Swasth hind, Vol. 27, No.10, October 1983.pdf

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swasth
hind
October 1983

°Family welfare—an essential input for
development
°Planning health for all by 2000 AD

°Deteriorating global environment

°Housing and environmental planning
°lntegrated effort in malaria control

°Open heart surgery in infancy and early
childhood

swasth

Page No.

IN THIS ISSUE
HEALTH PLANNING

237

Family Welfare—an essential input
for development

B. Shankaranand
Planning Health for all by 2000 AD

241

Dr N. K. Sinha
ENVIRONMENT
Asvina-Kartika

October 1983

Saka 1905

Vol. XXVII No. 10

Deteriorating global environment

246

Dr Arthur Westing

OBJECTIVES

S. V. Joshi

Swasth Hind (Healthy India) is a monthly journal
published by the Central Health Education Bureau,
Directorate General of Health Services, Ministry of.
Health and Family Welfare, Government of India,
New Delhi. Some of its important objectives and aims
are to :

Integrated effort in malaria control

REPORT and interpret the policies, plans, pro­
grammes and achievements of the Union Ministry of
Health and Family Welfare.

Schistosomiasis—an environmental
disease

ACT as a medium of exchange of information on
health activities of the Central and State Health
Organizations.

FOCUS attention on the major public health
problems in India and to report on the latest trends
in public health.

KEEP in touch with health and welfare workers and
agencies in India and abroad.
REPORT on important seminars, conferences, dis­
cussions, etc., on health topics.

Assll. Editor

D. N. Tssar

Sub-Editor

:

M. S. Dhillon

G. B. L. Srivastava

252

Nedd Willard
Measures to control environmental
noise pollution

255

K. R. Swadeshi
256

Kunwar Jalees
RESEARCH
Open heart surgery in infancy and
early childhood

257

Dr M. R. Girinath

ON LEPROSY
New approaches in leprosy control

BOOKS

Single Copy

258

HI
cover

•

.

Annual Subscription

Sr. Sub-Editor

248

Housing and environmental planning

.25 Paise (SO-25)

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Rs.3-00 (S2-50)

(Postage Free)
Articles on health topics are invited for publication in this
Journal.
State Health Directorates are requested to send reports of
their activities for publication.

Editorial and Business Offices

The contents of this Journal are freely reproducible. Due
acknowledgement is requested.

Central Health Education Bureau

The opinions expressed by the contributors are not necessarily
those of the Government of India.

Kotla Marg, New Delhi-110 002.

SWASTH HIND reserves the right to edit the articles sent
for publication.

HEALTH PLANNING
CENTRAL COUNCILS OF HEALTH & FAMILY WELFARE CONFERENCE

FAMILY WELFARE

an essential input for development
B. Shankaranand
The Ninth Joint Conference of the Central Councils of
Health and Family Welfare was held from 7 to 9 July,
1983, in New Delhi. The objective was to have an over­
view of the situation in the national context and for­
mulate guidelines and strategies on the basis of col­
lective experience, which would help us achieve a
much better implementation of programmes during
the current year. Shri B. Shankaranand, Union Minis­
ter of Health and Family Welfare delivered the inau­
gural address. He said that the Sixth Five Year Plan
took due note of the Co-relationship between Socio­
economic factors and success of population stabiliza­
tion measures. “The revised 20-point programme,
which is a bold attempt to translate into reality these
population concepts, accords a crucial role to health
and family welfare”, he added.

Earlier in her welcome address, Smt. Mohsina Kid­
wai, Union Minister of State for Health and Family
Welfare, said that the role of mass media in health
and family welfare education cannot be over-empha­
sized. More and more programmes should be designa­
ted, produced and presented over Radio and Doordarshan. she added. The conference made a number of
recommendations. These recommendations pertain to:
family welfare programme including maternal and child
health: primary health care including minimum needs
programme: acceleration of health care facilities for
Scheduled Castes/Tribes: school health: control of
leprosy: tuberculosis: blindness: National Malaria
Eradication programme; health education: medical
education and indigenous systems of medicine. We
publish here the extracts of the inaugural address by
Shri B. Shankaranand, Union Minister of Health and
Family Welfare.

October 1983

he ninth Joint Conference of the Central Council
for Health and the Central Family Welfare Coun­
cil is the culmination of a series of regional level
meetings which were held recently in various parts of
the country. It has indeed been a very fruitful ex­
ercise in taking stock of the progress made and
problems
encountered in the implementation
of
health and family welfare programmes in individual
States and Union Territories.

T

Before proceeding further, I would like to share
with you the sense of pride at the international recog­
nition of India’s efforts in tackling the vexatious
population problems. This year, our Prime Minister,
Smt. Indira Gandhi was chosen for. the United Na­
tions Population Award for the first time after its
institution by the United Nations General Assembly.
The note released at the U.N. Headquarters said:
“Mrs. Gandhi’s leadership in creating awareness and
understanding of population issue, specially at the
individual and the community levels, has been of
crucial importance to the success of India’s popula­
tion programme. She has both governmental and
non-governmental bodies to promote family planning
with confidence and dedication. She has consistently
attempted to make the family planning programme
the people’s movement, as a result, the programme
out-reach has been extended”. While congratulating
our Prime Minister in this august forum, I would
like to assure that under her inspiring leadership,
we shall continue our efforts with renewed vigour
and dedication in solving the most challenging pro­
blem of population growth and thereby accelerating
the pace of development in the country.
Essential input for development

It is important to emphasise the fact that develop­
ment and acceptance of the small family norm inter­
act with each other in a mutually beneficial way.
Development by itself provides a strong motivation
for parents to have fewer children. However, a deve­
loping nation with a high birth rate like ours, cannot

237

afford to wait for development alone to bring about
a change in the attitudes of people to limit the size
of their families, as the process of development itself
is stifled by unchecked population growth. Family
Planning is. thus, an essential input for the develop­
ment process making it an integral part of the total
national effort for providing a better life to the people
and to reduce inequalities among them. Alongwith
family planning there is also the obvious need for
increasing investment on human resource develop­
ment in the field of education, health, maternal and
child health care, water supply and environmental
sanitation.
The Sixth Five Year Plan takes due
note of this co-relationship between socio-economic
factors and success of population stabilisation mea­
sures. The revised 20-Point Programme which is a
bold attempt to translate into reality these policy
concepts, accords a crucial role to health and family
welfare.
Achievements

Family Welfare Programme showed significant im­
provement during the year 1982-83. Nearly 40 lakh
sterilizations were performed, which represented 42.6
per cent increase over the 1981-82 performance. The
performance in regard to IUD was about 11 lakhs
which is 43.2 per cent higher than that of the preced­
ing year. This is a record achievement'under IUD
since the inception of the Family Welfare Programme
over two decades back. As regards the use of con­
ventional contraceptives the trend was similarly en­
couraging. The sale of Nirodh under the commer­
cial scheme registered a positive increase over the
last year. The steady improvement in performance
during the last three years is reflected- in the couple
protection levels which had fallen from 23.7 per cent
during 1976-77 to 22.3 per cent in 1979-80, but in­
creased to 22.7 in 1980-81 and further to 23.7 in
1981-82. ft is estimated that the couple protection
should have gone upto 26 per cent by 31st March,
1983.
It is satisfying to note that almost all the States
and Union Territories did well in 1982-83. While
Punjab. Maharashtra, Himachal Pradesh, Haryana,
Sikkim, Delhi, Arunachal Pradesh,
Pondicherry,
Chandigarh, Mizoram and Dadar & Nagar Haveli
exceeded their targets in sterilisation set for the year,
achievements of some other States like Tamil Nadu.
Gujarat and Andhra Pradesh were above the national
average. Although short of its target, U.P. showed
a very encouraging trend by registering 171 per cent
increase over the preceding year’s achievement.

238

With over 80 per cent realization of their annual tar­
gets, Madhya Pradesh and Bihar also did compara­
tively better.
Tn IUD insertions, a number of States
and U.Ts. like Punjab. Sikkim. Haryana, Himachal
Pradesh, Maharashtra, Manipur, U.P., Gujarat,
Chandigarh, Pondicherry, Delhi and Mizoram did
quite well. Tn C.C. Users while Haryana, Maharash­
tra, Punjab, Himachal Pradesh and Dadar & Nagar
Haveli exceeded their targets, U.P. and Orissa and
Chandigarh also came close to realising their targets.
While congratulating the better performing States and
U.Ts. for their achievements during the last year, I
would expect of them a much better performance
during the current year. At the same time, I would
urge those States and U.Ts. which could not reach
upto the expected level of performance last year to
redouble their efforts to achieve their targets for the
current year. All of us have to put in much more
vigorous efforts during this year to realise the en­
hanced targets of 5.9 million sterilizations, 2.5 million
IUD insertions and 9 million equivalent C.C. and oral
pill users.
Long term goals

The long term goals before us are to bring about
rapid decline in birth, death and infant mortality
rates to 21. 9 and 60 per thousand respectively by
the turn of the century. This calls for an increase in
the eligible couple protection level to about 60 per
cent from today’s level of nearly 26 per cent. This
task, no doubt, is stupendous yet we have got to
accomplish it if we do not want to condemn our child­
ren and grand-children to a nightmarish future. This
calls for creating an all-pervading atmosphere wherein
the small family concept and its practice gets woven
into the very life-style of the people.
While we feel greatly encouraged by the trend of
the Family Planning Programme, which indicates that
the programme has picked up momentum, it is equally
essential to ensure that in our enthusiasm to achieve
the targets, the quality of the performance is not
diluted.
Population education

The high rate of infant mortality in our country has
been causing concern to all of us. The main causes
of infant mortality are prematurity, respiratory infec­
tions. diarrhoea and digestive disorders, tetanus, mal­
nutrition. fever, convulsions and other causes peculiar
to infancy including asphyxia and birth injuries. Our
objectives is to promote family planning on voluntary
basis by bringing about an informed change in indi­

Swasth Hind

vidual and social perceptions and behaviour.
We
have got to have a very effective communication stra­
tegy.
Simultaneously, we have to make a major thrust
towards population education through formal and
non-formal channels. Population education primarily
aims al conveying basic facts and information per­
taining to population and its trends, its growth and
regulation, and its strong influence on the nation's
development programmes and on the life of the indi­
vidual and his family.
Operational efficiency

Appreciating the need for mobility in the delivery
of services, a large fleet of vehicles was provided at
various levels at different times. The Government of
India has decided to replace 1500 such vehicles under
the Family Welfare Programme by the end of the
current Plan period.
The Central Government has also made an upward
revision in the ceiling of funds for POL including pro­
visions for maintenance and repair of vehicles.
It has been . raised from Rs. 8,000 to Rs. 12,000
per vehicle per annum in respect of F.W. vehicles and
from Rs. 3,300 to Rs. 8,000 for other vehicles. With
the removal of these two major bottlenecks in mobility,
it should now be possible to achieve a very high level
of operational efficiency.
Maternal and child health

In spile of India’s spectacular success in sharp de­
cline in the overall death rate, its infant mortality rate
continues to be quite high. Low infant mortality pro­
vides its own rationale for limitation of family size.
If couples are assured that the children who are born
have a reasonable chance of survival, they will them­
selves avoid having too many children.
Recently,
there has been a big expansion in our programmes to
protect pregnant ’mothers and children from diseases
and nutritional anaemia. May I request the States
and U.Ts. to give special attention to this aspect which
has a direct impact on the family planning pro­
grammes as a whole?
Population Advisory Council

Ever since the Prime Minister gave a call to make
family planning a people’s movement, we have taken

October 1983

While we feel greatly encotnaged by the
trend of the family planning programme,
which indicates that the programme has
picked up momentum, it is equally essential
to ensure that in our enthusiasm? to achieve
the targets, the quality of the performance is
not diluted.
vigorous steps for a much wider and deeper involve­
ment of opinion—leaders, social workers and all those
who arc in a position to influence the thinking of the
people. The constitution in 1982 of a 20-Member
Population Advisory Council to analyse the implemen­
tation of the family welfare programme and to
advise the Government on policy matters is a big
step in this direction. The Population Advisory
Council has set up five working groups to discuss
and suggest innovations to the various aspects of
the Programme. The initiative taken by the Indian
Association of Parliamentarians on problems of popu­
lation and Development by holding State Level Con­
ferences after its successful national level conference
in 1981, has. assured in good measure the involvement
of the elected representatives of the people.

The increase in the amount of compensation from
Rs. 70 to Rs. 100 a scheme of giving cash awards to
the best performing States and U.Ts. and the scheme
of issuing “Green Cards” to the acceptors of terminal
methods of family planning give a new dimension to
our efforts.
National Health Policy

The Government of India has evolved a National
Health Policy which has been placed before the Par­
liament. The Policy lays stress on the preventive, pro­
motive, and rehabilitative aspects of health care, and
points to the need of establishing comprehensive pri­
mary health care services to reach the population in
the remotest areas, the need to view health and human
development as a vital component of overall inte­
grated national socio-economic development, decen­
tralize system of health care delivery with the maxi­
mum community and individual participation and selfreliance. The Policy also lays stress on ensuring ade­
quate nutrition, safe drinking water supply and im­

239

proved sanitation for all. The Policy sets out specific
goals to be achieved by 1985, 1990, 1995 and 2000
A.D.
Control of major diseases

Control and conquest of major diseases which en­
danger the health and life of the people, is an im­
portant plank of our strategy for advancement of the
quality of human life. We have intensified our efforts
to tackle diseases like malaria, leprosy, tuberculosis
and blindness. It is a matter of some satisfaction that
as a result of vigorous action under the National Ma­
laria Eradication Programme and continuous liaison
with the State authorities it has been possible to gra­
dually bring down the mortality on account of malaria
in general and of p. falciparum type of malaria in
particular.
Leprosy eradication

The incidence of leprosy is not uniform all over the
country. There are 97 districts in the country where
the incidence rate is more than 10 per thousand popu­
lation. The Prime Minister has given a call for era­
dication of leprosy on a time-bound basis. As a first
step in this direction, the leprosy control programme
has been renamed as National Leprosy Eradication
Programme and converted into a 100 per cent cen­
trally financed programme and financial provisions
have also been considerably stepped up. A National
Leprosy Eradication Commission and National Le­
prosy Eradication Board have also been constituted
for effective implementation of the policies evolved
by the Commission.
A new multi-drug regimen strategy for interruption
of transmission of leprosy in hyper-endemic districts
has since been launched.

undoubtedly given a boost to its implementation. I
am happy that the target of 10 lakh new case detec­
tion fixed for 1982-83 was exceeded. In view of this
achievement the target of the current year has been
increased by 25 per cent and I am sure this too will
be realised.
Medical research

In the field of medical research we have to define
our research priorities to coincide with national health
priorities and develop the research strategy and plan
of action. Considering the fact that there is uneven­
ness in the geographical distribution of scientific and
research capability of biomedical sciences and the fact
that there are large tracts in the country with major
health problems which are not being serviced by signi­
ficant regional research facilities, the Indian Council
of Medical Research (ICMR) is implementing a stra­
tegy of setting up Regional Medical Research Centres
in the country. The ICMR is actively pursuing re­
searches for the control of communicable diseases,
fertility control, promotion of maternal and child
health and control of nutritional and major metabolic
disorders.
Indian Systems of Medicine

It is our policy to encourage and support all systems

of medicines for ensuring better health to our people.
As such a number of measures were taken to promote

Indian Systems of Medicines, viz., Ayurveda, Siddha,

Unani, Nature Cure and Yoga and also Homoeopathy.
The Sixth Plan provides for sufficient financial sup­
port for the development of Indian Systems of Medi­
cines and Homoeopathy and the various schemes in­

Control of blindness

cluded in it aim at improving the quality of education,

The National Programme for Control of Blindness
envisages the development of various services at the
peripheral, intermediate and central levels. I would
request State and U.T. Governments to pay urgent
attention to achieve their targets this year for the Na­
tional Control of Blindness Programme.

promotion of research programme based primarily on

T.B. control

The inclusion of the National T.B. Control Pro­
gramme in Governments’ 20-Point programme has

240

their respective philosophy,

planned production of
herbal and other medicines on a large scale and their
standardization.

Primarily rural

based programme,

these systems of medicines are rendering a great ser­

vice to narrow the gap existing in medical care bet­

ween the rural and urban sectors. We intend to
harness these systems fully for achieving the target
of ‘Health for AU by 2000 A.D.’.

A

Swasth Hind

PLANNING HEALTH FOR ALL BY 2000 AD
Dr N. K. Sinha
T is well recognized that an investment on health
is investment on human resources development and
on improving the quality of life. To improve the quality
of life horizontal and vertical linkages have to be es­
tablished among all the inter-related programmes like
protected water supply, environmental sanitation,
housing, nutrition, education, family planning and
maternity and child welfare. An attack on the pro­
blem of disease cannot be entirely successful unless
it is accompanied by an attack on poverty which is
the main cause of the ill health. For this the Gov­
ernment of India assigns high prority in the Sixth
Plan (1980-85) to the programme of promotion of
gainful employment, eradication of poverty, popula­
tion control and meeting the basic needs as integral
components of the Human Resources Development
Programme.

I

Some of the main objectives of the Sixth Plan are:

The health status of India has improved
considerably during the last. 30 years.
Even though there is a gap between the
health service facilities available in the
country and the need for the same both
in urban and rural areas, still we aim at
attaining the historic goal, “Health for
all by 2000 AD". This is a social goal
of providing an acceptable level of health
which will permit all the citizens to lead
a socially and economically productive
life.

(i) A significant step up in the rate of growth
of economy, the promotion of efficiency in
use of resources and improved productivity;

(ii) A progressive reduction of
employment;

poverty and un­

(iii) Improving the quality of life of the people
in general with special reference to the eco­
nomically and socially handicapped popula­
tion, through minimum needs programme
whose coverage is so designed as to ensure
that all parts of the country attain within a
prescribed period nationally accepted stan­
dards;
(iv) Promoting policies for controlling the growth
of population through voluntary acceptance
of the small family norms; and
(v) Promoting the active involvement of all sec­
tions of the people in the process of develop­
ment through appropriate education, com­
munication and institutional strategies.

October 1983

Primary health care is the main instrument through
which it will be possible to achieve “Health For All
By 2000 AD”. As per WHO. the primary health
care includes at least the following eight elements:
(i) Promotion of food supply and proper nutri­
tion;

(ii) An adequate supply of safe drinking
and basic sanitation;

water

(iii) Education concerning prevailing health pro­
blems and the methods of preventing and con­
trolling them;

(iv) Maternal and child care including family plan­
ning;

(v) Immunization against major infectious diseases;
(vi) Prevention and control of locally endemic di­
seases;

241

(vii) Appropriate treatment of common diseases and
injuries;

(viii) Provision of essential drugs.

Alongwith the objective of “Health For All By 2000
AD”, the objective of population stabilization by re­
ducing the birth rate, death rate and infant mortality
rate to 21, 9 and below 60 respectively will have to
be achieved by the end of the century. Regarding the
health care (i) emphasis should be shifted from the
city to the rural areas and the health care system
would be based on a combination of preventive, pro­
motive and curative health services starting from the
village as a base; (ii) Primary Health Centres and Sub­
centres which are at present serving a population of
approximately 0.1 million and eight thousand respec­
tively will be increased so that each Primary Health
Centre serves a population of 30,000 and a sub-centre
a population of 5,000. Tn case of hilly and tribal areas
each primary health centre will be established for a
population of 20,000 and a sub-centre for a population
of 3,000 respectively; (iii) the village or a population of
1.000 would form the base unit where there will be a
trained Village Health Guide as a first link between
the population and the health infrastructure; (iv) facili­
ties for treatment in basic specialities will be provided
at the Community Health Centre at the block level for
a population of about 0.1 million. A 30-bedded hos­
pital with four specialists will be attached to the Centre
and a system of referral link will be established from
the village level to the district hospital/medical college
hospitals through the community health centres; (v) the
people would be involved in tackling their health pro­

blems and community participation in the health pro­
grammes would be encouraged by forming village
health committee.
The present rural health infrastructure and as ex­
pected to be by 2000 AD are given in Statement 1:
Statement 1

Rural Health Infrastructure

In
Likely to Require­
position
be in
ment and
as on
position
expected
1-4-1980 by
to be
31-3-85
achieved
by
2000 AD

Institution Personnel

1. Village Health
Guides

0.14
million

2. Sub-cent res
3. Primary Health Centres
4. Upgraded PHCs (to be
named as community
health centres) .

48,960
5,500

(Unit Nos.)
To be
covered
all the
village
(7,38,000
VHGS)
1,60,800
90,000
6,000
22,470

0.34
million

218

315

5,500

The amount of positive contribution that health
sector can make for the development of other sectors
like agriculture, industry, etc., should be appreciated.
Keeping in view the present health status of the coun­
try, pragmatic planning has been made as per the
policy, strategies and objectives stated earlier. Plan­
wise outlays of Health Sector and percentage of the
total outlays is given in Statement 2:

Statement 2

Plan outlay

(Rs. in Millon)
Expenditure incurred on

Plan period

1.
2.
3.
4.
5.
6.
7.
8.
9.

First Plan (1951-56)
.
•
•
• . •
Second Plan (1956-61).....................................
Third Plan (1961-66).....................................
Annual Plans (1966-69) .
•
•
•
•
Fourth Plan (1969-74) .
•
•
•
Fifth Plan (1974-78)
.
Annual Plan (1978-79) (anticipated expenditure)
Annual Plan (1979-80 outlay)
Sixth Plan
.
•
•

242

Percentage of expendi­
ture of

Overall
Public
Sector

Social
Services
Sector

Health
Sector

Health
Sector
to Public
Sector
(Col. 4 as%
of Col. 2)

Health
Sector
to Social
Services
(Col. 4 as
% of Col. 3)

.19600
46720
85765
66254
157788
286532
114443
126007
975000

4119
7302
13187
8601
26854
40150
18679
17637
140353

653
1430
2508
2106
6135
9097
3542
3844
28311

3.3
3.1
2.9
3.2
3.9
3.2
3.1
3.0
2.9

15.8
19.6
19.0
24.5
22.8
22.7
19.0
21.8
20.2

Swasth Hind

In addition, benefit will flow from programme of
other sectors like agriculture and food, water supply
and sanitation, housing, rural reconstruction, nutrition,
social welfare, welfare of Scheduled Castes and
Tribals, employment generation, education, etc.,
which will lead to better health of the community.
Water supply and sanitation

Most important of all the other sectors is perhaps
“Water Supply and Sanitation”. The available statis­
tics relating to the status of rural and urban water
supply in India, present a distressing picture especial­
ly in the rural areas. By March 1980 about 9.2 mil­
lion villages in the country with a population of
about 160 million were yet to be provided with pot­
able water supply facilities. The situation in urban
areas is relatively better but here too, particularly in
smaller towns (in 2092 out of 3119 towns) water sup­
ply and sanitation arrangements are far from adequate.

Concern has been expressed in the ‘Water Supply
and Sanitation’ chapter of the Sixth Plan document as
under:

“............... in terms of man-days lost due to water
borne or water related diseases which constitute
nearly 80 per cent of the public health problem of
our country, the wastage is indeed colossal.”
“........... the current methods of excreta disposal are
a serious health hazard and until these are improv­
ed, the benefits derived from other programmes will
be vitiated on account of the propagation of gastro­
intestinal infections caused by the existing environ­
mental conditions in the poor areas of our towns
and cities. In particular, the health benefits derived
from the provision of safe drinking water are nulli­
fied unless accompanied by sanitary measures. The
Sixth Plan, therefore, views the problems of shelter
and urban development as being inexorably connect­
ed with the provisions of safe water supply and
adequate sanitation.”
With a view to ameliorate such a condition, the
Government of India keeping in view the ‘Interna­
tional Decade on V'ater Supply and Sanitation (1980—
90)’, is planning to provide drinking water for 100
per cent population of both urban and rural areas
and to provide with satisfactory sanitary condition to
80 per cent of urban and 25 per cent of rural popu­
lation by 1990. It has been decided to provide drink­
ing water to all the problem villages during 1980—
85.

Present position of water supply and sanitation in
India and as expected by 1990 is given in Statement 3.

October 1983

Statement 3
Water Supply and Sanitation
(Population Covered)
Present
Position

By 1990
(Expected)

80 percent

100 percent

30 percent

100 per cent

20 percent

80 per cent

Water Supply :
(a) Urban

•

(b) Rural

.

.

Sanitation :
(a) Urban
(b) Rural

. •

.

.

Nil

25 per cent

Housing

• Shelter is one of the basic needs of the human be­
ings. Millions of people do not have a bare mini­
mum shelter under which they can live with their
family members. The problem is enormous. It is not
possible to solve the country’s housing problem dur­
ing Sixth Plan period but it should be feasible to
catch up with the housing requirements of the coun­
try, if a sustained programme of investment and
construction is undertaken over the next 20 years.
It has been planned to construct 13 million dwelling
units in rural areas and 5.7 million in urban areas
with an outlay of Rs. 12,955 million during the Plan
1980—85.

Out of an estimated 14.5 million landless families,
7.7 million families have already been allotted house
sites, rest 6.5 million landless families will be provi­
ded house sites by March 1985, construction assis­
tance will also be provided to all of them gradually.
Urban slums constitute about one-fifth of the urban
population and such population is expected to be
about 33 million by 1985. Out of this, about 6.8 mil­
lion have been covered by improving the condition
and by investing Rs. 1,500 million during the Sixth
Plan, living condition of 10 million more people will
be improved. The improvements are of the nature of
providing improved water supply and proper drain­
age, storm water drainage, paving of the streets, light­
ing, community latrine in the slum areas.
Education

It has been amply proved that high literacy rate
helps in improving the developmental activity in at­
taining good health and helps in bringing down the
birth rate also. The present coverage with regard to
elementary (Class I to Class VIII) education of our

243

country and target to be achieved is given in State­
ment 4:
Statement 4
Position of Elementry Education

Percentage covered
of the group

Position
as during
1950-51

Position
during
1979-80

Target by
1984-85

By 2000

32

67.8

78.8

100%

Food production on various fronts is expected to
increase considerably through various programmes.
The present status of our country and annual target
of 1984-85 is shown in Statement 6:
Statement 6

Target for food production

It has been decided that the knowledge about the
elements of primary health care should be included
in the text books of the elementary education (class I
to class VI11). Ministry of Education, in collaboration
with the National Council of Educational Research
and Training (NCERT) and the Central Health Edu­
cation Bureau (CHEB), have developed such text
books and the programme has been implemented in
some States/UTs. It is expected that rest of the States
will also follow the same.

Such a step will go a long way in building up an
attitude of healthful living amongst the children who
are the future fathers of the children and head of the
families. Those who are in the age-group of 1 year to
14 years now will form the most important group (2034) years during 2000 AD. Vigorous and sincere at­
tempt to impress upon this group from now is of para­
mount importance. And if this can be done it will be
easier to achieve the goal.
Minimum Needs Programme

Benefit which will flow by the implementation of
the minimum needs programme will be of conside­
rable socio-economic improvement in rural area. The
outlay for the different areas of minimum needs pro­
gramme for 1980—85 and expenditure of 1974—79
arc shown in Statement 5:
Statement 5

Outlay on Minimum Needs Programme
(Rs. in million)
Programme

1. Rural Health.......................................
2. Rural Water Supply
3. Environmental Improvement of Slums
4. House sites for rural landless •
5. Nutrition.......................................
6. Elementary and Adult Education
7. Rural Roads.......................................
8. Rural Electrification
Total
’
’
‘

244

Food Production

Expendi­ Outlay
ture of
for
1980-85
1974-79

1070
3950
480
720
690
3670
3830
1370
15780

5770
20070
1510
3540
2190
10330
11650
3010
58070

Item

Unit

Present
status

Target
upto
(1984-85)

1. Cereal

Million
tonnes

116.25

139.10

2. Pulses

•

-du-

ri.oi

14.50

3. Edible oils

.

-do-

9.32

11.00

-do-

2.50

3.50

5. Milk

.

-do-

30.00

37.00

6. Eggs

.

No. in
million

12320

• 16500

4. Fish

It is expected that by bringing more area under
cultivation and increasing the yield per hectare by
using better technology, we will be self-sufficient in
the field of food production. Increase in the produc­
tion and utilisation of edible oils, pulses and animal
protein will contribute considerably to improve the
nutritional status of the population in general. An­
nual average area under harvest, yield per hectare
and total cereal production in 2000 AD as projected
by F.A.O. are shown in Statement 7:
Statement 7

Projection of Cereal Production
Area under harvest
1’000 hectare)

Yield (Kg./He.)

1973-77 2000 AD
(Average)

1973-77 2000 AD 1973-77 2000 AD
(Average)
(Average)

01,802

121,784

1,196

2,010

Production (’000MT)

121,828

244,764

Only food production may not necessarily make
it available to all sections of people unless unem­
ployment problem is solved. As such. Sixth Plan
envisages to reduce the number of unemployed.
Position in regard to the employment status of the
country is also expected to improve as shown in
Statement 8:

Swasth Hind

Statement 8
Employment situation

Facts about Leprosy in India

During
1977-78
1 • Rate of unemployment in age group
(15-59 yc.-.rs)*
....

During
1980-85

8-5%

2. Expected annual growth rate of po­
pulation
.....

18%

3. Estimated annual growth rate of
labour force (all active population) .

2-4%

4. Estimated annual growth rate of em­
ployment generafon

4.0%

♦ Average number of persons unemployed per day expressed
as a percentage of corresponding labour force i.c., rll
economic. Uy active population (as per 32nd Round of NSS)

It is expected that the gap between the increase
in labour force and the increase in the employment
opportunity will be gradually narrowed down.
Social Welfare and Nutrition

Various social welfare and nutrition programmes
are being implemented with encouraging results. Va­
rious nutrition intervention programmes, integrated
child development programmes are providing package
benefits to the vulnerable group of population, like
children of various age-groups and expectant and
lactating mothers. Area of such programmes will be
increased to cover sizeable number of beneficiaries.

Besides these, various other programmes like: (i)
Food for Work Programme, (ii) Programmes for the
Physically t Handicapped, (iii) Welfare of Scheduled
Caste/Tribes and Backward Classes, (iv) Labour and

Labour Welfare, (v) Special Employment Programmes,
(vi) Rehabilitation of Displaced Persons, (vii) Special
Component Plan for Scheduled Castes, (viii) National
Rural Employment Programmes, (ix) Integrated Rural
Development, and (x) Development of Backward
Areas will be taken up and benefit on health aspect
will improve.

It is expected that with the proper implementation
of all these programmes, the living condition of the
people will improve considerably and thereby it will
be possible to achieve the goal of “Health For All
By 2000 AD”.

—Courtesy. YOJANA, April 1—15. 1983.

October 1983

Leprosy eradication is a significant aspect
of the 20-point programme of the Prime
Minister Smt. Indira Gandhi. Steps are being
taken to evolve an action plan to remove this
scourge from the face of our country by the
turn of the century. Here are some facts about
leprosy in India:
OThere are over 32 lakh leprosy patients
in India now.

OAbout 25 lakh patients have been identi­
fied and 22 lakhs are under treatment.
OAbout 2.3 lakh new cases
every year.

are detected

OThe number of patients who get cured
and those who die of the disease every
year is around 2 lakhs.
OAlmost 25 per cent of the patients are
children below 14 and that one fourth
of the patients suffer from physical de­
formities.

OAbout four lakh patients have their
socio-economic life dislocated because of
the disease. Some two lakh patients have
become wandering beggars.

,OWe have about. 8000 centres to treat the
patients.
OBetween 1951 and now more than 10
lakh patients have been discharged by
these centres as cured. During the same
period, about Rs. 4675 lakhs were spent
on fighting leprosy.

OSixth Five Year Plan proposes to spend
Rs. 4000 lakhs to fight leprosy and more
funds are available if needed.

OThe National Leprosy Eradication Com­
mission and the National Leprosy Eradi­
cation Board have been constituted by
the Government of India to evolve an
action plan to remove this scourge from
the face of our country by the turn of
the century. A

245

ENVIRONMENT

Deteriorating Global Environment
Dr Arthur Westing
International cooperation and dependable and openly available statistics must pro­
vide a necessary basis for sensible planning and rational action, such as making zero or
even negative population growth rate on a world wide basis a coordinated human goal.
Over-riding social and ecological reasons demand this.
t the United Nations Conference on Human En­

A

vironment, held in Stockholm in June 1972, a
modern era of environmental awareness and concern
was bom. Most nations of the
world came to­
gether at the time in response to a deteriorating
global environment and to a growing threat to its
integrity from military and other actions.

Between 1972 and 1982, global population is esti­
mated to have risen from 3800 million to 4600 mil­
lion. Most of it took place in the developing coun­
tries whose agricultural potential and natural environ­
ments have already been stretched to the limits.
Forests, grasslands and fisheries are the world’s
three major renewable resources. Their utilization
began to exceed the natural rate of their replenish­
ment. The under-nourished people on earth today
are greater than ever before and arc continuing to
increase. The world has seen an unprecedented loss
of topsoil and farmaland, spread of deserts and an
alarmingly rapid rate of extinction of species, leading
to a growing loss of biological diversity and ecological
balance.

tively high level by the military sector. Moreover,
some major air and water pollutants are a corollary
to military activity. Military and allied sectors
employ about 40 per cent of all the scientists, doctors,
and engineers of the world, thus decimating the dues
of sectors like health, food and environment.

Conventional wars of a so-called limited nature
continue to plague the human race, depleting its re­
sources and disrupting its environment. Added to
this is the potential cataclysmic impact of war using
nuclear or other weapons of mass destruction. During
the past decade, the world continued its retreat from
the elusive goal of disarmament. Major military
powers continued to synergise nuclear weapons as the
main components of their obscenely large arsenals.
The injection of vast quantities of nitrogen oxides by
nuclear air bursts into lower stratosphere and the
consequent depletion of ozone would permit dange­
rous levels of ultra-violet radiation, especially UV-3
portion, to reach the earth, killing or injuring all
living things and severely unbalancing ecosystems.
Chemical arsenals are the latest enemies of human
habitat. The effects of new generation nerve gases
could be environmentally devastating.

Military sector

In this context, the military sector of society is
worth a look. Global military expenditures rose from
$ 53500 milion to $ 645000 million at 1980 prices
between 1972 and 1982. This represents roughly six
per cent of the GNP of the world. It will be natural
to assume that to that extent, military spending led to
deplesion of natural resources and increase of global
pollution.
Several factors contribute to a disproportionate
amplification of military spending on human envi­
rons. Scarce natural resources like copper, lead, ger­
manium, titanium, etc., are consumed at a compara­

246

Growing awareness

But it is not all Armageddon. An evergrowing
awareness and recognition of the inseparable link­
ages between environmental protection and long term
development is spreading among the nations surely,
albeit slowly. In 1972 there were only 10 countries
to have environmental protection agencies. Today
they exceed a hundred. And the world urgently
awaits an international renunciation of nuclear and
chemical weapons. Environment is beginning to be
seen as something that the humans must depend upon
not merely for their continued well-being and deve­
lopment but for their very survival.

Swasth Hind

"Ohl Mother Nature, for besmirching thy face by
building on this little plot an abode of man, pardon
mel

“Ohl Birds, who lose thy nests in the trees felled in
the forests far away, to build this abode of man,
pardon mel”
—(Ancient Indian prayer
at ths breaking of earth
to build a house)

Today global environment continues its deteriora­
tion. Development is slow and erratic. International
security is increasingly elusive. Official recognition of
a tripartite linkage among environmental protection,
development and peace and security was the innova­
tive highlight of the “Session of a Special Charter”
of the Governing Council of the UN Environmental
Programme held in Nairobi in May 1982. (The Prime
Minister, Smt. Indira Gandhi made clear the anxie­
ties of the Third World in a remarkable address in
the meet.)
Among the environmental factors that have to be
urgently monitored on a world wide basis arc the
atmospheric burdens of carbon dioxide, sulphur,
radio-active and other pollutants, the reduction of
ozone in stratosphere, the encroachment on tropical
forests and other endangered habitats, desertification
and reductions in marine fish populations. Similarly*,
population growth rates, infant mortality rates, food
production, literacy rates and higher education and
GNP also require urgent attention. Continuing wars
and remnants of the past wars, nuclear weapon stock­
piles, their testing and delivery systems/ international
trade in arms, etc., remain to be studied among the
security factors. International cooperation and depen­
dable and openly available statistics must provide a
necessary basis for sensible planning and rational
action, such as making zero or even negative popula­
tion growth rate on a world wide basis a coordinated
human goal. Over-riding social and ecological
reasons demand this.
Agriculture

Agricultural production and food distribution
systems have to be developed to such an extent where
each nation supplies its own people with an adequate
level of basic food staples. Larger nations must strive
for the goal of equitable food staple self-sufficiency
in each of a number of internal geographic sub-divi­
sions. A major concomitant goal of agricultural
development implies an indispensable insistence upon

October 1983

tillage, fertilizer, pesticides and other practices that
ensure soil conservation for the prevention of deser­
tification and greater reliance upon renewable sources
of energy. All these require enhanced cooperation
between developing and developed nations and ex­
panded research, development and dissemination of
appropriate technologies through relevant agencies.

The great bioproduclive systems
of the world,
especially the woodlands, the grasslands and the
oceans provide homes for the world’s wild flora and
fauna. The wood, the livestock and the fish derived
from them are indispensable for the survival and well­
being of the earth. It is a tragedy that forests, fish­
eries and range are now being exploited at rates
beyond those of their natural renewal. All nations
must bring into balance the harvest and regeneration
of these resources.
Transnational resources like
ocean fisheries and tropical forests should be managed
through international treaties and related instruments.
"While the earth was left to its natural fertility
and its immense forests, whose trees were never muti­
lated with axe, it could afford, on every side, both
sustenance and shelter for every species.”
—Rousseau

Growth in national products necessitated by deve­
lopment must be carried out with fully adequate
standards of public health, safety and pollution con­
trol. It must conform to health and safety standards
promulgated by the WHO and other appropriate inter­
governmental agencies.
Crucial for survival

The Universal Declaration of Human Rights pro­
claims: “Everyone has the right to a standard of
living adequate for the well-being of himself and his
family, including food, clothing, housing and medical
care..... ”. Today, 35 years after this Declaration was
accepted without dissent by the world family of
nations, more people than ever are hungry, sick,
shelterless and illiterate. To reverse these terrible
trends we humans must first of all learn to live within
our global environmental means. True international
security will depend upon population controls, selfsufliciency in food staples, exploitation of renewable
natural resources on a sustained basis, pollution con­
trol, maintenance and restoration of the balance of
nature and the development of a deep respect for
all things living.
Such an agenda for the 80s is
crucial for our survival and betterment.
A
—Based upon the author’s thesis (UNDF).

247

HOUSING" AND
ENVIRONMENTAL PLANNING
S. V. Joshi

There are 1.6 and 0.8 persons per room in East European
and West European countries, respectively, whereas the same in
India is 2.8 persons per room. This is a pointer to (he fact
that there is an urban congestion which should be considered as
the root of many ills afflicting the society. Ill-health, unhygienic
conditions, and child delinquency flow from this over-crowding
and congestion.

248

Swasth Hind

ndia is a big country which has the characteristics

I

of a sub-continent in respect of size, population,
climates, languages, and living habits. Its housing
has been greatly influenced by all these factors.
It
has an area of 32,97,352 sq. kilometers and it is con­
sidered as the seventh largest and second populous
country in the world. Its population in mid 1976 was
609 million people, and in less than five years reached
684 million in 1981, an increase of 75 millions. By
the turn of this century it is estimated to cross one
billion mark. Out of the 609 million people in 1976
nearly 21 per cent lived in urban areas. In absolute
numbers this urban population of 128 million exceed­
ed the population of many countries of the world,
like Pakistan, Bangladesh. U.K., Canada and U.A.R.
This comparison will, to some extent, give an inkling
of the enormity of the problems in general and that
of the housing in particular.
Housing shortage

The land factor, what it is, is to remain constant
whereas the population factor is ever on the increase.
In other words, the solution to the nagging problem
of housing and housing shortage will be illusive. It
is estimated that the overall shortage of housing is
about 15 million housing units and the projected de­
ficit in the next decade will be anywhere between 23
to 26 million units. The deficit in housing is most
felt in the income group below Rs. 100. Two thirds
of total deficit accrue from this income group. It
has been observed that the housing deficit in the
income group of Rs. 101-200 and Rs. 201-500 is
about 21 and 13 per cent respectively.
Housing iu rural area#

The houses that are in occupation of the people in
rural area do not in fact deserve the attribution of a
‘House’ as most of them do not have the basic ameni­
ties like waler taps, latrines and baths. Four out of
every five houses do not have water laps, latrines and
bathrooms. They are constructed mostly of thatch
and mud. Only 13 per cent of the rural households
stay in structures built with permanent building mate­
rials, the urban households have a better lot compara­
tively, as they have belter structures and have access
to the basic amenities. Every other household has a
structure built with permanent and semi-permanent
building materials and has waler, latrine and bath.
This plus point in case of urban household is negated
by inadequate space within the confines of the four
walls. They barely have one or two small rooms.

October 1983

Congestion

The number of persons per house has increased
from 5.6 in 1951 to 5.9 in 1971. The number of
rooms per housing unit has, however, remained
constant at two only.
In this regard, it may be educating to see the pro­
portion of persons per room in East European and
West European countries. There are 1.6 and
0.8 persons per room in East European and
West European countries respectively, whereas
the same in India is 2.8 persons per room.
This is a pointer to the fact that there is an urban
congestion which should be considered as the root of
many ills afflicting the society.
Ill-health, unhy­
gienic conditions, and child delinquency flow from
this over-crowding and congestion.
It has been given to understand that about twothirds of the urban households are bracketted in the
income-group of Rs. 101-500, and 43 per cent get a
little more than Rs. 200 per month. On rural side
the condition is anything but pleasing. Nearly onehalf of the households are in the income group of
below Rs. 100 per month. It may be deduced from
this that the average income of the urban household
is Rs. 3660 per annum and that of the rural house­
hold is Rs. 1850 per annum. Among the two poors
the urban poor is a little better placed.

The perspective planners have projected a scenario
whereby, by the turn of the century the households
that may not afford to own standard houses may
range between 50 million to 92 million. On the rural
side the number of households incapable of paying
for a standard house may range between 37 million
and 70 million whereas that on the urban side may
vary between 12 million and 13 million.
If all of them were to be given standard R.C.C. houses
al present rales the subsidy figure may be very stag­
gering to the time of Rs. 610 billion. This, however,
need not preclude from setting an ideal, which if
not achieved in the immediate future may at least
lead us nearer our goal of bridging the gap between
the man and the house. To this end we may begin
by giving a high priority to housing, scaling down
the standards but aiming at better environment. *We
may not aim at having a house to last 50 to 100
years, but should set our eyes on a house which may
carry us through its life span of say 10 to 15 years.

249

Standardization

This leads to an inescapable conclusion that in
order to meet the challenge some sort of standardi­
zation leading to manufacturing of some of the im­
portant components of houses, like the doors, win­
dows, lintels, hollow concrete blocks, built in cup­
boards, precast cooking platforms, precast shelves
for storing groceries and utensils, drying bars, peg
sets, etc., is required to be resorted to. The use of
flyash which is obtainable in plenty, from the thermal
power stations could, to some extent, help conserve
the cement which is in short supply.

The people in rural areas have, through ages, deve­
loped an expertise in construction of houses with
materials locally available to them. Besides encour­
aging this trend the know-how obtained from the
laboratories may have to be taken to them to pro­
mote their acceptability. It is a common experience
that any new device is taken with a pinch of salt.
People in general will not fritter away the hardearned saving on untried
and untested material.
Materials like flyash, quick setting lime, stabilized
earth "'and a host of others have on experiment
proved to be useful in construction work, yet they
have to become acceptable to the public. It is on
record that it took about 50 years for bath-tub to
come in baths of European countries as the idea of
seeing the reflection of one’s own nude body was
considered a moral taboo. The introduction of bio­
gas in rural houses suffers from similar inhibitions.
The majority of rural houses are marked by the
absence of adequate light, ventilation, and sanitation.
As a result they become dingy and unhealthy. Of
all the bounties of nature there are only two which
are still free and unfaxed. They are sunshine and air.
They, therefore, should be used to the desired limits
to make the houses of teeming millions cheerful and
healthy. In a tropical country like India openings ina house to the tune of 10 to 17 per cent of floor area
are considered enough to admit adequate sun and air.
Envb*oomenf

Motorized transport is at once the boon and the
bane of urban life. It brings in its wake din and
dust which pollute the atmosphere. Excessive noise has
been a part of industrial environment for a long time.
Motors, horns, metal presses, riveters, drills, lathes,
heavy machinery,, work and movement, blaring radio
and loudspeakers, supersonic aeroplanes have
become irritant and a source of environmental an­

250

noyance. In the process of planning of the settle­
ments these are required to be kept at a safer dis­
tance to assure an atmosphere of serenity within and
without the houses.
Road accidents

For the poor the only means of easy, cheap and
handy conveyance is the bicycle which is seen plying
everywhere throughout the country. But the road
pattern available in the urban areas do not take
kindly to the poormans vehicle. There are about one
million cycles in Delhi which means 6 or 7 out of
every ten vehicles are bicycles and in many other
cities like Bangalore, Pune and Hyderabad they are
as many as 65 per cent of the total traffic. The sem­
blance of the footwalks and the cycle tracks are fast
giving way to the road widening meant to accom­
modate the motorized transport. Cycle tracks are
now conspicuous by their absence and wherever they
do show their existence they are bumpy and are
hazardous owing to the access to the bungalows
crossing the cycle tracks at interval of every 100 feet
or so.

About 30 per cent of oxygen we get is from
the trees, vegetation and grasslands. In the
light of this fact the need 1o preserve and plant
more trees should be impressed upon the minds
of the people.
If has now been estimated that on an average 25
per cent of the persons killed in road accidents in
cities arc the cyclists. This apathetic indifference to
the needs of the poorman is inexcusable when the
consideration of improvement in the houses of the
lowest income group is being discussed for imple­
mentation. The housing we contemplate for the low
income groups must promise a relationship of people
to one another so as to create confidence in them and
to shed their economic backwardness and the inferi­
ority complex that follows.
The roads have a dual function. They provide a
thorough passage and access. There is, therefore, a
possibility of conflict between these (wo functions,
(he motorized and non-motorized transport should
have well defined traffic lanes to avoid bottlenecks
and accidents. In housing colonies motorized trans­
port should be confined to the periphery and should

Swasth Hind

not be allowed to penetrate into (he open spaces and

SIGNIFICANCE OF WATER AND

play-fields.

SANITATION FOR PHC WORKERS

Landscaping

The area surrounding the houses and settlements
should have a fair sprinkling of trees, lawns and
shrubberies.
The trees besides giving the desired
shade to the houses, bring down the temperature by
transpiration process. Prof. Lamant Cole has shown
that Oxygen in atmosphere has remained stable be­
cause of green plants recycling it by photosynthesis.

About 30 per cent of Oxygen we gel is from the
trees, vegetation and grasslands. In the light of these
facts the need to preserve and plant more trees should
be impressed upon the minds of the people.

There is no doubt about the fact that the use of
local materials, standardized
building component's
and scaling down the standards in area and specifica­
tion will decidedly bring down the cost to be within
the tolerable reach of the persons badly in need of
houses. No efforts should, therefore, be considered
too great in popularizing all the technological mea­
sures aimed at economizing on construction. This,
however, need not be considered as an end in itself
and a panacea to cure all evils. Standardization is
not a magic wand the touch of which would bring
quick results on platter.
Efforts in this direction are required to be made at
the highest political level, without which housing for
poor will remain a distant dream.

The key building materials like
brick, cement,
steel and timber must, of necessity, be handled at
Government level. It would be advisable to open
building material markets al important centres so as
to make them available lo the people. Secondly the
land policy should undergo a drastic change and that
the majority of the land should be under Govern­
ment control. Such a policy if pursued properly, the
land for house building would be available at a
fairly cheaper rates. Technological progress and the
policy of the Government will in the end enable the
common man to realise his dream which had hitherto

Water quality, water quantity, excreta disposal and
all the aspects connected with sanitation and the tran­
smission of water-connected disease usually have been
considered as factors, each contributing its part, to
the spread or containment of these diseases.
The
available empirical evidence suggests that it may be
more fruitful to look at all these aspects: if only one
of them is not met it has immediate detrimental
effects on health. If all are not met the improvement
of any one or two of them will not contribute much
to the reduction of disease.

In developing countries the most important aspect
of the water-connected
diseases
probably is the
“water-washed” mechanism where disease transmis­
sion depends mainly on the availability and the use
of large quantities of water irrespective of their
quality. Where water scarcity is an important fea­
ture of life—true for many rural (and urban) areas
of developing countries—nothing much can be done
about it on the local level without considerable eco­
nomic improvement. This is possibly the reason why
the question of water quantity is virtually not add­
ressed
in the training manuals
of PHC-workers.
Theoretically there are three aspects related to the
transmission of water-connected
diseases on which
the PHC worker can have an impact : improving the
water quality by advice on protecting wells/springs,
on boiling drinking water and on building latrines.
These measures, however, are not easily accepted by
the population for a variety of reasons.
Even if
individuals or the population at large would adopt
them this would probably have hardly any impact on
the prevailing morbidity and mortality pattern as long
as the other conditions, notably increased
water
quantities and changed hygiene habits are not met.

At the moment there is a lot of talk about the im­
portance of preventive measures in the context of
primary health care and PHC workers in developing
countries. Yet a closer look at the originally “water­
borne”—labelled diseases shows that the interruption
of the transmission probably depends much more on
waler quantity
than water quality.
Because the
PHC worker—due to his training and due to econo­
mic constraints of a poor population-can at best
improve water quality, his ability to reduce the mor­
bidity and mortality due to these diseases is rather
limited.
— ZACHER, W. HYGIE

A

From: Highlights from Current Health Literature,
Vol. II, No. 11 dt. 25 June 1983. National
Medical Library, New Delhi-! 10029

October 1983

251

been eluding.

INTEGRATED EFFORT IN MALARIA
CONTROL
Nedd Willard
Integrated effort in malaria control includes, chemotherapy, vector control,
environmental management. Much can already be done now with the means at
hand.
For example, so-called “man-made malaria" may be the result of faulty
drainage or the creation of breeding grounds for mosquitoes.
When roads are
built, the pits from which soil was dug are often left uncovered and become mosquito
breeding spots. Sometimes these swampy ditches can be eliminated simply by
using a pick and shovel. Irrigation that is poorly conceived or executed can spread
malaria so that it is important for sanitary engineers to be associated with the
design and operation of irrigation systems.
40 per cent of humanity, 1,900 million
people, are still at risk from malaria today. The
disease exists in varying degrees of intensity in 102
countries and poses a continuing problem to health
authorities. Resistance of the Anopheles mosquitoes,
which transmit the disease, to pesticides and resis­
tance of the most dangerous malarial parasite, Plas­
modium falciparum, to the drugs most commonly used
to treat the disease have made things worse. These
factors give urgency to devising new strategies, both
nationally and internationally, and have spurred re­
search.
Resistance to DDT and other insecticides was first
recorded in Anopheles mosquitoes in Greece in 1950.
Since then there has been a steady increase in the
number of Anopheles species showing resistance. By
1968, malaria vectors were reported in several areas
to be resistant to one or more insecticides.
The intensive and in many instances excessive and
irrational, use of pesticides was mainly responsible
for the “selection” of resistant mosquitoes. Those
which are most susceptible die. Those which are resis­
tant survive and go on to multiply and fill the popula­
tion gaps left by the others. Where massive agricul­
tural spraying has been going on for a number of years
in some cotton growing areas for example, mosquitoes
now show a high level of resistance to the main classes
of insecticides: Organochlorines, organophosphates.
carbamates and synthetic pyrethroids.
Fortunately, in some countries, insecticide resistance
does not yet pose a serious problem. This is the case
in most of South America, Africa and the Western
Pacific. In other places, such as Sri Lanka, the local
malaria vector is resistant to DDT but remains suscep­
tible to most of the other insecticides.
oughly

R

252

Chloroquine falters

A similar situation has developed in relation to the
malarial parasite itself, which has developed resistance
to many of the drugs most commonly used in treat­
ment, especially chloroquine. Chloroquine-resistant
forms of Plasmodium falciparum were first reported
from South America and South-East Asia. In the
Americas, resistant forms are found in ten countries
as far north as Panama. In Asia, they are found as
far west as India and as far east as some of the Pacific
islands. Alarmingly, resistant P. falciparum is now
known to occur in East Africa. In some places, such
as Thailand, up to 90 per cent of all P. falciparum
malaria cases fail to be completely cured with the stan­
dard dosage of chloroquine. And increasing propor­
tions of these sufferers derive no benefit at all from
this drug. Other drugs are available for the treatment
of chloroquine-resistant falciparum infections, for exa­
mple. quinine, the tetracyclines and combinations of
sulfamides with pyrimethamine such as Fancidar. But
reports are coming in of treatment failures with Fansidar in some areas with a high degree of chloroquineresistant P. falciparum. New drugs, safe drugs, are ur­
gently needed.

In addition to these grave problems, efforts to con­
trol malaria have been hampered by administrative.
financial and even political problems. Fighting mala­
ria costs money and, over the years, many developing
countries have been reluctant to put their scarce funds
into a struggle that has no end in sight. Moreover,
changing health priorities have often meant depriving
anti-malaria programmes of the vehicles, personnel and
funds they vitally need. Also, most measures require

Swasth FIind

a high degree of cooperation on the part of the people
concerned, which is hard to achieve on a long-term
basis.
New strategy

Working with its Member States, WHO has helped
to draw up a new strategy which is intended (I) to
reduce mortality, (2) to curb suffering from the disease
(both of these steps rely primarily on making effective
drugs and good treatment available to all those suffer­
ing from malaria), and (3) to prevent and control
malaria to the extent possible, so that socio-economic
development is not hampered by the effects of the
disease and to achieve eradication whenever this is fea­
sible.
Malaria control as part of Primary Health Care
(PHC) systems requires technical, organizational and
administrative changes. Priority will go to supporting
activities that are related to integrated effort in malaria
control. Integrated effort means using all measures
available today for the control of the disease: chemo­
therapy, vector control, environmental management.
Much can already be done now with the means at
hand. For example, so-called “man-made malaria” may
be the result of faulty drainage or the cereation of breed­
ing grounds for mosquitoes. When roads are built,
the pits from which soil was dug are often left unco­
vered and become mosquito breeding spots. Some­
times these swampy ditches can be eliminated simply
by using a pick and shovel. Irrigation that is poorly
conceived or executed can spread malaria so that it
is important for sanitary engineers to be associated
with the design and operation of irrigation systems.
Larviciding, through the application of biological or
chemical agents, also has an important role to play
although it can rarely be successful in isolation.

In fact, the environment as a whole can be used
with good engineering to cut down on malaria but this
will require proper planning and active community in­
volvement. Combinations of insecticides, integrated
with such biological methods as larvivorous fish and
other methods of control, offer some hope. They
should be combined with treatment of malaria cases.
Strong educational programmes can show how personal
protection, such as the use of mosquito nets and im­
provements in housing, can help bring down the inci­
dence of malaria.
Speeding up research

Research is being accelerated in a number of fields:
applied field research, research on chemotherapy, re­
search for potential malaria vaccines.

Applied field research means finding out more
about the complex factors involving the mosquito and

October 1983

Roughly 40 per cent of humanity, 1,900 million people
are still at risk from malaria today. The disease exists
in varying degrees of intensity in 102 countries and poses
a continuing problem to health authorities. Resistance
of the Anopheles mosquitoes, which transmit the disease,
to pesticides and resistance of the most dangerous mala­
rial parasite, Plasmodium Falcipen uni, to the drugs most
commonly used to treat the disease have made things
worse. These factors give urgency to devising new
strategies, both nationally and internationally, and have
spurred research.
the human and natural environment in which the mos­
quito operates. It means finding answers to practical
problems. The types of crops being grown and the
pesticides used are studied. Changes in the behaviour
of mosquitoes must be closely watched as well, since
they may develop the ability to avoid contact with
insecticides sprayed on the inside of houses.
More training is going to be needed. In the early
days of malaria eradication programmes, simple skills
often seemed enough. Today, with the complex evo­
lution of the situation in all its aspects, a variety of
skills are necessary. Therefore, WHO is pressing
ahead with expanded training and retraining of health
professionals in many different fields.
Drugs—new and- ancient

Research and development are vitally necessary to
develop alternative anti-malaria medicines. Two pro­
missing drugs, mefloquine and Quinghaosu, are under
development by the UNDP/World Bank/WHO Spe­
cial Programme for Research and Training in Tropi­
cal Diseases. Both are effective against chloroquineresistant falciparum strains but neither is ideal. Mafloquine, discovered by the Walter Reed Army Institute
to Research (USA), is the only new anti-malarial drug
that has reached an advanced stage of development
and clinical assessment. Qinghaosu is derived from an
ancient Chinese herbal remedy. But all drugs that may
be used have to be carefully tested first and used in
a controlled manner to prevent rapid development of
parasite resistance. This will mean strict measures of
drug control by national health authorities.

The reliance on drug treatment in the new strategy
will require; the establishment of a surveillance system
to detect the development of malaria parasite resistance.
This system should be based on observations by all
those responsible for treating malaria cases. WHO
has developed kits with which health workers can
observe in a test-tube the response of P. falciparum
parasites to the commonly used anti-malaria drugs.

253

More research is needed to discover and trace how
resistance arises and spreads. Moreover, held workers
need simple methods of measuring serum and plasma
drug levels in order to distinguish between drug resis­
tance and the effects of abnormal drug metabolism or
absorption.
Developing vaccines

Great strides have been made over the past decade
in research aimed at discovering a vaccine against
malaria. It is likely that one or more types of malaria
vaccine will be tested in humans before long. But
since unforeseen problems may arise at any stage along
the complex route from antigen identification to vac­
cine production it is impossible to predict exactly when
malaria vaccination will become a reality. Vaccina­
tion could make a major contribution to malaria con­
trol by protecting susceptible individuals from the di­
sease and by limiting transmission of the parasite. Re­
search towards the development of malaria vaccines
is the subject of a coordinated effort in several coun­

Involvement of Private Medical Practitioners
in Family Welfare Programme
T has been decided that private practitioners of in­
tegrated medicine who are members of the National
Integrated Medical Association may also be allowed
to undertake tubectomy (mini lap) operations as per
the following terms and conditions:
1. Only those private practitioners of integrated
medicine with necessary expertise and who are mem­
bers of the National Integrated Medical Association
and are recommended by the National Integrated
Medical Association will be covered under the Scheme
to undertake tubectomy operations in his/her nursing
home/ clinic / hospital.
2. The nursing home/clinic/hospital should have
all facilities for the conduct of tubectomy operations
and post-operative care services, viz. equipment, fur­
niture, instrument—sterilization facilities, operation
theatre, beds, anaesthesia, resuscitative and emergency
services, etc.
The Civil Surgeon/C.M.O/D.F.W.O.
must certify in advance that the private medical
practitioner of integrated medicine who is also a
member of the National Integrated Medical Associa­
tion is experienced and has necessary surgical facili­
ties to undertaken tubectomy operations.
3. The private doctor will be responsible for
follow-up care and treatment of complications free
of cost in respect of his/her own patients either in
the hospital/nursing home/clinic or at the residence

I

254

tries and is being carried out under the auspices of a
number of national and international funding agencies.
Important recent technological advances have enabled
protective antigens of the parasite to be identified and
isolated, and it is expected that when the appropriate
antigens have been selected for use in vac­
cines their production on a large scale will be feasible.
Yet important questions remain: How long will the
new vaccines protect people and to what extent? How
safe will they prove in use, and how can we be sure
that these vaccines will get to those who need them
most and be produced at a price developing countries
caii afford?

Like new drugs and insecticides, it is unlikely that
vaccines alone can eliminate malaria. The only fea­
sible strategy will be an integrated approach using all
methods, constantly updated by research and data
gathered in the field, and understood and supported
by practical measures carried out by the people them­
selves who are most at risk.
—W. H. O. Feature

of the acceptor. In cases of complications of tubec­
tomy requiring hospitalization he/she can refer the
case to the Government hospital.
4. The operatee/acceptor should be within the eli­
gible category and should also fulfil other conditions
laid down by the Ministry.
5. The following amounts will be admissible to the
private doctor/acceptor out of the compensation
amount of Rs. 200 regardless of whether the private
doctor charges his/her own fee from the acceptor:—
(i) Amount payable to the acceptor of
Tubcctomy Operations
(«i) Private doctor.
(iii) ♦Diet to be provided to the acceptor.
(iv) ♦*Misc. Purposes (State Govt’s Share)
Total

Rs. 100/Rs. 50/Rs. 20/Rs. 30/Rs. 200

(Two Hundred only)

*Thc amount to be paid in case to the acceptor in case diet
is not provided in the Nursing Home.
♦♦To be retained by Stale Govt.

6. In order to ensure the reliability of the informa­
tion supplied by the private practitioners, the State
Governments should prescribe a 20 per cent verifica­
tion of the cases by the Dislt.
Family Welfare
Bureau and a 2% to 5% check by the State Family
Welfare Bureau.
7. The private doctor will have to maintain some
minimum records as prescribed by the State Govern­
ment in respect of acceptors of tubectomy as regards
their age, sex, religion, number of children with sex,
(Contd. in Page 257)

Swasth Hind

U

MEASURES TO CONTROL ENVIRONMENTAL
NOISE POLLUTION
K. R. Swadeshi
noise has become one of the active pollu*
tants of man’s environment. He is completely
helpless in avoiding it everywhere—at work, at home
and even in the street. Its omnipresence around his
surroundings is not only a major factor which affects
his hearing power but also results in lessening his
working capacity, particularly in the cities all the
world over. Medical specialists have also confirmed
that noise is playing a very dangerous role in creating
nervous disorders and cardiac diseases. It is enor­
mously contributing to create health hazards.
oday,

T

Sources of Noise

Paradoxically, man himself is responsible for noise.
During the present century, he has made stupendous
scientific and technological progress. He has mech­
anized most of the manual operations by developing
more and more powerful machines, which are res­
ponsible, to a large extent, for culminating noise that
surrounds him. What a pity that the local source of
noise is created by one person or a group of persons,
but is affects and has to be faced and tolerated by a
large number of people of the locality. The more the
scientific and technological advance the newer the
source of noise. In other words, noise is going out of
man’s control assuming larger and larger proportions.
In order to control the problems of noise pollution
in Soviet cities, some strict measures have been taken
which include a law on the protection of the atmos­
phere air. The experts are taking concrete scientific
steps in order to control noise as far as possible, if
not wholly. For instance, recently a State standard
of noise has been introduced on maximum permissi­
ble noise levels in the Ukraine. Now all the work
of noise control is coordinated by the Inter-Depart­
ment Commission in this republic.
Preventivt steps

Health and epidemiological centres of the republic
make about 300,000 noise level measurements every
year. Preventive measures are always far better than

October 1983

surgical operations. Therefore, health control is ex­
ercised in the republic at all stages of design, construc­
tion and modernization of projects.
During the last six years, more than 1,000 industrial
enterprises in the Ukraine have been screened for noise.
The ones which created nuisance have been shifted
from the residential zones to special industrial com­
plexes. The remaining have either been modernized
or their equipments have been replaced in the light of
health regulations. For instance, when a mining
machine was found short of State standards it was
discontinued. At the same time, some types of metal­
working machines in the engineering industry have
also been replaced.
Scientific devices

Sound-absorbing walls have been constructed in
the textile industries. Blueprints for an oxygen conver­
ter workshop provide for a new technology at the iron
and steel works in Dnieprodzerzhinsk, which is under
construction. It will greatly help in reducing noise.
In other large cities, blocks of residential flats are
built at a far distance from the roads where heavy
traffic, which engineers noise to every house, is plying.
Detours have been provided and streets are opened
only to pedestrians. Sound-insulating materials, use of
triple glass and special direction of windows used in
the flats have proved very effective and help avoid
much of noise penetration into the residential locality.
Living rooms face the yard, with closed galleries fron­
ting the street and a hospital and a polyclinic have
been built in the acoustic shade of one of the blocks
of flats in Dnepropetrovsk. These measures have
resulted in reducing noise level by 20 to 30 decibels in
this particular block.

The specialists of the Dniepropetrovsk Institute of
Civil Engineering have set up unique acoustic proving
grounds and a quiet chamber. The ideal acoustic
conditions, thus, provided help to test future residen­
tial areas with shops, schools and kindergartens. In­
struments imitate any city noise. Here not only blocks

255

and areas arc modelled but also terrain. Now, new
houses in Dnepropetrovsk arc erected only on the
sc ic 111 is t s' rccom me nd a Lio ns.
Curbing transport noise

Transport is the greatest noise-maker in modern
cities. In order to control its noise, studies were car­
ried out in 30 cities of the Ukraine republic. The ex­
perts made special maps, which indicate zones of
acoustical discomfort, the “hottest” spots, and noise
perspectives for the future. These maps are taken into
consideration whenever the development of the cities
is planned. They help choose the right type of building
and more rational architectural and planning directions.

Morcvcr. river ships on the Dnieper are prohibited
to sound signals when they pass residential localities.
hi order to reduce aircraft noise, the number of night
Hights has been cut. Over-flight over residential areas
has also been forbidden. Tn Kiev, protective screens
have been erected along railway lines, which help avoid
the noise.

Tn green spaces the dust content of the air drops by
40 per cent. The “green fences” absorb and dissipate
sound energy and are good means of noise%protection.
Therefore, every year about 40,000 trees and 350,000
bushes are planted in the city of Kiev. The green bar­
rier along the streets, in fact, is an effective absorber
of sonic bang. A

SCHISTOSOMIASIS—AN ENVIRONMENTAL DISEASE
H the past decade many water
resources development
pro­
grammes have been undertaken in
endemic areas of Africa, South Ame­
rica and Asia. During this period
an increase has been observed in
the transmission of communicable
diseases, particularly of schistoso­
miasis. (A blood-fluke (trematode)
disease with adult male and female
worms living in veins of the host
(mainly mesenteric, portal and pel­
vic veins). Eggs there deposited
produce minute granulomata and
scars in organs where they lodge).
Such projects have led to the deve­
lopment of many regions, but as
a result schistosomiasis has now at­
tained an unprecedented prevalence.

The disease occurs mainly in the tion, schistosomiasis
will conse­
tropical and sub-tropical regions, quently be reduced. The provision
where it ranks high among the major of water should be linked with en­
public health problems. It has been suring adequate drainage, otherwise
estimated that at least 200 million the problem of schistosomiasis and
people in 72 countries suffer from other infections may even be ag­
this chronic disease. During the gravated.
first half of the present century
schistosomiasis affected more than
The control of schistosomiasis is
10 million Chinese, and probably an urgent need for improving health
resulted in greater number of deaths in endemic areas and also for en­
than in any other country. Pro­ hancing socio-economic progress in
ductivity is inevitably affected these areas. However
no single
through increased absenteeism and method for the control of schisto­
decreased work capacity. Reduced somiasis has been
recommended;
productivity and costs of medical only an integrated approach which
care, can be expressed in monetary takes local factors into account can
terms, but other losses are more achieve successful results. Health
difficult to quantify, for example, the education, medication and surveil­
discomfort of illness, increase in lance of population movements are
Schistosomiasis is caused by water­
the dependency ratio due to mor­ the principal tasks to be undertaken
borne parasite which is snail-trans­ bidity, etc.
to control the disease. Japan was
mitted and infects humans on con­
Efficient disposal of human ex­ able to procure active community
tact. Its transmission is always a
local ecological phenomenon, parti­ creta should be an adequate method support to eliminate snail habitat
environmental
modifications.
cularly in desert lands, where it of controlling transmission of schis­ by
Also
in
China,
the
socio-political
occurs in oases or fertile valleys. tosomiasis, but the socio-economic
structure
made
it
possible
to imple­
Difficulties in control in rainy and conditions prevailing in many en­
ment
the
necessary
environmental
intensively irrigated areas may fre­ demic areas make the provision of
quently be anticipated, particularly adequate facilities difficult. Wash­ changes and thus achieving a con­
when there is dense population re­ ing and laundry facilities require a siderable reduction in prevalence.
lying on the use of water for land safe water supply as bathing in
and cultivation for example Nile water is a common mode of infec­
—Kunwar Jalecs.
Schoo! of Environmental Sciences,
delta of Egypt and Gezira region tion. Tf adequate water is provid­
Jawaharlal Nehru University,
ed to meet the needs of the popula­
New Delhi-110 067.
of Sudan.

T

256

Svvasth Hind

RESEARCH

OPEN HEART SURGERY IN
INFANCY AND EARLY CHILDHOOD
Dr M. R. Girinath
t is estimated that two and a half lakh children
with congenital heart defects arc born each in
India. Of these, roughly one third die in the first
month of life and another one third between one
month and one year of age. Approximately 50 per
cent of those who survive the first year of life die
before they reach the end of the fifth year. Thus,
by waiting till a child with congenital heart disease
is about five years of age, less than 20 per cent of
these children can be salvaged by corrective surgery.

I

Open heart surgery in very small children has now
become feasible with the help of techniques that have
been developed during the last decade or so. The
main problem confronting the surgeon is that very
small children, especially infants do not withstand
conventional techniques of open heart surgery very
well. The post-operative management of these child­
ren is also very much more difficult than in older
children and adults. The most significant advance
in this area has been the introduction of the profound
hypothermia and total circulatory arrest technique
devised at first by Mohri et al and later perfected
by Barratt-Boyes. Merendino. Kirklin, Cartmill and
others. Various modifications of the technique exist
but the technique developed by Barratt-Boyes is the
most widely used. The technique essentially consists
of covering the infant with ice packs after induction
of anaesthesia and allowing the nasopharyngeal tem­
perature (which reflects the brain temperature) to
come down to around 25C. At this temperature
the chest is opened and the child connected to a
heart lung machine. The temperature is brought
down to about 17°C with the heart lung machine

{Could, from Page 254)
age of youngest/younger child, address, etc., and send
the return to the
Distt. Family Welfare Officer
through the local branch of National Integrated
Medical Association every month.
8. Ex-Gratia Payment in the event of Death after
Tub ectomy operation.

A sum. of Rs. 5.000/- (Rupees five thousand only)
as ex-gratia payment will be paid to the spouse or

October 1983

during a short period of Cardio-pulmonary bypass.
At this temperature, the circulation is arrested and
the repair carried out in a still, relaxed and empty
heart without any cannulae
obstructing the .field.
Following completion of the repair, the child is re­
warmed with the help of the heart lung machine to
a rectal temperature of’ 37" C. The advantages of
this technique arc that the period of cardio-pulmonary
bypass is considerably reduced and the surgeon gets
the most ideal operating conditions for doing difficult
repairs in small hearts.

There are a few congenital heart defects such as
transposition of the great arteries, total anomalous
pulmonary venous connections, ventricular septal de­
fects with large flows, total atrio-ventricular canal
defects, some cases of tetralogy of Fallot etc., in
which without surgical intervention survival beyond
the first year of life is not possible. These exciting
new techniques arc now available at a few centres
in India—namely at the Southern Railway Hospital,
Madras Bombay Hospital and the All India Institute
of Medical Sciences New Delhi. At the Southern
Railway Hospital, Madras more than 100 operations
have been done during the past four years using these
techniques for a variety of conditions. The overall
mortality has been less than 20 per cent which though
high is acceptable because many of these children
had complicated defects. Because of a lack of aware­
ness that surgery is possible in very young children
there has been a paucity of referrals. The develop­
ment of this field has therefore been slow in our
country. a

the natural heir in the event of death of the person
as a consequence of tubectomy operation by the
above categories of private medical practitioners of
Integrated Medicine. The ex-gratia payment will be
regulated by rules and conditions already laid down
by' the Govt, of India, Ministry of Health & Family
Welfare (Deptt. of Family Welfare) in this regard.
For this purpose, the concerned private integrated
medical practitioners will be required to contact the
chief Medical Officer Of the respective district. /\

257

ON LEPROSY

NEW APPROACHES IN LEPROSY CONTROL
VACCINE TRIALS UNDER WAY
REHABILITATION OF

have started with human volunteers on a
vaccine that scientists hope will combat leprosy,
a disease suffered by millions of people and still
spreading.
rials

T

The vaccine has been prepared by the Wellcome
Foundation drug group of London for Britain's Na­
tional Institute for Medical Research, where a team
is working as part of a World Health Organization
special programme to speed progress in fighting
major diseases.
The vaccine, which is made up of dead leprosy
germs taken from two-year-old armadillos, is badly
needed because present-day drugs are not containing
the disease as new strains develop. A once-only in­
jection of such a vaccine given to children when they
go to school from isolated rural areas could overcome
the problem of repetitive drug injections and lead
eventually to world eradication of the disease, as re­
cently happened with smallpox.

The vaccine has already been used with dramatic
effect on groups of patients with the most serious
form of leprosy at an advanced stage in Venezuela.
Now the aim is to carry out organised trials with
humans in Britain, Norway and the United States.
These countries have been chosen because of their
varying public health immunisation programmes. The
trials will, therefore, produce wider-ranging informa­
tion than simply covering individual response to the
vaccine.

The first of these trials has started in Norway and
involves a group of seven to 10 people. The group
will be progressively widened, depending on the res­
ponse. Similar U.K. trials arc expected to start later
this year.
Once these trials have been carried out and the
results analysed, a more detailed study will start with
trials in an area of the world where leprosy has a firm
hold.

Although it was one of the first human diseases
shown to be caused by a bacterium, leprosy has been
particularly difficult to study because the organisms
cannot be grown in the laboratory. A major step
forward was made in 1971 when it was confirmed
that the nine-banded armadillo was susceptible to
the disease.

LEPROSY

PATIENTS

Zail Singh, President of India, has called
upon humanitarian organizations like the Hind
Kushl Nivaran Sangh to help leprosy affected
persons to earn their living by doing some work
and not being forced to resort to begging or living
on doles.
uri

S

Addressing the annual general
meeting of the
Sangh in New Delhi in August 1983, the President
said it was a crime on the part of the society to
let leprosy patients beg for a living.

These patients needed job training, employment,
marketing of what they produce and assistance to
avail themselves of the facilities granted by the
government.

“Whatever we can give, let us give with love and
sympathy which patients crave for”, the President
said.
Leprosy could not be handled successfully
by doctors alone. “The psychological, social an<l
economic problems that leprosy
creates for its
victims and those of the victims’ families have to
be tackled by social workers as well”, he said.

“The vital role the voluntary agencies have to
play in this field cannot be overemphasized. Health
education and rehabilitation are the two important
areas where voluntary agencies are
better suited
than the government department to produce
results,” he added.
Shri Zail Singh spoke of the interest shown by the
Prime Minister, Smt. Indira Gandhi to wipe out
leprosy by the turn of the century and its inclusion
in the new 20-point programme. “Voluntary organi­
zations are best suited to take advantage of the
people’s
enthusiasm
to strengthen the national
leprosy eradication programme”, he said.

Health for All by 2000 AD would remain an
empty slogan if the participation of the people was
lacking in the efforts. Therefore, voluntary organi­
zations should prepare the ground by educating the
people about the basics of good health.
The President said that doctors and scientists
were doing commendable work in research and we
can only hope that the day will not be far off
when an effective vaccine is discovered to protect
people from the onslaught of this disease.
a

(Contd. in Page 26)

258

Swastii Hind

AID TO EARLY DETECTION
the size of a fountain pen offers
the prospect of early detection of leprosy at a stage
when action can prevent the victim from being dis­
figured.

A

tiny instrument

The thermal sensation tester is a new approach to
leprosy detection and has been developed by a Scot­
tish firm (Speyside Electronics Ltd.) which normally
specialises in microprocessors for the oil industry. In
the face of world competition, it won the contract to
develop an idea put forward by Mr. Michael
O’Regan, a leprosy worker for the World Health
Organization in Geneva. He and Mr. Bent Stumpe,
an electronics engineer also from Geneva, put forward
plans for a neat and simple electronic device that
could detect leprosy in its early stages.

An estimated 15 million
people worldwide arc
currently suffering from leprosy and, although the
disease can be cured, 25 per cent, of those who con­
tract it are left permanently disabled. Early detection
is therefore vital before the disease disfigures its
victims.
Mr. Michael Ramsay, Managing Director of Spey­
side Electronics, said: “One of the characteristics of
leprosy is the inability of victims to distinguish bet­
ween hot and cold in patches of skin affected by the

disease. Various methods arc used to test thermal
sensation, one of (hem involving holding test tubes
of water at different temperatures against a patient’s
skin. In remote parts of the world where there is
neither water easily at hand nor the means to heat it,
a new method was needed.”
The Speyside tester has already been described as
a “magic fountain pen” because of its ability to pro­
vide a simple and instant nerve reaction when put
to the skin. The device, which operates on two small
penlight batteries, has an electronic head at one end
with a probe that is heated to 40 degrees C when the
tester is switched on. The other end of the unit acts
as a contrasting cold probe.
Speyside has supplied 20 prototypes to the WHO,
and trials in India. Africa and Thailand with them
have another couple of months to run. Mr. Ramsay
said that, although the device is deceptively simple,
it took a long time to solve the problem of fitting the
electronic mechanism into such a small casing where
it competed for space with the two batteries. Mr.
Ramsay said it was not only leprosy victims who
would benefit from the development. Neurosurgeons
doing research on pain thresholds think they might
also be able to develop the device for their own
tests. A prototype tester has already been supplied
to a neurosurgeon in Stockholm.
—Bis

More Tooth Decay Reported in Third World Countries
N 1982 for the first time ever, more people in
the developing world were victims of toothache
than those in the developed world, according to a
report presented to the thirty-sixth World Health
Assembly held in Geneva.

I

That is one indication why the state of oral health
today is deteriorating in most countries of the third
world,
and particularly in urban areas, while
it is improving in the industrialized world.
This represents a sharp reversal of trends from two
decades ago, and is attributed to preventive program­
mes against both dental caries and periodontal dis­
eases (diseases of the gum and tissue around the
tooth). While such programmes are carried out by
developed countries, they are. in large part, neglected
by developing countries.

The prevalence of dental caries is recognized as
the chief indicator of oral health trends. Accord­
ing to experts of the World Health Organization
(WHO), the average number of caries in a popula­
tion is gauged by an index, based on a count of

October 1983

teeth “decayed”, “missing” and “filled” (DMF) in a
person at age 12.
Drawing on new data available from a WHO bank,
the report shows the DMF-teeth index as an aver­
age of 4.1 for the third world in 1982, but only 3.3 for
the industrialized world. For urban areas of develop­
ing countries, it is even higher than 5.

By way of comparison, 20 years ago the index
was less than 1 DMF-teeth for most developing
countries, and as high as 10 DMF-teeth for developed
countries. An index of up to l.l is rated “very low”
in caries; from 1.2 to 2.6, “low”; from 2.7 to 4.4
“moderate”: from 4.5 to 6.5, “high”; and above 6.6,
“very high”.

According to targets set in 1979, the goal is an
average of a 3 DMF-teeth index for all countries by
the year 2000. Although health officials believed
that the prevalence of dental caries “could be health
for most of the developing countries at, or below, the
level of 3 DDF-teeth”, that is not as yet proving to
be the case, the report states.

259

Another indicator of oral health is in the prevalence
of periodontal disease. Here, again the pattern for
developing and developed countries is dissimilar.
The prevalence of periodontal disease “remains
high’* in the third world, the WHO report says, while
it is decreasing to “moderate or even to low levels”
in industrialized countries.

By the year 2000 “many of the highly industriali­
zed countries will do far better than expected, re­
ducing their prevalence well below 3 DMF-teeth. and
very markedly reducing their levels of periodontal
diseases also”, the report says in summarizing the
situation, while adding :

Warning that targets are “unlikely to be achieved
by present endeavours”, the report calls on third
world countries to carry out programmes that promote
oral hygiene, essentially, brushing teeth: fluorides in
water, in tooth paste, in salt, and as tablets: as well
as diets low in sugar. “Though adequate, simple,
inexpensive, preventive technology is available”, the
WHO report states, “it has almost been exclusively the
highly industrialized countries” that have used them.
The greatest need of the third world is for the pri­
mary health care worker, trained in preventive mea­
sures, with dental auxiliaries next, at the level of first
referral, and with dentists only at the second level, but
with responsibility for all.
—U.N. Weekly Newsletter
July, 29 1983.

deficiency, which has been identified in children with
several metabolic diseases. must contribute signi­
ficantly to the spectrum of symptoms observed.” Dr
Stacey added. One in 5.000 people suffered such dis­
orders.
Dr Stacey said “dramatic” clinical improvement
and favourable biochemical changes had been de­
monstrated in a three-year-old patient as a result of
being given oral doses of carnitine. In another case,
a baby girl, one of twins, who was admitted to hos­
pital in a coma, was found to be excreting large
amounts of acylcarnitine. But when given extra car­
nitine the child recovered within hours.

There is hope that the use of carnitine may have
what Dr Stacey describes as “wider implications”.
BIS

(Contd. from Page 258)
From then on the armadillo has provided a regular
supply of the bacilli from which London’s National
Institute for Medical Research has produced vaccine.
Originally it was difficult to extract dead leprosy
germs from the animals without damaging the com­
ponents that immunize, but three scientists from the
Institute devised a process that was adequate both on
grounds of purity and volume of yield.
Scientists believe it may still take another seven
years to prove the effectiveness of the vaccine and so
open the door to a campaign of eradication.
BIS

VITAMIN B IS NEW CHALLENGE TO DISEASE
have discovered that children suffering
from metabolic diseases can achieve a “remark­
able” recovery by being given doses of Vitamin B.

S

cientists

Research at the Clinical Research Centre at Harrow,
London has shown that children with disorders of
organic acid metabolism can develop a secondary
deficiency or insufficiency of carnitine, which is also
known as Vitamin Bl. It appears to be associated
with increased acylcarnitine excretion.
Dr Terry Stacey, of the centre’s paediatric research
group, told a London conference that it was now
thought that extra carnitine would prove to be of
general value in the treatment of patients suffering
such diseases.

He said the clinical consequences of carnitine defi­
ciency included music weakness, recurrent vomiting
and general failure to thrive. “Secondary carnitine

260

DR KAKAR IS FIRST INDIAN
HONORARY F. R. C. S.

Dr Prem Kumar Kakar, Professor and
Head of the ENT Department, Maulana
Azad Medical College, New Delhi, was made
the first Indian Honorary Fellow of the Royal
College of Surgeons, London, at a private
ceremony held on 13 July, 1983.
Dr Kakar is a renowned ENT specialist
who pioneered eardrum transplant in Asia
in 1971 and established the only national ear
bank in India in 1975. He received the pre­
stigious Dr B. C. Roy National Award in
1982. A
Swasti-i Hind

Authors of the month
Sliri B. Shankaranand

Union Minister of Health & Family Welfare
Nirman Bhawan
NEW DELHI-110011.

IMPROVING
PHYSICIAN-PATIENT
INTER­
ACTIONS: A REVIEW. STRECHER, VJ. PATI­
ENT COUNSELLING AND HEALTH EDUCA­
TION. 1983; 4 (3): 129-36.

; The interaction between physician and patient
comprises aspects of communication common to any
two human beings and other aspects peculiar to the
roles exclusively adopted by physicians and patients.
In this
review, nonverbal and verbal elements of
general communication are discussed, detailing im­
portant aspects of vocal tone, body postures, appea­
rance, and verbal cues that may influence attributions
made of physicians by patients. Role-related element
of physician-patient interactions are discussed in the
light of findings from research on interactions bet­
ween physicians and patients. Developmental ele­
ments of general communication are discussed, re­
lating stages that evolve in interactions to physician­
patient interactions. Finally, an examination is made
of how interpersonal skills are taught to physicians
and medical, students.
Discussion of what skills are
specified for teaching, whether they are effectively
taught, and whether the learning of these skills pro­
duces desired patient health-related outcomes is pre­
sented.

Dr N. K. Sinha

Deputy Adviser (Health & F.W.)
Planning Commission
Yojana Bhawan
NEW DELHI-110001.
Dr Arthur Westing
Professor of Ecology
Hampshire College
U.S.A.

Shri S. V. Joshi
Retired Senior Architect
Central Public Works Department
NEW DELHI.
Mr Nedd Willard
Information Officer
World Health Organization
GENEVA (Switzerland).

Dr M. R. Girinatli
Addl. Chief Medical Officer (CVS)
Southern Railway HQ Hospital
MADRAS (Tamil nadu).

levels of communication within the group and with
those outside it should be commensurate with the goals.
The multi-disciplinary team should provide a service
relevant to its own community and patients. It should
be able to maintain its identity and sense of purpose
and must possess capacity for change.

THE MULTI-DISCIPLINARY TEAM: A DIFFE­
RENT APPROACH TO PATIENT MANAGEMENT.
LOGAN, RL. AND MCKENDRY, M. THE NEW
ZEALAND MEDICAL JOURNAL, 1982 DEC. 22;
95 (722): 883-4.

Qualities of ideal family physician

The use of multi-displinary teams in some areas of
patient management reflects changing concept of ill­
ness and increased specialization of those providing
health care. This paper discusses the ways in which
they function: Co-ordination of such teams with spe­
cial reference to the role of the doctor is considered.
Briefly examines the reasons why they may fail?

The ideal family physician was variously des­
cribed as communicative, sympthetic, easily
accessible and knowledgeable at a panel dis­
cussion on "What a family physician is to me”,
held during the annual conference of the
General Practitioners3 Association—Greater
Bombay, held in Bombay recently.

The optimal functioning of a multi-disciplinary team
is difficult to achieve and to maintain. The attitudes
and modes of behaviour are participative rather than
hierachical. If the team is to maintain its cohesion and
vitality, it is important that it pays attention to its own
health by regular review and assessment of its func­
tions and aims.
The principal causes of failure usu­
ally lie within rather than outside the team. Goals and
roles must be clearly defined and agreed upon. The

The panelists, representing a broad sec­
tion of society, insisted that doctors should
listen patiently, talk freely and regard their
patients not as impersonal cases but as indi­
viduals. Patients must be told the nature of
their illness and feel confident that they are
receiving the best care available, the panelists
said.

—Highlights of Cunent Literature
National Medical Library, New Delhi-

—Courtesy :

ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU,
AND PRINTED

BY

THE

MANAGER, GOVERNMENT

OF

KOTLA

INDIA

Medical Times. April/May 1983

MARG, NEW DELHI-1 10 002
PRESS,

COIMBATORE-641 019.

Regd. No. D(C)-359
Regd. No. RN. 4504/57

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