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Member's Profile
Syeda Saiyidain Hameed
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Member, Planning Commission, Government of India.
Tel. No.: (Off.) 2309 6570, 2309 6571, 2309 6666/ 96 Extn. 2120
Email: s.hameed@yojana.nic.in
2000 to present:
Founder Member: Muslim Women’s Forum
Forum is involved in Legal Literacy for Muslim women, for voicing concerns of Muslim women to
government and interfacing with Ulemas on matters concerning their rights.
Founder Trustee: Women’s Initiative for Peace in South Asia (WIPSA)
An organization of women as catalysts for people to people contact in the South Asian region on
a sustained basis to bring about a climate of peace in the region through dialogue. Women’s Bus
of Peace from Delhi to Lahore and Lahore to Delhi, later Women’s Bus of Peace from Kolkata to
Dhaka was one of the highlights of this initiative.
Founder Member: South Asians for Human Rights (SAHR)
A regional membership based body focusing on human rights issues in the South Asian Region.
It consists of members from the 5 countries namely Pakistan, Bangladesh, India, Srilanka and
Nepal. It is committed to addressing Human Rights at both regional and national level.
Founder Trustee: Centre for Dialogue and Reconciliation
Serving as an initiative that links the issues of dialogue with justice and equity and through this
integral link, begins to serve as a catalyst for both internal and external peace and reconciliation
in South Asia.
1987 to 2000
Member National Commission for Women, Govt, of India
National Commission for Women (NCW) is a statutory body under the National Commission for
Women Act 1990. The powers of the Commission are listed under Section 10 of the Act and
encompassed under the clause ‘ To investigate and examine the safeguards provided to women
under the Constitution of India and make recommendations to govt, on the proper working of the
safeguards.’
1991-1994 Nehru Memorial Museum and Library
- Worked on Maulana Abdul Kalam Azad
1987-1991 Indian Council for Cultural Relations (ICCR)
- Worked on Azad and Also on Sufism
Present Honorary Positions
Trustee National Foundation of India
Trustee Dalit Foundation
Governing Board Member Indian Social Institute
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Trustee Janvikas, Ahmedabad Gujarat
Trustee Navsarjan Ahmedabad Gujarat
Governing Board Member Centre for Women’s Development Studies India
Member Governing Body: Rajdhani College
Member Jury Sarojini Naidu Prize for Journalism (Hunger Project)
Past Honorary Positions
Member Women’s Empowerment Committee, Govt, of NCT Delhi
Chairperson Governing Body: Lady Irwin College
Member Management Committee: Modern School
Member Delhi Urdu Academy
Member Haryana Urdu Academy
Member National Council for Promotion of Urdu Language
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Administration
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1975-1978: Executive Assistant to Minister of Advanced Education and Manpower Govt,
of Albetra, Canada
1978-1985: Director of Colleges and Universities, Govt, of Alberta, Canada
Teaching
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1972-1974: Sessional Lecturer University of Alberta, Canada
1965-1967: Lecturer, Lady Shri Ram College, New Delhi, India
Personal
Resident of Delhi, Born in Kashmir, Traveled in South Asia, USA, Canada. A few countries in
West Asia, South East Asia, UK and Europe. Husband: Dr. S.M.A. Hameed (late) was Professor
of Business Administration and Commerce at the University of Alberta, Canada. Three children:
Dr. Morad Hameed, Assistant Professor of Surgery, University of Calgary, Canada, Yavar
Hameed, Lawyer in Ottawa, Canada and Ayesha Hameed, Phd student at York University
| Canada.
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Ms Meenakshi Datta Ghosh
Joint Secretary, Ministry of Health and Family Welfare, Government of India
Ms Meenakshi Datta Ghosh was Joint Secretary, Government of India, Ministry of Health &
Family Welfare, Department of Family Welfare. She was responsible for formulating the National
Population Policy, 2000.
Ms. Ghosh was finalizing a strategy paper, already on the website, on the social franchising of
services and the social marketing of reproductive health products. She has motivated the
updating of standards and specifications of contraceptives and instrumentation used in the
national family welfare programme.
Her special interests are in the areas of decentralization of health care and convergence of
service delivery.
Ms Ghosh is a Ph.D. candidate at the University of Pittsburgh, USA, in the field of Public Policy
Research and Analysis. She has a Masters in Public Policy, Kennedy School of Government,
Harvard University; a Masters in Sociology, Delhi School of Economics Delhi University as well as
Diplomas in French and in Russian.
Ms Meenakshi Datta Ghosh belongs to the Indian Administrative Service (since 1970) and has
held several positions of reponsibility in development administration.
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Planning Commission
Approach to the Mid-term Appraisal
of the Tenth Plan (2002-07)
The Mid-Term Appraisal (MTA) of the Tenth Plan (2002-03 to 2006-07) is due in the current
year and work on preparing it has commenced. The MTA provides an opportunity to take stock of the
economy and to introduce policy correctives and new initiatives in critical areas in the context of the
new priorities outlined in the National Common Minimum Program. This note presents some of the
issues which the Mid-Term Appraisal needs to address.
Growth Performance
2. The Tenth Plan had targeted an average annual growth rate of GDP of 8.1% for the Tenth Plan
period to be achieved by a steady acceleration in the course of the Plan period from around 6.7%
targeted in 2002-03 to 9.3% in the terminal year 2006-07. This was expected to lay the basis for a
growth rate of above 9% during the Eleventh Plan period.
3. The MTA will consider whether the original 10th Plan growth target is still feasible. The growth
target of the first two years was about 7% on average and the actual performance has been 4.6% in
2002-03 and 8.3% in 2003-04, averaging 6.4% for the two years. The shortfall in the first two years
appears modest but the disturbing fact is that the momentum for acceleration, which was essential to
achieve the 8.1%, target, has not been achieved. The current year’s GDP growth is likely to range
between 6 and 6.5 per cent of GDP so that achievement of the Plan target is only possible if GDP
growth in the last two years averages 11% per year, which is clearly infeasible. The MTA should
explore the scope for accelerating growth in the remaining years of the Tenth Plan to achieve the
target of 7-8% growth set in the NCMP.
4. Sectorally, the Tenth Plan had targeted growth of agricultural GDP of 4% per year, aiming to
reverse the deceleration in the second half of the 1990s - from 3.2% in the period 1980-1996 to 2.6%
in the period 1996-2002. This is nowhere near being achieved. The average agricultural GDP growth
in the first two years of the Plan was 1.8% and it is unlikely to exceed 1.5% in the current year. The
failure in this area is a major factor underlying rural distress which has been visible in recent years.
The MTA will focus on corrective policies needed in this area.
5. Industrial growth in the first two years was 6.7% which was also short of expectations. Although
industrial growth has picked up in the current year, we are still far from the rates of above 10%
needed to achieve Plan targets. Failure to achieve high rates of industrial growth will limit the ability
of the economy to generate high quality jobs, particularly for the educated youth.
6. One of the brightest spots in India’s economic performance in recent years has been the
emergence of knowledge-based industries as front-runners in the global marketplace. The early
successes of the software sector are being replicated in a number of other activities such as business
process outsourcing (BPO), bio-technology, pharmaceuticals, industrial design, tertiary health-care,
etc. There is vast potential in these activities but it is clear that a number of other developing countries
have also identified them as areas of focus for the future. In order to prevent an erosion of India’s
present pre-eminence from these emerging threats, the MTA will identify the factors behind our
success and to ensure that we strengthen and creatively build upon them. The entrepreneurial
dynamism and competitiveness of these sectors indicate that there are lessons to be learnt about the
policy and operating environment that can be fruitfully applied to the less dynamic segments of Indian
industry. Equally importantly, IT should be harnessed to improve connectivity and governance in
rural areas.
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Grjox/ ~ 3- 2Mid Term Review of Ninth Plan (1997 - 2001)
Chapter 16
HEALTH
Improvement in health status of the population has been one of the major
thrust areas in social development programmes of the country. This was to be
achieved through improving the access to and utilization of Health, Family Welfare
and Nutrition Services with special focus on under-served and under-privileged
segments of population. The states fund infrastructure for delivering health care
services; the Centre provides funds through Centrally Sponsored Programmes for
combating major public health problems. Technological improvement and increased
access to health care have resulted in steep fall in mortality but disease burden due to
communicable diseases, non-communicable diseases and nutritional problems
continue to be high. In spite of the fact that norms for creation of infrastructure and
manpower are similar throughout the country, there are substantial variations
between States and districts within a state in availability and utilisation of health care
services and health indices of the population. The Special Action Plan for Health
envisages improvement of the health services to meet the increasing health care heeds
of the population.
Current problems faced by the health care services include:
Persistent gaps in manpower and infrastructure especially at the primary
health care level.
Sub-optimal functioning of the infrastructure; poor referral services.
Plethora of hospitals in Government, voluntary and private sector; they do not
have appropriate manpower, diagnostic and therapeutic services and drugs;
Massive inter-state/ inter district hiatus in performance as assessed by health and
demographic indices; availability and utilisation of services are poorest in the
most needy states/districts.
Sub optimal inter-sectoral coordination
Increasing dual disease burden of communicable and non-communicable
diseases because of ongoing demographic, lifestyle and environmental transitions,
Technological advances which widen the spectrum of possible interventions
Increasing awareness and expectations of the population regarding health care
services
Escalating costs of health care, ever widening gaps between what is possible
and what the individual or the country can afford.
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Health Care Infrastructure And Manpower.
Primary Health Care Services
2.
The primary health care infrastructure provides the first level of contact
between the population and health care providers. Realising the importance of the
primary health care infrastructure in delivery of health services. States, Centre and
several agencies simultaneously started creating primary health care infrastructure
and manpower. This has resulted in substantial duplication of the infrastructure and
manpower.
3.
The primary health care infrastructure created include:
Subcentres 134094 with 127384 ANMs in position
Primary Health Centres (PHCs) 22991 with 24648 doctors
Community Health Centres (CHCs) 2712 with 3624 specialists
(Source : RHS bulletin December, 1997).
Sub-divisional/Taluk hospitals
The Department of Family Welfare supports personnel in 5435 rural family
welfare centres, 871 urban health posts, 1083 urban family welfare centres, 550
district post partum-centres and 1012 sub-district post-partum centres.
Under the Department of Indian Systems of Medicine & Homoeopathy (ISM&H)
there are 22,104 dispensaries, 2862 hospitals and 300 medical colleges;
(Source : Indian Systems of Medicine and Homoeopathy in India, 1998. Dept, of
ISM&H, Ministry of Health & Family Welfare, New Delhi).
Municipalities provide urban health services.
Central Government Health Services (CGHS) provides health care for central
Government employees.
Railways , Defence and similar large Ministries/Departments have their own
hospitals and dispensaries to cater to health care needs of their staff.
Public Sector Undertakings (PSUs) and large industries have their own medical
infrastructure.
Employees State Insurance (ESI) provides hospital and dispensary-based health
care to employees
All hospitals - primary, secondary or tertiary care
also provide primary health
care services to rural and urban population.
There are the voluntary organizations and the private sector which are providing
heath care
4.
It is important to take into account all these institutions and manpower before
estimating the gaps. It is possible to achieve substantial improvement in coverage
and quality of health services by appropriately restructuring the existing infrastructure
making them responsible for health care for the population in a defined geographic
area. Substantial proportion of the manpower problems can be sorted out by
reorientation and re-deployment of existing manpower. While there are several
districts which have institutions well above their required norms, it is a matter of
concern that many of the districts with poor health indices do not have adequate
health infrastructure and here the need for the health services is very great. The Ninth
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Five Year Plan emphasised on the need to address the inequitable distribution of
existing institutions and manpower as well as poor functional status due to mismatch
between personnel and infrastructure, the need for orientation and skill upgradation
of personnel and lack of appropriate functional referral system.
Progress and suggestions:
Rural Primary Health Care Services
5.
A vast infrastructure for primary health care has been created but it is all
functioning sub-optimally. The factors responsible for this condition at the rural
institutions are:
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Inappropriate location, poor access and poor maintenance;
Gaps in critical manpower;
Mismatch between personnel and equipment;
Lack of essential drugs/diagnostics and poor referral linkages;
Ongoing initiatives to improve access to Primary Health Care include:
Strengthening/ relocating Sub-centres/ PHCs;
Merger, restructuring, re-locating of hospitals/dispensaries in rural areas and
integrating them with existing infrastructure;
Re-structuring existing block level PHC, Taluk, Sub-divisional hospitals ( states
like Himachal Pradesh have undertaken this);
Utilising funds from Basic Minimum Services (BMS), Additional Central
Assistance for BMS and Externally Aided Project (EAP) to fill critical gaps in
manpower and facilities;
District level walk-in interviews for appointment of doctors of required
qualifications for filling the gaps in PHC (States like M.P and Gujarat have reported
limited success).
Use of mobile health clinics - Orissa, Delhi - expensive and perhaps not
sustainable;
Appointment of doctors/specialists on part-time basis; and
Adoption of PHC by NGO/Voluntary organisation/industry.
Important Steps:
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Construction activity is taken up only when it is absolutely necessary.
High priority is accorded to filling the reported large gap in the vital CHC/First
Referral Unit (FRU) by redesignation and strengthening, providing appropriate
equipment and consumables and drugs required.
Retraining and skill upgradation of male workers in vertical programmes and their
redeployment as male multi-purpose workers.
Correct mismatches between infrastructure/equipment and manpower to make
institutions fully functional
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Urban Primary Health Care Services
6.
Nearly 30% of India's population lives in urban areas. There is either non
availability or substantial under utilisation of available primary care facilities along
with an over-crowding at secondary and tertiary care centres. Nagar Palikas, State
Govts., Central Ministries and EAPs provide funding for building upgradation and re
structuring urban primary health care infrastructure and establishing effective
linkages.
7.
The Planning Commission has provided Additional Central Assistance to:
Punjab for development of urban primary health care centres and establishing of
linkages with secondary and tertiary hospitals in Amritsar City;.
Strengthen existing dispensaries in under-served East Delhi and establish referral
linkages with secondary care institutions in the region;
Reorganisation of urban primary and secondary health care infrastructure and
building up referral linkages at Nasik.
8.
The progress in these and similar initiatives by State Governments is being
monitored.
Tribal Health
9.
The tribal population is not a homogeneous one. In North Eastern States, the
tribals have high literacy levels; they access available health facilities and their health
and demographic indices are better than the national level though the region is
endemic for malaria. On the other hand, the Onges in Andaman and Nicobar remain a
primitive tribe with very little access either to education or to health care. Differential
area-specific strategies are therefore being developed for each of the tribal areas to
improve access to and utilisation of health services.
Ninth Plan Strategies to Improve Health Care in Tribal Areas:
Ensuring availability of adequate infrastructure and personnel.
Area specific Reproductive Child Health (RCH) programmes.
100% Central Plan funds for National Anti Malaria Programme.
Focus on effective implementation of the Health & Family Welfare (FW)
programmes.
Close monitoring under Tribal Sub-plan, early detection of problems in
implementation of all on-going programmes and midcourse correction.
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Progress and Suggestions:
Successful Experiments in Improving primary health care to Tribals
Andhra Pradesh - Committed, Govt, persons running health facilities in tribal
areas
ACA for mobile health units with fixed tour schedule. Problem • Orissa
Expensive, difficult to replicate
• Karnataka, Maharashtra- NGOs adopting’ and running PHCs in Tribal areas Success is mainly due to commitment of individuals and credibility of NGOs.
Problems:
Initiatives and commitment of key individuals are responsible for success. Difficult
to replicate in a vast system.
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Secondary Health Care
Priorities in the Ninth Plan include efforts to :
Strengthen FRU (CHC/Sub-Divisional Hospital) to take care of the referrals from
PHC/Sub Centres (SCs).
Strengthen district hospitals so that they can effectively take care of referrals from
the entire districts.
Strengthen referral system and rationalise care at each level to:
Enable patients to get care near their residence
Ensure optimal utilisation of facilities at PHCs/CHCs.
Reduce overcrowding at district and tertiary care levels.
Provide adequate diagnostics, consumables and drugs
Strengthen emergency services and management of high risk cases.
Progress & Suggestions:
10.
In addition to funds from State Plan, several States have been seeking
External Assistance to build up FRU/District hospitals. So far six States have initiated
such projects with external assistance from World Bank.
11.
States have reported :
Progress in construction works, procurement of equipment, increased availability
of ambulances, drugs.
Improvement in services following training to improve skills in clinical
management, attitudes and behaviour of health care providers.
Reduction in vacancies and mismatches in health personnel/infrastructure.
Improvement in Hospital Waste Management,
Disease surveillance and response systems have been initiated.
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12.
All these six States have attempted introduction of user charges for
diagnostics and therapeutics from people above the poverty line. Initial problems
have been sorted out. Some States are still unable to ensure retention of collected
charges in the same institutions. This problem has to be speedily resolved. Referral
system needs further strengthening. All states are also simultaneously strengthening
primary health care infrastructure so that the referral linkages between primary and
secondary care become operational. These measures need to be closely monitored.
Tertiary Health Care:
13.
Along with an emphasis on enhancing the outreach and quality of primary
health care services and strengthening the linkages with secondary care institutions,
there is a need to optimise the facilities available in the tertiary care centres. At this
level, there is an ever-widening gap between what is possible and what is affordable,
for the individual or for the country.
Tertiary Health Care
Problems:
Giowing demand for complex, costly diagnostic & therapeutic modalities
Lack of skilled manpower, equipment & consumables to meet the demand
Overcrowding
Ninth Plan priorities
Provide funds for capacity building
Levy user charges for people above poverty line
Explore alternative modalities to meet the growing cost of care
Ongoing Activities
14.
Several states (e.g. Rajasthan, UP) are trying out innovative schemes to give
greater autonomy to these institutions, allowing them to generate resources and utilise
them effectively. Some states e.g. Rajasthan and Kerala have been levying user
charges and attempting to utilise the funds to improve hospital services. On an
experimental basis, an attempt is being made to improve quality of services in
tertiary hospitals under a Citizen’s Charter for Central Government Hospitals in
Delhi. The Charter aims to provide access without discrimination in those Delhi
hospitals and put in place a redressal mechanism for public grievance.
Development Of Human Resources For Health
Health professionals - production and utilisation
15.
Every year over 16,000 doctors graduate in the Modern System and over
1 1000 graduate in ISM&H. Two-thirds of the medical graduates under the modern
system go in for post graduate training. Majority of the practitioners of both modern
system and ISM&H are working in private/ voluntary sector.
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16.
With facilities available for training of medical graduates outstripping the
need, the Medical Council Act was amended in 1993 to stipulate Central Government
permission for any person to establish a medical college and to provide that no
medical college would open a new or a higher course of study or training including a
post graduate course of study or training or expand its admission capacity in any
course of study and training. Even so, medical colleges are opened and existing
under-graduate and post-graduate colleges continue to increase their seat capacities
with permission from the Central Government.
17.
There are continuing vacancies in primary, secondary and tertiary care
institutions at the level of general doctors as well as of specialists both in Central and
State institutions In order to ensure that vacancies of doctors in primary health care
institutions are filled, several states are trying to make service in PHCs a pre
requisite for post graduate admission. Some states are also experimenting with
appointment of doctors on contractual basis. As a long- term measure, the vacancies
are sought to be filled by creating new medical teaching institutions and increasing
the existing admission capacity. However, it would appear, the vacancies are not
getting filled because of poor service conditions rather than lack of professionals
being produced. Majority of the graduates and post graduates from the Modern
System and ISM&H practice in private/voluntary sector.
Para-professional Production & Utilsation:
18.
There was a major gap in para-professional production in the eighties.
Facilities were created for training of male and female multipurpose workers, and
currently there are adequate number of ANMs though there is still a dearth of male
workers. However, there are several para professionals employed in various vertical
programmes who are functioning as male unipurpose workers. The Ninth Plan has
recommended adequate retraining, redeployment and integration of these workers
into the existing primary health care institutions.
19.
Para-professionals are trained in three categories of training institutions:
existing Government institutions, private institutions and as a part of the 10+2
vocational training. The requirement of para-professionals has to be assessed in each
district and appropriate training taken up preferably as a part of 10+2 Vocational
Training Course. Utilisation of these vocational courses as a major mode of training
para-professionals would enable districts to respond to the changing needs while
enhancing career prospects for the para -professionals themselves.
Health manpower position at district level
20.
Currently there is no mechanism for obtaining and analysing information on
health care infrastructure and manpower (including private and voluntary sectors) in
the district. In order to create such a data base, a Standing Technical Advisory
Committee has been set up under the Chairmanship of Director General of Health
Services. The Central Bureau of Health Intelligence has been entrusted with the task
376
of compiling the data on rural and urban primary, secondary and tertiary health care
infrastructure and manpower in private, voluntary, industrial, governmental and other
sectors.
Continuing medical education
21.
Medical technologies are rapidly evolving; therefore, continuing education to
update the knowledge and skills is essential for medical and paramedical personnel..
Ninth Plan advocates an integrated comprehensive in-service training programme for
Health and Family Welfare. The programme is yet to be fully operationalised. For
Govt., private and voluntary sector personnel there are ongoing training programmes
conducted by National Academy of Medical Sciences, ICMR and professional
associations. In addition, the Ninth Plan has proposed an increasing use of' distance
learning' by utilizing information technology (IT) tools currently available. PlanniiTg
Commission has provided Additional Central Assistance to University of Health
Sciences in Andhra Pradesh, Karnataka, Punjab and Tamil Nadu to accelerate IT
upgiadation effoits and networking between pre-service and in-service institutions for
medical and para-medical personnel. The progress is being monitored.
New Initiatives In Ninth Plan
Horizontal integration of vertical programmes
Disease Surveillance and Response mechanism with focus on rapid recognition,
report & response at district level
Development of Integrated Non-Communicable Disease Control programme to
be implemented through existing health care system.
Health Impact Assessment as a part of environmental impact assessment in
developmental projects.
Appropriate management systems for emergency, disaster, accident and trauma
care at all levels of health care.
Improvement of Health Management Information System (HMIS) and supply
logistics.
Progress and Suggestions :
Horizontal Integration of Vertical Programmes:
22.
to:
At the Central level attempts are being made to integrate the activities related
Training, IEC in all CSS
SI D/RTI prevention and management under RCH and AIDS control Programme
HIV/TB Control Programme Coordination
At state level:
The Central Council of Health and Family Welfare has endorsed formation of
composite Health and Family Welfare Societies at state and district level. States like
377
Orissa and Himachal Pradesh have formed one Health and Family Welfare Society at
state and district level to implement all health and family welfare programmes.
Disease Surveillance and Response
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A phot project on development of a model disease surveillance system has been
initiated in 20 districts. Development of disease surveillance system is also one of
the components of the on-going Secondary Health Systems Project in many states.
Specific on-going communicable disease control programmes e.g., National Anti
Malaria Programme (NAMP) have a component of disease surveillance.
Surveillance for polio is being intensified under the Family Welfare Programme.
All these have to be integrated into a single cohesive system for monitoring
and responding to emerging health problems at district level.
Hospital Waste Management
Planning Commission provided ACA to National Capital Territory (NCT) of
Delhi for a pilot project in hospital waste management which could be replicated in
other States if found feasible.
Several States are incorporating the Hospital Waste Management as a part of their
Health Systems Project.
Environment and Health
A number of cities have taken steps to reduce air pollution and water pollution.
Delhi has promoted use of lead free petrol and utilization of CNG for vehicles.
Efforts are under way to re-locate polluting industries away from the main city and
improve waste management practices.
Projects for prevention of water contamination, water quality monitoring are
receiving increasing attention.
Health Sector Reforms
Ninth Plan Policy:
1. Commitment to provide essential primary health care, emergency life savings
sei vices, sei vices under National Disease Control programmes and National
Family Welfare programmes free of cost to all, based on the need for care
irrespective of their ability to pay.
2. Different states will evolve, implement, evaluate strategies for cost recovery for
secondary, tertiary as well as super specialty care from people above poverty line
and at the same time they will provide a mechanism for improving access to
these sei vices for people below poverty line. Based on the experience of these
efforts future course of action will be charted out.
378
23.
As a part of economic reforms, health sector reforms are perhaps inevitable.
However, due care should be taken to ensure that the reforms do not shut out
vulnerable groups access to health care nor result in deterioration of health status in
poorer segments of the population.
24.
In the last few decades there have been major advances in health care related
technologies but many of them are very expensive. Some of the data from the
developed countries suggest that widespread use of these would inevitably result in
cost escalation but benefits in terms of improvement in the quality of life or
increased longevity may not be commensurate with the cost. However, there is
giowing public awareness about the availability of these technologies and population
tries to access these facilities.
25.
So far the health sector has been targeting interventions at persons who are ill
and need cate, those who are at risk of becoming ill and those who are vulnerable and
tequite specific protective measure. Services are being provided to all without any
uset chaiges iuespective of their ability to pay. This policy may be difficult to sustain
in the future. There is an urgent need to evolve appropriate policy guidelines for
funding of health care services to different segments of population. There has been
an increase in the per capita income over the last two decades and therefore it might
be time to try out levying user charges for diagnostic and therapeutic services from
people above the poverty line; if found feasible this would enable the public sector
health care institutions to improve their services.
26.
Health insuran£e for individuals, families and for groups have been in vogue
in many developed countries for several decades. While they do offer mechanism for
meeting hospitalization costs for major ailments, there has been growing concern
even in the developed countries that the system results in unacceptable escalation of
health care cost without commensurate improvement in health care. Cost effective
methods for meeting health care expenses need to be evolved. In addition, there is a
need to promote healthy lifestyles and empower people to remain healthy. The
Ninth Plan envisages a novel approach to promote healthy life style. The Plan
suggests that the premium for health insurance may be adjusted on the basis of health
status of the persons and age of the persons at the time of entry into health insurance;
a yearly no claim’ bonus could be given to those who have remained healthy and
claimed no reimbursement of medical expenses. This could serve as an economic
incentive for remaining healthy and adapting healthy life styles.
Control Of Communicable Diseases
27.
At the time of Independence communicable diseases were a major cause of
morbidity and mortality in the country. Efforts were therefore initially directed
towaids their prevention and control. Effective therapy for infections and vaccines to
prevent infection caused a steep fall in crude death rate (from 25.1 in 1951 to 8.9 in
1996). However, the morbidity due to communicable diseases continues to be high.
Detei ioi ating uiban and rural sanitation, poor liquid and solid waste management and
overcrowding have escalated the prevalence of common communicable diseases.
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The re-emergence of diseases like Kala Azar has added to the burden. Control of
communicable diseases is becoming more difficult because of emergence of drug
resistant pathogens and development of insecticide-resistant vectors.
Strategies to improve performance of Disease Control Programmes during
Ninth Plan:
Rectify identified defects in design and delivery
Fill critical gaps in infrastructure and manpower
Make service delivery responsive to user needs
Ensure skill upgradation, supplies, and referral services
Improve community awareness, participation and effective utilisation of
available services
National Anti Malaria Programme (NAMP)
28.
During the Ninth Plan NAMP is being implemented through a modified plan
of operations, assisted by the World Bank and has the following components :
Early diagnosis and prompt treatment
Selective vector control & personal protection
Prediction , early detection & effective response to out breaks
IEC
Control activities will be intensified in areas with:
Annual Parasite Incidence (API) of > 2 in the last three years
Plasmodium Falciparum (PF) rate of> 30%
Reported deaths due to malaria
25% of the population is tribal
Targets for 2002
Annual Blood Examination Rate (ABER) of over 10%
API <0.5%
25% reduction in morbidity and mortality due to malaria
Progress and Suggestion :
29
The progress under NAMP is given in Table I. There has not been any
substantial improvement over the last three years; utilisation of funds has been suboptimal. The Programme was reviewed by the Government of India and World Bank
in Feb.99. Progress has been slow in some interventions like introduction of
medicated mosquito net and application of GIS for planning operation. It was
recommended that Operational Research on vector control and selection of specific
agencies by NAMP are to be taken up quickly.
380
| TABLE -1 |
NATIONAL ANTI MALARIA PROGRAMME
YEAR
B.S.E.
(in Million)
POSITIVE
CASES
1996
1997
1998 *
1998 **
1999 **
91.54
89.45
86.26
49,83
47.95
3.04
2.66
2.15
0.91
0.88
A.P.KIN ABER%
P.F.
1000)
CASES
S.P.R%
S.F.R%
10.49
10.11
9.51
3.32
2.97
2.49
1.84
1.84
1.29
1.13
1.08
0.76
0.81
1.18
1.01
0.93
0.38
0.39
3.48
3.01
2.37
NO.OF
DEATHS
1010@
879
658
221
373
Provisional, **:- comparative data for 1999 with corresponding period of 1998, as per reports received from states upto 25"' Oct.. 1999.
@ Out of 1010 deaths, 926 arc confirmed and 84 suspected dealths. This does not include 1794 fever related deaths from Haryana.
______
YEAR
STH PLAN
1996-97
9TH PLAN
FINANCIAL SCENARIO
|
Rs. Lakhs
OUTLAY
EXPD./RE
42500.00
59106.55
14500.00
14366.76
1997-98
1998-99
1999- 2000
100000.00
19000.00
29700.00
25000.00
14352.00
I6393.97i
Source : Annual Report 1999-2000, Ministry of Health and Family Welfare
Kala Azar:
30.
Kala-azar is endemic in 36 districts in Bihar and 10 districts in West Bengal
(population 75 million). Periodic outbreaks of Kala-azar with high morbidity and
mortality continue to occur in these States. Over 90% of the reported cases and over
95% of the reported deaths are from Bihar. Over two- thirds of the cases in Bihar are
reported from 7 districts.
Progress and suggestions:
31.
There has been a decline in both Kala-azar cases and deaths in spite of
inadequacy of the insecticidal spray operations and poor outreach of diagnostic
services.
Year
Cases
Deaths
1996
27049
687
17429
1997
255
13342
1998 (Prov.)
217
It is important to ensure timely insecticidal spray, early detection and prompt
treatment of Kala -azar patients
Revised National Tuberculosis Programme (RNTCP)
32.
The National Tuberculosis Control Programme was initiated in 1962 as a
Centrally Sponsored Scheme. The programme was aimed at early case detection in
symptomatic patients reporting to the health system through sputum microscopy and
X-ray and effective domiciliary treatment with standard chemotherapy. The Short
381
Course Chemotherapy was initiated in 1983 and expanded in a phased manner. The
Ninth Plan envisaged:
RNTCP will be implemented in 102 districts
NTCP will be strengthened in 203 SCC districts
Strengthening of standard regime in remaining non- Short Course
Chemotherapy (SCC) districts
Strengthening of Central institutions, State TB Cells & State TB training
Institutions
Targets up to 2002
Enhance case detection to at least 70% of estimated incidence.
Achieve at least 85% cure rate among smear positive cases in 102 RNTCP
districts and 60% cure rate in SCC districts.
Reduce proportion of smear negative detected to 50% or less of the total cases.
Ensure that the number of TB suspects tested for smear positives is not less than
2.5% of OPD in Primary Health Institutions (PHI) and no. of smear tested is at least
3 per suspected patient.
Progress and Suggestion
33.
The performance under the Tuberculosis Programme is shown in Table IL
~]
TABLE - II
|
NATIONAL TUBERCULOSIS CONTROL PROGRAMME
YEAR
1997- 98
1998- 99
1999-2000
Sputum Exam.
Sputum Positive
Total New Cases
TAR.
ACH.
TAR.
ACH.
TAR.
ACH.
14189175
14189175
4823930*
4518068
3893213
472980
472980
482390
351921
321920
1277026
1277026
1309665
1249446
* :- No. of patients (3 smears/ patients)
FINANCIAL SCENARIO
YEAR
OUTLAY
EXPO.
8TH PLAN
8500.00
19442,00
1996- 97
6500.00
4180.00
9TH PLAN
45000.00
1997- 98
9000,00
3205.00
1998- 99
12500.00
721 LOO
1999- 2000
10500.00
10500.00 Expected
Source : Annual Report 1999-2000, Ministry of Health and Family Welfare
34.
Review of the RNTCP has shown that in spite of the delays in initiation of
project in the project area:
More than 25,000 health staff were trained
Uninterrupted drug supply has been ensured
382
Population of more than 120 million in 16 States/UTs covered
Half of the patients were sputum positive compared with less than one in 4 earlier.
More than 1,00,000 patients put on treatment, nearly half of them in the past 12
months.
The performance indicators including sputum conversion & cure/completion rate
are showing steady improvement.
35.
In the pilot phase, the project was being implemented by committed workers
and patients were closely monitored. As the programme expands to cover the larger
population and is implemented by the health service staff there is a need to improve
close monitoring and supervision at all levels to ensure continued good performance.
There are reports of problems faced by the patients and the staff in adhering to the
Directly Observed Treatment Short-Course (DOTS) regimen. The World Bank loan
was under suspension since May, 1998 because of procurement-related problems.
These need to be expeditiously sorted out.
National Leprosy Eradication Programme:
36.
The National Leprosy Eradication Programme (NLEP) was launched as a
100% Centre-funded programme in 1983 with the goal of arresting disease
transmission and bringing down its prevalence to 1/10000 by the year 2000. With
MDT there has been a sharp reduction in the prevalence of leprosy from 57/10000 in
1981 to 5.8/10000 inl995.
Strategies and targets for NLEP during the Ninth Plan
Intensifying case detection and MDT coverage in high prevalence States and
areas difficult to access
Strengthening laboratory services in PHC/CHC,
Establishing surveillance system for monitoring time trends
Preparing for initiating horizontal integration of leprosy programme into
primary health care system
Providing greater emphasis on disability prevention and treatment
Implementing Modified Leprosy Elimination Campaign
Ensuring rehabilitation of cured patients.
Target for Ninth Plan
□ Reduce prevalence of leprosy to 1/10000.
37.
While the endemic states of Andhra, Tamil Nadu and Maharashtra have
shown a steep decline in leprosy, the prevalence in states like Bihar-10.6, Orissa12.35, West Bengal 7.9 and M.P. 6.7 continues to be high. Earlier 50% of cases were
in Andhra Pradesh and Tamil Nadu. Now over 50% of the cases requiring treatment
are in UP, MP, Bihar and West Bengal.
383
Progress and suggestion:
Performance under NLEP in the Eighth Plan and first two years of the Ninth
38.
Plan is shown in Table III.
TABLE
in
NATIONAL LEPROSY ERADICATION PROGRAMME
CASE DETECTION CASE TREATMENT CASE DISCHARGE
ACH.
TAR.
ACH.
TARACH.
TAR.
YEAR
485644
474200
455362
218240
218240 461082
1996- 97
549975
431615
522309
323640
52441 I
323640
1997- 98
652400
714779
746486
323640
751018
323640
1998- 99
611666
286365
286365
1999-2000
FINANCIAL SCENARIO________
Rs. Lakhs
EXPD./RE
6533.00
YEAR
1996-97
OUTLAY
7400.00
9TH PLAN
30100.00
1997-98
7900.00
7828.00
1998-99
7900.00
7818.00
1999-2000
8500.00
39.
The Department has initiated steps for a phased integration of the vertical
programme in the general health services by training and reorientation of Health
Care personnel in detection, management of leprosy cases, making MDT available
at all health facilities, strengthening of disability and ulcer care, strengthening of
monitoring and supervision.
During 1997-98 the duration of treatment of MDT was reduced from 24
months to 12 months for multibacillary patients and from 12 months to 6 months for
paucibacillary patients; single dose Rifampicin, Ofloxocin and Minocycline (ROM)
treatment for single lesion patients was also introduced. 29 NGO centres were
recognized for reimbursement facility for reconstructive surgery and appropriate
footwear; 210 District Leprosy Societies were provided fund for conducting
disability/ ulcer care training.
40.
Modified Leprosy Elimination Campaign:
A Modified Leprosy Elimination Campaign aimed at detection of unidentified
cases of leprosy in the community was taken up first in Tamil Nadu in 1997 and
41.
384
then implemented during 1997-98 in Maharashtra, Orissa, Gujarat, Jammu Division
of J&K and Daman & Diu. The programme was extended to all the districts during
1998-99. During the six day campaign 4.6 lakh cases were detected and put on
treatment.
NEW CASES DETECTED BY MLEC AND PR BEFORE AND AFTER MLEC
POPULATION IN
NO. OF
NO. OF
NO. OF
PR
PR
%
______ LAKHS
SUSPECTED CONFIRMED SINGLE BEFORE AFTER INCREA
ENUMER EXAMINED
CASES
CASES
LESION MLEC
MLEC SE IN
ATED
8209.67
PR
6448.71
2858267
454290
53115
4.75
10.02
I 10.95,
42.
It is important carefully to train the health manpower in existing primary
health care system in prevention and early detection and1 management and
rehabilitation of leprosy patients. Some of the evaluation studies indicate that during
NLEC there was both over- diagnosis and under-diagnosis in some districts because
the detection was done by persons newly trained without much experience. However
this campaign provided a mechanism for involving the entire health services and had
paved the way to a progressive integration of leprosy care within the health service
infiastiucture. Careful supervision and monitoring of progress in the performance of
the programme and process of integration are essential to achieve the Ninth Plan goal.
National AIDS Control Programme (Phase-II)
43.
India has the distinction of initiating a National Searosurveillance to define
the magnitude and dimension of HIV infection in the silent phase of the HIV
epidemic long before AIDS cases were reported. Based on the data from ICMR
studies , the country drew up the National AIDS Control Programme Phase I which
has been implemented with assistance from World Bank. In spite of the numerous
shoitcomings in implementation, it is noteworthy that WFIO estimates that as of 1997
India had relatively low prevalence of HIV infection (2.6/1000) (Table IV).
385
TABLE - IV
AIDS AND HIV INFECTIONS IN SEARO COUNTRIES AS OF 1st JULY 1997
ESTIMATED HIV
INFECTIONS
COUNTRY
RATE PER 1,00,000
POPULATION*
75
<16
12
<100
2500000
<1
262
INDONESIA
95000
47
MALDIVES
60
23
MYANMAR
350000
737
22
32
1345
>258
BANGLADESH
<20,000
BHUTAN
DPR KOREA
INDIA
NEPAL
5000
6000
800000
SRI LANKA
THAILAND
>3750000
TOTAL
Source
WHO SEARO - 1997
But, because of the size of its population, India is expected within the next
decade to have nearly 10 million HIV infected people; the number of AIDS cases will
also show a steep increase. It is therefore imperative that the country gears up to
provide necessary preventive, diagnostic, curative and rehabilitative care to tackle
this problem.
44.
Progress and suggestions:
45.
National AIDS Control Programme (NACP Phase II), a Centrally Sponsored
Scheme was initiated in October 1999 and is funded by World Bank, DFID and
USAID The project has the following five components: -
•
•
•
Reducing HIV transmission among poor and marginalised section of the
community at the highest risk of infection by targeted intervention, STD control
and condom promotion;
Reducing the spread of HIV among the general population by reducing blood
borne transmission and promotion of IEC, voluntary testing and counselling;
Developing capacity for community -based, low- cost care for people living with
AIDS;
386
•
•
Strengthening implementation capacity at the National, States and Municipal
Corporation levels through the establishment of organisational arrangements and
increasing timely access to reliable information; and
Forging inter-sectoral linkages between public, private and voluntary sectors.
46.
The performance under NACP is given in Table V.
YEAR
1996-97
1997-98
1998-99
31 st May 1999
No
Screened
(000)
2816
3034
3413
3481
TABLE - V
SeroAIDS TOTAL NO.
HIV
Positivity CASES OF GOVT.
TESTING
Rate
BLOOD
FACILITIES
(per 1000)
BANKS
225
8
2528
715
154
564
19
3551
715
154
824
24
6693
715
154
85666
25
7450
715
154
SERO POSITIVE
(000)
FINANCIAL SCENARIO
__ _____________ Rs. Lakhs
YEAR
OUTLAY
EXPD./RE
STH PLAN
28000.00 27538.00,
11996-97
14100.00 11537.00
9TH PLAN
76000.00
1997-98
10000.00 12100.00
1998-99
11100.00 11100.00
1999- 2000
14000.00
47.
It is important to achieve a paradigm shift in the National AIDS Control
Programme:
From raising awareness to changing behaviour
Decentralised area-specific need assessment, planning, implementation and
monitoring of intervention programmes
• IEC strategy to reach the unreached through emphasis on inter personal
communication
• Participation of PRJ and people themselves in the AIDS prevention and
control programme
• Changing the emphasis from condom promotion to
reinforcement of
traditional ethos of mutually faithful monogamous relationships
• Improving utilisation of STD services in the governmental sector
• Emphasis on low cost strategies for prevention, counseling and care of HIV
infected persons
It is imperative to build up:
• epidemiological data on time trends in the disease,
• details of specific interventions based on epidemiological data
• mechanisms for estimating requirements, unit costs, total costs,
• process and impact indicators to monitor the progress in interventions
•
•
387
baseline figures and target to be achieved by the end of the project.
•
National Programme for Control of Blindness
Programme Priorities during Ninth Plan are :
To improve the quality of cataract surgery, clear the backlog of cataract cases
To improve quality of care by skill upgradation of eye care personnel
To improve service delivery through NGO and public sector collaboration
Increase coverage of eye care delivery among underprivileged population.
Targets for the period 1997-2002
17.5 million cataract operations; 100,000 corneal implants
Progress and suggestions:
48.
The performance under National Blindness Control Programme (NBCP) in
first two years of Ninth Plan is shown in Table VI.
TABLE-VI
Unit
NATIONAL BLINDLESS CONTROL PROGRAMME
1998-1999
1997-1998
Target
Achievement
Target
Achievement
1999-2000
Target
_______ 1______
Cataract
Operations (lakhs)
30.00
3
30.30
4
33.00
5
33.00
6
35.00
% 1OL
implantation
20.00
22.00
25.00
NA
30.00
2
FINANCIAL SCENARIO
Rs. Lakhs
YEAR
OUTLAY
EXPD./RE
STH PLAN
10000.00
19297.00
1996-97
7500.00
5858.00
9TH PLAN
44800.00
1997-98
7000.00
5834.00
1998-99
7500.00
7274.00
1999-2000
8500.00
5816.00*
*:- Finally allocated
Source : Department of Health
49.
A significant number of cataract operations are performed on unilateral
cataract blind persons and on second eye of bilaterally blind persons. To clear the
backlog of cataracts surgery has to be done at a rate of well over 400 operations per
388
100,000 population. However, only 3 states (Tamil Nadu, Andhra Pradesh and
Maharashtra) have reached that level. An analysis of service data reports indicate that
both in medical colleges and in district hospitals the cataract operations done per bed
or operation per surgery days were far below the expected levels in most of the states.
This under-utilisation of existing facilities needs to be corrected. In order to improve
the quality of services and the follow-up, the programme has shifted from the camp
approach to increased use of fixed facilities except in under- served areas.
Mid Term Evaluation:
50 .
A mid term evaluation of World Bank-assisted project carried out in 7
project states during 97-98 has revealed :
• an increase in the number of cataract operations performed in all those States.
• the performance is far less than desired level in Orissa and Rajasthan.
• Overall, 8.15 million operations (74%) have been performed against the
Project target of 11.03 million operation
51.
Revised National Blindness Control Programme (RNBCP) was drawn up for
1998-2002 to cover the entire country and will focus both on prevention of avoidable
blindness and restoration of vision in those who have been already visually disabled
irrespective of their capacity to pay. Over the years there has been a steady increase in
patients who go for Intra Ocular Lens (IOL) implantation. At a tertiary care level
where skilled surgeon and adequate post-operative care is available, use of IOL may
be preferred but extending IOL services at or below district level with no such
facility may have adverse consequences. Loss of vision after IOL implantation have
been reported from different parts of the country. There is a need to document
sequelae of IOL / Extra Capsular Cataract Extraction (ECCE) in tertiary, secondary,
district and below district level and in camps. The programme has to define long term
strategy and goals for eye care and has to provide for a close co-ordination between.
Government, voluntary and private sector eye care providers.
Integrated Non-communicable Disease Control Programme
52.
Growing numbers of aged population, urbanisation, increasing pollution,
changing lifestyles, increasing longevity, change from traditional diets, sedentary life
style and inciease in the stress of day to day living have led to an increase in lifestyle
related disorders and non-communicable diseases. It is essential that preventive,
promotive, curative and rehabilitative services for NCD are made available
throughout the country at primary, secondary and tertiary care levels so as to reduce
the morbidity and mortality associated with NCD.
Progress and suggestions:
389
•
•
•
Central sector programme provides funds for strengthening facilities for Cancer
Control, setting up distinct models for replication under national mental health
project and for pilot projects on Diabetes control.
Some states e.g. Kerala are making efforts to implement an integrated noncommunicable disease control programme at primary and secondary care level
with emphasis on prevention of Non-Communicable Disease (NCD), early diag
nosis, management and building up of a referral system.
Tertiary care centres are being strengthened to improve treatment facilities for
management of complications.
53.
An increase in NCD prevalence is anticipated over the next few decades,
which is due at least in parts to changing lifestyles. Therefore, it is imperative that
health education for primary and secondary prevention as well as early diagnosis and
prompt treatment of NCD receive the attention it deserves.
Research
54.
Indian Council for Medical Research is the nodal organisation for bio-medical
research in the country. The process for modernization of several ICMR Institutes,
upgradation of skills of scientific and technical personnel in modern biology and
epidemiology, development of linkages and networking for bio-informatics as well as
epidemiological activities has been initiated during the Ninth Plan period. These
efforts would be expanded. Steps are being taken to strengthen and develop country’s
research and development (R&D) facilities. ICMR is establishing a Microbial
Containment Complex to do studies on new as well as re-emerging infections under
maximal bio-safety conditions,
55.
Development and spread of multi-drug- resistant infections poses a threat to
controlling communicable diseases. It is planned to set up laboratory-based
monitoring network for research studies on new and re-emerging infections and
antibiotic resistance monitoring in different regions of the country. These data will be
of use for formulation of national treatment policies and prescription practices,
identifying outbreaks of resistant infections and promoting research for new drug
development. Operation Research (OR) studies for development and implementation
of site-specific disease control, RCH strategies are being initiated. Sentinel sero-and
behavioural surveillance for STDs including HIV is planned to generate data for
targeting interventions, evaluation of impact of interventions, advocacy and planning.
56.
Some of the priority areas for research in non-communicable diseases are
community based intervention programmes for control of Rheumatic fever and
Rheumatic heart diseases, OR studies for prevention and control of mild essential
hypertension and coronary heart disease at community level, assessment of unmet
treatment needs of the mentally ill in rural areas, identification, management and
prevention of occupational health hazards and health problems due to environmental
deterioration.
390
Outlay : State sector
57.
The Outlay and expenditure in first three years of the Ninth Plan are shown in
Table VII.
58.
State Governments are required to take several critical steps to improve
functional status and efficiency of the existing health care infrastructure and
manpower. These measures are:
• Restructuring of the health care infrastructure,
• Redeployment of manpower and skill development,
• Development of a referral network,
• Improvement in the health management information system, and .
• Development of disease surveillance and response at district level.
The centrally sponsored disease control programmes and the family welfare
programme provide funds for additional manpower and equipment; these have to be
appropriately utilised to fill critical gaps. The ongoing and the proposed EAPs are
additional sources for resources. Health is one of the priority sector for which funds
are provided in the central budget under the head Additional Central Assistance
(ACA) for basic minimum services. The States will also be able to utilise these funds
for meeting essential requirements for energizing urban and rural health care.
Centre
59.
Health is one of the sectors identified under the Special Action Plan. In
addition to the funds available from Domestic Budgetary Support, several centrally
sponsored disease control programmes are receiving funds from EAPs. The following
are such sponsored programmes which have received funding from the World
Bank:
•
•
•
•
•
National Leprosy Eradication Programmes
National Programme for Control of Blindness
Revised National Tuberculosis Control Programme
National Malaria Eradication Programme
National AIDS Control programme - Phase II
60.
These programmes provide diagnostics, drugs, equipment, training and
capacity building for implementation, monitoring and mid-course correction in these
disease control programmes. In addition, central sector institutions i.e. National
Institute of Biologicals and Kalavati Saran Hospital have been receiving funds for
strengthening and expansion from external agencies. Table VII provides outlay for
Health sector during first three years of the Ninth Plan.
391
Table VII
APPROVED OUTLAY AND EXPENDITURE FOR HEALTH
Eighth Plan Ninth Plan
1997-98 1997-98 1998-99 1998-99
Outlay
(B.E.) (Actual) (B.E.) (Actual)
Outlay
(1992(1997-2002)
1997)
814.34
5118.19
920.20
716.15 1 145.20
1712.00
392
19992000
(B.E.)
19992000
(R.E.)
1160.00 1010.00
Rs. in
Crores
2000-2001
(B.E.)
1300.00
GiW -
Planning Commission
Approach to the Mid-term Appraisal
of the Tenth Plan (2002-07)
The Mid-Term Appraisal (MTA) of the Tenth Plan (2002-03 to 2006-07) is due in
the current year and work on preparing it has commenced. The MTA provides an
opportunity to take stock of the economy and to introduce policy correctives and new
initiatives in critical areas in the context of the new priorities outlined in the National
Common Minimum Program. This note presents some of the issues which the Mid
Term Appraisal needs to address.
Growth Performance
2. The Tenth Plan had targeted an average annual growth rate of GDP of 8.1% for
the Tenth Plan period to be achieved by a steady acceleration in the course of the Plan
period from around 6.7% targeted in 2002-03 to 9.3% in the terminal year 2006-07.
This was expected to lay the basis for a growth rate of above 9% during the Eleventh
Plan period.
3. The MTA will consider whether the original 10th Plan growth target is still
feasible. The growth target of the first two years was about 7% on average and the
actual performance has been 4.6% in 2002-03 and 8.3% in 2003-04, averaging 6.4%
for the two years. The shortfall in the first two years appears modest but the disturbing
fact is that th& momentum for acceleration, which was essential to achieve the 8.1%,
target, has not been achieved. The current year’s GDP growth is likely to range
between 6 and 6.5 per cent of GDP so that achievement of the Plan target is only
possible if GDP growth in the last two years averages 11% per year, which is clearly
infeasible. The MTA should explore the scope for accelerating growth in the
remaining years of the Tenth Plan to achieve the target of 7-8% growth set in the
NCMP.
4. Sectorally, the Tenth Plan had targeted growth of agricultural GDP of 4% per
year, aiming to reverse the deceleration in the second half of the 1990s - from 3.2% in
the period 1980-1996 to 2.6% in the period 1996-2002. This is nowhere near being
achieved. The average agricultural GDP growth in the first two years of the Plan was
1.8% and it is unlikely to exceed 1.5% in the current year. The failure in this area is a
major factor underlying rural distress which has been visible in recent years. The
MTA will focus on corrective policies needed in this area.
5. Industrial growth in the first two years was 6.7% which was also short of
expectations. Although industrial growth has picked up in the current year, we are still
far from the rates of above 10% needed to achieve Plan targets. Failure to achieve
1
high rates of industrial growth will limit the ability of the economy to generate high
quality jobs, particularly for the educated youth.
6. One of the brightest spots in India’s economic performance in recent years has
been the emergence of knowledge-based industries as front-runners in the global
marketplace. The early successes of the software sector are being replicated in a
number of other activities such as business process outsourcing (BPO), bio
technology, pharmaceuticals, industrial design, tertiary health-care, etc. There is vast
potential in these activities but it is clear that a number of other developing countries
have also identified them as areas of focus for the future. In order to prevent an
erosion of India’s present pre-eminence from these emerging threats, the MTA will
identify the factors behind our success and to ensure that we strengthen and creatively
build upon them. The entrepreneurial dynamism and competitiveness of these sectors
indicate that there are lessons to be learnt about the policy and operating environment
that can be fruitfully applied to the less dynamic segments of Indian industry. Equally
importantly, IT should be harnessed to improve connectivity and governance in rural
areas.
Investment Strategy
7. The Tenth Plan was built around a specific set of assumptions which affected the
investment strategy of the Plan. In the base year of the Tenth Plan (2001-02), the
economy was in the middle of a cyclical slow-down, with the investment rate at
23.2% of GDP as against the peak of 26.2% achieved in 1995-96. Capacity utilisation
was low in a number of sectors, especially in manufacturing. Agricultural output, and
thereby rural incomes, had shown relatively low growth and high volatility through
the Ninth Plan period (1997-98 - 2001-02). International markets had gone into a
recessionary phase.
8. It was felt that private investment demand was unlikely to revive until the
capacity utilisation in industry increased to significantly higher levels. Revival of
rural consumption demand was expected to contribute to investment expansion, but
this would only happen over time if agricultural growth targets were met. Exports
were unlikely to provide adequate demand support due to depressed international
market conditions. Moving into a high growth trajectory from this base level situation
therefore required a sustained demand impetus from public expenditures, especially
public investment, even if it required some relaxation of fiscal discipline. There was
little danger of “crowding out”, since private investment demand was well short of the
resources available, especially if one included the potential availability of external
resources which went into a build up of reserves.
9. The strategy adopted, therefore, was to accelerate the recovery process through an
early stimulus to public investment which in turn would lead to a revival of private
investment to take the momentum forward in the later years. Since private investment
would really start to pick up only some time during 2003-04, the level of investible
resources available to the private sector would not be a major concern until then, but it
would become so in the last two years of the Plan. It was, therefore envisaged that the
2
process of fiscal correction should focus on the revenue deficit and not the fiscal
deficit, which could remain as high as 4.3% of GDP for the Centre and 2.2% for the
States even in the terminal year of the Plan. The consolidated revenue deficits,
however, would have to go down to around 2.4% of GDP by the terminal year 200607 in order to provide the requisite amount of public savings.
10. A key assumption in the Tenth Plan was that the high growth rate of 8% could be
achieved with only a relatively modest investment rate of around 28%, instead of 32%
or so suggested by traditional ICOR relationships. This was felt to be justified because
of the existence of two types of unutilised capacities:
• Those which have arisen out of the demand constraint; and
• Those which are more structural in nature and arise out of policy rigidities in
transfer and utilisation of capital assets.
It was visualized that much of the growth during the first two years of the Plan
would come from the former. In later years, policy reforms (including legal changes)
were expected to facilitate more effective use of structurally hampered capacities.
11. Infrastructure was recognized to be a critical constraint needing large investments
and it was expected that policies would be evolved which would allow a large
contribution of private investment to support expanded public investment in their area.
Investment in irrigation and watershed management was recognized to be critical for
agriculture.
12. The MTA will take stock of the progress made in utilizing productive capacities
and the success achieved on the investment front. The following points are worth
noting.
• Investment data are available only for the first year of the Plan 2002-03 and the
investment rate for that year according to the national accounts is only 23%. It
is unlikely that the investment rate in 2003-04 was much higher.
• Although growth has been slow, the low rate of investment has meant that
capacity utilisation in industry has increased across the board. While some
excess capacity remains for tapping in the immediate future, growth will now
depend on a major renewal of private investment and also public investment in
critical infrastructure.
• Inadequate progress has been made in releasing capacities which are locked up
due to structural factors. The Securitisation Act for the banking sector has been
a step forward so far. Other Tenth Plan proposals were (a) Repeal of SICA &
winding up BIFR, (b) Bankruptcy & foreclosure laws, (c) Reform of Industrial
Disputes Act, (d) Release of excess lands held by PSUs and (e) Privatisation of
sick PSUs. The MTA will consider how we should proceed in these areas.
• Data on private corporate investment are not available beyond 2002-03 but
there is some evidence that the economy is in the recovery phase of the
3
business cycle and private investment may have picked up. However, this still
appears tentative. Improvement in infrastructure is necessary to ensure that the
private investment expands robustly.
• There is an unfinished agenda as far as creating an investor-friendly climate is
concerned. The Mid-Term Appraisal should attempt to identify critical policy
constraints that may be holding back private investment including Foreign
Direct Investment. The Plan had indicated that FDI is an important instrument
for expanding private investment in the economy. FDI flows have continued,
but the perception remains that there are bottlenecks holding up FDI which
could be much larger if these are addressed. The MTA will need to make an
assessment of problems in this area.
• The SME sector has been a dynamic segment of Indian industry and has proved
its competitive ability in recent years. There is reason to believe that the
growth of this sector is hampered by the lack of a sufficiently dynamic
financial sector. More generally, the functioning of the financial system as a
whole is critical for investments to be realized. The mid-Term Appraisal should
seek to identify the reforms in the financial sector which are needed to achieve
investment targets, including tapping project appraisal capabilities of the
Industrial Development Banks.
•
Since the growth performance has been the worst in agriculture, the Tenth Plan
proposals in this area and in rural development need to be carefully reviewed
for their effectiveness. In particular, the MTA will give special emphasis to
promoting public investment in rural areas based on the possibility for
absorbing unemployed labour for asset creation.
Resources for the Plan
13. The MTA will present a candid assessment of the resources position facing both
the Centre and the States and the implications for the last two years of the Tenth Plan.
It is clear that Plan allocations have been below expectations. With the allocations
made for 2004-05, the Central Sector Plan (including PSU plan) for the first three year
will be about 44.2% of the total Plan against expectations of 54%.
14. The position in the States is likely to be even more difficult. States have not
received as much resources as were envisaged through devolution because (a) the
economy has grown more slowly than projected (b) the Centre’s ratio of tax revenue
to GDP has not increased as was projected in the Plan -the States’ performance has
also been below targets but it has been better than the Centre’s (c) the losses of the
SEBs continue to impose a very heavy burden and (d) the Pay Commission effect on
the States, though it is beginning to wear off, had left most of the States with a very
heavy debt overhang. The MTA will examine trends in States’ resources and identify
priority corrective steps.
15. The Fiscal Responsibility and Budget Management (FRBM) Act introduces
targets for the fiscal deficit which have implications for the size of Gross Budgetary
4
Support in the years ahead. Preliminary analysis in the Planning Commission suggests
that on optimistic assumptions, which include early implementation of major tax
reforms, the FRBM targets indicated to Parliament will limit the Gross Budgetary
Support to the Plan as a ratio of GDP to increase by about half of one percentage point
over the next two years. More realistic projections about the likely impact of tax
reforms suggest that if the fiscal deficit targets are insisted upon then the GBS as a
ratio of GDP may actually decline. The trade off between having a larger plan size and
risking a higher fiscal deficit will have to be explored in depth with the Finance
Ministry so that we have a realistic assessment of what can be expected by way of
Gross Budgetary Support in the next two years. The assessment in the MTA must be
coordinated with the view of the Finance Ministry which would be reflected in the
Medium Term Macro economic projection to be presented at the time of the next
budget.
16. It is clear that the resources position in the remainder of the Tenth Plan period will
be much more difficult than was envisaged at the time the Plan was formulated. The
resources constraint will be especially difficult because the NCMP has established
new priorities which require a substantial increase in allocation in critical areas such
as health, education, irrigation, watershed management, railway modernisation and
employment programmes. The Mid Term Appraisal will examine the resource
position critically and its implication for plan programmes, keeping in mind the new
priorities identified in the NCMP.
Poverty and Employment
17. There are no NSS based data on poverty for the Tenth Plan period so all
judgments have to be based on past trends. The Tenth Plan had set a target for poverty
reduction of 5 percentage points by the end of the Plan period. Econometric exercises
indicate that this is likely to be attained even if the over-all growth rate averages
around 6.5% for the Plan. However, there are three issues which need to be kept in
mind:
• The regional spread of growth has to approximate that given in the Plan.
• Average agricultural growth should not be below 3% for the period.
• Employment growth should exceed growth of the labour force to reduce the
backlog of unemployment.
18. In addition to the inadequacy of the growth in agriculture, the position regarding
employment is clearly disturbing. The economy is not generating sufficient productive
jobs to absorb the addition to the labour force especially when the rising aspirations of
the new and more educated entrants are taken into account. In the 1990s, the role of
agriculture in providing additional employment opportunities was virtually zero. The
main solutions proposed by the Plan were bringing waste and degraded lands into
production and encouraging diversification to more labour intensive crops. Neither
has progressed very much and a review needs to be made of the approach. The other
sector which holds promise for large-scale employment creation, especially for the
5
unskilled or semi-skilled, is construction. At present, the potential of this sector is
restricted by all manner of land-use restrictions and procedural hurdles and by lack of
resources to expand public investment in infrastructure. This is an area which needs
reform, especially in urban areas.
19. The proposed Employment Guarantee Scheme mentioned in the NCMP is of
obvious relevance in the context of persistent unemployment in rural areas. However,
implementation of the scheme depends critically upon whether the necessary
resources can be provided. Preliminary estimates made in the Planning Commission
place the likely cost of introducing an employment guarantee for rural areas only at
between Rs.21,000 - Rs.40,000 crores which could be shared between the Centre and
the States. The feasibility of embarking on such a commitment will have to be
examined on the basis of (i) the overall resources picture and demands of other sectors
and (ii) the feasibility of increasing the employment content of investment expenditure
especially in rural areas.
20. The most striking characteristic of the recent employment experience is the large
scale withdrawal of women from the labour force that has been reported. This gender
specific employment behaviour needs to be carefully analysed and factored into the
employment strategy of the MTA. The Tenth Plan does little to address it.
Labour Laws
21. The Tenth Plan has identified the reform of labour laws as one of the crucial
factors both for sustained industrial growth and for creating high quality employment
opportunities in the economy. The Plan document, however, does not present any
concrete proposals in this regard. The recommendations of the Second National
Labour Commission are now available, and the MTA will consider these
recommendations in the context of the current needs of the economy.
Agriculture and Rural Incomes
22. The Plan had projected a gradual acceleration of the growth rate of agriculture
from about 3% in the initial year to around 5% in the terminal year. After the first two
years of the Plan, it is evident that there is no discernible acceleration in agricultural
growth. The MTA should examine the critical policy issues in this area.
23. Irrigation and more effective water resources management are crucial for
agricultural development. The following issues need consideration:
• The Accelerated Irrigation Benefit Programme (AIBP), which was designed to
bring on-going irrigation projects to quick completion, does not appear to have
had any tangible benefit. The area under irrigation is still expanding very
slowly. The CAG has criticized the functioning of the scheme on a number of
grounds.
• Existing irrigated areas are displaying serious water-stress, as both reservoirs
and ground water sources seem to be depleting. Consequently, the agricultural
6
output from irrigated areas also seems to be more vulnerable to weather shocks
than earlier. The problem is made worse by the fact that cheap power
encourages farmers to use excessive water. While this problem is widely
acknowledged we do not have a wholesale policy framework to address the
problem effectively.
• The origin of rivers and their catchment areas continue to be neglected. More
generally, there is no effort at either restoring the natural recharge systems of
primary water sources or creating artificial recharge mechanisms.
• Watershed development has been given high priority in name for several years,
but it does not appear to be making much headway except in isolated cases. A
possible reason could be that there is insufficient technical expertise available
for this purpose. In addition, there are too many agencies of the Centre and
State governments implementing watershed schemes. This opens the possibility
of large-scale misuse. A more structured and monitorable system, with much
greater community participation, needs to be put in place. Lack of community
participation is now regarded as the principal reason why earlier efforts failed.
However, the ability to achieve effective community participation varies
enormously across states.
• Traditional water harvesting structures have become virtually defunct. Their
restoration involves not only the physical aspects of the task, but a clear
demarcation of water rights. Indeed, assignment of water rights may lie at the
heart of successfully implementing decentralized irrigation systems.
• The existing institutional structures and manpower deployment in State
Irrigation Departments were designed essentially for major and medium
irrigation projects. There is further potential for these, but much more attention
must now be paid to watershed development and micro-irrigation. The
departments may need to be completely reconstituted to provide necessary
technical expertise for such purposes.
24. Bringing wastelands and degraded lands into productive use was an important
component of the agricultural strategy. To this end, two major initiatives were
proposed - the bamboo mission and the bio-diesel programme. Although there has
been some progress in this direction, it appears that the issue of land rights is yet to be
resolved for the most part, and this is proving to be the major constraint. For both
forest and government lands, it is difficult to involve local communities unless land
ownership is given to them.
25. Revival of agricultural dynamism will also call for corrective steps to deal with
the near collapse of the extension systems in most states and the decline in agricultural
research universities. The other major problem is the lack of credit availability and
inability of the farmers to repay debt. This is due, in part, to the pervasive sickness of
the co-operative credit system and also the unwillingness or inability of the banks"to
extend direct credit.
7
26. Agricultural diversification has to be a major element in the strategy for
accelerating agricultural growth and this calls for action on several fronts. Ideally,
there should be a shift of land from cereals to non-cereals (increasing both farm
incomes and employment) combined with an increase in productivity in cereals to
ensure that per capita availability of cereals does not decline. Diversification is
unlikely to be a feasible strategy all over the country but it could hold great promise in
some areas. The shift from cereals to horticultural crops requires a supportive policy
framework in other respects, notably a much greater focus on (a) marketing
arrangements, including encouragement of private sector involvement in marketing,
(b) encouragement of downstream food processing and (c) research linked to market
requirements for diversifying into horticulture.
4
27. The Tenth Plan had identified the Essential Commodities Act (ECA) as a major
impediment to the development of modern markets and suggested that it should be
replaced by a suitable provision which could deal with emergency situations without
hampering normal market activity. It had also recommended that the Agricultural
Produce Marketing Acts in the states restrict the growth of agricultural marketing and
are not conducive to development of horticulture, and should be replaced by a new
model legislation which would allow co-operatives and private parties to set up
modem markets. A number of items have been taken off the ECA, but the relatively
rigid rules framed under the Act by various States continue for the most part. The
NCMP states that the Essential Commodities Act will not be diluted, but it is
necessary to examine this issue in depth so that changes which are necessary in the
interest of accelerating growth of farm incomes can be made. A model Agricultural
Produce Marketing Act has been drafted and circulated to the States, but there is little
movement towards its adoption. There has also been no progress in rationalizing the
multiple food safety laws, which hamper the development of a modem food
processing industry. The Mid-Term Appraisal should address these issues to evolve a
workable set of policy initiatives in this area.
28. Non-farming rural activities have seen a secular decline in recent years. To some
extent this may be related to the slow down in agriculture, but there does not appear to
be any strategic approach to this issue in terms of policies and programmes. The Plan
itself has little to say about this, other than the initiatives taken on Self-Help Groups
(SHGs). Much greater focus is clearly necessary on agro-processing and rural
services.
29. It is evident that the agriculture sector thus far has not demonstrated the
resurgence of growth that was expected in the 10th Plan. The MTA will focus on
corrective steps that can be taken in order to improve delivery and achieve the best
possible growth performance in the second half of the Plan period.
Food Security and Nutrition
30. Over the years, a number of programmes have come into existence for providing
food and nutritional support, especially for the poor. At present, from the Centre, the
schemes which provide food support are: (a) Targeted Public Distribution System
8
(TPDS); (b) Antyodaya Anna Yojana; (c) Mid-day Meal Scheme; (d) Integrated Child
Development Scheme (ICDS); and (e) Food for Work Scheme. In addition, some
States have their own schemes for similar purposes. These schemes have increased in
recent years as a result of a perceived worsening of the nutritional problem. However,
there has been no stock-taking of the over-lap between these various schemes in terms
of the target groups. The MTA needs to reflect on this and to rationalize the over-all
food and nutritional interventions being made by government. The issue of adequacy
of nutrition needs to incorporate the fact that certain vulnerable groups require
interventions that go beyond the calorie-protein norms currently sought to be met
through food grains alone.
31. The price support and procurement systems, combined with input subsidies on
fertilizer, electric power and canal water have been the main pillars of domestic
support for agriculture. However, they have led to a sharp increase in subsidy based
support while public investment in agriculture has suffered. The outcome is
distributionally inequitable since the subsidies typically go to the richer farmers in
areas of assured irrigation, while the lack of public investment hurts poorer farmers
and those in arid regions. The MTA will consider how the systems can be changed
gradually in a manner which does not affect food security.
Social Development
32. A basic shift in priorities signalled by the NCMP was the need to give greater
importance to social sector expenditures as part of the effort to promote development
with social justice, in particular for the Scheduled Castes and Scheduled Tribes. The
Tenth Plan specifies monitorable targets for certain indicators of social development
in health, education and gender equality. These targets are not identical to the
Millennium Development Goals (MDGs) but it is believed that if these targets are
met, then the other MDGs are also likely to be achieved. It is a matter of deep
concern that at the current pace of progress, it appears unlikely that many of these
targets will be met. The MTA will focus on how this failing can be corrected.
33. The targets regarding education required that 100% enrolment in primary schools
be achieved by 2003 and 100% retention be achieved immediately thereafter. The
slow pace of roll-out of Sarva Shiksha Abhiyan (SSA) has led to a situation that the
100% enrolment target is unlikely to be achieved even by 2005. There are a number
of issues that need to be addressed in this context:
• The fiscal implications of SSA, especially for State finances, does not seem to
have been factored in adequately. Unless this is done, and either the Twelfth
Finance Commission or the Planning Commission provides adequate support,'
the programme is likely to run into financial constraints rapidly.
•
Since elementary education has been declared a Fundamental Right, there is
always the possibility of the Courts intervening, which could prove disruptive.
In order to forestall such a possibility, it is necessary to clearly lay down the
9
roll-out plan and to adhere to it strictly. This will require close coordination
between the Centre and the States.
• An important instrument for improving retention in schools is the Mid-day
Meal scheme. This scheme has worked well in some states but its operation has
not been satisfactory in a number of States. At the moment, however, the
MMS is operating under Supreme Court direction as a component of the right
to food, and the Centre has been charged with providing adequate financial
support.
• The Tenth Plan had pointed out that if the SSA succeeded, it would place
heavy demands on the secondary school system, which may become difficult to
meet unless steps are initiated right away. This concern remains valid even
though the progress of SSA has been slower than planned.
34. Inadequate progress on the health and family welfare front is a matter of grave
concern. Unless prompt and decisive steps are taken, the Plan targets on IMR and
MMR will not be met and the MDG targets too will almost certainly be missed.
Unlike the case of primary education, where a well-designed intervention in the form
of SSA exists, there is no real blue-print for the development of the primary health
sector. There is need to initiate a fresh approach in this area that can be initiated
within the Tenth Plan period even if it can be fully operationalized only in the
Eleventh Plan period. In addition, it may be necessary to identify more limited
interventions within the existing health framework e.g. focusing on the EAG states
identified for family welfare purposes.
35. Concerns about gender equity are reflected in the monitorable targets of the Plan,
but little appears to have been done about empowering women so that these intentions
are backed up by gender-sensitive institutional structures. More generally, inadequate
attention has been paid to finding ways of mainstreaming gender concerns in our
policies and programmes. This is an issue which needs careful consideration while
designing intervention strategies.
36. Social justice and empowerment of backward classes by and large continues to be
followed as a set of special programmes rather than as an integrated strategy. The
Plan needs to be re-examined from this perspective.
Infrastructure
37. Infrastructure was identified as a critical area for the Tenth Plan in recognition of
the fact that the quality of infrastructure in India is far below the level required to
achieve 8% GDP growth. The Government has also underscored the importance of
these sectors and this is reflected in the establishment of a Committee on
Infrastructure headed by the Prime Minister. The MTA will make an assessment of the
position in each major infrastructure sector, including in particular the scope for
increasing capacities through a combination of enhanced public investment and also
attracting private investment where feasible. The Planning Commission will undertake
a review of the regulatory structure in these sectors to identify critical initiatives
10
needed to bring the existing structure in line with international best practice. This is
essential if public-private partnership is to become a reality.
38. The National Highway Development Programme (NHDP) appears to have gained
considerable momentum and the Mid-Term Appraisal will seek to document progress
•"
and alS° ldentify bottlenecks if any. Fortunately, the projects in pipe-line
in NHDP are sufficient for the next few years and the funding is more or less tied-up.
39’Jj6 f1?™1 r°adS Pro§ramme does not appear to have developed the momentum
needed although the potential backward and forward linkages of this are at least as
great as for the NHDP. One of the reasons for this is that the rural roads programme
is entirely dependent upon the flow of budgetary support without any effort at
leveraging the cess funds through borrowing as has been done for the NHDP. The
position with regard to State highways and district roads is even worse, and there is no
programme to ensure that these too come up to the standards necessary for a high
quality road network in the country. The MTA needs to examine this issue.
40. As far as the Railways are concerned, there has been practically no movement in
terms of implementing many of the key recommendations of the Plan. Since the
efficiency of the Railways is a key element in improving the efficiency of the Indian
economy the MTA should focus on what is needed to achieve the objective of
modernising the Railway system.
41 The development of port infrastructure appears broadly satisfactory, but the
collateral measures needed to increase water-borne transport, whether coastal or
riverine, do not appear to have progressed.
?2’
?r aS airp°rtS are concerned’ the Plan did not address the issue substantively
but the Naresh Chandra Committee Report did so subsequently. Efforts are underway
to modernise Mumbai and Delhi Airport through private public partnership. The MTA
will assess the status of these initiatives.
43. The telecommunication sector is a major success story with an impressive
increase in both capacity and service levels. However there are some issues which
deserve focused attention. One of these is broad-band connectivity which is critical for
evelopment of Internet and also for spreading the benefits of e-Govemance in rural
areas. The MTA will present an assessment of priority action needed in this area.
44. Electric Power is clearly the area which remains perhaps the single largest cause
oi concern to the economy. Progress in this area has clearly been disappointing. This
sector suffered from serious under-investment in the Ninth Plan period 1997-98 to
2001-02 and this was to be corrected in the Tenth Plan through much larger
investment m both the public and private sectors. The MTA will review progress in
these areas but it is evident that there are large gaps. Although there have been a
number of experiments in SEE reform, none of them has yet established a viable
model. Populism by state governments continues to be an impediment to following a
rational electrification strategy. The enactment of the Electricity Act 2003 does have
the potential to bring about dramatic changes, but this can only happen if the States
11
take collateral steps. The operation of the SERCs in the various states also needs to be
greatly improved. All these issues would have to be a major focus of the MTA.
45. Another area of concern is urban infrastructure. The demographics of urban India
are changing and needs of towns and cities of different sizes are very different. There
is at present no programme which addresses these issues in a long-term sense and in a
case-sensitive manner. Urban renewal in its widest form must become an important
component of the Plan. This would include mass rapid transport systems, drinking
water and sewage systems, solid waste management, urban roads and lighting, etc.
Much of this, however, may not be possible without a thorough overhaul of municipal
functioning. Not enough thought has been given to this issue, and it may be desirable
for the MTA to conceptualise a workable municipal model.
Environment
46. The Tenth Plan target on forest and tree cover is critically dependent upon the
greening of waste and degraded lands, which is also an important component of the
employment and livelihood strategy. As has already been mentioned, there is
inadequate progress on this, mainly because of jurisdictional and procedural
complications. Another issue which needs to be considered is that a number of States
have been representing that an unfair burden is being borne by them in preserving
their forest areas, and that compensatory mechanisms need to be developed.
47. The revival of water bodies has been mentioned earlier, but the cleaning of rivers
is an imperative of its own. This would have to be integrated with both agricultural
practices and waste water management in urban and industrial areas.
48. At a more general level, global climate change is an issue that has not been taken
into account in the planning framework. The Tenth Plan does have a chapter on
Disaster Management, but it may be necessary to go beyond the issues raised there.
Regional Balance
49. The Tenth Plan clearly recognizes that growing regional disparities across an
array of indicators has led to a situation where national targets need to be broken
down to regional targets for any meaningful intervention. The issue of regional
balance has also been highlighted in the NCMP which mentions a Backward Areas
Grant Fund.
50. The MTA will examine recent experience in this area including the effectiveness
of specific initiatives deployed to counter regional disparity and regional
backwardness.
International Developments
51. The Indian economy today is much more sensitive to international developments
than before, and this needs to be reflected in the MTA. The need for external markets
for agricultural goods, the international energy scenario, availability and volatility of
12
external capital, etc are clearly issues that affect the pace of development. The MTA
will consider whether developments in these areas call for specific responses to better
manage the process of globalisation. The MTA will also consider the implications of
recent developments in the WTO and the role of Free Trade Arrangements.
Governance
52. Governance forms the key element of the Tenth Plan, but there has been
practically no movement on this front. The NDC had set up three empowered sub
committees on (a) Governance, including e-Govemance; (b) Creating an investor
friendly environment; and (c) Empowerment of PRIs, which were expected to draw up
blue-prints for governance reforms. There is nothing available from these sub
committees at present, except for a national plan for e-Govemance, which has the in
principle approval of the previous Prime Minister. The MTA needs to reiterate this
issue forcefully, and perhaps even provide some operational guidelines for carrying
out administrative and judicial reforms.
Panchayati Raj Institutions (PRIs)
53. The Tenth Plan has laid great stress on the role of Panchayati Raj Institutions
(PRIs), not only as the cutting edge of democratic decentralization but also for
improving the efficiency and accountability of the delivery systems for a number of
publicly provided services. In view of the importance of this approach, the NDC had
constituted an Empowered Sub-committee of the NDC for the Empowerment of PRIs.
Although the report of this Empowered Sub-committee is not available as yet, the
MTA may have to outline some steps which can be taken early, subject of course to
the views of the NDC. In particular, the initiatives that are being proposed in the areas
of primary education, nutrition and food security, watershed development and
employment guarantee cannot be successful without the active participation of PRIs at
the appropriate levels. Conversely, well financed and well directed thrusts putting
these areas firmly within PRI jurisdiction may accelerate PRI empowerment.
54. The Planning Commission will consider these and other issues in preparing a
Mid-Term Appraisal which will be completed by the end of the year and submitted to
the NDC sometime early next year. In preparing the Mid-Term Appraisal the
Commission will consult Central Ministries and State Governments and also consult
extensively with experts and representatives of the non-government sector. To
facilitate such consultations, 19 Consultative Groups have been constituted in
different areas. These will be chaired by the Members concerned and Minister of State
for Planning and will serve to provide inputs into the process of preparing the MTA.
* * *
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Position: 1725 (3 views)