Swasth hind, Vol. 27, No.5, May, 1983.pdf

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WORLD COMMUNICATIONS YEAR : 1983
D Communications for social change
Communications research
... Developmental communications
Telecom in rural areas

ALL INDIA INSTITUTE OF HYGIENE
AND PUBLIC HEALTH, CALCUTTA
Five decades of progress

swasth
hind

HEALTH 2000

May 1983

Vaisakha-Jyaistha
Saka 1905

IN THIS ISSUE

Vol. XXVII No. 5
Readers Write

I am a regular reader of Swasth Hind and I have been
reading it for the last 10 years. This journal is very useful
not only for the medical men but also for any lay man. Every
issue gives new information regarding health.

Dr Rabindra K. Parida
Village Health Home
Sorisada, P.O. Patrapur
Cuttack.

Health for all: the count-down has begun

97

Expanded programme on immunization
Dr R. N. Basu

JOI

Goitre can be prevented
Dr P. C. Sen
Health problems in elderly females
Dt (Smt) Daksha D. Pandit

104
105

INSTITUTE
All India Institute of Hygiene and
Public Health, Calcutta-Five decades of
progress
Dr A. K. Chakraborty
Golden Jubilee celebrations

108

H3

communications
Swasth Hind has proved to be informative for library
users, We would like to subscribe it for three years.
Sint. Tajinder Kaur
Librarian
Indian Council for Child Welfare
4 Deen Dayal Upadhyaya Marg
New Delhi-110002

World Communications Year 1983:
development of communications infrastructure

Communications: a potent force for change
Salim Lone
Priorities in communications research
in Asia
Communications for development at the
village level

Articles on health topics are invited for publication in this
Journal.
State Health Directorates are requested to send reports of
their activities for publication.
The contents of this Journal are freely reproducible. Due
acknowledgement is requested.
The opinions expressed by the contributors are not necessarily
those of the Government of India.
SWASTH HIND reserves the right to edit the articles sent for
publication.

ASSTT. EDITOR
D. N. Issar

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11.6

117

120

123
Hl
cover

HEALTH FOR ALL

—The Count-down has Begun
Now is the time to evaluate the progress achieved in respect of
various health programmes with regard to the
overall development, updating and implementation of the strategy
for achieving the social goal of health for all by
the year 2000. It is in this context that the World Health
Organization (WHO) had chosen the theme
for the World Health Day-7 April, 1983 as
“HEALTH FOR ALL : THE COUNT-DOWN HAS BEGUN”.

May 1983
97

he country
witnesses significant progress in
health and family* welfare work since indepen­
dence. In the recent years the emphasis has been on
‘primary health care’ denoting a positive and pro­
motive health
status, with protection to people
against risk of diseases or illnesses that can be pre­
vented. The family welfare programme is aimed at
reducing birth, death and infant mortality rates and
improving the health status of the nation, especially
of women and children.

T

New 2Q-Point Programme
The key clement of the goal ‘Health for AH’ is
the provision of primary health care (PHC) to all
people, especially to those sections of the commu­
nity who continue to be trapped in poverty and illhealth. The new 20-point programme announced by
the Prime Minister Smt. Indira Gandhi on 14 Jan­
uary. 1982. pinpoints areas of special thrust which
would show immediate tangible results for the vari­
ous segments of the population. It includes health and
family welfare programmes concerned directly with
the health of the people and the universal augmen­
tation of primary health care facilities. These health
and family welfare programmes are:
— Substantially augmenting universal primary
health care facilities.
— Supply of safe drinking water to all problem
villages,
— Improving the environment, especially of
slums,
— Promote family planning on a voluntary basis
as a people’s movement.
— Control of leprosy.
— Control of T.B.
— Control of Blindness.
— Accelerating programmes of welfare for women
and children and nutrition programmes for
pregnant women, nursing mothers and child­
ren. especially in tribal, hill and backward
areas.
Primary health care
Indian health infrastructure aims to provide pri­
mary health care to all people who are as yet un­
served or underserved. To achieve this, the govern­
ment is not only revamping the organizational set-up
for rural health care by strengthening primary health
centres, but is also intensifying training activities for
a variety of primary health care workers in keeping
with their specific needs. The emphasis is now on the
active involvement of the community in the ongoing
health programmes, especially at the grass doot level

98

through Health Guides. The Health Guide Scheme
has been converted into a 100 per cent centrally spon­
sored scheme in order to make the health guides more
oriented towards family welfare.
An integrated approach to the health problem
through preventive, promotive, curative and rehabili­
tative measures along with effective linkages, with
other programmes like safe drinking water supply,
improvement in sanitation, nutrition education has
been adopted under the Sixth Plan. The rural health
infrastructure is being strengthened and remodelled.
For every 1000 people in villages there will be a
trained Health Guide who will provide health educa­
tion to the people, including family planning, treat
minor ailments, and refer cases requiring attention of
a doctor to the nearest primary health centre. There
will be a sub-centre for every 5000 population (3000
in hilly and difficult areas). A primary health centre
will serve roughly a population of about 30.000
(20.000 in hilly and difficult areas). A referral service
will be built up right from the village level to take
care of patients requiring specialist attention at the
Community Health Centre or District/Medical Col­
lege Hospital nearby.
By 1979-80, the country had 1.4 lakh health guides
and 50,000 sub-centres, 5,400 primary health centres
and 340 rural hospitals (community health centres).
The programme in the Sixth Plan is to add another
four lakh health guides. 174 rural hospitals (CHCs),
40.000 sub-centres and 1600 PHCs/Subsidiary Health
Centres. These form part of the Minimum Needs Pro­
gramme for which provisions have been made in the
Central/State Plans.

Supply of safe drinking water
Lack of safe drinking water continues to be a ma­
jor cause of water-borne diseases like cholera, typhoid
dysentry and diarrhoea and is responsible for high
incidence of guinea worm. Almost 80 per cent of all
diseases in the developing world are linked to unsafe
water. Also linked to this is the problem of sanitation
which needs to receive more attention.

It is proposed to ensure safe drinking water to vil­
lages suffering from chronic scarcity or those with
unsafe sources of water. Based on the nationwide sur­
vey during 1971-72. a total of 1.52 lakh villages in the
country were identified, as being without safe and as­
sured sources of drinking water.
Between 1972-73 and March 1980 as a result of the
larger investments made in the rural water supply
sector, about 95.000 problem villages have been pro­
vided with safe drinking water. The latest: data re-

Swasth TTfnd

Family Planning : Ser vice facilities and supply of contraceptives are being expanded in both rural and ur bandareas.
ccived from the State Governments show that as on
1st April, 1980, there are 2.31 lakh villages in the
country which need to be provided safe water supply
facilities on a priority basis.
During the Sixth Plan the effort is to cover all the
identified problem villages with at least one source of
safe potable water available throughout the year.
Improving the slums
Environmental sanitation is another important pro­
blem of our country, which has a direct bearing on
the health status of our people. Diseases like diarrhoea,
dysentery, cholera, and diseases of the chest and
worm-infestation can be controlled if the environ­
mental sanitation is improved along with the supply of
safe drinking water.
A scheme of environmental improvement of slums
was launched in 1972 under the central programme of
Special Welfare Schemes. From the commencement
of the Fifth Five Year Plan, the scheme became part
of the Minimum Needs Programme and was trans­
ferred to the State Sector.
It is visualized that the total slum population by
1990 would be around 37.87 million. Of this, a popu­
lation of 6.8 million has been covered under the
scheme up to March 1980 and efforts will have to be
made to cover the balance of slum population, esti­
mated at 31.07 million by 1990.

The facilities that would be provided are water
supply, storm water drainage, paving of streets, street
lighting and provision of community latrines. Areas
inhabited by Scheduled Castes are to be given due
priority. So also the residential areas of scavengers.

Family Planning
Family planning is essentially a people’s movement.
The people now realise the benefits of a small family.
The Government’s role is to educate them in the me­
thods of contraception so that they arc motivated to
accept, on their own, any one of them. Trained Gov­
ernment personnel have been deployed in all rural
and urban medical institutions in the country for
educating and motivating the people. Service facili­
ties and supply of contraceptives are being expanded
in both rural and urban areas to enable the people
to adopt any method of their choice including steri­
lization, IUD, conventional contraceptives and oral
pills.

It is necessary that a voluntary effort is intensified
at every level, i.e., from the village upwards to the
national level. The energies of all social, political, re­
ligious and cultural organizations and organizations
of youth, women employees, etc., have to be chan­
nelled and utilized in the process of educating the
people and making them adopt the small family
norm.

Control of leprosy
A programme for control of leprosy is being im­
plemented as a centrally sponsored scheme founded
by the Centre on 100 per cent basis. The objective of
the programme is to detect at least 90 per cent of the
cases and arrest the disease in at least 40 per cent
cases. It has since been decided to draw up and im­
plement an intensive programme for the eradication
of this disease before the end of this century.
The campaign for the eradication of the disease
will have to be launched with vigour and continued
till the objective is achieved. In this, the entire nation
is to play its role to tackle the problem. People’s par­
ticipation can come in many ways for case detection,
case holding and rehabilitation of the leprosy pa­
tients.

Control of tuberculosis
Tuberculosis continues to be one of the most seri­
ous public health problems in our country, but it is
no longer the frightening disease it used to be not
long ago. Effective tools to treat and prevent this di­
sease are now available, new methods of control have
been developed and anti-bacterial drugs are found to
be effective in curing even advanced cases. Still we
have nearly 10 million people suffering from this di­
sease, of whom about one fourth are active cases re­
quiring intensive treatment. Furthermore, about twoand-a-half million fresh cases arise every year and
about half a million die of this disease annually.

To tackle the problem of tuberculosis, 353 fully
equipped and staffed district TB centres have already
been set up covering more than 95 per cent of the
rural population.
It is a pity that a large number of our people suffer
and die of TB when they can be saved if proper pre­
cautions arc taken and infection avoided. Health edu­
cation can play a vital role in the prevention of the
disease. Making the people aware of the problems of
the disease, its spread, treatment and prevention will
go a long way in improving the health status of our
people.
Control of blindness
The National Programme for Control of Blindness
has also been converted to a 100 per cent centrally
sponsored scheme.

Under the current programme of control of pre­
ventable blindness on account of disease, nutritional
deficiency and cataract, the target in the Sixth Plan
is to bring down the incidence of blindness from 1.40
per cent in the base year to one per cent by the end

100

of 1984-85. There is a back-log of 60 lakh cases of
cataract and ten lakh cases are added each year. The
present capacity for dealing with cataract cases has
to be augmented. The thrust of the blindness control
programme is on development of preventive care at
the periphery to prevent blindness on account of nu­
tritional deficiencies and development of curative
facilities at the primary health centre and district
hospitals. Mobile clinics will also be provided for eye
care including operative treatment. Voluntary organi­
zations will continue to be given grants for conducting
eye camps.

Maternal and child care
The Sixth Plan for the first lime includes a separate
chapter on women, and development programmes for
the social and economic upliftment of women will re­
ceive greater attention. Priority attention will be given
to expand facilities for the improvement of education,
health and nutrition for both women and children.

In spite of expansion of the health infrastructure and
educational programmes in the country, the knowledge
about health and nutrition education and child rearing
practices continues to be quite low; particularly in the
rural areas.

Infant mortality is very high among lower socio-eco­
nomic groups. For tackling these problems a scheme of
Integrated Child Development Services was formulated
and initiated during 1975-76 on an experimental basis
in 33 rural and tribal blocks and urban slum areas.
The scheme aims to provide a package of services
consisting of (i) supplementary nutrition, (ii) immu­
nization, (iii) health check-up, (iv) referral services,
(v) nutrition and health education, and (vi) non-fornial education to children in the age group of 3-5
years. Functional literacy programme for young girls
and mothers has also been taken up in these blocks
to promote non-formal education that is functionally
relevant to child care, nutrition and health education.
Programme for supply of safe drinking water will also
make a contribution to this objective.

This shows that India’s health development efforts
are progressing well. However, these efforts need to
be stepped up if the goal of ‘Health for All’ is to be
achieved. The most important aspect is that the poli­
tical and professional leadership should work vigo­
rously and jointly to support and sustain the health
and welfare efforts with the active involvement of the
community and should also sweep aside any barriers
that might thwart the progress of the revolution that
is just building up.
—M. S. Dhillon

Swaslli Hind

nriiE Expanded Programme on Immunization (EPI)
1 was started in the country in January J978. With
this, continued progress has been achieved in the deve­
lopment of EPl al State, district and primary health
centre (PHC) levels. However, it will be worthwhile
to find out how far the programme is behind achieving
the goal “Health for All by 2000 A.D.” Immunization
is a basic activity of primary health care. It is rational
to identify the major areas of progress and shortfall
after the programme has been operated for five years.

Survey to estimate disease incidence

A sample survey to collect baseline data on polio­
myelitis and neo-natal tetanus was organized m the
country. Out of the planned 16 urban and 15 rural
units, surveys have been completed in all but three
urban and rural units each. Surveys have yielded use­
ful epidemiological data:

EXPANDED
PROGRAMME
ON
IMMUNIZATION
Dr R. N. Basu

(i) Data from routine reporting system is consider­
ably under-reported and. therefore, difficult to use
either for planning or evaluation. The annual incidence
rate of poliomyelitis in children varied from 1.5 to 1.9
per thousand children of 0-4 years. Based on this rate,
about 1.40 to 1.90 lakh children developed poliom­
yelitis every year. Less than one out of every 15 cases
.is reported to Central Bureau of Health Intelligence.
(ii) Results have conclusively shown that poliom­
yelitis is as serious a problem in the rural areas as in the
urban areas. Poliomyelitis was the single major cause
of lameness in children (62%). Majority of the cases
of poliomyelitis occur in children under two years of
age (70%).
(iii) As expected the incidence of neo-natal tetanus
was more in the rural areas as compared to the urban.
In some States, the neo-natal tetanus amounts to more
than 30 per cent of the neo-natal deaths in the rural
areas.

Cold chain

Expanded Programme on Immuni­
zation involves several tasks like orga­
nization of disease surveillance, deve­
lopment of cold chain, community
participation, training of personnel,
supply of equipments, periodic moni­
toring, in addition to expansion of
vaccination coverage.
o

May 1983

Major constraint in extending the vaccination ser­
vices is the limited cold storage facilities in the rural
areas and in many small towns. The erratic power
supply (electricity not available for about 12 hours a
day in some areas), large number of non-functioning
refrigerators, difficulties in getting ice. multiple storage
points are some of the problems.

Following steps have been taken to improve the
cold chain:
(i) Two workshops on cold chain were organised for
the programme officers to identify problems and for­
mulate proper remedial measures.

101

(ii) A booklet on the use of cold chain equipment
and their maintenance was circulated to all the con*
cemed officers, who are confronted with many pro­
blems relating to the maintenance of existing facilities
for their maximum utilization.
(iii) An inventory of refrigerators available at the
various levels has been prepared and is being updated
from time to time.
(iv) One national course for refrigerator repair tech­
nicians has been organized, who will be able to provide
maintenance services in their areas. A crash pro­
gramme of survey and repair of refrigerators to remove
the backlog has been taken up in three States.

(v) The present strategy is to have a cold room for
bulk storage at State/regional level (in big States), a
bank of refrigerators/deep freezers at district level and
a working refrigerator in each primary health centre.
Vaccine carriers will be used in sub-centres.
(vi) AH vaccines are supplied by air by the manufac­
turers to the States/regional stores. Polio and measles
vaccines are sent in cold boxes packed with ice.

Production of vaccine

India is now self-sufficient in the production of all
vaccines except polio and measles vaccines. Pasteur
Institute, Coonoor, has started to produce DPT vaccine
from 1982. Action has been taken to increase the ins­
talled capacity for production of DPT vaccine at Cen­
tral Research Institute, Kasauli. Indigenous manufac­
ture of polio vaccine has started and the batches are
being tested for quality, including neurovirulence test.
Polio vaccine at present used in the programme, is
imported in bulk_ concentrate and diluted, blended and
nmnouled in the country.
The epidemiological impact of the polio vaccination
programme will be greater if a large percentage of
children under two years of age in the selected areas
are covered with three doses of polio vaccine.

Measles immunization project
A measles immunization feasibility study is being
carried out in 34 selected medical colleges in the
country to determine the need for and the adminis­
trative feasibility of introducing measles vaccine in
the routine immunization services. The study includes
the monthly follow up of over 10,000 children, 9 to
23 months of age for two years to find out if measles.
directly or indirectly, influences the morbidity and

102

Results have conclusively shown that poliom­
yelitis is as serious a problem in the rural
areas as in the urban areas. Poliomyelitis
was the single major cause of lameness in
children (62 per cent).
Majority of the
cases of poliomyelitis occur in children
under two years of age (70 per cent).
growth pattern of children of this age group and whe­
ther measles vaccination will influence this by prevent­
ing the disease. The data is being analyzed using com­
puter at the National Informatics Centre, Delhi. Meas­
les vaccination will be included in the services delivery
programme whenever specific epidemiological condi­
tions warrant.

Monitoring of the programme
Vaccination coverage assessment surveys give objec­
tive data on the coverage of children under two years
of age. Such surveys are regularly carried out using
the cluster sampling technique by interview of mother
or observing the vaccination card. These surveys were
organized in nine areas in 1979, 19 areas in 1980. 20
areas in 1981 and 21 areas in 1982. Tn the urban area,
many of the children are being covered by voluntary
organizations and private medical practitioners, which
are not reflected in government reporting. In the rou­
tine reporting the age-wise vaccination is not indicated.
Thus the survey findings helped to know how many
were vaccinated in right age group and completed the
immunization schedule.

Training
About 28,000 former National Smallpox Eradica­
tion Programme (nsep) Staff were retrained in 1978
to take up various activities under Expanded Pro­
gramme on Immunization (epi). National training
courses on planning and management of EPT were
organised in different States for the medical officers
Responsible for implementation of EPT at the district
level. 516 officers have attended 31 courses held bet­
ween May 1980 and July 1982. 65 medical officers
of the State level and the centre (including national
institutes) and 35 principals of the Regional Health
and Family Welfare training centres participated in
the WHO training course on the planning and mana­
gement of EPI organized during 1978 to 1982. The
modules used in the training courses have been inte­
grated in the curriculum of the postgraduate students
of D.P.H. and MD. in Public Health at All India

Swasth Hind

Institute of Hygiene and Public Health and in courses
in Epidemiology at the National Institute of Commu­
nicable Diseases.
Areas needing urgent action

High drop-out rate—The drop-out rale from the
first to the third dose of DP T and polio vaccine is
high (more than 30%). Community participation has
to be ensured so that the mothers arc well motivated
to bring back their children repeatedly to the health
centres. The health workers should use every oppor­
tunity to immunize eligible children. The great majo­
rity of the children attend health centres for treatment
of minor illness, frequently combined with malnutri­
tion, and should be considered eligible for immuniza­
tion. Some of the reasons for drop-out rate are (i)
public not being adequately informed to return for
the subsequent dose, (ii) repeat visits for the second
and third dose missed in case of outreach operation
or campaign, and (iii) people not returning for fcar
of side reactions.

Neo-natal tetanus—National survey has shown that
nco-natal tetanus remains a serious public health pro­
blem in some states of the country. Each Primary
Health Centre [P.H.C.], district and State' should aim
for a nco-natal tetanus mortality rale of less than one
per 1000 live births by 1990. The successful control
of neo-natal tetanus should include both improved
maternity care and immunization of pregnant women
with tetanus toxoid. The immunization programme of
infants with DPT, school entrants with DT and the
children leaving primary school (10 years) and high
school (16 years) with TT, will protect the population
against non-nco-natal tetanus.
Control of poliomyelitis—Considering the severity
of the problem of disability caused by polio, it has
been proposed for faster expansion of polio vaccina­
tion programme. The following ycar-wisc coverage
has been planned:
Year

No. of beneficiaries

1982-83

50 lakhs

1983-84

75

|

1984-85

100

„

1985-86

150

|

1986-87

200

„

May 1983

Intensification of polio vaccination
Special polio vaccination drive was organised during
winter in J 98/ in the Integrated Child Development
Services (/CDS) blocks (tribal and blocks in remote
rural areas) and other selected areas, to have wider
coverage of the eligible population. During 1981, the
coverage was on an. average 6! per cent and it was
84’ 1 per cent in one block of Maharashtra with
three doses of polio vaccine.
Similar campaign
has been organized from
November 1982 to
vaccinate:
i) child born after last campaign ;
ii) children under two not covered during the last
campaign;
iii) children who received only one or two doses.
The timing of the programme had advantages of
low ambient temperature and lesser incidence of
diarrhoea. The period also preceded the seasonal out­
break of the disease.
By the year 1987, it should be possible to immunize
85 per cent new borns in the country. The coverage
of a large number of children who were at maximum
risk of getting the disease is expected to result in the
reduction in the incidence of poliomyelitis in these
areas. The surveillance of poliomyelitis must be
strengthened to monitor the programme effectively.
All health workers in close contact with community
should report any suspect polio cases, which have to
be investigated by the medical officer.
Expansion of vaccination coverage—Different strate­
gies could be adopted in different areas depending on
local conditions, which can be broadly classified in two
groups.
(i) increase in the number of centres (fixed station)
where vaccinations could be made available routinely
on a daily or weekly basis, along with other immuniza­
tion and health services.
(ii) organizations of short-term intensive outreach
operations during winter in selected areas, where addi­
tional inputs can be made available.

The present problem especially in BCG vacci­
nation is that large number of children vaccinated
are above two years of age. Emphasis has to be
given on vaccination of children before first birthday
with three doses of polio and DPT and one dose
of BCG vaccine. The use of immunization card will
help the health workers during domiciliary visits in
reminding the mothers for completing the dosage
schedule.
A

103

LOCALLY ENDEMIC DISEASES

GOITRE CAN BE PREVENTED
Dr P. C, Sen
Endemic goitre has been reported from all over the
World.
In I960, about 200 million people in the
world were estimated to be suffering from goitre, since
then a number of countries in Central and South
Americas have introduced control measures and
reduced the prevalence of the disease.
|n India alone, it is estimated that about 120
million people live in the known goitre endemic areas,
out of which nearly 40 million are suffering from
varying degrees of goitre.

TpN LARGE MEN T of thyroid
•'—'gland caused by an
insuffi­
cient intake of iodine is known as
goitre. Goitre is known to occur
universally with very few countries
entirely free from it. From the
public health point of view, it js
assumed that endemic goitre exists
—when the sample survey shows a
goitre prevalence rate of more
than 10 per cent among the popu­
lation in any circumscribed area.

These measures have narrowed
the geographical distribution of the
disease and in the map of the world
goitre can be described as a locally
endemic disease.

In India alone, it: is estimated that
about 120 million people live in
when iodized salt has been introduc­ the known goitre endemic areas,
ed, endemic goitre has been reduced out of which nearly 40 million are
to a large extent. Endemic goitre is suffering from varying degrees of
apt to appear in mounlaneous and goitre.
isolated places where a monotonous
diet is consumed for iong periods. Endemic belt
The cause of deficiency of iodine in
The endemic belt of goitre in
the soil may be related to flooding India exists along the Sub-Himalaand other geophysical characteris­ yan Region including the States of
tics.
Jammu and Kashmir, Himachal

Epidemiologically endemic goitre
is associated with endemic cretinism,
It is universally agreed that lack deaf mutism and with mental retar­
of iodine in foods is the primary dation of the new borns whose
cause of goitre. Other factors such mothers are suffering from goitre.
as excessive intake of certain goi­
Locally endemic disease
trogenic vegetables, increased de­
Endemic goitre has been reported
mand for thyroxin hormone during
from
all over the world. In 1960,
puberty, pregnancy and lactation,
etc., may play' contributory roles. about 200 million people in the
However, studies have shown that world were estimated to be suffering

104

from goitre, since then a number of
countries in Central and South Ame­
ricas have introduced control mea­
sures and reduced the prevalence
of the disease.

Pradesh, Punjab (2 districts), West
Bengal (5 districts), Sikkim, Assam,
Mizoram,
Meghalaya,
Tripura,
Manipur, Nagaland and Aruna chai
Pradesh. Incidence of goitre has
also been found in Aurangabad dis­
trict of Maharashtra, Bharuch dis­
trict of Gujarat and Shahdol and
Sidhi districts of Madhya Pradesh.
The average prevalence rate of
goitre in the endemic areas of the

Swastli Hind

country is estimated to be 30 per
cent.
Classification of goitre

Usually the classifications distin­
guish between visible and palpable
goitre. While visible goitre indicates
a moderate to severe deficiency of
iodine, its presence in children in­
dicates severe iodine deficiency. Si­
milarly nodular goitre may also
be found in areas where the defi­
ciency of iodine has been marked
for a very long time. Nodular goi­
tre is more common among the el­
derly.

Fortification of common salt with iodine has been accepted to
be the effective and most economical method for the control
of goitre. Nearly 40 countries in the world have been imple­
menting the salt iodization programme for the prevention of
goitre out of which 22 countries of the world have compulsory
iodization of kitchen salt and have eradicated goitre.
In India, fortification of common
salt with Potassium Iodate is being
implemented since 1959. Surpris­
ingly cases of goitre have been
found even .in those areas which
were previously thought to be goitre
free such as coastal regions. So
it is assumed that no part of India
can be called, goitre free and the
whole country is goitre prone.

iodization is possible near to ihc
consumption points.

The problems of transport,
a
regular indent for the iodized salt
to the plants, banning entry of com­
mon salt except iodized salt in the
area are some of the operational
problems of the programme. The
question of quality control of iodiz­
Prevention of goitre
ed salt from the point of manufac­
In
order
to
achieve
the
goal
of
turing to the point of consumption
Fortification of common salt with
iodine has been accepted to be the eradication of goitre, it has been is also another problem. There is
effective and most economical me­ recommended to supply iodized salt a possibility of deterioration
of
thod for the control of goitre. Near­ as a total replacement of kitchen iodine content during transit in the
ly 40 countries in the world have salt in a phased manner giving high­ hot and humid tropical climatic con­
been implementing the salt iodiza­ est priority to the hyper-endemic ditions in India.
tion programme for the prevention zone. Approximately eight lakh
The Government of India is
of goitre out of which 22 countries MT of iodized salt is required for
the
people
already
living
in
known
fully
aware about the problems and
of the world have compulsory iod­
ization of kitchen salt and have endemic areas. Twelve iodization trying to solve it through Technical
plants are functioning under the Review Committees of the National
eradicated goitre.
control of Salt Commissioner, Jai­ Goitre Control Programme, where
Alternative methods for controll­ pur. Ministry of Industry, for this members of the different Ministries
ing goitre are also being tried out. purpose. The Ministry of Health are present to take decisions.
For example in Argentina, New and Family Welfare give grant in
The problem in India is gigan­
Guyana, Peru, Zarie and Nepal, in­ aid to manufacturing units for the
tic
as far as goitre control is con­
jections of iodized oil is being tried. cost of iodization and plants are
Prophylactic trials with iodine ta­ supplied by UNICEF. The number cerned as it requires co-operation of
blets have been tried in Burma and of plants which arc in operation is salt industry. International Agen­
in some other countries. Tn the meagre to produce the total requi­ cies, different Ministries and commu­
South East Asiatic region introduc­ rement. Government is trying to nity at large. A strong political
tion of iodized salt was done in decentralize the plan of operation will and commitment is needed to
1959 in India, 1962 in Thailand. and bringing the State Governments give Goitre control a top priority
1970 in Burma, 1973 in Nepal and of hyper endemic regions to build and only then it can be eradicated
O
up their own plants so that the by 2000 A.D.
1977 in Indonesia.

Health problems and socio-economic problems are intimately interlinked
—Thirty-fourth. World Health Assembly

May 1983

105

or centuries women have been
programmed to accept their
ability to reproduce the children
as their prime function in life. Even
today, any woman who resists in
asserting her identity to the detri­
ment of her conventional role, runs
the risk of being ridiculed. Because
of these deeply ingrained sexist at­
titudes together with our society’s
pre-occupation with youth, is it any
wonder that many women regard
the menopause as the beginning of
the end? At no other time in
woman’s life is there such a com­
plex interplay between physical
and psychological factors as during
the menopausal years.

F

After 40, various physical and
harmonal changes take place which
are the result of manifestation of
various symptoms at the time of
menopause. Strictly speaking, the
menopause should be defined as
the time at which menstruation cea­
ses, and not used synonymously with
the climateric which is the phase of
waning ovarian activity and may
start two or three years before the
menopause and continue for two to
five years after it. The climacteric
is thus a phase of adjustment betmeen active and inactive ovarian
function and may occupy several
years of a woman’s life. The meno­
pause occurs between the ages of
45 and 50. There are variations in
the time of the onset in different
individuals. The three classical
ways in which the periods cease
are:
1. Sudden cessation.
2. Gradual diminution in the
amount of loss with each
regular period until
they
disappear.
3. Gradual increase in the
spacing of the periods until
they cease for an interval
of six months. Any patient
who bleeds after a gap of
six months must be considcr-

106

Dr (Smt) Daksha D. Pandit

HEALTH
PROBLEMS
IN
ELDERLY '
FEMALES
Ageing is a natural phonemenon which, as far as is known,
affects all higher forms of life
and perhaps all living things.
But it is not a disease. How­
ever, chronic diseases become
more common with increasing
age. Cardiovascular diseases,
cancer,
mental
illnessess,
diseases
of
locomotor
system, ear and eye diseases,
fractures are few which are
very common to both males
and females. But there are
certain disorders which are
specific to females.

ed to be suffering from post­
menopausal bleeding and
treated as such. Continuous
bleeding, menorrhagia, i.c.,
excessive bleeding, irregular
bleeding or other menstrual
abnormalities arc not nor­
mal. They must be investi­
gated despite the common be­
lief that they are “signs of
the change”.

Tt is a common misconception
that irregular and excessive uterine
haemorrhage is a
characteristic
symptom of menopause. Even to
this day cases of carcinoma of the
uterus are missed in their early
stages because the irregular hae­
morrhage caused by the carcinoma
is regarded as menopausal.
Besides these, there are other
menopausal symptoms:
1. The most common and noti­
ceable symptoms are
hot
flushing, sweatings and pal­
pitation.
2. Paraesthesiae, which take the
form of sensations of pins
and needles in the extre­
mities, are again very com­
mon. Headaches and noises
in ears are complained of
Psychical disturbances which
take the form of irritability
and depression arc frequent.
3. Sometimes there is flatulent
distension of the colon which
is associated with tendency to
constipation.
4. There are changes in
the
genital tract also. There is
atrophy of the vulva, vagina
and cervix. Because of this,
sometimes intercourse be­
comes painful. Uterus dimi­
nishes in size. Ovaries also
shrink in size.

There is a fear of the cancer, a
fear of end of sexual life and fear
of being rejected by the husband.
This is the time when she needs

Swasth Hind

reassurance, support from the hus­ Cancer of uterus
band and feeling of being wanted
For the cancer of the uterus or
by the family members.
any
other part of l he genital tract
To many people, old age
the
warning
is the irregular bleed­
appears to be a time of chro­ Sexuality in woman over fifty.
ing. In such cases doctor should
There is a misconception that
nic illness, failing mental abi­
white discharge, spoiling after in­
lities and stagnation. But the beginning of menopause is an end tercourse or post-menopausal bleed­
problems associated with old to sex life. The enjoyment of the ing. In such cases doctor should
sex act during or after menopausal
age are not medical problems years will depend upon the previous be consulted immediately without
only; they have social, cul­ coital experiences and self image. wasting time. Sometimes when the
tural and economic ramifica­ Women can enjoy sex and remain cancer of the genital tract is in
very early stage, no symptoms are
tions that affect the life of the orgasmic all the days of their life. there but it can be detected by a
individual and the commu­ In fact, for some women, sex is ‘papsmear test’. Zill women above
even better after menopause, be­
40 to 45 years ol age should go
nity.
cause by this time most women
for this test every three to five years
Ageing people need the reach their middle fifties and their to rule out cancer of the genital
major family responsibilities arc
same social interaction, emo­ over. Thus, with less worry, more tract in very early stages.
To remain healthy, the following
tional support and health spare time and perhaps financial
principles
should be practised'
care as the rest of society. security at last realised, many
*
Regular
physical check up at
There is also a need for inno­ women can enjoy sex on a more
least
twice
a year is very im­
vative measures to provide mature and emotionally gratifying
portant
in
tills age group. It
social security, fixed income, plane.
will help to detect the early
housing, meals, and other Cancer of breast
onset of the diseases and
If the breast cancer is detected in
services within the commu­
sometimes may even spot the
disease which can be danger­
nity. Therefore, helping the very early stages then it can be
ous and incurable if not treat­
elderly must be given greater cured, and there is a very simple
method by which
breast cancer
ed
in the initial stages.
prestige in national health can be detected by a woman. They
* Regular physical exercise.
and social services. There should examine the breasts with
• Balanced diet.
should be a drive to bring their hand for any difference in
* Avoiding obesity.
people of all ages closer and size, shape and contour. If any
*
Protection from accidents.
change is noticed, any nodule is
together.
*
Avoidance
of mental sticss
there in the breast the doctor should
and strain.
be consulted immediately.

Prize for work on communication
Under UNESCO’s patronage, an international prize for work in communication,
the McLuhan Teleglobe Canada Award, will be presented this year for the first time.
The prize, worth 50,000 Canadian Dollars, will be awarded every two years to an
individual, or a group of individuals working as a team, who make an exceptional
contribution to better understanding of the influence of the communication media and
technology on society in general and on the cultural, artistic and scientific life.
The prize has been established by the Canadian Commission for UNESCO in
association with the Teleglobe Canada Corporation.
A five-man jury of Canadian citizens will select winners from candidates nomi­
nated by National Commissions for UNESCO. Deadline for submission of candi­

datures for 1983 is 31 July.
Herbet Marshall McLuhan who died in 1980, was born in 1911 in Edmonton,
in the province of Alberta, Canada, and became famous for his theories on communica­
tion and the media.
U. N. Weekly Newsletter, 4 February, 1983
May 1983

107

The onset of plague in 1896, roused the colonial
Government from their aparthy and plague commis­
sion was appointed. It submitted report in 1904 and its
recommendations paved the way for development
of public health departments and research in India.
In 1912, the Government of India formulated an im­
portant declaration of sanitary policy, establishing re­
search on a sound basis, and giving grants to local
Governments for the augmentation of their sanitary
staff. The Government of British India insisted that
candidates for Assistant Directorship of Public Health
should have a British Diploma of Public Health.
Health Officers of first class towns were also required
to have a British Diploma of Public Health. After the
publication of plague commission’s report, Calcutta
University decided to institute the Diploma in Public
Health (DPH) in 1907 to encourage the study of public
health.

Golden Jubilee Year

ALL INDIA
INSTITUTE OF
HYGIENE
AND
PUBLIC HEALTH
CALCUTTA
Dr A. K. Chakraborty

108

Sir Leonard Rogers of Calcutta Medical College con­
ceived in 1914 the idea of establishing an institution in
India for post-graduate study in tropical medicine and
hygiene. Owing to his perseverance and enthusiasm
Calcutta School of Tropical Medicine was established
in 1920 for teaching and research in tropical medicine
and hygiene. Sir, Leonard had to leave India because
of ill-health and Sir John Megaw became the first direc­
tor of the School. He was quick to start the DPH course
at the School from October 1922. A Professorship in
Hygiene was established in the School and Lt. Col.
A.D. Stewart held that post.
As the concept of public health was gradually ex­
panding and diverse subjects were included in the
DPH course, it was felt that a separate institution was
needed to deal purely with public health subjects.
Dr. W. S. Carter, Associate Director of the Rockefeller
Foundation in his periodic tours of India and the
Far East, met Major General Megaw and MajorGeneral Sir J. D. Graham, Public Health Commis­
sioner, with the Government of India on various oc­
casions and became deeply impressed with the neces­
sity for establishing an All India Institute of Hygiene.
Much of the teaching in basic subjects such as bac­
teriology and protozoology for the Diploma of Public
Health is similar to that for the Diploma of Tropical
Medicine and as this was being taught in the School
of Tropical Medicine, Dr Carter grasped the obvious
advantage of Calcutta as a location for an All India
Institute of Hygiene and Public Health and a site
close to the Calcutta School of Tropical Medicine,
where basic subjects would continue to be taught. The
Institute was formally opened on 30 December, 1932
by Sir John Anderson, Governor of Bengal.

Swasth Hind

FIVE DECADES OF PROGRESS
AU India Institute of Hygiene and Public
Health, Calcutta (AIIH&PH). started with four
departments, viz- Public Health Administration, Malariology and Rural Hygiene, Vital Statistics and Epide­
miology, Biochemistry and Nutrition. Number of
seats for Diploma in Public Health was 24.
he

T

During the fifty years, with the expansion of the
horizon of public health, the Institute grew in size
and activities. The number of Departments rose from
four to thirteen and of academic courses increased
from one to twelve and of students admitted annually
increased from 24 to 300 approximately.

Objectives of the Institute
The chief objectives of the Institute are: (a) to
develop health manpower by providing post-graduate
facilities of the highest order; (b) to conduct research
directed towards the solution of various problems of
health and disease in the people; (c) to evolve and
develop methods for optimum utilization and appli­
cation of the results of both pure and applied research
towards promotion of health, effective and efficient
delivery of health care services.

Organization
The Institute is under the control of the Director
General of Health Services (DGHS) in the Ministry
of Health and Family Welfare of the Government of
India.
The Director is the executive Head of the Institute
and is assisted by the Deputy Director and the Faculty
Council in academic and technical matters, and by an
Administrative Officer and three Superintendents in
Administration.
The Institute is well equipped and has well quali­
fied and experienced teaching faculty on its full-time
staff. There arc thirteen Academic Departments each
under the control of a Professor, and two health cen­
tres. one rural and the other urban. The departments
arc Behavioural Sciences, Biochemistry and Nutrition;
Maternal and Child Health; Health Education: Epi­
demiology: Microbiology: Occupational Health. Pub­
lic Health Administration: public Health Nursing:
Sanitary Engineering: Preventive and Social Medicine;
Health Statistics: and Veterinary Public Health.

May 1983

The Post Independence phase of the develop­
ment of the Institute was marked by significant
augmentation of training facilities both by
way of increasing the seats for the? Diploma
in Public Health and by way of introducing
new academic and refresher courses in sub­
speciality subjects.
Taking over the responsibility of Rural Health
Unit and Training Centre, Singur, in 1944:
MCH Project, a joint venture of the WHO,
the UNICEF and the Government of India
in 1953; establishing Urban Health Centre,
Chetla, in 1955; RcA Project at Singur with
the help of Fold Foundation in 1957 are some
of the significant landmarks in the develop­
ment of the Institute.
All the Departments provide good facilities for re­
search in various health and allied sciences.

The two field practice areas at Singur and Chetla
arc the population laboratories and form special fea­
tures of the Institute. They provide excellent opportu­
nities for field training, research and learning all as­
pects of community health care in a true setting.

Each department has its responsibility in the rural
and in the urban practice fields. While the technical
guidance is given by the departmental heads, the ad­
ministrative control rests with the respective Officer­
in-Charge of Administration, who reports to the Direc­
tor. The participation of the people is ensured through
the Local Health Councils in the urban area and
Panchayat Samities and Local Health Committee at
the village level.
Library
The Institute library is one of the few reference
libraries on health sciences in India. It has a collec­
tion of 41.634 books and back volumes of journals.
307 current journals and periodicals and 12.226 re­
ports and research papers. The staff and students of
the Institute also avail full facilities of the library of

109

Field Training : The Rural Health Unit and Training Centre at Singur, serves as a rural .
field area for various categories of health personnel.
P C

the School of Tropical Medicine, across the road,
through a coordination programme.
Training
The Institute is affiliated to the Calcutta University
which confers degrees and diplomas in several sub­
specialities of public health.

tions such as Indian Council of Medical Research
(ICMR). World Health Organiation (WHO), etc. About
300 students from various States and Union Terri­
tories of India and other Asian and African countries
are trained every year.

Academic courses conducted by the Institute
Courses

This Institute is the only one in India where multi­
professional, post-graduate training is made available
in various disciplines to medical doctors, engineers,
nurses.
nutritionists, dieticians, health educators,
veterinarians, statisticians, demographers, social scien­
tists. epidemiologists, microbiologists, etc.
The Institute conducts three Doctoral Degree cour­
ses, two Masters Degree courses, seven Diploma cour­
ses. three Certificate courses and many orientation
training programmes supported by the Government of
India and/or National and International Organiza­

110

-Doctor of Science (PH)
Doctor of Philosophy (Epid)
Doctor of Medicine (PSM)
Master of Engineering (PH)
Master cf Veterinary Public He;.1th
Diploma in Public Health
Diploma in Industrial Health
Diploma in Maternity & Child Welfare
Diploma in Dietetics
Diploma in Health Statistics
Diploma in Health Education
Diploma in Public Health Nursing

Sanctioned s cuts
No fixed number
No fixed number
7
30
10
60
10
30
20
5
35
40

Swasth Hind

Total number of students trained in degree and
diploma courses upto 30 June, 1982:
Course

Doctor of Science (PH)
Doctor of Philosophy (Epid)
Doctor of Medicine (FSM)
Master of Engineering (PH)
Muster of Veterinary Public Health
Diploma in Public Health
Diploma in Industrial Health
Diploma in Maternity & Child
Welfare
Diploma in Dietetics
Diploma in Health Statistics
Diploma in Health Education
D’ploma in Health Public Nursing

Cumulative
Year of
total upto
commence­
30 June, 1982
ment
1936
1958
1973
1948
1970
1932
1950

5
32
43
858
67
2158
211

1933
1949
1966
1966
1976

330
482
74
470
235

As many as 379 students from 40 countries of
Africa and Asia have been trained so far in this
Institute.
The teaching at the Institute comprises class room
lecture-discussion, seminars, problem solving exercises,
laboratory sessions and field experiences in both urban
and rural practice areas.

The students of different training programmes have
obligatory block placements at the Rural Health Unit
and Training Centre, Singur. In addition, students
from other institutions also use the facility. Main
objectives of the field placements are understanding
and diagnosing health problems of the community,
providing solutions to some of them, and evaluating
health programmes. Developing professional skills is
stressed in the assignments.
Field experiences of varied nature are given at the
Urban Health Centre, Chetla, to the students of diffe­
rent courses of the Institute as well as to those from
other institutions. Family care programme, where
suitable families are assigned to students for a period:
observation visits; participative assignments in clinics
and community, and block field placements for longer
periods are some of the types of field training being
given.

Research
Thd Institute has provided ample facilities within
its field practice areas and laboratories both for ap­
plied and fundamental research. Research activities of
the Institute have steadily increased to cover wide

May 1983

1 raining ; Students oj a training course parti cipating in a seminar.

fields giving shape to new concepts and to develop­
ments of methodology for tackling community pro­
blems. Collaborative studies between diverse fields
and different departments of the Institute have catered
to meet the health needs of the community. The In­
stitute has collaborated with State governments to find
solutions to problems particular to the area. Areas in
which research has been conducted are: communi­
cable
diseases; nutrition; sanitation; maternal and
child health; occupational health; Family planning;
health services; demography; veterinary public health;
community participation; epidemiology, health ser­
vices and health care delivery.

Some studies which have gained wide acclaim
are in the field of cholera, protein hydrolysate, epi­
Health Services :
A health worker taking blood­
slide in Singur area.

{continued from page 112)
cutaneous diphtheria
in natural immunization was
established.
6. Rural latrine: An acceptable design of a pit type
latrine for rural area under the Rescarch-cum-Action
projects was worked out. This type of latrine has
been accepted all over the country as a low cost sani­
tary latrine, especially for the rural areas.
7. Stream pollution surveys: Realizing the import­
ance of developing an overall water pollution control
programme for the country, the Institute carried out
surveys on Hooghly. Sone, Daha, Damodar and Gomti
rivers. These surveys yielded data on the pollution
status of the rivers and their self purification capacity.
This prompted enactment of prevention of water pollu­
tion act of the Government of India.

10. Rural population control: The objectives of the
study were to develop suitable methods of approaching
rural population with acceptable methods of family
planning and to test the effect on the birth rate of
the community. The study was conducted in Singur.
The study showed perhaps for the first lime in India
that the subject of family planning could be discussed
freely among the village people by social workers and
health staff. It demonstrated also the most appro­
priate methods for approaching the rural people and
persuading them to accept methods for control of
family size. It was shown that there was usually a
lag of several months between acceptance and regular
practice of any method of family planning. During the
intensive phase the birth rale showed a slow but
steady decline.

Rural Health Unit And Training Centre, Singur
8. Air pollution: Nature and extent of air pollu­
tion in Calcutta were studied. The levels of such poten­
tially harmful contaminants as sulphur dioxide, am­
monia. oxides of nitrogen, etc., were determined and
fluctuation over the different seasons were noted.

9. Health survey: A methodology for health sur­
vey was developed in order to obtain an integrated
picture of the health conditions of the community.
First survey was carried out in Singur in 1944. Subse­
quently many surveys were carried out in different,
parts of the country.
Nutrition :

A Nutrition Clini

The Rural Health Unit and Training Centre at
Singur was established in 1939 as a joint project bet­
ween the Government of Bengal, District Board,
Hooghly and Rockefeller Foundation. In 1944, All
India Institute of Hygiene and Public Health, Cal­
cutta, assumed full administrative responsibility of the
area.

Singur is located about 40 Kms. North-West of
Calcutta, off Calcutta-Delhi National Highway. The
area of operation under the Centre is 60 Sq. Kms.
located in the Singur Block of Chandernagore Sub-

at a rural health centre of the Institute.

’

Primary Health Care :

A lubewell being repaired in the Rural Health Centre area, Singur,

division, Hooghly District-. A population of 60,000 re­
siding in 61 villages are provided comprehensive health
care.

tipa villages. An upgraded Primary Health Centre at
Singur provides both indoor (60 beds) and outdoor
services.

Objectives

The total area is divided into twelve units, of about
5.000 population each. A unit has one male health
worker and one female health worker. A male and a
female supervisor supervise the work of four units.
The Supervisors in tum are responsible to the Medical
Officers of the Health Centres serving the units.

— To serve as a rural practice field area for vari­
ous categories of public health personnel under­
going post-graduate training.
— To organize rural communities for self-help
and for increased participation in solving health
problems and supplementing government efforts.

— To conduct research on rural health problems

and to evolve and apply practical methods for
solving them.
—

To provide comprehensive health services to
the rural population.

Organization

The Rural Health Unit and Training Centre, com­
prises main campus where the administrative block,
students’ hostel, polyclinic, padiatric unit with eight
beds, chest, clinic, public health laboratory, radiology
unit and engineering workshop are situated. Tt also
includes two health centres, one located in Dearah
with 16 beds and another in Anandanagar with eight
beds and sub-centres at Nasibpur. Paltagarh and Bali-

May 1983

Basic services

Primary health care is provided in the area taking
the family as a unit for service. Such care comprises
provision of water supply through tubewells; sanitary
disposal of excreta maternal and child health care
family welfare services: control of communicable dis­
eases including immunization of vulnerable groups;
health education: provision of nutrition services, medi­
cal care at the home, and at the health centres both
outdoor and indoor and referral services. These com­
ponents are supported by public health laboratory,
radiology, ambulance and statistical services.

Community participation
Rapport with local leaders and the people has been
well established over the years. Village Health Com(con tinned on page' 123)

115

WORLD
COMMUNICATIONS

YEAR:
development
of
communications
infrastructures

#1983

Next only to food, shelter and energy on the list of vital
needs for human survival, communications constitute the life
blood of today’s world and serve as a constant reminder of the
oneness of human destiny.
The past half century or so has witnessed an exponential
growth in the world’s communications capability: yet, with the
introduction of every new service, man's needs grow even faster
and the spiralling demand for more and more communications
facilities is a reflection of man's endless search for a better life.
The development of communications infrastructures all over
the world is the primary objective of the world communications
year. The world of today is getting smaller and smaller, thanks
to the. constant growth of communications net-works in many
countries. However, there exists an imbalance in the develop­
ment of communications infrastructures in various parts of the
globe. Only through the redress of this imbalance by a more
even development of communications infrastructures everywhere
can the peoples of the world be brought together, thus creating
more stable conditions for the maintenance of international
peace and security.
A World Year for what purpose?
Better communications
through improved infrastructures
The result of any move to improve communications infra­
structures is an improvement of the communications which are
essential to most human activities:
posts and telecommunications; broadcasting, television, press,
etc.: transport (air, see, rail, road): industry: trade,
agriculture; health: education .........................
Better communications mean
better living conditions.

Communications infrastructures include:
All the fixed and. mobile installations—building and equipment
—needed to make communications work.
For example: Telephone exchanges, radio stations on ships, air­
craft, satellites and manned space vessels, transmitters, antannae,
cables. Post Offices, postal vehicles, etc.

“Everyone has the right... to
seek, receive and impart infor­
mation and ideas... through
any media.”
(Art. 19 of Universal Declaration of
Human Rights doptcd by the United
Nations General Assembly on 10 December,
1948)

World Communications Year 1983
emanates from the determination clearly expressed by all States
to intensify the endeavours of the United Nations system to
promote balanced social and economic development by speeding
up the establishment of communications infrastructures. Tt will
be given practical expression in programmes of reflection and
action at the World, regional and national levels.
The General Assembly
Recognizing the fundamental importance of communications
infrastructures as an essential element in the economic and social
development of all countries.
Convinced that a World Communications Year would pro­
vide the opportunity for all countries , to undertake an in-depth
review and analysis of their policies on communications develop­
ment and stimulate the accelerated development of communica­
tions infrastructures.
Endorsed the proposal made by the Economic and Social
Council in paragraph 1 of its resolution 1981/60 and proclaimed
the year 1983 World Communications Year.
(Extract from United Nations General
Assembly resolution 36/40 adopted on
19 November, 1981.)

116

Swasth Hind

COMMUNICATIONS:
a potent force for change
SaLiM Lone
. . . There is tlie growing realiza­
tion in the international community
that a major shortcoming of many
development efforts of the past two
decades has been the absence of
close communication between all
those—planners, professionals and
the population—involved in deve­
lopment programmes.

More than a medium, more
than a message, communica­
tion is the total process
whereby people understand
each other, and each other’s
environment and aspirations.
Correcting
misperceptions,
and placing real communica­
tion at the centre of develop­
ment
programmes,
can
help overcome the obstacle;
that stand in the way of social
change.

It is from the development arena
that some of the strongest challenges
to the established communication
structures are emerging. One cle­
ment of the challenge comes from
those struggling to place communi­
cation between the deprived com­
munities and those providing them
Not that awareness of the im­ expertise, at the centre of develop­
portance of communication wasn't ment planning. Contending that
there. But just as the process of human communication is the pivot
development was seen primarily as on which balances the success or
the provision of goods and services failure not only of individual pro­
to the people, communication was grammes but of the whole process
conceived as a static, one-way flow of development, these protagonists
of information from the “profes­ argue that traditional societies are
sionals'’ to the masses. Enormous socially literate. Over generations,
amounts of energy and resources they established their own norms
were spent on developing a tech­ and technologies, which were dyna­
nology which would make “com­ mic and constantly propelled the
munication” as instantaneous and societies to higher stages of pro­
far-reaching as possible and the duction. Not to understand this,
whole exercise was predicated on and to perceive third world commu­
the notion that those providing this nities as helpless bystanders who are
technology were also the ones to .too backward to understand the in­
provide the ideas and the solutions terventions that are being organized
for those at the listening—receiv­ on their behalf, is a sure recipe for
failure.
ing-end.

The sophisticated new systems—
new generations of satellites being
launched, submarine cables being
laid, optical fibres and lasers being
harnessed for information transport
—actually emphasize the technologi­
cal mastery of one group and heigh­
ten the fear of scientific incompetence
of the other. They have even some­
times become the instruments for
hindering the very participation and
interaction that communication is
meant to promote.

May 1983

Third World Communities

The argument would seem pain­
fully obvious were it not for the fact
that even to this day, the vast
majority of development program­
mes are conceived and executed
without a serious communication
component.
Communications personnel arc
rankled by this “plan first, commu­
nicate only after initial failure” syn­
drome. But as more and more of

117

those alter-thc-fact appeals are A leans and ends
is closely related to the paternalistic
heard, it is becoming clear to plan­
Amongst those who have been method of teaching described by
ners that communication is not
advocating a more careful study Brazilian educator Paulo Frcirc as a
merely another hardware component
of communication for social develop­ "banking’’ system, where informa­
consisting of posters, radio messages,
ment is Andreas Fugelsang, a de­ tion is passed down from the active
and so on, but a central and deci­
velopment specialist who learned a teacher to the passive recipient. Tn
sive factor of any programme. Whe­
great deal from the cultures in which Freire’s view, this “prescriptive tea­
ther it is an cQort to reduce the
he lived. Noling the tenuousness of ching” diminishes the learner who
death rale from water-borne diseases
traditional culture, which "is a care­ is encouraged not to act upon his
in West Africa or an attempt to
fully balanced man/environment in­ or her world, but to reflect back the
increase the rice yield in Asia, the
teraction system, in which every de­ ideas given by the teacher. Freire
conunuuication of the ideas involv­
tail has both technological function counters this with the notion of
ed does not lake place automatically.
and spiritual significance and can­ “liberating education” which treats
On the contrary: not only is their
not be disrupted without drastic learners not as objects but as sub­
value far from self-evident to pro­
repercussion for the function of the jects who act upon their world to
gramme recipients, but their dis­
whole,” Fugelsang argues that the change it. The tenets of Freire’s
placement of an existing set of
way new systems, processes and thought are that no-one can teach
strongly-held ideas is a complex
ideas are introduced into a way of anyone else; no-one learns alone;
undertaking.
life is as important as the benefits people learn together, acting in and
which those new systems and ideas on their world.
Helping communications gain a
hope to generate. To introduce
Freire rejects conventional educa­
more appropriate place in the deve­
what seems eminently logical to the tion as the tool ruling classes use to
lopment context has been enor­
outsider might in fact strain the re­ discourage the poor from learning
mously helped by recent evidence
cipient community's delicate fabric and understanding the bases of their
about its impact. We have seen,
of socio-economic cohesion.
deprivations. The learning experi­
for example, the massive shift away
ence’s primary purpose is to help
from breastfeeding in just one gene­
To work in these traditional en­ change society, says Freire, parti­
ration. The aggressive use of mar­ vironments, Fugelsang argues insis­
cularly that aspect which has denied
keting techniques and the mass tently, requires sensitive and astute
the illiterates an opportunity to par­
media to convince mothers of the workers who can sympathetically
ticipate in their own destiny.
merits of formula feeds has contri­ comprehend the web of social rela­
buted to the breastfeeding decline. tions of the group. Villages are
The commercial communicators
In a Latin America study we have not the collection of individuals that
Among those who must be classi­
seen how two groups of children industrial, urban populations lend
from identical, impoverished social to be, and their attitude towards fied as successful in fully investigat­
classes show markedly different nu­ their leaders is different too. Mo­ ing their target-group and understan­
tritional status, thanks in the main dern societies allow professionals to ding how to communicate with them
to the ownership of radios by the lead them not necessarily for what are the commercial manufacturers.
healthier families. And we have they are intrinsically, but for their Their advertising campaigns have re­
seen the yearning in many countries position in the system. But in the volutionized consumption habits and
for expensive imported clothing in­ village, a professional will have cre­ life-styles across the world. They
ferior in quality to locally made dibility problems until he or she has have saturated the media with ad­
garments, on the. strength again of proved his worth on a purely human vertising carefully researched to
the myths and lifestyles promoted basis. “Villagers live in commu­ gauge the concerns of their audience,
by their communication environ­ nion,” says Fugelsang. “and life and have succeeded far better in
ment. We are now realizing that there is characterized by intense changing behaviour than have con­
sciously-designed development pro­
when we talk of communications in communication and interaction”.
grammes. In most third world
the context oF social and behaviou­
countries,
companies marketing agri- •
ral change, we need to consider
The distorted view of traditional
not only the “medium” and the societies that Fugelsang and others cultural products have reached re­
“message” but also all those ideas, have in the last decade tried to mote farming communities with
habits and aspirations acquired correct was responsible for the hier­ weed killers, fertilizer and insec­
through social contact and inter­ archical approach typical of so much ticides. But try asking the same
action*
development work. This approach villagers if they know what is the

118

Swaslli Hind

Telecommunication media could be used advantageously to promote better health
and to encourage, greater utilization of the existing health services.

best remedy for diarrhoea. And in educator confined to traditional approach is often too serious and
many poor urban areas people will channels doesn’t stand a chance”. academic, and therefore less impact­
pay hard-earned cash for snacks he asserts.
ful. For example, when I was help­
and junk food, persuaded by com­
ing promote oral rehydration thera­
mercial advertising that they are
ManofT begins with a religious py in Nicaragua, we tried to make
somehow “better” than vegetables conviction that there is no idea that the message simple and catchy. We
from the backyard.
'annot be promoted as are com­ just said: “Make super lemonada
mercial products. The way to get at home—it will fight diarrhoea’.
A growing number of voices, your message across, he says, is The lemonade
concept was one
recognizing the impact of comme- to create one which is short and most mothers related to immediate­
cial advertising, are therefore advo­ confined to a single idea. Tf you ly. and that is basically what anti­
cating that their techniques be adop­ took through history, you will find dehydration is: lemon, salt and
ted in the promotion of social deve­ that the great messages have been sugar. And we didn’t give it any
lopment. They argue that not to do simple and short. Moses only had formal name such as ORS. either.
so is to abdicate the print and air 10 commandments and they hardly The
reach of the message was
waves to those whose primary aim add up to 60 words and the 17 enormous”.
is profit and whose objectives arc Rock Edicts of Ashoka are equal­
Participation and communication:
in direct conflict with the develop­ ly brief and to the point.
two sides of one coin
ment propagandists. Richard ManofT is an experienced advertising
While many educators and com­
“Since we are not trying to make
man who has used his commercial the rural mother a nutritionist or municators do not accept Frei re’s
skills to promote developmental a doctor. I don’t see why so many ideological analysis, his emphasis on
messages
in the third
world. of you are writing books or pam­ participation reflects what is proba­
Against the enormous power of phlets which few people except your bly the strongest new orientation in
the mass media to fashion food colleagues are going to read”, he development work. The whole
habits via advertising, the nutrition says. “The development worker’s
(Contd. on page 124}

May 1083

119

here has been a growing aware­ the cost effectiveness of media. Some logy; Uneven and inequitable ac­
ness of the need for research in research questions which may be cess to information due to disparity
the field of communications.
asked are as follows: Which of the in technology: Social costs of tech­
media or media mix arc most cost- nology: Appropriate and alterna­
Instructional communication
effective for different purposes? tive technologies.
Research in this area is important What is an optimal investment st­
Institutional studies
because of the vast number of ap­ rategy in the financing of commu­
Communication institutions can
plications for communication and nication technology? What is the
be
distinguished by several features:
communication technology
for economic trade-off between invest­
(a)
the employment of technology:
instructional purposes. In several ment in communication as against
(b)
the
rapid production and mana­
other
sectors,
such
as
transportation?
Asian countries, media are used for
gement of creative material; (c) the
formal as well as non-formal edu­
Areas covered include: Alterna­ demanding circumstances such as
cation. “Open” Universities have
been established in a number of tive financial support systems for pressing deadlines.
Asian countries. Educational Tele­ different media: Communication in­
Research on the influences and
and effects of these factors can help
vision is also being used in nearly vestment strategies among

T

Priorities in Communications
Research in Asia
all Asian countries. Media techno­ between media; Production of me­
logy is applied for instructional and dia output: Economics of the comdemonstration purposes in develop­ munication/information media sec­
tors).
ment campaigns at village level.

Projects which may be studied in
this area are: Analysis of ETV
(formal and non-formal) systems
in selected countries relating to co­
ordination, utilization, and feed­
back; Principles and techniques of
distance learning: Development tea­
ching and training programmes in
instructional communication and
technology: and Feasibility/Appiication of low-cost media for instruc­
tional purposes.
Media economics

In view of the scarce resources of
Asian
countries, the relatively
heavy investment in various media
require justification and rationaliza­
tion especially where such expendi­
ture has pressing alternative uses.
Research can be done to improve

120

us understand and manage such
institutions better. These studies can
examine themes such as: decision­
making
processes;
gate-keeping
functions
in
the
flow/refraction
of
Communication technology
information; influence of institutio­
Increasingly rapid development of
nal cultures on media personnel
new ■ communication technology and performance programme mana­
and its fast rate of acceptance and gement.
change, have confronted develop­
ing nations in this region with new Communication for development
problems at various levels and in
All Asian societies have adopted
all aspects of life. This growth is the goal of rapid socio-economic
expected to continue and will bring development. Most of them also
forth new problems
which will exhibit an imbalance between ur­
need immediate solutions in the fu­ ban and rural areas. Thus communi­
ture.
cations have been looked upon
Communications research is ur­ as a tool in engineering change,
gently needed toz answer current particularly in the rural sector.
Unfortunately, due to socio-eco­
pressing questions and anticipate
developments to come. Among nomic disparities that exist in Asian
the priority areas are: Technology societies, such efforts have not been
transfer:
Implications of techno­ informed by adequate knowledge
logy for interpersonal and mass of: (a) actuality of rural socio-eco­
communications: Social
prepara­ nomic conditions, and (b) processes
tions for future trends in techno­ of communication in rural areas.

Swasth Hind

Without such data, investment on
social change
becomes wasteful.
The participation of ‘actors’ in the
development effort is not obtain­
ed.
Following are some of the
areas that need to be researched
further: Participatory modes of com­
munication; Indigenous communi­
cations network such as religious
networks which affect rural beha­
viour; Social marketing techniques
for development messages; Role of
mass media as against other message
systems in affecting behaviour in
villages; ‘Exposure limits’ for me­
dia in rural societies; Social structu­
ral factors that affect the percep­
tion of developmental messages,
particularly local stratification sys­
tems.
Impact studies

The phrase impact study is used
here deliberately to indicate that
it denotes more than ‘effects’ study.

A large number of ‘effects’ studies,
mostly correlating a few variables,
have been done in the region. How­
ever, there remains the need to take
a critical look at the strengths and
weaknesses of these basic studies.
They need to be collated, classified
and codified so that theory, with
predictive value, can be evolved.

communication processes and be­
havioural change, on the basis of
integrative studies; Media content
studies or critical analyses of va­
rious media “content” and their
effect on individual behaviour, Di­
fferential impact of communications
media; Multivariate studies; Studies
on model or theory construction on
media impact on development.
Sociology’ of knowledge in the field
of communications
An analysis of decision-making
regarding research priorities, fund­
ing, utilisation of research and the
relationship between
researchers.
policy-makers, and value structures
that impinge on such relationships,
leads us to the area of the Sociolo­
gy of Knowledge. This is an area
which has not been examined at
all in the Asian Communications
context. But priorities in seeking
and using knowledge are related
to so many sociological and cultu­
ral factors, particularly in an area
so multi-faceted as Asia.

lation, analysis and synthesis of
existing research data on the sub­
ject; structural analyses;
various
modes of disseminating data; the
flow of information from initial
sources to receivers; utilisation of
data by various intended levels of
users.

Communication and culture
Communication occurs in a given
culture. It has been shown to both
affect media as well as be affected
by media. Even so we sec a trend
towards mass cultures.

In Asia, very little research has
been done in the area of commu­
nication and culture. A
number
of countries in the region
are
multi-lingual,
multi-religious
or
multi-ethnic, which makes
com­
munication and its understanding
more difficult. As the introduc­
tion of modern communication te­
chnology aims at bringing about
social change, it is important to
know what the media can do and
cannot do in given social contexts.

An examination of Asian commu­
nication research shows a lack of
Studies that should be done in­
systematic studies on values affec­ clude: Profiles of potential audien­
ting opinion, attitudes and percep­ ces: Communications subcultures:
tions, among decision-makers and Attitudes, beliefs, values of pro­
researchers.
duction personnel: Cultural auto­
At the same time, efforts should
Areas of research may include: nomy: Cultural considerations in­
be made to fill gaps in existing re­
public opinion polls or attitude sur­ fluencing media production disse­
search in this field and examine
veys of the sources and receivers of mination and use.
new aspects of impact studies.
communication toward important
Extracts o( the Report of
AMIC Seminar held at
Among areas which need investi­ national areas of concern: psycholo­
Singapore, 17-21 May,
gation are: Relationship between gical studies of key personnel, col­
1982, AMBC, June, 1982.

CHANGE OF ADDRESS
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quote your Subscriber Number.

To ensure prompt supply of the Swasth Hind, please

For all enquiries, please write to :
The Director
Central Health Education Bureau
(Directorate General of Health Services)
Kolla Marg
New Delhi-HO 002

May 1983

121

SHRAMA EVA JAYATE
Leadership, discipline and hard work made the 9th Asian

Games a dazzling success which brought world-wide tributes
to India's capacity for organisation and rapid execution of
ambitious projects.
The stadia were built in record time. Colour television
brought the games live into millions of homes all over the
’
country and abroad. Computers, electronic exchanges.
micro-wave and satellite links were smoothly and efficiently
utilised in a mammoth network of services.

Keep the Torch Burning
.
ift

XWyjf

dtvp 82/558

122

Let us extend the Asiad spirit to the larger arena of national
endeavour.
^ur economy 16 on
move. It Is In our hands to maintain
*he improvement to lighten the burdens of our millions. This
endeavour Is for each one of us.

S

LET US ALL JOIN HANDS

F
F|

TO BUILD A STRONG NATION

Swasth Hind

Communications for development at I he village level
A SPECULATION ON HIE BAREFOOT MICROCHIP
1983 is a World Communications Year and it is also the
tenth birthday of Development Forum, the United Nations
monthly newspaper on economic, and social aflairs. A $ a
contribution to the Year and to mark the anniversary of
Development Forum, the Government of France has hosted
an Anniversary Colloquium in Faris on 23-24 February, 1983
with the support of several former contributing governments
to the DES! Trust Fund and other * organizations. The
subject was communication at the village level in the Third
World in the light of the current and and expected technolo­
gical revolution—**A speculation on the barefoot microchip''.
The idea of the most sophisticated modern technology
having any relevance to Third World rural development
problems may seem, at first sight, absurd and provocative.
For such a development could well be merely the latest
example of inappropriate technology applied to develop­
ment which, like tractors, big roads and green revolution
plants are capable of doing more harm than good. However.
the microchip is a little different. It is a channel of know­
ledge and it may multiply manifold the supply of the
scarcest resource in development—that of knowhow.
The Colloquium lasted for one and a half days and ex­
plored the subject by drawing on resources of the fore­
most electronics industries and on the accumulation of ex­
perience in field communications
gathered in the Third
World.
The Colloquium covered: —
I. Technical and economic horizons for village level and
rural area communications to the year 2000, and the techno­
logical f commercial state of the arr:
The panelists touched on remote terminals’ reliability and
likely costs by year 2000; rural telecommunications, lower
power radio transmission; data bank accessing, voice or key­

(con tinned from page 115)
mitlccs arc means of maintaining liaison with the
health programmes and the people. Enhanced status
recently awarded to Panchayats has enthused leaders
to take on further responsibilities for the people’s
welfare.

board (for, for example: the barefoot radio doctor and
compiiler-assibicd diagnosi-. —weather advice for harvesting or
disaster warnings-— inter-village local market advance in­
telligence--inter-villagc-self-hclp. e.g., techniques. services,
personnel exchanges, etc.—construction and repair consulta­
tions—regional availability of spares stocks etc.); radio trans­
mitters at village level; storage and editing of radio material;
satellite input prospects for village level TV and necessary
power sources.
II. Review of lessons learned about village level communi­
cations and how to apply them:
Do we know the basic rules of programming—how to
communicate—at village level—ground rules in the field?
How can communicators plug into the experience that has
been accumulated? What will be specifically new vis-a-vis
programming and docs not derive from previous radio/TV/
teaching machine etc. programming experience? Recapitula­
tion of the programme experience gained in applications
technology satellite experiments. Methods of avoiding irres­
ponsible commercialism—conserving the public service cle­
ment.
HI. Synthesis:
What could be the scene, in the year 2000. in an idealized/
archetypical village? What are the obstacles; Government
and aid donors’ lack of understanding; political problems
arising from local misuse of communications for develop­
ment: economic factors in the world electronics industry as
a whole-—is there any chance of developing the right tech­
nology for the village level or of making appropriate modi­
fications?
— United Nations ‘Develop­
ment Forum’
Ten lit Annivcisary Colloquium.

The Urban Health Centre, Chetla
The Urban Health Centre, the first urban health
centre in India, was established at Chetal in Decem­
ber 1955 under the joint auspices of Government of
India and of West-Bengal, Calcutta Municipal Cor­
poration, WHO and UNICEF. It is located approxi­
mately 7 Kms. to the south of the Institute and covers
an area of 2.17 Sq. Kms. in Ward 86 and part of
the wards 78 and 85 of the Calcutta Corporation. It
serves a population of about 68,000 and provides total
health care and training facilities similar to those at
Singur.
Objectives

Organization
The service area is divided into three units of ap­
proximately 24,000 people per unit. Medical officers of
the Health Centre, look after the Unit Health Clinics
Services. Health care services both clinic based and
domiciliary are provided to the families residing in the
area. They include treatment of the sick, immuniza­
tion, care during ante-natal and post-natal periods,
care of the under five and school children, and family
planning services. Special referral clinics for tuber­
culosis, sexually transmitted diseases, diseases of eye,
ear. nose and throat, dental problems and mental ill­
nesses are conducted at the Centre. An Industrial
Health Clinic is conducted for workers from small
scale industries. A Rehabilitation Workshop for tuber­
culosis patients and their families, a nursery school
and a Women’s Work Therapy Centre are run by the
Urban Health Centre as part of community Welfare
Services.

Main objectives of the Centre are: (a) to serve as
an urban practice field area for students of various
courses of the Institute; (b) to organize primary health
care delivery with the family as the basic unit: (c)
to provide domiciliary care through follow-up services
and to care for high risk groups: (d) to promote and
conduct research in public health.

Community participation
Community participation is ensured in the health
activities and training
programmes of the centre
through the local health council and zonal health com­
mittee members and through voluntary and social
welfare agencies.
O

May 1983

123

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