternal mortality,
a high incidence of children bom with low birth weight and general loss of
productivity of women in particular and society in general. As a prophylactic
measure, iron fortified salt is used in noon meal centres. The current production
is 6,000 MT annually.
tn Tamil Nadu state, data is not available on prevalence of iodine deficiency
disorders (IDD).
However, scattered studies in a few districts such as
TiruchirapaUi, Niigiris and Pudukottai have shown an endemic pattern ofprevalence
of goitre. Other indicators such as high frequency of abortions, high incidence of
premature birth, low birth weight and still births show that there may be a much
higher level of iodine deficiency in the State than is currently officially
acknowledged.
Iodised salt is being produced in the State by private
manufacturers, in Tamil Nadu, the Salt Department of Government of India has so
far permitted 46 plants with a capacity of 500,000 MT for manufacture of iodised
salt. However, the actual production is only about 100,000 MT for want of
demand.
63
Various surveys in the state done by the NNMB have shown that percent
prevalence of Vitamin-A deficiency signs has declined from 1.9% among preschool
children and 5% among 5-12 year children in 1981 to 1% and 2.7% respectively
in 1991. Vitamin-A deficiency was found to be more prevalent among boys than
girls. No urban-rural difference has been found. Vitamin-A deficiency is generally
linked to malnutrition and the adverse effects include increased morbidity and
mortality.
The nutritional status of children 6+ to 14 years has not been systematically
documented though a school health programme is operational in the state.
Existing data indicate that malnutrition including micro nutrient deficiencies is
prevalent and the situation calls for specific focus on this age group as well
including programmes to cover children out of school.
III.
STRATEGIES:
A.
CURRENT STRA TEG1ES:
The current strategies include regular growth monitoring, supplementary
feeding, immunization and referral care facilities for risk management.
1.
Village based integrated services for child development focussing on
maternal, child nutrition and health and early childhood education
through Tamil Nadu Integrated Nutrition Project and Integrated Child
Development Services. These projects have provided opportunities
for Human Resource Development at village level to tackle issues of
maternal and child nutrition and child development.
a.
Services under TINP/ICDS include regular growth monitoring,
supplementary feeding, nutrition health education, non-formal
pre-school education, immunisation, health check-ups and
referral services.
b.
In urban areas under the existing projects,50 of the 108
municipalities and corporations 50 are covered for services for
children under-3 and pregnant and nursing mothers.
64
B.
2.
Supplementary feeding under the Puratchi Thalaivar MGR Noon Meal
Programme to cover children from 2+ to 14 years in all municipalities
and rural villages. 2+ to 10 years is being implemented since 1982
throughout the state. While for children under 5 years the scheme
is integrated with ICDS/TINP, for children above 5 years the scheme
is implemented in the schools.
3.
Specific interventions such as growth monitoring and Vitamin A
prophylaxis are also provided under the IPP covering 25 municipal
corporations and major municipalities.
NEW STRATEGIES:
1.
General
a.
Extending and strengthening the existing maternal and child nutrition
programmes in the state with specific focus on reaching the currently
excluded hamlets and most needy areas.
b.
In accordance with the National Nutrition policy approved in 1993,
the key strategy will be convergence of services for better nutrition
of children.
c.
Strengthening inter-sectoral coordination among Government and
NGOs providing child nutrition.
d.
Integrating nutrition objectives in other sectoral programmes such as
agriculture, UBSP, etc.
e.
Extending and strengthening urban, maternal and child nutrition
services to bridge existing gaps in services.
f.
Promote research on prevalence of various nutrition problems and
impact of existing programmes.
g.
Generate data and. identification of resistent groups/areas to service
intervention and behavioural change.
65
2.
h.
Focus on developing and implementing effective communication
strategy to bring in behavioural change in practice affecting maternal
and chid nutrition.
i.
Encouraging and enabling communities to assess, analyse and take
action for nutrition interventions to solve problems of malnutrition.
j.
Promoting community mobilisation of human and material resources
for health and nutrition interventions.
k.
Training of functionaries at all levels to equip them with technical
communication and managerial skills necessary to achieve the sector
specific goals.
I.
Developing a reliable Nutrition Information System to assess current
status and to monitor programmes and to develop further plans.
Strategies/Activities for Specific Goals:
a. SPECIFIC GOAL ONE:
REDUCTION IN SEVERE ENERGY PROTEIN
MALNUTRITION (EPM) TO LESS THAN 3%
AND MODERATE EPM TO LESS THAN 15%
AMONG UNDER-5 CHILDREN
1995: Reduction of severe EPM to less than 6% and moderate EPM to less
than 25% among children under 3 years
1998; Reduction of severe EPM to <5% and moderate EPM to <20% among
children under 5 years or a reduction of 50% of current levels,
whichever is less.
2000: Reduction of severe EPM to <3% and moderate EPM to <15% among
children under 5 years.
i.
Supplementary nutrition for children under 3 with weaning food and for
children above 3 with noon meal.
ii.
Involving parents and community in growth promotion and monitoring of
children’s nutritional status.
Hi.
Improve and extend preventive health care and referral facilities.
66
b. SPECIFIC GOAL TWO:
Reduce incidence of low birth weight and increase
mean birth weigh to 3 Kg.
1995: Reduction of LBW to <25% and increase mean birth weight to 2.9 Kg.
1998: Reduction of LBW to <15% and increase mean birth weight to >2.9 kg.
2000: Reduction of LBW to <10% and increase mean birth weight to 3 Kg.
i.
Support to health and nutrition services will be strengthened and better
targeted such that the expectant mother has more access to information,
additional food and resources and health and medical care and some
respite from hard physical labour.
ii.
AH maternal and child nutrition and health programmes will adopt a strategy
of intra-uterine growth monitoring to reduce incidence of low birth weight.
Hi.
Detection of intra-ut&rine growth retardation (HJGR) by health workers for
appropriate management and reduction.
iv.
Encouraging small family norms and adequate spacing through intensive,
family welfare and motivational measures.
v.
Strengthen supplementary food distribution to pregnant mothers with
nutritional risk as a short/medium term measure.
67
c. SPECIFIC GOAL THREE:
Reduction in severe malnutrition among 6-14 years
children by half of current levels reducing gender
disparities.
1995:
Reduction by 20% of existing levels
1998:
Reduction by 30% of existing levels
2000:
Reduction by 50% of existing levels
i.
Assess current malnutrition levels among children 6-14 years by crosssectional surveys and fine tune the existing noon meal programme to
monitor nutritional status of children with special reference to adolescent
girls.
ii.
Improving nutrition status of adolescent girls to maximize growth during
adolescent spurt and to reduce micro nutrient deficiencies through nutrition
education, through adolescent girls scheme of ICDS and by targeting
households with adolescent girls for NFE/income generation schemes.
d.
MICRONUTRIENT DEFICIENCIES
*
SPECIFIC GOAL FOUR:
Reduction of iron deficiency (anaemia) in pregnant
women and children 0-5 years.
1995:
Reduce 1990 levels by 10%
1998:
Reduce 1990 levels by 20%
2000:
Reduce 1990 levels by 30%
SPECIFIC GOAL FIVE:
Universal consumption of iodised salt.
1995: Ban sale of non-iodised salt in the state. All salt required for human
and animal consumption to be iodised.
1998: Achieve satisfactory iodisation levels in at least 90% of salt tested in
market place in identified endemic districts.
2000: 100% of all salt for human and animal consumption to be iodised for
universal consumption.
68
* SPECIFIC GOAL SIX: Elimination of Vitamin-A deficiency and its consequences,
including blindness.
1995: Reduction of Vitamin-A deficiency by 75% of current levels in children <
3 years.
1998: Elimination of Vitamin-A deficiency.
2000: Sustain achievement
i.
Implementing iron and folic acid supplementation resolving operational
problems in logistics of supply, outreach and compliance by beneficiaries
and improving quality and packaging.
ii.
Control of hookworm infestation by periodic deworming and improved
sanitation.
Hi.
Strengthening of supply and distribution of therapeutic dose of iron and
folic acid and ensure compliance by beneficiaries.
iv.
Establishing an IDD Cell at State level to monitor programme control of IDD.
v.
Notify compulsory iodisation under PFA and ban sale of non-iodised salt for
consumption.
vi.
Assess the extent of IDD district-wise by comprehensive surveys and
identify endemic areas for intensified interventions.
vii.
Explore possibilities of double fortification in order to ensure that progress
made under Iron Fortified Salt and Iodised Salt programmes are
consolidated.
viii
Administration of Vitamin-A to all children between 6-36 months and to child
population at-risk.
ix.
Awareness generation on importance of micronutrients
deficiencies and measures to qddress the problem.
x.
Intensify nutrition education to increase production and consumption of iron
and Vitamin-A rich foods especially among vulnerable groups,
and their
69
e. SPECIFIC GOAL SEVEN:
Empowerment of all mothers to breast-feed their
children exclusively for four to six months and to
continue breast-feeding with complementary food,
well into the second year.
1995: All hospitals with annual number of deliveries over 1000 to be made
baby-friendly.
1998: AH hospitals and maternity centres in the State to be made baby
friendly.
2000: 80% mothers in all districts, towns, PHCs, HSCs, urban slums to follow
correct infant and child feeding practices.
i.
Awareness creation and training on proper infant feeding practices
among functionaries and extending the Baby Friendly Hospital
Initiative for proper lactation management in all government and non
government hospitals.
ii.
Baseline surveys of hospitals and breast-feeding practices
Hi.
Review of existing laws relating to maternity benefits .and remove
obstacles in organised and unorganised sectors in empowering
women to adopt recommended breast-feeding practices.
iv.
Increasing creche facilities for working women.
v.
Enforcement of laws pertaining to commercial infant food formulae.
70
f. SPECIFIC GOAL EIGHT:
Growth promotion and its regular monitoring to be
institutionalised.
1995: 80% of children 0-36 months to be covered for growth promotion
strategies
1998: 90% of the children 0-36 months to be covered for growth promotion
strategies
2000: AH children 0-36 months to be covered for growth promotion strategies
i.
Active involvement of parents and communities in growth promotion
of children <3 years.
ii.
Emphasis on nutrition education for parent/family/ community
through well planned community strategy including social marketing.
Hi.
Promotion of appropriate infant feeding practices including breast
feeding and timely weaning.
g. SPECIFIC GOAL NINE:
Reduction in percentage of households with
inadequate household .food security by 50% of
current levels.
1995:
Reduction by 10%
1998:
Reduction by 20%
2000:
Reduction by 50%
i.
Increasing production ofprotective foods by strengthening nutritional
considerations in agriculture and horticulture sectors.
ii.
Promoting concepts of kitchen garden to increase household food
security.
Hi.
Identifying famiHes/groups at great risk of food insecurity.
71
iv.
Covering all families at health and nutrition risk under Public
Distribution System to ensure monthly household food security.
v.
Introducing innovative concepts like distribution of low cost weaning
food through public distribution system to make quality weaning
food available to mothers and children in villages.
vi.
Introducing thrift and credit system among cohesive women's
groups to promote coping strategies among communities.
vii.
Targeting poverty alleviation and income generating schemes to
families with inadequate household food security.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS
IV.
A.
TAMIL NADU INTEGRATED NUTRITION PROGRAMME:
Tamil Nadu Integrated Project-1 (TINP-I) was implemented in the State
during 1980-89 and was acclaimed to be a successful and cost-effective
model of improving the nutritional status of children <3 years. Based on
valuable experience and lessons learnt from Project-1, TINP-II is being
implemented from 1990-91. Upto 1992-93, 13 districts comprising of 224
rural blocks have been covered under TINP-II.
The project already covers 13 districts comprising of 224 blocks. The
project is being extended to two more districts (52 blocks) during 1993-94
and the final phase during 1994-95 will cover an additional 41 blocks in 3
more districts bringing the total coverage to 317 blocks. The allocation for
1993-97 is Rs.300.44 crores and budget estimate for 1993-94 is Rs.67.09
crores.
/
B.
ICDS:
69 rural/tribal ICDS projects and 42 urban ICDS projects are also
operational in the state. It is proposed to cover the rest of the State in the
next phase (Attachment-!).
72
ICDS will continue to be implemented in 69 rural and 42 urban areas. The
budget allocation for 1993-94 is Rs.26.14 crores and the total outlay for
1993-97 is around Rs. 117.98 crores including proposed StDA expansion.
C.
NOON MEAL PROGRAMME:
The programme currently covers children 6-14 years in 37,756 school noon
meal centres and 29,048 child welfare centres. The projected expenditure
for 1993-97 is around Rs.976.97 crores while allocation for 1993-94 is
Rs.226.67 crores.
D.
BABY FRIENDL Y HOSPITAL INITIA TIVE (BFHt):
BFHI programme under CSSM is to be funded by UNICEF, the estimated
requirement until 1995 is Rs. 15 lakhs.
V.
ISSUES TO BE ADDRESSED:
A.
Area specific coverage by NGOs: Provide support to voluntary agencies
operating maternal and child health services for improving nutritional status
of children and pregnant/lactating mothers, instead of government opening
centres to cover such areas.
B.
In very remote, hard-to-reach areas, mostly supplementary feedings
programmes by distribution of monthly rations to PDS to families or by
organising monthly camps using additional manpower resources for service
delivery. This will cut down regular supervisory costs and ensure benefits
reaching families/beneficiaries directly.
C.
Review to be made of maternity benefits including maternity leave and
enforcement of bill relating to commercial infant food formulae and
advocacy and support for empowering women to breast-feed their children.
D.
A policy paper on the nutritional status of under 3 and need to bridge the
gap in services to the urban child can be recommended to the World Bank
for inclusion in TINP-II.
73
VI.
E
Priority to be given to repair and maintenance of noon meal centres for
which an allocation of Ps. 10 crores will be required.
F.
Resource allocation of Rs. 720 lakhs per year to be made towards providing
3,000 additional creches.
G.
Professional bodies (FOGSI/IMA/IAP/NNF) can issue directive to all
maternity hospitals to follow the Ten Steps of Breast Feeding Policy.
KEY INDICATORS
A.
B.
C.
Reduction in severe and moderate EPM:
'1.
Weight for age status of children.
2.
% of children receiving exclusive breast-feeding. .
3.
% of children 6-12 months receiving supplementary feeding.
4.
Height and weight of children at entry of school.
5.
Anthropometric survey during EPI coverage survey and specific
ICDS survey.
Reduction in LBW:
1.
Mean birth weight.
2.
% of children <2.5 Kg.
3.
Pre-pregnancy weight and weight gain during pregnancy i.e., > 7
Kg.
Reduction in anaemia:
1
% of pregnant women given iron and folic acid supplements.
2.
% of pregnant women consuming iron and folic acid supplements.
3.
% of villages with availability of IFS.
74
D.
E.
Control of iodine deficiency:
1.
% of iodised salt marketed.
2.
90% of salt tested in the market (retails) to have minimum 30 PPM
iodine.
3.
Iodised salt to be made available through PDS, retail stores, etc.
4.
Prevalence of IDD district-wise.
5.
% of households consuming iodised salt (during CES).
Control Vitamin A deficiency:
1.
% of children exclusively breast-fed for the first four months.
2.
% of children receiving Vit-A rich foods in their diet by 12 months of
age (CES).
3.
% of children covered by doses of Vit-A supplement as scheduled.
4.
% of pregnant women reporting night blindness.
5.
Prevalence of night blindness in pregnant mothers, reporting for
tetanus immunisation (ICDS monthly monitoring).
6.
Daily consumption of green leafy vegetables by a child of 9 months
of age.
7.
% coverage high dose Vitamin A (health routine reports).
8.
Prevalence exclusive breast-feeding (household surveys).
9.
Trend production food containing Vitamin A.
75
F.
Breast-feeding:
1.
% of children below 6 months.
2.
% of mothers started on complementary feeding, 4-6 months.
3.
% hospitals, maternity centres declared "baby friendly".
4.
Change in specific hospital practices (survey).
5.
Change in breast-feeding practices of mothers (Coverage Evaluation
Survey).
G.
Growth promotion: % of children <3 years of age receiving at least 9
weighments during the year
H.
Reduction in malnutrition among 6-14 year old children:
Nutritional status of children 6-14 years
I.
Increasing household food security
1.
% of families with inadequate household food security
2.
% of families with inadequate food security benefiting from poverty
alleviation and income generating schemes
Chapter Four:
EDUCATION, SPORTS AND RECREATION
76
4. EDUCATION, SPORTS & RECREATION
MAJOR GOAL:
I.
II.
ACHIEVEMENT OF UNIVERSAL PRIMARY EDUCATION, FOR
EVERY CHILD TO COMPLETE 5 YEARS OF PRIMARY SCHOOL.
SPECIFIC/SUPPORTING GOALS:
1.
Universal enrolment and retention for five years of primary education by
children 6-11 years;
2.
Ensure adequate facilities and materials for improvement in quality of
education.
3.
Improve teaching-learning activities for Minimum Levels of Learning (MLL) at
every stage and holistic development of every child (scholastic, non-scholastic,
values, behavioural & health).
4.
Extend knowledge and skills on early childhood development of children in the
0-3 age group for all mothers through ICDS/TINP functionaries.
5.
Ensure access to pre-school education for children 3-5 years.
6.
100% enrolment in non-formal education for out-of-school children under 15
years.
7.
Achieve 100% Female Literacy.
SITUATION ANALYSIS AND CHALLENGE:
Tamil Nadu, with a steadily increasing literacy rate (62.66% in 1991 - male: 73.75%
and female: 51.33%), now ranks second only to Kerala among the larger states of
India. It is also among the top four most advanced states in primary education
measured in terms of facilities, quantity and quality.
While the State has recorded some remarkable achievements through the Total
Literacy Campaigns in several districts, it is recognised that primary education is the
essential cornerstone for total literacy. Without priority attention to primary education,
there will be a continuous flow of new generations of illiterates.
77
Pre-school:
Approximately 38% (14 lakhs) of the estimated 37 lakhs of children in the 3-5 age
group are enrolled in the 22,000 pre-school centres of ICDS/TINP/NMP.
Primary School:
Tamil Nadu has achieved over 100 per cent gross enrolment at the primary level;
while net enrolment is not known.
The drop out rate at the primary level has declined steadily, from 54.9% in 1961-62
to 19.3% in 1991-92. However, there is considerable disparity between boys and girls
with SC/ST girls having the highest drop-out rate of over 30%.
Considerable progress has been made in terms of coverage: there are primary
schools in all habitations with populations of 5000 and above and 82% of habitations
with a population of 500-999 have primary schools and 97% are within 1 km distance.
Despite the extensive coverage, access to primary schools is still difficult for children
living in hilly and remote areas. Children of SC/ST, migrant workers and other
nomads suffer lack of access. Girls are at a greater disadvantage where walking to
school over some distance is necessary.
Less than 2% of primary schools still function with a single teacher.
primary schools in the State have 2-4 teachers.
Over 50% of
Tamil Nadu's over-all teacher-pupil ratio has steadily increased from 1:42 in 1985 to
1:47 in 1992. Also, the distribution of teachers is not uniform.
Available materials, such as those supplied under Operation Blackboard, are
frequently not used because teachers are not trained to use them or because
materials are of poor quality.
Other drawbacks in infrastructure include inadequate classroom space and lack of
drinking water and sanitary facilities.
Studies have shown that more than half the children in classes 4 and 5 fail to meet
the basic requirements of literacy.
Low achievement and lack of interest are major reasons for dropping out and twothirds of out-of-school children dropped out for reasons other than family economic
needs.
78
While the various incentive schemes helped provide an impetus to the drive for
greater enrolment and retention, they now appear to have reached an optimum level;
it is only quality, resulting in real achievement of skills, which will provide a base for
further development.
Non-Formal Education & Female Literacy:
It is estimated that there are over 3.5 million out-of-school children in the 6-14 age
group, with a break down of 1.78 million 6-11 year olds and 1.77 million 11-14 year
olds. They constitute both drop-outs and children who never enrolled.
With drop-out rate of 19.3% (1991-92) at the primary level and 40% for elementary
education, there is a constant out-flow of children from the formal system, many of
whom are put to work. With a higher drop-out rate among girls, especially SC/ST
girts, the main target group for NFE are girls.
Similarly, women constitute a majority of the estimated 7.8 million illiterates in the 1535 age group. With over 22% disparity between male and female literacy rates and
the close correlation of female literacy with birth and infant mortality rates as well as
with children’s retention in schools, the critical importance of addressing female
literacy as a priority has been fully recognised.
The Challenge:
The challenge that faces the State today is: What can be done to ensure that all
children start primary school; that they stay through at least class 5; and that they
leave school equipped with basic education?
The combined numbers of out-of-school children (6-14 years) and adult illiterates (1535 years) represent 23% of Tamil Nadu's population over 6 years old. The challenge
of the state is to ensure that these two groups are effectively covered by NFE and
Adult Literacy Programmes within a short period to eradicate illiteracy.
While the main focus will be to achieve UPE, efforts to improve access and retention
at the secondary level will need to be made, especially for girls; thereby working
towards the achievement of Universal Elementary Education.
Non-Formal Education is an essential stepping stone for children who have never
enrolled or have dropped-out to be prepared for entry into the formal system. It is
therefore not to be seen as an alternative to the formal system.
79
III.
A.
STRATEGIES:
EXISTING OVERALL STRATEGIES:
1.
2.
B.
NEW OVERALL STRATEGIES:
1.
2.
3.
C.
Increased access through provision of primary schools within all habitations
with a population range of 500-999.
Up-grading of the remaining 459 single teacher schools to double teacher
schools.
Decentralisation and local management of the primary education system with
involvement of parents and local communities as part of the panchayat
system.
District-level planning and implementation in a systematic manner throughout
the state with preparation of district plans of action.
Phased coverage of the District Primary Education Programmes, starting with
the three most educationally backward districts in 1994-95.
ACTIVITIES FOR EACH OVERALL STRATEGY:
1.
Decentralisation/Local Management:
a.
Village Education Committees (VECs) to be constituted, consisting of parents,
teachers, educational patrons and other community members, to be involved
in planning and implementation of UPE strategies. VECs existing under TLC
should be drawn into UPE Programme.
b.
Local bodies, such as village panchayats/wards or VECs, to be given
substantial role towards improving the management of primary schools.
Communities are therefore to be made aware and motivated to take on local
involvement and management.
c.
The teacher-pupil ratio by school and by district to be assessed at the district
level, and the DEO to allocate and redeploy teachers accordingly, at school
level to suit the local situation. Allocation of teachers to be reviewed at the
macro/state level only if necessary.
d.
Strong networking of communities, teachers and schools horizontally among
primary schools and vertically among pre-primary, primary, middle, secondary
and university levels, to strengthen guidance and support at the local level.
80
e.
2.
Human and other resources to be mobilised locally. For example, teachers
may be appointed by local communities on a temporary basis, to augment
teacher strength where necessary.
District-level planning:
a.
The District UPE Committee, headed by the Collector, to ensure coordination
and linkages with other departments and NG Os, so that UPE goals are
achieved.
b.
Planning for UPE to be done by a committee at the district level, drawing on
all available resources. District action plans to be prepared. Within the district,
phasing can be done to give priority attention to:
I.
II.
Hi.
iv.
3.
DPEP Coverage in phases:
a.
First phase coverage from 1994-95 in three most educationally backward
districts of Dharmapuri, T. Sambuvarayar and South Arcot funded by the
World Bank at an estimated outlay of Rs. 8 crores per district per year for a
period of 3 years.
b.
Remaining districts to be proposed for inclusion in phase II and III.
c.
Activities under DPEP include:
i.
H.
Hi.
D.
More educationally backward blocks/areas;
Areas of SC/ST concentration
Low female literacy areas.
Child Labour intensive areas.
Improving classroom facilities and provision of drinking water.
Training of teachers and supervisory staff.
Up-grading of DIET facilities equipment and materials.
KEY INDICATORS:
1.
Number of VECs and MTCs established and actively functioning.
2.
Number of District Plans of Action prepared and operationalised.
81
IV.
A. 1.
STRATEGIES, ACTIVITIES AND INDICATORS FOR EACH SPECIFIC GOAL:
SPECIFIC GOAL ONE: Universal enrolment and retention.
1995: a.
b.
c.
d.
e.
100% enrolment of children (6-7 years) in formal system;
100% enrolment of 8-11 age group in schools or NFE.
100% retention in classes 1 and 2;
Minimum of 75% attendance rate for every child.
Reduction in overall drop out rates by 40% of 1990 levels.
1998: a.
b.
c.
d.
e.
100% enrolment of 6-11 age group in formal
system.
100% enrolment in NFE of out-of-school children up to 14 years;
100% retention in classes 1 to 5;
Minimum attendance of 75%.
Reduction in overall drop out rates by 75% of 1990 levels.
2000: Sustaining achievement of 100% net enrolment with 100% completion of
primary education within 5 years for every child.
Primary School Drop Out Rates
Tamil Nadu
TRENDS
-hBoys
Girls — Total SGoa/s
Source: Education Statistical Handbook - 1992 (GOTN)
82
2.
A.
EXISTING STRATEGIES:
1.
2.
3.
4.
5.
A.3.
NEW/ADDITIONAL STRATEGIES:
1.
2.
3.
4.
5.
4.
A.
Introduction of legislation on compulsory primary education.
Annual enrolment registration and drive by teachers in school catchment area.
Exclusive appointment of female teachers in primary schools.
Establishment of Mother-Teacher Councils (MTCs) in all primary schools.
Incentive schemes such as noon-meals and provision of free textbooks, slates,
uniforms, foot wear and bus-passes.
Operationalising compulsory primary education.
Priority targeting of girls, SC/ST children, working children and other
educationally backward groups.
Linking of Total Literacy and Post Literacy Campaigns (TL C/PL C), Non-Formal
Education (NFE) and Early Childhood Care and Education (ECCE) directly
with UPE strategies and activities.
'"
Flexibility of the system to allow adaptation to local needs, with possible
introduction of shift system in child labour intensive areas.
Integration of children with mild and moderate disabilities into the mainstream
of formal education.
ACTIVITIES FOR EACH STRATEGY:
1.
Operationalising Compulsory Primary Education:
a.
Legislation on compulsory education to apply to the entire State.
b.
Wide publicity on legislation and create awareness among parents on need
to send children to school, through:
i.
ii.
Hi.
c.
A multi-media effort;
District administration;
Link with TLC/PLC.
Compulsory registration of all primary school age (6-11) children and
determination of educational status.
83
d.
Implementation of compulsory education to be in phases, with children eligible
for classes 1 & 2 being the target group in the first phase; class 3 in second,
and classes 4 and 5 in the third phase respectively.
e.
Village Education Committees/Mother- Teacher Councils (VECs/MTCs) to keep
track of all registered children and enforce compulsory primary education.
f.
Possible introduction of graded penal provisions to be applied against parents
who do not send their children to school:
i.
ii.
Hi.
A series of three warnings;
Denial of beneficiary status in all government programmes until the child
is enrolled in formal or non-formal education;
Two rounds of fines.
g.
The Abolition of the Child Labour Act to be strictly enforced against employers
of children. A special enforcement mechanism to be established in child labour
intensive areas.
h.
Positive reinforcement through:
i.
Recognition and awards for panchayats/wards, blocks and districts
which achieve enrolment, retention and completion targets;
ii.
Mobilising community opinion to exercise social pressure in favour of
Universal Primary Education (UPE);
Hi.
Ensuring that adequate access/facilities are available;
iv.
Guaranteeing admission to class 6 for all children who achieve the
prescribed Minimum Levels of Learning (MLL) on completion of class
5;
v.
Improving the quality of education provided.
84
2.
Priority targeting of girls, SC/ST &
educationally backward groups:
a.
Specific actions for girls:
i.
ii.
Hi.
iv.
v.
b.
working children and other
Continued posting of women teachers for primary schools.
Creches & balwadis to be provided, attached to primary schools
wherever possible, so that girls may be relieved of child care
and attend school
Local escort system to be organised, with an adult
woman/adolescent girl accompanying groups of girls to ensure
regular attendance and to provide social protection.
Examples of female achievers to be introduced in textbooks to
serve as models for girls to aspire to emulate, and textbooks to
be reviewed to eliminate gender bias.
Co-curricular activities to be strengthened, with special attention
to girls.
Specific Action for SC/ST children:
i.
ii.
Hi.
iv.
v.
vi.
The school mapping to ensure access for SC/ST children.
MTCs or local committees to establish an escort system (soft
version of truant officer) to ensure attendance.
Teachers to be sensitised against discriminatory attitudes
towards SC/ST children.
Adi Dravidar and other community-specific schools to be
integrated with primary education system for effective
administration, quality control and monitoring, while retaining
special privileges.
Special training programmes for teachers serving in
predominantly SC/ST communities to address the additional
efforts required to enrol and retain SC/ST children.
Appointment norms to be relaxed for appointment of local
teachers in hill areas.
85
c.
For other disadvantaged categories such as children of migrant
labour and linguistic minorities:
i.
ii.
3.
Linkage with TLC/PLC/NFE/ECCE:
a.
«
b.
c.
d.
e.
f.
4.
Relaxed and flexible admission rules for children of migrant
workers and nomads.
Special attention to appointment of appropriate teachers for
linguistic minority areas.
Social mobilisation for UPE to build and be directly linked to TLC
mobilisation which has created a favourable atmosphere for education.
Experiences of the TLC to be drawn upon to improve the UPEprocess.
TLC/PLC to have a strong UPE element with coordinated activities.
NFE to be strengthened for children who cannot immediately be
brought into the formal system (older, out-of-school children).
However, UPE through formal education is the ultimate goal and NFE
must be seen as a temporary measure.
ECCE centres to be strengthened and linked with primary schools in
the vicinity, to ensure full enrolment and retention.
Collaboration with non-governmental organisations (NGOs) working in
TLC and NFE.
Flexibility:
a.
b.
c.
School timings and calendar, while fulfilling norms on number of
working, to be made flexible and adjusted at the local level, with the
approval of the AEO, to allow for adapting to the local situation.
The curriculum (teaching-learning activities) to be related to children’s
life incorporating ecological context, local culture, etc., and eliminate
gender bias.
Children who have missed admission at the beginning of the year to be
admitted in the middle. Those who have left school before completion
can be admitted without Transfer Certificate, taking into consideration
their age, and on the basis of achievement tests in cognitive areas of
development.
86
d.
5.
Integration of children with mild to moderate disabilities:
a.
b.
c.
A. 5.
Special provision to be made for slow learners, in addition to the
normal school education programme. Supportive educational activities
can be managed by the community.
Adaptation of the NCERT Pilot Project on Integrated Education of the
Disabled (IED) for selective components to be introduced in all schools.
In-service training of teachers to include sensitisation for acceptance
and support to children with disabilities.
Training of teachers (one per school) on simple techniques on special
education for different disabilities. Training may be linked to Schoo!
Health Scheme training for one teacher to serve as focal point.
KEY INDICA TORS:
1.
Increase in Net Enrolment Rates (6-11 age group) from 1986 levels with
disparity reduction between boys and girls.
2.
Decrease in annual drop-out rates, especially among girls, SC/ST and other
educationally backward groups.
3.
Attendance rates per school (boys/girls).
4.
Number and percentage of children completing class five within 5 years
(boys/girls).
5.
Number/percentage of schools/blocks/districts which have adopted flexible
timings and calendar.
6.
Number of children with mild/moderate disabilities enrolled.
87
1.
B.
SPECIFIC GOAL TWO:
1995:
a.
b.
c.
a.
1998:
b.
c.
2000:
a.
b.
Availability of Facilities and Materials:
Provision of basic materials such as play, sports and instructional materials
and simple musical instruments for 50% of primary schools and 30% of
pre-schools.
Provision of basic facilities such as adequate class room space, drinking
water supply, sanitation and play ground facilities in 50% of pre- and
primary schools.
Provision of electricity supply for 30% of pre- and primary schools and
noon-meal centres.
Provision of basic materials in 80% of primary schools and 70% of pre
schools.
Provision of basic facilities in 75% of pre- and primary schools.
Provision of electricity supply for 70% of pre- and primary schools and
noon-meal centres.
Provision of basic facilities and materials in all pre- and primary schools.
Provision of electricity supply for all pre- and primary schools and noonmeal centres.
Facilities and materials have been provided under
Operation Black Board.
2.
B.
EXISTING STRATEGY:
3.
B.
NEW/ADDITIONAL STRATEGIES:
1.
4
B.
Based on assessment of gaps, basic facilities and materials will be provided
through existing schemes and through DPEP according to NIEPA/NCERT
norms, in terms of:
a.
School space/class rooms;
b.
Drinking water supply and school latrines;
c.
Teaching/learning materials;
d.
Play materials and musical instruments;
e.
Electricity or alternative energy sources;
f.
Separate store-room for noon-meal equipment so that classroom space
is not used for storage.
KEY INDICATOR:
Number and percentage of schools provided with basic
facilities and materials.
88
SPECIFIC GOAL THREE:
C. 1.
1995:
a.
b.
c.
d.
a.
b.
c.
1998:
d.
2000:
a.
b.
c.
d.
2.
C.
Improve Teaching-learning for MLL and holistic
development.
Introduction of MLL in selected blocks in all districts.
Instruction on all working days by teachers, substitute or para-teachers.
Rationalisation of teachers to ensure at least one teacher for classes 1 & 2
as a unit with a teacher-student ratio of 1:35 in classes 1 & 2.
Re-training class 1 to 3 teachers in scholastic and non-scholastic areas, in
multi-grade teaching and MLL.
Introduction of MLL in all primary schools.
Instruction on all working days.
Rationalisation of teachers to ensure at least one teacher for classes 1 & 2,
one for classes 3 & 4 and one for class 5 with maintenance of the teacher
student ratio at 1:35.
Re-training of teachers handling classes 4 and 5.
Attainment of MLL at every stage of primary education.
Rationalisation of teachers to ensure one teacher for each class (all
schools to have a minimum of 5 teachers), subject to a viable student
strength.
Continuous teacher training and orientation of all primary school teachers
in non-scholastic areas of development.
Each child to realise full potential in scholastic and non-scholastic areas of
development.
EXISTING STRATEGIES:
1.
2.
3.
Design of MLL curriculum and pedagogy and introduction of MLL on a pilot
basis in 10 schools per district through DIETS.
Linking of primary with middle and high schools for sports and other facilities
as part of school complex approach.
School health scheme implemented by the Directorate of Public Health for
annual check-ups and early detection and referral of health and dental
problems.
89
3.
C.
NEW/ADDITIONAL STRATEGIES:
1.
2.
3.
4.
5.
4.
C.
Introduction of MLL in selected blocks in a phased manner by classes.
Creation of teacher support systems.
Encouragement of innovative approaches at all levels of the primary education
system.
Improved access to library services for young children as an extension of
existing system.
Strengthening non-scholastic activities and existing School Health Scheme for
holistic development.
ACTIVITIES FOR EACH STRATEGY:
1.
Introducing Minimum Levels of Learning (MLL) Approach:
a.
b.
c.
d.
e.
2.
Creation of Teacher Support Systems:
a.
b.
c.
d.
3.
Training of teachers and primary education personnel in MLL to be
provided in a phased manner.
Communities/Village Education Committees (VECs) to be sensitised
towards MLL.
Materials and appropriate evaluation processes for MLL to be
developed.
Teaching/learning to be evaluated vis. achieving MLL.
MLL to be periodically reviewed and revised.
Primary school teachers to be provided with continuous upgrading of
skills and content-oriented training, especially for multi-grade teaching
and MLL.
Periodic guidance from supervisory staff and DIET with proper folio w-up
and evaluation.
Motivational support with recognition of effective performance to ensure
continued commitment and enthusiasm of teachers.
Support and feedback from VEC/community.
Encouraging innovative approaches:
a.
Recognition of teachers and others who are creative in actualising UPE
through motivation, teaching/learning and community participation
processes.
90
4.
b.
Dissemination of current innovative approaches through training,
newsletters, etc.
c.
Special efforts to be made to apply lessons and experiences of past
and current innovative projects.
Access to library services:
a.
b.
c.
5.
Existing library services to have children's books especially for young
children.
Mobile library services to be extended to primary schools.
Establish linkages with National Book Trust and avail of their translation
and printing assistance.
Holistic Development:
a.
b.
c.
d.
e.
f.
g.
h.
i.
Strengthen non-scholastic activities (sports, recreation, music, drawing,
crafts) to be an integral and active part of school education.
Physical education to be graded as a subject to encourage sports as
an integral part of the curriculum.
Linkage with Sports Authority activities to encourage sports in primary
and middle schools.
Awareness and appreciation of the environment and learning through
use of environment and nature study to be incorporated into the daily
routine of teaching-learning activities in pre- and primary schools.
Strengthen the linkages and coordination between the Directorate of
Public Health and the Primary Schoo! system to strengthen the school
health scheme being implemented by the DPH with regular meetings
between the Asst. Education Officer (AEO) and Medical Officer (MO) at
the local (PHO) level and between the District Education Officer (DEO)
and District Medical Officer.
Training of selected teachers (one per school) in monitoring health
situation and use of the existing School Health Cards already provided
by DPH for every child.
Pole of NSS to be enhanced in secondary schools with one unit to be
established per school to extend support to area primary schools.
Extend cub, scouts and guides units (at least one unit per school) for
all primary schools.
Provision of personal hygiene kits to all pre- and primary schools to
instill good hygiene practices.
91
KEY INDICA TORS:
C. 5.
Annual decrease in the Teacher-Student ratio from current level of 1:47
towards goal of 1:35.
Number of in-service Teacher Training Sessions held and number and
percentage of teachers trained.
Number of schools which have introduced MLL approach.
MLL attainment levels per child, class, school.
1.
2.
3.
4.
D. 1.
1995:
SPECIFIC GOAL FOUR:
Improve knowledge and skills of mothers on Early Child Development of
children 0-3 years.
NEW STRATEGIES/ACTIVITIES:
2.
D.
Training for all ICDS/TINP functionaries on ECCD for children under 3 years.
Incorporate into existing mothers' group sessions organised by ICDS/TINP,
early childhood development for children 0-3 years in addition to child care.
1.
2.
KEY INDICA TORS:
D. 3.
Percentage of ICDS/TINP Mothers’ Groups being taught early child
development.
Percentage of pre-school teachers trained on Early Childhood Care,
Development and Education.
1.
2.
1.
E.
SPECIFIC GOAL FIVE:
Access to Pre-School Education.
Ensure access for pre-school services for children (3-5) especially for
those below poverty line.
b. Training of all pre-school teachers including anganwadi and noon-meal
workers.
1998/2000: Sustain access and quality of services.
1995:
2.
E.
a.
EXISTING STRATEGY:
1.
Increased coverage of pre-school services through conversion of noon-meal
centres to child welfare centres.
2.
ECE Project in selected blocks.
92
3.
E.
NEW/ADDITIONAL STRATEGY:
Strengthen play, recreation, music, arts and crafts activities in pre-school education
so that activity-based learning is the main approach for ECCE.
KEY INDICA TORS:
E. 4.
1.
2.
3.
1.
F.
SPECIFIC GOAL SIX:
100% enrolment in non-formal education for out-ofschool children under 15 years of age.
65% of out-of-school children to be enrolled in NFE.
100% enrolment of out-of-school children.
Completion of NFE and ensured access to format education.
1995:
1998:
2000:
2.
F.
Number and % of children (3-5) registered in pre-schools.
Percentage of pre-school teachers trained on Early Childhood Care,
Development and Education.
Schoo! readiness at entrance to class I.
EXISTING STRATEGY:
NFE Schemes with GOI/GOTN shares have thus far had limited coverage with at
most 200 centres having 25 children each.
3.
F.
NEW STRATEGIES:
a.
The newly approved Education Volunteers Service Scheme will cover 1.5
million out-of-school children (6-14 years) through 150,000 "volunteer"
instructors. Educated unemployed youth will thereby be given socially useful
employment.
b.
A large-scale NFE scheme has been proposed to GO! to open 4000 NFE
centres in two phases to cover all out-of-school children.
c.
Utilisation of child welfare centres and schools for NFE and adult education
classes.
KEY INDICA TORS:
F. 4.
1.
2.
Percentage of out-of-school children enrolled in NFE.
Percentage of NFE students enrolled into formal system.
93
SPECIFIC GOAL SEVEN:
1.
G.
1995:
1998:
2000:
Achieve 100% Female Literacy.
80% Female literacy.
90% Female Literacy.
100% Female Literacy.
Female Literacy
Tamil Nadu
TRENDS
—“Male * Female S Goals
Source: Registrar General, India
94
2.
G.
3.
G.
EXISTING STRA TEG1ES:
a.
The TLC which was launched in 1991-92 will complete its final phase by 1994
covering the entire state.
b.
The Post Literacy Campaign (PLC) will continue up to 1996. In all, 8.29 million
illiterates will be covered. This includes 9-14 years old which were covered in
10 districts thus far.
c.
Each district has prepared a plan implemented through an intensive one-year
campaign approach under the guidance of the District Literacy Council chaired
by the District Collector.
d.
Instructors teach purely on a voluntary basis with Village Education
Committees overseeing the local organisation.
e.
The State is expected to be declared totally literate (according to the GO!
definition) by 1994-95.
NEW/ADDITIONAL STRATEGY:
TLC/PLC activities, especially the social mobilisation and formation of VECs to be
directly linked with UPE activities.
KEY INDICA TORS:
G. 4.
1.
2.
Percentage of illiterate women made literate.
Percentage of TLC learners enrolled in PLC.
Chapter Five:
DRINKING WATER SUPPLY
95
5. DRINKING WATER SUPPLY
MAJOR GOAL:
UNIVERSAL ACCESS TO SAFE DRINKING WATER WITH ALL
HABITATIONS COVERED:
ONE SOURCE FOR 250 POPULA TION WITHIN 1.5 KM. DISTANCE
AND 100 METRES ELEVATION BY 1998.
-
I.
II.
ONE SOURCE FOR 150 POPULATION WITHIN 1 KM DISTANCE
AND 50 METRES ELEVATION BY 2000 AD.
SPECIFIC GOALS:
1. Extend coverage from current level of 1:300 to 1:150 in rural areas through
improved sustainability and quality.
2.
Reduction of handpump maintenance cost and down time.
3.
Increased institutional coverage.
4.
Reduction in diarrhoeal diseases.
SITUATION ANALYSIS AND CHALLENGES
A.
Safe drinking water for the rural population in Tamil Nadu is provided through
bore wells, sanitary wells and infiltration wells. The current status of coverage
is:
Out of total habitations of
fully covered (35%)
partially covered (63%)
not covered (2%)
: 66,631
: 23,250
: 41,954
: 1,427
No. of SC/ST habitations (26.77%)
fully covered (31%)
partially covered (66%)
not covered (3%)
: 17,840
: 5,569
: 11,731
:
540
No. of rigs available
Rig utilisation
Hard rock
Sedimentary
:
:
:
:
59 nos.
77%
43 nos.
16 nos.
96
The status in urban and semi-urban areas is as follows; the main sources are
piped water supply/spot sources:
B.
SI. No.
Civic Status
1.
Corporation
2
2.
Municipality
3.
No. of
schemes
pro
posed
Total No.
of
schemes
imple
mented
Total
popu
lation in
lakhs
Total
popu
lation
bene
fited in
lakhs
2
17.47
17.47
-
101
99
81.89
78.69
2
Municipal
Township
7
5
4.40
3.15
2
4.
Panchayat
Township
16
13
3.74
3.04
3
5.
Town
Panchayat:
Urban
Rural
364
266
266
116
57.30
22.00
43.60
13.00
98
150
TOTAL.....
756
501
186.80
158.90
25fF-e
a.
b.
C.
STA TUS OF RURAL AREAS:
a.
Status of bore wells as on 1992-93:
Percentage of successful bores
Percentage of failures
Average depth
b.
Status of handpumps as on 1992-93:
Total No. of handpumps
Functioning
Not functioning
c.
: 90%
: 10%
: 60 metres
: 131,530
: 127,487
: 4,043
Status of Power pumps as on 1992-93:
Total no. of power pumps
Functioning
Not functioning
: 25,672
: 24,173
: 1,499
Water
schemes
to be
imple
mented
97
d.
Status of Water Quality:
The availability of potable water in all the districts of Tamil Nadu is periodically
analysed by conducting chemical analysis of water from observation wells in
all the districts.
The district-wise potability percentage for the last three years based on
random samples shows that 3 districts i.e., Dharmapuri, Thanjavur and
Ramnathapuram, show the lowest potability level (53-54%). The low cost
treatment plants installed in fluoride and iron content areas were tampered by
the public due to poor discharge of water from those handpumps. This is
mainly because of lack of knowledge about the system introduced.
e.
Reduction in ground water level:
tn spite of massive inputs from Central and State sectors, the rural population
could not be provided with the required per capita supply of 40 Ipcd (litre per
capita per day) due to successive poor rainfall, extraction of ground water for
industrial and agriculture requirements. In 1983, 76% of wells and tubewells
were utilised for irrigation while only 24% were for domestic consumption.
f.
Maintenance System:
The existing centralised three-tier maintenance system of handpumps in rural
areas involves high cost and a long down time.
g.
Institutional Coverage:
Institutional coverage has not been taken on a priority basis. As a result,
majority of the schools in rural areas do not have protected water supply and
proper sanitary facilities.
g.
Reduction in Diarrhoeal Diseases:
The reduction in diarrhoeal diseases over the past decade (see Health
chapter) to some extent, may be attributed to increased availability of potable
water. However, all the contributing factors such as water, sanitation and
health care are not addressed as an integrated package of services for the
effective control of diarrhoeal diseases.
98
III.
STRATEGIES FOR EACH GOAL:
A.1 SPECIFIC GOAL ONE:
Extend coverage from current level of 1:300 to
1:150 in rural areas
1995:
10,000 habitations to be covered (50%)
1998:
15,349 habitations, to be covered (58%)
2000:
30,000 habitations to be covered (62%)
CURRENT STRATEGIES (RURAL):
A.2.
a.
To provide entire rural population with potable water supply of 40 Ipcd.
b.
For SC/ST colonies, one handpump to be provided for population of 50
and a power pump may be provided for more than 150 population.
Out of the total budget allocated, 25% will be made available for SC
and 10% for ST habitations.
Drinking Water Supply Coverage
Tamil Nadu
H Current status B Planned targets H Desired Goals
99
c.
Upgradation of partially covered habitations to fully covered.
d.
Upgradation of not covered habitations to fully/partially covered by
1995.
e.
To ensure sustainability of sources, model projects on artificial
recharging through percolation ponds and underground dyke, injection
well, rainwater harvesting structure are underway in coordination with
the Ground Water Board (GWB). There is currently no infrastructure
facility available to extend these projects to other problem areas.
f.
To improve quality of drinking water in problem areas alternative
sources of water is provided in those areas where concentration of
fluoride is very high. Low cost water treatment for fluoride, salinity, iron
content were undertaken in limited areas.
g.
Improve the supply of drinking water to 90 Ipcd and 70 Ipcd in
Municipalities and Town Panchayat respectively. Urban and semi-urban
centres are provided with piped water supply from infiltration, open
bore wells for surface water after treatment. Spot sources are being
provided during drought period and also in unserved/newiy developed
areas.
A.3 NEW STRATEGIES
1.
To improve coverage levels, apart from increasing the number of
sources, importance to be given more on ensuring sustainability of
existing sources and improvement of quality of drinking water.
2.
District level monitoring mechanisms are to be set up to ensure
sustained availability of drinking water in rural/urban areas through
regular monitoring and water management.
3.
Continuous R&D programme to suggest suitable cost-effective
techniques for improved recharging of the ground water.
100
B. 1
4.
Apex body to be formed at the State level to monitor ground water
recharging, use, water level fluctuation and develop guidelines for
ground water management.
5.
Provision of appropriate treatment plants and educate users on
home treatment.
6.
Before introducing the new low-cost treatment plant in the problem
areas, awareness programme to be undertaken to educate the
people on the purpose and special features of the plants. Such
schemes be implemented with community participation.
7.
State level study team to be set up to categorise quality and suggest
appropriate viable technologies.
SPECIFIC GOAL TWO:
Reduction of down time from current level of 48 hours to 24
hours
2000 AD:
B.2.
Reduction of maintenance costs and down
time.
CURRENT STRA TEGIES
1.
A centralised three tier system of handpump maintenance.
2.
Introduction of decentralised maintenance system at the village
panchayat involving the local community in a limited area.
3.
Conversion of existing India Mark II handpumps to Mark III VLOM
handpump in a phased manner.
4.
Support R&D on handpump for developing cost effective appropriate
technology.
101
C. 1
2
C.
SPECIFIC GOAL THREE:
Increased coverage of Government
services institutions.
1995:
30% coverage
1998:
70% coverage
2000:
100% coverage
CURRENT STRA TEGIES:
There are currently no special norms to cover Government institutions such
as primary and secondary schools, iCDS, TINP and NMP centres, primary
health centres and health sub-centres on a priority basis, hence they have
been categorised under general coverage.
C.3
NEW STRA TEGIES:
For full coverage of government community-based institutions for water
supply and sanitation, priority will be given to these institutions under
regular programmes.
To achieve the set goal of 70% coverage by the end of VIII Five Year Plan,
special programme may be undertaken.
1
D.
SPECIFIC GOAL FOUR: Reduction of diarrhoeal diseases (Same
goals set under Heaith/Sanitation).
2
D.
CURRENT STRA TEGIES:
Providing safe drinking water and safe disposal of excreta, promotion of
personal hygiene, environmental cleanliness, promotion of ORT and
availability of ORS at the village level are currently undertaken as vertical line
programmes in various districts. Each component is being handled by
different agencies independently: water supply by TWAD Board/DRD,
Environmental Sanitation by DRD and ORS/ORT by Public Health.
C H - lOT)
09821
102
3
D.
NEW STRATEGY:
Water, sanitation and control of diarrhoeal disease are interrelated and
interdependent. Hence, addressing single component or addressing each
of the three components separately will not produce the desired result. The
Control of Diarrhoeal Diseases involves all three components. Therefore,
the integrated "CDD-WATSAN" approach will be introduced in selected
districts.
IV.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS
A.
COVERAGE
1.
Rural Sector
Proposed to be covered
Cost
Population covered
2.
:
:
:
158 nos.
118.61 crores
15.81 lakhs
Municipal and Urban Town Panchayat
Coverage
Cost
Population
4.
23,000 habitations
38 crores
124 lakh
Urban Sector
RTP VIII Plan
Cost
Population covered
3.
:
:
:
:
:
:
120 nos.
160 crores
35 lakhs
World Bank Assisted Schemes (1985 to 1994)
Major towns
Medium/small towns
Rural habitation
Cost
Population
:
:
:
:
:
3
85
965
321.86 crores
50 lakhs
103
5.
DANIDA Assisted Schemes
Project area:
Total pumps (TARA/Mark II)
Cost
Population to be covered
: Porto Nova and Mavahana in
Cudda/ore district
: 860
: Rs.286.17 lakhs
: 2 lakhs
SUSTAINABILITY OF SERVICES:
1.
Under Technology Mission:
Sustainable source created
Piped water supply scheme
Cost
Water harvesting structure
(Ramnathapuram District)
Cost
Roof-top Water Harvesting
structure: household units
(Kanyakumari district)
: 1972
: 385
: Rs. 12 crores
: 19 nos.
: Rs. 14 lakhs
: 73 units
QUALITY IMPROVEMENT
1.
Desalination plants of smaller capacity erected:
a.
b.
c.
d.
2.
Ramnathapuram
Chengelput
South Arcot
Mobile desalination
plants: Ramnad and
South Arcot
: 13 nos.
: 3 nos.
: 9 nos.
: 2 nos.
Other types:
a.
TARA: 500 TARA (VLOM) handpumps were installed in
coastal district
b.
Iron removal: 6 iron removal plants installed in Chengai MGR
district out of 25 sanctioned by GOI.
104
c.
D.
Defluorination: Out of 11 deflourination plant supplied, 9 had
been erected at Dharmapuri and 2 at Periyar district. Out of
726 habitations identified with excess fluoride, 486 habitations
have been provided with alternative or distance water supply.
The remaining 240 habitations will be covered in stages.
VILLAGE LEVEL OPERATIONS AND MAINTENANCE
1.
Village Level Operation and Maintenance of the Mark III handpump:
In order to reduce the maintenance cost and down time of the
handpump, a village based operation and maintenance system has
been introduced in two blocks on an experimental basis where all
the Mark II pumps will be converted into Mark III and village based
maintenance will be established by involving the community.
Total cost for 2 blocks
UNICEF share
Government share
Panchayatshare
: 55.65 lakhs
: 28.65 lakhs
: 13.40 lakhs
: 13.40 lakhs
Total number of handpumps to be converted: 267
2.
In coastal areas, TAFIA direct action village level operation and
maintenance pumps have been erected on an experimental basis at
Gumudipundi, Cuddalore, Thanjavur and Nagapattinam.
KEY INDICATORS
1.
Availability of 40 Ipcd of safe water to all households: one source per 250
population within 1.5 Km. distance and 50 metres on elevation.
2.
Reduction in source failures.
3.
Reduction in break down of handpump.
4.
Reduction in down time.
5.
Reduction in maintenance costs (costs to be defined).
6.
Improved availability of potable water.
7.
Improvement in institutional coverage.
8.
Improved health status.
Chapter Six:
ENVIRONMENTAL SANITATION
105
6. ENVIRONMENTAL SANITATION
MAJOR GOAL:
INCREASED ACCESS TO SANITARY MEANS OF EXCRETA
DISPOSAL FROM CURRENT LEVELS OF 9% IN RURAL
AND 60% IN URBAN AREAS TO 25% IN RURAL AREAS
AND 90% IN URBAN AREAS BY THE YEAR 2000.
Percentage of Households with Sanitary Facilities
Tamil Nadu
Current Status
Urban + Rural
I.
Goals
Urban * Rural
SPECIFIC GOALS:
1.
Increase sanitary facilities coverage from current level of 9% of rural
households and 60% of urban areas by 2000 AD.
106
II.
2.
Increased coverage of institutional latrines in government primary and
secondary schools; ICDS, TINP and NMP centres; Primary Health Centres
and Health Sub-Centres.
3.
Increased awareness in the community with a view to bringing behavioural
change in maintaining personal hygiene home sanitation with a particular
emphasis on washing of hands and voluntary construction of sanitary
facilities without any subsidy by a majority of the households.
SITUATION ANALYSIS AND CHALLENGE:
With only 9% of rural households and 60% of urban households (1990) having
sanitary facilities, the global goal of universal access by the year 2000 does not
seem feasible.
Sanitation programmes in Tamil Nadu are implemented by Hural Development
Department, Metropolitan City Corporations, Municipal administrations and
Department of Town Panchayats. Both sewer based excreta disposal and on-site
excreta disposal systems were adopted in metropolitan and municipal cities while
in the town panchayats and rural areas only on-site disposal systems are being
used.
■
Two pit water seal pour flush latrines have been constructed through government
rural sanitation programme in the state as on-site disposal method. Single pit
water seal latrines as well as direct pit latrines were also tried in a few places. Two
area-based projects in Periyar and South Arcot demonstrated better coverage in
respect of sanitation promotion in rural areas. Periyar Sanitation Project has
recently been linked with control of diarrhoeal diseases and water supply to have
a better impact on diarrhoeal disease reduction. Other projects such as the urban
low-cost sahitation project and small scale NGO projects have limited coverage.
Over the last decade few industries have come up which produce squatting pans
and water seal trap of various make. Small scale production units have also
developed and produce similar items making the unit further low cost. However,
their total capacity has not been assessed compared to the total need of the state
as envisaged over the coming years.
107
Thus, the basic problem has been a combination of low coverage, low demand for
sanitary facilities as well as inadequate production capacity and supply of low-cost
sanitary ware.
Given the current rate of service delivery and present approach of providing low
cost latrines to the household, sanitation coverage appears to be a major
challenge in this decade.
III.
SPECIFIC GOALS/OBJECTIVES:
A. SPECIFIC GOAL ONE:
Increase coverage of sanitary facilities from
current level of 9% of rural households and
60% of urban areas by the year 2000 AD.
1995: 10 % rural and 65% urban
1998: 15% rural and 80% urban
2000: 25% rural and 90% urban
B. SPECIFIC GOAL TWO:
Increased coverage of institutional latrines in
government primary and secondary schools;
1CDS, TINP and NMP centres;
Primary
Health Centres and Health Sub-Centres.
1995: 30% coverage.
1998: 70% coverage.
2000: 100% coverage.
108
C.
OVERALL OBJECTIVE:
Increased awareness in the community with a view to bringing
behavioural change in maintaining personal hygiene and home
sanitation with a particular emphasis on washing of hands and
voluntary construction of sanitary facilities without any subsidy by a
majority of the households.
IV.
STRATEGIES:
A.
B.
CURRENT:
1.
Provision of low cost sanitary latrines free of cost or at a subsidised
rate to urban and rural households through area-based projects and
schemes.
2.
Involvement of NGOs to promote sanitation through enhanced
community participation.
3.
Construction of latrines through low cost housing programme (JRY).
4.
Conversion of dry latrine into sanitary latrine through scavenger
rehabilitation programme.
ADDITIONAL STRATEGIES:
1.
Awareness creation and social mobilisation, possibly through NGOs
(block level), with a view to attain behavioural change in the
community for adopting sanitation facilities and habit. Extension
Officer Social Welfare, Social education, Rural welfare for women and
mothers’ sangam be utilised for monitoring the awareness creation.
2.
Introduction of Environmental Sanitation as a package which
includes handling of drinking water, disposal of waste water (to
kitchen garden), disposal of excreta, garbage disposal, food and
home sanitation, personal hygiene and environmental cleanliness.
109
3.
Provision of subsidy for latrines for the families below poverty line to
the possible minimum extent, preferably in the form of materials.
4.
Social marketing of appropriate technology range with a view to
create favourable conditions for voluntary construction of sanitary
facilities without any subsidy.
5.
Development of local production, delivery and marketing capacity by
strengthening existing PDS or similar outlets.
6.
Development of alternative approaches for sanitation promotion such
as establishment of revolving funds, sanitary marts, linkage to bank
loans at the block level.
7.
Construction of sanitary latrines in all important public institutions eg.
anganwadi centres, TINP, NMP, primary health centres, primary
schools, secondary schools etc., with a view to create awareness
among the community as well as contribute towards improving the
quality of services.
8.
Implementation of sanitation project, adopting at least one model
village in each block each year covering all the families with
sanitation facilities emphasising maximum effort on community
participation and management.
9.
Priority for tribal population, difficult terrain, coastal village, etc.
10.
Development of appropriate design to suit the local needs based on
the habitation pattern.
11.
Establishment of linkages with other programme (JRY, NRY, Trysem,
DWCRA, Health, Education, Water Supply) through coordination at
district and state-levels.
110
12.
V.
Introduction of school sanitation through curriculum development for
maintaining personal hygiene by the students and through provision
of personal hygiene kits to all pre and primary schools.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS:
A.
RURAL SANITATION PROGRAMME:
The state government plans to expand the Rural Sanitation programme
beyond the area based projects (Periyar and South Arcot districts). Of the
uncovered 78 lakh rural families, 8th plan envisages a coverage of 6% i.e.,
4.7 lakh families, half of whom are below the poverty line.
Total fund requirement for achieving a 6% incremental coverage in the rural
area during the 8th plan period is estimated to be Rs. 9,670 lakhs, which is
considerably higher than the provision of state sector allocation (Rs. 1,729
lakhs) and Central programme (Rs.2,500 lakhs).
B.
LOW COST SANITA TION IN URBAN AREAS:
Sanitation coverage trend in urban areas appears to be better compared
to the rural coverage. For 108 Municipal cities of the state, comprehensive
schemes are available for constructing low-cost latrines or conversion of dry
latrines into sanitary latrines by 1995.
111
The fund requirement will be approximately Rs. 7,900 lakhs and adequate
allocations have been made in the 8th Plan.
For the 88 Town Panchayats, allocation has been ensured in the 8th Plan
to convert dry latrines into sanitary latrines.
VI.
KEY INDICATORS
1.
Increase in proportion of population and households with access to sanitary
latrines.
2.
Improved practices related to persona! hygiene and home sanitation with
particular emphasis to hand washing.
3.
Households provided with latrines constructing other sanitation facilities
thereby adopting sanitation as a package.
II. INTER-SECTORAL ISSUES
Chapter Seven:
CHILD LABOUR
112
7.
MAJOR GOAL:
I.
ELIMINATION OF BONDED CHILD LABOUR AND CHILD
LABOUR IN HAZARDOUS INDUSTRIES FOR CHILDREN UP TO
14 YEARS AND FULL-TIME CHILD LABOUR OF ALL CHILDREN
UNDER 12 YEARS.
SPECIFIC GOALS:
1.
2.
3.
4.
II.
CHILD LABOUR
Elimination of child labour in the match and fireworks industries.
Elimination of child labour in other classified and non-dassified hazardous
industries which affect the normal and healthy development of a child.
Elimination of full-time child labour in all industries and categories for
children under 12 years, in line with the Universal Primary Education goal.
Elimination of bonded child labour in all industries and categories.
SITUATION ANALYSIS AND CHALLENGE:
While the exact number and scale of child labour in Tamil Nadu is not known, the
fact that it is extensive in selected areas and industries such as the match, hosiery
and beedi industries is well-established.
Another well-established fact is that child labour is primarily a problem for girl
children. This is correlated with the higher levels of drop-out among girls in
primary and secondary schools.
The exact scale of child labour in the match and fireworks industries in
Kamarajar, VO Chidambaranar, Tirunelveli districts will soon be ascertained when
the door-to-door survey undertaken by the Department of Social Welfare and NMP
is completed in October 1993. Preliminary findings indicate that the number may
be even higher than the estimated range of 45,000 to 80,000.
113
Apart from the match and fireworks industries which fall under the category of
“hazardous industries" in the National Child Labour Act of 1986, others which are
also hazardous and are known to have child labour are the small-scale beedi
units, quarries, cashew production and first level tannery production units.
The concerned districts for these industries are: N. Arcot for beedi and tanneries;
Dindigul for tanneries; Kanyakumari for cashew; Pudukottai, N. Arcot, Salem,
T.Sambuvarayar and Chenglepet for quarries.
Though not classified as hazardous, child labour, especially among girls, is also
stated to be extensive in the hosiery (Tiruppur in Coimbatore District) industry as
well as the cotton ginning industry in Virudhnagar, Kamarajar District.
Bonded child labour is also found in varying degrees in all the above-mentioned
industries as well as in the form of "kutti vidaradu", the practice of bonding very
young girls as maid servants to landlords until the age of marriage. This is a
well-known practice found in selected districts such as Salem, PMT and
Ramanathapuram.
The challenge before the Government of Tamil Nadu is to achieve its declared
intention to eliminate child labour in the match and fireworks industries by 1997.
The intention to eliminate child labour in other hazardous industries has also been
declared. The need to prepare an integrated and multi-sectoral Plan of Action has
been recommended by the Sub-Committee formed for the purpose of developing
a strategy framework.
The intention to eliminate child labour in the hazardous industries may also be
extended to bonded child labour as an equal priority area. The elimination of child
labour must also be in line with the goal of achieving Universal Primary Education
by the year 2000 which has set 1998 as the target for universal enrolment of
children in the 6-11 age group. This will mean that full-time labour of primary
school age children must be eliminated by the same year.
114
III.
SPECIFIC GOALS BY TARGET YEARS:
A.
SPECIFIC GOAL ONE:
1995: a.
b.
c.
Elimination of child labour in the match and
fireworks industries.
Total elimination of vestiges of child labour in
the fireworks industries.
Withdrawal of children under 12 years with no new entrants in the
match industry.
Special Courts established for Child Labour cases, especially
located in Child Labour intensive areas with jurisdiction for several
districts.
1997: Total elimination of child labour.
B.
SPECIFIC GOAL TWO:
Elimination of child labour in other hazardous
industries classified in the Child Labour Act as
hazardous which are relevant to Tamil Nadu;
namely, beedi, match, fireworks, tanning, woo!
cleaning, doth printing, dyeing and weaving as well
as others which affect the normal and healthy
development of a child.
1995: Programme of action framed and initiated, especially for key industries,
such as beedi, cashew and skin cleaning and wool processing units.
1998: Eliminate Child Labour of children under 12 years.
2000: 100% elimination of Child Labour for upto 14 years.
C.
SPECIFIC GOAL THREE:
Elimination of full-time child labour in all
industries and categories for children under
12 years, in line with the Universal Primary
Education goal.
1995:
100% of children 10 years and under.
1998:
100% of children under 12 years.
2000:
Sustain achievement of 1998 goal.
115
D.
SPECIFIC GOAL FOUR: Elimination of bonded child labour in all industries
and categories.
1995:
Elimination of bonded Child Labour in the beedi industry with
assessment of situation in all other areas.
1998:
Total Elimination of bonded labour.
2000:
Achievement sustained.
IV.
V.
CURRENT STRA TEGIES:
1.
Limited enforcement of the Child Labour Act in registered factories and
scheduled industries.
2.
Special schools under the National Child Labour Project and non-formal
education through various NGOs projects.
3.
ILO/IPEC supported NGO projects in selected pockets aimed at weaning
children away through non-formal education and other services.
4.
Strategy framework for elimination of Child Labour in the match and
fireworks industries prepared. Plan of Action to be undertaken by various
departments concerned.
NEW STRATEGIES AND ACTIVITIES:
A.
OVERALL STRATEGIES
1.
Legislation on and operationalising of compulsory primary education
through local bodies and village level committees, especially in child labour
intensive areas, making parents responsible.
2.
Situation analysis of the extent of child labour in the hazardous industries
and to identify industries and areas with bonded child labour throughout the
state (to be completed by mid-1994).
3.
An integrated and multi-sectoral approach which addresses the problem
from different dimensions for each hazardous industry, i.e., raising income
earned by adults, rural and agricultural development in drought-prone
areas, spreading of selected industries to alleviate concentration of labour
demand, formation of workers cooperatives and unions, etc.
116
4.
For the match and fireworks industries, an integrated and multi-sectoral
approach as outlined in #3 above based on the recommendations of the
Sub-Committee on the Elimination of Child Labour in the Match and
Fireworks Industries in Tamil Nadu (See Report dated April 1993 for details).
5.
Immediate finalisation and notification of the Rules under the Child Labour
Act of 1986 along with orientation of the enforcement officials, Public
Prosecutors and the judiciary.
6.
Strong enforcement of the Child Labour Act especially in the match and
fireworks industries and other hazardous industries.
7.
Strengthening enforcement machinery of the Labour and Factory Inspection
wings, in the CL intensive areas.
8.
Establishment of Special Courts in child labour intensive areas with
appointment of Public Prosecutors exclusively for child labour cases.
9.
Designation of a panel of Medical Officers for certification of proof of age
where no birth certificate is available.
10.
Increase in minimum wages in selected industries with a piece rate system
to ensure that minimum wages are earned within the stipulated time of 8
hours. A strategy for introducing a time-rated system in the long run may
be explored.
11.
Enlisting the cooperation of industrialists, unit owners’ associations and
trade unions.
12.
Communication and social mobilisation on improving the status of the girl
child, value of basic education and evils of child labour through non
governmental organisations, NSS, Nehru Yuwak Kendras and other local
organisations.
13.
Introduction of shift schools in child labour intensive areas to ensure that a
minimum of 4 hours of schooling is provided in the forma! system.
14.
Introduction of a flexible school calendar and timings (as stated in the
Universal Primary Education strategy) in rural areas according to planting
and harvest seasons.
117
VI.
B.
SPECIFIC STRATEGIES FOR BONDED CHILD LABOUR:
1.
Ensuring availability of credit for parents through NGOs, local banks and
other financial institutions to stem bonding of children to employers for
loans granted.
2.
Mobilising of NSS, NYK and other youth groups in bonded child labour
intensive areas to discourage parents from such practice.
3.
Counselling and support systems for parents through NGOs, teachers and
field functionaries to dissuade them from bonding their children.
4.
Strict and immediate action by Revenue Officials, Police and other
authorities to charge cases against employers and parents for bonding
children.
EXISTING SCHEMES:
There are currently no State Government schemes, programmes or projects
towards the elimination of child labour. A multi-sectoral Programme for Action, as
proposed by the Sub-Committee on the Elimination of Child Labour in the Match
and Fireworks Industries, needs to be developed on a priority basis if the goal of
total elimination by 1997 is to be met.
There are only small-scale efforts at providing non-formal education for working
children as part from the National Child Labour Project in the Sivakasi area and the
IPEC/ILO funded NGO projects.
VII.
KEY INDICATORS:
1.
Education indicators such as enrolment and drop-out rates, out-of-school
children for elementary level.
2.
Number of inspections made and cases launched by Factory and Labour
Inspectors.
3.
Number of cases launched by Revenue Officials and Police against bonded
child labour.
4.
Number of cases acquitted, withdrawn, convicted, fined or imprisoned.
5.
Reduction in number of child labour in selected industries (especially in
hazardous and intensive areas) through periodic surveys.
Chapter Eight:
GIRL CHILD
AND ADOLESCENT GIRL
118
8. GIRL CHILD AND ADOLESCENT GIRL
MAJOR GOAL:
/.
IMPROVE STATUS OF GIRL CHILD TO ACHIEVE EQUAL
SEX RATIO
SITUATION ANALYSIS AND CHALLENGE:
The sex ratio in Tamil Nadu has been declining steadily during this century: from
1050 in 1901; 1007 in 1951 to the current level of 972 in 1991.
This key indicator of the low status of girls and women in society is further
supported by the reversal of the infant mortality rate (IMR) between boys and girls:
1980 1986 -
Male : 96
Male : 74
Female : 90
Female : 86
Both show a decline; but the rate of decline is much slower for girls - a reflection
of how environmental factors have countermanded nature’s "protection" to the girt
child of making her biologically stronger. The impact of improved health services
have been greater for boys while girls are not receiving the same degree of care
and access. Other indicators of gender disparities in the state include:
a.
b.
c.
d.
e.
Literacy Male/Female
Primary School Drop-out M/F
Secondary School Drop-out M/F
Agriculture Wage M/F
Members of Legislative Assembly M/F
74.88% / 52.29%
17.1%/ 19.6%
34.7% / 43.5%
Rs.10/Rs.8per day
234 / 30.
These indicators reflect the depressed status of girls and women due to a
fundamental preference for a male child and a belief that girls are more an
economic and social liability than a value.
This fundamental belief is compounded and perpetuated by socio-cultural
practices which affect the whole life cycle:
Girls are Mother’s Helpers in child care, house work, fetching water and fuel
or supplementing the family income and are therefore not sent to school.
Older girls, adolescent girls and women get a lesser share of the food
available within the family and are therefore more malnourished, especially
affected by anaemia.
119
Gir/s are married off early at a great expense to the family having to pay
dowry in various forms. When the dowry is inadequate, she is subject to
rejection and abuse by her in-laws.
*
Early marriage means early pregnancy, exposing her to risks of maternal
death. After too many and too closely spaced pregnancies and child birth,
the young woman is weakened and vulnerable to ill-health.
*
As an illiterate adult, her awareness level is low; options and opportunities
for better income are limited and her capacity to contribute to society is
even more limited.
*
Thus, having had a life of deprivation and abuse, the older woman in turn
deprives her own daughter and daughter-in-law.
The worst manifestation of this social problem is the practice of female infanticide
and foeticide, prevalent in several districts. Known cases are found in Madurai,
Salem, Dharmapuri, North Arcot and Periyar.
The sex ratio in selected villages in Salem is far below the State average: 932
against 974. A study conducted in Salem in 5 blocks, revealed that out of the
1200 infant deaths, nearly 45% were due to infanticide.
The challenge is truly great - how can the status of the girl child, the adolescent
girl and the woman be improved? How can such deep-rooted and fundamental
beliefs and practices be changed? How can the decline in sex ratio and the slow
decline in girls’ IMP be reversed?
To reach all the sectoral goals, special and concerted attention must be paid to
the girl - so that her chances for survival are vastly improved; her opportunities
broadened and capabilities developed to full potential through education and
thereby her true value recognised by her family and by society.
120
II.
SPECIFIC GOAL:
To reverse the trend of decline in sex ratio
1995: Arrest the declining trend of sex ratio to 980
1998: Reverse the existing declining trend of sex ratio to 990
2000: Achieve equal sex ratio of 1000
Sex Ratio
Tamil Nadu
K3 Past trends E3 Goals
Source: Registrar General, India (1951-1991)
121
III.
PROCESS OBJECTIVES:
Apart from the general goals listed above and those that are already addressed
in the various sectoral strategies and activities covered in the various chapters,
additional objectives are required for the adolescent girl:
A.
To cover 80% of adolescent girls by special health camps to improve
personal health awareness and health status
1995: 40% Coverage in health camps
1998: 70% Coverage in health camps
2000: 80% Coverage in health camps
B.
To provide vocational skills towards self reliance for 50% of school
drop out adolescent girls
1995: 20% Coverage under vocational skills
1998: 35% Coverage under vocational skills
2000: 50% Coverage under vocational skills
IV.
CURRENT STRATEGIES ON STATUS OF GIRLS/WOMEN:
1.
2.
3.
4.
5.
6.
7.
8.
Thrust on female literacy.
Health systems geared up to focus on care of girl child.
Communication and social mobilisation for societal, attitudinal change
involving media, field level functionaries of TINP/ICDS/teachers/NGOs and
health workers and other local organisations.
Monitoring of 'high risk pregnancies’ - ie., mother with two and more girl
children, in female infanticide areas.
State Women’s Commission formed to look into gender issues.
Programmes on economic activities through Social Welfare Board, NGOs,
Women’s Development Corporation, etc.
ICDS network focusing on adolescent girls.
Government interventions to ensure survival of girl children in ’high-risk’
blocks and incentives schemes to promote status of girl children.
122
V.
VI.
CURRENT STATE SCHEMES/PROGRAMMES:
1.
Government cradles provided in female infanticide areas. Unwanted female
children can be left in cradles kept in primary health centres, orphanages
and noon-mea! centres.
2.
Rs. 2000/- invested (in a special public fund account maintained by the
government) in the name of every girl child born in Tamil Nadu subject to
eligible conditions. Small amounts will be released periodically with the
lump sum (Rs. 10,000) paid at age 20.
3.
Scheme for eligible girls who have studied up to Class 8 where Rs.5,000/will be awarded.
NEW/ADDITIONAL STRATEGIES:
1.
2.
GENERAL:
a.
Qualitative study to assess the situation in selected female infanticide
prevalent blocks.
b.
Develop an Action Plan based on study.
c.
Ensure major portion of the budget in all developmental programmes
for children is allocated for girls.
d.
Active participation of State Women's Commission in issues relating
to girl child abuse.
e.
Enforce taws relating to protection of girls and women.
f.
Ensure availability of sex aggregated data in all sectors to monitoi
disparity reduction progress.
HEALTH & NUTRITION:
a.
To provide all health and nutrition services to female children under
14 years removing gender disparity.
b.
Enforce ban on ’sex-identification’ of foetus. Educate the public on
high risks involved in such late abortions; build awareness among
health professionals to desist from this practice; and build an
effective lobby among health professionals to eliminate this practice.
123
3.
4.
c.
Home care of new bom infants (LBW infants) by promotion of early
and exclusive breast-feeding and other measures without gender
disparity.
d.
Age at marriage postponed indirectly through training and self
employment opportunities for out-of-school girls above 15 years.
e.
Birth interval to be raised to 3 years and number of children limited
to two.
f.
Child bearing age to conclude by 27 years.
g.
Assess current malnutrition levels among children 6-14 years and
fine tune the existing noon meal programme to monitor nutritional
status of children with special reference to adolescent girls.
h.
Improving nutritional status of adolescent girls to maximise growth
during adolescence and reduce micro nutrient deficiencies,
especially anaemia.
i.
Conducting special health camps for adolescent girls to improve
their health and nutrition status and awareness (See Details in
Chapter on Maternal Health)
EDUCATION:
a.
Priority targeting girls, SC/ST children, working children and other
educationally backward groups to ensure 100% enrolment and
retention.
b.
Creches and balwadis to be provided to relieve girls of child care.
c.
Local escort system to be organised for girls to ensure regular
attendance and provide social protection.
d.
Women empowered through achievement of 100% female literacy
and increased awareness.
WATER AND SANITA TION:
Provision of drinking water and sanitary facilities in primary and secondary
schools to contribute to girls’ retention.
124
5.
CHILD LABOUR:
Communication and social mobilisation for improving the status of girl child,
value of basic education and evils of child labour through non-governmental
organisations, NSS, Nehru Yuwak Kendras, film star fan clubs and other
local organisations.
6.
CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES (CEDC):
a.
b.
c.
7.
8.
Identify NGOs in urban and semi-urban areas for maintaining night
shelters for street and working children (especially for girls).
Opening of child guidance centres and Child Assistance Bureaus
(CABs) in urban and semi-urban areas to assist children living on
their own and to address child abuse, child rape and neglect.
Empower State Level Committee for legislative sanction for the
Eradication of Child Prostitution.
ECONOMIC PROGRAMMES:
a.
Existing government schemes (IRDP, DWCRA, TLC & DEW/IFAD)
to focus on vulnerable areas and target 'high risk' mothers.
b.
To provide vocational skills to drop out adolescent girls to become
economically self-reliant.
SOCIAL MOBILISATION:
a.
To create awareness about family welfare measures. To eliminate
social practices such as dowry, child marriage, female infanticide,
early pregnancy, etc.
b.
To create awareness among all community groups including youth
and men.
c.
To orient all programme planners and imple'mentors to gender
issues.
d.
To generate gender sensitive data in all programmes influencing the
status of girl children. To include gender sensitive objectives as an
integral part of other sectoral programmes.
e.
Formation and strengthening of action committee to discuss and
monitor issues related to girl child.
126
4.
c.
Loans for self employment to be given to mothers of adolescent girls
who have received skill training, since the girls themselves may not
be eligible for loans because of low age.
d.
Special focus in skill training to agriculture oriented programmes like
agro-forestry, social forestry and waste land development
programmes.
e.
50% of IRDP loans to be given to women with special emphasis to
cover risk groups and blocks with adverse sex ratio and other
gender sensitive indicators.
f.
Intensify programme of patta distribution to women in districts.
g.
Waiving registration fee for inclusion of women as joint owners of
property.
h.
One economic programme in every revenue village exclusively for
women.
SOCIAL MOBILISATION:
a.
Awareness programmes on gender-equality and women’s issues to
be conducted for various segments of society - school children,
adolescent girts, youth, local leaders, women's groups and
authorities such as government officials, police officials and judicial
officers.
b.
Effective use of media as a medium to build self-confidence and selfrespect in women. A committee consisting of representatives of
women’s organisations to be set up to monitor the portrayal of
women in print and electronic media.
c.
Government/NGOs to undertake the responsibility of strengthening
Mahalir Maudrams (women’s working groups) with leadership
training, skills development and income generation programmes and
use them as agents to remove gender disparity.
d.
Increase the household food availability especially of green leafy
vegetables through ’kitchen garden’ concept. Propagating
community based kitchen garden activities.
e.
Support and encouragement to NGOs for innovative programmes in
creating awareness on girl child protection.
f.
To make efforts for the elimination of all forms of discrimination and
exploitation of girl child.
Special attention to be focussed on
eliminating trafficking and prostitution.
127
5.
VIII.
LEGISLATION:
a.
Compulsory registration of marriages to be enforced.
b.
Enforcement of laws relating to child marriage.
c.
Amendment and enforcement of Dowry Prohibition Act.
d.
Legislation to eradicate Child Prostitution
ACTIONS AND ACTIVITIES AT THE STATE LEVEL:
1.
The state government will declare the priority goals and rededicate
all development programmes to improve the status of girl children
and women.
2.
The various departments of the state - more specifically the
Department of Social Welfare and Nutritious Meal Programme,
Education, Rural Development, Health, Agriculture, Backward
Classes, Tribal Welfare to incorporate these goals in their
programmes.
3.
The Department of Social Welfare will be the nodal department for
review of goals and action in relation to the girl child.
4.
The Social Welfare Department will review the regulatory measures
under existing laws during 1993 and suggest modifications/additional
regulations for the protection of the girl ghild.
5.
Constitution of an inter-departmental steering group to plan and
coordinate the interventions by different departments and NGOs to
achieve the state goals for the improvement in the situation and
status of the girl child.
6.
State level policy to enable girls from the non-formal stream to enter
the main stream at the elementary stage.
7.
The Social Welfare Department through village level net work will
organise various activities and monitor the progress towards
implementation of the goals.
128
8.
IX.
Advocacy Support:
a.
The State Government through its various channels for public
information, education and communication, advocate for focus
on the girl child.
b.
The State Government will provide and disseminate
information needed for planning area based specific
interventions using existing ICDS, TINP and Social Welfare
network.
c.
The Social Welfare Department will organise state and district
level interactions to share experiences and replicate success
stories of NGOs running special programmes for girl children.
d.
The State government will encourage academic institutions
and research organisations to undertake special studies on
the situation analysis of girls in minority groups, geographical
regions, migrants and disabled and use the information to
support and strengthen policy.
KEY INDICATORS:
1.
2.
3.
4.
5.
6.
7.
Number of girl children completing primary education
Nutritional status of girl children < 14 years
Age specific death rates for female children
Sex ratio
Coverage of girls under special health camps
Percentage of funds allocated to development programmes spent on girl
children
Gender specific indicators for covered and impact under sectoral
programmes with emphasis on socially-disadvantaged groups.
Chapter Nine:
CHILDREN IN
ESPECIALLY DIFFICULT CIRCUMSTANCES
129
9. CHILDREN IN ESPECIALLY
DIFFICULT CIRCUMSTANCES
I.
MAJOR OBJECTIVES:
1.
While the sectoral chapters will address all children across the states, this
chapter covers special strategies and activities that will be required to
ensure that children who are in difficult circumstances are given the
required special attention.
To ensure that sectoral goals relating to education (forma! and non-format),
including opportunities for skill development, health and nutrition are
achieved in order to tackle the root cause.
2.
To address needs of children in especially difficult circumstances for their
protection, care and development focussing on the following groups:
a)
b)
c)
d)
e)
f)
3.
II.
Street Children
Neglected, destitutes & orphans
Children of prostitutes
Juvenile Delinquents
Children of AIDS affected parents/AIDS affected children/AIDS
orphans
Drug Addicts
To reduce disintegration of families and destitution of children by focussing
on situations of ’at-risk’ families through inter-sectoral cooperation and
collaboration in preventive strategies.
SITUATION ANALYSIS, CURRENT EFFORTS AND CHALLENGE:
As in other parts of the country, Tamil Nadu faces the problem of increasing
number of children in especially difficult circumstances (CEDC).
Family
disintegration, poverty, non-enrolment and drop-out from schools, migrations from
rural areas to cities, unhealthy social environment in city slums are some of the
factors which leave children in unprotected and difficult circumstances.
130
The major categories of CEDC in the context of the state are: street children,
neglected, orphaned and destitute children, juvenile delinquents, children addicted
to drugs and involved in drug trafficking, children of prostitutes and child
prostitutes, children ofAIDS/HIV infected patients and AIDS affected children/AIDS
orphans. Statistics of these categories are not available and there is a need to
document the magnitude and dimension of the problem.
It is estimated that there are approximately 27,000 street children in Madras and
approximately 3000 in Madurai. In response to the needs of street children,
Government of Tamil Nadu implemented a scheme of night shelters in Madras in
1989 and 5 more were established in 1991-92, in Madras, Madurai, Salem and
Villuppuram.
There are 14 Observation Homes (11 govt., 3 NGOs) and 21 Juvenile Homes (10
govt., 11 NGO) in the state under Juvenile Justice Act, 1986 to handle neglected
and destitute children in 13 Juvenile Boards are functioning for processing
neglected juveniles. (4000 children are being covered by the JJA institution).
Matters relating to orphans and destitutes are also looked after in orphanages
established under Orphanages and other Charitable Homes Act, 1960. These
children do not come under the purview of the JJA. These institutions need to be
brought under the purview of inspection and monitoring.
The statistics compiled with reference to the admissions in the Observation
Homes/Special Homes reveal that there were 5465 admissions in Observation
Homes, 1291 admitted in Special Homes or Fit Institutions.
For the year 1991, the statistics reveal that there were 5346 admissions in
Observation Homes and 2936 admissions in Special Homes or Fit Institutions.
The strength of inmates (delinquents) in special homes is 130.
There 24 orphanages run by government. In addition support is provided to 176
institutions providing care and protection to children in need run by NGOs. 5,400
children are taken care of by government orphanages and 14,350 by NGO
institutions receiving support from government.
131
Government of Tamil Nadu is maintaining correctional institutions
(Protective/Vigilance Homes) under the I.T. (P) Act, 1956.
The children of
offenders under the Act are tried before the Juvenile Welfare Board and referred
for care and protection. With regard to children of prostitutes, statistics is being
compiled through NGOs. The Directorate has initiated a survey in the life pattern
of women and girls discharged from correctional institutions.
Government of Tamil Nadu has instituted an advisory committee on eradication of
child prostitution. It is envisaged that the committee will be empowered by state
legislation.
Children of AIDS affected patients, AIDS affected children and AIDS orphans is
a new challenge. While awareness creation and preventive interventions would be
within the mandate of the health department, care of AIDS affected children and
AIDS orphans are envisaged to be handled by the Directorate within services for
neglected juveniles and care and protection programme facilities available.
III.
PROCESS OBJECTIVES:
1995:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
To cover 40% of street and working children for non-forma!
education programme and enrol 6-7 year olds in formal schools.
To provide access to health services to 40% of street and working
children.
To establish five night shelters.
To provide skill training to 3,600 street and working children.
Establish 5 additional juvenile welfare boards and 5 additional
Observational Homes.
Conduct medical camps to cover all children in juvenile/special
homes annually.
<
Open 5 additional juvenile homes.
Obtain legislative sanction for the eradication of child prostitution.
Initiate pilot project on two short-stay institutions attached to Juvenile
Guidance Bureau.
Screen 40% of risk groups among CEDC for AIDS.
Open 5 de-addiction centres with mobile units.
Set up an inter-sectoral committee to ensure directing of poverty
alleviation, development and welfare programmes for ’at-risk’families.
132
1998:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Step up coverage for NFE to 75% and integrate 6-11 year olds into
formal system.
Step up coverage for health services to 75% for street and working
children.
Establish five more night shelters.
Provide skill training to 1800 additional children
Establish 5 additional Juvenile Welfare Boards and 5 additional
Observational Homes and complete coverage, of all districts.
Establish 5 additional juvenile homes.
Constitute 5 Juvenile Courts
Establish 2 additional special homes with skill development facilities
and recreation.
Open 5 additional de-addiction centres
Develop and implement an inter-sectoral programme to address ’atrisk' families in at least 4 districts.
2000 A.D.:
1.
2.
3.
Increase coverage for education programme to 100%
Increase coverage for health services to 100%
Provide skill training to 1800 children.
NEW STRATEGIES/ACTIVITIES:
A.
General:
1.
B.
To develop a mechanism for inter-sectoral cooperation to ensure ’atrisk’ families are targeted on a priority basis for all development
programmes.
Street Children:
1.
Conduct of surveys and studies on magnitude and dimensions of the
problem of street children in cities in Tamil Nadu.
2.
Facilitate re-instatement of younger children back in their families and
into formal schools.
3.
Identify non-governmental organisations in urban and semi-urban
areas for maintaining night shelters for street and working children.
133
C.
4.
Establish mechanism for access to municipal health services for
street children/NGOs and supplementing health service delivery
through mobile health units.
5.
Vocational programmes to cover 7200 beneficiaries - by 2000 AD.
6.
Educational programme to cover all street and working children - by
2000 AD.
7.
Establishment of Children Assistance Bureaus (CABs) through NGOs
with the Collector as Ex-officio President and District Social Welfare
Officer/Probation Officer as member secretary, social welfare board
member as a member to cover all municipalities and corporations by
2000 A. D.
8.
Conduct training programmes for the functionaries and non
governmental organisations.
9.
Creation of a monitoring cell to oversee and evaluate programmes
for street and working children.
Neglected Orphans and Destitutes:
1.
Strengthen existing and open additional Juvenile Welfare Boards and
recognition of fit institutions.
2.
Open observation homes in all districts through non-governmental
organisations.
3.
Strengthen family support services, foster care and sponsorship
programmes.
4.
Encourage non-institutional services including in-country adoption to
benefit institutionalised children and ’at risk’ children in community.
5.
Open child guidance centres to deal with problems of child abuse
in urban and semi-urban areas and involving NGOs and community
participation.
6.
Conduct free medical camps in all juvenile/special homes - through
linkage with the health system.
134
D.
7.
Establishment of working committee for developing strategies for
addressing needs of children destituted due to natural or other
calamities.
8.
Creation of a Statistical and Resource Development Wing.
9.
Creation of a welfare fund for discharged inmates ofjuvenile/special
homes to provide assistance for self employment and integration in
society.
10.
Open juvenile homes through non-governmental organisations.
11.
Inspection of institutions under the orphanages and other charitable
Homes Act 1960 for reviewing quality of child care is institutional.
12.
Development and implementation of a district based pilot project for
a comprehensive strategy for prevention of destitution and care,
protection and rehabilitation of destitute, orphaned and delinquent
children through non-institutional approaches.
13.
Evaluation of non-institutional services and expansion of services.
Children of Prostitutes:
1.
Empower State Level Committee by legislative sanction for the
Eradication of Child Prostitution.
2.
Strengthen social mobilisation activities to eradicate this practice.
3.
Survey and assessment study of the children of prostitutes - through
non-governmental organisations and documentation.
4.
Develop programme approaches on the basis of the study.
5.
Extending care and protection programmes under the Juvenile
Justice Act 1986.
135
E.
F.
G.
Juvenile Delinquency:
1.
Prevention of juvenile delinquency through community based
services.
2.
Introduction of short-stay institutions as a pilot project attached to
Juvenile Guidance Bureau.
3.
Constitution of a Juvenile Court in a phased manner.
4.
Area Project (in specified vulnerable areas) for the prevention of
juvenile delinquency with a task force.
5.
Opening of additional special homes with skill development facilities
and recreation.
6.
Strengthening of Juvenile Aid Police Units and diversion projects.
Children ofAlDS affected parents/AIDS affected children/AlDS orphans:
1.
Awareness on AIDS through non-governmental organisations in
slums and pockets of CEDC.
2.
Counselling centres and providing guidance and access referral
services.
3.
Rehabilitation of orphans and integration into the main stream of the
society.
Drug Addiction among children:
1.
Conducting of a survey on drug abuse by children - through non
governmental organisations.
2.
Awareness programme on alcohol and drug among children.
3.
Open de-addiction centres using existing facilities in the city and also
mobile units.
4.
Production of Education/Training/Awareness materials on self
development, drugs, etc., for use by Street Educators.
Chapter Ten:
URBAN CHILD
136
10. URBAN CHILD
I.
MAJOR OBJECTIVE :
All sectoral goals to be attained in urban areas, specifically among "at risk" groups
such as pavement dwellers, street children and migrant groups including
construction workers, as well as among populations living in slum pockets and
areas such as:
notified slums
unauthorized slums (including those on private land)
' fringe areas, re-classified municipal areas and resettlement schemes.
White the specific goals set by the sectors are applicable for the State as a whole,
there is a special need for direct targeting to the above "at risk" groups. The focus
in this chapter is on complementary "urban" strategies and activities to ensure
access and coverage for those most in need.
II.
SITUATION ANALYSIS
Tamil Nadu is the third most urbanised state in India after Maharashtra and
Gujarat. The urban population is 19.3 million (1991), representing 34.2% of the
total population.
With 41.5% incidence of urban poverty, 7 million people or 10% of the total state
population are estimated to be living in poverty conditions in urban areas.
Children of families living in poverty in urban areas have not been adequately
targeted under many programmes. For the state goals to be achieved, the "at
risk" groups and areas need to be specifically targeted.
While the 26 Class-1 towns (over 100,000 population) contains 50.55% of the total
urban population, Madras alone holds 28% and the 5 metropolitans (Madras,
Coimbatore, Madurai, Salem and Tiruchirapalli) contain almost 49% of the urban
population and have the highest incidence of urban poverty. Thus, the problems
of the urban poor are most acute in these cities.
137
III.
STRATEGIES FOR THE URBAN POOR
A.
B.
CURRENT STRA TEGIES:
1.
Priority attention to housing and environmental improvements
especially for slum and pavement dwellers through sites and
services for pavement dwellers and worst-off slums, and "in-situ"
improvements such as proper access, lighting, clean water, latrines,
drainage etc.
2.
Regionally balanced urban development through efforts to control
distribution of urban in-migration among different urban centres.
3.
Slow down growth of the 5 urban agglomerations and of Class-1
(over 100,000 population) towns through planned diversion by:
a.
Locating employment generating economic activities in Class11 and III towns.
b.
Increased investments for urban development in small and
medium towns both in terms of commercial and service
projects.
c.
Incentives and disincentives such as subsidies, taxation
measures and provision or non-provision of necessary inputs.
NEW STRATEGIES/ACTIVITIES:
While the main focus of the strategy for urban development in Tamil Nadu
has been on trying to stem further growth of the metropolitan cities where
the problem of urban poverty is most acute, the focus here must be on the
problems where they are most acute and targeting those most in need.
Given the high level of investments and schemes available for urban
development being implemented by various departments and agencies,
there is a clear need for the preparation of an overall urban plan of action
to focus attention on the poorest of the poor in urban areas. Thus, this
chapter on the Urban Child will be elaborated in the Urban Action Plan
which will be prepared jointly by the Departments of Housing and Urban
Development and Municipal Administration and Water Supply.
138
The agencies concerned are:
1.
2.
3.
4.
5.
6.
7.
Directorate of Municipal Administration
Directorate of Town and Country Planning
Tamil Nadu Slum Clearance Board
Tamil Nadu Urban Development Project Office
India Population Project V
Integrated Child Development Services
Representatives from the 5 Corporations and selected Municipalities
OVERALL STRATEGIES/ACTIVITIES:
1.
Identification and mapping of all locations and areas where the
poorest population groups are found, including pavement dwellers
and street children.
2.
Assessment of the status of children and women living in these
areas/locations in terms of health, nutrition and education and
access to basic facilities such as shelter and drinking water supply
and sanitation.
3.
Targeting of available basic services and existing programme
coverage to those most critically in need and ensuring access to
health, nutrition and education facilities.
4.
Preparation of city/town level action plans by Municipalities and
Corporations to focus on the most vulnerable groups for the
achievement of sectoral goals through convergence of existing
programmes and services.
5.
SUDA (State Urban Development Agency) to be established by 1994
to coordinate the planning and monitoring and assessment of the
urban poor specific targets under the State Progamme of Action
(SPA).
6.
A city le vel coordination committee to be established in all to wns with
the Municipal Commissioner as Chairperson to plan, implement and
monitor the SPA, especially ensuring urban targets are met,
especially among the "at risk" groups.
139
7.
IV.
Community development Cells to be established in the Urban Basic
Services for the Poor (UBSP) programme towns to promote
intersectoral coordination and planning.
SPECIFIC ACTIVITIES:
Specific activities for achievement of sectoral goals are outlined below by each
sector.
These activities must be addressed by. the concerned municipal
authorities. Some of the activities are to be undertaken by the various existing
projects (marked with an asterisk *); while the remaining activities should be
elaborated in the respective town plans for implementation by the municipalities.
A.
B.
HEALTH:
1. *
Provision of outreach services for families on the street under IPP-V
in 25 towns and cities, with a health identity card system to be
established.
2. *
AH Municipal Health Officers to be trained under CSSM
participation in the programme activities.
3. *
Adequate quantity of OPS packets to be made available to the urban
at risk families through IPP-V in 25 cities; through ICDS and though
Community Development Societies
(CDS)/Neighbourhood
Committees (NHCs) under the UBSP.
4. *
Slum level OPS depots can be established through animators of
TNSCB in project areas and through Resident Community Volunteers
(PCV) in project areas of the UBSP.
with full
NUTRITION:
1. *
Urban at-risk groups to be ensured access to basic commodities
through fair price shops.
2. *
Iodised salt to be made available through fair price shops at an
affordable price.
140
C.
D.
3. *
For children in the age group 2-5, NMP will provide supplementary
food to 80% of the urban at risk children in the above categories and
their growth monitoring in the 108 municipalities and under IPP-V
areas of larger cities.
*4.
Household food security needs to be addressed through better
targeting of PDS system to reach urban at risk groups by 1995.
EDUCATION:
1.
In Madras and Coimbatore which are not under the purview of the
Directorate of Elementary Education, attention will need to be paid
by the Corporation authorities that all strategies and activities
outlined for achievement of universal primary education are adhered
to.
2.
Municipality and Corporation schools and noon meal centres to be
made available for running coaching classes for primary school
going children and non-formal education classes for children and
adults.
3. *
Linkages to be established with ICDS pre-school centres and NGOs
to ensure full enrolment, follow-up of drop-outs and enrolment in
NFE for older working children.
4. *
Mapping of primary school catchment areas to ensure access by the
"at risk" groups.
WATER:
1. *
By 1995, the urban norm of one source for 100 persons (20 families)
to be ensured by developing alternative systems (handpumps;
wherever possible, providing additional storage capacity). The
physical norm of providing pipe water is reportedly achieved for all
urban at risk groups, with the exception of street/pavement dwellers
for which public systems will need to be developed.
141
E.
F.
ENVIRONMENTAL SANITATION:
*
1.
Under existing schemes for Low Cost Sanitation (LCS) and
Environmental Improvement of Urban Slums (EIUS) for community
facilities (at the rate of 1 latrine per 10 families) all urban poor will be
covered, with special attention to facilities appropriate for pavement
dwellers and small pockets.
*
2
In UBSP, project areas community maintenance systems for water,
sanitation, drainage and solid waste collection may be developed
*
3
Under Slum Clearance and slum upgradation schemes, planning
norms to provide space for smaller community latrine units for better
access in the at risk communities, including public latrines for
pavement dwellers.
*
4
Develop suitable designs for community latrine to meet the special
needs of women and children. All ICDS centres to construct child
sized latrines (and while construction of new buildings for ICDS,
latrine also to be included immediately).
*
5
Suitable design models for drainage will need to be developed and
provided through existing urban development schemes based on an
assessment in all towns and cities, with special attention on the
worst-off areas inhabited by the "at risk" groups.
WOMEN’S EMPOWERMENT:
1. *
Train the women volunteers and community leadership on the
concept of local self government and the implications of the 74 CAA
in 18 UBSP cities (25 IPP-5 cities and the 42 urban ICDS projects).
2. *
Ensure registration and independent functioning of the women’s CD
Societies in the slum pockets covered in the 18 cities of UBSP.
3. *
Promote thrift and credit societies for urban women in the at risk
groups through the 18 cities covered by UBSP.
142
IV.
EIGHTH PLAN PROGRAMME SCHEMES/PROJECTS
SI
No
SCHEMEAND
IMPLEMENTING AGENCY
COMPONENTS
BUDGET
PROVISION
1993-1994
1.
TamB Nadu Urban
Development Project
(Commisslonerate of
Municipal Administration)
Introduced: 1988 World Bank aided project total outlay of
Rs.875 crores. Assistance to Munlclp. & Corporn. from
MUDFto undertake Infrastructural devt activities &
commercial projects. So far Rs.57 crores spent
Rs. 40 crores
2
Integrated Devt of Small
& Medium Towns (CMA &
Dept of Town & Country
Planning)
Centrally sponsored scheme to generate employment In
small and medium towns. H aims at reducing migration
from rural areas.
Rs.20.76 crores
(1992-1997)
3.
Assistance to Growth
Towns
(CMA)
Improving urban facilities: drainage, street lighting, water
supply, road maintenance In Cuddalore, Tlruppur, Erode,
TuunetveB, Hosur, Vellore, Kancheepuram & Tuticorln
Rs. 25 crores
(1992-1997)
4.
Scavengers Rehabi-litation
(TNSCB)
Employment opportunities tor scavengers
Rs. 57 lakhs
5.
Pavement Dwellers
Housing Scheme
(TNSCB)
Low cost housing for pavement dwellers
Rs.42 lakhs
&
Shelter tor the Shelterless
(TNSCB)
Low cost housing for pavement dwellers
Rs. 103 lakhs
7.
Nehru Rojgar Yojana
(CMA)
Urban Microenterprises, Urban Wage Employment &
Housing and Shelter Upgradation
Rs.226 crores
&
Urban Basic Services for
the Poor: 18 towns (CMA)
Formation of neighbourhood groups & bottom-up
planning Io improve quality of life through provision of
basic services.
Rs. 3 crores
9
Accelerated Slum
Improvement Scheme
(CMA/TNSCB)
Grants given to Municipalities every year for improving
roads, storm water drains, providing drinking water, public
la trines, etc
Rs.210 lakhs
10
Integrated Devt of
Backward Areas (CMA)
Provide civic amenities to non-slum areas. Scheme
Introduced: 1986-87. So far, Rs. 105 lakhs spent and 148
backward areas Improved.
(not available)
11
Municipal Maternity and
Child Welfare
(CMA)
Health facilities for mother and child
Rs. 40 lakhs
(50% each for
dispensaries &
mat
child
welfare
hospitals)
VI.
<S
KEY INDICATORS
1.
Town plans prepared and made fully operational.
2.
Coverage levels in Health, Education, Water and Sanitation in urban areas
3.
Community operation and maintenance of water and sanitation facility
4.
Number of Community Development Societies established.
Chapter Eleven:
CHILDHOOD DISABILITY
143
11. CHILDHOOD DISABILITY
MAJOR GOAL:
I.
II.
PREVENTION, EARLY DETECTION, INTERVENTION AND
REHABILITATION OF CHILDHOOD DISABILITIES FOR ALL
CHILDREN BY THE YEAR 2000 A.D.
SPECIFIC GOALS:
a.
Elimination of poliomyelitis in all districts by 1995 and eradicate by 2000 A.
D.
b.
Control of Vitamin A deficiency and its consequences, including blindness.
c.
Control of iodine deficiency disorders including cretinism.
d.
Reduction of other preventable childhood disabilities
e.
Early detection and Community Based Rehabilitation for all children under
5 years:
f.
Integration of Children with mild or moderate disabilities into the mainstream
of formal education.
g.
Ensured institutional rehabilitation support or care for children with severe
or multiple disabilities.
SITUATION ANALYSIS AND CHALLENGE:
The actual situation of childhood disability in Tamil Nadu is not known. Based on
sample surveys, the number of handicapped persons in Tamil Nadu is estimated
at 10 lakhs consisting of 1.92 lakhs blind, 2.05 lakhs hearing impaired, 5.88 lakhs
locomotor handicapped and 0.15 lakh mentally retarded. The number of disabled
children (0-14 years) is modestly estimated to be 2.75 lakhs: this represents 27.5%
of the total disabled persons. The breakdown by type of disability is:
1.
2.
3.
4.
Visually handicapped
Hearing handicapped
Locomotor or Orthopaedically handicapped
Mentally retarded & other handicapped
53,000
56,000
162,000
4,000
144
The main causes of childhood disabilities include:
a.
b.
c.
d.
e.
f.
g.
h.
I.
III.,
Poliomyelitis
Vitamin A deficiency caused blindness
Iodine deficiency disorders (IDD) including goitre, mental retardation and
cretinism.
Maternal causes leading to intra-uterine growth retardation (IUGR);
Environmental effects during pregnancy such as communicable diseases,
accidents, heavy work in the second or third trimester, non-prescribed
medication, alcohol consumption, smoking and x-rays.
Consanguineous marriages (a practice common among selected
communities) may result in higher risk of hereditary disabilities.
Accidents during childhood
Birth asphyxia leading to spastic paralysis and mental retardation is the
leading cause of childhood disability.
High maternal age at childbirth may lead to Down’s Syndrome.
SPECIFIC GOAL BY YEARS:
1.
Elimination of poliomyelitis in all districts by 1995 and eradicate by
2000 A. D.
1995:
1998:
2000:
2.
Control of Vitamin A deficiency and its consequences, including
blindness
1995:
1998:
2000:
3.
Achieve Polio-free Tamil Nadu
Sustain elimination status
Eradicate poliomyelitis
Virtual elimination of Vitamin A deficiency.
Sustain achievement.
Sustain achievement.
Control of iodine deficiency disorders including cretinism
1995:
1998:
2000:
Ban sale of non-iodised salt in the state. All
salt required for human and animal
consumptions to be iodised.
Universal consumption of iodised salt.
Sustain achievement.
145
4.
Reduction of other preventable childhood disabilities
1995:
1998:
2000:
5.
5 % (from the present estimated levels)
20%
30%
Early detection and Community Based Rehabilitation for all children
under 5 years:
1995:
1998:
2000:
6.
Initiated in 5 districts.
Initiatedin 15 districts.
Initiated in All districts.
Integration of Children with mild to moderate disabilities into the
mainstream of formal education:
1995: 20% (from the present level)
1998: 60%
2000: 100%
7.
Ensured institutional care or rehabilitation support for children with
severe or multiple disabilities:
1995: 10% (from the present level)
1998: 25%
2000: Over 50%
IV.
STRATEGIES:
A.
CURRENT:
1.
Preventive health and nutrition programmes such as:
Immunisation against polio;
Provision of Vitamin A Prophylaxis;
Ban on sale of non-iodised salt in two IDD prevalent districts;
Use of iodised salt in the Nutritious Noon-meal programme for all
children in need; and
v.
General nutrition education through ICDS/TINP
(Please refer to the Health and Nutrition Chapter for details)
i.
ii.
Hi.
iv.
146
2.
Institution-based detection and rehabilitation through Special Education
Schools, Rehabilitation Medicine Units and pre-schools for the hearing
impaired (Government and non-government).
3. '
Training of anganwadi workers in early detection and referral on a limited
basis.
4.
Free distribution of aids and appliances and mobility aids by the Operation
Polio Programme.
5.
Scholarships for disabled students, scribe assistance for blind students and
free supply of Braille Books for students in government and Aided Special
Schools for the visually handicapped.
6.
Pilot Project on Integration in Education for the Disabled (IED) in one block
in Chingleput District to integrate children with single or limited disabilities
into the mainstream of primary education.
f
B.
NEW STRATEGIES AND ACTIVITIES:
1.
To extend early detection and rehabilitation to the village level, the
Community-Based Rehabilitation (CBR) approach may be introduced as the
main strategy through linkage between various government and non
governmental agencies with coverage of districts in phases: Activities and
division of responsibilities would include:
a.
Preparation of District Resource Directories and Referral Networks of
available (government and non-government) technical expertise and
facilities to be made (available at the block level).
b.
Strengthen existing CBR efforts by NGOs and encourage linkages
with government infrastructure and network among each other.
c.
Training of all ICDS/TINP workers, VHNs and TBAs in early detection
and simple early stimulation techniques and neo-natal follow-up for
high-risk babies for home management.
147
d.
Training of local volunteers on simplified rehabilitation techniques to
be taught to primary care givers (parents).
e.
Establishment of district/sub-district rehabilitation teams to provide
guidance and support to field functionaries through low frequency
visits.
2.
Screening of new-borns and high risk infant follow-up at all maternity, taluk
and district hospitals, by development of simplified techniques.
3.
Communication through media and through field functionaries for increased
awareness of:
4.
a.
Risks involved in having children when maternal age is below 18 and
above 30 years and in consanguineous marriages, especially in
families with persons born with disability.
b.
Care during pregnancy against accidents and communicable
diseases and avoidance of smoking, alcohol, X-ray, heavy work
during first trimester, and non-prescribed medication.
c.
The disabled for better acceptance and integration into society.
d.
Child care to avoid accidents in and around the home.
Strengthening and extension of facilities and assistance for greater
coverage through the Directorate for Rehabilitation of the Disabled:
a.
Early Detection Institutions:
i.
ii.
Hi.
iv.
v.
To start multi disciplinary centres as follows:
*
State level - 1
*
District level - 22
3 Genetic Counselling Centres;
For Hearing Handicapped: Establishment of 17 Audiological
Units in uncovered districts;
For Locomotor Handicapped: Establishment of Artificial Limb
Centres in 11 more districts
For Mentally Handicapped: (Establish early stimulation units
for preventing severe handicaps in all 23 districts in Tamil
Nadu.)
148
b.
Genetic Laboratory:
3 Additional Genetic Laboratories should be established (to detect
in born errors of Metabolism) and chromosomal anomalies.
c.
Rehabilitation and Skill Development
i.
To start 61 more special schools in all the districts
ii.
To give scholarships for 15,000 children by 1995 for 20,000
children by 1988
Hi.
Training and Production Centres for all the disabled children:
5 centres by 1995; 15 centres by 1998 and a total of 23
centres by 2000.
d.
Creation of facilities for Repairs, Regular Supply of Aids and
Appliances : Establishment of Fabrication and Repair Units in:
-12 districts by 1995
- 11 districts by 1998
e
Research
for Intervention
Aids/Appliances:
Methodology
and
low-cost
Establishment of a Special State Resource Research Centre and a
State Institute of Special Education
f.
Extension of maintenance allowance to severely disabled children
(75% and above) with Rs. 100/- per month for 150 children per district
at an estimated total cost of Rs.41.40 lakhs.
Extension of the IED approach to all pre- and primary schools to fully
integrate children with mild and moderate disabilities such as
orthopaedically handicapped, and low vision. Activities may include:
5.
1
a.
Training of teachers: this may be linked to training of teachers (one
per school) through the School Health Scheme for acceptance and
support to children with disabilities; and on simple techniques on
special education for different disabilities.
b.
Linkage with the health system for referral and with the CBR network.
149
c.
V.
Special education and needs of children with disabilities in pre
service teacher training curriculum.
6.
Establishment of special education classes in selected secondary schools
at taluk level.
7.
Providing emergency obstetric care to all complicated deliveries to prevent
birth asphyxia and neo-natal care to manage birth asphyxia including
provision of optimum neo-natal resuscitation facilities.
8.
Legislation for the Protection and Integration of the disabled against
discrimination, segregation and protecting rights of the disabled.
9.
Avoid pregnancy/childbirth below 18 and above 30 years and screen all
such pregnancies for Down's Syndrome.
10.
Advise pregnant women for Measles/Mumps/Rubella Vaccine (MMR) for
prevention of rubella.
11.
Barrier-free environment to be promoted for persons with disabilities. This
includes facilities for the disabled in schools, colleges, buildings, roads,
parking lots, telephones, railways, airlines, etc.
12.
Popularise eye donation through awareness campaigns.
13.
Early detection of congenital heart disease and provision of free heart
surgery for selected number of needy children.
KEY INDICATORS
1.
2.
3.
4.
5.
6.
8.
9.
Percentage of Polio affected children.
Percentage of Visual Disability due to Vitamin A deficiency in Children.
Percentage of Iodine Deficiency Disorders in Children.
Number of persons served by Genetic counselling centres.
Percentage of children under 5 years benefitted by early detection and
Community Based Rehabilitation Services.
Number of disabled children enrolled in the mainstream of formal education.
Percentage of children with severe or multiple disabilities benefitted by
institutionalised care or rehabilitation.
Percentage of babies detected to have early developmental handicaps.
Percentage improved or received early stimulation.
- Media
9321.pdf
Position: 6105 (1 views)