India was one of the pioneers in health service planning with a focus on primary health care. In 1946, the Health Survey and Development Committee, headed by Sir Joseph Bhose recommended establishment of a well structured and comprehensive health service with a sound primary health care infrastructure.
Social development through improvement in health status can be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition service with special focus on underserved and under privileged segment of population.
Under the Constitution, health is a state subject. Central Government can intervene to assist the state governments in the area of control/eradication of major communicable and non-communicable diseases, broad policy formulation, medical and para-medical education combined with regulatory measures, drug control and prevention of food adulteration, Child Survival and Safe Motherhood (CSSM) and immunization programme.
2. National Health Programmes
(i) Kala Azar
Kala-azar is a serious public health problem endemic in Bihar and West-Bengal. Kala-azar control was being provided by the Government of India out of the National Malaria Eradication Programme (NMEP), until 1990-91. The Centre provides insecticide, anti-Kala-azar drugs and technical guidance to the affected states.
During the Ninth Plan, the focus will be on ensuring effective implementation of the programme so as to prevent outbreaks and eventually to control infection. DDT will continue to be the mainstay for insecticide spray as the vector (phlebotomus argentites) is still susceptible to DDT.
National Anti-Malaria Programme was implemented in 1958, which reduced the annual incidence of malaria to one lakh in 1965. Deaths due to malaria were completely eliminated. But resurgence of malaria necessitated review of vigorous anti-malaria activities. The Modified Plan of, Operation (MPO) was implemented from April, 1977, which reduce the incidence of malaria to 1.66 million in 1987 from 6.47 million in 1976.
In view of the high incidence of malaria and resource, constraints in seven north-eastern states, 100 per cent Central Government assistance was provided with effect from December, 1994. For effective control of malaria, the Enhanced Malaria Control Project was launched in September 1997, with World Bank assistance, under which 100 hard core and tribal predominant districts of Andhra Pradesh, Bihar, Gujarat, Madhya Pradesh, Maharashtra, Rajasthan and Orissa and 19 problematic towns of various states have been included.
(iii) National Filaria Control Programme
It was launched in 1955 and it took up several activities including: (i) delimitation of the problem in hitherto unsurveyed areas and (ii) control in urban areas through recurrent anti-larval measures and anti parasite measures. At present about 49.87 million urban populations is protected by anti-larval measures through 206 control units, 199 filaria clinics and 27 filaria survey units
(iv) Modified Plan of operation for NMEP during the Ninth Plan
Intensification of control activities in areas with
- API of > 2 in the last 3 years
- Pf rate of > 30 per cent
- Reported deaths due to malaria
- >25 per cent of the population is tribal.
(v) Component of the Modified Plan of Operation
- Early diagnosis and prompt treatment.
- Selective vector control and personal protection.
- Prediction, early detection and effective response to out breaks.
(vi) Japanese Encephalitis
Japanese Encephalitis (JE) has been reported in the country since mid-fifties and caused by virus and spread by mosquitoes has a mortality ratio of 30 to 45 per cent.
Due to development of irrigation projects and changing pattern of water resource management there has been a progressive increase in the number of states reporting cases of J.E. in India. The National Malaria Eradication Programme (NMEP) has been implementing, the recommendations of the Expert Committee on J.E. control.
Under the Ninth Plan, Information, Education and Communication (IEC) activities to ensure community awareness and co-operation, for prevention and control of vector borne diseases will be intensified.
Tuberculosis is a major health problem in India. Studies carried out by the Indian Council of Medical Research (ICMR) in the fifties and sixties showed that:
- Unlike the situation in developed countries, BCG did not protect against adult TB and BCG given at/soon after birth provided some protection against TB in infancy and early childhood.
- Domicialiary treatment with anti TB drugs was safe and effective.
National Tuberculosis Control Programme
It was initiated in 1962 as a CSS, which aimed at earl) case detection in symptomatic patients reporting to the health system through sputum microscopy and X-ray and effective domiciliary treatment with standard chemotherpy The short course chemotherapy introduced in selectee districts in 1983, has shortened the duration of treatment to nine months.
The Revised National Tuberculosis Programme (RNTCP) was launched in the country on March 1, 1997, and is proposed to be implemented in a phased manner in 102 districts of the country, covering a population of 271 million, with the assistance of World Bank.
Under; the Ninth Plan, the NTCP (National TB Control Programme will be strengthened in 203 Short Course Chemotherapy (SCC) districts as a transitional step to adopt the RNTCF Under the Ninth-Plan, standard regime will be strengthened in the remaining non SCC districts and Central Institutions, State TB cells, and state TB Training Institutions through out the country will be strengthened.
Dengue fever is a viral disease which is transmitted through the bites of female Aedes mosquitoes. There are four serotypes of Dengue virus which are prevalent in India since 1950. Dengue viral infection may remain a symptom atic/manifest itself either as undifferentiated febrile illness (Viral syndrome), Dengue fever (DF) or Dengu haemorrhaphic fever (DHF).
An outbreak of Dengue was reported in Delhi in 1996, when 10,252 cases and 42 deaths reported, and was also reported from U.P, Punjal Haryana, Tamil Nadu, and Karnataka. Formulation of a National Dengue Control Programme is under consideration of the Central Government.
During the Ninth-Plan efforts will be made to:
(a) Establish an organized system of surveillance and monitoring.
(b) Strengthen facilities for early diagnosis and prompt treatment.
(c) Intensify IEC efforts to ensure that all households implement pre-domestic measures to reduce breeding of Aedes.
The National Leprosy Eradication Programme (NLEP) was launched in 1983 as hundred percent centrally sponsored schemes with the availability of Multi Drug Therapy (MDT). It became possible to cure leprosy cases within a short period (6-24 months) of treatment.
The NLEP programme was initially taken up in endemic districts and was extended to all over the country from 1994 with World Bank assistance.
The first round of Modified Leprosy Elimination Campaign (MLEC) is to be implemented in all the states and UTs to create mass awareness.
The target for the Ninth-Plan will be to decrease prevalence of leprosy 1/10,000 by 2002 A.D.
It is estimated that there are 12.5 million economically blind persons in India. Of these over 80 per cent of blindness is due to cataract. The National Blindness Control Programme started in 1976 as 100 per cent centrally sponsored programme with the objective of providing comprehensive eye care services at primary, secondary and tertiary health care level and achieving substantial reduction in the prevalence of eye disease in general and blindness in particular.
The activities under the programme are yet to show an impact in reducing the prevalence of blindness to the goal level of 0.3 per cent by the year 2000 A.D. A major thrust was given under the Eight Plan to strengthen the programme in Jammu and Kashmir and Karnataka.
Funds from domestic budget as well as EAP were provided for this. At the tertiary level of opthalmic care there are eleven regional institutes of ophthalmology including the apex institute, Dr. Rajendra Prasad Centre for Ophthalmic Sciences in the All India Institute of Medical Sciences, New Delhi.
The programme priorities during the Ninth-Plan is to improve the quality of cataract surgery, clear the backlog of cataract cases, improve quality of case by skill upgradation of eye case personnel, improve service delivery through NGO and Public Sector collaboration and increase coverage of eye care delivery among underprivileged population. The targets set up under Ninth-Plan are 17.5 million cataract operations and 100,000 corneal implants in between the period 1997-2002.
3. Sexually Transmitted Disease
Control of Sexually Transmitted Disease (STDs) was introduced as a national control programme by the Government of India during the Fourth Five Year Plan (1967). Since STD was one of the major determinants for transmission of HIV infection, the programme has been merged with National AIDS Control Programme (NACO). There is involvement of private practitioners in STD control through Indian Medical Association (IMA).
Realizing the gravity of the epidemiological nature of HIV infection, the Government of India launched a National AIDS Control Programme in 1987. In 1992, National AIDS Control Organization was established and a 5 year strategic plan was implemented with a US $ 84 million soft loan from the World Bank and another US $ 1.5 million in the form of technical assistance from the World Health Organization.
Under the Chairmanship of Minister of Health and Family Welfare, National AIDS Committee has been constituted.
During the Ninth Plan the focus will be more on increasing the number of HIV testing network, more effective implementation of the programme for ensuring safety of blood/blood products, augmenting STD, HIV/AIDS case facilities, strengthening Sentinel Surveillance and enhancing efforts to improve HIV/AIDs awareness, counselling and care.
National AIDS Control Programme in Five-Yearly Plan
I. More effective implementation of the Programme to ensure safety of blood/blood products.
II. Increasing the number of HIV testing network.
III. Augmenting STD, HIV/AIDS case facilities.
IV. Improving hospital infection control and waste management to reduce accidental infection.
V. Improving HIV/AIDS awareness, counselling and care.
VI. Strengthening Sentinel Surveillance. Components of NACP (Phase II)
VII. Reducing HIV transmission among poor and marginalized section of community at the highest risk of infection by targeted intervention, STD control and condom promotion;
VIII. Reducing the spread of HIV among the general population by reducing blood based transmission and promotion of IEC, voluntary testing and counselling;
IX. Developing capacity for community based low cost care for people living with AIDS;
X. Strengthening implementation capacity at the National, States and Municipal corporations levels through the establishment of appropriate organisational arrangements and increasing timely access to reliable information and
XI. Forging inter-sectoral linkages between public, private and voluntary sectors.
4. Iodine Deficiency Disorders
Iodine Deficiency Disorders (IDD) has been recognized as a public health problem in India since mid-twenties. IDD is not only a problem in sub-Himalayan region but also in riverine and coastal areas. It is estimated that 61 million populations are suffering from endemic goitre and about 8.8 million people have mental/motor handicap due to iodine deficiency.
The National Goitre Control Programme was initiated in 1962 as a 100 per cent centrally funded, centre sector programme with the objective of conducting goitre survey, and supplying good quality iodised salt to areas having high IDD, health education and resurvey after five years. In 1985, the government decided to iodise the entire edible salt in the country by 1992 in a phased manner. To date the production of iodated salt is 42 lakh MT per annum. The NGCP was renamed and redesigned as National Iodine Deficiency Disorders Control Programme (NIDDCP) to emphasize the importance of all the IDDs.
During the Ninth-Plan the major objective of the NIDDCP programme is
(1) Production of adequate quantity of iodised salt of appropriate quality.
(2) Appropriate packaging at the site of production to prevent deterioration of quality of salt during transport and storage.
(3) Facilities for testing the quality of salt not only
at production level but also at the retail outlets and household level so that consumers get and use good quality salt
(4) IEC to ensure that people consume only good quality iodised salt.
(5) Survey of IDD and setting up of district level IDD monitoring laboratories for estimation of iodine content of salt and urinary iodine excretion.
5. Disease Surveillance Programme
National Surveillance Programme for Communicable Diseases which has potential of causing large outbreaks such as acute diarrhoeal diseases and didesa, viral hepatitis, dengue/DHF, Japanese encephalitis, leptospirosis and plague. The objective of the programme is capacity building at the district level for strengthening the disease surveillance system and appropriate response to outbreaks.
6. Mental Health
The National Mental Health Programme was started in 1982. The programme did not make much headway either in the Seventh or Eight Plan. The Mental Health Act (1987), which came into existence from April 1993, requires that each State/UT set up its own state level Mental Health Authority as a statutory obligation. Majority of the State/ UTs have complied with this and have formed a Mental Health Authority.
The Cancer Control Programme was initiated in 1975- 76 as 100 per cent centrally funded centre sector project. It was renamed as National Cancer Control Programme in 1985. The objectives of the programme are
I. Primary prevention of tobacco related cancers.
II. Secondary prevention of cancer cervix.
III. Extension and strengthening of treatment facilities on a national scale.
The Focus during the Ninth-Plan will be
I. Intensification of IEC activities so that people seek care at the onset of symptoms.
II. Provisions of diagnostic facilities in primary and secondary case level so that cancers are detected at early stages when curative therapy can be administered.
III. Filling up of the existing gaps in radiotherapy units in a phased manner so that all diagnosed cases do receive therapy without any delay as near to their residence as is feasible.
IV. IEC to reduce tobacco consumption and avoid life styles which could lead to increasing risk of cancers.
8. National Diabetes Control Programme
The National Diabetes Control Programme has included a pilot programme in Seventh Five Year Plan. It was initiated in Tamilnadu and in one district in J and K.
9. Guinea Worm Eradication Programme
In 1983-84, India became the first country to launch an eradication programme against the disease, which had been causing great human suffering where safe drinking water is not available. The programme was implemented through existing primary health care infrastructure along with Ministry of Rural Development and the State public health engineering departments.
10. Yaws Eradication Programme
It can be cured and prevented by a single injection of long acting (benzathine benzyl) penicillin. Yaws is amenable to eradication. The pilot project to eradicate the disease in Koraput district was started in 1996-97. The programme has been extended to districts in Madhya Pradesh, Andhra Pradesh, Maharastra and Gujarat in 1997-98 and 1998-99. The programme is proposed to be extended to all affected districts during the Ninth Plan for which Rs. 4 crore have been earmarked.
11. Medical Relief and Supplies
Medical Services are primarily provided by Central and State government, apart from Charitable, voluntary and private institution. The number of hospital beds was 8.70 lakh as on 1 January, 1996 as compared to 1.17 lakh in 1951.
12. Rural health Infrastructure
Under the Minimum Needs Programme, Government has started developing the rural health infrastructure. In rural areas service are provided through integrated health and family welfare delivery system.
13. Central Government Health Scheme
It was introduced with a view to providing medical and health care facilities to the Central Government employees and expensive reimbursement of medical expenses under Central Services (Medical Attendance) Rules, 1944. This scheme was started in Delhi/New Delhi.
14. Emergency Medical Relief
Disaster management is the responsibility of State governments, but the Directorate General of Health Service, Ministry of Health and Family Welfare, Government of India provide technical assistance to the states. The responsibility is discharged by the Emergency Relief Division of the Directorate, which requires constant communication with the state governments.
The Drugs and Cosmetics Act, 1940, as amended from time to time, regulates import, manufacture, sale and distribution of drugs and cosmetics in the country. Under the Act, import, manufacture and sale of sub-standard, spurious, adulterated/misbranded drugs are prohibited.
16. Vaccine Production
India is self-sufficient in the production of all vaccines, including measles required for the National Immunization Programme, except Polio. Polio vaccine which is imported in bulk, is blended at the Haffkine Bio-Pharmaceuticals Corporation Ltd. (Mumbai), Bharat Immunologicals and Biologicals Corporation Ltd. (Bulandshahar, UP), Radicura Pharma (Delhi) and Bromed Pvt. Ltd. (Ghaziabad, UP).
Major nutritional problems in India are Protein Energy Malnutrition (PEM), Iodine Deficiency Disorder (IDD), Vitamin-A deficiency and anaemia. To combat these problems arising from nutritional deficiencies, Government has initiated various programmes.
18. Medical Education and Research
The Indian Council of Medical Research (ICMR) was established in 1911, as the apex body in India for the formulation, coordination and promotion of biomedical research.
Medical Council of India
It was established as a statutory body under the provisions of the Indian Medical Council Act, 1933, which was later repealed by the Indian Medical Council Act, 1956, with minor amendments in 1958. A major amendment in the IMC Act, 1956 was made in 1993 to stop the mushroom growth of medical colleges/increase of seats/starting of new courses without prior approval of the Ministry of Health and Family Welfare.
Dental Council of India
It was established under the Dentists Act, 1948 with the prime objective of regulating dental education, profession and its ethics in the country.
Pharmacy Council of India
The Pharmacy council of India is a statutory body constituted under the Pharmacy Act, 1948. It is responsible for regulation and maintenance of uniform standard of training of pharmacists.
National Academy of Medical Sciences
It was established as a registered society with the objective of promoting growth of medical sciences. To keep the -medical professionals abreast with new problems and update their knowledge in those fields for the required delivery of health care, a programme of Continuing Medical Education (CME) is being implemented by the Academy since 1982. Nursing Education
The Central Health Education Bureau (CHEB) was set up in 1956 and provides up-to-date information on current issues and development in health education, besides communication and training.
19. National Illness Assistance Fund
It has been set up in the Ministry of Health and Family Welfare with an initial contribution of Rs. 5 crore in 1997. The Fund will provide necessary financial assistance to patients livings below poverty line, suffering from life- threatening diseases, to receive medical treatment at any of the super specialty hospitals/institution or other government/private hospitals.
All the States/UTs administration has been advised to set up an Illness Assistance Fund in the respective States/UTs.