Swasth hind, Vol. 30, No.8, August 1986.pdf

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extracted text
HEALTH PROGRESS IN INDIA

In this Issue

swasth
hind

Page No.
Health achievements—1985-86
S. S. Dhanoa

Sravana—Bhadra

August 1986

India on way to achieving the goal of
health for all

173

175

Smt. Mohsina Kidwai
Vol. XXX, No. 8

Saka 1908

National malaria eradication progiamme

177

National leprosy eradication programme

180

National tuberculosis control programme

181

National programme for control of blindness

182

Diarrhoeal diseases control programme

184

National goitre control programme

185

Family welfare—makes headway

186

Maternal and child health programme

190

Rural health services

192

Prevention of adulteration of food and drugs

196

39th World Health Assembly

198

READERS WRITE

It is really an achievement to have such
an informative and useful magazine with such
a little amount. All the educational institutions
must subscribe to the ‘Swasth Hind’.
Prof. M. S. Gill

Government College
Bhatinda

Editorial and Business Offices
Central Health Education Bureau

(Directorate General of Health Services)

Kotla Marg, New Delhi-110 002

Books

Third
inside
cover

EDITOR
N. G. Srivastava

ASSTT. EDITOR
D. N. Issar

Sr. SUB-EDITOR
M. S. Dhillon

Articles on health topics are invited for publication in this
Journal.

COVER DESIGN
B. S. Nagi

State Health Directorates are requested to send reports of
their activities for publication.

SUBSCRIPTION RATES
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The contents of the Journal arc freely reproducible. Due
acknowledgement is requested.
The opinions expressed by the contributors are not neces­
sarily those <.f the Government of India.

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

Broad objectives of the health programmes have been to control and eradicate
communicable diseases, to provide preventive, curative and promotive heafrh services
to the people with improved primary health care services in rural and tribal areas.

HEALTH ACHIEVEMENTS 1985-86
S. S. Dhanoa
Secretary
Ministry of Health and Family Welfare

N the year 1985-86, the Ministry
This is the first year of the 7th improving indigenous skill and
of Health and Family Welfare Five Year Plan and during the plan human development. We have now
continued their efforts to place period, it has been decided that the 3.85 lakh trained Health Guides,
the health and family welfare pro­ emphasis will be laid on preventive and about 5.16 lakh trained Dais.
grammes on a sound footing, to and promotivc aspects and organis­ A programme for training of tradi­
bring about more effective integra­ ing effective and efficient health ser­ tional birth attendants is being con­
that
tion between them, to extend out­ vices which are comprehensive in tinued, and it is envisaged
reach, particularly in rural areas. nature, easily arid widely available 25.000 Dais will be trained during
and to achieve greater participation and accessible to and affordable by 1985-86.
Accordingly, broad
of the community in schemes in­ the people.
objectives
of
the
health programmes
tended to improve its own health
have
been
to
control
and eradicate Malaria eradrcationi
standards. There was a renewed em­
Great emphasis has been given to
phasis on the child survival pro­ communicable diseases, to provide
grammes. “Universal Immunization preventive, curative and promotive the National Malaria Eradication
Programme” was launched on 19 health services to the people with Programme by the Government.
November, 1985, as a living memo­ improved primary health care servi­ During the year 1985, as per reports
received upto 31 December, 1985,
rial to Smt. Indira Gandhi, for whom - ces in rural and tribal areas.
total malaria incidence and P. falci­
the health of the mother and the
parum cases recorded a decline of
child had been of paramount consi­ Emphasis on indigenous skills
All the peripheral level facilities 16.87% and 24.49% respectively as
deration in all developmental pro­
the corresponding
grammes. This programme aims for health delivery system were en­ compared to
at providing protection to child­ larged to meet the health needs of period of 1984. However, during
ren against six vaccine preventa­ the people closer to their doorsteps. 1985, the States of Bihar, Himachal
ble diseases—diphtheria,
tetanus, Long term measures have been for­ Pradesh, Jammu & Kashmir. Pun­
whooping
cough,
tuberculosis, mulated to expand the network of jab, Sikkim, Tamil Nadu, West Ben­
polio and measles.
For this, a primary health centres, sub-centres gal and UTs of Chandigarh, Dadra
beginning has been made in 30 dis­ under the Minimum Needs Program­ & Nagar Haveli, and Mizoram have
As on 31 December, 1985, reported some increase in the total
tricts and catchment areas of 50 me.
there
were
11,530 Subsidiary/Pri­ incidence in comparison to last year.
medical colleges in 628 blocks to
mary
Health
Centres, 84,013 sub­ Increase in P. falciparum cases was
cover 66 million population by the
Multipurpose observed in Bihar, Jammu & Kash­
end of this financial year. The pro­ centres, 1.80 lakh
gramme will be expanded in a phas­ Health Workers of which 0.94 lakh mir, Karnataka, West Bengal, Anda­
ed manner to cover die entire coun­ are females. In fact, the Ministry’s man & Nicobar Islands and Mizo­
try by 1990.
efforts have been directed towards ram.

I

August 1986

173

Newer drugs for leprosy

Concerted efforts are being made
to educate the people for early detec­
tion of leprosy, its treatment and
rehabilitation of the patient. At the
end of the 6th Plan period, 3.24
million leprosy cases were on re­
cords and 3.02 million have been
brought under treatment. ,1.93 mil­
lion cases have been discharged as

cured since the
programme.

inception of the

Newer drugs, rifampicin and clafazimin, have been introduced in
the programme. These drugs and
dapsone, when given in proper com­
bination, have been found to pro­
duce complete cure and make the
cases non-infectious and interrupt

the spread, over a comparatively
short period of 2 to 3 years. The
preliminary indications are that cas­
es have become non-infectious and
the disease activity has been arrest­
ed in over 85% of cases in a 3-year
period. During 1985-86. nine more
highly endemic districts are being
taken up for
Multi-Drug Treat­
ment.

T.B. Control Programme

Under the National Tuberculosis
Control Programme, 364 Districts
in the country have been provided
with District T.B. Centres with es­
sential equipments. These are man­
ned by medical and para-medical
personnel duly trained at National
Tuberculosis Institute, Bangalore.
From April to November 1985 these
centres have detected 11.35 lakh
new T.B. cases. Besides. 11.70 lakh
sputum examinations were conduct­
ed out of the chronic chest symptomic cases during this period. Ten
X-ray units and 25 Odelca cameras
are being supplied to States/U.Ts.

Control of blindness

To control blindness, the PHC
infrastructure is being strengthened
and central mobile units are provid­
ed.
Upgradation of Departments
of Ophthalmology in the Medical
Colleges have also been taken up
along with the strengthening of Dis­
trict Hospital infrastructure.
As
against the target of 10, so far 9
Regional Institutes under the Na­
tional Programme for Control of
Blindness have also been providing
training, health education and re­
search which forms an integral com­
ponent of the programme. Volun­
tary organisations engaged in the
eye-care work are being encouraged
All the peripheral levelfacilities for health delivery system were enlarged
to meet the health needs of the people closer to their doorsteps.

174

(Conid. on page 176}

Swasth Hind

India on way to Achieving
the goal of Health for AU
Smt. Mohsina Kidwai
mt. Mohsina Kidwai has said that the global
economic crisis had hit the efforts of the deve­
loping countries resulting in substantial cuts in health
budgets. If one fifteenth of the expenditure going in
for the production of deadly weapons was diverted to
health programmes, the goal of health for all could
be achieved easily, she added.

S

The then Union Health Minister was speaking at the
plenary session of 39th World Health Assembly in
Geneva on 6 May, 1986.

On the subject of increasing population and high
birth rate, Smt. Kidwai said that though the birth
rate had declined from 36.8 per 1000 population in
1971 to about 33 in 1982, the rate of growth of popu­
lation was increasing. In this context the Health
Minister said that around 70 million births had been
averted by family planning methods in India.

About the high rate of infant mortality prevailing
in India, Smt. Kidwai said that India had launched a
massive programme of Universal Immunization in
1985. Under this programme all expectant mothers
and infants were proposed to be immunised by 1990.
This programme of universal immunization was ex­
pected to bring in the reduction in morbidity and
mortality with vaccine preventable diseases, she added.
On communicable diseases which were taking a heavy
toll or life in developing countries, Smt. Kidwai said
that India had launched a massive programme to
eradicate leprosy, malaria and such other dreaded dise­
ases. The incidence of malaria had declined from
2.18 million in 1984 to 1.74 million in 1985.

On the emerging disease of goitre, the Health Minis­
ter said that the arrangements were being made to

August 1986

iodise the entire edible salt in India by 1992 with a
view to eradicating the iodine deficiency diseases.
Smt. Kidwai said that India had formulated a drug
policy as early as 1978 and was in a position to supply
a whole range of drugs and medicines to other develop­
ing countries. India had also established an elaborate
drug control machinery for ensuring the quality of
drugs, she added.

On medical education and research, the
Health
Minister said, “Medical education and practice cannot
respond to the present day needs if they also do not
train people to identify the community’s special pro­
blems and assist the individual to- tackle them. Primary
health care approach would succeed only when the
personnel involved in delivering the services have faith
in the system and are imbued with the same degree
of commitment and responsibility for the health of
community members as for hospital patients. Besides,
there is need for a close inter-action between medical
colleges and health departments of State Governments”.
“We are reviewing our strategy with a view to re­
orienting the medical education system to make it
more responsive to the needs of the society. We hope
to evolve a new medical and health education policy
very soon?’, the Health Minister added.

She called upon the world community to find out
ways to find ‘necessary resources to translate into
concrete action the goals we set before ourselves in
Alma Ata’. Unless the necessary resources were mobi­
lised to finance the health programmes throughout the
world the cherished goal of Health for All by 2000 AD
might remain nothing more than a pious intention, Smt.
Kidwai added. A

175

International agencies and some foreign Governments have shown interest in our
Health and Family Welfare Programmes. They have come forward with a helping hand

to augment our efforts which have been taken up with our own resources.
much has been done to ensure

“Health for all by 2000 A.D.”

Though

and bringing down

the NRR to one by the turn of the century, more concerted efforts are needed to
reach these cherished goals.
(Contd. from page 174)

nity participation through voluntary Maternal and Child Health Care ser­
organisations and non-governmental vices. Our efforts are being augmen­
agencies is being encouraged so that ted through Post-Partum Program­
Family Planning becomes a people’s me and upgraded PHCs. It needs
movement. 300 voluntary organisa­ mention here though we do not pro­
tions are working in the field of vide services for the medical termi­
family welfare. Voluntary organisa­ nation of pregnancy as a family
tions operating in social welfare and planning method, an appreciable
income generation sectors are also work has been done by providing
Family Welfare
being encouraged to lend their help­ services for MTP to avoid health
ing hands for the National Pro­ hazards to more than 41 lakh preg­
Country’s population presently is
nant women who came forward to
gramme.
estimated at around 75 crores and it
benefit themselves from these servi­
is needless to emphasise the need to
ces. The services have been a great
control the population growth rate.
The Ministry have instituted help to check clandestine abortions.
As such, the Family Welfare Pro­ innovative schemes and additional
gramme seeks to promote on volun­ incentives during the year to encou­
tary basis the two-child norm, irres­ rage people to come forward and
International agencies and some
pective of the sex of the child. We help the acceptance of this program­ foreign Governments have shown in­
are aiming at reducing the crude me.
All available methods and terest in our Health and Family
birth rate to 21, crude death rate to media will be used to educate the Welfare Programmes.
They have
9 and infant mortality rate below people about the need to have a come forward with a helping hand
60 per thousand live births by 2001 small family and a planned parent­ to augment our efforts which have
AD. We can take credit of avert­ hood. In this endeavour, Govt.
been taken up with our own resour­
ing about 68.25 million births upto has also involved private medical
ces.
Though much has been done
March, 1985 since the inception of practitioners in the programme by to ensure “Health for All by 2000
the Family Welfare Programme.
providing necessary help to them. A.D.” and bringing down the NRR
‘Opinion Leaders Training Camps’ to one by the turn of the century,
have greatly helped in dispelling ap­ more concerted efforts are needed
In order to speed up our Family prehensions and
mis-conceptions to reach these cherished goals. This
Welfare activities, we are refining about methods and the programme.
Ministry has the commitment to ful­
the strategy to achieve hastened de­ The number of acceptors of all me­
fil the 7th Plan objectives, political
cline in the birth rate. The task of thods of family planning during
will to support its activities and
motivating the people to accept the the first nine months of 1985-86 was
people’s participation to help realis­
programme is stupendous and the 25.6 per cent higher than the level
ing the goals.
challenge is great. It is only through reached last year.
effective information, education and
(Excerpted from the Introduction
communication strategy that we can
to the Annual Report of the Minis­
The
Family
Welfare
Programme
convince the masses to adopt con­
try of Health and Family Welfare
is
being
implemented
as
a
package
traception as a way of life and there­
by limit the family size. Commu­ deal of Health, Family Welfare and 1985-86)

to carry out comprehensive eye
health care activities particularly in
remote rural areas. During the 6th
plan, an expenditure of Rs. 23.73
crores was incurred. For the 7th
Plan, an amount of Rs. 31 crores has
been allocated.

176

Swasth Hind

Communicable diseases account for more than two-thirds of the total morbidity and
mortality in the country.

For the control and eradication of communicable diseases,

the programme implementation at all levels is being strengthened.
Health Care system is being utilised

for

The Primary

delivering comprehensive frontline care

and for better diseases surveillance and control.

NATIONAL
MALARIA ERADICATION PROGRAMME
esurgence of malaria in late sixties and seven­

R

ties necessitated renewed vigorous antimalaria
activities and the programme was modified in the
context of escalating malaria situation and available
resources in the country to tackle the deteriorating
situation of malaria, to prevent deaths from malaria
and to maintain the agricultural and industrial growth.
The Modified Plan of Operation was implemented
from 1st April, 1977, and it paid rich dividend and
during the next 6 years the incidence was reduced
from 6.46 million in 1976 to 2.18 million in 1982.
By and large, the incidence has been maintained at
that level during the subsequent years till 1984. The
present anxiety is that further desired reduction has
not been forthcoming and spread of outbreaks have
been reported’ in some areas in the country. In addi­
tion, the problem has been further aggravated by the
fact that though the malaria incidence has been sta­
tionary around 2 million, the P. Falciparum cases
have been recording a gradual increase during the
same period.

Year

1976
1977
1978
1979
1980
1981
1982
1983
1984

Blood
P. Falci­
Total
slides
incidence parum
examined
cases
(in Mill)

1

2

.
.
.
.
.
.
.
.
.

55.98
57.01
50.46
61.42.
67.17
67.84
65.03
64.29
66.36

3

6467215
4740900
4144385
3064697
2898140
2701141
2182303
2018605
2184446

4
753713
461484
548567
558433
588011
589591
551057
600964
655453

Total
deaths

•5

59
55
74
198
207
170
187
239
32

During the year 1985 (as per reports received upto
31-12-1985) total malaria incidence and P. falciparum
cases recorded a decline of 16.87% and 24.49% res­
pectively as compared to the corresponding period of
1984.
However, the situation is not uniform every­
where.
In some States total malaria cases and
P. falciparum cases have shown increase during 1985
as per reports received upto 31-12-1985.

Incidence of malaria

Malaria situation as recorded in the country follow­
ing implementation of modified plan of operation is
given below:

August 1986

Training

Malariology training courses are being conducted
by National Institute of Communicable Diseases,

177

Vigorous measures are being undertaken to tackle the menace of malaria

Delhi.
These courses were conducted out of WHO
regular Budget for 1985.
The total allocation of
funds for training was 51400.
Directorate of Nation­
al Malaria Eradication Programme extended help
with Faculty Members to National Institute of Com­
municable Diseases for conducting such courses.

qualitative and quantitative improvement would
bring down malaria incidence markedly in spite of
the vector(s) exhibiting resistance to a particular in­
secticide.
This has been amply demonstrated by
the State Entomological zones of Gujarat and Maha­
rashtra.
In the absence of spraying steep increase
in malaria incidence was evident.

Research

Monitoring of P. falciparum resistance to Chloro­
quine was carried out during 1985. 555 P. falciparum
cases were tested, 10 resistants foci have been detect­
ed, but none was found to be .of R-3 level.
88 per
cent cases with Pf infection were cleared with Quinine.
Analysis of spray coverage and epidemiological
data clearly indicated that the timely spraying with

178

Urban Malaria Scheme : The Scheme is under im­
plementation in 122 towns.
71 towns (60%) out
of 117 towns, from where comparable data was avai­
lable showed a decline in malaria cases during 1984
as compared to that of 1983.
But towns like Mad­
ras, Calcutta, Chandigarh, Ahmedabad, Gandhi Nagar
(Gujarat) etc., recorded a very large number of cases
leading to an overall increase in incidence.

Swasth Hind

P. Falciparum Containment Programme: This is
a component of the Modified Plan of Operation de­
signed to deal with some of the hardcore areas of
the country where the intensity of malaria is high,
transmission period is prolonged, terrain and acces­
sibility are difficult and majority of the population
belongs to tribals of different ethnic groups.
Be­
sides, there is the problem of drug resistance in some
parts specially in the north-east zone.
The total
population involved is 98 millions, i.e. about 14% of
the people of the entire country.
There are 84 dis­
tricts (entire or in part) within the sphere of influence
of PFCP.

Epidemiological Situation in 1985 (January—Sep­
tember) indicated that when compared to 1984. in 80
per cent of the PFCP areas P. falciparum remained
contained (15%) or declined significantly (in 64%
areas).
In the rest 20% of the areas, there has been
some increase in falciparum malaria.
This is parti­
cularly noticeable in the State of Bihar and parts of
West Bengal where the programme is faced with a
number of constraints.

National Filaria Control Programme

Filariasis? is one of the major public health problems
in the Country.
All the States/Union Territories
except Jammu & Kashmir, Himachal Pradesh, Delhi.
Chandigarh, Punjab, Haryana, Meghalaya, Arunachal Pradesh, Sikkim, Rajasthan, Tripura, Mizoram
and Manipur are endemic for filariasis. Present esti­
mates indicated that about 304 million population is
living in known endemic areas of which about 82
million are in urban areas and the rest in rural areas.

Control Units

189

Survey Units

27

.

Clinics
Rural Filaria Control Project

122

2

During the year 1985-86, it was proposed to set-up
10 new control units, one survey unit and fifty clinics.
Progress : At present about 27 million Urban
population is being protected through antilarval mea­
sures by 189 control units.
Another 5 million rural
population is being protected by 2 Rural Filaria Con­
trol projects through detection and treatment of
Filaria cases.
Use of common salt medicated with
Diethylcarbamazine citrate powder for the control of
filariasis was implemented with success in Lakshad­
weep during 1976—1978. This method is being car­
ried out in Karaikal district of Union Territory of
Pondicherry from April, 1982.
During the year
1985-86, one control unit, one survey unit and seven
Clinics have been established so far.
Achievement: 300 districts are situated in ende­
mic areas. Of which 238 districts have been survey­
ed for delimitation of filaria problem and 173 have
been detected to be endemic for filariasis.
27 sur­
vey units are carrying out delimitation survey in equal
number of districts. It is observed that 94 per cent
of the towns where control measures are in operation
for more than five years have shown marked reduc­
tion in microfilaria rate.

Future Plans : In addition to the continuing set­
up, it is proposed to set up 10 new Control Units.
One Survey Unit and Fifty Clinics during 1986-87.
KALA-AZAR

For the control of filariasis, the National Filaria
Control Programme was launched in 1955.
Under
the programme the following activities are being
undertaken: —

1. Delimitation of the problem in hitherto unsur­
veyed areas.

The Kala-azar unit of NMEP is monitoring the
Kala-azar situation in India.
This unit is regularly
collecting the Kala-azar reports and is keeping a close
vigil over the situation.
The Kala-azar incidence in
India since 1982 is given below:
Cases

Deaths

.......

12360

38

............................................................

14406

135

1984 (Prov.)..................................................

16459

65

1985 (As per report received upto 8-11-85)

10708

24

Year

2. Control in urban areas through.

(a) recurrent antilarval measures.

1982

1983

(b) anti-parasitic measures.

Present set-up : The following is the present set­
up in endemic States and Union Territories.

August 1986

179

NATIONAL LEPROSY ERADICATION
PROGRAMME
Sexually Transmitted
remains a major public health and
social problem in India, in spite of three decad­
es of National Leprosy Control Programme activities
since 1955.
Over 400 million population is covered
with an infrastructure created under National Leprosy
Eradication Programme (NLEP).
The important
existing physical set up is as follows:
eprosy

L

In India 403 Leprosy Control Units, 661 Urban
Leprosy Centres, 6985 Survey Education Treatment
Centres, 253 Temporary Hospitalisation Wards. 190
District Leprosy Offices, and 43 Leprosy Training
Centres are functioning at present.
A total of 19.5
lakh leprosy cases have been discharged after treat­
ment.

During the year 1985-86 till the end of September
1985, the objective performance under the programme
continues to be good. A total of 2.08 lakh new cases
were detected till September 1985 against the annual
target of 3.81 lakh, 1.94 lakh new cases detected were
put on treatment, and 1.65 lakh cases were discharged
against the annual target of 3.74 lakh. Effective and
short term multidrug treatment of leprosy cases has
been introduced under the programme in selected
districts replacing the less effective, prolonged dap­
sone monotherapy.
The districts of Visakhapatnam
(APj, Puri (Orissa) and Chengleput (Tamil Nadu) have
been brought under Multi-drug Treatment of all lep­
rosy cases during the current year with the financial
assistance of UNICEF and the districts of Belgaum,
Dharwar in Karnataka and Varanasi in U.P. with the
assistance of Swedish International Development
Agency through WHO.
Thus, a total of 15 districts
with a population of about 37 million and 3.2 lakh
leprosy cases arc under multi-drug Treatment cur­
rently.
It is proposed to create infrastructure on priority in
hyper-endemic districts to enable introduction of multi­
drug treatment.

The Central Leprosy Training and research Insti­
tute. Chengleput (Tamil Nadu) and Regional Train­
ing and Referral Institutes at Aska (Orissa), Raipur
(Madhya Pradesh) and Gauriput (West Bengal) con­
tinue to support the programme in technical, opera­
tional and training personnel.
A

180

Diseases Control
Programme
S.T.D. Control Programme has been a con­
tinuing scheme since the second Five Year Plan,
The disease could not be checked during the past
plan periods and it was then decided to give a new
dimension to the scheme by uplifting the scheme from
its very grass root level so as to combat the disease in
all aspects. The scheme was then restructured to in­
duct the scheme as a purely central sector scheme with
100% central assistance during the 6th Five Year
Plan. For teaching, training and research in the field of
S.T.D. (a) Regional Teaching-cum-Training centres
for imparting orientation courses to the in-service Me­
dical and Para-Medical personnel in the discipline of
Venereology have been/are being established at Cal­
cutta, Nagpur, Hyderabad, in addition to the existing
teaching and training centres at Institute for S.T.D.
Madras Medical College, Madras and S.T.D. Training
and Demonstration Centre, Safdarjang Hospital, New
Delhi; (b) Regional S.T.D. reference Laboratory to
p. ovide orientation courses to the Laboratory Techni­
cians working in the district hospitals/PHCs/Civil
Hospitals/STD Clinics in the Lab. diagnosis of STD
and to conduct inter-Laboratory evaluation of V.D.R.L.
test to set up a uniform standard of doing V.D.R.L.
test throughout the country have been/are being esta­
blished at Calcutta, Delhi, Hyderabad and Nagpur
in addition to the existing central reference Labora­
tory at the Institute for the Study of venereology
Madras, Medical College, Madras. Regional Surveycum-mobile STD units provide immediate therapy to
the patients suffering from S.T.D.

T

he

Achievements
The details of the achievements under S.T.D. Con­
trol Programme are given gelow:
Item

1983-84

1984-85

1985-86

1

2

3

4

1. Training of M.O’s
2. Training of Para-Medical
Personnel
3. Interal-Lab. evaluation of
VDRL test
4. Estt. of VDRL testing at
District Hospital/P.H.Cs. .

25

47

25

50

82

52

36

55

61

100

A

Swasth Hind

364 Districts in the country have
District T.B. Centres with essential
equipments which are being man­
ned by trained Staff.
These cen­
tres are undertaking T.B. Program­
me in the Districts in collaboration
with general health and medical
institutions. In addition, there are
about 300 TB Clinics functioning in
the country which are mostly located
in big towns and cities looking after
the needs of local population living
nearby.
A total of about 45.500 beds are
available in the country for treat­
ment of seriously sick TB patients.
17 TB Training and Demonstration
Centres have been established in
major States of the country to un­
dertake the basic training of the
para-medical personnel required for
the programme.

Anti-TB Drugs for free treatment
of T.B. patients are being supplied
to the TB Clinics run by State Go­
vernments as a Centrally Sponsored
Scheme on 50 : 50 sharing basis
between the Centre and the States.
The Scheme of supply of anti-TB
Drugs to the TB Clinics run by vo­
luntary bodies and scheme of sup­
ply of material and equipments/
Anti-TB Drugs to U.Ts., however,
continues as 100% Centrally Spon­
sored Scheme.

A patient waiting to give sputum
sample at the health centre.
(W. H. O. Photo by P. Almasy)

20-Point Programme'.
with the
inclusion of TB Programme in the 20
Programme, the essential activities
have been considerably expanded.
The new TB case detection is in­
creasing from year to year. Against
10.80 lakh new TB cases delected
during 1982-83, nearly 12.08 lakh
uberculosis is a major public 1.5% of the total population is esti­ cases were detected during 1983-84
health problem in the country. mated to be suffering from radiolo­ and 12.55 lakh during 1984-85. Fur­
As per the National T.B. Sample gical ly active T. B. Disease of the ther, to expand the TB case detec­
Survey which was conducted by lungs of which about 1 /4th or 0.4% tion among the rural population and
(Contd. on page J 84)
I.C.M.R. in years 1955-58, nearly are sputum positive or infectious.

NATIONAL
TUBERCULOSIS
CONTROL PROGRAMME

T

August 1986

181

(W. H. O. Photo by T. S. Satyan)

NATIONAL PROGRAMME FOR
CONTROL OF BLINDNESS
ccording to a Survey undertaken by I.C.M.R.
**in 1971-73 India has about 9 million blind and
another 45 million suffer from visual impairment.
Roughly 8 out of 100 persons need eye care in some
form or the other. The problem of this magnitude
causes considerable strain on National economy in
terms of loss of manpower and social dependence of
the blind.

Plan of Action: The National Programme for Con­
trol of Blindness was launched throughout the coun­
try by the Govt, of India in 1976. The ultimate aim
is to reduce the blindness in the country from 14%
to 0.3% by the year 2000 A.D. To achieve this aim,
the programme is providing immediate relief to the
needy by camp approach and by establishing perma­
nent eye care facilities with graded expertise at diffe­
rent levels coupled with ‘Health Education’ measures.

182

The Programme has received explicit recognition in
the new 20-Point Programme of the Govt, of India.
Financial Allocation: The programme
Centrally Sponsored Scheme.

is 100%

The total allocation during the sixth plan period was
Rs. 22.50 crores.
In the VII Plan a Budget allocation of Rs. 31 crore
has been proposed.

Development of Infrastructure : The following in­
frastructure has been developed up till now:
Target

Strengthening of PHCs .
Central Mobile units
Strengthening of Distt. Hospitals

1

Achieve­
ment
2

2000
80
400

2000
80
404

Swasth Hind

1

2

carried out by Dr. R.P. Centre in collaboration
National Programme for Control of Blindness.

60
10
37
30
18

59
9
37
30
18

Performance: Cataract operations are being
monitored against the. given targets for each State
and UT Administration. The Performance of
Cataract Operations for the country as a whole has
been reported as under:

Training Programme'. Each Primary Health Centre
and District Hospital are to be provided with one
Ophthalmic Assistant each. To train the Ophthalmic
Assistants 37 training schools have been established
throughout the country. They are conducting two
years training course for Ophthalmic Assistants.
About 900 Ophthalmic Assistants are expected to
be trained annually.

Target
Achieve­
(in lakhs) ment
(in lakhs)

Upgradation of Department of Ophthal­
mology in Medical Colleges
Establishment of Regional Institutes
Ophthalmic Asstt-. Training Centres
Setting up of Distt. Mobile Units
Setting up of State Ophth. cells

Health Education’. Some basic concepts on eye
care have been included in school curriculam. Sim­
ple messages on eye care are being spread through
A.I.R. and Doordarshan net work. A number of edu­
cational folders in different regional languages and
other audio visual material have been distributed to
intensify community educational efforts.
Research Programme’. Dr. R. P. Centre of Opthalmic Sciences, New Delhi, has been developed as
a major Research Centre under National Programme
for Control of Blindness.

In the Sixth Plan total allocation to develop this
Centre was 1.69 crores. Presently a survey to mea­
sure the quantum of blindness in the country is being

1982-83
1983-84
1984-85
1985-86

13.03
12.54
12.78
13.84

with

9.04
10.49
10.82
2.05
(upto
Septem­
ber 1985)

Participation of Voluntary Organisations: Volun­
tary organisations
engaged in eye care work are
being encouraged to carry out comprehensive eye
health care activities, particularly in remote rural areas.
Voluntary Organisations are being assisted for eye
camps @ Rs. 60/- per intra-occular operation to the
maximum of Rs. 12,000/- per eye camp.
Monitoring and Evaluation: Central Ophthalmic
Cell at the Central Govt, level has been proposed. 18
State Ophthalmic Cells at the State Level of 18 major
States are continuously monitoring the various aspects
of the programme including quantitative and qualita­
tive evaluation of the programme.

Photo show a group of cataract patients
(W. H. O Photo by T. S. Satyan)

DIARRHOEAL DISEASES CONTROL PROGRAMME
JIiarrhoeal diseases still remain a major cause
morbidity and mortality in India especially in
children below 5 years of age. Though cholera which
was very prominent in the early years, has almost dis­
appeared, other diarrhoeal diseases caused by Bacil­
lary Dysentery, ELTOR, E.Celi, Rota-Virus still take
a heavy toll of human life. Unlike 1984, when a
major outbreak of Shigella Dysentery has been re­
ported from all the districts of West Bengal, during
the current year, no major outbreak was reported from
any State. However, small outbreaks of diarrhoeal
diseases caused by ELTOR and Shigella were reported
from the states of Orissa, Manipur, Maharashtra, West
Bengal, etc. These outbreaks were reported during
the summer and were precipitated due to scarcity of
drink water supply in the affected regions.

level officers conducted during 1984, 8 courses have
been conducted during the year under review.

Supply of O.R.S.: Under the Village Health Guides
Scheme, the supply of oral rehydration salt to the
village health guides during the year has been increas­
ed from 60 to 100 packets per year. In addition 200
packets of ORS supplied to the 80,000 sub-centres
functioning under the Family Welfare Programme.
Survey: A multi-centric survey on the morbidity
and mortality from diarrhoeal diseases in children be­
low 5 years of age has been conducted during the,
year from the following areas:

(a) Urban Areas: Delhi, Bombay, Calcutta,
Madras, Hyderabad and Coimbatore.

A national plan of action to control the diarrhoeal
diseases problem as part of the primary health care
programme has been drawn up.

(b) Semi-urban areas:

Training'. Training programme for the doctors at
the district level has been geared up. Incomparison to
2 courses of supervisory \skill training for the district

(c) Rural areas: Bishnupur and Thubal, districts
of Manipur and Kangra District of Himachal
Pradesh, Primary Health Centres attached to
the 7 medical Colleges of Uttar Pradesh. A

(Contd. from page 181)
to involve the Primary Health Cen­
tres in TB case finding activities,
targets were also laid for conduc­
tion of 50 Sputum Examinations
per month at each of the Primary
Health Centres for the first time
during 1983-84 and nearly 12.11
lakh examinations were conducted.
There was a significant improvement
during 1984-85, and about 17.30
lakh sputum examinations were con­
ducted by the Primary Health Cen­
tres.

Burdwan and Nizamabad.

to be detected, and nearly 8.18 lakh India.
The supply to States and
sputum examinations (provisional Union Territories is done under the
figures) conducted at the Primary Expanded Programme on Immuni­
Health Centres.
sation and supplies are also made
to Medical Institutions and Private
BCG Vaccine Laboratory, Madras
Practitioners.
This is the only
B.C.G. Vaccine Laboratory, Mad­ BCG Vaccine producing Laboratory
ras. was established in 1948 at Guin- in India.
dy. Madras, with the assistance of
UNICEF and W.H.O. to produce
The Production and Supply of
and supply BCG Vaccine and Tu­ biologicals made by this Laboratory
berculin PPD Dilutions to all the during the period April to October
States and Union Territories of 1985 is as under:

Targets for 1985-86 : Consider­
Production (Lakhs)
Supply (Lakhs)
ing the high prevalence of Tuber­
Ampoules/ Doses
Ampoules/ Doses
culosis in the country, it was consi­
Vials
Vials
dered necessary to step up the tem­
1
2
3
4
5
po of new TB case detection during
1985-86.
Accordingly, the target Freeze Dried BCG Vaccine 20 doses
.
.
.
92.00
5.066
101.32
4.60
for detection of new TB cases has per ampoule .
been raised to 14 lakhs, and Primary Tuberculin 100 doses per vial
12.00
0.11
11.00
0.12
Health Centres continued to be in­
volved in case finding activity. Up to
Future Plan of Action: With a vernment has tentatively allocated
the end of 2nd Quarter of 1985-86, view to meeting the increased re­ one crore of Rupees under the VII
nearly 6.03 lakh new TB cases (pro­ quirement of Freeze Dried B.C.G. Five-Year Plan for the Expansion
visional figures) have been reported Vaccine under the E.P.I., the go- of the BCG vaccine Laboratory. A

184

Swasth Hind

NATIONAL GOITRE CONTROL PROGRAMME
Deficiency is the primary cause of goi­
tre and it occurs in areas where food is produced
on lands deficient in iodine. Apart from disfiguring
swelling in the neck, endemic goitre may cause respi­
ratory difficulties. The most serious health consequen­
ces of endemic goitre are the high incidence of en­
demic cretinism, deaf-mutism and mental retarda­
tion.

Rather, these results suggest that no region in the
country can be considered completely free from goitre.

In order to control the problem of goitre in the
country, the National Goitre Control Programme was
launched by the Government of India towards the
end of 2nd Five Year Plan with the following objec­
tives:

Achievement :

odine

I

(1) Identification of the goitre endemic regions.
(2) To supply iodized salt in place of ordinary
common salt to the goitre endemic areas.
(3) To assess the impact of goitre control measures
over a period of time.

Activities/ PerformancesFor the identification of
goitre endemic regions, two survey teams have been
established in the Directorate General of Health Ser­
vices. These teams have completed surveys in various
parts of the country and their findings have revealed
that nearly 40 million people are suffering from vary­
ing degrees of goitre and an estimated number of
140 million people are living in the known hyper goi­
tre endemic areas. Further, goitre problem has been
found to be equally alarming in areas which were not
known to be goitre prone earlier such as Madhya
Pradesh, Guj’arat, Maharashtra, Kerala, Delhi, etc.

In order to control the problem of goitre,
the
Ministry of Health is coordinating the supply of iodi­
sed salt to the population living in the goitre endemic
areas under the National Goitre Control Programme.
The Ministry of Health continues to provide subsidy
for cost of iodization of salt.

(a) Survey*. During the year, the central teams
have cmpleted surveys in Satara District of
Maharashtra and Bilaspur district of Madhya
Pradesh. Surveys are also contemplated in
Gujarat & Karnataka this year.
(b) Production Distribution of iodised salt'. 170
lakh MT of iodised salt was supplied to the
various goitre endemic areas from April to
September 1985.
(c) Expansion of the Programme'. It has been pro­
posed to expand the National Goitre Control
Programme to 11 more districts each of Uttar
Pradesh and Bihar, 8 districts of Madhya Pra­
desh, 3 districts of Maharashtra, 1 Districts each
of Gujarat, Andhra Pradesh and Kerala, en­
tire’ State of Assam, Tripura, Sikkim and Mizo­
ram.

Future Plans'. The Govt, have recently approved a
proposal to take up the idoization of edible salts in
the country in two phases. During the first phase
(1985-90) it is proposed to take up the iodisation of
30 lakh tonnes of common salt and supply the same
to the goitre-endemic areas.
A

RE-ORIENTATION OF MEDICAL EDUCATION
The scheme of Re-orientation of Medical Education was
launched by the Government of India in 1977. It is a 50 :50
centrally sponsored scheme requiring the State Govts., U. T.
administrations to give, a matching proportionate grant of an
equivalent amout for both recurring and non-recurring. The res­
ponsibility for the implementation of the scheme rest entirely with
the concerned State Governments and U. T. Administrations.
The main odjectives of the scheme are : (i) involvement
of Medical Colleges in the community health problemes and direct

August 1986

delivery-of health care services to the rural and semi-rural
population; (ii) exposing the students and faculty members of
the medical colleges to the rural environment; (iii) upgrading
the quality of health services in rural and peripheral areas with
provision of expertise and assistance in specialised services such
as Laboratory services, Radiology services, Clinical services, etc.;
(iv) phased transfer of total and comprehensive health care
namely preventive, promotive and curative to community develop­
ment blocks and later on in the whole district in which the
medical college is situated.
A

185

FAMILY WELFARE
MAKES HEADWAY
he importance of Family Welfare

Programme in
our socio-economic developmental plans is well
established and needs no emphasis. The most crucial
problem facing the nation today is the galloping po­
pulation, which has been growing at an alarming
rate. The country’s population stood at 68.5 crores
in 1981 and is estimated to touch 74.2 crores in 1985.
It has been estimated that the population of the coun­
try would increase to 83.7 crores in 1991 and to 98.6
crores in 2001. According to the estimates based on
the 1981 Sample Registration System, the annual
growth rate was 2.2%, whereas the growth rate in the
seventies was 2.25%. The decaded growth rate of po­
pulation has now started showing a declining trend.
However, in view of the serious implications of the
current population growth, it is imperative to devise
suitable policies and strategies in order to achieve
a very rapid decline in birth rate. This is possible
only if substantially more and more couples can be
made to restrict their family size by using one or the
other method of family planning. Experience shows
that acceptance of family planning method is closely
associated with the level of infant mortality and socio­
economic status of women. Maternal and Child
Health Care (MCH) services are, therefore, provided
as part of the Family Welfare Programme.

T

The family welfare programme seeks to promote
on a voluntary basis, responsible parenthood, with a
two-child norm—male, female or both—through in­
dependent choice of the family planning method best
suited to the acceptor. Family Planning services are
offered through the total health care delivery system.
People’s participation is sought through all institu­
tions, voluntary agencies, opinion leaders, people’s
representatives and Government functionaries. Ima­
ginative use of the mass media and inter-personal
communication is restored to for explaining the va­
rious methods of contraception and removing socio­

186

cultural barriers, wherever they exist. As a result of
this strategy the number of acceptors of various me­
thods of family planning has started to register an
increase from year to year.
National Demographic Goals

The long-term demographic goals set out in the
National Health Policy document to be achieved by
the year 2000 A.D. are : crude birth rate of 21, crude
death rate of 9 and infant mortality rate below 60 per
1000 live births. Achievement of these goals is ex­
pected to yield a net reproduction rate (N.R.R.) of
one. Demographers are of the view that the goals of
NRR=1 can be achieved if 60% of the eligible couples
are effectively protected. The corresponding goals for
the VII Five Year Plan period (by the year 1990) are
—crude birth rate of 27, crude death rate of 10,
infant mortality rate of 87 per 1000 live births and
couple protection rate of 42 per cent.
Performance under the Programme

The family welfare programme in India has gone
through several phases in its evolution. It started
in a small way in 1952 but continued to receive greater
emphasis in successive five year Plans. It is estimated
that the crude birth rate declined by about 8 points
in 16 years—from 41 per 1000 population in
1966 to 33 in 1983 which account for an average
decline of 0.5% per year. Approximately 7.0 crore
births have been averted since the inception of the
programme so far. The programme performance
touched a fairly high level in the mid-seventies. Dur­
ing the year 1976-77 about 12.5 million acceptors of

The family welfare programme seeks to promote
responsible parenthood, small family norm on a
voluntary basis. —>
(W. H. O. Photo by E. Schwab)

Swasth Hind

£81

9861 JsnSny

family planning methods were enrolled. Subsequently,
in the three years that followed, the programme receiv­
ed a severe set-back and the number of acceptors
steeply declined to 4.5 million during 1977-78. During
the 6th Plan the programme started gaining momen­
tum once again with reviewed political commitment
and performance under the Programme has been
improving since 1980-81.
During 1984-85, nearly 4.08 million sterilisation ope­
rations were performed and a total of 2.56 million
IUD insertions were done. In addition, 8.38 million
users of conventional contraceptives and 0.93 million
users of Oral Pills were enrolled. The total num­
ber of acceptors of different family planning methods
in 1984-85 was of the order of 15.95 million—an all
time record since the inception of the programme.
In relation to targets at all India level, achievement
in sterilisation was 70.01 per cent, and that under
IUD insertions was 80.04 per cent. The achievement
of targets with respect to Conventional Contraceptive
(C.C.) users and Oral Pill (O.P.) users were respec­
tively about 84% and 93%.
About 40.22 million couples (31.0 per cent of the
total eligible couples in the reproductive age-group
whose wives were in the age group 15—44 years)
were effectively protected against conception by one
or the other approved family planning methods, as on
March 1985. Of these, 25.0 per cent were protected
by sterilisation alone.

The performance under the programme during the
VI Five Year Plan is as given below :
1980-85 % of tar­
(in million) get achie­
ved

Family Planning

Sterilisation ......
IUD............................................................
C.C. & O.P. Users (Couple year Protection)
Total acceptors ....
Increase in couple protection rate 9.7%

17.44
7.17
31.84
56.45

79.1
81.7
83.6

Family Planning Targets for 1985-86 and the VII Five
Year Plan

The Family Planning targets for 1985-86 and dur­
ing the VII Plan are given below:
Sterilisation

1985-86

1985-90

188

IUD

(Figures in million)
3.24
5.56

31.0

21.3

C.C.
Users

O.P.
Users

9.51

0.96
62.5

The achievements from April to September, 1985
were 1.52 million sterilisations and 1.19 million IUD
insertions. During the period April to August 1985,
5.02 million CC Users and 0.56 million Oral Pill
Users have been recorded. The total number of ac­
ceptors of different Family Planning methods record­
ed during the period (April—September 1985) was
8.29 million.

Action Plan and New Initiatives
In order to achieve a fast decline in the birth rate
by bringing about a change in the peoples’ percep­
tions in favour of small families, an Action Plan has
been prepared. The major elements of the Action
Plan are increased community participation, improved
communication strategy, provision of suitable incen­
tives, improving programme management and appro­
priate research and evaluation. The various initia­
tives taken in these different areas are summarised
below :
Community Participation: Two national level
conferences of well known Non-governmental Orga­
nisations were held in March 1985 and September
1985 to explore the ways and means of expanding
their area of operation and securing involvement of
NGOs in the family welfare work particularly in the
rural areas. As a follow up of these conferences
high level committees at the Ministerial and other
levels are being constituted at the Centre and in the
States. With a view to simplifying the procedure for
grants-in-aid to voluntary organisations, the States
have been delegated increased powers upto the ex­
tent of Rs. 5 lakhs to sanction such grants. Grants
have been given to the Family Planning Association
of India to set up a small fund of Rs. 5 lakhs to
encourage smaller organisations for taking up
fa­
mily planning projects.
The National Institute
of Health and Family Welfare (NIHFW) has
been provided a sum of Rs. 30 lakhs to assist volun­
tary organisations for project formulation and to
monitor and evaluate their working. A subsidy of
Rs. 5,000/- is now available to private medical prac­
titioners for purchase of laparascopes. The scheme
is being implemented through the Federation of Obs­
tetric and Gynaecological Society of India, Bombay.
Communication Strategy: An Annual Plan of ac­
tion has been drawn up both in physical and finan­
cial terms for the mass media organisation of the

Swasth Hind

Government. With a view to induct greater profes­
sionalism in the task of demand generation for Fa­
mily Planning, the Ministry has launched upon an
exercise to seek participation of leading advertising
concerns. Meetings have already been held with five
leading advertising agencies. Further, this Ministry
is also taking steps to seek participation of leading
film personalities in preparation of films for Family
Planning. Studies are being conducted to assess the
knowledge, attitude and practices of the people to­
wards family planning which would provide clues and
material for framing appropriate communication stra­
tegies, plans, programmes and messages.

Services and Supplies : Services and supplies are
provided entirely free of cost at various levels of
the health delivery system according to the facilities
available. While all services are available at dis­
trict and sub-divisional hospitals and above, the Pri­
mary Health-cum-Rural Family Welfare Centres pro­
vide all services except female sterilisation (many
PHCs are now providing these services also) and the
sub-centres manned by Auxiliary Nurse Mid-wife
(ANM) usually provide only non-terminal methods
other than IUD (IUD insertion is also being carried
out in many sub-centres after training of ANMs/
LHVs).
Post-Partum Programme: Post-Partum Programme
is a hospital-based and maternity-oriented component
of the programme. At the time of delivery, a woman
is generally more receiptive to adopt one or the other
family planning method so as to stop further addi­
tions to the family. The programme offers necessary
facilities to such women, and promotes all methods
of contraception. A ten-bedded ward and an opera­
tion theatre have been provided to each participating
institution, alongwith other inputs in the form of
staff and equipment.

The programme at present covers 554 medical ins­
titutions throughout the country including 106 Medi­
cal Colleges and leading hospitals run by the volun­
tary organisations. Almost all the institutions func­
tioning at Medical Colleges, State and District level
organisations have since been covered under the pro­
gramme.
With a view to providing maternal and child health
and family welfare services in rural and semi-urban

August 1986

areas, as well as to bring an overall improvement in
the health status of mothers and children, the PostPartum Programme has been extended to 400 SubDivisional hospitals.

Medical Termination of Pregnancy (MTP) : Abor­
tion is not permitted as a means for fertility regula­
tion. However, from 1972 onwards Medical Termi­
nation of Pregnancy has been allowed as a part of
health care facility for pregnant mothers on health
and related socio-cultural considerations. Primarily,
this facility is provided to save millions of women
who take recourse to clandestine abortions by Alqualified doctors or quacks in un-hygienic conditions
from health hazards. More than 10,000 doctors have
been trained in MTP technique and over 41 lakh
pregnancies terminated upto June 1985. It is pro­
posed to make available at least one trained doctor
in MTP in each PHC.
Maternal and Child Health Care Services : In fact,
Maternal and Child Health (MCH) is an important
part of any sound health care system. Because of
the close relationship between population control and
improved health of mothers and children an inte­
grated approach for both these programmes is being
followed. A

INDIAN SYSTEMS OF MEDICINE
AND HOMOEOPATHY
‘‘Indian Systems of Medicine” include all the nonallopathic systems of medicine and regimens ex­
cluding Homoeopathy, viz. Ayurveda, Siddha, Unani Medicine, Nature Cure, Yoga and Amchi (Tibe­
tan system of medicine). In the Seventh Plan Rs. 40
crores have been provided in the Central Sector for
the development of Indian Systems of Medicine and
Homoeopathy. The various Schemes included in the
Seventh Plan aim, mainly, at improving quality of
education, promotion of research programmes based
primarily on their respective philosophies, enhancing
the availability of raw drugs, planned production of
herbal and other medicines on a large scale and their
standardisation.

189

Goals under M.C.H. Programme

Prophylaxis against nutritional an­
aemia among mothers and children*.
Anaemia is one of the important
causes of morbidity and mortality
among mothers and children. Under
the scheme of prophylaxis against
nutritional anaemia, pregnant and
nursing mothers, acceptors of Family
Planning and Children (1-12 years)
are given daily dose of iron and
folic acid for a period of 100 days
as a prophylactic measure.
The Expanded Programme on •
Immunization (EPI) was started by
the Government of India in 1978
with the objective of reducing the
morbidity and mortality due to diph­
theria, pertussis, tetanus, poliomyeli­
tis, tuberculosis and typhoid fever by
making vaccination services available
to all eligible children and pregnant
women by 1990. Measles was in­
cluded in the programme in 1985-86.
It was also aimed at achieving selfsufficiency in the production of
vaccines required for the programme.

(W. H. O. Photo by P. Mcrchez)

MATERNAL AND CHILD
HEALTH PROGRAMME
M
and child health ser­
vices are provided as part of
total health care to the community
through the existing health infra­
structure in rural and urban areas.
The health infrastructure is gradual­
ly being expanded to reach the po­
pulation as near to their door-steps
as possible. Further, the Ministry
aternal

•190

of Health and Family Welfare have
taken up immunisation scheme for
infants, children and mothers against
common vaccine preventable disea­
ses, prophylaxis schemes against nu­
tritional anaemia among mothers
and children and prophylaxis against
blindness due to Vitamin A defi­
ciency etc.

The immunization programme is
one of the most cost effective pub­
lic health measures and an important
component of the primary health care
services. The vaccines available for
the control of the diseases are effec­
tive, safe and relatively cheap. Be­
sides the reduction of the vaccine pre­
ventable diseases, the positive impact
of the immunization programme is
also likely to be reflected in related
programmes of maternal and child
health and family planning. The
immunization programme is, how­
ever, a long-term one.

The immunization services are
provided through the existing health
care delivery systems and there is no
separate cadre of field workers. The
services are available in the hospitals,
dispensaries and MCH clinics in the
urban areas and the primary health
centres (PHCs) in the rural areas.

Swasth Hind

Maternal and child health is an important part of any sound health care system.
(UNICEF Photo by T. S. Nagarajan)

The health workers also organize out­
reach sessions in the sub-centres and
villages which are not within easy
reach of the health centres.

Coverage under the immunization
programme :
The immunization
programme has been expanding ste­
adily during the sixth plan, 37.2 mil­
lion pregnant women received 2 boos-

ter dose of TT vaccine. 49.8 million
and 26.5 million infants received
three doses each of DPT and Polio
vaccines, respectively during the
same period. 66.7 million children
were given 1 dose of BCG. The ser­
vices would, however, have to be
intensified more rapidly to meet the
objective of universal coverage by
1990.

GOALS FOR MOTHER AND CHILD HEALTH CARE
GOALS

Indicator

Current’

1985

1990

2000

Infant Mortality (thousand live birth) .

125
(1978)
67
(1976)
24
(1976)
5
(1976)

106

87

Below 60

20—24

15—20

Below
30—35
10

3—4

2—3

Below 2

50—60

60—75

100

Peri-natal Mortality (thousand live birth)
Pre-School Child (1—5 yrs) Mortality .

Maternal Mortality Rate
Pregnant mothers receiving ante-natal
care (%) .
.
.
.
.

40—50.

The. programme ahead : Additio­
nal inputs are being provided and
infrastructure expanded during the
seventh plan period to rapidly ex­
tend the services to larger number of

beneficiaries. During the next five
years it is planned to cover over 82
million infants with three doses each
of DPT and polio vaccines and 1
dose of BCG. Measles vaccine which

August 1986

was introduced in the programme in
1985-86 is planned to be given to
over 50 million infants by 1990.
More than 93 million expectant
mothers are likely to receive
protection against tetanus by TT
vaccination services as part of the
antenatal core.
Universal Immunization Programme-. While the aim of universal
immunization for the country as a
whole has been set for 1989-90,
areas are being identified which have
the capability of achieving this goal
earlier. Besides achieving high levels
of coverage, such areas will be re­
quired to sustain them over the
years. Minimal additional inputs are
being provided to make the pro­
gramme operationally feasible. The
main thrust of the programme in
these areas would, however, be the
improvement, in the logistics and
managerial aspects for the optimal
utilization of the available resources
and cost effective implementation of
the programme.
(Contd. on page 194)

191

RURAL HEALTH SERVICES
ne of the significant things that happened during

O

the Sixth Plan was the adoption of the National
Health Policy by both Houses of the Parliament.
Health Care Programmes were restructured and re­
oriented for achieving the objectives of the Policy.
Priority was given to extension and expansion of the
rural health infrastructure through a network of Com­
munity Health Centres, Primary Health Centres and
sub-centres on a liberalised population norm. Efforts
were made to develop promotive and preventive ser­
vices alongwith the curative services.
High priority was given to the development of pri­
mary health care located as close to the people as
possible. The approach and strategy for developing
health care delivery system in rural areas initiated in
the sixth plan is being persued vigorously during the
seventh plan to consolidate the health infrastructure
and making up the deficiencies in respect of training
personnel, equipment and other physical facilities. Co­

192

ordinated efforts are being made under various pro­
grammes to provide effective and efficient rural health
services to the people.
Minimum Needs Programme

The main programmes/schemes being implemented
under the Minimum Needs Programme, to provide
Primary Health Care relevant to the actual needs of
the community in the rural areas are:

Sub-Centres : The sub-centres are being established
on the basis of one sub-centre for every 5000 popula­
tion in general and for every 3000 population in hilly,
tribal and backward areas. The additional sub-centres
established during the sixth plan period raised the
number to 82,946 against the estimated total require­
ment of 1,30,000. The progress is as under: —
(a)

Functioning on 1-4-1980 .

(b)

Target for the Sixth Plan period

.

.

.

47,172

.

40,000
(approx.)

Swasth Hind

(c)

(d)

Establsihcd during 1980-85

35,774

Target for 1985-86

6,132

Primary Health Centres : The additional Primary
Health Centres are being established in places where
the existing Primary Health Centres cater to a lar­
ger population, so as to reduce the work-load in exist­
ing primary health centres. Details are given below:
Functioning on 1-4-1980 .

5,484

(b) Target for the Sixth Plan period

756

Established during 1980-85

1,800

(a)
(c)

(d) Target for 1985-86

1,446

New Primary Health Centres : It is proposed to
convert the Rural Dispensaries into Primary Health
Centres. The ultimate objective is that by providing
additional input, the rural dispensaries which are pro­
viding curative services only, will function as primary

health centre providing package of promotive, preven­
tive and curative services. The progress achieved in
this regard is stated below :
(a)

Functioning on 1-4-1980 .

.

.

(b)

Target for the Sixth Plan period

.

(c)

Established during 1980-85

-

2,056
2,270

1,689

Upgraded Primary Health Centres : It is proposed
to establish rural hospitals with specialists facilities by
upgrading the existing primary health centres. Each of
the upgraded Primary Health Centres will have 30
beds.
(a) Functioning on 1-4-1980 .

217

(b) Target for the Sixth Plan period

315

Established during 1980-85

438

(c)

(d) Target for 1985-86

298

In rural areas most of the deliveries are conducted by Traditional Birth Attendants (Dais'). Photo shows
the simple basic midwifery kit.
(W. H O. Photo)

August 19'86

.^2

of Multi Purpose Workers

monthly Honorarium of Rs. 50/- to cover their out
of pocket expenses.

To make Primary Health Care Services available to
our rural population, it has been a persistent endea­
vour on the part of the Government of India to make
most rational and cost efficient utilisation of the avai­
lable resources. With this aim in view the MPW Sc­
heme was launched in the year 1974.

4,172 Primary Health Centres have been covered un­
der the scheme upto 31-12-1984 since the inception of
the scheme. 3,58,043 Health Guides have been trained
tin 31-12-1984.

Training & Employment
(MPW) Scheme

Health Guide Scheme

With a view to provide Primary Health care in the
rural areas, Health Guide Scheme (formerly known as
Community Health Volunteer Scheme) was started in
the country on 2-10-1977. These persons are purely
Voluntary Workers, selected by the Village Health
Committees as per the Guidelines issued by Govern­
ment of India. The important deviation from the pre­
vious instructions is that only women should be selec­
ted as Health Guides and trained. The selected can­
didates are given training for 200 hours spread over
3 months. During the training, the candidates are
paid Rs. 200/- per month as stipend. At the end of
the training, these health guides are given a kit with
medicines and manual. Thereafter, each health guide
is provided with drugs periodically at an overall ann­
ual cost of Rs. 600/-. Health Guides are also given

(Contd. from page 191)

'Dais' Training Programme : In rural areas most
of the deliveries are conducted by traditional Birth
Attendants (Dais). It has been endeavour of Govern­
ment of India to utilise this available manpower in
the field by imparting training in basic aspects so that
the deliveries are conducted under hygienic conditions
thereby reducing the maternal and infant mortality.
The trained Dai is also expected to play a vital role
in propagating small family norm since she is more
acceptable to the community. Each Dai is also pro­
vided with a mid-wifery kit to conduct safe and hy­
gienic delivery.

During the ’year 1984-85, 23.206 Dais have been
trained against the target of 50,000 Dais. The target
fixed for the year 1985-86 is 25.000. Total number of
Dais trained from 1974 to date is 5.15 lakhs. Our ob­
jective in the seventh plan is to train 1 lakh Dais.
Efforts are being made to start re-orientation training
for Dais similar to that of village health guides.

tion programme are supported by
the Area Projects. As many as 100
The immunization programme is of the 628 blocks are covered under
part of a package of services. It is
the ICDS.
not the intention to develop a vertical
type of programme which might ad­
The 30 districts under the univer­
versely affect the functioning of sal immunization programme in­
other, equally important national clude one or two districts from all
programmes. While selecting districts the large States. The total population
for universal immunization coverage of these districts is over 66 million.
the main criteria taken into consid­ Except for 4 districts the population
eration was, therefore, the availabi­ of the districts ranges from 1.1 to
lity of adequate infrastructure and 5.1 million. The birth rate varies
trained manpower. 19 of the 30 dis­ from 28 to 39.6 per 1000 population
tricts under the universal immuniza­ and the IMR from 40.2 to 159.0 per

1000 live births. There are 628 PHCs
and 100 ICDs blocks in the 30 dis­
tricts. 19 districts are also covered
by the Area Projects. The number of
expectant mothers and infants pro­
posed to be covered is 1.6 and 1.4
million respectively. This would
constitute about 75% of the estima­
ted number of eligibles in these
areas;
The Universal immunization Pro­
gramme is also proposed in the cat­
chment areas of 50 medical colleges
in 17 states and 3 union territories.

To ensure prompt supply of the Journal quote your Subscriber Number and intimate
the change of address

For all enquiries, please write to :
The Director,
Central Health Education Bureau,
KotlaMarg, New Delhi-110 002.

194

S was th Hind

At 10*he just wants to be able...tosee.
If your heart goes out to the blind
It was a life full of ambition and
hope. Of secret dreams and a smiling during your lifetime, let your eyes go
future. Till one day tragedy struck. In out to them after death. It’s the most
precious gift you can give them.
the form of a disease that shattered
his life.
To know more about eye donation,
and what kinds of blindness can be
Gone were the days of pranks and
play.Smiles and laughter. Hopesand
cured, send*us the coupon for a
detailed brochure.
aspirations. Replaced by a hopeless
terror fewcan understand. The terror Do it today. Remember, miracles can’t
of becoming blind.
cure the blind. You can.
But young Ajay’s case is not without
hope. His blindness is not without cure.

There is a remedy that’s simple,
doesn’t cost anything and is effective.
Only it needs you.

1 would like to know more about eye donation and
cornea grafting. Send me a detailed brochure.
(Kindly Gil in block Iciten)

Name: Mr / Ms.

A simple cornea transplant can restore
his sight. The useless cornea, replaced
by a healthy one. And the healthy one
could be yours
Eye removal leaves no scar or
disfigurement, and once you’ve
pledged to donate, you'll live with the
gratifying emotion that your eyes will
live much longer than you. And that
some blind person will see...through
them.

Address:

Slate:

JiGHE

Pincodc:

Age:

TIMES EYE RESEARCH FOUNDATION
7. Bahadur Shih Zafar Marg. New Delhi-110 002.

Sight. A gift only you can give.
Reproduced by the Central Health Education Bureau,
Directorate General of Health Services,
in the interest of eye donation programme.
August 1986

195

PREVENTION OF ADULTERATION
OF FOOD AND DRUGS
rT"' he Prevention of Food Adulteration Act, 1954,
1 had been enacted in 1954 by an Act of Parlia­
ment (37 of 1954) with the objective of ensuring pure
and wholesome food to the consumer and also to pro­
tect them from fraudulent and deceptive trade practices.
Enforced since June 1955 the Act stands extended to
the entire country. In Jammu and Kashmir it was ex­
tended in year 1972 whereas in the State of Sikkim
it came into force from 1st January, 1980. The Act
is, by and large, enforced by the State Governments
and local bodies in their respective areas. However,
the Centre plays a vital role in proper coordination,
monitoring and surveillance of the programme through­
out the country and extends necessary guidance and
coordination whenever expedient in the interest of pro­
per functioning.

The Act was amended in 1964 in order to provide
powers to the Central Government to appoint its
own functionaries, namely, Food Inspectors, Public
Analysts, etc., to supplement the efforts of the State
Government. In 1976, the Act was again amended,
plugging the loopholes and making the provisions for
punishments more stringent. The new concept of in­
troducing the definition of “Primary Foods”: streamling the procedures for sampling and analysis were
also included in this amendment.
Implementation'. Though the implementation is
carried out by both State Govts, as well as local bo­
dies in general, yet, in the States of Andhra Pradesh,
Gujarat, Madhya Pradesh, Maharashtra, Sikikm, Tamil
Nadu and the Union Territory of Delhi, the State
Governments have taken up the responsibility of im­
plementation of the Act at their level by establishing
separate Food and Drug Administration/Directorates
or Food Wings. A Committee known as the Central
Committee for Food Standards (CCFS) has been con­
stituted under the provisions of the Act of guide the
Central and the State Govts, in implementation of the
Act. The CCFS is vitally involved in the various
amendments to the Prevention of Food Adulteration
Rules, 1955 formulated under the provisions of the
Act and prescribed various food standards.

196

The Central Food Laboratories provide essential
assistance to the courts in the adjudication of prosecu­
tion cases launched under the PFA Act. Presently,
there arc 4 Central Food Laboratories in the country,
namely, at Ghaziabad. Calcutta, Mysore and Pune,
These laboratories, besides analysing the appellate
samples, also analyse food samples forwarded to it
by various Departments of the Govt, of India for
investigation and research, Review of methodology for
analysis is also their vital responsibility.

Performance’. The number of samples of food
articles analysed and found adulterated during the
last 3 years is given below:
Year

No. of
samples
analysed

No. of samples
found percentage of

adulte­
rated

adulte­
ration

1981

....

1,33,242

19,050

14.2

1982

....

1,29,595

16,765

12.9

1983

....

1,29,062

17,965

13.9

.

Training'. The Directorate General of Health Ser­
vices in the Ministry of Health and Family Welfare
have been arranging Orientation Training Courses for
various functionaries, namely, Food Inspectors, Public
Analysts and Local (Health) Authorities.

The main thrust in these in-service orientation train­
ing courses has been to enhance the knowledge and
skills of the existing personnel by exposing them to
the latest advancement in technology, market fluctua­
tions and price spirals, in order that they are able to
tackle the problem of adulteration against a back­
ground of changing perspectives.

Education and Publicity. Considering the impor­
tance of education and publicity in creating awareness
among the general public against the evils of adul­
teration, in order to familarise the consumer with un­
scrupulous trade practices and the various remedial
provisions of the Act and Rules, the Dte. General of

S was th Hind

Health Services have brought out the following pam­
phlets: (i) Help Fight Food Adulteration, and (ii)
Quick Tests for detection of common adulterants in
food.

action to either re-export the drug to the country of
origin or cause them to be destroyed. In case where
the defects are remediable reconditioning of the drug
is allowed.

Future Programmes: With a view to streamline and
increase the effectiveness of the implementation of
the Prevention of Food Adulteration Act’in the coun­
try, under the 7th Five Year Plan it is envisaged to
augment the infrastructure presently available in the
Dte. General of Health Services for continued moni­
toring, surveillance and evaluation.

Approval of New Drugs : Under the provisions of
the Drugs and Cosmetics Act and Rules, the Drug
Controller (India} is the approving authority in res­
pect of New Drugs proposed to be imported or ma­
nufactured in the country and only such drugs as
arc considered safe and efficacious are permitted to
be marked.

Drugs standard control

The quality control over drugs is exercised in the
country under the provisions of the Drugs and Cosme­
tics Act, 1940 as amended from time to time. The
Central Drugs Standard Control Organisation is res­
ponsible, alongwith the State Organisations, for en­
forcing the provisions of this Act and functions in the
Directorate General of Health
Services under the
Drugs Controller (India;.

Central Drug Laboratory, Calcutta'. The Central
Drugs Laboratory, Calcutta is the Statutory Labora­
tory under the Drugs and Cosmetics Act for the test­
ing of drugs. The main functions of this Laboratory
are : (i) To test samples of drugs imported in the
country; (ii) To act as an appellate authority in cases
where the report of the Govt. Analyst is challenged
in the Court of Law, and (iii) To act as Govt. Analyst
on behalf of those States/Union Territories which do
not have their own facilities for testing of drugs.
At present this Laboratory is acting as Govt. Analyst
for 21 States/Union Territories.

The main functions of this Organisation are :

1. To control the quality drugs.
2. To co-ordinate the activities of the States
and advise them on matters relating to uni­
form administration of the Act in the country.

3. To lay down the regulatory measures
standards of drugs.

and

4. To grant approval to “New Drugs” proposed
to be imported into or manufactured in the
country.

Quality Control over Imported Drugs'. Control
over quality of imported drugs continued to be ex­
ercised by the Offices of the Organisation located at
Bombay, Calcutta, Madras, Cochin and Delhi.
During the period April to October, 1985 bulk
drugs, drug intermediates and Chemicals and solvents,
etc., valued at Rs. 131.34 crores were imported into
the country. 534 samples of drugs were sent for test,
out of which 63 samples were found to be not of
standard quality.
In respect of consignments of
drugs which were found to be not of standard qua­
lity and where the defect noticed is not remediable
the Custom Authorities have been advised to take

August 1986

Central Indian Pharmacopoeia Laboratory, Ghaziabad : The CIPL is the Statutory appellate Labo­
ratory for testing of condoms under the Drugs and
Cosmetics Rules. In addition, this Laboratory func­
tions as Govt. Analyst for the States of Andhra Pra­
desh, Bihar, Delhi, Goa, Punjab, Tripura, Orissa and
Rajasthan and also tests samples on behalf of some
Central Govt. Departments. Besides, the Laboratory
is also responsible for carrying out Laboratory investi­
gations in connection with standards for drugs in­
cluded in the Indian Pharmaceuticals.

Drugs Technical Advisory Board : The Drugs Tech­
nical Advisory Board is a statutory Board constituted
unde rthe Drugs and Cosmetics Act to advise the
Central and the State Governments on technical mat­
ter arising out of the administration of this Act.

Training Programmes : The Central Drugs Stan­
dards Control Organisation has been conducting train­
ing programmes for training of Drugs Inspectors and
Drug Analysts concerned with Drug Standard Con­
trol. During the period April to October, 1985 one
training programme for Drug Inspectors was arranged
at Bombay, which was attended by 18 Drug Inspec­
tors from the State Drug Control Administrations. A

197

39th World Health Assembly

PROPER BALANCE BETWEEN
SUCCESSES AND DIFFICULTIES
he 39th World Health Assembly concluded its work

T

in Geneva on 16 May, 1986, in a spirit of full sup­
port of the Health for All Strategy. The Assembly,
which had as its President Dr Zeid Hamzeh, Minister
of Health of Jordan, noted with appreciation that al­
most 90% of the countries making up the World
Health Organisation (WHO) submitted reports on the
evaluation of their national strategies.
The Director-General of WHO, Dr Halfdan T.
Mahler, told delegates “You have been very open in
your statements about the health situation in your
countries, and I think you have struck a very proper
balance between reporting on both your successes and
your difficulties”. The Director-General added that this
readiness to exchange health information across geo­
graphic and ideological borders “....... is a must, if WHO
is to fulfil its constitutional role as the directing and co­
ordinating authority on international work”.
Earlier in his address to the Assembly, the DirectorGeneral emphasized the importance of good organiza­
tion and management in order to build up health sys­
tems based on primary health care. Dr Mahler sug­
gested that countries be divided into manageable units
for the delivery of primary health care. The optimal
size of these areas will vary from one country to the
next, but such a unit will need to have “primary
health care facilities in communities and possibly for
groups of communities,...a referal hospital, laboratory
facilities inside or outside the hospital, and a district
health office with a full time health officer”.

and speedy dissemination of information on the health
effects of accidents resulting from the peaceful use of
atomic energy, the Director-General Dr Halfdan Mah­
ler, told the 39th World Health Assembly.
Presidential Address

Dr Zeid Hamzeh, Minister of Health of Jordan, and
President of the Thirty-Ninth World Health Assembly,
warned the delegates in his inaugural address against
“irrational expenditure” on sophisticated medical care
and expensive hospitals. This, he said, “constitutes a
burden to many countries with limited resources and
consequently undermines the attainment of health ob­
jectives”.

Dr Hamzeh went on: “What is the use of advanced
medical technology to someone suffering from ema­
ciation and malnutrition, or who has not been immu­
nized against diseases and epidemics?”
International cooperation in the field of health, he
said, was indispensable for the well-being of all nations.
This included the rich ones “who by contributing to
the promotion of the health standard of the not-so-rich
nations would in actual fact be also protecting their
own health...Diseases and epidemics know no fron­
tiers, whether political or geographical, and need no
passports or visas to cross any such barriers”.
Intersectoral Action

Emphasizing this point, the Director-General add­
ed, “I believe the time has come to concentrate on
building up district health infrastructures”. The way
to achieve this would be to draw up action programmes
with defined targets, such as the number of districts
to be set up in a given time, for example.

Member States of the World Health Organization
(WHO) pledged themselves to combat inequities in
health, whether in the developed or developing worlds.
The 39th World Health Assembly accepted without
a dissenting voice the recommendations which emerged
from Technical Discussions held concurrently with the
Assembly. The discussions were on “the role of in­
tersectoral cooperation in national strategies for Health
for All”.

The World Health Organization (WHO) will inten­
sify its action in coordinating the collection, analysis

One of the recommendations was that combating
inequities in health must be “an overriding, concern”

198

Swasth Hind

in national strategies for attaining Health for All by
the Year 2000, since vulnerable groups among the
population are often by-passed in the general process
of social and economic devlopment.

rational throughout the world. It contains no mention
of any international code of drug marketing, a subject
that has given rise to considerable polemic in recent
years.

Immunization—major gains over the decade

The strategy is based on recommendations made to
the WHO Director-General, Dr Halfdan Mahler, at
the WHO Conference of Experts on the Rational Use
of Drugs, held in Nairobi, Kenya, in. November 1985.
Assembly delegates maintained the “spirit of Nairobi”
—that is, a spirit of cooperation rather than confronta­
tion—in Geneva this week, as Dr Mahler had urged
them to do.

Some 60 per cent of children are now receiving ei­
ther a first dose of diphtheria, pertussis and tetanus
(DPT) or polio vaccines, and 40 per cent a third
dose—up from negligible levels in 1974—a report by
the World Health Organization (WHO) says.

WHO launched its Expanded Programme on Immu­
nization that year to protect against the four diseases,
plus measles and tuberculosis.

The report, presented to the Thirty-Ninth World He­
alth Assembly gives an account of the achievements
thus far in the world-wide immunization drive. But
its main thrust is on what needs to be done to reach
all children by 1990.
Water Supply and Sanitation

Progress made during the first half of the Interna­
tional Drinking Water Supply and Sanitation Decade
(1981—1990), and the situation at its mid-point and
the prospects for the remaining years up to the end
of 1990, were reviewed/

It was concluded that although the establishment of
the Decade had resulted in an increase in the number
of people in the developing countries with access to an
adequate and safe water supply and appropriate sani­
tation facilities, and in an improvement of the stan­
dards of existing services during the first half of the
1980s, progress had fallen short of aspirations. In fact,
if programmes are not decisively expanded, slightly
more people will still be without water in 1990 than
at the start of the Decade and approximately 200 mil­
lion more will have no access to an appropriate means
of disposal of faecal wastes.
Although it seems clear that greater attention and
priority is being given to the rural populations and
urban poor in the developing countries, the services to
these groups still fall far short of the level and qua­
lity of service found in better equipped urban areas.
In general, much will have to be done if the levels
of sanitation service coverage are to be brought up
to match those for water supply.
WHO drug Strategy Approved

The World Health Assembly unanimously approved
a strategy designed to make the use of drugs more

August 1986

The strategy requires WHO to secure the coopera­
tion of a number of “concerned parties” in fulfilling
the responsibilities which were laid down for each at
the Nairobi conference.

HEALTH INNOVATORS AWARDED
SASAKAWA HEALTH PRIZE
The President of the 39th World Health Assembly,
Dr Zeid' Hamzeh, 8 May, 1986 presented! the second
Sasakawa Health Prize for outstanding innovative work
in health development to three recipients: The Ayadaw
Township People’s Health Plan Committee from Bur­
ma, Drs Lucille Teasdale Corti and! Pietro Corti from
Uganda, and Dr Amom Nondasuta from Thailand.

The Sasakawa Health Prize of US Dollars 100,000
was established! and first awarded in 1985 by Mr Ryoichi Sasakawa, Chairmn of the Japan Shipbuilding
Industry Foundation and President of the Sasakawa
Memorial Health Foundation. This year, the Ayadaw
Township Health Plan Committee has been awarded
US Dollars 40,000 and Dr Lucille Teasdale Corti,
Dr Pietro Corti and Dr Amom Nondasuta US Dollars
30,000 each. The prize is not intended) as a reward for
the laureates, but to encourage further development of
their outstanding innovative work.

These parties are: governments; the pharmaceutical
industry; health personnel involved in prescription, dis­
pensing, supply and. distribution; universities and other
teaching institutions; professional non-governmental
organizations; the public; patients’ and consumer
groups; and the mass media.

199

RESOLUTIONS
AIDS Prevention and Control
Over 20 delegates took the floor to describe the
programmes undertaken in their respective countries
and to express their satisfaction with the measures
WHO had rapidly taken to invest funds to control the
serious health problem posed by Acquired Immunode­
ficiency Syndrome (AIDS), despite current financial
constraints. The Assembly adopted a resolution which
urges Member States to continue their collaboration
among themselves and with WHO to control the AIDS
epidemic. WHO is requested to cooperate with coun­
tries to study the problem and set up national and
collective programmes for the prevention and control
of AIDS.

cotic and psychotropic substances, the Assembly urged
Member States to further develop national prevention
and treatment programmes. It also requested WHO
to formulate a plan of action aimed at controlling
health problems related to drug abuse, and suggested
the United Nations should increase its financial sup­
port to this area.

Strategies for the Advancement of Women in the
Health Sector
The Assembly endorsed and Nairobi forward-look­
ing strategies for the advancement of women as pro­
viding a comprehensive policy framework for advanc­
ing the status of women to the year 2000 and decided
that WHO will take all appropriate measures with
other Organizations of the United Nations system in
the implementation of these strategies.

Tobacco or Health
The Assembly affirmed that tobacco smoking and
its use in all forms is incompatible with the attain­
ment of health for all by the year 2000. In a resolu­
tion, the Assembly called for a global public health
approach and action now to combat the tobacco pan­
demic. It appealed to other Organizations of the Uni­
ted Nations system to support WHO in all ways pos­
sible within their fields of competence and to show
solidarity with WHO in stemming the spread of toba­
cco-induced diseases by protecting the health of nonsmokers on their premises. The difficulties of small
farmers who derive their living from the growing of
tobacco in developing countries was another subject
of concern. The Director-General of WHO was re­
quested to ensure that WHO plays an effective global
advocacy role in tobacco and health issues and that,
in common with other health institutions, it plays an
exemplary role in non-smoking practices.

The Executive Board
The Assembly considered a proposed amendment to
the WHO Constitution which would increase member­
ship of the Executive Board from 31 to 32 Members
so that the Western Pacific Region would be entitled
to designate four persons to serve on the Board and
adopted amendments to Articles 24 and 25 of the Con­
stitution accordingly. Notification of acceptance of
these amendments will be effected by the deposit by
each Member State of a formal instrument with the
Secretary-General of the United Nations.
Abuse of Narcotic and. Psychotropic Substances

In response to the dramatic increase of serious health
and social problems related to the abuse of nar­

200

Infant and Young Child Nutrition
Nearly fifty delegates commended WHO on its over­
all approach to maternal and child health and nutri­
tion. Many of them stressed the importance of women’s
status and their education in relation to infant and
young child nutrition. There was overwhelming recog­
nition of the importance of breast-feeding.

The Assembly passed a resolution noting that tho­
ugh many Member States had made substantial eff­
orts to implement the international code on market­
ing of breast-milk substitutes, concerted efforts would
continue to be necessary to achieve its full implemen­
tation. The resolution urged Member States to imple­
ment the code if they had not yet done so.
The International Year of Peace

The Assembly recalled the provisions of the WHO
Constitution concerning the close relationship of he­
alth with the promotion of peace and international se­
curity as well as the provisions of the United Nations
General Assembly Resolution 34/58 stating that peace
and security are important for the preservation and
improvement of the health of all people and that co­
operation among nations on vital health issues can
contribute significantly to peace.

Use of Alcohol in Medicines
The Assembly accepted a proposal requesting the
Director-General of WHO to set up an Expert Work­
ing Group to examine the scientific and health eff­
ects of alcohol in medicine and the implications of
its possible reduction or elimination.
A

Swasth Hind

BOOKS
Low-cost water supply and sanitation technology :
pollution and health problems. New Delhi, WHO
Regional Office for South - East Asia, 1984, 40 pages
(SEARO Regional Health Papers, No. 4) ISBN
92 9022 1739 Price; Sw. fr. 5.—.

Under the aegis of the International Drinking Water
Supply and Sanitation Decade (1981—90), designated
by the United Nations, there has been progress in the
provision of water supply and sanitation facilities
in the developing countries. However, if the Decade
targets are to be met, nearly half a million people
would have to be given access to new water supply
and sanitation facilities every day. It would be impos­
sible to achieve this using conventional technologies
alone owing to their high costs and the level of skills
required. Hence alternative approaches have to be
tried—approaches that are simple and cheap. Many
such methods have been tried and tested for water
supply, particularly in the rural communities, and
several applications have also been designed for ex­
creta disposal. Some of these technologies have pro­
ved socially acceptable and economically viable, and
hence have come to be called “appropriate technolo­
gies”.
While some of these technologies can undoubte­
dly increase the coverage, their improper use can give
rise to health problems. This aspect assumes special
significance in developing countries where the inci­
dence of waterborne and water-related diseases and
diseases resulting from soil pollution and food conta­
mination is very high. It has thus become imperative
that the provision of simple low-cost technologies be
preceded by an assessment of their design, quality, and
the existence of adequate maintenance facilities.

This publication, based on a report submitted to the
United Nations Economic and Social Commission
for Asia and the Pacific (ESCAP), starts by summari­
zing the health problems that can result from the im­
proper use of low-cost technologies.

The apparent paradox of how a high coverage by
water and sanitation facilities can actually lead to low
health status is discussed, using the example of a ty­
pical family that lives in a mud hut with a thatched
roof. A chapter is devoted to a few principal appli­
cations on low-cost technology in water supply based
or rainwater, groundwater, surface water, and piped
water. Water-quality surveillance is also discussed.

The chapter on low-cost technology applications in
sanitation covers on-site excreta disposal systems, pit
latrines, groundwater pollution, septic tanks, aquaprivies, waste-stabilization ponds, fish ponds, biogas
digesters, nightsoil disposal systems, land irrigation sys­
tems, and refuse disposal.

A 10-page summary table also lists suggested pre­
cautions and remedial measures to be applied with
different types of low-cost technology.
Written in simple and lucid language, this publi­
cation should be useful to public health administrators,
health planners, health educators, designers, sanitary
engineering personnel, and all those actively engaged
in planning and maintaining low-cost water supply
and sanitation technology.

COLD FACTS ABOUT
POPULATION GROWTH
The outstripping of the world’s resources by a po­
pulation projected , to reach 6,000 million people in
15 years is the focus of the State of the World 1986
report by the World Watch Institute.
Per capita grain production has dropped since
1950 in 40 developing countries, home to more than
700 million people, states the report.

The decline in per capita grain production in most
countries is not exclusively due to ecological deterio­
ration.
Failed or non-existent
population policies
can expand demand for food and undermine agricul­
tural support systems. In essence, population growth
hastens the process of ecological decline.
A. quarter of the world’s families live in makeshift
shelters. Fully half of the third world’s urban dwel­
lers live in shantytowns which double in population
every 5 to 10 years.

A thousand million people lack safe drinking water
and 2,000 million have no basic sanitary facilities.
According to State of the World 1986, two per cent
of the world’s tropical forests are destroyed each year.
Far faster in South-east Asia and West Africa, where
moist tropical forest will have virtually disappeared
by the end of the century.
7 per cent of the
earth’s topsoil is lost each decade. The fish catch per
person, including from fish farming, is down 15 per
cent since 1970. Biggest consumption cuts are in
third world countries such as the Phillippines. Water
demand is outpacing sustainable supplies in many
parts of the world.

One in ten children born in developing countries
dies before its first birthday.
Every year, 5
million infants and children die from malnutrition
and diarrhea and 12 million more die from infections
and preventable diseases. Almost half a million women
die in childbirth each year. Half of these lives could
be saved through access to family planning.
(Source: State of the World 1986).

ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU, (DIRECTORATE GENERAL OF HEALTH SERVICES), KOT LA

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AROGYA SANDESH

SPECIAL NUMBERS 1985
January

The International Youth Year (Theme: Parti­
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Nutrition

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