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AGENDA NOTES
3rd CONFERENCEOF
CENTRAL COUNCIL OF
HEALTH & FAMILY WELFARE
PARLIAMENT HOUSE ANNEXE
JULY 14-16, 1993
GOVERNMENT OF INDIA
MINISTRY OF HEALTH R. FAMILY WELFARE
BUREAU OF PLANNING
NEW DELHI
indhra
Agenda Item No. IX
sa and
om the
NATIONAL TB CONTROL PROGRAMME
xpedite
I
1.
Tuberculosis has been a major public health problem since decades and
sail conttnues to remain so. It is estimated that nearly 14 million active
pu monary TB cases exist in the country as on today of which l/4th are
sputum positive, or
of 180
i
other words infectious and responsiblefor sp^
infection in the community. Against the estimated total prevalence of
3 to 3.5 million sputum positive cases at this point of time around l/3rd
t-e. I million cases are new cases per year. Under the programme only
1.5 million TB cases (both sputum positive and. sputum negative) are
I water
treated annually and 0.5 million deaths from TB are reported annually,
it is also further known that the prevalence of TB is almost of the same
order in both urban and rural areas.
malaria
2.
igh the
National TB Control Programme was initiated following extensive field
research by NTI, Bangalore and TRC Madras as centrally sponsored
as also
scheme on j0:50 sharing basis between the State and the Centre in 1962
by establishing district TB Centres, TB clinics. TB Hospitals covering a
.few districts which over a period of time has now been covering 390
■gislative
districts in the country.
through
In addition to the 390 districts. 18 centres, a
large number of TB clinics and hospitals are also fimctioning where
es of the
laboratory diagnostic support services and radiological facilities are
■n by the
available.
3.
The objectives of the programme
death from TB. However, over
National TB Control Prog
was to reduce suffering, disability and
the last 30 years achievement under the
ramme are far short of the expectations. While
117
reasons for such shortfall were generally and specifically identified by
expert committees in 1975 and 1985, not much was done as a follow
to rectify them.
While, other National Health Programmes like NMpp
LHP, NLEP affected substantial organisational and strategy changes and
3)
improved (heir overall efficacy, National TB Control Programme did
not make much headway largely for want of an appropriate strategyf0r
reaching the peripheral areas and due to gross under-funding.
4.
The programme was recently reviewed by a joint team from WHO and
Government of India. Some of the important observations are Gross underfunding of the programme resulting in inadequate
availability of drugs for treatment of detected cases.
h)
Over-reliance on radiological diagnosis as against smear testing
through microscopy resulting in concentration of cases diagnosed
at the district TB centres and non-utilisation of the facilities
available in the peripheral health institutions.
c)
Ineffective and inadequate laboratory services leading to very low
performance in case finding.
d)
Poor case holding because of inappropriate perception of the
people in the importance of completion of recommended course of
treatment, time and cost factors involved in visiting the health
institutions to obtain drugs, non-availability of drugs and lack of
awareness and neglect of treatment following disappearnace of the
symptoms.
Issues involved are broadly :
I)
To involve the available health infrastructure in appreciation ofthe
problem ofTB and make available sputum microscopy facilities as
close to the people as possible.
To improve the awareness amongst (he. people (hat TB is a fully
118
4
[fed by t^Q
curable disease and if recommended regimens are followed
1 follow up
recovery is almost universal.
ke NMEPt
,a^es and
3)
To make available supervised short course chemo-therapy of all
"amme did
smear positive cases as close to the people as possible and need
trategyfor
for hospitalisation is minimal as domiciliary treatment has been
found to be highly effective.
Hospitalisation should only be
resorted to for seriously sick cases, emergency cases and
complicated cases etc.
and
'adequate
4)
Funds that have been provided under the programme have been
very inadequate. During the current financial year 35 crores have
ir testing
been provided whereas to treat one million sputum positive cases
iagnosed
an annual outlay of the order of Rs. 10() crores or more is
facilities
required.
In the context of the above the Govt, of India, has decided
very low
to formulate a revised National TB Control Programme and seek
the assistance from World Bank to implement the same. A Task
' of the
Force was constituted under the Chairmanship ofDG, ICMR. The
nose of
Task Force has prepared a Concept Paper and the same has been
health
submitted and DGHS has been asked to prepare the detailed action
lack of
plan document to seek the World Bank assistance.
’ ofthe
decided, that the project will be implemented in 5 States namely
It has been
Kerala, West Bengal, Bihar, Gujarat and Himachal Pradesh and
in the six metropolitan, cities namely Delhi, Calcutta, Bombay,
As a part of advance action
ofthe
Madras, Hyderabad and Bangalore.
ies as
the revised TB Control Programme will be taken on pilot basis in
one or part of the district or corporation areas selected for the
implementation of the project.
fully
Financial details, achievements under the programme are
119
given in rhe Annexures.
Council is requested to deliberate on the issues enlisted and
suggest ways and means involve the existing health machinery to
detect desired number of sputum positive cases in the community
and to make available to them the recommended regimen of anti
TB therapy to affect a cure rate of atleast 85 to 90 percent.
E
f
I
’ll
7
I*.
1
1
1
1
S5.
120
Financial Outlay & Expenditure Incurred During 7th
Plan and Budget Provision Made for 1990-91 and
1991-92 - (For Supply of Anti-TB Drugs, Material
and Equipments)
o
y
(Rupees in lakhs)
ti
Budget
Provision
Actual
Expenditure
During seventh Plan (1985-86
- 1989-90)
6100.00
6176.00
-do-
(1990-91)
1500.00
1247.60
-do-
(1991-92)
1525.00
718.95
During Eighth Plan
(1992-93)
2900.00
2495.90
(1993-94)
3500.00
Target laid down
Under 20
Point Programme during
Seventh Plan, Plan Holiday and Eighth Plan
Duration
Target for
detection
of cases
(lacs)
Achieve
ment
(lacs & % )
Target for
Achieve
ment
sputum Exam.
(lacs
& %)
(lacs)
7th Plan
74.50
76.09(103%)
170.00
1990-91
16.50
16.68 (104%)
34.00
1991-92
16.75
9.57( 57%)
34.00
1992-93
17.5
14.75(84%)
34.00
1993-94
18.0
34.00
=:=:—
121
ti
116.47
(69%)
23.88
(77.33%)
19.53
(57%)
26.56
(78%)
Annexure
STATEMENT SHOWING THE TOTAL NUMBER OF DISTRICTS
]--district tb
CENTRE.S AND TB CLINICS IN THE COUNTRY AS ON 31.12.1992.
S.No. Name of State/
U.T.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12 .
13 .
14 .
15.
16 .
17.
18 .
19 .
20.
21.
22 .
23 .
24 .
25.
26.
27 .
28 .
29.
30.
31.
32 .
TOTAL
=====::
No. of
Districts
Andhra Pr.
Arunachal Pr.
Assam
Bihar
Goa
Gujarat
Haryana
Himachal Pr.
Jammu & Kashmir
Karnataka
Kerala
Madhya Pr.
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamilnadu
Tripura
Uttar Pr.
West Bengal
A&N Islands
Chandigarh
D&N Haveli
Daman & Diu
Delhi
Lakashdweep
Pondicherry
23
12
18
42
1
19
12
12
14
30
14
45
30
8
7
3
7
13
12
27
4
21
3
56
17
2
1
1
2
1
1
1
459
122
No. of Distt.
TB Centres
23
5
11
32
1
19
11
11
10
20
12
45
30
3
2
2
2
13
12
27
3
16
3
56
16
1
1
1
1
1
Total No.of
other T.B.
Clinics
25
9
25
4
4
4
7
4
6
9
5
19
1
1
1
4
4
2
3
40
20
116
1
13
1
4
390
331
Annexure-•b »
STATEMENT SHOWING THE
THE TOTAL
TOTAL NUMBER
DISTRICTS TB BEDS
NUMBER OF
OF DISTRICTS
NO. OF
__ ______
1 ° ' AND
AND
OF nTQTDTf'mc
DISTRICTS HAVING 10 OR
LESS__THAN 10 BEDS
DISTRI
c:
HAVING NO TB BEDS IN THE COUNTRY AS ON 31.12.1992
S. Name of State/
No.U.T.
1
i
>i i
: mi
l'
J
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13 .
14 .
15 .
16.
17.
18 .
19 .
20.
21.
22 .
23 .
24 .
25.
26.
27.
28.
29 .
30.
31.
32 .
TOTAL
No.of
No.of
Distts. TB Beds
Andhra Pr.
23
Arunachal Pr.
12
Assam
18
Bihar
42
Goa
1
Gujarat
19
Haryana
12
Himachal Pr.
12
Jammu & Kash.
14
Karnataka
30
Kerala
14
Madhya Pr.
45
Maharashtra
30
Manipur
8
Meghalaya
7
Mizoram
3
Nagaland
7
Orissa
13
Punjab
12
Rajasthan
27
Sikkim
4
Tamilndau
21
Tripura
3
Uttar Pr.
56
West Bengal
17
A&N Islands
2
Chandigarh
1
D&N Haveli
1
Daman & Diu
2
Delhi
1
Lakshdweep
1
Pondicherry
1
459
123
2
6
7
27
3
3
1
3
4
8
1
1
7
2
4
2
13
2
1
5
2
1
4
3
9
1
1
2
13
1
1
2
3
3
3
2
188
47321
5
r;
2579
202
809
2109
260
3563
410
743
655
3545
2283
1986
8207
145
254
95
100
901
921
2018
100
3620
60
3437
6433
67
10
4
10
1607
No.of
Disttr""
Distt. with having n(
10 or less
TB Beds.
than 10 Beds.
85
57
J ,
T<
-
1
.. ..
irerABj.
Annexure C
STATEMENT SHOWING PROVISIONAL ACHIEVEMENT IN RESPECT OF
DETECTION OF NEW T.B.CASES DURING 1992-93
beds and
I DISTRICT
Distt.
having no
TB Beds. !
2
3
4
8
1
1
7
2
4
2
5
1
1
2
13
1
57
NATIONAL T.B.CONTROL PROGRAMME
(D.G.H.S.)
S.No. States/Union
Teritories
Annual
Target
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12 .
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
90,400
65,517
2,800
2,998
39,100
17,975
1,98,640
183
3,800
3,498
1,48,200
1,58,228
31,200
31,058
18,960
17,008
16,200
3,655
85,200
65,653
46,600
27,275
1,22,800
52,473
2,36,500 2,34,147
4,200
2,603
2,600
2,426
1,000
827
1,800
1,354
41,300
28,367
43,400
44,764
46,360
33,557
1,600
4,351
1,18,940
99,034
2,100
2,163
2,97,500 2,56,861
93,200
51,113
400
440
2,600
1,723
320
265
260
581
47,200
64,028
220
167
4,600
4,863
Andhra Pr.
Arunachal Pr.
Assam
Bihar
Goa
Gujarat
Haryana
Himachal Pr.
Jammu & Kash.
Karnataka
Kerala
Madhya Pr.
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamilnadu
Tripura
Uttar Pradesh
West Bengal
A & N Islands
Chandigarh
D & N Haveli
Daman & Diu
Delhi
Lakshdweep
Pondicherry
^TAL:
17,50,00
Achievement
1992-93
14,75,155
124
% Achieve
ment.
72
107
46
99
92
107
100
90
23
78
59
43
99
62
93
83
75
69
103
72
272
83
103
86
55
110
66
83
223
136
76
106
84
Annexure STATEMENT SHOWING PROVISIONAL AZZZZLV
ACHIEVEMENT IN RESPECT OF
CONDUCTION OF SPUTUM EXAMINATION
----- J DURING 1992-93
NATIONAL T.B.CONTROL PROGRAMME
(D.G.H.S.)
S.No. States/Union
Teritories
I
J
1
1?
I
I
Annual
Target
Achievement
1992-93
1.
Andhra Pr.
2,52,600
2.
Arunachal Pr.
6,750
3.
Assam
87,600
4.
Bihar
3,76,200
5.
Goa
4,500
6.
Gujarat
1,53,500
7.
Haryana
60,000
8.
Himachal Pr.
46,200
9.
Jammu & Kash.
51,600
10.
Karnataka
1,85,000
11.
Kerala
1,07,400
12.
Madhya Pr.
2,90,500
13 .
Maharashtra
2,76,900
14 .
Manipur
9,300
15.
Meghalaya
7,200
16.
Mizoram
3,000
17 .
Nagaland
5,100
18 .
Orissa
1,90,200
19 .
Punjab
85,000
20.
Rajasthan
1,40,400
21.
Sikkim
4,500
22 .
Tamilnadu
2,41,800
23 .
Tripura
8,400
24 .
Uttar Pradesh
5,75,000
25 .
West Bengal
2,14,200
26.
A & N Islands
1.200
27.
Chandigarh
600
28 .
D & N Haveli
500
29.
Daman & Diu
600
30.
Delhi
1,200
31.
Lakshdweep
1,000
32 .
Pondicherry
7,800
TOTAL:
33,95,848
lz 84,765
7,610
8,226
3,41,779
14,997
2,65,577
49,720
50,150
10,900
1,69,585
37,789
1,17,433
3,39,063
4,134
1 , 152
3,254
1,376
1,22,232
1,12,461
64,228
2,657
1,11,482
5,865
5,13,951
26,672
2,452
430
265
1,313
76,683
231
8,764
26,55,820
125
% Achieve
ment.
73
113
9
90
333
173
78
109
21
92
35
40
122
44
16
108
27
64
132
46
59
47
70
90
12
204
72
53
219
6390
23
112
78
I
d,
RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING
COMMITTEE ON HUMAN RESOURCE DEVELOPMENT
FOURTH REPORT
ON
NATIONAL HEALTH PROGRAMMES OF THE DEPARTMENT OF HEALTH
(MINISTRY OF HEALTH & FAMILY WELFARE)
(Presented to the Rajya Sabha on the 21st December, 1993)
(Laid in Lok Sabha on the 21st December, 1993)
RAJYA SABHA SECRETARIAT
NEW DELHI
DECEMBER, 1993/AGRAHAYANA, 1915 (SARA)
.
1
z l4-c-
Pc
- r/ P
L-c>
SobMc
•<. *
CONTENTS
Pages
I
I
1.
Composition of the Committee
2.
Introduction
(v)
3.
An Overview
1
4.
National Malaria Eradication Programme; Kala-azar and National Filaria
Control Programme
2—6
5.
National Leprosy Eradication Programme
6—10
6.
National Programme for Control of Blindness
10—12
7.
National AIDS Control Programme
12—14
8.
Minutes of the meetings of the Committee
17—20
(iii)-(iv)
COMPOSITION OF THE DEPARTMENT-RELATED
PARLIAMENTARY STANDING COMMITTEE ON
HUMAN RESOURCE DEVELOPMENT
(1993-94)
I. Shri Ram Naresh Yadav—Chairman
MEMBERS
RAJYA SABHA
2. Prof. Saurin Bhattacharya
3. Shrimati Renuka Chowdhury
4. Dr. Jinendra Kumar Jain
5. Miss Saroj Khaparde
6. Shri V. Hanumantha Rao
* 7. Vacant
8. Shri Md. Salim
9. Shri Pravat Kumar Samantaray
10. Prof. I.G. Sanadi
II. Shri Ashoke Kumar Sen
12. Shri Vishnu Kant Shastri
13. Shri P. Upendra
14. Shri Ranjan Prasad Yadav
LOK SABHA
15. Dr. Viswanathan Kanithi
16. Dr. V. Rajeshwaran
17. Prof. (Smt.) Savithri Lakshinanan
18. Shri Mani Shankar Aiyar
19. Dr. Vasant Niwrutti Pawar
20. Prof. P.J. Kurien
21. Shri Subash Chandra Nayak
22. Shri Bapu Hari Chaure
23. Shri Z.M. Kahandole
24. Shri Datta Meghe
25. Shri Ishwarbhai Khodabhai Chavda
26. Shri K. Thulasiah Vandayar
27. Shri Aslam Sher Khan
28. Shri Inder Jit
29. Dr. Ramesh Chand Tomar
30. Shri Chinmayanand Swami
31. Shri Dau Dayal Joshi :
32. Prof. K. Venkatagiri Gowda
33. Dr. K.D. Jeswani
•Vacancy caused due to expiry of Shri T. Chandrasekhar Reddy on 15-9-1993.
(iii)
(iv)
34. Dr. Mahadeepak Singh Shakya
35. Dr. G.L. Kanaujia
**36. Shri Anna Joshi
37. Shri Braja Kishore Tripathy
38. Shri Rambadan
39. Shrimati Malini Bhattacharya
40. Shri Ram Chandra Dome
41. Shri Brahma Nand Mandal
42. Prof. Ummareddy Venkateswarlu
43. Shri Suraj Mandal
44. Shri Kanshi Ram
SECRETARIAT
Smt. Vanaja N. Sarna, Director
Shri Ram Krishan, Under Secretary
Shri Rohtas, Committee Officer
Nominated w.e.f. 26-8-1993 in the vacancy caused by the resignation of Shri Chandrajeet Yadav w.e.f. 13-3-1993.
PRINTE
INTRODUCTION
I, the Chairman of the Department-related Parliamentary Standing Committee on Human
Resource Development, having been authorised by the Committee to present the Report on its
behalf, do hereby present the Fourth Report of the Committee on the National Health
Programmes of the Department of Health (Ministry of Health de Family Welfare).
The Committee considered various documents and papers received from the Department of
Health and also heard its Secretary and other officials to elicit further information at its meetings
held on the 10th & 11th June, 1993.
The details of the working, targets, achievements, allocations and expenditure regarding
major National Health Programmes of the Department viz. National Malaria Eradication
Programme; Kala-azar; National Filaria Control Programme; National Leprosy Eradication
Programme; National Programme for Control of Blindness and National AIDS Control
Programme were discussed by the Committee and have been included in the Report.
The Committee considered and adopted the Report at its sitting held on the 16th December,
1993.
RAM NARESH YADAV
NEW DELHI;
16th December, 1993
25 Agrahayana, 1915 (Saka)
I
I
Chairman
Department-Related Parliamentary Standing
Committee on Human Resource Development
An Overview
1. ‘Health is Wealth’ is a well-known proverb and it is an axiomatic fact that only healthy
citizens can make a nation prosperous and healthy. Health plays a vital role in the making of a
nation great and strong. Development and maintenance of good health is not only a personal or
an individual effort but a Welfare State also plays a very important role in it.
2. It is expressly mentioned in our Constitution in Article 47, which relates to the Directive
Principles of State Policy, that ‘The State shall regard the raising of the level of nutrition and the
standard of living of its people and the improvement of public health among its primary duties...’
The improvement of health and nutrition on national basis is the responsibility of the Central
Council of Health. Since the inception of planning process in 1952, various health programmes
have been introduced in the country. In pursuance of its commitment. Government also
formulated a national Policy on Health in 1983.
3. But, the dimensions that health problems have acquired in our country are really complex
and alarming. Majority of diseases people suffer from are poverty-related, while some have their
origin in the utter lack of cleanliness and awareness or consciousness towards health. Rapid
increase in environmental pollution, increasing population, cropping up of new diseases like
AIDS and cancer are some of the challenges that the nation is facing today. To fight on all these
fronts simultaneously is, of course, a formidable task, particularly when the resources at hand are
limited.
4. As per World Bank estimates, in India only 1.3% of the Gross Domestic Product is spent
on health which is perhaps the lowest amongst the developing countries. It is flabbergasting to
further note that the allocation has shown a gradual diminishing trend in the successive Five Year
Plans. For instance, 3.3% of the total outlay in the First Five Year Plan has come down to a
dismal 2.74% during the Eighth Five Year Plan. In the face of the financial constraints foreign
assistance was sought. Some traditional diseases like Leprosy, Tuberculosis, Malaria, Blindness,
etc. still persist affecting the majority of our population. In such a situation, it is to be seen if
Government’s commitment to attain the goal of health for all by 2000 A.D. could possibly be
fulfilled.
K
J
5. World Bank assistance to the scale of 100 to 200 million dollars per year has been cleared
for Health sector throughout the Eighth Five Year Plan. The first project taken up under this
project is the AIDS Control Programme. Assistance is also expected for Leprosy and Blindness ’
Control Programmes.
6. In an effort to fight the menace of major diseases Government is implementing various
National Health Programmes. The Committee had detailed deliberations on some of them
namely; National Malaria Eradication Programme; Kala-azar; National Filaria Control Prog
ramme; National Leprosy Eradication Programme; National Programme for Control of Blindness
and the National AIDS Control Programme.
1
2
I. National Malaria Eradication Programme
7. It is estimated that at the time of country's Independence-in 1947, there were over 7o
million malaria cases and about one million deaths had occured due to it. For its control a
national strategy was formulated in the year 1953 DDT proved to be a very' e«eet.ve msechcide
and a great success was achieved in controlling this disesase. Encouraged by this initial success
the Nahonal Malaria Control was renamed as ‘National Malaria Eradication Programme
the
year 1958 By the year 1965, the incidence of malaria witnessed a downward trend vith n
mortality rate which was, in itself, a great achievement. But this success was
m the
mid-seventies recurrence of malaria was visible. There was a sharp increase m the "umber of
reported malaria cases to the tune of 6.47 million per year. The strategy was revised once: agam
named Modified Plan of Operation (MPO) with the object.ve of ehmmation of mortahty rate
effective control of malaria and maintaining the gains achieved so far in its eradication. The
objectives were sought
prompt case- detection through active and passive
sought to
to be
be achieved
achieved by
by prompt
surveillance and vector control by residual insecticidal spraying.
8 Since 1984, the incidence of malaria has stabilized at around 2 million cases per year. It is
reported that during the year 1991, there were 1.81 million positive cases of malaria and around
400 deaths. During the year 1992, there were approximately 1.4 million rePorte^a!“"a
Though tribals constitute only 8% of the total population, yet they account for over 30/o of the
malaria cases and 60% of the deaths on account of P. Fakiparurn Simdarly ta w a . rp
increase in the number of cases detected in urban slums from 1,39,057 in 989 to 2 1 890 in
1991. Studies and surveys conducted in this regard have shown the presence of resistance to DDT
and a combination of anti-malaria insecticides.
9 There are Seven States in the country namely, Madhya Pradesh, Andhra Pradesh, Bihar
Gujarat Maharashtra, Orissa and Rajasthan which are more vulnerable and most of the malar a
deaths have occured there. According to the Annual Report of the Ministry of ^Health &_Fami y
Welfare for the year 1992-93, Malaria cases during the last five years indicated that iri the> yea
1988, there have been 1.85 million cases with 0.68 million P. Falciparum
‘‘"‘1 209 dea,hs ^
1989 there were 2.05 malaria cases with 0.76 million P. Falciparum cases and 268 deaths, m 1990
out of the 2.02 million malaria cases there have been 0.75 million P. Falciparum cases wit
deaths in 1991 out of 2.11 million malaria cases there were 0.91 million P. Falciparum cases wi 1
421 deaths and in 1992, there were 1.42 million cases with 0.45 million P. Falciparum cases and
246 deaths.
10. The National Malaria Eradication Programme is being implemented as a centrally
soonsored category-II on a 50:50 cost sharing basis between the States and the Central
Government Under this Programme, the Central Government meets the cost of entire quantity
of DDT and partially of BHC and Malathion, antimalaria drugs like Chloroquine Primaquine
and Pyrenthamine, etc. The State Governments are expected to meet the expenditure on staff
and other operational costs for successful implementation of the Programme.
11 During his oral evidence tendered before the Committee, ‘he Secretary Department of
Health informed that malaria has taken an endemic turn because of the fact that the health
infrastructure in the most affected States is'extremely weak. The Dcptt. has also realised that the
tribal and hilly areas where malaria infection cases are high, have to be dealt with on a
footing from the rest of the country. Fifty per cent share of the States has to be reviewed and the
3
Central Government is thinking to have the central scheme implemented by taking assistance
from World Bank to fight this menance. Keeping this in view, it is proposed to intensify the
efforts for the full containment of malaria during the Eighth Five Year Plan. Accordingly, major
attention is proposed to be given to the tribal sub-plan areas of Seven States of Andhra Pradesh,
Bihar, Gujarat, Madhya Pradesh, Maharashtra, Orissa and Rajasthan, the urban population and
population living in the project areas and rest of the country. This control strategy is a balanced
mixture of preventive and curative measures for elective spraying for vector control, larviciding
and source reduction in urban areas and early detection and treatment.
12. During his oral evidence tendered before the Committee, the Secretary, Department of
Health, informed that they had achieved a great initial success in controlling malaria, but when
the incidence reached a figure of 1,00,000 in the entire country in the seventies, they had a
rebound and the incidence rose to about 6.5 million. Thereafter, the programme was started in
1977 and they were able to bring this figure down to 2 million in 1984. After that, this figure has
more or less ramained stable. It means there has been no further improvement after 1984. This
was due to a very high level of infection in the tribal areas of North-East. The migrant labour
force from these areas going to different parts of the country also contributes to the spread of
Malaria. A lot of on going construction activities contribute to the cause of stagnation of water
and pollute environment leading to breeding of mosquitoes, hence the incidence of malaria.
13. The Committee was informed that for this purpose, a sum of Rs. 86 corres was spent
during the year 1991-92. In 1992-93, Rs. 65 crores were allocated for malaria control programme
which also included other vector diseases like Kala-azar and Filaria. Now, this amount has been
increased to Rs. 87 crores for procuring insecticides, larvicides and drugs. For the year 1993-94, a
sum of Rs. 110 crores has been allotted. It is also proposed to provide 100% Central assistance to
the North Eastern States and the tribal sub-plan areas. For the tribal areas, it is also proposed to
mobilise resources from the World Bank as well.
14. The Committee was informed that there was mainly three reasons for the resurgence of
malaria, namely:—
(i) Administrative reasons—complacency shown by the administration after getting some
initial success.
(ii) Technical reasons—
(a) Mosquitoes became immune to many insecticides and the insecticides which were
very effective in the past became ineffective;
(b) the parasites have been irresistable to certain drugs;
(c) New drugs were tried out which also contributed in non-effectiveness of the
programme to some extent.
(iii) Financial reasons—The programme was integrated into the Primary Health Centres after
getting initial success in the sixties. The Primary Health Centres being very busy in their
own programmes, could.not provide attention and time which was very necessary for
controlling malaria. Even financial allocation required for filling up the posts which were
available in the sub-centres for eradication of malaria remained unfilled; the supply of
PLO, etc. was not available because of financial constraints. All these factors
contributed to the failure of the programme. Even financial allocations were reduced.
’ ’
T w
nniiiTT
T” I II ’
IHI
i
4
Kala-Azar
Bihar and West Bengal. It is observed that
g
.
and 9 districts in
has spread over from 4 districts toadjommg ateas..nd now 30Jist
Government
West Bengal are the most affected. J11
d th
main unreported. The disease is
i
—»<■ —.
16. According to the estimates, there were 14079'
deaths and in West-Bengal there were 3718 ^es
same^yean TherThTs
J j Bihar In the year 1989, there
l
requires immediate remedial steps.
17 Organised control measures have been initiated to
financial assistance for its control was being
control Kala-azar. Upto 1990-91,
Central Government out of the
to Rs. 4.06 crores were made
BengaL
18. The Committee was informed that in order to check the menace efforts are being made
for interruption of transmission
^nt of Kala-azar cafes and providing
S^dSn “munity aw/renefs, are also being undertaken in this connect.on.
19. The Committee was also informed that in view of the= financial “-treints.^Central
Government decidedi to meet the total costhave agreed to deploy
1’ adequate material with strict supervision,
exclusive infrastructure for Kala-azar con
Afferent functionaries at various levels
£ ^nX fToresuXPof the programme is likely to make a good impact on
reduction of the incidence of Kala-azar.
20. The CeoM Co—j
Pentamidine Isothionate to the West Benga
duri the last tw0 years i.e. in
?^:da" 2? toet^e1^une^<ofeR^ie389.49 and Rs. 1535.99, respectively.
21. a W
•< * »“> “ “ h,e.«”nh“
£
Kala-azar control. However, in viewro Jh
effectivePcontrolj a Revised Estimates
Central Government to ensure availability
insecticides and anti Kala-azar drugs,
for Rs. 2376.55 lakh has been proposed to meet the cost oi
22. in addition UNICEF assistance of R. 15^5 hkhtad
State Governments for public inf°™a‘1°p’UroViding assistance on continuing basis directly to
Xsute^ZtXent"^. Material assistance including the insecticides, DDT and the
imported drug Pentamidine Isothionate is also provided.
i-
5
National Filaria Control Programme
23. Filaria, like Malaria is also a deadly disease which has become a major health problem in
our country. The disease has been prevalent throughout India except the States of Jammu &
Kashmir, Punjab, Himachal Pradesh, Mizoram, Meghalaya, Tripura, Manipur, Rajasthan,
Arunachal Pradesh, Delhi, Chandigarh, Haryana, Sikkim & Nagaland. Present estimates indicate
that about 389 million people are living in 175 endemic districts of which about 103 million are
living in urban areas and the rest in rural areas.
24. In order to control this disease, the National Filaria Control Programme was taken up in
the year 1955 with the following action plan:—
(i) Delimitation of the problem in hither-to unsurveyed area;
(ii) Control in Urban Areas through:
a) Recurrent anti-larval measures; and
b) Antiparasitic measures.
25. For this purpose about 206 Central Units, 27 Survey Units and 195 Clinics are working in
the country. About 43.43 million people in urban areas are being protected through anti-larval
measures by 206 control units and 195 clinics are giving treatment with Diethy/ Uarbanarine to
clinical cases and microfilaria.
26. During the course of his oral evidence tendered before the Committee, the Secretary,
Department of Health informed that efforts made in this connection have shown remarkable
results. It is observed that about 73 per cent of the towns in microfilaria rate and about 69 per
cent of towns in the disease rates where control measures are in operation for more than five
years, have shown marked reduction in the filaria cases.
Monitoring
27. The Programme is being monitored by the Directorate of Malaria Eradication
Programme and this organisation has got a good number of people spread all over the country. In
addition to this, there are about 17 Regional Directors of Health posted in different States.
Observations / recommendations
28. The Committee is unhappy to note the sense of complacency shown by Government in
eradication and control of malaria, resulting in ]resurgence of malaria eases, especially after
achieving initial success to a great extent during the fifties and the sixties.
29. The Committee feels that assistance of World Bank be obtained expeditiously and new
methods and technology should be used for the purpose.
30. I he Committee recommends that State Governments should be asked to be more
vigilant, prompt, to strengthen the infrastructure including adequate staff and to make it
obligatory for the private practitioners to report all the cases to the authorities concerned.
Malaria Research Centres should be provided requisite infrastructure and staff to act as watch
dogs.
31. The Committee observes that the allocations for .M ilaria are combined with the
allocations for filaria and Kala-azar, which means that when there is an increase in filaria and
Kala-azar part of allocations may be accordingly shifted to these areas, reducing the actual
allocation for malaria. The Committee recommends separate allocations for all the three wings
namely Malaria, Kala-azar and Filaria respectively. The Committee further observes that in view
of all three diseases having common allocations , it is quite clear that tiierc has been no actual
» IULOUWJ
6
increase in funds for anti-malaria programme in spite of the fact that the number of malaria cases
have not come down since 1984. Not only that, there has been an increase in malaria cases,
particularly cases of Malaria falciparum in tribal areas and in urban slums. The fact that majori. y
rf deathsitai malaria being in tribal areas (60% of total cases) was found shocking by
Committee It is recommended that the recently-cleared proposal of making malaria eradication
programme in tribal and other malaria-prone areas where health serv.ce is weak a 100/o
cenfrally-sponsored Scheme should be immediately implemented. Regular monitoring must also
be done through cooperation with State Governments and local bodies.
32 The Committee expresses its deep concern over the shortage of some effective and
potent medicines to cure malaria particularly P. Falciparum and recommends that steps should be
taken to ensure that the requisite medicines are easily available in all the Hospitals/Dispensanes
and in the open market. Government should also supply such medicines under National Malana
Eradication Programme to all the States so that all the State Government Hospitals could have
the medicine Arrangements should also be made to supply these medicines through Mobile
dispensaries in the areas most affected by Malaria. Regular spray in the affected areasi should a so
be undertaken. Inpregnated bed nets duly dipped in synthetic chemicals which not only kill the
mosquitoes but also acts a repellent be provided wherever possible.
33 As oer the annual report (1992-93) of the Ministry of Health & Family Welfare budget
Programmes.
34 The Committee recommends that adequate funds, separate from the Malaria Eradication
Programme, may be provided for control/Eradication of Filaria and Kala-azar.
35 The Committee also recommends that concerted efforts should be made to use new
sa
xwassrxxr -
Programme should be given wide publicity through print and electronic media. Adequate supp y
of antiXa dZ in hospitals, dispensaries and in the open market be ensured apart from the
usual spraying.
II. National Leprosy Eradication Programme
36. India has a very high rate of incidence of leprosy, which is widespread all over the
country, and is one of the major health problems.
37 The magnitude of the disease can be judged by the fact that as per the Ministry’s Annual
Report' (1992-93) out of 10 million cases o
wOO^opnlatioVin 201 districts
X^tr^ Xtoml^ 5 SX’^X^e childre’ Uw 15 years of age.
38. The leprosy control Programme, which was in existence since
State governments.
39. During the course of his oral evidence tendered by the Secretary Department of Health,
“
-x:
"x"
remains to be launched in 66 other districts which are in the same category.
IT
7
there are 77 other districts which are moderately endemic i.e. having a prevalance rate of 2 to 5
per thousand If these 143 districts are covered over and above 135 districts that are already
covered then 95% of the leprosy patients will be covered.
ird The
wts also in^med that in the last 5-6 years, since the introduction of
ulti-diug Therapy there has been a major breakthrough in bringing down the incidence of
leprosy as out of estimated 4 million cases in 1981, the number has come down to 1.4 million by
the end of february, 1993. Wherever the Multi-drug Therapy Programme has been in operation
oi more than 5 years, there is 80% reduction in incidence.
41 The Secretary of the Health department stated that the programme has produced
dramatic results and it is expected that leprosy would be eliminated from the country by the turn
ot the century, i.e. when the prevalence rate will be below 1 per 10,000 population.
42. The Secretary of the department admitted that in an effort to cure more and more cases
sufficient attention had not been paid to rehabilitation and reconstructive surgery and to help the
patients lead a normal life after they arc cured.
43. Therefore, it is very necessary to have centres of reconstructive surgery and rehabilitation
and a sustained health eduction campaign to make people understand that the patients who are
cured or have undergone treatment for the disease are absolutely safe and infection free.
44. The Committee was informed that under the programme of major reconstructive surgery
there is no plan to create new institutions instead under the world Bank project institutes where
reconstructive surgery is available will be revamped and provided with equipments and appliances
free of cost.
I
45. These institutes will also be provided Rs. 2500/- for each i._
major surgery and package of
services which include full cost of operation service, OPD and total
-„1 care of the patient. If an
institute is not available within a district then the patient will be referred to any such institute
established in a nearby district. In that case, the amount will be Rs.
250(y- plus the
reimbursement of travel expenses of the patient.
46. It was informed that there are district Leprosy Officers in 105 districts in which Multidrug Therapy Programme has been taken up and also "there
i one doctor for every 4-5 lakhs of
------is
population. To ensure fthat the programme reaches every village there are village level workers
for every 20,000 population who are SUppOse(j t0 g0 aroun(j and find out thc cases and see that
the services reach them for their treatment.
47. The Secretary conceded that some posts of doctors are lying vacant in some districts and
the State Governments have been urged to fill them up.
48. There are also District Leprosy Societies in all thc districts where the programme has
een taken-up. In the societies there are local representatives, members of Legislatures
panchayats etc. with whom various aspects of the programme are discussed.
49. As regard role of Voluntary organisations it was informed that out of about 285
voluntary organisations, 55 are receiving assistance from Central Government. The grants-in-aid
are given under the Survey, Education and Treatment (S.E.T) Scheme and are released through
the State Governments.
&
50. The performance of the voluntary organisations are being closely monitored by the
Central Government and also by the State Governments themselves. However, the Secretary
a mitted that it is possible that some voluntary organisations may not be performing upto the
expectations but by and large they are doing commendable work. It was also informed that there
rrriHr
’ "hbim-
D "
I
I III UM
8
are some international voluntary organisations also who have covered the entire districts and
done extremely good work.
51. The NLEP is given high priority and for the Eighth Five Year Plan it has been allocated
Rs. 140.00 crores as against actual expenditure of Rs. 40.00 crores during the Sixth Plan (^BO
SS) and Rs. 85.82 crores during Seventh Plan (1985-90). The expediture for the Sth Five Year
Plan is constantly increasing on yearly basis from 17.58 crores in 1990-91. to 24.38 crores in 199091, and Rs. 35.00 crores as per revised estimates of 1992-93. The Budget estimates for 1993-94 is
also Rs. 35.00 crores. In reply to query as to why the budget provision of Rs. 35 crores for 199394 has been kept at the same level as that of the last year, it was informed that after negotiations
with the World Bank a loan of Rs. 332 crores, over a period of 6 years, for the expansion of the
programme has been approved and the formal approval by the Board of World Bank is likely to
come in June-July. This additional amount will substantially add to the financial resources for this
programme.
52. The external aid component earlier was as meagre as Rs. 1.05 crores in 1990-91. Rs. 1.78
crores in 1991-92 and Rs. 1.10 crores in 1992-93. However, the aid has substantially increased to
Rs. 11.00 crores in 1993-94 due to major contribution of Rs. 9.50 crores by the World Bank.
53. The evaluation of the programme was done in December, 1991 through 15 specially
created teams of experts each, one of the members of which was International expert on leprosy.
Observations/recommendations
1. The reported data has been validated.
2. The progress of programme is slow in Uttar Pradesh. Madhya Pradesh, Bihar. Orissa
and West Bengal.
3. A good number of posts of Medical Officers, Non-Medical Supervisors are vacant in
some states. Such vacancies are 20% to 30% in Uttar Pradesh. Madhya Pradesh. Bihar
and West Bengal.
4. There is need for further toning up of logistic arrangements i.e. drugs, vehicles and
equipments.
5. Temporary Hospitalization wards are not being utilised to their capacity.
6. There is need to further tone-up the training activities.
7. M.D.T. has been found to be very effective.
54. The Committee appreciates the optimism of the Ministry that they will be able to
eliminate leprosy from the country by the turn of the century and hopes that the Ministry will
make all out efforts to achieve the target.
55. The Committee also hopes that the Ministry will learn lesson from their mistakes in
Malaria Eradication Programme and will not repeat them in this programme and recommends
that foolproof steps be taken not only for the elimination of the leprosy but also for rehabilitation
of the people who arc inflicted with the disease and the programme be continued with same
vigour till leprosy is completely eradicated.
56. The Committee recommends that M.D.T. programme, which has produced dramatic
results, be expanded to such an extent that all the districts of the country where the prevalence
rate of leprosy is more than 2 per 1000 population and pockets of districts which have endemic
leprosy, are brought under it immediately. The Committee also recommends that rural and
backward areas which have endemic leprosy be given special attention.
9
57. The Committee expresses its deep anguish over the fact that Department has done
almost nothing for so many years for the rehabilitation of the patients which virtually negates the
objective of the programme. The Committee, therefore, recommends that rehabilitation and
reconstructive surgery be given utmost priority and centres of reconstructive surgery and
rehabilitation be opened in all the districts where prevalence rate is more than 2 per 1000
population.
I
58. The Committee takes strong exception to the approach of the Department to treat cases
in which disease starts eating up fingers and nose, as burn put cases for whom nothing much can
be done except rehabilitation to a limited extent.
59. The Committee is of the view that if the explanation of the Department is accepted no
treatment is to be provided to the advance cases of AIDS and Cancer as they are not curable.
The Committee feels that no case is a burn out case and every patient deserves the best
treatment and rehabilitation even if he cannot be cured.
60. The Committee, therefore, recommends that for the so called burnt out cases more
humanistic approach be adopted and they be provided best possible treatment and he kept in the
hospitals as long as it is required.
61. The Committee also recommends that some scheme be formulated for the poor patients
who are living on the river banks of religious places, begging on the streets or living in isolated
places for whom even their families do not care and they may be provided food, clothing, shelter
and all other medical attention.
62. The Committee is not convinced with the claim made by the Secretary during the cdurse
of his oral evidence that they have one doctor for every 4 to 5 lakhs of population and
recommends that it should be ensured that there are doctors for every 4-5 lakhs of population
and also recommends that Committee be informed of numbei of doctors in position in each
district.
I
63. The Committee fails to understand the rationale for having District Leprosy Officers in
105 districts only when the programme has been launched in 135 districts. The Committee,
therefore, recommends that post of District Leprosy Officers be immediately created in remaining
30 districts and also recommends that District Leprosy Officers be appointed in all the districts of
the country, in phases, where the prevalence rate is more than 2 per 1000 population. The
Committee is of the considered view that only doctors as District Leprosy Officer can properly
monitor the progress of programme and recommends that only medical men be appointed as
District Leprosy Officers.
64. The Committee also recommends that wherever the post of District Leprosy Officer is
vacant it should be immediately filled up and it should also be ensured that posts of District
Leprosy Officers are not kept vacant for long durations. In case it is not possible to fill up the
post for some reasons the alternative arrangements be made.
65. The Committee feels that budget allocation of Rs. 35.00 crores for NLEP for the year
1993-94 is inadequate and it should have been increased substantially keeping in view the
importance of the programme and rate of inflation, irrespective of the fact that World Bank grant
worth Rs. 68 crores was expected to be released from August, 1994. In the course of oral
evidence before the Committee, the Health Secretary said that refampicin, needed for both
leprosy and tuberculosis, is now likely to be produced in the country from the basic stage. This
would lead to the reduction of the cost of Refampicin, which is a costly drug now. The
Committee thinks that instead of the price of drugs being primarily within the purview of the
III TnniBiiBBl
ma i
in
rnsi n si in i ivih
10
Ministry of Chemicals and Fertilizers, Health Ministry be also involved in this particularly in the
case of basic drugs needed for national programmes.
III. National Programme for Control of Blindness (NPCB)
66. Eye is the most beautiful and invaluable gift of nature. Without eyes world is nothing but
darkness. India being the second most populous country in the world, has at present 14 per
thousand cases of blindness. Government in its first effort to meet the backlog of blindness on a
national scale, launched a National Programme for Trachorma Control in 1963. This Programme
was subsequently merged into the National Programme for control of Visual impairment and
prevention of blindness which was re-named in 1976 as National Programme for Control of
Blindness (NPCB). Phis is 100% a Central Government sponsored scheme.
67. As per the evaluation of blindness done by All India Survey 1988-89, cataract is found to
be responsible for 81% of blindness in India.
68. National Programme for Control of Blindness (NPCB) aims at providing intensive health
education for eye care through the mass media and extension education methods; extension of
ophthalmic services in rural areas through mobile units and eye camps and establishment of
permanent infrastructure for eye care as an integral part of general health services. Government
claims that it is engaged in the control of blindness since 1963 but the Committee is surprised to
note the fluctuation in the funds released, expenditure incurred and actual cataract operations
performed/proposed to be performed during the period 1985-94 as illustrated in the following
statistics:—
Year
1985- 86
1986- 87
1987- 88
1988- 89
1989- 90
1990- 91
1991- 92
1992- 93
1993- 94
Amount released
on the NPCI3
(in crores)
Expenditure
incurred
(in crores)
Cataract
operations
performed
(in lakhs)
6.16
5.56
6.05
5.44
5.70
5.67
9.70
20.00
25.00
6.76
6.88
8.50
7.65
9.82
8.12
9.70
12.24
12.09
12.09
11.90
10.70
11.98
15.13
12.25
(provisional till
Feb. 1993)
69. The Committee finds no plausible reason to the variations in the above figures and
therefore, recommends that there should not be any let up in the efforts to achieve the target of
reducing the blindness from the present 14 per thousand to 3 per thousand by the turn of the
century i.e. 2000 A.D.
70. The Secretary, Department of Health, Ministry of Health & Family Welfare, in his oral
evidence tendered before the Committee, has stated that at least two million people are being
added every year to the number of persons requiring cataract operations whereas the
performance has been to the tune of 1.5 million operations per year. In other words at least
50,000 people are being added to the list of patients requiring cataract surgery every year.
71. The Committee takes it seriously that the achievement rate of cataract operations is
declining steadily. For instance, in the year 1990-91, the percentage of achievement for cataract
11
operations was 92.53% but in the year 1991-92 it was only 73.47% and in 1992-93 it is
expected still to go down as against the target of 20.00 lakhs, only 12.25 lakh operations have
been performed till February, 1993. Therefore, this is a matter of great concern and anxiety.
72. The Committee strongly recommends that Government should find out the reasons of
this fall in the cataract operations and devise some programmes so that more and more
cataract operations can be performed at a greater speed and if not more, at least targets fixed
should be achieved every year. The Committee also puts a word of caution that in its urge to
achieve the targets, Government should ensure that no quacks are used in such operations
and that the number of casualities should be eliminated completely. It should also be ensured
that post-operations care should be given high priority and benefits given to the poor families
undergoing such operations should reach them immediately such as grant of Rupees Sixty for
spectacles and the like.
I
73. The Committee is surprised to find that no foolproof method has been adopted in
calculating the cataract operations done by the private and non-Government organisations
(NGOs) and recommends that supply of information to the PHC or CHO at the district level
should be made mandatory for all such organisations engaged in the cataract operations.
74. The Secretary, Department of Health informed the Committee that corneal blindness
is not a major reason for blind nor a contributory factor. But, the Committee feels that there
is a need to set up eye-banks in the country and therefore recommends that Government
should persue, educate and encourage people through mass media to donate eyes voluntarily
on a large scale. Simultaneously, Government should also develop adequate infrastructure and
facilities in order to successfully procure the eye of each and every donor.
75. Voluntary Organisations play a significant role to make National Programme for
Control of Blindness (NPCB), successful, especially in the field of Education, Prevention,
Rehabilitation and Surgical services, etc. Government have been giving emphasis in the recent
past to form District Blindness Control Societies in all the States and Union Territories which
are to be registered under the Societies Registration Act of 1860, under the control of Deputy
CommissionepDistrict Magistrate by involving voluntary organisations of the area and raising
funds from local sources. In this connection, the District Ophthalmic Surgeon is the Member
Secretary of the Society apart from the representatives of the local and voluntary organisations
and as per the oral evidence tendered before the Committee by the Secretary, Deptt. of
Health 174 such societies have been formed so far and are functioning.
I
76. The Committee feels that it is a very good step taken by Government in order to
achieve targets fixed for cataract operations and making National Programme for Control of
Blindness a success and recommends that a mechanism may be evolved to hold meetings of
such societies at least once in three months and all concerned should be asked to attend the
meetings and also monitor the cataract operations performed in their district invariably. The
Committee also recommends that concerted efforts should be made to form such societies in
all the remaining distircts all over the country as soon as possible.
77. As per the Annual Report of the Ministry of Health & Family Welfare for the year
1992-93 funds allocations under Eighth Plan for the National Programme for Control of
Blindness has been fixed at rupees 120 crores apart from the foreign aid agreed upon between
the Government of India and Government of Denmark which is Rupees 22.25 crores over a
period of five years 1989-94 under phase-II, the funds for which are to be released in a
phased manner depending upon the actual expenditure incurred by the various State Govern
ments undci the scheme. The Committee recommends that indigenous allocation may be
I III
Illi I
ii
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12
enhanced in order to achieve the targets fixed for National Programme for Control of
Blindness apart from exploring funds from such foreign agencies.
National AIDS Control Programme
78. Acquired Immuno Deficiency Syndrome (AIDS) has emerged as one of the major
public health problems in recent years. It is caused by human immuno deficiency virus (HIV).
AIDS virus destroys the body’s immune system i.e. strength to fight against disease. Hence
the person becomes susceptible to all kinds of diseases and slowly and slowly goes down and
dies. The virus spreads primarily through sexual intercourse, but can also be transmitted by
sharing drug injecting needles, through transfusion of infected blood, and from infected
mothers to their unborn and new born children.
79. According to the World Health Organisation (WHO) estimate, there are about one
million people infected with HIV in- India. HIV infection in the country has been reported
from as many as 23 States/Union Territories of which Maharashtra, Tamil Nadu, Delhi and
Manipur have the highest incidence.
80. The first HIV infection case in India was detected in Madras in 1986, in a survey
conducted by the Indian Council of Medical Research (ICMR). Subsequently, the AIDS
Control Programme was formulated in 1987, which has following components: (i) Surveillance;
(ii) Safety of blood and blood products; and (iii) Health Education.
81. A separate wing known as AIDS Control Organisation has been established in the
Ministry of Health & Family Welfare from September/October, 1992, in order to co-ordinate
the programme effectively. Since AIDS has no cure as of now, the thrust of the whole
programme is on creation of awareness through information, communication and education for
promotion of safe practices including safe sex, use of sterilised/disposable needles, use of
uninfected blood and blood products etc.
82. The Committee feels that proper and effective implementation of the National AIDS
Control Programme is possible only when there exists essential infrastructure. In a country
like India where a large number of population is illiterate, it is a challenging task to educate
and arouse awareness to make them understand the causes of the disease and advise them on
taking necessary precautions. In the absence of a vaccine, it is necessary to inform people as
to how HIV is transmitted and educate them to protect themselves and their loved ones from
the deadly disease. As the number of AIDS cases increase education aimed at preventing the
syndrome becomes more important and imperative.
83. During the course of his oral evidence tendered before the Committee, the Secretary,
Department of Health informed that efforts are being made to educate people in order to
control Sexually Transmitted Disease (STD) because it is one of the major factors for
transmission of HIV infection. There are 332 STD clinics spread all over the country. Efforts
are also being made to impart training to rural doctors so that they can identify the symptoms
and refer the persons suffering from the disease to STD clinics. Alarming and rapid increase
in HIV positive cases in our country has necessiated utmost and precautionary measure in the
field of AIDS control. The Committee, therefore, recommends that it should be made
mandatory to carry out HIV tests of persons who undergo normal blood tests in hospitals. It
will in this way be easier to detect and screen out the AIDS cases.
84. The Committee observes that services available in some of the STD clinics are not
being properly utilised. 'Hie Committee recommends that efforts should be made to utilise the
STD clinics fully for the treatment of the afflicted persons.
13
85. The Committee feels the need to launch a massive programme to promote public
awareness and community support. So that myths and misconceptions about the disease could be
obliterated. In this regard the Committee recommends that:—
(i) An advertisement campaign should be designed to reach large number of people with
messages about prevention of AIDS. Television and radio spots may also be used.
(ii) Leaflets should be published for distribution in various public forums and in health care
facilities. Such material must contain latest medical information, reach new target popula
tion, and should stress matters that survey results have indicated to be of special importance.
This material may also be prepared in regional languages for distribution among local
population.
(iii) Forums should be set up and workshops, classes and seminars should be organised from time
to time in different areas to enable members of the general public to interact with the
experts. This will allay the fears and wrong notions which exist in society about the disease.
(iv) Journalists and specialists should prepare articles to enhance readers’ general knowledge and
arouse awareness and understanding about AIDS.
(v) The programme should be designed not only to inform the target population about the
disease but also to motivate them to act on information they already possess.
(vi) The programme should not rely entirely on printed and broadcast messages. Face to face
education may also help people to clarify their misconceptions. More and more voluntary
organisations may be encouraged to take up the challenging task of enlightening the people
through the use of different media viz. drama, street plays, exhibitions and videos.
I
(vii) While educating people about the disease and its control, public sensibilities should be
considered carefully in order to make the programme acceptable to them.
86. The Committee emphasises on the need to evolve broad AIDS Control Strategy covering
all major aspects such as revamping of STD Control Programme, safe blood transfusion and
streamlining infection control in hospitals. There should be a stricter enforcement of Screening of
blood donors. Besides this, a responsible system of primary health care centres should also be
established for providing psycho-social care to infected persons and to counter social ostracism
against them.
87. The Committee also stresses the need to encourage extensive grass-root participation of
general public and voluntary organisations in the AIDS prevention and control programme.
88. The indigenous systems of medicine contain a reservoir of wisdom which concerns public
health. The Committee recommends that efforts may be made to revive and strengthen the
traditional systems. Ayurveda and other indigenous systems of medicine may be encouraged to
find treatment of the AIDS.
89. Neem is found in abundance in India. Many International investigations and research
studies have proved beyond doubt that it is very effective and safe in the cure of deadly diseases
like AIDS and Cancer, etc. Therefore, the Committee recommends that concerted efforts should
be made to harness the use of Neem and its products in the cure of AIDS and cancer in addition
to other such diseases. The Committee also recommends that more and more emphasis should be
laid on research in this regard for which adequate funds should be provided.
90. While the Committee agrees that proper precautionary measures should be taken to
check the spread of HIV infection which might lead to AIDS, the Committee recommends for an
indigenous study of AIDS cases in the country, for proper assessment of its extent, instead of
I IIIB i I
14
relying on World Health Organisation report alone. The Committee fails to understand the
reasons for the priority given to the anti-AIDS programme in the World Bank assisted scheme.
While assistance is still to come for most of the other national programmes (e.g. Malaria
Eradication Programme) and hardly any real increase in budgetary allocations has been made.
The enormous quantum of World Bank assistance for the anti-AIDS programme seems to be
totally lop-sided, to say the least. The Committee feels that instead of this lavishness,
enhancement of allocation in basic health services like Anti-Malaria, Anti-Tuberculosis Program
mes, etc. would also have pre-empted spread of AIDS.
*
MINUTES
"iPi >
• MINUTES OF THE MEETING OF THE COMMITTEE ON HUMAN
RESOURCE DEVELOPMENT
VII
♦SEVENTH MEETING
The Department Related Parliamentary Standing Committee on Human Resource Develop
ment met at 11.00 A.M. on Thursday, the 10th June, 1993, in Committee Room ‘A’, Ground
Floor, Parliament House Annexe, New Delhi.
PRESENT
I. Shri Ram Naresh Yadav — Chairman
RAJYA SABHA
2. Prof. Saurin Bhattacharya
3. Miss Saroj Khaparde
4. Shri Md. Salim
5. Shri Pravat Kumar Samantaray
6. Shri Vishnu Kant Shastri
7. Shri P. Upendra
8. Shri Ranjan Prasad Yadav
LOK SABHA
9. Dr. Viswanatham Kanithi
10. Dr. V. Rajeshwaran
11. Dr. Vasant Niwrutti Pawar
12. Shri Ishwarbhai Khodabhai Chavda
13. Dr. Ramesh Chand Tomar
14. Shri Dau Dayal Joshi
15. Dr. K.D. Jeswani
16. Dr. Mahadeepak Singh Shakya
17. Dr. G.L. Kanaujia
18. Shri Braja Kishore Tripathy
19. Shrimati Malini Bhattacharya
20. Shri Brahmanand Mandal
21. Shri Suraj Mandal
REPRESENTATIVES OF THE MINISTRY OF HEALTH & FAMILY WELFARE
(DEPARTMENT OF HEALTH)
Shri R.L. Misra, Secretary
Shri I. Chaudhari, Additional Secretary (Health)
Shri P.R. Das Gupta, Additional Secretary (AIDS)
Dr. A.K. Mukerjee, Director-General, Health Services
Shri T.K. Das, Joint Secretary
Shrimati S. Chandra, Joint Secretary
Shri Pawan Chopra, Joint Secretary
’Minutes of 1 to VI meetings relate to matters not included in this report.
17
18
Shri I.S. Bist, Joint Secretary
Shri B.S. Lamba, Joint Secretary
Shrimati A.P. Ahluwalia, Financial Advisor & Jt. Secretary
Dr. C.H.S. Shastri, Advisor (ISM)
Dr. V.T. Augustus, Advisor (Homoeopathy)
SECRETARIAT
Shri R.C. Soperna, Deputy Secretary
Shri Om Prakash, Under Secretary
Shri A.K. Singh, Committee Officer
2. The Committee heard the Secretary (Health), Ministry of Health & Family Welfare
regarding Annual Report for the year, 1992-93 concerning Department of Health.
The Committee adjourned at 1.25 P.M. and re-assembled at 4.00 P.M.
A verbatim record of the proceedings was kept.
3. The Committee then adjourned at 6.45 P.M. to meet again on the 11th June, 1993 at
11.00 A.M.
VIII
EIGHTH MEETING
The Department Related Parliamentary Standing Committee on Human Resource Develop
ment met at 11.00 A.M. on Friday, the 11th June, 1993, in Committee Room ‘A’, Ground Floor,
Parliament House Annexe, New Delhi.
PRESENT
1. Shri Ram Naresh Yadav
RAJYA SABHA
2. Prof. Saurin Bhattacharya
3. Shrimati Renuka Chowdhury
4. Miss Saroj Khaparde
5. Shri Md. Salim
6. Shri Pravat Kumar Samantaray
7. Shri P. Upendra
LOK SABHA
8. Dr. Viswanatham Kanithi
9. Dr. Vasant Niwrutti Pawar
10. Dr. Ramesh Chand Tomar
11. Shri Dau Dayal Joshi
12. Dr. K.D. Jeswani
13. Dr. Mahadeepak Singh Shakya
14. Dr. G.L. Kanaujia
15. Shri Braja Kishore Tripathy
16. Shrimati Malini Bhattacharya
17. Shri Brahmanand Mandal
18. Shri Suraj Mandal
Chairman
19
*
REPRESENTATIVES OF THE
(DEPARTMENT OF HEALTH)
MINISTRY
OF
HEALTH
&
FAMILY
WELFARE
Shri R.L. Misra, Secretary
Shri I. Chaudhari, Additional Secretary (Health)
Shri P.R. Das Gupta, Additional Secretary (AIDS)
Dr. A.K. Mukerjee, Director-General, Health Services
Shri T.K. Das, Joint Secretary
Shrimati S. Chandra, Joint Secretary
Shri Pawan Chopra, Joint Secretary
Shri I.S. Bist, Joint Secretary
Shri B.S. Lamba, Joint Secretary
Shrimati A.P. Ahluwalia, Financial Advisor & Joint Secretary
Dr. C.H.S. Shastri, Advisor (ISM)
Di V.T. Augustus, Advisor (Homoeopathy)
SECRETARIAT
Shri R.C. Soperna, Deputy Secretary
Shri Oin Prakash, Under Secretary
Shri A.K. Singh, Committee Officer
2. The Committee heard the Secretary (Health), Ministry of Health & Family Welfare
regarding Annual Report for the year, 1992-93 concerning Department of Health.
A verbatim record of the proceedings was kept.
3. The Committee then adjourned at 2.25 P.M.
XXI
’TWENTY-FIRST MEETING
The Departinent-related Parliamentary Standing Committee on Human Resource
Development met at 3.00 P.M. on Thursday, the 16th December, 1993 in Committee Room ‘A’,
Ground Floor, Parliament House Annexe, New Delhi.
PRESENT
1. Shri Rain Naresh Yadav
Chairman
RAJYA SABHA
2. Prof. Saurin Bhattacharya
3. Sint. Renuka Chowdhury
4. Shri Md. Salim
5. Prof. LG. Sanadi
LOK SABHA
6. Prof. (Sint.) Savithri Lakshnianan
7. Shri Mani Shankar Aiyar
8. Dr. Vasant Niwrutti Pawar
* Minutes of IX to XX meetings relate to matters not included in this report.
20
«
9. Shri Bapu Hari Chaure
10. Shri A. Thulasian Vandayar
11. Dr. G.L. Kanaujia
12. Shri Anna Joshi
13. Smt. Malini Bhattacharya
14. Shri Ram Chandra Dome
SECRETARIAT
Shri Ram Krishan, Under Secretary
Shri Rohtas, Committee Officer
2. The Committee considered and unanimously adopted the Draft Fourth Report with some
modifications. The Committee decided to resent the Report in the Rajya Sabha and to day the
same on the Table of Lok Sabha on Tuesday, the 1st December, 1993 and authorised the
Chairman and in his absence Shri Md. Salim and Prof. I.G. Sanadi to present the Report in the
Rajya Sabha and also authorised Dr. Vasant Niwrutti Pawar and Shri Dau Dayal Joshi to lay the
Report on the Table of the Lok Sabha. The Committee decided to hold its next meetings at 3.00
P.M. on Monday, the 10th January, 1994 and at 11.00 A.M. on Tuesday, the 11th January. 1994
to take up for consideration the National Culture Policy, 1992.
3. The Committee then adjourned at 4.00 P.M.
Position: 2693 (2 views)